Building a Workforce for Safe, High-Quality Older-Person Care in Viet Nam: Competency, Supervision and Accountability Across Care Settings
LONG-TERM CARE QUALITYMEASUREMENT, IMPLEMENTATION & LEARNING
Building a Workforce for Safe, High-Quality Older-Person Care in Viet Nam: Competency, Supervision and Accountability Across Care Settings
LONG-TERM CARE QUALITY, MEASUREMENT, IMPLEMENTATION & LEARNING
Last reviewed: October 2026
An older person recovering after hospitalization may need support with medications, mobility, nutrition, bathing, cognition, rehabilitation and follow-up care. Some of that support may come from doctors and nurses, some from rehabilitation professionals or primary and community health workers, some from paid care workers, and much of the day-to-day help may still come from family members. If the person later moves between hospital, transitional care, home, community services and long-term care, the people involved may change again.
This makes workforce quality much more than a question of how many people are available. It also depends on whether each person understands their role, is competent to perform it, recognizes when a situation is beyond that role, can obtain appropriate supervision and knows how to escalate a concern. Responsibility also needs to remain clear when several professionals, workers, caregivers and organizations are involved.
A caring workforce is essential, but goodwill alone cannot make care safe. Older people may live with multimorbidity, frailty, cognitive impairment, functional limitations and complex medication regimens. Small failures in observation, communication or escalation can have significant consequences: sudden confusion that is dismissed as “normal aging,” swallowing difficulty that goes unnoticed, a medication change that is misunderstood, or gradual functional decline that no one recognizes as requiring reassessment.
Building the workforce for older-person care is therefore not simply a matter of recruiting and training more people. It means building a system of capability around the people delivering care.
Competency is more than attending a training course
Training matters, but attendance at a course does not by itself demonstrate competence. Someone can complete training in older-person care and still have difficulty recognizing acute deterioration, assisting a frail person with a transfer safely, communicating with someone who has cognitive impairment, or deciding when a problem needs to be escalated to a health professional with the appropriate expertise and authority.
Competency is the ability to apply relevant knowledge, skills and judgment appropriately in real situations. In older-person care, that may include person-centered communication, recognition of functional decline, mobility and fall prevention, nutrition, cognition and delirium awareness, medication safety, rehabilitation support, continence, skin care, safeguarding, documentation, care transitions and communication with families. Just as importantly, competence includes understanding the boundaries of one’s role.
WHO’s Integrated Care for Older People, or ICOPE, approach reflects this broader view. The current ICOPE handbook supports health and care workers in detecting declines in intrinsic capacity, identifying health and social-care needs and developing personalized care plans in primary and community care. WHO’s ICOPE Training Programme is aimed at a broad range of workers, including physicians, nurses, community health workers, rehabilitation professionals, nutritionists, psychologists, pharmacists and social workers. WHO states that implementing integrated, person-centered care requires health and care workers to acquire new knowledge and competencies, making workforce capacity a key part of implementation.
This is particularly relevant for Viet Nam because older-person care cannot be built around one profession alone.
Different roles need to connect without becoming blurred
Older-person care involves people with very different education, authority and responsibilities. In hospitals and other healthcare facilities, licensed practitioners and other health professionals provide clinical assessment, diagnosis, treatment, nursing, rehabilitation and related services within their respective professional scopes. At primary and community level, commune health staff, village health workers, population collaborators, social workers and trained volunteers may contribute to screening, health education, follow-up and community support. At home, paid care workers and family caregivers may provide much of the practical assistance with everyday life.
These roles need to connect, but they should not become interchangeable. A person who supports bathing, meals or mobility does not automatically have the competence or legal authority to diagnose a condition, change a prescription or carry out a regulated clinical procedure. At the same time, a highly trained clinician may know little about what happens to the person between medical encounters unless information from the home and community reaches the clinical team.
The objective should therefore not be to make everyone capable of doing everything. It is to ensure that each person is competent for the activities expected of their role, understands what they should not do, and knows how their work connects with the people responsible for the next level of care.
This distinction will become increasingly important as Viet Nam develops more home-, community- and long-term-care services.
Workforce capability is increasingly being treated as a quality-of-care issue
The international direction is moving beyond workforce numbers alone. In 2026, WHO convened a Technical Working Group to develop Global Standards for Quality Health Care Services for Older People. WHO has identified limited workforce capacity alongside fragmented services, weak coordination across health and social care, ageism and inadequate support for carers among the continuing gaps in older-person care. The standards are intended to define quality healthcare for older people and provide practical standards, indicators and implementation guidance for person-centered, integrated and responsive care.
