Effective Practices Model Programs In Elder Care - Research Paper Example

Effective Practices Model Programs In Elder Care Dissertation Prospectus Introduction With our aging population living longer, data shows that age is one variable that correlates to the development of Alzheimer’s disease (Alzheimer’s Association, 2006). According to the United States Department of Health and Human Services (2011) life expectancy in the United States has risen from 76.9 years of age in 2000 to 78.3 years of age in 2010 with an anticipated life expectancy of 79.5 years in the year 2020. According to the Alzheimer’s Association (2012) 5.4 million Americans are living with Alzheimer’s disease or other related dementias, such as mild cognitive impairment (MCI) organic brain syndrome (OBS), vascular, Lewy Bodies, frontal temporal lobe (FTL), Pick’s disease, head trauma induced, substance induced and other dementia due to other medical conditions (i.e. HIV, Parkinson’s Disease, Huntington’s Disease). Of the 5.4 million people diagnosed with Alzheimer’s or dementia, 5.2 million are of the age of 65 years or older. The World Health Organization (WHO) report on dementia (2012) reported that dementia is the leading cause of dependency and disability among older people worldwide. According to Park-Lee et al. (2011) in 2010 residential care facilities (this would include assisted living and group homes) totaled 21,100 with 971,900 beds nationwide. Of the 971,900 beds nationwide 42% were occupied with persons diagnosed with Alzheimer’s or some other dementia. These numbers show an increase from the United States Department of Health and Human Services (2011) historical data from 2006 reflecting 750,000 residential beds nationwide with 40.7% occupied by cognitively impaired individuals. The direct cost of caring for those afflicted with Alzheimer’s disease and other related dementias for 2012 is estimated to total $200 billion, including $140 billion in costs to Medicare and Medicaid. Knowing that more people will need specialized care related to cognitive impairment and dementia, there will also be a greater need for dementia specific care facilities and caregiver training to provide specialized quality care in long term care environments – including assisted living. According to Moyle, Hsu, Lieff & Vernooij-dassen (2010) there is increased evidence that specialized training for the geriatric long-term care workers in mental health care (dementia included) can contribute to increased knowledge of the disease and the disease processes, including treatment needs and working conditions for the formal caregiver. There is little consistency in the standards, topics, hours, and level of dementia staff training from state to state (Yee-Melichar, Boyle, & Flores, 2011). Furthermore, although the literature supports the critical role of caregiver training in improving the quality of life for those with dementia, there is still a gap in the practical implementation and application of training (Beer, C. D., Horner, B., A, O. P., meida, Scherer, S., Lautenschlager, N. T., et al. 2010). A number of investigations identified the need for more education related to dementia training for formal caregivers and education for family members. A study completed by Hobbs (2009) reported a growing concern related to the aging population diagnosed with dementia and the lack of trained staff to care for these individuals. According to Reimer, Slaughter, Donaldson, Currie & Eliasziw (2004), purpose-built facilities designed specifically for the dementia population contributed to the quality of life for the person with mid to late stage Alzheimer’s/ dementia than the traditional medical model of care. A research investigation of Florida's Alzheimer’s/ dementia training program review process found that out of 445 curricula received over four and a half years, more than 90.0% were substandard, and frequently had content with inaccurate information, and language that was not person-centered, and missing required training components (Hyer, Molinari, Kaplan, & Jones, 2010). An analysis of assisted living center inspection data, over a two-year period in seven states, noted that 25.0% of the centers had been cited for training violations, and concluded that staff shortages and insufficient training placed elderly residents at risk with inadequate care, delayed diagnosis and treatment, and even death (McCoy & Appleby, 2004). This is complicated by the annual staff turnover rates of about forty percent. Yet a recent review of papers on staff training for elders with mental illness found that most focused on behavior skills training (Moyle, Hsu, Lieff, & Vernooij-Dassen, 2010). A dementia coalition in Michigan lists enriching people’s lives as a dementia staff training core competency (Dementia Competencies Workgroup, 2008). A further problem is inconsistency ofdementia-specific training programs and the lack of training program efficacy evidence. A study reviewing 21 studies of nursing home training programs concluded that, “On an international and, particularly, on a national level a lack of evaluated in-service training programs for caregivers in homes for people with dementia is apparent” [Bet07]. Researchers called for “methodologically improved studies, providing conclusive evidence of the effects of intervention types to help improve the quality of dementia care”[Bet07] This study responds to the rapidly rising dementia