University of Wisconsin–Milwaukee

Tailored Caregiver Assessment and Referral®


TCARE® is a caregiver assessment and referral protocol developed by Dr. Rhonda JV Montgomery and colleagues in 2007. The protocol is designed to assist care managers who work with family caregivers who care for their older adult relatives. TCARE® incorporates the core elements of care management into a manualized six-step guide. The major goal of TCARE® is to provide care managers with a set of steps that are needed to move from the assessment to the implementation of a care plan.


TCARE® is grounded in the caregiver identity change theory, articulated by Rhonda JV Montgomery and Karl Kosloski (Montgomery, Rowe & Kosloski, 2007). The caregiver identity change theory describes caregiving as a systematic process of identity change (e.g., change from original familial role of daughter to caregiver, change from original familial role of son to caregiver, change from original familial role of wife to caregiver, and change from original familial role of husband to caregiver). This identity change is understood to be a significant factor influencing the type and level of caregivers' stress and burden.


The theory is grounded in 25 years of research on family caregiving and provides three insights that are reflected in the TCARE® process. First, caregiver stress is understood as an integral concept that has been empirically shown to be the most direct measure of caregiving experience. Moreover, stress is multidimensional with a wide range of factors affecting different types of caregivers' stress and burden. Second, there is great diversity among caregivers in terms of the type and quantity of tasks they undertake, the duration of time over which they serve in the role, the costs they incur, and the benefits that caregivers perceive as a consequence of their caregiving role. Third, there is great variation in patterns of service use among caregivers. Essentially caregivers will not use services that they do not perceive as needed and the perception of need is influenced by characteristics of the caregiver, the care receiver, and the provider. The caregiver identity change theory provides a lens to understand why caregiver interventions are not uniformly beneficial for all caregivers.