Grant: Travel Awards - Institute Community Support

It is well recognized that residential care aides' (RCAs) knowledge about the person with advanced dementia is essential to providing optimal end-of-life care in nursing homes. While there is a growing understanding of RCAs' formal and on-the-job training, less is known about how RCAs in their everyday practice, learn about, and subsequently respond to, the psychosocial, spiritual, and physical needs of the person with advanced dementia. This paper presents findings from a qualitative study that explored how RCAs understood and responded to the needs of women with advanced dementia nearing the end of life. In-depth interviews with 24 care staff (14 RCAs, 3 LPNs, 2 managers, 5 allied health professionals) and over 500 hours of observation were conducted in a not-for profit faith-based nursing home. Analysis revealed that RCAs develop a highly individualized approach to caring for people with advanced dementia that is based on their relational, sensorial, and embodied knowledge of the resident. They also build knowledge about the resident through their embodied interactions with other care staff. However, RCAs' knowledge and practice are influenced not only by the physical and organizational environment of the care setting, but also by their own social and cultural background. Study findings highlight the less visible dimensions of RCAs practice, and offer an understanding of how they develop ways of knowing that enables them to provide empathic and responsive end-of-life dementia care.