Caregiving for Older and Disabled People Level 2

Who it is for. People who have finished Caregiving for Older and Disabled People (Level 1), or who already work as carers and can show the same skills. National Proficiency II covers varied work, mostly routine, under limited supervision.

Bridge from Level 1: what you already know

Level 1 did not cover working from a full care plan, risk assessment, medicine support records, continence products and catheter observation, slide sheets and transfer boards, wheelchair handling, stroke and diabetes warning signs, deeper dementia care, end-of-life comfort, financial abuse and boundaries, or pricing a care business. Level 2 covers all of these.

How the module works

Each unit has learning outcomes, performance criteria, the range and the evidence your assessor needs. You are judged Competent or Not Yet Competent. About 70% of the time is practical, following CTVET's Oil Palm programme split of about 30% school and 70% workplace.

Where the guidance comes from. Ghana-specific carer standards were not found. International guidance is used and labelled: WHO, the UK NHS, UK NICE guidelines, the UK HSE and St John Ambulance. Their clinical advice applies in Ghana; their laws and phone numbers do not. In Ghana, the emergency number is 112.

Honesty rule. Numbers marked example were invented to teach the method. Where a Ghana fact could not be found, the book says not verified. Every worked sum was checked by a computer script.

Competency standard

Range. Two sample care plans; one practice shift; a demonstration MAR chart with dummy tablets. Evidence. Annotated care plan; risk assessment form; observation notes; correctly completed MAR chart; oral questions.

What a care plan contains

A care plan is written by the nurse, the family and the person together (and by the agency, if there is one). Your job is to follow it and say when it is out of date.

Many older people live with more than one illness at once: a CDD-Ghana fellow, citing international research, wrote that on average 60% of people over 60 live with two or more chronic diseases. That is why the plan must be read in full, not just the task list.

Risk assessment in five steps

A risk assessment asks: what could go wrong, how likely is it, how bad would it be, and what will we do to reduce it?

1. Look for hazards: the floor, the bed, the bathroom, the gate, the stove, the person's own condition (dizziness, confusion, weak side).
2. Decide who could be harmed and how (the person, you, visitors).
3. Decide what to do: remove the hazard, change the routine, use equipment, add supervision.
4. Write it down on the form and agree it with the family and nurse.
5. Review it after any fall, illness or change, and at the review date.

Observing and reporting

Notice and write down what you see, hear and smell, compared with what is normal for this person.

Report it the right way (SBAR). Use four short parts when you phone the nurse or family:

• Situation: "This is Ama, the carer for Nana Esi. She is more confused than usual today."
• Background: "She has dementia and high blood pressure. Yesterday she was talking normally."
• Assessment (what you see, not a diagnosis): "She does not know where she is, she drank only 600 ml yesterday, and her urine is dark."
• Request: "Can you come to see her today, or what should I do?"

Use the red/amber/green table from Level 1. New confusion, not drinking and dark urine are amber or red.

Medicine support: what carers may and may not do

Ghana guidance on carers and medicines was not found. This unit uses UK guidance, NICE NG67 (managing medicines for adults receiving social care in the community), and keeps inside the hard gate.

NICE NG67 says, in summary:

• A care provider should not take responsibility for a person's medicines unless an assessment shows it is needed and it is agreed.
• Care workers should only give the medicines support that is agreed and written in the care plan.
• A care worker should only give a medicine when there is authorisation and clear instructions (for example on the dispensing label) and the "six rights" are met: right person, right medicine, right route, right dose, right time, and the person's right to decline.
• Before helping, ask the person if they have already taken the dose and check the records, so it is not given twice.
• Record the support given for each medicine, every time, on a medicines administration record (MAR).
• Medicines must not be hidden in food or drink (covert administration) unless there is clear, lawful authorisation and instructions in the care plan.
• Get advice about medicines from the prescriber, a pharmacist or another health professional when needed.

In this course, the carer's medicine role is:

The MAR chart

Codes: ✓ = taken (initials); R = refused; S = asleep; H = in hospital; N = not available (ran out). Every R or N is reported to the family or nurse the same day.

Check yourself

1. Name the six rights of medicine support in NICE NG67.
2. What does the "A" in SBAR stand for, and why must it not be a diagnosis?
3. A person refuses their evening tablets. What do you do?

