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In Direct Care, Quality Supervision and Support Are Key

November 9, 2020

On October 26, PHI introduced its new framework—The 5 Pillars of Direct Care Job Quality—which 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 on quality supervision and support, the third pillar, is taken from Would You Stay? Rethinking Direct Care Job Quality.


A quality direct care job should offer workers the support and supervision they need to work safely and effectively.

Clear presentation of job requirements, responsibilities, workflows, and reporting structures

In a quality direct care job, a worker clearly understands their job requirements and responsibilities, as well as their employers’ workflows and reporting structures. A fuller picture of the job—ideally introduced during the onboarding process and then reinforced over time—helps workers deliver better care and contribute to the organization’s success. On the other hand, a lack of understanding about the job can lead to mistakes, accidents, and other negative outcomes for workers and consumers.

Consistent, accessible, and supportive supervision

Poor supervision in many industries, including long-term care, drives workers away and contributes to costly turnover rates. A quality job in direct care must provide consistent, accessible, and supportive supervision that helps workers succeed. Unfortunately, these workers are often unaware of who their supervisors are or have more than one, which can create confusion—and many supervisors are promoted into their roles without proper training or support. To be successful, a supervisor must be accessible to their reports, engage in clear and consistent communication, and encourage supportive problem solving that helps resolve daily challenges and empowers workers to flourish in their roles.

Access to personal protective equipment and other supplies to ensure worker and client safety

Safety must be guaranteed in a quality direct care job. As COVID-19 demonstrates, a lack of safety measures for direct care workers places them and consumers in peril. Direct care workers should have sufficient access to personal protective equipment such as gloves, masks or face shields, gowns, and hand sanitizer. Workers should also be trained and educated in infection control and prevention practices. Moreover, especially during a crisis, workers should be privy to the latest developments in preventing and containing the spread of infectious disease. When workers are safe and feel protected, their health and productivity remain strong.

Connection to peer mentors and peer support networks

Given the numerous and complex demands that direct care workers face on the job, peer support can be profoundly beneficial. Especially during their first few months of employment, direct care workers can turn to peer mentors to help answer their questions, address their concerns, understand their new roles, and develop their knowledge and skills. Over time, peer mentors and peer support networks can continue offering their fellow workers regular support and guidance, contributing to a culture of belonging and high retention.

Connection to community-based organizations to address employment-related barriers

A quality job in direct care should connect direct care workers to community-based organizations that address employment-related barriers. As a result of the legacy of low wages in this field, to succeed on the job, direct care workers might need support with other aspects of their lives, such as housing, transportation, childcare, family caregiving, immigration-related issues, and more. While no single employer can address all these needs, they can play an important role in developing relationships with community-based organizations and providing referrals for their employees. Employers can also institutionalize this referral practice by designating its responsibility to a single staff member.

Download The 5 Pillars of Direct Care Job Quality here.

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