Thursday
May182017

FACTS ABOUT SENIOR ISOLATION

 

Here are facts about senior isolation to help you stay informed:

1. Senior isolation increases the risk of mortality.

There is a higher risk of mortality in adults aged 52 and older.

One possible explanation: “People who live alone or lack social contacts, withdraw from social contacts may be at increased risk of death if acute symptoms develop, because there is less of a network of confidantes to prompt medical attention.” Efforts to reduce isolation are the key to addressing the issue of mortality.

2. Feelings of loneliness can negatively affect both physical and mental health.

Regardless of the facts of a person’s isolation, seniors who feel lonely and isolated are more likely to report also having poor physical and mental health.

Connecting seniors with social resources, such as senior centers and meal delivery programs, is one way to combat subjective feelings of isolation.

3. Perceived loneliness contributes to cognitive decline and risk of dementia.

Dr. John Cacioppo, a neuroscientist and psychologist at the University of Chicago, has been studying social isolation for 30 years. One frightening finding is that feelings of loneliness are linked to cognitive performance.

4. Social isolation makes seniors more vulnerable to elder abuse.

A critical strategy for reducing elder abuse is speaking up: abuse, neglect and exploitation often go unreported. As for prevention, maintaining connections with senior loved ones helps us ensure their safety.

5. LGBT seniors are much more likely to be socially isolated.

Stigma and discrimination are major roadblocks to support for LGBT seniors, but there are more and more community groups and online resources devoted to helping these elders avoid isolation.

6. Social isolation in seniors is linked to long-term illness.

Illnesses and conditions such as chronic lung disease, arthritis, impaired mobility, and depression are associated with social isolation. Ensuring appropriate care for our loved ones’ illnesses can help prevent this isolation.

For homebound seniors, phone calls and visits can be a critical part of connecting with loved ones.– the need for ongoing care and the desire for companionship.

7. Loneliness in seniors is a major risk factor for depression.

Numerous studies over the past decade have shown that feeling loneliness is associated with both middle-aged and older adults.

One important first step is recognizing those feelings of loneliness, isolation and depression and seeking treatment – whether it’s on your own behalf or for the sake of a loved one.

8. Loneliness causes high blood pressure.

A 2010 study in Psychology and Aging indicated a direct relationship between loneliness in older adults and increased systolic blood pressure over a 4-year period. These increases were independent of race, ethnicity, gender, and other possible contributing factors.

9. Socially isolated seniors are more pessimistic about the future.

Awareness, communication and a place to go are helpful in helping ward off potential problems and improving quality of life for older people.

10. Physical and geographic isolation often leads to social isolation.

Economic security and their ability to live healthy, independent lives.

Referring isolated older adults to ABIGAIL HOUSE IN CCSVILLAGE  ACTIVITY AND VOLUNTEER PROGRAMS and TRANSPORTATION SERVICES can go a long way toward creating valuable connections and reducing isolation.

11. Isolated seniors are more likely to need long-term care.

Loneliness and social isolation are major predictors of seniors utilizing home care, as well as entering nursing homes.

Long-term health care services can in itself connect seniors with much-needed support. Particularly for seniors in rural areas, entering a care facility may provide companionship and social contact.

12. Loss of a spouse is a major risk factor for loneliness and isolation.

Losing a spouse, an event which becomes more common as people enter older age, has been shown by numerous studies to increase seniors’ vulnerability to emotional and social isolation. The loss of social interactions that were facilitated by being part of a couple.

Ensuring seniors have access to family and friendship support can help alleviate this loneliness.

13. Transportation challenges can lead to social isolation.

After age 70 by about six years for men and 10 years for women 41% of seniors do not feel that the transportation support is available and adequate.

Having access to adequate public transportation or other senior transportation services is key to seniors’ accessing programs and resources, as well as their feelings of connectedness and independence.

CCS offers a volunteer program for driving seniors to appointments. If you are interested in becoming a volunteer through our agency and helping the network of Churches in our area to provide transportation we welcome you to contact our office 1-519-376-7396.

14. Caregivers of the elderly are also at risk for social isolation.

Being a family caregiver is an enormous responsibility, whether you are caring for a parent, spouse, or other relative. When that person has Alzheimer’s disease, dementia, or a physical impairment, the caregiver may feel even less able to set aside his or her caregiving duties to attend to social relationships they previously enjoyed. This can trigger loneliness and depression.