Competency standard

Range. Practice on a partner or manikin; demonstration catheter bag with coloured water. Evidence. Observed pad change on a manikin; skin check record; spill clean-up demonstration; oral questions.

Continence care

Changing a pad (on a manikin first):

1. Gather a clean pad, wipes or warm water and soap, a towel, a bag for waste, gloves and apron. Clean hands.
2. Explain; privacy; bed at a safe height.
3. Turn the person onto their side (Level 1 method, two carers if needed).
4. Roll the used pad inwards, away from you; put it in the bag.
5. Wash front to back, rinse and pat dry, especially in skin folds.
6. Look at the skin on the bottom, tailbone and hips.
7. Fold the clean pad lengthways, place it with the centre at the right place, roll the person back and fasten it snugly but not tight.
8. Remove gloves, clean hands, record the change and what the urine and stool looked like.

Living with a urinary catheter: what the carer does

A catheter is put in, changed and removed only by a nurse or doctor. The carer only observes and keeps the bag in the right place (teaching guidance within the hard gate):

Skin protection in depth

UK NICE guidance (international) for adults says:

• Everyone is potentially at risk of pressure ulcers; risk is assessed by a trained professional, who may use a validated scale such as the Braden, Waterlow or Norton scale.
• Adults at risk should change position at least every 6 hours; adults at high risk at least every 4 hours; help those who cannot move themselves, using equipment if needed, and record how often.
• Use a high-specification foam mattress for adults at high risk in community care; consider a pressure-redistributing cushion for wheelchair users or people who sit for long periods.
• Agree a plan to take pressure off the heels for people at high risk of heel ulcers.
• Consider a barrier preparation to protect skin for people at high risk of moisture damage (for example from incontinence). The nurse decides which product; the carer applies it only as the plan says.
• Do not massage or rub the skin to prevent pressure ulcers.
• When early damage is found (skin that does not go pale when pressed), start prevention and recheck the skin at least every 2 hours until it resolves.
• On darker skin, early damage may show as a colour change or discolouration.

Daily skin check (on dark skin): look in good daylight or with a torch; compare left and right; look for a patch that is darker, purple, blue or shiny; feel for warmth, coolness, hardness or a spongy patch; ask about pain or itching.

Seating. A person sitting all day in a chair is also at risk. Use a pressure-redistributing cushion if advised; encourage small weight shifts; follow the plan for how long they sit.

Infection prevention in depth

Body fluid spills (urine, vomit, stool, blood):

1. Keep others away. Gloves and apron on.
2. Soak up with paper towels or old cloth; put in a bag.
3. Clean the area with detergent and water.
4. Disinfect with a disinfectant made up exactly as the label says.
5. Dry; remove gloves and apron; clean hands.

Signs of a serious infection (sepsis): an emergency. The NHS (UK) lists symptoms in adults including: confusion or slurred speech; uncontrollable shivering; muscle pain; difficulty breathing; blue, pale, grey or blotchy skin, lips or tongue; a high or low temperature (a high temperature is less common in older adults); and passing very little or no urine. Call 112 if you see fast breathing, confusion, blotchy skin, a rash that does not fade when pressed, or any symptom you are worried could be sepsis.

Check yourself

1. Where must a catheter bag be kept, and why?
2. What does NICE say about massaging skin to prevent pressure sores?
3. Name three signs of sepsis in an older adult.

Competency standard

Range. Training bed, slide sheets, transfer board, wheelchair, commode; two-carer moves. Evidence. Observed equipment moves; wheelchair route; fall scenario; handling plan.

Before every move

Get training from a health professional before using handling equipment, and ask an occupational therapist or physiotherapist for advice before buying it.

Moving a person up the bed with slide sheets (two carers)

1. Explain. Lower the bed head flat if the person can tolerate it.
2. Roll the person to one side (Level 1 method). Place the rolled-up slide sheets (two layers, or a tube sheet) under them, from shoulders to hips.
3. Roll them back and unroll the sheets.
4. Each carer stands at one side, feet apart, facing the head of the bed, one foot forward.
5. Each holds the top layer of the sheet near the shoulders and hips. Knees slightly bent.
6. On "ready, steady, slide", shift your weight from the back foot to the front foot. The sheet slides; nobody lifts.
7. Repeat small slides if needed.
8. Roll the person to remove the sheets (never leave a slide sheet under a person; they can slide down).
9. Position with pillows; check the skin; record.

