Care Ecosystem: Navigating Patients and Families Through Stages of Care, Extension Trial

This study will enroll patients as well as their primary caregivers as research participants. Inclusion criteria for patient participants: * Patient has a diagnosis of dementia with a progressive course * Patient has a primary caregiver (identified as having primary responsibility for patient) that is eligible for and agrees to join the study * Patient is covered by Medicare or Medi-caid or is Medi-pending * Patient is expected to live at least 3 months based on assessment by the referring provider, the patient's primary care provider, or medical record review * Patient speaks English, Cantonese, or Spanish * Patient lives in California or Nebraska or Iowa * Patient is age 45 or older Inclusion criteria for caregiver participants: * Caregiver has primary responsibility for dementia patient that is eligible for and agrees to join the study * Caregiver speaks English, Cantonese, or Spanish * Caregiver is a legal adult * Zarit-12 caregiver burden score greater than or equal to 17 at pre-randomization (baseline); this criteria is specific to this extension trial Exclusion Criteria: * Patient resides in a nursing home or skilled nursing facility at time of enrollment * Participant is enrolled in a similar clinical trial that precludes their participation in the investigator's trial * Patient is pregnant