UCLA Alzheimer’s and Dementia Care (ADC) Program
Background & Goal
As there is no cure for dementia, patients and families often feel alone in a long and arduous journey without guidance or support. The multiple demands placed on primary care providers often limit their availability to discuss important concerns including advance care planning, legal and financial issues, and advice to family caregivers. To help patients and families navigate the many challenges associated with dementia, Leslie Chang Evertson, GNP-BC, Mihae Kim, AGPCNP-BC, Michelle Panlilio, GNP-BC, and Kelsey Stander, AGNP-BC designed and developed the UCLA Alzheimer’s and Dementia Care (ADC) Program - a collaborative practice in which patients retain their primary care provider while both patients and their families receive dementia care from nurse practitioner Dementia Care Managers (DCMs). The goals of the ADC program are to maximize patient function, independence, and dignity while minimizing caregiver strain and unnecessary costs.
Program Description
Nurses understand that patients are more than their diagnosis alone; they are the sum of their health, social factors, and relationships. Proceeding from this premise, nurse practitioner Dementia Care Managers (DCMs) identify the specific, though diverse, needs of the patients with dementia and their family caregivers. The DCM performs a standardized assessment with each initial and annual visit which includes a dementia-focused history and physical, cognitive testing, depression screening for both the patient and caregiver, functional status assessment, and a review of behavioral symptoms. Three acuity levels (red, yellow, and green) have been developed to determine the intensity of care management needed. The DCM communicates with the patient’s team of health providers including his or her primary care provider, physician specialists, hospitals, facilities, and community-based organizations regarding the patient’s dementia assessment and the DCM develops a personalized care plan for each patient and family which is updated as needed over time. In addition to the standardized assessment, the DCM works with the patient and family annually to address issues of advance care planning, legal, and financial concerns. The professional collaboration is mutual, with the patient’s physicians following up with the DCM regarding a concern or to help the patient and family through a crisis. Patients and family members enrolled in the program have 24/7 access to healthcare professionals. Each DCM carries a panel of 250 patients and the program has served over 2600 patients since it began in 2012.
Evidence of Success
The ADC intake visit was perceived to be time well spent by 90% of caregivers surveyed. Similarly, 94% felt that the DCM listened to their concerns and 87% felt that the decisions made during the visit were important to the patient. Almost all (96%) caregivers said they felt supported in their role and 95% of the caregivers would recommend the program to other caregivers. Of the physicians surveyed, 51% believed DCMs provided valuable medical recommendations, 82% believed the ADC provided valuable behavioral and social recommendations, and 87% would recommend the program to other patients. Participants in the UCLA ADC program have reduced caregiver burden, caregiver strain, and caregiver depression after one year. In addition, the program results in reduced nursing home placement and lower healthcare costs – namely a 40% reduction in long-term nursing home placement and a $601 per quarter spending reduction. The UCLA ADC has emerged as a national model for dementia care and was featured in the 2017 National Research Summit on Dementia Care.