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Direct Care Workers Deserve Quality Training

October 27, 2020

For too long, direct care jobs have been characterized by poor job quality, as evidenced by low compensation, inadequate training, limited career advancement, and a range of gender and racial inequalities that harm a mostly female, people of color workforce.

As a result, workers have struggled to make ends meet and deliver quality care to older adults and people with disabilities. Poor job quality in direct care affects the entire sector. For example, direct care employers—home care agencies, nursing homes, and various residential care settings—are increasingly struggling to find and keep workers in a time of growing demand.

Our new framework—The 5 Pillars of Direct Care Job Quality—is meant to guide employers, policymakers, and industry leaders in designing high-quality jobs for direct care workers. The framework covers 29 elements across five pillars: quality training, fair compensation, quality supervision and support, respect and recognition, and real opportunity.

The excerpt below—which describes the first pillar, quality training—is taken from Would You Stay? Rethinking Direct Care Job Quality.

Quality Training

A quality direct care job should ensure that all workers acquire the skills, knowledge, and confidence to succeed in their complex roles.

Training is accessible, affordable, and relevant to the job

In a quality job, direct care workers have access to training that is relevant to their roles and responsibilities. Training should be easily accessible to workers—including people with disabilities and people with different learning styles—and not require workers to travel long distances. If the training is virtual, workers should be supported in having the right hardware, high-speed internet, and tech support to complete the training program. Training should also be free or low cost, and workers should ideally be paid for time spent while completing the training. Furthermore, programs should meet relevant training requirements and exceed them where possible to ensure workers have the full range of skills and knowledge they need to perform their jobs successfully.

Content covers a range of relational and technical skills associated with quality care

A quality direct care job should train workers on the range of skills required in direct care, which are delineated in the previous installment of this report series. Direct care workers should receive training on supporting individuals with activities of daily living (bathing, dressing, eating, toilet care, and mobility) and instrumental activities of daily living (preparing meals, shopping, housekeeping, managing medications, and attending appointments). In addition, training should be offered on how best to navigate the physical, social, and emotional demands of direct care and on health-related topics and best practices for supporting individuals with complex conditions and care needs—a growing population. A direct care worker should feel confident in delivering care no matter who they are supporting or what challenges may arise.

Competency-based, adult learner-centered instruction with opportunities for hands-on learning

Quality direct care training should be competency-based (i.e., focused on acquiring the specific knowledge, skills, and abilities required for the job) rather than the current norm in which training programs focus on vaguely-defined topics or time spent receiving instruction, regardless of what’s learned. Various direct care competency sets are in circulation in the field, commonly covering areas such as communication, infection control and prevention, safety and emergencies, person-centered practices, and more. Quality direct care training should also be adult learner-centered, a type of instruction that has been shown to work best in direct care, leading to high satisfaction among trainees. As described in a previous PHI report, “The adult-learning classroom is oriented around the students’ learning process—not the teacher or trainer’s expertise—with an emphasis on inquiry, interaction, application, and reflection.”

Programs account for cultural, linguistic, and learning differences

Quality direct care training should account for the full diversity of direct care workers. First, given the significant presence of people of color and immigrants in direct care, training approaches should be responsive to the multicultural norms and practices of each local community and assessed for implicit bias and disparities in learning outcomes and access. Training should also be provided in multiple languages when necessary, based on local trainees’ linguistic needs. Finally, because trainees have various learning styles and differences, training programs should be as engaging and accessible as possible.

Documentation and verification of program completion and/or certification, with connections to employment

When direct care workers complete a training program and/or become certified, this information should be centrally documented so that workers can share their training credentials and certifications when job hunting, and employers can verify job candidates’ qualifications. This systematized approach can also prevent certain workers from undergoing unnecessary additional and costly training when transferring to a new job—recognizing that moving from one long-term care setting to another requires additional training, and workers cannot move from state to state without meeting the new state’s training requirements. For independent providers (i.e., direct care workers who are employed directly by consumers), a matching service registry—an online job board where consumers and workers find each other based on needs, preferences, and availability—can provide a useful platform for this type of documentation.

Download The 5 Pillars of Direct Care Job Quality here.

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