Dementia Expert Teepa Snow: U.S. Memory Care Sorely Lacking, Better Training Needed 

The number of older Americans living with Alzheimer’s disease and other forms of dementia is growing every day – and providers of memory care services are not ready to care for them.

That’s according to Teepa Snow, founder and CEO of Positive Approach to Care, an approach to dementia care used by many senior living operators across the country.

Specifically, Snow has concerns regarding the current state of dementia care in light of the approaching “silver wave” of older adults.

“We’ve got the biggest population of human beings that we’ve ever had, all in this age group,” Snow said. “Not only are there more of us getting older, there are more of us getting older and having brain changes.”

About 10,000 people have turned 65 per day since 2010, according to stats Snow cited. And the need for increased training for dementia care is rapidly approaching, with between 60% and 70% of residents living in and entering in long term care developing cognitive changes “consistent with early signs of various forms of dementia” she said.

These signs, however, are often missed by those taking care of residents.

“The reason we’re missing it is we’re not preparing people to recognize the early signs and signals of the various forms of dementia,” Snow said.

But increasing the amount of training and changing the way staff are interacting with residents in the months and years to come may help people living with cognitive changes.

A need for more training

In most cases, certified nursing assistants require the most training when it comes to dementia care at six hours, and the “vast majority” of skilled providers do not require any hours of dementia care training, according to Snow. By comparison, a nail technician in North Carolina is required to have 300 hours of training and practice before they can operate on their own, she said.

As of 2019, 23 states required dementia training for all staff and 13 required training for home health aides. Some of that training includes watching videos without any form of testing, Snow said.

“Most curricula have one portion of one classroom content area that’s spent on dementia, unless they enter specifically into geriatrics in which they may get an entire class on dementia,” Snow said. “We are asking people to step forward into this role without preparation.”

Because of this, Snow added the industry is setting itself up for dissatisfaction within caretaker jobs.

The answer, according to Snow, can’t be simply adding more staff, despite the difficulties the industry is facing with staffing shortages. She added that bringing on more staff but not appropriately training them does not increase the overall quality of care — and in fact, the opposite is often true.

The Covid pandemic “socked the industry in the gut,” Snow said, and there hasn’t been a recovery of the workforce. Because of this, there are worries regarding the quality of care, especially in memory care and dementia care.

“This is getting harder and harder to do,” she said. “What is the state of dementia and dementia care in the U.S.? I wish it were not where it is.”

But she added: “I know we can get it where it could be, with collaboration.”

Changing brains

It’s no secret to senior living operators that memory care communities are not the only places that house residents with dementia. Many older adults living in assisted living or at home often have some form of cognitive decline.

Compounding this is the fact that dementia is incredibly varied, and no one treatment works for every resident.

Part of what makes training for dementia care so difficult is the definition of what dementia is has changed “dramatically” over the past 20 years. As just one example, dementia is now classified as a collection of symptoms rather than a diagnosis with over 120 forms, causes and types.

Adults over the age of 80 are also more likely to have a “mixed-picture dementia,” Snow said. Residents with a form of dementia are considered among the highest risk for falls within a community at a nine times greater chance compared to an individual with Parkinson’s, according to Snow.

Residents with a form of dementia are also more likely to have continuous sleep disturbances, delusional thinking and visual hallucinations that cause stress and distress.

“So the challenge is … that for 50% of people living with this type of dementia, they have hypersensitivity to medications that would classically be used to reduce the distress, reduce the risk of having them actually have these delusional thoughts or hallucinations, and might in fact, immobilize them or heighten their risk for falls,” Snow said.

An additional challenge comes from older adults not being identified with the early symptoms of a form of dementia, which Snow said happens in around 80% of cases. The changing behaviors of these residents is often seen as angry and frustrated, which leads to pharmaceuticals often being used.

“We start looking to fix a symptom without being able to step back and have the right support in place,” Snow said. “These brain changes are not going to resolve themselves with a medication application.”

Family members and caretakers also need to be educated on the physical changes to the brain caused by a form of dementia. Snow said that most older adults don’t realize it will lead to a gradual decline, no matter what is done.

Snow stressed the importance of recognizing that the overall abilities of a person with a form of dementia’s abilities are changing, and what they are capable of has a tendency to shift throughout the day. Identifying when these changes tend to occur can be helpful..

Communication and assessment methods also need to improve and evolve, Snow said, and she encourages teams to be sure they are meeting and knowing their communities.

“With dementia, if you’re not present, people don’t know how to be present,” she said.

Family members and caretakers can be another resource for residents with a form of dementia due to how frequently they are with the residents when staff members can’t be. However, by the time they are brought into a memory care community, it can be at a time when families are overwhelmed and don’t know what to do.

“I think facilities are dealing with the endpoint of where we have not done a good job from beginning to end. It’s an unfair place to be, but unfortunately, it’s sort of where we are,” Snow said.