The Dementia Symptom Management at Home Program Hospice Edition

A Cluster Randomized Controlled Trial (RCT) of the Dementia Symptom Management (DSM) at Home Program Hospice Edition

Alzheimer's Disease and Related Disorders (dementia) poses a significant challenge to our public health. While many persons with dementia are cared for by friends and family in the community with the assistance of home healthcare and hospice, most clinicians and agencies are ill prepared to care for this population and therefore have difficulty assisting patients and caregivers in maintaining quality of life leading to adverse patient outcomes, increased caregiver stress and burnout, and healthcare utilization. This study will utilize a cluster randomized controlled design with 6 care teams at a single study site to examine the ability of a multi-component evidence-based practice hospice care quality improvement program for registered nurses, social workers and chaplains to improve the quality of life and reduce healthcare utilization for persons with dementia and their informal caregiver.

training, assigning of champions to serve as mentors and performance improvement leads, and workflow changes including caregiver education pamphlets, interdisciplinary care plans, treatment algorithms, and assessment instruments.

Patients in the performance improvement group will receive care from a care team who has received the DSM-H Hospice Edition performance improvement program

control will receive usual care from a care team who has not received the performance improvement program.

pain assessment tool for use in persons with moderate to severe dementia who cannot provide reliable report, and will be used if the QDRS>12

Reduction in Behavioral and Psychological Symptoms of Dementia (BPSD) using Neuropsychiatric Inventory Questionnaire (NPI-Q):

Inclusion Criteria: PWD over the age of 65 Admitted to MJHS hospice agency The patient and family caregiver speak English and/or Spanish. The informal caregiver is ≥18 years of age and spends at least 8 hours per week with the patient. Patients who score ≥6 on the Quick Dementia Rating Scale (at least mild impairment). Exclusion Criteria: Patients with a separate Axis 1 diagnosis other than forms of dementia, depression or anxiety. PWD residing in assisted living facilities, nursing homes or board and care homes PWD solely receiving infusion or home health aide services.