Tailored Caregiver Assessment 

and Referral (TCARE)

Program Description

Tailored Caregiver Assessment and Referral (TCARE) is a care management protocol designed to support family 

members who are providing care to adults, of any age, with chronic or acute health conditions. TCARE is grounded 

in the Caregiver Identity Theory, which conceptualizes caregiving as a series of transitions that result from changes 

in the caregiving context and in personal norms that are grounded in familial roles and culture. A major tenet of 

the theory is that identity discrepancy, defined as a disparity between a caregiver’s behavior and his or her identity 

standards, or personal norms, is a major source of caregiver stress. Identity discrepancy can be manifested in three 

domains of burden (objective burden, relationship burden, and stress burden) and in depression.

TCARE is a triaging mechanism for identifying strategies and services to minimize identity discrepancy. The 

comprehensive system includes software, assessment tools, decision algorithms, and a training and technical 

assistance program. TCARE is implemented by the care manager (usually a social worker, nurse, or other human 

service professional) after he or she has completed training and become certified as a TCARE “assessor.” The 

protocol, using Web-based software that enables care managers to integrate extensive information, begins with a 

40- to 60-minute assessment, in which the care manager meets with the caregiver, either over the phone or in 

person, and assesses caregiver demographics, length and phase of caregiving, obligations, and physical and 

emotional health. The care manager also obtains information regarding the care receiver, such as demographics, 

activities of daily living (e.g., walking, bathing, dressing), and instrumental activities of daily living (e.g., cooking, 

shopping, managing medication). Key information is transferred to an assessment summary sheet, and scores are 

calculated for each of the key measures. Using these scores and other algorithms, the care manager identifies 

intervention goals, strategies, and an initial list of recommended services and resources (e.g., respite services, 

psychoeducational skills training, cognitive behavioral therapy, family counseling) from a catalog of 90 types of 

services. These recommendations, including the type of services and the amount of services, are tailored to the 

caregiver’s needs, preferences, and availability. The care manager consults with the caregiver to discuss the 

findings and provides the caregiver with information to make an informed choice on whether to use the 

recommended services and how the services will help with his or her caregiving needs. The process is repeated at 

3-month intervals so that the care plan can be adjusted as appropriate. The full assessment and referral process 

requires 21⁄2 to 3 hours of staff time to complete, and this time includes two 1-hour meetings (over the phone or in

person) with the caregiver.

In the studies reviewed for this summary, the follow-up periods included both the TCARE triage process and the 

receipt of any tailored services by participants.

Descriptive Information

Areas of Interest  Caregiver support

 Long-term services and supports

1 
Outcomes

Review Date: June 2014

 Caregiver identity discrepancy

 Intention for nursing home placement

 Depressive symptoms

 Relationship burden

 Stress burden

Ages 

 18–25 (Young adult)

 26–49 (Adult)

 50–60 (Older adult)

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

Genders  Female 

 Male 

Races/Ethnicities

 Black or African American

 White

 Race/ethnicity unspecified

Settings  Home

 Other community settings

Geographic Locations

 Urban

 Suburban

 Rural and/or frontier

Funding Partially/fully funded by Administration on Aging

Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the 

developer.

Implementation History

TCARE was first implemented in 2008. It was tested with the aging population 

between 2008 and 2012 in two randomized controlled studies in Georgia, Michigan, 

Minnesota, and Washington. In 2012, a military version of TCARE was evaluated at 10 

Soldier and Family Assistance Centers at Fort Bliss (Texas), Fort Bragg (North 

Carolina), Fort Campbell (Kentucky), Fort Gordon (Georgia), Fort Hood (Texas), Fort 

Knox (Kentucky), Fort Riley (Kansas), Fort Stewart (Georgia), Joint Base LewisMcChord (Washington), and Schofield Barracks (Hawaii). Since 2008, TCARE has been 

implemented in over 250 organizations in 17 States, serving approximately 20,000 

nonprofessional family caregivers.

