Statewide Implementation of CAPABLE-Community Aging in Place, Advancing Better Living for Elders in the Michigan Medicaid Home and Community Based Waiver Program

在全州范围内实施能力社区老龄化，促进密歇根州医疗补助家庭和社区豁免计划中老年人的更好生活

基本信息

批准号：
10117746
负责人：
Sandra Lee Spoelstra
金额：
$ 24.46万
依托单位：
GRAND VALLEY STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-15 至 2021-07-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY/ABSTRACT Nearly half of older adults report problems with function, which can lead to difficulty with activities of daily living and nursing home placement. Thus, there is a need to implement evidence-based models of care to improve function and those factors that support function in older adults living in the community. One such model is a person-centered, self-directed, nurse and occupational therapy intervention supported by assistive devices and home modifications. We build on current work that is implementing the model statewide in an R15 AREA 3- year, randomized, Hybrid-3, mixed trial. We extend this NIA-funded trial by addressing a problem found while deploying the model with beneficiaries with Alzheimer’s disease or dementia. There are 39.8 million informal caregivers in the US and 16.3 million who care for someone with Alzheimer’s disease or dementia; and 1,500 are in the Michigan waiver. Most beneficiaries with those conditions did not accept the model as they were unable to receive instruction. Our setting is Medicaid Home and Community Based Service waiver program sites (in the National Institutes of Aging funded parent trial 1 R15 AG058193-01A1, 9/1/2018-8/30/2021, ClinitalTrials.gov NCT03634033) in Michigan that care for community-dwelling disabled older adults. The goal of this Supplement is to extend provision of the model to waiver beneficiaries with Alzheimer’s disease or dementia via engagement of their informal caregivers. A 12-month phased project will occur. First, we will consult experts to refine our toolkit for use by informal caregivers so they can assist with delivery of the model to those with Alzheimer’s disease or dementia. Second, we will enroll 5 caregivers, assess age, sex, race, education, and relationship to beneficiary, provide the toolkit, and use an iterative process to refine the toolkit. Third, we will confirm and finalize toolkit content with experts. Fourth, after consent, we will assess clinician characteristics, train them in use of the toolkit, and examine knowledge uptake and satisfaction with training. Fifth, we will use a mixed method pre/post-design with a convenience sample of 60 caregivers and beneficiary’s dyad to examine acceptability, feasibility, and satisfaction with use of the toolkit. After consent, caregivers will be assessed for age, sex, race, education, self-efficacy, and relationship to beneficiary at baseline. After 1 month, the clinicians will provide the toolkit and the model will be deployed. Toolkit use will be examined for 3 months and at exit, we will assess caregiver self-efficacy and satisfaction with the toolkit. Finally, preliminary efficacy of an informal caregiver toolkit to support deployment of the model of care will be tested based on the beneficiary outcomes. This work will impact use of the model with informal caregivers of those with Alzheimer’s disease or dementia, to improve older adults’ outcomes in a Medicaid waiver program. This natural setting approach has high generalizability for waivers, as we learn what caregivers need to support use of the model of care with Alzheimer’s disease or dementia beneficiaries.

项目概要/摘要近一半的老年人报告有功能问题，这可能导致日常生活活动困难因此，有必要实施基于证据的护理模式来改善。功能以及支持社区老年人功能的因素就是这样一个模型。以人为本、自我指导、护士和职业治疗干预，并辅以辅助设备和我们以当前在 R15 AREA 3- 范围内实施该模型的工作为基础。今年，我们通过解决发现的问题来扩展这项 NIA 资助的试验。在患有阿尔茨海默病或痴呆症的受益人中部署该模型有 3980 万非正式受益人。美国的护理人员以及 1,630 万名照顾阿尔茨海默病或痴呆症患者的护理人员；以及 1,500 名护理人员；大多数具有这些条件的受益人并不接受原来的模式。我们的设置是 Medicaid 家庭和社区服务豁免计划。站点（在国家老龄化研究所资助的家长试验 1 R15 AG058193-01A1，9/1/2018-8/30/2021， ClinitalTrials.gov NCT03634033）位于密歇根州，旨在照顾社区居住的残疾老年人。本补充的目的是将模型的提供范围扩大到患有阿尔茨海默病或首先，我们将开展一个为期 12 个月的分阶段项目。咨询专家来完善我们的工具包，供非正式护理人员使用，以便他们能够协助交付模型其次，我们将招募 5 名护理人员，评估年龄、性别、种族、教育和与受益人的关系，提供工具包，并使用迭代过程来完善工具包。第三，我们将与专家确认并最终确定工具包内容。第四，在同意后，我们将评估临床医生。特征，培训他们使用工具包，并检查知识吸收情况和对培训的满意度。第五，我们将使用混合方法进行设计前/设计后，并抽取 60 名护理人员作为方便样本，受益人双方检查工具包使用的可接受性、可行性和满意度。将对护理人员的年龄、性别、种族、教育程度、自我效能以及与受益人的关系进行评估 1个月后，爱好者将提供工具包，模型将被部署。检查为期 3 个月，退出时，我们将评估护理人员的自我效能和对工具包的满意度。最后，支持护理模式部署的非正式护理人员工具包的初步功效将是这项工作将影响该模型在非正式护理人员中的使用。患有阿尔茨海默病或痴呆症的人，以改善老年人在医疗补助豁免计划中的结果。当我们了解护理人员需要什么时，这种自然环境方法对于豁免具有很高的普遍性支持对阿尔茨海默病或痴呆症受益人使用护理模式。