Paone_Business Planning for Dementia Programs_Toolkit FINAL

October 2015
Business Planning for Dementia
Programs: Toolkit for Nonprofit and
Government Agencies
Prepared for
Erin Long, MSW
Administration on Aging
Administration for Community Living
1 Massachusetts Avenue, NW
Washington, DC 20005
Prepared by
Deborah Paone, DrPH, MHSA
Paone and Associates LLC
Minneapolis, MN 55438
www.paoneandassociates.com
RTI Project Number 0212050.035.001.001.001

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Disclaimer and Acknowledgments
The author gratefully acknowledges the editorial assistance of Elisabeth O’Toole, Michelle
Brooks, and Michelle Myers, and of Joshua Wiener and Elizabeth Gould of the National
Alzheimer’s and Dementia Resource Center and Erin Long of the Administration for Community
Living for review and comment. This toolkit was produced under contract with RTI
International through Contract HHSP2332009565IWC, Task Order HHSP23337038T with the
Administration for Community Living/U.S. Department of Health and Human Services.
This toolkit is the work of the author and does not necessarily express the opinions of the
Administration on Aging/Administration for Community Living, the U.S. Department of Health
and Human Services, or RTI International.

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Table of Contents
Executive Summary........................................................................................................................... 1
Introduction.......................................................................................................................................3
How to Use This Toolkit....................................................................................................................4
Chapter 1: Purpose and Business Model...........................................................................................5
Key Questions ..............................................................................................................................5
Business Model Defined........................................................................................................5
Step #1: Define Purpose ........................................................................................................5
Step #2: Clarify Goals............................................................................................................6
Step # 3: Attend to Context/Environment ...........................................................................7
Example: Urban AAA ......................................................................................................7
Example: Rural AAA .......................................................................................................8
Step #4: Identify Partnership or Network Strategies...........................................................8
Case Example #1: Structure, Purpose of the Dementia Program: Rosalynn
Carter Institute for Caregiving, Georgia.........................................................................9
Chapter 2: Program Components and Operations......................................................................... 13
Key Questions ............................................................................................................................ 13
Program Choice ................................................................................................................... 13
Step #1: Select the Dementia Program(s)........................................................................... 15
Step #2: Identify Necessary Infrastructure/Inputs ........................................................... 15
Step #3: Learn From Others ............................................................................................... 16
Chapter 3: Funding Strategies and Considerations........................................................................ 19
Key Questions ............................................................................................................................ 19
Financial Strategy Defined.................................................................................................. 19
Step #1: Consider Revenue Sources.................................................................................... 19
Step #2: Build a Budget and Service Forecast.................................................................... 21
Building a Budget and Service Forecast .......................................................................22
Case Example #2: Funding Strategies for a Dementia Program: Aging and
Adult Services Agency, Department of Health and Human Services, Michigan ........35
Chapter 4: Marketing ......................................................................................................................37
Key Questions ............................................................................................................................37
What is Marketing? .............................................................................................................37
Step #1: Clarify Who the Customers Are ............................................................................37

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Step #2: Understand the Distribution Channels................................................................38
Step #3: Connect Marketing Methods to Constituents/Customers .................................. 41
Step #4: Be Aware of Special Considerations Within Partnerships ..................................43
Chapter 5: Evaluation......................................................................................................................45
Key Questions ............................................................................................................................45
Why Evaluate?.....................................................................................................................45
Step #1: Identify Stakeholders............................................................................................45
Step #2: Select Indicators/Measures..................................................................................46
Step #3: Collect and Analyze Data......................................................................................47
Step #4: Make Program Adjustments Based on Evaluation..............................................48
Conclusion........................................................................................................................................50
Bibliography.....................................................................................................................................52
Appendix ..........................................................................................................................................56
Resources Chapter 1: Business Model and Partnerships .........................................................56
Resources Chapter 2: Program Operations and Business Planning........................................58
Resources Chapter 3: Funding Strategies.................................................................................59
Resources Chapter 4: Marketing............................................................................................... 61
Resources Chapter 5: Evaluation..............................................................................................62
About the Author .............................................................................................................................63
Tables
Table 1. SWOT Example for Dementia Program .......................................................................... 14
Table 2. Organization A Dementia Program—Cost/Volume Scenarios at 20 hours per
client..................................................................................................................................28
Table 3. Organization A Dementia Program—Cost/Volume Scenarios at 12 hours per
client..................................................................................................................................28
Table 4. Organization A Dementia Program Payer Rates and Expected Volume, by Source......32
Table 5. Revised Costs per Client, by Volume—Year One.............................................................33
Table 6. Net Revenue Gain/Loss, by Volume With Payer Source Assumptions..........................33

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Executive Summary
Addressing the needs of individuals with dementia and their family caregivers living in the
community is a key focus of states as they recognize the growing number of individuals with
dementia. State Units on Aging, Area Agencies on Aging, and Aging and Disability Resource
Centers are working to integrate services and create connected systems of care using business
principles and practices. They are fostering funding sources to braid together a set of reliable
revenue streams, developing marketing and communications plans, and engaging in
collaborative partnerships, especially with the health care sector.
Using a basic business plan template as an organizing framework, this Toolkit walks the reader
through key issues for consideration, offers examples, and provides resources for further
exploration. The steps offered in this Toolkit provide a guide for writing the components of a
business plan. Although this Toolkit is crafted to focus on dementia programs, the questions
posed involve considering larger issues, such as an assessment of internal organizational
capabilities and external constraints in the marketplace. These factors influence choice of the
business model, operational approach, financing, implementation success, and sustainability.
Preparing and using a sound business plan increases the likelihood that the program will be
sustained.
A fundamental starting point is to set forth the purpose for the program, clearly describing the
program’s focus and intent and tying them to the mission and strategic priorities of the
larger/parent organization. If the dementia program is not tied to organization priorities, it will
be difficult to embed it. Likewise, if there is not a foreseeable way for the dementia program to
be sustained, then it is questionable whether the organization should devote valuable resources
to building the organization’s capability and offering the program in the first place. Chapter 1
walks through identifying purpose, setting goals, attending to context, and understanding
partnership considerations.
Once the overall purpose and goals are clear, specific dementia programs can be reviewed to
meet goals. The task of selecting the program requires attention to the inputs (resources
required), competencies, and steps necessary to offer the program with fidelity. Clarity around
the components of the program and an understanding of requirements is critical. It is wise to
learn as much as possible from other organizations that have successfully implemented the
chosen dementia program(s). This helps address hurdles that are not easily anticipated.

Chapter 2 walks through program selection, investigating components and operational issues,
and recognizing core competencies which will be needed.
Determining funding sources and charting a course for financial sustainability for the dementia
program ideally should be done before the organization’s leadership commits to developing the
program. In general, greater diversity in payment/revenue sources is a goal to help ensure
reliability of funding. There may be a mix of revenue sources including federal and state service
contracts, Medicare, Medicaid, project grants, operating grants, individual donations, corporate
contributions, fees for services, and endowments or investments. Building the budget and
service forecast involves conducting a thorough cost analysis and making informed estimates
about service capacity, service volume, and payment sources. Chapter 3 walks through the
budgeting process and offers seven steps: calculating costs and a cost per unit of service,
estimating program capacity, determining the total program cost, understanding potential
service payment rates, investigating referral sources, creating volume scenarios, and choosing
targets to finalize the forecast.
The marketing and communication strategy for the dementia program must be developed with
the business model, program focus, and funding model in mind. Marketing and outreach takes
time and money—resources must maximize referrals to the dementia program. The end user of
the dementia program is the person with the disease or the caregiver, such as a spouse, adult
child, or live-in friend. However, there are many other potential customers (intermediaries) who
will be the actual purchaser of the service or who are key constituents in getting the service to
the end user. Chapter 4 walks through clarifying customers, understanding distribution
channels, connecting marketing methods to constituents, and attending to special populations.
Even with the best preparations, no business strategy is assured. An evaluation provides the
information to determine whether the resources invested achieved intended results and is the
final component of creating the business strategy. Chapter 5 walks through identifying key
stakeholders, selecting indicators, and conducting the evaluation and communicating results.

Introduction
Addressing the needs of individuals with dementia and their family caregivers living in the
community is a key focus of states and health and social service providers as they recognize the
growing number of individuals with dementia. In particular, states are working to build
dementia-capable systems of care (Tilly et al., 2011, 2014). Services for people with dementia
include information about and referral to community services, assessment, counseling and care
planning, caregiver education, caregiver self-care, respite, wellness, meaningful engagement,
day care, transportation, transition support, and other programs. Many evidence-based service
programs have been successfully developed, tested, and translated to community settings,
although dissemination remains limited (Maslow, 2012).
State Units on Aging (SUAs), Area Agencies on Aging (AAAs), Aging and Disability Resource
Centers (ADRCs), and aging services providers are increasingly recognizing the need to use
business principles and practices as they develop and sustain programs (Bowers et al., 2004;
Gage et al., 2004). Emphasis on incorporating business principles and practices has included
creating a business plan, identifying and fostering a variety of funding sources to build or braid
together a set of reliable revenue streams, developing marketing and communications plans,
and engaging in collaborative partnerships and relationships to develop more formal
agreements around referrals and reciprocal accountability.
Policymakers and experts in the field are encouraging providers of long-term services and
supports (LTSS) (including dementia and caregiver programs) to build their capacity and
business acumen to participate as a provider of services within a larger health care or social
services network. Organizations seeking to foster dementia-capable networks or systems of care
must consider the larger environment in which the dementia system or program will reside.
External factors (for example state policies, funding priorities, community characteristics)
influence what organizations can do in terms of developing and sustaining programs and service
network systems (Durlak & DuPre, 2008). At the same time, internal factors (for example
organizational culture, staff capability, administrative supports) heavily influence
implementation of programs (Fixsen et al., 2009). In studies of implementation success of
evidence-based programs, for example, factors such as program-to-organization fit, mission
alignment, presence of a strong organizational champion or leader, strong technical support,
and continuity of stable funding have been shown to be important (Aarons et al., 2009;
Greenhalgh et al., 2004; Kaczorowski et al., 2011; Ory et al., 2010; Paone, 2015).

This report provides organizations with information about the five key components of a business
plan that program managers can use to strengthen their chances of successfully meeting the
needs of people with dementia and their caregivers and sustaining those initiatives over time.
How to Use This Toolkit
This Toolkit was written for public and private entities that provide or promote dementia
programs and services as part of the LTSS system or aging and caregiver services network.
Using a basic business plan template as an organizing framework, the Toolkit walks the reader
through key issues for consideration, offers examples, and provides resources for further
exploration. Although this Toolkit is crafted to focus on dementia programs, the questions posed
often involve considering larger issues, such as an assessment of internal capabilities and
external realities in the marketplace. Internal and external factors ought to be taken into
account, because they will influence choice of the business model, operational approach,
financing, implementation success, and sustainability.
The key message of this Toolkit is that investing the time and energy to develop a business plan
for dementia programs will provide useful benefits to the organizations making the
commitment. The five chapters of the Toolkit mirror the key components of a business plan:
1. Purpose and Business Model
2. Program Components and Operations
3. Funding Strategies
4. Marketing
5. Evaluation
For each chapter, the Toolkit provides an overview of the chapter topics. A few key questions are
posed and addressed. Case examples are offered, providing both illustrations of the content and
practical advice and lessons learned from various agencies and organizations operating at the
state or regional level in the field. Case examples from the field and illustrative case examples
were developed by the author to clarify and provide guidance around technical methods or
specific steps. The Appendix includes additional resources, with brief descriptions and
electronic links to reports, articles, and other material.

