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2018 Conference Presentation


10 September 2018

Operational and policy implications of recognition of front line elder care workers’ high-level skills

Joan Hyde, UMass/Boston, United States

Rose Kiggundu, UMass/Boston Gerontology Institute
Rosa Perez, Ivy Hall Senior Living


Developed and, increasingly, developing countries, are struggling to attract, develop, and retain adequate numbers of direct care workers needed to meet the needs of the rapidly growing population of older people. Very little has been done to specify what knowledge, skills, attitudes and other characteristics these eldercare workers should have, beyond the basic skills training they receive for their certification as nursing assistants or home health aides. Aware of the growing complexity of direct care work, this preliminary study set out to identify the higher-level skills and qualities common among effective direct care workers in today’s senior care.

To accomplish this, the team reviewed several hundred articles, in both academic and trade publications. We then interviewed researchers, managers of senior care organizations, and direct care workers, in order to understand how these three different groups of experts view and conceptualize frontline workers’ key skills and characteristics.

Many of the studies reviewed for this project discussed the need for training and support to engender person-centered approaches among workers, while the expert informants universally considered empathy and compassion, as well as patience, emotional intelligence, cultural competence, and maturity to be crucial characteristics that were already present in many if not most workers who make caregiving their career. Perhaps more surprising was the extent to which both the literature and experts, including direct care workers themselves, found that health-related knowledge and technical skills were important for high quality elder care.

Most surprising of all was the sheer numbers of skills and characteristics found to be essential for quality care. Contrary to conventional wisdom, providing effective and person-centered direct care requires a wide array of knowledge, high-level skills, as well as attitudes regarding person-centered care.

This presentation will report on a Delphi Study which collected data from three sets of experts (researchers, supervisors, and direct care workers) regarding the importance and operationalization of high-level characteristics of frontline workers. Based on their responses and a review of the literature regarding knowledge, skills, attitudes and other characteristics (KSAOCs) of direct care workers, we have identified five clusters that have been hypothesized to be important to the well-being of older people receiving services:

1. Knowledge, especially theoretical understanding of the chronic diseases from which their clients/residents may be suffering, and an appreciation of end-of-life psycho-biological processes

2. Skills, such as those taught in CNA, HHA and Personal Care training classes

3. Attitudes, like commitment to caregiving; the belief that helping older people is meaningful work

4. Interpersonal Capabilities: empathy, ability to forge authentic relationships, understanding and respecting each client’s preferences regarding their care routines

5. Other Characteristics, such as dependability, ability to maintain equanimity in the face of difficult situations

Policy implications of this study include need for additional pre-employment and ongoing training, and adequate wages and benefits to attract and retain people with the skills and characteristics needed to be effective in this challenging career. Further research is planned to measure the correlation between specific skill clusters and outcomes for subgroups of older people in various settings and specified medical conditions.

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