Adaptations

The TCARE protocol was adapted for use with U.S. military personnel, as part of a 

program to support wounded troops. The TCARE assessment form has been adapted 

for use with those caring for individuals with developmental disabilities. Cultural 

adaptations have been made to the TCARE protocol for use with minority caregivers 

and those whose first language is not English. The assessment tool has been 

translated into Chinese, Korean, and Spanish. The Tailored Care Enterprises team is 

working with the University of Hawaii Center on Aging and the Hawaii Executive 

Office on Aging to conduct a feasibility study to culturally adapt the protocol to 

support caregivers in Hawaii’s multicultural population and to create a blended 

training curriculum to include Web-based and in-person training. 

2 
Quality of Research

Review Date: June 2014 

Documents Reviewed 

The documents below were reviewed for Quality of Research. The research point of contact can provide 

information regarding the studies reviewed and the availability of additional materials, including those from 

more recent studies that may have been conducted. 

Study 1

Kwak, J., Montgomery, R., O’Connell Valuch, K., & Kosloski, K. (2013, November). Results of a randomized trial of 

an innovative care management protocol for family caregivers. Poster presented at the annual meeting of the 

Gerontological Society of America, New Orleans, LA.

Montgomery, R. J. V., Kwak, J., Kosloski, K., & O’Connell Valuch, K. (2011). Effects of the TCARE intervention on 

caregiver burden and depressive symptoms: Preliminary findings from a randomized controlled study. Journals 

of Gerontology, Series B: Psychological Sciences and Social Sciences, 66(5), 640–647. PubMed abstract available 

at http://www.ncbi.nlm.nih.gov/pubmed/21840840

Study 2

Kwak, J., Montgomery, R. J. V., Kosloski, K., & Lang, J. (2011). The impact of TCARE on service recommendation, 

use, and caregiver well-being. Gerontologist, 51(5), 704–713. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/21593010

Supplementary Materials

Montgomery, R., & Kwak, J. (2008). TCARE: Tailored Caregiver Assessment and Referral. American Journal of 

Nursing, 108(9, Suppl.), 54–57. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18797229

Montgomery, R. J. V., & Kosloski, K. (2009). Caregiving as a process of changing identity: Implications for 

caregiver support. Generations, 33(1), 47–52.

Montgomery, R. J. V., & Kosloski, K. D. (2012). Pathways to a caregiver identity and implications for support 

services. In R. C. Talley & R. J. V. Montgomery (Eds.), Caregiving across the lifespan: Research, practice, policy. 

New York, NY: Springer.

O’Connell Valuch, K., Kwak, J., Brondino, M., Kosloski, K., & Montgomery, R. J. V. (2010, November). Caregiver 

Identity Discrepancy Scale: Reliability, construct validity and unidimensionality. Poster session presented at the 

annual meeting of the Gerontological Society of America, New Orleans, LA.

Savundranayagam, M. Y., & Montgomery, R. J. V. (2010). Impact of role discrepancy on caregiver burden among 

spouses. Research on Aging, 32(2), 175–199.

3 
Savundranayagam, M. Y., Montgomery, R. J. V., & Kosloski, K. (2011). A dimensional analysis of caregiver burden 

among spouses and adult children. Gerontologist, 51(3), 321–331. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/21135026

Outcomes 

Outcome 1: Caregiver Identity Discrepancy 

Description of Measures

Caregiver identity discrepancy is defined as the affective psychological state that 

accrues when there is a disparity between the care activities in which a caregiver is 

engaging and those activities that would be otherwise consistent with his or her 

identity standard. Using a scale ranging from 1 (strongly disagree) to 6 (strongly 

agree), respondents indicated the extent to which they agreed with each of 6 

statements (e.g., “The things I am responsible for do not fit very well with what I 

want to do,” “It is difficult for me to accept all the responsibility for my [care 

recipient]”). Scores range from 6 to 36, with higher scores indicating greater

caregiver identity discrepancy. 

