Caregiver Training
As mentioned previously, one way to empower caregivers, decrease turnover, and increase client satisfaction is to provide relevant training. Federal requirements for Certified Nurse Assistant include a minimum of 75 hours of training (Missouri requires 175 hours; most states are 75-120 hours). (PHI, 2017). For personal care aids, there are no federal or standardized training requirements in some states and inconsistent requirements in others. Most states do not have training requirements for home health aides. Interesting, eh?
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The Caregiver Training website offers DVDs and packages to meet state training requirements if they exist. (Texas training DVDs OnCourse Learning Healthcare (n.d). Retrieved January 1, 2018 from https://www.careandcompliance.com). The CNA package for Texas, for example, is 12 hours of DVDs and is said to meet ‘federal in-service requirements’. The Home Health Aide (HHA) continuing education package is also 12 hours in Texas. An individual can tailor their own training package by choosing from these (mostly) 1-hour topics:
Postural support Elder abuse Recognizing diversity
Infection control Bloodborne pathogens ADLs
Emergency procedures Aggressive behavior Intro to dementia care
Pressure ulcers Falls precaution in AL Resident rights
End of life Food safety in residential care Diabetes
General workplace safety Dementia care: Sundowning
Specialty care needs (oxygen, catheter, etc.)
Assistance with medication administration
What if an assigned caregiver has selected training in areas that do not apply to the individuals currently in their care? What if they lack the expertise and experience for the skills the client requires?
The American Caregiver Association offers a 200-hour course for Caregiver Certification. The course consists of 72 topics. Three of these topics deal with cognitive impairment. These topics are 1) communicating with cognitively impaired residents, 2) understanding the behavior of cognitively impaired residents, and 3) reducing the effects of cognitive impairment. In addition, only 3 of the 72 areas of training address behavior. These are:
Modifying the caregiver’s behavior in response to resident behavior
Responding to resident behavior, and
Anticipating and addressing the needs and behaviors of residents with dementia or AD.
Is it any wonder that in-home caregivers may not know how to address dementia care issues?
The IPA, International Psychogeriatric Association (2010), states that BPSD rather than cognitive functioning or difficulty with ADL impose the greatest burden on caregivers. BPSD with the most negative impact are physical aggression, wandering, resistance to care, paranoid delusions, sleep disturbances, and screaming. It is also known that specific behaviors of the caregiver exacerbate BPSD. These include:
Changes in the routine or environment
Power struggles (rigid or controlling insistence to do things in a particular way)
Demands exceeding capability
Unmet needs
Excessive criticism
Repetitive question or quizzing to ‘make patient remember’
Anger, exasperation, or aggression
Talking to the patient as if he/she were a child (IPA, 2010, p. 47)
Another study by Teri et al (2005) found training in behavior and mood management techniques in addition to helping the caregiver develop support strategies reduced the severity and frequency of BPSD, decreased caregiver depression and burden, and resulted in less caregiver reactivity to behavioral issues/problems. Such training should be offered to family caregivers when a diagnosis of dementia is made. It should also be mandatory for personal care workers.
Training specific to dementia caregiving needs to include an explanation of Alzheimer’s disease and related disorders, how to assist with activities of daily living, problem solving for challenging behaviors, and strategies for communicating with the cognitively impaired (Leading Age Minnesota, June 2015). Training should also include topics of transferring clients, bathing, incontinence care, as well as an understanding of how one’s own behavior impacts the client. In fact, competency-based training in dementia care is paramount to caregiving efficacy. Competency-based training requires staff to demonstrate the knowledge to complete a task or handle an issue. Best practice training would include a ‘skill day’ in which staff learns a specific skill or skill set and then demonstrates acquired skills in role plays or other similar situations.
After all, isn’t this what real live caregiving is all about?
Sources:
International Psychogeriatric Association. The IPA complete guides to behavioral and psychological
symptoms of dementia. Milwaukee, WI: International Psychogeriatric Association, 2010,
[PHI maps of state training requirements for care positions]. PHI Group, 2017. Retrieved November 12, 2019 from https://phinational.org).
Teri L, McCurry SM, Logsdon L, Gibbons L. Training community consultants to help family members improve dementia care: A randomized controlled trial, The Gerontologist, 2005; 45(6):802-811.