Background and Objectives This study examined how financial strain and changes in employment status affect subjective stressors over 12 months in 184 family caregivers of individuals with dementia. Research Design and Methods Subjective stressors of role overload and role captivity, and employment status were measured at baseline, 6-, and 12-months. Self-reports on financial strain were measured at baseline only. Caregivers were categorized into 3 groups based on changes in their employment status during the study over 12 months: (a) who were never employed, (b) who experienced some sort of employment status change, either going from employment to unemployment or vice versa, and (c) who were always employed. Growth curve analyses were conducted to examine within-person changes in role overload and role captivity, and associations with employment and financial strain. Results Caregivers with greater financial strain at baseline had higher levels of role overload and increasing role captivity over time. Caregivers who experienced a caregiving transition and had low financial strain at baseline showed greater decrease in role captivity over 12 months. Although caregivers who were consistently unemployed reported lower levels of role overload, they also showed steeper increase over time than those who were consistently employed. Discussion and Implications Caregivers’ perceptions of financial strain add to the long-term stress of the caregiving role. Changes in caregivers’ employment status may have complex associations with their feelings of stress over time.

Background and Objectives Many persons with Alzheimer’s disease or related dementias (ADRD) receive care from paid staff in residential communities. The most common staff in these communities are certified nursing assistants (CNAs). While CNAs have a high number of interactions with residents, and thus the possibility of engaging in social interactions, evidence suggests that they provide limited social support to persons with ADRD. Little is known about attitudes of CNAs towards providing social support to persons with ADRD and their perception of components of quality social interactions with these individuals. Research Design and Methods We conducted a thematic analysis of semi-structured interviews with 11 CNAs (91% female, mean age 23.6) to understand their perceptions about providing social support to persons with ADRD and the components of effective social interactions. Results Our results show that CNAs consider providing social support to be an important part of their role as CNAs. Additionally, participants emphasized the interplay of verbal communication, non-verbal communication, and internal beliefs and attitudes towards persons with ADRD in creating effective social interactions. Participants highlighted multiple barriers to providing residents with social support, including lack of time, lack of training, and the behavioral and psychological symptoms of dementia. Discussion and Implications We offer implications for expanding training for CNAs working with persons with dementia and improving policy based on our results.

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Certified nursing assistants (CNAs) provide direct care for persons with dementia in formal settings and are therefore positioned to engage socially with clients during care. Our prior published observational study in memory care (7000 minutes of observation over 1 year) identified infrequent negative interactions of CNAs with clients, but many opportunities where CNAs did not socially engage a client, including ignoring attempts for engagement. This followup study seeks to understand CNAs experiences and attitudes towards social interaction with clients with dementia. Through semi-structured interviews with 11 CNAs at two care facilities (not included in the prior study), we examined the perceived role that CNAs have towards engaging socially with clients with dementia, barriers to interactions, and behaviors and attitudes that promote quality social interactions. Thematic analyses with multiple trained coders identified that all CNA participants reported feeling personally responsible for engaging with clients socially, having learned this through observation and trial and error, rather than formal training. Barriers to social interaction were lack of time, training, and managing symptoms of dementia. In describing quality social interactions, CNAs highlighted multiple verbal and nonverbal behaviors, including touch, eye contact, body posture, and volume and tone of voice. CNAs emphasized that quality social interactions were facilitated by internal attitudes of valuing personhood, getting on the client’s level, and being a friend. Our findings highlight that CNAs identify the importance of social interactions in their work in memory care, and they identify needing training in effective interaction techniques, specifically with their clients with dementia.

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