1. 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

2. 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.

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

4. 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.

5. 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.

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

7. 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

8. 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

9. 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 ( miles at $0.54/mile)
$429.53
Total $
$626.59
Cost Difference: $

10. Thank you!
Layton Aging & Alzheimer’s Disease Center