Tension between reality and visions: Lessons from an evaluation of a training program of paid elder care workers.

The present study is based on a 3-year evaluation of an Israeli training program for local paid elder care workers, called, 'community care'. Interviews were conducted with all stakeholders involved in the program, including program developers, facilitators, funders, trainees, dropouts, graduates, employers and older care recipients. Qualitative thematic analysis was used. Analysis was supplemented by quantitative data concerning the program's inputs, outputs and outcomes. The program had multiple strengths, including a substantial funding stream and a highly skilled and committed team. Yet, out of 130 participants, 94 completed the program and 31 worked as care workers afterwards. Three main challenges to the efficacy of the training program were identified. A first challenge stems from the gap between the program's vision and real-life requirements and constraints. The second challenge concerns a disagreement between stakeholders concerning the definition of the new community care profession as an opportunity to empower trainees and encourage personal growth versus the community care worker as being no different from the traditional direct paid carer. A third challenge concerns the program's lack of integration between personal/physical care on the one hand and emotional and psychological care, on the other hand. The findings stress the importance of adequately conducting a needs assessment prior to embarking on a new social program and the tension between an ideal prototype and real-life constraints. The findings also stress the necessity of top-down processes, supported by the government to the development of a new profession of community elder care.