A Model Program of Community-Based Supports for Older Adults at Risk of Nursing Facility Placement.

Transitioning an older adult into a nursing facility is a major life event for older adults (care recipients, CRs) and their family caregivers (CGs). This article describes the implementation of a community living program and presents findings on important health and well-being indicators. One hundred ninety-one participants aged 60 and older not eligible for or currently enrolled in Medicaid and meeting four risk domains (functional, health, cognitive/emotional, informal support system) were enrolled for the 10-month program. Two evidence-based interventions were blended into a comprehensive community-based approach to long-term care that included $750 per month for home care services. Measures were conducted at baseline and 6 and 12 months. Nine (6%) participants did not complete the program because of nursing facility admission. CRs had fewer physician visits (4.1 vs 7.3, P < .001), emergency department visits (0.3 vs 1.4, P < .001), hospital stays (0.4 vs 0.9, P < .001), and total nights in the hospital (0.8 vs 5.1, P < .001) at 12 months than at baseline. Center for Epidemiologic Studies Depression Scale (CES-D) scores also improved significantly (6.8 vs 9.4, P < .001). CGs had improvements in CES-D scores (5.9 vs 3.9, P < .001) and CG burden (14.7 s 12.6, P = .01) from baseline to 12 months. This multicomponent program improved the physical and mental health of CGs and CRs at risk of nursing facility placement. Future studies are needed to compare the overall placement rate to determine the success of diverting nursing facility placement in this population of older adults.

Implementing an evidence-based caregiver intervention within an integrated healthcare system.

The complexity of dementia care combined with the lack of care experience and external support systems creates unique burdens for the caregiver. This article describes the initial findings from the Scott & White Family Caregiver Program (FCP), the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) intervention adapted for a healthcare setting. The FCP targeted one large hospital and one large ambulatory internal medicine primary care clinic within the Scott & White system. The 6-month program provided support and skills training tailored to the specific needs of caregivers based on their level of risk. At follow-up, the overall risk score, caregiver burden, and patient problem behaviors were significantly decreased and care recipient safety significantly increased. All caregivers reported that the information provided was helpful. This model successfully translated REACH II into an integrated healthcare setting and significantly reduced risks associated with dementia caregiving.

Engaging communities in evidence-based interventions for dementia caregivers.

Caring for a family member with dementia is associated with unique stressors and burdens related to caregiving. Delivering interventions with proven efficacy to dementia caregivers remains a challenge because of the complexity of providing psychosocial support and skills training for caregivers within current models of formal healthcare services. This article focuses on implementation research and presents a dementia caregiver model program that merges an evidence-based intervention with a proven volunteer program, resulting in the implementation research program called Support Teams for Caregivers. In this article, we delineate our implementation model, describe the program, and present a case study.