Key Findings

TCARE was evaluated in two randomized controlled trials (RCTs) that compared 

TCARE and treatment as usual. Care managers assigned to the treatment as usual 

group served caregivers following the normal customary practices of their 

organization. In one study, family caregivers were served by care managers from 

social service organizations in Georgia, Michigan, Minnesota, and Washington. In the 

other study, family caregivers were served by care managers from three area 

agencies on aging in Georgia. Assessments for both studies were conducted at 

baseline and at 3-, 6-, and 9-month follow-ups. 

Over time, caregivers in the intervention group had a decrease in caregiver identity 

discrepancy, whereas caregivers in the treatment as usual group had an increase (p = 

.012, Study 1; p = .0309, Study 2).

Studies Measuring 

Outcome Studies 1 and 2

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.7

Outcome 2: Intention for Nursing Home Placement 

Description of Measures

The caregiver’s current and future intention to place the care receiver in a nursing 

home was assessed with 2 items. Using a 4-point scale ranging from “definitely not” 

to “definitely would,” respondents indicated whether they intended to place the care 

receiver in a nursing home or other long-term care facility, given the care receiver’s 

current condition, as well as the care receiver’s future condition if it became worse. 

Scores range from 2 to 8, with higher scores indicating the caregiver’s greater 

intention to place the care receiver in a nursing home or other facility. 

4 
Key Findings

TCARE was evaluated in an RCT that compared TCARE and treatment as usual. Care 

managers assigned to the treatment as usual group served caregivers following the 

normal customary practices of their organization. Family caregivers were served by 

care managers from social service organizations in Georgia, Michigan, Minnesota, and 

Washington. Assessments were conducted at baseline and at 3-, 6-, and 9-month 

follow-ups. 

Over time, caregivers in the intervention group had a decrease in intention to place 

the care receiver in a nursing home, whereas caregivers in the treatment as usual 

group had an increase (p = .002).

Studies Measuring 

Outcome Study 1 

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.5

Outcome 3: Depressive Symptoms 

Description of Measures

Depressive symptoms were assessed with the 10-item version of the Center for 

Epidemiological Studies–Depression scale. Using a 4-point scale ranging from “rarely 

or none of the time (less than 1 day)” to “all of the time (5-7 days),” respondents 

indicated the frequency of various depressive symptoms experienced during the past 

week (e.g., “I was bothered by things that usually don't bother me,” “I felt 

depressed,” “My sleep was restless”). Scores range from 0 to 30, with higher scores 

indicating more frequent depressive symptoms.

Key Findings

TCARE was evaluated in two RCTs that compared TCARE and treatment as usual. Care 

managers assigned to the treatment as usual group served caregivers following the 

normal customary practices of their organization. In one study, family caregivers were 

served by care managers from social service organizations in Georgia, Michigan, 

Minnesota, and Washington. In the other study, family caregivers were served by care 

managers from three area agencies on aging in Georgia. Assessments for both studies 

were conducted at baseline and at 3-, 6-, and 9-month follow-ups. 

Over time, caregivers in the intervention group had a decrease in the frequency of 

depressive symptoms, whereas caregivers in the treatment as usual group had an 

increase (p = .0051, Study 1; p = .0286, Study 2).

Studies Measuring 

Outcome Studies 1 and 2

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.8

5 
Outcome 4: Relationship Burden 

Description of Measures

Relationship burden was assessed with the Relationship domain of the Montgomery 

Borgatta Caregiver Burden Scale (modified version), which contains 5 items regarding 

the demands for care and attention over and above the level that the caregiver 

perceives is warranted by the care receiver’s condition (i.e., the extent to which the 

care recipient’s behavior is perceived by the caregiver to be manipulative or overly 

demanding). Using a scale ranging from 1 (not at all) to 5 (a great deal) to indicate the 

extent to which their caregiving responsibilities changed each aspect of their life, 

respondents rated each item (e.g., “Have your caregiving responsibilities caused 

conflicts with your care recipient?” and “Have your caregiving responsibilities made 

you feel you were being taken advantage of by your relative?”). Scores range from 5 

to 25, with higher scores indicating a greater relationship burden. 

