Primer: MIND at Home Alzheimer’s and Dementia Care Coordination Program

Abstract

AbstractBackgroundPeople living with dementia (PLWD) represent some of the highest‐need and highest‐cost individuals living in the community. The complexity and range of needs (including medical, behavioral, and social needs) make dementia one of the most expensive chronic conditions in the U.S., and a strong candidate for improving care and reducing costs through care management support.MethodThe Maximizing Independence (MIND) at Home dementia care program, developed and implemented in a variety of settings and contexts over the last 15 years, is an advanced care coordination program for community‐living persons with dementia and cognitive impairment and their informal caregiver. The program is delivered through an interdisciplinary, dementia capable collaborative team. Developed by researchers at Johns Hopkins University, the MIND program consists of a comprehensive set of assessments, tools and staff trainings designed to increase individual longevity in the home/community; reduce unmet care needs and improve quality of care; improve person‐centered outcomes; reduce costly acute health care utilization; and reduce caregiver burden.ResultThe MIND at Home program model builds on three prior trials (two RCTs, one quasi‐experimental design) of the MIND at Home dementia care coordination model. These have included a philanthropically‐funded parallel group randomized controlled single blind trial (RCT) (MIND‐RCT‐1 n = 303; 2007‐2012), an NIA‐funded RCT (MIND‐RCT‐2; n = 302; 2014‐2020), and a CMS Health Care Innovation Award Round 2 demonstration project (MIND‐HCIA; n = 342; 2014‐2018). The program has been embedded into 3 types of real world practice settings to date: managed care health plans, primary care, home health care.ConclusionThe research findings to date for in development of the MIND model show that community‐living older persons with dementia and cognitive impairment experience substantial unmet, yet modifiable care needs among community‐living PWD and caregivers, and that MIND at Home can benefit persons living with dementia and their family caregivers. Benefits include delay in transition from home and nursing home placement; reductions in use of acute and institutional care and total Medicaid spending; and improvement in care quality, behavior, and high program satisfaction. Individuals with lower income may benefit more.