PSW, RPN or RN: who should be coming into your home?

A Personal Support Worker helps with daily living. A Registered Practical Nurse and a Registered Nurse provide clinical care. Most families need the first one every day and the second or third one occasionally, and very few people explain that clearly at discharge.

PSWs complete a college or vocational certificate program and provide non-medical, hands-on support: bathing, dressing, grooming, toileting, transfers and mobility, meal preparation, feeding assistance, light housekeeping, medication reminders and companionship.

They are the person in your home most days of the week. In Ontario they work in long-term care, hospitals, retirement residences and private homes. In a private home setting a PSW works under a written care plan and reports changes to a coordinator, a family member or the client's nurse — they do not make clinical decisions independently.

What a PSW does not do: dress a surgical wound, administer injections, manage a catheter, or adjust a medication regimen. If a provider suggests otherwise, ask who is supervising that practice.

RPNs — called Licensed Practical Nurses elsewhere in Canada — complete a two-year college diploma and are regulated by the College of Nurses of Ontario. They provide nursing care for clients with predictable conditions: medication administration, wound care, injections, catheter care, monitoring and patient education.

In home settings an RPN is often the right clinical resource for a stable client who needs regular nursing tasks rather than complex assessment.

RNs hold a four-year degree and are also regulated by the College of Nurses of Ontario. They manage clients with complex, unpredictable conditions: post-surgical assessment, infusion therapy, complex wound care, chronic disease management, and the clinical judgement to recognize deterioration early.

After a hospital admission, an RN visit is usually what is ordered. What families often do not realize is that the RN visit is episodic — it ends when the clinical goal is met — while the daily help with bathing, meals and mobility does not, and was never part of that order.

Ask three questions of whoever is planning the care. Is a clinical task required, and how often? Is the person's condition stable or changing? Who is responsible if something deteriorates at 2am?

If the answers are 'no clinical task', 'stable' and 'the family calls the provider', then a PSW is the right resource, and you should be spending your money on hours of support rather than on nursing you do not need.

If there is a wound, a catheter, injections or a recent complex admission, nursing is required — and you should still ask who is covering the rest of the day.