Alzheimer Experts Offer Providers and Policymakers Solutions to Slow Shocking Rate of Staff Turnover and Increase Care Quality–

WASHINGTON, D.C., July 17,2000; The United States is about to be blindsided by a devastating one-two punch;Alzheimer’s disease and the long-term care workforce crisis, said care experts today at World Alzheimer Congress 2000.

“We are on the brink of a health care disaster,” said Anna Ortigara, RN, MS of Life Services Network in Chicago. “With millions of Baby Boomers marching their way toward Alzheimer’s disease, our nation will see a major long term care workforce shortage and a dramatic drop in care quality unless we address this problem immediately.”

This workforce crisis was the focus of World Alzheimer Congress 2000 today, which featured four innovative programs that have figured out how to empower direct care workers and retain a high quality workforce. Administrators and direct care workers from the four programs offered ideas for both policy markers and providers.

The Alzheimer’s Disease Workforce Problem

Today, four million Americans have Alzheimer’s disease. Unless a cure or prevention is found, that number will jump to 14 million by the year 2050, thanks largely to the aging of the population and increase in accuracy of diagnosis. Each person with this disease will eventually require total care, whether they live in a residential care facility or at home. At least half of all nursing home residents have Alzheimer’s disease or other dementia.

“Quality Alzheimer care is complex, stressful and time-consuming,” said Stephen McConnell, vice president of public policy and program service for the Alzheimer’s Association (U.S.A.). “The critical factor in quality dementia care is staff ; adequate numbers of well trained and fairly compensated direct care workers who understand and respect the person with Alzheimer’s disease and are empowered to manage their care individually and effectively.”

Today, more than one million certified nursing assistants (CNAs) provide as much of 90 percent of hands-on care in nursing homes and other settings.

“However, inadequate staffing levels, low wages, poor or nonexistent benefits and lack of recognition are driving these workers to other sectors of the economy where work is easier and compensation is better,” added McConnell. Recruiting and retaining quality staff in this demanding field in a strong economy is very difficult. National long-term care staff turnover rates are at a mind-boggling 94 percent annually. Some facilities are facing turnover rates of 100 to 500 percent.

For people with dementia, this type of staff turnover can be harmful, causing frustration and further disorientation.

“What incentive is there for these direct care workers to stay and care for people with Alzheimer’s disease for $7.56 an hour when the retail store down the street is offering over $1.00 more an hour, plus benefits and career advancement?” said Ortigara. Although wage is certainly an issue, Ortigara is quick to point out that money is not the only factor that motivates people to leave the direct care field. “Time and time again, research tells us that direct care workers do not feel that their hard work, expertise and relationship with residents are respected and acknowledged by their supervisors,” said Ortigara. “They do not feel as if they are part of the decision-making process, even though they are on the front lines.”

Care and public policy experts at World Alzheimer Congress 2000 offered the following solutions to this workforce crisis.

Provide adequate Medicaid reimbursement to assure adequate numbers of staff and fair compensation for the critical work they do. Since Medicaid is a source of payment for almost 70 percent of nursing home residents, some of the responsibility and potential solutions to this workforce crisis rest at the policymakers’ feet.

“State and federal governments can help head off this workforce crisis by providing adequate reimbursement that is directly tied to staffing levels, wages, benefits, resources for training, and recognition for proficiency in dementia care,” McConnell said.

Build career ladders for direct care workers. Providers must build career development into the workday. They should create an environment where staff is encouraged to develop additional skills, take on added responsibility and earn more money. The payoff is significant to the facility; the staff has more skills and motivation. The workers feel that they have built something up with the organization and have more to lose if they leave, plus it makes their day-to-day job more rewarding.

Create cooperatives where frontline workers actually co-own the organization. One New York City home health care agency shared their 15-year cooperative experience with congress attendees. In this very innovative and successful model, staff can borrow money from the agency (paid through payroll deductions) to purchase shares of the agency. As co-owners, they have input into the policies and structure of the organization and benefit from the profits, making them less likely to seek employment elsewhere and more likely to provide top-notch care.

This model has been replicated successfully in Boston and Philadelphia. Involve all staff in the monitoring of residents’ well being. In one Ohio continuum of care facility, all staff, from custodian to CNA to CEO, participate in a relatively new approach, called “dementia care mapping.” Using a measurement scale, staff monitor and record how and what each resident is doing every few minutes during the day. All levels of staff analyze the data and try to improve the dementia care that is provided. By allowing access to education and tools, staff is empowered and has a significant impact on the quality of care provided.

This strategy has improved the outcomes for people with dementia and decreased the CNA turnover rate from 38 to five percent. Recognize staff for their dedication and hard work. Little things mean a lot to this overworked and underpaid population. Chicago CNAs have a special day set aside for an annual “Celebrate the CNA” conference. This conference involves area CNAs in the planning and presentation of dementia education sessions. Traditionally, CNAs participate in educational events on their own free time, not work time. All participating facilities have made a special commitment to their CNAs and provide them with this education and recognition opportunity during paid hours. This gesture goes a long way to show these professionals that their facility is concerned with quality and career advancement. “To avert this crisis, providers and policymakers have to be open to change and willing to empower, recognize and compensate direct care workers,” said Ortigara.


  • The Alzheimer's Association (U.S.A.) assumed leadership of the world's largest international conference on Alzheimer's disease, World Alzheimer Congress 2000. Over a 10-day span, world leaders in Alzheimer research and care united in July 2000, marking the first time these Alzheimer specialists have come together for the vital purpose of sharing information on research and care to improve the lives of people affected by Alzheimer's disease. This unique gathering of scientists, healthcare professionals and other specialists was the collaborative effort of the Alzheimer's Association (U.S.A.), Alzheimer's Disease International, and the Alzheimer Society of Canada. For more information, visit the web site.