Grants & Research
Our Emphases
The aging of Americans with lifelong developmental disabilities such as mental retardation
and cerebral palsy has caught researchers, policy makers, and service providers relatively off-guard, within both the
gerontology and disabilities fields. In Virginia, an estimated 9,000 citizens have survived beyond age 60 with lifelong,
developmental disabilities. At the same time, the increasing longevity of mainstream Americans has effectively meant that
more of us live long enough to acquire late-onset disabilities such as Alzheimer's Disease, stroke, and Parkinson's.
The Virginia Center on Aging has committed itself to research, demonstration, and training
initiatives that assist individuals with disabilities, lifelong or late-onset, to remain relatively independent in their
communities for as long as is meaningfully possible. Our initiatives recognize the individual's desire for independence, the
importance of family caregiving in long-term care and family caregivers' needs for acknowledgment and assistance, the
requirements of planners and policy makers for accurate data and insightful recommendations, and the practical needs of
service providers for innovative model programs that maximize existing resources.
Accordingly, our work emphasizes self-development, self-care, caregiving, and effective
service collaboration. Recent projects of the Virginia Center on Aging include developing and delivering a model training
program on home-and-community-based care to help rural and minority Virginians remain in their own homes through use of
available community resources and self-advocacy; field-testing a strategy for inter-system cooperation between the
disabilities system and the aging network to benefit older adults with developmental disabilities and their families;
researching the prevalence of eldercare among employed caregivers, the impact of their eldercare upon work performance, and
their desire for assistance; employing a train-the-trainer model curriculum for dementia caregiving among rural and minority
Virginians that involved clergy and other respected community leaders; and following up the enduring benefit of model program
initiatives designed to prevent or reduce geriatric alcoholism.
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Cost-Effectiveness of Family Caregiver Training
Educational interventions for family caregivers provide skill- and knowledge-building
information on caregiving topics. Frequently, the objectives of these interventions are to improve the quality of care
provided by the caregiver and to reduce caregiver stress. Moreover, it is hypothesized that improving quality of care and
reducing caregiver stress ultimately improve the care recipient’s quality of life, which, in turn, may alter the demand for
formal long-term care services and/or delay more costly nursing home placement. However, few studies have empirically
demonstrated the cost-effectiveness of caregiver training.
The Virginia Center on Aging was awarded a Virginia Commonwealth University Grant-in-Aid,
which ran from June 1998 through May 1999, to investigate the cost-effectiveness of family caregiver training programs. The
objectives of this hypothesis-generating study were to: 1) assess the relative merits of the alternative measurement systems
that can be used to value the health effects accruing to care recipients as a result of caregiver training, and 2) develop a
methodology for evaluating the resource costs and health effects of educational interventions such as the Families Who Care
project, which is described elsewhere on this site.
Project staff conducted a literature review of health-state measurement instruments, and
selected the EQ-5D (EuroQol Group, 1990) and the SF-36 (Ware and Sherbourne, 1992) for field-testing. In addition to these
instruments, the project staff also selected a care recipient rating scale. The purpose of this instrument was to provide a
means of classifying care recipients into mild, moderate or severe disease stage. The scale was adapted from the Clinical
Dementia Rating Scale (CDRS), which was developed as a global rating device for a prospective study of mild senile dementia –
Alzheimer’s type (Hughes, Leonard, Danzinger et al, 1982). Project staff developed questionnaires to measure the time and
money costs of having caregivers and community leaders participate in the intervention. The project team recruited community
leaders and trained them on the selected health-state measurement instruments. The community leaders recruited former
participants from the Families Who Care project to field-test the EQ-5D, SF-36 and CDRS. Evaluations on the ease of
completion for each of the instruments were obtained from the participating family caregivers and the community leaders who
assisted them with the instruments. The project team reviewed the cost-effectiveness literature and ascertained reasonable
assumptions regarding the costs of dementia care by setting (community-based or institutional) and by disease severity (mild,
moderate and severe).
