MSHA Final Paper

Running Head: MSHA FINAL PAPER: EDUCATION TO IMPROVE EMPATHY 1
Improving Education at Assisted Living Facilities to Produce More
Empathetic Caregiving
By
Gina Swanson
Felician University
November. 2015
* In partial fulfillment of the Masters of Science in Health Administration
I pledge my honor that I have neither given nor received inappropriate aid on this assignment.

MSHA FINAL PAPER: EDUCATION TO IMPROVE EMPATHY 2
Table of Contents
Abstract ............................................................................................................................................3
Introduction......................................................................................................................................4
Needs Assessment............................................................................................................................5
Literature Review.............................................................................................................................9
Methodology..................................................................................................................................14
Implementation ..............................................................................................................................16
Evaluation ......................................................................................................................................19
Conclusion .....................................................................................................................................21
Works Cited ...................................................................................................................................22

Abstract
Dementia is the main cause of dependency in older people and unless the stigma attached to the
disease is overturned, we won’t have enough people to care for them. According to a survey, about 64%
of people believe there are negative associations regarding dementia and those who treat it. Nearly 2 of 3
respondents feelthere is little or no understanding of dementia in their countries. Worldwide, less than
25% of people with dementia are formally diagnosed, with few people receiving sufficient care and
support. There is a clear need for practical, emotional, and financial support, and a key ingredient of the
solution is education.
To help ease the burden on caregivers, it’s necessary to build and maintain strong relationships
between caregivers and the patients they care for. Proper placement in assisted living facilities and
nursing homes can go a long way in establishing relationships, as well as improving the patients’
psychological well-being and problem solving abilities. By contrast, situations where the caregivers
avoid or establish an insecure connection with patients have led to more behavioral problems. Studies
present strong evidence that caring relationships are “dynamic co-constructions built upon everyday
events, interactions, environments, and disease progression.” (Norton et al., 2009) Cooperative care
relationships are based on mutual respect and sensitivity to individual needs, whereas a relationship
without trust and compassion will fall short of expectations and result in negative responses.
By educating the employees at a senior living center in New Jersey,the project has shown a
significant improvement in both caregiver attitudes when caring for Alzheimer’s patients and the methods
used. Using a modification of the Jefferson Scale of Empathy (2011), as well as some follow-up
inspirational material posted throughout the facility, caretakers have found new ways of nurturing the
assisted living residents, and in turn, the residents have reported feeling more comfortable and secure
around them.

Introduction
Alzheimer’s Disease is a serious condition that has been affecting more and more people
worldwide in recent years. While the exact cause is unknown at this time, there are clear connections
between the onset of the disease and the aging process. However,Alzheimer’s is not considered a natural
part of getting older, since not everyone becomes affected in the same way,if at all. As patients’
memories and other cognitive abilities become seriously weakened by Alzheimer’s, they start to lose a
sense of who they are and need more time just to live out each day. Among the major issues faced when
combatting this disease is the attitude of those given the responsibility of looking after the patients.
Working with someone afflicted with Alzheimer’s takes an extraordinary amount of patience and time
commitment, and leads to excessive burden on the part of the caregivers (Leggett et al., 2011).
Unfortunately, not everyone working in the medical field is willing to put in the additional time and effort
needed to take care of patients with Alzheimer’s, leaving the situation wide open to getting worse. The
two questions this paper will be addressing are how the people in charge of caretaking Alzheimer’s
patients can be made aware of the serious impact of the disease, and how this knowledge can help them
become more empathetic providers.
Improving early detection of Alzheimer’s is a top priority among the medical community. Early
detection is difficult in primary care across different healthcare systems,with the time of diagnosis taking
anywhere from 18 months to 4 years. In early stages of Alzheimer’s, many patients are unaware they
even have a problem. This proves especially problematic with patients who live alone, since it’s up to
the caregiver to make this kind of diagnosis. There’s also the matter of how people tend to perceive those
with Alzheimer’s. The stigma attached to the condition may prevent families from pursuing help right
away because of embarrassment,shame, or uncertainty. (Koch and Iliffe, 2010)
A major barrier to diagnosing Alzheimer’s Disease or dementia is a lack of support, both on the
part of patients and doctors. Time constraints become an issue as physicians, many of whom have not yet
recognized the serious threat of the disease, have trouble making time in their schedules to address it.
Therefore,the caregiver also contributes to the bad reputation by failing to diagnose the disease until it’s
too late. This means during the earlier stages,many people can only speculate without knowing for sure
what’s happening. Concerns about uncertainty are also barriers, especially if the physicians feel their
training didn’t prepare them enough to handle Alzheimer’s cases. “Dementia-specific training and
education of staff in all long-term care-settings, including induction, should address the management of
problem behavior in dementia and thereby improve staff fulfilment and relatives' satisfaction” (Train,
2005, p. 237).
According to a survey, people generally misconstrue Alzheimer’s as just a result of getting older
and not something that needs to be addressed. The idea that nothing can be done leads to helplessness
and frustration. However,proper education can help combat this idea and get more people to understand
the severity of the situation, which might actually put their minds more at ease. “Compassionate care
depends on showing empathy for a patient's illness experience no matter what his or her background”
(Sanghavi, 2006, p. 283). Studies show people generally find doctor’s visits helpful if the doctor
provided counseling and education regarding the disease. “Empathy significantly influences adherence to
medical recommendations, reduces medical errors, increases patient satisfaction, and increases physician
well-being” (Wilson, Prescott,and Becket,2012, p. 24). Families of people afflicted have benefitted from
this because they learned how to communicate with their loved ones. They were able to modify the way
in which they interact with the family members and help them cope. Interventions may help both the
patient and caregiver cope with Alzheimer’s and dementia.