Seeking support, and caring for yourself and even looking for temporary respite care can help ward off caregiver loneliness and restore your sense of connection.

15. Loneliness can be contagious.

Studies have found that loneliness has a tendency to spread from person to person, due to negative social interactions and other factors. In other words, when one person is lonely, that loneliness is more likely to spread to friends or contacts of the lonely individual. Making things even worse, people have a tendency to further isolate people who are lonely because we have evolved to avoid threats to our social cohesion.

It’s a complicated situation, and simply telling seniors to engage in more social activities may not be enough. Considering our loved ones’ needs as individuals is a valuable first step to figuring out how to prevent or combat isolation.

16. Lonely people are more likely to engage in unhealthy behavior.

Risky health behaviours such as poor diet, lack of physical activity, and smoking. Conversely, social support can help encourage seniors to eat well, exercise, and live healthy lifestyles.

Living in a community situation can be an effective barrier to loneliness, and most senior communities specifically promote wellness through diet and exercise programs.

17. Volunteering can reduce social isolation and loneliness in seniors.

We all know that volunteering is a rewarding activity, and seniors have a unique skill set and oodles of life experience to contribute to their communities. It can also boost longevity and contribute to mental health and well-being, and it ensures that seniors have a source of social connection. Please consider joining our volunteer seniors group at CCS Village. Call 519-376-7396.

18. Feeling isolated? Take a class.

A review of studies looking at various types of interventions on senior loneliness found that the most effective programs for combating isolation had an educational or training component: for instance, classes on health-related topics, computer training, or exercise classes. At CCS Village in Abigail House there is an opportunity to take a course of study called Certified Caregiver/PSW online as well as have a career assessment and provide you with a program/job training with over 600 courses.

19. Technology can help senior isolation – but not always.

Even though modern technology provides us with more opportunities than ever for keeping in touch, sometimes the result is that we feel lonelier than ever. The key is matching interventions to the specific needs of the individual seniors. For example an interest in personal history can prompt a senior to write and share the family history.

One simple strategy that does help: for seniors with hearing loss, simply providing a hearing aid can improve communication and reduce loneliness. Investigate your personal needs and then have someone help direct you.

20. Physical activity reduces senior isolation.

Group exercise programs, it turns out, are a wonderfully effective way to reduce isolation and loneliness in seniors – and of course they have the added benefit of being great for physical and mental health. Senior isolation is neither inevitable nor irreversible. Getting the facts can help us prevent loneliness in our senior loved ones as they face the life changes of ageing.

Have you or a loved one suffered from loneliness or social isolation during the ageing process? Would you like to volunteer within your church family, immediate family, community? Contact gail@ccscare.co. There is much we can do together.

 

Tuesday
May162017

Social Isolation

Senior Loneliness and Isolation

 A worrying and growing trend is starting to come to light regarding our ageing seniors. There is growing evidence of health risks that stem from loneliness and social isolation in seniors, and the numerous negative effects it has on both mental and physical health. While loneliness and isolation is something many adults can relate to, the increased negative impact it has on seniors health is gaining awareness.  

Our ageing population deserve to be properly cared for as they age, much like they cared for us as we grew into adults. Often times we don’t think of our parents or grandparents as lonely, or the growing health concerns that can result if that loneliness is left too long.

CCS is working on changing this in Grey/Bruce with volunteers matching one-on-one. It is our belief that it takes one small candle to light a dark room.

The Impact of Social Isolation on Seniors’ Quality of Life and Well-being

The social isolation of seniors can cause communities to suffer a lack of social cohesion, higher social costs, and the loss of an unquantifiable wealth of experience that older adults bring to our families, neighbourhoods and communities.

Socially isolated seniors are less able to participate and contribute to their communities. Yet seniors benefit  from volunteering and participating in their communities due to a sense of satisfaction and efficacy, and communities benefit from the services and social capital seniors are providing. A decrease in contributions by seniors is a significant loss to organizations, communities and society at large.

Social isolation can result in reduced social skills. For example, seniors “who develop depression, social anxiety, loneliness, alcoholism, and schizophrenia tend to become socially isolated and uncomfortable around other people. This leads to an atrophy of social skills, partly because of disuse, and partly because of the way that psychological symptoms can disrupt social behaviour.”

Social isolation is considered a risk factor for elder abuse, including financial abuse, and may increase fear of crime and theft; thus making seniors even less likely to participate in social activities.

