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Evaluating a National Person-Centered Training Program to Strengthen the Dementia Care Workforce

This article originally appeared in the School of Social Work 2024 Fall Impact Report.

Alzheimer’s disease affects almost seven million people across the country. When people living with dementia need more support than can be provided by their families, they often move to assisted living communities.

Today, more than 40% of almost 820,000 assisted living residents have Alzheimer’s disease or a related dementia. Staff providing care must understand, and be able to respond to, their needs.

Sheryl Zimmerman, a distinguished professor and associate dean for research and faculty development at the University of North Carolina at Chapel Hill School of Social Work, runs a research study funded by the National Institute on Aging — one of the National Institutes of Health — to evaluate a training program developed by the Alzheimer’s Association that, in the process, has vastly extended the access of online training to direct care staff. The $3.9 million grant covers the project that began in 2022 and will run through 2027.

The direct care workforce in assisted living provides the majority of residential long-term care for individuals with dementia, more even than in nursing homes. Yet similar to nursing homes, assisted living communities are chronically understaffed. Workers tend to be young and are not required to have much training. Some training can be acquired on the job, but, “there are real things to learn,” Zimmerman said. Staff shortages leave direct care staff overextended; they don’t get a lot of training and turnover is high.

“It’s important to train people up to a level of competency,” Zimmerman said. “People who feel more competent are more satisfied and less likely to quit their jobs.”

Well-known in her field, Zimmerman received the 2024 Distinguished Career Achievement Award from the Society for Social Work and Research. In 2018, the Alzheimer’s Association invited her to co-lead an effort to gather evidence that they would use to develop dementia care practice recommendations. From the recommendations, the group crafted an online training program called essentiALZ to provide direct care staff the tools they need to work more effectively with persons living with dementia.

The group also created a companion Project ECHO series, a six-week online mentoring program for administrative and direct care staff. Based on the original ECHO model, it brings together people from different organizations to learn from one another. During the COVID-19 pandemic, 9,000 nursing homes across the country used it to learn one another’s best practices.

Zimmerman’s research study takes a three-pronged approach. She compares caregiver competency and care before and after taking only the essentiALZ training or participating in both essentiALZ and Project ECHO. Then, she looks for any differences between each of those two groups and a control group that didn’t participate in any training. Families of residents also weigh in via a questionnaire to note any changes they see in their relatives after staff are trained.

For her subject pool, Zimmerman invited assisted living national chains to participate. She and her team are conducting and evaluating training in 126 assisted living communities over three waves. Her first cohort consisted of 42 facilities, among them six of The Bristal Assisted Living communities, where Mark Paretti is vice president of resident experience. While some staff members at each community had previously completed the essentiALZ training, Zimmerman’s study allowed Paretti to extend person-centered care training to all direct care staff in the participating communities.

Staffing is a challenge in the industry across the board, he said, and the number of people living with Alzheimer’s or memory loss issues continues to grow. The training program supports staff members by providing information about the symptoms and progression of dementia. The program also offers recommended care planning and assessment strategies and approaches to effective communication, which are grounded in real-world, interactive video case studies and expert-led clinical discussion, emphasizing person-centered care in community-based settings.

“The goal of much research is to slow or stop the disease, but we’re not there yet,” Paretti said. “There’s not as much focus on those living with the disease and how to support those caring for them. If this training provides team members with more knowledge, we’re enabling them to do better and feel better about themselves, to feel strongly enabled, encouraged and have great knowledge of what to do.”

The training program could point to changes the organization needs to make, such as giving staff more time to do certain tasks or changing the way staff are allocated. For example, in training staff how to deal with agitated behavior, essentiALZ may suggest what causes the agitation, and Project ECHO might get agency leaders talking about what systemic changes to make to reduce the source of the agitation.

As systems-level work, Zimmerman’s research has the potential to improve multiple constituencies within the system.

“Training benefits the people with dementia, the workforce and the organization,” Zimmerman said. “It’s a win-win-win.”