Availability and access to caregiver training is an important element in effectively supporting caregivers in their caregiver role. Knowledge of training programs available is often another barrier. One study identified lack of knowledge of existing resources as the top barrier to effective support for caregivers; this effect was exacerbated for African American caregivers who were less aware of resources available to them than their non-African American counterparts (Casado, 2011). Measuring the extent to which caregivers are aware of the resources available to them was beyond the scope of this particular assessment but remains an important factor for all communities to assess and consider.

In the Caregiver Friendly Communities Assessment, availability and accessibility is measured by several features:

• Training Frequency. Participants in the Caregiver Friendly Communities Assessment testing phase from across the State of Michigan emphasized that training should be available at least annually to caregivers to ensure maximum and effective access.

  Recommended Practice: ensure caregiver training programs are offered a minimum of once per year.

• All Resident Access. This feature applies primarily to counties where some residents may have access to municipal programs that those living in other areas of the county do not. County officials should seek ways to make training available to all residents in their county.

  Recommended Practice: catalogue existing caregiver training programs available to county residents and identify ways to ensure they are accessible to all residents.

• Additional Training Supports. Providing additional training supports can make all the difference in whether or not a caregiver can access training. Additional supports may include free or reduced cost for training, respite care availability, and cost of respite care.

  Recommended Practice: Check the supports available for training programs and 1) find subsidized training; 2) find ways to offer respite care for in-person training; and 3) invest in virtual training which may be more accessible for some caregivers.

Sample Programs & Resources:
(note that online training programs can greatly increase access as long as participants have computer equipment, internet access and basic computer skills knowledge)

• Best Practice Caregiving, developed through a partnership between Benjamin Rose Institute on Aging and Family Caregiver Alliance, is a free online database of proven dementia programs for family caregivers. It offers a searchable, interactive, national database of vetted, effective programs that offer much-needed information and support. https://bpc.caregiver.org/
• Diverse Elders Coalition Family Caregiving Training: https://www.diverseelders.org/caregiving/
• The County of San Diego developed an online training program in 2012 that earned it an Innovation Award from National Association of Area Agencies on Aging (N4A). Aging & Independence Services coordinates the Caregiving Webinar Series that enables working family caregivers to take advantage of traditional training and education workshops through the internet. The live, 30-minute sessions occur during lunchtime and allow participants to type in questions while watching and listening to presentations.

Recorded sessions enable caregivers to watch them “on demand.” The webinars are a convenient and cost-effective way to make the same information available to caregivers that they would get at traditional conferences. The County of San Diego incurred no additional costs in launching the program in 2010. Software was already available through existing county resources and staff dedicated to caregiver support shifted their time to the program. If existing online webinar software is not available, the cost of buying a webinar software license is about $4,000 annually, depending on capacity. For more information about this program, visit their website at:
https://www.sandiegocounty.gov/hhsa/programs/ais/

Caregiver feedback programs are a different kind of education involving professionals reviewing and shadowing caregivers when they are “on-the-job” and providing them with custom feedback to improve their care. Research has found that individualized, caregiver training significantly improves caregiver self-efficacy and results in declines in depression (Hendrix, 2011). Further, family-centered empowerment programs which include the whole family in similar types of individualized feedback showed a significant increase in caregiver self-efficacy for families with a loved one diagnosed with multiple sclerosis (Jafari, 2020).

Recommended Practice: ensure that individualized caregiver skills assessment training programs are available to residents in your region.

Availability of an array of training levels and topics is important to optimally support caregivers in their role. Advanced training in caregiver skills was found to be very important in a Maine study evaluating the Maine Savvy Caregiver Program (Samia, 2012). Additionally, caregivers need access to condition-specific information relevant to their loved one (such as Alzheimer’s Disease, Parkinson’s Disease, Multiple Sclerosis, Cancer, and other conditions) and its disease progression impacts for the caregiver.

“If caregivers do not have the knowledge and skills to perform their work, they may unintentionally harm their loved one. This risk for injury is directly related to lack of knowledge and competence, which can be improved through caregiver education and support. For example, a recent study confirmed that patients had many negative outcomes when untrained informal caregivers managed their home enteral nutrition or tube feeding. Problems included tube displacement, tube clogging, infection, and dehydration—all of which can lead to a stressful caregiving situation and hospital readmission.” (Silver 2004).

Recommended Practice: catalogue existing caregiver training programs available, identify gaps and locate training to supplement gaps.

Sample Programs & Resources:

• The Family Caregiver Training Program, developed in collaboration with the Alzheimer’s Association of Greater Michigan, was found effective in training family caregivers to provide better care to their loved ones with a series of three modules focused on 1) communication and nutrition; 2) toileting and transferring; and 3) bathing and dressing. The training includes short explanations, group discussions, real life demonstrations and role-playing (DiZazzo-Miller, 2014). https://www.alz.org/gmc/helping_you/education_programs
• The online iCare Stress Management Training Program for family caregivers may be effective at significantly reducing caregiver stress levels and improving their information retention, as compared to more traditional training programs (Kajiyama, 2013).
• Best Practice Caregiving, developed through a partnership between Benjamin Rose Institute on Aging and Family Caregiver Alliance, is a free online database of proven dementia programs for family caregivers. It offers a searchable, interactive, national database of vetted, effective programs that offer much-needed information and support. https://bpc.caregiver.org/
• Teaching caregivers how to manage specific patient problems can improve the caregiver’s well-being. For example, not being able to sleep at night is a serious problem for caregivers of people with Alzheimer’s disease, as the caregivers become fatigued and exhausted, which can have an adverse effect on both the physical and emotional health of the caregiver. Teaching them how to improve their family members’ nighttime insomnia through daily walks and exposure to light can improve sleep time for both the caregiver and care recipient (McCurry 2005).
• United Way of Tarrant County/Area Agency on Aging of Tarrant County (AAATC) created Model for Alzheimer’s/Dementia Services (MAS) to help people who either have or are at high risk of developing Alzheimer’s disease and related dementias continue living safely at home for as long as possible. MAS expands the existing dementia-capable services and supports to minorities and increases access to culturally sensitive, evidence-based support services for unserved and underserved populations and their caregivers. The person-centered planning also often includes evidence-based caregiver education programs, ensuring people with dementia and their caregivers have ample support to manage their situations. https://www.n4a.org/content.asp?admin=Y&contentid=1000