Advanced Behavioral & Cognitive Care Career Pathway Certificate

This certificate is designed to enhance the knowledge and develop the skills of direct care providers to work with older adults experiencing cognitive decline, dementia, and other challenging behavioral and cognitive conditions, in long term care, adult daycare, hospice, home, and community settings. The certificate would enhance the ability of any aging services professionals to work effectively with this population. The courses in this Career Pathway Certificate are wholly contained within the State Board approved Gerontology AAS Degree.

Successful completion of the Certificate prepares students for the National Certification Board for Alzheimer Care (NCBAC) certification examination for designation as a Certified Alzheimer Caregiver.

The Need

According to the 2008 Alzheimer’s Disease Facts and Figures report published by the Alzheimer’s Association, close to 5.5 million Americans of all ages have Alzheimer’s disease or another dementia. Thirteen percent of persons 65 and over has Alzheimer’s disease. Millions more suffer from some level of cognitive impairment. With the aging of the population and the increase in the number of Americans who survive into their 80s and 90s, the prevalence of Alzheimer’s disease and dementia is expected to increase. The number of people age 65 and over with Alzheimer’s disease is expected to increase from an estimated 5 million in 2000 to 7.7 million in 2030 (a greater than 50% increase) and to between 11 and 16 million by 2050, barring effective prevention and treatment developments. In Oregon, according to the report, the number of people age 65+ with Alzheimer’s disease alone is expected to increase from 57,000 in 2000 to 76,000 in 2010 – a 33% change.

Currently, over 70% of persons with dementia and cognitive impairment are cared for in their homes, primarily by unpaid family care providers, with paid in-home caregiving increasing with the severity of impairment. People with dementia make up about 25% of those receiving home care from governmental programs, and 50% of persons using adult day care. Persons with dementia are high users of home and community services. A 2002 study of community-living, home-based older adults requiring some assistance with daily activities found that about 29% of persons with cognitive impairment used paid services, and that about 27% of those with other severe disabilities were also cognitively impaired.

Persons with dementia disproportionately utilize health care services even before they enter a long term care facility. They are 3.4 times more likely than other Medicare beneficiaries to have a hospital stay (25% of older hospital patients are people with Alzheimer’s and other dementias), and average 1.3 times more physician visits than other Medicare beneficiaries in the same age group. And they often suffer from coexisting medical conditions, including hypertension, coronary heart disease, congestive heart failure, osteoarthritis, diabetes, and other cardiopulmonary or vascular diseases. These healthcare figures point to the importance of dementia care training for a wide spectrum of healthcare professionals, as well as social and financial services professionals working with an older population with multiple chronic conditions and disabilities.

About 30 percent of people with dementia are living in long-term care settings, ranging from assisted living residences to skilled-nursing facilities. Persons with dementia represent about half of those living in long term care facilities. Nursing home Alzheimer’s Special Care Units had 90,285 beds in June 2007, representing only 5.26% of all nursing home beds, and clearly serving only a minority of nursing home residents with dementia.

Oregon and the Portland Area

There are currently some 2200 long term care facilities in Oregon: skilled-nursing facilities, residential care and assisted living facilities, and adult care foster homes, in addition to independent retirement communities. However, the vast majority of seniors and persons with disabilities requiring paid care, including those with cognitive impairment, receive it through home care agencies, community based centers and day care programs.

According to the Oregon Department of Human Services, 6% (199,225 persons) of Oregon’s population (3,421,399) currently require long term care (2005). In 10 years (2015) it is projected that 6% or 265,567 persons will require long term care, and by 2025 the percent of the population requiring long term care will rise to 8% or 374,394 persons.

In 2005, Oregonians 65 and older made up 12-13% of the population (about 460,000 persons), and are projected to comprise 15% (605,606 persons) by 2015, and 19% (853,778) by 2025. Various sources estimate that the 65+ population will continue this upward trend, reaching 21-24% of the state’s population by 2030.

[Sources: Oregon Department of Human Services, Future of Long Term Care for Seniors and Persons with Disabilities. See also the Oregon Health Care Association, the Oregon Alliance of Senior & Health Services, and the Governor’s Taskforce Report on the Future of Services to Seniors & Persons with Disabilities].

With estimates that 21% of women and 14% of men will develop dementia in their remaining lifetime if they live to be at least age 55 (Framington Heart Study), the aging of Oregon’s population portends a significant need for dementia care specialists to serve those that will require long term care in a facility or in a community setting. The vast majority of the older population needing assistance and care will remain in their homes or live with relatives, rather than move into a long term care facility, opting for institutional care only for short, rehabilitative periods, or in the final days or months of the dementia process. This reality requires a fundamental restructuring of community-based supports, including qualified specialists like those earning the Advanced Behavioral & Cognitive Care Certificate.

Using the projected rate of growth in Oregon’s 65+ population and in the population needing long term care, combined with the estimated number of Oregon residents with some form of dementia, the increasing need for qualified advanced behavioral and cognitive care specialists becomes apparent.