Chapter 1: Purpose and Business Model
Key Questions
1. What is a business model?
2. What is the purpose for the dementia program, vis-à-vis the mission and purpose of the
organization?
3. What are emerging core competencies for partnerships, particularly with health care
systems?
Business Model Defined
A business model is an organization’s approach to making and then delivering a product or
service effectively. Every organization has a business model—even volunteer organizations—
whether adopted consciously or not. For example, a volunteer scout troop may focus on building
young leaders through training, education, and team-building experiences and rely on families
who provide both in-kind labor and materials to the troop and voluntary fees. A dementia
program may focus on increasing self-care capacity of dementia caregivers and rely on training
programs and support groups funded by grants.
Business models identify the customer/client of a service or product and what that customer
values about that service or product (Ovans, 2015). Parameters include the following:
1. Who will be our key partners or collaborators for the dementia program?
2. What key activities and resources will be required?
3. What is the value proposition of the dementia program, from the organization’s
perspective and from the perspectives of key partners?
4. What are the dementia products or services the organization is offering?
5. Who are the customers and what are the key customer relationships that need to be
fostered?
6. What are the distribution channels through which the customer is reached?
7. What is the organization’s cost and pricing structure?
8. What are possible revenue sources?
Step #1: Define Purpose
The starting point in business planning is to set forth the purpose for the product, program, or
service, clearly and concisely describing the program’s focus and intent and tying this to the
mission and focus of the parent organization or system. For a dementia program (or network) at
the state or regional level an illustrative purpose statement for its business plan might read:

To create and sustain a comprehensive network of information, referral, training,
and person-centered support services for persons living with Alzheimer’s disease
and related dementia and their caregivers as an integral part of the
_____________ (state’s/region’s) long-term services and supports provided to
individuals, families, and caregivers.
And further,
To build this network as part of the home and community-based services system
that is based on a single entry point/no wrong door approach that reaches
underserved ethnic and other minority population groups and those in remote or
rural areas of _________ (state/region).
This dementia network aligns with the mission and purpose of our department
within the state, which is to “Help people meet their basic needs so that they can live
with dignity and achieve their highest potential.”
For a dementia program at the organizational unit level (e.g., within one aging service provider
or AAA), the purpose statement might read (illustrative):
To increase physical activity and meaningful engagement of individuals living with
Alzheimer’s disease and to improve caregiver self-care through implementing with
fidelity and sustaining the ___________ (name of the program) in the geographic
region covered by __________ (name of the organization or AAA) as part of the
menu of services offered to individuals, families, and caregivers by this
organization.
This dementia program aligns with the mission and purpose of our organization,
which is to “Assist individuals to age with vitality and enrich the capacity of
communities and families to care for the aging population in our region.”
Step #2: Clarify Goals
Following the purpose statement, the business plan will provide one or more goals and a set of
objectives for the program. The program manager will need to clarify the organization’s goals for
this dementia program(s). The business plan will also define the target user of the service and
any intermediary agents that serve as third parties or are important in getting the service to the
user. Illustrative goals and objectives follow:
GOAL: (1) To improve access to ADRC (or AAA) programs and services for individuals
and families, particularly in underserved areas.
Objective 1a: Increase the number of ADRC/AAA programs serving minority,
culturally/ethnically diverse, and rural communities.

Objective 1b: Ensure that ADRC/AAA program communication, marketing, outreach
materials and methods, and informational resources are appropriately
translated or redesigned to match the language, culture, and
communication channels of minority and ethnically diverse communities
AND that they are transmitted through informal and formal channels,
building on the natural means of communication in the community.
Step # 3: Attend to Context/Environment
In writing the business plan, the program manager needs to take context into account. What is
going on in terms of the geographic setting or marketplace? What is the demographic profile of
the area the program will be serving? Are there unique challenges or characteristics of the
market? How will people who are considered the ultimate end user come to find and use the
dementia program? Who are possible competitors? Briefly, the business plan should describe
the environment in which the program will be operating. Illustrative examples follow:
Example: Urban AAA
Our agency serves a densely populated ethnically and racially diverse urban area of more
than 2 million people. The population is becoming more ethnically and racially diverse
through immigration of individuals and families from more than 36 countries. In some schools
more than 100 languages are spoken. Major employment is in the retail sector,
manufacturing, and self-employment. Approximately 14% of the population is over age 65
(294,000). The average age is 30 and declining, as the proportion of households with young
families increases. Although the economy is improving, many individuals are working two
jobs. The major means of transit is through public subways, bus, and rail transportation
systems, and some private shared ride programs.
Based on estimates from the Alzheimer’s Association, one out of every nine individuals over
age 65 may have Alzheimer’s disease, representing 32,666 individuals in this geographic area.
National estimates reveal that approximately two-thirds of caregivers are women and over
one-third of caregivers are elders themselves. In this geographic area, almost 45% of all
households with children are managed by single working mothers.
Thus, our dementia programs and dementia care networks need to address the needs of both
working women with children and older women. These women are most likely to be caregivers
of individuals living with Alzheimer’s disease or dementia. We also need to work
collaboratively with our partners across service areas, because caregivers may work in one
area but live in another within our city. In addition, our dementia programs need to be
tailored to immigrant and ethnic/racially diverse subgroups within our resident population,
ensuring that our program design, materials, service format, and outreach methods are
ethnically, culturally, and language competent.
OR

Example: Rural AAA
Our organization serves a rural and remote area of more than 15,000 square miles in the
southwest corner of the state with about one household for every 3 miles. Major employment is
in agriculture. The population of approximately 9,900 has declined as young people and
families move to suburban and urban areas. Thus, the average age has increased and the
proportion of residents over age 65 is now nearly 30%. Of these 2,970 elders approximately
35% live alone (1,039 individuals). Service providers are few and far between. Transportation
is by private automobile. There is almost no public transit. Some shared ride programs and
shuttle services exist but serve less than 5% of the area. Based on estimates from the
Alzheimer’s Association, approximately 330 older residents (1 out of every 9) in our service
area may have Alzheimer’s disease or a related dementia. We estimate that between 50 and
115 older residents with ADRD are living alone.
Given the nature of our service area, we have considered how to craft our dementia program
to reach those in need. We are exploring the use of remote technology that provides clear audio
and visual information and allows for communication in real time as part of our dementia and
caregiver education and support, including caregiver consultation. In addition, our programs
need to be connected with all sectors. We are exploring how to link our dementia programs
with any organization (public or private) to raise awareness and inform the community at
large about dementia and caregiver supports we provide. This would include faith
communities; community service centers such as libraries, nursing homes, retail and
agricultural businesses; and civic/volunteer groups. Our goal is to build both informal and
formal communication channels and support systems that can help reach persons with
dementia and caregivers living in our rural area.
Step #4: Identify Partnership or Network Strategies
However large the organization is, it will likely need to partner with other organizations to meet
the needs of people with dementia and their caregivers. Over the last 10 years, partnering with
other aging/social services providers or with health care entities has been promoted by experts
as a way to increase reach, extend service availability and choice, and improve the potential for
financial sustainability.

Case Example #1: Structure, Purpose of the Dementia Program:
Rosalynn Carter Institute for Caregiving, Georgia
This example is offered to highlight business purpose and model/strategy and is based on a key
informant interview conducted in July 2015 with Executive Director, Leisa Easom, PhD, RN,
and Gayle Alston, MA, Director of the RCI Training Center for Excellence. Information from the
RCI website was also used (see http://www.rosalynncarter.org).
Brief Introduction to RCI
The Rosalynn Carter Institute of Caregiving (RCI) is part of Georgia Southwestern State
University, located in Americus, Georgia. The mission and philosophy of RCI is to:
Establish local, state, national, and international partnerships committed to building
quality, long-term, home and community-based services … that begins with providing
caregivers with effective supports to promote caregiver health, skills, and resilience
(http://www.rosalynncarter.org/about_rci/).
There are four strategic priority areas for RCI: (1) advocacy, (2) education, (3) research, and
(4) service. RCI currently focuses primarily on two types of caregivers: (1) those who are
assisting a person with dementia, and (2) those assisting a person who has served or is currently
serving in the military.
Discussion With RCI
The discussion with RCI representatives focused on the following:
• How RCI structured its dementia programming and services and created its business
model that aligns with the overall strategy and business model of the organization
• What assumptions were made in setting up the program
• How any partnerships or networks were developed/fostered
• What worked in terms of creating and implementing the dementia program and strategy
• Key lessons learned and sustainability
Structure/Model
Everything we do within RCI lines up with our four strategic priorities (listed above). Our
work around dementia focuses on training and education, based on scientific evidence and
research about what is effective.
Our “business purpose” for the dementia program is to enhance the organizational capacity
and effectiveness for implementing these evidence-based programs through best practices in
training and technical assistance. As part of a university, we also espouse the principle that
research and evaluation—that is, measuring the results—must be woven into what we do. We
provide guidance to the community agencies and organizations in the field for how to do that
with the dementia programs. Critical to evidence-based program implementation is fidelity to

the intervention. Licensure for training programs is available to ensure that technical
assistance support is continued as are updates on training.
Assumptions, Development
When we started (about 7 years ago), we brought in research scientists to talk about caregiver
support programs that had been tested through a clinical trial and proven effective in
improving caregiver health, burden, depression, or other measures. This research approach—
the randomized control trial—is tightly controlled by the scientist. Although this is an excellent
study design, it does not yield a practical approach for implementing in the field of direct
service.
This led to an understanding that there was a significant need for translation of the research-
based effective practices/interventions. We took on the role (with others) to translate these
effective interventions so that they can be implemented in community agencies, AAAs, and
other service organizations in the field—the direct service organizations. We spent some time
with these direct service organizations learning with them.
Our assumptions were that the focus in the future would be on evidence-based programs. This
has turned out to be true. Creating robust technical assistance and helping to translate these
programs to be used in the field was clearly a gap. We saw that was aligned with our mission
and purpose. So we went about creating our training, technical assistance, and fidelity
support service, which is what we are now disseminating beyond Georgia, nationwide. The
RCI REACH program is a recent and continuing effort to support dementia caregivers.
We also saw that all organizations needed to move from a passive offering of programs and
counting number of units provided to a more active recruiting/outreach and measuring value
of what was provided. The measures have to be objective and all organizations need to build
that capability to prove that what is being done is working. Further, achieving similar
program outcomes to the original clinical trial outcomes is an indication of successful
adherence to fidelity. The external environment was starting to push this, and we crafted our
approach with the commitment to do this.
Partnerships/Networks
We had multiple research partners and collaborators, and funders, to develop our service and
approach. This included Johnson & Johnson, the Administration on Aging/Administration for
Community Living, Area Agencies on Aging, Councils on Aging, the Alzheimer’s Association,
AARP, Easter Seals, and other organizations that have caregivers as a focus. We worked with
the Georgia state unit on aging, and providers statewide, including residential care providers,
hospitals, home care agencies, and home and community-based services providers. We held
expert panels and encouraged all these stakeholders to meet and talk with one another. In a
real way we became a conduit for these stakeholders to share information and ideas.
The university is a key partner as well. We are able to tie this work to both the mission of RCI
and the mission of the public university where we reside—its mission supports learning and
teaching. This is the focus of our dementia training and technical support
(https://gsw.edu/about-gsw/mission-statement).

What Worked
The timing. We were focusing on evidence-based programs and on measuring value precisely
when the external environment was also moving in that direction. There was agency buy-in
and a willingness to change from its usual approach.
Our approach. Our approach was grounded in on-site, hands-on learning with the
organizations at the community level. We saw first-hand the struggles on the ground that
some of the community agencies had with evidence-based programs, identifying where it
needed adaptation or where additional resources and technical support were needed. For
example, some programs had never followed an evidence-based program protocol before and
were unfamiliar with fidelity monitoring.
Researcher buy-in. The researchers were supportive in recognizing this need for translation,
implementation, and dissemination guidance. In most cases, this was not something they could
take on themselves. We found that robust training and technical assistance is much more than
a day or two of training on the intervention/program—it is working with the agency along its
implementation journey.
Lessons Learned
Service agencies are not the same. They have different sizes, staff training, capacity,
organizational orientation, even geographic and market characteristics. We learned that not
every program is going to be a good fit. Also, the community service provider that is
implementing the dementia program will sometimes need additional help to get it to a place of
readiness. Our technical assistance needs to be flexible and meet providers where they are.
Any agency will have staff turnover. Program directors don’t want their program walking out
the door when a staff member leaves. Therefore, we built in retraining as a part of our service
support under the licensure. We focused on doing this in an affordable, accessible way. We are
bringing training to directors in the most effective way we can that still follows fidelity to the
program and helps ensure the outcomes expected (e.g., reduction in caregiver depression,
burden). We learned this was very important to the agency directors. They also came to see
that we are not there simply to audit them. We are there to support them and build on their
strengths.
Sustainability
We have been building program capacity in the field through providing affordable, effective
training and technical assistance on evidence-based dementia programs. We sustain our
organization and this program through (1) being part of the university, (2) renewals and
licensure fees, and (3) additional service payments for the training and technical assistance
through subcontracts with organizations (increasingly we are being written into another
organization’s grant application as it seeks funding for starting its dementia program).

