MDS Alert

Make sure your onboarding program and continuing education cover dementia.

There are more than 5 million people in the U.S. living with dementia, according to the Alzheimer’s Association, and many reside in nursing homes. “At the age of 80, three-fourths of people with Alzheimer’s are expected to be admitted to a nursing home, compared with just 4% of the general population,” the Alzheimer’s Association says.

With COVID-19 protocols still affecting how people interact, as well as requiring more social isolation, residents with dementia may really be struggling. Staff turnover is especially high right now, during the pandemic, so it’s especially important to make sure staff are provided with the proper education. With a good onboarding program that helps both direct care staff and staff providing other services feel prepared for and able to understand — and even connect with — residents with dementia, everyone will feel calmer and more comfortable.

Devote More Hours to Training

Advocacy groups like the Alzheimer’s Association, through its Alzheimer’s Impact Movement, are encouraging states to enact measures that would provide some protection for residents with dementia living in nursing homes, via some sort of standardized education requirements for care staff. Even if your state does not have any such requirements, your facility can perhaps serve residents best by following these recommendations.

“Require a minimum of six to eight hours of evidence-based dementia training for all those who serve individuals with dementia,” the Alzheimer’s Impact Movement says. The advocacy group suggests that states make any such trainings portable across facilities or care settings, which might emphasize for workers that the training is about real and usable skills instead of just checking off boxes.

One example: Certified nurse aides require at least 75 hours of training in most states, but dementia is only one of around 40 topics that must be covered, the Alzheimer’s Impact Movement says. Providing enough education for staff to be able to genuinely support residents living with dementia is a much higher bar to meet.

“Effective communication is critical when caring for a person with dementia. Changes in a person’s ability to communicate can vary based on their environment and where he or she is in the stage of the disease,” the Alzheimer’s Association tells AAPC.

One of the most important takeaways for staff interacting with residents living with dementia is that the disease affects each person differently, so there’s no one-size-fits-all approach. However, some general tips are to speak and interact directly with the person, and to try and conduct conversations in quiet spaces with minimal distraction. Regardless of whether the resident is in the early, middle, or late stage of the disease, it’s important to speak clearly and slowly, the Alzheimer’s Association says. Utilize eye contact, as well as other forms of nonverbal communication, like pointing or gesturing.

Make training part of your onboarding program, but focus on continuing education as well. These are skills staff will use every day and should be treated as such.

Try These Tools, Focus On These Staff Members

Making sure people providing care directly to residents living with dementia are sufficiently educated about dementia is an obvious first step. This includes people with a range of titles, roles, and responsibilities, including but not limited to registered nurse, licensed practical nurses, licensed vocational nurses, nurse practitioners, certified nurse aides, nursing assistants, physician assistants, home health or personal care aides, activities directors, feeding assistants, social workers, dietary staff, and all therapy staff, the Alzheimer’s Impact Movement says.

But don’t forget about other people working in the facility, who may have less intensive but frequent interactions with residents living with dementia. This includes administrative staff like managers and administrators, as well as housekeeping, front desk, and maintenance staff.

You can boost your education through the Alzheimer’s Association Project ECHO (Extension for Community Healthcare Outcomes), “the free telementoring program that uses videoconferencing technology to build workforce capacity and improve access to specialty care in local communities,” the Alzheimer’s Association notes.

This kind of education “emphasizes the importance of a team-based approach to care using the entire team of care providers, from the front desk to social workers to pharmacists, to help keep people safe and engaged in the delivery of care during the pandemic,” the Alzheimer’s Association says.

Resources: Find out more about Project ECHO here www.alz.org/professionals/health-systems-clinicians/echo-alzheimers-dementia-care-program.

Emphasize Adaptations to COVID-19

Knowing some aspects of living with dementia can vastly improve the resident and staff experience while mitigating the risks of COVD-19.

“Emergency situations, such as the current COVID-19 pandemic, present special challenges for people living with dementia and their care team,” the Alzheimer’s Association says. “It is important that all members of a person’s care team, including front-desk staff, recognize and adapt for these added challenges to ensure people living with dementia receive the best possible care.”

For example, underscore the importance of hand hygiene by placing written reminders in the bathroom, near the sink, and throughout the facility, wherever you’ve placed public hand sanitizer.

Personal protective equipment (PPE) generally and masks, specifically, can be an issue for people living with dementia or Alzheimer’s Disease (AD). There is now a type of mask with a clear plastic panel that the CDC recommends for some populations.

“People with AD can have sensorial deficits and perceptive troubles, leading to difficulties in seeing, facial and emotional recognition, hearing, and understanding their interlocutors, and even much more, when face masks are added to physical distancing, because they are confronted with a physical barrier and a fragmented perception of the face, which may no longer even induce a feeling of familiarity and no emotional recognition,” says Roger Gil, emeriti professor of neurology at University Hospital at Poitiers and director of the ethical reflection area of Nouvelle- Aquitaine in France, and Eva M. Arroyo-Anlló, who works at the department of psychobiology at the University of Salamanca, Neuroscience Institute of Castilla-León, Spain.

Gil and Arroyo-Anlló suggest that procuring and using transparent face masks could make people living with dementia more at ease without compromising COVID-19 precautions.