Evaluating a National Person-Centered Training Program to Strengthen the Dementia Care Workforce

April 9, 2026 updated by: University of North Carolina, Chapel Hill

This project will compare two training models of an evidence-based online dementia care training program for direct care staff in assisted living to a waitlist control: 1) essentiALZ training and 2) essentiALZ training + Project ECHO. It will examine the extent to which each model is implemented and achieves its intended outcomes to improve staff knowledge and attitudes, change care practices, and improve the wellbeing of staff, residents, and residents' family members. Results will inform next steps in dementia care training for the assisted living (AL) and broader long-term care workforce.

To examine these outcomes, data will be collected from AL staff and families over the course of 6 months. Staff will complete questionnaires and participate in interviews (as applicable) at baseline, post-training, 3-months, and 6-months. Families will participate in interviews at baseline, 3-months, and 6-months.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

More than 75% of persons living with Alzheimer's disease and related dementias who reach 80 years of age require residential long-term care, which is increasingly provided in assisted living (AL). Across the country, almost 29,000 AL communities with more than 996,000 beds have become the primary residential care provider for persons with dementia: 90% of AL residents have cognitive impairment and 42% have recorded moderate or severe dementia, with actual rates being higher. AL provides supportive but not nursing services; consequently, virtually all care is provided by direct care workers (nursing assistants and personal care aides).

Unfortunately, direct care workers are undervalued and under-trained, leading to poor care, workplace injury, dissatisfaction, and high turnover. AL is state-regulated, and only 17 states stipulate minimum training hours (some being as low as one hour), meaning that two-thirds of states are silent on training. Fewer than 40% of staff have education beyond high school, and so it is not surprising that a minority report sufficient knowledge to care for persons with dementia. In striving to fill this gap, training for direct care workers must be accessible and have efficacy in benefitting the staff, organization, and persons with dementia.

Online training is an especially promising option due to its low cost, wide availability, and potential for self pacing, automated skills tests, and certification. The Alzheimer's Association is the national leader in dementia care training, and in 2021 developed essentiALZ (pronounced "essentials"), an online program teaching evidence-based, person-centered care, which can be accessed from a computer, tablet, or mobile device. Already more than 1,500 staff have essentiALZ certification, but as is true of the majority of training programs, evidence as to its ability to improve care and outcomes is lacking. It is possible that essentiALZ is effective in changing care and outcomes, but it may also be that additional supports are necessary to do so. A timely model of support is Project ECHO, which has flooded the field of long-term care as a proven way to provide expert guidance and peer support via a remote, online approach. Adding ECHO to online dementia training might provide a necessary boost to achieve care change and improved outcomes.

The project responds to the National Institute on Aging Notice of Special Interest that calls for strengthening the workforce through enhancing and supporting skills training. It will conduct a hybrid implementation/effectiveness randomized trial in 126 AL communities, comparing essentiALZ alone, essentiALZ + ECHO enhancement, and a waitlist control. Outcomes grounded in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model and the Kirkpatrick training effectiveness model will be examined over six months, comparing the arms in terms of (1) implementation and (2) effectiveness, and (3) examining the extent to which implementation and effectiveness differ based on characteristics of the AL community, staff, residents, and family members. Results will inform next steps in dementia care training for the AL and broader long-term care workforce.

Study Type

Interventional

Enrollment (Estimated)

1764

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • United States
    • North Carolina
      • Chapel Hill, North Carolina, United States, 27599
        • Recruiting
        • University of North Carolina at Chapel Hill
        • Contact:
        • Principal Investigator:
          • Sheryl Zimmerman, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

AL Staff:

  • Staff (part-time, full-time, and including contract staff) who provide direct care to residents at the participating assisted living community (e.g., certified nursing assistants, personal care aides, registered nurses, licensed practical nurses, activity directors, social workers, and others) as determined by the administrator/health care supervisor
  • Are 18 years of age or older
  • Are able to read and speak English fluently

Family:

  • Resident not expected to die or be transferred in the next six months at baseline
  • At follow-up, resident lived in AL community at least one month during the three months prior to interview date
  • Are a family member/legally authorized representative (LAR), or designated contact of a resident with Alzheimer's disease and related dementia (ADRD) of a participating AL community
  • Are 18 years of age or older
  • Are English speaking
  • Visit the resident at least monthly