With regard to the first objective, the EQ-5D was determined to be the most appropriate of
the preference-based measurement systems for assessing caregiver-training programs. However, the degree of difficulty noted
by participants in completing this instrument is a limiting factor in its proposed use. While the SF-36 was rated as less
difficult by the caregivers, it also has a drawback in that it is not a preference-based instrument. Therefore, information
gleaned from this questionnaire cannot be used to determine estimates of changes in quality-adjusted life-years resulting
from health interventions. Without this information, standardized comparisons of caregiver training interventions to other,
similar or dissimilar, health interventions on the basis of cost-effectiveness cannot be made. The SF-36 could be used,
however, to demonstrate a change in quality of life as a result of an intervention.
The second objective involved the development of a methodology for evaluating both the health
effects (denominator of the cost-effectiveness ratio) and resource costs (numerator). With regard to the health effect
methodology, a change could be made in the way the EQ-5D is administered, so as to avoid some of the difficulty experienced
by the caregivers. The first section of the EQ-5D did not seem to generate as much difficulty as did the second section. The
design of the EQ-5D does permit Part I to be administered independently of Part II. Part I (the rating of the individual’s
health state on selected domains, and an overall rating) could be administered to caregivers participating in a caregiver
training program on a pre- and post- basis, in order to measure any gains from the intervention. Part II (a measure of
preferences for various health states) can be administered to a separate group of individuals, instead of to the caregivers.
Reducing the scope of the questionnaire for an individual may serve to reduce the level of difficulty.
This study also was successful in identifying data from which assumptions could be made
regarding the cost of care for Alzheimer’s disease by care setting and disease severity. Logs were developed to capture the
time that caregivers and trainers spend in training, so as to determine the time costs. Logs were also developed to capture
monetary expenditures by caregivers and trainers.
References:
EuroQol Group. (1990) "EuroQol — A new facility for the measurement of health-related quality
of life," Health Policy, 16 :199-208.
Ware, J.E., and Sherbourne, C.D. (1992) "The MOS 36-item short-form health survey (SF-36). I.
Conceptual framework and item selection." Medical Care, 30(6):473-83.
Hughes, C.P., Leonard, B., Danziger, W.L., Coben, L.A., Martin, R.L. (1982) A new clinical
scale for the staging of dementia. British Journal of Psychiatry, 140, 566-572.
For more information about this study, contact Paula Knapp Kupstas at (804) 828-1525 or
pkupstas@vcu.edu
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Dementia Caregiving
Alzheimer's disease (AD) is more common now than in the earlier years of this century because
more people are living to the age of risk. An estimated 10% of those over 65 years of age have Alzheimer's disease; above the
age of 85, almost half may develop the disease. As the number of older persons increases, so will the number of persons with
AD. The number of lay and professional caregivers knowledgeable about AD will need to increase as well to meet the demand for
care.
Research has consistently shown that community services are under-used by those caring for
individuals with dementia, whatever their residence or ethnic background. Caregivers of relatives with dementia have concerns
about the ability of service providers to understand the particular needs of demented persons. Often, families simply prefer
to be self-reliant and regard the use of formal services as unacceptable. These attitudes can be counter- productive, however,
and may eventually result in caregiver "burn-out." Convincing family caregivers to access the help that is available will
likely reduce caregiver stress and improve the quality of care they provide.
At the same time, certain groups historically have been outside the information and service
networks. The Fourth Report of the Advisory Panel on Alzheimer's Disease to the U.S. Congress and the U.S. Department of
Health and Human Services calls for "public education and outreach efforts specifically targeted to ethnic elders and
their families and communities through the development and dissemination of culturally relevant materials emphasizing both
the established facts about [Alzheimer's Disease and Related Disorders] and the efficacy of seeking treatment." There is a
similar need to train family caregivers of rural elders with dementia, for their informational and service needs may be
greater than those of their urban counterparts.
