CNA Guide: How To Deal With Clients with Alzheimer’s Disease?

According to the Mayo Foundation for Medical Education and Research, dementia reportedly affects 3% to 11% of community-residing adults older than 65 years of age and about half of community-residing adults older than 85 years of age. Many of those suffering from dementia who are older than 85 reside in institutional settings. Almost 60% of adults 100 years of age and older demonstrate dementia. With this high incidence, the need for nurses to take care of these demented clients also increases. As such, becoming a certified nursing assistant or a CNA opens you to several job opportunities. The Western countries would never lose the need for CNAs as the baby boomers are expected to hit the retiring age soon. Thus, there’s a great possibility that as a CNA, you’ll be working with clients with Alzheimer’s disease. So here’s a quick CNA guide to dealing with clients with Alzheimer’s disease:


  • Alzheimer’s disease is a progressive, irreversible, degenerative neurologic disease that begins insidiously and is characterized by gradual losses of cognitive function and disturbances in behavior and affect. Although Alzheimer’s can occur in people as young as 40, it is uncommon before age 65. The prevalence of this disease increases dramatically with increasing age, affecting 30% of those 85 and older.


  • loss of speech
  • loss of motor function
  • profound personality and behavioral changes such as paranoia, delusions, hallucinations, inattention to hygiene, and belligerence

Nursing Management:

  • Supporting Cognitive Function
    • Provide a calm, predictable environment to help the client interpret his surroundings and activities.
    • Limit environmental stimuli and established a regular routine.
    • Speak in a quiet, pleasant manner. Offer clear and simple explanations. Use of memory aids and cues help minimize confusion and disorientation, as well as provide a sense of security to these clients.
    • Display clocks and calendars prominently to enhance client’s orientation to time.
    • Encourage client to have active participation to help maintain cognitive, functional, and social skills for a longer period of time.
  • Promoting Physical Safety
    • Remove all obvious hazards and install hand rails to facilitate the client’s maximum independence and sense of autonomy.
    • Adequate lighting must be ensured, especially in halls, stairs, and bathrooms. Nightlights are helpful especially for clients who have the tendency to be confused during nighttime.
    • Persuasion or distraction may help in reducing client’s wandering behavior.
    • Restraints should be avoided, as this will further agitate the client.
  • Promoting Independence in Self-Care Activities
    • Clients should be assisted in to remain functionally independent for as long as possible. Simplify daily activities into short, achievable steps so that the client will feel a sense of accomplishment. Clients should be encouraged to make choices when appropriate and to participate in self-care activities as much as possible.
  • Reducing Anxiety and Agitation
    • Move client to a familiar environment.
    • Listening to music, stroking, rocking may help.
    • Distraction may quiet the client.
  • Providing for Socialization and Intimacy Needs
    • Encourage visits, letters and phone calls from friends. Visits should be brief and non-stressful. Also, limit the visitors to one or two at a time to help reduce overstimulation.
    • Encourage client to enjoy simple activities as a form of recreation. This may include walking, exercising, socialization, caring for a plant or a pet.
  • Promoting Adequate Nutrition
    • Serve familiar foods that look appetizing and taste good. Food must be bite-sized to prevent choking. Hot food and beverages must be served warm to avoid burns.
    • Offer one dish at a time for clients to avoid playing with food.
    • Provide aprons or smocks, rather than a bib to protect the client’s clothes.
  • Promoting Balanced Activity and Rest
    • During daytime, encourage clients to participate in exercise regimens. Discourage long periods of daytime sleeping.
    • During nighttime, if client has trouble sleeping, offer warm milk, back rub or play music to help the client relax.

How much does a CNA earn?

Being a certified nursing assistant nowadays can be demanding both physically and mentally. Aside from intangible knowledge about the human body and how to make it come in a calm state despite the illnesses, as a CNA this job can also be financially rewarding one. However, with the fast paced like we have sometimes you might think is the earning of CNA enough? This is a question that might have been roaming around the minds of newly employed CNAs. An earning from one employer can be enough if you have minimal needs.

An average pay of a CNA in an 8 hour job could be between $10.50 to $12.10 per hour for a private agency such as private nursing homes. Others may even opt to have short term employment from nursing care homes so that they can maximize their time – that means they work from two to three employers making them earn triple when staying with a single employer.

Earning financially as a CNA may actually depend upon numerous factors. Annually a certain CNA may earn between $30,000 to $50,000 and that depends on the creativity of the person to earn such amount. Here are some determinants of the potential pay a CNA can have:

1. Type of employment – an employment might be under a private or public sector. A private agency may offer the CNA an ample amount of pay monthly. Such private institutions can be private nursing homes or geriatric care homes. For government owned institutions this may include hospitals or mental institutions that my offer minimal pays but the benefits and stability of work is guaranteed over the years.

2. Location of the employment – The pay of the CNA may actually depend upon the location of the employment. Farther assignments may also entitle you to have other allowances such as trip allowance that is separate from the take home pay.

3. Facilities – Different types of facilities can also demand a varied work load for CNAs. From hospitals to private patient care many options are actually available for each personality of the CNA. There are times that the CNA wants to work with a team, so he or she can choose working on a hospital setting. Others may opt working alone or with less supervision which can be found for those who want to work with a patient or long-term care.

Thinking through about CNA earnings, the word “enough” can be really subjective. A CNA can actually claim that he or she is earning enough to cover his or her expenses and rent. Some may say it is not enough since he or she has a growing family. With the advancements in health care, CNAs gain popularity in terms of being an important part of the health care team. So earning of CNAs can be actually unlimited. It only depends on how resourceful a CNA can actually.

