This blog post was adapted from a paper (PDF) published last month by NCCNHR at the request of The SCAN Foundation.
Sarah Wells
Direct care workers (DCWs) are essential to determining the quality of care and quality of life experienced by long-term care consumers. DCWs serve as a liaison to the nursing staff, reporting on the medical and emotional status of the person receiving care. They may also be the person’s key connection to the outside world.
Consider the following scenario:
You are an older adult receiving long-term care services who needs assistance with almost every aspect of your life. It is morning and you await the DCW assigned to you, who could decide the following:
- When and whether you get out of bed;
- How long you have to lie in wet pants;
- If you get to decide what you want to wear;
- Whether your teeth are brushed, your nails filed and your body washed;
- If the curtains are closed so that no one can see you naked;
- If the nurse is notified of the red spot on your heel that could easily become a bedsore;
- If you have enough to eat and are positioned correctly so that you will not choke;
- Whether the water by the bed can be reached and if there is a straw that you need;
- If you are taken to any morning activities;
- Whether you start your day hearing a few kind words;
- If you are rushed or relaxed; and
- Where you are able to call for help with a call bell or phone in reach.
“On some days, I am just the recipient of a task that [the DCW] has to do and record – give me water, wash my face, help me into the wheelchair. On good days, I get what I need as well as a smile, kind words and support so I can do what I can for myself. The worst days are when no one has time to talk to me. I am too often sitting here – alert and wanting human contact – and no one can or will have a conversation because they have to complete their tasks.”
- Judith Mangum, former NCCNHR board member and nursing home resident for over 20 years
Because direct care workers are so important to consumers — and to the entire long-term care system — it is essential that any training that is developed for DCWs be mindful of specific characteristic of these workers and the people they provide care for. For example:
Cultural diversity. Information on varying communication styles, lifestyle and diet preferences, religious practices and attitudes about end-of-life should be addressed as part of resident/care receiver rights that maintain that each person should be treated with dignity and respect as an individual.
Individualized care plans. Equipping DCWs to understand, implement and participate in the care planning process can improve care for all consumers, particularly since DCWs are most likely to recognize physical and emotional changes in the care receiver that need to be addressed by nursing and other members of the care team.
DCW supervisor training. Every effort should be made to make sure that those responsible for supervising and mentoring DCWs receive the same training, ideally participating with the workers in the training. If not, workers attempting to implement what they have learned may be frustrated by a work environment that does not support their active participation or respect their important observations.
Dementia training. Every DCW needs to be familiar with Alzheimer’s disease and other dementias, and comfortable with consumers whose behaviors are affected by these diseases.
Adult learning. One way to respect nursing home residents and those receiving home health care is to respect the workers who care for them. This means providing training that is designed for adult learners that is interactive, participative, stimulating and fun.
Systemic issues. While training is essential to quality, it is important to recognize that DCWs also need adequate compensation, benefits and a work environment that is respectful. Equally important, there must be adequate numbers of CNAs to perform the care and to interact with the residents.
No matter what laws and regulations are in place, no matter whether the care is provided by a for-profit or a not-for-profit organization, no matter how much money is being paid or by whom, the experience of the care recipient in long-term care is largely determined by his or her interactions with direct care workers.
Sarah Wells
Executive Director
NCCNHR
