Alzheimer's Disease and Related Disorders (dementia) are a group of serious life limiting illness that cause significant challenges to our public health system, with significant illness burden for both the person with dementia and the caregiver. At the end of life, over 230,000 persons with dementia annually are cared for in hospice, yet hospice agencies are ill prepared to care for this population and often resort to inappropriate pharmacologic measures such as antipsychotics that reduce quality of life rather than improve it. This study will therefore through its two phases refine and then implement, using a pragmatic stepped wedge trial design, the Dementia Symptom Management at Home Program Hospice Edition, with the goal improving quality of care for the person with dementia and their caregiver, reducing antipsychotic use, and increasing bereaved caregiver satisfaction in the hospice setting.

Inclusion Criteria:

• Must have dementia as primary diagnosis for admission to hospice
• Must be newly admitted to a participating hospice
• Must be 50 years or older

Clinicians:

• Must be a skilled clinician or home health aide who provides care through an eligible home health agency
• Must be 18 years or older

Exclusion Criteria:

Persons with Dementia:

• None

Clinicians:

• None

All of the individual participant data collected during the trial, after deidentification.

Beginning 3 months and ending 5 years following article publication.

Researchers who provide a methodologically sound proposal.

1 month

All qualifying adverse events were pulled from all eligible patients' electronic health records. Adverse events were only reported on the Advanced Dementia Patients arm.