The Residential Care Transition Module: a single-blinded randomized controlled evaluation of a telehealth support intervention for family caregivers of persons with dementia living in residential long-term care

Abstract

Background: Families do not fully disengage from care responsibilities following relatives' admissions to residential long-term (RLTC) care settings such as nursing homes. Caregiver stress, depression, or other key outcomes remain stable or sometimes increase following a relative's RLTC entry. Some interventions have attempted to increase family involvement after institutionalization, but few rigorous studies have demonstrated whether these interventions are effective in helping families navigate the potential emotional and psychological upheaval presented by relatives' transitions to RLTC environments. The Residential Care Transition Module (RCTM) provides six formal sessions of consultation (one-to-one and family sessions) over a 4-month period to family caregivers who have admitted a relative to a RLTC setting. Methods: In this embedded mixed methods randomized controlled evaluation, family members who have admitted a cognitively impaired relative to a RLTC setting are randomly assigned to the RCTM (n = 120) or a usual care control condition (n = 120). Primary outcomes include reductions in family members' primary subjective stress and negative mental health outcomes; secondary role strains; and residential care stress. The mixed methods design will allow for an analysis of intervention action mechanisms by "embedding" qualitative components (up to 30 semi-structured interviews) at the conclusion of the 12-month evaluation.

Transitioning to Long-Term Care: Family Caregiver Experiences of Dementia, Communities, and Counseling

“…Qualitative data were obtained from counseling session case notes (Gaugler et al, 2020). Case notes consisted of key caregiving topics addressed, family dynamics, intervention components provided by TC, verbatim quotes, caregiver’s reaction to the session, topics to address during the next session, and counselor impressions.…”

“…The study was approved by the University of Minnesota Institutional Review Board (UMN IRB; #1511S80406). Detailed information on the RCTM intervention and study design is available elsewhere (Gaugler et al, 2020).…”

“…Among the objectives for each session were the caregiver's acquisition of information and strategies designed to deal with their unique caregiving situation. The sessions were designed to establish a therapeutic rapport between the TC and the caregiver, provide a safe environment to explore stressors, examine family relational dynamics as they pertain the RLTC placement decision itself as well as the roles that different family members play in the life of the caregiver and care recipient, identify new modes of communication to facilitate more effective interactions with other family members and community staff, and identify effective ways to advocate for improved quality of care and quality of life for their care recipient (Gaugler et al, 2020).…”

“…People with dementia living in the community often rely on family members for care, and moving to RLTC does not eliminate family caregiving responsibilities (Kemp, 2012; Williams et al, 2012). Instead, family involvement in care often pivots from activity of daily living care to responsibility for care coordination, health care decisions, and financing (Gaugler & Kane, 2007; Gaugler et al, 2020). Kemp et al (2013) theorized that family caregivers are integral members of assisted living of each resident’s convoy of care, providing support and enhancing care.…”

“…Although previous qualitative and quantitative research contributed knowledge of factors that impact communication and collaboration between family and community staff, the current study explored a much broader array of factors related to caregiver adjustment to RLTC through a descriptive analysis of both qualitative and quantitative data from the multicomponent Residential Care Transition Module (RCTM) intervention. The primary aim of the RCTM is to help family caregivers adjust to their new caregiving roles following their care recipient's move to a RLTC setting for memory concerns (Gaugler et al, 2015(Gaugler et al, , 2020. The RCTM focuses not only on the caregiver's relationship and communication with staff but also on personal factors such as stress management and self-efficacy as well as external factors that may influence the caregiver's experience such as finances and location as proposed by Kemp's theory on convoy of care (Kemp et al, 2013).…”