Literature Review
People who have worked in the geriatric field for severalyears have seen far too often the
devastating results when a caretaker doesn’t give an elderly patient the attention he or she needs. Many
people over age 65 not only start to lose their physical capabilities, but their mental strength as well. In
many cases,this can be attributed to Alzheimer’s disease or other forms of dementia. If ignored or
unsupervised, a patient suffering from such an ailment may begin wandering off, sometimes out of their
nursing home or assisted living facility altogether, creating a security breach. Other times, patients may
be left unfed or uncleaned because a negligent caretaker incorrectly assumed they could feed or clean
themselves when their declining states caused them to forget how.
At the moment, there is no cure for Alzheimer’s or dementia, nor is there any medication
available that will significantly slow the deterioration process brought about by the illness. This fact may
cause caretakers to feelhelpless and unwilling to make an effort toward caring for the patients. They
might feel their work is all in vain, since they’re not able to prevent the cognitive decline (Braun et al.,
2005). On top of that, patients suffering from this affliction need their daily activities and instructions
repeated constantly, since they now have trouble remembering them. This can lead to frustration and high
stress on the part of the caretaker,which, if he or she doesn’t know how to manage these emotions, could
result in lashing out at the patient. In turn, the patient will become just as stressed and angry, and
possibly retaliate. Not only that, but the added stress may accelerate the deterioration process and make
the patient’s condition worse (Detweiler et al., 2012).
There needs to be a way for caretakers to lessen their frustration and become more willing to look
after these elderly patients without agitation. The key behind accomplishing this goal is empathy. If
caretakers can learn how to empathize with the patients and fully understand what they go through, both
inside and out, they may not become as frustrated at the patients’ lack of understanding or memory. In
order to create this sense of empathy, the caretakers need proper education and training (Brunero et al.,
2010). There already is a great deal of training, both when they begin working at the facility and during
regular intervals over the course of their employment, regarding protocol and how to manage elderly
patients in general. However,this training alone may not go far enough for caretakers to really put
themselves in the shoes of the residents. There’s no doubt that people involved in the business of
providing care for senior citizens have good hearts and helpful natures, but now is the time to really tap
into that natural feeling and get them to see more than just a deteriorating body.
Another reason why further education may be necessary at assisted living facilities is because
caretakers need to fully realize the consequences of their actions. Even if a person is doing what he or she
loves, there’s little chance of escaping the human tendency of ignoring how actions and words affect
others. “When assessing the world around us and our fellow humans, we use ourselves as a yardstick and
tend to project our own emotional state onto others” (Singer et al., 2013, p. 15466). Today’s popular
culture has practically celebrated the “self” and how changes in daily lives impact us, but not so much
other people. With so many heated arguments, public tirades, and even acts of violence erupting from an
inability to see another’s point of view, it’s difficult for even the most kindhearted people to become
influenced by the common way of thinking. This can be especially detrimental for an assisted living
caretaker,who may grow angry from only being able to see his or her point of view and not the
perspective of the one who is suffering.
For this project, the focus will be on paid caregivers who are not registered nurses, and allowed
for a time limit of two months before results become apparent. So the question to address here is, when
working with paid caregivers for assisted living residents with Alzheimer's or dementia, will providing
educational sessions on empathetic behavior result in an increase of empathetic understanding within a
two-month time frame? Before even attacking this question, there needs to be a specific aspect of
empathetic behavior to focus on, and a way of telling if the project is successful. This is where the
research needed to begin.
The first thing to look for in a search for articles was information on empathy itself—
specifically, how a more empathetic caretaker affectsthe attitude of the patients. The first step was to

perform an online search for “empathy studies,” and right away, there was a good variety of results.
Many articles pertained to the effectiveness of empathy on the part of physicians and other medical
employees as well as ideas on how to train them accordingly. In addition, though, there were articles
debating how exactly empathy is defined. Most people would not likely think about the subject this way
before, and consider the definition of the term rather straightforward. It seems there are different takes on
empathy that relate to emotional perspective, neurology, and even culture. Furthermore, some articles
provided ideas on how to assess the project and make sure the training and education will prove effective.
These works would definitely help define the goals of the project and break apart the steps in more detail.
The articles generally came from psychology-based publications, such as Emotion Review and
Psychology Today,as wellas medical journals like The British Journal of General Practice. Not every
publication is a legitimate source for the project, however. Since caretaking for the elderly is a relatively
new practice, only dating back to the early 1980s, there are bound to have been significant changes to the
field over the past few years. Therefore, one article that was written before the turn of the century had to
be eliminated, drawing the line for publication dates at around 2004. Overall, there were seven articles
which would potentially serve the purpose well and hopefully go a long way toward showing that
members of the underappreciated geriatric population should be treated with the respect and dignity they
deserve.
Like with any research,it helps to begin with a general question: What is empathy? There is a
surprisingly complex answer to that question, and Engelen and Rottger-Rossler (2012) bring up several
different points of view. Using their own research from a wide variety of sources,their level-7 article
from Emotion Review explains how empathy can be described as a way of fully grasping the emotional
state of another person through what was termed a “social feeling.” The main focus of the article was on
six different sources presenting six different ideas on how empathy should be defined. The first two take
a neurological approach to the issue, the first one connecting empathy with the process of understanding
by making inferences from outward appearances,and the second suggesting the concept of an overlap
between perceiving another’s emotional process and experiencing one’s own emotional process given the
same situation. The third source focuses purely on the idea of sharing the emotional state of another
person.
The fourth source places an importance on contextual clues, concluding that empathy can only be
achieved by fully understanding the other person’s character traits and what he or she would normally do
in certain situations. The fifth source was written by noted anthropologists, so naturally it would
emphasize culture and how it’s important to be familiar with a person’s customs and moral standards in
order to be truly empathetic. Finally, the last source described a three-step process on where empathy
comes from: social hyperactivity, blocking the excessive emotions, and controlling the blocking
mechanisms.
With these various perspectives on the subject of empathy, there are likely to be others. Engelen
and Rottger-Rossler even invite the readers to contemplate their own definitions of empathy when reading
the article. They don’t really draw a conclusion, but they do raise interesting questions, which, given the
complexity of the subject matter, may be the more effective approach.
Once empathy can be defined in the context of the project, the next thing to do is find a way to
measure the success. This is where Mercer et al. (2004) comes in. In an article from Family Practice,
they developed an assessment tool centered around the patients, getting their direct feedback on how
empathetic they felt the physicians were behaving. Designing this tool proved to be a challenge for them,
as they found they needed to redo the experiment multiple times to the questions were both clear to the
patents and relevant to the studies.
The biggest strength of the experiment was the fact it was based on processes and not the
outcome. Physicians can get feedback on their work as they’re doing it and not base its merit solely on
the results. Obviously, being able to treat the patient and restore health at the end is the primary purpose
of the medical field, but the true measure of empathy and comfort for the patient happens during the
treatment process itself.

