Week 3 Assignment: Topic

Research Paper 1

The Cost of Dementia Care

Yazmillie Fuentes

Webster University

GERN 5690

Donna Jaeger-Williams, PH.D.

Research Paper 2

The Cost of Dementia Care

Introduction

The World Health Organization estimates that there are over 55 million people living

with dementia globally. The number is likely to increase considering the number of new cases is

10 million people annually (WHO, 2021). The rising numbers of people being diagnosed with

dementia annually means an increase in the cost of dementia care. Dementia does not have a cure

with the most recognized form of treatment being provision of dementia care. This means

providing support for those living with dementia to help them improve their lives. Considering

some of the symptoms of dementia include repetitive behavior, behavioral changes that may lead

to aggressive behavior, difficulty in walking, and the need for assisted self-care. The assisted

self-are involves various costs like physician fees, the cost of caregivers, and other professionals

like nurses. The cost is quite huge considering the dementia affects those who have retired with

minimal sources of income. One of the limitations of the current healthcare system is its inability

to fully support long-term dementia care. In the United States, Medicare partially covers the

costs that are associated with dementia care. The costs associated with dementia care are huge

considering people with dementia require long-term care that includes custodial care.

Dementia

The Center for Disease Control and Prevention (2019) defines dementia as a general term

for impaired ability to think or make decisions that interferes with the person’s ability to perform

everyday activities. It is a syndrome that leads to the deterioration of cognitive function beyond

the normal. Many people confuse dementia because of aging because it affects older people.

However, dementia is not a certain consequence of aging. Normal aging includes memory loss,

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weakening of muscles and bones, and the stiffening of vessels. Alzheimer’s disease is one of the

most common types of dementia. Dementia is the seventh leading cause of death globally and

one of the main causes of disability among the elderly.

There are various factors that increase the risk of dementia. Old age is the biggest risk

factor for dementia. As the age increases so does the risk of dementia. Those above the age of 65

are at a higher risk. Family history is also a risk with those with family members who have had

dementia being at a greater risk. African Americans are twice more likely to have dementia than

other races (CDC, 2019). Hispanics are 1.5 times more likely to have dementia than whites.

Traumatic brain injuries and poor heart health including high cholesterol, high blood pressure

and smoking also increase the risk of dementia.

There are three stages of dementia where each stage presents different symptoms and

symptoms. The early stage is normally confused with some of the signs of old age. The

symptoms include losing track of time, being forgetful especially of some of the familiar places,

and general forgetfulness (WHO, 2021). The middle stage of dementia will see the signs and

symptoms of dementia becoming clearer. The signs and symptoms of the middle stage will

include being forgetful of people’s names, confusion, difficulty in communication, and being

repetitive. The person experiencing the late stage of dementia will be totally dependent on others.

This is because the signs and symptoms are more crucial as they will include behavioral changes

that may lead to aggressive behavior, challenges in walking, memory problems and even

forgetting friends and relatives, and being unaware of time and places.

The late stage of dementia means the person will be totally dependent on others. The

various forms of dementia care include home care, adult day centers, long-term care in hospital

or care community, hospice care, and long-distance care giving. Home care involves the

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provision of various services at home rather at the hospital or community care. The family must

engage a caregiver to help in provision of these services. All forms of dementia care will involve

the professionals and other costs which may be indirect. The total cost of dementia care is high.

This makes the cost of dementia care the biggest issue in both dementia and dementia care.

Dementia Care

The person with dementia may require more care than the care which is being provided at

home. This will require them to choose a long-term care setting which will be suitable for them.

There are different types of long-term care which suit the person living with dementia. Some of

them include retirement housing for those who are at an early stage, assisted living, nursing

homes, special care units, and life plan communities. All these types of long-term care come with

different costs to the person. An example is the life plan communities where the person must pay

the initial entry fee and monthly subscription. The other costs that are associated with long-term

care will include direct costs like physician’s fees, hospitalization, nursing home costs, and

drugs.

In-home care includes the services that are provided at home. In-home services will

include personal care services like bathing, eating, toileting, and cleaning. In-home care will

include skilled care where the person will require help with injections, medication, and physical

therapy. Hospice care provides care for those who are terminally ill. Hospice focuses on

providing support for those who are in the final stages of dementia and their families. The

hospice care is provided by a team of professionals including doctors, nurses, social workers,

clergy, and volunteers. The cost of hospice care is high as it includes medical care to reduce the

symptom and pain. This includes the cost of equipment and medicine.

