Examining Models of Dementia Care: Final Report. APPENDIX B. SELECTED DEMENTIA MODELS

09/01/2016

Model Citation Description of Intervention Setting & Method of Care

ACCESS

Vickrey, B.G., Mittman, B.S., Connor, K.I., Pearson, M.L., Della Penna, R.D., Ganiats, T.G., DeMonte, R.W., Chodosh, J., Cui, X., Vassar, S., Duan, N., & Lee, M. (2006). The effect of a disease management intervention on quality and outcomes of dementia care: A randomized, controlled trial. Annals of Internal Medicine, 145(10), 713-726.

ACCESSwas designed to enable 6 health care and social service organizations in San Diego to provide coordinated medical care and community support. Key components of the model include a steering committee to determine care goals and care coordination protocols; care managers; targeted provider education; and a web-based communication and decision support system. The steering committee developed 23 quality dementia care guidelines.

Primary care clinics

Acquiring New Skills (ANSWERS)

Judge, K.S., Yarry, S.J., Looman, W.J., & Bass, D.M. (2013). Improved strain and psychosocial outcomes for caregivers of individuals with dementia: Findings from Project ANSWERS. Gerontologist, 53(2), 280-292.

The Acquiring New Skills (ANSWERS) protocol was designed to focus both on the person with dementia and his or her caregiver, with an aim to reduce strain and psychosocial outcomes for dyads. The program included 6, 90-minute counseling sessions conducted by an intervention specialist. The sessions were designed to cover topics such as education on dementia and caregiving strategies, strategies to improve communication between the dyads, training to better manage behavioral and memory-related issues, and education on the importance of physical and mental activity for the dyads. Following the first introductory session, the dyads were given an opportunity to complete a strength-based inventory. The outputs from the inventory were used as a reference guide for the following sessions.

90-minute sessions

Setting unclear

Advanced Caregiver Training (ACT)

Gitlin, L.N., Winter, L., Dennis, M.P., Hodgson, N., & Hauck, W.W. (2010). Targeting and managing behavioral symptoms in individuals with dementia: A randomized trial of a nonpharmacological intervention. Journal of the American Geriatrics Society, 58(8), 1465-1474.

The Advanced Caregiver Training (ACT) is designed to improve caregivers' ability to recognize problem behaviors and to manage them effectively. The intervention tracks the problem behaviors linked to 3 main triggers: patient based, caregiver based, and environment based. Target outcomes include frequency of targeted problem behaviors and caregiver's upset behavior and confidence level of managing caregiving tasks. The program is conducted in 2 phases. The main phase of the program runs over 16 weeks and includes up to 9 occupational therapy sessions and 2 nursing sessions. Using standardized checklists, the occupational therapists work with the caregiver to review the problem areas and discuss strategies to improve patient caregiver communication, coping strategies, and environmental modifications. The nursing sessions include education on common medical conditions that may be associated with behavioral problems. The maintenance phase includes 3 contacts with an occupational therapist aimed to reinforce the strategies discussed in the main phase.

Home-based, in-person, telephone

Advanced Illness Care Team (AICT)

Chapman, D.G., & Toseland, R.W. (2007). Effectiveness of advanced illness care teams for nursing home residents with dementia. Social Work, 52(4), 321-329.

This study evaluated the effectiveness of Advanced Illness Care Teams (AICTs) for nursing home residents with advanced dementia. AICTs included members from various disciplines including medicine, nursing, social work, psychology, physical and occupational therapy, and nutrition. The AICTs used a holistic approach that focused on 4 domains: (1) medical; (2) meaningful activities; (3) psychological; and (4) behavioral. The authors recruited 118 residents in 2 nursing homes for this study and randomly assigned them to AICTs or to usual care. This is 1 of a few studies to examine the effectiveness of team care on the health and well-being of nursing home residents with advanced dementia.

Nursing home

Alzheimer's and Dementia Care (ADC) Program

Tan, Z., Jennings, L., & Reuben, D. (2014). Coordinated care management for dementia in a large academic health system. Health Affairs, 33(4), 619-625.

The Alzheimer's and Dementia Care (ADC) Program seeks to improve dementia care through support and training for caregivers, improved care transitions, and linkages to community-based resources. A key component of this model is the dementia care manager, a geriatric nurse practitioner who provides in-depth assessment, coordination of care with the medical treatment team, and referral to community resources. The electronic medical record system is designed to alert the dementia care manager when a patient is treated in a UCLA health facility. Patients and caregivers are asked to contact the dementia care manager with changes in their status such as symptoms, caregiver stress, or hospice enrollment. Formalized partnerships with other community organizations enable referral for additional supportive services.

Community-based resources

Anger and Depression

Coon, D.W., Thompson, L., Steffen, A., Sorocco, K., & Gallagher-Thompson, D. (2003). Anger and depression management: Psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist, 43(5), 678-689.

This study includes discussion on 2 psychoeducational skill training interventions: anger management and depression management. The study examines the impact of these interventions on caregivers' outcomes, such as anger-hostility, depression, use of coping strategies, and perceived self-efficacy for caregiving. Both interventions include 2-hour workshops over 8 consecutive weeks. In addition, 2 skill reinforcement sessions were conducted at the end of each month.

Small group meetings in a community setting

Assisted Living Care Transitions

Bellantonio, S., Kenny, A.M., Fortinsky, R.H., Kleppinger, A., Robison, J., Gruman, C., Kulldorff, M., & Trella, P.M. (2008). Efficacy of a geriatrics team intervention for residents in dementia-specific assisted living facilities: Effect on unanticipated transitions. Journal of the American Geriatrics Society, 56, 523-528.

The intervention is designed to minimize transitions out of assisted living for residents with dementia. Four multidisciplinary assessments conducted by a geriatrician, geriatrics advanced practice nurse, physical therapist, dietitian, and social worker during the first 9 months that an older adult with dementia was living in an assisted living facility in Connecticut. The categories for assessment included medical, cognitive, functional, and nutritional status and issues related psychosocial adjustment and long-term planning. The assessment was conducted at 7, 30, 120, and 320 days. The team met bimonthly to discuss assessments and provide recommendations to the primary care physician, facility director, and families. Team also provided in-person or phone consultation with facility staff through the study.

Assisted living facilities

Behavior Treatment

Teri, L., Logsdon, R.G., Uomoto, J., & McCurry, S.M. (1997). Behavioral treatment of depression in dementia patients: A controlled clinical trial. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 52(4), P159-P166.

This study evaluates 2 nonpharmacological treatments aimed at treatment of depression in patients with dementia. The first program aims to reduce depression among patients by increasing pleasant events and positive interactions. The second seeks to reduce depression by training caregivers problem-solving strategies. Both interventions include 9 60-minute weekly sessions by therapists over 9 weeks. In the first session, the therapists meet with the patient and caregiver to cover the program and to discuss the importance of pleasant events in reducing depression. The next 4 sessions focus on identifying pleasant events and their implementation strategies. The following sessions examine the factors that may interfere with pleasant activities. The final session summarizes patients' pleasant event and their implementation plans.

