They occupy the front lines of Canada's crowded nursing homes, providing the bulk of care to increasingly challenging, dementia-suffering residents.

But the workers known as health-care aides have limited training, no regulation, "worrisome" levels of burnout and, in cities, are as likely as not to speak English as a second language, a new study suggests.

The study's authors call for urgent action to optimize the crucial workforce of an estimated quarter-million, described as dedicated and hard working. They recommend funding for more on-the-job education and examining the dynamics of multi-ethnic employees serving clients of largely Western European background.

"Care aides, who are looking after your mother or your father who's in a very frail, difficult state, aren't required to have any ongoing upgrading," said Carole Estabrooks, a University of Alberta nursing professor and the study's lead author. "And we've got pretty good evidence that regular, in-service training helps them provide better care."

The authors tout their survey of 1,381 aides in three western provinces, just published in the Canadian Journal on Aging, as the first scientific study of a group who has been called health care's "hidden" army.

'Because someone can converse and live and survive in Canada doesn't necessarily mean they have enough conversational skill to interact in a complex health-care system'

The survey in urban areas of Saskatchewan, Manitoba and Alberta found more than 60% of the care aides were born outside Canada and just under 50% had a first language other than English. That is "in stark contrast" to the occupants of nursing homes, most of whom are of European, particularly Anglo-Saxon ancestry, the study says.

"We shouldn't ignore it, we should look at what it means for us," said Prof. Estabrooks. "Because someone can converse and live and survive in Canada doesn't necessarily mean they have enough conversational skill to interact in a complex health-care system."

Sienna Caspar, a post-doctoral fellow at the University of British Columbia who has shadowed care aides on the job as part of her research, said the key issue is that the workers face a dramatically changed resident population.

With more elderly people treated at home or in out-patient clinics, they are sicker by the time they enter nursing homes than in the past, she said.

And the most common and challenging health problem the aides encounter is dementia, said Ms. Caspar, who was not involved in the new study.

"I asked them if they felt their education and training had prepared them and, by and large, they said 'No,' because there is such a small component on dementia," said Ms. Caspar. "And that's where the vast majority of the work is."

But Govind Rao, a researcher with the Canadian Union of Public Employees, which represents care aides in some provinces, argued that the workers are, in fact, "very skilled" and well-qualified to do the work.

The problem, said Mr. Rao, is that there are not enough of them.

"We have care aides who are overworked, and they're not able to get their work done and answer patients when patients need them."

He also said it was "offensive" to even raise the issue of the workers' ethnic make-up, saying there is no evidence that having English as a second language would affect their skill as care-givers.

It is estimated - no one knows the true number - that as many as 250,000 care aides, also known as personal support workers, are employed in Canada, providing 70-80% of the direct care to nursing-home residents. Most provinces require some kind of education and certification to work in the field, but the standards differ widely, said Prof. Estabrooks.

Unlike nurses, physiotherapists and other professionals in the sector, they are not subject to regulation. Meanwhile, the number of registered nurses has been dwindling, partly due to cost cutting, experts say.

The aides' tasks can be menial, including washing, feeding and changing residents, but they also act as the eyes and ears of more highly trained workers, said Prof. Estabrooks.

"The care aides are literally often the only people who see the residents' bodies on a regular basis," echoed Ms. Caspar. "They're going to see when their skin breaks down, when there's dehydration, when there's a change in cognitive status."

The survey Prof. Estabrooks and her colleagues conducted in 30 urban nursing homes found that almost all their subjects had a high school education, most were middle-aged or older women, and less than half had received any continuing education after starting work.

They voiced a high level of job satisfaction, but also elevated feelings of burnout compared with nurses and other workers in the sector, the study indicated.

A spokeswoman for one province's nursing homes dismissed suggestions that care aides are not properly trained and suggested that tightening oversight of them would be counter-productive.

"We're already so heavily regulated, and you already have so many measures in place to ensure safety and quality," said Candace Chartier, president of the Ontario Long-term Care Association.

National Post

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