The pandemic has magnified the value of direct care workers; but they often lack the training to live up to their potential, help manage chronic conditions, and stay physically and mentally safe in a grueling job.
Training requirements for direct care workers are uneven and insufficient, according to a new report from PHI. This is complicated by federal mandates that are applicable only to some workers and varying state training regulations. The authors point to needs and opportunities to ensure consistent, appropriate training for caregivers.
In Direct Care Work Is Real Work: Elevating the Role of the Direct Care Worker, the authors observe that the “considerable differences in direct care training standards and quality across states, programs, and job titles mean that many workers lack the proper preparation to do their jobs and are left to fill these gaps on their own.” They also observe that disjointed training regulations make it difficult for workers to translate their experiences across settings, limiting career mobility and the versatility of the workforce overall.
The report authors observe that direct care training policies often fail to “capture the full complexity and scope of the demands faced by the workforce.” Among the issues that should be addressed include:
- Physical strain. Direct care workers provide most of hands-on care delivered to residents and clients. They need training and skills for tasks such as safely lifting or transferring people. However, few caregivers have the opportunity to adequately practice physically intensive caregiving tasks before beginning work. As a result, back injuries, strained or sore muscles, and skin wounds are common among these workers.
- Social and emotional labor. An essential part of caregivers’ work is developing relationships with clients/residents to support their emotional wellbeing. These relationships can also boost the successful delivery of more technical or clinical care. To be effective in this role, workers need training on relational skills such as communication, listening, and conflict resolution.
- Managing complex health conditions. The growing acuity of home and post-acute care clients/residents has increased in recent years and has been exacerbated recently by the COVID-19 pandemic. This has heightened the complexity of service delivery in this care setting and often requires caregivers to provide chronic and serious illness support. The training gaps that need to be addressed include in-depth training/education about conditions such as Alzheimer’s disease and other dementias, diabetes, heart failure, chronic obstructive pulmonary disease, and asthma. More general clinical skills that should receive greater attention include infection control and prevention, cultural competence, geriatric care, behavioral health, and the use of assistive and medical devices.
The authors state, “Inconsistent attention to the real work involved in direct care has contributed to poor understanding of direct care workers’ roles among the public and even among health care officials whose decisions affect this field.” They also note that labeling these jobs as “unskilled” or “low-skilled” further contributes to the limited enforcement and expansion of training standards and opportunities for direct care workers.