Home-based

BRI Care Counseling

Bass, D.M., Clark, P.A., Looman, W.J., McCarthy, C.A., & Eckert, S. (2003). The Cleveland Alzheimer's managed care demonstration: Outcomes after 12 months of implementation. Gerontologist, 43(1), 73-85.

Clark, P.A., Bass, D.M., Looman, W.J., McCarthy, C.A., & Eckert, S. (2004). Outcomes for patients with dementia from the Cleveland Alzheimer's Managed Care Demonstration. Aging & Mental Health, 8(1), 40-51.

BRI Care Counselingwas delivered as a partnership between a managed care health system and an Alzheimer's Association chapter. Care consultation was delivered as a phone intervention where Association staff (2 master's trained social workers and 1 other staff person) worked with persons with dementia and their caregivers to identify personal strengths and available resources within the family, health plan, and community and then develop an individualized care plan.

Home-based, telephone counseling

Brief Occupational Therapy

Dooley, N., & Hinojosa, J. (2004). Improving quality of life for persons with Alzheimer's disease and their family caregivers: Brief occupational therapy intervention. American Journal of Occupational Therapy, 58(5), 561-569.

This study examined the extent to which adherence to occupational therapy recommendations would increase the quality of life of persons with Alzheimer's disease living in the community and decrease the burden felt by family members caring for them. Caregiving strategies that were recommended to participant pairs in the treatment group fell into 3 categories: environmental modifications, caregiver approaches, and community-based assistance. All participants received a combination of all 3 types of recommendations. The population targeted was people diagnosed with possible or probable Alzheimer's disease in mild to moderate stages of impairment.

Home-based

Caregiver's Friend: Dealing with Dementia

Beauchamp, N., Irvine, A.B., Seeley, J., & Johnson, B. (2005). Worksite-based internet multimedia program for family caregivers of persons with dementia. Gerontologist, 45(6), 793-801.

Caregiver's Friend: Dealing With Dementiais a web-based multimedia intervention that provides text material and videos modeling positive caregiving strategies. The goal was to evaluate the efficacy of the Internet based multimedia support program to employed family caregivers of persons with dementia. The intervention included multiple components of knowledge, cognitive, and behavioral skills and affective learning, which are presented in 3 modules: Being a Caregiver, Coping with Emotions, and Common Difficulties.

Internet based

Caregiver Skill Building (CSB)

Farran, C., Gilley, D., McCann, J., Bienias, J., Lindeman, D., & Evans, D. (2007). Efficacy of behavioral interventions for dementia caregivers. Western Journal of Nursing Research, 29(8) 944-960.

The goal of Caregiver Skill Building (CSB) is to help caregivers address behaviors that are most distressing by understanding the causes of the behaviors, determining the care receiver's abilities and needs, and working through possible responses. The main topics addressed include prevention of behavioral symptoms during personal care, particularly verbal and physical aggression; management of restless behaviors; and management of hallucinations, delusions, and paranoid or suspicious behaviors. A social worker or nurse meets with a group of family caregivers weekly for 5 weeks, and then conducts weekly telephone sessions with each participant over the following 7 weeks to enable greater focus on the specific concerns and needs of each caregiver. The sessions start with simpler and less distressing behavioral symptoms and move on to those that are more upsetting and complex to address, such as agitation and aggression. Group booster sessions take place at 6 and 12 months, and ongoing telephone contacts are provided as needed.

Group meeting, telephone sessions

Care of Persons with Dementia in their Environments (COPE)

Gitlin, L.N., Winter, L., Dennis, M.P., Hodgson, N., & Hauck, W.W. (2010). A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: The COPE randomized trial. Journal of the American Medical Association, 304(9), 983-991.

The Care of Persons with Dementia in their Environments (COPE) program sought to support patient capabilities by reducing environmental stressors and enhancing caregiver skills. In this multicomponent intervention, all COPE dyads received exposure to each treatment element: assessments (patient deficits and capabilities, medical testing, home environment, caregiver communication, and caregiver-identified concerns); caregiver education (patient capabilities, potential effects of medications, pain, constipation, dehydration); and caregiver training to address caregiver-identified concerns and help them reduce stress. Training in problem-solving, communication, engaging patients in activities, and simplifying tasks was tailored to address caregiver-identified concerns and patient capabilities.

Home-based

Clinical Decision Support System (CDSS)

Boustani, M.A., Campbell, N.L., Khan, B.A., Abernathy, G., Zawahiri, M., Campbell, T., Tricker, J., Hui, S.L., Buckley, J.D., Perkins, A.J., Faber, M.O., & Callahan, C.M. (2012). Enhancing care for hospitalized older adults with cognitive impairment: A randomized controlled trial. Journal of General Internal Medicine, 27(5), 561-567.

Clinical Decisions Support System (CDSS)and a screening program were used in a randomized controlled clinical trial to evaluate the efficacy of the integrated systems to enhance hospital care for elders with cognitive impairment. The intervention used CDSS to alert physicians of patients with cognitive impairment and recommend referral for a geriatric consult, discontinuation of Foley catheterization, physical restraints, and anticholinergic drugs.

Hospital

Cognitive Behavioral Therapy

Akkerman, R.L., and Ostwald, S.K. (2004). Reducing anxiety in Alzheimer's disease family caregivers: The effectiveness of nine-week cognitive behavioral intervention. American Journal of Alzheimer's Disease and Other Dementias, 19(2), 117-123.

This study evaluates the effectiveness of a 9-week cognitive behavioral group therapy intervention for anxious community-dwelling family caregivers of persons diagnosed with Alzheimer's disease. Caregivers were randomly assigned to receive the cognitive behavioral therapy intervention or to the waitlist control group. The small group cognitive behavioral therapy intervention included didactic skills training. Caregivers in the cognitive behavioral therapy intervention group were asked to practice skills to reduce anxiety related to physical, cognitive, and behavioral components of caregiving.

Small group meetings

Collaborative Care

Galvin, J.E., Valois, L., & Zweig, Y. (2014). Collaborative transdisciplinary team approach for dementia care. Neurodegenerative Disease Management, 4(6), 455-469.

The Collaborative Care model seeks to improve dementia care by focusing on patient-centered care achieved by collaboration among different team members involved in patient care and inclusion of patients and caregiver in the decision making process. This article provides an example of collaborative care focuses on the role of nurse practitioners as substitutes for physicians where possible. An information packet about the program and a survey questionnaire is sent to the patients/caregiver dyads before their first visit. On the day of the visit, a 30-minute neuropsychological evaluation is conducted. As a parallel activity, the caregiver meets with a team of providers to discuss the case history of the patient. Following the first activity, the patient meets with the providers while the caregiver has a psychosocial interview needs assessment, both which take about 20 minutes. The final event is combined for the dyads where the entire team comes together to discuss assessment results, care plan, and schedule follow-ups. The final activity takes about 20 minutes.

