Promoting better health care: Best practices in staff development for direct-care workers who support adults aging with disabilities

Significance: The Direct-Care Worker (DCW) shortage challenges care quality for older adults, including those aging with developmental disabilities. Retention measures remain a large part of the strategy to close the “care gap.” Since DCW cite lack of quality training as a reason for leaving (Ejaz et al., 2008), “best-practices in training” becomes pertinent to stakeholders and policy-makers. Little is known about how the varying structural and cultural characteristics of service provider organizations, such as their size, population, funding sources, and the value and place of DCWs within them, relate to training practices. This study examines how structural and cultural characteristics of service provider organizations (SPO) relate to best-practices in DCW training. Method: A survey of 328 organizations included questions about training practices, structural indicators, and cultural variables. Factor analysis revealed three best-practice content areas (aging, disability, universal). OLS and Logistic Regression analyses were used to understand how training content areas varied with the structural and cultural aspects. Findings: The null hypotheses were rejected regarding the influence of evaluation practices, type of facility, organization size, intensity of care, and DCW integration on best-practices in training. The level of evaluation practices predicted best-practices in all three content areas. However, the influence of structural/cultural variables differed based on content. Implications: organizations can improve by implementing a comprehensive evaluation, shorter-more-frequent sessions, on-the job mentoring, and cross-training on aging and disability content. Rather than rely on regulations, future policy-makers can prioritize best-practices through collaborative efforts that bridge aging and disability networks.