Social Work Interventions for Transforming Dementia Care (SWIFT-DC)

Connecting persons with dementia and their caregivers to Social Workers to provide services and support within and outside of the medical systems.

Dementia has staggering social and economic consequences, and models of care are needed to address the triple aims for this disease: improved quality of care, patient and caregiver satisfaction and decreased costs. In order to address this need and with prior UniHealth funding, we developed a pilot program for the care management of patients with dementia (PWD), utilizing interns from local undergraduate social work programs in partnership with Alzheimer’s Orange County (AlzOC), a major community organization dedicated to the care of individuals with dementia and their loved ones.

During our pilot program, A Comprehensive Agile Response Team for Dementia Health Care: CART-DC, we articulated workflows between the organizations, developed curriculum for the interns, tested our evaluation program and successfully enrolled PWD and their caregiver dyads into the program. We expanded this model into the SWIFT-DC program, Social Work Intervention for Transformation of Dementia Health Care. This model uses Social Work interns from the Geriatric Social Work Education Consortium (GSWEC) and coordinated by a social worker supervisor at AlzOC. The GSWEC is an integrated network of Southern California Schools of Social Work with the aim of providing interns who are highly motivated to pursue careers in geriatric care. Interns are assigned to dyads of PWD and their caregivers from a UC Irvine dementia registry. They conduct focused assessments to form individual care plans for the dyads. Interns provide person-centered support for at least one year. If dyads continue to have ongoing needs, support will continue to be provided.

Social Work intern training includes education on dementia related behaviors, medication review, environmental fall assessment, and social determinants of health. Measurable outcomes for dyads include changes in caregiver burden, neuropsychiatric symptoms, functional status, and utilization of healthcare services, in addition to satisfaction with the intern program by clients, healthcare providers and AlzOC staff. The development of this innovative model integrating a healthcare system and community organization will allow for better responses to the unique needs of PWD and their caregiver(s) at their time of need.