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Chapter 2: Program Components and Operations
Key Questions
1. What factors should be considered in choosing among options for dementia programs?
2. What are the dementia system or program components?
3. What are the infrastructure and operational requirements (the inputs) necessary to
host/provide the program?
Program Choice
Organizational leaders must ensure that the dementia program developed is consistent with the
mission and strategic priorities and capabilities of the entity. Moreover, if there is no foreseeable
way for the dementia program to be sustained over time, the organization must consider
whether it is worth investing the time and effort to implement a new initiative. A scattered “start
and stop” programming approach is difficult for both staff and potential clients/consumers.
If the organization is considering offering more than one dementia program, those planning the
program menu will want to unpack the program components for each service and then compare
across services. New program ideas should be compared to what already exists. Can economies
of scale be achieved? Are the programs so similar that they compete with each other—both for
staff time and for clientele? What does the market need? Are there gaps? What programs best fit
with the capacity and strategy of the organization?
Organizational leaders designing the approach may wish to conduct a Strengths, Weaknesses,
Opportunities, and Threats (SWOT) analysis regarding their organization’s ability to deliver the
dementia program/package and meet defined goals. This approach can help crystalize the
discussion and pinpoint areas that will need attention for the program to be successful. In some
cases the “threats” can be turned into “opportunities.” An example is provided in Table 1 where
potential dementia program competitors could be approached as partners. This would be the
case if a program that targets only the person with dementia and a program that targets only the
caregiver were linked, for example, if a respite care day program and a caregiver educational
workshop and support group were held concurrently and cross-marketed.

Table 1. SWOT Example for Dementia Program
SWOT Examples
Strengths • Organization is well known in the community.
• Experienced staff with credentials.
• Active volunteers (more than 100).
• Strong Board of Directors.
• Strong collaborative relationships with local providers and service
organizations.
• Low-rent space with good visibility.
• Stable core programs.
• Dementia programs tie to existing core programs in caregiver education
and support, wellness, meaningful engagement, information and referral.
• Infrastructure—database, financial management, policies and procedures,
other operations—is solid.
Weaknesses • Small size.
• Do not have evening/weekend hours, except for first Saturday of the
month.
• Limited marketing/outreach budget or capacity.
• Grants have been harder to get and almost all focus on new programs;
very little grant funding for core support.
• We have tested various funding streams and they are limited—insurance
does not cover our dementia programs. We rely on Title III funding
(which is capped). We have developed a sliding fee scale and provided a
fee-for-service schedule to every client to build our private pay. The
market is not responding to fee-based programs. Seniors do not want to
pay.
• Medical care providers (hospital, clinics, home care, and private physician
offices) are not referring patients once a person is diagnosed with
Alzheimer’s disease or related dementia, despite our outreach to clinics.
Most clients find us through word of mouth or through referral from
other sources (e.g., the Alzheimer’s Association).
Opportunities • Growing awareness of Alzheimer’s disease and dementia issues in our
community. More calls for information. May be able to create a market
niche to be recognized as a full-service program provider.
• Could perhaps set up a direct-connect referral process with two local
physician groups that have a once-a-month “memory assessment clinic.”
Threats • Other providers are developing programs and in dementia—more
competition.
– Note that some do not offer respite and may be interested in
partnering with us to enhance their support to caregivers.
• The marketplace is full of assisted living providers emphasizing that
people with dementia should be in a memory care unit; this is affecting
caregivers, because they come to believe that is the only or the best option
for their loved one.

Step #1: Select the Dementia Program(s)
Once the overall purpose and goals are clear, specific dementia programs can be selected that
best meet those goals. The task of selecting the program to develop requires attention to the
inputs (resources required), organizational competencies, and steps necessary to offer the
program with fidelity to the designers’ intent. Clarity around the components of the dementia
program and an understanding of requirements is critical if the organization is to successfully
implement and sustain the program.
To clarify and align consumer/client needs, organizational goals, and program expectations for
the dementia program(s), organizational leads will want to determine program focus, intent,
and delivery. Maslow (2012) offers several characteristics to consider:
• Type and stage of condition (e.g., Alzheimer’s disease, other dementia, and early/mild,
mid/moderate, late/severe)
• Where the practice/program can be delivered (e.g., home, office or clinic setting, nursing
home, workplace)
• How the practice/program is to be delivered (e.g., in person, telephone, Internet,
support group)
The choice of what the organization does is based on the purpose, funding, and partnership
criteria or preferences of key stakeholders/leaders. That is why purpose and goals are so
important to establish first. It is also important to understand potential competitors. What
existing programs or services in the marketplace are similar or may be service substitutes? Look
for existing memory programs and investigate what other organizations are offering. How might
the dementia program of this aging services provider be differentiated?
Step #2: Identify Necessary Infrastructure/Inputs
The manager will need to research and define all of the necessary components and
infrastructure, what it takes for the organization to offer the chosen dementia program(s). This
may include one or all of the following:
• Personnel (staff with specific clinical or educational background, or with specific
training, skills, etc., and sometimes trained volunteers)
• Additional training and skills development using a set curriculum
• Certification/testing with recertification requirements
• Clinical monitoring or oversight by an expert
• Information systems with specific database or computer application programs

• Written and audiovisual materials and other physical resources (e.g., program
workbooks, DVDs, CDs, art supplies)
• Meeting room space and other equipment or facilities (e.g., computer, projection
equipment, Wi-Fi access, sound system)
• Travel time/mileage reimbursement for staff/program volunteer to provide the service
• Additional professional or business insurance, fidelity bonding, legal review for contracts
or agreements, and other corporate costs arising as a result of the dementia program
Step #3: Learn From Others
It is wise for program designers to learn as much as possible from other organizations that have
successfully implemented the chosen dementia program(s). This information will help the
manager address hurdles that are not easily anticipated. An organization implementing its first
dementia program will face additional startup issues as compared to an organization that
already has a set of programs for persons with dementia and their caregivers. Operational issues
in program implementation might include the following:
• Lack of leadership around partnership and collaboration to build linkages and funding
relationships
• Difficulty balancing staff workload; staff deployment; dependency on one or two trained
staff members (leaves the program vulnerable to staff turnover)
• Need for staff with different background/education/skills than exists within the
workforce
• Initial and ongoing staff training needs around specialized dementia programs
• Need for ongoing and intense recruitment efforts to build demand, such as staff-
dependent outreach, to reach end user participants or answer questions posed by
possible referral sources
• Need for tailored communication and marketing in all formats (including using social
media)
• Challenges arising from organizational issues, such as shifting or competing
organizational priorities, budget cuts, internal approval processes, resource limitations,
lack of necessary infrastructure (e.g., billing systems, electronic databases matching the
data needs of the program)
• Resistance to using new technologies requiring additional administrative support time
(e.g., required by a tailored database, new software or cloud-based electronic data and
information management systems), or new hardware (e.g., tablet or handheld devices for
staff members in the field)
• Need for easy-to-follow fidelity monitoring methods (for evidence-based programs)
Lessons learned from implementation pilots and demonstrations of evidence-based dementia
programs are available. For example, the experience of more than 60 grantees of the Alzheimer’s
Disease Supportive Services Program (ADSSP) grants is presented in the ADSSP Completed
Grants Final Report (Gould et al., 2014). This report presents information about the dementia

program components, implementation activities, partners, populations served, and fidelity
monitoring used (as in the case of evidence-based programs). There are in-depth case examples
from program implementation providing practice-based information about program
components and operations.
For example, a process evaluation of Minnesota’s implementation of the New York University
Caregiver Intervention (NYUCI) across 14 program sites offers lessons related to the importance
of external and internal factors. The implementing sites were located in metropolitan, suburban,
and rural areas. Most did not have preexisting services for people with Alzheimer’s disease and
dementia care partners, but almost all had existing programs for older people and caregivers.
Challenges in implementation for these program sites included the amount of time needed for
required training and ongoing oversight to maintain fidelity to the protocol, the difficulty in
recruiting participants—despite the extensive time the trained staff member spent in personally
pursuing many avenues to increase visibility and referrals—and the lack of a reliable funding
source to support the cost of the program (Paone, 2010, 2014). These challenges, particularly
recruitment and funding, affected sustainability (Gould et al., 2014; Paone, 2010, 2014). Ways
that delivery organizations, AAAs, and state offices have addressed these challenges since that
implementation experience have included streamlining the data collection tools and training
requirements, adding information about the program and where to find providers on the state’s
website and database, and including the program as an option under National Family Caregiver
Support Program (Title III-E of the Older Americans Act [OAA]) funding.

Chapter 3: Funding Strategies and Considerations
Key Questions
1. What financial strategies can be derived or explored for dementia programs?
2. What are two basic considerations in evaluating revenue sources?
3. What calculations need to be performed to build a budget and service forecast (a
financial plan) for the dementia programs?
Financial Strategy Defined
Determining the financial strategy for how the program will be funded is an important part of
the business plan. Aging service providers typically rely on a mix of revenue sources including
federal and state service contracts, Medicare, Medicaid, grants, individual donations, corporate
contributions, fees for services, and endowments or investments.
Advice to nonprofits in developing a strong funding model includes the following (Foster et al.,
2009):
• Begin planning for sustainability immediately, in the earliest stages of program
development.
• Have clarity around goals for the funding model and the programs that the organization
is committed to offering. For example, the organization may not expect the program to
break even but act as a feeder to other revenue-producing programs.
• When building the funding model, focus on possible funder motivation and incentives
and funding sources.
• Investigate all possible funding sources, even beyond those already tapped by the
organization. Allow time to become familiar with possible financing sources. Seek advice
from public and private funders, experts, and third-party payers.
• Reflect on the organization’s strengths and weaknesses of current approaches to funding.
• Have a well-developed financial plan.
Step #1: Consider Revenue Sources
Organizations should consider specific factors when evaluating potential revenue options, such
as the reliability, the autonomy, and the size of the source of funds (Pratt, 2004). Providers
should consider each possible funder/payer for the dementia program and evaluate that source
based on the following:
• What is the reliability of the funding source (high, medium, low)? High reliability
provides advantages for planning and is desirable.
• What is the effect of the revenue source on organizational autonomy (high, medium,
low)? Government benefit programs usually have compliance requirements;

organizations need to be prepared for these requirements including additional oversight
and reporting.
• What is the likely to be the largest source of funding? For example, in low-income areas,
Medicaid may account for most of the potential funding.
Many sources of funding can be explored, including the following:
• Government Funding
◦ Federal Service Contracts and Grants—grants, service contracts, or agreements (e.g.,
federal OAA Title III-E funds for caregivers support services, ADSSP and ADI-SSS
grants)
◦ Federal/State Insurance Programs—Medicare or Medicaid reimbursement for
eligible services (fee-for-service, managed care, bundled payments, etc.)
◦ State/County/Municipal Programs—state discretionary funding for caregiver
programs or behavioral or mental health services
• Philanthropy
◦ United Way
◦ Private foundation grants
◦ Nonprofit foundation grants
◦ Individual giving
◦ Corporate charitable giving programs
• Corporate or Health Network Service Agreement
◦ Corporate/Business—establish a service agreement or contract with a company to
provide dementia program education or caregiver services as part of an employee
assistance program, employee wellness program, or the corporation’s workforce
continuing education and training
◦ Health Network—establish a service agreement or contract with a health care system
as an approved provider of caregiver consultation and support and dementia care
education/training
• Private Pay
◦ Individual—bill individuals receiving care/support at full or reduced cost, offering a
sliding fee scale
◦ Insurance—bill insurance for services as an approved service provider for eligible
services under an individual’s long-term care or health insurance policy

Step #2: Build a Budget and Service Forecast
To be viable (at a minimum) over the long run, the sum total of revenues earned or received by
the organization must cover expenses. To evaluate the potential viability of a dementia program,
the organizational manager builds a budget and service forecast. Assuming that the organization
has a variety of service lines that it offers to clients/consumers, the dementia program budget
can be developed to cover all of its own programmatic and distribution costs or to be part of an
overall package of services. In this second case, the dementia program funding may be less than
or more than its direct and indirect costs. Leaders and managers will want to make explicit their
assumptions and expectations about where the dementia program will land among these
financial scenarios. In other words, leaders in the organization determine financial goals. The
dementia program may:
• Be a loss leader or flagship program—where revenue sources do not cover funds, but the
program is of such significance that it ties to other related services that are fully funded
• Bring in enough funds to cover direct costs
• Bring in enough funds to cover direct and indirect costs
• Attract funding beyond that which is required to cover direct and indirect costs (offer a
surplus), to allow the organization to build reserves or cover costs of other programs/
services that do not have adequate funding support
The dementia program may be one of several programs and services offered by the organization.
If it has more than one caregiver or dementia service, the manager will consider how all of the
programs relate to one another. By being purposeful in creating this dementia program menu,
the organization can more effectively build competency and maximize efficiency. It also offers
the opportunity to cross-market the programs and offers more choices to potential referral
organizations and partners.
Management will need to estimate and then track the direct and indirect costs of each service
and the dementia/caregiver program as a whole. A forecast of service utilization and
calculations about rates and service volume by payer will be used to compare to actual
experience. The goal is to predict, as accurately as possible, whether the dementia program
menu as a whole (or each individual dementia service) can cover the total costs needed to
operate these programs.

