Integrated Dementia Care Research Articles

Evaluation of an Integrated Dementia Care Network in the Northern part of Singapore

Introduction: The growing prevalence of dementia is of concern in Singapore as it poses significant health, social and economic burden on individuals, families and the healthcare system. While it widely known that dementia is best managed by a multidisciplinary team of healthcare providers working together across different healthcare settings, dementia care has been primarily delivered by tertiary hospitals in Singapore. Hospital-centric dementia care is insufficient because needs of persons with dementia PWDs and their caregivers extend beyond medical needs and are best provided for in the community. As demand continues to rise, the healthcare system now faces the challenges of ensuring sustainability, appropriateness and quality of dementia care. To cope with these, the CARITAS network was established in 2012 to foster integrated, person centered care across different healthcare settings through i formation of primary care and community PCC providers network ii empowerment of PCC to manage PWD in the community iii empowerment of caregivers and iv integration between tertiary hospital and PCC through clinical, professional and functional integration. With these strategies, the CARITAS aims to provide a comprehensive, accessible, responsive, individualized, trans-disciplinary, accountable and seamless care for PWDs in the northern part of Singapore within their community. Methods: To support further development of the CARITAS network, this study was designed as a formative evaluation. Using sequential exploratory mixed methods, we aim to examine the degree of care integration within the CARITAS network, identify moderating factors that affect its implementation by taking into consideration the context in which it operationalized so as to identify areas for improvements. Guided by the Rainbow Model of Integrated Care RMIC, the RMIC measurement tool RMIC-MT was first administered to 100 healthcare providers within the CARITAS network. Then, based on the findings from the RMIC-MT, 30 healthcare providers and caregivers were invited to participate in interviews to gather insights into the moderating factors of the implementation of the CARITAS network. Data from the various sources will initially be analyzed according to their data types and subsequently triangulated according to the RMIC. Recommendations for improvements will then be made. Results & Discussions: The results which will be presented at the conference have significant implications on a few levels. It will potentially i provide information for improvement of the CARITAS network, ii provide insights to other countries that are experimenting with new models of dementia care and iii contribute significantly to the international literature on improvement science. Lessons Learned: In the evaluation of complex healthcare intervention such as the CARITAS network, it is essential to conduct process evaluation in conjunction with outcome evaluation so as to account for variability in implementation. Without process evaluation, it would be difficult to determine actions to take for improving the intervention. Limitations: As this is a single site study, findings gathered from this study needs to be interpreted with consideration of the context in which the CARITAS network is implemented. Suggestions for future research Future research should be conducted to examine the effectiveness of the CARITAS network in improving its intended outcomes.

Implementation of Integrated Care in Singapore: A Complex Adaptive System Perspective.

Background:Integrated care that focuses on organising healthcare services around people and their communities rather than their diseases is promoted as the strategy to overcome the challenges associated with growing complexity in healthcare needs, demand for healthcare services and inadequate supply of services due to fragmentation in the provision of services. While conceptually appears to be simple, integrated care is made up of multicomponent delivery strategies targeting various levels of the healthcare system while engaging various stakeholders in their execution.Methods:We applied the complex adaptive system (CAS) perspective to two different initiatives that exemplify approaches towards integrating care in Singapore: the Regional Health System (RHS) model, implemented across healthcare institutions at the national level, and CARITAS Integrated Dementia Care implemented in the northern region of Singapore. We adopted an inductive approach in our analysis in which we studied the RHS and CARITAS Integrated Dementia Care according to the components of the CAS. We applied the typical characteristics of CAS: (i) diverse, interdependent and semi-autonomous actors (ii) self-organizing capacity and simple rules (iii) relationship with the bigger system, emergent behaviour and non-linearity in our analysis of key drivers behind the implementation of both the RHS and CARITAS integrated dementia care.Results:By considering the RHS and CARITAS as whole networks each comprising of interacting and adaptive components instead of separate entities within a bigger system, the CAS provided a new mind-set in surfacing issues associated to the implementation of these integrated care networks. In addition to important actors, systems, it informed understanding of relationships and dependencies between different parts of the network – revealing the lack of homogeneity, conformity and difficulties in designing any optimal system in advance given the many moving parts.Conclusions:Drawing on the two examples of integrated care networks, this paper highlights the significance of effective collaboration built on a common focus, responsiveness to emergent behaviours, simple rules, the ability to self-organize and adapt in response to unexpected situations in further development of integrated care in the Singapore context and beyond.

