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The aim of this paper is to critically consider the role of the support worker in the nursing home sector and with particular reference to the United Kingdom situation. With the expansion of the nursing home sector, there is an increasing population of support workers in this field. Literature in this paper covers the period between 1989 and 2002, beginning with the build up to the introduction of the National Health Service and Community Care Act (available at: http://www.hmso.gov.uk), which necessitated a major shift between public and private sector employment. The findings of this paper indicate limited research, investigating the role of support workers in general and specifically those working in the nursing home sector. The literature suggests that the majority of the role focuses on direct patient care, however, a lack of role clarification was evident and differences emerged between the views of support workers and Registered Nurses regarding the place of support workers in the care process. In particular, support workers saw their role as similar to that of the Registered Nurse, although Registered Nurse regarded 'basic nursing care' as the key remit of the support worker role. The paper also indicated inadequate preparation and subsequent supervision of support workers. These key findings indicate that role clarification, appropriate preparation and a process of continuing development require careful consideration by managers if the positive contribution of this group of care workers is to be fully realized. Furthermore, while there exists no central source of funding to finance the role preparation and mentorship of support workers, training provision will remain ad hoc. Obtaining core funding would allow for the training and education of support workers to become standard practice, which, in turn, is more likely to lead to improvements in the planning and resourcing of care provision. Equally, further research is needed if the support worker role is to be used effectively and efficiently within the expanding nursing home sector.

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The major findings indicate that, although positive progress is being made in specific communities, a coordinated and comprehensive response is needed. To create policy and normative change, a statewide, multilevel framework is needed with a unifying message to better target policymakers. The framework should include targeted efforts at all levels that include education, promotion and environmental policy change.