Key Findings

TCARE was evaluated in two RCTs that compared TCARE and treatment as usual. Care 

managers assigned to the treatment as usual group served caregivers following the 

normal customary practices of their organization. In one study, family caregivers were 

served by care managers from social service organizations in Georgia, Michigan, 

Minnesota, and Washington. In the other study, family caregivers were served by care 

managers from three area agencies on aging in Georgia. Assessments for both studies 

were conducted at baseline and at 3-, 6-, and 9-month follow-ups. 

In Study 1, over time, caregivers in the intervention group had a decrease in 

relationship burden, whereas caregivers in the treatment as usual group had an 

increase (p = .003). In Study 2, there were no significant between-group differences 

for relationship burden. 

Studies Measuring 

Outcome Studies 1 and 2

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.7

Outcome 5: Stress Burden 

Description of Measures

Stress burden was assessed with the Stress domain of the Montgomery Borgatta 

Caregiver Burden Scale (modified version), which contains 5 items regarding the 

perceived effects of caregiving on affect. Using a scale ranging from 1 (not at all) to 5 

(a great deal) to indicate the extent to which their caregiving responsibilities changed 

each aspect of their life, respondents rated each item (e.g., “Have your care 

responsibilities made you nervous?”). Scores range from 5 to 25, with higher scores 

indicating greater stress burden. 

Key Findings

TCARE was evaluated in two RCTs that compared TCARE and treatment as usual. Care 

managers assigned to the treatment as usual group served caregivers following the 

normal customary practices of their organization. In one study, family caregivers were 

served by care managers from social service organizations in Georgia, Michigan, 

Minnesota, and Washington. In the other study, family caregivers were served by care 

6 
Ratings 

managers from three area agencies on aging in Georgia. Assessments for both studies 

were conducted at baseline and at 3-, 6-, and 9-month follow-ups. 

Over time, caregivers in the intervention group had a decrease in stress burden, 

whereas caregivers in the treatment as usual group had an increase (p < .0001, 

Study 1; p = .0258, Study 2).

Studies Measuring 

Outcome Studies 1 and 2

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.7

Study Populations 

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity 

Study 1

 18–25 (Young adult)

 26–49 (Adult)

 50–60 (Older adult)

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

 79.7% Female 

 20.3% Male

 75.7% White

 19.4% Black or African 

American

 7.9% Race/ethnicity 

unspecified

Study 2

 26–49 (Adult)

 50–60 (Older adult)

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

 84.5% Female 

 15.5% Male

 54.6% White

 42.3% Black or African 

American

 3.1% Race/ethnicity 

unspecified

Quality of Research Ratings by Criteria (0.0–4.0 scale) 

Criterion Outcome 1 Outcome 2 Outcome 3 Outcome 4 Outcome 5 

Reliability of 

Measures 3.9 3.3 4.0 4.0 4.0

Validity of Measures 3.3 3.0 3.8 3.5 3.5

Intervention Fidelity 3.9 3.9 3.9 3.9 3.9

7 
Criterion 

Ratings 

Outcome 1 Outcome 2 Outcome 3 Outcome 4 Outcome 5 

Missing Data and 

Attrition 3.6 3.3 3.6 3.6 3.6

Potential 

Confounding 

Variables

3.5 3.5 3.5 3.5 3.5

Appropriateness of 

Analysis 4.0 4.0 4.0 4.0 4.0

Overall Rating 3.7 3.5 3.8 3.7 3.7

Study Strengths 

Internal consistency reliability was adequate to high for all outcome measures. The items used to assess intention for 

nursing home placement have face validity, and the other outcome measures have evidence of construct validity. 

Intervention fidelity efforts included TCARE care managers receiving 2 days of intensive training, a 1-day follow-up 

practicum session, and a Web-based application training, and all intervention group cases were reviewed by the 

research team at baseline and the 6-month follow-up for adherence to the intervention protocol. One study reported 

the results of analyses of scores from a 27-item fidelity checklist. The mean scores for mechanics (accuracy of the 

information recorded) and implementation (consistency of the care plan with the TCARE protocol) improved from 

baseline (68% and 71%, respectively) to the 6-month follow-up (85% and 89%, respectively). Although attrition was high 

at the 9-month follow-up, there were almost no missing data for program completers, and restricted maximum 

likelihood estimation was effectively used to address missing data and attrition. Caregivers were randomly assigned 

to intervention or treatment as usual groups. There were no significant differences between caregivers in the 

intervention and treatment as usual groups at baseline on demographic or outcome measures. Repeated measures 

random effects regression analysis was used.

