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Dementia Training Reaches Too Few of the Workers Who Give the Care

Published 2026-10-16

Much of the paid care that people living with dementia receive comes from care workers, nursing assistants and ward staff, yet their dementia training is patchy, often unrecorded, and undercut by high turnover. In England, dementia care training is recorded for 38% of adult social care workers. In US nursing homes, nursing staff turnover averages roughly 128% a year.

For a person living with dementia, the quality of a day often rests on whoever comes through the door: a care worker who knows how to help without taking over, or a nurse who reads distress as a sign of pain or fear rather than "difficult behaviour". Families notice quickly when that knowledge is missing, and when the familiar face keeps changing. This study draws on workforce statistics, clinical audits and research from several countries on who gives paid dementia care, how often they leave, how much dementia training they get, and what training changes care.

38%of adult social care workers in England had dementia care training recorded in the national workforce dataset in 2025/26[1]
42%of general hospitals audited in England and Wales in 2024 could not say how many of their staff had higher-level dementia training[2]
128%was the approximate mean annual turnover of nursing staff across 15,645 US nursing homes, measured from payroll data in a 2021 study[3]

Most paid dementia care is given by a care workforce that is short of people

In England, Skills for Care estimates that 885,000 of the 1.59 million filled posts in adult social care in 2025/26 were in services supporting older people with dementia. Over three-fifths (61%) of filled posts in residential services supported older people with dementia care needs[1]. In Australia, Dementia Australia notes that an estimated two-thirds of people in Australian residential aged care live with moderate to severe cognitive impairment[4].

England had 96,000 vacant adult social care posts in 2025/26, a vacancy rate of 6.2%. That is down from a peak of 10.4% in 2021/22, but it is still well above the estimated 2.2% for the wider UK economy[1]. If the workforce grows in line with the population aged 65 and over, Skills for Care estimates England will need an additional 410,000 posts (24% growth) by 2040[1].

In the United States, the Alzheimer's Association estimates that "between 2024 and 2034, nearly 800,000 additional direct care workers will be needed", which it calls "the largest worker gap of any single occupation in the U.S."[5] Elsewhere, migrant workers fill part of the gap. A 2026 commentary on home-based care in Taiwan, Singapore and Austria notes that live-in migrant carers report that a lack of care skills and of enough rest makes their work with people with dementia harder[6].

Vacancy rates: adult social care compared with the NHS and the wider UK economy, 2025/26Estimated vacancy rates: adult social care in England 6.2% in 2025/26; NHS 6.5% as at March 2026; wider UK economy 2.2% as at February to April 2026.0%2%4%6%8%Adult social care, England(2025/26)6.2%NHS (March 2026)6.5%Wider UK economy (Feb-Apr2026)2.2%
The three figures come from different data collections, as the source notes, so compare them with care. Adult social care vacancies fell from a peak of 10.4% in 2021/22. Source: Skills for Care, The state of the adult social care sector and workforce in England, 2026, section 3.2.

Staff turnover is high enough to wash training away

Training only helps if trained staff stay. The clearest measure comes from US federal payroll-based staffing data for nursing homes. Using 492 million nurse shifts at 15,645 facilities, Gandhi, Yu and Grabowski calculated that "mean and median annual turnover rates for total nursing staff were roughly 128 percent and 94 percent, respectively"[3]. The measure is the share of nursing care hours that turned over in a year, so it can exceed 100% when some posts change hands more than once. Figures reported by the Alzheimer's Association put annual turnover among direct care workers at "79% annually for those providing home care and 99% for nursing assistants in nursing homes"[5].

England's figures are lower but still substantial. Skills for Care estimates a turnover rate of 22.1% for directly employed adult social care staff in 2025/26, about 320,000 leavers in a year. For care workers and support workers the rate was 26.9%[1]. Half of recruitment comes from within adult social care, so much of this movement is between employers rather than out of care altogether[1].

Country and groupAnnual turnoverHow it was measured
US nursing homes, all nursing staffAbout 128% (mean); 94% (median)Share of nursing care hours that turned over, from payroll data at 15,645 facilities[3]
US nursing assistants in nursing homes99%Reported by the Alzheimer's Association, 2026 report[5]
US home care direct care workers79%Reported by the Alzheimer's Association, 2026 report[5]
England, care and support workers26.9%Skills for Care estimate, directly employed staff, 2025/26[1]
England, all adult social care staff22.1%Skills for Care estimate, directly employed staff, 2025/26[1]

These rates use different methods and definitions and are not directly comparable between countries.

