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Direct Care Workers Deserve Career Ladders

By Kezia Scales, PhD (she/her) | October 1, 2018

Editor’s Note: This excerpt is from Growing a Strong Direct Care Workforce: A Recruitment and Retention Guide for Employers.

As with all employees, direct care staff need opportunities to learn and grow in their jobs; otherwise, they will start looking elsewhere for new challenges. By offering specialty training and advancement opportunities, you can maximize a worker’s contribution, reward their dedication, and improve retention in the long run.

Specialty training

Effectively prepare workers to provide a higher level of care for clients—and keep them interested and engaged in their work—with specialty training opportunities. Depending on your organization’s clients, topics may include: Alzheimer’s disease and related dementias, behavioral health, chronic obstructive pulmonary disease, congestive heart failure, diabetes, falls prevention, hypertension, palliative care, and preventing abuse and neglect, among others. As with entry-level training, specialty training is most effective when rooted in adult learner-centered methodology and designed to build on workers’ knowledge, skills, and problem-solving abilities.

Advanced roles

Leverage the contributions of your strongest workers—and increase their compensation to reflect their new knowledge and responsibilities—through advanced roles.

Examples include:

  • Senior Aides: Provide on-the-job coaching and problem-solving support for entry-level direct care workers (and family caregivers) during care transitions or other disruptions in a client’s care or health status, while also serving as a resource to the interdisciplinary care team.
  • Peer Mentors: Strengthen workforce retention by providing support for new and incumbent direct care workers as they navigate personal and professional challenges associated with their employment.
  • Assistant Trainers: Support licensed nurses in delivering entry-level or ongoing training for direct care workers, drawing from their experience to help facilitate the interactive demonstrations and skills-building sessions that are central to adult learner-centered training programs.


The Care Connections Project, launched in 2014 by PHI with lead funding by the New York State Department of Health, created an advanced role for home care workers called the Care Connections Senior Aide (CCSA). CCSAs provide coaching and support for home care workers and family caregivers and serve on the interdisciplinary care team. When the pilot project was implemented with the managed care plan Independence Care System and three licensed home care service agencies in New York City (Cooperative Home Care Associates, JASA, and Sunnyside Community Services), the first cohort of CCSAs reported improvements in their job satisfaction, inclusion in the care team, relationships with clients and families, and communication with clinical managers—all factors that contribute to better retention. Moreover, the Care Connections pilot was associated with an 8 percent drop in the rate of emergency department visits and reduced caregiver strain among family caregivers.[1]


How can long-term care providers improve their recruitment and retention? Read our new guide, where you can also find a list of citations.

Kezia Scales, PhD (she/her)
About The Author

Kezia Scales, PhD (she/her)

Vice President of Research & Evaluation
Kezia Scales leads PHI’s strategy for building the evidence base on state and national policies and workforce interventions that improve direct care jobs, elevate this essential workforce, and strengthen care processes and outcomes.

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