Furthermore, there is a substantial amount of evidence that describes the relationship between health and social isolation. A senior’s social network can positively influence good health behaviours such as successful smoking cessation or remaining active.

Conversely, socially isolated seniors are more at risk of negative health behaviours including drinking, smoking, being sedentary and not eating well; have a higher likelihood of falls; and, have a four-to-five times greater risk of hospitalization. Research also indicates that social isolation is a predictor of mortality from coronary heart disease/stroke.

Disabilities can further marginalize. According to the 2013 Canadian Survey on Disability, just over a third of Canadians aged 65 and older are living with a disability (rising from 26.3% among individuals aged 65 to 74 to 42.5% among individuals aged 75 and older). Furthermore, many older adults have to cope with two or more chronic illnesses, and 37.5% of adults 80 years or older report having two or more chronic conditions.

Social isolation also affects the psychological and cognitive health of seniors. It is associated with higher levels of depression and suicide. According to research, 1 in 4 seniors lives with a mental health problem (e.g. depression, anxiety or dementia) or illness, and 10 to 15% of adults 65 years or older and living in the community suffer from depression. The percentage of seniors in residential care who have been diagnosed with depression or showed symptoms of depression without diagnosis is higher at 44%. Approximately 50% of people over the age of 80 report feeling lonely; men over the age of 80 have the highest suicide rate of all age groups.

Mental health contributes to social isolation and has an impact on the individual’s quality of life. Social isolation increases the risk of developing mental health issues, has an impact on the person’s self-esteem and confidence, which decreases their connection with the community and inhibits them from accessing health care services, thus perpetuating isolation.


Factors Increasing the Risk of Seniors Becoming Socially Isolated, Including Critical Life Transitions

Understanding how seniors become or remain isolated is key to understanding why we have embarked on this program. These include, but are not limited to the following:

  • living alone;
  • being age 80 or older;
  • having compromised health status, including multiple chronic health problems;
  • having no children or contact with family;
  • lacking access to transportation;
  • living with low income; and,
  • changing family structures, younger people migrating for work and leaving seniors behind, and location of residence (e.g. urban, rural and remote).

Critical life transitions such as retirement, death of a spouse, or losing a driver’s license further increase the risk of becoming socially isolated. The more risk factors seniors face, the more likely they are to be isolated.

Some of the most common risk factors. They are as follows:

  • lack of awareness of or access to community services and programs;
  • fear, stigma or ageist attitudes (internal and external) that prevent seniors from accessing community services/programs or being socially active in their community;
  • lack of accessible and affordable transportation options were mentioned in all regional roundtables as one of the most important issues;
  • lack of affordable and suitable housing and care options to meet the varied needs of older adults;
  • loss of sense of community;
  • lifelong health issues including disabilities;
  • late onset or age-related disabling conditions, such as incontinence or fear of falling when going to and from venues;
  • challenges relating to technology – including access and costs, literacy and comfort with technologies including telephone systems (press “1” for service, etc.), computers, social media, as well as others (e.g. parking meters); and,
  • life transitions (death of a spouse, move to long term care facilities or other residence, loss of driver’s licence, etc.).

Specific groups of seniors were also identified as being at greater risk of social isolation, such as:

  • seniors with physical and mental health issues (including older adults with Alzheimer’s disease or other related dementia, or multiple chronic illnesses);
  • low income seniors;
  • seniors who are caregivers;
  • Aboriginal seniors;
  • seniors who are newcomers to Canada or immigrant seniors (language proficiency issues, separation from family, financial dependence on children, low levels of inter-ethnic contacts, discrimination); and,
  • lesbian, gay, bisexual or transgendered seniors.

As many as 44% of seniors living in residential care in Canada  have been diagnosed with depression or show symptoms of depression without diagnosis, and men over the age of 80 have among the highest suicide rate of all age groups. Therefore, the link between mental health and social isolation cannot be ignored.

Similarly, studies show that the lack of a supportive social network is linked to a 60% increase in the risk of dementia and cognitive decline; while socially-integrated lifestyles protect against dementia.

In sum, social isolation can have a number of consequences for seniors that are often difficult to separate from the underlying risk factors associated with isolation. The results of this association can be the development of self-reinforcing and reciprocal patterns of social isolation.

 

 

What is Isolation and Loneliness in Seniors?

