This informal CPD article, ‘Proximity to Care Matters: Competency-Based Training for Those Closest to the Patient’, was provided by Chika Odioemene, RN, MSN, Founder of Utopian Healthcare, a training and consulting organization focused on supporting health systems by preparing caregivers, clinicians, and institutions to provide care that reduces risks and helps prevent complications.
Care delivery frequently depends on individuals who remain physically closest to the patient during daily routines. These individuals include trained caregivers, family members, domestic workers and migrant laborers. Their proximity positions them to influence patient safety, yet many lack formal training. Verified global evidence suggests that unpaid and domestic care work is disproportionately performed by women and by domestic or migrant workers. Additionally, research on dementia caregiving demonstrates that informal caregivers experience high burden and often perform complex tasks without structured instruction. This article examines evidence suggesting that competency-based training can help to benefit anyone who provides the last touch of care, regardless of title, socioeconomic status or formal role. Research indicates such training addresses both safety and equity considerations.
Introduction
Care systems around the world often emphasize the roles of licensed professionals, yet the realities of daily care reveal that those who remain closest to the patient frequently provide the majority of hands-on support. These individuals assist with feeding, mobility, hygiene, comfort and observation. Their actions may go unnoticed in formal documentation, yet they form the practical frontline of patient safety. The concept of the last touch recognizes that the final interaction shaping a patient’s daily wellbeing is determined not by title but by proximity. The central question becomes whether the person who provides this last touch is adequately prepared.
Proximity and Responsibility in Daily Care
Proximity influences responsibility because the person closest to the patient is often the first to detect early signs of deterioration. Changes in breathing, skin integrity, mobility, appetite or mood frequently occur during routine interactions. Without foundational caregiving knowledge, these early cues may be overlooked, delaying necessary intervention.
Titles do not determine functional responsibility. Actions do. Individuals who perform caregiving tasks shape patient outcomes, regardless of whether they identify themselves as caregivers.
Evidence From Dementia Caregiving Research
Caregiver burden is extensively documented in dementia-caregiving literature. A review by Goto, Morita, Suematsu, Imaizumi and Suzuki (2023) reports that caregivers of dementia patients frequently experience significant emotional, physical and psychological strain, often without formal training in managing behavioral changes, mobility limitations or safety risks. This evidence supports that caregivers across contexts perform complex care responsibilities and that lack of training contributes to higher stress and potentially compromised care quality.
This body of research demonstrates that proximity alone does not ensure safe caregiving. Competence is important.
The Role of Competency-Based Training
Competency-based training provides structured, practical preparation for safe caregiving actions. It equips caregivers to prevent falls, maintain skin integrity, support safe feeding, uphold hygiene, recognize early warning signs and communicate observations effectively. Training does not grant diagnostic authority but can often enhance safety for both caregivers and patients. When applied consistently, competency-based programs can help turn proximity into protection rather than risk.
International Labour Organization
Global Inequities in Caregiving Roles
Internationally verified evidence suggests that care work is not evenly distributed. The International Labour Organization reports that women perform approximately three quarters of all unpaid care work globally. UN Women and UNDP confirm similar findings, noting that women’s disproportionate care burden limits economic opportunity and reinforces structural inequities. Domestic work, including care for older adults and children, is largely performed by women and by migrant or informal workers who often face low wages, limited protections and minimal access to training.
These inequities underscore the importance of competency-based training not only as a safety intervention but also as a mechanism for recognizing and valuing those whose labor is essential yet historically undervalued.
Awareness and Role Recognition
Many individuals performing caregiving tasks do not see themselves as caregivers. Family members may view their care as familial duty. Domestic workers and migrant helpers may perceive it as a household responsibility. Without recognizing their role, they may lack the awareness necessary to perform care safely. Training can increase awareness and supports intentional, safety-focused action.
System-Level Considerations
Competency-based training alone cannot offset systemic constraints such as inadequate staffing, emotional strain or lack of legal protection for domestic and migrant caregivers. Training can be paired with supportive environments that value caregivers, ensure fair working conditions and provide appropriate resources.
Conclusion
The individual who delivers the last touch of care holds a critical role in patient safety. Proximity places them at the frontline of daily risk and protection. Verified global evidence suggests that caregiving responsibilities fall heavily on women and migrant domestic workers and that many caregivers, particularly those serving dementia patients, face high burden without adequate training. Competency-based education can help ensure that anyone who provides daily care, regardless of title or background, develops the skills and awareness necessary to protect those who depend on them.
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References
International Labour Organization. (2018). Care work and care jobs for the future of decent work. ILO.
UN Women. (2020). Whose time to care? Unpaid care and domestic work during COVID-19. UN Women.
United Nations Development Programme. (2020). Gender inequality and care work: Global patterns and impacts. UNDP.
World Health Organization. (2023). Dementia fact sheet. WHO.
Goto, Y., Morita, K., Suematsu, M., Imaizumi, T., & Suzuki, Y. (2023). Caregiver burdens, health risks, coping and interventions among caregivers of dementia patients: A review of the literature.