The study was conducted on 20 patients of both genders of various ages and marital statuses.
However,the study was limited to white people whose native language was English. Clearly, and the
article itself admitted to this, more studies need to be done to cover different cultures, backgrounds, and
languages. The results were still promising, though, as the data seemed to support what was expected
based on previous studies. The assessment has potential to be a very useful tool for examining a
physician’s bedside manner, so it can prove similarly handy in assessing a caregiver’s attitude toward
senior citizens afflicted with Alzheimer’s or dementia.
The next two articles deal more directly with the effectiveness of empathy. Derksen et al. (2013)
point out in the British Journal of General Medicine that during their research,they discovered how
patients can perceive an empathetic physician and disease symptoms seem to become less severe when
they do. They also mention how a medical student starts out with a strong sense of empathy, but the
feeling does tend to decline over the next few years. Some may argue this state of mind is innate and
can’t really be taught, but there is a clear indication that some kind of training is necessary at some points
during medical programs.
The article focuses on database searches,though some original experimentation and exploration
would have helped the argument greatly, especially since its format appears to be structured as a lab
report. However,the authors did produce useful visual aids and acknowledged the existence of different
levels of empathy. The databases used in the article focused on results between July 1995 and July 2011,
and the authors did not spare any details describing the research process. Overall, it is promising work.
Its conclusion was similar to the other articles in that a patient-centered method of measuring physician
empathy is ideal, while also pointing out how side effects of empathy and patient expectations of it should
also be taken into account.
Kathryn Braun et al. (2005) in their article from The Gerontologist explain how they developed a
full-fledged curriculum for people working with the elderly based on active-learning strategies. They
start out echoing my very sentiments on the subject, in that interpersonal training for caretakers who
specifically look after the aging population is lacking and often relies on limited-time lectures instead of
round-the-clock hands-on experience. The proposed curriculum was far more interactive and reflected
many different kinds of learning styles, as well as different intellectual strengths.
The curriculum, dubbed the Paraprofessionals in Aging Project (PAP) was divided into six
modules, each of which containing its own set of learning objectives, and was given to Hawaii County’s
Area Agency on Aging, which serves a predominately rural population. Over half the participants were
Asian, and more than three-quarters were female. Nearly all of them spoke English as their first
language, and ages ranged from 18 to 71. In total, there were 88 participants who completed the course
(29 others were enrolled but did not complete it). Given the limited budget the experimenters had, this
seems like a feasible group to at least supply a first step in confirming the effectiveness of a training
seminar.
The design was not experimental in the strictest sense of the word, but there was initial feedback
and opportunities for participants to share their views and offer suggestions. Those involved in PAP got
to use the topics they learned right away on the job, with some reporting on their effectiveness
immediately. A satisfaction survey given to those who completed the seminar asked what they liked and
disliked, in addition to any open-ended comments regarding what they were able to take from it. The two
most common themes the participants brought up in these surveys were knowledge of aging and empathy.
The article includes a breakdown of the curriculum and a partial table of statistical results. Some
more charts might have helped make a more convincing argument, but the discussion openly admitted the
process was not based on objective measures. Also, the report only took into account immediate results
and was not able to record long-term effects of the training. More funds would be needed to conduct a
larger-scale experiment which attracts a wider variety of participants and would not inconvenience health
care employers. As a result, this experiment may not become an earth-shattering discovery in the
scientific community, but as it is, the model does have promising results and managed to get caretakers to
understand their clientele better and reduce their stress on the job. These are without question useful facts
for the argument presented in this project.

Psychology Today reprinted the results from an article by researchers at Max-Planck-GesellSchaft
in Germany explaining how egocentric thinking is part of human nature. The research,conducted by
Tania Singer et al. (2013), concluded that people tend to use their own emotions to measure the feelings
and perspectives of others, often incorrectly. The experiment incorporated 191 participants, all of whom
were female,right-handed undergraduate students.
Both groups were given dramatically different sets of visual and tactile stimuli and were asked to
judge each other’s reactions to them. One group was shown pictures of maggots and felt slime on their
hands. The other group was shown pictures of puppies and felt soft fur. At the end, the participants were
asked how they felt their own teammates reacted to the stimuli, as well as how the other team reacted to
theirs. The participants seemed to understand quite well how their teammates handled the material,
whether they were exposed to the pleasant or unpleasant ones. When it came time to figure out how the
other group responded, the results were not that accurate. The ones who saw puppies and touched fur
underestimated the negative response from the maggots-and-slime group, while the people who were
grossed out by their stimuli believed the puppies-and-fur group acted far less pleasant than they did.
A technique known as Mindfulness-Based Stress Reduction (MBSR) was the subject of a paper
by Peter Barbosa et al. (2013) in an effort to connect it with an increased sense of empathy. Like the
article from the British Journal of General Medicine,this study from Education ForHealth pointed out
how medical students tend to experience a reduction in empathy as their studies progress, which can be
connected with high stress. MBSR seeks to reduce stress and increase empathy through specially-
designed meditation techniques.
The study involved 33 student volunteers from Samuel Merritt University in Oakland, Calif., and
took the form of a controlled experiment. One group, after a pre-screening process,was selected to
participate in the eight-week MBSR program, while the other group did not. Everyone completed a
psychometric test for conditions like anxiety, burnout, and of course, empathy before the seminar, after
eight weeks,and after 11 weeks (to test for long-term effects). All participants ranged in age from 22-30
and were either white or Asian, but there was only one male in either group. Five different healthcare
programs at the university were represented by each group, such as podiatric medicine and physical
therapy.
There wasn’t a significant difference between the control group and experimental group when
burnout was measured,but a much higher percentage of the experimental group experienced a reduction
in anxiety. As far as empathy goes, the experimental group had a noticeable increase in this score at the
eight-week mark, while the control group had almost none. However,at the 11-week mark, both groups
showed a sharp decline in empathy scores. This could have a lot to do with the fact that the 11-week
point coincided with the students’ final exams, so the experimental group may not have been able to
continue the medication tactics.
Even though the sample size was small and the demographics didn’t exactly represent a wide
variety of students, there’s enough evidence here for me to believe MBSR’s medication tactics can be
used in a potential training seminar for caregivers of the elderly. If you just take into account the
significant decrease in anxiety, that by itself can go a long way in getting healthcare employees to better
understand what their patients are experiencing.
Finally, during a search using the keywords “empathy education,” the result was an article from
Nursing Inquiry by Scott Brunero et al. (2010) that literally reviewed empathy education for the nursing
field. The purpose was to examine the outcomes of previous studies regarding empathy education
programs to both determine their usefulness and develop recommendations for future seminars. Seven
programs for undergraduate students and 10 programs for graduate students were brought up (one
involved both groups of students, but was placed in the graduate group) and the outcomes for each were
clearly described and organized on a table.
The drawback to this article was that more than half the articles studied were printed before 2000,
so some information may have been outdated. Still, the majority of the studies showed significant
improvement in severalpromising categories, such as the nursing students becoming more person-
centered in their overall approach, and patients showing less anxiety and hostility than ones in control

