Supporting Hispanic Family Caregivers Facing Financial Strain in Dementia Care (CONFIDENCE)

Hispanic family caregivers play a significant role in supporting loved ones living with dementia, often while navigating significant financial, emotional, and logistical strain. Caregiving for persons living with dementia imposes substantial financial burdens, averaging $9,000 annually. Given that the median net worth for Hispanic households in the US is significantly lower than average, many Hispanic families must pay a high percentage of their annual household incomes for out-of-pocket caregiving costs. When Hispanic households enter caregiving with fewer financial resources, the result can be reliance on savings or high-interest debt and increased risk of income loss. These compounded financial pressures contribute to heightened psychological distress, commonly experienced as financial strain. These burdens can include out-of-pocket spending on medical supplies, transportation, home modifications, medications, and lost income from reduced work hours or leaving the workforce altogether.

The Confidently Navigating Financial Decisions and Enhancing Financial Wellbeing in Dementia Caregiving (CONFIDENCE) program is an online culturally tailored psychoeducational intervention designed for Hispanic family caregivers to reduce financial strain. The 5-week, 7.5-hour program is delivered in English and Spanish and focused on both practical financial problem-solving and the emotional toll of financial strain in dementia caregiving. It was developed through collaboration between Dr. Donna Benton (PhD, Research Associate Professor of Gerontology and Director of the University of Southern California Family Caregiver Support Center) and Dr. Kylie Meyer (PhD, MSc, Associate Professor, Frances Payne Bolton School of Nursing at Case Western Reserve University). The project was supported by AARP Foundation and the National Institute on Aging though the ORCASTRAIT Roybal Center.

The project emerged early in the COVID-19 pandemic, when Drs. Benton and Meyer saw growing evidence of economic instability and recognized that family caregivers were likely being disproportionately affected. In Dr. Meyer’s words: “We have got to do something.”

Rather than framing caregiving costs as an issue of individual financial decision-making, the intervention was built on recognition that many caregivers are navigating complex systems, often with inadequate support (see CAPC’s Financial Toxicity Position Statement for more information on this topic). The CONFIDENCE program emphasizes financial strain as both a practical and emotional experience, supporting caregivers in identifying resources, understanding available supports, and reflecting on the broader policy and systems context shaping their experiences.

The intervention includes:

• A culturally tailored group-based education program for Hispanic family caregivers with peer discussion and shared reflection
• Delivery in English and Spanish, with virtual and telephone-based access
• Education on:
• “out-of-pocket” caregiving costs and strategies to reduce or “displace” those costs and community resources
• caregiving-related financial planning, employment challenges, and long-term care planning as well as policies and systems that shape access to financial and support resources
• Resource navigation support, including information about community services, equipment options, and long-term care systems
• Practice exercises and workbook-based learning, with strong preference from participants for physical materials. This resource was rated as highly valuable with the project lead noting:

The CONFIDENCE model emphasizes cultural relevance, plain language, real-life applicability, and emotional validation as core elements of caregiver support. The program was delivered virtually during the COVID-19 pandemic, with interview insights suggesting that this could be adapted and in-person formats could further strengthen engagement, trust and connection among participants.

The program has been evaluated through feasibility and pilot work focused on Hispanic family caregivers of persons living with dementia. Recently published reporting described CONFIDENCE as a culturally tailored intervention intended to reduce caregiver financial strain, and early findings showed promising movement in the intended direction. In the 2025-2026 feasibility study of the AI-enhanced version, 55 caregivers completed the intervention. This version leveraged an interactive artificial intelligence (AI) assistant and text message reminders to engage participants between sessions. While participants using the app attended more sessions on average, engagement with interactive app features remained low. The article also notes that an earlier feasibility study found preliminary efficacy in lowering financial strain, though maintaining consistent attendance across sessions remained a challenge.

Program data demonstrate the following impact:

As Kylie Meyers emphasized during the interview: “Don’t neglect the emotional side of financial strain.”

The interview also highlighted the importance of both practical learning and peer connection within the program. The interview highlighted that the program’s impact may not only come from the educational content itself, but also from helping caregivers feel less isolated and more supported. This insight is especially important in dementia caregiving, where families often carry significant responsibilities with limited formal support.

These findings reinforce the importance of culturally tailored financial education and resource navigation for Latino family caregivers, particularly when combined with opportunities for reflection, discussion, and social connection.

