Wednesday, September 5, 2007

Challenges In Training Staff for Today's Caregiving Needs

My friend and colleague Keren Brown Wilson and I were recently discussing some of the most challenging aspects of preparing a work force to meet the caregiving needs of seniors today and into the future. As Keren pointed out, it's not like we're training people to do highly repetitive, step by step assembly-line tasks.

We're actually teaching people "complex judgment and decision-making skills", as Keren phrased it. Each task that involves another person, especially an elder adult, must be respectful of that person and responsive to his or her needs and rights.

That's why teaching someone to help give a shower isn't simply a "Step 1 - Step 2" process. I like to say that as soon as we complete the "Here's how to assist with a shower" lesson and send a new caregiver off to do just that, he or she will encounter something we never covered in this lesson.

What happens if the person refuses to shower? Prefers a bath? Wants a helper of another gender? Finds the experience frightening or overwhelming? As often is the case, the person sent to assist with the shower and the person being helped may have entirely different needs and agendas.

Clearly, we need to teach caregivers some more basic skills before we begin the lesson on bathing assistance.

We need to teach about basic resident rights - but more importantly, we need to give caregivers the tools to understand those rights. Although it may seem simple from the outside, when you're actually in caregiving situations there are many shades of gray; rarely is anything simply black and white.

The person who is being assisted with bathing has a right to refuse to bathe - but what about the rights of the other people who must share a table with him/her at mealtime? Do we then have the right to make the person who will not bathe regularly sit at a table all by him/herself, essentially isolating him/her from social interaction? How do we meet the health care needs of the person who is refusing to bathe, resulting in skin breakdowns or other problems? When does the person no longer have the right to refuse to bathe?

Trying to boil down caregiving training to simple assembly-line-style procedures results in some of the abuse situations currently making news, situations where the person did what he/she was taught, but didn't take into account the unique individual needs of the resident. (Here's an example where the caregiver may have simply been doing what she was taught - and now is facing the next 6 years in prison.)

How do we teach complex judgment and decision-making skills? Join us as we continue to explore that question, using all of the incredible tools we now have available. Through our team, we're using stories (helping caregivers understand the PEOPLE behind the tasks), situational decision making and games. We're exploring approaches using interactive multi-generational games to allow people to experience, in a safe but realistic environment, the options and choices that come with every task related to caregiving.

It's an exciting challenge - but such a necessary one if we're going to prepare the next wave of caregivers to provide the kind of care that we'd want for our loved ones - or for that matter, for ourselves!

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