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Keeping Patients with Dementia at Home in Maryland

A Johns Hopkins study assesses whether professional assistance can prevent or delay placing people with dementia in a nursing home.

Summary:

  • A Johns Hopkins study is trying to measure whether professional assistance can prevent or delay placing people with dementia in a nursing home.
  • Participants are given advice about resources to help keep patients with dementia at home.
  • Participants are still needed from north and northwest Baltimore and nearby areas.

The 89-year-old retired accountant is increasingly forgetful, and his 80-year-old wife increasingly stressed as she tries to care for him while working part-time. He has gotten lost while driving and has hit a street sign. His wife worries he might lose his driver’s license.

Enter an assessment team from the Johns Hopkins University School of Medicine in Baltimore. The team finds the house so cluttered that the couple spend most of their time in the kitchen. The team assigns a care coordinator.

Six months later, with guidance, the couple is doing much better. The house is clutter-free, reducing the risk of a fall. The wife is attending an Alzheimer’s disease support group, keeps track of her husband’s pills, and is less stressed. The husband, who might have ended up in a nursing home, instead is still at home.

This couple is a composite drawn from people participating in Johns Hopkins’ Maximizing Independence at Home (MIND at Home) study. It is designed to measure whether professional assistance can prevent or delay placing people with dementia in a nursing home.

AARP Maryland, which champions the goal of allowing older adults to age in place, is helping to recruit participants. “The information gained could further reinforce the need for insurance to pay for coordinated care caseworkers,” said Jennifer Holz, AARP Maryland’s program assistant. “On average, home- and community-based services cost about a third as much as nursing home care.” Next year, it is estimated that Alzheimer’s will affect 12 percent of Maryland residents 65 and older.

The Hopkins study plans to follow 300 people, 70 or older, for 18 months to see whether care coordinators can keep people with dementia living at home longer than those without such help. So far about 100 people are enrolled.

Here’s the process: A psychiatrist or nurse from Johns Hopkins conducts a lengthy home visit assessing the participant’s mental abilities, physical condition, home environment, and caregiver burden. A second home visit involves tests establishing a baseline that will be used to measure progress.

All of the study participants, as well as their caregivers and primary care physicians, are given the assessment’s results, along with a resource guide of agencies and services that offer assistance. About a third are randomly assigned to receive additional help from a care coordinator; the rest are left to follow up on their own. Hopkins pays a nominal fee to study participants.

For those targeted for more help, a care coordinator with a social services background makes another home visit and follows up as needed. The coordinator helps participants establish their needs and priorities. It could be something as simple as setting up a pillbox to organize medications or ensuring that someone comes in once a week to assist.

“The frequency is determined by needs and how the person is doing,” said Deidre Johnston, a geriatric psychiatrist and the study’s clinical director. Some contacts are by phone, others in person.

The goal is for the clients—with the list of resources the program provides—to arrange their own services, whether it’s adult day care or Meals on Wheels. If all else fails, the coordinator will step in and make the calls.

The $2 million study, funded by the Associated Jewish Community Federation of Baltimore, draws participants from north/northwestern Baltimore and adjoining areas of Baltimore County, roughly from Pikesville/Owings Mills to Parkville/Towson.

Anyone interested in enrolling or referring someone for the study should contact Chris Lyman at 410-502-0773.

Eugene L. Meyer is a freelance writer living in Silver Spring, Md.

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