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What Workers Say about Training and Advancement

November 21, 2022

Direct care workers are the best experts on the nature of their jobs. They hold extensive knowledge of how to perform their complex work and how their employers can help resolve the many barriers they face They are also acutely aware of which interventions would create a genuinely satisfying job for the long term and make a difference in providing them with lasting economic security.

Unfortunately, despite their crucial wisdom, direct care workers are rarely formally asked to describe how their on-the-job experiences can both improve their jobs and care for their clients—lessons that would help stabilize a precarious long-term care field.

In this context, PHI held a series of focus groups earlier this year with a diverse mix of home care workers and residential care aides from different parts of New York State. We offered them anonymity and encouraged them to be as candid as possible, and they described their daily work, how COVID-19 has impacted their jobs, their thoughts on training and advancement opportunities, and what has kept them in this field and what might push them out eventually. 

This article is the third in a three-part series that shares the highlights of these powerful and insightful conversations.*


Direct care workers in these conversations observed that their training hasn’t always prepared them for what they encounter on the job. Several workers also noted the need to adapt standard training to the unique needs, preferences, personality, moods of each of their clients. One worker said they had requested training in job-specific topics, but without any response; another described having to seek out the information they needed on their own. Workers also noted that the COVID-19 pandemic has shifted many training programs to virtual formats, which some believed are less effective than in-person, hands-on training.

WORKER 5: “Honestly, my training was horrible. I entered my role at 18 years old, and I pretty much had to learn my role myself by watching everyone do their job… Both companies I’ve worked at do not take training seriously. I think training needs to be extensive. This is a very serious role, and something you need to be fully trained on.”

WORKER 3: “I definitely believe it should be hands on, a lot more than going to the main office and getting trained. Even while we are going through the training, we should come to the house and shadow…. And then they should do more mental training, preparing us… what’s going to happen to us. What’s going to get said to us. They don’t prepare us mentally, they just pretty much show us a lot of the physical things that might happen, but we definitely need a lot more mental training.”

WORKER 14: “I’m doing a two-hour case, hospice case, right now, and we have a very good training program, but that’s a little thing that you learn when you work with another company, a private company, and they teach you other ways to move the patient without making a lot of effort… How to put the patient up and down. I mean, really up, because the patient is supposed to be turning on position every two hours to avoid sores, the bed sores. I really learned that new. Those little details are very important when you take care of somebody in bed, especially when they’re in hospice. For me, that’s a really good thing that I did learn.”

WORKER 8: “It’s like the textbook type of training. It gives you an idea. Things you can do, but it’s nothing really that truly prepares you for working. You know what I’m saying? In a place where people can be one way, one day and then the next minute, things can go differently. So, to me, there’s really, just really, no kind of training that’s just going to [fully] prepare you. You have to get in there and get hands on.”

WORKER 2: “The trainings, actually, they really didn’t prepare me like I thought it would. I watched the videos. I went to the trainings, and it was nothing like that at all. Really, you had to use common sense for it, mostly. It didn’t help me, for real. The trainings really didn’t help me. And then the access to training, they want us to go through a bunch of training that don’t even apply to every house, that probably don’t even apply to my house, or whatever it is. But we got to go through all of them, just for nothing.”

WORKER 7: “Our training is done very well. They make sure we’re well trained on everything, but ever since the COVID, now everything is on computer. … It’s [online training] not the same as in person. You don’t get the hands on, and you don’t get to ask the questions you really need.”

WORKER 1: “We have a staff development day, and we get asked afterwards, what kind of trainings would you like? And I’ve asked every single year, multiple times a year, to have things like American Sign Language, technology, those sorts of things. Because we have individuals who can’t speak verbally to each other, or to us, we should know sign language. Or even technology, I can’t tell you how many co-workers I have, or even myself. I don’t know how to use [Microsoft] Excel. I never learned how to use that, in college. I’d like to know how to use Excel. Or even, I have co-workers who can’t manage Zoom. We should have had trainings on how to use Zoom. Like, ‘No, you’ll figure it out. It’ll be fine.’ That sort of stuff would’ve been nice to have, as a training.”

“…[As] much as you can read, take a training in a classroom, or read a book… you’re working with another human. So, their personality to you, their personality to the staff on shift, just their mood that day, like we all have ups and downs, is really important.” ~ Worker

WORKER 12: “Hands-on training is still always the best, and most realistic. Sitting behind a computer for training is not helpful.”

WORKER 1: “We received extensive training on a lot of things pertaining to working with our guys [clients]. Perhaps there could be more training on how to work with other staff… Maybe team-building exercises, stuff like that.”

WORKER 10: “I feel like we were properly trained. I feel like maybe there could be more training and documentation and everything, but I think it just takes time and you just have to learn through your experience. I think if anything, that’s the only thing I could think of, is maybe just some more training on documentation [documenting their visits with clients].”

WORKER 6: “It [their training program] was about three and a half weeks. I actually felt like it was a little bit too long. They took it slow, so that was good… There’s a lot of people that come in. They have the recruiting lady. They have some other upper management… there’s a lot of people, like over six different people that come, and they say you know this could happen. So it was good. It was stressful, but it was good to actually have somebody that went through it before you. It’s kind of like boot camp a little bit with the emotion like you’re ready.”