The Virginia Center on Aging, therefore, conducted the Families Who Care project to
assist caregivers of African American and rural elders with dementia, with support from AoA, between October, 1992 and
August, 1995. The project partnered institutions of higher education with state and local service provider organizations in
order to implement a train-the-trainer educational outreach effort that targeted family caregivers in Central and Southside
Virginia. Key features of this project included our involving trusted community resource persons such as pastors as
first-level trainers and our organizing training material according to the likely progression of the disease.
Since the conclusion of the Families Who Care project, the VCoA has continued its work
to improve the quality of life for the families who care for elders with dementia, especially those in "traditionally
unserved" communities. Efforts have included further dissemination of the project's training manual and replication plan, and
collaboration with the Virginia Geriatric Education Center in the training of adult day care and adult care residence owners
for the Virginia Department of Social Services. VCoA is currently pursuing external funding to test the long-term impact of
the intervention, relative to sustained quality care, cost-effectiveness, and improvement in caregiver well-being.
Families Who Care
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The Training Manual |
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The training manual, Families Who Care: Assisting African American and Rural
Families Dealing with Dementia, was designed to enable trusted community leaders, such as clergy, to provide
family caregivers with sequenced training which corresponds roughly to the stages of Alzheimer's Disease. The training
manual specifically targets African American and rural family caregivers, and is culturally sensitive as well as literacy
appropriate. |
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The training manual is innovative in a number of ways. The content not only benefits
from editing for cultural sensitivity, but also assumes a unique position among other products in its organization
according to the progression of dementia. Since trainers can market their workshops as pertinent to issues which occur
with successive disease stages, caregivers are guaranteed to get the information they need when they need it most. As
important as using literacy appropriate materials is when utilizing members of the lay community as trainers, it is
doubly important when complex information needs to be translated to caregivers in a palatable form. |
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The training manual has additional utility, beyond the objectives specified for this
project. Much of the information is more generally applicable for non-minority caregivers, those in urban or suburban
areas, or those whose care recipients are not experiencing cognitive decline. The utility of the manual extends beyond
the audience of informal caregivers and can be easily adapted for use with formal caregivers. For example, because the
manual is a particularly adept tool for in-service training of nurse aides in special care units. The inclusion of
modular lesson plans which "stand alone" and are structured with a stated goal, rationale, educational objectives,
detailed mini-lecture, suggested readings and audio-visual reinforcement, experiential learning exercises, and hand-out
materials, allows users to abstract whatever topic meets their need at any given time. |
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Another special feature of the training manual relates to the extensive evaluation tools
provided for those who would replicate the project. Pre-training and post-training questionnaires for both the first and
second levels of training have been abbreviated based on extensive item analyses, and therefore have enhanced
discriminative ability. The results of pre-training and post-training knowledge tests may be used to determine where
added emphasis is needed. Alternatively, trainers may choose to use the knowledge questions as a didactic aid to
reinforce key points. The evaluations of one training session can be used to improve subsequent sessions by revising the
structure of workshops (e.g., including more video material or adjusting presentational style). |
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The Replication Plan |
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The project has produced a detailed replication plan for anyone interested in
implementing the train-the-trainer model. Dubbed the "Integrated Model Plus," the plan is organized around four
components: 1) collaboration, 2) outreach, 3) capacity building, and 4) evaluation. The document opens with a brief
discussion of these components and provides a rationale for replicating the project. |
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Collaboration. The Replication Plan describes appropriate partners to involve and
the ways in which these individuals can facilitate project activities. From guiding the content of the training manual to
the recruitment of trainers and caregiver participants, the collaborating partners provide a firm foundation upon which
the project can build. |
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Outreach. The Replication Plan describes a variety of recruitment efforts
undertaken and how the involvement of trusted community leaders can offset the further challenge presented by the
colloquial stigma attached to dementia and Alzheimer's Disease. |
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Capacity building. The Replication Plan details how project staff accomplished
this objective by directly developing the capacities of trusted community leaders who served as trainers of caregivers,
by indirectly improving the capacities of caregivers through the conduct of workshops, and by subsequently increasing the
ability of elders with dementia to remain, as appropriate, in their communities and avoid premature institutionalization. |
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Evaluation. The Replication Plan includes all questionnaires and forms used to
evaluate the project. It also delineates the advantages of conducting a summative evaluation of the first and second
levels training. |
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Home-and-Community Based Care
The Virginia Center on Aging recently concluded A Consumer Driven Model for Improving
Home and Community Based Care (HCBC), a 2 1/2 year project funded by the U.S. Administration on Aging. The purpose of
the project was to help community-dwelling elders and their families to help themselves by becoming better-informed consumers
of available resources, more active agents of their own care, and more knowledgeable advocates for self- and community
well-being. The project targeted those elders who have been underrepresented historically in the governance of their
communities, especially rural and minority elders. This project involved a partnership of VCoA, five Area Agencies on Aging
from the Tidewater through Central Virginia to Lynchburg, and Mattaponi-Pamunkey-Monacan, Inc., representing Virginia's
first-contact Indian tribes. Together, the project's partners developed and conducted 33 seminars on the keys to remaining in
one's own home and on advocacy, benefiting almost 500 elders and their families.
