This article excerpt examines the potential of online education as a strategy to adequately prepare an eldercare workforce.

We first address key challenges associated with preparing an eldercare workforce and then evaluate the relative advantages of online education to address challenges, and the evidence supporting this approach. We discuss our experiences with a massive online open course (MOOC) on dementia to illustrate the strengths, limitations, and potential of online education.

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Examines the potential strengths, weakness, and limitations regarding the use of online curricula to train eldercare workers. The authors draw on their own experience conducting a six-week online dementia-related training. They conclude that while online training has its drawbacks, it has enough positive applications to the healthcare field to make the concept worth pursuing. The article is part of the American Society on Aging Spring 2016 issue of Generations Vol. 40, No. 1

To evaluate the evidence for online approaches, we conducted an electronic search of published studies from 2004 to the present. We searched MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (Ovid SP), CINAHL, and Educational Resources Information Center (ERIC) (Pro-Quest), using a combination of keywords and MeSH terms capturing varied training forms (e.g., online) and trainees (e.g., professional and paraprofessional). A combination of terms was used for online training (e.g., Online Training OR Massive Open Online Course OR MOOC OR Websites OR Distance Learning OR E-learning) and eldercare (e.g., gerontology, geriatric). The search yielded thirty-nine published studies on online options and their effectiveness, and we summarize their key take-home points. We also identify and discuss articles reporting cost analyses and blended approaches.

What Is Online Learning—and Is It Effective?

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Online learning refers to varied approaches and formats ranging from text-only “electronic correspondence courses” to multimedia-rich offerings featuring a high degree of interactivity, access to external links, animations, and high quality simulations. This is an evolving field, so there are continuous innovations and improvements in options and educational platforms offering online training, as well as available types of technologies (Moore, Dickson-Deane, and Galyen, 2011). Innovations range from Massive Open Online Courses (MOOC) that use an open learning platform and a common structure for validating competency; to Open Badges that use digital badges as currency to demonstrate skills; to simulation applications offering trainees opportunities to demonstrate competencies using immersive products that mimic actual environments; to blended strategies combining online and face-to-face learning formats. (Online learning terminology definitions are summarized in Table 1.)

A review of the extant literature suggests online learning is equivalent to and possibly even more effective than traditional training approaches (Gallagher et al., 2005; Hobday, Savik, and Gaugler, 2010). Meta-analyses and systematic reviews comparing online to traditional face-to-face training find that online training, on average, produces stronger outcomes for learners than classes with only face-to-face instruction (Cook et al., 2011; Means et al., 2009). Findings also suggest “online learning is much more conducive to the expansion of learning time than face-to-face instruction” (Means et al., 2009; Irvine et al., 2012).

There is mounting evidence to suggest that online trainings, including blended learning models, result in significant savings compared to traditional face-to-face trainings. A comparison of costs associated with a blended E-learning approach compared to traditional didactic training costs of 100,000 community healthcare workers found savings of as much as 67 percent (Sissine et al., 2014). Web-based approaches require fewer enrollments for programs to reach a break-even point, and thus tend to be more cost-efficient (Maloney et al., 2012).

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Online learning offers many important advantages and overcomes some but not all challenges confronting the preparation of an eldercare workforce. This form of learning is evolving, and is estimated to be at least five years away from fully integrating new and advanced technologies and reaching its maximum impact (Johnson et al., 2014). New educational technologies, such as gaming and simulation approaches, have yet to be widely adapted and integrated into online platforms. Progress in learning analytics, adaptive learning platforms, and the combination of innovative asynchronous and synchronous tools will advance the state of online learning now and into the future. Additionally, strong signals from a small body of research suggest this is a potentially powerful mechanism for transferring knowledge and possibly enhancing skills. Further evaluations combining online and in-person training scenarios are warranted to determine for which segments of the workforce and types of competencies they will work best.

Taken as a whole, studies to date support moving forward with online approaches to prepare an eldercare workforce. The advantages and potential for cost-savings suggest that these promising approaches warrant our investment.

Relative Advantages of Online Learning

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The leveraging and integrating of sophisticated multimedia and technologies offered by online learning afford important learning advantages. Available technologies offer the potential to create and implement highly engaging and effective online environments to support a wide variety of learning goals. Foremost among the numerous benefits of online education are flexibility and ease of access. In asynchronous modalities in particular, learners are able to access information and participate in knowledge forums on their own time, to fit work and life schedules. Access requires a computer and continuous Internet connectivity, which can pose a challenge for individuals with limited income, or in remote settings in which access and connectivity are intermittent or inadequate.

In another distinct advantage, online learning eliminates a “one-size-fits-all” approach, which has been shown to be ineffective. There is something for everyone (Kenefick et al., 2014). While content and delivery can be standardized, these also can be customized to meet diverse learning needs and styles. Participants can progress at their own pace, have repeated exposures to lectures or exercises as needed, and actively shape their learning experience based on personal style and preferences. Consequently, adaptive learning is possible by identifying a learner’s style and need, personalizing content, and individualizing tracking, monitoring, support, and assessment (Braude et al., 2015; Cook et al., 2011).

