Translation of a dementia caregiver intervention for delivery in homecare as a reimbursable Medicare service: outcomes and lessons learned.
OBJECTIVE
families of dementia patients receiving skilled homecare do not receive supportive services. We evaluated whether a proven intervention, Environmental Skill-building Program (ESP), which reduces caregiver burden and enhances skills managing patient functioning, can be integrated into homecare practices of occupational therapists (OTs) and reimbursed through Medicare Part B.


METHODS
a 2-year translational project with a homecare practice was conducted. Five translational activities included refining ESP, site preparation, therapist training, establishing referral mechanisms, and evaluating outcomes using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM).


RESULTS
of 30 OTs approached for participation, 23 (77%) agreed, 22 (96%) completed training, and 21 (95.5%) used ESP and intended to continue use. Of 69 eligible caregivers, 41 (59%) agreed to participate averaging 4.7 sessions. Of 20 returned caregiver surveys, enhancements were reported in all targeted areas of knowledge and skills. Fidelity monitoring revealed inconsistency in therapists use of problem solving, yet caregiver enactment of ESP strategies was high. ESP sessions integrated within patient-directed therapy were reimbursed by Medicare Part B.


CONCLUSIONS
RE-AIM indicators suggest moderate translational success. As ESP was reimbursed through Medicare B, its delivery may be sustainable and meet the needs of family caregivers of dementia patients receiving therapies at home.
Gitlin
Laura N
LN
Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S.9th Street, Suite 513, Philadelphia, PA 19107, USA. laura.gitlin@jefferson.edu
Jacobs
Mimi
M
Earland
Tracey Vause
TV
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D017028:Caregivers / Q000193:education* / Q000523:psychology; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D019317:Evidence-Based Medicine; D006701:Home Nursing / Q000193:education*; D006801:Humans; D016345:Medicare Part B / Q000191:economics*; D009788:Occupational Therapy / Q000193:education*; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011788:Quality of Life; D012051:Reimbursement Mechanisms; D012931:Social Environment; D014481:United States