Lisa Fagan Walts graduated from BU School of Social Work Master’s Program with a primary interest in addressing the unique needs of older adults with cognitive impairment and related neurological disorders. She specializes in advocating for and supporting people with dementia, and in working with and educating their families to better understand and communicate effectively with their loved ones. She brings deep experience in training long-term care staff on person-centered care, as well as educating the public, medical professionals and first responders about Alzheimer’s and other forms of dementia.
Walts is a member of the Network Alumni Training Board and helped pilot the Train-the-Trainer Certificate. We spoke with her about her experience training many different stakeholders in caring for people with dementia.
Tell us about your professional background and what led you to a specialization in aging and advocacy for people with dementia.
In 2010 or 2011 I noticed some changes with my mom who was living in the Midwest. It was becoming rapidly clear that she was not functioning well at home on her own anymore. Her diagnosis was vascular dementia with atypical Alzheimer’s. Her dementia unfortunately took the form of extreme paranoia, agitation and fear. We met with doctors and neurologists and, in the end, I moved her to Boston to a memory care community to be near me. I view myself as a some-what privileged, white professional who has a great deal of knowledge and resources at my disposal, yet I found it very difficult to navigate the medical system and get the care that my mother needed. It astonished and infuriated me. When my mom died in 2013, I thought, “What am I going to do with all of this information and knowledge I never wanted to have? If I couldn’t figure how to get help for my mom in a timely fashion, how could most people figure it out?”
That’s how I got to where I am. I applied to BUSSW knowing that I was going to be working in the aging field from the start. My goals at graduation were to work with those with dementia and their families. I started to do volunteer work for the Alzheimer’s Association, and realized I really liked doing training for professionals and non-professionals alike. I’ve done training and presentations in my previous career as a computer professional, but I don’t really have any formal background in it. I was just using life experience to figure out how to do it. That’s one of the reasons I took the Train-the-Trainer certificate.
With so many different stakeholders involved in caring for and advocating for people with dementia, how do you make sure that older adults and their families are at the center?
Assisted Living Staff
In many ways, the people who work the hardest at any care community are the Certified Nursing Assistants (CNAs), along with the dining, maintenance and cleaning staff. They are also the ones who see the residents on a day to day basis. They can often spot changes in a person before Directors can, if they just know what to look for. My training approach with staff has always been that humor and hands-on training go a long way to help keep them focused, as the state mandated training can be 8 hours a day. It’s not just me talking to them, but we’re acting out scenarios that can occur. I want the staff to understand what it’s like to be older and in need of care, with or without dementia. And I want them to see a resident as a real person – with a full life. For a simple example, if an older adult is in a wheelchair and a staff member walks up behind them and then starts moving the chair without any notice, that can be very frightening. Add on dementia and it can result in severe confusion and agitation. So my training with staff tends to be very interactive and leans towards problem-solving using the education I’m providing during the training.
Many families are in denial. They might say their loved one is not ready for memory care, or that she can still do fine on her own. There may be cultural differences as well. For them, it’s much more delicate. It takes multiple conversations. In each conversation, there’s a little bit of education about the brain and what might be happening, and that’s going to be very person-specific, depending on what’s happening with their loved one. The goal there is to help them to acknowledge that perhaps something is changing, and the earlier they can think about what will need to happen the better.
In the past I’ve worked with primary care doctors, neurologists, inpatient and outpatient geriatric psychiatrists, nurses, and other members of the medical community. Everyone has a different view of the person the team is caring for because of their unique roles and professional values. And because you are dealing with medical professionals, you really need to understand the aging process and the basics of pharmacology and psychopharmacology. You need to know enough about each of the professions involved to be part of the conversation
I learned that with many in the medical community, you have to just be assertive. As a social worker, we often bring a different view of the whole person to the table. You have to just put yourself out there and say, “This is what I know. This is what my knowledge and my skills say.”
When a first responder arrives at a dementia care community, the approach is so important, because when someone has dementia and a first responder walks in and says, “Ma’am we’re going to take you somewhere,” they don’t know what’s happening. They’re going to be stressed and they’re going to lash out. When I worked in an assisted living facility, and assuming this was not a crisis emergency, I would tell the first responder, “This is what’s going to happen. We’re going to enter slowly and calmly, and you’re going to introduce yourself. You’re going to say, ‘I’m sorry that you seem to be hurting. I’m here to help you.’”
I’ve given presentations to teams where first responders are present. We talk a lot about what it’s like for someone who has dementia when a first responder walks into a room. They are usually a receptive audience because there’s no way that a police officer, for example, wants to go in and escalate a situation. I teach them about dementia and how it affects the person – that the reality for the person with dementia is often very different than theirs, and that the best way to deal with someone with dementia is to try to enter their reality.
As a trainer, what would you say are the benefits of joining the Trainers Hub?
For me, the hope is that the community gets built up enough and the outside world is aware of what the Trainers Hub offers. The value to me is being a part of a strong repository of qualified trainers. When someone looks for information about older adults, I’m one of those names that pops up. That, for me, is worth it alone.
What were some of the most valuable takeaways from the Train-the-Trainer course?
For me, the most important part was understanding the broader picture of how to create a training that works. I can create PowerPoints. I can facilitate trainings. And I can think about what training professionals and families need, but I’ve never done that on a professional level. That’s what I wanted to get from the course. I wanted to learn how to take that next step. I learned how to understand your audience to make the training meaningful for them. I also learned how to think systematically about evaluating how effective the training was, which is one of those things I’ve never had to do.
Do you have any advice for social workers or other professionals in aging who are looking to follow a similar path in becoming a trainer?
Well, I would say in an older adult’s world, there are multiple fields of expertise on a team. You might have a cardiologist, a PCP, a geriatrician, a geriatric psychiatrist and more. You may have staff at an Assisted Living and Memory Care. You have the person and their family. And to train well, you need to understand everyone’s culture, professional ethics and values, all the while keeping the patient or resident at the center of the conversation. So you really need to know your audience, because everyone attending the training may have different viewpoints, and they can often clash. So you need to be strong in your beliefs about what a social worker brings to the table, about what person-centered care really is and know how to incorporate that into the trainings.
Read more about Lisa’s work here.
Learn More About the Trainers Hub