The project maintained that the "keys" to relative independence for elders in the community
include: 1) the Area Agency on Aging, 2) good coping skills, 3) maintaining one's health, 4) maintaining one's home, 5)
continuous involvement for one's mind, 6) regular community connections, and 7) effective advocacy for oneself and others.
The first six keys were the focus of the project's first series, while advocacy was the theme of the second series.
The Project Highlights and Executive Summary are available on-line
at no cost. For a copy of the Final Report (100 pages), please send $19 check or money-order post-paid to the Virginia Center
on Aging, PO Box 980228, Richmond, VA, 23298.
Dr. Michael A. Pyles, Assistant Professor in the School of Pharmacy, was the project director
and principal investigator. Ms. Shobha R. Shenoy, M.S., was the project manager. Several VCoA staff members served on the
project team, including Drs. Constance Coogle and Edward Ansello. Dr. Pyles can be reached at (804) 828-8314 or at his e-mail
address: mapyles@vcu.edu. Send inquiries to: Dr. Michael A. Pyles, School of Pharmacy,
Dept. of Pharmacy & Pharmaceutics, Virginia Commonwealth University, PO Box 980533, Richmond, VA 23298-0533.
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Internet and E-mail Resource Directory
Compiled by Constance L. Coogle, Ph.D. in May, 1996,
this directory focuses primarily on the exploration of resources available on the World Wide Web. Addresses and descriptions
of sites that would be of interest to consumers of aging services and informal caregivers are provided. The directory is
organized into discrete sections with resources pertaining to general consumer information, consumer resources in Virginia,
long term care and independent living resources, health-related information, and legal information.
Although the directory does not specifically include meeting places for seniors or lifelong
learning resources, many of the addresses offer the browser specific information in these and other areas. The directory is
meant to give older adults and their caregivers a place to start searching for information.
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NA/PCA Training Collaborative with the VGEC
The Virginia Geriatric Education Center (VGEC) and the Virginia Center on Aging (VCoA) at
Virginia Commonwealth University have converged in partnership with the Virginia Department for the Aging (VDA), the Nursing
Assistant Institute (NAI), and the Alzheimer's Association network of Chapters to provide dementia-related training across
the Commonwealth of Virginia.
