Table 1.

JHDCNA Domains and Care Option/Strategy Examples

Memory Care Needs Domains of Participants	No. Items	Abbreviated Care Option/Strategy Examples*
A. Evaluation / Diagnosis	5	In-depth review by DCC/DCS; Referral to PCP or specialist physician for dementia evaluation and workup; neurologic evaluation, substance abuse referral.
B. Treatment of Cognitive  Symptoms	2	Evaluate whether a medication might be indicated and refer to PCP or Geriatrician or physician specializing in memory disorders for discussion/evaluation
C. Treatment of  Neuropsychiatry  Symptoms	5	In-depth review and characterization of concerning symptoms by DCC; Assessment of potential causes (e.g. UTI, constipation, pain); Refer to PCP or Geriatrician or physician specializing in memory disorders for discussion/evaluation of possible medication indications.
D. Behavior Management	3	In-depth review and characterization of concerning symptoms by DCC; provide instruction on specific behavior management/caregiver skills counseling; Assessment of potential causes (e.g. UTI, constipation, pain); Refer to Alzheimer’s Association
E. Medication Management	4	Initial review of medications by DCS; Request PCP or prescribing physician to evaluate polypharmacy or regimen adjustment; Assist in coordination of multiple prescribing physicians/pharmacies.
F. Medication Administration	3	Create medication administration routine that promotes compliance; Coordinate second party supervision or medication administration; Recommend specific devices or reminder tools
G. General Medical/Health Care	8	Referral to PCP, medical specialist or geriatric care manager; Recommend family and PCP consider hospice care
H. Allied Health Specialist Care	4	Referral to PCP. Recommend referral by PCP to PT, OT, SLP, home health care agency.
I. Safety	7	Identify possible environmental hazards (e.g. scatter rugs, out of date food, fall risks, fire risks, wander risks, guns/power tools) and make a plan to address each. Referral to driving evaluation program; home safety evaluation. Recommend asking PCP for PT, OT referral.
J. Assistance with Daily Activities	10	Arrange for informal or formal assistance for needed service. Provide caregiver skills counseling
K. Meaningful Activities	6	Evaluate and develop a list of activities that would match preferences, personality, and lifestyle and help caregiver implement. Provide caregiver skills counseling for help with creating a daily routine structure; Refer to friendly visitor programs, senior center, adult day, transportation service, etc.
L. Legal Issues / Advance Care Planning	5	Recommend patient and family engage in end-of-life care discussions with PCP and family members; Referral to eldercare attorney, or state attorney office about POA, will, advance directives
M. Assistance with Health Insurance	5	Review current medical needs, medications and referral to SHIP (Senior Health Insurance Program), CMS, US Veterans Affairs, AARP, ect.
N. Patient Education	1	Refer to PCP for discussion of illness. Refer to Alzheimer’s Association support group
O. Caregiver Availability	3	Identify and arrange for someone to take responsibility for intermittent phone checks, in-person visits, supervision.
P. Other Patient Needs	–	Dependent on needs listed
Memory Care Need Domains of Caregivers	No. Items	Abbreviated Care Option/Strategy Examples *
Q. Caregiver Education	3	Educate CG about dementia course and impact; provide written learning material; inform of educational events or local resources (health fairs, clinicians, senior centers, day care/home care services, support groups); instruct and counsel CG on care management issues (behavioral issues, ADLs, communication, family conflicts, planning, safety)
R. Resource Referrals	5	Refer to local or national chapter of Alzheimer’s Association; eldercare attorney (e.g. estate planning, will, power of attorney, advanced directives); Maryland Dept. of Aging or local agency; private geriatric care management services; Adult protective services.
S. Caregiver Mental Health Care	4	Proactively monitor CG stress levels; provide informal counseling, help with coping skills, and emotional support; Refer to licensed mental health professional; Arrange and plan regular respite care periods
T. Caregiver General Medical/ Health Care	3	Referral to PCP; specialist physician; other health care professional (e.g., dentist, optometrist, PT)
U. Other Caregiver Needs	–	Dependent on needs listed

^*Listed recommended interventions are not exhaustive. Actual recommendations based on the individual’s specific need within a category.

Note: Each need item was assessment as being either “fully met” (i.e. need is being addressed and potential benefits of available interventions have been achieved to the extent possible for the individual) or “unmet” (i.e. (1) it has not been addressed and potentially beneficial interventions are available, or (2) it has been or is being addressed but potential benefits of available interventions have not yet been achieved).