PHInational.org

The newest additions to the PHI National Clearinghouse on the Direct Care Workforce:

Frontline Caregivers: Still Struggling — This article, from the Winter 2012 issue of Dissent, outlines the struggle faced by home care workers as they try to achieve better wages and more consistent hours. It notes that, in the current political and economic climate, many public funding avenues for paying home care workers and family caregivers are drying up, and unions are being stripped of their collective bargaining rights. The authors explain that, under federal labor law, home care workers aren’t even guaranteed basic minimum-wage and overtime protections.

Assisted Living State Regulatory Review 2012 — This report summarizes the state laws and regulations that govern assisted living facilities, including requirements for staff criminal background checks and age minimums, CPR training, staff-to-resident ratios, and training requirements. It also provides contact information for each state’s assisted living regulatory agency and offers brief commentary about regulations and legislation currently under consideration. The report is published yearly by the National Center for Assisted Living.

Mental Illness Training for Long Term Care Staff — This study notes that direct-care workers in nursing homes are often not specifically trained to provide care for residents with dementia and other mental disabilities. It presents the findings of a study in which nursing aides are given an internet-based training in caring for residents with mental illnesses. The researchers found that the aides performed their jobs more confidently after being trained. The authors further theorize that widespread use of such internet trainings could boost quality of care nationwide. The study was published in the January 2012 JAMDA.

The PHI National Clearinghouse on the Direct Care Workforce is a national online library for people in search of solutions to the direct-care staffing crisis in long-term care. It houses over 1,000 articles, reports, issue briefs, and fact sheets on the direct-care workforce.

– by Matthew Ozga

Legislation proposed in Massachusetts would require that direct-care workers employed by nursing homes and their supervisors, as well as activity directors, be trained in dementia care.

Should the bill pass, the law would apply to all licensed nursing homes in the state regardless of whether the facility markets itself as having specialized dementia-care units.

Facilities that have special dementia care units would — for the first time — be required to adhere to minimum standards to “ensure safety and quality of services,” which would be set by the Massachusetts Department of Public Health in consultation with the Massachusetts Alzheimer’s Association and representatives from the nursing home provider community.

Activity programs geared specifically to people with dementia would also be mandated by the law for facilities that have dementia care units, as well as guidelines for the physical design of the unit.

Under the proposed law, such facilities would be responsible for disclosing to consumers and the state public health department exactly what services their specialized dementia care units provided.

According to a Boston Globe article, a 2005 federal report indicated that 44 states had requirements for “training, staffing, security, and other areas” for facilities that provide dementia care services.

While similar legislation has been proposed for the past seven years, it never passed. These bills were opposed by the industry because they “stipulated specific staffing levels for dementia care units,” according to the article. It notes that the Massachusetts Senior Care Association, an industry group, supports the current legislation since it does not have minimum staffing level provisions.

A provision in the bill, titled An Act Relative to Dementia Patients in Long-Term Care Facilities, states that any regulations promulgated to implement it “may not be used as a basis for higher reimbursement rates” for the licensed homes.

– by Deane Beebe

One strategy identified in the U.S. Department of Health and Human Services‘ (HHS) draft taskforce plan to meet the Obama Administration’s goal of developing effective ways to treat and prevent Alzheimer’s disease by 2025 is to “Build a Workforce with the Skills to Provide High-Quality Care.”

The plan recognizes direct-care workers as long-term care providers who care for people with Alzheimer’s disease and recommends expanding and enhancing direct-care workers’ “dementia-specific capabilities” to “Enhance Care Quality and Efficiency,” one of the taskforce’s five general goals.

HHS and other experts met on January 17 and 18 to finalize the Draft Framework for a National Plan to Address Alzheimer’s Disease (pdf), according to a USA Today article.

HHS is seeking emailed input on the plan through February 8, 2012. A final report is due to HHS Secretary Kathleen Sebelius in early February.

– by Deane Beebe

The October issue of the PHI Training and Organizational Development (TOD) newsletter is available online.

