Innovation in direct care worker training: preparing a workforce to provide in‐home care to older adults living with Alzheimer’s disease and related dementias

Abstract

AbstractDirect care workers who provide in‐home care – such as caregivers hired by consumers of California’s Medicaid‐funded In‐Home Supportive Services (IHSS) program – are well positioned to observe changes in their consumer’s cognition, health, or behaviors to report to family members and healthcare partners, thereby helping to reduce risk of emergency department visits, avoidable hospitalizations, and other adverse outcomes that are disproportionately high among people living with Alzheimer’s disease and related dementias (ADRD) (Alzheimer’s Association, 2023). Despite their vital role in supporting people living with ADRD, direct care workers receive low wages and minimal training or supportive supervision. Strengthening the dementia care workforce is a public health priority; failure to do so will add health, social, and economic burdens to individuals, families, and society (American Public Health Association, 2020). An innovative initiative to bolster the direct care workforce is the IHSS+ADRD Training Project, which provides a 10‐week, instructor‐led, competency‐based, online training in English, Spanish, and Cantonese. The goal is to train 600 IHSS caregivers in Alameda County, California between 2020‐2024. We use a quasi‐experimental, longitudinal design to evaluate outcomes. Pre‐training, post‐training, and 3‐month follow‐up surveys are used to compare changes in IHSS caregivers’ dementia knowledge and self‐efficacy. Administrative records pulled one‐year before and after training are used to compare healthcare utilization patterns of IHSS consumers whose caregiver completed the training. This poster presents updated preliminary results from an analytic sample of 165 IHSS caregivers and consumers for whom we have complete follow‐up data to‐date. Dementia knowledge and self‐efficacy significantly increased at post‐training (p≤ 0.05), with trends suggesting retention at follow‐up. Most IHSS caregivers were very satisfied with the training (83%). Healthcare utilization data followed expected trends given COVID‐19 pandemic protocols in Alameda County. These results reveal promising signs that direct care workers do value training opportunities to better support consumers at home; however, the results need to be further understood in the context of COVID‐19 and the ADRD illness trajectory. Implications include replicating this training to other counties and beyond California to help meet the estimated 1.2 million additional direct care workers needed in the U.S. by 2030 (PHI, 2022).