Bringing Direct Care Staff Education Where It’s Needed Most: Rural Wisconsin

“I am always looking for affordable educational opportunities, but don’t find many that are close enough to attend,” said Kathryn Nachreiner, who has managed a residential care home in Plain, Sauk County, for 14 years.

Fennimore participants, with Kathryn Nachreiner on left; photo by Alex Andre

Kathryn was excited to participate in a one-day conference for direct care staff at Southwest Technical College in Fennimore, organized by the Center for Aging Research and Education (CARE) at the University of Wisconsin–Madison School of Nursing. To her, the opportunity was well worth taking time off—which she rarely does—and arranging for a temporary service to provide care to her residents.

It was CARE’s fourth conference for certified nursing assistants (CNAs), personal care workers (PCWs) and other direct care staff who work with older adults in long-term care, hospital and community settings. There are some 90,000 direct care staff in Wisconsin, who like Kathryn work hard but often have trouble accessing professional development. In rural areas like southwest Wisconsin, their educational opportunities are especially limited. That’s why CARE is partnering with Bader Philanthropies to offer five free conferences in rural Wisconsin communities over two years.

“I’m here because I want to be better prepared to care for really ill people,” said Mary Jane Reimenapp of Dodgeville, who participated in the Fennimore conference in late June. Over her 20-plus years as a CNA, working in nursing homes, hospital rehab and other settings, Mary Jane has seen a trend of increasing chronic conditions and complex care needs among older adults.

CARE’s direct care staff conferences are designed to help participants understand complex health conditions and follow best practices. Topics include maintaining older adult mobility, understanding vision changes, responding to dementia-related behavioral symptoms and managing caregiver stress.

Fennimore conference participants were eager to put the new information into practice. UW–Madison School of Nursing Assistant Professor Lisa Bratzke, PhD, RN explained the cascading health problems caused by inactivity and shared best practices for safely helping older adults get up and walk. Following her presentation, two CNAs from the same assisted living residence brainstormed how to fit more physical activity into the daily care routine.

Photo by Alex Andre

CARE’s conferences also include simulation exercises, which help participants understand what it might be like to live with age- or health-related sensory changes. At the Fennimore event, attendees put on low-vision goggles right before the lunch break. Then, looking through lenses approximating macular degeneration, glaucoma or cataracts, they struggled to use the restroom, get their lunch, or simply eat or drink. Still wearing the goggles, they tried to pick up a white candy “pill” placed on a white napkin. Many couldn’t see the candy and knocked it to the floor. When the white “pill” was then placed on a dark napkin, sounds of “aha!” filled the room.

Throughout the day, conference presenters and attendees discussed how many older adults depend on CNAs and PCWs, not only to provide physical care, but to be their eyes, ears and advocates. Direct care staff spend the most time with long-term care residents and are often the first people to notice subtle changes in residents’ health or behavior.

That’s especially helpful when caring for people with dementia, said conference presenter and UW–Madison School of Nursing Assistant Professor Andrea Gilmore-Bykovskyi, PhD, RN. She explained how difficult “behaviors” are often attempts by people with dementia to communicate unmet needs, and walked participants through a simple approach to figure out what those needs or triggers might be.

At the close of the Fennimore conference, Gina Green-Harris of the Wisconsin Alzheimer’s Institute asked, “What drives you to keep doing what you are doing? Is it sustainable? What do you do to care for yourself, to stay fresh and energized?”

Many conference participants admitted that they tend to put others first and themselves last. Green-Harris encouraged them to recharge and reclaim their purpose, to better care for themselves and the older adults who they work with. She then described some stress-management techniques, adding to the evidence-based practical tips that direct care staff can put to good use, in any community.

–Peggy Rynearson