Policy Memo for Belmont Village

TO: Lora Connolly, Director for the California Department of Aging

FROM: Rohila Kusampudi

DATE: March 19th, 2018

RE: Policy Memo for Belmont Village

Key Points

• Annual staff training on caregiver behavior to better meet the emotional and cognitive needs of residents.
  
• A redirection of corporate profits towards staff training - which may result in short-term losses but will pay off in long term dividends.
  

Overview

The senior care agency I am associated with is Belmont Village located in Westwood, Los Angeles. Belmont Village serves a large variety of residents including independent older adults, older adults with ADL limitations, and older adults with varying forms of memory impairment. This agency provides an important service to the people of California by providing a safe and organized environment in which older adults can age comfortably. My role in this agency is to provide company and assistance to residents of Belmont as part of a service-learning initiative through UCLA’s cluster course on human aging. During my time spent here, I’ve appreciated the genuine efforts of the agency to create a nurturing environment. Unfortunately, I’ve recognized a need for additional staff training that improves the residents’ mental and emotional health and creates an atmosphere of respect, trust, and mutual understanding. I wish to recommend that annual staff training conducted by qualified gerontologists and  financed by annual corporate profits be established in order to better the quality of care that Belmont provides to its residents.

Observations of the Staff

During the many hours spent at Belmont Village, I’ve interacted with both residents and staff in various settings. It was nice to see that many members of staff were caring, patient, and knowledgeable. However, I observed the following instances of behavior which could be improved:

1. Availability
   

In spaces like the dining hall pictured to the left, the availability of staff is compromised due to both the large space and the large resident-to-staff ratio. On several occasions, residents had their orders taken late or taken incorrectly, did not receive adequate answers to their concerns, or simply felt neglected. I would advise staff training to include suggestions on how to be accessible and attentive to patients’ needs in order to increase the feeling of support and comfort.

1. Infantilization
   

While most mean no harm when doing so, several staff speak to the residents with overwhelming concern and friendliness, reminiscent of the manner in which one speaks to a child. Despite cognitive decline, residents are aware of these changes in tone and behavior and respond by increasing their own dependency (Hooyman, 2018). Because of the debilitating psychological effects of this behavior, I would like to recommend the inclusion of appropriate caregiver behavior in the annual staff training.

1. Gossip
   

Although it is important for staff members to share important information about the residents with one another, the comments can sometime be of a rude and slanderous nature. Communicating about the residents’ actions with a roll of the eyes, talking about an incident that occured with exasperation and anger, and speaking informally about private details should all be discouraged. This can be achieved by emphasizing the importance of privacy and respect in an annual staff training.

Gerontological Reasoning

Through my gerontology education at UCLA, I was better able to identify the problems in the staff’s behavior and devise solutions that would conform with medical and ethical principles. Memory impairment can cause a once dynamic and intelligent person to feel like a shadow of their former selves and inferior to everyone around them (Brody, 1984). In order to mitigate this process and the overall loss of independence that is often age, self-efficacy and active aging should be encouraged. It is true that complete self-efficacy is not possible in a facility where time and efficiencies also have to be considered (Gendron, 2016). However, small efforts to minimize the difference in behavior between how we treat individual before and during memory decline can actually decrease the rate of progression and even improve chances for recovery (Hooyman, 2018). 

Policy Recommendation

In order to transform the behavior of the staff members at Belmont Village and create an atmosphere where senior residents can age with grace and dignity, I would like to recommend a policy of annual staff training conducted by a trained gerontologist and financed by Belmont Village’s annual corporate profits. While Belmont does have training for new staff and monthly in-service training, all of this training is related to the medical and practical aspects of dementia, memory loss, and physical impairment and there seems to be little attention to the behavioral aspects of caregiving. It is for this reason that I believe there should be an annual staff training that focuses on the behavior of the staff in order to better the residents’ comfort and emotional support. In order for this additional training to cost no additional funding, I suggest that it should be paid for from Belmont’s own annual profits. While I recognize that this leads to a temporary loss for the company and its employees, it is important to realize that Belmont is already benefiting from being one of the few for-profit senior living facilities in the area. Despite a temporary decrease in profit, it is certain that these measure will improve the happiness of the residents and improve Belmont’s consumer base, profitability, and quality of service over time.

References

Brody, E.M., Johnsen, P.T., Fulcomer, M.C. (1984) What Should Adult Children Do for Elderly Parents? Opinions and Preferences of Three Generations of Women. Journal of Gerontology, 39, 736–746. https://doi.org/10.1093/geronj/39.6.736

Gendron, T.L., Welleford, L.A., Inker, J., White, J.T. (2016). The Language of Ageism: Why We Need to Use Words Carefully. The Gerontologist, 56 , 997–1006. https://doi.org/10.1093/geront/gnv066

Hooyman, N. R., Kawamoto, K. Y., & Kiyak, A. H. (2018). Social Gerontology: A Multidisciplinary Perspective (10th ed.). Boston, MA: Pearson.