Collaborative care dementia practice

Complementary Alternative Medicine (CAM) Therapy

Korn, L., Logsdon, R.G., Polissar, N.L., Gomez-Beloz, A., Waters, T., & Rÿser, R. (2009). A randomized trial of a CAM therapy for stress reduction in American Indian and Alaskan Native family caregivers. Gerontologist, 49(3), 368-377.

This study includes analysis of 2 complementary alternative medicine (CAM) therapies: polarity therapy and enhanced respite control condition. The study compares the impact of these 2 CAM therapies on psychological and physical well-being of American Indian and Alaska Native family caregivers. The intervention group received physical therapy and the control group received enhanced respite control condition. Both groups received 8 sessions. The polarity therapy program included 50-minute sessions over 8 weeks. The interventionists followed a therapist manual and physiology and point charts developed for this project. The enhanced respite control condition program provided paid care for the care recipient, allowing caregivers to participate in an activity of their choice. The enhanced respite control condition activity of the caregiver choice ranged from 60 to 120 minutes. For each session, both groups received paid care for 3 hours.

PT--Center for Traditional Medicine in Olympia, Washington, tribal health clinics

ERCC--home/activity site

Coping with Caregiving

Gallagher-Thompson, D., Coon, D., Solano, N., Ambler, C., Rabinowitz, Y., & Thompson, L. (2003). Change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia: Site-specific results from the REACH national collaborative study. Gerontologist, 43(4), 580-591.

Coping with Caregivingis a psychoeducational intervention that teaches caregivers relaxation skills, assertive communication to improve interactions with providers and others in their social networks, daily pleasant event scheduling to bolster mood and activity, ways for caregivers to appraise their loved one's behavior more realistically and intervene more appropriately, and strategies to change how caregivers think about their caregiving situations. Its goal is to help caregivers cope by reducing sources of negative feelings and bolstering sources of positive mood. Training is provided to family caregivers in a group setting. Weekly 2-hour sessions take place over 10 weeks, followed by monthly booster sessions for 8 months. Interventionists are generally psychologists, social workers, or other mental health professionals. Key components of workshops include stress management, behavior problem management, communication skills, mood management strategies, and basic education about dementia and caregiving.

Group meetings in community settings

Creative Caregiving Training Modules

National Center for Creative Aging (NCCA). Available at http://www.creativeaging.org.

NCCA Creative Caregiving Initiative. Available at http://www.creativeaging.org/programs-people/ncca- creative-caregiving-initiative.

The web-based NCCA Creative Caregiving Guide©and 7 Creative Caregiving Training Modules (available soon) were developed for family and professional caregivers of adults with dementia. The short, self-administered modules are designed to equip busy caregivers with research-based caregiving exercises using creative arts activities that help the caregiver and the person with dementia flourish in the art of daily caregiving, enhancing positive emotion, engagement and relationship, meaning, and mastery. Expected outcomes include enhanced quality of life and decreased depression and anxiety for persons with dementia and caregivers, but the program evaluation is not yet completed. Caregivers (family or professional) will be able to view the training modules online at their convenience as frequently as desired, but the modules are not downloadable. Each module features a master teaching artist demonstrating specific techniques with a person with dementia and a family caregiver. The modules incorporate self-care for the caregiver (such as conscious breathing), call-and-response and movement, a creative caregiving practice, and encourage the dyad to "savor the moment." The caregiver may watch the video first alone, or may include the person with dementia. At their own pace and comfort level, caregivers may begin using the techniques with the person with dementia. Most of the modules either focus on music (Sing Like a Bird, Love Duets, Mirror Dance) or include music in the activities (Tree Poems, Starry Night) demonstrated by the master teaching artist.

Web-based

Dementia Care Consultation

Fortinsky, R.H., Kulldorff, M., Kleppinger, A., & Kenyon-Pesce, L. (2009). Dementia care consultation for family caregivers: Collaborative model linking an Alzheimer's association chapter with primary care physicians. Aging and Mental Health, 13(2), 162-170.

The primary purpose of this study was to test the efficacy of a dementia care consultation intervention for family caregivers of persons with dementia living in the community. The intervention consisted of care consultants providing individualized counseling and support to family caregivers and persons with dementia over 12 months. Consultants sent copies of care plans developed with the family caregiver to the referring primary care physicians.

Primary Care, Alzheimer's Association

Dementia Care Network

Alzheimer's Association of Los Angeles, Riverside, and San Bernardino Counties Chapter, Inc., Dementia Care Network Replication Manual, (2004).

The Dementia Care Network is an interorganizational, community-based collaborative model to provide dementia care services to underserved ethnic communities. Nonprofit human services providers, community representatives, and government entities work together to achieve provide these services. The Dementia Care Network has been used in Latino, African American, Chinese, Japanese, and Vietnamese communities in California. A lead agency subcontracts with agencies in the targeted community to provide direct service. The Dementia Care Network uses a Care Advocate as the main contact for family home visits, care planning, purchase of services, and service coordination and monitoring, but range of services will vary depending on what is available in the community that is implementing a Dementia Care Network.

Nonprofit human services providers, community settings

Dementia Friendly Hospitals

Galvin, J.E., Kuntemeier, B., Al-Hammadi, N., Germino, J., Murphy-White, M., & McGillick, J. (2010). "Dementia-friendly hospitals: Care not crisis" an educational program designed to improve the care of the hospitalized patient with dementia. Alzheimer Disease and Associated Disorders, 24(4), 372.

The Dementia Friendly Hospitals program provided nurses and other direct care staff (social workers, pastoral care, discharge planners, physical therapists) working in hospital settings with information and resources to allow them to better care for patients with dementia from admission to discharge planning. The curriculum consisted of 5 learning modules (Introduction, Medical Overview, Approaches to Communication and Behavior, Dementia Friendly Care, and Connecting the Caregiver). The program lasted 7 hours with each module delivered by a different specialist in the relevant area.

Hospitals

Dialectical Behavior Therapy (DBT) Skills Training

Drossel, C., Fisher, J., & Mercer, V. (2011). A DBT skills training group for family caregivers of persons with dementia. Behavior Therapy, 42(1), 109-119.

Dialectical Behavior Therapy (DBT) Skills Traininguses a type of cognitive behavioral psychotherapy to help caregivers develop mindfulness, improve dementia communication skills, increase pleasant events and self-care, and develop distress tolerance skills. The main goals of this program were to reduce the risk for elder abuse and to improve quality of life for both the caregiver and the person with dementia. The program is targeted to the caregiver and lasts 9 weeks, including regular individual psychotherapy sessions using the DBT Skills Training approach and a series of 9 weekly 2.5-hour group sessions. The first session provides an introduction to the approach and to the group; after that there are 2 sessions dedicated to each module: (1) mindfulness; (2) interpersonal effectiveness; (3) emotional regulation; and (4) distress tolerance. Two graduate student therapists lead each group. Three weeks after the end of the training, optional booster sessions begin and last for an additional 9 weeks.