population in residential care facilities, the minimum dementia training required by the State, and inconsistency of training offered among facilities, without evidence of efficacy. This study will introduce, test for efficacy, and formalize a dementia-specific caregiver training program which can hopefully be offered to other assisted living facilities with dementia populations. It rests on the assumption that minimum State requirements are inadequate. The State requires 62 hours of training for caregivers at assisted living facilities, with follow-up education of a single hour per month. However, only a miniscule amount of this training, specifically four hours per year, is required to be dementia-specific. With ever-expanding life expectancy, dementia is an increasing reality in assisted living facilities. It is also a disorder that manifests in behavior disturbances, anxiety and aggression, so that it taxes the patience and creative intervention capacity of caregivers. As it robs the patient of personality and personal history, dementia also taxes the tolerance and understanding of patients and their family members. Caregivers need to be well-trained to deliver care, maximize patient cognition and tolerance, and provide needed support to family members as well. Assisted living facilities and nursing homes are left on their own to design adequate dementia-specific training, since the State requirements are so minimal. They do so in a near vacuum, since there is as yet no consensual certainty about specific training model efficacy. This research study aims to identify and describe the components of a successful Dementia Training Program, developed and successfully implemented with a population of dementia patients, at the assisted living facility where Researcher is an Administrator. Then, this study aims to present those components in a cohesive training model to dementia caregivers at another assisted living facility, where Researcher has no administrative influence. These caregivers will be interviewed to determine efficacy of the model in terms of caregiver confidence, competence and tolerance, the construction of occupational meaning, and caregiver observations. The interview data will be analyzed for patterns of feedback and will be compared to data from interviews with caregivers from a similar, associated facility, where dementia caregivers have had only the state required dementia training. It is hoped that conclusions from the analysis of this data will provide indications of increased efficacy, and will thereby facilitate a training model contribution that can be introduced and recommended to other facilities. Background of the Study Per the State Department of Health Services (2009), the assisted living environment consists of three levels of care, which are a reflection of the clients’ needs and abilities. The first level of care under the Department of Health Services is Personal care services, which provides minimal assistance to the resident, including reminders for medication administration, assistance with bill paying and possible assistance with transportation. The second level of care under the Department of Health Services is Supervisory care, which provides more assistance with self-administration of medication, may assist with shopping, some food preparation, and activities of daily living (ADL), which includes bathing, dressing, and oral care. The third and highest level of care is Directed care services, which incorporates care for persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions. Care may include incontinence care, administration of medications and full assistance with ADL’s. Clients at this level may need more assistance with walking, eating and have limited verbal abilities to communicate wants and needs [Ari07]. Problem Statement The need for quality care for cognitively impaired individuals is on the rise. The population of older adults over age 85 increased by 29.8% within the last 10 years (United Census Bureau, 2010). The percentage change for those over 90 years old is even higher at 30.2%t within the same ten-year period. It was estimated in 2009 that 5.3 million Americans had Alzheimer’s disease with a projection of 10 million people being afflicted with Alzheimer’s disease by the year 2050 (Alzheimer’s Association, 2009). Assisted living facilities have become an alternative to nursing homes for persons with dementia, which warrants the need for specialized training for the directed-care caregiver (Mollica, 2008). There is little known about the characteristics and impact that a formalized, specialized dementia training for the directed-care caregiver, in the assisted living environment in the Southwest state to be used in this study, has on caregiver confidence, tolerance, and skill competence. Dementia training varies from state to state and by regulatory bodies (Hyer, Molinari, Kaplan, & Jones, 2010). A study showed that facility specific staff training was common, but had a general focus on orientation to the facility, such as policies and procedures. Moreover, more than 90.0% of curricula submitted did not include learning objectives, time formats or didactic approaches (Hyer et al). Most caregivers’ knowledge, related to caring for someone with dementia, has been acquired from life experience or learned on the job (Rasin & Kautz, 2007). State training requirements, for an assisted living caregiver, consist of a