How Memory Care Staff Are Trained in Dementia Care

Marlena Gates
By Marlena GatesMarch 2, 2021
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Caring for people with Alzheimer’s disease or another type of dementia takes specialized skills. Thanks to formal training and learning from one another, caregivers in memory care communities know a variety of techniques to reinforce residents’ remaining cognitive abilities to ultimately minimize frustrations caused by dementia.

Proper staff training reduces crises for residents, lowers caregiver stress, and contributes to a more positive community environment overall, says Pamela Atwood, a gerontologist and owner of Atwood Dementia Group consulting group in Amston, Connecticut. “Quality training ensures that pain is recognized and treated effectively, that behaviors are minimized with a variety of approaches, and that staff and other residents feel safe, appreciated, and cared for,” she says.

Discover the various types of dementia care training, what states require, and the research-backed standards of compassion that have become the new norm.

State requirements for memory care training

Most states require some training for caregivers in memory care, while less than half require dementia care training for skilled nursing facility staff. However, requirements vary greatly from state to state and range from no mandated specialized training to guidelines requiring intensive hours of ongoing caregiver training.

Training for memory care ranges from basic deescalation techniques to yearly training in progressive cognitive strategies. Learning tools include videos explaining how dementia affects the brain and behavior to interactive role-playing sessions and live discussion. Often memory care staff must have “pre-care” training. This teaches new caregivers the basics of engaging with the patient or resident with dementia in a way that’s “empowering and practically applicable,” says Brenda Gurung, a certified dementia practitioner for the Alzheimer’s Association and senior national account manager at A Place for Mom. Caregivers learn comforting ways of communicating with their body, voice, and environment across a range of methods and personalized techniques.

Even if a state has few memory care training requirements, don’t despair. Many memory care communities offer more dementia care training than is required by state law, especially in states with few requirements. When touring a memory care community, ask how caregivers are kept up-to-date on dementia care techniques, Gurung recommends.

Common memory care training techniques

Though training techniques vary across styles and environments, typical topics in memory care training include:

  • Psychology of aging
  • Deescalation techniques
  • Redirection
  • Reminiscence

Psychology of Aging focuses on typical problems that may arise in older adults, such as depression and disconnection. Training will cover common ways to remedy such issues like facilitating outdoor activities and community connection.

Deescalation techniques are an important part of memory care training, experts say. These involve the use of verbal and non-verbal cues to help deescalate situations. They consider the patient’s personal space and the caregiver’s body language, empathy, and tone of voice.

Deescalation training teaches caregivers to present themselves to a resident in non-threatening ways, says Atwood. This can mean facing a person with dementia at an angle instead of head-on and positioning your hand in a way that enables someone to hold it instead of the caregiver controlling the resident’s hand. To teach these kinds of skills, real-world scenario training is best, experts say.

Redirection involves appealing to someone’s interests or comfort objects to best reduce agitation. For example, if someone does not like what’s on the menu for dinner, they can be redirected toward a personal comfort food as an alternative.

Reminiscence therapy aids in redirection and deescalation. It involves caregivers understanding residents’ long-term memories and accessing them to calm and comfort a person with dementia. Sometimes just knowing a person’s age can help orient the caregiver in choosing music, movies, or activities that may spark comfortable memories from the resident’s past. Many communities utilize reminiscent therapy even in the artwork on the walls in memory care units — such as scenes from the area, nostalgic images, and personalized “memory displays” of photos outside a resident’s room to help them recognize their space.

Advanced memory care training techniques

Advanced dementia care training techniques focus on “how we connect with people with dementia with an adamant belief that the person with dementia is still whole and present,” says Gurung. When it comes to more advanced training, the following theories are typically taught through in-person seminars:

  • Validation orientation
  • GEMS: Brain Change Model
  • Montessori Method
  • Bathing Without a Battle

Many of these techniques involve what’s called person-centered care, or taking time to understand a person’s past, preferences, and emotional needs in order to offer the best care. Such techniques teach caregivers how to use meticulous compassion to secure a high quality of life for residents.

Validation orientation works to validate a resident’s emotions and re-orient them in the moment, without retraumatizing them with a reality they may not be emotionally able to face. “It’s the most humane way to interact with someone with dementia,” says Atwood. “We only use reality orientation if someone is asking something non-emotional, like ‘what’s for dinner, how’s the weather?’ If someone asks something more emotional — ‘where’s my mother, why am I here?’ — then we use validation.” The idea is not to lie, but to creatively and compassionately redirect the person while validating their feelings. We may instead respond with, “Your mother was such a great cook” and then perhaps offer them a favorite childhood meal. Reality orientation only risks further emotional breakdown.

