Towards Preventing Potentially Avoidable Hospitalizations in Dementia
Minimizing avoidable hospitalizations improves the value of healthcare. For community dwelling dementia patients and their caregivers, key value-based outcomes include minimizing the risk and severity of acute illness, responding quickly to illness onset, and maintaining the physical, emotional and cognitive functioning of both partners. This study will generate new understanding of caregivers’ unique contributions to managing the acute healthcare needs of patients with dementia, create typology of caregiver responses and identify the gaps in in-home care management. Typology of caregiver's actions and responses during crisis will be used in future studies to develop tools for training caregivers to recognize early signs of Ambulatory Care Sensitive Conditions in dementia and to engage a timely health system response, filling a gap in existing models for engaging and supporting caregivers as partners in care and answering the call of the National Alzheimer’s Plan for tools to improve the efficiency and effectiveness of dementia healthcare.
This developmental study will acquire new knowledge instrumental for setting the stage for innovative caregiver resilience coaching interventions to address the broad scope of caregiving responsibilities and assigning commensurate weight to managing care recipient's health and caregiver personal wellness in the face of crises. Several critical issues converge to support the importance of this research. The landscape of informal caregiving is changing and includes many more skilled health care management tasks than at any time in history. Longer lives, more years lived with cognitive decline and chronic disease, shorter hospital and post-acute stays, undersupply of geriatric specialists, increased demand for skilled nursing/medical care at home, and limited insurance coverage and restricted eligibility for receiving professional home health care services have all created unprecedented pressures on families and friends to provide this care. We do not yet fully understand the scope and complexity of care that dementia caregivers provide and do not have interventions to address the full range and context of this care, coupled with maintenance of caregiver self-care as caregiving demands change.