Upskilling isn’t just for professionals in the corporate world. For health-care workers, professional training and skill development is a chance to gain new knowledge and provide high-quality care.

For many, a toy car isn’t worth a second glance. But for one Ontario health-care aide, who had recently completed training to learn new techniques for communicating with individuals living with dementia, noticing a toy car in his client’s home was a game-changer.

The health-care aide (HCA), who had taken the Be EPIC person-centred communication training program, struck up a conversation with his client about cars. That conversation led to the client opening up about his physical needs for the first time, allowing the HCA to elevate the care he provided. But making this connection would have been much harder for the HCA had he not made an effort to upskill.

Canada’s first national dementia strategy, released last June, states that having a “skilled workforce will… improve the quality of life of people living with dementia and caregivers.” A skilled workforce is one that’s continuously learning and incorporating current research and new, evidence-based best practices into their day-to-day work.

Upskilling — which is to say, teaching health-care workers new skills or providing training to develop skills that will enhance how they do their job — is essential in providing ongoing, quality care. Recent examples of upskilling across Canada have a common element: they’re person-centred.

The Alzheimer Society of Canada calls person-centred care a relationship-based approach to caregiving. It’s about care providers focusing on the needs of people with dementia, where care is “based on the values of dignity and respect, information sharing, participation and collaboration.” It’s about seeing people with dementia as people first, by going beyond their medical history.

Training the health-care workforce to think in this way means teaching soft skills that elevate relationship-building, communication and trust. These following businesses and post-secondary institutions are all providing new educational approaches to better prepare the health-care workforce to meet the demands of the future.

Be EPIC

Person-centred communication

Be EPIC is a person-centred communication training program created by Dr. Marie Savundranayagam, an associate professor in the Faculty of Health Sciences’ School of Health Studies at Western University, and her research team out of that university’s Sam Katz Community Health and Aging Research Unit. It aims to change the way the health-care workforce communicates with people living with dementia by training staff to focus on who the individual is, forging deeper, more meaningful relationships with their clients. The training is for health-care aides, or what Ontario calls personal support workers, and is made up of two sessions that total 10 hours of training, all taught by the Be EPIC research team.

Be EPIC integrates various theories, studies and evidence from the last 20 years, and is an acronym that reminds HCAs of the key elements that contribute to person-centred communication.

“E stands for ‘environment’ or surroundings, which offers lots of clues about the person with dementia’s personal history, what matters to them, their likes and their dislikes,” says Savundranayagam.

“P stands for ‘person-centred communication strategies’ meant to empower individuals with dementia to make their own choices and communicate them.” For example, asking yes or no questions, or asking the person living with dementia to choose between two options. This type of questioning can be less cognitively taxing than asking open-ended questions.

“I stands for ‘I matter, too.’ That puts the focus on the caregiver. Sometimes there’s a misunderstanding that person-centred care is all about the person receiving the care, but really, it’s about the relationship,” says Savundranayagam.

“C reminds caregivers to focus on the ‘client.’ Often they can tell you about what they like or don’t like.”

How is Be EPIC upskilling?

“We’re [upskilling the workforce] so that they recognize their clients are persons with a wonderful, rich life history that needs to be acknowledged,” says Savundranayagam. “Caregivers can connect with the person by focusing on their identity and sense of self.”

Be EPIC also allows trainees to apply the communication skills they’ve learned immediately. During training sessions, learners interact with actors trained to respond in a similar way to someone living with dementia.

“We teach the trainees about the various communication strategies, and then we get into a simulated scenario,” explains Savundranayagam. “Then, the person who is engaging with the actor gets to reflect on [their reaction and response], and the actor comes out of character to talk about how they felt about the interaction. That [direct feedback] isn’t often something you get working in the field.”

Why is this important?

Savundranayagam and her team have found that Be EPIC participants are more confident communicating with people living with dementia compared with caregivers whohaven’t taken the training.

“That’s important because, when workers are confident in their communication skills, then they are less likely to go into the encounter with fear or with stigmas,” says Savundranayagam. “They can address responsive behaviours and connect with the individual with dementia in a way that is meaningful to them.”

She adds that, with compassionate communication techniques, clients feel understood and listened to, increasing the likelihood of a reciprocal relationship and elevating the quality of care HCAs can provide.

Be EPIC Quick Facts

What’s happening to upskill the workforce?

Be EPIC is a person-centred communication approach that teaches health-care aides to communicate with people living with dementia by creating meaningful
relationships.

Upskilling health-care aides since: 2016

Where does training take place? At long-term care homes and care agencies across Ontario.

Number trained so far: About 50 health-care aides.

AgeCare

Shifting the culture of care

In 2018, the staff at AgeCare — a Calgary-based company that runs long-term care and supportive living communities for older adults in Alberta and B.C. — examined how they could improve the quality of life for all their residents, especially those living with dementia.

