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

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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.