Online learning addresses many but not all of the challenges to workforce preparation discussed above. Although it requires an initial investment in content development, once completed, it is not dependent upon availability of trainers or having a large number of educators, although expert involvement for ongoing monitoring and updating of materials is important. Thus, this type of learning overcomes the significant issue of educator shortages. Its reach is broad, without borders or geographic limitations; therefore it has the potential to provide self-paced learning approaches, to have widespread distribution, and to result in the preparation of large numbers of eldercare workers efficiently and within a short time frame.

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[T]he rapidly advancing field of simulation suggests that some skills can be imparted via online platforms. Existing simulation programs include a broad array of instructional strategies such as video animation, interactive gaming scenarios, multimedia instructional material, virtual patients, and online quizzes. Because simulation puts learners in quasirealistic situations, it is considered an authentic learning tool to prepare learners for real-life work (Cant and Cooper, 2014; Lahti, Hätönen, and Välimäki, 2014; Ellman et al., 2012).

But simulation training cannot replace real-life work-based experience, and there remains a need for in-person assessment of the learner’s application of content, particularly with hands-on care. Blended learning may address this. Practical skills application is essential to the eldercare workforce’s development and successful performance. An evaluative approach combining knowledge assessment and attitudes using E-learning technology with some in-person skills observation would allow a more in-depth understanding of the learner’s application of skills and behaviors (Stathakarou, Zary, and Kononowicz, 2014).

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[F]lexibility and ease of access to online learning may motivate some direct care workers to expand their knowledge base and skills repertoire.

The Massive Online Open Course

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The relative advantages and limitations of online training are exemplified in MOOCs (Goldberg et al., 2015; Liyanagunawardena, Adams, and Williams, 2013; Liyanagunawardena and Williams, 2014).

This MOOC illustrates the potential strengths of online training. Foremost is its reach to large numbers of individuals to create a powerful international dialogue and learning community. It demonstrates that online learning can quickly create communities of learners that are able to use the platform for joint problem-solving and resource-sharing. It also illustrates how this approach generates high levels of participation, as evidenced in the discussion boards, completed assignments, and the number of times video lectures were opened and watched (>175,000 in the first course and 173,000 in the second). Finally, testimonies (see Table 2, below) demonstrate that participants expressed gaining both substantive knowledge and skills

Table 2. Select Testimonies Demonstrating Knowledge and Skills Gained

Excerpted Testimony Knowledge Skills
“As a caregiver, I feel much more informed and prepared to provide the best care possible.” X X
“I learned an enormous amount and realize that there is much more to learn about dementia and Alzheimer’s Disease.” X X
“I am so glad I took this course. It will help me think more analytically about clients’ behaviors, which I often find confusing.” X
“You have no idea what a gift you have given all of us in the form of knowledge and empowerment. Thank you again, a million times.” X
“This course has helped me relate to some of the patients who are having memory problems.” X


“Competency-based learning allows students to work through an online course at their own pace, taking less time if they understand the material and more time if they are struggling. When students feel like they can demonstrate their knowledge or “competencies,” they take a test or complete a project to show their mastery.”


“An umbrella term for the use of computers in both instruction and management of the teaching and learning process. CAI (computer-assisted instruction) and CMI (computer-managed instruction) are included under the heading of CBT. Some people use the terms CBT and CAI interchangeably.”


“Distance Learning (DL) is an instructional delivery system that connects learners with educational resources. DL provides educational access to learners not enrolled in educational institutions and can augment the learning opportunities of current students. The implementation of DL is a process that uses available resources and will evolve to incorporate emerging technologies.”


“E-learning is learning that utilizes electronic technologies to access educational curriculum outside of a traditional classroom. In most cases, it refers to a course, program or degree delivered completely online.”


“A massive open online course (MOOC) is a model for delivering learning content online to any person who wants to take a course, with no limit on attendance. The updated ‘ELI 7 Things You Should Know About MOOCs II’ (June 2013) provides additional key facts about MOOCs.”


“Credit-granting courses or education training delivered primarily via the Internet to students at remote locations, including their homes. Online courses may be delivered synchronously or asynchronously. An online course may include a requirement that students and teachers meet once or periodically in a physical setting for lectures, labs, or exams, so long as the time spent in the physical setting does not exceed 25 percent of the total course time.”


“The type of online learning system you choose will depend on what you want your online program to ‘be.’ That, in turn, depends on a number of factors—what students should know and be able to do, technical considerations, and the skills of online instructors.”


Ironically, the number of U.S. educational programs focusing on gerontology has declined precipitously this past decade (Pelham, 2008; Pachana et al., 2010). Consequently, novel training initiatives to prepare an eldercare workforce have become a critical public health priority (Scanlon, McAndrew, and O’Shea, 2015).

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American Society on Aging Spring 2016 issue of Generations Vol. 40, No. 1.

By Laura N. Gitlin and Nancy Hodgson


About Elder Care Advice blog

Get professional elder care giving advice, advocacy, education and tips for those who care for and about the frail elderly at the ElderCareAdvice blog. We are generously sponsored by Most posts are written by Cathleen V. Carr, unless attributed otherwise. We welcome relevant submissions. Submit your article and by-line for publishing consideration (no promises!) to Havi at, our own editor who will ensure submissions are given the best possible treatment and polish before publication, ensuring a professional level of publication. There is a nominal service fee involved ($45). Allow up to 30 days for publishing.
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