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Dementia Care Training: Policies and Priorities Randi Chapman Alzheimer’s Association Director, State Affairs

Patty Barnett Mouton Alzheimer’s Association, Orange County Chapter VP, Outreach & Advocacy

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Overview • Alzheimer’s Association and Alzheimer’s Disease • Why Dementia Training is Necessary • Dementia Training Concepts • State Policies • Policy Recommendations • CARES/EssentiALZ #ALFA2014


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.

Alzheimer’s is a progressive disease of the brain that destroys brain cells, causing problems with memory, thinking and behavior.

3 stages: pre-clinical, mild cognitive impairment (MCI), dementia due to Alzheimer’s

Advanced Alzheimer’s, cognitive and functional abilities decline: failure to communicate and recognize loved ones, 24/7 care, bed-bound

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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 #ALFA2014


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 •

Poor training has also been identified as one of the factors that contributes Improved Ability to Provide Dementia Care 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… A Great Deal

45%-67%

Moderate Improvement High levels of training have been positively associatedLittle with Improvement recruitment of home health workers No Improvement

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 Individuals with ADRD in Assisted Living jobs

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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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State Examples: Alabama and Mississippi Alabama

Mississippi

• 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

• 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

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Current State Legislation: CT and MN 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 #ALFA2014


California’s 10-year History  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  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: Assembly Bill 1570 Chesbro      

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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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 ď Š ) there is no perfect training method evidence-based curricula, reliable passionate instructors!

use Adult Learning Principles #ALFA2014


Overall Policy Recommendations

• Crisis provides opportunity e.g. Tylenol • Do what will improve care regardless of what is “required” • Perception is reality • Confidence MATTERS! #ALFA2014


 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 #ALFA2014


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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Visit Our Booth--1226 • Stop by to ‘Test Drive’ a training • Learn about Community Resource Finder – Make sure our constituents can find you – Online tool for accessing local resources & services – Create or update your profile

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HOMEWORK

HELP LINE 1 800 272 3900

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QUESTIONS Randi Chapman National Alzheimer’s Association rchapman@alz.org

Patty Mouton Alzheimer’s Association, Orange County Chapter pmouton@alz.org HELP LINE 1 800 272 3900 #ALFA2014


2014 alfa conference dementia care