Bed to chair with a transfer board (person can sit and use arms)

1. Wheelchair or commode next to the bed, arm removed on the bed side, brakes on, footplates swung away.
2. Bed and chair seat at about the same height.
3. The person sits at the edge of the bed. Place one end of the board under the thigh nearest the chair, the other end on the chair seat.
4. The person leans slightly away and pushes with their hands to slide across in small moves; you guide at the hips and keep the board steady.
5. When seated, remove the board, replace the arm and footplates, feet on the footplates.

Wheelchair handling

Wheelchairs on Jiji Ghana in October 2026 ranged from about GH¢2,450–2,500 for long-back manual or commode wheelchairs to GH¢8,500–24,500 for electric models.

Hoists: awareness only

A mobile hoist lifts a person who cannot bear weight, with a sling. One was listed at about GH¢12,300 on Jiji Ghana. Hoisting needs two trained carers, a sling of the right size and type for that person, and training from a physiotherapist or supplier. This course does not certify you to hoist.

After a fall: deciding whether to help up

WHO lists poor balance, poor mobility, poor vision, medication side effects and unsafe surroundings among the risks for falls. After any fall:

1. Do not rush. Reassure. Check for danger.
2. Check: breathing, bleeding, pain (especially hip, back, head, neck), a bent or short leg, new confusion, whether they hit their head.
3. If any of these, or you are unsure: do not move them; keep them warm and comfortable with a pillow and cloth; call 112 and the nurse; stay with them.
4. If uninjured and able: let them rest; then guide them to roll onto their side, onto hands and knees, and up using two firm chairs, one to hold and one to sit on. You guide and reassure. You do not lift.
5. Record the fall, the time, what you found, what you did and who you told. Review the risk assessment.

Check yourself

1. Why must slide sheets be removed after the move?
2. How do you take a wheelchair down a kerb?
3. A person has fallen and has a short, turned-out leg. What do you do?

Competency standard

Range. Case studies and role-plays; a visit or talk from a person with a disability if possible. Evidence. Distress record; role-play observation; oral questions.

Dementia in more depth

Later dementia brings more need for personal care, difficulty recognising family, trouble walking, incontinence, trouble eating and drinking, and sometimes distressing behaviour such as aggression. Behaviour is often a way of telling you something.

The distress record (ABC):

Look for patterns: time of day, noise, hunger, pain, a full bladder, constipation, being rushed. Change the cause, not the person.

Practical tips:

WHO's iSupport manual for family and friends caring for someone with dementia has modules on understanding dementia, being a carer, caring for yourself, everyday care and dealing with behaviour changes; it can be downloaded and printed.

After a stroke

Stroke can leave weakness or numbness on one side, speech problems, vision problems and confusion.

Diabetes: watch for low blood sugar

Low blood sugar usually affects people with diabetes who take insulin or some other diabetes medicines. Signs include feeling hungry, dizzy, anxious or irritable, sweating and shaking, tingling lips, a racing heartbeat, tiredness, blurred vision and confusion; severe low blood sugar can cause a fit or unconsciousness.

What the carer does:

1. Follow the person's written diabetes plan from the nurse or doctor (it should say what to do).
2. If they are awake and can swallow safely, and the plan says so, give the sugary drink or snack written in the plan.
3. Never give food or drink to someone who is unconscious. Put them in the recovery position and call 112.
4. Record it and tell the nurse the same day.
5. Do not give or adjust insulin or tablets. That is outside the hard gate.

Supporting persons with disabilities

Ghana's 2021 census counted about 8% of people with some disability, according to a summary of GSS data. Persons with Disability Act 715 forbids abusive or degrading treatment of a person with disability, and requires people who provide public services to make them accessible.

Nothing about us without us. Ask the person first, not the family, how they want to be helped.

Check yourself

1. What does ABC stand for in a distress record?
2. Why must you never give food or drink to an unconscious person?
3. Which side do you dress first after a stroke?

Competency standard

Range. A weight chart; a texture plan; role-play of end-of-life care. Evidence. Weight calculation; observed mouth care on a manikin; oral questions.