Building a Budget and Service Forecast
Building the budget and service forecast for a dementia program involves conducting a thorough
cost analysis and making informed estimates about service capacity, service volume, and
payment sources. Using an example that was crafted for this Toolkit, we walk through seven
steps for building the budget and service forecast for a dementia program. This dementia
program is one that relies on a trained social worker to provide consultation, education, and
guidance to persons with dementia and their caregivers. Steps are:
1. Calculate costs (direct and indirect, fixed and variable) of the program/service, and a
cost per unit of service
2. Estimate service/program capacity
3. Calculate total dementia program cost to the organization
4. Understand the potential service payment rates, by payer source
5. Evaluate referral sources—estimate referrals per unit of time (e.g., month) by source
6. Set up scenarios using different estimates for demand/volume by payer source
7. Finalize budget and service forecast
Example—Aging Services Organization A
As an illustration, let us assume that Aging Services Organization A is implementing a dementia
program that involves an upfront investment (fixed costs) of $12,000 for training, online
electronic database access, and licensure. The centerpiece of this exemplary dementia program
is a trained expert licensed social worker who provides caregiver counseling, information, and
referral and family meetings, and sets up an action plan with trigger points for follow-up. This
particular program requires multiple interactions with the caregiver and family. It is evidence
based; therefore, the consultant must follow a protocol with specific service components and
data collection/reporting requirements.
We begin with three assumptions:
• The dementia program is consistent with the strategic direction and service complement
of the organization (i.e., is part of a set or menu of programs and services focused on
caregivers and persons with dementia offered by an organization).
• The organization can fund the startup costs to build the key components and capacity of
the organization to launch the dementia program (e.g., through grants, reserves).
• Direct and indirect costs, service units, and referral sources can be tracked; for example,
participants in the dementia program will be asked how they came to find out about and
use the program (e.g., through referral from a health care or social service agency, friend,
or through self-direction).

Step 1: Calculate Costs and Cost per Unit of Service
The first step the manager needs to take is to calculate or estimate direct and indirect costs of
the dementia program.
Direct and Indirect Costs
The program costs such as staffing (including fringe benefits), workbook materials, and mileage
to clients’ homes are direct costs of the dementia program—that is, they arise only because of the
program. Some costs will be incurred by fidelity to an evidence-based protocol. As an example,
in the translation and implementation experience of the NYUCI program in Minnesota (2008–
2012), each organization was required to have at least one trained memory care consultant. As
part of the program protocol, the consultant:
• Conducted multiple in-home or in-office assessments of the primary caregiver through
one-on-one visits, using a designated set of validated instruments
• Entered the assessment data into a state-mandated database system
• Facilitated family meetings—up to four family sessions
• Responded to calls and e-mails when questions or concerns arose
• Provided information and referral to supportive services
All of the expenses arising from the consultant’s direct service, and his or her travel time to
clients’ homes, the consultant’s data entry of the assessments, and his or her participation in
required training/certification and clinical monitoring, were direct costs of the program. In
addition, the consultant was expected to conduct the marketing and outreach for this specific
program. Thus, the outreach time spent by the consultant and the promotional materials were
also direct costs (Paone, 2010).
Other costs are indirect, such as the overhead costs for the organization’s day-to-day operations.
Rent/lease costs, utilities, and use of shared office equipment are examples of indirect costs.
Additional indirect costs may include advertising or marketing/communication costs, to the
extent that these are not associated solely with the dementia program. However, if the outreach
and marketing strategy for the program depends on the dementia program staff, then these
costs (staff time) should be included as direct costs.

Fixed and Variable Costs
Fixed costs are those that the program will incur regardless of volume or number of units of
service produced. For example, the purchase cost of software that must be used to offer a
licensed evidence-based program is a fixed cost. The purchase happens before the program sees
any clients and is not dependent on the number of clients served. Regular salary costs are also
fixed costs, although some of those costs may be covered by other program revenue, to the
extent that the staff person’s time can be shifted to these other programs. If the staff person is
hired only for the dementia program (e.g., half-time occupational therapist hired for in-home
didactic instruction and skills development of caregiver), then all of those costs are fixed costs
attributed to the dementia program. Required training and certification costs for the staff
person to meet the preparatory requirements of a dementia program (e.g., to be a certified
trainer or instructor/facilitator, coach, or consultant) are also examples of fixed costs. The cost
of printing fliers for a given program is another example of a fixed cost—the fliers have to be
printed and distributed before any client is served. All of these types of costs (training,
certification, and printed materials) have to be incurred before even one unit of service is
provided by the organization.
Variable costs are costs that vary based on volume or units produced. Examples of variable costs
include mileage costs for travel to a client’s home (if no clients, no mileage costs incurred),
meeting room and snack expenses (e.g., for support group and workshop classes), and supply
costs where the supplies can be purchased in small units, based on service volume.
In our example, Organization A employs three licensed social workers in aging and caregiver
services, but only one FTE is available for and trained in the specialized dementia program. To
begin the calculations to create a budget and service forecast, the operations manager works
down from 40 hours per week (52 weeks or 2,080 hours per year) to determine the time
available for direct service.
There are hours devoted to other required non–dementia-related administrative and service
activities that have to be performed by that social worker because she is a part of the
organization (e.g., attending staff meetings and required trainings or continuing education,
documenting progress notes in the database). She must do these things whether the dementia
program exists or not. The paid time off, holiday, sick, and other leave of the social worker also
must be subtracted from the total hours available.

In our example, this results in 20 hours per week available for the dementia program. This is the
maximum amount of time/capacity that is available to produce the total units of service (defined
as completed client experience) for this dementia program by Organization A. The manager
could hire a second part-time social worker as well, but first calculates a budget and service
forecast based on the one half-time social worker.
The social worker’s salary is $31 per hour inclusive of 22% benefits ($64,480 per year). She is
allocated half-time to the dementia program (20 hours per week), thus the organization is
allocating $32,240 of salary costs to the dementia program in year one (direct cost, considered
“fixed” for year one). In this simplified example, the total direct fixed costs estimated for this
program are $44,240 to be “up and running.” This includes the fixed costs of a required online
database, program licensure, and the costs of training ($12,000), together with the salary and
benefit costs.
Other variable direct costs that will come into play for this dementia program include mileage
costs and client materials. Reviewing current client records, and calculating that the social
worker will do only one home visit per client but may have additional travel costs, the manager
estimates a cost of $58 per client for mileage (.58 per mile, 100 miles per client). Client
educational materials that are printed/mailed are estimated to come in at a total cost of $25 per
client over the course of the experience.
In this example, the manager of Organization A includes as indirect costs the following:
allocated overhead expenses of a portion of the administrative support staff member’s time (e.g.,
5 hours per month), some portion of the supervisor’s time (1 hour per month), a portion of the
IT data support team time (5 hours per year), and a proportion of the office rental/utilities and
some risk management/insurance costs.
Cost Per Unit of Service
To reach an estimate of cost per unit of service, the manager needs information about how much
time it takes to produce a complete caregiver program experience, as defined by the intervention
protocol. The manager and social worker consider the activities that will be performed by the
social worker, such as telephone consultation, in-person assessment, data entry, creating an
action plan with the client, providing follow-up information to the client, and connecting that
person to additional services. They take into account factors such as travel time, charting, or
training that the staff member(s) will have to spend in related activities.

For illustration purposes, assume that the total time to serve one client is estimated to be
between 12 and 20 hours. The manager chooses to use the estimate of 20 hours to create a
conservative budget where she can feel confident that the resources required to produce the full
“client experience” will be available.
The manager calculates the direct costs (taking into account salary/wages, materials, average
mileage, etc.) to be $703 for serving one client if each full client experience takes 20 hours. The
indirect costs of administrative support time, a portion of utilities, data support, and supervision
costs are all allocated proportionately (i.e., based on total staffing allocation). Note that these
are fixed costs to the organization and do not vary by client.
However, in this startup year, the organizational leadership decides to treat the overhead and
administrative costs as variable to this dementia program. Management decides that a cost of
$2 per hour for overhead will cover the indirect expenses that are reasonably allocated to the
dementia program. By charging $2 per hour to the program versus a set overhead fixed cost,
these allocated expenses are treated as variable and thus go up or down based on volume of
service units produced. In our example of Organization A, at a 20-hour of service program, the
manager estimates the total cost to produce an “average” unit of service (which is the completed
experience for that caregiver) to be $743 for this dementia program. This includes $703 of direct
costs and $40 of allocated overhead costs. This is the baseline cost before additional fixed or
variable costs are added.
Step 2: Estimate Service Capacity
The next step the manager takes is to estimate the service capacity that is possible within the
department/agency. In addition to personnel costs, the other required resources needed might
include meeting space, resource materials, audio-visual equipment, or other supplies. Usually
the staffing component is the limiting variable. That is, given the available trained staff, how
many units of service can be produced?
The manager should calculate a low and high end for the possible service units that can be
provided in a given time period. The more that the program is multidimensional and stretched
over weeks or months, the more variable the time commitment per client will be. The most
tightly scripted programs are the easiest to estimate in terms of time required per client and are
therefore more predictable in terms of cost.
The service and time commitment to serve a client/family (e.g., as for this counseling type of
dementia support) for this type of program typically takes weeks if not months. For an ongoing

service such as this, rarely will the time commitment be for one or two interactions. In addition,
not every client will require the same amount of time, even for the same service. Some clients
will require more follow-up, counseling, and guidance than others.
In our example, the social worker has about 20 hours per week, but 4 weeks per year are for paid
time off and for required dementia-specific training, leaving 960 hours per year dedicated to
direct service for the dementia program. The estimated time commitment per client will be
between 12 and 20 hours. Therefore, the total number of clients she could serve in a year would
be between 48 and 80. The manager chooses to use the low estimate of 48 clients (960 total
hours available divided by 20 hours per client). Because this is a new program, the manager is
being conservative. She knows that it is almost impossible to start at full capacity. Moreover,
developing a relationship with the client in this kind of service is important. Relationships take
time, as does building outreach and program visibility. In addition, service intensity is not
constant, even with the same client/family. Thus, the social worker with more clients may feel
stretched and have less ability to take on new clients. There will be a gradual ramp-up in year
one for this program. As part of building a budget and service forecast, the operational manager
will offer volume scenarios for management to consider as they set program targets.
Step 3: Calculate Cost to Produce the Program
Using our example, the total costs to Organization A to produce this dementia program at a
client volume of 48 individuals served in year one will be $50,144. This figure includes the fixed
direct costs ($44,240) and the variable costs to serve 48 clients ($5,904). Dividing the total costs
by 48 clients, we have a cost per unit of service of $1,045.
The manager creates various volume scenarios, calculating total variable costs while keeping
fixed costs constant. At greater than 48 clients, the manager adds first another 0.25 FTE at 60
clients and another 0.25 FTE at 80 clients to account for the time commitment of 20 hours per
client. This has the effect of raising estimated fixed costs by the salary level and training
expenses for an additional social worker.
Table 2 provides a simplified example using the cost estimates shown for the dementia program
offered by Organization A. Note that the cost per unit of service is highest at lowest volume. The
lowest cost per unit of service comes in at a volume of 48 clients, where the half-time social
worker is working at maximum capacity (if it takes 20 hours to produce completed caregiver
experience). For more clients, the manager needs to add an additional half-time social worker
and the program will incur additional training costs, which bump up the costs per unit of service.

