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Comprehensive dementia care may reduce need for long-term care facilities

Patients enrolled in a comprehensive dementia care program were less likely to be admitted to a long-term care facility, according to findings published in JAMA Internal Medicine.

The program did not add any additional costs, according to the results.

“In the United States, Alzheimer disease and related dementias affect an estimated 4 to 5 million persons,” Lee A. Jennings, MD, MSHS, assistant professor in the Reynolds Department of Geriatric Medicine at the University of Oklahoma Health Sciences Center, and colleagues wrote. “Dementia is a chronic disease that requires comprehensive medical and social services to provide high-quality care and prevent complications and hospitalizations. This care is expensive, with annual estimated costs of $157 billion to $215 billion in 2010.”

Jennings and colleagues analyzed Medicare claims data to determine the health care utilization and costs of the University of California Los Angeles Health System Alzheimer and Dementia Care program.

The researchers compared 1,083 Medicare fee-for-service beneficiaries with dementia who were enrolled in the comprehensive program (382 men; mean age, 82.1 years) to 2,166 similar patients based on demographic characteristics, comorbidities and prior-year health care utilization who were not enrolled in the program (759 men; mean age, 82.42 years).

Nurse practitioners and physicians comanaged patients in the dementia care program. Patients and caregivers in the program were assessed for structured needs and received individualized dementia care plans with input from primary care physicians, referral to community organizations for dementia-related services and access to a clinician for assistance and advice 24 hours per day, 7 days per week.

Data indicated that participants in the dementia care program had lower odds of being admitted to a long-term care facility (HR = 0.6; 95% CI, 0.59-0.61) than those not participating in the program. Hospitalizations, ED visits and 30-day readmissions did not differ between the two groups.

After excluding program costs, the total cost of care to Medicare was lower by $601 per patient per quarter (95%CI, –1,198 to –5). When accounting for the estimated program costs of $317 per patient per quarter, the cost of the program was neutral for Medicare, totaling an estimated net cost of –$284 (95% CI, –881 to 312) per program participant per quarter.

“New models of care that are effective without substantial cost increases are needed for patients with Alzheimer disease and other dementias,” Jennings and colleagues concluded. “Comprehensive dementia care addresses several goals of the National Plan to Address Alzheimer Disease, can reduce the number of admissions to long-term care facilities, and depending on program costs, may be cost neutral or cost saving. Wider implementation of such programs may help more people with dementia remain in their communities.” – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.