The Evolution of Long-term Care Programs; Comment on “Financing Long-term Care: Lessons From Japan”

The need for long-term care (LTC) represents a “new social risk,” one that overlaps with and complements systems of care that pre-date such programs, complicating LTC program design. This commentary expands on Ikegami’s discussion of how these structural factors must be accommodated, as well as historical and cultural factors that influence public expectations of such a program. The commentary specifically focuses on the role of cash payments, caregiver benefits, and the sometimes indistinct line between LTC and health systems. The experiences of countries operating LTC program in a wide range of contexts can illuminate common challenges, as well as some potential solutions to these vexing design and operational issues

The Alzheimer’s Association Dementia Care Coordination Program: A Process Evaluation, Executive Summary

The Massachusetts/New Hampshire (MA/NH) Chapter of the Alzheimer\u27s Association has long sought ways to systematically increase the number of families who utilize its services and support. According to the Alzheimer’s Association’s 2015 Alzheimer’s Disease Facts and Figures, there are 142,000 individuals living with Alzheimer’s disease in Massachusetts and New Hampshire, and the Alzheimer’s Association estimates that less than 30% of those individuals and their caregivers take advantage of its programs (Alzheimer’s Association, 2015). The MA/NH Chapter recognized that one major barrier to accessing services is a model that relies on families taking the initiative to seek out assistance. In 2005, The MA/NH Chapter of the Alzheimer’s Association initiated the Health Liaison Program. Rather than relying on affected persons to reach out to the Chapter, the Health Liaison Program sought to improve chapter service utilization by encouraging health care providers to make direct referrals for families affected by Alzheimer’s disease and related dementias (ADRD). After many years of operating the Health Liaison Program with existing staff, the Alzheimer’s Association MA/NH Chapter decided to pursue funding to expand the Health Liaison Program into the more formal Dementia Care Coordination (DCC) program. This study reports on the Dementia Care Coordination (DCC) Program. In 2013, with support from a non-profit health insurer, Tufts Health Plan (THP) and a private funder, the Eisenberg Family Trust, the development and implementation of the DCC Program became possible. Under the DCC Program, dedicated care consultants connect directly with persons with ADRDs and their families who are referred to the Chapter by health care providers. Once connected, the care consultant is able to provide disease-specific education, symptom management strategies, emotional support, and referrals to community resources and encourage the caregiver to utilize other Alzheimer’s Association services including support groups, education programs, and advocacy opportunities. Consultants collaborate with other staff members and volunteers to provide ongoing information and support to families. Moreover, consultants provide written feedback to health care providers and nurse case managers on client needs and recommendations to meet those needs. Connecting families affected by ADRD with the services and support of the Alzheimer’s Association has important benefits for both the caregiver and affected person. Integrating primary care with caregiver support will likely improve the health status and quality of life for the person with ARDA and family caregivers. Mittleman et al. (2006) has demonstrated that such support and education delays institutionalization and improves physical and emotional health outcomes for the caregiver. Unfortunately, many caregivers delay seeking any kind of assistance. Richardson (2012) reporting on a 2012 study by the Alzheimer Society of Canada, stated that 44% of caregivers for people with ADRD waited a year or more, after the first signs of dementia, to seek any kind of support. The overall finding of this study is that the DCC program is highly successful and has engendered high levels of satisfaction by participants and multiple stakeholders. The DCC program represents an important element in a comprehensive integrated approach to patient care. Our analysis has also led us to make recommendations on how this important program can be improved, with the hope that it can be expanded and replicated

Is late-life dependency increasing or not? A comparison of the Cognitive Function and Ageing Studies (CFAS)

