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Be sure you cover the basics
If your staff works with Alzheimer’s patients, even if those patients make up a small percentage of your patient population, you understand the necessity of Alzheimer’s training. And, if it’s been a while since your last Alzheimer’s inservice, it’s probably time for an update.
"The depth of your training depends on the specific purpose of your inservice," notes Betsy Pegelow , RN, MSN, director of Special Projects, Channeling Program, an Alzheimer’s caregiver support program of the Miami Jewish Home and Hospital for the Aged. "But whether we are training our dementia-specific case managers, caregivers, or support staff, there is some basic content that we always cover."
The following is some basic information that Pegelow suggests anyone working with Alzheimer’s patients should receive — whether they are family members, housekeeping staff, nurses, social workers, or other professionals:
• Characteristics of dementia. "We cover not only the definition of dementia, theories for the causes of dementia, and diagnostic testing for dementia, but we also cover the impact of dementia on the caregiver and extended family," she explains. "We want our staff to understand not only the common problems they might encounter when working with the families of Alzheimer’s patients, but how coping with those problems affects families."
• Stages of disease. "Alzheimer’s is a progressive disease. Your professional staff — in particular — case managers, should understand how to stage the disease in order to help families plan and anticipate issues common to each stage," says Pegelow.
• Drug therapy. "There are drugs available to enhance memory and manage behavioral issues. Staff and caregivers should be updated regularly on the newest drug therapies," she adds.
• Caregiver issues. "Case managers, aides, and home health providers must partner with caregivers when working with Alzheimer’s patients. Their relationship will be more with the caregiver than the patient."
• Dementia-proofing the house. "Living with an adult with dementia is very similar to living with a toddler," she notes. "Case managers, social workers, and home health staff should help caregivers evaluate safety issues in the home in order to limit the risk of accidents and injuries."
• Techniques for behavior management. "There are so many behavioral issues involved in Alzheimer’s care," she notes. "There is agitation and the potential for injury. There is aggressive, abusive behavior." Pegelow teaches her staff and caregivers communication and distraction techniques to help manage behavior common to Alzheimer’s. "Some techniques can be used with any frail, elderly population. However, redirection, distraction, and cueing are specific to dementia clients." (Both the national office and your local chapter of the Alzheimer’s Association have resources for training staff in these and other techniques for managing Alzheimer’s patients. Also see editor’s note at end of this article for other resource suggestions.)
• Legal and financial issues. "This is especially important for caregiver training," notes Pegelow. "The primary caregiver must have an emergency plan that clearly outlines what should happen if the caregiver becomes ill or injured." She adds that it’s your staff’s responsibility to explain the importance of such a plan and help the caregiver develop it. A case manager or social worker often fulfills this task.
• Resources. Of course, health care providers understand the value of information. Pegelow has a library of written materials and videos specific to dementia, and she refers to them regularly.
She has also taken all the handouts she’s assembled through the years to fill a resource manual for her staff. The manual has plastic pages that staff members can pull out and copy for families as needed. Many of the sheets discuss specific issues, such as coping with incontinence.
However, no inservice replaces the need for attending professional meetings, says Pegelow. "We send our staff to an annual meeting. We are fortunate enough to have a one-day work- shop in our local area that provides updates on Alzheimer’s and breakout sessions. It’s very important to keep current, and nothing is as effective as a professional meeting," says Pegelow. "Consumers are very sophisticated. They have access to the latest developments via the Internet. Case managers have to be knowledgeable enough to answer caregivers’ questions."
[Editor’s note: One Alzheimer’s resource that Pegelow strongly recommends is now available through the Alzheimer’s Association, Public Policy Division, in Washington, DC. Resources for Serving Caregivers in Culturally Diverse Communities: A Compendium of Products Developed through the HRSA-AOA Alzheimer’s Demonstration Grant to States Project sells for $12. It lists Alzheimer’s-specific community resources with an emphasis on respite services and other caregiver support programs. It includes information on handbooks, manuals, pamphlets, videos, and other training materials. Pegelow notes that most local chapters of the Alzheimer’s Association can also provide training for caregivers, staff, and aides. To order the compendium, contact the Alzheimer’s Association, Public Policy Division, 1319 F St., N.W., Washington, DC 20004. Telephone: (202) 393-7737.
The national office of the Alzheimer’s Association is also an excellent resource. Contact the Alzheimer’s Association, 919 N. Michigan Ave., Suite 1000, Chicago, IL 60611-1676. Telephone: (800)272-3900.
In addition, the National Chronic Care Consortium and the Alzheimer’s Association recently completed a joint project called the Alzheimer’s Disease Project. As part of that project, the organizations compiled and released a package that contains information on tools available to assess and treat patients with all stages of dementia, from early identification through the end-of-life in managed care settings. For more information, contact the National Chronic Care Consortium, 8100 26th Ave., S., Suite 120, Bloomington, MN 55425. Telephone: (612) 858-8999.]