Relational Agency and Ethical Professionalism Among Long-Term Care Workers: Evidence from Taiwan

Background: With the rapid aging of populations worldwide, strengthening the professional capacity of long-term care (LTC) workers has become a critical priority for health systems. While competency-based training frameworks are widely implemented, it remains unclear which domains of competency are most closely associated with ethical professionalism in daily care practice. Methods: A cross-sectional survey was conducted with 268 LTC workers across home-based, community-based, and institutional settings in Taiwan. Multiple linear regression analyses were performed to examine the associations between core competency domains and perceived ethical professionalism. Results: Participants reported relatively high levels of overall competency and ethical professionalism. Among the competency domains, interpersonal communication (β = .345, p < .001), psychological support (β = .184, p = .020), and teamwork (β = .111, p = .045) were significantly associated with ethical professionalism. In contrast, technical competencies, including physical care, daily living care, and emergency management, were not significantly associated (p > .05). Conclusion: The findings suggest that ethical professionalism in LTC practice is more strongly associated with relational and psychosocial competencies than with technical skills. These results highlight the importance of incorporating communication, emotional support, and teamwork training into workforce development programs. Strengthening these competencies may enhance care quality, workforce sustainability, and person-centered care delivery in aging societies.