The Effects of Dementia Care <scp>Co‐Management</scp> on Acute Care, Hospice, and Long‐Term Care Utilization

Jennings, Lee A.; Hollands, Simon; Keeler, Emmett B.; Wenger, Neil S.; Reuben, David B.

doi:10.1111/jgs.16667

Cited by 26 publications

(35 citation statements)

References 25 publications

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“…The researchers also found, however, that other types of single interventions, including exercise, psychosocial support and health professional training, and multifactorial assessment and treatment had no effect on nursing home admissions 654 . In a retrospective case‐controlled study of a dementia care program that used nurse practitioners and physicians to co‐manage individuals with dementia, individuals enrolled in the program had 9.4 fewer emergency department visits and 160.1 fewer hospital days per 1,000 participants per quarter, 656 and were less likely to have a long‐term care nursing home admission over three years, 657 although there was no difference in hospital admissions 656 . Additionally, the program saved $284 per person per quarter in 2013 dollars ($346 in 2020 dollars) after taking into account program costs that included clinician and staff time, payments to community‐based organizations, supplies and other costs 657 .…”

Section: Use and Costs Of Health Care Long‐term Care And Hospicementioning

confidence: 99%

2021 Alzheimer's disease facts and figures

2021

Alzheimer's & Dementia

1,768

849

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth‐leading cause of death in the United States and the fifth‐leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID‐19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes — costs that have been aggravated by COVID‐19. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain — both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID‐19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.

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Section: Use and Costs Of Health Care Long‐term Care And Hospicementioning

confidence: 99%

2021 Alzheimer's disease facts and figures

2021

Alzheimer's & Dementia

1,768

849

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“…In the context of evaluating a comprehensive dementia care program [9] that has shown clinical [10], utilization [11], and cost benefits [12], we interviewed and surveyed a subset of caregivers of persons in the program who did not demonstrate any benefit on clinical outcomes, including validated scales assessing dementia-related neuropsychiatric symptoms and caregiver strain and depression [10]. When examining characteristics of caregivers interviewed, we found that they commonly reported feeling "completely overwhelmed," [13] an item from the Modified Caregiver Strain Index [14], which was administered to all program participants at entry into the program.…”

Section: Introductionmentioning

confidence: 99%

Overwhelmed: a Dementia Caregiver Vital Sign

et al. 2021

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BACKGROUND:The emotional stress of caring for someone with Alzheimer's disease and related dementias is high and results in adverse effects on caregivers and the persons living with disease. In preliminary work, caregiver reports of regularly feeling "completely overwhelmed" were associated with lack of measurable clinical benefit from a comprehensive dementia care program. OBJECTIVE: To examine the sociodemographic and clinical characteristics of all caregivers who felt overwhelmed at entry into a comprehensive dementia care program, the trajectory of this symptom over 1 year, and its predictive value for 1-year caregiver outcomes. DESIGN: Longitudinal cohort study SETTING: Academic health center PARTICIPANTS: Caregivers of patients enrolled in a comprehensive dementia care program EXPOSURES: Caregiver report of feeling "completely overwhelmed" at baseline MAIN MEASURES: Caregiver report of feeling "completely overwhelmed" at baseline and 1 year, and validated scales of caregiver strain, distress, depressive symptoms, burden, mortality, and long-term nursing home placement KEY RESULTS: Compared to caregivers who were not overwhelmed, overwhelmed caregivers had more distress from behavioral symptoms of the person living with dementia, worse depression scores, and higher composite dementia burden scores at baseline. They also had worse depressive symptoms, strain, and composite burden scores at 1 year, after adjustment for baseline scores.Having an overwhelmed caregiver did not predict longterm nursing home placement or mortality among persons with dementia. CONCLUSIONS: A single question about whether a caregiver is overwhelmed might indicate caregivers who have considerable current and future symptom burden and who may benefit from increased support and resources.

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“…[6][7][8][9] Specialized care for older adults living with dementia, such as a dementia care program, has demonstrated reductions in acute health service use and long-stay transitions to a nursing home. 8,10 Assisted living facilities are referred to as retirement homes in the province of Ontario, Canada. Similar to assisted living facilities in the United States that are regulated at the statelevel, 11 retirement homes are regulated by an independent, not-for-profit regulator (i.e., Retirement Homes Regulatory Authority [RHRA]) in Ontario since 2011.…”

Section: Introductionmentioning

confidence: 99%

“…6–9 Specialized care for older adults living with dementia, such as a dementia care program, has demonstrated reductions in acute health service use and long-stay transitions to a nursing home. 8,10…”

Section: Introductionmentioning

confidence: 99%

Do Assisted Living Facilities That Offer a Dementia Care Program Differ from Those That Do Not? A Population-Level Cross-Sectional Study in Ontario, Canada

Manis

Rahim

Poss

et al. 2021

Preprint

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Objective: To identify the characteristics of licensed assisted living facilities that provide a dementia care program compared to assisted living facilities that do not provide such a program. Design, Setting, and Participants: Population-level cross-sectional study in Ontario, Canada on all licensed assisted living facilities in 2018 (n = 738). Methods: Data on facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of other provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to licensed assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program. Results: There were 123 (16.7%) assisted living facilities that provided a dementia care program. Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7%) and more than 115 suites (46.3%). All assisted living facilities that provided a dementia care program also provided nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjusting for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding than those that did not (Prevalence Ratio [PR] = 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that provided medical services than those that did not (PR = 1.78, 95% CI 1.00 to 3.17). Conclusions: A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and provided at least five of the other 12 regulated care services. These findings deepen the understanding of specialized care for dementia in assisted living facilities.

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The Effects of Dementia Care Co‐Management on Acute Care, Hospice, and Long‐Term Care Utilization

Cited by 26 publications

References 25 publications

2021 Alzheimer's disease facts and figures

2021 Alzheimer's disease facts and figures

Overwhelmed: a Dementia Caregiver Vital Sign

Do Assisted Living Facilities That Offer a Dementia Care Program Differ from Those That Do Not? A Population-Level Cross-Sectional Study in Ontario, Canada

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