Researchers who reviewed national dementia training standards list "high staff turnover" among the barriers to putting those standards into practice. The others include lack of organisational support, lack of access to relevant training and lack of funding[7].

Dementia training reaches only part of the workforce, and often goes unrecorded

England has unusually detailed social care training data. In the Adult Social Care Workforce Data Set, 38% of workers employed by councils and independent providers had dementia care training recorded in 2025/26. Even so, dementia was the most commonly recorded training among specific conditions[1]. Not every job role needs it, and some training may go unrecorded, but most of these workers are in services for people with dementia. More broadly, 56% of the workforce had engaged with the Care Certificate standards, the induction for new care workers, and 55% had no relevant social care qualification recorded[1].

Hospitals show a gap between basic awareness and the deeper skills needed for hands-on care. The National Audit of Dementia for general hospitals in England and Wales found that, on average, 77% of staff per hospital were trained in dementia awareness (Tier/Level 1) in 2024, but only 46% had higher-level dementia skills training (Tier/Level 2). And 42% of hospitals (73 of 172) could not give Tier/Level 2 figures at all[2]. The audit's own standard is that "any staff member involved in the direct care of people with dementia should receive Tier/Level 2 training"[2].

Dementia training recorded for staff in England and Wales: care workers and hospital staffShare of staff with dementia training recorded. Adult social care workers in England with dementia care training recorded in the ASC-WDS, 2025/26: 38%. General hospital staff in England and Wales trained in dementia awareness (Tier/Level 1), average per hospital, 2024: 77%. Staff trained in higher-level dementia skills (Tier/Level 2), average per hospital, 2024: 46%.0%25%50%75%100%Hospital staff: dementiaawareness (Tier/Level 1)77%Hospital staff:higher-level skills (Tier/Level 2)46%Social care workers:dementia care training recorded38%
Different measures: the social care figure is unweighted ASC-WDS data for local authority and independent employers in England, covering all job roles (not every role needs dementia training); the hospital figures are per-hospital averages from the 58% of hospitals able to report Tier/Level 2 training. Sources: Skills for Care 2026, Chart 108; National Audit of Dementia, Round 6 (2023-24).

In Australia, Dementia Australia states that personal care workers "make up 70 per cent of the direct care workforce" and that the minimum qualification for the role "involves no compulsory units in dementia competency" (its page was last updated in January 2025)[4].

Where knowledge has been measured, the gaps are consistent. A survey of 785 care workers in 34 randomly sampled residential aged care facilities in China found that "the majority of caregivers showed limited knowledge of dementia". Those who had received dementia care training knew more[8]. A national survey of 234 Australian health professionals found knowledge gaps about risk factors, types of dementia and cognitive symptoms. Dementia-specific training was associated with higher knowledge scores[9]. Among 341 general practitioners in 27 community health centres in Beijing, the average knowledge score was 21.42 out of 30 (71.4%). Most believed dementia care belonged to specialists rather than general practice[10]. In the US, half of primary care physicians report that they do not feel adequately prepared to care for people with Alzheimer's and other dementias[5].

Specialist dementia roles are scarce, and their evidence is still thin

Specialists such as geriatricians, old-age psychiatrists and specialist dementia nurses diagnose, advise colleagues and support families when care becomes complex. In the US they are in short supply: 55% of primary care physicians report that there are not enough dementia care specialists, and 71% of rural primary care physicians report shortages. The Alzheimer's Association estimates that the country would have to "more than quadruple the number of geriatricians who were practicing in 2021" to meet the needs of its growing older population[5]. Specialist shortages also feed the waits covered in our study of memory assessment waiting times.

Specialist dementia nursing is one model that has been studied. In the UK, Admiral Nurses are "registered nurses specialising in dementia" who work with families[11]. One research team described Admiral Nursing as "the only service of its kind in the United Kingdom dedicated to helping people with dementia and their carers"[12]. In a survey of carers using the service in three regions of England, 207 questionnaires were analysed (a 30.2% response rate). The nurses' knowledge and skills were rated helpful by 81.5% of respondents[11]. That measures the experience of the carers who responded, not outcomes.

For hospitals, a scoping review of dementia specialist nurse roles found that "direct evidence for the effectiveness of these roles is lacking". It concluded that a skilled specialist nurse with a clearly defined role, working directly with people with dementia and their carers for much of their time, could benefit them in hospital[13]. That matters because, as one review of hospital training notes, people with dementia "occupy up to one quarter of acute hospital beds"[14]. The case for these roles is plausible and valued by families, but rests more on experience than on trials: an argument for funding evaluation as they grow.