DEDICATE: proposal for a conceptual framework to develop dementia-friendly integrated eCare support

BackgroundEvidence shows that the implementation of information and communication technologies (ICT) enabled services supporting integrated dementia care represents an opportunity that faces multi-pronged challenges. First, the provision of dementia support is fragmented and often inappropriate. Second, available ICT solutions in this field do not address the full spectrum of support needs arising across an individual’s whole dementia journey. Current solutions fail to harness the potential of available validated e-health services, such as telehealth and telecare, for the purposes of dementia care. Third, there is a lack of understanding of how viable business models in this field can operate. The field comprises both professional and non-professional players that interact and have roles to play in ensuring that useful technologies are developed, implemented and used.MethodsStarting from a literature review, including relevant pilot projects for ICT-based dementia care, we define the major requirements of a system able to overcome the limitations evidenced in the literature, and how this system should be integrated in the socio-technical ecosystem characterizing this disease. From here, we define the DEDICATE architecture of such a system, and the conceptual framework mapping the architecture over the requirements.ResultsWe identified three macro-requirements, namely the need to overcome: deficient technology innovation, deficient service process innovation, and deficient business models innovation. The proposed architecture is a three level architecture in which the center (data layer) includes patients’ and informal caregivers’ preferences, memories, and other personal data relevant to sustain the dementia journey, is connected through a middleware (service layer), which guarantees core IT services and integration, to dedicated applications (application layer) to sustain dementia care (formal support services, FSS), and to existing formal care infrastructures, in order to guarantee care coordination (care coordination services, CCS).ConclusionsThe proposed DEDICATE architecture and framework envisages a feasible means to overcome the present barriers by: (1) developing and integrating technologies that can follow the patient and the caregivers throughout the development of the condition, since the early stages in which the patient is able to build up preferences and memories will be used in the later stages to maximise personalization and thereby improve efficacy and usability (technology innovation); (2) guaranteeing the care coordination between formal and informal caregivers, and giving an active yet supported role to the latter (service innovation); and (3) integrating existing infrastructures and care models to decrease the cost of the overall care pathway, by improving system interoperability (business model innovation).

Integrated Dementia Care in the Center for Geriatrics and Gerontology at Kaohsiung Veterans General Hospital

Due to the increasing aging and dementia populations all over the world, Taiwan has followed the global action plan to propose the seven key action areas. As one key action area, the authors conducted a systematic literature review regarding the diagnosis, treatment, care, and support of patients with dementia and their caregivers. The findings of a systematic literature review suggest that the case management model could be applied for dementia care; however, the evidence is still weak because of the roles and intensity of case managers, as well as their communication skills. Except for the literature review, the authors also introduced the center for geriatrics and gerontology at Kaohsiung Veterans General Hospital in southern Taiwan providing as the integrated dementia care. Additionally, 10-year long-term care plan 2.0 of Taiwan was also introduced and compared with the systems of integrated dementia care. Based on this model of long-term care provision, the Center for Geriatrics and Gerontology at Kaohsiung Veterans General Hospital has potential to be an A level center, the daycare center and aforementioned three dementia care units could function as B level care centers, and the Double-Bliss Welfare and Charity Foundation, as well as other local community organizations and activity centers, could provide C level care services. Furthermore, the correspondent author held the 2018 comprehensive practicum conference for integrated care of patients with dementia from January 19 to February 22, 2018 in collaboration with 19 nursing faculties from various nursing schools. Finally, the correspondent author intends to conduct further research in collaboration with the Center for Geriatrics and Gerontology at Kaohsiung Veterans General Hospital to further develop the “3D” (delirium, dementia, and depression) assessment scale and evidence-based care protocols.