groups. The sample sizes varied greatly in the experiments, ranging from 10 to 428, and the articles
seemed to ignore the idea of gender bias.
Some more recent examples and better consistency in the demographics of the participants would
make this a far more useful source of information. As it is, though, there are still positives to be taken
from it. There have been empathy education seminars dating farther back than I had previously thought,
and the various types of programs seen here show me that I am not limited to one specific structure or
curriculum if I want to see results from the project. Also, since more positive results came from the
graduate student group, it’s reassuring to know that caregivers of a more mature age can be taught just as
easily, if not more so, than younger employees just getting started.
The question on whether appropriate training will increase empathy on the part of caretakers for
people with Alzheimer’s is a rather complex one. There are many different perspectives a person can take
on how to define the word and evaluate the process. However,previous experiments and conclusions
have shown that the task is not insurmountable. Even the most basic of research projects and primitive of
experimental designs can at least give some insight toward the kind of results we can reasonably expect.
To reach any kind of definitive conclusion, there needs to be more thorough research and experimentation
covering a wide range of ages,locations, and demographics. There may be a long way to go before a
guaranteed method to produce caretakers with excellent bedside manner can be established, but the
information from these articles is a good place to start.
The best way to define empathy in this context would be the ability to put oneself in the other
person’s shoes, and more in-depth education on Alzheimer’s disease itself can help make that happen.
The main focus, however,needs to be the presence of a well-structured training program, with different
aspects of empathy being covered at different times and in a variety of ways. It appears the most effective
kind of empathy training is the ongoing method. Relying on lectures and brief seminars won’t be enough
to ensure any long-term success. Caretakers need to continually apply what they’ve seen on the job and
many of them require supervision to make sure of that. The progress made toward becoming a truly
empathetic caretaker should not be judged by the administration, but by the residents themselves (or
family members if the residents can’t speak on their own behalf), because they’re the ones actually on the
receiving end. In addition, there needs to be some sessions regarding techniques on reducing stress,
whether it be through meditation or simply an exposure to positive stimuli.
In short, while this research does not offer absolute and unquestionable proof, there is evidence in
support of my topic. A well-structured and well-timed seminar containing information about the effects
of Alzheimer’s, communication techniques, and stress reduction can help greatly in allowing senior
citizens afflicted with this disease live out their remaining years comfortably and serenely.

Needs Assessment
The literature review has illustrated a significant amount of research that has been done on
empathy and how it helps in the geriatric field. However,it is a disappointment to realize how despite all
this information, it does not seem to be implemented very often. In addition, there appears to be a number
of different definitions of empathy and ways of measuring it. What currently exists is an issue consisting
of far more levels and details than many would have originally thought.
It’s not surprising to learn that behaving in a rational, civilized manner around other people is an
effective way to have these pleasant attitudes reciprocated toward you. This is especially true around the
elderly population, who are especially sensitive to other people’s behavior. Many people think this is not
the case,and that the elderly, in their declining physical state,wouldn’t notice if they were being treated
harshly. Many caretakers for the geriatric population have seen firsthand how wrong this assumption is.
People who have grown old may not be able to express themselves very well, but there’s no doubt they
can tell when they are being mistreated.
While assisted living caretakers react as others in society, it’s important they exercise great
patience when working with elderly residents. Many require having instructions repeated to them several
times. Others may not remember where they are and where they need to be. Some may have even
forgotten how to do basic activities such as eating or bathing. It would be easy for a caregiver to either
grow frustrated at this behavior and start lashing out, or talk down to the residents as if they were infants.
Neither one of these approaches would prove healthy for patients, and the situation will only grow worse.
Still, it is quite clear that being a more empathetic caregiver, that is, being a caregiver who is
more “in tune” with the patients’ needs and desires, will strengthen the dynamic between patients and
caregivers, and assist with the healing or comforting process. Derksen et al. (2013) explain how patients’
disease symptoms had become less severe when treated by an empathetic physician. Other researchers
like Engelen and Rottger-Rossler (2012) have discussed severaldifferent ways to define empathy, but the
one best suited for this case would be a thorough understanding of what the other person is going through.
This is certainly relevant in the assisted living field, where employees need to have advanced knowledge
of the human body and how it deteriorates with age. This is why the major key in becoming more
empathetic and thus more connected with the clientele is education.
So despite the complexity, there is still a realistic goal. The geriatric population is one that
deserves more respect and dignity, and with better understanding on the part of the caregivers, the
profession can go a long way in making these patients feel important and loved. If the caregivers do not
show their elderly residents empathy and compassion, then there will be harsh reactions from them, a
state of unrest at the facility, and ultimately a decrease in revenue when families and friends hear about
what’s going on. This is especially true in units where the patients are stricken with Alzheimer’s or
dementia. Given the residents’ weak memories, it’s very easy for a caregiver to become frustrated and
start giving orders angrily. Residents may not be able to remember the exact occurrences,which some
caregivers might try to use as an excuse for their actions, but the emotional sting these aggressive
movements bring to them will stick around in their minds for a long time.
The first thing needed in order to achieve the goal of improved relationships and empathy is more
intense training. Many assisted living facilities only give general information about what to do with
residents on a daily basis and how to respond to certain situations. While these procedures are certainly
important, they seem to leave out the key point: why the residents behave the way they do. We can no
longer use the excuse “They’re just old.” We, as a society, have learned much about the aging process
and now realize that no two people grow old the same way. Since there’s no way to prepare for every
possible situation, the alternative would be to provide further education on the aging process itself.
“Integrating activities within the [healthcare] curriculum, such as interprofessional experiences,
experiential education, geriatric electives, and simulation games that improve health professions students’
empathy toward different patient populations is needed to promote patient-centered care” (Kiersma et al.,
2013, p. 94).

