CNA sitting on stairs with head in her hands.
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As federal lawmakers ponder ways to address workforce shortages and quality in senior living communities and other long-term care settings, the Alzheimer’s Association and its advocacy affiliate, the Alzheimer’s Impact Movement, have some specific suggestions for assisted living and memory care communities.

Thirty-four percent of assisted living residents have Alzheimer’s disease or another type of dementia (the federal government estimate is higher, at 42%), and “[a]n adequate and well-trained workforce is fundamental to providing quality dementia care,” the organizations said in a letter submitted to the US Senate Special Committee on Aging for the record of the hearing it held Tuesday, titled “The Long-Term Care Workforce: Addressing Shortages and Improving the Profession.”

The need for members of the paid dementia care workforce across all settings is increasing as the prevalence of Alzheimer’s disease increases, the groups wrote. “From 2016 to 2026, the demand for direct care workers is projected to grow by more than 40%, while their availability is expected to decline,” they said.

Recommendations specific to assisted living

Many of the points in the April 16 letter echoed points the groups made in a Jan. 25 letter to the Aging Committee for the record of a hearing titled “Assisted Living Facilities: Understanding Long-Term Care Options for Older Adults.”

For instance, the April 16 letter also pointed to the Alzheimer’s Association’s Dementia Care Practice Recommendations for professional caregivers, released in 2018, which in part call for providers to “create and maintain a supportive community for individuals, families and staff.”

The organizations also reiterated that, to maintain a strong dementia care workforce, assisted living communities should:

  • have staffing levels adequate to allow for proper care at all times, day and night;
  • ensure that all staff members are sufficiently trained in all aspects of care, including dementia care;
  • adequately compensate staff members for their work;
  • provide a supportive atmosphere for staff members that appreciates their contributions to overall quality care, because improved working environments will result in reduced turnover in all care settings; and
  • ensure that staff members have the opportunity for career growth.

Also among their staff-related recommendations, the organizations once again said that assisted living communities should:

  • provide a thorough orientation program for new staff members, as well as ongoing training;
  • develop systems for collecting and disseminating person-centered information;
  • encourage communication, teamwork and interdepartmental/interdisciplinary collaboration;
  • establish an involved, car[ing] and supportive leadership team;
  • promote and encourage resident, staff and family relationships; and
  • evaluate systems and progress routinely for continuous improvement.

‘Consider proposals that support states’

The organizations also urged the Aging Committee to “consider proposals that support states in implementing and improving dementia training for direct care workers, as well as their oversight of these activities,” and they offered specific recommendations for training policies. 

The groups also called for an expansion of the use of a telementoring program known as Project ECHO. “These education models can improve the capacity of providers, especially those in rural and underserved areas, on how to best meet the needs of all patients, including people living with Alzheimer’s,” they wrote.

A bill introduced in the House (the Accelerating Access to Dementia and Alzheimer’s Provider Training, or AADAPT, Act, H.R. 7688), would expand the program through grants, “to address the knowledge gaps and workforce capacity issues primary care providers face given the increasing population living with Alzheimer’s disease and other dementia,” they noted.

The letter also discussed potential investments in direct care workers in nursing homes, palliative and hospice care settings, and home- and community-based services.

Read the letter here.

Committee chair introduces bill

As McKnight’s Senior Living previously reported, the Senate Aging Committee’s chairman, Sen. Bob Casey (D-PA), announced the introduction of the Long-Term Care Workforce Support Act, S 4120, at the committee’s April 16 hearing, noting that almost 70% of assisted living communities have reported significant or severe workforce shortages. 

Casey said the bill would ensure that caregiving can be a sustainable, lifelong career by providing “substantial” new funding to support workers in assisted living and other parts of the long-term care continuum. Specifically, he said, the bill would provide pathways for people to enter the workforce, improve wages and benefits, ensure a respectful and safe working environment, and introduce best practices on recruitment and training to promote retention.

Senior living industry advocates offered mixed reviews of the bill, although the Center for Excellence in Assisted Living (CEAL@UNC) was among the groups formally endorsing it.

Senate Aging Committee Ranking Member Sen. Mike Braun (R-IN), however, cautioned against a federal “one-size-fits-all” approach, suggesting that innovation at the state and local levels is needed to meet the increased demand for direct care professionals.