Community setting

Early-Stage Memory Loss (ESML) Support Groups

Logsdon, R.G., Pike, K.C., McCurry, S.M., Hunter, P., Maher, J., Snyder, L., & Teri, L. (2010). Early-stage memory loss support groups: Outcomes from a randomized controlled clinical trial. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65(6), 691-697.

This randomized controlled trial compared a time-limited ESML group program conducted by a local Alzheimer's Association chapter to a waitlist control condition. The ESML intervention is a structured support group program that follows a written manual that has been revised and updated regularly by Alzheimer's Association staff to ensure continued accuracy and regional applicability. ESML sessions averaged 90 minutes in duration and met weekly for 9 weeks. Each session included both individuals with early-stage dementia and a family care partner, who met together for part of the session and separately for part of the session. All groups were provided free of charge to participants. Groups were held in convenient community locations (adult day centers, senior centers, etc.) to minimize transportation burden on participants. Each ESML group had 3-4 volunteer facilitators. At least 2 facilitators in each group were master's degree level professionals experienced in working with individuals with dementia, who had already conducted 1 or more early-stage support groups prior to participating in this investigation. To ensure treatment fidelity, facilitators participated in a daylong training workshop each year to familiarize them with research procedures and refresh their knowledge of the intervention.

Community locations (adult day centers, senior centers, etc.)

ECHO-AGE

Catic, A.G., Mattison, M.L.P, Bakaev, I., Morgan, M., Monti, S.M. & Lipsitz, L. (2014) ECHO-AGE: An innovative model of geriatric care for long-term care residents with dementia and behavioral issues. Journal of the American Medical Directors Association, 15. 938-942.

ECHO-AGEis a remote case-based video consultation program that connects experts in the area of managing behavior of people with dementia to nursing home care providers. The intervention tested involved long-term care facilities presenting challenging cases related to the behavior of residents with dementia or delirium to specialists via video-conferencing. Specialists included a geriatrician, geriatrics hospitalist, geriatrics psychiatrist, behavioral neurologist, and community resource specialist. Specialists typically recommended behavioral plans or medication adjustments. Patients' families were invited to participate in the video-conferencing sessions.

Long-term care facilities

Family Intervention: Telephone Tracking-Caregiver (FITT-C)

Tremont, G., Davis, J.D., Papandonatos, G.D., Ott, B.R., Fortinsky, R.H., Gozalo, P., Yue, M.S., Bryant, K., Grover, C. & Bishop, D.S. (2015). Psychosocial telephone intervention for dementia caregivers: A randomized, controlled trial. Alzheimer's and Dementia, 11(5), 541-548.

This was a randomized controlled trial with an objective to examine the effects of an entirely telephone-based intervention on caregiver well-being, including depressive symptoms, burden, and reactions to care recipient behavior problems in distressed dementia caregivers. Secondary aims were to examine effects of the intervention on measures of self-efficacy, family functioning, and health-related quality of life.

Academic medical center

Healthy Aging Brain Care (HABC)

Boustani, M.A., Sachs, G.A., Alder, C.A., Munger, S., Schubert, C.C., Guerriero Austrom, M., Hake, A.M., Unverzagt, F.W., Farlow, M., Matthews, B.R., Perkins, A.J., Beck, R.A., & Callahan, C.M. (2011). Implementing innovative models of dementia care: The Healthy Aging Brain Center. Aging and Mental Health, 15(1), 13-22.

LaMantia, M.A., Alder, C.A., Callahan, C.M., Gao, S., French, D.D., Austrom, M.G., Boustany, K., Livin, L., Bynagari, B., & Boustani, M.A. (2015). The Aging Brain Care Medical Home: Preliminary Data. Journal of the American Geriatrics Society, 63, 1209-1215.

Monahan, P.O., Boustani, M.A., Alder, C., Galvin, J.E., Perkins, A.J., Healey, P., Chehresa, A., Shepard, P., Bubp, C., Frame, A., & Callahan, C. (2012). Practical clinical tool to monitor dementia symptoms: the HABC-Monitor. Clinical Interventions in Aging, 7, 143-157.

Health Care Innovation Awards. Available at https://innovation.cms.gov/files/x/hcia-project-profiles- second-batch-only.pdf .

Healthy Aging Brain Care (HABC)is a type of collaborative care model designed to reduce dementia-related burden among dementia patients and their caregivers. HABC was developed at Wishard Health Services. The first phase of the program, which is the initial assessment phase, includes 3 steps: (1) pre-visit is used for initial assessment of patient/caregiver dyads; (2) first visit is used for complete diagnostic evaluation; (3) second visit involves the initiation of the care plans, which is personalized based on the first 2 steps. The follow-up phase of the program includes: (1) telephone follow-up by the care coordinator within 2-3 weeks of initial visit; and (2) in-person follow-up to evaluate patient's individualized care plan. The frequency of in-person follow-up may vary based on patient's need.

Primary care clinic, telephone, email

Individualized Music

Park, H., & Pringle Specht, J.K. (2009). Effect of individualized music on agitation in individuals with dementia who live at home. Journal of Gerontological Nursing, 35(8), 47-55.

Individualized Musicwas a pilot program designed to reduce agitation in persons with dementia by selecting music based on their personal preferences and integrating the music into their daily lives. The music is intended to trigger positive memories to reduce anxiety and agitation. Key elements of the training are guidance for family caregivers in selecting culturally appropriate music for the person with dementia and in choosing the best timing for playing the music to reduce agitation. Additional benefits may include positive affect, meaningful interaction with others, expression of satisfaction, and reduction of anxiety, but these have not been tested in the home setting. A nurse trainer visits the family twice, 1 week apart, to train the family caregiver in use of individualized music, selection, and preparation of the person with dementia's choices of music on a CD using the author's Assessment of Personal Music Preference. The nurse also assesses the person with dementia's daily patterns of agitation. For 2 weeks the family caregiver plays 30 minutes of individualized music for the person with dementia a minimum of 30 minutes prior to peak agitation times. The family caregiver measured agitation levels 30 minutes before, during, and after playing music. Following a 2-week break without music, the researcher then repeated the cycle for a total of 8 weeks of intervention. The nurse visited the family once a week during music-playing weeks to answer caregiver questions.

Home-based

Interventions to Reduce Acute Care Transfers (INTERACT) at Brookdale Senior Living

Health Care Innovation Awards: Second (Final) Batch. Available at https://innovation.cms.gov/files/x/hcia-project-profiles- second-batch-only.pdf.

