Care Ecosystem Toolkit

Implementation Tool
February 2018
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This toolkit details implementation guidance for the evidence-based Care Ecosystem model, which improves supports for people with dementia and their caregivers.


The Care Ecosystem model is a telephone- and web-based care program that provides education, support, and care coordination for people with dementia and their caregivers. A randomized controlled trial of this model showed improved quality of life of people with dementia, reduced emergency department visits, and decreased caregiver depression and burden. This toolkit can guide interested organizations in implementing this model.

About this Tool

The toolkit provides:

  • An introduction to the issue of dementia and caregiving, as well as an overview of the Care Ecosystem;
  • An implementation guide addressing organizational readiness and capabilities, roles and staffing, training, monitoring and evaluation, and physical space and system requirements;
  • Operational details, such as information on outreach and enrollment, caseload, individualized care plans, team meetings, and funding;
  • A set of care protocols, including, for example, an immediate needs assessment, medication review, and referrals and education; and
  • Appendices with supporting materials, such as job descriptions, templates, and workflow diagrams.


Provider-based delivery systems, accountable care organizations, health plans, Medicare Advantage or Medicaid Managed Care plans, state/county health and social service systems, home health organizations, and adult day care providers can use this toolkit to implement the Care Ecosystem model in their organizations.

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