Advisory Council November 2020 Meeting Presentation: VA Caregiver Support Program

Monday, November 9, 2020

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VA Caregiver Support Program Interventions for Caregivers: REACH VA Dementia

Jennifer Martindale-Adams, EdD
Linda O. Nichols, PhD
VA Caregiver Center, Memphis, Caregiver Support Program, Department of Preventive Medicine, University of Tennessee Health Science Center

VA Caregiver Center, Memphis

• The VA Caregiver Center helps VA staff help caregivers. We:
  • Deliver the REACH VA Caregiver Program to VA caregivers nationally
  • Train staff to deliver the REACH VA Caregiver Program and REACH Telephone Support Groups to their caregivers and provide materials
  • Deliver Self-Care Courses for groups of caregivers and provide materials
  • Enroll caregivers in the Annie Caregiver supportive texting program
  • Evaluate all Caregiver Center programs
  • Develop and implement different types of caregiving interventions for different populations of caregivers

REACH and Telephone Support Evidence

• REACH VA Telephone Support for Caregivers of Veterans
  • 2005-2017
    • CONNECT RCT (VA)
    • Spouse Battlemind (DoD)
    • Spouse READI RCT (Army)
    • Spouse Deployed RCT (Army)
  • 1995-2019
    • REACH I feasibility (NIA, NINR)
    • REACH II RCT (NIA, NINR)
    • REACH VA pilot (VHA)
    • Costs of REACH II/VA (NIA)
    • REACH into Indian Country (Rx Foundation)
    • REACH VA MS pilot (VA RR&D)
    • REACH Parent RCT (Army)
    • REACH Hope (DoD)

REACH VA/Telephone Support Groups

• Evidence based
• Structured, protocol driven
• Simple to use scripts, guidelines, talking points
• Materials
  • Caregiver Notebook
    • Behavioral, Caregiving, Red Flag topics
  • Program Coach Notebook
• Sessions
  • Four individual one-hour sessions
  • Six group one-hour sessions
  • Face-to-face, telephone, videoconference
  • Additional sessions if needed
• Education, support, standardized skills
  • Problem solving
  • Positive thinking/mood management
  • Stress management
• Targeted through Risk Assessment of caregiving risk areas
  • Safety
  • Emotional well being
  • Self-care/healthy behaviors
  • Social support
  • Patient problem behaviors

REACH VA/Telephone Support Outcomes

• Caregivers significantly improve in
  • Burden
  • Anxiety
  • Depression
  • Caregiver frustrations
  • Stress
  • Decrease in time in providing care
  • Decrease in time on duty
  • Safety concerns
  • Troubling behaviors

"It's ok to do things I need to do for myself too. It's ok to take care of me."

"Knowing that there was somebody out there who cares. And, that phone call from her was a personal contact."

"I was able to see how some situations improved dramatically with the Program. Other team members ... would comment on the improvement in families receiving this service."

Nichols et al., 2011; 2016; 2017
Martindale-Adams et al.,2017;2020

REACH VA/Telephone Support Groups

• Available to Caregivers of Veterans and Veteran Caregivers https://www.caregiver.va.gov/REACH_VA_Program.asp
  • Multiple sclerosis (MS) https://www.va.gov/MS/Products/REACH_MS/index.asp
  • Dementia https://www.dementia.cindrr.research.va.gov/caregiver_topics/caregiver_support/caregiver_support_groups.asp
  • Spouses of post 9/11 Veterans
  • Amyotrophic lateral sclerosis (ALS)
  • Post-traumatic stress disorder (PTSD) https://www.caregiver.va.gov/Tips_by_Diagnosis/PTSD.asp
  • Any condition All eras
  • Spinal cord injury/disorders (SCI/D)

REACH VA Caregiver Program

• Caregiver Center and Field Delivered
  • Delivered to caregivers of Veterans and Veterans who are caregivers through the Memphis Caregiver Center -- referred by any facility
    • 515 Caregivers of Veterans with Dementia or Veterans providing care
  • Staff at each VA trained and certified to deliver REACH and Telephone Support -- ongoing and as part of the Mission Act
    • Caregivers of Veterans with Dementia - 2426 REACH VA; 241 Telephone Support

"The visualization exercise knocked it out of the park, and all commented on how effective it was in reducing their stress level."

"I felt empowered to think of myself."

"She has me participate and use examples to make sure I understand. She helps me put words to what I can't say, and she helps me verbalize."

Annie Caregiver Text Program

• Annie texts promote self-care and require a basic cell phone
• Caregivers must have a VA electronic health record
• Stress reduction texts (currently over 2400 caregivers) -- year long
• Supportive texts after bereavement -- two months long
• Coronavirus precautions
• Educational
  • As a caregiver you're at risk for high blood pressure, heart problems, colds, and flu. Be sure to watch your own health. -Annie
• Motivational
  • Thank you for taking care of your loved one. Even if no one remembers to tell you, what you are doing is appreciated and makes a difference. - Annie
• Creative with activities
  • Annie says go outside and enjoy the sun and the breeze for a few minutes.

Annie Caregiver Text Program -- Dementia Behaviors

• Pilot testing October-November 2020 -- national roll-out after changes from caregiver feedback
• Seven texts a week - educational, motivational, stress management, dementia behavior tips
• Different dementia behavior each week
• Examples
  • Monday -- There are many reasons why a person with dementia may not want to take a bath -- Annie. Click link for bathing tips: https://tinyurl.com/y6kuofc5
  • Tuesday -- When you are in a stressful situation, stop and think about your thoughts and feelings. Can you make them milder? Disappointed versus angry? Annie
  • Wednesday -- Get the bathroom ready ahead of time. For example, have the towels and washcloths ready - Annie
  • Thursday -- Annie here, For every minute you are angry you lose sixty seconds of happiness. --Ralph Waldo Emerson
  • Friday -- Schedule bathing for the same time and place each day as your loved one may be confused. Changing the routine may be upsetting - Annie.
  • Saturday -- Be an observer. Think about activities or places that calm you. Try to recreate them in your mind and imagine how they make you feel. -Annie
  • Sunday -- Showers and baths can be dangerous. Use non-slip mats, tub seat, or grab bars. Make sure there are no puddles in the floor - Annie.

"Annie always knows just what to say and when to send it."

REACH Hope - Caregivers of Veterans with TBI and Dementia

• DoD funded RCT -- Wait List Control design
• REACH VA and DoD Virtual Hope Box mobile app
• Hope Box content
  • Remind Me - supportive photos, videos, recorded messages, music
  • Distract Me - sudoku, photo puzzles, word search, mahjong
  • Inspire Me - preloaded and user loaded quotes
  • Relax Me - breathing, muscle relaxation, guided meditation
  • Coping Tools
  • Coping Tools - coping cards (user developed skills for common problems) and positive activity planner (plan activities with contacts)
  • Support Contacts - user-selected contacts
• https://www.research.va.gov/research_in_action/Virtual-Hope-Box-smartphone-app-to-prevent-suicide.cfm

Contact Us

Jennifer Martindale-Adams, EdD
(901) 523-8990, press 1, then 7080
jennifer.martindale-adams@va.gov

Linda Nichols, PhD
(901) 523-8990, press 1, then 5082
linda.nichols@va.gov