The University of North Texas Health Science Center, in partnership with Brookdale Senior Living, is expanding and testing the Brookside Senior Living Transitions of Care Program, which is based on an evidenced-based assessment tool called Interventions to Reduce Acute Care Transfers (INTERACT) for residents living in independent living, assisted living, and dementia-specific facilities in Texas and Florida. In addition, community-dwelling older adults who receive Brookside Senior Living home health services will be included in the Transitions of Care Program. Over the course of the award, the program will expand to other states where Brookside Senior Living communities are located. The program will employ clinical nurse leaders to act as program managers. Clinical nurse leaders will train care transition nurses and other staff on the use of INTERACT and health information technology resources to help them identify, assess, and manage residents' clinical conditions to reduce preventable hospital admissions and readmissions. The goal of the program is to prevent the progress of disease, thereby reducing complications, improving care, and reducing the rate of avoidable hospital admissions for older adults.

Dementia-specific facilities, other facilities, home-based

Living RIte

Health Care Innovation Awards: Project Profiles, University of Rhode Island. Available at http://innovation.cms.gov/initiatives/participant/Health- Care-Innovation-Awards/University-Of-Rhode-Island.html.

The University of Rhode Island's Living RIte innovations project is delivering coordinated care through 2 Living RIte Centers. The Centers provide comprehensive chronic care management to coordinate services between multiple community providers, improve health, and decrease unnecessary hospitalizations and emergency room visits. There is an interdisciplinary team that includes physicians, nurse practitioners, RNs, pharmacists, occupational therapists, physical therapists, and dieticians. Clients are trained in how to best manage their chronic diseases. Centers provide career development, benefits planning and job placement for certain clients.

Community-based

MIND at Home

Samus, Q.M., Johnston, D., Black, B.S., Hess, E., Lyman, C., Vavilikolanu, A., Pollutra, J., Leoutsakos, J.-M., Gitlin, L.N., Rabins, P.V., & Lyketsos, C.G., (2014) A multidimensional home-based care coordination intervention for elders with memory disorders: The Maximizing Independence at Home (MIND) Pilot Randomized Trial. American Journal of Geriatric Psychiatry, 22(4): 398-414.

MIND at Homeis a home-based care coordination intervention with the goal of delaying transitions from the home and reducing unmet care needs in persons with dementia or persons with mild cognitive impairment who live in the community. A nonclinical community worker provided the care coordination with assistance from an RN and geriatric psychiatrist. Care coordination included identification of needs and care planning to address unmet needs based on results of Johns Hopkins Dementia Care Needs Assessment and to match preferences of the patient and family, dementia education and skill-building, coordination, referral and linkage to services within the community, and care monitoring.

Home-based

Mindfulness

Whitebird, R.R., Kreitzer, M., Crain, A.L., Lewis, B.A., Hanson, L.R., & Enstad, C.J. (2013). Mindfulness-based stress reduction for family caregivers: A randomized controlled trial. Gerontologist, 53(4), 676-686.

The purpose of this study was to compare a mindfulness-based stress reduction intervention to a community caregiver education and support intervention for family caregivers of people with dementia. Mindfulness-based stress reduction participants (family caregivers of persons with dementia) received instruction about concepts of mindfulness and practiced meditation and gentle yoga each week. Mindfulness-based stress reduction was compared to community caregiver education and support where caregiver participants received education on issues affecting family caregivers and social and emotional support.

Research center--in-person group sessions

Namaste Care Program

Simard, J. & Volicer, L. (2010). Effects of Namaste care on residents who do not benefit from usual activities. American Journal of Alzheimer's Disease and Other Dementias, 25(1), 46-50.

The Namaste Care Program is for nursing home residents who cannot participate in regular nursing home activities because of advanced dementia or earlier stages of dementia with agitation. Activities are conducted in a room free from environmental distractions and staffed by specially trained nursing assistants. Nursing assistants receive training on advanced dementia and the Namaste Care Program components. The program is offered 7 days a week for 5 hours a day. Once residents are in the program room, nursing assistants provide ADL care as meaningful activities, such as soaking hands in warm lavender-scented water prior to clipping nails. Other activities included watching nature DVDs and providing comfort through realistic-looking stuffed animals.

Nursing home

New York University Caregiver Intervention (NYUCI)

Mittleman, M.S., & Bartels, S.J. (2014). Translating research into practice: Case-study of a community-based dementia caregiver intervention. Health Affairs, 33(4), 587-595.

The goals of New York University Caregiver Intervention (NYUCI) are to improve caregivers' ability to handle difficulties of caregiving and to avoid or delay the need for institutional care for the person with dementia. Intervention includes individual and family counseling, caregiver support group, and telephone-based counseling for caregiver. The counselor also provides information and referrals to services.

Individual and small group meetings, telephone

Nighttime Insomnia Treatment and Education for Alzheimer's Disease (NITE-AD)

McCurry, S., Gibbons, L., Logsdon, R., Vitiello, M., & Teri, L. (2005). Nighttime insomnia treatment and education for Alzheimer's disease: A randomized, controlled trial. Journal of the American Geriatric Society, 53, 793-802.

Nighttime Insomnia Treatment and Education for Alzheimer's disease (NITE-AD)is a 2-month intervention program on sleep in people with dementia living at home with family caregivers. The intervention was introduced in 6 1-hour sessions in their home over 2 months which were led by a geropsychologist. The targeted population was people with dementia living at home with family caregivers. Patients showed significant posttest differences with control subjects, including reductions in number of nighttime awakenings, total time awake at night, depression, and an increase in mean weekly exercise days. A treatment manual is available for both the active treatment and contact control conditions described in the article.

Home-based

Palliative Care for Advanced Dementia

Kuhn, D.R. & Forrest, J.M. (2012). Palliative care for advanced dementia: A pilot project in 2 nursing homes. American Journal of Alzheimer's Disease and Other Dementias, 27(1), 33-40.

Long, C.O. (2009). Palliative care for advanced dementia: Approaches that work. Journal of Gerontological Nursing, 35(11), 19-24.

Alonzo, T., Mitchell, K., & Knupp, C. (2015). Comfort care for people with dementia: The Beatitudes campus model. In M.L. Malone et al. (eds.), Geriatrics Models of Care: Bringing "Best Practice" to an Aging America (pp. 299-302). Switzerland: Springer International Publishing.

Palliative Care for Advanced Dementiaincludes a core training program where staff learn key concepts of dementia care, have 1:1 direct care experience peer training at a facility using the program, engage in self-study, and receive targeted training on comfort-focused behavior management, assessing and addressing pain, stimulating the senses for persons with dementia, end-of-life/hospice care, and medical provider education and support. The program takes place in a long-term care facility unit where residents in the moderate to advanced stages of dementia live. The program uses many practices to promote comfort. Care plans are written from the perspective of the person with dementia, no physical restraints are used, and there is a 24-hour restaurant with customization for dietary needs. The program also has a continuous activity program with individualized sensory-calming and sensory-stimulating activities to help avoid sundowning. Direct caregivers received training in comfort-management. Staffing ratios of 1:8 for certified nursing assistants and 1:22 for licensed nursing staff.

