Program Budget and Cost Analysis Line-Item Budget for an in-Service Dementia Care Training Program

Florida now requires all direct-care staff working with dementia patients to receive specialized training. The curricula offered must be vetted by the Training Academy of the University of South Florida's Policy Exchange Center on Aging, otherwise assisted living facilities, nursing homes, adult day care, and hospices will be unable to accept patients with dementia into their facilities. In order to meet these statutory requirements and improve patient care, an in-service training program in dementia care will be instituted for a hospice facility located in Florida.

The Hospice House in Cape Coral, Florida maintains 36 beds for patients with terminal illnesses. On average, a little over 60% of the residents suffer from dementia at any one time, which is consistent with national trends (Williams, Hyer, Kelly, Leger-Krall, and Tappen, 2005, p. 98). The number of patients tends to average around 29 and staffing levels currently provide at least one nurse per two patients 24 hours per day, although the goal of one nurse per 1.5 patients is actively being pursued (IAHPC, 2009). The nursing staff consists of an even mix of RNs, LPNs, and CNAs. The medical staff also consists of four full-time physicians, one physiotherapist, one clinical psychologist, one pharmacist, three bereavement counselors, and two social workers. Support personnel include those involved in meal preparation, administrative duties, and 24-hour custodial/janitorial services.

Hospice residents with dementia place special demands on professional caregivers who staff such facilities, because they often suffer from significant emotional and cognitive problems that create safety issues for staff, other patients, and visiting family members (Irvine, Ary, and Bourgeois, 2003, p. 270). The additional burden that these patients place on staff who has not received specialized training leads to poor morale, high turnover, and staffing shortages, at a time when the need for end-of-life caregivers is increasing.

The staffing and patient safety problems are unnecessary, since specialized training in dementia care has been shown to improve workplace safety and job satisfaction, and reduce staff turnover (Irvine, Ary, and Bourgeois, 2003, p. 270). Under Florida law, any staff that could come into contact with patients suffering from dementia must receive a minimum amount of specialized training, while staff involved in direct care must receive advanced training (Hyer, Molinari, Kaplan, and Jones, 2010, p. 869). For example, janitorial and food preparation personnel would be required to understand Alzheimer's disease from a clinical perspective, understand the challenges caregivers face, and to develop the necessary skills to effectively communicate with residents suffering from dementia. In addition to these topics, direct care personnel would be required to receive advanced training in behavioral management, stress management, coping with family concerns, designing the lived environment, and patient care ethics.

Line-Item Budget for an In-Service Dementia Care Training Program

Full-Time RN Dementia Care Instructor and Training Supervisor

$83,000

Part-Time RN Dementia Care Instructor and Training Supervisor Assistant

$45,400

Conference Room and Training Supervisor Office Construction

$72,721

Staff Overtime Allotment for Trainin

$20,000

Travel Budget for Instructors

$3,000

Background Screening for Instructors

$55

CARES® Unlimited 1-Year Site License

$2,000

Learning Center Reference Library

$1,500

Textbooks

$1,500

Computer Equipment and Accessories

$4,085

Microsoft Office Professional 2010 Software

$440

Learning Center Projection System

$800

Miscellaneous Office Supplies

$1,200

Refreshment Fund

$1,500

TOTAL

$237,201

Justification of Expenses

Full-time RN Dementia Care Instructor and Training Supervisor $83,000 Total compensation is $83,000, of which $58,300 is base salary. The person hired for this position will be certified for dementia care by either the State of Florida or the Alzheimer's Association. The Hospice House has close to 100 full-time employees, of which the majority either is involved in direct care or may be required to interact with a dementia patient at some point during their shift. Given that the nurse to patient ratio is still below the ideal goal, it is easy to justify employing a full-time dementia care instructor that can step in should staffing needs temporarily fall short of demand. This will be a permanent position and training will be the top priority, in order to avoid overreliance on the extra personnel at the expense of training goals. Creating and filling this position will allow the Hospice House to meet current Florida state requirements, which require that direct care personnel receive four hours of training and any other staff that...

