Dementia Care Training:
Policies and Priorities
Randi Chapman Patty Barnett Mouton
Alzheimer’s Association Alzheimer’s Association, Orange County Chapter
Director, State Affairs VP, Outreach & Advocacy
#ALFA2014
Overview
• Alzheimer’s Association and Alzheimer’s Disease
• Why Dementia Training is Necessary
• Dementia Training Concepts
• State Policies
• Policy Recommendations
• CARES/EssentiALZ
#ALFA2014
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Alzheimer’s is More Than a “Little Memory Loss” – Alzheimer’s Kills.
Dementia is a general term used to describe a decline in cognitive functioning and Alzheimer’s disease is the most common form of dementia.
3 stages: pre-clinical, mild cognitive impairment (MCI), dementia due to Alzheimer’s
Alzheimer’s is a progressive disease of the brain that destroys brain cells, causing problems with memory, thinking and behavior.
Advanced Alzheimer’s, cognitive and functional abilities decline: failure to communicate and recognize loved ones, 24/7 care, bed-bound
Alz.org The Alzheimer's Association is the world's leading voluntary health
organization in Alzheimer's care, support and research, and we are the largest non-profit funder of Alzheimer's research.
Our mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and
support for all affected.
Our vision is a world without Alzheimer’s.
HELP LINE
1 800 272 3900
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Why is Dementia Training Necessary
The goals of training and education for ADRD Units are to
enhance staff understanding and sensitivity toward the Unit
residents, to allow staff to master care techniques, to ensure
better performance of duties and responsibilities, and to prevent
staff burnout.
Mississippi Department of Health
Rule 50.2.2
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Why is Dementia Training Necessary
45%-67%
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Individuals with ADRD in Assisted Living
• Poor training has also been identified as one of the factors that contributes
to occurrences of neglect and abuse in nursing homes, especially for
patients with behavioral difficulties associated with dementia
• In a survey of direct-care workers across multiple settings…workers
identified a number of areas where their knowledge and skills needed
further developments, including dementia…
• High levels of training have been positively associated with recruitment of
home health workers
• Nurse aides who have received adequate training have been found to
provide higher-quality patient care and to be less likely to want to leave their
jobs
Improved Ability to Provide Dementia Care
A Great Deal
Moderate Improvement
Little Improvement
No Improvement
What Should Dementia Training Cover
• Dementia Basics
• Communication
• Understanding Behaviors
• Food and Hydration
• Understanding Pain
• Social Connections
• Understanding Wandering
• Falls Prevention
• Restraint-free Care
• End of Life Care
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Alabama • Specialty Care Assisted Living
Facilities
• State-approved training program
(DETA)
• All staff—at least 6 hours continuing education
• All staff having contact with residents--initial DETA training prior to resident contact and refresher training
• Key concepts covered
• staff—1 hour
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State Examples: Alabama and Mississippi
Mississippi
• Licensed personal care home
with separate unit for ADRD and
nursing homes
• Ongoing in-service training for all
staff in direct contact with
residents of A/D Unit--quarterly
• Pre-admission assessment
including cognitive assessment
• Key Concepts Covered
Connecticut
• ADRD training provided to all
direct care staff upon employment
• Annual update of training
• Serving persons with Down’s
Syndrome 50+
• Direct care: 8 hours, 6 months
after employment
• 2 hours pain recognition and
management
• Unlicensed staff—1 hour
Minnesota • Special Care Units
• Supervisors of direct care staff: 8 hours w/in first 120 hours; 2 hours annual
• DCW: 8 hours w/in first 160 hours; 2 hours annual
• Non-care staff: 4 hours w/in 160 hours; 2 hours annual
• Key Concepts
• ALF: 4 hours w/in 120 hours; 2 hours annual supervisors and DCW
• Managers: 8 hours/ 4 hours ALF
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Current State Legislation: CT and MN
First California dementia
bill enacted in 2004
Defines dementia based
on physician diagnosis;
excludes mild cognitive
impairment
Law applies exclusively
to facilities that advertise
or promote specialized
care
Establishes new
category of dementia
training and specifies
topics
Requires additional
hours, specific to
dementia (6 hours
orientation within 4
weeks and 8 hours
within 12 mos. and
every 12 mos. thereafter
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California’s 10-year History
State and national
media scrutiny
Successive years of
state budget cuts
resulted in facility
inspections only once
every 5 years
Special legislative
hearing called
Advocates introduce
RCFE Reform Act of
2014, an 11-bill package
Others sponsor
legislation bringing total
to 17 RCFE bills in one
session.
The Alzheimer’s
Association supports
just one: AB 1570
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California
Addresses dementia training in all RCFEs
Focuses training on direct care staff
Doubles the # of dementia training hours
Provides greater flexibility for instruction
Strengthens Administrator training & testing
Consistent with California’s State Plan for Alzheimer’s Disease
re: dementia competent workforce
Sponsored by CALA and co-sponsored by LeadingAge and
Alzheimer’s Association
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California: Assembly Bill 1570 Chesbro
Overall Policy Recommendations
• Training as soon as possible after employment
• Competency Measures
• Key Concepts Included
• Training Supervised by management
• Targeted to Audience
• Continuing Education
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Overall Policy Recommendations
• A few assumptions: over 400 peer-reviewed journal articles can be believed
experience with over 10,000 classroom participants is reliable (mine )
there is no perfect training method
evidence-based curricula, reliable passionate
instructors!
use Adult Learning Principles
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Overall Policy Recommendations
• Crisis provides opportunity
e.g. Tylenol
• Do what will improve care regardless of what is “required”
• Perception is reality
• Confidence MATTERS!
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Training & certification
Tests knowledge of evidence-based Alzheimer’s Association Dementia Care Practice Recommendations
Recommended by AHCA/NCAL to help reduce the off-label use of antipsychotic medications
CARES Dementia Basics & Advanced Care recommended by CMS to meet Section 6121 of the Affordable Care Act
Over 21,000 certified since October, 2011
The CARES® Online Training Options
There are 5 online course options with certification
1. CARES ® Dementia Basics™ (4 modules/4 hours)
2. CARES ® Dementia Advanced Care™ (6 modules/6 hours)
3. CARES® Dementia Basics & Advanced (10 modules/10 hours)
4. CARES ® Dementia-Related Behavior™ (4 modules/4 hours)
5. CARES® Activities of Daily Living™ (10 modules/10 hours)
Separate online certification exams for each course
• 24,929 essentiALZ exams have been taken since 2011
• 21,200 trained test takers have passed
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HOMEWORK
HELP LINE
1 800 272 3900
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QUESTIONS
Randi Chapman
National Alzheimer’s Association
Patty Mouton
Alzheimer’s Association, Orange County Chapter
HELP LINE
1 800 272 3900
