REACH II 

Resources for Enhancing Alzheimer’s 

Caregiver Health 

 

 

 

March 2022 

REACH II – Brief Description 

REACH II (Resources for Enhancing Alzheimer’s Caregiver 

Health) is a program for supporting caregivers of people with 

Alzheimer’s disease and related dementias (ADRD). The 

program was developed as part of the REACH project, a large, 

multi-state randomized control study jointly funded by the 

National Institute of Nursing Research and the National 

Institute on Aging, designed to test promising interventions to 

enhance family caregiving for persons with dementia. REACH 

II addresses common stressors experienced by caregivers and 

provides care and self-care skills. The in-person sessions and 

therapeutic phone calls are delivered by a trained dementia 

care specialist (DCS) guided by a standardized manual. The 

program was tested and found effective in a multisite 

randomized control study of over 600 caregivers in five states. 

The model has since been “translated” to community settings 

by revising the materials and protocols to better fit the 

resource constraints and client needs of specific communitybased organizations while remaining faithful to the core 

elements of the original model. Some of those adaptations are 

reviewed below. 

Is It a Good Fit for My Agency? 

Evidence-informed community adaptations of REACH II are 

suitable for any community-based organization serving ADRD 

caregivers. The standardized DCS training and certification 

program takes 1.5 – 2 days to complete. A typical caseload is 

approximately 12 – 20 caregivers per DCS. 

Community Adaptations and Cultural 

Adaptability 

The original REACH II multi-site study made a special effort 

to recruit caregivers from a variety of racial/ethnic 

backgrounds. The study results indicate that the program is 

effective for Hispanic, African American, and indigenous 

communities as well as for non-Hispanic White communities. 

There have been multiple adaptations of the program to 

specific community settings. For example, REACH-TX is an 

adaptation of REACH II for embedding the model in 

integrated community-based services. The REACH-TX 

evaluation study offered the intervention to both English and 

Spanish speakers. The protocol requires an initial assessment 

of each caregiver’s support needs and tailors the intensity of 

each program component accordingly. This flexibility makes 

it possible to customize the program to varying socioeconomic 

and cultural contexts. It was developed and tested in Texas by 

a large health system in partnership with an Area Agency on 

Aging. REACH-TX uses assessment tools and intervention 

materials of the original REACH II model with a reduced 

number of contact hours tailored to the specific needs of each 

participating caregiver. It has been endorsed by the National 

Council on Aging and included in the Administration for 

Community Living’s list of grantee-implemented evidencebased and evidence-informed dementia interventions. The 

Veterans Administration adapted the model to the needs of 

veterans and their families. REACH-VA is listed by the 

Benjamin Rose Institute on Aging as a best practice in 

caregiving. This model has been successfully implemented in 

Native American and Alaska Native communities. The 

Rosalynn Carter Institute for Caregivers (RCI), in partnership 

with the Coastal Georgia Area Agency on Aging, adapted the 

REACH-VA intervention for implementation in a broader 

range of community settings (RCI REACH) then piloted this 

model in eleven rural communities in Georgia and 

community-based organizations in four additional states with 

positive outcomes. Community REACH is an adaptation 

developed through a partnership between the original REACH 

II investigators and United HomeCare Services, a nonprofit 

organization located in Florida. The model was tested and 

found effective in a majority Hispanic community. 

How Does It Work? 

The DCS (referred to as “caregiver coach” in some settings) 

uses tools developed by the original REACH II intervention to 

obtain information about the caregiver’s environment and 

quality of life and conducts a standard risk assessment. 

Following the initial assessment, the DCS prepares an 

individualized profile that serves as a roadmap for the rest of 

the intervention. The caregiver also receives a “Caregiver’s 

Notebook” containing resources to meet their support needs. 

The number of in-person sessions and follow-up phone calls 

and the content of the sessions are tailored to each caregiver 

based on the results of the risk assessment. The sessions 

address the caregiver’s stressors and provide coping skills. A 

typical intervention lasts about six months; the risk assessment 

and intervention customization are completed during the first 

month. 

Program Materials 

A full description of the REACH II study, including 

intervention materials, is available here. The implementation 

guide for the RCI REACH adaptation can be accessed here. 