Exclusion Criteria:

AL Staff & Family:

- Are under 18 years of age

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: essentiALZ
Communities randomized to this arm will receive the essentiALZ training: a web-based training taken by AL staff that contains three hours of self-paced content separated into five modules, plus a final review. Modules include: 1) Alzheimer's disease and dementia; 2) person-centered care; 3) assessment and care planning; 4) activities of daily living; and 5) behaviors and communication. Staff will be encouraged to take the training over the course of four weeks.
Behavioral: essentiALZ
essentiALZ is a web-based training that contains three hours of self-paced content separated into five modules, plus a final review. Modules include: 1) Alzheimer's disease and dementia; 2) person-centered care; 3) assessment and care planning; 4) activities of daily living; and 5) behaviors and communication. Staff will be encouraged to take the training over the course of four weeks.
Experimental: essentiALZ + ECHO
Communities randomized to this arm will receive the essentiALZ training: a web-based training taken by AL staff that contains three hours of self-paced content separated into five modules, plus a final review. Modules include: 1) Alzheimer's disease and dementia; 2) person-centered care; 3) assessment and care planning; 4) activities of daily living; and 5) behaviors and communication. Staff will be encouraged to take the training over the course of four weeks. Additionally, they will receive access to Project ECHO. ECHO is a virtual tele-mentoring model grounded in case-based learning. It includes six weekly one-hour sessions of didactic and discussive learning. The first five sessions will reflect the content of the five essentiALZ modules, and the final session will address maintenance. ECHO sessions are group sessions that will be conducted via Zoom.
Behavioral: essentiALZ
essentiALZ is a web-based training that contains three hours of self-paced content separated into five modules, plus a final review. Modules include: 1) Alzheimer's disease and dementia; 2) person-centered care; 3) assessment and care planning; 4) activities of daily living; and 5) behaviors and communication. Staff will be encouraged to take the training over the course of four weeks.
Behavioral: Project ECHO
ECHO is a virtual tele-mentoring model grounded in case-based learning. It includes six weekly one-hour sessions of didactic and discussive learning. The first five sessions will reflect the content of the five essentiALZ modules, and the final session will address maintenance. ECHO sessions are group sessions that will be conducted via Zoom.
No Intervention: No Intervention
Standard care will be provided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Score Over Time of Sense of Competence in Dementia Care (SCIDS)
Time Frame: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Sense of Competence in Dementia Care (SCIDS) is a 17-item instrument. Responses are indicated using a 4-point Likert scale. Minimum score (worst value) = 1. Maximum score (best value) = 4. Higher values represent a better outcome (range 17-68). Measure is assessed at Baseline Questionnaire, a 3-month Follow Up Questionnaire and at a 6-month Follow Up Questionnaire.
Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Change in Score Over Time of Staff Experience of Working with Residents with Dementia Questionnaire - Care Organization, Satisfactory Contact with the Patient, and Satisfaction with the Expectations of Others Subscales (SEWDRQ)
Time Frame: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Staff Experience of Working with Residents with Dementia Questionnaire - Care Organization, Satisfactory Contact with the Patient, and Satisfaction with the Expectations of Others Subscales (SEWDRQ) is a 9-item instrument. Responses are indicated using a 5-point Likert scale. Minimum score (worst value) = 0. Maximum score (best value) = 4. Higher values represent a better outcome (range 0-36). Measure is assessed at Baseline Questionnaire, a 3-month Follow Up Questionnaire and at a 6-month Follow Up Questionnaire.
Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Change in Score Over Time of Dementia Attitude Scale - Short Form (DAS-6)
Time Frame: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Dementia Attitudes Scale (Short-Form) is a 6-item instrument. Responses are indicated using a 7-point Likert scale. Minimum score (worst value) = 1. Maximum score (best value) = 7. Higher values represent a better outcome (range 6-42). Measure is assessed at Baseline Questionnaire, a 3-month Follow Up Questionnaire and at a 6-month Follow Up Questionnaire.
Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Score Over Time of essentiALZ exam items
Time Frame: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
essentiALZ exam items is a 5-item instrument. Instrument is a measure of knowledge on the subject of the intervention training. Responses are multiple choice, with only one answer per question considered 'correct'. Higher values of correct responses represent a better outcome/retention of knowledge (range 0-5). Measure is assessed at Baseline Questionnaire, Post-Training Questionnaire, a 3-month Follow Up Questionnaire and at a 6-month Follow Up Questionnaire.
Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Change in Score Over Time of essentiALZ organizational practices
Time Frame: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
essentiALZ exam items is a 5-item instrument. Instrument is a measure of knowledge on the subject of the intervention training. Responses are multiple choice, with only one answer per question considered 'correct'. Higher values of correct responses represent a better outcome/retention of knowledge (range 0-5). Measure is assessed at Baseline Questionnaire, a 3-month Follow Up Questionnaire and at a 6-month Follow Up Questionnaire.
Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Change in Score Over Time of Emotional Burnout
Time Frame: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
The researchers will assess intent to leave job by asking "Overall, based on your definition of burnout, how would you rate your level of burnout? Select one." Response options are: "1 = I enjoy my work. I have no symptoms of burnout.", "2 = Occasionally I am under stress, and I don't always have as much energy as I once did, but I don't feel burned out.", "3 - I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion.", "4 = The symptoms of burnout that I'm experiencing won't go away. I think about frustration at work a lot.", "5 = I feel completely burned out and often wonder if I can go on. I am at the point where I may need some changes or may need to seek some sort of help." Minimum = 1 (best value), maximum = 5 (worst value). Measure is assessed at Baseline Questionnaire, a 3-month Follow Up Questionnaire and at a 6-month Follow Up Questionnaire.
Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Change in Score Over Time of Intention to Leave
Time Frame: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
The researchers will assess intent to leave job by asking "How likely is it that you will leave this job in the next year? "Would you say... 1 is Not at All Likely, 2 is Somewhat Likely, 3 is Very Likely." Minimum = 1 (best value), maximum = 3 (worst value). Measure is assessed at Baseline Questionnaire, a 3-month Follow Up Questionnaire and at a 6-month Follow Up Questionnaire.
Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
Change in Score Over Time of Feeling Valued
Time Frame: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months
essentiALZ exam items is a 5-item instrument. Instrument is a measure of knowledge on the subject of the intervention training. Responses are multiple choice, with only one answer per question considered 'correct'. Higher values of correct responses represent a better outcome/retention of knowledge (range 0-5). Measure is assessed at Baseline Questionnaire, a 3-month Follow Up Questionnaire and at a 6-month Follow Up Questionnaire.
Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of North Carolina, Chapel Hill

