Academic journal article Generations

The Policy Challenges of Alzheimer's Disease

Academic journal article Generations

The Policy Challenges of Alzheimer's Disease

Article excerpt

The condition poses some of the most serious problems in healthcare and long-term care today.

Alzheimer's diseaseand the various other conditions generally referred to as dementiaposes one of the most serious health policy challenges of the new milenium. The focus of this analysis is Alzheimer's disease, but the policy issues raised are relevant to all forms of dementia. As the twentieth century comes to a close, an estimated 4 million people in the United States already have Alzheimer's (Evans, 19go), and the costs are staggering:

* The annual cost of care is estimated at $100 billion a year.

* Medicare spends 70 percent more on average for people with Alzheimer's disease, even though Medicare does not cover what they most need-long-term care and prescription drugs (Eppis and Poisal, 1997).

* Medicaid spends $8,200 more on average for each Alzheimer's beneficiary, in large part because the average stay in a nursing home is nearly twice as long for those who have the disease as those without it (Menzin, 1999).

* Families -the invisible long-term-care system-provide unpaid care valued at $196 billion a year; at least one-third ofthat is for Alzheimer's care (Arno, Levine, and Memmott, 1999).

*Alzheimer's disease is costing American business $33 billion a year, primarily in the lost productivity of employees who are caregivers (Koppel, 1998).

But these costs are just the tip of the iceberg. By the time the baby boomers reach the age of greatest risk, 14. million will have Alzheimer's disease (Evans, 19go). The annual costs of the disease will overwhelm our healthcare system and bankrupt families, Medicare, and Medicaid.

For too long, healthcare policy has put the care and treatment of people with Alzheimer's disease in a box, marked it "custodial care,' and largely ignored it. In our zeal to bring attention and public resources to long-term care, Alzheimer's advocates may in fact have contributed to this artificial separation of the care needs of the people we represent. In fact, people with Alzheimer's disease have chronic healthcare needs, and the failure to address these needs as part of healthcare- and specifically Medicareis contributing to poor health outcomes, overutilization of expensive hospital and nursing home care, cost-shifting, inefficiencies, and waste. That has to change.

CHRONIC HEALTHCARE NEEDS

First, Medicare must respond to the chronic healthcare needs of beneficiaries. One of the biggest disappointments ofthe Bipartisan Commission on the Future of Medicare was its failure to address the issue of c1ironic care. in fact, with the enactment of the Balanced Budget Act, Medicare is moving in the opposite direction, concentrating resources on "episodes of care," placing per capita limits on essential services like home health and physical and occupational therapy for people with chronic illness, and tying risk adjustments to hospital stays and single diagnoses.

Most people who have Alzheimer's and related dementias are over age 65. Medicare pays a lot for their healthcare, even though, as has been said, it does not pay for long-term care and prescription drugs. According to federal actuaries, Medicare is spending almost 70 percent more on beneficiaries with dementia than on those who arc not cognitively impaired.

That is because people with dementia are elderly and fi-ail. They have health problems that are common at their age- cancer (20 percent), congestive heart failure (28 percent), diabetes (22 percent), and chronic obstructive pulmonary disease (27 percent) (Newcomer, 1998). But dementia complicates treatment of these other conditions. When they are hospitalized, people with dementia stay an average of four days longer than others their age who are not demented- at an average added cost of $4,000 a patient (Lyketsos, 1998).

Much of the high healthcare cost for people with Alzheimer's disease comes from preventable crises caused by their impaired memory and judgment and their inability to manage their own care. …

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