When we think of isolation and loneliness, we often attribute it to feelings of sadness and depression. This is the same for seniors, but with the added threat to physical and mental health. Since seniors are in a more fragile state in terms of declining health and cognitive function, the negative effects of social isolation are more severe.

It is important to know there is a subtle difference in isolation and loneliness, and this is vital to understand as each require a different form of remedy. Social isolation is the objective state of not having enough people around to socialize with, whereas loneliness is the subjective state of not having enough social relationships or not enough regular contact with people. If these two concepts sound similar, think about it like this: someone who is socially isolated may not necessarily feel lonely, and someone who is surrounded by others can still feel lonely.

Knowing the difference between these two allows you to effectively deal with them better. For example; if someone feels lonely but they are surrounded by people, the solution would not be to surround them with more people, as that was not the issue in the first place. 

What Causes Isolation and Loneliness in Seniors?

For seniors, the feeling of isolation and loneliness can come from a number of sources, but all contribute to an overall feeling of being left out or forgotten. The primary causes for isolation and loneliness are:

  • Living alone with little to no contact with friends/family.
  • Having chronic health problems that contribute to difficulty in mobility.
  • Having no existing children/family.
  • Lack of transportation.
  • Living with low income or lack of financial freedom.

What is Being Done?

AWARENESS - IMPROVED ACCESS TO INFORMATION AND SERVICES

While there are a variety of social organizations and events aimed at reaching out to seniors, many aging adults find it difficult or frustrating “navigating the system” in order to find out about these services. This causes many seniors to avoid engaging with the organizations that seek to assist with loneliness and isolation.

A pivotal part of reducing loneliness and isolation is ensuring the seniors, who need them most, have an easy way to access the information, and can connect with organizations without hassle. The government of Canada has launched the website Seniors.gc.ca that offers a wide range of information for seniors in hopes of providing easier access for the aging population. The site hosts information on caregivers, aging in place, age-friendly workplaces and various articles on topics ranging from financial planning to avoiding frauds and scams. 

 

What can be done? As a church, as a Christian, as a neighbour, as a concerned community member we can reach out to individuals and bring them out for a coffee/tea and some time at CCS Village. We are located at 118 Drive-In Crescent, RR#5 Owen Sound Ontario. You can reach us if you wish to be more involved by email at gail@ccscare.co.

 

 

Tuesday
Sep302014

Benefits Services and Value for seniors in rural communities

A new project is underway at Abigail Ministries that could provide an alternative to urban nursing homes and assisted living for seniors living in Canada.

Until now, a lack of housing options and health support, for those who live in the country, has forced many rural residents into the cities, ending their way of life and connection to rural areas. Rather than uproot the residents and move them into an urban care centre, a program, called the CCS Way, a network of Christian Communities and Services, would bring the city care and facilities to the hamlets across the nation.

Community Care Solutions and Abigail Ministries is a private sector corporation and non-profit  respectively that support grassroots community development in rural communities. CCS Way is a segment of the society dedicated to engaging the community in responding to rural ageing needs.

CCS and Abigail Ministries has created a micro community, CCS Village, within a Hamlet, a small settlement of land located in Georgian Bluffs Township in Grey, Bruce Ontario. This micro community will facilitate affordable comfortable ageing.

At a cost of approximately $1 million, CCS has funded the early stages of engineering, feasibility and development studies. The project is looking for purchasers and financial backers to complete the remaining four homes by 2015. Located on the 2 acres of land are a Host Home, Community Centre, Workshop and two model homes of 500 sq ft to 1060 sq ft priced from $85,000 to $149,999.

Like many innovative business models, we are looking for church communities to come alongside this model and help to expand the Christian message through acts of care.

Future residents could include business owners, farmers, those who wish to use their later years assisting and volunteering in building homes, or caregiving in other countries. This project is for those who wish a rural lifestyle of ageing from age 55 on. We at CCS are redefining ageing.

The CCS concept was designed and shaped by Gail A Acton, who holds a Masters in Social Work, for senior alternatives to care and housing. The joining of rural senior volunteers, church communities, and government to advise and fund this new strategy and overall vision, is an expectation towards shaping senior living, from warehousing and shelving seniors in nursing homes and retirement lodges, towards a vision of seniors as mentors to the young, working to assist younger entrepreneurs in business, creating care facilities and new lifestyle that moves the emphasis of isolation for seniors to contributors in our society into their 90's..

