Training the Long-Term Services and Supports Dementia Care Workforce in Provision of Care to Sexual and Gender Minority Residents

摘要 在美国，性和性别少数(SGM)老年人患阿尔茨海默病的风险不成比例 和相关痴呆症(AD/ADRD)，更有可能依赖长期服务和支持(LTS)，而不是 他们的同龄人是顺性别、异性恋。如果没有对LTSS工作人员进行文化响应护理方面的培训，SGM 居民容易受到不适当和/或较差的护理，从而导致生活质量下降和 健康结果。为了解决这一问题，一些州最近要求对LTSS工作人员进行培训 对SGM老年人的文化响应护理。这种方法成功的主要障碍有两个。 首先，我们缺乏对LTSS政策的研究，这些政策管理有AD/ADRD护理的SGM(在文化关怀的州 培训不是强制性的)，这将告知是否需要这样的州立法。第二，没有 可扩展的、可持续的、基于证据的培训计划，通过AD/ADRD培训SGM中的LTSS员工 响应文化的关怀。本申请的重点是实训服务课程，它已经培训好了 12个州的12,000多名LTSS工作人员。这一可接受的、可行的、有前途的课程采用了 采取多层次的方法，培训管理层和一线LTSS工作人员在文化上响应SGM的护理，通过 AD/ADRD。但是，它没有经过严格的评估，仅仅依靠面对面的指导。这是混合的 方法和比较有效性研究有三个具体目的。在目标1中，我们将进行 明尼苏达州362家养老院和362家辅助生活设施评估综合政策分析 在人力资源方面有明确的特别利益攸关方扶持政策的机构的数量和比例， 营销、培训、治理；指导文化响应护理和住院医生的反歧视政策 性取向和性别认同(SOGI)数据收集。这些发现将为Aim 2课程提供参考。在……里面 目标2，使培训在全国范围内更具可扩展性和高保真度，我们将设计和开发一种 异步在线版，并与30名LTSS管理人员和30名工作人员一起进行试点。在目标3中，评估 培训效果，我们将进行三臂，管理层/员工分层，小组随机，对照试验 面对面培训、在线课程和等待名单控制组(在62个LTSS机构中，有 每支部队310名管理人员和450名工作人员)。在个人层面，我们将评估管理层和员工 为SGM客户提供关怀的知识、态度和技能。在机构一级，在六个月的后续行动中，我们 预计接受培训的机构将有更多SGM明确的政策，更多SGM欢迎 环境、入口处的SOGI数据收集，以及拥有更多知识、舒适度和技能的员工 在向SGM提供AD/ADRD文化响应护理方面。

SUMMARY In the US, sexual and gender minority (SGM) older adults are disproportionately at risk for Alzheimer’s disease and related dementias (AD/ADRD) and more likely to rely on long-term services and supports (LTSS) than their cisgender, heterosexual peers. Without training in culturally responsive care of the LTSS workforce, SGM residents are vulnerable to receiving inappropriate and/or inferior care contributing to poorer quality of life and health outcomes. To address this, some states have recently mandated training of the LTSS workforce in the culturally responsive care of SGM older adults. There are two major barriers to this approach being successful. First, we lack research on LTSS policies governing SGM with AD/ADRD care (in states where cultural care training is not mandated), which would inform whether such state legislation is needed. Second, there are no scalable, sustainable, evidence-based training programs to train the LTSS workforce in SGM with AD/ADRD culturally responsive care. This application is focused on the Training to Serve curriculum, which has trained over 12,000 LTSS workers in 12 states. This acceptable, feasible, and promising curriculum employs a multilevel approach to train management and frontline LTSS staff in culturally responsive care to SGM with AD/ADRD. But, it has not been rigorously evaluated and relies solely on in person instruction. This mixed methods and comparative effectiveness study has three specific aims. In Aim 1, we will conduct a comprehensive policy analysis of 362 nursing homes and 362 assisted living facilities in Minnesota to assess the number and proportion of agencies that have explicit SGM affirmative policies in human resources, marketing, training, governance; anti-discrimination policies guiding culturally responsive care, and resident sexual orientation and gender identity (SOGI) data collection. These findings will inform Aim 2 curriculum. In Aim 2, to make Training to Serve more scalable nationally and with high fidelity, we will design and develop an asynchronous online version and pilot it with 30 LTSS management and 30 staff. In Aim 3, to assess the effects of training, we will conduct a 3-arm, management/staff stratified, group randomized, controlled trial of the in-person training versus an online curriculum versus a waitlist control group (in 62 LTSS agencies, with 310 management and 450 staff per arm). At the individual level, we will assess management and staff knowledge, attitudes, and skills providing care to SGM clients. At the agency level, at six months follow-up, we predict agencies who receive training will have more SGM explicit policies, more SGM welcoming environments, SOGI data collection at intake, and staff with significantly greater knowledge, comfort, and skills in providing SGM with AD/ADRD culturally responsive care.