sixty-two hour training course, and one hour of continuing education per month (Arizona Senior Housing Institute, 2011). Only four hours per year are needed specifically for the directed care, dementia component of the training. Researcher is an Assisted Living Center Administrator which serves a dementia population, In the course of training facility caregivers, a training model has been developed. There is sufficient documentation (five years of formal records) to support the apparent efficacy of this model at this particular facility. It is now time to deliver it elsewhere and analyze to what extent it is a useful model for wider distribution. Purpose of the Study The purpose of this interview-based qualitative study, is to administer the developed dementia-specific training curriculum to an area facility (unrelated to Researcher’s facility) and to assess, through caregiver and administrator interviews, the efficacy of the dementia-specific, multi-faceted training model. Interviews will also be conducted with dementia caregivers and administrator at a facility associated with the selected training facility, for caregivers who have had only the minimum training required by the State. At this stage in the research, evidence of efficacy of the Dementia Training Program will be generally defined as staff satisfaction with training, which Researcher anticipates will be reflected in self-reports of increased confidence, increased tolerance, increased competence, increased occupational meaning, and a happier environment, The Dementia Training Program covers multiple dimensions (interventions, medication administration, wound care, dietary knowledge to prevent weight loss, keeping the environment of care safe for this vulnerable population) The need for quality care for cognitively impaired individuals is on the rise. According to the 2010 United States Census Bureau data, the population of older adults over age 85 increased by 29.8 percent within the last ten years. The percentage change for those over 90 years old is even higher at 30.2 percent within the same ten year period. According to Mollica (2001), clients are choosing to live in assisted living facilities instead of nursing homes, which may explain the higher acuity level of resident admissions. In view of this shifting demographic, dementia’s association with the elderly, and the special challenges presented in dementia care, it is imperative that sufficient trained caregivers be available to provide for the needs of this population. The sixty two hour training, required by the State (Arizona Senior Housing Institute, 2011), and one hour of continuing education per month, with only four hours per year being dementia-specific is suspected to be highly insufficient. Research Questions The following research questions guide this study: 1. What are the key components of the Dementia Training Program under investigation? 2. What are the qualitative differences in the response patterns of caregivers with multi-faceted dementia-specific direct-care training vs response patterns of caregivers with only State required dementia training? 3. What program elements and outcomes indicate efficacy of caregiver training? 4. How might the components of the Dementia Training Program be succinctly stated in a formalized model that could benefit other residential care facilities with a dementia-affected population? Significance of the Study With a rapidly increasing population of older adults, particularly much older adults, and with the prevention of their rapid cognitive and physical decline relying on knowledgeable providers and dementia-friendly lifestyles, dementia is an escalating international issue. The General Assembly of the United Nations has adopted (September 2011) a declaration that includes Alzheimer’s as a major world-wide priority, citing the primary contributions of lifestyle and the critical importance of prevention in chronic, non-communicable diseases. The Political Declaration Annex, to that declaration, contained in item 39, “Recognize that the incidents and impact of non-communicable diseases can be largely prevented or reduced with an approach that incorporates evidence-based, affordable, cost-effective, population-wide and multi-sectoral interventions (UN General Assembly NCD Summit, 2011).” This research study is an effort in line with these goals, identifying best practices that give dementia residents a lifestyle that will maximally prevent or reduce rapid cognitive and physical decline, and identifying a training approach that is evidence-based and can be shared with caregivers at other assisted living, dementia resident facilities, and involves multi-sectoral interventions. As people live longer and families become busier, home care is an increasingly less viable option for those who suffer from dementia. Assisted living centers, to meet the needs of the elderly and their families, are finding it advisable and necessary to develop units for dementia care. People with dementia, however, often have behavior disturbances, such as restlessness, inappropriate action, crying, anxiety, and aggression. Those who care for them require training, in order to sustain good care, soothe the disturbed, calm their own response tension, and engage the dementia patient in a beneficial way. The current challenge faced by assisted living centers, however, is the lack of adequate training standards, based on efficacy. Educators