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Is It Worth Your Investment?
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Dr. Macie P. Smith, LSW, SW-G, C-SWCM Gerontology Social Worker
DEMENTIA-CAPABLE EDUCATION
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TOTAL INVESTMENT
PEOPLE
PROCESS
PRODUCT
Is It Worth Your Investment?
PEOPLE
How many Americans are turning 65 every day? a. 100 b. 1,000 c. 10,000 d. 100,000
BABY BOOMERS
2012 43.1 million
2050
83.7 million
Alzheimer’s disease/dementia
PREVALENCE
Over 47 million in the US have dementia
Over 5 million individuals in the US have Alzheimer’s
1 in 9 (65 and older)
1 in 3 (85 and older)
Every 66 seconds
By 2050 - 16 million in United States
MYTHS DEBUNKED
Curable
Contagious
Normal Part of Aging
Intentional Behavior
Small Amount
Touch of It
ALZHEIMER’S DISEASE CHARACTERISTICS
Onset is 60-90 years of age
Progressive
Average 6-12 years
6th leading cause of death in the US
5th leading cause of death in US (for 65+)
The only cause of death in the top 10 in the US that
Prevented Cured Slowed
ALZHEIMER’S DISEASE
Progressive, irreversible, brain disease
Destruction affects a person’s
Destroys brain cells Memory Thinking skills Carry out simple activities of daily living
Dementia
Set of symptoms that result from brain impairment Impairs ability to carryout basic activities
CUSTOMERS 4% 12%
Alzheimer’s disease
24% 60%
Vascular dementia
Mixed dementia Other conditions
Increase 52%
POSSIBLE CONTRIBUTORS
Age
Heredity
Genetics
APOE – 4
Head trauma
Disability
POSSIBLE CONTRIBUTORS
Education
Ethnicity
Gender
Lifestyle
PSYCHOSOCIAL CHARACTERISTICS
Personality changes
Mood swings
Depression
Delusions
Anxiety
Agitation
BEHAVIORAL CHARACTERISTICS
Wandering
Misplacing items
Aggressive/Compulsive
Inability to perform basic tasks (ADL’s):
Bathing Dressing Grooming Eating Toileting
COGNITIVE CHARACTERISTICS
Memory (recent) loss
Confusion
Disorientation to time and place
Poor judgement
Unable to make decisions
Concrete thinkers
Difficulty with abstract thinking
STAGES OF LIFE Teenager
Toddler
Infant
CUSTOMERS 5% Community
27% 68%
Nursing Facility Unknown
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DIRECT CARE WORKFORCE
1.5 million direct care workers
Majority in home and community-based
At least 90% are women
Women in their 20s – 50s
Care for residents and their own families
Few have paid vacation, sick leave, or childcare benefits
DIRECT CARE WORKFORCE
Jobs are rewarding for many direct care workers BUT:
Lack of health insurance
Little or no advancement opportunities
Poor relationships with supervisors
Lack of respect
Physical and emotional demands
Low pay
Inadequate workload caused by turnover
Inadequate training
DIRECT CARE WORKFORCE
Low Pay
Demand grew / Wages fell ~$11.00/hr Median ~$16,500/yr 42% rely on public assistance 28% food stamps 22% Medicaid for medical coverage Pay is not competitive “Walmart Effect” Turnover due to better wages/benefits
DIRECT CARE WORKFORCE
High turnover rates are associated with increase use of:
High turnover rates are associated with increase:
Physical restraints Catheters Psychoactive drugs Contractures Pressure Ulcers Quality of Care Deficiencies
Direct care worker turnover impacts providers
DIRECT CARE WORKFORCE
Turnover rate in AL ranged from 77% to more than 164%
40% for personal care workers
39% for certified nursing assistants
38% for medication aides
Job vacancy rates of 11% to 20%
High turnover rates affect providers’ financial health
PROVIDERS ON WORKFORCE
Unaware how much direct care worker turnover actually costs
Spend $1400 - $4300 for each worker that is replaced
An amount that can exceed 4 times the monthly salary
The average turnover cost is $3,500 per direct care worker
High turnover affects quality of care
CARE IMPACTS COINS 7 6 5 Level of Care Turnover Quality of Care Satifaction Rating
4 3 2 1 0
Impact on Care
DIRECT CARE WORKFORCE NEEDS…
Strategies that improve retention
Competitive wages and health insurance benefits
Strategy of culture change
Strategies of management practices and trained supervisors
Career advancement opportunities
Cultural competence
Comprehensive training needed to deliver quality care
DIRECT CARE WORKFORCE 
Current direct care worker training requirements have been viewed as inadequate
DIRECT CARE WORKFORCE 504. Inservice Training (I). 
