FOCUS OF THE WEEK
Community-Based Caregiver Support Improves the Costs of Care Associated with Alzheimer's Disease
May 9, 2014, 01:54:19 PM
Katie Sullivan, MA
As the elderly population grows, state legislators across the United States are seeking to control the rising costs of caring for them. Specifically, legislators are focused on those elderly who have Alzheimer’s disease. In 2010, 4.1 million people aged 70 years and older in the United States were diagnosed with dementia. Direct annual costs for treating this population were estimated at $109 billion. Health providers are being encouraged to adopt models of care that can support this population because it is an important factor in controlling state spending budgets.

One Alzheimer support program in Minnesota—known as ACT on Alzheimer’s—effectively demonstrated an ability to divert the costs of care associated with Alzheimer’s by focusing on care coordination and community support. The program is similar to the New York University Caregiver Intervention program (NYUCI), which provides caregivers with sessions of individual and family counseling, an opportunity to participate in a weekly support group, and telephone counseling as needed.

“Models of community-based caregiver support that include education and support programs for informal—that is, unpaid—caregivers for people with dementia have demonstrated multiple benefits,” said researchers who studied the Minnesota program. “These programs aim to educate caregivers about dementia, involve the family to support the primary caregiver, and provide the caregiver with tools to cope with the behavioral symptoms that often accompany the progression of disease. Repeatedly documented benefits include reduced levels of caregiver stress and depression, reduced time spent caregiving, and delayed residential placement of the person with dementia.”

By keeping patients with Alzheimer’s in community and home settings, and if the program were implemented state-wide, researchers determined that the program could save Minnesota nearly $970 million by 2025. They noted that expansion would also likely reduce the risk of patients with dementia dying in an institution by 19.3%.

“Our results indicate that enhanced caregiver support is a promising way to moderate the growing economic burden of dementia,” said the authors. “Our findings are relevant to the larger policy question of where resources should be directed in the fight against dementia. Multicomponent support programs for informal caregivers, such as the NYUCI, may be cost-effective ways to manage dementia while researchers continue to seek effective treatments.”

Although Minnesota’s ACT program demonstrated significant cost savings, some providers worry that there may be cost burdens associated with training community care providers. Mary Mittelman, DPH, research professor in the department of psychiatry at the NYU School of Medicine, suggests that web-based training may be one way control the price to educate staff.

As well, while improving community support is a start, some policy advocates suggest that the biologic drug market also needs to be changed. Drug development for Alzheimer’s disease lags behind other serious conditions including heart disease, cancer, diabetes, and HIV.

Kenneth Davis, MD, CEO and president of the Mount Sinai Health System in New York City, said that appropriate incentives to develop a treatment which could delay the onset of Alzheimer’s by 5 years within the next year would save insurers $447 billion in 2050.

“Most individuals who develop Alzheimer's begin to show signs of the disease in their 70s. If we were able to slow the progress of the disease by 50%, most of these individuals wouldn't show symptoms until their 90s,” said Dr Davis. “Such a delay would enhance quality of life for patients and their families, while leading to substantial savings for Medicare and Medicaid.”
 
 Around the Web

Alzheimer’s Disease Support Model Could Save Minn. Millions [Kaiser Health News]

Estimating The Potential Cost Savings From The New York University Caregiver Intervention In Minnesota [Health Affairs]

How Congress Can Fight the Alzheimer's Epidemic [Wall Street Journal]