do not have sufficient guidance to design adequate curriculum, and the State requires very little dementia-specific training. Research results continuously document the caregiver and resident benefits of training, such as a review of 273 studies on training outcomes indicates [Aim13], but there are few definitive training protocols. Researcher has licensed expertise in caring for dementia patients, and has developed a training model that has worked well at the facility she administrates. By testing this model on a non-associated population, and comparing the qualitative outcomes with those of a minimally-trained, State-standards-only group of dementia caregivers, data becomes available that is desperately needed in the field of dementia care and training. Much of the literature is methodologically and definitively vague [Bet07]. The idea of this study is to gain a deep understanding, through outcome responses at a case study facility (contrasted and compared with State training responses at a control facility), of training model efficacy, specific to factors known to impact patient care. Those factors are caregiver confidence [Glo05], competence [Dia02], tolerance [SSm05], occupational meaning [Lin05], and a happy environment [Mar03]. Research indicates that when caregivers are trained to provide a positive, supportive environment for dementia patients, even those whose dementia has caused severe personality, cognitive and emotional changes, “will show a rich pattern of mental reactions in spite of their dementia” (Kihlgren, Hallgren, Norberg, & Karlsson, November 1996, p. 219). Furthermore, with dementia-specific training for caregivers, it was demonstrated that, “behavioral disturbances, such as inappropriate behaviors, repetitive questions, and crying in this patient population decreased” (Tannazzo, Breuer, Williams, & Andreoll, October/December 2008, p. 221). If the training model is shown to be effective, it can be quantitatively tested at other facilities, in the future. If it not shown to be effective, still it will add to the field by providing a case that differs from Researcher’s own facility experience, thus motivating scholarly reflection on variables that might be involved in the unexpected outcome. In either case, it will be in a position to advance scientific knowledge in the field. Preliminary Review of the Literature A number of investigators have offered research-based insight into the training of assisted living caregivers, and even some dementia-specific training suggestions, but most research simply concludes that better training is needed, and stops short of defining the elements of that training, Here is a summary review of that literature, A research investigation of Florida's assisted living caregiver training program curriculum review process found that out of 445 1st-time submitted curricula received over four and a half years, more than 90% were substandard, and frequently had “content with inaccurate information, language that was not person-centered, and missing required training components” (Hyer, Molinari, Kaplan, & Jones, 2010, p.864). An analysis of assisted living center inspection data, over a two year period in seven states, noted that 25% of the centers had been cited for training violations, and concluded that “staff shortages and insufficient training place elderly residents at risk with inadequate care, delayed diagnosis and treatment and even death” (McCoy & Appleby, 2004). This high-risk situation is complicated by the annual staff turnover rates at about 40%. Yet a recent review of papers on staff training for elders with mental illness found that most focused on behavior skills training (Moyle, Hsu, Lieff, & Vernooij-Dassen, 2010, p.1097). Although the literature supports the critical role of caregiver training in improving quality of life for those with dementia, there is still a gap in the practical implementation and application of training (Beer, et al., 2010). There is a call for more multi-faceted training, something that goes beyond behavior skills alone. In an innovative experiential training program in UK, caregivers’ glasses are smeared with Vaseline, to blur vision, and movement is inhibited by binding an arm. They are spoon-fed boring food and violations of dignity are the order of the day, all in an effort to promote empathy in those who care for dementia patients (Davis, 2010). Australia’s Victorian Government Health Information advises that dementia-friendly environments require staff to be trained in “helping people gain personal satisfaction in their lives” (Victorian Governemt, Australia, n.d.). A dementia coalition in Michigan lists “enriching people’s lives” as a dementia staff training core competency (Dementia Competencies Workgroup, 2008, p.21). These are some of the identified areas in which it is felt that more training effort should be provided. But, another training need is for definitive training standards. There is little consistency in the standards, topics, hours, and level of dementia staff training from state to state (Yee-Melichar, Boyle, & Flores, 2011, p.102). This is the implementation and application issue said to plague the field of assisted learning center dementia training, It is this gap in the practical implementation and application of dementia training that is being addressed by this study Following is a table indicating categories and some key topics for dementia care, which echo