Julia Nickrosz, CPC, CDP, Aging Life Care Manager, Dementia Specialist

When someone you love is living with dementia, there is no shortage of advice. Don’t argue. Redirect. Keep a routine. Encourage independence. Watch for safety concerns. Take care of yourself. All of that may be good advice, but knowing what you are supposed to do and figuring out how to actually do it with the person you love are two very different things.

That is where caregiver coaching can be so valuable.

A 2025 randomized controlled trial looked at an individualized program called ICECaP, which paired family caregivers with a dementia care coordinator for ongoing one-on-one support. Caregivers who received the intervention became significantly more prepared for their caregiving role. Within the intervention group, greater preparedness was also associated with lower caregiver burden and fewer negative reactions to dementia-related behaviors.

This builds on years of research showing that caregiver support is most useful when it goes beyond education alone. The Resources for Enhancing Alzheimer’s Caregiver Health (REACH) program combined dementia education with individualized problem-solving, skills training and ongoing support based on what caregivers were actually dealing with at home. In the REACH VA study, after six months caregivers reported significant reductions in burden, depression, frustration and dementia-related behaviors they found troubling. Ninety-six percent said the program should be offered to caregivers through the VA.

This is very much the idea behind caregiver coaching at Symphony Care Management. Families come to us with what is actually happening with their loved one, and we talk it through together. We help them understand how dementia may be contributing, provide dementia-specific education and offer practical recommendations based on both our knowledge of dementia and our direct work with their loved one.

A family may know they shouldn’t argue with someone who has dementia, but that doesn’t necessarily help when Mom is standing at the door at 8:00 at night insisting she needs to go home. A spouse may understand that dementia can cause resistance to personal care but still not know what to do when their partner becomes angry every time they suggest a shower. A daughter may know her father shouldn’t be driving, but that doesn’t make the conversation any easier when he insists there is nothing wrong with his driving.

These are the moments when families often need more than information. They need someone who understands dementia and someone who knows their loved one.

Through our direct work with the person living with dementia, we learn about their personality, history, routines, relationships, strengths and preferences. This allows us to apply person-centered care to our recommendations rather than relying on a generic list of dementia do’s and don’ts. Families bring us the concerns they are seeing. Mom won’t shower. Dad is accusing people of stealing. My husband wants to drive. She keeps asking to go home. He refuses help. We don’t agree about whether it is still safe for her to live alone.

We listen and talk it through. We look at what may be driving the behavior, what has already been tried, how dementia may be affecting the person’s ability to understand the situation and what we know about that individual. Recommendations might include changing the language being used, validating rather than correcting, offering fewer choices, approaching personal care differently, adding more structure to the day, using a therapeutic fiblet when the truth is causing unnecessary distress, or changing something in the environment.

It can also mean recognizing when something may not be dementia. A sudden change in behavior or function may warrant looking for pain, infection, medication effects, dehydration, constipation, sleep problems or another medical issue.

Caregiver coaching isn’t about telling a family what they have to do. Our role is to listen, educate, talk through the options, explain our recommendations and help families understand the potential risks and benefits. Ultimately, we respect where the person and family land. Families know their loved one in a way no professional ever can, and their values and circumstances have to be part of the decision.

WHY ONGOING CHECK-INS MATTER

Dementia doesn’t stand still. A plan that worked three months ago may not be working today, and changes can happen gradually enough that they are difficult to recognize when you are living with them every day.

There is research supporting regular contact with caregivers. In the 2025 ICECaP trial, caregivers had contact with a dementia care coordinator at least once a month for a year, with additional support available as needed. The support was individualized and included dementia education, behavioral and safety strategies, supportive counseling and care coordination. Caregivers receiving the intervention became significantly more prepared for caregiving, and greater preparedness was associated with lower burden and fewer negative reactions to dementia-related behaviors.

This is one reason monthly check-ins are an important part of our work at Symphony, even when things seem relatively stable. They give us an opportunity to hear what has changed, what is becoming harder and what is working. We can revisit strategies, identify new concerns and make adjustments before a small issue becomes a larger problem or crisis. When more is happening, families can reach out between scheduled check-ins rather than waiting for the next meeting.

These conversations also give families a consistent place to bring the questions that come up between medical appointments. Do we need more help at home? Is this behavior part of dementia? Should we be worried about the stove? Is driving still safe? How do we introduce an aide when Mom insists she doesn’t need one? Is this still the right living situation?

Regular contact also creates continuity. Families aren’t starting over with someone new each time something changes. We already know the person, the family, what has been tried, what has worked and what hasn’t. That history helps us recognize changes in context and think ahead about what may be coming next.

Other research suggests that caregiver support can affect the larger course of dementia care. In a randomized study of the NYU Caregiver Intervention, 66% of adult children receiving usual care eventually moved their parent into residential care, compared with 37% of those receiving the caregiver intervention. Residential placement was delayed by an average of approximately 228 days in the intervention group.

Keeping someone at home longer isn’t always the goal. Sometimes assisted living, memory care or skilled nursing is the safest and most appropriate next step. What the research reinforces is that supporting the caregiver is an important part of supporting the person living with dementia.

At Symphony Care Management, caregiver coaching combines our knowledge of dementia, what we learn about the person through our direct work with them, and the family’s lifelong knowledge of the person they love. We listen, educate, make recommendations and continue to adjust as things change, while respecting that these are personal decisions and that families ultimately decide what feels right for them.

The goal is for families to feel less like they are figuring out dementia on their own and to know they have someone who understands dementia, knows their loved one and can help them navigate what comes next.

RESEARCH

Gallagher VT, Reilly SE, Arp A, et al. (2025). Randomized clinical trial of the Individualized Coordination and Empowerment for Care Partners of Persons with Dementia (ICECaP) intervention: impact on preparedness for caregiving. Aging Clinical and Experimental Research.

Nichols LO, Martindale-Adams J, Burns R, et al. Translation of a Dementia Caregiver Support Program in a Health Care System: REACH VA. Archives of Internal Medicine.

Gaugler JE, Reese M, Mittelman MS. (2013). Effects of the NYU Caregiver Intervention Adult Child on Residential Care Placement. The Gerontologist.