Training changes care when it is long enough, practical and backed up on the job

Research is fairly consistent about what separates training that changes care from training that ticks a box. The broadest synthesis we found, a review of 152 papers by Surr and colleagues, found that more effective programmes were relevant to the learner's role and experience, involved "active face-to-face participation" and were "delivered by an experienced facilitator". They also had "a total duration of at least 8 hours with individual sessions of 90 minutes or more" and supported staff to apply what they learned in practice[15].

The evidence on outcomes for people living with dementia is encouraging but mixed. A review of 20 studies of staff training aimed at behavioural and psychological symptoms of dementia found that "twelve studies resulted in significant symptom reductions, four studies found positive trends and four studies found no impact"[16]. A review of person-centred training for care home staff found that the packages that worked "included a sustained period of joint working and supervision with a trained mental health professional" alongside teaching. Yet of 170 training manuals identified, only 30 met quality criteria and "only four had been evaluated in clinical trials"[17]. Most of the manuals on offer to care homes had never been tested in a trial.

One of the largest tests is the WHELD trial in 69 UK nursing homes. Staff were trained in person-centred care and social interaction, with ongoing delivery through "a care staff champion model". Among 847 residents randomised, of whom 553 completed nine months, the programme improved quality of life, agitation and overall neuropsychiatric symptoms, "albeit with relatively small effect sizes". Positive care interactions rose by 19.7%, and the intervention cost less than usual care[18]. It did not reduce antipsychotic use, which was already low and stable in both groups[18]. Prescribing is covered in our study of antipsychotic prescribing.

Hospital training has a weaker evidence base. A review of training for hospital staff included 20 papers, "the majority of which were low or medium quality"[14]. Good training is possible; what is rarer is training that is long enough, rooted in daily practice, sustained, and evaluated for what it changes for people receiving care.

What the evidence asks of us

The figures point to practical demands that dementia organisations can put to governments, regulators, commissioners and providers.

  • Make dementia training a standard, not an option, for everyone who gives hands-on care. England's NICE guideline NG97 says care and support providers "should provide all staff with training in person-centred and outcome-focused care for people living with dementia". Staff who deliver care should get additional "face-to-face training and mentoring", including "follow-up sessions where staff can receive additional feedback and discuss particular situations"[19]. Where minimum qualifications include no compulsory dementia content, as Dementia Australia reports for personal care workers, that gap is a policy choice that can be changed[4].
  • Buy training that has been shown to work. Commissioners and providers can ask for the features linked to effective programmes: at least eight hours in total, face-to-face, practice-based and led by an experienced facilitator[15]. They can favour packages tested in trials, such as WHELD, over the many manuals that have never been evaluated[17][18].
  • Count it. When 42% of audited hospitals cannot report how many staff have higher-level dementia training, nobody can be held to account for the gap[2]. Regulators and national data sets should record dementia training by role and setting, in social care as well as health care.
  • Treat retention as part of training. Training is lost every time a trained worker leaves, and turnover in long-term care runs from around a fifth of staff a year in England to a mean above 100% in US nursing homes[1][3]. Pay, conditions and career routes for care workers are part of the quality of dementia care, not a separate issue.
  • Involve families and people living with dementia. NICE suggests considering giving carers and family members the chance "to attend and take part in staff dementia training sessions"[19]. National training standards from the UK, US, Australia and Ireland offer a starting point for countries building their own[7].
  • Fund specialist roles and evaluate them. Specialist dementia nurses and enough specialist doctors are needed where care becomes complex, and their effect on outcomes should be properly measured as services expand[5][13].

Families who give unpaid care also need training and support of their own; our study of unpaid carers sets out that evidence. For the wider picture, see the full Dementia & Health research library.

Language: this piece uses person-first language ("people living with dementia", "people with dementia"), as most dementia organisations and people with lived experience prefer, and uses clinical terms such as "Alzheimer's disease" or "mild cognitive impairment" only where a study, dataset or diagnosis refers to that specific condition.

Why we're publishing this

Good dementia care depends on people: who turns up, whether they stay, and whether they understand dementia. Dementia charities and carers' organisations in many countries campaign for better-trained, better-supported care staff, and need evidence that covers the whole workforce. We have brought it together so that case can be made plainly. The shortfalls described here are failures of funding, staffing and training systems. They do not reflect on the people receiving care, or on the many care workers who do skilled work without the support they deserve.