Study Weaknesses 

The items used to assess intention for nursing home placement are not established in the field. Evidence of the 

validity of the measures for the diversity of the study samples was unclear. In one study, there was no discussion of 

the characteristics of those who dropped out relative to those who remained, nor was there a discussion of how 

attrition might have affected the outcomes. Care managers were not randomly assigned to the intervention or 

treatment as usual group.

Readiness for Dissemination

Review Date: June 2014 

8 
Materials Reviewed 

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can 

provide information regarding implementation of the program and the availability of additional, updated, or 

new materials.

Kwak, J., Montgomery, R., O’Connell Valuch, K., & Kosloski, K. (2013, November). Results of a randomized trial of 

an innovative care management protocol for family caregivers. Poster presented at the annual meeting of the 

Gerontological Society of America, New Orleans, LA. 

Montgomery, R. J. V., & colleagues. (2010). TCARE military family member assessment. Milwaukee: University of 

Wisconsin–Milwaukee. 

Montgomery, R. J. V., & colleagues. (2010). TCARE military family member assessment: Follow-up form.

Milwaukee: University of Wisconsin–Milwaukee. 

Montgomery, R. J. V., Rowe, J. M., Jacobs, J., & associates. (2010). Guide for selecting support services: Military.

Milwaukee: University of Wisconsin–Milwaukee Research Foundation.

Montgomery, R. J. V., Rowe, J. M., Jacobs, J., & associates. (2010). Tailored CARE: Tailored Caregiver Assessment 

and Referral user manual (Version 3.0). Milwaukee: University of Wisconsin–Milwaukee Research Foundation.

Program Web site, http://www.tailoredcare.com

Tailored Care Enterprises, LLC. (2014). TCARE training manual. Mequon, WI: Author.

TCARE training presentation materials:

1. Tailored CARE: Improving Care for Caregivers [PowerPoint slides]

2. Exploring the Caregiver Experience [PowerPoint slides]

3. Caregiver Identity Change Theory [PowerPoint slides]

4. Rethinking Support Services [PowerPoint slides]

5. TCARE Screening [Video] 

6. Assessment & Overview of Steps [PowerPoint slides]

7. TCARE Decision Maps [PowerPoint slides]

8. Introduction to the Guide for Selecting Support Services [PowerPoint slides]

9. The “Ity Lens” Helps Make Decisions [PowerPoint slides]

10. Creation of the Care Plan Consultation Worksheet & Care Plan [PowerPoint slides]

11. Follow-Up [PowerPoint slides]

12. Wrap-Up [PowerPoint slides]

Other materials and forms:

• Educational Resource Form

• Local Resources—Organization Resource Profile

9 
• Sample TCARE Certificate of Certification

• Six-Step TCARE Process

• TCARE Assessment Questions

• TCARE Brochure

• TCARE Certification Exam (with sample narrative and assessment form)

• TCARE Process Video

• TCARE Related Bibliography

Readiness for Dissemination Ratings by Criteria (0.0–4.0 scale) 

Criterion Rating 

Implementation Materials 3.9

Training and Support 3.5

Quality Assurance 4.0

Overall Rating 3.8

Dissemination Strengths 

The user manual includes all of the tools and information needed to implement the program. Participant criteria and 

implementer qualifications are described, and assessment forms, decision maps, and service planning forms are very 

clear and easy to use. Video presentations provide excellent introductions to the program and demonstrations of how 

the screening is implemented. The TCARE software allows users to integrate local, regional, and statewide resources 

as needed with support from the Tailored Care Enterprises team. Training materials and support resources are 

extensive and audience appropriate, tailored to individual organizational types. As a part of the licensing fee, ongoing 

consultation and support are available through Tailored Care Enterprises, who address issues at all levels of 

implementation (i.e., policy, administration, intake, and program delivery) through in-person meetings, phone calls, 

and Webinars. The TCARE software guides the screening process, monitors outcomes, and directs planning and 

decisionmaking on the basis of responses to screening questions—all of which promote fidelity and quality of 

implementation. Care managers (i.e., assessors) must be trained and certified annually.