A three-phase training strategy was developed to include training programs that build on each
other sequentially. The overarching goal is to offer an array of complementary training opportunities to professionals and
paraprofessionals who provide caregiving services. The three training phases aim to:
| 1.) |
enhance the skills of caregivers across the spectrum of long term care |
| 2.) |
improve the performance and job satisfaction of the nursing assistants who provide
direct care, and |
| 3.) |
facilitate their career development through a job-focused intervention. |
Phase I training was supported last year and continues this year with appropriations from
Virginia's General Assembly (through the Virginia Department of Social Services) to the Alzheimer's Association of chapters
in Virginia. Phase II training began in the Fall of 2002 through a contract with NAI from VDA and is supported with funds
from the Administration on Aging (DHHS), as part of the Alzheimer's Disease Demonstration Grants to States Project. That
contract has been recently transferred to the Greater Richmond Chapter of the Alzheimer's Association, and extended with
funding for evaluation to the VCoA. Phase III of the training collaborative will be conducted through the VGEC as part of its
Case Management Initiative (funded under a million dollar grant from the Bureau of Health Professions, HRSA, DHHS). In-kind
support from the VCoA and the VGEC has enabled continuous and thorough evaluation of each Phase of the training since the
inception of the collaborative venture.
Essentially, facilities are being given the opportunity to take advantage of three jointly
coordinated training programs. First (Phase I), they are encouraged to register their staff for 12-hours of training
developed by the National Capital Area Chapter. The Person Centered Care: Skill Building for Caregivers of People with
Dementia training curriculum was offered all of last year to professional and paraprofessional caregivers. Now (Phase II),
the Alzheimer's Association - Greater Richmond Chapter is beginning to prepare selected NAs who have participated in the
dementia program to provide in-services for co-workers back at their home facilities. The in-service instruction will focus
on three important skills that NAs need to know when caring for residents with Alzheimer's and related diseases. The NA
instructors will also help their peers apply the new information and skills on the job. Finally (Phase III), the VGEC stands
prepared to offer job-focused training for "Super NAs" who successfully complete both the person centered care training and
train-the-trainer components. This aspect of the partnered project concentrates on enhancing the work environment to promote
balance between desired residential services and the provision of those services. Pastoral care professionals will help NAs
find meaning in connecting and communicating with residents and families using interactive role playing on the art of
providing compassionate, creative, and adaptive responses to residents with dementia. NAs will then practice basic
communication and interpersonal caring skills. Loss and bereavement issues will also be explored within the context of a
stress reduction model.
Evaluation Results from Phase I: Year 1 Training (July 1, 2001-June 30, 2002)
Person Centered Care: Skill Building for Caregivers of People with Dementia, includes: a)
current information on the causes and progression of dementia, b) the care needs of individuals with dementia, c) available
treatments, d) environmental issues, e) behavioral management, and f) state-of-the-art caregiver interventions. The 12-hour
multidisciplinary training program emphasized the team approach, and was recommended for all levels of staff in a variety of
long-term care settings, including adult day care, assisted living, retirement communities, home care agencies, hospices, and
nursing homes.
Trainees were evaluated using a pre-knowledge questionnaire, which asked for basic
demographic information and included 10 knowledge-based questions; a post-knowledge questionnaire, consisting of 10
knowledge-based questions; and a "homework" survey, that asked for additional demographic data and included two short
career-related questionnaires. All forms were designed to preserve the anonymity of trainees. The knowledge questions sampled
content from each of the modules included in the training curriculum, and employed a multiple-choice format. Questions were
evaluated for literacy appropriateness. The career-related questionnaires measured levels of job satisfaction and the extent
to which trainees had developed a sense of professionalism.
Extensive demographic data were collected from 832 of the participants who attended the
training sessions across the State. Most were female, ranging in age from 17 to 78 (M = 42.39), slightly more than half were
Caucasian, and more than one third were African American. Nearly half of the responding sample held Nursing Assistant
Certificates, and while 16.6% had no degrees beyond the high school diploma, 11.1% had Bachelor's degrees and 5.5% had
Master's degrees. Trainees reported affiliations with a total of 114 different agencies and organizations. More than half
were employed at assisted living facilities, continuing care retirement communities, or other adult care residences, while
one quarter were employed at nursing homes.
Trainees worked an average of 38.18 hours per week in their current positions, and the vast
majority worked predominantly with individuals age 60 or older. More than half of the trainees were paid providers of direct
care to persons with Alzheimer's disease, and slightly more than one quarter indicated that they were informal caregivers as
well. More than half of the trainees had received some formal education in the area of gerontology, with attendance at
conferences, workshops, or other education programs in aging most frequently cited. Most participants appeared to anticipate
an emphasis on long-term care across the course of their careers.
