MULTIDISCIPLINARY CARE COORDINATION ADDRESSING FINANCIAL VULNERABILITY IN DEMENTIA: QUALITATIVE FINDINGS FROM THE CARE ECOSYSTEM STUDY

Abstract

Financial mismanagement and abuse in dementia can have serious consequences for patients and their families. Vulnerability to these outcomes is believed to reflect both patient (cognitive, psychiatric) and contextual (family, psychosocial) factors. Multidisciplinary care coordination/navigation programs hold promise for assisting families in addressing psychosocial vulnerabilities and accessing needed resources. Our study was embedded in a pragmatic clinical trial of the Care Ecosystem, a telephone-based supportive care intervention for patients with dementia and caregivers. This program is built around the role of the Care Team Navigator (CTN), a nonlicensed dementia care guide who serves as the patient and caregiver's primary point of contact, screening for common problems and providing support as well as standardized education. CTNs are supervised by a nurse, social worker, and pharmacist, and are able to triage complex issues to this supervising multidisciplinary team. Given their specialized roles, CTNs are able to follow patient/caregiver dyads over the course of months or years, developing a deeper understanding of the dyad's unique psychosocial situation. We conducted a qualitative analysis of case summaries from a subset of 19 patient/caregiver dyads identified as having increased risk for financial mismanagement and abuse, to examine how Care Ecosystem staff identified vulnerabilities and provided support to patients and families. CTNs elicited patient and caregiver needs using templated conversations designed to address common financial and legal planning issues in dementia. Sources of financial vulnerability included changes in patients' behavior, high caregiver burden, intrafamily tension, and confusion about resources to facilitate end-of-life planning. In several cases, while planning documents establishing financial and medical decision-making powers had been executed, caregivers still required guidance and assistance in how to utilize them. The Care Ecosystem staff's familiarity and rapport with their dyads helped them address these issues by providing emotional support, tailored strategies to deal with day-to-day issues, and information on how to access external financial, legal, and medical resources. The Care Ecosystem offers a scalable way to address vulnerabilities to financial mismanagement and abuse in patients and caregivers through coordinated care and communication by nonlicensed care guides supported by a multidisciplinary team.