Can community health workers ease the transition home for dementia patients?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: Hospitalized Patients: 1. Aged 50 or older 2. Has confirmed or suspected dementia or cognitive impairment (i.e., having memory concerns) ; 3. Has FAST score 4-6; 4. Admitted from home (not a long-term care facility) Family Caregiver: 1. Aged 18 or older; 2. English or Spanish speaking; 3. Patient's relative, or partner who assists with medical care on a regular basis and who may or may not live in the same residence and who is not paid for their help; and 4. Legally authorized representative (LAR) for the patient if the patient is not able to consent for themselves in the study. Staff Participants: 1. Aged 18 and older, 2. English speaking, 3. Employed full-time or part-time at or affiliated with either site, and 4. Involved directly or indirectly with patient care (i.e., administrative or non-clinical support staff) such as: nurses, physicians, physician assistants, care managers, social workers, chaplains, discharge planners, IT staff, administrative managers Key Informants: 1. For hospital staff key informants, same eligibility criteria as above 2. For family caregivers (current or formal) 1. Aged 18 or older; 2. English or Spanish speaking; 3. Currently or previously were caring for a relative with dementia Content experts or community service providers: 1. Aged 18 or older; 2. English or Spanish speaking; 3. Have professional experience working with and/or have expertise about dementia care and caregiving or related areas (e.g., aging service providers, staff at Alzheimer's association, scholars in the area of aging, dementia, caregiving, or care transition) Exclusion Criteria: Hospitalized Patients: 1. Patients who do not meet eligibility criteria 2. Patients who are eligible for hospice Caregivers: 1\. Caregivers who do not meet the eligibility criteria Staff participants: 1. Staff who do not meet the eligibility criteria 2. Staff who do not speak English Key Informants: 1\. Individuals who do not meet the eligibility criteria