DESK REVIEWS | Are there recognized professional training and qualification systems for the long-term care workforce?

DESK REVIEW | Are there recognized professional training and qualification systems for the long-term care workforce?

According to the Brazilian Classification of Occupations (Classificação Brasileira de Ocupações, CBO) (CBO 5162-10 Cuidador de Idosos), the carer occupation can be performed by anyone. There are many private skill training courses being offered for people who want to get trained to work as carer, which are provided online or face-to-face, freely or paid for by the individual, the older person’s family, or by a care agency, or other health service. Here is an example of such courses.

‘Formal caregiving’ has been recognized as an occupation since 2002 by the Brazilian Classification of Occupations (Classificação Brasileira de Ocupações, CBO), but not as a profession (for that it would be necessary a law regulating its activities). Changing the status from occupation to profession had been approved by the Chamber of Deputies and the Senate House. However, the president of Brazil later denied this recognition justifying that the proposal had incurred conditions which restricted the free professional work. This project of law (PLC11/2016) stated that informal care workers should have completed basic education attainment (8 years or more), at least 160h of relevant training, to be aged 18 and above, to have no criminal records, and attested physical and mental capabilities. This would have been a landmark on improving the quality of the care provided for older people.

Due to the absence of a formalization of such profession, informal care workers do not have regulated set of training skills or basic professional rights. Even though the President has denied the recognition of the occupation as a profession, there is still a chance of this recognition to happen as deputies and senators plan to further discuss this in the near future (Conselho Federal de Enfermagem, 2019b). In addition, state and municipal laws have been proposed to try and systematise the care provided to older people locally, such as in Rio de Janeiro state (ALERJ, 2016). This state law states:

Art. 5º: The regular qualification, preparation, and qualification courses for Carers of Older People must have, at least, the duration of 160h (one hundred and sixty hours) of in-class training, with theoretical and practical content, being 25% (twenty-five percent) of the total number of hours dedicated to practical activities involving monitoring and supervision, and the course provider must involve professionals from professions related to the field of gerontology, such as: geriatricians, nurses, nutritionists, physiotherapists, psychologists, occupational therapists, and social workers.

Other professionals who are part of the Brazilian LTC workforce are regulated by their professional bodies, such as the Nursing Council for nurses and health assistants, Medical Council for physicians, and Physiotherapy Council for physiotherapists. However, none of these professionals need to be specialised in LTC beyond their generalist training in order to provide LTC for older people. It would depend on the employer to require such training.


ALERJ. (2016). Lei Ordinária 7332.

Conselho Federal de Enfermagem. (2019b). Projeto de Lei do Cuidador é vetado Conselho Federal de Enfermagem—Brasil.


Under the NPHCE, post-graduate training for medical doctors in geriatric medicine has been initiated in a few centres and the Medical Council of India recognised the MD course in Palliative medicine in 2012. In addition, post-graduate diploma programmes in gerontology are available for graduates from disciplines other than health (UNESCAP, 2016). While there has been progress in geriatric and gerontology training in India, training for staff engaged in other roles in care homes, such as administration and service delivery still have significant gaps (Johnson et al., 2017).

Although, the long-term care workforce system is not well organised, a few training institutions as part of the government, private sector, and universities offer programmes and coordinate employment opportunities for formal caregivers. The Ministry of Social Justice provides financial support to institutions for training geriatric workers and formal caregivers through the National Institute of Social Defence (NISD). However, there is a need to standardise the content and evaluate the quality of these courses (UNESCAP, 2016). There are other various non-governmental and private sector operators, for example Nightingales medical trust, ARDSI etc., which offer training and other innovative long-term care programmes (Nightingales Medical Trust, 2014; ARDSI, 2015).


Alzheimer’s and Related Disorders Society of India (ARDSI). (2015). Alzheimer’s and Related disorders Society of India (ARDSI).

Johnson, S., Madan, S., Vo, J., Pottkett, A. (2017). A qualitative analysis of the emergence of long term care (old age home) sector for seniors care in India: Urgent call for quality and care standards. Ageing International, 43(3), 356–365.

Nightingales Medical Trust. (2014). TRAININGS AT NIGHTINGALES MEDICAL TRUST.

