The United States is about to face a crisis; an estimated 5.7 million Americans currently have Alzheimer’s. It’s uncommon in persons younger than 65, but as we age, so does our risk of developing dementia. Ten percent of those aged 65 and older will suffer from the debilitating effects of this disease. As our population ages, the number of patients with Alzheimer’s is projected to rise by a minimum of 13 percent in the next seven years. Our medical infrastructure is not prepared to serve these patients, who experience increased debility as this incurable disease progresses. It’s past time we do something to curtail this impending disaster.
The U.S. is already experiencing a shortage of facilities and doctors to care for the current dementia patients, let alone the expected increase in those requiring dementia care. Nursing homes already have a shortage of beds that are appropriate for people with dementia. They have specialized needs often requiring a locked unit to keep them safe. In the beginning stages of the disease, many patients can be cared for with the use of adult daycare centers, sometimes known as life care centers, but there are not nearly enough of these types of facilities either. All forms of care currently available for Alzheimer’s sufferers can be prohibitively expensive and often not adequately covered by personal resources or even long-term care insurance.
{mosads}In the beginning, an Alzheimer’s patient’s care might be manageable for their spouse, but often, their spouses are also experiencing age-related health problems and are themselves in need of care. Previously the nuclear family structure where aging parents moved in with their children was a viable option, but as our society moves away from this, Alzheimer’s patients have few options. Aging individuals’ extended families all have jobs and no time to help care for their loved ones—a full-time job on its own. For a time, a home visit from a health-care provider sent by a government service like the Office of Aging can suffice, but eventually, all Alzheimer’s patients reach a point where they require 24/7 care.
On top of the shortage and prohibitive cost of care facilities, dementia patients are ill-served by a health-care system not designed to suit their needs. Doctors are trained to save lives, and so patients with progressive, terminal illnesses like Alzheimer’s are put through the same battery of expensive diagnostic tests that otherwise healthy patients are regularly given. They’re regularly admitted to hospitals when they acquire pneumonia or urine infections, despite the confusion it causes them to be in an unfamiliar place. And at the same time, our system is set up such that it benefits an Alzheimer’s patient for them to become hospitalized, because that will qualify them to enter a nursing home for rehabilitation covered by Medicare.
What Alzheimer’s patients really need is a separate track of health care designed just for them. This track would be covered by a separate form of Medicare designed specifically for people with dementia. Patients should be able to opt out of regular Medicare and opt into this new system I’m proposing in which care is focused on comfort and quality of life. Care for dementia patients would become less costly by funneling their Medicare dollars toward palliative care needs rather than costly, unnecessary diagnostic tests. In this new system, rather than hospitalize patients for infections, the focus would be on out-patient management of diseases, especially infectious diseases. Keeping patients in their familiar surroundings while treating them for infections will save them from the disorienting and confusing experience of being hospitalized, an ordeal that can cause dementia symptoms to worsen.
Their Medicare funding should also cover support for their families, something that is currently non-existent. Dealing with a loved one’s progression through Alzheimer’s is taxing, and many loved ones, especially those acting as caregivers, suffer from increased stress and depression. Supporting family members should be considered part and parcel with caring for the patient as an added means of improving quality of life.
Even though we’re already behind, it’s not too late to prepare for the impending rise in Alzheimer’s cases. We need more geriatricians and facilities designed for Alzheimer’s patients, but we also desperately need to overhaul how we’re caring for these patients, starting with a special Medicare track tailored to their care.
Ann Norwich is director of the Adult Gerontology Nursing Practitioner Program and an assistant professor of nursing at York College of Pennsylvania. She is also a practicing nurse practitioner in the palliative care field.