Care Work in the Older Persons’ Sector: The Case for Standard Practice and Enhancing the Status of Care Workers

The world population is ageing and South Africa is no exception. As the South African population ages, demand for human and economic resources for the care of older persons is expected to increase. The move towards community-based health services and support for older persons re-affirms the critical role of care workers. Care workers can complement the work of health care professionals in providing care to older persons. However, without proper training and a clear scope of practice, care workers can compromise the outcomes of health and social programmes.  

Findings emerging from a current Samson Institute for Ageing Research (SIFAR) research project on care worker training shows that there is variable quality of care provided to older persons in South Africa, partly due to inconsistent training. Current training programmes vary in terms of duration and geriatric care focus. There are no care worker skill requirements or benchmarks for the various elder care settings (e.g. frail care and community care).  

In addition, care workers’ scope of practice varies across the board, with quite a number of service providers employing care-givers as ‘domestic carers’, responsible for making beds, bathing patients, providing companionship, walking frail patients, cleaning and feeding patients. Some institutions may also allocate care givers more advanced tasks such as: administering prescribed medication, taking blood pressure and temperature, care planning and management, and reporting on patient health and behavioural changes.  

There is lack of support for care worker training in the health system because lower-level nurses such as Auxiliary Nurses and Ancillary Nurses have overlapping roles. An attempt to increase the role of care workers is seen as an encroachment on the role of healthcare professionals. However, stakeholders in the older persons sector believe that the role of care workers can be enhanced without necessarily encroaching on the role of healthcare professionals.    In light of international best practice, SIFAR’s position is that standardisation is needed in terms of care worker training and scope of practice. Thus, benchmarks of the skills needed to work with older persons need to be in place, taking into account the fact that care workers can be trained to do more specialised tasks beyond ‘domestic work’. SIFAR is in the process of engaging stakeholders in the older persons sector on benchmarking skills needed for caring for older persons.  

The Canadian Personal Support Worker Programme Standard provides a good example of benchmarking care worker skills across the sector. The programme articulates key skills and competencies required for care work in various care environments, and these programme standards apply to all colleges offering certificates in the care of older persons. Furthermore, the Australian government-funded Aged Care Workforce Reform: Building a Complexity Competent Support Workforceprogramme shows that with adequate and appropriate training, care workers can develop skills to do more specialised work in community organisations for the aged. This has helped alleviate the shortage of health professionals by freeing nurses to do more specialised tasks. Specialised tasks may include, but are not limited to: administering prescribed medication, administering assessment tools, contributing to care planning, and taking temperatures. The Friendship Bench Project in Zimbabwe successfully trains laypersons to administer clinical assessment tools for depression and deliver problem-solving therapy. These examples highlight the need for a change in attitude towards care work in South Africa, where care work is relegated to the fringes of the healthcare system and workers receive minimal training and are only capable of carrying out routine and rudimentary care tasks.  

The National Department of Social Development is currently piloting a new training manual for care work in the older persons’ sector. As the manual is not yet publically available, we only know that the training programme aims to address the need for geriatric-focused training. This is a step in the right direction, but we also need to start a conversation about the scope of care practice and the possibility of enhancing the role of care workers. Allowing care workers to take on more responsibility will enable them to provide greater support to health professionals and better care for patients. This has the potential to make care work a more challenging and exciting career, with opportunities for progression into the nursing profession.