For example, anyone can stand up and recite the symptoms of Alzheimer’s, but it’s far more
difficult to fully grasp what a patient struggling with this ailment is actually going through. Caregivers
need to be aware that the residents’ behavior has a reason beyond their control, and so effective
caregiving requires a great deal of patience. “Acknowledgment of the personhood of sufferers and
affirmation of their condition and struggle have long been recognized as the most basic and sustaining of
moral acts” (Kleinman, 2012, p. 1550).
The second thing needed to help accomplish this mission is an assessment. A facility can provide
all the training and education in the world, but none of that will matter if the caregivers don’t utilize what
they learned. Some kind of assessment is needed to find out if the extra training was effective in making
the residents feel more at ease. Mercer et al. (2004) explain how this type of assessment needs to be
centered on the patients themselves, and not the administrators. This makes sense,considering the
patients are the ones on the receiving end. Even if they have trouble processing the questions, they can
still show in their own way how much more comfortable they feel.
Another thing worth noting is the wide variety of ways in which a patient can be comforted.
People naturally have their own sets of interests, but many caretakers may not realize just how diverse the
related activities can be. For example, Detweiler et al. (2012) explained the details and benefits of
horticultural therapy, where residents ease their stress and socialize more by taking up gardening. If this
technique were as effective as the article claimed, it would definitely be something more assisted living
facilities should look into for the sake of comforting the residents and really understanding their behavior.
So as part of the education process,caregivers can emphasize the use of sensory stimulation as a way of
getting to know the patient better.
Another way of connecting with the residents is to induce empathetic behavior would be sharing
stories. Specifically, allow residents to share their life stories with the caretakers. Hearing about certain
events in their lives may inspire the active listeners to relate to their situations. This ties into the concept
of sensory stimulation, though only one sense should be impacted here because “the non-visual relies on
each mind using its personal experience to build its imagination, making it a more intimate, relatable
‘vision’ with a greater impact on one’s empathy” (Manney, 2008, p. 51). Perhaps the caretakers
experienced something similar in their own lives, making the process of understanding much easier.
Bornat and Walmsley (2008) describe the growing effectiveness of using biographies in healthcare,
giving patients a sense of empowerment. In addition, “there is a growing realization that patients and
service users are a rich source of healthcare-related stories that can affect,change and benefit clinical
practice” (Haigh and Hardy, 2011, p. 408).
McAdams et al. (2015) go into detail about how a person’s life story helps shape him or her
psychologically, so a seminar related to this aspect could prove beneficial. Caretakers can be informed on
how to conduct storytelling sessions and invite a resident to open up about his or her life. Sometimes a
low-functioning resident may have trouble remembering certain details of events that happened years ago
and get stuck. A common strategy for a caretaker is to fill in the details for them, making sure to follow
along with the emotions conveyed by the description of the events up to that point. Even if residents can’t
provide an exact account of what happened, the emotions and feelings tied to those events will remain in
their memories for life. Understanding the residents’ experiences can even help caregivers communicate
medical information, since they would have a better idea of what the residents can and cannot
comprehend (Gray, 2009). As stated before, this is another reason why empathetic caregiving is
extremely important.
In addition to assessing the residents, the caretakers should also undergo an assessment to
discover how effective the programs will be. The Greater Good Science Center at the University of
California, Berkeley, provides a good example of an empathy test so administrators can find out how “in
tune” with others’ emotions their caretakers are (greatergood.berkeley.edu).
In order to reach a conclusion, however, a case study needs to take place. Both residents and
caregivers will take an assessment before any seminars occur to evaluate current conditions. After the
seminars take place, the same people will be re-assessed to find out if any improvements have been made.
But the testing should not stop there. A third assessment needs to happen a significant amount of time

after the seminars, perhaps two months afterward,to discover if the education process proves to have
long-term success.
The key factor when it comes to addressing these issues will be research. There are numerous
articles available, which delve into the nature of empathy and its connection with various aspects of
healthcare, so they will be reviewed. The aforementioned research papers plus articles that also came
from the Greater Good Science Center at Berkeley provide a good look at the importance of empathy.
For example, Jill Suttie (2015) discusses how stress is directly related to a lack of empathy in the medical
field, and how patients who experience a stronger emotional connection with their doctors are more likely
to follow their orders.
More importantly, information needs to come directly from people in this field in order to find
out what they currently do for employee training and how much they value empathy. In addition, it is
crucial to calculate how much an additional seminar would cost. The administrative staff of nursing
homes and assisted living facilities would reasonably request more compensation if they are required to
give an extra presentation to current and future employees regarding empathy and understanding. If the
staff doesn’t wish to conduct the seminar or are simply under informed themselves, the facility could hire
a guest speaker to present the importance of empathy and patience when working with residents afflicted
with Alzheimer’s or dementia. This means prices of such speakers and agencies where they can be found
must also be included.
Before any of this happens, it’s important to establish an exact definition of empathy. As stated
earlier, there are various ways to explain what it means to be empathetic, and there are numerous studies
revolving around that very idea. The definition used here will likely focus on thoroughly understanding
another person’s point of view. Dimberg, Andreasson,and Thunberg (2010) focus on an emotional
connection when defining empathy, and also explain how the feeling can be cultivated through
understanding and responding to another’s facial expressions. This idea is certainly relevant to this
project, as many elderly residents have lost their ability to communicate clearly and must rely on people
to “read” their outward appearances.
Developing an appropriate assessment strategy will also prove to be a challenge. While the
assessment must be patient-centered and not centered around administrators, the patients at assisted living
facilities need to be able to do them. The questions must be detailed enough so the answers can be
practical, but simple enough so lower-functioning elderly residents can answer them. There needs to be
an appropriate balance.
The real test, however, will be the reaction from residents’ families. They are the ones paying for
the care,so their opinion directly impacts the revenue of the assisted living facility. After the assessment
is given to the residents, a follow-up assessment may be given to the families and loved ones, so they can
address any concerns they might have noticed from their point of view. Like the one given to the
residents, the questions must be very precise and detailed enough so answers will paint a direct picture of
what they feel is going on. However,since the families are not as low-functioning as the residents, it will
not pose as big a challenge to make the questions understandable for them.
Finally, there’s the question of lasting power. A seminar may give the caregivers more insight
about the residents’ condition and at least get them to become more empathetic for the time being. A
follow-up assessment two months later will help see if the information from the seminar has stuck with
them. But how can we be sure the caregivers will still be just as empathetic severalmore months down
the road? One possibility is to make the seminar an ongoing process, holding a meeting on a regular
basis. However,that may prove too cumbersome and take up more of the caregivers’ time better spent
with the residents. Another possibility is to hang up posters throughout the facility with little reminders
of how to behave and lists of general rules to follow in order to maintain a strong connection. Caregivers
will pass these by on a regular basis, and even if they don’t read them in full detail every single time, their
presence may serve as a mental boost in case they forget who and what they’re dealing with. The costs of
manufacturing these posters will be added to the costs of the seminars themselves when figuring how
much needs to be spent on this project. Hopefully, the final tally will be a reasonable one that will fit into
most facilities’ budgets.