Collaborators

National Institute on Aging (NIA)
Alzheimer's Association

Investigators

  • Principal Investigator: Sheryl Zimmerman, PhD, University of North Carolina, Chapel Hill

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 12, 2024

Primary Completion (Estimated)

April 30, 2027

Study Completion (Estimated)

April 30, 2027

Study Registration Dates

First Submitted

January 24, 2024

First Submitted That Met QC Criteria

January 24, 2024

First Posted (Actual)

February 2, 2024

Study Record Updates

Last Update Posted (Actual)

April 13, 2026

Last Update Submitted That Met QC Criteria

April 9, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 23-1643
  • R01AG079124 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

A de-identified computerized dataset will be available for the use of other researchers. The de-identification of the dataset will follow IRB guidance. Select data will be transformed as appropriate (e.g., items in a scale that were reverse coded will be transformed), and scales will be developed from individual items where indicated (maintaining the individual items).

The de-identified dataset will be shared in excel or CSV format and will include a codebook for use. Similarly, all data collection instruments will be made available. No specialized tools or software will be necessary to access or use the data. The project coordinator and/or senior analyst will work with potential users for procedures to share the dataset using secure methods informed by Cecil G. Sheps Center for Health Services Data Analytics and Information Technology Department.

IPD Sharing Time Frame

A de-identified computerized dataset of all information will be available for the use of other researchers no later than the date of acceptance of the publication that reports the main findings derived from the project, and will remain available for the following ten years.

IPD Sharing Access Criteria

Those who wish to use these data will be asked to enter into a data-sharing agreement that will specify the protection of data confidentiality, as well as prohibit the recipient from transferring the data to other users or using the data for purposes other than those expressly agreed upon. In addition, researchers who proposes to use the data will be required to have approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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