Supporting Family Caregivers of Persons With Dementia in the Community: Description of the 'Memory Care Home Solutions' Program and Its Impacts.

BACKGROUND AND OBJECTIVES

Most persons with dementia live at home, cared for by families with limited access to supportive services. We describe "Memory Care Home Solutions" (MCHS), a community-based dementia care program, and evaluate enrollees' characteristics, strategies provided and implemented, and impact on adverse health-related events (emergency medical calls, emergency room visits, hospitalizations, falls) of persons with dementia.

RESEARCH DESIGN AND METHODS

Retrospective observational study of MCHS' Basic (5 contacts) and Enhanced (additional 4 occupational therapy contacts) services for enrolled caregivers (September 1, 2014 to March 31, 2016). In both programs, caregivers received dementia education, care strategies, and social support. For Enhanced, caregivers had additional opportunities to practice care strategies. Caregivers were interviewed by interventionists at intake, 3 and 6 months (in-person or telephone).

RESULTS

Of 717 enrolled caregivers, most were female (73.1%), nonspouses (58.2%), Caucasian (70.8%), 63.02 (standard deviation [] = 13.20) years old, and caring for persons with dementia of low income (54.1%, <$39,000). Caregivers reported managing on average 11.64 ( = 4.64) behavioral symptoms and high functional dependence (6 instrumental activities of daily living [IADLs]; 2 activities of daily living [ADLs]). Caregivers opting for Enhanced ( = 314, 44.9%) were older ( = .025), spouses ( = .002), reported greater distress with behaviors ( = .051), and managed higher dependence (ADLs, = .018; IADLs, = .002) than caregivers in Basic ( = 403, 56.2%). Of 1,462 strategies offered, 68.9% were implemented with no differences in implementation rate between the 2 programs. Of 279 families with follow-up, 53.4% ( = 149) reported ≥1 adverse health-related events over 3-months pre-enrollment. By 3-months post-enrollment, 27.2% ( = 76) reported ≥1 adverse events; reflecting a 51.0% reduction in caregivers reporting events ( < .0005). African Americans, Whites, spouses, and nonspouses benefited similarly.

DISCUSSION AND IMPLICATIONS

MCHS offers brief supportive services, resulting in fewer adverse health-related events of persons with dementia. Families managing high functional dependence opted for more assistance from occupational therapists. Evaluating real-world programs yields new understandings of caregiver service preferences for staff planning.