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

总结 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（AD/ADRD），更可能依赖长期服务和支持（LTSS）， 他们的顺性异性恋同伴如果没有对LTSS劳动力进行文化上敏感的护理培训， 居民容易接受不适当和/或低劣的护理，导致生活质量下降， 健康成果。为了解决这一问题，一些州最近授权对黎巴嫩临时安全部队的劳动力进行培训， 对SGM老年人的文化敏感护理。这种方法要取得成功有两个主要障碍。 首先，我们缺乏对LTSS政策的研究，这些政策管理着患有AD/ADRD护理的SGM（在文化护理 培训不是强制性的），这将告知是否需要这种国家立法。其次，没有 可扩展的、可持续的、基于证据的培训计划，以培训患有AD/ADRD的SGM中的LTSS员工 文化关怀。此应用程序的重点是服务培训课程，该课程培训了 12个州的12，000多名LTSS工人。这个可接受的，可行的，有前途的课程采用了 多层次的方法，培训管理和一线LTSS工作人员在文化上对SGM的照顾， AD/ADRD。但是，它没有经过严格的评估，只依赖于亲自指导。这种混合 方法和比较效果研究有三个具体目标。在目标1中，我们将进行 对明尼苏达州362家疗养院和362家辅助生活设施进行全面政策分析， 在人力资源方面有明确的SGM平权政策的机构的数量和比例， 营销、培训、治理;指导文化上敏感的护理的反歧视政策， 性取向和性别认同（SOGI）数据收集。这些调查结果将为目标2课程提供信息。在 目标2，为了使服务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个 异步在线版本，并与30名LTSS管理人员和30名工作人员进行试点。在目标3中，评估 培训的影响，我们将进行一项3组，管理/工作人员分层，随机分组，对照试验， 面对面培训与在线课程与等待名单对照组（在62个LTSS机构中， 310名管理人员和450名工作人员）。在个人层面，我们会评估管理层和员工 知识、态度和技能，为SGM客户提供护理。在机构一级，在六个月的随访中，我们 预计接受培训的机构将有更多的SGM明确的政策，更多的SGM欢迎 环境，SOGI数据收集，员工的知识、舒适度和技能都大大提高 在为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.