STAR-C-Telemedicine: Accessible Caregiver Support Layton Aging & Alzheimer’s Disease Center –27 NIH funded Alzheimer’s Disease Center Research Clinical care Family support Allison Lindauer, PhD, NP; Nicole Bouranis MA, Katherine Mincks, BA; Jeff Kaye, MD Spring 2017 ACKNOWLEDGEMENTS: NIA P30 -AG008017

Background “…telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” 1968: Massachusetts General Hospital Program 1997: Dementia care: Montani et al., MMSE Both clinicians and patients find telemedicine a feasible and satisfactory method of care. Telemedicine is being used around the world. Telemedicine can be used to provide neurological care, cognitive skills therapy and psychosocial support. In Oregon, private insurance pays for direct-to-home telemedicine care.

Aims Assess feasibility of implementing STAR-C via telemedicine Describe levels of caregiver burden, depression, desire to institutionalize Assess participant satisfaction with telemedicine intervention

The Problem Alzheimer’s disease affects 62,000 Oregonians Care provided by 178,000 family members Valued at $2.5 billion in 2015 Total Medicaid costs of $225,000 in 2015 Depressed and overburdened caregivers are more likely to place family members into long term care Support options are available, but often not used Telehealth provides a new avenue of care.

STAR-C A systematic, evidence-based training program which teaches caregivers how to understand and manage behavioral and mood disturbances in family members with ADRD. Significantly reduces caregiver burden, depression, and negative reactions to care-recipient behavioral symptoms of dementia. One-on-one training, in the families’ homes, Originally developed to train caregivers in assisted living facilities (Staff Training in Assisted living Residences, STAR). The one-on-one approach of STAR-C is both a benefit and drawback of the program.

Participants Caregiver for person with dementia Lives with care-recipient Over age 18 Speaks English Computer with internet access

STAR-C-TM STAR-C Protocol: 8 visits via telemedicine Pre-intervention assessment: RMBPC, CESD, SCB, ZBI, Desire to Institutionalize, via telemedicine 2 follow up phone visits Focus group at completion

Results Range 5-22 10-59 6-54 28-58 28-446 4-38 0-36 Mean 10.6 32.7 MoCA RMPBC: Reaction Pre Reaction Post SCB: Pre SCB: Post CESD: Pre CESD: Post Range 5-22 10-59 6-54 28-58 28-446 4-38 0-36 Mean 10.6 32.7 26.4 40.2 36.9 17 15.7

Table 2: Cost per Participant: STAR-C vs. STAR-C-Telemedicine Expenses STAR-C STAR-C-TM Initial set up, Visit 1, and Follow-Up Scheduling visits (30min at $22/hr) $11 Caregiver training ($43.51/hr) $43.51 RA phone interviews (3.5 total hours at $22/hr) $77 Trainer phone interviews (1 total hour at $43.51/hr) Recruitment and marketing (4 hours at $22/hr) $88 Cost of materials ($6 each when ordered at group rate) $6 Telemedicine set-up (10-60min at $22/hr) N/A $22 RA mailing materials (30 minutes at $22/hr) Cost of mailing materials ($10 each way) $20 Total Costs for 8 Visits (STAR-C Protocol) Caregiver training (8 hours at $43.51/hour) $348.08 Average cost for trainer travel time(17.73 hrs at $43.51/hr) $771.51 Average mileage reimbursement costs (795.54 miles at $0.54/mile) $429.53 Total $1774.63 $626.59 Cost Difference: $1147.41

Thank you! Layton Aging & Alzheimer’s Disease Center