What is the dementia wrap around service?

Studies have shown that providing in-home care within a familiar environment can significantly reduce confusion and anxiety for individuals with dementia. A dementia wrap around service takes this concept further, offering a holistic and deeply personalized approach that supports both the individual with dementia and their caregivers.

Quick Summary

A dementia wrap around service is an intensive, team-based care approach that delivers highly personalized and coordinated support directly to a person with dementia and their family, often within their own home. It combines formal and informal services to meet complex needs, aiming to prevent crises and delay institutionalization by providing consistent and familiar support.

Key Points

• Holistic and Individualized: A dementia wrap around service creates a customized care plan that builds a network of formal and informal supports around the individual with dementia and their family.

• Team-Based Approach: Care is coordinated by a multidisciplinary team, including a facilitator, clinicians, service providers, and the family's natural support network.

• Preventive Focus: A key goal is to prevent crises, reduce stress, and delay or avoid the need for premature institutionalization by providing consistent and coordinated support.

• Supports Caregivers: The service is designed to reduce the emotional and physical burden on family caregivers by providing essential respite, guidance, and support.

• Enhances Quality of Life: By enabling the individual to remain in a familiar environment, the service helps reduce anxiety, increase security, and maintain dignity and independence.

• Flexible and Adaptive: The care plan evolves with the individual's needs, ensuring a smooth and consistent progression of care as the dementia advances.

Understanding the Wraparound Philosophy

At its core, the wraparound model is a philosophy of care that is radically individualized and centered on the person, not the available services. Instead of fitting a person's needs into a predefined menu of services, the wraparound approach builds a unique, comprehensive support plan around the individual and their family. This process is needs-driven and strengths-based, meaning it focuses on the individual's assets and desires to achieve their goals, rather than focusing solely on their deficits.

The wraparound process is most effective for individuals with complex issues where coordination across multiple services is required. It is a collaborative effort that brings together various perspectives to create a unified strategy. A central principle is "unconditional commitment," meaning the team adapts as the person's needs change over time, rather than abandoning the plan when challenges arise. This adaptive nature is crucial for managing a progressive condition like dementia.

The Team Behind the Care

A key element of a dementia wraparound service is the multidisciplinary team. This team is built around the person with dementia and their family, empowering them to have a central voice in decision-making. Typical team members include:

• The Facilitator: This person organizes meetings, coordinates efforts, and ensures the family's plan is working effectively. They assess the family's strengths and needs and develop the initial safety and crisis plan.
• The Individual and Family: The person with dementia and their family are the most important members of the team. Their goals, values, and preferences guide every aspect of the care plan.
• Mental Health Clinicians: For some services, a mental health professional may be involved to address emotional needs through individual and family therapy.
• Service Providers: This can include home health aides, physical therapists, occupational therapists, and nurses who provide formal care.
• Informal Support Network: Friends, neighbors, church members, and other trusted community members often participate, broadening the base of support.

Key Services Included in a Wraparound Plan

Wraparound care is not a one-size-fits-all solution. A typical plan might include a combination of the following formal and informal services:

• Case Management and Care Navigation
• Crisis Intervention and 24/7 Support Lines
• Respite Care for Caregivers
• Transportation Assistance for Appointments and Activities
• Therapies (e.g., physical, occupational, speech)
• Nutritional Support and Meal Planning
• Personal Care and Assistance with Activities of Daily Living (ADLs)
• Social and Recreational Activities
• Safety Assessments and Home Modifications

How a Dementia Wraparound Service Works

The process is typically structured in four key phases, designed to be methodical and responsive to the family's evolving situation:

1. Engagement and Team Preparation: The initial phase focuses on building a trusting relationship. A care coordinator works with the family to introduce the wraparound model and assemble the core care team, including both professionals and the family's natural support network. Urgent crisis situations are also addressed during this time.
2. Initial Plan Development: The team collaborates to create a highly individualized plan of care. This plan prioritizes the family's needs and preferences and sets clear, measurable goals. It also includes a robust crisis plan to help manage potential challenges.
3. Implementation: The team puts the plan into action, with regular monitoring to track progress toward the established goals. The plan is reviewed and adapted as needed, celebrating successes and addressing any setbacks.
4. Transition: As goals are achieved and stability is maintained, the family can transition out of the formal wraparound program. This is done gradually, with continued support from the natural support network and some formal services, but in a less intensive structure.

Benefits of a Wraparound Model for Dementia

Choosing a wraparound service can offer substantial advantages for individuals with dementia and their families. These benefits focus on enhancing quality of life and providing sustained support.

