Mapleton, Maine - In the course of a conversation with someone this morning, a man asked me a question. He asked, "How do you know if the care center is managed by someone who has a high emotional quota resulting in appropriate care being provided to individuals living with Alzheimer's"? Here's the answer.

Every person living with Alzheimer's has a different experience. In the beginning and middle stages of Alzheimer's it is possible to stay at home and receive home care from a family caregiver who may also be assisted by care attendants.

In the late stages of Alzheimer's it is often impossible to continue living at home because the family caregiver becomes physically and emotionally sick. This is largely due to exhaustion and extreme stress from the 24/7 schedule that may have been going on for several years. I know, because I've been there. Alzheimer's can last up to 20 years or more.

The ratio of residents to professional caregivers goes from 1:1 at home to 1:7-10 in long-term care. When I say that family caregiving is physically and emotionally exhausting, it is the same in long-term care for professional caregivers. Management just does not seem to "get it" and simply allows burnout and resignations instead of addressing this workforce problem.

Professional caregivers go through FOUR STAGES of their own (Remembering 4 You) when compared to seven stages for Alzheimer's (Alzheimer's Association). Management is not aware of this either and therefore does not address those stages properly, leaving each worker to fend for themselves when they experience one stage after another.

The administrator is most often a trained Licensed Social Worker (LSW) or Nurse (RN), but rarely a trained business individual with a MBA and leadership skills, as administrator of a facility. These individuals do not have any leadership background or training. They often overlook employees who should be released into the workforce on the spot for unacceptable behavior. This creates a loose team formation that eventually lets go and contributes to a crisis work environment managed by crisis intervention instead of solid leadership direction, planning, and execution.

Training does not cover the latest research and technology that would bring up the quality of care and quality of life of their residents. Instead the training director often chooses to run old training recordings and make the least possible effort with the least amount of resistance from the workforce ~ just enough to meet the requirements to remain licensed to keep the care center running on "fumes" instead of substance.

Staffing is also controlled by government regulations. Although government dictates the absolute minimum number of staff to residents, facilities choose to go by this regulation in order to save more money for their facility. Governments dictate the same ratio of staff to residents in all areas of long-term care without taking into consideration that a memory loss unit filled to capacity with individuals who are living with Alzheimer's or other forms of dementia, demands specialized care and therefore specialized training. It also requires specialized training which is not provided to the staff. Let me give you a few examples.

Staff will repeat and raise their voice each time they speak to someone with Alzheimer's, as though they are hard of hearing. The problem is that the person with Alzheimer's heard it the first time; they only get one out of every four words. No one can make sense of that behavior even if the message is repeatedly yelled in your face.

Staff will start talking as they approach an individual with Alzheimer's from the side and move into their space at the same time they continue talking. Perhaps they are approaching to give medicines or to take them to their room.

The person with Alzheimer's can only see a small radius directly in front of them. The brain narrows vision quickly in order to save brain energy in a person with Alzheimer's. For them it is like looking at their environment with a pair of binoculars.

Staff will feed someone who has Alzheimer's and cross talk with other workers. Maybe they will feed two individuals at the same table, at the same time. I have seen staff feed individuals at three different tables running from one to the other.

Eventually the person who is being fed gets tired and quits eating altogether. I call that forced starvation because if they were fed properly they would eat more instead of going hungry. Staff who is not trained in feeding can do more damage than good.

Seriously, how do you know that someone who receives a few months of training like a certified nursing assistant (CNA) and a nurse who receives about a year of training or two with less than a glance at the condition known as Alzheimer's can provide the right care?

How do you know that an individual with a degree in Social Work or Nursing can become a leader of a large workforce tomorrow? Would we not want to know that when we bring a loved one with a complicated disease to a specialist, it is in fact the best care we can find? Is the nursing center where your loved one resides safe and understood, even appreciated? Take a look at THIS CLIP to understand what a person with Alzheimer's experiences every day.

In closing, there are many more examples and questions. As the reader, this should give you a good idea of the lack of training and preparation of long-term care in America and around the world. Our healthcare system leaders need to do some soul searching and the public needs to do the same.

Let's wake up and stand for better care through better training everywhere. Let's ask for a better trained healthcare workforce. Let's lend a hand when we can. Let's ask the leaders to stop managing by crisis and lead by example such as in a servant leadership style. This is not a North America problem, it is a world-wide healthcare problem.

About Éthelle Lord, DM

Dr. Lord is a former president of the Maine Gerontological Society in the State of Maine, currently President and Professional Alzheimer's Coach offering Alzheimer's coaching and consulting with businesses at Remembering4You.com, and is a professor of Organizational Behavior at several universities. Dr. Lord has a Doctorate of Management in Organizational Leadership from the University of Phoenix.