Table 2. Organization A Dementia Program—Cost/Volume Scenarios at 20 hours
per client
10 clients 30 clients 48 clients 60 clients 80 clients
Fixed $44,240 $44,240 $44,240 $60,860 $76,980
Variable $1,230 $3,690 $5,904 $7,380 $9840
Total $45,470 $47,930 $50,144 $68,240 $86,820
Cost per Client $4,547 $1,598 $1,045 $1,137 $1,085
Table 3 shows the same volume scenarios, but this time the social worker time per client is
estimated to be 12 hours. Thus, the one half-time social worker can serve a maximum of 80
clients over the course of the year. No new fixed costs are added in. This substantially reduces
the cost per client. With this cost structure, the dementia program can be produced at a cost of
$676 per client if the social worker has a maximum caseload of 80 clients.
Table 3. Organization A Dementia Program—Cost/Volume Scenarios at 12 hours
per client
10 clients 30 clients 48 clients 60 clients 80 clients
Fixed $44,240 $44,240 $44,240 $44,240 $44,240
Variable $1,230 $3,690 $5,904 $7,380 $9840
Total $45,470 $47,930 $50,144 $51,620 $54,080
Cost per Client $4,547 $1,598 $1,045 $860 $676
Step 4: Understand Service Payment Rates, by Payer
What outside revenue sources are available to the organization to help pay the costs for this
dementia program? For purposes of this illustrative example, let us assume that the targeted
payers include (1) Title III-E OAA funds, (2) a regional health care organization that includes the
program within its service network at a defined payment rate, (3) health insurance plus
copayments from clients, and (4) private pay fees.
With the list of potential payers, the manager has to determine what these different payers will
reimburse the agency for this program. The manager selects among the volume scenarios (she
uses the scenario of 20 hours per client). She determines that the price point to meet or exceed
is $1,598 per unit of service. This is the cost at a volume of 30 clients. The manager and social

worker agree that at fewer than 30 clients per year, the program is potentially financially
vulnerable; the organization’s leadership likely might choose to discontinue the program if
volume was under 30 clients.
So with this target, the manager evaluates each payer source. Although it is true that producing
one dementia program “unit of service” will cost the organization from $1,045 to $1,598, this
does not mean that every payer will cover that cost. The price tag may be too high for some
payers. However, over the long run, without subsidy from the organization, the dementia
program cannot provide service for a price/payment below cost for all or even most of its clients
served.
Private Pay. Starting with the private pay/fee for service market, the manager begins to
estimate what price point might be viable. In most areas of the country few clients would be
willing or able to pay $1,598 out of pocket for this dementia program. However, if this dementia
service were covered as a benefit under the client’s private long-term care insurance policy, it
might bring the cost into reach for the consumer. For example, the insurer might provide a set
payment for the client’s care management and counseling services—let’s say $100 per day—and
the insured client can show the service was provided over 7 days; then the $700 payment from
the insurance company together with a $500 copay from the client would represent a combined
payment of $1,200. Organization A might accept this amount as payment in full. (The
organization would have set up billing and payment guidelines and exceptions in advance to
assist the manager or billing office personnel with how to handle discrepancies in payments
compared to billing amounts, by payment source.) The number of clients with long-term care
insurance may be small, but this could be a market niche that Organization A seeks to address as
a target.
The manager will want to conduct some market research to get a sense of what payment rates
are being paid for similar services in the area. A similar service would be one that involves the
same type of practitioner, addresses the same problem or issue, provides equivalent service, and
has produced similar outcomes.
For example, perhaps there are private home care agencies that have identified their social work
expertise in working with caregivers of persons with Alzheimer’s disease or dementia. These
agencies charge a rate of $180 per hour for their care manager consultation service (e.g., social
worker or other practitioner). Clients, on average, use 5 hours of time at a total cost of $900. If
this service is seen as equivalent in the general layperson’s mind, then the Organization A

dementia program will appear very expensive at $1,600 per client. A way to differentiate the
Organization A program might be to describe the components of the service, explaining that at
least 12 hours of social worker time is involved and sometimes as much as 20 hours. Potential
customers will quickly calculate that the cost from the private home care agency for that level of
social worker time would range from $2,160 to $3,600, making the Organization A dementia
program look like a bargain.
Service Contract. For a service network contract arrangement, the payer (Health Care entity)
and the aging services provider (Organization A) will negotiate a payment per unit of service.
The dementia provider will want and need to research payment rates that are being offered for
these similar services in the area (if they exist). If no service contracts exist in the region for
similar services, then the organizational manager will need to look to other regions. Any
information about rates for a similar service can be helpful in negotiating a reasonable rate.
Assume that Health Care Entity B has negotiated a rate with Aging Services Organization A to
provide service to up to 20 clients at a payment of $1,800 per client, not to exceed $36,000 for
year one. For this payer, Organization A will experience additional costs to execute a business
associate agreement and service contract and to enter data via a secure remote access system
that this payer requires. So there will be some additional administrative costs. Despite
determining that this will add $2,500 to upfront costs, leadership from Organization A decides
this is still a good course of action, because it is building the revenue sources for longer term
sustainability and because this provider partnership is strategically important to Organization A.
OAA Funds. Organization A is an approved provider of Title III-E Caregiver Support services.
The organization serves about 240 caregivers per year who qualify for Title III-E and receive
services such as caregiver counseling, information, education, respite care, and assistance with
access to needed services. The Organization A dementia program fits the service definition of an
approved service under Title III-E. Organization A has to comply with the allowable costs and
the 25% match of provider to federal funds that is required for Title III-E providers. In this case,
the maximum the organization can receive per hour of social work time is $85. Based on the
estimated hours of service that would be provided to the average caregiver (between 12 and 20
hours), the total expected payment from OAA Title III-E is between $1,020 and $1,700 per
client served. An average rate of $1,500 is chosen for this payer. Again the manager notes that
there are additional administrative costs to use a national database required by this payer. In
addition, Title III-E providers are paid quarterly, following the quarter in which the services
were provided. Therefore, the OAA Title III-E funds will be received up to 4 months following

the date of service. Despite these administrative challenges, leadership from Organization A
recognize the value of participating in Title III-E to the market and to the organization. They
determine that the OAA payment will be sufficient to cover costs of producing the program for
caregivers under this funding source.
Step 5: Understand Potential Referral Sources and Estimate Volume
The next part of this equation is to estimate demand, which will drive actual service use. To do
this, it is best for the manager to look at historical service utilization and current client service
patterns. From where do clients come? How do they get referred or self-refer to the program?
Are new patterns emerging? It is also wise to investigate the use patterns of other organizations
offering similar programs. The actual experience of these organizations, particularly if they serve
a similar population (e.g., they have similar geographic, demographic, and other market
characteristics), is useful in setting estimates of demand.
For example, assume that the aging services provider (Organization A) examines its existing
caregiver support and social work counseling services. It determines that most referrals (e.g., 20
per month) come through word of mouth (e.g., from past clients) and many qualify for Title III-
E Caregiver Support. The manager then looks at a 1-month sample of clients served by the
organization. Staff social workers who served these clients report that about half of them came
to the organization with concerns about their loved one’s memory loss and confusion. Thus, of
the 20 clients served that month, 10 may have been candidates for the dementia program.
Based on discussions with the social workers and previous experience with client use of services,
the manager determines that of the 10 possible dementia caregivers per month under Title III-E
funding, only 2 are likely to use the program. The manager uses this to estimate that about 20
clients will likely use the program in year one.
In this way, for each referral source, the manager builds a sense of what volume could be
expected for the dementia program. For the Health Care B service contract, the manager realizes
that reaching 25 clients in year one with physician referrals will be ambitious and estimates that
a reasonable target to set will be 15 for year one.
The manager can set up volume and payment scenarios, changing the mix of payer sources and
volume projections to create a high and low end estimate of what type of demand will be
expected for the dementia program. In our simplified example, the manager has set forth
expectations for four possible payer sources and volume expectations as shown in Table 4.

Table 4. Organization A Dementia Program Payer Rates and Expected Volume, by
Source
Payer Source
Expected Year One
Volume Potential Rate
#1—Older Americans Act Title III-E 20 clients $1,200 to $1,700
(choose $1,500)
#2—Health Care B Service Contract 15 clients $1,800
#3—Blended Insurance/Private Copay 3 clients $1,200
#4—Out of Pocket (discounted) 2 clients $1,000
Total: 40 clients —
Step 6: Calculate Break-even Point(s)
The break-even point for a program is the level at which the volume of units of service produced
at a specific price point (payment rate) covers the expenses to produce the service after which
additional service units produced provide net revenue after expenses. (Note that this is true only
up to a point; given staff capacity, eventually additional fixed costs have to be added to serve
more clients, that is, another trained social worker).
In our example, the manager adds in the additional upfront administrative costs that will be
required to work with the different payers and recalculates cost per client. Table 5 shows that
the manager has added in additional fixed costs that will be required to work with the payers.
Thus, at 20 hour per client for social work time, the dementia program costs from $1,117 to
$1,713 per client.

Table 5. Revised Costs per Client, by Volume—Year One
Volume: 30 clients 40 clients 48 clients
Fixed—Includes additional upfront costs which
have been added to comply with payer requirements $47,690 $47,690 $47,690
Variable $3,690 $4,920 $5,904
Total Costs $51,380 $52,610 $53,594
Revised Cost per Client $1,713 $1,315 $1,117
The manager then calculates net revenue by payer source, using the assumptions about volume
and price, by payer (Table 6).
Table 6. Net Revenue Gain/Loss, by Volume With Payer Source Assumptions
Volume: 30 clients
40 clients
(expected volume) 48 clients
Fixed—Note that additional
upfront costs which have been
added to comply with Payer
requirements $47,690 $47,690 $47,690
Variable $3,690 $4,920 $5,904
Total Costs $51,380 $52,610 $53,594
Cost per Client $1,713 $1,315 $1,117
Payer 1-OAA 18 clients @ $1,500 20 clients @ $1,500 25 clients @ $1,500
Payer 2-HC B 10 clients @ $1,800 15 clients @ $1,800 18 clients @ $1,800
Payer 3- Insurance
+Copayment 2 clients @ $1,200 3 clients @ $1,200 3 clients @ $1,200
Payer 4-Client No clients 2 clients @ $1,000 2 clients @ $1,000
Total Payment $47,400 $62,600 $75,500
Net Gain/Loss ($3,980) $9,990 $21,906
As shown, the program break-even point with this payer mix and this cost profile is between 30
and 40 clients served—about 34 clients. At the expected volume of 40 clients—averaging 20
hours of social work time per client and assuming this payer mix—the program has net revenue
of almost $10,000. At 48 clients, the program has net revenue of almost $22,000. Note that if
most clients who came to the program were covered at the rates shown by Payer 3 (insurance
plus copayment) or Payer 4 (Private Pay Client), then the program would hardly produce any

net revenue or might lose money. Even at full capacity for the one .5 FTE social worker (48
clients), the payment rates for these two payers are low as compared to costs borne by the
organization to produce that unit of service.
Step 7: Finalize Budget and Service Targets
The final step is to finalize the budget and service targets. In our example, the manager uses the
revenue and expense estimates and the payer mix and volume assumptions. This analysis
becomes the blueprint against which the program is measured and assumptions checked. The
more that the demand/volume, operating costs, or payments received vary from the estimates,
the more that the program’s performance will vary. The manager may wish to set parameters for
making mid-course corrections on the program if actual experience greatly deviates from the
ranges that have been set. The volume of services delivered, the units by payer source, and the
cost per unit of service are some of the metrics that determine whether the dementia program is
viable. Each year of service provision provides more data points from which the manager is able
make more accurate forecasts. As data are collected about costs to produce a unit of service,
volume by payer, and payment rates, the original assumptions made can be tested and revised.
The manager will present this information to organizational leaders who determine whether it is
worth continuing to offer the service. This assessment goes back to the business and financial
model expectations and needs of the organization.

Case Example #2: Funding Strategies for a Dementia Program:
Aging and Adult Services Agency, Department of Health and Human Services,
Michigan
This example highlights the Creating Confident Caregivers® Program in Michigan. It is based
on a key informant interview conducted in July 2015 with Sally Steiner, Project Director, and
Scott Wamsley, Division Director, Department of Health and Human Services, and information
from ADSSP Grant (#90AE0341) and the Michigan State Plan on Aging (2014–2016).
Background
The Creating Confident Caregivers® Program is the name used in Michigan for the evidence-
based Savvy Caregiver Program (designates the implementation with state monitoring and
oversight). The Savvy Caregiver Program was developed by researchers Kenneth Hepburn
(formerly with University of Minnesota, now with Emory University) and Carey Wexler
Sherman (Institute of Social Research, University of Michigan). The Creating Confident
Caregivers Program delivers the Savvy Caregiver program using the manual, audiovisual and
printed materials, and ongoing training, assistance, and fidelity oversight. The program is
provided in six, 2-hour weekly sessions to caregivers of persons with dementia living at home.
The program is provided by a trainer who has completed an approved training program.
Discussion
The discussion focused on the following:
• Funding options explored
• The budget and funding strategy used for the dementia program
• Assumptions made
• Conducting a cost analysis
• Financial sustainability and lessons learned
Funding Options
From the beginning, sustainability was our goal. We used the RE-AIM framework (Reach,
Effectiveness, Adoption, Implementation, and Maintenance) to guide our program
development and implementation. The AAA directors were encouraged to use National Family
Caregiver Support Funds, including Title III-E dollars. The Administration for Community
Living put out a transmittal to focus on evidence-based programs for Title III-D health
promotion dollars, and the state of Michigan approved the use of these funds for the Savvy
Caregiver/Creating Confident Caregivers program. The good news is that Michigan already
had a strong history of implementing evidence-based health promotion programs.
The State of Michigan offers caregiver support funds in addition to the OAA dollars available.
This is an important source of funding for these programs as well.
Private pay fees were never part of our model. With the federal funds, we do not charge
caregivers. Of course through the OAA, a voluntary contribution is allowed. However, our
programs have not built this in as part of their formal funding model.

