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Alzheimer's Care Crisis

Nursing aides, the backbone of the caregiver system, are undervalued, undertrained, and leave their jobs at an alarming rate. But facilities across the nation are taking steps to close the revolving door.


Each day spent caring for Alzheimer's patients poses unending, energy-sapping challenges. There's the woman who screams in the shower because she finds the experience terrifying. The man who refuses to eat without coaxing. The patient who becomes combative on the way to the bathroom.

Forgetfulness and confusion can be the least of it.

Still, there are rewarding moments, and most of these tasks could be managed with specialized training.

But the legions of nursing aides providing the vast majority of hands-on care tend to have little if any training, earn little more than minimum wage and complain they get little respect or recognition for some of the toughest jobs in health care.

"The patients are often mismanaged by a worker who has good intentions but simply does not understand," said Debra Cherry, associate executive director of the Alzheimer's Assn. of Los Angeles.

Not surprisingly, most of these caregivers don't stay long on the job. At the majority of nursing homes--increasingly populated by patients with Alzheimer's and other memory disorders--more than nine of every 10 nursing assistants quit each year.

Many walk away from these tasks, which pay an average of $8 an hour, for higher-wage positions selling shoes, serving fast food or cleaning hotel rooms, none of which carry the emotional toll of caring for dementia patients.

But consistent care is critical for Alzheimer's patients. They have short attention spans and limited ability to communicate. They need extra interaction. Indifferent care from stressed workers or temporary hires can lead to poor nutrition, social withdrawal and physical declines. Without caregivers who know their life histories, likes and moods, residents are more likely to deteriorate.

"Imagine how difficult it would be for a person with Alzheimer's, who doesn't always know where they are, who just because of the nature of the disease may be fearful and insecure," said David Troxel, a consultant to long-term care and dementia programs and executive director of the Alzheimer's Assn. of Santa Barbara. "Imagine then being cared for by people who may not know a thing about you, an aide who has just started that day, doesn't know your name very well and doesn't know your traditions or background."

Nursing homes and long-term care facilities have long had difficulty hiring and retaining aides. With Alzheimer's and dementia patients constituting 65% of the growing population of nursing home residents, advocates for the elderly are particularly concerned about how they will fare.

As the number of Americans with Alzheimer's increases from 4 million today to a projected 14 million in 2050, more patients with the memory-robbing disorder will come to rely on the help of nursing and home health aides. Although 70% of Alzheimer's patients are cared for at home, there comes a time when many families will need outside help--and it's getting harder to find.

"This is a crisis clearly understood by the industry," said Judy Riggs, director of federal and state policy for the Alzheimer's Assn., at a recent session of the World Alzheimer Congress in Washington, D.C.

"We should be paying attention to these issues because we have this tremendous turnover, because it's so hard to find staff," Troxel said. "The problem is some facilities treat their staff badly and expect badly treated staff to treat their residents well."

Yet in nursing homes and care facilities coast to coast, ambitious administrators are setting out to halt the employee revolving door.

"I do sense from talking with people around the country that facilities are waking up to the importance of orienting staff and training them well. There are many progressive facilities that--because things have gotten so bad--are finally getting serious about training," Troxel said. "This means not just a 45-minute videotape or lecture on payday; it means role-playing, reinforcement, doing training in people's native languages."

Some facilities have also increased wages, added bonuses, and begun offering educational benefits. A few facilities in the Chicago area are paying as much as $11 an hour, said Anna Ortigara, a registered nurse with decades of dementia-care experience.

And, she said, "I'm starting to see 401K plans, good health insurance and tuition reimbursement that we didn't see 10 years ago."

The federal government has also recognized the need for training and job advancement, providing a $2.2-million grant to the Service Employees International Union Local 250 in Northern California and Kaiser Permanente, the state's largest HMO. Union members working for the HMO and community nursing homes, such as housekeepers and clerks, can be trained as nursing or medical assistants. Nursing assistants in nursing homes will be able to train for acute-care jobs at Kaiser. As they move up the ranks, the union will recruit low-income and welfare-to-work recipients to replace them.

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