Overall, the caregivers at assisted living facilities need to be better informed of what the residents
are going through in order to fully empathize with them. “Although [healthcare] team members
frequently express emotional concerns with family caregivers during one-on-one visits, there is a need for
more empathic communication during team meetings that involve caregivers” (Wittenberg-Lyles, 2012).
Once a mutual understanding takes place, there will be a stronger connection between residents and
caregivers, and everyone will feel more comfortable where they are. There will be fewer cases of resident
abuse, fewer complaints and lawsuits from residents’ families, and higher revenue as more people become
aware of the facility’s kindness. Accomplishing this goal starts with education, and even if providing this
service costs a little more up front, the effectiveness and positive feedback will make up for it and then
some.

Methodology
Using the literature as an inspiration, the overall backbone of this project would be to test and see
how effective educating the workers at an assisted living facility is at bringing out more empathy and
mutual understanding between them and the residents. The goal would be for caregivers to become more
“in tune” with residents’ needs and for the residents to feelthis kind of support on their end. While it is
difficult to quantify how a resident feels, making comparing data a challenge, some well-thought-out
assessments and satisfaction surveys could give substantial insight into how they are being treated.
The first thing needed to gather data for this project was the assessment itself. The Jefferson
Empathy Assessment has been used by numerous institutions as a way of measuring how healthcare
workers value emotional support and their patients’ perspectives, so it serves the purpose of this project
very well. Previous studies have shown how it effectively measures different levels of empathy among
nursing students (Fields et al., 2011). A copy of the Jefferson Empathy Assessment was downloaded and
modified to make it easy to follow and complete. It was then distributed to 20 employees at a senior
living facility in New Jersey. The employees came from various backgrounds and age groups, and had
representatives from both genders.
The assessment consists of 20 statements for which respondents must give a numeric reply from 1
to 7, an answer of 1 indicating he or she strongly disagrees with the statement,a 7 indicating he or she
strongly agrees. Each question is scored independently since not every one of them is indicative of the
same level of empathy. For example, one statement says “I try to think like my patients in order to render
better care,” while another statement says “My understanding of how my patients and their families feel is
an irrelevant factor in medical treatment.” Clearly, having a high level of empathy would result in
drastically different answers for these.
After the assessments were retrieved from the employees, their current level of empathy was
measured. This served as the control part of the experiment. The average response for each question was
compared to the ideal response for those who feela high level of empathy. The next step is to add the
catalyst for actual experimentation phase.
To find out if educating the workers would have any effect on how empathetic a caregiver each
one would be, a seminar was held to address the issue. The employees who took the assessment,along
with a host of other workers at the facility, were gathered to hear a presentation. The speaker addressed
the importance of fully understanding what a senior citizen is going through both physically and mentally,
so there would not be as much frustration on their part as they work with someone struggling to perform
basic tasks. The subjects of Alzheimer’s and dementia were brought up, with the explanation of the
residents’ seemingly irrational behavior. The underlying moral was the importance of seeing things from
the residents’ point of view, so caregivers can comprehend how daily activities for someone struggling
with cognitive difficulties are not as easy as they might think. The speaker went on to suggest another
way to build rapport with residents, sharing life stories with them. Despite the generation gap, there is a
lot of potential when it comes to similar experiences between the residents and caregivers. “The use of
repetitive narratives arouses empathy by providing an opportunity for empathically forming a subjective
understanding of users’ experiences and points of view” (Fritsch et al., 2007, p. 3). Finding such
common ground, according to the speaker,can serve as the foundation for mutual understanding and help
gain the residents’ trust.
To further reinforce the ideas presented by the speaker, motivational material was also posted on
the walls of the facility. Brief summaries of why the patients behave a certain way, reminders to be
patient, and tidbits regarding the effectiveness of sharing stories were shown in conspicuous locations so
caregivers would easily notice them in passing. Even if they don’t make a point to stop and read every
word, the idea and concept would still enter their minds and stick with them when speaking with
residents.
To make this happen, there needed to be substantial research on the costs of producing the
material. Seminars are relatively inexpensive, since very little is needed outside of notes and a display
board. Using an easel,poster board, and art supplies borrowed from the facility, the speaker created

illustrations of how the brain is commonly affected by the aging process, and enlarged inspirational
photos showing what can happen when caregivers and residents are fully supportive of each other.
Producing severalposters and flyers to hang around the facility proved to be more costly, so there had to
be an exact count of how many of these messages were needed. After the number was finalized, the next
step was to contact severalcopy and print facilities to find the most reasonable price. Once the material
was ordered, the last step in this phase was to enlist the help of volunteers and other workers to hang them
up in strategic locations.
After two weeks,the caregivers were once again given a copy of the empathy assessment. This
time, the questions were rearranged and the scoring system was reversed (a 1 now meaning strongly agree
and a 7 now meaning strongly disagree) to minimize the possibility of a caregiver merely remembering
the numerical grade from before and copying the result. The purpose of this was to see if there were any
lasting changes in their attitudes since the seminar. Even if a caregiver was very enthusiastic about the
new ideas and wanted to incorporate them right away,there was still a possibility of he or she forgetting
about them in a few days and sinking back into the previous behavioral pattern.
The assessments were completed and collected, and the scores were tallied once again. Using data
analysis, the numbers obtained would paint a picture of whether the seminar proved successfulin
educating the workers about empathy, and whether that education brought about improved attitudes on
their part.
In addition to the caregivers’ assessment,there also needed to be a way to measure the
satisfaction of the residents themselves. The residents were previously given a satisfaction survey to
inform administrators how they felt about activities, food selection, and most importantly, the attention
given to them by the employees. They were also asked to rate their feelings on these matters on a
numeric scale,or, for the lower-functioning residents, a scale consisting of a series of “smiley faces,”
whose expressions ranged from very sad to very happy. These surveys were taken and examined.
Following the seminar and the two-week period, they were given to the residents again. In the same way
as the Jefferson empathy tests, the results from the surveys were recorded and analyzed to see if there
were any noticeable changes.