To host a DCS training using the REACH-TX materials and 

protocols, organizations should contact Alan Stevens at 

alan.stevens@bswhealth.org. RCI offers virtual caregiver 

specialist training classes; further detail can be obtained by 

contacting info@rosalynncarter.org. 
 

 

 

 

 

 

 

 

 

 

 

 

 

Implementing and Financing REACH-TX 

Implementation Example and Lessons 

Learned: REACH-TX* 

REACH-TX was developed and originally implemented in a 

hospital setting. One lesson learned from the initial pilot was 

that the program was better suited for a community 

environment. The development team worked with communitybased organizations to understand their need for financial and 

technical support to implement the program with fidelity and 

revised program materials based on those insights. Texas 

Healthy at Home, a network of community-based 

organizations including Area Agencies on Aging and the 

Baylor Scott and White health system that developed the 

model, has been implementing the program for a decade. It is 

their lead intervention for the grant supporting their dementia 

services. Their experiences have taught them that the program 

works best if embedded within a CBO with strong 

partnerships and well-established community trust and as part 

of a broader portfolio of dementia support services. An ideal 

service provider is a trained dementia care specialist with a 

bachelor’s degree and some experience in public health and 

behavioral health fields, preferably a full-time employee. The 

REACH-TX team has a training and technical assistance (TA) 

program, including DCS certification. Their on-site training 

takes approximately two days and costs $5,000 plus travel 

expenses for the trainer—virtual trainings are not yet 

available. Trained CBOs have free access to electronic copies 

of all training materials to replicate trainings according to 

local needs. If needed, the REACH-TX team will support 

grant proposals by providing letters of commitment or acting 

as subcontractors for the grant. There are no additional fixed 

costs. The cost of services varies by the level of need of the 

service recipient. Service dosage is adjusted in line with the 

participant’s level of need. If home visits are needed, mileage 

should be included in costs per participant. 

Organizations interested in REACH-TX training and TA 

should contact Alan Stevens at alan.stevens@bswhealth.org. 

Potential Funding Sources 

Caregiver support services are typically non-reimbursable 

however, there may be opportunities for reimbursement 

through formal contracts with health care entities to meet 

SDOH needs, including caregiver support services. 

Community-based organizations can obtain grants to fund 

their REACH II and REACH-TX implementation. The 

Alzheimer’s Disease Programs Initiative grants offered by the 

Administration for Community Living can be used to fund 

ADRD caregiver support programs. Some community 

partnerships have used Older Americans Act Title IIID 

funds for program implementation. Texas Healthy at Home 

has indicated that it also received funding from United Way 

for its implementation. 

Program Impact 

The following are important program outcomes to note in this 

context: 

REACH-TX was evaluated in a study of 1,500 ADRD 

caregivers. The results indicated statistically significant 

improvements in all five quality of life domains assessed by 

the program’s standard measurement tools. 

 Caregiver depression score decreased by 24.2%. 

 Caregiver burden score decreased by 20.6%. 

 Caregiver social support score increased by 10.8%. 

 Caregiver self-care score increased by 2.8%. 

 The problem behaviors of care recipients decreased by 

15.5%. 

Expected Impact on Healthcare Costs 

A study of the impact of REACH II and REACH VA on 

healthcare costs found that REACH II was cost-neutral, and 

REACH VA was associated with a 33.6% reduction in total 

VA costs, comparing treatment to control. A randomized 

control study observed 406 spouse caregivers of people with 

Alzheimer’s disease over a 9.5-year period. The results 

showed that individuals with Alzheimer’s whose spouses 

enrolled in a caregiver support program had a 28.3% reduction 

in the rate of nursing home placement compared to the control 

group. The median time to placement among the intervention 

group was 557 days later than the control group. According to 

Genworth’s Cost of Care Survey, the median daily cost of a 

nursing home stay in 2020 was $255 for a semi-private room 

and $290 for a private room. Combining the results of these 

two studies, the caregiver support program, by improving the 

quality of life of the caregiver, saved between $142,035 and 

$161,530 in healthcare costs. 

* We would like to extend our gratitude to Don Smith from 

Texas Healthy at Home and Alan Stevens and Thomas Birchfield 

from Baylor Scott & White Health for taking time away from 

their busy schedules to share their experiences with us.