Task Shifting in the Provision of Home and Social Care: Implications for HHR (March 2011)

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Title: Task Shifting in the Provision of Home and Social Care: Implications for Health Human Resources
Principal ApplicantTitle(s)Institutional AffiliationFunding AmountAnticipated Completion Date
Dr. Margaret Denton Professor Department of Health, Aging & Society at McMaster University $23,809 March 2011
Co-Applicant(s)Titles(s)Institutional Affiliation(s)
Dr. Isik Zeytinoglu Professor of Management and Industrial Relations DeGroote School of Business at McMaster University
Dr. Catherine Brookman Vice President Research and Program Development, Saint Elizabeth Health Care

 mdenton12.comBiography of Principal Investigator: Dr. Margaret Denton is the director, Gilbrea Centre for Studies on Aging and Professor of Health, Aging & Society and Sociology at McMaster University in Canada.  Dr. Denton received her PhD in 1984 from Department of Sociology, McMaster University. Her areas of research expertise include women’s health, heath services research (home health care), age friendly cities, age inequality, and work, retirement and pensions.   She has held research grants from the Canadian Institutes Health Research, Social Sciences and Humanities Research Council, Workplace Safety & Insurance Board of Ontario and Human Resources Social Development Canada.  Recently, as a Director for the Hamilton Council on Aging she applied for and received a grant from the Trillium Foundations for a Age Friendly Hamilton initiative.  Her most recent publications are found in Canadian Public Policy, Healthcare Policy, Research on Women and Aging, Social Sciences and Medicine, International Journal of Health Services, Home Health Care Quarterly and the Canadian Journal on Aging.


In 2006, the Health Professions Regulatory Advisory Council indicated that there are now 90,000 Personal Support Works (PSWs) employed in Ontario alone of whom 26,000 work in the home and social care sector. PSWs, who make up 73% of the home care workforce, play an integral role in providing care to seniors in programs such as adult day programs, supportive housing that provide personal support services and essential homemaking in permanent, residential settings and home at last programs, initiatives that enable a safe, smooth transition from hospital to home for frail, at-risk elderly patients. There have been many changes in the home care sector in Ontario since the mid-1980s when the restructuring of the hospital sector moved patients "quicker and sicker" from hospitals to the home care sector. As one means to make more efficient use of human resources currently available, there has been a trend to using unregulated home care providers such as personal support workers to perform tasks once done only by trained nurses or therapists. This change has been labeled "task shifting" and it is defined as a process of delegation whereby tasks are moved, to less specialized health workers (World Health Professions Alliance, 2008) who usually receive shorter pre-service training and possess lower qualifications. In home and social care it may consist of both the transferring of skills from a regulated professional (such as a nurse or therapist) to a PSW and/or the delegation of tasks—delegated acts.

The purpose of this preliminary study is to explore the process of task shifting whereby tasks are moved to less specialized health workers in the provision of home and social care and to explore the relationship, if any, of task shifting to health human resource issues such as training, competency, retention, job satisfaction and occupational risk factors such as occupational health and safety and chronic stress. The research methodology for this pilot project includes key informant interviews with managers and with separate focus groups with supervisors, nurses, therapists and PSWs at Saint Elizabeth Health Care. The intent is to use the results of this pilot project to develop a research project to study the impact of task shifting on health human resources in the home and social care sector in Ontario.

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