Transitional Care for Alzheimer’s Patients in SNFs and their Caregivers
Official title: Transitional Care for Skilled Nursing Facility Patients with Alzheimer’s Disease and Related Dementias and their Caregivers: a Cluster Randomized Trial.
Funded at Univ of North Carolina Chapel Hill · NIH-11361696 · Data updated 2026-11-12
A program tested in skilled nursing facilities to help people with Alzheimer’s and related dementias transition home or to other care settings with less stress for caregivers.
Quick facts
| Grant type | R01 grant |
|---|---|
| Study type | NIH-funded research |
| Funding institution | Univ of North Carolina Chapel Hill NIH-funded |
| Lab location | 1 site (Chapel Hill, United States) |
| Project start | August 9, 2024 |
| Project end | May 31, 2028 |
| Funding year | 2026 |
| Award (this year) | $586,886 |
| NIH project number | 5R01NR017636-07 |
| Project ID | NIH-11361696 on NIH RePORTER |
Who could benefit from this research
✓Could help
Adults with ADRD who are being discharged from SNFs and their unpaid or family caregivers.
✕Less likely to help
Patients without ADRD or those not transitioning from SNFs may not benefit from this program.
What this research studies
This project tests a home-and-SNF transition program for people with ADRD and their caregivers. It builds on a prior Connect-Home model by adding an ADRD-focused discharge plan and post-discharge phone support from a Dementia Caregiving Specialist. The study uses a cluster randomized trial across 12 SNFs to see if the program reduces hospital readmissions, caregiver strain, and patient dementia-related symptoms. It targets about 360 patient–caregiver pairs to measure how well the transition support works in real-world SNF settings. If successful, the approach could become a standard part of post-SNF care for ADRD patients.
Why it matters
Potential benefit: If successful, patients may have smoother transitions from SNFs with fewer readmissions and caregivers may experience less stress.
How similar studies have gone: Previous Connect-Home work showed feasibility and potential benefits, with this study testing efficacy in the ADRD population.
Where this research is happening
-
Univ of North Carolina Chapel Hill
Chapel Hill, United States Active
Researchers
- Principal investigator: Toles, Mark P — Univ of North Carolina Chapel Hill
- Study coordinator: Toles, Mark P
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About this research
- This is an active NIH-funded research project — typically early-stage science, not a clinical trial accepting patient enrollment.
- Some NIH-funded labs run parallel clinical studies or seek volunteers for related work. To check, contact the principal investigator or institution listed above.
- For full project details, budget, and progress reports, visit the official NIH RePORTER page.