A total of 802 trainees responded to both the pre-training and post-training questionnaires.
Statistical analyses indicate that participants achieved significant gains in knowledge overall, and with respect to all but
four of the individual test items used to sample learning domains. Indeed, an overall improvement of 33.17% was achieved, and
the percentage of improvement for individual items ranged from 20.8% - 496.2%. A psychometric examination of knowledge test
items to assess the reliability and discriminative ability of items showed that seven of the ten items showed good
discriminative ability. Recommendations for future knowledge testing included the elimination of three items, however, and
modification of two others.
Phase II: Train-the Trainer Program for Nursing Assistants (July 1, 2002-June 30, 2003)
Aims
The ultimate goal of the train-the-trainer and support intervention was to improve the
quality of care provided to persons with dementia. The specific aims of this study were to:
| 1.) |
Document changes in levels of job satisfaction and career commitment
among Nursing Assistants (NAs) who participate in the Alzheimer' Association's train-the-trainer education workshop and
then provide in-service training for their co-workers. |
| 2.) |
Evaluate the train-the-trainer instruction; |
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Discover how NAs applied their training on the job and measure their perceptions
about the extent to which it may have improved the quality of care provided to persons with dementia; and |
| 4.) |
Investigate the extent to which supervisors perceive that the intervention affected
work-based practices and care provision. |
Curriculum
The training curriculum utilizes the "Speaking from Experience: Nursing Assistants Share
Their Knowledge of Dementia Care" manual developed by Cobble Hill Health Center, Inc. The training followed the outline
below:
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Characteristics of the adult learner |
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Factors for adult learners |
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Tips for trainers |
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Fundamentals of learning |
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Nature of communication |
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Roles of the training team member |
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Methods of teaching |
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Discussion of in-service content areas |
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Person-centered care and communication skills |
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Minimizing difficult behaviors and involving residents in meaningful and appropriate
activities |
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Stress management and the team approach |
Evaluation Measures
NAs who were identified to serve as trainers and deliver in-services to peers in their
facilities are expected to show improvements with respect to two fundamental concepts: Job Satisfaction and Sense of
Professionalism. A number of demographic and job-related variables were measured to be related to these constructs as well.
Job Satisfaction. The Minnesota Satisfaction Questionnaire (MSQ) was chosen to
operationalize the construct of job satisfaction because it can be administered easily, it requires only an elementary
school reading level, and it evaluates both job context (or extrinsic) and job content (or intrinsic) dimensions.
Sense of Professionalism. In order to measure the extent to which NAs develop a sense
of professionalism, the 12-item Career Commitment Measure (CCM) will be used (Carson & Bedeian, 1994). The scale measures
three dimensions of career commitment: Career Identity, Career Planning, and Career Resilience.
Ancillary Measures. At the end of the day, after the train-the-trainer instruction
has concluded, NAs will be asked to evaluate the education they have just received. This will take the form of the standard
evaluation questionnaire employed by the Virginia Geriatric Education Center.
Follow-Up Questionnaires. Both NAs and their supervisors were contacted after the
training to document the provision of in-service training. NAs were additionally be asked to relate how they had applied
their training on the job, the extent to which it may have improved the quality of care provided to persons with dementia,
and the likely impact on job retention and the promotion of career ladder options. Supervisors were also queried and asked
to report their perceptions of the extent to which participation in the train-the-trainer intervention affected work-based
practices and care provision. In addition, they were asked about whether the training had impacted intra- or inter-agency
cooperation/communication and the training opportunities available to their direct care staff.
Phase III: The VGEC Curriculum (October 1, 2002-September 30, 2005) Doing Your Best in an
Important Job: Knowledge, Skills and Attitude Enhancement
The Virginia Geriatric Education Center job-focused training initiative is provided for
personal care attendants (PCAs) providing Medicaid-waivered services. This aspect of the partnered project concentrates on
enhancing the work environment to promote balance between desired residential services and the provision of those services.