After learning from visiting experts at the Dementia Network Calgary’s Dementia Re-imagined conference — including Claire Surr, a professor of Dementia Studies at Leeds Beckett University — and hearing feedback from AgeCare residents and their families, the business developed its own person-centred care model for residents living with dementia. This model doesn’t have a name, but Marilyn Willison-Leach, senior-vice president, operations at AgeCare, calls it a company-wide culture shift.

“The important first step to take in shifting the culture and implementing our person-centred care model was to look at education,” says Willison-Leach. “To achieve change, we had to [address] the knowledge, skills and attitudes that all our employees have toward people living with dementia.”

How is AgeCare upskilling?

Instead of a formal, strictly classroom-style program, Jennifer Grusing, AgeCare’s director, education and skills development, says AgeCare is taking an incremental educational approach.

“We wanted to develop an educational course that was going to stick,” says Grusing, who created the program together with the AgeCare education and skills development team. She adds that all staff receive the training, not just those providing care. AgeCare educators created a five-module course, taught over five months, that helps staff absorb new information and then apply it. Registered nurses or licensed practical nurses who are in an educator role at AgeCare teach the course on-site.

“In the weeks in between each monthly module, staff have a workbook to read, questions to answer and can put what they learned into practice,” says Grusing.

The course teaches employees about the personal, emotional and physiological factors that all play a role in providing compassionate, person-centred care. For example, one module touches on personal values, beliefs and stigmas. Another explores empathy and the importance of knowing a resident’s life story and their interests. There’s even a module on how dementia physiologically affects the brain. Grusing adds that the course design allows staff to interact with the course material through skits or by analyzing workplace interactions.

Why is this important?

Grusing and Willison-Leach both say the five-module training program provides staff with an in-depth understanding of life with dementia, helping them empathize with family members and connect with residents.

“Families that visit and physicians that work in our dementia care neighbourhoods say they’ve seen a positive change in interactions between staff and residents,” says Willison-Leach. “Mainly, I think [because of this culture shift], residents’ quality of life has changed because the primary focus has been put on their abilities.”

AgeCare Quick Facts

What’s happening to upskill the workforce?

To help shift its care culture, AgeCare created a five-module course that teaches its staff about living with dementia and the various social, emotional and physical factors that go into providing compassionate, person-centred care.

Upskilling the workforce since: 2019

Where does training take place? For now, AgeCare is offering its education program at its seven communities that specialize in memory care; five are in Calgary, one is in Brooks, and one is in Strathmore.

Number of staff trained so far: 375
AgeCare employees.

Bow Valley College

Training tomorrow’s health care aides

In January 2020, Bow Valley College implemented the province’s new curriculum for its health-care aide (HCA) students.

The decision to update the provincial HCA curriculum came from the Government of Alberta, and the curriculum’s refresh was developed with input from government, educational institutions and industry representatives. Bow Valley College is one of the first post-secondary institutions in Alberta to adopt the updated HCA curriculum.

How is Bow Valley upskilling?

Previously, the HCA curriculum was four months in duration. Now, students study this curriculum for eight months before graduation.

Doreen Stewart, the associate dean of applied health in the School of Health and Wellness at Bow Valley College, says students now have time to learn more theoretical content in-class. They spend more hours in the lab, where theory is put into practice in a simulated environment. Students also complete more clinical hours in a real health-care setting.

Specifically, students now spend 69 more hours in lab and obtain 120 more hours of in-clinic practice hours before entering the workforce. Students also spend 21 more hours learning theory related to the complex care they will provide as HCAs. These theoretical, in-class enhancements are peppered throughout the eight months of training.

“The course updates [focus on] cultural competency and sensitivity, reflection on our own perspectives, and development of communication skills to support diverse populations,” says Stewart. “And across all courses, there is an enhanced focus on developing person-centred communication strategies for individuals with dementia.”

Why is this important?

The enhanced curriculum will better prepare HCAs entering the workforce, as they’ll be armed with up-to-date theoretical tools and significantly more hands-on experience before graduating.

“Having a better understanding of some of those complex care needs will definitely improve the resiliency of the HCA workforce,” says Stewart. “And improved resiliency means they can better meet their clients’ needs without fatigue, stress or burnout. Our HCAs will be more work-ready upon graduation.” [ ]

Bow Valley College Quick Facts

What’s happening to upskill the workforce?

The new provincial HCA curriculum has doubled in duration. During the enhanced eight-month certificate program, students learn more theory and complete more lab and clinical hours before joining the workforce.

Upskilling the workforce since: Bow Valley College’s first cohort began classes in January 2020.

Where does training take place? As well as running at Calgary’s Bow Valley College, any Albertan post-secondary institutions that deliver the HCA program will have to use the new, updated curriculum moving forward.

Learn more about any course changes due
to COVID-19 at bowvalleycollege.ca