An eclectic mix of farmers, business, entrepreneurs,  government, artists, caregivers, and Christians, highlight the common denominator of CARE for our community and our people.

A workshop, commercial business and office, enterprise centre, crafting space, commercial kitchen, and multi-purpose community gathering and functions space for up to 20 people is located on site close to the Host Home;

• Community gardens;

• A transportation system to reach shopping destinations as well as social and medical trips outside the community;

• Health and Social care will be available via visiting providers, and ensure long term care  and living in place lifestyle for residents;

• Personal and companion care, housekeeping, home maintenance, delivery services and more will be made available via contracts and according to means;

• Fitness and recreation opportunities, education and learning, as well as community involvement, will be stressed to help residents remain active;

Community resources are shared and cost effective management with just in time service management.

 

All of this is ensconced in the natural beauty of Georgian Bluffs, a Township in southwestern Ontario, Canada in Grey County located between Colpoy's Bay and Owen Sound on Georgian Bay.  The township comprises the communities of Alvanley, Balmy Beach, Benallen, Big Bay, Clavering, Copperkettle, Cruickshank, East Linton, Hogg, Inglis Falls, Jackson, Keady, Kemble, Kilsyth, Lake Charles , Lindenwood, Oxenden, Shallow Lake, Shouldice, Springmount, Squire, Wolseley and Zion.

 The project supports rural values, such as encouraging land stewardship and the appreciation of the environment, with a design that reflects the culture and history of the residents' entrepreneurism.

CCS Village and Abigail Homes attracts a market segment that are 55-plus seniors, either near, semi- or fully retired, living or have lived in a rural area, and prefer a rural setting and a rural area retirement community; do not want to live in a typical urban retirement community, and want to remain within a social network and/or live with like-minded individuals.”

Gail Acton, adds that the low-cost design appeals both to the pocketbooks of residents, and ageing baby boomers, and the desires of rural seniors.

CCS Village is not a typical development, nor is it using a typical development approach. It’s an appropriate housing development not adequately met by the existing market. It values supporting ageing residents within their own community. "What we’ve been focusing on is how to bring economic balance into rural development,” says Acton. CCS Village is planned for land donated by Gail and Ken Acton, who have lived and worked in this area for over 47 years, with business and family, and with the specific purpose of supporting rural living for senior citizens. Acton was heavily involved in the community planning, and developed the Certification and training for PSWs, for Ontario and then created a National Association of Certified Caregivers/Personal Support Workers, the first Volunteer Services Network into Owen Sound, and workplace training for young and old.

Espousing the rural ideal of neighbour helping neighbour, CCS Village and Abigail Homes offer rural seniors a unique option as they grow a little older. It allows long-time residents to remain in their community among supportive friends, neighbours and family as they age and require more support.

Tuesday
Aug052014

Rehabilitation at CCS

Rehabilitation Success after a car accident that nearly kills Bob

"Most of you folks who know me are aware that i was in a serious car accident fracturing my neck and back and lost the ability to walk. I want to thank Gail A Acton, her staff and facility for getting me on my feet again. Gail runs her programs with "CCR" and although I'm still recovering the progress is amazing because of her help. I highly recommend her facility to anyone needing therapy. Thanks" ―Bob


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Thursday
Dec262013

PSW Strike

Gail Acton recently received the following email. Her response is also featured below:

We the People, By the People and For the People

As you are aware the 4600 Personal Support Workers (PSWs) employed by The Canadian Red Cross Society and Red Cross Care Partners have been on strike since Wednesday December 11th. This affects 150 PSWs in Sault Ste. Marie and continues to have a devastating impact on untold numbers of elderly and disabled persons throughout our community. The vast majority of Ontarians would prefer the independence to age and receive care in their home. This provides them the dignity they rightly deserve. The question before this community and indeed this Government then is what value we place on the dignity and independence of our most vulnerable.

Currently our working conditions hover at the poverty line.  The average wage of a PSW working for the Red Cross is $14.32 per hr. We receive $0.34 per/km driven.  A five year wage freeze in which inflation and rising gas prices have resulted in a 7% decrease in wages and substandard remuneration for mileage have further compounded this. The latter has resulted in many of us having to pay out of our own pocket to deliver care. For years we have done so out of care and respect for our clients and now we are simply asking the same for ourselves.

