Ancillary health care providers can play a critical role in a dementia capable community, from early identification to family/caregiver education regarding community resources. These health care providers may include hospice and mental health care providers.

The information gathered here is part of the full Community Needs Assessment. Each survey question is cross-referenced to the full assessment. These questions are best investigated by someone working in health care.

Assessing Ancillary Health Care Providers for a Dementia Capable Community

  1. Review the information and resources on the ACT on Alzheimer’s Dementia Capable Communities Toolkit website related to the health care community.
  • Information & Education for Patients & their Families
  • Wellness Programs/Risk Reduction
  • Meaningful Activities
  • Independence at Home Services
  1. Develop a list of all of the ancillary health care providers in your community. Area Agencies on Aging (AAA) may be able to help you identify many of these organizations that support people with dementia in your community.
  2. Prioritize and determine which organizations to contact.
  3. Identify the appropriate contact(s) in these offices, such as the executive director.
  4. Keep track of your data sources, including who you interview and their responses to the questions in your interview.
  5. Create a code for each interviewee, using the sector abbreviation, plus a number. For example, ancillary health care provider interviewees would be AP1 for first interviewee, AP2 for second, etc.
  6. Use the Community Information Gathering - Survey/Call Script to introduce yourself and the project.
  7. Conduct interviews.
  8. After your information gathering, organize the data and summarize it in the Synthesizing the Assessment – Team Worksheet, which will be the basis for how your community rates its current level of activity and prioritizes what to focus on.

Interviewer/Your Name______Date of Interview______

Community Member/Interviewee ______Interviewee Code: AP

Name______

Title______

Address______

Phone______

Email______

Which organization type does this person represent?

☐Hospice

☐Mental health clinic (only questions 1, and 6-9 apply)

☐Other (please specify) ______

  1. Have you had personal experience with someone with dementia?☐Yes ☐No

Impairment Identification & Care - Section M

Identifying people with cognitive impairment is the first step toward diagnosis. Early diagnosis is important because it allows individuals and their families to plan for the future. Having a medical diagnosis opens the door to a number of resources that might not be available otherwise.

  1. Has your organization trained its staff in early detection of dementia and caring for people with dementia?Rate each setting on a scale from 0 to 4, with 4 being the highest. (Q28 in full assessment)

Training type / Rate whether training is provided
Never Sometimes Always Not Applicable
Early detection / ☐0 ☐1 ☐2 ☐3 ☐4 ☐NA
Caring for / ☐0 ☐1 ☐2 ☐3 ☐4 ☐NA

Note: This question is not intended to account for all continuing medical education (CME) pursued by individuals, although that may be the primary means of dementia education in private practices.

Level of Current Activity / Priority for Action
Indicate your level of agreement with this statement: Our community adequately trainshealth care staff in early detection of dementia and caring for people with dementia. / Indicate your level of agreement with this statement: Training health care staff in early detection of dementia and caring for people with dementia should be a priority for action in our community.
1.Strongly disagree
2.Disagree
3.Neither agree or disagree
4.Agree
5.Strongly agree
0.Do not know / 1.Strongly disagree
2.Disagree
3.Neither agree or disagree
4.Agree
5.Strongly agree
0.Do not know

What opportunities do you see for training ancillary health care providers in early detection of dementia and caring for people with dementia? What barriers do you see?

Wellness Programs/Risk Reduction - Section F

  1. Which of the following wellness programs and risk reduction services, tailored to people with dementia living outside a formal care setting, does your organization currently offer in our community? (Q14 in full assessment)

Services tailored to people with dementia / Currently available
Cognitive training / ☐Yes ☐No
Exercise programs / ☐Yes ☐No
Falls prevention / ☐Yes ☐No
Home safety / ☐Yes ☐No
Music or art therapy / ☐Yes ☐No
Nutrition programs / ☐Yes ☐No
Physical and occupational therapy / ☐Yes ☐No
Safety programs/devices for remote location monitoring (e.g., Comfort Zone,
MedicAlert + Safe Return (ALZ-MASR), Project Lifesaver) / ☐Yes ☐No
Socialization programs for early stage dementia / ☐Yes ☐No
Other (please specify) / ☐Yes ☐No
Level of Current Activity / Priority for Action
Indicate your level of agreement with this statement: Our community has an adequate level of wellness programs and risk reduction services tailored to people with dementia living outside a formal care setting. / Indicate your level of agreement with this statement: Increasing the level of wellness programs and risk reduction services tailored to people with dementia living outside a formal care setting should be a priority for action in our community.
1.Strongly disagree
2.Disagree
3.Neither agree or disagree
4.Agree
5.Strongly agree
0.Do not know / 1.Strongly disagree
2.Disagree
3.Neither agree or disagree
4.Agree
5.Strongly agree
0.Do not know

What opportunities do you see for wellness programs and risk reduction services tailored to people with dementia living outside a formal care setting? What barriers do you see?