Background: Little is known about how the proportions of dependency states have changed between generational cohorts of older people. We aimed to estimate years lived in different dependency states at age 65 years in 1991 and 2011, and new projections of future demand for care. Methods: In this population-based study, we compared two Cognitive Function and Ageing Studies (CFAS I and CFAS II) of older people (aged ≥65 years) who were permanently registered with a general practice in three defined geographical areas (Cambridgeshire, Newcastle, and Nottingham; UK). These studies were done two decades apart (1991 and 2011). General practices provided lists of individuals to be contacted and were asked to exclude those who had died or might die over the next month. Baseline interviews were done in the community and care homes. Participants were stratified by age, and interviews occurred only after written informed consent was obtained. Information collected included basic sociodemographics, cognitive status, urinary incontinence, and self-reported ability to do activities of daily living. CFAS I was assigned as the 1991 cohort and CFAS II as the 2011 cohort, and both studies provided prevalence estimates of dependency in four states: high dependency (24-h care), medium dependency (daily care), low dependency (less than daily), and independent. Years in each dependency state were calculated by Sullivan's method. To project future demands for social care, the proportions in each dependency state (by age group and sex) were applied to the 2014 England population projections. Findings: Between 1991 and 2011, there were significant increases in years lived from age 65 years with low dependency (1·7 years [95% CI 1·0-2·4] for men and 2·4 years [1·8-3·1] for women) and increases with high dependency (0·9 years [0·2-1·7] for men and 1·3 years [0·5-2·1] for women). The majority of men's extra years of life were spent independent (36·3%) or with low dependency (36·3%) whereas for women the majority were spent with low dependency (58·0%), and only 4·8% were independent. There were substantial reductions in the proportions with medium and high dependency who lived in care homes, although, if these dependency and care home proportions remain constant in the future, further population ageing will require an extra 71 215 care home places by 2025. Interpretation: On average older men now spend 2·4 years and women 3·0 years with substantial care needs, and most will live in the community. These findings have considerable implications for families of older people who provide the majority of unpaid care, but the findings also provide valuable new information for governments and care providers planning the resources and funding required for the care of their future ageing populations. Funding: Medical Research Council (G9901400) and (G06010220), with support from the National Institute for Health Research Comprehensive Local research networks in West Anglia and Trent, UK, and Neurodegenerative Disease Research Network in Newcastle, UK

The Alzheimer’s Association Dementia Care Coordination Program: A Process Evaluation, Executive Summary

The Massachusetts/New Hampshire (MA/NH) Chapter of the Alzheimer\u27s Association has long sought ways to systematically increase the number of families who utilize its services and support. According to the Alzheimer’s Association’s 2015 Alzheimer’s Disease Facts and Figures, there are 142,000 individuals living with Alzheimer’s disease in Massachusetts and New Hampshire, and the Alzheimer’s Association estimates that less than 30% of those individuals and their caregivers take advantage of its programs (Alzheimer’s Association, 2015). The MA/NH Chapter recognized that one major barrier to accessing services is a model that relies on families taking the initiative to seek out assistance. In 2005, The MA/NH Chapter of the Alzheimer’s Association initiated the Health Liaison Program. Rather than relying on affected persons to reach out to the Chapter, the Health Liaison Program sought to improve chapter service utilization by encouraging health care providers to make direct referrals for families affected by Alzheimer’s disease and related dementias (ADRD). After many years of operating the Health Liaison Program with existing staff, the Alzheimer’s Association MA/NH Chapter decided to pursue funding to expand the Health Liaison Program into the more formal Dementia Care Coordination (DCC) program. This study reports on the Dementia Care Coordination (DCC) Program. In 2013, with support from a non-profit health insurer, Tufts Health Plan (THP) and a private funder, the Eisenberg Family Trust, the development and implementation of the DCC Program became possible. Under the DCC Program, dedicated care consultants connect directly with persons with ADRDs and their families who are referred to the Chapter by health care providers. Once connected, the care consultant is able to provide disease-specific education, symptom management strategies, emotional support, and referrals to community resources and encourage the caregiver to utilize other Alzheimer’s Association services including support groups, education programs, and advocacy opportunities. Consultants collaborate with other staff members and volunteers to provide ongoing information and support to families. Moreover, consultants provide written feedback to health care providers and nurse case managers on client needs and recommendations to meet those needs. Connecting families affected by ADRD with the services and support of the Alzheimer’s Association has important benefits for both the caregiver and affected person. Integrating primary care with caregiver support will likely improve the health status and quality of life for the person with ARDA and family caregivers. Mittleman et al. (2006) has demonstrated that such support and education delays institutionalization and improves physical and emotional health outcomes for the caregiver. Unfortunately, many caregivers delay seeking any kind of assistance. Richardson (2012) reporting on a 2012 study by the Alzheimer Society of Canada, stated that 44% of caregivers for people with ADRD waited a year or more, after the first signs of dementia, to seek any kind of support. The overall finding of this study is that the DCC program is highly successful and has engendered high levels of satisfaction by participants and multiple stakeholders. The DCC program represents an important element in a comprehensive integrated approach to patient care. Our analysis has also led us to make recommendations on how this important program can be improved, with the hope that it can be expanded and replicated