In the GEMS: Brain Change Model, developed by dementia care educator Teepa Snow, caregivers learn to “research” the patient to find their likes and dislikes, what affects their moods, and how their reactions to their environment are a part of who they are. It’s designed to help people caring for those with dementia understand the remaining abilities at each stage of the dementia journey.

TheMontessori Method offers the resident many choices within their environment and empowers them through their own preferences. This whole-person method teaches that it is up to the caregivers to figure out the complete picture of the patient by giving them choices through which to express themselves. Examples of this range everywhere from offering outfit options during morning dressing to meal and activity choices.

The Bathing Without a Battle training technique focuses on the difficulty caregivers and patients face during bath time. This is a highly vulnerable time for those with dementia, as patients commonly experience fear and aggression during bath time. Research shows that when caregivers were trained to offer a variety of bathing styles, including showers, sponge baths, under-the-clothes baths and even singing baths, instances of aggression were greatly reduced. The famous Bathing Without a Battle study showed how training caregivers to use person-centered, validation, and communication techniques during bath time greatly reduced instances of aggression and ultimately reduced antipsychotic medication use by 30 percent.

Multiple studies show improved mood and reduced antipsychotic use when caregivers adopt person-centered and progressive behavioral techniques. Antipsychotics can be dangerous to residents when overused as a deescalation strategy. Dependence on antipsychotics to deescalate situations has dangerous potential side effects, such as cerebrovascular and cognitive decline as well as increased risk of mortality. This is especially concerning with antipsychotic use among a senior population already struggling with underlying health conditions.

Standards of care for dementia

Research-based, person-centered techniques have become the “standard of care” across memory care communities, says Doug Oliver, lead trainer for Life Care Services’ Heartfelt Connections memory care program. “As an industry, we see a universal standard of dementia care emerging that consumers and advocates are demanding regardless of state regulator requirements,” Oliver says. Communities across the country and beyond have taken to uphold their own standards of science-backed, progressive care.

Doug explains how this new “standard of care” for dementia trains caregivers in three central tenets: “person-centered care, a focus on remaining abilities, and the person’s environment — the physical and social.” Of course, other areas are addressed during training sessions including help with activities of daily living care, memory care activities, effective communication, and common dementia responses or behaviors, but they all tie back to the three central tenets.

These tenets came from the pioneering work of the late Professor Tom Kitwood. His research aims to observe the person’s emotional and cognitive state at any one time and how best to reach them. Kitwood explains these techniques in his book Dementia Reconsidered as “a serious attempt to take the standpoint of the person with dementia, using a combination of empathy and observational skill.” Compassionate observation and empathy is exactly what the caregiver and staff in specialized memory care units are trained to utilize for effective communication.

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Communities Create Personalized Training Programs for Caregivers and Support Staff

Many memory care communities have curated resources to create their own training programs. These often include videos, in-person role-playing, and formal, ongoing discussions of everyday situations with residents. Staff regularly meet to discuss care approaches that either helped or were ineffective at improving a resident’s quality of life.

Training of non-caregiving staff is also common within specialized memory care units. Memory care experts agree that everyone in the community, from housekeepers to chefs and servers, needs to use compassion and empathy when interacting with residents.

Sources:

Center for Applied Research in Dementia. “Why Montessori Inspired Lifestyle Training?” https://www.cen4ard.com/why/research/

Health Affairs. “CMS Strategies To Reduce Antipsychotic Drug Use In Nursing Home Patients With Dementia Show Some Progress.”
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.1439

International Psychogeriatrics. “A Cluster-Randomized Crossover Trial of Montessori Activities Delivered by Family Carers to Nursing Home Residents with Behavioral and Psychological Symptoms of Dementia.” https://pubmed.ncbi.nlm.nih.gov/31762434/

JAMA. “Risk of Death with Atypical Antipsychotic Drug Treatment for Dementia; Meta-analysis of Randomized Placebo-Controlled Trials.”
https://jamanetwork.com/journals/jama/article-abstract/201714

Journal of the American Geriatric Society. “Effect of the Bathing Without a Battle Training Intervention on Bathing-Associated Physical and Verbal Outcomes in Nursing Home Residents with Dementia: A Randomized Crossover Diffusion Study.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584541/

Kitwood, Tom. 1997. “Dementia Reconsidered: The Person Comes First.”

Snow, Teepa. “The GEMS® Brain Change Model.”
https://teepasnow.com/about/about-teepa-snow/the-gems-bra

Marlena Gates
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Marlena Gates

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