Ok Brother Paul, I've come to this thread late, and I'm not even from Tokyo or the US, so what I have to say might not even count in Tokyo or the US where you might be more used to those with ALS.......here the estimate is that only about 250 people in the entire population at any given time have ALS.......but if you are writing a grant application to train carers for persons with ALS this is what I would add. ( I am not a nurse, just someone who has gained their experience through caring, alias the school of hard knocks, as you put it. Since we haven't met, I should add my Pals is bulbar onset since Nov. 09, hasn't spoken in over a year, all limbs now involved.)
-Give them info specifically about ALS. (Even a nurse in a teaching hospital said to me: 'can she understand what we are saying?'). They need to know that often the person's mental capacities are present and correct, even if the person cannot respond quickly and vocally.
-Tell them about swallowing issues. (Sick of carers offering my Pals water when she's coughing and me having to intervene.) They need tuition on taking a deep breath, letting the fear go and encouraging the Pals to cough if they can. If Pals can't cough, or even if they can, carers need to know what a cough assist does and how to use it. Also tuition on a suction machine. (Here, cough assist machines are few and far between and carers won't use suction machines unless public health nurse have sanctioned it)
-Moving and handling. In my opinion carers need to have hands on experience of at least some of the different kinds of lifts/hoists and slings out there. Not just paper practice. ( How many carers have you had to teach how to use your hoist and sling?) Also how to move a person who cannot move on their own soas not to hurt them...or yourself.
-PEG. In my opinion not rocket science. But over here if the person lives at home, no carer or nurse will touch it. ( litigation nervous?) Show the carer how to use it and not be frightened of it.
-assistive technologies, both high tech and low tech. Expose the carers to a few of these. Give them an experience of the frustration involved when a person can't communicate.
-mobility. Put the carer in a wheelchair for the day and have them visit a shop or cinema. Let them see the world from a little lower. Teach them the basics of negotiating a ramp in a manual or powered chair.
Probably would have more to say for the self care and emotional help of the primary carers but that's a bit outside the current application.
Good luck with your application. I think it's just great that you are using the training to do put together a real live application.
All the best. Avril