Dissemination Weaknesses 

Little guidance is provided on incorporating TCARE into existing services or recruiting participants. It is unclear how 

frequent training opportunities are available; training options are not clearly presented in a central, public location 

(such as on the program Web site). 

Costs

The cost information below was provided by the developer. Although this cost information may have been 

updated by the developer since the time of review, it may not reflect the current costs or availability of items 

(including newly developed or discontinued items). The implementation point of contact can provide current 

information and discuss implementation requirements.

10
Implementation Materials 

Item Description Cost 

Required by 

Developer 

TCARE Overview Webinar Free No

Annual licensing fee (includes ongoing 

consultation and technical support)

 Medicaid organizations: 

• For 1–50 assessors, $350 per 

assessor

• For 51–100 assessors, $300 per 

assessor

• For 101 or more assessors, $250 

per assessor

 For-profit organizations: 

• For 1–100 assessors, $600 per 

assessor

• For 101–200 assessors, $480 per 

assessor

• For 201 or more assessors, $360 

per assessor

Yes

2-day, on-site TCARE Assessor Training 

(includes TCARE Training Manual and 

TCARE User Manual) 

 Medicaid organizations: $19,000 for 

up to 12 assessors, plus travel 

expenses for 2 trainers

 For-profit organizations: $23,000 for 

up to 12 assessors, plus travel 

expenses for 2 trainers

Yes, one training option is 

required

2-day, off-site TCARE Assessor Training $1,700 per assessor Yes, one training option is 

required

2-hour TCARE Screen Training Webinar $250 for up to 30 assessors No

Replacement TCARE Training Manual $100 each No

Replacement TCARE User Manual $110 each No

Incorporation of regional/statewide 

resource database into TCARE software $6,400 per site No

Program evaluation support Varies depending on site needs No

Creation of State/organizational data 

reports Varies depending on site needs No

11
Item Description Cost 

Required by 

Developer 

Tailored Care Enterprises review fee 

(includes review and approval of any 

changes made to licensed materials)

$60 per hour Yes

2-hour Assessor Recertification Webinar $50 per assessor

Yes, if assessor did not 

complete 5 TCARE cases 

during licensing year

Other Citations

Hauptman, H., & Korte, l. (2013, January). Family Caregiver Support Program: A report on the FY 2012 expansion.

Olympia: Washington State Department of Social and Health Services, Aging and Disability Services 

Administration. Available at 

http://www.altsa.dshs.wa.gov/stakeholders/TCARE/documents/FCSP%20Expansion%20Report%20-

%20January%207%202013.pdf

Miller, M. (2012, November). Did expanding eligibility for the Family Caregiver Support Program pay for itself by 

reducing the use of Medicaid-paid long-term care? (Document No. 12-11-3901). Olympia: Washington State 

Institute for Public Policy. Available at http://www.wsipp.wa.gov/ReportFile/1110/Wsipp_Did-ExpandingEligibility-for-the-Family-Caregiver-Support-Program-Pay-for-Itself-by-Reducing-the-Use-of-Medicaid-Paid-LongTerm-Care_Full-Report.pdf

Montgomery, R. J. V. (2011). Final narrative report: Assessing a care management protocol to strategically 

support family caregivers (Report submitted to the Jacob & Valeria Langeloth Foundation). 

Montgomery, R. J. V. (2011). Final scientific progress report: Accessing a protocol to strategically support family 

caregivers (Report submitted to the Alzheimer’s Association; Grant No. IIRG-07-60123). 

Montgomery, R. J. V., Kwak, J., Rowe, J. M., Jacobs, J., Lang, J., O’Connell Valuch, K., & Wallendal, M. (2010). 

