Support workers doling out pills in nursing homes are under-qualified, some health professionals say

After being a nurse for over 30 yearsspecializing in seniors' care, Monya Johnson, 65, isenjoying retirement near Morrisburg, Ont.

But, as she follows the Elizabeth Wettlaufer inquiry intothe safety and security of residents in nursing homes, the former registered nurse says she's growing anxious about what will happen if she loses her own independence.

"We don't have children, and I'm really thinking, 'Who will be my advocate? Who will be there for me?'"

Last year, Wettlaufer, a nurse, was convicted of killing eight senior citizens, and trying to kill or harm six others, while working in seniors' homes in southern Ontario between 2007 and 2016.

The public inquiry into those deaths has learned there were serious red flags raised about Wettlaufer, including a litany of medication errors she had committed. Yet she was allowed to continue nursing.

Johnson feels the Wettlaufer case is exposing larger systemic problems in long-term care.

"I really thought there was a system and checkpoints in place for having to report nurses' behaviour."

Who dispenses medications?

After working in the Ottawa region for nearly a decade as a private nurse hired by families to support seniors, Johnson herself grew concerned about how drugs are dispensed in seniors' homes.

She says a growing number of tasks in long-term care fall to personal support workers (PSW) who she feels are less qualified than nurses when dealing with medication.

"I came across a PSW who said, 'I can give medication.' And I said, 'Excuse me?'" Johnson recalled.

"He said, 'Yes, we had a pharmacist come in [and] give us a five-hour lesson and I can then teach other PSWs to give medication.' And I thought, 'Oh my goodness.'"

Make sure you have eyes and ears on the ground. You can't go there 24/7.- Monya Johnson, retired nurse

She recalls one seniors' home where the director of care instructed staff to call themselves nurses which she felt was confusing and deceptive to patients.

"I'm thinking you're not nurses. I reported her to my College of Nursing and I understand afterwards she was let go," Johnson said.

After watching her own mother improperly supervised when it came to taking her medications, Johnson has advice for those considering long-term care facilities for their loved ones.

"Make sure you have eyes and ears on the ground. You can't go there 24/7. Of course you can't," she said.

"The thing is, though, have a friend [or] a community of people that can go in and visit."

Decline in quality of care

Dr. Warren Bell echoes Johnson's concern about the decline in quality of care in long-term care facilities.

"The worry I have is with reduction in not just training levels of health-care practitioners in long-term care institutions, but also in staffing levels," says Bell, who has practised as a family physician in Salmon Arm, B.C., for 38 years.

Bell says registered nurses receive four years of training and licensed practical nurses receive two, but health-care aidesincluding PSWs, only receive three months of training in British Columbia. He views the increased reliance on health-care aides as a cost-saving measure with potentially harmful implications.

"Now, [dispensing drugs] is the responsibility of care aides, who have a three-month course, which doesn't include any pharmacology. Nothing more than essentially a Reader's Digest version of what drugs do and what they don't do," says Bell.

He says that doling out medications is a somewhat automated task as drugs are packaged at pharmacies in blister packs that indicate the date and time each pill is to be administered.

However, he suggests health-care aides don't have the expertise to recognize symptoms, or decide if a drug needs to be withheld.

"It does open the door to possibility of error or just simply misunderstanding on the part of somebody whose training is limited with respect to patient function and health issues," Bell said.

"A three-month course doesn't substitute for a two- or four-year course."