Care Coordination for People With Alzheimer's Disease and Related Dementias. Coordinating Long-Term Services and Supports


Two studies focused on coordinating LTSS. Influenced by the National Long-Term Care Channeling Demonstration of the early 1980s, the Medicare Alzheimer Disease Demonstration and Evaluation (MADDE) was an RCT that was designed to increase access to formal LTSS through care coordination and access to additional LTSS for people with Alzheimer's disease (Fox et al., 2000; Miller et al., 1999; Newcomer et al., 1999a, b). The study did not have an explicit goal of reducing nursing home entry (Miller et al., 1999). The care coordinators were responsible for linking participants with community-based services, providing psychological support, and managing costs within the budgeted amount for LTSS. Those in the treatment group were eligible for an 80 percent discount on community care benefits, up to about $600 per month. MADDE had the largest sample size of any study in this review, with 8,905 enrollees who remained in the demonstration for more than 30 days across eight United States cities between 1989 and1994. Implementation--the type of care coordinator and arrangement of services--varied across sites. Only one location directly attempted to change the use of medical services. Most caregivers in this intervention had baseline scores of burden and depression that were not considered clinically problematic, making it difficult to show significant improvements.

Lam et al. (2010) evaluated care coordination for persons with mild dementia who were recruited from memory clinics at a teaching hospital in Hong Kong. The participants were randomized to either the intervention or control group. The 4-month home, clinic, and telephone-based intervention consisted of providing support, skills training, coordination of needed services, and referrals to local social services, led by an occupational therapist. The primary outcomes were caregiver burden and quality of life; secondary outcomes included changes in clinical measures (such as the MMSE) and use of care services, such as day care and home health. The limited availability of community LTSS and dementia training for domestic helpers were cited as issues affecting the intervention.

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