Even the greatest idea in the world will go absolutely nowhere without a robust evidence base and a trained workforce.
I’m getting a reputation as a “Debby Downer.”
It usually happens when I attend a meeting focusing on an exciting new intervention that promises to “revolutionize” the field of long-term services and supports (LTSS).
I just can’t help myself. While others in the room are celebrating the “next best thing” in LTSS delivery, I’m spoiling the fun by asking 2 potentially unsettling questions.
My first question is always about the evidence base.
Do we have real, research-based evidence to show that the intervention in question actually works in real-world settings? A promising new idea often sounds good in theory, but is it too good to be true? Will it yield long-term benefits for the people it is designed to help? Or will it end up being just another flash in the pan?
My second question is always about the people we’re depending on to carry out the new intervention.
Do we have a cadre of caregivers, both paid and unpaid, who can deliver the promising intervention? Do those caregivers have the skills necessary to make the intervention work? If not, do we have the means to train them?
You’d be surprised how often policy makers and LTSS providers get carried away with a great idea without asking these questions.
Don’t get me wrong. Their intentions are honorable, and I admire their enthusiasm.
But here’s the stark reality: even the greatest idea in the world will go absolutely nowhere without a robust evidence base and a trained workforce.
This reality is true for a variety of issues we face in the LTSS field, including the challenges associated with delivering services and supports to people living with dementia.
DEMENTIA: THE NEW FRONTIER
As we await a cure for Alzheimer’s disease and other forms of dementia, we clearly need to step up our efforts to identify evidence-based approaches to providing the nonpharmacological support people living with dementia need to live their lives, maintain their well-being, and enjoy quality of life. We also must find ways to support the paid and unpaid caregivers who will deliver those evidence-based interventions.
A new initiative at the National Academy of Medicine (NAM) could help us make progress on both fronts. I’m proud to be part of that initiative as a member of NAM’s Committee on Care Interventions for Individuals with Dementia and Their Caregivers.
For the past few months, our committee at NAM has been working closely with researchers from the Agency for Healthcare Research and Quality’s (AHRQ) Evidence-Based Practice Center at the University of Minnesota School of Public Health. We’re advising these researchers as they design a systematic review of the evidence on effective care-related interventions for persons with dementia and their caregivers.
Next year, when the study is completed, our committee will review the evidence and develop a report designed to inform decision making about which care interventions are ready for dissemination and implementation on a broad scale.
The research is being conducted with funds from the National Institute on Aging (NIA). The study, and the NAM review, are really significant for a couple of reasons.
This is the first study of its kind to be funded by NIA. And it’s exactly the kind of scholarship that LeadingAge members need as they strive to provide the most effective and appropriate services and supports to people living with dementia and their caregivers.
THE WORKFORCE CONNECTION
Of course, just having a list of evidence-based interventions isn’t going to automatically erase the challenges facing people who live with dementia. As I told participants in January’s Memory Care Summit 2019, if you want to provide high-quality interventions for people living with dementia, you’ve got to have a high-quality workforce that is trained in those interventions.
This sounds obvious, I know. But for some reason, we don’t always see the vital role that workforce plays in making the critical connection between a great idea and its successful implementation.
We desperately need the robust evidence base that the Minnesota-based researchers and my NAM committee will be exploring over the next year. But we also need to tap into another evidence base: the one pointing us to effective strategies for recruiting and retaining a highly skilled LTSS workforce. That evidence base is growing and includes studies identifying:
- Better measures of supply, demand, and shortages.
- The impact of baby boomers on LTSS demand.
- The role of immigration in meeting that demand.
- The relationship between improved working conditions, recruitment and retention, and quality outcomes.
WE’RE ON THE WAY
We have a lot of work to do before we can create a society in which people living with dementia and their caregivers receive the support they need to continue living independent, meaningful, connected, and healthy lives.
But I’m hopeful that, with continued attention to the evidence base of promising dementia care interventions and the evidence base of strategies for improving the quality of our workforce, we can take some important steps toward creating that society.
Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.