Implementation
It would prove to be quite a challenge implementing this project. Given that the assisted living
field is already one that requires undivided attention, gathering enough people to meet at the same time
for a seminar is very difficult. The schedules needed to be examined so as little time as possible gets lost
and residents’ needs are still addressed. The state requires at least one knowledgeable staff member to be
on call at all times, so even if the number of available hands is depleted, there still needs to be enough
people so no resident is left having to fend for him or herself. In addition, the seminar can take place only
after the initial surveys have been distributed, completed, and collected. So before the project even
begins, there’s a time issue.
Some presentation notes need to be carefully written and researched so the information is
accurate and clear. Also, it is not a good idea to merely have the speaker read to the crowd, as this will
not hold their attention or get them to understand the issues being addressed. There needs to be a sense of
interactivity along with visual aids. A question-and-answer period at the end as well as a role-playing
activity in the middle help in clarifying the overall purpose of the seminar. More importantly, however,
there must be visual stimulation as the presentation goes on. Much like with the residents, the caregivers
can be reached more easily if more than one sense is stimulated. The activities department at the assisted
living facility can supply an easelas well as art supplies to create a display board to illustrate the impact
of Alzheimer’s both physically and emotionally, and the importance of empathetic caregiving for those
afflicted.
The facility gets funding for various organizations within the community, and since art supplies
are relatively inexpensive, it would not be a challenge to seek reimbursement for the seminar illustrations.
There are also situations where employees are entitled to additional pay during or after attending a
professional development session. Whether this qualifies as such a session is the decision of the
executive director, who would need to look into the company budget or seek out the aforementioned
organizations to distribute proper payment.
The next obstacle in the project is the creation and distribution of motivational posters and flyers.
Again, these cannot consist of mere words on a paper or else they may never actually be read. These
documents need to have a visual style to draw the attention of others. Without on-hand psychological
knowledge, there needs to be research on what specifically has the best chance of capturing the attention
of a passerby. Using this information and various software programs such as MS Paint, Photoshop, and
Adobe, eye-catching and informative material can be produced multiple times.
However,in order to obtain numerous copies of the documents, the project again needs funding
to cover the costs of using a local copy and print center. These expenses need to be carefully calculated,
because while the art supplies and copy center services may not be expensive by themselves, repeated
uses can add up, leaving a financial hole deeper than anticipated. Outside funding may be necessary to
implement a project such as this.
Upon further research,the current price for producing flyers at the copy and print center is $18
for every 100. One hundred flyers is substantially more than necessary,but leftovers can be used as
handouts to any visitors or volunteers who may wish to pursue caretaking as a career down the road. The
cost of producing a poster is approximately $10-$15 depending on overall style. To maximize results, the
$15 option would likely work best. Estimating six posters for the entire facility, the cost of the posters
becomes 6 × $15 = $90, for a total of $108 for the motivational material. If this figure goes beyond the
company budget, administrators could ask for donations from the community, or possibly even the copy
and print center itself.
Once the flyers have been produced, they need to be posted in conspicuous locations throughout
the facility. Building regulations mandate that certain documents already be visible in high-traffic areas,
such as the fire exit directions and safety precautions. Menu options must also be conspicuously
displayed in order to comply with state requirements for assisted living. To make sure people see the
motivational material, it’s important not to place them in an area already covered with postings, because
people tend to pass them by without paying much attention to any one in particular. An area with fewer

postings would be favorable so the material can still be noticed without overshadowing the required
documents or making a spot too cluttered. Finding an empty wall to hang a flyer will definitely make it
stand out, but the inherent question would be how many people will notice it there. If no one else has any
postings in that location, there could be a reason. On the other hand, it’s possible the empty location
could be a place no one had previously considered, and might eventually become one of the more
conspicuous locations at the facility. It would be in the best interest of the project to find out how many
people walk by a certain location on a daily basis to judge whether placing a flyer there would be
effective.
Once employees have learned about the importance of understanding Alzheimer’s and fully
grasping what the residents are going through, there needs to be way of educating them regularly. There
is only so much that can be squeezed into the seminar, and the overall purpose of that event is to show
why such knowledge is important and how it helps participants become more empathetic caregivers.
Employees at the facility need to have regular access to material, whether they are books, pamphlets, or
specific websites, teaching them more about the disease. However, this does not guarantee effectiveness,
since this would rely on the caregivers acting on their own accord. The facility needs to set up
professional development sessions, which are already mandated by regulations, to emphasize the
importance of understanding Alzheimer’s. Since this cannot interfere with the required protocols, the
seminars would have to be longer or more frequent. This leads back to the first obstacle in implementing
this project, the time issue. There must be a healthy balance between how much time devoted to the
residents would be lost and how much empathy and rapport is gained as a result of the sacrifice.
At the specific facility where the project is being conducted, a seminar is held once a month for
the review of safety procedures and regulations. The seminars typically last 30-45 minutes. If this
frequency is enough for the state to legally recognize the employees as well-informed of the facility rules,
it stands to reason that a similarly-timed seminar on the importance of Alzheimer’s and patient
understanding would be sufficient in making sure the points are made clear to the employees. This
facility may schedule seminars every two weeks rather than monthly, with alternating sessions being used
to promote caregiver empathy. Sacrificing an additional 30-45 minutes in exchange for a more caring,
patient, and generous attitude would strike anyone as a fair trade-off. (Even though the project itself only
lasts two weeks,the pursuit of stronger empathy and solid rapport with patients should rightfully be an
ongoing process.)
Another aspect of the project concerns the manner in which caregivers may become more
empathetic. The ability to share life stories with assisted living residents has been shown to build a
stronger rapport with them. Residents may become more secure and trusting, and caregivers can more
easily perceive what they need. Even with this technique, everyone involved needs to know his or her
limits. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prevents personaland
medical information to be divulged outwardly without consent. As many residents may not be in a proper
mental state to withhold private information while sharing their stories, the caregivers have to make a
promise, likely through a signed contract, that they will not share anything a resident tells them with
anyone, both within and outside the facility. To make this happen, these talks must happen during one-to-
one sessions and take place in an isolated, private room so no one can accidentally hear something he or
she shouldn’t. For many residents, this does not pose a problem, since they might enjoy spending time
away from large gatherings in favor of a more peaceful environment. Other residents, however, might
prefer the company of others and enjoy the large social get-togethers. Earning trust and respect from
these patients by taking them away from their favored environment would be massively difficult, if not
impossible, so the method of sharing life stories would not be an effective approach.
Assisted living facilities generally have set schedules for activities on a month-by-month basis,
but there’s always the possibility of something out of the ordinary happening on the premises.
Representatives from the state department could be making a visit, influencing the caregivers to be
exceptionally nice to the residents (often much more than they would be otherwise). The activity
department might schedule a special guest for entertainment or enlightenment, making the facility come
off as a far more exciting or hopeful environment than it is during ordinary times. Restrictions only allow

this project to be undertaken once, so there may be severalvariables such as this to keep in mind when
examining the results.
Finally, after the second time the caregivers are given the Jefferson empathy test (this one slightly
modified), the results need to be examined. Using data analysis techniques, any significant improvement
will be revealed. Hypothesis testing for a normal distribution when n = 20 would be the best bet. Even if
the numbers suggesting positive empathy are noticeably higher, it might not necessarily mean an actual
improvement. Setting the traditional Type I error at α = 0.05 will show whether the numbers are different
enough to safely conclude a positive influence. There are quite a few assumptions that need to be made in
the mathematical setup for the analysis, and these may also have an impact on the results.