Initially there were six AAAs involved. Then this expanded to all 16 AAAs. Fifteen AAAs are still
offering the program. They see this as part of their normal funding model now, and this
program is embedded within their caregiver services and health promotion programs. Some
AAAs tried sponsorships (e.g., to do a program at the corporate office, or with underwriting
from a business). However, such arrangements had limited success.
Chosen Budget/Funding Strategy
With regard to the budget development to support the grant program implementation and
expansion of Creating Confident Caregivers®, each partner AAA developed its own project
budgets during the proposal phase. Each AAA met the match requirement for the federal funds
they received. We compiled the AAA budgets to create the overall project budget.
Cost Analysis
We conducted an analysis across the AAA program sites. In general, the direct costs were very
similar across the sites. Under the grant funding we had to very carefully track costs. Going
forward, while we continue to track funds and services provided, this level of cost tracking
detail is not necessary.
We did look at the cost components. Staff time is the biggest component. The caregiver manual
costs about $20 per copy. There are session costs, handout materials, and supplies. Some AAAs
do include a statement on their marketing that donations are welcome; however, that is not a
sustainable funding source. We think the program should not be fee-based.
Financial Sustainability and Lessons Learned
Under the service definition, AAAs can use state caregiver funds, Title III-B, D, and E funds.
Most AAA directors indicate that they are using a mix of these sources. Some use local millage
funds. Having the service definition include this evidence-based program is key to financial
stability. Those sources of funds will cover program costs.
The bigger issue for us in terms of sustainability is capacity—of trainers, program fidelity
monitoring (done at the state level), and recruitment to fill classes—especially in remote areas
of the state. Some AAAs have high program demand, while remote areas have high need, but
low numbers. Staff turnover is unavoidable. Word of mouth is the biggest referral source—
those who have taken the class tell others.
Our approach has been to play to the AAA strengths and determine with them what works best
with their service approach and their regional needs. This program was very congruent with
the AAA strengths and approach. The local budget control also played to their strengths. They
know what it takes, what is needed operationally. The local implementation of this program
was very important.
I feel we’re sustainable. The program is embedded and there is local control and ownership.
Just since 2008, we’ve served nearly 5,000 caregivers, 10,000 if you include the person with
dementia. That is success.

Chapter 4: Marketing
Key Questions
1. What is marketing?
2. Who are the customers?
3. What is the distribution channel?
4. What are marketing and outreach methods?
5. What marketing considerations arise when operating within partnership agreements?
What is Marketing?
Marketing is defined as a function of planning, pricing, promoting, and distributing the
organization’s programs and products (Kotler & Andraesen, 1991). The benefits of good
marketing include (Holland, n.d.):
• Greater consumer satisfaction
• Increased consumer participation
• Better attraction of resources
• Stronger donor, staff, and volunteer loyalty
• Greater efficiency and effectiveness of services
• Stronger organization
The marketing and communication strategy for the dementia program must be developed with
the business model, program focus, and funding model in mind. Because marketing and
outreach takes time and money, the organization needs to decide where to allocate resources
that will maximize referrals to the dementia program. The marketing must also differentiate this
program from others that may be potential competitors in the marketplace so that consumers
will choose this organization’s services.
Step #1: Clarify Who the Customers Are
The end user of the dementia program is the person with the disease or the caregiver, such as a
spouse, adult child, or live-in friend. However, there are many other potential customers
(intermediaries) who may be the actual purchaser of the service or who are key constituents in
getting the service to the end user. These purchasers or payers often influence who will be
served, when and how that service can be provided, and what can be offered to the person and
caregiver. The dementia provider organization needs to consider both the end user and these
intermediaries.

Casting the net widely, the target audiences could include the following:
• The general public who are potential end users of the program (caregivers and persons
with dementia and their families, friends, and colleagues)
• Professionals from potential referral sources and businesses providing health care or
related products and services
• Staff members from elder advocacy and voluntary health organizations (e.g., Alzheimer’s
Association, Parkinson’s Society, Stroke Association)
• Staff in regional or statewide helplines, ADRCs, or AAAs
• Those in helping or counseling professions, such as leaders from faith communities,
therapists, or counselors
• First responders, such as emergency medical technicians, paramedics, fire, or police
Step #2: Understand the Distribution Channels
The program will need to consider the distribution channels—the potential pathways through
which the person with dementia or caregiver and the service are connected. The intermediaries,
such as payers or other providers, are part of these distribution channels. The manager will want
to understand how caregivers and persons with dementia are most likely to find and access the
dementia program and how professionals and others refer people to programs.
To map out the possible distribution channels, the program manager will need to investigate
how people with dementia and their caregivers seek, find, and use dementia programs. Although
there is some information in the literature about this pathway from identification of need to
service use, the best source of information may be the organization’s own staff serving older
people and caregivers. If the dementia services provider is a member of a larger partnership or
network, these collaborator organizations also can offer information and insight about these
distribution channels and how people seek care.
The journey of care seeking to care finding can be a long one. There is not a clear path from the
time the family or person with dementia identifies issues with memory loss/confusion to the
time they receive help. Delays of years between noticing symptoms and seeking help are not
uncommon. There are many reasons for this delay. Symptoms are not often recognized in the
early stages of the disease. There may be denial that anything is wrong. Out-of-town family
members may not be aware of changes in daily living or cognition. If there are indications of
mild memory loss or confusion, family members may believe they are part of normal aging or
because of fatigue.

Unfortunately, even once the person or family member begins seeking a medical diagnosis
related to the memory loss, confusion, or other symptoms, he or she may not receive a diagnosis
right away. Many individuals with Alzheimer’s disease or related dementia experience delayed
diagnosis.
After the diagnosis, the person and family may be in a state of shock or denial and can be
reluctant to make the call for dementia/caregiver supportive services, even when their physician
has advised them to do so. Thus, the person and his or her care partner might go for months or
years before learning about supportive dementia and caregiver programs. Likewise, the
dementia service provider is usually unaware of who has dementia or who is a caregiver in his or
her service area until that person seeks help. For all of these reasons, the person and dementia
services provider remain separated.
Eventually, some individuals find dementia programs through informal and formal distribution
channels. Typical referral sources for these types of programs include the following:
• LTSS system in the state/region (e.g., “Senior Help Line,” ADRCs)
• Word of mouth—general lay public (e.g., family, friends, neighbors, and previous clients)
• Advocacy organizations and voluntary health organization serving target population
(e.g., Alzheimer’s Association, Stroke Association, Parkinson’s Society)
• Professional referrals from general or specialty medical or social service organizations
(e.g., primary care physicians or neurologists)
The dementia provider will need to consider how the person and caregiver work through or are
guided within each of these distribution channels. Each referral source may need a different
approach in marketing, communication, and outreach.
Long-Term Services and Support System—The LTSS system in each state represents an
important way to connect older people or caregivers to a service provider. The LTSS system
largely depends on ADRCs and AAAs to help direct people in need to the appropriate services.
Many states have been working to ensure a “no wrong door” approach to their LTSS systems.
Using such processes as online screening, telephone and in-person intake and assessment, and
self-directed web-based database, information, and referral systems, consumers (or
professionals acting on behalf of consumers) are provided with lists and summary information
about programs and services for dementia and caregiver education, counseling, or other
programs. To effectively use this system, the dementia service provider has to ensure that the
list of services it offers is in the LTSS database and is accurate. Providers may be able to include
information that helps differentiate their program from others (e.g., offering services on evening

and weekends, providing services by a master’s-level clinician, offering services in several
counties).
The LTSS systems are an excellent starting point for getting the dementia program on the radar
within the state and region and for reaching consumers. However, the system has limitations
and can offer challenges, especially from the perspective of the consumer (end user), who may
be either the caregiver of the person with dementia or the individual with dementia. A study of
policy and field experts notes that the weaknesses in the LTSS system may be particularly
difficult for persons with dementia (Shih et al., 2014; Tilly et al., 2011).
Strategies that dementia service providers can use to address the limitations of the current
system include the following:
• Offer open information and educational sessions about dementia, where the whole
community is invited for building general awareness about dementia, caregiving, and the
benefits of seeking help early.
• Assist callers by being attuned to the primary need of the caller and synthesizing
information in useable, manageable pieces.
• Follow up with a call to check on the consumer within a week or two, triggered by follow-
up alerts in a database.
• Assist the consumer with finding relevant resources that meet current needs and
preferences.
• Build awareness of service substitutes, when a particular program is not available but
there is another service that might meet the need.
Word of Mouth—Direct recruitment of older adults (including those with dementia) and
caregivers to gain their participation in evidence-based programs has proven to be challenging
(Frank & Lau, 2013; Gould et al., 2014; Paone, 2014, 2015; Woodstock et al., 2013). Typically,
word-of-mouth referrals—from friends, family, neighbors, or caregivers’ work colleagues—
represent the top referral source for aging services providers. This distribution channel is
unfettered and not formally organized. This channel requires a marketing and outreach
approach that maximizes visibility throughout the community. The approach should target
specific groups or locations (physical or virtual), to focus in on people who are more likely to
need the dementia program or caregiver services. For example, hardcopy fliers or electronic
updates that describe dementia support services could be included in electronic announcements
or bulletin boards used by caregiver support group participants.
Person-to-person outreach has been found to be most effective in reaching caregivers (Navaie,
2011). Distribution by mail has been found to be the least effective method. Timeliness of

recruitment—that is, meeting the caregiver with the information and invitation at the right time
(just when he or she has self-identified as requiring help)—plays a key role in success.
Families and caregivers may not know where to go to find services or may be uncertain about
the type of services available. Use of advertising, blogs, social media, and other methods can
draw the attention of a general audience and drive them to an agency’s phone number or
website. However, caregivers frequently do not identify as such, and the person with dementia
may be trying to avoid being labeled. Therefore, simply advertising the availability of a dementia
program may not yield self-referrals. Building some basic understanding of the symptoms/signs
of dementia, and general awareness of caregiver issues faced, may be part of marketing the
program. In your materials, include brief descriptions of the dementia service purpose and how
a caregiver or person with dementia experiences/uses the service. This can be helpful to
caregivers—making the service more approachable and understandable.
Often it is adult children, other family members, or close friends who seek out information
about the disease and services. Building awareness may include advertisements, articles, or
videos and placing them in newsletters, on websites, and in other virtual communities—
targeting information to those who are more likely to have recognized assistance is needed. For
example, there may be advocacy organizations, employee assistance programs, faith community
forums, or therapists/counselor sites that could include links to websites of local providers,
provide service definitions and guidelines, or offer tips to assist caregivers as they seek help.
Testimonials or short vignettes from caregivers speaking about how the program helped them
during a difficult time may be especially compelling.
Health Care and Social Services Professionals—An important distribution channel is
professionals working in the health care and social services sectors; those who are likely to come
into contact with older people and families dealing with dementia. In many cases, physicians do
not have the time to provide the education and counseling that people with dementia and
caregivers need.
Step #3: Connect Marketing Methods to Constituents/Customers
As the organization prepares a marketing strategy for the dementia program, it needs to reach
the intermediaries and end users of the program. This will require deployment of many
strategies and a variety of methods intended to reach a number of audiences. Recruitment and
marketing/outreach methods can include:

• Personal phone calls to existing clients
• Brochures/print pieces mailed to existing clients and distributed at caregiver meetings or
other gatherings, conferences, and events
• Personal visits made to local clinics, hospitals, pharmacies, and local social service and
home health care agencies (leave print materials and business cards)
• Materials offered through the local Alzheimer’s Association chapter
• Written announcements or bulletins in newsletters, local papers, e-bulletin boards,
websites of cities/towns, senior centers, advocacy organizations, faith communities,
schools, local businesses, legal and financial planning firms, etc.
• Presentations at health fairs, local festivals, educational events, etc.
• Facebook and Twitter announcements and ongoing feeds
• Articles, feature stories, case stories in local publications, cable-access channels, blogs
Effective recruitment strategies for building enrollment of persons with Alzheimer’s disease and
their caregivers into clinical trials offers some insight into how these individuals are reached and
why they decide to participate. For example, one study by researchers from the University of
Kentucky compared recruitment methods for an Alzheimer’s disease research study, including
methods that directly targeted potential subjects (e.g., family and friends) and those that
targeted primary care physicians. Greater recruitment success came from directly targeting
potential subjects than from going through primary care physicians (Carr et al., 2010). In this
case a community outreach health fair event was held where 14 research teams participated as
exhibitors and provided hands-on activities that highlighted research studies and offered free
memory screens. The event was advertised through a number of media formats: a local
magazine, a local TV news program, the local Alzheimer’s Association chapter, and through
direct mail to 600 community members who were already on a university mailing list.
Tools and methods for designing ways to reach consumers and professionals include the
following (Holland, n.d.):
• Focus group discussions
• Analysis of demographic and census data
• Key informant interviews
• Surveys of consumers, sponsors, and referral sources
The dementia provider should:
• Plan specifically what it will do, why, how, and when as it delivers the dementia program
• Identify and describe the products that the various constituents value
• Ensure that prices are acceptable and provide sufficient revenue
• Make sure that the places that the end user and intermediary use (the distribution
channels) are easily accessible and user-friendly