throughout the literature, and which should inform training : Patient Health Care Patient mental Wellbeing Caregiver Wellbeing Preventing falls (leading cause of injury and death) Dementia-friendly environment Preventing and responding to caregiver stress Preventing/treating pressure sores and other medical issues Computer-assisted and other cognitive interventions Caregiver confidence Infection control Computer-assisted and other reminiscence training Caregiver competence Wandering safety Activities of daily living Caregiver tolerance/resilience Nutrition and diet Responding to early memory loss Occupational meaning Pharmacological management of dementia Depression and suicide in elderly Reducing high staff turn-over Promoting privacy, dignity and resident rights Preventing abuse Communicating effectively Lifestyle interventions Research Methodology This research prospectus is in support of a qualitative case study. It is based on a training application developed at an Arizona residential care facility, Huger Mercy Living Center, serving residents with dementia (Catholic Healthcare West, 2011). The facility is known for innovative services, quality outcomes and client & family satisfaction. Researcher is the Assisted Living Manager there and has spent five years developing a model dementia-specific, outcome-guided training program. The dementia-specific caregiver training program will be qualitatively tested at an unaffiliated Southwest assisted living facility with a dementia population. Interviews of caregivers and administrator will be conducted in order to find indicators of efficacy, based on the presence or lack of presence of caregiver claims of confidence, competence, tolerance, occupational meaning, happy environment, etc. Caregiver responses will be compared with interview responses of an affiliated Southwest facility (same ownership and similar environment) at which caregivers have only the required minimal training required by the State. Emergent response patterns will be analyzed. The dementia training model will be formalized and clearly articulated, based on five years of curriculum content and delivery records at Researcher’s facility and will be fine-tuned, based on interview feedback from this study. Researcher expects to identify the components of the Dementia Training Program utilized at the Huger Mercy Living Center. Researcher expects to find strong evidence of its efficacy in the testing facility, with indicators arising from a contrast of interview responses at testing facility and control facility. Researcher expects to eventually have an efficacy-based, multi-dimensional model of quality dementia-care training, with a specified curriculum and delivery system for use with training staff in other residential facilities with dementia-affected populations. Research Design The research design, used here, is a descriptive case study with also a qualitative measurement of contrast between interview responses from a training intervention test facility caregiver population and interview responses from a no intervention control facility caregiver population. It is descriptive in that it is Researcher’s intention to identify and make note of the approach to dementia training taken by a well-reputed residential care facility, and, secondly, to describe the qualitative experience outcomes that indicate caregiver training efficacy at the case facility and, thirdly, to describe a Dementia Training model that can be made available to other assisted living residential centers with dementia-affected populations. Although having a test control facility is more common in quantitative studies than in qualitative case studies, it is important, iu the quest for an in-depth understanding of the case facility’s training efficacy, to compare interview responses to those at a facility with only the minimum State standards. Otherwise, there can be no certainty about why responses present in a given way. If the training intervention is given to the case facility, responses might arguably have been the same after State training. Since it is a prime and critical purpose of this study to establish a training model that improves on the State’s minimal attention to dementia-specific training, a control facility is called for. However, because an in-depth description is sought, a quantitative test model is thought to be premature and a qualitative model is thought to be more appropriate at this stage of investigation. It was decided to focus on efficacy evidence of dementia training because there is an increasing population of dementia-affected residents in assisted living residential centers and the available literature indicates a strong need for better dementia training, in particular. Researcher professional observation and experience, in the field of residential assisted living care for dementia-affected residents, confirms what the literature indicates. While the disadvantage of a case study is the small population sample and concern about its generalizability to non-represented persons or facilities of interest, the advantage of a case study design is the capacity to look in depth and to identify patterns of information that can be used to construct an experiential description, in the context of which others can be later compared. This is especially appropriate when working with multiple dimensions of information, as happens when analyzing caregiver satisfaction with resources