Dementia training improves care delivery: speakers

Research shows that when staff members are trained how to care for residents who have Alzheimer's disease and related dementias, they find more satisfaction in their work, they are less likely to leave their positions and they deliver improved care, Randi Chapman, director of state affairs for the Alzheimer's Association, told those attending a session at the Assisted Living Federation of America annual conference.

"Alzheimer's disease brings with it a very challenging set of issues–behavioral issues, communication issues, safety issues, you name it. And they're really unique to those with Alzheimer's disease and related dementias," she said at the "Dementia Care: What Should It Look Like" session. "So if people with this disease are going to be in your facility, then you've got to have staff that know how to deal with it."

And most likely, your facility houses people with dementia, Chapman said, citing research that one-half to three-fourths of long-term care residents have some kind of dementia.

The Alzheimer's Association used to but no longer recommends a specific number of hours for dementia training, preferring instead to measure competency in what was taught, Chapman said. Many states maintain hour requirements for such training, however, she added.

Ideally, Chapman said, training should cover:

• Dementia basics,
• Communication,
• Understanding behaviors,
• Food and hydration,
• Understanding pain,
• Social connections,
• Understanding wandering,
• Falls prevention,
• Restraint-free care and
• End-of-life care.

Patty Barnett Mouton, vice president of outreach and advocacy for the association's Orange County Chapter in California, advised facilities to use and advocate for policies supporting evidence-based curricula and passionate instructors who have experience caring for residents with dementia. "Instructors…have to really empower and impassion your workers that what they're doing is doing to make a difference in whether or not somebody lives or dies," she said.

Instructors should view themselves as facilitators who respect that audience members already possess some knowledge, learn in differing ways and will learn from others going through training session(s) with them, Mouton added. Training should begin as soon as possible after someone is hired, should be supervised by management, should be targeted to the trainees and should include continuing education, Mouton added. Regardless of state requirements, she said, "Train people so they know what to do" and who to call.

Mouton also recommended training family members of those with dementia so they understand and appreciate the approaches taken by trained staff members and can become part of the care process.

State initiatives

"It is amazing the difference in states when you look at what's required in different settings and then what's required for different professional classifications and then all the different names for all of the different residential settings," Chapman said. "It's just mind-boggling."

Alabama and Mississippi, not usually known for being leaders in the provision of long-term care, she said–confessing that she is from the South, are among the states already requiring dementia training for those working with this population. In Alabama, regulations apply to all specialty care assisted living facilities (ALFs). The state approved one training program in 1993 (and approves others as well) and requires all staff members to have at least six hours of continuing education related to dementia. All staff members whose work requires contact with residents must undergo initial training before such contact can occur, as well as subsequent refresher training. Key concepts are covered for other staff members for at least one hour.

In Mississippi, regulations apply to nursing homes and licensed personal care homes that have separate units for those with dementia. All staff members in direct contact with residents must undergo quarterly in-service training related to dementia. Pre-admission assessments include cognitive assessments.

And in Connecticut and Minnesota, bills related to dementia training await the respective governors' signatures after being passed by the state legislative branches, Chapman said. The Connecticut legislation, which applies to several settings, including ALFs, would require dementia training of all direct care staff members upon employment and then annually. Direct care workers would undergo eight hours of training within six months after employment, including two hours of pain recognition and management training. Unlicensed staff not providing direct care would undergo one hour of training. The Connecticut legislation also covers facilities that house residents who have Down's syndrome and are at least 50 years old, Chapman said, noting that such residents are likely to develop dementia.

In Minnesota, regulations would apply to special care units in a variety of settings. Supervisors of direct care workers would be required to have eight hours of training within their first 120 hours of work and then two hours of continuing education every year thereafter. Direct care workers would be required to undergo eight hours of training within the first 160 hours of their employment–and could not provide unsupervised care until trained–and then two hours annually thereafter. Non-direct care staff members would need to undergo four hours of training within their first 160 hours of work, with two hours of training thereafter.

In California, Chapman said, 17 bills related to residential care facilities for the elderly (RCFEs) are under consideration following last year's airing of an unflattering documentary on "Frontline." The Alzheimer's Association supports one of them, Assembly Bill 1570, although Mouton said it has little chance of passing.

"Our laws, our regulations and certainly the way our licensing responds to the needs of this vulnerable population have not kept pace," she added.

The association supports the bill because it would address dementia in all RCFEs, doubling the number of hours of training required of direct care staff, providing increased flexibility for instruction and strengthening training and testing of administrators, Mouton said. The bill is consistent with the state's Plan for Alzheimer's Disease and is sponsored by the California Assisted Living Association and co-sponsored by LeadingAge California as well as the California Council of the Alzheimer's Association, she added.