According to Journey of Caring: An analysis of long-term care for dementia commissioned by Alzheimer’s Disease International (ADI), “long-term care for older people is, mainly, about care for people with dementia.” The report states that about half of all older people who need care have some form of dementia, and 80% of older nursing home residents have dementia; that number is up to 63% in Assisted Living.

With these numbers growing rapidly, it is important to understand the implications for front-line staff in charge of programming, life enrichment and therapy:

1. A greater need for smaller group programs and 1:1 or room visits
2. More behaviors to deal with throughout the day, especially with sun-downing at the end of the afternoon
3. A greater need to know the resident better
4. Although scheduled programming helps with orientation, flexibility needs to be built in to allow for behavioral management

To ensure the best quality experience for residents and their families, front-line staff needs to be supported slightly differently than before:

1.Flexibility and time to assess

Because residents are less able to communicate their preferences or talk about themselves, it is important to interact more with the family and allow more time for residents to express themselves. It is also important to build care plans or Individual Service Plans on an ongoing basis. Non-life enrichment staff often overhear things of interest to residents and programming staff needs to be informed so they can take that into account.

2. Allow for more person centered care and ad-hoc decisions

Once assessments are done and programs are delivered, reactions of residents should be taken into account.  Allowing to fine tune programs will help the staff do this.  Large group programs are often disturbed; hence there is a greater need for smaller interactions.  This increases the need of variety in programming and creates stress on staff that needs to provide these programs.

3. Resources

As stated above, a higher proportion of residents with dementia increases the number of different programs that need to be offered. To respond dynamically, staff members often need to research or access a wider variety of resources. The old 3Bs (Bingo, Bible & Birthdays) doesn’t work anymore.  Retirement communities often have more than 10 different religions represented in their populations, all of which need to be included in programming so that no one feels left out.

4. Employee stress management & support

With increased population dependency comes increased stress on frontline teams that need to provide better quality programs to a greater number of residents. Staff often report that they are the “bottleneck” to the experience they deliver to residents because of resource & time constraints.

It is important to understand the typical symptoms of stress so teams can continue providing the best care to residents. Symptoms of stress can be mental, emotional and physical. According to the Mayo Clinic, employees may feel tired, overwhelmed, irritable or depressed. Because of the changing needs of the resident population, it is also important to have clear objectives and assess the staff frequently. Beyond that, ongoing training gives the staff confidence in delivering experiences to meet the needs of the residents and helps them be more efficient by understanding which type of response is most appropriate to each type of dementia.

To improve the workplace environment and help staff understand the importance of wellness, wellness initiatives such as walks, fitness or nutrition information campaigns are cost effective and long lasting perks for frontline staff.

5. Community wide involvement

Any interaction with a resident represents a “touch point” with the individual and provides an opportunity for better care. This is why effective programming goes beyond the activity department and should include every person that interacts with residents. Involving staff beyond the programming department becomes easier once everyone embraces person centered care and the activity staff shares valuable information about the residents.  For example, a lady might be difficult to dress until the staff understands that she loves fashion, so giving her choices might reduce the time it takes in the morning.

6. Family involvement

Family members are often the staff’s best allies and know their loved ones better than anyone else. Standard questions should include: How does your family member express themself when they are scared, angry, anxious, and hungry? What, in the past, has comforted them? What is their typical daily routine? Are there any behaviors that you have found more difficult to respond to than others?

Attending care plan or Individual Service Plan meetings should be recommended to all family members so they understand what an important role they play in delivering good quality care to their loved ones.