The work we do each and every day enables clients to stay in their own home, keeping them away from Nursing homes, hospital and long term care facilities. It seems this is a case of corporate greed, as the company is allotted $30 per hour for their PSW's. that means the worker receives less then 50% of that money, when we are the eyes, ears, and hands of this company. Last year RC's CEO received a 9% wage increase, which amounted to approx. $23 000. A front line worker doesn't even make that in a year.

Support is needed from friends and family of the members, as well as our community. Help us show the government and the employer that we ARE important, and we deserve respect and to be treated fairly. We as workers are not happy about this decision, however it is what needs to be done , as all other means of negotiating have been exhausted.

The support from the community has been overwhelming yet you remain silent on the issue. As voters I am sure you can understand this has been disappointing to put it charitably. The home care system needs good jobs to provide a stable workforce for our clients who depend on it and this Government should strive to ensure that funding goes to front line care rather than corporate profits and bureaucracy.

Although we understand that your reply will likely centre on not wanting to interfere in a labour dispute this empty rhetoric ignores the human element of this struggle and does little to ease the suffering those who deliver and receive care. Sadly it seems the home care system is designed to be an exercise in exploitation with the Government a willing participant. You were elected to be a voice of leadership for our community. Its time you stood up and recognized the essential role we play in the health care system and advocated for the justice that we and our clients deserve. If you chose to remain silent then you can be assured that our voices as well as those of our families and friends will be heard in the next general election.

We are asking you to help remedy this and help our local employer to ratify this strike action and help our PSW's get back to serving the community which is now at a high risk.  Thank you for your assistance in this urgent matter.  Is there a time you could meet with us?

Sincerely,

The men and women PSW's of the Canadian Red Cross Assisted Living Program, Sault Ste, Marie Ontario.

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Response from Gail Acton:

I am aware that 4,600 Personal Support Workers have been on strike since December 11th. I do not believe it has a devastating impact on elderly and disabled, although PSWs would like you to think so. If the PSW truly had the dignity and independence of our most vulnerable as their prime concern, they would not be handling this strike in this militant and vigilante fashion.
This strike is a political battle that pits the PSWs against the political mismanagement of Red Cross and the Liberal government of Ontario. Red Cross Care Partners have become the second scandal for incompetence, with the first being the tainted blood scandal. Waste and mismanagement have been as much on Red Cross' door step as on the door step of Deb Mathews, Minister of Health, and the bureaucracy that aides and abets a system that has little concern for the vulnerable they serve. Eighty per cent of every dollar spent from the government goes to serve more levels of government employees, and less to the client and the PSW.
All PSWs making $13.00 to $15.00 an hour, as health care providers, have less than 40 hours of Anatomy and Physiology and study in the province of Ontario, and 350 hours or less of academics to become a health care provider. They deserve more money in front line care, but they need to be better educated and hired directly by the seniors, so they learn the skill of customer service and accountability to the customer, and not another government agency. The Government is sailing a sinking ship, and the crew members, such as the existing PSWs, need upgrading and require more knowledge and skills for front line professionals. Shop stewards and union bosses, and especially the government sector unions such as SEIU, are taking bigger wages than the PSW,  and then pitting the PSW and the situation of health care as the only issue.
PSWs you are also victims, and until you change a mentality that says I only have to train this much to get this much, you too are losers in the system that pits vulnerable against vulnerable. This has nothing to do with corporate greed, only with government and union greed.
I may also add that I have been writing to the appropriate Ministries, and spending my own money to battle this ignorance. I conceived and wrote this program, called the Personal Support Worker (PSW), which because of government standards is still the same as twenty years ago, and the battleground is the same.
Certified Caregivers/PSWs are a mandatory service, and as such should not be allowed to strike. Yes you provide an important service, but the costs of nursing have increased thus creating your jobs, and now the government union is taking a portion of your pay. As professionals with education and training, you should be making $20.00 an hour, and if the provincial government took their hands out of the cookie jar, you could be paid the rate you deserve. Currently the $15.00 an hour is sufficient, considering you do not have any Anatomy and Physiology training, the cornerstone of health care.
I have met with political parties to change the 80/20 rule of management by government and ensure that PSWs become better trained and payed. This could be accomplished through a similar program to the Veterans Affairs program for caregivers and putting the hiring of front line workers in the hands of the consumer of the service. In the meantime think of your client and go directly to serve them and not the agency.
Regards.