Results of a multiple case study to evaluate the merits of a network-based primary care innovation for community-dwelling dementia patients

Introduction: Rearrangements are needed in primary care because of aging populations, the increased prevalence of dementia and increasing costs of health care. With DementiaNet, we aim to enhance primary care via integrated network-based care. We focus on structural collaboration from healthcare professionals from medical, care and social domains, and increased dementia expertise. Here, we describe our evaluation study on the DementiaNet innovation to provide insight in the merits and drawbacks of the DementiaNet innovation. Methods: The evaluation study is a longitudinal, mixed methods, multiple case study. The study population consists of two levels: (i) local DementiaNet networks of primary care professionals, and (ii) dyads of dementia patients and their informal caregivers who receive care from DementiaNet networks. At the start of participation and after 12 and 24 months, quantitative data is collected in each network on the maturity of the network, quality of care indicators, and outcomes reported by informal caregivers. Additionally, qualitative data is collected via in-depth interviews with professionals in the networks and dyads of patients and informal caregivers which provide insight in experiences and opinions regarding effects of the DementiaNet approach and the mechanism through which changes in quantitative outcomes are effectuated. Results: This study is currently ongoing with 17 networks included. Preliminary results of the first five networks show stable or improved quality of care and mostly positive experience with the DementiaNet approach. Analysis of quantitative data at 12 months (n=12) and at 24 months (n=5) will show time trends of these networks regarding their quality of care scores and association with informal caregiver-reported outcomes. Additionally, qualitative results from the interviews will be available. Discussion: This study will show whether the DementiaNet innovation leads to improved quality of dementia care and if this is associated with informal caregiver-reported outcomes, through an innovative study design that is designed to capture the complexity. Furthermore, it will provide insight in how this approach is perceived by primary care professionals. This evaluation study adds to the evidence-base of integrated health care, taken from a complex systems perspective. Conclusion: To conclude, this evaluation study will provide insight in the merits and drawbacks, facilitators and barriers, and improvement opportunities of the DementiaNet approach for integrated dementia care. Lessons learned: Evaluation of a complex program requires innovative design and flexibility. Limitations: Some data will be self-reported by network members. A proportion of networks will be followed for the first year only, because of time restrictions for the evaluation study. Suggestions for future research: We suggest the evaluation of this generic approach in primary care for other chronic conditions. Furthermore, we suggest application of the current design for future research into complex programs in primary health care.

Primary Care Education, Pathways and Research of Dementia (PREPARED): Promoting integrated dementia care through Primary Care Team education

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

(Un)Met needs of community dwelling people with dementia: the importance of providing integrated holistic care