Improving options for persons with Alzheimer’s Disease and their caregivers in the State of Georgia: Tailored 

Caregiver Assessment and Referral project final report—July 1, 2007–March 31, 2010 (Report submitted to the 

Georgia Division of Aging Services). 

Montgomery, R. J. V., Rowe, J. M., & Kwak, J. (2009). Final report: Georgia Division of Aging Services regarding 

Tailored Caregiver Assessment and Referral (TCARE) protocol project July 1, 2007–December 31, 2008 (Report 

submitted to the Georgia Division of Aging Services). 

Translational Work

TCARE has been implemented in over 250 organizations in 17 states. The most successful translation of the 

TCARE protocol into practice has been accomplished by the State of Washington. The Family Caregiver Support 

Program (FCSP) was established by the Washington State Department of Social and Health Services, Aging and 

12
Disability Services Administration (ADSA), to provide a more comprehensive array of information, resources, and 

services for unpaid family caregivers caring for adults with functional disabilities. In 2007 TCARE was integrated 

into the FCSP and implemented through the State’s 13 area agencies on aging (AAAs). 

The TCARE protocol is designed to tailor services to the unique needs of each caregiver, thereby reducing 

depression and burdens (i.e., objective, relationship, and stress burdens) associated with caregiving. TCARE 

provides a consistent, objective, and reliable screening and assessment process that identifies at-risk caregivers 

and allows care managers to target resources to those most in need and determine whether support and 

services are making a measurable difference to caregivers. TCARE also helps inform policy through the collection

of statewide data. Washington is the first State to automate the full TCARE process through integrating the 

assessment tools and decision algorithms into the State’s client data system, using custom-built software.

Eligible caregivers are those who provide uncompensated care for a parent, spouse, or another adult with 

medical issues, mobility limitations, or decreased cognitive functioning. As a result of a significant increase in 

funding in Fiscal Year (FY) 2012, 1,518 new caregivers received information and limited services (up to a value of 

$250 once annually). A total of 859 new caregivers received the TCARE screening and services without going 

further in the TCARE process, and 2,273 new caregivers received a TCARE assessment and/or a care plan and 

tailored services. To date, the State of Washington has served over 11,000 caregivers using TCARE, and more 

than 8,000 of these caregivers have completed the full TCARE process at least once.

When TCARE was first launched in Washington, ADSA and its AAA partners formed a policy oversight committee 

to develop comprehensive policies for implementation and establish restrictive criteria for assessments and 

costlier services in response to budget constraints. From July 2009 to January 2010, significant staffing resources 

were dedicated to training, implementation, and policy development related to TCARE. At that time, a portion of 

the TCARE protocol, the TCARE screen, was offered to all interested family caregivers to identify those who 

should receive a full assessment. The full TCARE protocol, which includes a caregiver assessment, consultation, 

and care planning, along with a more comprehensive set of services, was available only to those family 

caregivers at the highest levels of burden.

Recognizing the need to better serve family caregivers before they are close to placing their loved ones in a longterm care facility, the 2011 Washington Legislature expanded the FCSP to serve more caregivers by increasing its 

funding by $3.45 million for FY 2012. This increase allowed the FCSP to serve up to 1,500 new family caregivers 

who were experiencing depression and/or burdens but were not yet eligible to receive a full TCARE assessment 

and care plan, as well as related services, under the previous criteria. Most of this funding was used to pay for 

higher tier services offered to more families as a result of lowering eligibility thresholds. The increased funding 

in FY 2012 assumed that savings would be achieved by diverting care receivers from more costly Medicaid longterm care services. To serve the increased number of caregivers, the AAAs or other community service partners 

hired new staff, and many staff had to be certified to administer TCARE. The TCARE certification process, 

managed by Tailored Care Enterprises, LLC, includes an intensive, on-site, 2-day training plus assessment

practice and online testing; it can take up to 6 weeks for staff to become certified, but most staff are certified in 

4 weeks. 