Long-term care facility

Palliative Excellence in Alzheimer Care Efforts (PEACE)

Shega, J.W., Levin, A., Hougham, G.W., Cox-Hayley, D., Luchins, D., Hanrahan, P., Stocking, C., & Sachs, G. A. (2003). Palliative excellence in Alzheimer care efforts (PEACE): A program description. Journal of Palliative Medicine, 6(2), 315-320.

The Palliative Excellence in Alzheimer Care Efforts (PEACE) program aims to improve end-of-life care of persons with dementia and to integrate palliative care into the primary care of patients with dementia throughout the course of the illness. The PEACE program is a disease management model for dementia that incorporates advance planning, patient-centered care, family support, and a palliative care focus from the diagnosis of dementia through its terminal stages. Patients and caregivers are interviewed every 6 months for 2 years, and a post-death interview is conducted with caregivers. These interviews assess care domains important for the optimal care of persons with dementia and their caregivers. A nurse coordinator reviews interviews and provides feedback to physicians, facilitating enhanced individual care and continuous quality improvement for the practice.

Hospice

Partners in Dementia Care

Bass, D.M., Judge, K.S., Maslow, K., Wilson, N.L., Morgan, R.O., McCarthy, C. A., Looman, W.J., Snow, A.L., & Kunik, M.E. (2015). Impact of the care coordination program "Partners in Dementia Care" on veterans' hospital admissions and emergency department visits. Alzheimer's and Dementia: Translational Research and Clinical Interventions, 1(1), 13-22.

Bass, D.M., Judge, K.S., Lynn Snow, A., Wilson, N.L., Morgan, R., Looman, W.J., McCarthy, C.A., Maslow, K., Moye, J.A., Randazzo, R., Garcia-Maldonado, M., Elbein, R., Odenheimer, G., & Kunik, M.E. (2013). Caregiver outcomes of partners in dementia care: Effect of a care coordination program for veterans with dementia and their family members and friends. Journal of the American Geriatrics Society, 61(8), 1377-1386.

Bass, D.M., Judge, K.S., Snow, A.L., Wilson, N.L., Morgan, R.O., Maslow, K., & Elbein, R. (2014). A controlled trial of Partners in Dementia Care: Veteran outcomes after six and twelve months. Alzheimer's Research and Therapy, 6(1), 9.

The Partners in Dementia Care model provides education, resources, and support via telephone. The model also coordinates health care and community services between VA Medical Centers and Alzheimer's Association chapters with a goal of reducing hospital admissions and emergency department visits by veterans with dementia. Care coordinators from the VA and the Alzheimer's Association work with persons with dementia and their caregivers to identify priority concerns and to develop specific, manageable action steps. Care notes are shared via cross-organization electronic records.

Telephone, e-mail, mail

Progressively Lowered Stress Threshold (PLST)

Gerdner, L., Hall, G., & Buckwalter, K. (1996). Caregiver training for people with Alzheimer's based on a stress threshold model. Image: Journal of Nursing Scholarship, 28(3), 241-246.

Hall G.R., & Buckwalter, K.C. (1987). Progressively lowered stress threshold: A conceptual model for care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1, 399-406.

Smith, M, Gerdner, L.A., Hall, G.R., & Buckwalter, K.C. (2004). History, development, and future of the progressively lowered stress threshold: A conceptual model for dementia care. Journal of the American Geriatrics Society, 52, 1755-1760.

The Progressively Lowered Stress Threshold (PLST) model addresses the anxiety and agitation caused by environmental stressors, such as unnecessary noise and internal stressors such as pain. The PLST intervention aims to reduce stress by modifying the environment which promotes adaptive behavior and in turn a decrease in anxiety, wandering, and agitation. PLST sessions take place in a nursing facility, adult day care, acute care hospitals, or the home of the person with dementia and include both the person with dementia and the caregiver as active participants. The nurse interventionist provides education about the disease process, assists with strategies that promote adaptive behavior, simplifies daily tasks, assists with problem-solving strategies over the course of the illness as abilities change, locates resources and provides support, and assumes a case management role.

Nursing facility, adult day care, acute care hospitals, home-based

Project CARE

Gonyea, J.G., O'Connor, M.K., & Boyle, P.A. (2006). Project CARE: A randomized controlled trial of behavioral intervention group for Alzheimer's disease caregivers. Gerontologist, 46(6), 827-832.

Project CAREis a behavioral intervention that included 5 weekly sessions to teach caregivers techniques for managing neuropsychiatric symptoms of dementia in their home. Each session was run by a therapist and had a different focus, including teaching the ABC model of behavior change.

Group setting

Reducing Disability in Alzheimer's Disease (RDAD)

Menne, H.L., Bass, D.M., Johnson, J.D., Primetica, B., Kearney, K.R., Bollin, S., Molea, M.J., & Teri, L. (2014). Statewide implementation of "reducing disability in Alzheimer's disease": Impact on family caregiver outcomes. Journal of Gerontological Social Work, 57(6-7), 626-639.

Teri, L., Gibbons, L.E., McCurry, S.M., Logsdon, R.G., Buchner, D.M., Barlow, W.E., Kukull, W.A., LaCroix, A.Z., McCormick, W., & Larson, E.B. (2003). Exercise plus behavioral management in patients with Alzheimer disease. Journal of the American Medical Association, 290(15).

Teri, L., McKenzie, G., Logsdon, R., McCurry, S., Bollin, S., Mead, J., & Menne, H. (2012). Translation of two evidence-based programs for training families to improve care of persons with dementia. Gerontologist, 52(4), 452-459. doi: 10.1093/geront/gnr132.

Reducing Disability in Alzheimer's Disease (RDAD)is designed to increase exercise and physical activity in persons with dementia and to instruct caregivers in approaches to reducing behavioral and psychological symptoms using the ABC model of behavioral change. Outcomes of interest include physical functioning, depression, and behavioral symptoms in the person with dementia. RDAD sessions take place in the home of the person with dementia and include both the person with dementia and the caregiver as active participants. The interventionist, who may be a physical therapist, social worker, or other aging services professional trained in the intervention, guides the person with dementia through a series of exercises while the caregiver observes. The caregiver is also provided with dementia education and instructed in behavior management through problem-solving. Topics covered include disease symptoms and progression, home safety and environmental modifications, and legal and financial issues. Training takes place over 12 1-hour sessions, which occur more frequently initially (2 sessions/week for the first 3 weeks, then once/week for 4 weeks, then biweekly for 4 weeks).

Home-based

Resources for Enhancing Alzheimer's Caregiver Health (REACH) ESP Home Environmental Skill-Building- (Now known as Skills2Care™)

Gitlin, L.N., Winter, L., Corcoran, M., Dennis, M.P., Schinfeld, S., & Hauck, W.W. (2003). Effects of the home environmental skill-building program on the caregiver-care recipient dyad: 6-month outcomes from the Philadelphia REACH initiative. Gerontologist, 43(4), 532-546.