UNESCAP. (2016). Long-term Care of Older Persons in India. Available from:

There is no professional training and qualification system specific for the national LTC workforce yet. In the LTC guideline for Puskesmas, certification or registration with a professional body is indicated for GPs, nurses, and other health care workers such as nutritionists or physiotherapists, but not for caregivers (Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat, 2018). Trainings aimed at volunteers (cadres) providing LTC services through the Posyandu Lansia have been done by local governments in collaboration with universities, such as in Malang and Depok (Kartika et al., 2019; Nugraha et al., 2019). There has been LTC training in Puskemas level too, such as in Sungailiat, Bangka District (Dinas Kesehatan Kabupaten Bangka, 2019). However, these initiatives seem to be at regional coordination level, and thus the training provision might not yet be standard nationally.

On the international level, professional training and qualification systems are managed by the National Agency for the Protection and Placement of International Migrant Workers (Badan Nasional Penempatan dan Perlindungan Tenaga Kerja Indonesia or BNP2TKI for short). This international collaboration offers training and certification on certain skills. For example, an annual placement program between Indonesia and Japan provides both skills and language training for Indonesian nurses or people undertaking diplomas and bachelor’s degrees in nursing (BNP2TKI, 2011). The Indonesia-Japan Economic Partnership Agreement (IJEPA), launched in 2008 (Ministry of Trade, 2018), established a system for ‘Indonesian health care workers to work as nurses and certified care workers in Japan’ (Nugraha et al., 2017, p.54). The length of training (6 months in Indonesia and 6 months in Japan) might not be sufficient, as it is heavily focused on nursing and language skills, while less on the use of technology and attitude in care service (Arianti, 2013).

Other sources of professional training for the LTC workforce are trainings held via third sector associations focusing on carers, people with dementia, or the provision of long-term care. Organisations providing training include Alzheimer Indonesia, Wulan 247, Indonesia Ramah Lansia or Yayasan Emong Lansia (Sabdono, 2015).


Arianti, R. K. (2013). Pengaruh Profesionalisme, Pelatihan dan Motivasi terhadap Kinerja Nurse dan Caregiver Indonesia. MIX, III(2), 121–132.

BNP2TKI. (2011). Sejarah Penempatan TKI Hingga BNP2TKI.

Dinas Kesehatan Kabupaten Bangka. (2019). Laporan Kegiatan Kesehatan Keluarga Pertemuan Perawatan Jangka Panjang (PJP Care Giver Lansia) Sungailiat 02 April 2019

Kartika, A. W., Choiriyah, M., Kristianingrum, N. D., Noviyanti, L. W., & Fatma, E. P. L. (2019). Pelatihan Tugas Perawatan Kesehatan Keluarga Caregiver Lansia dalam Pogram RURAL (Rumah Ramah Lansia). Jurnal Pengabdian Kepada Masyarakat (Indonesian Journal of Community Engagement), 5(3), 448.

Kementerian Kesehatan RI Direktorat Jenderal Kesehatan Masyarakat. (2018). Pedoman untuk Puskesmas dalam Perawatan Jangka Panjang bagi Lanjut Usia. Kementerian Kesehatan RI.

Ministry of Trade. (2018). Fact Sheet Indonesia-Japan Economic Partnership Agreement (IJEPA).

Nugraha, S., Agustin, D., Rahardjo, T. B. W., & Yuko, H. (2019). Pelatihan Bagi Kader Posbindu Tentang “Long Term Care” ( Perawatan Jangka Panjang ) Bagi Lanjut Usia Kota Depok. PAMAS, 3(2), 113–120.

Nugraha, S., Honda, S., & Hirano, Y. (2017). The change in mental health status of Indonesian health care migrant worker in Japan. Kesmas, 12(2), 53–89.

Sabdono, E. (2015). Commentary on Indonesia’s domain ranks in the 2015 Global AgeWatch Index.

There are no professional training and qualification systems for the long-term care workforce in Kenya. Furthermore, there is only one medical gerontologist who trained outside Kenya, working at policy level. According to the first palliative medicine specialist in Kenya, Dr. John Weru, “the duty for palliative medicine specialists is to teach other doctors and clinicians as this is a very new medical specialty practice in the country, to set up structures and processes for the growth and development of the service and to provide the much needed clinical care to patients and their families” (Star Correspondent, 2015).


Star Correspondent. (2015). Meet Kenya’s first palliative medicine specialist. The Star, 23 February. Nairobi, Kenya.


While there is no formal public long-term care system in Mexico, some government institutions are working towards creating different standard competencies of care. For example, the National Institute of Geriatrics is currently working with other health and higher education institutions to develop and implement standards of care and aptitudes (skills—competencies) in cognitive stimulation for older adults for health care professionals and older adult care standard and aptitudes for social workers within the health care system. However, while these could be mandatory and applicable to all health care institutions, they would not be alike for (temporary and permanent) long-term care services since there is no agency or regulation that requires them to do so.