Meaningful Activities - Section G

  1. Which of the following meaningful activities, tailored to people with dementia living outside a formal care setting, does your organization currently offer in our community? (Q15 in
    full assessment)

Services tailored to people with dementia / Currently available
Creative arts programs / ☐Yes ☐No
Dementia day programs / ☐Yes ☐No
Intergenerational connections / ☐Yes ☐No
Lifelong learning / ☐Yes ☐No
Outings/group activity programs / ☐Yes ☐No
Social program while caregiver is in support group at same location / ☐Yes ☐No
Spiritual support / ☐Yes ☐No
Other (please specify) / ☐Yes ☐No
Level of Current Activity / Priority for Action
Indicate your level of agreement with this statement: Our community has an adequate level of meaningful activities tailored to people with dementia living outside a formal care setting. / Indicate your level of agreement with this statement: Increasing the level of meaningful activities tailored to people with dementia living outside a formal care setting should be a priority for action in our community.
1.Strongly disagree
2.Disagree
3.Neither agree or disagree
4.Agree
5.Strongly agree
0.Do not know / 1.Strongly disagree
2.Disagree
3.Neither agree or disagree
4.Agree
5.Strongly agree
0.Do not know

What opportunities do you see for meaningful activities tailored to people with dementia living outside a formal care setting? What barriers do you see?
Independence at Home Services - Section J

  1. Which of the following services to help people with dementia remain independent in their homes does your organization currently offer in our community? (Q22 in full assessment)

Services / Pay source / Currently available
Care managers / Private / ☐Yes ☐No
Public / ☐Yes ☐No
Home safety assessment / Private / ☐Yes ☐No
Public / ☐Yes ☐No
Medication management, in-home / Private / ☐Yes ☐No
Public / ☐Yes ☐No
Occupational therapy (OT) assessment and interventions / Private / ☐Yes ☐No
Public / ☐Yes ☐No
Personal care assistant/home health aide / Private / ☐Yes ☐No
Public / ☐Yes ☐No
Personal emergency response system (e.g., Lifeline) / Private / ☐Yes ☐No
Public / ☐Yes ☐No
Other (please specify) / Private / ☐Yes ☐No
Public / ☐Yes ☐No
Level of Current Activity / Priority for Action
Indicate your level of agreement with this statement: Our community currently provides an adequate level of services to help people with dementia remain independent in their homes. / Indicate your level of agreement with this statement: Increasing the level of services to help people with dementia remain independent in their homes should be a priority for action in our community.
1.Strongly disagree
2.Disagree
3.Neither agree or disagree
4.Agree
5.Strongly agree
0.Do not know / 1.Strongly disagree
2.Disagree
3.Neither agree or disagree
4.Agree
5.Strongly agree
0.Do not know

What opportunities do you see for providing services to help people with dementia remain independent in their homes? What barriers do you see?

General

  1. Would you be interested in playing a greater role to help us implement this project in our community?
  • Suggestions:

-Serve on a coalition

-Serve on a task force or committee

-Public endorsement/testimonial

-Appoint a person to work on the project

-Donate resources, i.e., meeting space, advertising, personnel, funds, etc.

  1. Could you suggest other people/organizations/groups in our community who could take part in
    this project?
  1. Are there any other suggestions or ideas that you can give me as we prepare to get this
    project started?
  1. Are there any questions you would like to ask me?

Thank you for your time and support.

Would you like me to be in touch with you again to let you know how the project is progressing and how you can best help to ensure <community> is becoming more dementia capable?

☐Yes ☐No

Ancillary Health Care Provider SurveyPage1 of 6

©2014. This toolkit was made possible by funding from the Greater Twin Cities United Way.Rev. 01/08/14