The RAND Corporation recently released a research report, ‘Improving Dementia Long Term Care: A Policy Blueprint,” which provides a framework for stakeholders to look at how dementia and long-term services and supports (LTSS) intersect. The authors focused on five objectives for the dementia LTSS system:
- Increase public awareness of dementia to reduce stigma and promote earlier detection
- Improve access to and use of LTSS
- Promote high-quality, person-and caregiver-centered care
- Provide better support for family caregivers of people with dementia
- Reduce the burden of dementia LTSS costs on individuals and families
The report notes that there has been a “rebalancing” of care away from institutional caregiving towards home and community based services (HCBS). At the same time, studies have shown that relying on family members as caregivers for people with dementia is unsustainable over time. However, many nursing homes have struggled with providing adequate dementia training to direct care givers, which has been cited as directly related to residents’ poor quality of life, poor quality of care, abuse and neglect. Coupling these caregiver stresses with the fact that people with dementia have more care transitions means that care can be fragmented, uncoordinated and inadequate for a population that requires much assistance.
Training for Caregiving
The RAND report notes that as much as 80% of LTSS for all conditions is provided by informal caregivers. These caregivers can find themselves dealing with a wide range of behavioral challenges that they are not adequately trained to deal with, in addition to ADLs. Likewise, in formal care settings, direct caregivers for residents with dementia may experience more frustration without adequate training to treat these unique population. This results in high turnover and a lack of qualified workers for these positions.
This report also notes that people who have dementia experience more care settings and transitions than adults of the same age who have other chronic conditions. These transitions can often lead to issues that lead to future hospital readmissions. This is due in part to the lack of communication between the various settings that these individuals spend time in. Their data systems are siloed and important information can often be missed upon discharge or admission elsewhere. Additionally, comorbidities for people with dementia may be more difficult to manage, and those people who live in the community are more likely to end up in the hospital or emergency room.
High Impact Policy Options
The authors of this report identified almost 40 policy options, and recommended that 25 be implemented immediately. These options are part of five objectives mentioned at the beginning of this post, and include policy options such as:
- Encouraging providers’ use of cognitive assessment tools for early dementia detection and recognition
- Creating new and improving existing incentives for direct care workers
- Minimizing transitions and improving coordination of care across providers, settings and stages of dementia
- Creating new and disseminating existing dementia best practices and training programs for care workers
- Providing dementia-specific training and information about resources to family caregivers and volunteer groups
Read the full report on the RAND website.