Introduction: Research shows that PwD and their carers often do not receive the type, quality and amount of support needed from health and social care services. This study, part of the Access to Timely Care (Actifcare) JPND-funded project, aimed to identify the (un)met needs of Irish people with dementia (PwD) living at home and to compare these to needs assessments from a family caregiver and an independent Actifcare researcher. Theory/Methods: Forty-three PwD (22 female, mean age 74.05, mean MMSE 20.34) and family caregiver (33 female, mean age 58.12) dyads participated. The Camberwell Assessment of Need for the Elderly (CANE) was completed at baseline, 6-months and 12-months. All raters reported met and unmet need. Caregivers and researchers also reported formal and informal supports received. Additional measures included: Quality of life (Qol-AD, ICECAP-O, Carer-QoL), Neuropsychiatric symptoms (NPI-Q) and carer perseverance. Results: PwD perceived fewer met needs at baseline (M=4.79, SD=3.2) than caregivers (M=8.6, SD=3.78) and researchers (M=8.3, SD=3.6); particularly environmental and physical needs. Researchers identified significantly more unmet need (M=3.28, SD=2.33) than caregivers (M=2.19, SD=2.05) and PwD (M=0.72, SD=1.32). Unmet needs were typically psychological (memory) and social (daytime activities, company) and regularly rated as ‘not the right type of care’. PwD sex had no impact on ratings, but group differences in unmet increased with dementia severity. Greater met needs were significantly related to higher NPI scores and greater functional need. Caregiver ratings of met need indicated longer care perseverance. Lower levels of unmet need were significantly associated with better quality of life. Similar patterns were found at 6- and 12-months with researchers increasingly identifying umet needs. Discussions: PwD reported fewest needs. Although often unaware of their psychological needs, these are generally identified by caregivers with the exception of support for memory difficulties; these were typically reported by researchers. Addressing unmet need positively influenced the dyadic quality of life, yet all groups reported high levels of unmet social need and found available services lacking and inappropriate. High levels of met physical need demonstrates a continued primary policy emphasis on soley supporting these needs. Conclusions: Dementia needs assessments must address the full range of biopsychosocial needs of the PwD and their caregivers such that timely tailored supports can be provided. Case management approaches that integrate the provision of health and social care are recommended. Lessons learned: Meeting physical need alone is not sufficient to maintain quality of life. It is essential to take a holistic view of the individual and their environment in order to adequately assess the support needed. Limitations: Although all PwD were able to report their needs at baseline, fewer were able to do so at 6-months (n=38) and 12-months (n=33). Suggestions for future research: Future research could formally and regularly assess needs from diagnosis onwards. If coupled with analysis of the type, duration and benefits of supports used, greater insight will be gained to enable the development of integrated dementia care that better supports the complex biopsychosocial needs of PwD and their families.

A qualitative study on barriers to achieving high-quality, community-based integrated dementia care.

Introduction: High-quality, community-based dementia care requires a comprehensive, holistic approach. This study aimed to identify the barriers to achieving efficient cooperation and coordination among medical professionals, care managers, and medical social workers, and to improve the management model of community-based, integrated dementia care.Methods: We collected qualitative data through three focus group discussions at JA Konan Kosei Hospital. Thirteen participants (four directors of nursing service departments, three chief nurses, four medical social workers, and two care managers) were recruited for the discussions. The data were analyzed using an inductive, multi-step approach referred to as the qualitative content analysis.Results: Nine themes arose as follows: little attention given to patient wishes, lack of time and space to provide high-quality care, disturbing hospital environment, poor compensation for staff members, refusing to visit outpatient clinics, declined admission, daily life support by family members and caregivers, dementia care team, and community bonding.Conclusion: The participants wanted to launch a dementia care team in their hospital to improve the care environment and the quality of dementia-specific care. The study also suggested that advance care planning could be systematically implemented in clinical practice as a way to honor the decisions made by dementia patients.

Integrated care for dementia – need for new ways in training of health care professionals

Integrated care for dementia – need for new ways in training of health care professionals

Antidementia drug treatment in dementia networks in Germany: use rates and factors associated with treatment use.

BackgroundDementia networks in Germany constitute a specialised setting for integrated dementia care and have shown benefits on relevant outcomes, including those of drug treatment. National guidelines recommend treatment with acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) or the N-Methyl-D-Aspartate antagonist (memantine) to reduce cognitive symptoms. However, prescription rates are lower than 30 % in general practises. This study aims to describe antidementia drug treatment and the factors that are associated with the treatment in different dementia networks across Germany.MethodsWe have analysed the socio-demographic, clinical and utilisation data from 560 patients with dementia (PWD), as well as data from their caregivers, in 13 selected dementia networks in Germany. The patients and caregivers were interviewed in their homes or in the network facilities. Multiple logistic regression models were fitted to evaluate the socio-demographic and clinical factors associated with the utilisation of antidementia drug treatment in the various networks.ResultsIn all of the networks in the study, 52 % of the participants received an antidementia drug treatment. Factors associated with the utilisation of the antidementia drug treatment were: formal diagnosis (OR = 16.81, p < 0.001), association with a physician in the network (OR = 3.69, p < 0.001), higher number of comorbidities (OR = 0.88, p = 0.039), living alone (OR = 0.51, p = 0.032) and higher age (OR = 2.97, p = 0.002).ConclusionMedical treatment of PWD with antidementia drugs in dementia networks in Germany is more frequent than in primary and nursing home care settings. Our findings also suggest that participants with a formal diagnosis and a physician in the network have increased rates of receiving antidementia drug treatments. These findings suggest that dementia networks focusing on medical treatment should support diagnostic procedures and incorporate physician specialists.