WHO is also conducting public consultation on the draft Global Standards for Long-Term Care. The consultation runs until 30 October 2026, so the draft should not be treated as a finalized WHO standard. The consultation framework is nevertheless informative: workforce is one of eight chapters, alongside definitions and principles, home- and community-based care, facility-based care, support for unpaid carers, financing, governance and quality monitoring.
That placement matters. Workforce is not being treated simply as a human-resources issue outside quality improvement. It is part of the infrastructure needed to deliver safe and reliable care.
Recent research points in the same direction. A 2026 umbrella review covering 19 reviews of interventions for the formal long-term-care workforce found that continuing professional development and peer-led training consistently improved staff knowledge and competencies, although evidence for many other workforce interventions remained limited, heterogeneous or methodologically weak. PubMed A review focused on non-registered practitioners in long-term care similarly found that effective learning was commonly multifaceted, combining learning in practice with approaches such as supervision and formal education, within an organizational culture that supported shared learning and reflection.
The practical implication is important: training is necessary, but training without opportunities to practice, obtain feedback and access support is unlikely to be enough.
Viet Nam now has a stronger policy foundation for workforce development
Viet Nam has strengthened this foundation substantially over 2025–2026. The National Strategy for Older People to 2035, with a vision to 2045, approved by Decision No. 383/QĐ-TTg on 21 February 2025, contains a specific set of measures to strengthen personnel involved in supporting older people. These include developing training curricula in social work, care and rehabilitation; strengthening advanced skills among social-assistance and rehabilitation personnel; training staff, collaborators and families in care and rehabilitation; periodic retraining and training of trainers; and collaboration with universities in medical and other relevant professional education.
Decision No. 1116/QĐ-TTg of 22 June 2026, which updates the Older People Health Care Program to 2030, adds a clearer health-system component. It calls for professional training for people involved in older-person care across geriatric hospitals and hospital geriatric services, regional health facilities, commune health stations and other healthcare facilities, as well as population personnel and community volunteers.
Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026 makes these arrangements more operational for care at home and in the community. Under the guidance, trained commune health professionals, population collaborators, village health workers, social workers and volunteers may undertake initial screening using the ICOPE tool, while commune health stations are responsible for assessing identified impairments and care needs and advising on referral where appropriate. Commune health stations also organize training and assign responsibilities for home and community care. At community day-care points, care providers are assigned by the commune health station in a manner appropriate to their professional competence.
Decision 1976 also establishes a wider support structure. The Population Department has implementation, training and monitoring functions; the National Geriatric Hospital and geriatric departments of hospitals under the Ministry of Health have professional leadership, training and technical-support roles; provincial health authorities supervise implementation; provincial geriatric services support lower-level facilities; and commune health stations organize local training and assignment of care responsibilities.
Circular No. 34/2026/TT-BYT of 8 September 2026 adds another important layer. It includes a specific workforce-development component for geriatric hospitals, hospital geriatric departments and services caring for older people in the community and at home. Among other measures, the National Geriatric Hospital is assigned responsibility for assessing training needs, developing training materials, providing theoretical and clinical training, transferring geriatric techniques, evaluating training and supporting continuous professional updating and technical supervision remotely.
These are substantial developments. Viet Nam is moving from general recognition of workforce needs toward clearer training, technical-support and implementation structures. However, the national instruments reviewed for this article do not establish one unified competency framework covering everyone who provides older-person care across hospital, rehabilitation, primary care, home, community and long-term-care settings.
That distinction matters because these groups operate under different professional and regulatory frameworks. For clinical practitioners, the Law on Medical Examination and Treatment No. 15/2023/QH15 requires specified practitioner groups—including doctors, nurses and several other health professions—to update their medical knowledge continuously in a manner appropriate to their scope of practice, while healthcare facilities must create conditions for this professional updating. Circular No. 32/2023/TT-BYT requires practitioners subject to these provisions to complete at least 120 credit hours over five consecutive years.
Community workers, social-care workers, volunteers and family caregivers do not all operate within that same clinical regulatory framework. A safe system therefore needs to preserve professional boundaries while making the interfaces between roles clearer.
Competency, supervision and escalation need to work together
Not every task in older-person care carries the same level of risk. Helping someone participate in a social activity is different from assisting a person with severe mobility impairment to transfer. Supporting a meal is different from assessing swallowing difficulty. Reminding someone to take a prescribed medication is different from deciding whether that medication should be withheld. Measuring a vital sign is different from interpreting clinical deterioration and changing treatment.