Watching weight and intake

Weigh at the same time of day, in similar clothes, on the same scale, as often as the plan says. Report weight loss and poor eating. Over time, swallowing problems can cause weight loss and repeated chest infections.

Safe swallowing in more depth

Signs of dysphagia include coughing or choking when eating or drinking and food coming back up, sometimes through the nose. A GP may refer a person to a speech and language therapist or dietitian for advice on swallowing and diet.

End-of-life (palliative) care

WHO says palliative care improves the quality of life of patients and families facing life-threatening illness, by early identification and treatment of pain and other physical, psychosocial and spiritual problems. WHO estimates 56.8 million people need palliative care each year, but only about 14% of those who need it receive it. Sustainable palliative care depends on community and home-based care and on supporting family and community caregivers.

The nurse and doctor manage pain and medicines. The carer gives comfort:

Respect faith and culture. Ask the family early what matters: prayers, a pastor, imam or priest, who should be present, rituals for washing and dressing. Follow their wishes.

When a person dies

1. Note the time. Stay calm.
2. If the death was expected and the family and nurse have a plan, call the nurse or doctor and the family as agreed. If it was unexpected, or you are unsure whether the person has died, call 112 at once.
3. Do not move or wash the body until the nurse, doctor or family says so (a doctor must certify the death; the carer never does).
4. Close the eyes and mouth gently if the family wishes; straighten the limbs; cover with a clean cloth to the shoulders.
5. Support the family; give them privacy and time.
6. Write a record: time, who was present, who you called and when.
7. Look after yourself: grief is normal for carers too. Talk to someone (Unit 6).

Check yourself

1. What percentage of people who need palliative care receive it, according to WHO?
2. Name three comfort-care tasks a carer can do at the end of life.
3. A person you care for is found not breathing and it was not expected. What do you do?

Competency standard

Range. Case studies; a disclosure role-play; a boundary quiz. Evidence. Factual report; boundary answers; personal resilience plan.

Abuse in more depth

WHO estimates that about 1 in 6 people aged 60 and over experienced some form of abuse in community settings in the past year. In care homes and long-term care, 64.2% of staff (about 2 in 3) reported committing some form of abuse in the past year. Risk factors in the victim include dependence or disability, poor physical or mental health, memory problems and low income; in the abuser, mental illness, substance abuse and financial dependence on the victim. The most promising prevention includes caregiver support, money management programmes, helplines and multidisciplinary teams.

Financial abuse signs: pension or remittances not reaching the person; bank or MoMo PIN known by others; land or house papers missing; sudden new "friends" or relatives; pressure to sign documents; no money for food or medicines although money comes in.

Neglect signs (including by paid carers): left wet or dirty; not given drinks; no help to eat; missed visits; medicines not given; sores; locked in.

Responding to a disclosure

1. Listen calmly. Let them talk. Do not ask leading questions ("Did your son hit you?").
2. Reassure: "Thank you for telling me. You did the right thing."
3. Do not promise secrecy. Say you must tell someone who can help.
4. Act: if in danger now, call 112.
5. Report to your supervisor or the agency owner the same day; if they are involved, to the nurse, the family member in charge or the police.
6. Record facts in their words, with date and time, and sign.

Ghana's Ministry of Gender, Children and Social Protection says it will strengthen protection of older persons against neglect, abuse and exploitation, including through the Orange Support Centre. The contact route for carers to report to the Orange Support Centre or the Department of Social Welfare was not verified: ask your Assembly's social welfare office and write their number in your logbook.

Professional boundaries

Confidentiality and records

Keep records in the client's home folder or the agency's locked file. Share only with people who need to know for the person's care (the family member in charge, the nurse, the doctor). Do not discuss clients in public, on social media or in open WhatsApp groups. Any agency that processes personal data must register with Ghana's Data Protection Commission (see Level 3).

Carer resilience

WHO says carers of people with dementia need support from family, friends and professionals, regular breaks, and attention to their own health and stress. Women provide about 70% of dementia care hours.

Your weekly stress check (score 0 = never, 1 = sometimes, 2 = often): I feel exhausted; I sleep badly; I snap at people; I dread going to work; I have body aches; I feel alone; I cry easily. A total of 7 or more (example cut-off for this course, not a medical scale): talk to someone this week.

