You may be taken in by the beautiful cafeteria….or the flowers in the entrance lobby….or landscaping outside of the facility. But, the most important measure of a good nursing home is the number of hands-on, direct care workers (DCW).

Don’t believe me? How about the Scan Foundation, an independent charitable foundation focused on the healthcare needs of California seniors. It is one of the nation’s largest foundations dedicated to the needs of the elderly.

The Scan Foundation recently published a study which confirmed that 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 study 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.”

My Advice: Read the report for yourself and, if you agree that the number of competent direct care providers is important, talk to your facility’s Administrator or Director of Nursing and encourage them to add more staff.

Dan Frith
Dan Frith

Dan Frith has over 25 years of experience representing individuals and families in cases of medical malpractice throughout Virginia. He has been named "Best Medical Malpractice Attorney" by Roanoker Magazine and is a member of the Million Dollar Advocates Forum. To speak with Dan, contact him by email at