Competency requirements should therefore reflect the task, the person’s level of dependency and the potential consequences of error. People providing basic support may need competence in respectful communication, safe assistance with everyday activities, infection prevention, fall prevention, recognition of changes from the person’s usual condition and knowing whom to contact when something appears wrong. More highly trained community or care personnel may require additional competencies in structured screening, basic monitoring, rehabilitation support, documentation, caregiver education and communication with clinical teams. Medical diagnosis, prescribing, medication changes and other regulated clinical procedures remain subject to applicable professional scope and healthcare law.
Training alone, however, cannot anticipate every situation that arises in real care. An older person who walked independently last week may suddenly be unable to stand. Someone living with dementia may become acutely more confused. A caregiver may notice that the person is sleeping much more, eating less and refusing medications. A community worker may detect declining mobility but be uncertain whether it requires referral.
This is where supervision and escalation become essential. Less-experienced workers need a reliable way to seek advice, confirm what should happen next and escalate concerns. Supervisors also need mechanisms for identifying recurring gaps in practice and turning them into learning rather than waiting for harm to occur.
Decision 1976 already contains elements of this architecture. Central and provincial geriatric services have professional guidance and technical-support roles; provincial health authorities undertake supervision and inspection; commune health stations provide local training and assignment; and community actors may undertake screening while assessment of identified impairments, determination of care needs and referral remain connected to the health system.
This suggests an important principle for workforce design: competence includes knowing the limits of one’s competence.
For organizations, escalation should therefore be designed as explicitly as the task itself. People need to know which changes require attention, whom to contact, what information to communicate, what to document and what to do when the usual point of contact is unavailable. A training program that teaches techniques without establishing an escalation pathway leaves a significant safety gap.
Accountability and staffing conditions are part of workforce quality
Integrated care involves many people, and that can make responsibility less clear if roles are not deliberately defined. A hospital may discharge an older person with rehabilitation needs, while family members provide daily support, community personnel visit periodically and a primary-care team manages chronic disease. If function deteriorates gradually, someone needs to recognize the change and connect it to an appropriate response.
Accountability does not mean that one person is legally responsible for everything across the entire continuum. It means that the responsibilities attached to each role, service and transition are sufficiently clear. Organizations need role descriptions, scope boundaries, supervision arrangements, handover processes, escalation routes and mechanisms for reviewing incidents and concerns. The person who notices deterioration may not have authority to diagnose or treat it, but the system should ensure that the observation reaches someone who does.
Workforce quality also depends on the conditions in which competent people are asked to work. If workload is excessive, there may be too little time for observation, safe transfers, communication, documentation or family engagement. High turnover can weaken continuity and team knowledge, while supervision that exists only on paper may provide little protection in practice.
A 2026 narrative scoping review of 76 studies in long-term-care homes in OECD countries found that staffing decisions were shaped by factors including increasing care complexity, regulatory and organizational pressures and financial constraints. These factors contributed to chronic understaffing, changes in skill mix and greater reliance on agency workers; consequences included work intensification, strained team dynamics, dissatisfaction and turnover, particularly where registered-nurse oversight was limited.
Earlier realist evidence also shows why staffing cannot be reduced to headcount alone. A 2021 review found that staff numbers were important but did not fully explain quality; workforce behavior, relationships, organizational context and the way staff with appropriate knowledge and skills were deployed also influenced the quality experienced by residents.
For Viet Nam, the implication is not that an international staffing formula should simply be imported. A single staffing ratio should not be assumed to fit every older-person-care setting. Staffing decisions need to consider care dependency, clinical complexity, skill mix, supervision requirements and the activities expected of different workers. A service supporting largely independent older people will have different requirements from one caring for people with advanced dementia, major mobility limitations or complex medical needs.
Family caregivers need capability and support, but they are not a substitute for the formal care system
Families will continue to play a central role in older-person care in Viet Nam. National policy recognizes this reality: Decision 383 includes training families in care and rehabilitation skills, while Decision 1976 provides for counseling, training and technical support for people caring for older relatives at home.
That support matters. A family member assisting with transfers needs to understand how to reduce injury risk. Someone helping with medications needs clear instructions about the current regimen. A caregiver supporting a person with cognitive impairment needs to know which changes can be monitored and which require professional assessment.
But family education should not become a mechanism for shifting unlimited responsibility from formal services onto households. Family caregivers are not automatically nurses, rehabilitation professionals or case managers. Their health, physical capacity, employment, knowledge, willingness and availability vary considerably. A good care system therefore treats them as important partners who need information and support, while maintaining clear professional responsibility for activities that require professional judgment or clinical care.
Measuring workforce quality should go beyond training certificates
The easiest workforce measures are counts: how many people attended training, how many completed a course and how many certificates were issued. These are useful measures of implementation coverage, but they do not show whether practice became more reliable or whether care became safer.
