Why direct care workers need support

The UK care system is increasingly under pressure. Up to 80% of the older people living in care homes have some form of dementia. Whilst there are increasing numbers of people living with dementia, the number of care home places has fallen in the last few years. According to a study published last month in the Lancet medical journal, more than 70,000 extra care home places will be needed by 2025 [1].

Direct care workers – an undervalued workforce

Direct care workers (i.e. care assistants) represent the largest component of the long-term care workforce, and are often referred to as the “eyes and the ears” of the care system. It is recognised that direct care workers around the world share common characteristics; the overwhelming majority are middle-aged women, have low levels of educational attainment, and experience low-job quality as a result of a physically and mentally demanding occupation. These workers are among the lowest paid in the service industry, making little more than the minimum wage. Even though direct care workers provide most of the hands-on care, they lack opportunity for meaningful input into residents’ care planning, and they often receive inadequate recognition and appreciation by families, residents, or employers. Direct care workers often have to work with less than the scheduled number of staff for a given shift, and their working hours are frequently long and irregular. In addition, they often lack the understanding and training that is needed to work in this complex and rapidly changing environment, particularly with the increased number of people living with dementia. The combination of all these factors seems to be related to high rates of stress and job dissatisfaction, which in turn accounts for these workers’ turnover, absenteeism, and low morale. Stress and job dissatisfaction are also recognised as the most significant threats to care provision and residents ‘quality of life. Previous studies have suggested that workers with lower levels of stress are more willing to help, are more optimistic, and have more positive emotional responses to people´s behaviour [2].

How can these workers then fully attend to and be present for the increasing numbers of people living with dementia in their care?

Finding interventions to increase the wellbeing of staff, that will not only benefit staff themselves but also residents, is needed. We know little about effective ways to ameliorate stress in staff who care for people living with dementia. As part of my PhD, I sought to address this gap by providing care workers with tools for stress and emotional management (e.g., time-management, teamwork and relaxation techniques) (see more details here). The findings highlighted that providing staff with emotional support can reduce their levels of burnout and improve person-centred interactions. A study on mindfulness-based therapies is now being conducted in UK care homes which will almost certainly provide more data about the impact of this type of interventions on staff wellbeing and dementia care provision [3].

Whilst these studies constitute a first attempt to respond to direct care workers’ emotional wellbeing, they also highlight the need for interventions to go beyond staff knowledge and instrumental skills, and address emotional and relational skills. These skills hold promise as a means of improving person-centred dementia care. It is also important to be aware that the implementation of any intervention in care homes can only be effective as part of a wider strategy. These studies further reinforce the importance of seeing these initiatives as an important stimulus for change.

The long-term care sector is one of the fastest growing occupational areas today. It is therefore important that we recognise the pivotal role that investment in this workforce can play in achieving better quality of care. Given the increasing demand for long-term care and the costs associated with recruiting and retaining staff, it is crucial to identify how to create a satisfying work experience for direct care workers.


Author: Ana Barbosa

PhD, Dementia care consultant and trainer









[1] Kingston, A., et al. Is late-life dependency increasing or not? A comparison of the Cognitive Function and Ageing Studies (CFAS). The Lancet. doi: 10.1016/s0140-6736(17)31575-1

[2] Zimmerman, S., et al. (2005). Attitudes, stress, and satisfaction of staff who care for residents with dementia. Gerontologist, 45 Spec No 1(1), 96-105.

[3] Baker, C., et al. (2015). Alleviating staff stress in care homes for people with dementia: protocol for stepped-wedge cluster randomised trial to evaluate a web-based Mindfulness- Stress Reduction course. [journal article]. BMC Psychiatry, 15(1), 317. doi: 10.1186/s12888-015-0703-7