How to read this data

The figures come from very different sources. England's social care figures are Skills for Care estimates, weighted from a workforce data set covering just over half of regulated establishments. The 38% dementia training figure is unweighted, covers council and independent employers only, and counts training that employers recorded, which may undercount training actually done[1]. The hospital figures come from a clinical audit of general hospitals in England and Wales, and the training averages exclude hospitals that could not report[2]. The US turnover figures use different methods: one is calculated from payroll data, the others are figures reported by the Alzheimer's Association[3][5]. The knowledge studies from China and Australia are single surveys using different scales. Workforce projections rest on stated assumptions about demand. No figure here is a trend or a cross-country ranking. We found no cross-country dataset measuring dementia training directly.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Suggested citation: Understanding Aging (2026). Dementia Training Reaches Too Few of the Workers Who Give the Care. https://understandingaging.org/research/dementia-workforce-training

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

Sources

  1. Skills for Care. The state of the adult social care sector and workforce in England 2026 (data from 2025/26). Skills for Care, 2026. skillsforcare.org.uk/…/The-state-of-the-adult-social-care-sector-and-workforce-in-England-2026.pdf
  2. National Audit of Dementia project team. National Audit of Dementia Care in General Hospitals 2023-24: Round 6 Audit Report. Healthcare Quality Improvement Partnership (HQIP) / Royal College of Psychiatrists, 2024. hqip.org.uk/…/1-Ref.-497-NAD-R6-National-Report.pdf
  3. Gandhi A, Yu H, Grabowski DC. High nursing staff turnover in nursing homes offers important quality information. Health Affairs, 2021. europepmc.org/article/MED/33646872
  4. Dementia Australia. Are aged care workers required to have dementia training? Dementia Australia, 2022 (updated January 2025). dementia.org.au/news/are-aged-care-workers-required-have-dementia-training
  5. Alzheimer's Association. 2026 Alzheimer's Disease Facts and Figures: Workforce. Alzheimer's Association, 2026. alz.org/alzheimers-dementia/facts-figures
  6. Chiu HC, Yen CM. Live-in migrant care workers as part of the long-term care workforce in Taiwan, Singapore, and Austria: implications for home-based dementia care. Journal of Aging & Social Policy, 2026. europepmc.org/article/MED/39444211
  7. Pit SW, Horstmanshof L, Moehead A, et al. International standards for dementia workforce education and training: a scoping review. The Gerontologist, 2024. europepmc.org/article/MED/37071967
  8. Dai Y, Zhao J, Li S, Zhao C, Gao Y, Johnson CE. Caregivers' dementia knowledge and care approach in residential aged care facilities in China. American Journal of Alzheimer's Disease & Other Dementias, 2020. europepmc.org/article/MED/33089701
  9. Annear MJ. Knowledge of dementia among the Australian health workforce: a national online survey. Journal of Applied Gerontology, 2020. europepmc.org/article/MED/29313420
  10. Wang M, Xu X, Huang Y, et al. Knowledge, attitudes and skills of dementia care in general practice: a cross-sectional study in primary health settings in Beijing, China. BMC Family Practice, 2020. europepmc.org/article/MED/32416731
  11. Maio L, Botsford J, Iliffe S. Family carers' experiences of the Admiral Nursing Service: a quantitative analysis of carer feedback. Aging & Mental Health, 2016. europepmc.org/article/MED/26062969
  12. Gridley K, Parker G. Specialist nursing case management support for carers of people with dementia: a qualitative study comparing experiences of carers with and without Admiral Nursing. Health & Social Care in the Community, 2022. europepmc.org/article/MED/34028916
  13. Griffiths P, Bridges J, Sheldon H, Thompson R. The role of the dementia specialist nurse in acute care: a scoping review. Journal of Clinical Nursing, 2015. europepmc.org/article/MED/25469780
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  15. Surr CA, Gates C, Irving D, et al. Effective dementia education and training for the health and social care workforce: a systematic review of the literature. Review of Educational Research, 2017. europepmc.org/article/MED/28989194
  16. Spector A, Orrell M, Goyder J. A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Research Reviews, 2013. europepmc.org/article/MED/22820151
  17. Fossey J, Masson S, Stafford J, et al. The disconnect between evidence and practice: a systematic review of person-centred interventions and training manuals for care home staff working with people with dementia. International Journal of Geriatric Psychiatry, 2014. europepmc.org/article/MED/24535885
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