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Washington State Institute for Public Policy
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Case management with monetary assistance for caregivers of older adults with dementia

Public Health & Prevention: Home- or Family-based
  Literature review updated February 2018.

This analysis represents programs that include case management with monetary assistance for the informal caregivers of older adults that have dementia or Alzheimer’s disease (dementia/AD). These informal caregivers are typically the spouse or the adult child of the older adult with dementia/AD. Case management typically involves a standardized assessment, an individualized measurement-based treatment plan, and monitoring/reassessment of the plan as frequently as the program or case manager determines to be appropriate. Monetary assistance is typically allotted funds that caregivers can apply toward services referred to them by their case manager (e.g., adult day care, skilled nursing or rehabilitative therapies, respite care, housekeeping).

The single study included in this analysis is from the Medicare Alzheimer’s Disease Demonstration (MADD), a multisite national demonstration project that provided service coverage for the caregivers of older adults with dementia/AD. In the included study, monetary assistance for service benefits averaged $495 per client per month. Case managers were primarily social workers, with one site utilizing nurses instead. Case management occurred in one-on-one sessions in the home of the caregiver. The intervention lasted 36 months. Caregivers in the comparison groups receive the standardized assessment and referrals to other services without additional monetary assistance.
 
ALL
META-ANALYSIS
CITATIONS

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured No. of effect sizes Treatment N Effect sizes (ES) and standard errors (SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 63 1 1705 -0.049 0.035 63 -0.049 0.162
Caregiver burden
A measure of strain or stress for caregivers of older adults with dementia or Alzheimer's. Caregiver burden may include social, emotional, physical, or pratical stress or strain and is measured on a validated scale.
 63 1 1702 -0.036 0.035 63 -0.036 0.302

Citations Used in the Meta-Analysis

Newcomer, R., Yordi, C., DuNah, R., Fox, P., & Wilkinson, A. (1999). Effects of the Medicare Alzheimer's Disease Demonstration on caregiver burden and depression. Health Services Research, 34(3), 669-689.