Tailored Caregiver Assessment and Referral® (TCARE®)
Rhonda J. V. Montgomery, PhD
Helen Bader School of Social Welfare
University of Wisconsin-Milwaukee
P.O. Box 786
Milwaukee, WI 53201
OVERALL SNAPSHOT OF THE CAREGIVER PROGRAM:
TCARE® (Tailored Caregiver Assessment and Referral®) is an evidence-based, six step care management program developed in 2007 by Dr. Rhonda JV Montgomery and colleagues at the University of Wisconsin-Milwaukee. TCARE® provides care managers with an efficient way to triage resources and available support services within a community to effectively address caregivers’ needs. This comprehensive system includes software, assessment tools, decision algorithms, and training program. It enables consistent, accurate screening and assessment of caregiver needs; uses scientifically-based decision algorithms to target services to specific identified needs; and fosters informed client choice and person-centered care.
The TCARE® process empowers family caregivers by providing them with critical information to make informed decisions that lead to the creation of highly individualized care plans. Additionally, the use of TCARE® decreases the amount of time a care manager spends in crisis management as the process allows the care manager to continuously assess and identify resources tailored to the specific needs of the caregiver as they move through their caregiving journey. This leads to the efficient use of scarce resources and lower healthcare costs. Two longitudinal randomized control studies conducted with partner organizations in four states have shown TCARE® to: 1) reduce caregiver stress, relationship strain, and depression and increase uplifts or the positive outcomes associated with caregiving. Studies have also shown TCARE® to lower caregiver’s intention to place the care recipient in an alternate care setting.
TCARE® is currently used by over 250 organizations in 12 states and has helped over 10,000 family caregivers nationwide.
BACKGROUND RELATED TO THE DEVELOPMENT OF THE INTERVENTION/PROGRAM:
TCARE® is grounded in the caregiver identity change theory, articulated by Montgomery and Kosloski (2013). The theory describes caregiving as a systematic process of identity change (e.g., change from original familial role of daughter to caregiver, change from original familial role of son to caregiver, change from original familial role of wife to caregiver, and change from original familial role of husband to caregiver). This identity change is understood to be a significant factor influencing the type and level of caregivers' stress and burden.
The theory reflects 30 years of research on family caregiving and provides three insights that are reflected in the TCARE ® process. First, caregiver stress is understood as an integral concept that has been empirically shown to be the most direct measure of caregiving experience. Moreover, stress is multidimensional with a wide range of factors affecting different types of caregivers' stress and burden. Second, there is great diversity among caregivers in terms of the type and quantity of tasks they undertake, the duration of time over which they serve in the role, the costs they incur, and the benefits that caregivers perceive as a consequence of their caregiving role. Third, there is great variation in patterns of service use among caregivers. Essentially caregivers will not use services that they do not perceive as needed and the perception of need is influenced by characteristics of the caregiver, the care receiver, and the provider. The caregiver identity change theory provides a lens to understand why caregiver interventions are not uniformly beneficial for all caregivers as well as guidance for effectively supporting caregivers with a wide range of services and educational resources.
TARGETED CAREGIVER POPULATION (AGE, ETHNICITY, CONDITION/DISEASE):
The TCARE® process can be used to support non-professional caregivers assisting adults of any age, ethnicity, condition and/or disease of the person for whom they care. The assessment tools have been translated for use with Hispanic, Korean and Chinese caregivers. The tools have also been adapted for use with caregivers of wounded or ill military service members and for use with caregivers supporting adults with developmental disabilities.
INTERVENTION/PROGRAM SPECIFIC OUTCOME MEASURES:
• Caregiver identity discrepancy (a disparity between the care responsibilities assumed and their caregiver identity, conceptualized as a major source of caregivers’ stress)
• Three types of caregiver burden (objective, relationship, and stress)
• Intention to place the care receiver in an alternate care setting
LENGTH OF INTERVENTION/PROGRAM:
TCARE® is a care management program that emphasizes the importance of routine follow-up with the caregiver. The full assessment and referral process requires 2 ½ to 3 hours of staff time to complete and includes two in-person or telephone meetings with the caregiver. Care managers are encouraged to contact the caregiver every three months to conduct a short re-assessment and/or revise the care plan.
DESCRIPTION OF THE PROGRAM:
The TCARE® process starts by asking the caregiver to complete a short screening tool to determine the need for a full assessment process. The screening tool which is completed using a paper or electronic format can be self-administered or administered by a trained staff member. Caregivers who indicate they intend to move the care recipient to another care setting or who scores above an established threshold on one or more of five key measures of caregiver stress or depression are invited to complete the full TCARE® process.
The full six-step TCARE® protocol includes: (1) an initial caregiver assessment, (2) a decision algorithm that produces a preliminary care plan that includes a goal and strategies for intervention on an initial care plan, (3) a structured process for tailoring a care plan to the needs and preferences of the caregiver, (4) consultation with the caregiver to discuss and agree upon a care plan, (5) the creation of a final care plan that incorporates preferences and decisions of the caregiver, and (6) established procedures for follow-up meetings to monitor progress and changes. Efficiency and fidelity of implementation of the process are facilitated by the use of six tools that have been incorporated into the web-based TCARE® e software and links to local and regional resource data bases.
Measures incorporated into the TCARE® protocol can be analyzed to determine population risks.
METHOD OF ADMINISTRATION/DELIVERY:
The TCARE® program is implemented by professional staff that serve as care managers for caregivers and are trained and certified to use the TCARE® protocol. These care managers use a web-based software application to implement the process.
To become a licensed TCARE® Assessor, an individual must participate in a two-day, intensive in-person training followed by completion of 2 follow-up webinars and a certification exam.
COST AND TIME CONSIDERATIONS:
Please contact TCARE Navigator, LLC for pricing.
VIDEO CLIP OF PROGRAM:
DOWNLOADABLE FACT SHEETS:
Washington State: Caregiver Screening, Assessment, and Planning Through the Family Caregiver Support Program http://www.adsa.dshs.wa.gov/professional/TCARE® /
BRIEF DESCRIPTION OF EVIDENCE:
Results from two randomized, longitudinal studies conducted with 20 organizations in four states have shown that the TCARE® lowers caregiver stress, and depression, increases uplifts and lowers intentions to leave the caregiving role. Studies conducted by research for the Washington State indicate that the use of TCARE® also delays nursing home placement, and minimizes use of Medicaid services.
1. Impact of TCARE® on Service Recommendations, Use, and Caregiver Well-Being; The Gerontologist; 2011
2. Effects of the TCARE® Intervention on Caregiver Burden and Depressive Symptoms: Preliminary Findings From a Randomized Controlled Study; The Journal of Gerontology Series B: Psychological Sciences and Social Sciences; 2011
3. Impact of Role Discrepancies on Caregiver Burden Among Spouses; Research on Aging; 2010
4. Caregiving as a Process of Changing Identity: Implications for Caregiver Support; Journal of the American Society on Aging; Spring 2009
5. Journal of the American Society on Aging; Spring 20095. TCARE®: Tailored Caregiver Assessment and Referral®; American Journal of Nursing; Sept 2008
6. A Dimensional Analysis of Caregiver Burden Among Spouses & Adult Children; The Gerontologist; 2010
7. Montgomery, R.J.V., Kosloski, K., “Pathways to Caregiver Identity and Implications for Support Services,” Chapter 8, pp. 131-156. In Talley, R.C., & Montgomery, R.J.V. (Eds.) (2013). Caregiving Across the Life Span: Research Practice and Policy. New York. Springer.
Nursing Home Placement