EXPLORACIÓN BIBLIOGRÁFICA

As stated earlier, when caring for an individual living with dementia becomes too much for the care partner alternative options may be considered, options such as AL (Whitlatch & Orsulic-Jeras, 2018). In AL, individuals can get help with their ADLs while being in a home like environment with 24-hour care (Bowblis, 2012). When individuals living with dementia

transition to AL DCWs become their main provider of help with ADLs and IADLs. DCWs are very important to resident care as they help with physical care, engage residents in meaningful activities, and are really the ones in charge of maintaining residents’ quality of care and life (Gilster, Boltz, & Dalessandro, 2018). These individuals can influence the quality of life and overall experience that residents receive in AL (Gilster et al., 2018).

Despite the impact DCWs have on the quality of life of residents in long term care communities keeping up with the demand for these individuals as well as retaining these care providers continues to be a challenge (Gilster et al., 2018). Reasons for difficulty in retaining DCWs has been attributed to low wages, lack of benefits, and few opportunities for career

mobility; the median income for DCWs in AL is approximately $18,152 US (Kelly, Morgan, Kemp, & Diechert, 2018). Jobs in AL are considered accessible to those looking for entry level jobs as less formal training is required, when compared to nursing homes, but the lack of career opportunities makes workers view AL as a temporary job until they can reach their true

professional aspirations (Lepore et al., 2010). Researchers also point to lack of job satisfaction as another reason for the lack of job retention (Vernooij-Dasssen et al., 2009). Providing workers with opportunities of education, training, mentoring, and keeping them appropriately

compensated were seen as being facilitators of job satisfaction (Vernooij-Dasssen et al., 2009). As the older population grows and demand for long term care communities increases, AL communities will need to find solutions to the problem of worker retention so that proper care can be provided to residents and to prevent a shortage in the AL workforce (Vernooij-Dasssen et al., 2009).

Scant research attention has been paid to AL staff perceptions of and reactions to

“BPSD” or the behavioral expressions of those with dementia. McKenzie and colleagues (2012) address this knowledge gap by studying the effects of BPSD on direct care staff in AL, who typically cared for residents on a daily basis, but had limited training in caring for individuals living with dementia. Researchers found that the majority of direct care staff identified BPSD as upsetting and bothersome; depression-related behaviors affected the staff the most and were linked with increased staff reaction. McKenzie et al. (2012) concluded managing symptoms of depression among those living with dementia was seen as a concern and emphasized the need to train staff on how to address BPSD in ways that reduced staff stress. McKenzie et al. (2012) concluded that by training the staff not only will the emotional well-being of the staff improve but so too can the quality of life for residents.

Additional research on the effects of BPSD on staff focused on staff in nursing homes. A study conducted in Germany looked at the stress nurses faced when caring for individuals with “challenging behavior” (Schmidt et al., 2012). Schmidt et al. (2012) explained that BPSD often fell under this challenging behavior category and learned that residents with challenging

behavior would increase the stress of the nurses who help the individuals exhibiting the

behaviors. The stress related to BPSD could increase the risk of nurses feeling burned out which in turn would lead to the nurses quitting and creating a staff shortage at the nursing home

(Schmidt et al., 2012). While not directly translatable to AL communities, it is still relevant. If nurses who are taught and trained on how to care for residents living with dementia are

experiencing increased stress and burnout due to the expressive behaviors that can arise from those living with dementia, then the impact it can have on the DCWs and care partners who do not have as extensive training, could theoretically be even more severe.

In order to provide residents living with dementia high quality of care and prevent the over use or abuse of medication, researchers also recommend providing staff with more training on how to address the behavioral expressions of those living with dementia (McKenzie et al., 2012). Training staff has been shown to reduce BPSD in residents living with dementia (Spector, Orrell, & Goyder, 2013). The positive effects obtained after staff training has also been shown to be maintained over time (Spector et al., 2013). While the efficacy of various training programs may still require further research, the literature does show that providing staff and DCWs theoretical and practical techniques on how to address distress improved quality of life for residents (Serelli et al., 2017). DCWs also stated that after training in programs such as the STAR training program they began to believe they were more competent in providing the appropriate care (Serelli et al., 2017). DCWs reported having fewer negative reactions to

problems and felt greater job satisfaction (Serelli et al., 2017). Training programs that employ a strong theoretical base with good management and supervision may be the most beneficial to DCWs and residents living with dementia (Spector et al., 2013).