The curriculum was designed to help PCAs find meaning, in connection and communication with residents and families. The
trainer develops the participants' listening abilities while encouraging compassionate, creative, and adaptive responses.
PCAs then practice basic communication and interpersonal caring skills. Loss and bereavement issues are also explored within
the context of a stress reduction model. The primary focus of the curriculum is care management, and the secondary focus
includes important related skills such as stress management and professional behavior.
"Recognition, Respect, and Responsibility: Enhance Care Assistant Training" by Rita A.
Seeger Jablonski, PhD, RN, ANP-BC was originally designed to meet one of the objectives of The Geriatric Case Management
Initiative, which targeted the training and career development of Certified Nursing Assistants (NAs). It was modified to also
meet the objectives of the Virginia Department of Medical Assistance Services project. The primary focus of the curriculum is
care management, which includes the development of skills in screening, comprehensive assessment, care planning,
implementation, and reassessment. The secondary focus of the curriculum includes important related skills such as stress
management and professional behavior.
The curriculum is composed of four 7-hour modules. Total instructional time is 35 hours.
Teaching strategies include didactic, group exercises, discussion, and role-playing. The course objectives are as follows:
| 1.) |
Demonstrate the ability to manage challenging situations with specific
communication strategies. |
| 2.) |
Explain the importance of professional behavior. |
| 3.) |
Work effectively within the home care team. |
| 4.) |
Anticipate disruptive behavior based on assessments. |
| 5.) |
Describe strategies for preventing and de-escalating disruptive behaviors in agitated
adults with dementia or angry clients. |
| 6.) |
Provide members of the Team with NA-derived strategies for minimizing disruptive
behavior. |
| 7.) |
List methods to assess the spiritual needs of clients. |
| 8.) |
Describe how NAs can be a resource to clients who require spiritual support. |
| 9.) |
Explain the physical and psychological signs of death. |
| 10.) |
List ways to help others cope with the deaths of significant others. |
| 11.) |
Identify clients at risk for experiencing loss and bereavement. |
| 12.) |
Integrate knowledge of clients into care planning in order to minimize the effects of
the loss and promote adaptation. |
| 13.) |
Describe methods to prevent or resolve specific legal and ethical problems encountered
in the home care setting. |
| 14.) |
Identify strategies to minimize the effect of violence on caregivers and clients within
the home setting. |
| 15.) |
Identify strategies for successfully managing sexuality within the home care setting. |
| 16.) |
Describe methods necessary for caregivers to maintain optimal physical, psychological,
and emotional health while working with elderly and/or disabled clients. |
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Partners III Project
The Partners III Project (1993-96) has been an effort to respond meaningfully to the
needs of the aging individual with developmental disabilities (DD) and to the needs of the aging and DD service "systems."
Partners III follows in a tradition of projects supported by the Administration on Aging (AoA) and state DD Councils in
Maryland and Virginia. These projects attempted to help bridge the knowledge and practice gaps that exist within the service
systems now operating at the intersection of aging and lifelong developmental disabilities.
The Partners III Project, with support from AoA, built a model, based upon experience,
for improving the coordination and integration of services provided by the Aging Network and the DD System, in order to
benefit older persons with developmental disabilities and their caregiving families. This model incorporates the best
experiences of previous projects in Maryland and Virginia, and so it was labeled The Integrated Model of Service for Older
Persons with Developmental Disabilities. The Integrated Model emphasizes three key elements for inter-system cooperation ---
collaboration, outreach, and capacity-building --- and strategies to achieve them. The model was then field-tested in the
real world through sub-awards to five community-based agencies in Maryland and Virginia.
A detailed description and analysis of the Integrated Model in real-world practice is
contained in the book, Partners: Building Inter-System Cooperation in Aging with Developmental Disabilities, available
from the Virginia Center on Aging (first copy gratis, subsequent copies $10 post paid).
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