Nursing system needs dementia training

I work as a case manager on behalf of senior citizens in the city of

Los Angeles. As part of my job, I attend seminars to further my

knowledge.

Recently, I attended an “Elders at Risk Task Force” meeting

sponsored by the Veterans Administration and the Los Angeles City

Attorney’s office.

I especially wanted to attend this particular meeting as it

pertained to elder abuse in nursing homes. The three-person panel

included a representative from a nonprofit legal organization, the

ombudsman program, and the Department of Health Services.

What I heard did not make me feel any better about our nursing

home system or the Department of Health Services, for that matter.

The representative from the department said things were improving

in nursing homes because the homes were worried about liability. I

then posed the question that if nursing homes were so worried about

liability why is there such a “crisis of care” out there. The

representative further stated that he has seen an improvement in

nursing homes in the last 20 years. The represent- ative from the

legal organization disagreed and so did I.

I can’t tell you how many horror stories I’ve heard from family

members who had their loved ones in facilities even temporarily. I’ve

read about lack of enforce- ment due to cutbacks. And I have also

heard horror stories about negative employer/employee relations,

which of course, filters down level by level by level to negatively

affect the care of the patient.

I asked the representative from the department’s Valley office if

nursing homes were complying with Assembly Bill 1347. The deadline to

comply was July 1, 2005.

Based on my past experience with the Department of Health

Services, I was not totally surprised when the representative asked,

“What’s that?” I told him that it pertained to two hours additional

dementia-specific training in nursing homes. His reply?

“I’m not familiar with it.”

This particular employee and I discussed AB 1347 several times as

we met or spoke regarding my dissatisfaction with the department’s

investigation of a nursing home. Ultimately, the department wound up

giving the nursing home a Class B citation and x-number of

deficiencies (the reason for the “x” instead of the actual number is

that the investigator gave me one number and a person in management

who oversees the department gave me a smaller one). By the way,

citations and deficiencies are public knowledge and are listed on

several sites including o7https://www.canhr.org.

f7This is not the first time I have had to criticize the

department. In order to obtain justice, I had to physically attend a

Los Angeles County Board of Supervisors meeting and criticize the

department for not doing its job. Within a few minutes after the

meeting ended, a management person came to me and told me, “You will

never get what you want.” I played it and said, “What do I want?” He

said, “Citations and deficiencies.” Eventually I persevered and I did

get some of what I wanted. Even in late 2001 and early to mid-2002, I

had problems with the department.

The training Standards Act of 2001 was signed into law on Sept.

25, 2001.

Assembly Bill 1347 requires dementia-specific training for staff

in skilled nursing facilities as follows.

Skilled nursing facilities must develop a dementia-specific

training component within their existing orientation program no later

than July 1, 2005.

Any certified nursing assistant employed by a skilled nursing

facility must complete at least two hours of dementia-specific

training within the first 40 hours of employment as part of the

facility’s orientation program and a minimum of five hours of

dementia-specific training each year as part of the facility’s

ongoing in-service training.

So, there you have what AB 1347 is all about. Since the department

staff has been cut from 14 to 7, and the fact that this person who is

in management isn’t familiar with AB 1347, what do you think is going

to happen? Compliance and enforcement will be problems.

In May 2002, I attended Advocacy Day hosted by the Alzheimer’s

Assn.

I met Anthony Pescetti, the author of AB 1347. I thanked him for

his work on this very important bill for patients who have

Alzheimer’s disease and for their families. Dementia-specific

training in skilled nursing homes is vital for the betterment of the

patient.

I also have been pushing for dementia-specific training for

certified nursing assistants while they are in school with additional

training during employment since new information is always coming out

about Alzheimer’s disease.

I now wonder about the budget for community care licensing, which

oversees residential care facilities and is required under AB 1753 to

provide dementia-specific training for administrators and direct care

staff.

I hope residential care facilities are complying with the law.

In closing, I would like to say that there is still a lot of work

to accomplish. I would like to see legislation (and I’ve been pushing

for it for the last eight years), which addresses the need for

dementia-specific training in adult day care centers and adult day

healthcare centers, especially those which advertise that they

specialize in dementia and Alzheimer’s. If you had or have a loved

one with Alzheimer’s and dementia in an adult day care or adult day

healthcare center and the staff isn’t dementia-specific trained, I

suggest you pick up the pen and write to your elected officials about

this very important piece of legislation that is too long in coming.

For information about Alzheimer’s, dementia, and AB 1753 and AB

1347 go to https://www.alzla.org.

* EDEN ROSEN is a resident of Burbank.