Gitlin, L.N., Jacobs, M., & Earland, T. (2010). Translation of a dementia caregiver intervention for delivery in home care as a reimbursable Medicare service: Outcomes and lessons learned. Gerontologist, 50(6), 847-854.

REACH ESPis a translation of the REACH project. This program is designed for patients living in their homes and is aimed at reducing family caregiver burden by educating caregivers about the disease, easing the impact of the home environment on the person with dementia's behavior, and helping develop skills to better respond to environment related issues. REACH ESP was implemented in 2 phases: The active phase was delivered through 5 90-minute homes visits, and 1 30-minute telephone contact, over 6 months. The components of the home visits included assessment of areas that are difficult for the caregiver to manage, caregiver education, assessment of problem areas in the person with dementia's environment, and supporting caregivers in the process of making environmental modifications.

Home-based

Resources for Enhancing Alzheimer's Caregiver Health (REACH II)

Belle, S.H., Burgio, L., Burns, R., Coon, D., Czaja, S.J., Gallagher-Thompson, D., Gitlin, L. N., Klinger. J., Koepke, K.M., Lee, C.C., Martindale-Adams, J., Nichols, L., Schulz, R., Stahl, S., Stevens, A., Winter, L., & Zhang, S. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: A randomized control trial. Annals of Internal Medicine, 145(10), 727-38.

Nichols, L.O., Chang, C., Lummus, A., Burns, R., Martindale-Adams, J., Graney, M.J., Coon, D.W., & Czaja, S. (2008). The cost-effectiveness of a behavior intervention with caregivers of patients with Alzheimer's disease. Journal of the American Geriatrics Society, 56(3), 413-420.

Easom, L.R., Alston, G., & Coleman, R. (2013) A rural community translation of a dementia caregiving intervention. Online Journal of Rural Nursing and Health Care, 13(1), 66-91.

The overall objectives of REACH II are to identify and reduce risk factors among family caregivers, enhance quality of care for the person with dementia, and enhance the well-being of the caregiver. The REACH II intervention focuses on 5 areas linked to caregiver stress: safety, self-care, social support, emotional well-being; and problem behaviors. A risk appraisal is used to determine which areas need the greatest focus. Caregiver training and counseling are provided over a 6-month period in 9 1.5-hour sessions in the person's home, 3 half-hour telephone calls, and 5 telephone support group sessions.

Home-based

Resources for Enhancing Alzheimer's Caregiver Health (REACH VA)

Nichols, L.O., Martindale-Adams, J., Burns, R., Zuber, J., & Graney, M.J. (2016). REACH VA: Moving from translation to system implementation. Gerontologist, 56(1), 135-144.

REACH VAis a translation of the REACH II program through the VA system. The core goals of the program are the same as that of REACH II, but some details of implementation have been modified to meet the needs of the VA service providers. REACH VA has been implemented using 2 different approaches: the first was delivered through 12 individual sessions, primarily in the home, and 5 telephone support group sessions over 6 months, as in REACH II.

Home-based

Resourcefulness Training

Gonzalez, E., Polansky, M., Lippa, C., Gitlin, L., & Zauszniewski, J. (2014). Enhancing resourcefulness to improve outcomes in family caregivers and persons with Alzheimer's Disease: A pilot randomized trial. International Journal of Alzheimer's Disease, 1-10.

Resourcefulness trainingaims to reduce caregiver strain and depression, increase preparedness, and reduce problem behaviors using a cognitive-behavioral approach. The program uses dementia education to help caregivers understand disease-related changes, reframe thinking about caregiving issues, and use problem-solving and coping skills. Resourcefulness training sessions include 5-7 caregivers and meet weekly for 2 hours, led by a RN. Participants are guided through a process of finding facts about the situation, setting a realistic goal, developing optimism about the ability to manage the problem, using creativity to brainstorm solutions, considering which to implement, and evaluating the effectiveness of the solution.

Weekly sessions

Savvy Caregiver

Samia, L., Aboueissa, A., Halloran, J., & Hepburn, K. (2014). The Maine Savvy Caregiver project: Translating an evidence-based dementia family caregiver program within the RE-AIM framework. Journal of Gerontological Social Work, 57(6-7), 640-661.

Kally, Z., Cote, S., Gonzalez, J., Villarruel, M., Cherry, D., & Howland, S. et al. (2014). The Savvy Caregiver program: Impact of an evidence-based intervention on the well-being of ethnically diverse caregivers. Journal of Gerontological Social Work, 57(6-7), 681-693.

Savvy Caregiver is a psychoeducational program designed to train family and professional caregivers in the basic knowledge, skills, and attitudes needed to handle the challenges of caring for a family member with Alzheimer's disease and to be an effective caregiver. Targeted outcomes include caregiver knowledge, confidence, self-efficacy, and depression and development of meaningful activities for the person with dementia. Savvy Caregiver is a 12-hour training program that is delivered in a group setting, typically in 2-hour sessions over a 6-week period. Interventionists may come from a variety of professional backgrounds; train-the-trainer materials and resources are available. Session content covers dementia, the cognitive changes that are occurring and how they affect behaviors, establishing realistic caregiving goals, gauging the care recipient's abilities, designing appropriate activities for the person with dementia, and using a problem-solving approach to manage behavioral symptoms.

Group meeting

Savvy Caregiver 2

Samia, L., Merchant, C., O'Sullivan, A., & Fallon, K. (2014). The Maine Savvy Caregiver Project-Enhanced for Caregivers of Persons with Alzheimer's Disease and Related Dementias: Translation Report. Office of Aging and Disability Services, Maine Department of Health and Human Services.

Savvy Caregiver 2was developed to provide advanced training to family caregivers who completed the original Savvy Caregiver program. Savvy Caregiver 2 is a 4-week program that focuses on the challenges that are likely to be faced over time as dementia progresses and addresses ADLs, advanced behavior guidance (with increased emphasis on the effect the environment can have on the person with dementia), caregiver self-care, future planning to prepare for the challenges ahead, problem-solving, and care team enhancement. Interventionists come from a variety of professional backgrounds, but because the curriculum for Savvy 2 is less structured and covers more complex situations, the developers indicate that interventionists need to have strong problem-solving skills and the ability to think on their feet.

Caregiver workshop

Seamless Dementia Service Delivery for Rural Aged

Specht, J., Bossen, A., Hall, G.R., Zimmerman, B., & Russell, J. (2009). The effects of a dementia nurse care manager on improving caregiver outcomes. American Journal of Alzheimer's Disease and Other Dementias, 24 (3) 193-207.

In this program, a nurse care manager with specialized training in dementia management and assessment worked with persons with dementia and their caregivers to identify, assess, and address challenges and changing needs using a number of methods. Nurse developed service plans to promote communication and collaboration among community service providers, caregivers, and other informal supports with the ultimate goal of providing seamless service delivery. Included in-home and telephone meetings/support.