that engender improvements in competence, confidence, occupational meaning, tolerance, etc, and training program components. Sources of Data The initial data sourcs consists of routinely-collected facility records extending back five years, which detail a specific approach to and content for dementia-specific assisted living facility caregiver training. These data include records and reports of dementia training for staff, including topics covered, hours logged, frequency of training, and delivery methodology. The primary source of data will be interviews conducted after training is presented to caregivers of case facility. Another source of data will be researcher observations and conversations with caregivers during training. A source for comparative data will be interview responses from caregivers at the control facility. Data Collection Procedures This research is a case study of a single assisted-living residential facility, to whom a training program will be presented and from which caregiver responses will be collected by interviews. Comparative data will be collected by interviews from a similar facility with only State minimum training, in order to deepen and corroborate understanding of emergent response patterns from case facility. Researcher will identify dementia training curriculum components to present to case facility caregivers, and will modify after presentation, if indicated by interview responses, so as to formalize a well-articulated, efficacy-established model training program that can be more widely distributed. Data Analysis Procedures To address the first research question, “What are the key components of the Dementia Training Program under investigation?”, information on dementia training topics covered, type of curriculum used, method of delivery, at the facility with five years of dementia-specific training and efficacious outcomes will be extracted from the records and organized into a summary table. That table will be used to create a model training program that will be presented to the case facility. To address the second research question, What are the qualitative differences in the response patterns of caregivers with multi-faceted dementia-specific direct-care training vs response patterns of caregivers with only State required dementia training?”, caregivers at the case facility and caregivers at the control facility will be interviewed between 60 and 90 days after the training program under investigation has been presented. This will allow time for the training to settle in and influence caregiver behavior and attitudes. as well as to insure that approximately the same time period since State mandated training has elapsed at both facilities. Interview responses will be analyzed to identify patterns of response consistency and inconsistency. To address the third research question, “What program elements and outcomes indicate efficacy of caregiver training?”, interview response answers and patterns will be compared and contrasted between case facility and control facility, and will be analyzed as to whether the outcome is beneficial, neutral, or non-efficacious to the goals of providing good quality care to dementia patients at an assisted living facility. For example, a beneficial statement, indicating efficacy, might be, “I feel I am more patient, now that I understand dementia better”. A neutral statement might be, “My boyfriend was impressed that I got more training”. A non-efficacious statement might be, “I am more confused than ever after this training”. Likewise, specific program elements will be judged as reflecting efficacy or non-efficacy, based on responses. An efficacy indicative response might be, “I feel so much more confident about how to prevent pressure sores now”. A non-efficacy indicative response might be, “I thought the section on preventing pressure sores was really a waste of time because the State training includes more than enough of that topic”. Efficacy will also be considered as indicated when the State trained only caregivers show a pattern of responses showing that their jobs as caregivers seem meaningless or that they are looking for another line of work. A more efficacious response would be one that indicates that they feel, in spite of the challenges, that their work is a calling, an opportunity to help the most vulnerable population, or a way to develop themselves more. These examples are speculative, of course, and the actual data will be analyzed carefully to determine efficacious vs non-efficacious indicators. It is anticipated, based on the literature review, that efficacious answers will reflect increased confidence, tolerance, competence, occupational meaning, and a happier environment with minimal employee turnover. To address the fourth research question, How might the components of the Dementia Training Program be succinctly stated in a formalized model that could benefit other residential care facilities with a dementia-affected population?”, the interview responses will be taken into account and advisable modifications will be made to the model training program, if indicated. This will enable a polished training program to be formalized for wider facility application. It will also provide a model that can then be quantitatively tested, for more efficacy accuracy. Ethical Considerations Resident confidentiality will be protected by changing names of residents referred to by caregivers in