The additional funding provided by the Washington State Legislature in FY 2012 also was used to conduct a 

review of the FCSP by the Washington State Institute for Public Policy (WSIPP). The review confirmed that 

13
caregivers screened after the expansion were more likely to receive a full assessment and a broader range of 

support services than those screened in prior years. Family caregivers who participated in the full TCARE 

assessment and continued to be served through the FCSP 6 months later demonstrated positive changes. 

Despite an increase in assistance needed by their care receivers (e.g., daily living activities) over the 6-month 

period, caregivers demonstrated lower objective burden, stress burden, identity discrepancy, and depression. 

Although the focus of the FCSP has always been on improving outcomes for caregivers, the expansion and the 

WSIPP study led to the measurement of outcomes for care receivers as well. Care receivers whose caregivers 

were screened after expansion were approximately 20% less likely to enroll in Medicaid long-term care services 

in the 12 months following screening compared with prior years, despite the fact that more postexpansion care 

receivers were already enrolled in Medicaid medical coverage at the time of screening. Care receivers whose 

caregivers were screened after expansion were slower to transition to Medicaid long-term care, after controlling 

for differences in baseline characteristics.

Next steps in maintaining the TCARE protocol in the State of Washington include the following: (1) sustain 

funding for the FCSP at the current expansion levels; (2) consider a longer term study of the impact related to 

Medicaid long-term care diversion and savings, as well as the impact of caregiving on employment, family 

caregivers’ health outcomes, and health care costs; (3) continue to target higher levels of services to those 

caregivers and care receivers at highest risk, including caregivers whose care receiver is enrolled in Medicaid 

medical coverage at the time of the screen, caregivers whose care receiver has been diagnosed with dementia, 

caregivers who indicate that they definitely would consider placing their care receiver in a nursing home, and 

caregivers whose screen responses indicate a greater number of high burdens; (4) implement a standardized 

satisfaction feedback survey with caregivers using the program; and (5) implement a new system of tracking 

services and expenditures provided to each individual caregiver, which would help to address questions 

regarding whether specific services may have affected the use of Medicaid long-term care.

Site With 

Translational 

Work 

Articles Describing Site’s Translational Work, by Category 

Planning/ 

Partners Adoption 

Reach/ 

Recruitment Implementation Effectiveness Maintenance 

Washington 

State Articles 1–3 

Articles 1 

and 3 Articles 1–3 Articles 1–3 Articles 1–3 Articles 1 and 3

Article 

Number Article Reference 

1 

Hauptman, H., & Korte, l. (2013, January). Family Caregiver Support Program: A report on the FY 2012 

expansion. Olympia: Washington State Department of Social and Health Services, Aging and 

Disability Services Administration. Available at 

http://www.altsa.dshs.wa.gov/stakeholders/TCARE/documents/FCSP%20Expansion%20Report%20-

%20January%207%202013.pdf

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Article 

Number Article Reference 

2 

Lavelle, B., Mancuso, D., Huber, A., & Felver, B. E. M. (2014, April). Expanding eligibility for the 

Family Caregiver Support Program in SFY 2012: Updated findings (RDA Report 8.31). Olympia: 

Washington State Department of Social and Health Services, Research and Data Analysis Division. 

Available at http://publications.rda.dshs.wa.gov/1502/470/

3 

Miller, M. (2012, November). Did expanding eligibility for the Family Caregiver Support Program pay 

for itself by reducing the use of Medicaid-paid long-term care? (Document No. 12-11-3901). Olympia: 

Washington State Institute for Public Policy. Available at 

http://www.wsipp.wa.gov/ReportFile/1110/Wsipp_Did-Expanding-Eligibility-for-the-FamilyCaregiver-Support-Program-Pay-for-Itself-by-Reducing-the-Use-of-Medicaid-Paid-Long-TermCare_Full-Report.pdf

Contacts

To learn more about implementation or research, 

contact:

Rhonda J. V. Montgomery, Ph.D. 

Tailored Care Enterprises, LLC

(262) 236-6944

rhonda@tailoredcare.com

Additional program information can be obtained through the following Web site:

http://www.tailoredcare.com

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