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Innovations : maintain-mind-athomeprogram


Clinical Innovations

Title: Maintaining Independence at Home Project (MIND at HOME)

Organization:  Johns Hopkins Bayview Medical Center

Innovation Type: Community Based Chronic Disease Management

What They’re Doing: Community-based chronic disease management with intensive home health support  

Clinical Innovation: Maintaining Independence at Home delivers significant multidimensional care coordination support services to community-residing older adults with memory disorders and their families aimed at maximizing health, quality of life, and independent living. Care coordinators carry out an extensive in-home assessment of 21 domains of dementia-related needs for participants and caregivers, create an individualized care plan based on the results of the needs assessment, and assist the participants and families in meeting care plan goals through dementia education, dementia counseling, and community resource referrals. Coordinators work with families to closely monitor the success of care plans and reevaluate needs as indicated. Innovative features of this service include incorporation of current dementia care management best practices; attention to a wide range of clinical and non-clinical dimensions important in dementia care; a person-centered approach that incorporates individual preferences, desires, financial concerns and needs; and the use of custom software designed specifically for the intervention for easy clinical management and tracking of progress and success.    

Evaluation Type: Experimental 

Evaluation Plan: Single-blind randomized controlled trial. MIND is being evaluated systematically. Participants were randomly assigned to either the care coordination intervention group or the augmented usual care (control) group. Outcome data (e.g. ability to “age in place”, health measures, quality of life measures) are collected every 4.5 months for 18 months by trained assessors blinded to treatment group. Statistical analyses will be used to evaluate whether care coordination improved outcomes for individuals and their caregivers on assessed outcomes when compared to the usual care group. The major outcomes are participant unmet needs related to dementia and the ability to remain living independently at ​home. Secondary outcomes for participants include clinical measures (i.e. mood, behavior, functional dependency, cognition), quality of life, and health care service utilization.   

​​​Description of MIND at HOME study by Dr. Quincy Samus


Outcomes: Evaluation results will be available in early 2012.


  1. Marquardt G, Johnston DJ, Black B., Morrison A, Rosenblatt A, Lyketsos C, Samus, QM. Association of the spatial layout of the home and ADL abilities among older adults with dementia. American Journal of Alzheimer’s Disease & Other Dementias. 2011 Feb;26(1):51-7.   

  2. Marquardt G. Johnston DJ, Black B., Morrison A, Rosenblatt A, Lyketsos C, Samus, QM. A descriptive study of Home Modifications for People with Dementia and barriers to implementation Journal of Housing for the Elderly (in press).    

  3. Black BS, Johnston D, Morrison A, Rabins PV, Lyketsos CG, Samus QM.   Quality of life of community-residing persons with dementia based on self-rated and caregiver-rated measures.   Quality of Life Research , (In press).   

Target Population: Elders age 70+ with cognitive disorders living at home in a defined geographic area of northwest Baltimore that includes areas of the city and county including a significant underserved minority population.   

Date of Implementation: 01/01/2008-12/31/2011   

Contact:  Quincy M. Samus, PhD,  Principal Investigator, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 North Broadway, Suite 308, Baltimore, MD 21205,  



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