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The SCAN Foundation, a California philanthropic organization which was established to advance the development of a sustainable continuum of quality care for seniors released a paper which confirmed that direct care workers (“DCWs”) are essential to quality nursing home and home health care for the elderly. Having well trained direct care workers reduces the chances of nursing home abuse or neglect. The paper is authored by Sarah Wells, the Executive Director and Alice Hedt, Consultant with NCCNHR, the National Consumer Voice for Quality Long-Term Care.

The paper involved a study of California nursing home and home health patients who are dependent on DCWs to address their most fundamental human needs. These DCWs often act as liaison to the nursing staff, reporting the care-receiver’s medical and emotional status to key nursing and medical personnel. The DCWs are likely the patient’s key connection to the outside world. Older adults who need assistance with almost every aspect of their lives often each morning are seen a greeted by a DCW who is assigned to them and who may spend only 20 to 40 minutes but who in that short time directly affect :

• When and whether they get out of bed

• How long they have to lie in wet pants

• What they want to wear

• Whether teeth are brushed, nails filed and body washed

• If the curtains are closed to protect privacy

• If the nurse is notified of the red spot on a heel that could easily become a bedsore

• Whether there is enough to eat and the patient is positioned correctly so not to choke

• Whether the water by the bed can be reached and if there is a straw that if needed

• Whether there is access to morning activities

• If the patient hears a few kind words

• Whether the patient is rushed or relaxed

• Whether the patient can call for help the rest of the morning by providing a telephone or call button

This scene is replayed daily in 1.6 million nursing home residents’ rooms throughout the country and in thousands of homes where older adults receive much needed medical care and assistance from home health care providers. No matter what laws and regulations are in place, no matter if the care is from a for-profit or not-for-profit organization no matter the amount of money being paid by the individual or by the State’s Medicaid program — the experience of the older adult is determined by his or her interactions with the DCW.

The paper reiterates the 1985 NCCNHR study which identified the key components of quality from the consumer’s perspective. Nursing home residents throughout the country explained that the most important elements of quality in their day-to-day lives were the accessibility and attitude of the DCW. Since the 1985 study NCCNHR has actively and consistently studied how nursing home residents, individuals receiving care in their homes, family members and advocates have stressed that a good long-term care experience is dependent on having enough DCWs who are well trained and have a positive attitude. Training of the DCW is essential to providing this care. Poor training about dementia and mental health issues has been identified as a factor that contributes to nursing home neglect and abuse.

The paper cited that, for example, the third highest complaint in California is about staff attitudes – staff not treating residents with respect and dignity. The number one complaint category handled by California ombudsmen is another important DCW competency – handling roommate and resident conflict. Other important ‘non-medical care’ that promote quality of life as well as DCW job satisfaction include resident/care receiver rights, organizing work, empowerment, teamwork, stress management and cultural sensitivities. In other words, how a long term patient feels about their day to day existence and how a DCW feels about her job can affect how the patient responds both physically and emotionally. One long-time CNA summarized the link between quality of life and quality of care when she addressed a Career Nursing Assistants’ meeting saying, “We have all been taught how to clean up messes. The trick of being a good CNA is how to clean up messes and not make the resident feel bad, how to be supportive in my tone of voice and attitude.”

Through the paper, NCCNHR proposes that the DCW be taught the importance of cultural diversity, individualized care plans, systemic issues( pay issues, staffing issues, etc), dementia training and adult learning. The paper also points out the importance of supervisor training to learn and follow these same principles needed for these DCWs to perform their job. Utilizing these tools will help nursing homes and home health workers to provide better care for the patients and reducing nursing home neglect and abuse issues.

The paper can be read in its entirety at Please go to for a review of all the many services NCCNHR can assist family members

One Comment

  1. Gravatar for Mike Bryant

    When you look at it close it really makes sense. The residents have gone from their homes and self sufficiency to less control and in the care of others. The still want their dignity. Being nice to people never really gets old.

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