For example, the Oxford Textbook of Palliative Medicine, by Doyle et al. (2004), would provide a comprehensive overview of all relevant topics. A more user-friendly example would be Palliative and End of Life Care: Clinical Practice Guidelines, 2nd Edition, by Kuebler et al. (2006), which would provide a ready reference for practical information. Book use will be limited to the learning center.

Textbooks $1,500 Textbooks will be purchased for each direct care employee. The choice of which textbook to purchase will be left up to the training supervisor. In addition, the training supervisor will be able to devote a portion of this funding allotment for the purchase of his or her own training material.

Computer Equipment and Accessories $4,085 Two desktop and one laptop computer will be purchased. The laptop will be given to the training supervisor and the two desktops permanently assigned to the learning center. The three computers will be capable of multimedia performance ($2,250) and come with three flat screen monitors ($360). Additional purchases include security cables and locks to prevent theft ($300), and two workstations with chairs and chair mats ($1,050). One set of speakers ($50) and three sets of headphones with microphones ($75) sets will be purchased as computer accessories. An inkjet color printer/scanner/copier ($100) and supplies ($200) will also be purchased for use by the instructors.

Microsoft Office Professional 2010 Software $440 To assist the instructors in monitoring training progress for individual employees and provide the necessary software for preparing handouts, exams, and training announcements, the Microsoft suite of office software products will be purchased.

Learning Center Projection System $800 A projection system will be purchased to facilitate group instruction activities. The projector ($700) will be USB compatible to allow projection of computer monitor contents to a projection screen ($100).

Miscellaneous Office Supplies $1,200 The learning center will be outfitted with white boards and markers to facilitate classroom instructions. The instructors will be provided with a file cabinet to maintain hard copies of employee training records.

Refreshment Fund $1,500 To help motivate staff members to attend group meetings a refreshment slush fund will be provided and managed by the instructors. Of course, the purchase of alcoholic beverages will be prohibited as a matter of Hospice House policy.


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Doyle D, Hanks GW, Cherny, N, Calman KC. (2004) The Oxford Textbook of Palliative Medicine, 4th Edition. Oxford University Press, Oxford.

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Budget Cost Analysis


The creation of a dedicated learning center in a hospice facility represents a major investment. Justifying the costs of this investment, under the current trends toward reducing the cost of health care across the board, demands evidence-based justification. High staff turnover rates and job dissatisfaction are common among professional caregivers working with patients who suffer from dementia (Irvine, Ary, and Bourgeois, 2003, p. 270) and contributes to staffing turnover and shortages. If the caregiver to patient ratio becomes too low, patient health and safety will suffer and the facility providing the care risks violating federal and state regulations.

Reducing staff turnover and increasing job satisfaction has been shown to be possible through training programs that help caregivers better manage difficult patients (Irvine, Ary, and Bourgeois, 2003, p. 270). Proper training can help professional caregivers manage vocally or physically aggressive, or uncooperative, patients, helping to reduce the use of pharmaceutical and physical restraints as a control method. Such changes can have a positive effect not only on caregivers' sense of job satisfaction and their view of this patient population, but also on patient behavior.

Aside from improving patient health and safety, and lowering staff turnover rates, the potential savings could be significant in other ways, such as legal liability (Kollas and Boyer-Kollas, 2007). What follows is a cost analysis of the proposed budget, together with a discussion of how both intangible and tangible savings might be realized through the creation of a dedicated learning center.

Broad Scope Perspective

Florida statutes require end-of-life care facilities to provide training for all licensed and unlicensed direct care personnel, as well as staff that may be required to interact with dementia patients (Hyer, Molinari, Kaplan, and Jones, 2010, p. 866). Currently, Florida law requires four hours of basic and advanced training for direct care personnel and one hour for other staff who are expected to encounter dementia patients. Changes to current law are being considered that would dramatically increase the training requirements to eight and four hours, respectively, and create additional provisions that require new employees receive at least one hour of training within 30 days of starting employment (Polzer, 2012, p. 39-40). The statutory training requirements will therefore be substantial going forward if these changes are passed into law.

The quality of online training programs has increased dramatically over the past decade and the CARES® online interactive program is an excellent example. Not only does this course meet Florida statutory requirements, but is also promoted by the Alzheimer's Association. Students who complete the required course material will be eligible to receive dementia care certification from both the State of Florida and the Alzheimer's Association. The advantages of such a program seem obvious. Students can progress through the didactic material at their own pace and staff members can schedule 'classroom' time to meet their individual needs (Hobday, Savik, Smith, and Gaugier, 2010, p.13-14). Given the relatively low price of just $2,000 dollars per year, establishing a dedicated learning center may represent an unnecessary expense.

In contrast, research suggests there is a substantial benefit to using a more traditional training approach. Irvine, Ary, and Bourgeois (2003) reviewed what is known about the efficacy of training programs; at one point (p. 270) citing the effectiveness of combined classroom instruction and real-time consultations between staff and trainers. This suggests that having in-house training staff would provide a significant benefit in terms of dementia care competency. These researchers also mention findings from another study revealing that scheduling problems often arise in facilities with an unpredictable, volatile care burden, insufficient staffing, and poor staff morale. Having dedicated training staff would allow familiarization with staffing and scheduling problems, and the tailoring of a training program to the specific needs of a hospice facility.

By comparison, the CARES® program cannot motivate staff to attend group-training sessions, or act as a training compliance officer. The efficacy of online interactive programs can also be marginalized by poor English literacy levels within the nursing aid population (Irvine, Ary, and Bourgeois, 2003, p. 270; McKenzie, Teri, Pike, LaFazia, and van Leynseele, 2012, p. 1). In-house training staff can take steps to ensure that such limitations do not compromise the health and safety needs of patients and staff, or unnecessarily exclude a competent caregiver from attaining certification. Interactive online programs are great for providing the didactic material needed to create a foundation for attaining dementia care competency, and for ready access and self-directed instruction, but real-life consultations between trainers and staff offer a level of complexity in terms of patient behavior and caregiver responses that cannot be obtained except by having in-house training staff. In other words, maintaining in-house training staff would tend to exceed the baseline statutory…