Evaluation
After the surveys were collected both times, the scale was adjusted as necessary for each question
so the higher numbers represented a higher level of empathy. The average score was taken (n = 20), and
the results were as follows:
Scores from the Jefferson Scale of Empathy
Table 1. Average scores from the first and second assessments on each question, n=20.
# 1st 2nd # 1st 2nd # 1st 2nd # 1st 2nd
1 6.15 6.3 6 6.1 6.7 11 6.05 6.0 16 6.2 6.7
2 6.5 6.55 7 5.65 5.85 12 6.9 6.95 17 5.1 6.25
3 6.8 6.75 8 6.15 6.3 13 6.55 6.55 18 5.3 5.45
4 6.8 6.9 9 5.35 5.2 14 6.0 6.15 19 5.5 5.6
5 5.4 5.7 10 6.0 6.2 15 6.95 6.9 20 6.7 6.75
There are some clear differences between most of the numbers, but to find out if these differences
are significant, there needs to be a statistical test. Since there is no information at hand regarding a
standard deviation for this exact scenario, the ideal procedure is a t-test. The first thing to do would be to
find the differences between the test results:
Changes in Results Between First and Second Tests
Table 2. The differences between the two averages for each question, subtracting the first result from the second.
# Diff. # Diff. # Diff. # Diff.
1 0.15 6 0.6 11 -0.05 16 0.5
2 0.05 7 0.2 12 0.05 17 1.15
3 -0.05 8 0.15 13 0 18 0.15
4 0.1 9 -0.15 14 0.15 19 0.1
5 0.3 10 0.2 15 -0.05 20 0.05
Computing the differences between the first and second survey results and running single-variable
statistics on them, the result is a mean of 0.18 and a sample standard deviation of about 0.29. Since the
test is being run against the null hypothesis that the difference is zero, the test statistic becomes 0.18 /
(0.29/√20) ≈ 2.776.

This result is good news for the project, because using a one-tailed t-test (ideally, the numbers
should show a positive difference between the second and first results) when n = 20 (this now refers to the
number of questions, not participants), it becomes clear that the test statistic is large enough to draw the
desired conclusion.
Excerpt from a Student’s t-distribution Table
With 19 degrees of freedom and a pre-established 5% level of significance, the test statistic must be larger
than 1.729 for the data to be considered noteworthy. The result lies between 2.539 and 2.861, indicating a
very low probability that the differences came from ordinary variation.
Even though the second survey was taken only two weeks after the first, and there is still the
question of how much empathy would be maintained in the long run, the numbers look promising. The
initial seminar and motivational material do seem to be having a positive influence on how the caretakers
are viewing their positions and how they feel they connect with the assisted living residents. Quantitative
results were not available from the residents themselves, but after interviewing a sample of residents
being looked after by the caretakers who were involved in the seminar (again, n = 20), their feedback was
consistent with the results shown here. Many said they felt more comfortable with their caretakers,and
that there was a noticeable attitude change. It often takes a while to strengthen a personal relationship,
especially if it had previously been strained, so the fact that residents take notice this early into the project
says s great deal about its potential effectiveness in the long run.

Conclusion
As no two people age the same way, it makes sense that no two assisted living facilities provide
support in the same way. Given the sample in this project, it seems clear that the seminar and
motivational material have a positive effect on the level of empathy on the part of the caregivers.
However,the results are not entirely conclusive. There may have been confounding variables such as the
time of day, the background of the specific people involved, and the surrounding community at this
particular facility. Time constraints have also prohibited the project from running its full course so long-
term results can be observed.
Despite the setbacks,there is still much to be learned from this endeavor. Educating caregivers
on Alzheimer’s and the importance of empathy can help build strong rapport with the assisted living
residents, if at least for a while. This is enough for the administrative staff to consider making the
seminars a part of employee orientation, as well as including the information in mandatory professional
development sessions. The facility can also look into hiring speakers who specialize in matters like this
to deliver lectures to the staff, and possibly get ideas from other locations for interactive seminars.
The success of this project would lead to many benefits down the road. More satisfied residents
would mean more satisfied families, who would surely spread the word to other families that need to
decide on a home for their elderly relatives. “Healthcare quality affects patient satisfaction, which in turn
influences positive patient behaviours such as loyalty” (Naidu, 2009, p. 366). The increase in business for
the facility will allow for an increase in the budget, so the staff can afford to make their food, essentials,
and activities even better for the residents.
Another benefit from the project would be creating a positive influence onto other facilities. If
this establishment gains a reputation for having empathetic caregivers,more assisted living facilities and
nursing homes may catch on and begin incorporating similar tactics in their programs. Eventually,
facilities all over the surrounding area can utilize the findings of how important emotional connections are
and create many safe and hospitable options for the aging population.
While these benefits are certainly optimistic, it is important to realize that there is still much work
to be done to draw even a slightly definitive conclusion. A larger sample size, a longer time frame, and
variations in the testing method can help greatly to either reinforce or debunk the findings here. It would
also help to keep track of the kind of people involved in the project. Age range, gender, or race might
have an influence on the results one way or the other, as well as how serious the caregivers take their jobs
in the first place. One of the major obstacles in conducting a project like this is the fact that people who
are already passionate about their careers are the ones most likely to get involved, and those who do not
take their responsibilities that seriously are difficult to reach,creating an unavoidable skewness in the
results.
There may be a lot more to learn, but for the time being, this project supplies at least a ray of
hope toward a beneficial goal of providing senior citizens with a dignified, secure,and respectfullife.
Like people in all careers,those involved in caregiving need to be made aware that there is always much
more to learn.

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