Currently, 1.2 million full-time equivalent employees (FTEs) care for more
than 1.5 million residents in nursing homes where 75% of residents have dem
entia. By the year 2010, the number of residents in these institutions may
double. Registered nurses (RNs) make up less than 7% of a home's total FTEs
. In contrast, certified nursing assistants (CNAs) account for more than 40
% of total FTEs. Thus, CNAs serve as the primary caregivers in nursing home
s. Typically, CNAs have a high school education or less, and receive little
more than minimum wage. Their extensive contact with residents has a treme
ndous impact on quality of life, but significant barriers limit their careg
iving effectiveness. These barriers include poor pay, minimal long-term ben
efits, and insufficient training, recognition and support for their physica
lly and emotionally labor-intensive care. This paper addresses the issues o
f training CNAs for dementia care by suggesting an organizational framework
within which to view dementia training; providing an overview of barriers
to empowering CNAs to provide quality care to dementia residents; reviewing
research that has addressed a specific barrier; making recommendations for
future research; and suggesting research approaches to address these recom
mendations. Copyright (C) 1999 John Wiley gr Sons, Ltd.