Unlicensed Caregiver Experience in Dementia Care Dementia Care

Nearly 5.4 million people in the United States suffer from Alzheimer's disease, the most common form of dementia (Chodosh et al., 2012, p. 85). The health care burden this places on nursing homes, assisted living facilities, and hospices is significant, especially since some dementia sufferers exhibit disruptive and sometimes dangerous behaviors. These behaviors include verbal and physical aggression, wandering, restlessness, insomnia, irritability, and repetitive vocalizations (McKenzie, Teri, Pike, LaFazia, and van Leynseele, 2012, p. 96). Nearly 1 million Americans currently reside in assisted living facilities and an estimated 45 to 67% suffer from dementia. Of these, 34 to 56% exhibit behavioral problems.

The impact of dementia care on professional caregivers is therefore significant, especially when dealing with patients with more advanced forms of the disease. Early studies suggest that dementia care training can have a positive impact on both the patient's health and the care experience of professional caregivers (McKenzie, Teri, Pike, LaFazia, and van Leynseele, 2012, p. 96-97), but the bulk of the care burden in these facilities falls on the shoulders of unlicensed staff. With a resident to staff ratio of 14 to 1 in assisted living facilities, a lack of dementia care training for unlicensed caregivers (ULC) is predicted to contribute significantly to poor morale, high turnover, and reduced care quality.

Towards the goal of improving dementia care in assisted living facilities, McKenzie and colleagues (2012) investigated the reactions of ULC to dementia...

This qualitative experimental approach collected data concerning the perceived care experience of ULCs and the frequency of behavioral problems exhibited by residents with dementia.
Methods

The data was collected from 12 assisted living facilities and based on 87 ULC-patient pairings. Only dementia patients with a formal diagnosis and exhibiting behavioral problems that caused problems for caregivers were included in the study. Informed consent was provided by a family member. Perceived care experience data was collected using a questionnaire that required about 40 minutes to complete. An interviewer was present and the interview occurred during regular working hours.

Patient behavioral data was collected using the Revised Memory and Behavior Problems Checklist (RMBPC), which was filled out by the caregiver at least twice a week. This instrument records both observed dementia-related behaviors and the reaction of the staff members.

Results

The majority of ULC subjects was female, non-white, and did not speak English at home (McKenzie, Teri, Pike, LaFazia, and van Leynseele, 2012, p. 98). Of these, 37% reported receiving no formal dementia care training at their current job and the median hours of training overall was just 2 hours. The residents with dementia were on average 87 years old, 86% female, and 92% Caucasian. The average Mini-Mental State Exam score was 15.3 (std. dev. = 5.03), which suggests that most patients suffered from moderate cognitive impairment.

Memory problems were the most common dementia-related symptom encountered by ULCs (91%)…