interview responses. Caregiver confidentiality will be protected by assigning a subject numerical designation, rather than a name, in any report. The names and specific locations of the case and control facilities will not be revealed. Study files will be kept in a password protected file in the investigator’s computer and any hard copies or interview notes or audiotapes will be accessed only by Researcher and clerical assistant. No facility records will be taken off-site during the course of review. Researcher has full authorized access to training records and will need no additional site authorization. Comments will be reported discretely and anonymously, so as to eliminate any source identifying feature. A copy of the final dissertation will be made available to the case facility, for the interest and benefit of families and staff. Names will not be used in any publication, conference presentation, media release or interview, nor in the final dementia training model made available to other facilities. Researcher will secure informed consent from administration and interviewed, trained caregivers at the case and control facilities, prior to accessing data. Source data, already gathered, is covered by informed consent in facility records. This study involves no risk to humans or animals, other than the risk of lost privacy, which the study minimizes as carefully and professionally as possible. Foreseeing the possibility that there may be questions about Researcher bias, in view of the Researcher’s position at the training model source facility, Researcher has made full disclosure of her position, here in the Prospectus, and will continue to make full disclosure of her position in any presentation of findings. Researcher has no position in the case or control facilities. Complete objectivity in scientific endeavors is an ideal and never a reality, something to strive toward and never something to be certain about. In a quantum universe, the mere act of observing alters the “laws” of reality and the actions of the observed. Researcher values the scientific ideal of objectivity and will be ethically bound to report the facts, irrespective of personal desires. ­­­ References Alzheimer’s Association (2006). Know the top 10 signs [Web Blog Post]. Retrieved from http://www.alzheimers.org/know_the_10_signs.asp. Arizona Department of Health Services, Division of Licensing Services: Assisted Living Homes/ Centers, Adult Foster Care Homes & Adult Day Health Care Facilities. (2009). Retrieved from http://www.azdhs.gov/als/hcg/index.htm. Arizona Senior Housing Institute (2011). Caregiver Training Course Catalog. Retrieved from http://www.srhousing.org. Beer, C. D., Horner, B., A, O. P., meida, Scherer, S., Lautenschlager, N. T., et al. (2010). Dementia in residential care: Education intervention trial (DIRECT); protocol for a randomised controlled trial. Trials Journal, http://www.trialsjournal.com/content/11/1/63. Catholic Healthcare West. (2011). Huger Mercy Living Center. Retrieved November 3, 2011, from St. Joseph's Hospital and Medical Center: http://www.stjosephs-phx.org/Who_We_Are/188537 Creswell, J.W. (2009). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Thousand Oaks: Sage Publications. Davis, R. (2010, November 2). Dementia Training Puts Care Staff in Residents' Shoes. Retrieved November 4, 2011, from The Guardian: http://www.guardian.co.uk/society/2010/nov/02/dementia-training-care-staff-antipsychotics Dementia Competencies Workgroup. (2008). Knowledge and skills needed for dementia care in everyday language. Michigan Dementia Coalition. Eric M. Carlson, E. (2005). Critical Issues in Assisted Living: State Summaries. Washington, DC: National Senior Citizens Law Center. Hyer, K., Molinari, V., Kaplan, M., & Jones, S. (2010). Credentialing dementia training: The Florida experience. International Psychogeriatrics, vol 22:6, 864-873. McCoy, K., & Appleby, J. (2004, May 26). Problem With Staffing, Training, Can Cost Lives. Retrieved November 4, 2011, from USA TODAY: http://www.usatoday.com/money/industries/health/2004-05-26-assisted-day2_x.htm Moyle, W., Hsu, M. C., Lieff, S., & Vernooij-Dassen, M. (2010). Recommendations for staff education and training for older people with mental illness in long-term aged care. International Psychogeriatrics, Vol.22:7, 1097-1108. UN General Assembly NCD Summit. (2011, September 16). Declaration on Non-Communicable Diseases. Retrieved November 4, 2011, from United Nations General Assembly: http://alzheimerontario.org/local/files/Web%20site/Public%20Policy/UN%20Declaration%20NCD%20Summit%20Sep%202011.pdf Victorian Governemt, Australia. (n.d.). Staff: Culture Change, Education and Support. Retrieved November 4, 2011, from Dementia Changes: http://www.health.vic.gov.au/dementia/changes/staff.htm Yee-Melichar, D., Boyle, A. R., & Flores, C. (2011). Assisted living administration and management: Effective practices Model Programs in elder care. New York: Springer Pub. . Appendix A Variables, Phenomena, and Data Analysis Table 2 Research Questions Phenomenon Sources of Data Analysis Plan What are the key components of the Dementia Training Program under investigation? Dementia Training Program curriculum Five years of records of training curriculum content, delivery methods, and hours invested Examine records of dementia training administered in the facility and note (list) topics covered (example: wound care) and curriculum delivery styles (example: lecture with handouts and practical application rehearsal) and annual training hours per employee. Organize this information into a table. What are the qualitative differences in the response patterns of caregivers with multi-faceted dementia-specific direct-care training vs response patterns of caregivers with only State required dementia training? 