In-home and telephone meetings/ support

STAR-Caregivers (STAR-C)

Teri, L., McCurry, S., Logsdon, R., & Gibbons, L. (2005). Training community consultants to help family members improve dementia care: A randomized controlled trial. Gerontologist, 45(6), 802-811.

Teri, L., McKenzie, G., Logsdon, R., McCurry, S., Bollin, S., Mead, J., & Menne, H. (2012). Translation of two evidence-based programs for training families to improve care of persons with dementia. Gerontologist, 52(4), 452-459. doi: 10.1093/geront/gnr132.

STAR-Cis a behavioral intervention designed to decrease depression and anxiety in individuals with Alzheimer's disease and their family caregivers. Treatment components include general education about Alzheimer's disease, practice using a systematic approach to identifying and reducing behavior problems in dementia (the ABC model of behavior change), communication skills training, information about the relationship between mood and pleasant events, and caregiver support. The intervention is delivered over a 6-month period by community clinicians with a master's degree in counseling, psychology, social work, or a related field. The interventionist meets with a family caregiver in the home once a week for 8 weeks. Between meetings, caregivers record behavioral symptoms and the strategies he or she used to address them. After the in-home meetings, the consultant follows up with the caregiver through 4 monthly telephone calls. These calls are intended to help the caregiver develop strategies to address new behavioral symptom, and they help to reinforce previous learnings.

Home-based

Stress Busting Program

Lewis, S.L., Miner-Williams, D., & Novian, A. (2009). A stress-busting program for family caregivers. Rehabilitation Nursing, 34:4, 151-159.

The Stress-Busting Program provides caregivers with education, stress management, problem-solving, and support, including strategies on how to care for themselves while caring for a loved one with dementia. The goal is to improve caregiver health, mental health, and social support and to decrease anger, anxiety, burden, stress and depression. The program consists of 90-minute sessions that occur once a week for 9 weeks. The program is conducted in a small group setting with 2 group facilitators. Participants are provided many resources, including a handbook covering class material, a meditation CD, and a relaxation strategies DVD. Session topics include unique caregiver stressors; physical and emotional effects of stress; creating a relaxing environment; grief, loss and depression; coping skills; managing behavioral and psychological symptoms of dementia; positive thinking and cognitive restructuring; healthy living; and creating a plan.

Small group meetings

Tailored Activity Program (TAP)

Gitlin, L.N., Winter, L., Burke, J., Chernett, N., Dennis, M., & Hauck, W. (2008). Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: A randomized pilot study. American Journal of Geriatric Psychiatry, 16(3), 229-239.

The Tailored Activity Program (TAP) seeks to reduce behavioral disturbances and depression in the person with dementia by using occupational therapy techniques to identify patients' existing abilities and previous interests and to devise activities that build on them. The Program includes 6 90-minute home visits and 2 brief telephone contacts by occupational therapists over 4 months. Contacts are spaced to provide caregivers opportunities to practice using activities independently. During the first 2 sessions, interventionists meet with caregivers to discern daily routines and previous/current activity interests. They assess the person with dementia and the home environment and observe communication between the caregiver and person with dementia. In subsequent sessions, interventionists identify 3 activities and developed 2-3 page written plans for each, including an activity (completing a puzzle form board) and goal (engaging in the activity for 20 minutes each morning after breakfast) and specific implementation techniques. Activities are introduced through role play or direct demonstration with the person with dementia. Caregivers are also instructed in stress reducing techniques such as deep breathing to help establish a calm emotional tone. Caregivers practice using the activity between visits, and once an activity is mastered, another is introduced.

Home-based

Tailored Caregiver Assessment and Referral (TCARE)

Kwak, J., Montgomery, R.J.V., Kosloski, K, & Lang, J. (2011). The impact of TCARE on service recommendation, use, and caregiver well-being. Gerontologist, 51(5), 704-7013.

Tailored Caregiver Assessment and Referral (TCARE)is a care management process to help practitioners efficiently triage resources and services available within a community to address caregivers needs. This care management process includes 2 meetings with caregivers and a process for designing a care plan that meets the needs and preferences of the caregiver. An algorithm is used to identify an intervention goal, strategies to reach the goal, and a generic list of services consistent with the strategies.

Meetings with caregivers

Telehealth Education Program (TEP)

Wray, L.O., Shulan, M.D., Toseland, R.W., Freeman, K.E., Wasquez, B.E., & Gao, J. (2010). The effect of telephone support groups on costs of care for veterans with dementia. Gerontologist, 50, 623-631.

The Telehealth Education Program (TEP) is designed to provide education and support for spousal or partner caregivers of veterans with moderate to severe dementia. Each caregiver receives 1-hour sessions of the TEP weekly for 10 weeks. Sessions involved education about dementia and symptoms, caregiving skills and resources to address symptoms, coping strategies, and group support.

Small group via phone

Transitional Care Model (TCM)

Naylor, M.D., Hirschman, K.B., Hanlon, A.L., Bowles, K.H., Bradway, C., McCauley, K.M., & Pauly, M.V. (2014). Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults, Journal of Comparative Effectiveness Research, 3(3), 245-257.

Naylor, M.D., Stephens, C., Bowles, K.H., & Bixby, M.B. (2005). Cognitively impaired older adults: From hospital to home. American Journal of Nursing, 105, 52-61.

The Transitional Care Model (TCM) is intended to improve transitions from hospital to home, reduce associated functional decline, readmissions, and nursing home placement, and decrease mortality for people with cognitive impairment and dementia at any stage. Beginning in the hospital and continuing with visits in the person's home and ongoing in person and telephone contacts for about 2 months, the person and the family caregiver receive information, support, counseling, and help with coordinating care from the person's medical providers, managing medications, problem-solving, and arranging needed community services.

Hospital and home, in-person and telephone

University of California-San Francisco (UCSF) and University of Nebraska Medical Center (UNMC) Dementia Care Ecosystem

Health Care Innovation Awards Round Two: Project Profiles, Regents of the University of California San Francisco. Available athttps://innovation.cms.gov/initiatives/Participant/Health- Care-Innovation-Awards-Round-Two/Regents-Of- The-University- Of-California-San-Francisco.html.

The Dementia Care Ecosystem is a clinical program that builds on the UCSF Memory and Aging Center's dementia care, while incorporating the UNMC expertise in functional monitoring and rural dementia care. This model emphasizes continuous and personalized care. The target population is Medicare beneficiaries and persons dually eligible for Medicare and Medicaid. By supporting family caregivers, keeping patients healthy, and helping them prepare for advancing illness, the model aims to improve satisfaction with care, prevent emergency-related health care costs, and keep patients in their home longer. The primary point of contact for patients and families will be a Care Team Navigator with 24/7 availability. An innovative "dashboard" with both Care Team Navigator and patient portals will focus on efficient and personalized communication among the Care Team Navigator, care team, and the patient and family. There are 4 modules to the Dementia Care Ecosystem: Caregiver, Decision Making, Medication, and Functional Monitoring.

Intervention run through 4 modules