• Develop a promotion strategy that has two-way communication so that the
intermediaries and end users of the service realize the benefits of engaging with this
program and provider
Attending to Culturally Diverse Groups—In many U.S. markets, the population is increasingly
diverse in terms of ethnicity, culture, language, race, and religion. A marketing manager who is
not a member of a specific group may not be knowledgeable about the nuances of how that
particular group copes with Alzheimer’s disease or about their values, needs, and preferences. It
is useful to reach out to local social service or advocacy organizations with staff members who
will have firsthand experience as members of and service providers to these specific groups.
Review of the websites of these organizations and personal phone calls and interviews may help
the manager gain some understanding about values, beliefs, preferences, messages,
terminology, and images that are positive and respectful.
Step #4: Be Aware of Special Considerations Within Partnerships
When operating as part of a larger network, the manager from the dementia program will need
to comply with partner parameters set around marketing, outreach, and communication. Each
of the partner organizations will have its own logo, branding, website, and marketing/
communications strategy. The manager from the dementia program should understand any
written agreements that pertain to these issues. The astute manager will also find out about the
unwritten or implicit expectations that other partners may have regarding how the partnership
is described or promoted in materials. In some partnerships, the dementia program may be seen
as “co-created” or “co-promoted” where any written or electronic materials about the program
must be developed jointly and approved by the participating organizations. Any time the
partner’s name (or logo) is used, that partner will expect review and approval. Some partners
may request specific terminology to be used. Others may want input when the media format is
especially visible (e.g., a television or local news feature story). With some evidence-based
programs, the intervention owner/license holder expects the program to be described in a
certain way. They may offer templates for advertising their program to the general public.
Connecting information via web-links across partner websites is another good strategy for cross-
site awareness and promotion. These issues, strategies, preferences, and constraints should be
discussed prior to launching the marketing plan.

Chapter 5: Evaluation
Key Questions
1. Who are the stakeholders in evaluating the dementia program?
2. What are indicators or measures of success in financial and nonfinancial terms?
3. How will data be collected and analyzed?
4. How will the evaluation help the organization to meet its goals?
Why Evaluate?
Even with the best preparations, no business strategy is assured. Without a systematic
evaluation using meaningful measures, the organizational leader or manager is hampered in
knowing if he or she is succeeding. Evaluation should include more than financial metrics. It
should include nonfinancial information that captures key stakeholder perspectives. An
evaluation provides the information to determine whether the resources invested achieved
intended results. Outlining the evaluation plan is the final component of creating the business
strategy.
Step #1: Identify Stakeholders
It is very important to identify key stakeholders—those who the organizational leadership
consider integral to the program’s success—before designing the evaluation plan for the
dementia program. From a business perspective, these stakeholders must be satisfied with the
program if it is to continue. These stakeholders could include the following:
• Clients (persons with dementia and their caregivers)
• Leadership from the implementing organization
• Staff members and volunteers
• Payers and “intermediaries” using (referring to) the program
• Other funders
• Partners and collaborative organizations where there are programmatic or strategic ties
• Policy makers in state and federal agencies
• Consumer advocates
• Researchers (particularly for evidence-based programs)
Develop the evaluation plan to ensure that the type of information needed from and for each of
these stakeholders is gathered in a systematic way. This information from the stakeholders
could be gathered through informal or formal means; the type of information may be qualitative
or quantitative. Methods and data sources could include telephone conversations, in-person
interviews, electronic or mailed surveys, consumer/client data reports (e.g., on client referrals,

by organization, market penetration), or financial data. The goal is to capture and analyze
information in a structured way that provides a systematic assessment of the results of the
business strategy. The evaluation of the business strategy should be both internally and
externally focused.
Step #2: Select Indicators/Measures
When selecting indicators and measures, consider choosing a set that captures different
components. For example, include structure, process, and outcomes of the program, and attend
to the different domains or focus areas (e.g., financial, marketing). Set out your analytic
framework for the evaluation to ensure that all important domains are included.
Indicators—The evaluation plan for the dementia program could include a variety of types of
indicators and focus areas, such as:
• Visibility/Awareness/Marketing—How are the different marketing and communication
methods working? What type of outreach and marketing is generating the most return?
• Volume/Demand—Have the service volume projections occurred as expected? Who or
what organization is sending the most referrals to the dementia program? Are referrals
coming from word-of-mouth/previous client referrals or from professional service
providers? What is the overall demand for the dementia program?
• Geographic or Population Target Reach—What target population groups are using the
program? Is the programming reaching intended special populations?
• Services Delivered—How many “units of service” are being delivered? Are there waiting
lists? Is there excess capacity? Are different services being requested? Are there patterns
of service delivery emerging (e.g., do caregivers want evening and weekend hours)?
• Operational Efficiency—Are there duplications, gaps, or extra steps or processes that can
be eliminated to make service delivery more efficient, reduce administrative burden, and
ensure that the highest cost resource (usually the trained professional staff member) is
performing duties at the top of his or her license or capabilities? Are there tasks or steps
that can be delegated to others?
• Cost—How do actual revenue and cost experience match projections? Is the program
losing or making money for the organization? By how much?
• Service Effectiveness and Consumer Satisfaction—How effective is the service that is
being delivered? Are consumers satisfied? Are results, such as reduction in caregiver
stress/burden, being achieved? How is the program performing on the specific outcomes
that payers and partners are monitoring (e.g., clinical, functional, quality of life, and
utilization)?
• Partner, Payer, and Leader Satisfaction—Are the key partners and payers, and internal
managers and organizational leaders, satisfied with the quality and service outcomes and
with the administrative processes and efficiencies?

Measures and indicators of success could include the following:
• Structural measures—such as having a full complement of trained staff; having signed
partnership agreements
• Process measures—such as how the direct referral methods are working with partners;
marketing outreach response; staff workflows for the program showing efficiencies
• Output measures—such as the number of caregivers served; the number of caregiver
workshops held; the number of client counseling sessions provided
• Outcome measures—such as consumer satisfaction; pre/post workshop knowledge
scores from caregivers; reduction in caregiver burden; decrease in emergency room visits
or nursing home placement
Step #3: Collect and Analyze Data
All evaluations are only as good as the data they collect. You will be collecting your own data or
using data already collected by others. For example, you may conduct caregiver satisfaction
surveys, and your collaborative partner (e.g., partner health care system) may collect
information on the number of Emergency Room visits made by patients/clients using the
dementia program.
Collecting reliable and valid data is hard. Many organizations do not invest enough resources
into collecting usable data. It is important to make sure that the data collection has been thought
through and that you are using valid and reliable measures. Think through each instrument
(collection tool) and through each data source. Consider what is most valuable in terms of
decision-making. Do not collect data first and then figure out how you are going to use these
data. Likewise do not get to the end of your first year of operations without information to report
to key stakeholders.
With regard to outcome data—for example, the effect of your program on caregivers or persons
with dementia—data that are integral to the provision of services are likely to be more complete
and representative of service users than are surveys administered thereafter. For example, data
collected when counselors are speaking directly to clients are likely to be more complete and have
a higher response rate than mail surveys sent after the end of the service. Surveys with low
response rates raise questions about the representativeness of the data and validity of any
analyses.
If possible, embed the data collection into program operations. For example, include validated
depression or burden instruments in your caregiver assessment; add some kind of feedback
incentive in your marketing outreach or in a post-program survey; ensure that referral source

information is gathered at every intake call by including a request for the referral source on the
telephone script for staff who receive calls. You will, of course, also have regular financial reports
from accounting. Ensure that the costs and revenue for this dementia program are being coded
correctly, through having added specific items (for this dementia program) to the Chart of
Accounts used by your organization. This one action will save countless hours going back through
records to determine what was spent or received that is attributable to this dementia program.
Once the information has been collected, the data need to be analyzed and written up in a way
that can be communicated effectively to the organization’s management and other stakeholders.
The financial data is probably the most straightforward, as long as revenues and expenses have
been properly coded. Other quantitative data could include such items as number of referrals by
date, by source; caregiver burden/depression scores; staff hours per client; zip codes of clients
served; growth in referrals and referrals sources, by month.
Quantitative data can be entered into a spreadsheet program for analysis. For example, a
spreadsheet that shows the referral source that each client caller reported to the staff member at
intake, by date could provide information useful for gauging the effectiveness of marketing and
outreach methods. The manager might notice a spike in calls right after a particular outreach
method was conducted. In the same way, the data may reveal that one or two physicians in the
community represent a large percentage of total physician referrals to the program. It would be
worth finding out why these physicians have been referring so many of their patients—perhaps a
follow-up telephone call with a few interview questions would reveal important insight.
Qualitative data, such as from focus groups or interviews with partners, will enrich the financial,
service, and quality data picture to “get behind the numbers” and determine strengths and
weaknesses of the business and service approach.
Step #4: Make Program Adjustments Based on Evaluation
Ultimately, the purpose of the evaluation is to assess the strengths and weaknesses of the
business strategy and to make improvements in program operations, if needed. The evaluation
provides information and data for adjusting or reaffirming the course of action that has been set
for this dementia program. Thus, the results of the evaluation should trigger response on the
part of the organization to review procedures and to address identified problems or to enhance
and recognize those components that are going well. It also offers opportunity for increasing
visibility and ensuring support by payers. For example, if outcomes are successful and have been

credibly measured, the positive results can be used to help market the program to third-party
payers and clients.

Conclusion
The key message of this Toolkit is that the process of writing a business plan for your dementia
program is an effective discipline that will serve you well. A business plan that is based on clear
purpose and goals will provide the information and a structure that you can use to plan,
implement, and evaluate your program. The process of researching the information needed and
clarifying parameters for the dementia program will provide you with a better understanding of
possible pitfalls and opportunities. It should provide you with the tools to make the dementia
program more successful and likely to be sustained.
Key takeaway messages in the Toolkit are the following:
• Know the organization’s purpose. Organizations have many competing claims on their
resources. Why does the organization want to focus on persons with dementia and their
caregivers? Why implement a dementia program? How will doing so affect the
organization? What are leaders and stakeholders expecting from the program? How does
this program fit into the organizational strategy, funding model, and vision?
• Clarify goals for the program. Yes, there are operational, funding, and other
organizational goals for the program. Hopefully the ultimate goal relates to how this
program will affect people living with dementia and their caregivers. Be clear about
expectations and outcome/impact measures that address how the lives of people with
dementia and their caregivers may be improved as a result of the program.
• Understand your market—demand, payers, competitors. Geographic areas differ in
terms of population density, demographics, characteristics, and service availability. In
some locations, services for caregivers and persons with dementia are few and far
between. In other areas, there are already other organizations addressing needs. Does
this dementia program fill an unmet need or does it seek to reallocate market share? Are
there opportunities for partnering or collaborating to co-produce or co-market your
dementia program? What is the organization’s market niche? How is this dementia
program going to be different?
• Determine your input costs and set a budget and service forecast based on sound
information. To stay in business, the organization has to take in enough funding overall
to cover costs. As with most programs, the dementia program requires certain personnel,
materials, and other resources. When creating a budget, be sure you’ve accounted for
direct/indirect and fixed/variable expenses. Investigate all potential sources of revenue
and be explicit in your rate and utilization assumptions. Create service volume and payer
source scenarios that have a range of values for these variables to allow you to calculate
reasonable (fact-supported) targets. As you learn more about payer requirements, build
in the lead time necessary to be sure you’ve met the requirements (e.g., certification of
provider status with a provider number).