Support plan: a buddy carer you can call after a hard shift; a regular day off agreed in writing; a short debrief after a death or incident; a health check; a faith or community group; WHO's iSupport module on caring for yourself.

Check yourself

1. What share of staff in care homes reported committing some form of abuse, according to WHO?
2. Why must you never promise to keep a disclosure secret?
3. A client offers you GH¢200 as a "thank you". What do you do?

Competency standard

Range. The trainee's own business idea. Evidence. Price sheet; contract; marketing plan; accessibility note.

Business models

Location settings that give good returns

Pricing

Ghana carer pay data is thin: a salary survey showed about GH¢1,288 to GH¢4,045 a month gross for the middle 80% of carers, from a small sample of fewer than 20 verified responses. The 2026 national daily minimum wage is GH¢21.77.

Domestic-worker rules and your contract

If a family employs you directly in their home, the Labour (Domestic Workers) Regulations, 2020 (L.I. 2408) may apply. A summary of the regulations says: domestic work must be under a written contract, which the employer deposits with the District Labour Officer within one month of signing; pay must not be below the national daily minimum wage; overtime outside agreed hours is paid; workers get at least 8 consecutive hours of daily rest, at least 30 minutes' rest during continuous work, and at least 24 hours' rest each week; and the employer pays social security contributions. The summary does not say whether carers of older or sick people are covered: not verified. Ask the District Labour Office.

Your written contract should include: names; the client and their main needs; start date; days and hours; rest breaks and days off; pay, how and when; overtime; who supplies materials; tasks included and tasks excluded (the hard gate); emergency contacts; confidentiality; notice to end the contract; signatures and date.

Market yourself

• WhatsApp Business: a business profile with your name, area, services, hours and a short "about me"; a catalogue of services with prices; quick replies for enquiries. Never post clients' photos or details.
• Google Business Profile: free listing so families searching "carer Takoradi" can find you; ask satisfied families for honest reviews.
• Referrals: hospital social workers and ward nurses, pharmacies, churches and mosques, doctors in private clinics, funeral and welfare committees.
• Proof of quality: your Level 1 and Level 2 records, a first aid certificate, two references, and a clean police record if you can get one (process not verified).
• Be honest: "trained carer", never "nurse".

Accessibility

Persons with disabilities can run and work in caregiving businesses. Ghana's Disability Act requires employers to provide the tools and facilities a disabled worker needs and forbids discrimination unless the disability is relevant to the job. The Assemblies' disability fund rose to 5% in 2026 and now favours skills training, assistive devices and start-up capital.

• Good roles: companionship and reading; reminder and check-in calls; meal planning and seated preparation; record keeping and rotas; sign-language support for deaf clients; training families; running the business side.
• Adjustments: seated workstations; a vibrating or flashing phone alert; large-print or audio care plans; pairing so that heavy moves are shared; accessible transport between clients.
• For clients: ramps, rails, a raised toilet seat, good lighting, clear paths; talk to the client about what works for them.

Check yourself

1. Name two things the L.I. 2408 summary says about rest for domestic workers.
2. Why is "trained carer, not nurse" important in your marketing?
3. Name two adjustments that help a carer who is deaf.

1. Name four sections of a care plan.
2. What are the five steps of a risk assessment?
3. Name the six rights of medicine support (NICE NG67).
4. Name three things a carer must never do with medicines.
5. Name two things to report at once about a catheter.
6. What does NICE say about repositioning adults at high risk of pressure ulcers?
7. How do you move a person up the bed without lifting them?
8. Name three signs of low blood sugar.
9. A person lost 3.1 kg from 62 kg. What percentage is that?
10. Name four comfort-care tasks at the end of life.
11. Name three signs of financial abuse.
12. Name four things your care contract should include.

Best next reads: WHO iSupport for dementia carers; NICE NG67 on medicines support in social care (UK); the WHO palliative care fact sheet; a certified first aid and CPR course; the Hub's Money Skills Level 2; Caregiving for Older and Disabled People Level 3.

What this module does not cover: nursing tasks; hoisting certification; running a home-care agency, registration, staff and accounts (Level 3).

Every source used in this manual is listed, with links, in the Teacher Copy.