Trained staff enhance the resident experience

Culture change in long-term care has been a slow progression. Many, however, believe that serenity and harmony can be achieved with optimum staff training methods.

Chief among the current trends is online learning. No other method comes close in time efficiency and training consistency, although some say that nothing takes the place of good old-fashioned face-time. It just has to be handled in a way that’s in the best interest of the staff member being trained and the resident being cared for.

Iowa’s Briggs Healthcare, a supplier to the long-term care (LTC) industry, recently partnered with Relias Academy to provide a Learning Management System (LMS) for LTC staff. Mary Madison, RN, RAC-CT, CDP, a clinical consultant for Briggs, says: “Relias has a plethora of individual learning modules for therapists, direct caregivers, licensed nurses and administrators. They offer ethics classes as well as the skills needed to care for someone.”

Benefits of online training

A direct benefit of web-based training, Madison says, is convenience. “Direct care workers can step away from their day-to-day duties for short periods of time to learn about specific topics, while administrators and licensed nurses can set aside time after hours for their training.”

A second benefit to web-based training, Madison adds, is financial. “Classes used to be done on a face-to-face basis. You’d hire someone to present to the staff. There were travel expenses and teaching expenses, plus you’d have to pay your staff, too, so you could bring them in to train them.”

Udi Polonsky, CEO of LINTECH of Rochelle Park, NJ, takes a somewhat different approach by training the trainers. “We believe in personal interaction with the facility’s trainers, so we are onsite at least at the beginning. Once we have established at least some ‘face time’ with the staff to be trained, we can then provide more productive remote training.” 

Inherent in the LMS structure is the ability to track processes. According to Rachel Weeks, senior director of marketing for HealthcareSource, “Our LMS automates the process to ensure the right courses are delivered to the right people at the right time and enables organizations to track and report on education that is planned or delivered. When CMS or the Joint Commission comes knocking at the door, facilities that are able to demonstrate compliance by generating completed training transcripts have a much easier time providing information.”

The value of direct contact

Genevieve Gipson, RN, Med, RNC, is the founder of the National Network of Career Nursing Assistants and the Career Nurse Assistants Programs, Inc. (collectively referred to as The CNA Network). She established the Ohio-based organization in 1977, before the world became dependent on computers. Although Gipson is not against online education, she believes nothing will replace face-to-face training. “You also have to have workshops, formal in-services, skills training on different levels. The CNA needs to observe first, then imitate, then practice, then apply, then start adapting the training to the individual resident’s preferences, abilities and needs.”

Gipson also believes that for some of their training, CNAs need to go offsite, even if it’s local, “so they can see that they are a part of something much larger than what they see on a day-to-day basis.”

One trend Gipson would like to see take hold is “short shot training”—specifically scheduled, compact training, concentrated in five-minute segments. Short shot training is done standing up. The brevity allows for small bursts of education to be absorbed and applied immediately.

Peer coaching is another trend that’s high on her list. “We offer a whole piece (of curriculum) that has a subsection about mentoring, and that needs to be formal. There needs to be a curriculum. It’s not just, ‘Go with Mary. She’ll tell you how to do it.’ That’s not mentoring. Mentors need to have a specific assignment for working with the new CNA. They need to have a supervisor and be knowledgeable about anticipated outcomes. They need to know what skills to teach the new CNA and how to measure success,” Gipson says.

The Green House approach

Universal workers trained under one model of senior living have an expanded skill set and increased job satisfaction, according to Beth Baker—author of Old Age in a New Age: The Promise of Transformative Nursing Homes and With a Little Help from Our Friends: Creating Community as We Grow Older. She describes the Green House approach, the creation of William Thomas, MD, of the Eden Alternative. “It re-imagines everything (in an LTC facility) from what the space looks like to what a person’s day is like, to the role of what we have thought of as CNAs, but what Dr. Thomas calls shahbazim, which means royal falcon in Persian, she says. The idea is that shahbazim are given additional training, so they are there, not to do particular tasks, but to really make each elder’s day as pleasant and meaningful as possible. It’s a really profound shift in how these direct-care workers think about their roles and their jobs and their relationships with elders. The people I interviewed had much more self-respect and job satisfaction than many of the CNAs I’ve interviewed in traditional nursing homes.”

Shahbazim are given a lot of authority,” Baker continues. “They run the households on behalf of the elders. They act as housekeepers, cooks, direct caregivers and also as defenders of the people who live in the house.” This system works particularly well for communities with residents who have dementia, she says. “In the Green House, you ring the doorbell. You don’t just walk in. They try to reserve the space as a true home. And the ratio of worker to elder is much better than in a standard nursing home.

“Many of the shahbazim grew up on fast food. Their additional training teaches them how to cook, so they can prepare three nutritious, home-cooked meals a day. The homes always smell good, and the kitchens are open. There is a freedom in these places, and you just sense this deep well of affection among everybody. Plus, these facilities have reduced turnover,” Baker adds.

Dietary training

Caregivers trained in a person-centered approach to dining can contribute to increased resident satisfaction. The Pioneer Network advocates “deep system change in our culture of aging,” according to its website. To that end, the organization has rolled out a “Dining Standards Toolkit.” It’s based on scientific research suggesting that although dietary restrictions may benefit some people, more lenient blood pressure and blood sugar goals, for instance, may be more desirable for others.

“The less palatable restricted diets may actually lead to weight loss and its associated complications, and a 2 gram sodium diet has been shown to reduce blood pressure by only a small amount,” says Executive Director Lynda Crandall, RN, GNP. “The toolkit teaches staff how to negotiate between being safe and giving choice, and a more choice-driven diet can enhance the quality of life for most residents of LTC facilities without endangering their health.”

Crandall gives an example: “A resident might say, ‘I want two string beans and three pieces of meatloaf and four scoops of ice cream.’ It’s not what the dietitian ordered, but we’re honoring the resident’s choices. And the enjoyment piece of dining is a huge thing for all of us every day of our lives.”

The continual involvement of staff in the latest developments in caregiving increases job satisfaction regardless of the training methods used. Targeted, efficient and guided training is intended to improve the quality of life for each and every resident in an organization’s care.

Tobi Schwartz-Cassell is a freelance writer based in Cherry Hill, N.J.

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