Direct Care Workers’ Views on Improving Care for People with Dementia in Residential Setting

Abstract

Background: Dementia is a brain disorder affecting memory, mood, personality and behaviour. An estimated 5 million people in the United States (US) have dementia and the vast majority of elders in residential care are cognitively impaired. Direct care workers, Certified Nursing Assistant (CNAs) and Care Assistants (CAs), provide most of the hands-on assistance for these residents. However, little is known about their views on providing care and ways to improve it. Aims: This study examined the knowledge base, care practices and recommendations for quality improvement of direct care workers regarding residents with dementia in residential long-term care facilities. Sample: The population consisted of 69 CNAs and 22 CAs, comprising 15 focus groups, from 32 facilities in Georgia in the Southeastern United States (US). Methods: Qualitative interviews were conducted with direct care workers. Experts in elder care, including physicians, nurses, and CNAs, provided input on the script. Trained facilitators guided sessions. Extensive content analysis was used to identify themes related to dementia care. Results: Dementia affected the majority of residents carried for by CNAs and nearly all of those of CAs. Half of all workers reported that they were not formally notified by their facility when a resident had dementia. Most staff identified cognitively impaired residents based on observation. They used a range of indicators, including changes in mood and facial impressions with speech being the most common sign. All were consistent with physician diagnostic criteria for dementia. The main challenges in providing care were: general issues related to memory loss, such as facility orientation; difficulties completing activities of daily living (ADLs); becoming frustrated with patients, and safety issues, including physical threats to staff and other residents from cognitively impaired residents. The additional time required to monitor and care for these residents was stressed. Groups had a wideranging recommendation to improve care with the most common being staff monitoring their own behaviour. Training was viewed as valuable, but needed to be realistic, with one focus being medication. Conclusion: The findings here show that direct care workers have a wealth of information on how to provide quality care and identify targets ripe for QI. Those designing training and QI programs would benefit from incorporating their input.