Implementation of CONFIDENCE required:

• A culturally tailored curriculum focused on financial strain in dementia caregiving
• Bilingual delivery capacity for Latino/Hispanic caregivers
• Facilitated group sessions, initially delivered virtually during the pilot phase, with later efforts to enhance engagement through app-based reminders and support
• Educational materials and workbooks, with interview feedback suggesting a strong preference for physical materials
• Facilitators prepared to discuss caregiving costs, community resources, and health and social care system navigation
• A community-informed design, including qualitative interviews and input from a community advisory council composed of caregivers and community professionals

Barriers encountered included:

• Lower than expected session attendance, with caregivers attending on average approximately 3 out of 5 sessions in one cohort
• Competing caregiving responsibilities and overall time burden
• Cognitive and emotional overload among caregivers experiencing high financial strain
• Challenges with technology-supported engagement in later program iterations, where the app added complexity and interactive features were used infrequently

Interview insights also suggest that caregivers may benefit from more time between sessions to absorb and apply what they are learning. The project lead implied that a slower pace may improve real-world usability, reduce feelings of overload, and allow time for reflection.

Several features of the intervention support broader scalability:

• The content is educational and can be adapted for community-based caregiver programs
• The program was intentionally designed for bilingual Latino/Hispanic caregiver populations
• Its core topics, including resource navigation and financial strain, are relevant across many caregiving settings
• The intervention can be delivered virtually, by telephone, or through community-based organizations, which supports flexibility in implementation
• The program materials remain available through the USC Family Caregiver Support Center

However, scalability depends on:

• Staff capacity to facilitate sessions and guide discussion
• Strong community outreach and recruitment
• Local adaptation to reflect region-specific services and referral pathways
• Careful consideration of whether digital enhancements fit caregiver needs and capabilities
• Maintaining a format that feels supportive rather than burdensome

Interview feedback suggested that the intervention may work best when it stays simple, relational, and grounded in caregiver realities, rather than adding too many extra technological steps.

The project was initially supported through AARP Foundation funding, and the intervention has continued to evolve through additional research and feasibility work. The USC Family Caregiver Support Center describes CONFIDENCE as an ongoing program concept and resource, suggesting that the infrastructure and materials remain in place for future implementation.

Sustainability considerations include:

• Ongoing reliance on external grant funding for development, testing, and refinement
• Need for continued organizational buy-in from caregiver support centers and community-facing programs
• Recruitment demands in community setting
• Balancing research goals with practice-based realities, such as session attendance and caregiver burden
• Need for further efficacy testing before wider dissemination

Despite these challenges, the intervention has strong sustainability potential because it addresses a highly relevant and often neglected issue, was developed with caregiver and community input, and can be reintroduced through existing caregiver support infrastructure.

• Recognize financial strain as a core caregiving issue, not a secondary one
• Address both the emotional and material burden of caregiving costs
• Avoid framing financial education in ways that feel blaming or judgmental
• Involve caregivers and community members in intervention development and refinement
• Pair education with concrete resource navigation support
• Use group-based formats when possible, to foster shared learning and connection
• Keep materials practical, accessible, and easy to revisit outside of sessions
• Be cautious about adding new technologies unless caregivers have clearly indicated that those tools are useful
• Allow enough time between sessions for reflection and real-world application
• Remember that peer connection itself may be an important mechanism of support and change

Kylie Meyer, PhD, MSc

Frances Payne Bolton School of Nursing, Case Western Reserve University; previously affiliated with the University of Texas Health Science Center at San Antonio during the project’s earlier development

Donna Benton, PhD

Leonard Davis School of Gerontology, University of Southern California

Director, USC Family Caregiver Support Center

Additional published authors on the 2025–2026 feasibility study include Chitra Dorai, Jaime Perales-Puchalt, Frank Puga, Jaclene Zauszniewski, Rocio Aguila Rodriguez, Maite Garcia Rodriguez, and Philip Cola.

The project was informed by qualitative interviews, community advisory input, and collaboration between academic and community-based caregiver support partners. The USC Family Caregiver Support Center describes the CONFIDENCE council as including both professionals serving Latino/Hispanic communities and caregivers themselves.

https://gero.usc.edu/centers/fcsc/confidence-program/