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Adapting care to meet the needs of an ageing population using the Enhanced Care Worker role

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At the International Longevity Centre UK (ILC-UK) one of our main areas of interest is how the adult social care sector will adapt to meet the needs of an ageing population.

The social care sector is facing unprecedented pressure from demographic change, high turnover and vacancy rates in the workforce and chronic under-funding.

The report ‘Innovate to Alleviate: Exploring how the role of an enhanced care worker could address skills shortages in the social care sector’, by the ILC-UK, looks at the Enhanced Care Worker (ECW) role as it is an example of a recent and promising innovation in the sector which can help to meet these challenges.

The term ‘Enhanced Care Worker’ has been coined by the ILC-UK, however, the role will have different names in different organisations. An ECW is a care worker who has been upskilled to work closely with registered nurses (RNs), providing enhanced clinical support to residents.

The ECW role is not homogenous across the care home sector. This is because it has emerged organically in various cases and is therefore dependent on the context of the organisation. However, there are similar characteristics that run across the job descriptions. ECWs assist RNs with clinical tasks such as administering medication, ensuring care profiles are kept up-to-date, taking blood pressure, managing vital signs and developing nutrition plans.

The ILC-UK report is based on semi-structured interviews of 23 people: seven managers, eight RNs, and six ECWs, along with three interviews with high-level representatives from organisations that oversee a number of other care homes.

“The report provides the first insights into how the role is being implemented across the country, the challenges and benefits”

Due to the scope of the project, this report does not comprehensively evaluate whether the ECW role leads to an improvement in the quality of care. However, the report does provide the first insights into how the role is being implemented across the country, the challenges and benefits of the ECW role and what lessons can be learned.

The ECW role is needed because demographic change means that care homes have to respond to an older population that has increasingly complex care needs. The number of older people with care needs is set to increase by 61% by 2030.[i]

Furthermore, the number of those aged 85+ in the UK is predicted to more than double over the next 23 years.[ii]

“Many more people who are now entering care homes who will need more than just personal care and day to day support”

Therefore many more people who are now entering care homes who will need more than just personal care and day to day support; rather they will need coordinated health and care support to manage often a range of complex conditions such as dementia, diabetes or hyper tension. Hence there is a greater need for clinical and nursing expertise within care homes.

The ECW role can also assist in responding to the issue of shortages of nursing staff in care homes. Across the adult social care sector nurses have a vacancy rate of 7.6% and a turnover rate of 32.1%.[iii]

One solution to this shortage has been the use of agency staff. However agency staff are expensive and do not provide the same continuity of care as permanent staff. Allowing care workers to provide clinical support to RNs is a promising way of meeting the need for nursing services.

”The ECW role offers a much needed route for career progression in the sector”

Furthermore the ECW role offers a much needed route for career progression in the sector, by providing a bridge between care assistants and RN’s. Facilitating and promoting career progression within the sector both motivates employees who know they will be rewarded for good performance and makes the sector more attractive to new recruits.

Finally, the ECW role is a way of utilising the experience of care workers and allowing them to contribute more to the quality of care.

As previously mentioned, there are a lot of similarities between the ECW roles in the different care homes. All of the care homes featured in the ILC-UK report stated that ECW’s are all required to have at least an NVQ level 2 qualification. Some care homes also stipulated two years’ experience working in a care home setting when recruiting for ECWs.

”The report found that care homes valued ‘softer skills’ when recruiting for the ECW role”

Lastly, the report found that care homes valued ‘softer skills’ when recruiting for the ECW role, such as the ability to learn quickly, ambition to advance one’s career in adult social care and a desire to go the extra mile in caring for older residents.

The main difference however between the EWC roles in the different care homes is the scope of the role. Some care homes have specific tasks that the ECW would not be allowed to do and must be carried out by the RN. These tasks include liaising directly with GPs, administering injections and IV drips and advanced wound care.

In other care homes ECWs could undertake these tasks as long as good competency assessments and training programs were in place.

The ILC-UK report also found that the shortage of qualified nurses has led to a proliferation of ECW roles emerging across the care home sector. The evidence from the ILC-UK report provides lessons for other care homes who may be interested in implementing the role. Our research found that the success of the ECW role depends on the following factors:

  1. Clear lines of accountability and delegation of tasks: The relationship between the RN and the ECW has to be clearly established in terms of the respective role they play in caring for residents. This allows for a greater level of trust and accountability.
  2. An open environment for communication: ECWs should be made to feel comfortable expressing concerns about their responsibilities or confidence in performing particular clinical tasks. This will mean that nurses can help to provide the correct level of clinical support.
  3. Involving ECWs and RNs in planning meetings: This helps to foster a sense of inclusivity and improve care by offering multiple views on a resident’s care needs.
  4. A focus on a recognition of softer skills: It is necessary to look beyond just clinical training and qualifications and actively recognise the importance of softer skills. Softer skills can foster an understanding of residents’ emotional and psychosocial needs. Having a caring attitude and being prepared to go the ‘extra mile’ for residents are crucial skills needed for the ECW role.
  5. Recognise there will be growing pains: Implementing the ECW role comes with short-term challenges, though these can be mitigated through good communication and preparation. However, in the long-term, the role has the potential to be very beneficial.

If a nursing home can get through these growing pains then the rewards of the ECW role have the potential to be large. The ECW role can help to combat the shortages of registered nurses in the sector, provide a route for career progression and utilise the experience of existing care workers. The emergence of the ECW role across the care home sector is a good example of an innovative change which could be a partial solution to both the short and long term challenges faced by the sector.

Dashiell Shaw: International Longevity Centre - UK


The full report can be found here:



[i] Snell, R., Wittenberg, R., Fernandez, J-L., Malley, J., Comas-Herrera, A., & King, D. (2011) Projections of Demand for Social Care and Disability Benefits for Younger Adults in England. PSSRU Discussion paper 2800/3.

[ii] Dunsmith, S. & Large, P. (2015) National Population Projections: 2014-based Statistical Bulletin. London: Office for National Statistics.

[iii] Skills for Care (2015) The state of the adult social care sector and workforce in England. Leeds: Skills for Care.

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