Alzheimer’s: Sometimes, breaking convention creates a better way


Making a case for an Alzheimer’s Friendly Healthcare Workforce™

Millions of individuals are living with Alzheimer’s and receiving a form of caregiving. The 7 stages of Alzheimer’s (Alzheimer’s Association) often require close supervision in the early stages; an aid-in-attendance in the middles stage; and specialized care in the late stages. The cycle can take up to 20 years or more from start to finish.

Criticism of the quality of care and quality of life in long-term care has been a saga that seems to have no end. There are way too many excuses given by management and staff to justify the less than acceptable care and treatment of residents, especially those living in memory loss units (Wagner et al., 2001). Leadership enhancement programs which include interpersonal skills, clinical skills, organizational skills, and management skills continue to be weak and below average (Harvath et al., 2008; Wagner et al., 2001). Based on the author’s experience with her husband who has been living in a memory loss unit at a nursing center for about 2.5 years, there are more CNAs (Certified Nurse Assistant) with a minimum of only several months of training and LPNs (Licensed Practical Nurse) with limited training of about a year who are given way too many responsibilities and held accountable for the very life of residents in long-term care. These individuals often must provide full services for 10 to 12 residents each (some examples of care include dressing, changing, bathing, feeding, redirecting and supervision). I have seen one CAN left with as many as 22 patients in her care for periods of 30 minutes at a time, a humanly impossible task.

Nurses with only a few years of formal training and with little to no leadership training are left in charge for entire shifts of workers, sometimes covering a double shift or 16 hours straight, and the welfare of 70 or more sick residents in their charge (Harvath et al., 2008). Nursing homes do hire more low-end and low-paying staff in comparison to RNs (Registered Nurse) and NPs (Nurse Practitioner) who have a master’s degree in nursing (Christian & Baker, 2009). State governments will only approve a minimum number of workers for reimbursement and do not make a distinction between a rehab unit, nursing home unit or a memory loss unit. This one-size fits all is erroneous and for every worker in a memory loss unit,  7-10 totally dependent residents are assigned to his/her care. This problem is compounded by the fact that the nursing home business, whether it is a for profit or a not-for-profit entity, also refuses to hire more workers than the minimum dictated by state regulations ~ a major reason for unnecessary hospitalization of nursing center patients transported by ambulance on a daily basis (Christian & Baker, 2009).

Based on experience and facts such as listed above, nursing centers are broken down. They no longer, and maybe never really could, provide dependable services. Certainly the safety and wellbeing of those in their charge continues to be at risk on a daily basis. Frustrations from visitors and family caregivers are obvious when you visit such a center. A lack of teamwork stems from under-trained administrators/management, steady and impossible working conditions for institutional caregivers. Nursing homes are drowning in responsibilities they cannot deliver and if they continue to operate with such staff deficits, they will become unacceptable as a solution to providing care of frail older adults and especially Alzheimer’s patients in America.

Terms like person centered care and quality of care are just that, terms. What’s needed is a culture change and a very big shift in leadership training. The time has come to break convention where long-term care is concerned and adopt a new system of healthcare that is known as the Alzheimer’s Friendly Healthcare Workforce™. A basic theorem of the Alzheimer’s Friendly Healthcare Workforce™ is cooperation versus competition where a selected number of family caregivers are given the opportunity to complete their cycle of care with the assistance of a larger professional team.

A number of family caregivers are anxious to continue providing hands-on care to their loved ones even after placement in long-term care. Family caregivers have first-hand experience of the exhaustive demands of providing complete care and therefore do empathize with professional caregivers. Such care may involve assisting in bathing, attending and assisting at center activities, assisting with feeding, and companionship. This desire is largely driven by reality that nursing centers are drowning in their own inability to provide adequate care and provide the comfort their loved ones deserve in the late stage of life. Nursing centers do not have the time to get to know each resident despite an original request at intake as to dislikes and likes of each new resident. There is simply no time for that. Family caregivers already have this knowledge and experience which is a perfect fit in a very serious missing link in the service wheel.

Barriers, such as difficulty in communicating with staff and lack of teamwork in nursing centers, will need to be examined and removed (Lindman Port, 2004). Adopting an Alzheimer’s Friendly Healthcare Workforce™ program would improve the way services are delivered, increase teamwork, improve morale among workers and management, lower sick leave and burnout among the professional caregiver workforce, and increase the quality of life and care for persons in memory loss units as well as the general population in long-term care. Such a program requires training and commitment on the part of everyone.

Question:  Is your care center ready to receive and effectively cope with the millions of patients that will be diagnosed with Alzheimer’s requiring specialized care over the next decade?

References used for this article:

Alzheimer’s Association, Retrieved from

Harvath, T.A., Swafford, K., Smith, K., Miller, L.L., Volpin, M., Sexson, K., White, D., & Young, H.A. (2008). Enhancing nursing leadership in long-term care. Research in Gerontological Nursing, 1(3), 187-196.

Christian, R., & Baker, K. (2009). Effectiveness of nurse practitioners in nursing homes: A systematic review. JBI Library of Systematic Reviews, JBL 000254, 7(30), 1332-1351.

Lindman Port, C. (2004). Identifying changeable barriers to family involvement in the nursing home for cognitively impaired residents. The Gerontologist, 44(6), 770-778.

Wagner, C., van der Wal, G., Groenewegen, P.P., & de Bakker, D.H. (2001). The effectiveness of quality systems in nursing homes: A review. Quality in Health Care, 10(4), 211-217.

About the writer:

Dr. Lord is a former president of the Maine Gerontological Society in the State of Maine, currently President and Professional Alzheimer’s Coach offering Alzheimer’s coaching and consulting with businesses at, and is a professor of Organizational Behavior at several universities.  Dr. Lord has a Doctorate of Management in Organizational Leadership from the University of Phoenix.  Her 10-year experience as a family caregiver originated with her husband who was diagnosed with Alzheimer’s in Jan. 2003.  In that decade she has seen a daily influx of new Alzheimer’s cases. Dr. Lord realized there is an urgent need for a change in perspective with regards to providing individual and institutional care for individuals living with Alzheimer’s.  She is married to Maj. Larry S. Potter, USAF retired, and lives in Mapleton, Maine.  Dr. Lord is available for presentations, training, and Alzheimer’s coaching/consulting.

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