1. Comparative or contrasting responses to dementia-specific and State training program Caregiver and administrator interviews at case and control facilities. Identify statements that are neutral, those that indicate benefit to the goals of dementia care, and those that are non-efficacious in that they show confusion, resistance or sabotage to the goals of dementia care. Are there distinctions between case and control facility responses? What program elements and outcomes indicate efficacy of caregiver training? Training program content, organization, and delivery influence on caregivers Caregiver and administrator interviews at case and control facilities. Identify statements that refer to specific training program topics, delivery methods, time duration, or teaching style as particularly beneficial or positively influential How might the components of the Dementia Training Program be succinctly stated in a formalized model that could benefit other residential care facilities with a dementia-affected population? Organization and presentation of the Dementia Training Program Documentation of curriculum organization and presentation implemented over past five years at facility under investigation Cross-referencing the curriculum table and the efficacy tables, construct a model Dementia Training Program that can be recommended and made available to other residential care facilities. Appendix B Arizona State Assisted Living Facility Staff Training Requirements “All direct-care staff members must have training in first aid and CPR. If the facility provides supervisory care services, a direct-care staff member prior to employment must complete 20 hours of training, or the amount of time necessary to verify that he or she demonstrates competency in each of the following topics: promoting resident dignity, independence, self-determination, privacy, choice, resident rights, and ethics; communicating effectively with a resident, a representative and relatives, individuals who appear angry, depressed, or unresponsive; managing personal stress; preventing abuse, neglect, and exploitation and reporting requirements; controlling the spread of disease and infection; recordkeeping and documentation; following and implementing resident service plans; nutrition, hydration, and food services; assisting in the self-administration of medications; developing and providing social, recreational, and rehabilitative activities; and fire, safety, and emergency procedures. If a facility is licensed to provide personal care services, a direct-care staff member must comply with training requirements in addition to those required of staff members providing only supervisory care services. Prior to employment a staff member must complete 30 hours of training, or the amount of time necessary to verify that he or she demonstrates competency in each of the following areas: the aging process and medical conditions associated with aging or physical disabilities; assisting residents in activities of daily living and taking vital signs; and medications. If a facility is licensed to provide directed care services, a direct-care staff member must meet training requirements on top of the requirements applicable to supervisory care services and personal care services. Prior to employment, a staff member must complete 12 hours of training, or the amount of time necessary to verify that he or she demonstrates competency in each of the following topics: Alzheimer’s disease and related dementias; communicating with a resident who is unable to direct self-care; providing services, including problem solving, maximizing functioning, and life skills training for a resident who is unable to direct self-care; managing difficult behaviors in a resident who is unable to direct self-care; and developing and providing social, recreational, and rehabilitative activities for residents who are unable to direct self-care. Training must be conducted by one of the following: a nurse, physician, physician assistant, or related medical professional with at least 2 years of health-related experience; an individual with at least a bachelors degree in social work, gerontology, or closely-related field and at least 2 years of health-related experience; an instructor employed by an accredited junior college, college, university or health care institution to teach health-related courses; or an assisted living facility manager with at least 2 years experience serving as a manager in a residential care institution. At least six hours of continuing education is required annually, with an additional two hours for providing personal care services, or an additional four hours in directed care services. A facility shall ensure that there are sufficient staff members, consistent with the level of service the facility is licensed to provide, to provide services established in each resident’s service plan, and to meet the needs of each resident including scheduled and unscheduled needs, general supervision, and the ability to intervene in a crisis 24 hours a day” (Eric M. Carlson, 2005). Read More