Mild memory impairment and medical care: Results from a population-based study

Mild memory impairment may be associated with an increased risk of medical care and greater health care costs. To investigate this question, a multi-ethnic cohort of I I90 older adults without dementia was identified from a population-based study (Washington Heights-Inwood Columbia Aging Project). All subjects completed a full battery of cognitive evaluations in 1996 or earlier and survived through 1996. Subjects with Medicare (1996, n=81 I) and NYC Medicaid claims (1996.1998, n=560) were then identified and examined relative to performance on tests of memory (a factor-analytic derived composite of seven terta). In multivariate models that adjusted for age, gender, and education, mean [median] Medicare charges in 1996 were $7713 [$7505], $7930 [$7726), and $5848 [$5677] for subjects with the lowest, middle, and highest memory test performance, respectively (p < .OOl by KroskalWallis [K-S] test of median scores). Mean [median] annual Medicaid costs by memory tenile were $16,115 [$15,794], $10.651 [$10,313], and $7552 [$7197] (p < .OOl by K-S test). Memory tertile groups did not differ in number of comorbid conditions. Low memory scores were associated with risk of incident dementia after 1996 (half of 59 subjects diagnosed with dementia during follow-up were in the lowest memory score tertile). Removing these subjects from analyses eliminated cost differences in Medicare but not Medicaid claims, suggesting that low memory performance in non-demented elders may be an independent risk factor for medical care costs that are captured in the Medicaid system

Directory of local disability information providers

SIGLEAvailable from British Library Document Supply Centre-DSC:q96/18133 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The Alzheimer’s Association Dementia Care Coordination Program: A Process Evaluation, Executive Summary

The Massachusetts/New Hampshire (MA/NH) Chapter of the Alzheimer\u27s Association has long sought ways to systematically increase the number of families who utilize its services and support. According to the Alzheimer’s Association’s 2015 Alzheimer’s Disease Facts and Figures, there are 142,000 individuals living with Alzheimer’s disease in Massachusetts and New Hampshire, and the Alzheimer’s Association estimates that less than 30% of those individuals and their caregivers take advantage of its programs (Alzheimer’s Association, 2015). The MA/NH Chapter recognized that one major barrier to accessing services is a model that relies on families taking the initiative to seek out assistance. In 2005, The MA/NH Chapter of the Alzheimer’s Association initiated the Health Liaison Program. Rather than relying on affected persons to reach out to the Chapter, the Health Liaison Program sought to improve chapter service utilization by encouraging health care providers to make direct referrals for families affected by Alzheimer’s disease and related dementias (ADRD). After many years of operating the Health Liaison Program with existing staff, the Alzheimer’s Association MA/NH Chapter decided to pursue funding to expand the Health Liaison Program into the more formal Dementia Care Coordination (DCC) program. This study reports on the Dementia Care Coordination (DCC) Program. In 2013, with support from a non-profit health insurer, Tufts Health Plan (THP) and a private funder, the Eisenberg Family Trust, the development and implementation of the DCC Program became possible. Under the DCC Program, dedicated care consultants connect directly with persons with ADRDs and their families who are referred to the Chapter by health care providers. Once connected, the care consultant is able to provide disease-specific education, symptom management strategies, emotional support, and referrals to community resources and encourage the caregiver to utilize other Alzheimer’s Association services including support groups, education programs, and advocacy opportunities. Consultants collaborate with other staff members and volunteers to provide ongoing information and support to families. Moreover, consultants provide written feedback to health care providers and nurse case managers on client needs and recommendations to meet those needs. Connecting families affected by ADRD with the services and support of the Alzheimer’s Association has important benefits for both the caregiver and affected person. Integrating primary care with caregiver support will likely improve the health status and quality of life for the person with ARDA and family caregivers. Mittleman et al. (2006) has demonstrated that such support and education delays institutionalization and improves physical and emotional health outcomes for the caregiver. Unfortunately, many caregivers delay seeking any kind of assistance. Richardson (2012) reporting on a 2012 study by the Alzheimer Society of Canada, stated that 44% of caregivers for people with ADRD waited a year or more, after the first signs of dementia, to seek any kind of support. The overall finding of this study is that the DCC program is highly successful and has engendered high levels of satisfaction by participants and multiple stakeholders. The DCC program represents an important element in a comprehensive integrated approach to patient care. Our analysis has also led us to make recommendations on how this important program can be improved, with the hope that it can be expanded and replicated