P022: Towards a new focus on outcome of integrated community dementia care – Can Quality of Life serve as an outcome indicator of integrated dementia care?

P022: Towards a new focus on outcome of integrated community dementia care – Can Quality of Life serve as an outcome indicator of integrated dementia care?

P403: Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management

P403: Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management

Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management.

BackgroundThe aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. Insight into facilitators and barriers in the implementation of different models is needed to create future guidelines for successful implementation of case management in other regions.MethodsA qualitative case study design was used; semi-structured interviews were conducted with 22 stakeholders on the execution and continuation phases of the implementation process. The stakeholders represented a broad range of perspectives (i.e. project leaders, case managers, health insurers, municipalities).ResultsThe independence of the case management organization in the intensive model facilitated the implementation, whereas the presence of multiple competing case management providers in the linkage model impeded the implementation. Most impeding factors were found in the linkage model and were related to the organizational structure of the dementia care network and how partners collaborate with each other in this network.ConclusionsThe results of this process evaluation show that the intensive case management model is easier to implement as case managers in this model tend to be more able to provide quality of care, are less impeded by competitiveness of other care organizations and are more closely connected to the expert team than case managers in the linkage model.

The benefits of implementing a computerized intervention-management-system (IMS) on delivering integrated dementia care in the primary care setting.

A computerized Intervention-Management-System (IMS) has been developed and implemented to facilitate dementia care management. IMS is a rule-based expert decision support system that matches individual patient characteristics to a computerized knowledge base. One of the most important functionalities of IMS is to support the compilation of the individual intervention plan by systematically identifying unmet needs and suggesting the corresponding specific interventions for recommendation to the general practitioner (GP). The present analysis aimed to determine if the implementation of IMS improves the identification of unmet needs and the recommendation of adequate specific interventions. In addition, the feasibility and acceptability of the IMS were evaluated. Delphi-MV is an on-going GP-based, cluster-randomized, controlled intervention trial to implement and evaluate a collaborative dementia care management program for community-dwelling PWDs and their caregivers. IMS was developed and implemented over the course of the DelpHi-trial. The identified unmet needs and the interventions that were recommended to the GP before and after the implementation of IMS were compared. To evaluate the feasibility and acceptability of the IMS, a survey was conducted among the current users of IMS. After the implementation of IMS, the number of specific interventions recommended to the GP increased by 85%. Our findings provide evidence that IMS improves the systematic identification of unmet needs and the subsequent recommendation of interventions to address these needs. The users evaluated IMS as very helpful and would like to use it for their future work. However, the usability could be further improved.

Person-centered integrated dementia care: the way forward?

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Dementia Knowledge Translation Initiatives From Canada: Putting Knowledge to Action for Dementia Care in Primary Care, Driving and Long-Term Care