Several of the direct care workers that we spoke with noted that they’d been offered advancement opportunities. Additionally, workers noted the need for higher pay commensurate with these advanced roles and relevant training. Workers also noted several disincentives for advancement at their places of employment, including roles that feel too similar to previous ones, weaker benefit packages, and little recognition.

WORKER 3: “I was a med liaison [an employer-specific title/role] before, and an assistant manager before. I liked when I got promoted to those positions, but not getting trained on those positions, getting thrown out there is pretty hard to have to deal with when you have to deal with parents. They don’t think about that part when they’re saying, ‘Okay, you’re promoted to this.’”

WORKER 3: “So I definitely believe that when we’re getting thrown into these positions, we need training from the person before us. And we need more training on the house to handle paperwork, or the everyday things that come with the job. Because a lot of times they just say, ‘Okay, you’re the assistant manager, you’re the med liaison, you’re the shift coordinator. There you go. There go do your job.’ And then I’m just sitting there looking like, ‘Okay, let me figure it out. Let me read through something that might have been changed four years prior.’”

WORKER 1: “I was offered opportunities to advance, so I started as a DSP, and I’m now in a position where I actually, technically, have staff under me. But it’s really a lot of like, ’Okay, you’re in charge, now. Good luck. Talk to the person who was before you, they’ll help you. And there’s paperwork, yay. Have fun.’ There’s very little to no training of actually what you’re supposed to do.”

“It’s a lot of opportunities to go up in the company, but is it really worth it? The pay don’t really increase that much, the benefits don’t get better… It’s no perks for real, with a dollar increase. Not even, not even a dollar increase in wage. There’s no point… And it don’t make a big difference.” ~ Worker 2

WORKER 8: “Say you’re the assistant manager, and then you have a manager, and then you have the med liaison. But then the med liaison steps down for some reason, and now the assistant manager got to take on the med liaison duties, and the assistant manager duties. And they only still making what they’re making. You’re getting your regular responsibilities, on top of sometimes extra duties to compensate, so that the house can run smooth. Or to help the manager out because that’s only one person. So that, it kind of becomes, it makes you want to just be like, ‘Ah, I’m not sure if I’m here. I’m getting paid for one job, but I’m doing two.’

WORKER 11: “I’ve accepted different positions. I was the assistant two different times, before that I was a shift coordinator briefly, but it wasn’t all that I thought it was going to be. And at that location, I didn’t end up doing anything new that I hadn’t done as a senior staff. So even though I was getting paid a little bit more, I wasn’t really doing anything differently. And I believe I stayed a little bit over a year, but it wasn’t challenging me enough because it’s so customized, home to home, between the resident manager, the assistant manager, the med liaison, and the shift coordinator. How they divide tasks and things.”

WORKER 11: “I’ve been offered resident manager so many times, and it depends who your co-workers are, as far as co-leaders. And it’s just not worth the time commitment and responsibility because, it’s so much and you already know going into it, having worked in the system, what it’s going to be like. And it really depends, team to team, where the support is. Whether team level, team manager level, so many things. And we even saw that at the relief level. Why would relief want to come full time and take on the med responsibility, for what? It was like, a couple cents.”

WORKER 7: “Yes, there’s opportunities to move up, but you can be in different positions, but then it comes to moving your benefits, that’s when your benefits start to change. Some people would rather be DSPs and work more hours, instead of salary with no insurance, because you’re a DSP, because you like the insurance you have, and you don’t have to pay for stuff… but when you become management, you have to work on salary, and then you have to pay for your insurance. It’s different. A lot of people, that’s why they stay where they at, not because there’s not room to advance, it’s just, the money is better as a DSP with the insurance, I feel.”

WORKER 7: “There’s a lot of favoritism when you move up. Management is different, they don’t really understand what you go through. I think it’s better that we stay where we at amongst the people we know. Once you get higher, you start to forget where you come from. I know a lot of people who have transferred and [they] forget the daily day hard work that we have to put in.”

WORKER 4: “For me, I did a lot of courses through [an external training entity]. When you finish, you were told, ‘Okay, you get back to your agency.’ You would be paid something more and you will help your peers who are now entering the peer system to better understand your job role, and so forth. Until now, nothing has happened. It kind of discourages you. Yeah. I have a lot of certificates. I have new badges. New badge is okay…. Yeah, but you don’t get the money. You don’t get to do the job. It makes no sense. You go and you just get a stipend, you did the class, and that’s it. Your agency don’t even acknowledge you.”

WORKER 13: “There are lots of opportunities for advancement. Since I’m a full-time teacher, in addition to working as a DSP, I’m not currently looking for opportunities to advance… at this time.”


*Editor’s Note. In presenting these comments, we aimed to preserve the original voice as much as possible. However, in some instances, we made minor edits for clarity.

Methodology. The quotes in this report derive from two focus groups hosted by PHI in April 2022 and one individual interview in September 2022. Each session lasted approximately one hour. Direct care workers were recruited through their employers and were asked to provide written informed consent and were offered $25 for their time. In total, 14 home care workers participated, including eight direct support professionals (DSPs, who support individuals with intellectual and developmental disabilities), four home health aides, one respite provider, and one personal care aide. All conversations were conducted over Zoom, recorded, transcribed using and the Zoom transcription feature, and edited to remove all names and identifying features in order to preserve anonymity.

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