Professionalism and Deprofessionalism of Personal Assistants
In times of austerity and as increasingly numbers of disabled people are living in the community, Personal Assistants have found their roles expanding – no longer are they simply performing what may be considered as social care tasks such as providing assistance with dressing, toileting , eating and drinking and companionship,, but ones of a medical nature. Today, PAs would be involved in the administrating of medication, ventilator support, monitoring their PA user’s life-long health conditions such as diabetes or performing first aid. The list goes on, where there is a blurring of the boundaries between health and social care when many of the medical health tasks once would have been done by district and community nurses. With increasing numbers of disabled people with complex needs living within their own homes, PAs can be expected to get involved in maintaining PA user’s physical and emotional wellbeing without being aware of the consequences and risks involved. PAs are being expected to engage in occupational, physio and speech and language therapy programmes that once were undertaken by relevant professionals with university degrees in the area of specialism. Now, as people with learning difficulties and autism leaving long stay psychiatric hospitals, there is an expectation that PAs have an understanding of psychology and dialectic behaviour therapy interventions and not forgetting the thorny issue of mental capacity.
All this raises an important question – has the role of PAs been undervalued and the knowledge and skills required to do a great job with PA users been underestimated. Alternatively, has there been a disability industry out there that has peddled the professionalism agenda, where increasingly working with disabled people requires a distinct and accredited practitioner who has undertaken accredited training.
In most areas of care, there is a general acceptance that practitioners will have clinical knowledge on one or a number but not all areas of medicine. Similarly in teaching, teachers are not expected to know the whole of the national curriculum when teaching lessons within secondary school settings. So why do we expect PAs to be generalists, and know how to work with anyone requiring any form of care.This has not been helped by disabled people who have argued that PAs do not need to have prior training. For some PA users, prior training is seen as a disadvantage as PAs can often come into the role with preconceptions of the tasks in hand. Such a view is maybe acceptable if the PA user is solely relying on physical assistance given under instruction by the PA who knows exactly what to do in any situation. But even PA users who have strong views about trained PAs may need to rely upon their professional knowledge and experience such as first aid training. So, unintentionally, PA roles could be viewed as being unskilled when it is clearly not the case.
Its only recent that Social Workers, Occupational Therapists have protected occupational status, gained after successfully completing accredited courses and prolong period of work experience. One of the reasons for professionalism is accountability, care practitioners are being required to make “clinical” judgements involving selecting one of out a range of interventions that will meet the needs of individuals living with a broader range of needs.
Nursing now require degree level qualifications including prolonged periods of time in work-related practice. Gone are the days when nurses only attended to patients basic personal care needs such as showering & shaving patients, feeding and helping them feel comfortable.The nurses are performing tasks such as prescribing medication and dressings and in a high tech world, increasingly technical skills and knowledge are required in monitoring patients care. As part of the Multi-disciplinary teams, nurses are involved in complex clinical decision making processes, which once upon time remain under the remit of doctors and consultants.
It could be said that similar to other care-related practitioners, the role of PAs has evolved in a similar manner. PAs began in the days of only providing practical assistance in and outside the home that includes facilitation in community-based activities such as games and education under the Chronically Sick and Disabled Persons Act 1970 s(2). However, similar to other care-related professions, the role has become more extensive covering a broader range of tasks, working with disabled people with complex needs and a call for greater professional judgement. This now leads open the question of whether PAs without a protected occupational role leaves them open to deprofessionalism. But, if PAs have a protected occupational role, does it leave the role open to over professionalism if PA users perceive their assistance no more than human robots.