ALZHEIMER’S DISEASE: Family Care Could Save Billions
Delaying for one month the placement of an Alzheimer's patient in a nursing home could yield annual savings of $1.12 billion, according to a study published in today's Health Affairs. The study, conducted by Project HOPE's Center for Health Affairs and the Harvard School of Public Health, indicated that slowing the rate at which Alzheimer's patients enter nursing homes, coupled with substituting assisted living for nursing home care, could save the Medicaid program billions of dollars. "As the U.S. population ages, the costs of caring for Alzheimer's patients become an increasingly important long-term care policy concern," said the center's Joel Leon, one of the study's authors. Specifically, the study found that a one-month delay in institutionalizing an Alzheimer's patient would save $1,863 in formal services costs, yielding $1.12 billion in savings if the delay was applied to all Alzheimer's patients. Substituting assisted living for nursing home care would generate substantial cost savings of 21% to 30% -- $9,132 per patient, or between $3.5 billion and $5.1 billion for the country annually. The study noted that Alzheimer's affects 6% to 10% of the nation's elderly and 25% to 45% of those older than 80 -- a total of 1.9 million people. In 1996, the average yearly cost for treating an Alzheimer's patient was more than $27,000. That amounts to $51.3 billion -- $14.9 billion for mildly impaired patients and $36.4 billion for moderately and severely impaired patients.
And Now The Bad News
While the study's cost savings were impressive, the authors tempered the estimates with cautionary statements about the emotional and physical price family members would have pay for these financial savings. Noting that the frail condition of some Alzheimer's patients makes it unlikely that the suggestions could be applied to everyone, Leon said, "It's unlikely that a majority of nursing home patients will be transferred to assisted living facilities, but the argument is there for more states to provide Medicaid coverage for assisted living facilities." Leon cautioned that any push to achieve "cost savings must be balanced with the needs of family members who are already exhausted -- both emotionally -- and physically -- from meeting the daily demands of a loved one suffering from Alzheimer's. That too is a great cost to society."
Pass It On
The study suggests that managed care savings are being achieved at the expense of Alzheimer's patients' family members, particularly among the families of moderately impaired Alzheimer's patients. For example, the study found that family members of Alzheimer's patients covered by managed care plans had to devote 43 more hours of informal care than those who had a relative treated by an academic health center (release, 11/10). The authors write: "If managed care places more burdens on the family, then policymakers need to acknowledge that they may be adding to family burdens to realize managed care's cost savings. These findings provide fuel for advocacy groups arguing that managed care already puts a greater burden on family caregivers" (Leon et al, Health Affairs, November/December issue). To request this issue of Health Affairs, call 301/656-7401. A Table of Contents can be accessed on the journal's website at www.projhope.org/HA/.