Home care providers and care homes across the UK face a critical paradox: international staff with 'sufficient' language skills according to immigration requirements still struggle with essential care-specific communication. Our research definitively shows that standard language tests like IELTS fail to predict real-world care communication ability.
The issue stems from how we assess language ability. Tests like IELTS and CEFR levels were designed to provide standardised measures of general language proficiency - not the specialised communication competence needed in care settings. Yet they've become gatekeepers to care roles, with the flawed assumption that passing these tests indicates readiness for effective communication in care environments.
The Reality Gap: Evidence from UK Care Workers
We tested 40 international care workers who entered the UK on care visas and surveyed 63 others, all of whom had passed IELTS/CEFR B1 requirements. Our findings reveal significant workplace challenges:
- 90% failed to communicate effectively across key care areas, specifically: building rapport with service users, understanding service user needs, handing over to colleagues, or asking for emergency help.
- 95% demonstrate limited or ineffective vocabulary range for clear communication in care scenarios
- 70% exhibit grammatical weaknesses that are noticeable or potentially impede effective communication
Challenges Reported by Care Workers
These statistics come to life in the experiences reported by care workers themselves, revealing exactly how standardised language tests fail to prepare them:
Care-specific terminology gaps: Care workers struggle with specialised vocabulary that IELTS doesn't assess. Sophia* finds it difficult "to use the technically correct words" despite passing required language tests. Rafael* noted that improper use of terms like "refused" in documentation can have significant implications for care continuity.
"I passed my IELTS, but then when I came to the job, I found it difficult to use the technically correct words for care reporting." (Sophia*)
Regional accent and pace barriers: Standard language tests present controlled, clear speech - nothing like real-world care environments. Aisha* highlighted challenges with "accent and how quickly people talk" and specifically struggled with colloquialisms like "y'alrite." Miguel* reported "initial difficulty with service user accents," while Sonia described "ongoing difficulty with fast English" that general language preparation didn't address.
"The biggest challenge was the accent and how quickly people talk. I didn't understand when they said 'y'alrite' to me at first." (Aisha*)
"I had initial difficulty with service user accents. The controlled speaking in IELTS doesn't prepare you for this." (Miguel*)
High-stakes communication errors: Unlike academic writing tested in IELTS, care documentation has immediate consequences. Elena* experienced a "report error due to misinterpretation" that was "embarrassing for her, inaccurate" and potentially impacted care quality. She "smiles and nods when not 100% sure" - a dangerous practice in care settings. Aisha reported "can't [sic] understanding instructions" about care routines, while David noted "spelling mistakes for the care notes" among colleagues who had passed language requirements.
"I made a report error due to misinterpretation. It was embarrassing for me, inaccurate, and could have affected care quality." (Elena*)
"I smile and nod when not 100% sure, but this is dangerous in care settings." (Elena*)
These communication gaps create significant emotional toll and career barriers that IELTS simply doesn't address. Many surveyed care workers reported feeling "sad," "dumb" and "anxious."
But why does this gap exist in the care sector? Academic research helps explain the fundamental problems with our current approach to language assessment for care workers.
The Fundamental Flaws with General Language Assessments
Research reveals critical shortcomings in using tests like IELTS to predict care worker success:
1. They test the wrong care skills
IELTS and other CEFR-based tests measure general and academic language but not care-specific communication. Reading tests use general interest articles, not care plans or medication instructions. Writing tests ask for opinion essays, not care documentation. Speaking tests involve discussing everyday topics, not explaining care procedures or responding to service user needs.
2. They separate language from care knowledge
Elder & McNamara (2016) found that general tests treat professional knowledge as irrelevant, when in reality, language and care knowledge are inseparable in care settings. A care worker doesn't just need English – they need care-specific English.
3. The standards are inadequate for care work
The standard B1 level (CEFR) required for many care work visas only demonstrates "the ability to understand main points on familiar matters." O'Neill et al. (2007) point out this is clearly insufficient for handling unpredictable care situations where service users' wellbeing depends on clear communication.
The Solution: Test Real Care Language Skills
It's intuitive: if you test the skills care workers will actually use in their job, you'll get a better prediction of their real performance. Research consistently confirms this common-sense approach:
When language tests mirror real care situations, like explaining procedures to service users or discussing medication changes with colleagues, they better predict workplace communication success (Pill, 2016; Wette, 2011).
Yet despite this clear need, 82.5% of surveyed care workers received no specific language support from their employers, leaving them to navigate complex care communication challenges on their own.
While this issue is particularly acute in care settings, the principle applies across various specialised professions where context-specific communication is essential.
Conclusion
International workers are vital to the UK’s care sector, but with out-dated language assessment and a lack of training, we are setting them up for failure. This research has outlined the strenuous real world language requirements placed on our care workers, and the failure of language assessments to prepare workers for these.
Instead, we should set them up for success with context-specific language assessment. By testing what truly matters, communication effectiveness in specific care contexts, we can better ensure both opportunity for qualified workers and quality care for service users.
References
- Douglas, D. (2000). Assessing Languages for Specific Purposes. Cambridge University Press.
- Elder, C., & McNamara, T. (2016). The hunt for "indigenous criteria" in assessing communication in the physiotherapy workplace. Language Testing, 33(2), 153-174.
- O'Neill, T. R., Buckendahl, C. W., Plake, B. S., & Taylor, L. (2007). Recommending a nursing-specific passing standard for the IELTS examination. Language Assessment Quarterly, 4(4), 295-317.
- Pill, J. (2016). Drawing on indigenous criteria for more authentic assessment in a specific-purpose language test: Health professionals interacting with patients. Language Testing, 33(2), 175-193.
- Wette, R. (2011). English proficiency tests and communication skills training for overseas-qualified health professionals in Australia and New Zealand. Language Assessment Quarterly, 8(2), 200-210.
- Wiggins, G. P. (1998). Educative assessment: Designing assessments to inform and improve student performance. San Francisco: Jossey-Bass Publishers.
Methodology
- We ran care-specific conversational assessments with 40 UK-based international care workers who met IELTS/CEFR B1
- Effectiveness was evaluated on a 5 point scale, both for linguistic areas (e.g. grammatical accuracy) and key communication areas (e.g. building rapport with service users)
- We surveyed 34 international care workers & interviewed a further 12 international workers, seeking to understand their perspective and experiences with the language barrier.
- This was compared with a wider language learning survey, completed by 726 people, both lingly users & non-lingly users, predominantly outside of the care sector.
* Please note care worker names have been changed for privacy reasons