Knowledge translation (KT) is the application of research findings to clinical practice settings. Dementia is a complex chronic illness requiring knowledge and skills from a broad range of providers and backgrounds to achieve optimal outcomes. Geriatric psychiatrists have expertise in many areas of dementia care. However, given the rapidly increasing numbers of older adults with dementia, and the limited numbers of geriatric mental health practitioners, geriatric psychiatrists will increasingly be called upon to develop collaborative models of care to support other healthcare practitioners. Application and dissemination of best practices will need to use evidence-based KT strategies to achieve the greatest impact for patients and providers. Canada has a long tradition of KT and collaborative mental health care delivery and a unique healthcare system that poses both challenges and opportunities for KT activities in geriatric mental health. This session will begin by providing an overview of national initiatives for KT in dementia care in Canada. The Canadian KT frameworks will be introduced along with an overview of a national initiative the Canadian Dementia Knowledge Translation Network. A dementia guideline implementation project, the Primary Care Dementia Assessment and Treatment Algorithm (PC-DATA) will be discussed as an example of an integrated dementia care program illustrating collaboration between geriatric mental health and primary care. Results from the Driving and Dementia in Ontario project will provide an overview of the development of knowledge tools to help physicians decide whether to report individuals with dementia or mild cognitive impairment to driving authorities. Finally, the development of guidelines and several knowledge tools to support best practices in behavioral symptoms of dementia in the long-term care setting will be illustrated through the activities of the Canadian Coalition for Seniors Mental Health. Through this session attendees will gain an appreciation of several aspects related to KT science and learn about innovative methods for providing collaborative care using examples from Canada. This symposium is sponsored by the Canadian Academy of Geriatric Psychiatry. Faculty Disclosures: David Conn, MB Nothing to disclose Kenneth Le Clair, MD Nothing to disclose Mark J. Rapoport, MD Nothing to disclose Dallas Seitz, MD Nothing to disclose Am J Geriatr Psychiatry 21:3, Supplement 1 S11

P2‐350: Integrated dementia care: A case study

P2‐350: Integrated dementia care: A case study

Dementia-oriented case management for home-dwelling people with dementia and their family caregivers

Purpose: To describe the activities and time spent by casemanagers for home-dwelling people with dementia and their family caregivers in a western region of the Netherlands. Theory: People with dementia and their family caregivers go through several transitions in disease, care and social roles. Integrated care for this group is important. In the Dutch Guideline for Integrated Dementia Care (2008), the casemanager is put forward as the vital link in the health-care supply chain for demented people and their families. Methods: During six months, six casemanagers registered the frequency and content of their contacts with a total of 40 home-dwelling elderly and their families. Results and conclusions: On average, casemanagers had contact with their clients once every five weeks, mostly with the family caregiver alone (by phone) or with the client-caregiver dyad (home visit). The mean contact time was about 50 minutes. The most frequent interventions offered by the casemanager are: monitoring (keeping track), listening, and giving moral support, practical advice and information about services and procedures. Casemanagers spend most of their working time linking health care services with the clientcaregiver’s needs. They spend about 5–6 hours per month at non-client related activities, including education/studying, participation in dementia support groups and networking. Discussion: Case management includes monitoring, counselling and linking of care to stimulate tailor-made care that meets the needs of the client-caregiver dyad. A caseload of around 50 clients per FTE casemanager seems reasonable.

Integrated dementia care in The Netherlands: a multiple case study of case management programmes

The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy recommendations are to develop incentives for collaborative financial contracts between insurers and providers.

Formal Care Providers' Perceptions of Home- and Community-Based Services: Informing Dementia Care Quality

Little attention has been given to the perceptions of formal care providers on the nature and quality of home- and community-based dementia care. The purpose of this descriptive interpretive research was to explore formal care providers' perceptions of their experiences with Canadian home- and community-based dementia care. Participants within three personal interviews and six focus groups (n = 41) included nurses, social workers, therapists, home care aides, and Alzheimer Society personnel (front line/management) in rural and urban areas of Saskatchewan (n = 16), Manitoba (n = 20), and Ontario (n = 8). Two overarching thematic categories, Service Availability and Service Acceptability, emerged from the data analysis. Subthemes of availability were identified as: (a) challenges of service availability, including service wait lists, lack of home care provider training, lack of community-based dementia care infrastructure, and sociocultural and geographic barriers to accessing dementia services; and (b) essential facilitators of availability, including service infrastructure, service bridging, and agency partnerships to form coordinated care systems. Subthemes of acceptability were revealed as: (a) essential components of dementia care, including provision of comprehensive personal care and the use of dementia care professional practice knowledge within a home care setting; and (b) service challenges, including inadequate service time for the physical care and socioemotional support of the client and family caregiver, caregiver and formal provider difficulty with navigation of a fragmented care system, lack of system coordination, and financial costs of services. Essential, integrated dementia care could be established by listening to the “voices of formal care providers,” thereby decreasing dementia care costs and increasing the quality of life for those with dementia, and their family caregivers.