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NCT07182357NARecruitingAccepts Healthy Volunteers

Designing Care Management for Hospice Transitions for Persons Living With Advanced Dementia

New York University

Start Date

5/13/2026

Completion Date

7/31/2028

Summary

This study will test a care management intervention to guide end-of-life care and hospice transitions for persons with dementia and their care partners receiving home healthcare and ascertain feasibility, acceptability, fidelity, and usability of a dementia care management hospice transitions checklist. This study will also examine hospice enrollment, time to enrollment, and care partner satisfaction with the intervention. The intervention will be delivered within usual care management within a large home healthcare agency.

Detailed Description

This study has the following design: Unblinded, Non-Randomized, Single-Arm Intervention Study (Feasibility Trial). In this study, the team will pilot test the care management checklist intervention with care partners of persons with dementia. This intervention will be tested for feasibility (primary outcome), acceptability, fidelity, and usability (secondary) for in a single arm feasibility trial. The intervention will be administered (NIH Stage 1B) within usual care management for hospice transitions with care partners of PLWD. This study will also examine hospice enrollment and time to enrollment, and care partner satisfaction with the intervention. The study population includes care partners and persons living with dementia; HHC professionals who engage in hospice transitions care management with care partners of PLWD (e.g., care managers who are nurses or social workers) and field nurses; Medical providers who engage in hospice transitions communication (e.g., home care physicians and nurse practitioners); HHC administrators who oversee and manage the delivery of care management prior to hospice transitions.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion: Care Partners and PLWD Dyad: 1. Care partners of PLWD who have a diagnosis of moderate to severe dementia. 2. Able to provide informed consent HHC Professionals: Care Managers and Field Nurses: 1. Care managers who regularly engage hospice transitions with care partners of PLWD 2. Age 18 or older Medical Providers: 1. Medical providers (e.g., physicians and nurse practitioners) who refer patients for hospice enrollment. 2. Age 18 or older HHC Administrators: 1. Home healthcare administrators who work with the Certified Home Health Agency or the Advanced Illness Management Program that refers patients to hospice care 2. Age 18 or older Exclusion Care Partner and PLWD Dyad 1. Under age 18 2. Care partners who are caring for PLWD with Mild Cognitive Impairment 3. PLWD with Mild Cognitive Impairment HHC Professionals: Care Managers, Medical Providers, Administrators 1\. Do not have experience managing hospice transitions for PLWD

Interventions

BEHAVIORAL

Dementia Care Management Checklist for Hospice Transitions

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Conditions

Alzheimer Disease and Related Dementias

Locations

NYU Rory Meyers College of Nursing and VNS Health

New York, New York 10010

United States