Unlicensed caregiver stress and dementia care training in assisted living facilities

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 patients exhibiting behavioral problems. 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.

Discussion

The primary finding of this study is that dementia-related behaviors in an assisted living setting have a significant impact on the experiences of ULCs. In essence, the more frequent the behaviors are encountered the more negative the caregiver will perceive their experience, with behaviors related to depression triggering the biggest reactions.

The authors of this study selected a specific question to answer and provided the theoretical context for why this question is important enough to spend research dollars on (Ragin, Nagel, and White, 2004, p. 3-4). The experimental approach was outlined clearly, methods for data collection not controversial, and data analysis straightforward. As designed, this study could be easily replicated by others.

The limitations of the study were discussed openly and honestly by the authors. The main limitation was the ULC sample contained a significant number of certified nursing assistants (53%), which are considered licensed caregivers (McKenzie, Teri, Pike, LaFazia, and van Leynseele, 2012, p. 98). Despite this limitation, this sample still reported low levels of dementia care training overall. It would have been nice though, if the data could have been stratified by unlicensed and licensed caregivers to see if there was an effect. In addition, it would have also been interesting to see if the amount of dementia training influenced the perceived caregiver experience.

The authors discuss the relevance of the findings to prior research, which suggests that dementia-related behavioral problems have a significant negative impact on the morale of caregivers, from registered nurses to nursing assistants. The findings presented by McKenzie and colleagues (2012) reveal that the negative effects of dementia care is universal for all professional caregivers and provides empirical support for promoting increased dementia care training for all caregivers.