Improving health literacy among carers: Removing aged care’s blind spot

In the aged care sector, personal care workers (PCWs) play an essential role in the daily lives of residents. They are the frontline staff, the ones who interact most frequently with those receiving care.

Yet, despite their crucial position, many PCWs report feeling unheard and receive minimal training, leading to missed opportunities to prevent reversible deterioration in residents’ health.

The aged care industry is under increasing scrutiny to improve quality of care, yet one of the most overlooked areas remains the health literacy of its workforce.

As aged care providers face growing compliance requirements and workforce shortages, the ability of PCWs to identify early health deterioration is more critical than ever.

Addressing this gap is not just about upskilling staff — it’s a strategic move that could significantly improve care outcomes, reduce preventable hospital admissions, and enhance operational efficiency.

Recognising the strengths of carers

The carer workforce in aged care is diverse, comprising long-time employees with invaluable hands-on experience, students training to become Enrolled Nurses (ENs) or Registered Nurses (RNs), and a significant number of overseas workers with varying levels of training.

Many bring a wealth of cultural knowledge and personal commitment to their roles, making them indispensable to the sector. However, a persistent challenge remains: PCWs often feel unheard when raising concerns about residents’ health.

“If you talk to them as individuals and ask questions, you hear lots of interesting reasons why things happen in homes,” explains Wendy Bowker, a registered nurse and clinical governance expert.

“People deteriorate, and it’s often misinterpreted by PCWs as ‘normal ageing’ or there is a failure to escalate and act on what they have observed. Reversible deterioration often doesn’t get addressed promptly enough, and carers say things like, ‘We didn’t feel heard’ or ‘I don’t want to tell them (RNs) how to do their job.’”

Empowering carers through improved communication

A major factor contributing to missed early health deterioration is the communication barrier between PCWs and nursing staff. Many carers feel disempowered, fearing that their observations will be dismissed.

“They feel like they can’t tell an RN what they’ve seen because they won’t be believed and don’t have the confidence or knowledge to articulate the problem,” Wendy notes.

“There is still a bit of a divide rooted in historical structures where carers were once the primary caregivers with little clinical supervision from nurses. However, nurses benefit from being reminded to reflect on how they process information from all staff and families to aid their clinical critical thinking skills and decision-making.”

The introduction of more RNs into aged care homes has created a necessary shift, but it has not necessarily led to improved collaboration and communication between PCWs and RNs.

Improving training, documentation, and handover practices can help bridge this gap.

“Carers are constantly observing residents, but they may not always know what to document or how to escalate concerns effectively,” Wendy explains.

“By providing them with practical guidance on recognising early warning signs and tools to assist them in identifying and communicating, we can empower them to act as vital contributors to a resident’s care team.”

Training without added burden

One common concern when discussing workforce upskilling is whether additional training will lead to an increase in carers’ responsibilities without a corresponding pay adjustment. However, Wendy clarifies that the goal is not to add extra duties but to refine observation and reporting skills.

“This is not asking them to do anything more than they currently can do, which is observe and report,” Wendy explains.

“We’re teaching them to understand better what they see, not asking them to do what an RN does, like take a blood pressure or check a heart rate. But just saying to them, ‘You’re with this person all shift, and if you see anything that is a change or not normal, you need to escalate it.’ That’s their duty of care anyway.”

By focusing on basic health literacy tools and education at the PCW level, rather than expanding workloads, training can be introduced in a way that supports carers without overwhelming them.

A pathway to greater recognition

Wendy has developed a structured approach to improving health literacy among carers, one that benefits both providers and workers. This approach is based on the Ophelia (Optimising Health Literacy and Access) process, led by Professor Richard Osborne, which is applied in many parts of the world, including within WHO National Health Literacy Development Projects (NHLDPs).

Additionally, the Health Literacy Questionnaire (HLQ), created by Professor Richard Osborne, is one of the most widely used health literacy tools globally. These frameworks lend credibility and legitimacy to the initiative and ensure that the approach is evidence-based and internationally recognised.

Her proposal involves:

• Baseline Health Literacy Assessments – Conducting surveys and scenario-based questions to identify knowledge gaps among PCWs.
• Performance Data Benchmarking – Highlighting gaps related to unrecognised reversible deterioration in residents.
• Targeted Education – Providing training tailored to these gaps, focusing on recognising signs of deterioration, effective documentation, and communication skills.
• Communication Strategies – Teaching carers how to confidently escalate concerns and ensuring RNs understand the value of their input.
• Evaluation and Continuous Improvement – Regularly assessing training effectiveness and refining the program as needed.

A critical component of this initiative is shifting how providers view health literacy. Many fail to see the direct link between workforce capability and clinical outcomes, considering it a ‘nice to have’ rather than an essential investment.

However, with compliance already demanding extensive resources, improving the proactive health skills of PCWs could alleviate pressure on compliance measures and improve resident outcomes.

“Providers do like to be seen as innovative,” Wendy points out. “If they can showcase new training programs and improved outcomes at conferences, it gives them a competitive edge.”

By framing investment in PCW health literacy as a way to enhance reputation, improve care quality, and reduce risk, providers may be more inclined to act.

Moving forward: A collaborative approach

The solution to improving aged care at the resident level is clear: upskill carers, foster a culture of mutual respect and structured communication between PCWs and nurses, and prioritise real care improvements over compliance checklists.

Wendy remains committed to pushing for change, even offering to volunteer her time to implement these improvements.

“We have to find a way to make this happen. The PCW workforce is there every day, caring for and observing residents. They need targeted support to improve and add value and have been a neglected cohort in the sector.”

Providers should also consider pathways to facilitate the input of others close to the resident, such as cleaning, catering, and lifestyle staff, as well as family members. This was recognised and factored into health processes years ago, and the aged care sector must catch up.

Given the increasing frailty and comorbidities of aged care residents, managing reversible deterioration will only become more critical. All staff must be empowered with the right knowledge to contribute effectively.

“If we empower PCWs with the right knowledge and ensure ways for their voices to be heard, they can make a real difference,” she adds.