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

项目摘要/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 和养老院安置。因此，有必要实施循证护理模式，以改善 功能和那些支持社区老年人功能的因素。一种这样的模型是 辅助设备和辅助设备支持的以人为中心的、自我指导的、护士和作业治疗干预 家居改装。我们基于目前在全州范围内在R15地区3-3实施该模型的工作- 年，随机，混合-3，混合试验。我们延长了这项由NIA资助的试验，方法是解决在 在阿尔茨海默病或痴呆症受益者中部署该模型。有3980万个非正式的 在美国和1630万护理阿尔茨海默氏症或痴呆症患者的护理者；以及1500人 都在密歇根州的弃权书中。大多数符合这些条件的受益人都不接受这种模式 无法接收指令。我们的设置是基于医疗补助家庭和社区的服务豁免计划 网站(在国家老龄研究所资助的父母试验1 R15 AG058193-01A1,2018年9月1日-2021年8月30日， ClinitalTrials.gov NCT03634033)，为社区居住的残疾老年人提供护理。目标是 本补编的目的是将该模式的规定扩大到免除阿尔茨海默病或 通过非正式照顾者的参与导致痴呆症。这将是一个为期12个月的分阶段项目。首先，我们将 咨询专家以完善我们的工具包，供非正式护理人员使用，以便他们可以帮助交付模型 给阿尔茨海默病或痴呆症患者。其次，我们将招募5名护理员，评估年龄、性别、种族、 培训和与受益者的关系提供工具包，并使用迭代过程来改进工具包。 第三，我们将与专家一起确认和最终确定工具包内容。第四，同意后，我们将评估临床医生 培训他们如何使用工具包，并检查他们对培训的知识吸收情况和满意度。 第五，我们将使用前/后设计的混合方法，对60名照顾者和 受益人对使用工具包的可接受性、可行性和满意度进行检查。在同意之后， 照顾者将在以下方面接受评估：年龄、性别、种族、教育程度、自我效能和与受益人的关系 基线。1个月后，临床医生将提供工具包，模型将部署。工具包的使用将 检查3个月，在离开时，我们将评估照顾者的自我效能和对工具包的满意度。 最后，支持部署护理模式的非正式护理人员工具包的初步效果将是 根据受益人的结果进行测试。这项工作将影响该模型在非正式照顾者中的使用 阿尔茨海默病或痴呆症患者，以改善老年人在医疗补助豁免计划中的结果。 这种自然设定的方法对豁免具有很高的普遍性，因为我们了解到照顾者需要 支持使用阿尔茨海默病或痴呆症受益人的护理模式。

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.