Relationships of dementia care workforce experiences, training, & work environment to resident outcomes in skilled nursing facilities

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PROJECT SUMMARY ABSTRACT Alzheimer's disease is the sixth leading cause of death in the U.S., and the number of Americans living with Alzheimer's disease or Alzheimer's disease-related dementias (AD/ADRD) is expected to increase from 5.7 to 14 million by 2050. Therefore, the need for a qualified and sustainable workforce is now more important than ever. Direct care nursing staff such as licensed practical nurses (LPNs) and certified nursing assistants (CNAs) are an essential part of the workforce in skilled nursing facilities, caring for more than 700,000 U.S. residents diagnosed with AD/ADRD. Understanding the interactions between factors that impact work environment, workforce characteristics, and dementia care training are important to better inform programs that can improve health outcomes for AD/ADRD residents in US skilled nursing facilities and make for appealing dementia care jobs. Very little is known about the characteristics of the front-line dementia care workforce, their work environment as it relates to caring for residents with AD/ADRD (e.g., resident to staff violence; racial discrimination); and the specialized training this low-wage workforce receives, especially when only half of the U.S. states require specific dementia care training. The ultimate goal of this research study is to better understand how these relationships impact the care outcomes among residents. We will do so by accomplishing the following: (1) survey LPNs and CNAs on their work environment and dementia care training experiences; (2) conduct focus groups among a sub-sample of facility directors of nursing or directors of staff development to do an in depth examination of the elements in their dementia care training; and (3) look at whether worker experiences and training components are associated with care outcomes. The proposed study aligns with several objectives outlined in NIA's Strategic Plan, specifically Goal E: Improve our understanding of the consequences of an aging society to inform intervention development and policy decisions and Goal F: Understand health disparities related to aging and develop strategies to improve the health status of older adults in diverse populations. More specifically, it supports NOSI NOT- AG-20-026 by conducting research on the impact of dementia care training on quality as well as the supports available to the dementia care workforce in SNFs to encourage retention. Results will provide an evidence base on which to amend or create new current state policies regarding the content needed in dementia care training programs among this workforce.