A. The following training shall be provided by appropriate resources, e.g., licensed/registered/certified persons, books, electronic media, etc., to all staff members/direct care volunteers and private sitters in the context of their job duties and responsibilities, prior to resident contact and at a frequency determined by the facility, but at least annually unless otherwise specified by certificate, e.g., cardiopulmonary resuscitation (CPR):
DIRECT CARE WORKFORCE 504. Inservice Training (I).  5. Depending on the type of residents, care of persons specific to the physical/mental condition being cared for in the facility, e.g., dementia; cognitive disability; mental illness; or aggressive, violent, and/or inappropriate behavioral symptoms etc., to include communication techniques (cueing and mirroring), understanding and coping with behaviors, safety, activities, etc.
DIRECT WORKFORCE
There is a need for better training
LTSS grow in number, client needs become more medically complex
The skill level and training of the LTC workforce must expand
South Carolina will need more people trained as specialists
Personnel and professionals receive training in LTC competencies and geriatric content
CNA INSTRUCTOR SURVEY RESULTS
108 CNA Respondents:
60% - Satisfied with dementia content
Communication skills covered – 46% Inappropriate use of restraints – 50% Non-drug strategies to manage behaviors – 29%
49% - Inadequate space/time in the curriculum 22% - Quality teaching materials are unavailable 19% - Lack of time to develop material
“ We don’t get to decide whether we have challenging students, but we can decide how we respond to them” – Carol Ann Tomlinson
PROCESS
Is It Worth Your Investment?
PRODUCT
ESSENTIAL DEMENTIA CAREGIVER
Sincere
Respectful
Trustworthy
Competent
Committed
Uplifting
Cooperative
Collaborative
Responsible
Patient
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CAUSES OF CHALLENGING BEHAVIOR
Pain Medical / Medication Fear Low vision/hearing Impaired problem solving skills Loss of control Don’t want to do, but being forced Difficulty communicating needs Feelings of isolation Under stimulation / Over stimulation Environment not desirable
PERSON-CENTERED CARE
Do not take actions personally
If necessary, try later
Explore medication for agitation/anxiety
Engage in appropriate exercise, regularly
Keep environment simple and calm
Establish routine/ minimize change
Validate / Comfort / Redirect (VCR Approach)
Patience, Patience, Patience
EDUCATIONAL OPPORTUNITIES
Face-to-face
Online interactive training
Consistent care partner model
Mentoring program
Include direct support staff in decision making Offer flexible work schedules
Colleges/Universities offer free training
The Dementia Dialogues Experience
HOST SITES
LACK OF INVESTMENT
Lost productivity until a replacement is trained
Lost client revenues and/ or reimbursement
Increases in worker injuries due to clients’ physical and emotional
Increase workloads
Lower morale among remaining staff
Loss of continuity of care
Threatens quality of care
Residents suffer
PRODUCT OF YOUR INVESTMENT
Reduce costs
Reduce avoidable transfers
Reduce risk of survey penalty
Reduce the risk of litigation
Reduce the risk of elder abuse
Improve safety for ALL
Improve staff morale
Improve job satisfaction
Increase rate of retention
Improve resident outcomes
Competitive model of care
“ a national paradigm shift must occur before it is too late – for the sake of direct care workers, their families and the vulnerable people they serve.” - Steven Dawson (Spring, 2016Generations Journal)
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SOURCES
Alzheimer’s Association. (2015). Alzheimer’s facts and figures. Retrieved from www.alz.org
Barbarotta, L. (2010). Direct care worker retention: Strategies for success. Institute for the Future of Aging Services, AAHSA.
Barondess, L. (2008). Some potential solutions to high direct-care staff turnover rates. Annals of Long-Term Care. 15(10).
Glisky, E. (2007). Brain aging: Models, methods, and mechanisms. Boca Raton, FL: CRC Press.
Institute of Medicine and Public Health. (2012). Creating direction: A guide for long-term care in South Carolina. Retrieved from http://imph.org/wordpress/wpcontent/uploads/2015/06/creatingdirectionreportfinal.pdf
Riggs, J. (2002). Exploring pathways to long term care staffing solutions. Alzheimer’s Association.
SC DHEC. (June 26, 2015). Standards for licensing community residential care facilities. Bureau of Health Facilities Licensing.
University of South Carolina. (2016). Dementia Dialogues. Office for the Study of Aging. Pdf.
University of South Carolina. (2012). SC Alzheimer’s disease registry. Office for the Study of Aging.
Vockell, E. (n.d.) Educational psychology: A practical approach. Retrieved from http://education.purduecal.edu/Vockell/EdPsyBook/