A stronger approach would examine whether people can demonstrate the competencies expected of their role, whether supervision is actually available, whether concerns are escalated appropriately, whether handovers contain essential information, whether incidents lead to learning, and whether refresher training responds to identified gaps. Depending on the setting, organizations may also monitor workforce stability, turnover, vacancies, reliance on temporary personnel, supervision frequency and selected care outcomes that may be sensitive to workforce performance.
The 2026 umbrella review of long-term-care workforce interventions illustrates why this distinction matters. Continuing professional development and peer-led training improved knowledge and competencies, but the wider evidence base remained uneven and most included reviews were judged to be of low methodological quality. Training completion should therefore be treated as a starting measure rather than the endpoint of workforce development.
A practical quality question for any organization is:
Can we demonstrate that the person providing this care is competent for the task, has access to appropriate support and knows what to do when the situation exceeds their role?
If the answer is unclear, the workforce governance system is incomplete.
Viet Nam can build the system progressively
Viet Nam does not need to create a new national profession for every function in older-person care before improvement can begin. The policy architecture that now exists provides several places to start.
Hospitals could define a core set of older-person-care competencies for clinical staff who regularly care for older adults, covering areas such as frailty, cognition, functional decline, medication safety, mobility, care transitions and communication with caregivers. These competencies could be incorporated into continuing professional development and local competency-assessment systems rather than relying solely on specialist geriatric teams.
The National Geriatric Hospital and geriatric departments could increasingly function as capability hubs for training, clinical consultation, technical transfer and support to lower-level services. Circular 34 already assigns the National Geriatric Hospital substantial responsibilities for training and technical development, while Decision 1976 establishes professional-support relationships between geriatric services and lower levels of care.
Commune health stations could translate national guidance into clearly defined local roles for screening, basic support, referral, caregiver education and community day-care activities, with access to professional advice when needs become more complex. Community day-care services could identify which activities require which level of competence and what findings must trigger referral or reassessment. Home-care and long-term-care providers could similarly build orientation, observed practice, competency verification, supervision, periodic reassessment and incident learning into routine workforce governance.
These are implementation approaches rather than current national requirements. Their value would lie in testing what is feasible in Viet Nam, what can be sustained by the existing workforce and which arrangements actually improve safety, continuity and the experience of older people.
A safe workforce is ultimately a system, not a list of job titles
Older people do not experience workforce structures as organizational charts. They experience whether someone listens, whether support is safe, whether changes are noticed, whether help is available when needed and whether the people involved appear to understand how their work fits together.
Viet Nam now has a considerably stronger foundation for building that system. The National Strategy for Older People addresses workforce capability and training. Decision 1116 expands professional training across hospital, primary-care and community roles. Decision 1976 establishes practical responsibilities for training, professional support, assignment and referral in home and community care. Circular 34 goes further by supporting clinical training, technical transfer and workforce development for geriatric and older-person health services.
The next challenge is to move from training people to governing capability.
That means asking not only whether enough people are available, but whether the right people are doing the right work; whether required competencies can be demonstrated; whether supervision and escalation are reliable; whether workload and skill mix allow safe care; and whether responsibility remains visible as an older person moves between settings.
For healthcare and long-term-care organizations, the most useful question is therefore not simply, “Have our staff been trained in older-person care?” It is:
“Can we be confident that the people delivering care are competent for their roles, supported when they need help, and connected to a system that recognizes deterioration, escalates risk and remains accountable across the care journey?”
When that question can be answered consistently, workforce development becomes more than education. It becomes part of the infrastructure for safe, high-quality older-person care.
References
World Health Organization. Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. 2nd ed. Geneva: World Health Organization; 2025.
World Health Organization. ICOPE Training Programme. Accessed 3 October 2026.
World Health Organization. WHO Global Standards for Quality Health Care Services for Older People — Technical Working Group Members. 23 August 2026.
World Health Organization. Call for public consultation on Global Standards for Long-Term Care. 18 May 2026. Public consultation open until 30 October 2026.
National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. 9 January 2023; effective 1 January 2024.
Ministry of Health of Viet Nam. Circular No. 32/2023/TT-BYT detailing selected provisions of the Law on Medical Examination and Treatment. 31 December 2023.
Prime Minister of Viet Nam. Decision No. 383/QĐ-TTg approving the National Strategy for Older People to 2035, with a vision to 2045. 21 February 2025.
Prime Minister of Viet Nam. Decision No. 1116/QĐ-TTg amending Decision No. 1579/QĐ-TTg approving the Older People Health Care Program to 2030. 22 June 2026.
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