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Cost of Dementia Care

The number of people with dementia has been on the rise globally. The WHO (2021)

estimates that there are 55 million people living with dementia and a further 10 million cases

annually. This increases the burden of dementia care as the numbers represents the people who

require dementia care. The monetary costs associated to dementia and dementia care are more

likely to increase as the person progresses through the stages of dementia. The costs associated

with dementia also include physical, psychological, social, and economic impact of the disease.

The impact of the costs affects the family, the careers, and the society at large.

There are direct costs and indirect costs involved in dementia care. The direct costs

include the physician’s fees, the cost for hospitalization, fee for the nursing home, and drugs

(Davidson & Schnaider, 2000). The indirect costs will include the cost of training the caregivers,

nurses, and unpaid care and services that is usually provided by the family members. The total of

both the direct and indirect is quite high for the person, family, and society at large.

A study by Hurd et al., (2013) established that the total costs of dementia in the United

States in 2010 were between $157 billion and $215 billion. This was the individual cost of

dementia when the prevalence rate was 14%. During the same period, the monetary costs per

person were $56,290 (Hurd et al., 2013). Medicare was able to pay only 10% of these costs

leaving the balance of 90% to be paid by the individuals. The cost varied with the method of

informal care used. This presents a big financial burden to the individual, family, and the society

at large. The same financial burden can be linked to the burden of cancer and heart disease.

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Limitations of Healthcare Systems

The current healthcare systems have their own limitations that impact negatively on the

cost of dementia care (Durgante & Kishita, 2020). Medicare which is the federal health insurance

coverage for people over 65 years covers minimal costs that are associated with dementia. The

costs covered by Medicare in relation with dementia include the costs of inpatient stay at

facilities like hospitals, home healthcare, hospice care, cognitive assessment, and various

diagnostic tests related to dementia. Medicare also covers the cost of prescription drugs that are

related to dementia. However, in dementia care, the patient may need long-term care which will

include custodial care. Custodial care is a non-medical form of care that assists people in daily

living. This form of care will include activities like bathing, cleaning, cooking, and others like

assistance walking. Medicare and Medicaid do not cover long-term care. They partially cover

long-term care and custodial care in specific circumstances. Those who want to benefit for

Medicare are also required to pay out-of-pocket.

Medicare does not cover custodial care if it is the only type of care which is needed.

Medicare only covers long-term care and custodial care if these requirements are met; the care is

prescribed by a licensed physician and is provided by a healthcare provided participating in

Medicare. The requirements also vary from state to state making it one of the biggest limitations

of the healthcare system impacting those with dementia. The table below shows what Medicare

covers for patients with dementia and other conditions.

Medicare Part Services

Part A Part A covers inpatient stays at hospitals and

skilled nursing facilities.

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Part B Part B of Medicare covers doctor’s services,

medical equipment, and services required to

diagnose a condition.

Part C This covers dental, vision, and prescription

drugs.

Part D This part covers prescription medicine for

dementia patients.

Supplement This part helps in paying for the costs that are

not covered in Part A & B.

Conclusion

Persons with dementia require specialized care that will help them improve their lives.

This type of care involves the use of healthcare professionals like doctors and nurses and the use

of facilities like hospitals and skilled nurse’s facilities. The costs associated with dementia care

may be direct or indirect which compounds the expenses (Davidson & Schnaider, 2000).

Medicare the federal medical insurance for people over the age of 65 only covers a fraction of

the costs. The issues with Medicare and Medicaid are part of the limitations of the healthcare

system. Medicare only covers some parts of dementia care. Legislations should be enacted to

reduce the burden related of the cost of dementia care. This would ensure federal insurance for

those above the age of 65 covers more than 50% of the costs related to dementia care. Currently

the costs keep going up as more people are diagnosed with dementia.

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References

Center for Disease Control and Prevention (2019). What is Dementia? Available at from

https://www.cdc.gov/aging/dementia/index.html

Davidson, M., & Schnaider Beeri, M. (2000). Cost of Alzheimer's disease. Dialogues in clinical

neuroscience, 2(2), 157–161. https://doi.org/10.31887/DCNS.2000.2.2/mdavidson

Durgante, Helen & Kishita Naoko. (2020). Challenges in dementia care: comparing key issues from

Brazil and the United Kingdom. Dement. neuropsychology. 14 (03)

Hurd, M. D., Martorell, P., Delavande, A., Mullen, K. J., & Langa, K. M. (2013). Monetary costs

of dementia in the United States. The New England journal of medicine, 368(14), 1326–

1334. https://doi.org/10.1056/NEJMsa1204629

World Health Organization. (2021). Dementia. Available at https://www.who.int/news-

room/fact-sheets/detail/dementia