Dementia and Occupational Therapy - Home caregiver and senior adult woman

Despite progress in risk reduction, testing and treatment, the costs of dementia care in the United States continue to soar along with dementia prevalence. The onus is now on healthcare providers and other stakeholders to increase access to high-quality dementia care services despite these challenges.

That’s according to a new report from the Milken Institute released Tuesday. In Projected Prevalence and Cost of Dementia: 2022 Update, analysts estimated that Alzheimer’s disease and related dementia treatment expenditures will triple to $45 billion by 2040 and more than double from there, to $102 billion by 2060. The uptick in expenditures is due to treatment costs, which have risen by 31% since 2012 to $2.43 million (based on 2015 to 2019 data), the authors found.

Meanwhile, an estimated 62% to 78% of dementia cases remain undiagnosed or not reported, suggesting continued issues with detection, diagnosis, treatment and communication about dementia diagnoses, Milken’s analysts reported. 

Cost burdens

Care for adults aged 75 years and older accounts for most of treatment and medical expenditures, the authors reported. And the high likelihood of having comorbidities after age 65 also is a factor in the ballooning costs. Estimated 2022 expenditures for all treatments for people living with ADRD is $34 billion, they found. That’s almost three times the direct spending on ADRD-only treatment ($12.8 billion).

In addition, three health service categories account for 75% of this spending: inpatient care (26%), home health (29%) and prescription drugs (20%).

Care gaps

When it comes to the burden of care costs, the authors found a widening gender gap. Women account for 20% more ADRD cases than men. And dementia care costs associated with women are 44% higher than those for men due to longevity and social factors. It is more likely that women will leave work to provide unpaid care for others, for example. But by the time they need care themselves, they often are left to rely on Medicaid.

Meanwhile, medical expenditures have increased by 37% for all treatments associated with men who have ADRDs, compared with only 3% for women over the same period.

Racial and ethnic disparities also were highlighted in the report. Dementia is more prevalent in Black and Hispanic individuals who also are less likely to report receiving treatment when compared with whites.

Goals for long-term care facilities

Those and other troubling findings in the updated report show that many issues continue to require urgent attention, said Diane Ty, director of the Milken Institute’s Center for the Future of Aging. With an estimated 37% of post-acute residents and nearly 60% of long-stay residents diagnosed with dementia, the situation calls for enhanced workforce training and administration of a brief cognitive assessment upon admission, she said. 

Among Ty’s recommendations:  

  • Incorporate the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8 tool) into the admissions process. People who screen positive for possible cognitive impairment should be connected to a primary care provider or specialist for further evaluation.
  • Ensure staff receives dementia-specific training.
  • Introduce social prescribing practices within facilities to improve social relationships and provide holistic care with evidence-based tactics such as providing meaningful music to reduce agitation and anxiety.
Diane Ty, Milken Institute

Long-term care providers should also encourage for residents regular physical activity, provide nutrition-packed meals and carefully manage high blood pressure and other co-occurring conditions such as urinary tract infections, she said. Testing and correcting hearing loss and providing mental health support for depression are of key importance as well, she said.

Other ways long-term care stakeholders can help reduce the dementia burden is by supporting family caregivers through dementia education and referrals to community support, Ty noted. The Milken Institute also advises supporting the comprehensive tech-enabled care models of memory care in H.R. 596, which has been introduced in Congress and would provide funding to increase access to telehealth services and virtual visits, she added.

Reforms needed

More broadly, the Milken Institute supports systemic reforms, with improved financing and delivery of long-term care to middle-class households, Ty said. It recommends:

  • Increasing Medicare coverage of long-term care for targeted enrollees, including expansion of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act and the delivery of new benefits under the Value-Based Insurance Design (VBID) program;
  • Paid family and medical leave for family caregivers so that caring for a loved one with dementia does not compound the gender gaps in financial security; 
  • Retirement system reforms to cope with rising costs in an aging population with comorbidities; 
  • Expanding workers’ ability to save for retirement through state-facilitated Automatic IRA (Auto-IRA) programs; and
  • Supporting the passage of the Social Security Caregiver Credit Act of 2019, which credits certain unpaid caregivers of family dependents who provide at least 80 hours of care per month up to five years of deemed wages.

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