Redesigning Systems Of Care For Older Adults With Alzheimer’s Disease

Abstract

The basic principle of care for patients with Alzheimer's disease is support for a patient-caregiver dyad. Any model of care seeking to improve the quality, efficiency, or cost of care for persons with Alzheimer's disease must attend to this principle. Models of care seeking to support this dyad began with strategies focusing mainly on the family caregiver. These models have grown in complexity to encompass team-based care that seeks to coordinate care across settings and providers of care for a defined population of patients. Most Americans in most communities, however, do not have access to these best practices models. While the effectiveness of new models of care is evidence-based, there are multiple barriers to widespread adoption including workforce limitations and the cost of practice redesign. We review the origins and content of current models and describe early efforts to improve their implementation on a broader scale.

Workforce development to provide person-centered care

“…To carry out these responsibilities CCAs are provided with a mobile office, enhanced medical record-ABC (eMR-ABC) software, information on community resources and team member support. Details of the intervention and its tools, including care protocols have been previously published (Alder et al, 2015; Boustani et al, 2011; Callahan et al, 2011, 2014; Cottingham et al, 2014; Frame, LaMantia, Bynagari, Dexter, & Boustani, 2013; French et al, 2014; Guerriero Austrom et al, 2004, 2005, 2006; LaMantia et al, 2015; Monahan et al, 2012); therefore, we provide only a brief description of this here. The use of the ‘mobile office’ in the CCAs day-to-day work allows them to meet patients at their homes, their primary care doctor’s office, or any other safe location of their choosing.…”

“…This focus on the patient and caregiver begins with the first patient/caregiver visit and is provided continuously throughout the course of the disease. The program has been described elsewhere (Alder et al, 2012, 2014, under review) and the materials are offered to the caregivers in a guidebook/manual format titled, Aging Brain Care: Caregiver Resource Handbook , to help the family navigate through the disease process (Aging Brain Care, 2012). In addition, caregivers are encouraged to participate in a monthly support group and to utilize other resources available through the local chapter of the Alzheimer’s Association.…”

“…BPSD has been associated with caregiver burnout, nursing home placement, poor management of comorbid conditions, and excess health care costs (Callahan et al, 2006; Cohen-Mansfield, 1995; Steele, Rovner, Chase, & Folstein, 1990). We have been trying to address these issues through the implementation of the ABC Med Home model (Callahan et al, 2011, 2014; LaMantia et al, 2015) and our ongoing work with other community-based intervention models (Callahan et al, 2012). …”

Direct Care Workers’ Views on Improving Care for People with Dementia in Residential Setting

“…Much research has gone into the best way to care for these residents [9]. The main care models investigated have been developed from community interventions with dyad pairs of informal caregivers [10].…”

Person-Centered Approaches to Caregiving

“…Steps include assessment, problem identification, problem prioritization, care planning with evidence-based treatment and management interventions, intervention application and activation, evaluation, and monitoring and follow-up to provide medical and social service care and support to patients and caregivers (Vickrey et al, 2006). More recently, multifaceted care management programs are being demonstrated with the Center for Medicare and Medicaid Innovation (CMMI) support (Callahan et al, 2014;Tan, Jennings, & Reuben, 2014).…”