Integrated Memory Care: Weaving Together Dementia Specialty & Caregiver Support by Emory Integrated Memory Care

The complexities of dementia care are multifaceted, encompassing the challenges faced by both the individuals experiencing cognitive decline and their caregivers. Dr. Carolyn Clevenger is the founder and director of Integrated Memory Care Practice, which is a joint initiative between Emory University and Emory Healthcare providing a nurse-led approach that redefines the traditional paradigms of dementia care. Established in 2014, Dr. Clevenger shares that it is, at its core, three things—primary care, dementia specialty care, and caregiver support—woven together to exemplify the shift towards a more holistic and personalized healthcare system.

Dementia, as a chronic condition, often requires more than just medical intervention; it necessitates a deep understanding of the patient's unique circumstances and the incorporation of their caregivers into the treatment process. Patients often live with this condition for a decade, from onset of symptoms to end of life. Caregivers play a crucial role in managing the daily complexities that arise from cognitive impairment. Dr. Clevenger's approach recognizes this by offering caregiver therapy sessions aimed at navigating family dynamics and individual psychological needs. Caregiver services is a core component for Integrated Memory Care, understanding that it is necessary to engage the caregiver who is likely not just providing physical, but also emotional and financial support. For that reason, their practice offers as many services for caregivers as for their patients.

Solely serving patients already diagnosed with dementia, the initial visit involves only the patient’s caregiver and a nurse practitioner to discuss the path to diagnosis, often a winding one, as well as symptoms observed. Dr. Clevenger points out that this can be a sensitive topic as dementia patients exhibit symptoms ranging from out of character behavior and confusion to physical aggression. The patient often does not remember these behaviors, so it is important to have these discussions solely with the caregiver and then allow the provider to focus entirely on the patient during their first exam. 

Most of the caregiver services beyond the first visit are provided by a clinical social worker on staff who is a trained facilitator through Savvy Caregiver, a national program adapted for multiple settings. This course is offered a couple of times each year for caregivers of clinic patients. Because caregivers often struggle with their own emotional challenges as the role can create a lot of anxiety, support groups are also provided, along with individual or family psychotherapy.

Dr. Clevenger’s career as a gerontological nurse practitioner was born from an early desire to work exclusively with older adults. She earned her master’s degree from Emory University and then completed her doctorate at Medical College of Georgia while working with the Alzheimer's Association and a local senior living community. Her work during that time was focused on how we might delay the onset of dementia symptoms and provide better support, while also receiving training in developing and evaluating programs. She completed her postdoctoral fellowship at the VA (Veterans Affairs) Center for Geriatrics which had her traveling between Birmingham and Atlanta tending to patients with dementia, while observing their experience when visiting the emergency department of a hospital.

Dr. Clevenger has been a professor at Emory University for over 20 years, beginning her teaching career with her daughter, now 21, as an infant in her arms. She has taught undergraduate, graduate, and doctoral students, developing not just models of care but also programs for family caregivers to give them the training that they need in the stage that they need it. Continuously evolving, she has made significant changes within these studies every four or five years, fully recognizing the importance of her work supporting future nurses as well as these older patients and their caregivers.

When establishing the clinic, Dr. Clevenger sought the retrospective advice of previous family caregivers on what would have made a difference in their role as a spousal caregiver. With this guidance, she designed services within the realities of the healthcare system. Brain Health, the primary care clinic, has been in operation since 2015.

Recently, they added their Community Program where they bring their services out to senior living communities with the goal of providing high-quality dementia healthcare to individuals in these settings. Nurse practitioners visit patients in their community, providing a “house call” type of visit. Dementia care assistants are community health workers who provide specialized companionship and therapeutic activities, visiting patients once or twice a week to provide one-on-one activities that might look just like a friendly visit. Ultimately, they are improving the quality of life and independence of patients, with the ability to assess a “good” or “bad” day and alternate between activities such as playing games, puzzles, artwork, reminiscence, therapeutic talk, therapeutic listening, physical activity, and supporting nutrition and hydration. Dementia care assistants are often able to recognize changes in patients that may need to be brought to the attention of their nurse practitioner—providing reassurance and additional peace of mind for families. Integrated Memory Practice currently has agreements to serve 21 senior living communities around the Metro Atlanta area.

Integrated Memory Care is one of six comprehensive dementia care models across the US, each differing in their practices; and IMC is the only one to offer full scope primary care. Nurse practitioners are trained on a population, for example gerontology, as opposed to a specialty like primary care or neurology. This gives nurse practitioners the unique ability to center and design services around the patients as well as their caregivers and offer them all “under one roof.” 

Integrated Memory Care focuses on patient and family experience, ensuring that each feel satisfied and supported. Things that are important to Medicare, like keeping patients out of the emergency department and hospital unnecessarily, is a risk that has been found to be cut in half when IMC patients are matched with similar patients in the health system over a three-year period. Even for patients with a dementia specialist and a primary care provider in separate practices, their risk of being in the hospital over that same three-year period still increases by 66%.

The integration of memory care into the broader spectrum of primary care and the empathetic understanding of the patient-caregiver relationship are crucial in addressing the needs of those living with dementia. By prioritizing the often-overlooked caregivers, Dr. Clevenger's approach sheds light on their indispensable role in managing the cognitive complexities dementia unfurls. 

To find out more, you can visit nursing.emory.edu/IMC where you can read news stories about caregivers and patients' experiences as well as view a video. There is also an online interest form along with a list of senior living communities where Integrated Memory Care is actively seeing patients or will launch soon. You can also contact Integrated Memory Care directly at 404-712-6929.