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Translation of a dementia caregiver intervention for delivery in homecare as a reimbursable Medicare service: outcomes and lessons learned


Gitlin, Laura N, Jacobs, Mimi, Earland, Tracey Vause


The Gerontologist, Volume: 50, No.: 6, Pages.: 847-854

Year of Publication



Purpose: families of dementia patients receiving skilled homecare do not receive supportive services. We evaluated whether a proven intervention, Environmental Skill-building Program (ESP), which reduces caregiver burden and enhances skills managing patient functioning, can be integrated into homecare practices of occupational therapists (OTs) and reimbursed through Medicare Part B.; Design and Methods: a 2-year translational project with a homecare practice was conducted. Five translational activities included refining ESP, site preparation, therapist training, establishing referral mechanisms, and evaluating outcomes using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM).; Results: of 30 OTs approached for participation, 23 (77%) agreed, 22 (96%) completed training, and 21 (95.5%) used ESP and intended to continue use. Of 69 eligible caregivers, 41 (59%) agreed to participate averaging 4.7 sessions. Of 20 returned caregiver surveys, enhancements were reported in all targeted areas of knowledge and skills. Fidelity monitoring revealed inconsistency in therapists use of problem solving, yet caregiver enactment of ESP strategies was high. ESP sessions integrated within patient-directed therapy were reimbursed by Medicare Part B.; Implications: RE-AIM indicators suggest moderate translational success. As ESP was reimbursed through Medicare B, its delivery may be sustainable and meet the needs of family caregivers of dementia patients receiving therapies at home.;

Bibtex Citation

@article{Gitlin_2010, doi = {10.1093/geront/gnq057}, url = {}, year = 2010, month = {jul}, publisher = {Oxford University Press ({OUP})}, volume = {50}, number = {6}, pages = {847--854}, author = {L. N. Gitlin and M. Jacobs and T. V. Earland}, title = {Translation of a Dementia Caregiver Intervention for Delivery in Homecare as a Reimbursable Medicare Service: Outcomes and Lessons Learned}, journal = {The Gerontologist} }


activities of daily living, adaptation psychological, caregivers, dementia, economics, education, evidencebased medicine, home nursing, humans, intervention studies, medicare part b, nursing, occupational therapy, outcome assessment (health care), program evaluation, psychology, quality of life, reimbursement mechanisms, social environment, united states

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Before and After Study

Type of Outcomes

Other carer outcomes (e.g. financial burden and more)


Extra Care Housing

Type of Interventions

Non-pharmacological Treatment, Workforce oriented interventions

Non-Pharmaceutical Interventions

Occupational Therapy

Workforce Interventions

Professional Training / Continuing Professional Development