Working with individuals living with dementia and their family caregivers requires a special kind of dedication. We are glad to be part of the team bringing services and support to people affected by dementia in the state of Florida.

Funding for the FL-REACH program was provided by a grant from the Ed & Ethel Moore Alzheimer's Research initiative of the Florida Department of Elder Affairs (2019-2021; PI: Wharton, Co-PI: D Paulson); TeleREACH is funded through billing to insurance and Medicare.

Health Impact

The state of Florida spends an estimated $20 billion per year on care and treatment of individuals with Alzheimer’s disease. With more than 500,000 patients residing in the state, that equals nearly 10% of the total US cases.  Our healthcare system could never support the majority of this population in long-term care, and consequently relies heavily on the family caregivers of these individuals to provide the bulk of ongoing care in community based settings. According to the Department of Elder Affairs Purple Ribbon Task Force (Department of Elder Affairs, 2013), informal caregivers save the state significant money by fulfilling the Florida State Plan on Aging Objective 2.7: preventing premature facility placement, and by taking the burden off of the healthcare and funding systems (Department of Elder Affairs, 2013). According to the report, 75% of informal caregivers felt that early education and training should be a high priority for the state; 22% of these caregivers reported having no additional help in their duties, and the report concludes that difficult behaviors and limited knowledge about Alzheimer’s disease and other dementias were among the most significant challenges that they faced. Alzheimer’s is a disease where it is known that there is risk of future events that may be fairly predictable. Early intervention for training and contingency planning could ensure that caregivers have effective supports in place. Home based support and maintenance in the community “is considerably less expensive than a transfer to a hospital or institution” (Department of Elder Affairs, 2013, p.42).

This project was focused on the diverse individuals and their caregivers who receive a diagnosis of Alzheimer’s disease or another type of dementia from the Advent Health-Orlando Memory Disorder Clinic (MDC) or other similar clinics, and targeted the novel context of the specialty outpatient clinic where they receive ongoing care, or through telehealth community-based care. Using validated instruments, this study demonstrated that an 8-hour intervention can build on relationships and create a foundation for future intervention by providing common language and conceptualization that caregivers can apply to engage in future resources and supports.

Previous research has demonstrated that skills-based learning can transfer- meaning that families who are able to adopt problem-solving strategies early on should be able to apply those same skills later when more complex challenges arise (Burgio et al., 2009; Hepburn, Lewis, Tornatore, Sherman, & Bremer, 2007; Schulz et al., 2003). We have demonstrated that if we can provide patients and families with these high impact aspects of care coordination and intervention early enough in the disease progression, we can build foundational skills and knowledge which can provide the groundwork for future care by teaching language to describe and manage disease related symptoms, skills to problem solve meaning and need related to developing behavioral expressions, and awareness and willingness to engage with community and clinic based resources that are not standard mechanisms of care, such as legal and financial services, community-based support groups, art or music groups, or family support networks. 

Burgio, L., Collins, I., Schmid, B., Wharton, T., McCallum, D., & Decoster, J. (2009). Translating the REACH caregiver intervention for use by area agency on aging personnel: the REACH OUT program. The Gerontologist, 49(1), 103–16. 

Department of Elder Affairs. (2013). Department of Elder Affairs Purple Ribbon Task Force 2013 Final Report and Recommendations, State Plan on Alzheimer’s Disease and Related Forms of Dementia. Tallahassee, FL.

Hepburn, K., Lewis, M., Tornatore, J., Sherman, C. W., & Bremer, K. L. (2007). The Savvy Caregiver program: the demonstrated effectiveness of a transportable dementia caregiver psychoeducation program. Journal of Gerontological Nursing, 33(3), 30–36.

Schulz, R., Belle, S. H., Czaja, S. J., Gitlin, L. N., Wisniewski, S. R., & Ory, M. G. (2003). Introduction to the special section on Resources for Enhancing Alzheimer’s Caregiver Health (REACH). Psychology and Aging, 18(3), 357–360.