Assuming the average of 30% of persons with dementia living in a long term care facility, and using the industry standard of one qualified care worker for every 15 persons requiring care, we can expect that of the 90,000 to 135,000 persons with dementia in Oregon in 2007, 27,000 to 40,500 would live in long term care facilities, requiring 1,800 to 2,700 dementia care specialists. The remaining 70% living in their homes would also require an extensive paid labor force of qualified care workers in homes and community programs supplementing unpaid family caregivers. The estimated 33% increase in persons with some form of dementia over the next decade points to a comparable increase in the need for care specialists.

Assuming also that 50% of the Region 2 (Washington and Multnomah Counties) population needing long term care has dementia, the need for dementia care specialists from 2005 to 2025 would be as follows:

Year Total Using Long Term Care Total Needing Dementia Care Total Required Dementia Care Specialists
2005     49,823      24,912    1,661
2015    67,646      33,823    2,254
2025  100,212      50,106    3,340

While serving only a small portion of persons with dementia, the number of beds in State of Oregon Indorsed Alzheimer’s Care Units (IACU) provides another indicator of need:

Washington County 16 IACUs 571 beds
Multnomah County 17 IACUs 675 beds
Statewide 109 IACUs 3,777 beds

These estimates based on multiple data sources together suggest a high and increasing need for qualified dementia care workers in long term care facilities, adult day care centers, and home settings.

Common Job Titles

Advanced Behavioral & Cognitive Care Specialists may work under a wide range of titles that continue to grow and transform as the changing nature of the population experiencing cognitive impairment and dementia presents new challenges, and care facilities and programs adjust accordingly. The following represents a partial list:

  • Personal Care Provider, Home Care Provider, Resident Assistant for Dementia Care
  • Certified Nursing Assistant – Dementia Care (CNA2)
  • Dementia Care Assistant, Specialist, Director, Consultant
  • Memory Care Unit Assistant, Specialist, Director, Consultant

Several healthcare, social work, care manager, care planner and facility administrator positions would be enhanced by a dementia care specialization. The ABCC Certificate also complements the Activity Professional Career Pathway Certificates for Activity Professionals working in Alzheimer Care Units or in long term care settings including a high percentage of persons with cognitive impairment or dementia.

Other professionals working with the older population working in public, non-profit and private sectors could similarly benefit from the Certificate. These would include professionals working as social services directors, conservators and guardians, hospice workers, or in placement agencies and financial services.

Related Occupational Categories and Salary Range

Home Health Aides, Resident Assistants, and Personal Care Providers in Multnomah and Washington Counties earn between $8.20 and $10.15 per hour. A Certification in Advanced Behavioral & Cognitive Care would raise the salary range to between $9.00 and $12.00, and higher through self-employment or small agencies [Source: Local employers and employees]. Projects like Better Jobs Better Care and Jobs to Careers in Community-Based Care (a program administered through PCC and supported by the Robert Wood Johnson and Hitachi Foundations) have made progress in raising care and training standards, accompanied by higher salaries and better benefits, including tuition for advanced education. The goals of these projects find support among employers in long term care, who prefer voluntary standard-raising to enforced regulations, who are committed to the person-centered and person-directed care model, and who are responsive to consumer demands for quality care provided by highly trained and certified workers.

The Healthcare Practitioners and Technical Workers occupational category is comparable in terms of qualifications and training requirements to dementia and memory care specialists. The salary range in Multnomah and Washington Counties is between $17.42 and $37.15, with an average hourly salary of $24.58. The skill level of a dementia care specialist is comparable to that of the CNA2 – Dementia Care, and in long term care settings including Alzheimer Care Units, they would be doing comparable work.

Dementia care specialists in the related professional positions of activity professionals, geriatric care managers, assessment and care planers, social workers and so on can expect a salary premium for their knowledge, skills, and certification to work with persons with cognitive impairment and dementia, and the related challenging behaviors and chronic conditions.

Competencies and Certifications

Responding to these current and projected population trends and changes in the field, state agencies have begun to set care and training standards, and the National Certification Board for Alzheimer Care has developed certification standards and exams. The Advanced Behavioral & Cognitive Care Career Pathway Certificate has been designed to build on existing state standards, and to prepare graduates for NCBAC certification.

State of Oregon standards for care of persons with Alzheimer’s and other dementias are embodied in (1)DHS-SPD Division Oregon Administrative Rules for Memory Care Communities and in the Oregon State Board of Nursing Curriculum for Certified Nursing Assistant (CNA) 2: Dementia Care Training Programs.

The Advanced Behavioral & Cognitive Care Certificate of Completion builds on and extends the minimum 12 hours ACU orientation and training, and parallels the CNA 2 classroom content of 48 hours in 11 domain areas, with 120 internship hours that include work-based training and supervision.

Next Steps

For more information and guidance on getting started on the Advanced Behavioral & Cognitive Care Certificate of Completion, as well as for transcript evaluation and assessment of prior experience and training –

  • Contact Jan Abushakrah, Gerontology Program Director, 971-722-4077, jabushak@pcc.edu

If you'd like to start working on a certificate or degree and would like some guidance about the courses you should take and if previous coursework can apply toward your completion, ask for Transcript Evaluation and Course Planning.