• Enhanced Sense of Security: Being in a familiar home environment can significantly reduce the anxiety and disorientation common in dementia. This consistency and familiarity provide a sense of security that can be disrupted by a move to an institutional setting.
• Reduced Caregiver Burden: The physical and emotional strain on family caregivers can be immense. Wraparound services provide crucial respite care, navigation assistance, and emotional support, preventing burnout and allowing family members to focus on their relationship with their loved one.
• Personalized, Evolving Care: Unlike institutional care, the wraparound model is adaptable. As dementia progresses, the care plan can be seamlessly modified to address changing needs, ensuring continuity of care without a jarring transition.
• Prevention of Crises: With 24/7 support lines and coordinated care, potential crises like falls, behavioral issues, or medical concerns can often be addressed quickly, helping to prevent hospitalizations or emergency placements in facilities.
• Dignity and Independence: By providing the necessary support to remain at home, wraparound care helps individuals retain their independence and dignity for as long as possible, fostering a sense of purpose through meaningful activities.

Wraparound Service vs. Traditional In-Home Care

Feature	Dementia Wrap Around Service	Traditional In-Home Care
Scope	Holistic, team-based, coordinating formal and informal support.	Typically provides specific services (e.g., personal care, companionship).
Customization	Highly individualized, person-centered plans built from the ground up.	Services are often chosen from a predetermined menu of options.
Focus	Aims to build a sustainable network and address complex needs.	Focuses on providing direct, in-home assistance and companionship.
Crisis Management	May include 24/7 access to support and robust crisis planning.	Often does not provide 24/7 access or intensive crisis intervention.
Team	Involves a multidisciplinary team, including clinicians and family.	Usually involves one or a small number of caregivers and a single agency point of contact.

Challenges and Considerations

Despite its benefits, implementing a dementia wraparound service can have challenges. Barriers like lack of public awareness, complex processes for securing services, and long waiting times can hinder access for families. The cost of care is a significant factor, as intensive services can be expensive, though potentially more manageable than 24/7 institutional care in the long run. Stigma surrounding dementia can also cause families to delay seeking help. Navigating funding options, which can vary widely, requires research and persistence.

The Future of Dementia Wrap Around Care

As the number of people living with dementia continues to grow, there is an increasing demand for home- and community-based services (HCBS) that allow individuals to age in place. Policymakers and healthcare providers are recognizing the need to shift away from institutionalization and towards integrated, person-centered care models. The wraparound model aligns perfectly with this shift, providing a blueprint for comprehensive, community-based support that enhances dignity, independence, and overall well-being. Efforts to simplify access, address costs, and increase public education are underway, promising a more supportive care ecosystem for the future.

For more information on the development of these services, a good resource is the National Institute on Aging, which tracks initiatives and developments related to home- and community-based services for dementia.

Conclusion

A dementia wrap around service provides a powerful and compassionate solution for families navigating the complexities of dementia care. By creating an individualized, team-based, and adaptable plan, it empowers the person with dementia to remain in the comfort of their own home, surrounded by familiar faces and routines. While challenges exist in access and cost, the model's focus on holistic, person-centered care offers profound benefits for the individual's well-being and provides much-needed support for dedicated caregivers.

Frequently Asked Questions

What is the primary goal of a dementia wrap around service?

The primary goal is to provide comprehensive, individualized, and coordinated support to a person with dementia and their family, enabling them to safely remain in their home and community for as long as possible.

How is a wraparound service different from typical in-home care?

Unlike traditional in-home care, which may provide specific services, a wraparound service is a holistic, team-based process that coordinates a wide range of formal and informal services to meet complex, individual needs.

Who is involved in a wraparound care team?

A wraparound care team typically includes a facilitator, mental health clinicians, professional caregivers, and the person's family, friends, and community members.

What types of services are included?

Included services are highly customizable and may involve case management, crisis support, respite care, counseling, physical and occupational therapy, transportation, and assistance with daily activities.

Is a wraparound service covered by insurance?

Coverage can vary. Some programs funded by Medicare (like GUIDE) or Medicaid in certain states may cover wraparound services. Families should investigate available public and private funding options.

Can wraparound services help with caregiver burnout?

Yes, a significant benefit is the provision of support and respite care for family caregivers. This helps to alleviate the immense physical and emotional burden of caregiving.

When is it the right time to consider a dementia wraparound service?

Families should consider a wraparound service when the needs of the person with dementia are becoming more complex, requiring extensive coordination across multiple areas of support, especially if the family network is strained.