Comprehensive Home-based Dementia Care Coordination for Medicare-Medicaid Dual Eligibles in Maryland
Dementia, Caregiver Burden
About this trial
This is an interventional health services research trial for Dementia focused on measuring dual eligible, care coordination, community-based, care quality, care needs, health services, care management, low income, Neuropsychiatric behaviors
Eligibility Criteria
Inclusion Criteria:
- diagnosis of dementia
- community living
- has identified study partner willing to participate
- english speaking
Exclusion Criteria:
- situation at time of referral is a medical or mental health crisis
- they plan to move out to another area or into a residential care facility in the next 6 months
- they are currently on hospice.
Sites / Locations
- Johns Hopkins University
Arms of the Study
Arm 1
Experimental
MIND at Home- Plus Intervention
MIND at Home-Plus is a home-based, care coordination that focuses on persons with dementia living at home and their family caregivers. Its goal is to help persons age in place safely while increasing quality of life. Delivered over 18 months, MIND-Plus systematically assesses and addresses unmet care needs of persons with dementia and their caregivers which are known to be linked to poor health and quality of life outcomes, and that put people at risk for long term care placement. The needs addressed in the MIND program cover a wide range of care domains, ranging from home and medication safety, to cognitive and behavior symptoms management, meaningful activities and legal considerations. The care team made up of a memory care coordinator, nurse, occupational therapist, and physician.