• Use a marketing approach, and methods/media, that match the target constituents.
Organizations cannot assume that clients automatically will use the program’s services
just because they are offered. Clients must believe that they need or want the services,
know that the program offers the desired services, expect that they can afford the
services, and determine that the benefits of obtaining the services outweigh the
difficulties of doing so (e.g., travel, filling out forms, and involving a stranger in their
personal life). Dementia programs often overstate the number of clients that they will
serve, at least initially. Your marketing approach will address both the “end user”
(persons with dementia and caregivers) and the “intermediaries” who refer to the
program. A good marketing strategy has taken into account the distribution channels or
pathways for having your dementia program reach the end user customer. Your
marketing plan will have identified the types of media, messages, and images that best
match these constituents.
• Evaluate your strategy. Without evaluating your business/service strategy in a
systematic way, you will not know if you are reaching targets—program goals. In your
evaluation plan, you’ve identified all of the types of data and information that you need
to determine if the operational, funding, marketing, and quality monitoring approach
has been successful. You’ve selected valid and reliable measures and selected methods to
obtain data that balance resource constraints with the need for credible results. You have
a sound way to analyze the data and present the results. Your plan includes
communication and presentation to key stakeholders including organizational leaders.
The evaluation provides the information needed to adjust the strategy, marketing,
funding, service, or other components of this program. You can use the results to attract
additional funders as well.
• Plan for sustainability from the beginning. Many programs start with short-term grants
or seed money and then end when the grant money runs out. This start and stop
programming is hard on staff, clients, and the organization’s viability. Planning for
sustainability of the dementia program begins before the first client is served. It requires
the planning work as described in this Toolkit and engagement of leadership. If the
result of the examination is that the dementia program cannot be self-sustaining (cover
its own costs), then that message has to be brought to organizational and other
community leaders. There may be such interest and commitment to the issue of
increasing dementia and caregiver programs that new collaborators, funding avenues, or
advocates emerge. Better to engage these stakeholders upfront in the pursuit of
sustainable programs than to wait until the program is in its last year of funding.

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Appendix
The following resources provide additional tools, learning opportunities, and information
related to business planning. Although not all resources are dementia specific, the content is
applicable to dementia-related interventions and systems.
Resources Chapter 1: Business Model and Partnerships
Training Resources
• Integrating Community Programs Within Health Care: Building an Infrastructure and
Partnering to Scale and Sustain Self-Management Programs (Elder Services of the
Merrimack Valley, Inc. and Hebrew Senior Life)
Provides an example of the funding and partnership components of the Healthy Living
Center of Excellence, an innovative partnership between a community-based
organization and a medical provider in Massachusetts. Presentation slides also outline
some steps of marketing plan development.
• Partnerships: Key to Behavioral Health Service Success (National Council on Aging)
Webinar that serves as a companion to the Partnering to Promote Healthy Aging
manual referenced below. Shares factors in developing successful partnerships and the
benefits of these partnerships, as well as case studies.
• Developing Service Packages that Appeal to Healthcare Entities of Various Sizes,
Shapes and Motivation (Partners in Care Foundation, 2013)
Offers an example of a service provider that developed programs and a new business
model to better meet the needs of clients and partners. Presentation emphasizes offering
broad, diverse product lines for the diverse needs of payers and providers, identifying
clear roles and expectations, and using metrics to support initiatives and purpose.
• Nonprofit Sustainability Clinic (CompassPoint)
This slide presentation walks through a simple matrix of profitability and impact for
evaluating the business model and programmatic options for the nonprofit. The matrix
includes four quadrants into which a program could fall: Upper left—high mission
impact, low profitability; Lower left—low mission impact, low profitability; Upper right—
high mission impact, high profitability; Lower right—low mission impact high
profitability. Examples of each type of program are provided.
Further Reading
• Older Americans Behavioral Health Issue Brief 1: Aging and Behavioral Health
Partnerships in the Changing Health Care Environment (Substance Abuse and Mental
Health Services Administration and Administration on Aging, 2012)
Issue brief covers key components for health systems that choose to partner with aging
service providers and behavioral health providers in order to reach populations and link

to community-delivered evidence-based services with the ultimate goal of improving
care coordination and reducing cost. Useful sidebars list “Key Actions: Lessons Learned
from the Field”: checklists for Aging Services Network, Behavioral Health Services, and
Physical Health Services.
• Partnering to Promote Healthy Aging: Creative Best Practices Community
Partnerships (National Council on Aging, 2007)
Manual that serves as a companion to the Partnerships: Key to Behavioral Health
Services Success webinar referenced above. Provides ideas and strategies for building
state and local partnerships and features case studies of seven best practice programs.
Key “lessons learned” and contact information are shared for each study.

Resources Chapter 2: Program Operations and Business Planning
Tools and Templates
• Business Plan for Nonprofits and Social Enterprises (Nonprofits Assistance Fund)
An outline of a business plan developed from a nonprofit perspective.
• Aging & Disability Resource Center Technical Assistance Exchange (Administration on
Aging, Administration for Community Living)
Set of business planning resources developed for ADRCs but potentially useful for other
entities developing and providing dementia programs. Samples and templates include an
ADRC Business Plan Template (Lewin Group), and the Alaska ADRC Operational Guide
that includes a useful readiness checklist and a critical pathways flow chart (depicting
stakeholders, referral and intake pathways, and funding sources).
• Business Plan template (National Council on Aging, Center for Healthy Aging)
A companion resource to the Creating a Business Plan webinar listed below; provides a
template for a business plan.
Training Resources
• Creating a Business Plan for Evidence-based Health Promotion Programs (National
Council on Aging, Center for Healthy Aging)
A 36-minute webinar showing the process of creating a business plan. Topics include
ways to use a business plan; contents of a business plan; examples of Return on
Investment.
Further Reading
• South Carolina's ABCs of ADRCs Replication Manual (Aging and Disability Resource
Center in South Carolina, 2007)
A comprehensive “How To” manual, including information on purpose and background;
definition of terms; business planning; management/staffing; information systems;
marketing; evaluation; lessons learned. Illustrates how a dementia program can fit into a
larger system/organization. A useful appendix contains examples of work plans, job
descriptions, marketing tools, surveys, assessment tools, and more.

Resources Chapter 3: Funding Strategies
Tools and Templates
• Considerations for Conducting a Cost Analysis (Paone & Associates, 2009)
Memo and worksheets outline the approach used to conduct a cost analysis for the
NYUCI implementation in Minnesota. Assumptions and definitions are provided, and
instructions for filling out the worksheets. Materials can be adapted.
Training Resources
• Financial Stability Module (Minnesota Department of Human Services)
Developed for agencies that provide older adult services, this training module provides a
step-by-step process to achieve financial sustainability for the organization or program.
• Business Planning as a Tool for Financial Sustainability (National Council on Aging,
2011)
Webinar highlighting business planning examples from Illinois, New York, and Maine.
The importance of building relationships with funders is emphasized. Other key points:
Grants don’t last forever; determine the minimum reimbursement to be viable over the
long term; have an exit strategy if key milestones are not reached.
• True Program Costs (Nonprofits Assistance Fund)
This program budget and allocation template and webinar guides readers as they allocate
costs and calculate the true costs of programs and overhead. The video tutorial provides
an overview of the concepts and practices of program budgets.
• Financing and Sustaining Behavioral Health Interventions (Older Americans
Behavioral Health Technical Assistance Center, 2013)
A companion piece to the issue brief of the same name listed under Further Reading
below. This webinar has four separate presentations on sustainability: (1) “Strategies for
Sustaining and Financing Evidence-Based Programs and Practices”; (2) “The Older
Americans Act: Behavioral Health Funding”; (3) “Financing Older Adult Behavioral
Health Interventions Through Medicaid”; and (4) “Financing Evidence-Based
Depression Programs for Older Adults.”
Further Reading
• Financial Sustainability for Evidence-Based Programs: Strategies and Potential
Sources of Financing (National Council on Aging (NCOA) and Centers for Disease
Control & Prevention (CDC)
A four-page issue brief that reviews potential sources of revenue. The prospects for
financial sustainability are improved through partnerships, and with conscious effort,
accountability, and the development of tailored approaches which take advantage of a
state’s unique strengths and opportunities.

• Financial Strategies and Business Models (Nonprofits Assistance Fund)
This topic within Nonprofits Assistance Fund’s online Resource Library includes
business model definitions; the financial strategy and structure of nonprofits; how
nonprofits are changing their financial strategies; and emerging models. Four core
financial components are presented for designing a new funding and business model:
(1) program costs, (2) infrastructure, (3) capital structure, and (4) revenue mix.
• Financing and Sustaining Behavioral Health Interventions (Older Americans
Behavioral Health Technical Assistance Center, 2013)
A companion piece to the webinar of the same name under Training section above.
Materials include resource lists, and case studies. Factors within the program, the
organization, and the community are described for consideration, including program
impact and fit; organizational capacity; and community support. Potential funding
sources are also addressed.
• Lessons Learned on Sustainability of Older Adult Community Behavioral Health
Services (Substance Abuse and Mental Health Services Administration and The National
Council on Aging)
This report offers two valuable products for service providers and funders: (1) A
sustainability framework listing the ideal features of a program, the organization, and
the community. Each factor is categorized within the framework diagram and also
explained at greater length within the report text. (2) A financial resource guide reviews
public, nonprofit, and private funding sources and financing streams.
• Cost Analysis: NYUCI Intervention in Minnesota (“Family Memory Care”), Year 2
(Paone & Associates, 2010)
Summarizes costs experienced by nine NYUCI implementation sites in Minnesota, from
startup through the second year related to their implementation. Study illustrates how
(and which) costs vary and shift over the life of a program, particular costs being
higher/lower during a startup phase, and then shifting during ongoing programming.

Resources Chapter 4: Marketing
Further Reading
• Business Planning Tools for Aging and Disability Resource Centers (Aging & Disability
Resource Center, Technical Assistance Exchange, 2004)
ADRC-TAE Issue Brief prepared by The Lewin Group to assist ADRCs as they put
together a business plan. Resource is structured so as to explain the purpose of each of
the various components of a business plan (e.g., marketing plan, organizational
structure, environmental scan) and then provide a pathway to developing each of these
pieces for one’s own plan.
• Issue Brief 12: Caregivers as Partners and Clients of Behavioral Health Services
(SAMHSA and AoA, 2013)
This issue brief focuses on informal caregivers, describing characteristics, special issues
of caregivers dealing with individuals who have behavioral health issues, evidence-based
programs available for caregivers, key actions that the aging network and providers can
take, and identifying resources.

Resources Chapter 5: Evaluation
Training Resources
• Introduction to Program Evaluation for Public Health Programs: A Self-Study Guide
(Centers for Disease Control and Prevention, U.S. Department of Health and Human
Services)
This document is a “how to” for planning and implementing evaluation activities. The
authors offer four key areas for consideration: 1) utility of the evaluation results;
2) feasibility of evaluation activities; 3) propriety and protecting the rights of individuals;
4) accuracy of evaluation findings.
Further Reading
• Alzheimer’s Disease Demonstration Grants to States Program: Maine (Administration
on Aging, 2006)
This case study offers an example of program evaluation, in this case that of a large-
system federal grant recipient. The following strategies were identified as essential to
achieving systemic and sustained change: designing and operating projects that can be
implemented statewide; linking people and their families to existing services; building
technical expertise at the state, AAAs, and consumer levels; establishing ongoing training
programs using established curriculum; embedding initiatives in larger organizations;
investing in funding research to demonstrate the value of grant-funded activities;
leveraging ADDGS funding where possible.
• Evaluating Community Programs and Initiatives, Developing an Evaluation Plan
(Chapter 36, Section 5 (Community Tool Box)
This resource includes basic information on developing an evaluation plan. It includes
why and when you need an evaluation plan; different types of stakeholders; how to
develop an evaluation plan; what to expect (products) as a result of evaluation; and
standards to follow.

About the Author
Deborah Paone, DrPH, MHSA, is principal and owner of Paone & Associates, LLC, a company
she founded in 2002.
Dr. Paone has worked in hospital, clinic, and community-based settings in operations, as an
evaluator, and in the policy arena. She bridges these settings and disciplines and provides a
unique perspective toward creating real-world strategies that can be sustained.
Dr. Paone has served as a researcher and evaluator and administrator in health care and
community-based/aging services. She provided a 5-year implementation evaluation, including a
cost analysis, for the NYUCI translation in Minnesota, and a 3- year formative evaluation of ACT
on Alzheimer’s—the collective action initiative to create “dementia-capable communities” in
Minnesota. She served as Executive Director of a community-based aging and caregiver services
organization for 11 years, where she guided implementation of evidence-based programs and
fostered their sustainability through partnerships and service contracts.
Dr. Paone holds a Doctor of Public Health from the Gillings School of Global Public Health,
University of North Carolina-Chapel Hill, a Master of Health Services Administration from the
University of Michigan, and a Bachelor of Arts in Gerontological Issues in Community Health
and in English Literature from the University of Rochester, NY.
She can be reached through www.paoneandassociates.com.

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