The ordinary work context direct care workers have to deal with when assisting people with stroke is highly demanding. They are the most burdened group of workers (since they carry out the most essential tasks) and the least trained one (no academic title for their position is required). Vocational training is also lacking, since the context in which they work usually does not stimulate them to engage in lifelong training activities.
Even considering all the above mentioned issues, evidence from the literature suggest that if adequately trained, direct-care staff can contribute to greatly improve patients outcomes, e.g. in terms of quality of life, reduction of agitation, promotion of independence etc., at the same time improving their working conditions. Better-trained staff is indeed more likely to benefit from a reduced work-related stress, burden and injuries.