The latest issue includes “Navigating Hard Times in Long-Term Care,” by members of the PHI TOD team, and “Easing the Distress of Room Changes,” by guest blogger Ann Wyatt, residential care policy and strategy consultant at the Alzheimer’s Association, NYC Chapter.

To read past blog posts and subscribe to the TOD newsletter visit the TOD blog.

– by Deane Beebe

Jed A. Levine

A guest column by Jed A. Levine, executive vice president and director of programs and services at the Alzheimer’s Association, New York City Chapter.

Alzheimer’s disease (AD) is the public health crisis of the 21st century. An estimated 5.4 million people have AD in the United States, and that number is projected to increase to 13 million by mid-century unless we find a way to prevent, delay, or cure the disease.

We spend $183 billion annually caring for persons with AD.

The disease affects not only an individual’s memory, but all areas of thinking, function, and behavior. Persons with AD become progressively dependent on others for all their activities of daily living (ADLs). There is no cure, and only modest treatment for the symptoms of the disease. The disease can last up to 20 years, with a mean of 8-10 years.

For many families, home care workers are a lifeline. With the help of these workers, family members who would otherwise need to provide full-time care can continue working and providing for spouses and children.

For persons with dementia, quality of life depends on quality of care and their relationships with their care providers. In the early and middle states of the disease, persons with dementia can still experience pleasure and meaning in their lives. The quality of the assistance and support they receive is critical. Even when the disease is advanced, the person with dementia can experience comfort and does not have to suffer.

Valuable, Practical, and Proven

Dementia care is hard work; it takes specialized skills that can be learned by caregivers.

Since 1989, the Alzheimer’s Association, New York City Chapter (AANYC), has provided in-depth training on dementia care for home care workers, through agencies and for individuals.

This 50-hour training builds skills such as:

• communication;
• understanding and responding to “behavioral symptoms”;
• engaging the person with dementia;
• understanding the family’s experience; and
• self-care, such as meditation and yoga.

A recent formal evaluation of the 50-hour dementia care training showed that the person with dementia showed greater improvement in behavior and emotion when cared for by a trained aide. The person with dementia was also found to be “communicating more,” “less agitated,” and “more cooperative with ADLs.”

Family caregivers also rated trained aides positively, including overall satisfaction with the aide.

The study also found that trained aides were more likely than their non-trained counterparts to stay in the field of dementia home care.

As the population of persons with dementia, including AD, grows, so too will the demand for trained home care workers. AANYC has developed a model of training that is valuable, practical, and proven.

More Information

To learn more about the training evaluation, contact Edward Cisek, Ph.D., AANYC.

To inquire about the dementia training, contact Matt Kudish, LMSW, AANYC.

For more information about AANYC, or any of the 78 local chapters, visit the website, or call the national 24-Hour Helpline at 1.800.272.3900.

Some information in this article was taken or adapted from the following publications published by the Alzheimer’s Association:

• 2011 Alzheimer’s Disease Facts and Figures (pdf)
• The Shriver Report
• Alzheimer’s Association Quality Care Guide, Dementia Care Practice Recommendations for Professionals Working in a Home Setting (pdf)

This fall, the Center for Excellence in Assisted Living (CEAL) is offering four one-hour webinars on practices designed to improve the quality of assisted living.

“Workforce Practices: How to Achieve Successful Outcomes,” the first webinar, takes place on September 29.

The other webinars in the CEAL series are:

• Person-Centered Care: It’s More than an Art
• Dementia Care: What Works?
• Medication Administration: Getting it Right

“All four topics are critical to building solid relationships between staff and residents, as well as aligning public policies with quality outcomes,” said PHI Michigan State Policy Director Hollis Turnham.

Presenters for the CEAL webinars will include award winners from the organization’s Promoting Excellence in Assisted Living Awards Program.

There is a registration fee for each webinar. Continuing Education Credits will be offered.

– by Deane Beebe