Client Rights That Every CNA Should Know

Cna and LPN

Clients are entitled to receiving services that will make their hospice or hospital stay worthwhile. Otherwise termed as ‘Bill of Rights,’ the list of privileges focuses on the dealings between the patient and physician in addition to the patient’s personal responsibility to participate in his treatment and make sound decisions. As main personnel in providing health care, certified nursing assistants should know these things.

The core value in providing health care services is focusing on the key person – the CLIENT. Hence, service providers should be aware of the rights their patients are entitled to. In most cases, people are not aware of the rights they are privileged with at the time of their care. These rights include the following:

Right to be Respected and Treated with Dignity

Regardless of the race, religious belief or social status that person belongs to, each client are expected to be treated with respect and dignity. Explanation of procedures, carrying-out interventions, and performing bedside care should be initiated by explaining the procedure first and asking for client’s permission.

Right to Privacy  and Confidentiality

Confidentiality means non-disclosure of patient’s medical and personal information that the health personnel discovered while caring for the patient. Disclosure may only be done with the client’s permission. The main goal of this ethical practice is for patients to open up information comfortably and freely. However, certain situations may require disclosure of patient information if personal safety or well-being is at stake.

Right to Know the Progress of Treatment

Clients should be updated with the progress of his condition. In doing so, he is privileged of obtaining the needed information in his convenience. In addition, he should be informed of alternative therapies that will alleviate the discomfort of his disease.

Right to Autonomy

The client  may choose not to undergo certain procedures that will help his or her condition. He has the freedom to decide as long as he is of sound mind and is 18 years old older. Refusal to be examined and treated is a client choice that should be respected by CNAs. In the same way, when approach by students conduct research, the client has all the right to refuse participation in the said activity.

Right to Choose an Advocate

Hiring someone or asking someone to act on the client’s behalf in any transactions is another privilege that some patients are not aware of.

Reciprocity: Transferring Your CNA License to Another State

When you want to be a Certified Nursing Assistant, you are required to take a state accredited examination. If you could pass this examination, that is the only time that you could able to receive your certificate. You could then work in any healthcare setting that you want, be it in a hospital, hospice care, or healthcare facility. However, you need to remember that you could work in any place as long as it is within the state that you have applied for. You cannot work for any state that you want unless you have taken their examination. This is because each state has their own rules and regulations regarding the examination that they would give. This is where they would base if you are qualified to be included on their own roll or not.

However, if you are in the process of transferring to another state and you want to be able to work there as a certified nursing assistant, you still can. That is, after you meet whatever the state required. This is called Reciprocity.

What is it then?

Reciprocity is a process where you request the state where you are transferring to accept the approval that your former state has grant you. This is for you to be able to practice your course on your new state once they would be able to recognize the certificate that you are holding. How to apply in another state, you may ask? You may start by asking your Nurse Aide Registry on your former state and request an application for enrollment by reciprocity. You should not forget to ask them also if you would send it back to them and they would be the one to send it to your new state or you would be the one to do it. After that, you also call and inquire the Nurse Aide Registry of your new state and ask if they required that you personally send the application or if it needs to pass your former Nurse Aide Registry first. They may ask you also to send some credentials such as a copy of your Social Security Card, driver’s license, your former state approval, documents that state that you have worked in nursing homes or the likes in the past two years, and other relevant documents that the new state requires. This is where they would base if they would accept your application.

Here’s what the booklet says if you’re transferring to California.

Reciprocity Applicants

With implementation of the Omnibus Budget Reconciliation Act (OBRA) for nurse assistant training requirements in April 1992, California was instructed by the Health Care Financing Administration to offer nurse assistant certification to anyone who is listed on any state’s nurse assistant registry as:

  • In “good standing” (having no findings of abuse, neglect, or misappropriation of residents’ property) and
  • “Active” (maintained on the State Nurse Assistant Registry as having met the OBRA training requirements and having provided nursing services at least one day, for pay, in the previous 24 months).

Reciprocity applicants, who have been verified by the prospective employer with the respective state’s registry (see page 20) as meeting federal requirements in the United States, should submit the following to ATCS:

  • A completed HS-283B application form (;
  • A copy of their state-issued certificate (this is not mandatory but they must indicate the state in which they are certified);
  • Proof they have worked providing nursing services at least one day for pay in the last two years (this is only required if they received their certificate more than two years ago);
  • A copy of the completed BCII 8016 live scan form, (see page 19). You must wait until you move to California to obtain fingerprints through this method. Fingerprint cards are not acceptable.

Reciprocity applicants may work as CNAs (unless they receive a letter of denial from ATCS) if the facility:

  • Has verified the applicant is on the respective state’s registry in good standing and has active status. Some states do not provide information regarding “status.” In those states, as long as the name is listed, the CNA is considered “active.”
  • Has proof that the applicant has worked at least one day for pay providing nursing services in the last 24 months.
  • Has proof that the CNA has applied to ATCS for certification.

Reciprocity applicants may notwork as CNAs if:

  • They do not have “active” status on their respective states’ registries and are unable to get their certificates or registry status reactivated in their previous state.
  • Their certificates or registry status have been expired or inactive for less than two years. These applicants may be allowed to take the competency evaluation in California without having to retrain by following the “equivalency applicant” instructions on page 6. (After these applicants have passed the competency evaluation, they may work unless they receive a denial letter from ATCS.)
  • Their certificates or registry status have been inactive for more than two years in their respective states. These applicants must retrain and successfully complete the competency evaluation to receive a California nurse assistant certificate. (After these applicants have passed the competency evaluation, they may work pending receipt of a certificate or denial letter.)

Through the process of reciprocity, you could expand all your possibility and be able to work in another state of your choice.