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Part-Time RN Dementia Care Instructor and Training Supervisor Assistant $45,400 $45,400 is total compensation, of which $33,000 is the base salary. In order to meet the training requirements for all staff, regardless of which shift they may be assigned, a support position will be created that will provide training and training oversight for personnel working the graveyard shift. The part-time instructor will work under the direction of the training supervisor, whose shift will straddle the two daytime shifts. Should the person filling this position desire to work full-time, they will be encouraged to work as direct care personnel and compensation will be adjusted accordingly.

Conference Room and Training Supervisor Office Construction $72,721 To provide enough room for group training and a secure location for maintaining staff training records, an office and conference room will be added to the first floor of the Hospice House. The learning center construction costs are estimated to be approximately $158 per square foot (Dalvit, 2010) and the design calls for a 15' by 30' foot structure. The area added to the existing structure is 450 square feet, so the estimated cost of construction is $71,100. The expected additional property tax burden due to the addition is $1,621 per year at current commercial property rates (Lee County Property Assessor, 2011). Additional property will not need to be purchased, since land was already available. The increase in utility costs for the conference room and office is expected to be negligible compared to the rest of the facility.

Staff Overtime Allotment for Training $20,000 As a practical matter, group training sessions will take place either after a regular shift has ended or prior to the start of a regular shift. The demand that hospice care places on direct care providers, which is frequently unpredictable, makes it difficult, if not impossible, to schedule group meetings during regular working hours. For this reason, compensation in the form of overtime pay will be provided to facilitate group-training sessions. The State of Florida requires at least four hours of dementia care instruction for direct care staff (Hyer, Molinari, Kaplan, and Jones, 2010, p. 866). More recently, the Florida legislature began considering amendments to existing laws that would require the staff of special care units for Alzheimer's patients complete eight hours of an approved training course and four hours of continuing education per year (Polzer, 2012, p. 39-40). At any one time, close to 55 direct care staff are employed by the Hospice House, which translates into 660 hours of training required per year, assuming no staff turnover. New direct care employees who are not certified in dementia care would be required to complete an hour of in-service training within 30 days of the start of employment. Based on the expected mixture of direct care staff, including physicians, RNs, LPNs, CNAs, and health aids, an approximate overtime wage would be $30 per hour. At 660 hours per year, an approximate overtime allotment would amount to $20,000 per year.

Travel Budget for Instructors $3,000 In order to maintain a progressive training program, instructors will be encouraged to attend annual meetings relevant to dementia care and Alzheimer's disease. Travel and accommodations will be provided. For example, the Meetings of the Minds Dementia Conference (2012), being held in St. Paul, Minnesota on March 17, 2012, is sponsored by the Alzheimer's Association and the Mayo Clinic.

Background Screening for Instructors $55 The amount budgeted is for two, level-one criminal history record check at both the state and national level, as required by Florida law and the Department of Elder Affairs (Florida Department of Law Enforcement, 2012, p. 12). The Florida legislature is considering requiring level-two criminal history record checks through the FBI, using the applicants' fingerprints. If this amendment to the current statute is passed the cost will increase slightly.

CARES® 1-Year Unlimited Site License $2,000 The learning center will be outfitted with two computers for use by any staff required or interested in practicing their skills using the online interactive CARES® program. The CARES program meets all mandated requirements for dementia training by the State of Florida and has been approved by the University of South Florida Training Academy on Aging (HealthCare Interactive, 2012). The CARES program also provides access to the training and examination material that the Alzheimer's Association require to become certified in dementia care. All direct care staff will be required to complete all the training modules and encouraged to obtain their Alzheimer's Association certification.

Reference Library $1,500 Textbooks on dementia and palliative care will be purchased for the learning center, to be used as a reference library. For example, the Oxford Textbook of Palliative Medicine, by Doyle et al. (2004), would provide a comprehensive overview of all relevant topics. A more user-friendly example would be Palliative and End of Life Care: Clinical Practice Guidelines, 2nd Edition,…