Improving the Lives of People with Dementia; Authors Identify Promising Next Steps

Providing the best care for people living with dementia (PLWD) requires being certain that treatments and interventions are likely to benefit them while reducing the use of therapies that are likely to cause harm. Quality, person-centered dementia care also requires identifying goals for the person and family and what outcomes matter most to them. An article in the July issue of JAMDA took a hard look at dementia care and proposed some promising next steps that could improve the lives of PLWD.

In Chronic Care, Dementia Care Management, and Financial Considerations, the authors noted that optimal dementia care models likely involve people and services that are not considered core components of the health care delivery system, such as social workers and community services. However, they stressed that these are all critical partners. Over 200 models of dementia care, the authors noted, have demonstrated some efficacy. However, these successful interventions aren’t always covered services in a system where insurance generally focuses on acute care needs. 

There is promise, the authors said, in capitated financing structures where entities get paid a lump-sum amount to provide the totality of care. These include Medicare Advantage (MA) programs; care innovation models through the Centers for Medicare and Medicaid Services (CMS), such as the Program of All-Inclusive Care for the Elderly (PACE) that provides comprehensive medical and social services; and Accountable Care Organizations (ACOs), where providers working together to provide coordinated care take more responsibility for the total health and care provided to a patient. More widespread movement toward value-based insurance models, including the Chronic Care Management program, may also prove to be a promising avenue to improving dementia care. 

“While we have evidence that dementia care models have provided benefit for some people in specific settings, making such models practical and self-sustaining has been difficult. Moreover, we do not know the best way to provide care for everyone, especially those who do not have care partners or who have multiple chronic conditions,” the authors said. They stressed the need to understand personal and family goals, as most health-care decisions are actually preference-sensitive.

The authors also suggested that flexibility on the part of providers and clear definitions of who is a care team member will be key in promoting innovative care models and improved quality of life for people living with dementia and their families. They said, “This will require flexibility in the funding framework as well, to make sure that rules and regulations surrounding reimbursement is not limiting care received nor the innovation in care delivery.”

The study was conducted by researchers at Division of Geriatric Medicine, Department of Medicine, New York University, New York, NY; Division of Geriatrics and Palliative Care, Department of Medicine, New York University, New York, NY; Freedman Research Center on Aging, Technology, and Cognitive Health, New York, NY; NYU Aging Incubator, New York, NY; and VA Manhattan Healthcare System, New York, NY. 

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email emullally@paltc.org.