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3 Complexity of Systems for Dementia Care, Services, and Supports
Pages 61-74

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From page 61...
... That section ends by identifying some of the principal actors and programs that make up the complex system of dementia care in the United States. A MULTILEVEL FRAMEWORK FOR CARE INTERVENTIONS FOR PERSONS LIVING WITH DEMENTIA AND THEIR CARE PARTNERS AND CAREGIVERS The broad range and heterogeneity of the dementia care interventions evaluated in the Agency for Healthcare Research and Quality (AHRQ)
From page 62...
... Applying this framework allows dementia care interventions to be categorized as targeting various levels -- individual and family, community, policy, and societal -- either alone or in combination. As depicted in the figure, the levels are nested, and there is a dynamic interplay among them (i.e., individuals and families reside and receive care, services, and supports in communities, which in turn exist within policy environments, which are influenced by societal perceptions and cultural norms)
From page 63...
... In considering interventions at this level, it is important to recognize that individual care arrangements often extend beyond a person living with dementia–caregiver dyad to a broader network of engaged family, friends, and paid caregivers. These helping networks are recognized as being dynamic in response to the evolving care needs of persons living with dementia and the circumstances of care partners and caregivers, who may be managing multiple employment and family responsibilities or may experience health or financial circumstances that affect their ability to provide care (NASEM, 2016)
From page 64...
... Policy Level Interventions at the policy level include federal, state, and local legislation, regulations, and policies that affect available supports and services for persons living with dementia and their care partners and caregivers. Examples include insurance reimbursement policies, such as the structure and g ­ enerosity of Medicaid coverage of LTSS; state and federal policies regarding paid and unpaid leave for caregivers (e.g., the Family and Medical Leave ­ Act of 1993)
From page 65...
... . COMPLEXITY OF DEMENTIA CARE INTERVENTIONS AND IMPLICATIONS FOR ASSESSING THE EVIDENCE The interactions and interdependencies among persons living with dementia, care partners and caregivers, the community, and the broader
From page 66...
... Health service and public health interventions, such as nonpharmacological dementia care interventions, are often described as being complex interventions (Craig et al., 2008; Minary et al., 2018)
From page 67...
... Measuring the outcomes of dementia care interventions is critical for having a scientific approach to designing and delivering care, services, and supports for persons living with dementia, care partners, and caregivers. Medical outcomes for persons with cancer, osteoporosis, or heart disease can be captured through such measures as fewer deaths or fractures or less breathlessness and fatigue, or via biomarkers.
From page 68...
... An overview of the complex ecosystem of actors and programs that support dementia care interventions is presented in Box 3-1. CONCLUSION Interventions for persons living with dementia and their care partners and caregivers can be implemented at multiple levels, ranging from the individual to society.
From page 69...
... Two Healthy Brain Initiative Road Maps call for the implementation of effective interventions that will help meet the needs of persons living with dementia and their care partners and caregivers: --  tate and Local Public Health Partnerships to Address Dementia: S The 2018–2023 Road Map --  oad Map for Indian Country R Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services •  he 2019 Update of the National Plan to Address Alzheimer's Disease T (National Plan)
From page 70...
... •  he Program of General Caregiver Support Services offers care part T ners and caregivers of persons living with dementia a variety of interven tions. Care partners and caregivers of veterans or veterans who are care partners or caregivers and receive care through the VA are eligible for these interventions.
From page 71...
... As part of the Health Care Innovation Awards, four dementia care delivery models have been evaluated: --  are Ecosystem -- The University of California, San Francisco, and C the University of Nebraska Medical Center Dementia Care Ecosystem: Using Innovative Technologies to Personalize and Deliver Coordinated Dementia Care --  aximizing Independence at Home (MIND) -- Comprehensive Home M based Dementia Care Coordination for Medicare-Medicaid Dual Eli gibles in Maryland --  The University of California, Los Angeles, Alzheimer's and Dementia Care -- Comprehensive, Coordinated, Patient-Centered -- Aging Brain Care -- Dissemination of the Aging Brain Care Program •  pecial Needs Plans are a type of Medicare Advantage Plan that provides S benefits and services to individuals with certain diseases or health care needs.
From page 72...
... interventions considered. To improve the ability to answer ques tions about which dementia care interventions work, for whom, and under what circumstances, future research and synthesis approaches need to account for these complexities in the design, implementation, and evaluation of interventions.
From page 73...
... 2020. Care interventions for people living with dementia and their care­givers.
From page 74...
... 2005. Realist review -- A new method of systematic review designed for complex policy interventions.


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