Supporting the Competence of Dementia Care Teams

Dementia care is one of the most challenging types of patient care in every setting — from in-home care to assisted living, skilled nursing facilities, and hospitals. Having a care team with the competence to handle the complex challenges of people living with dementia is vital to providing respectful and optimal care.

“The biggest challenge in dementia care is creating a community,” said Teepa Snow, MS, OTR/L, FAOTA, during the 2022 Relias Impact Nation conference. “It’s hard to have a community when providers are leaving or don’t know what they are supposed to do and how to do it.”

People with dementia experience physical and behavioral issues like disorientation, confusion, difficulty managing finances, and resistance to care. The needs of a person with dementia can vary daily and hourly. Their behavior and responses to care can also change.

Because of these demands, clinicians and caregivers must have dementia expertise to appropriately manage the varied patient needs and the related stress of providing this type of care.

Staff turnover

Turnover adds pressure to patients and their families and hinders providers from delivering optimal dementia care. A study published in the Journal of the American Geriatric Society analyzed data from 13,631 nursing homes from October 2018 through September 2019. The average annual staff turnover rates were about 44% for registered nurses and 46% for total nursing staff. The data showed that higher turnover was consistently associated with lower quality of care.

An earlier study published in International Psychogeriatrics, which analyzed studies on stress and burnout among staff in long-term care facilities for people with dementia, found that most staff experienced low or moderate burnout levels. Factors associated with higher burnout and stress included lower job satisfaction and feeling unsupported.

“There is a lot of distress in dementia care at this point,” said Snow. “There were challenges before COVID. But since COVID, the degree of distress and the fatigue factor [means that] caregivers are reaching the end of their reserves and resources.”

Build team confidence

Attention to staff and professional development can help manage these stressors. The goal of building a dementia-competent community is to establish team members who are confident in the care they provide. “They don’t have to think about what they do; they model what they do,” Snow said. “Any newcomer to the team who sees this skill set in action becomes aware, seeks knowledge, and wants to become skillful and competent.”

To become competent in dementia care, team members need to go through the following steps:

• Unawareness — Recognize what you don’t know about dementia and dementia behaviors.
• Awareness — Appreciate what you learn and how it can help you provide care.
• Knowledge — Ask to learn and understand more.
• Skills — Develop the necessary skills for the situation and build them into your habit of care structure.

Focus your training

Alzheimer’s disease is the most common cause of dementia among older adults. According to a 2022 report from the Alzheimer’s Association, the population of Americans age 65 and older with Alzheimer’s is projected to grow from 58 million in 2021 to 88 million by 2050. The projected increase will create a demand for more clinicians and nurse aides with expertise in dementia care.

To personalize care, prepare your staff to treat people with dementia respectfully and effectively. Online and blended learning options can meet the needs of healthcare professionals in different settings.

Simulations can help them understand the challenges that a person with dementia faces every day. A Relias video, A Day in the Life of Henry, provides a virtual reality experience to help clinicians and caregivers understand the experiences a person with dementia has and how they affect their thoughts, feelings, and behaviors. It shows how residents perceive their environments and how interactions with caregivers affect their reactions.

When you plan your dementia care education, consider the following topics:

• Promoting effective communication
• Understanding dementia, depression, and delirium
• Managing behavior challenges
• Treating clinical conditions
• Responding to hallucinations and delusions
• Supporting functional abilities (activities of daily living)
• Building relationships and trust
• Working with family and friends

People with dementia deserve staff members equipped with up-to-date knowledge and skills to respond to their needs. Supporting your care teams with specialized training in dementia care will reduce stress and employee burnout, increase retention, enhance your organization’s reputation, and, most importantly, improve the quality of care you provide to patients and their families.