Caregiver-Support Program Decreased Dementia Emergencies

Abstract

BOSTON – A pilot program that supports the caregivers of Alzheimer's disease patients decreased emergency admissions for those patients in San Francisco by more than 40% in 6 months, Elizabeth Edgerly, PhD, reported at the Alzheimer's Association International Conference 2013. The preliminary analysis also found that caregivers reported significant improvements in 7 out of 10 quality of life and quality of care measures, according to Dr. Edgerly, chief program officer of the Alzheimer's Association Northern California and Northern Nevada Chapter. The early results paint an encouraging picture of the future, she said in an interview. “We are very excited about the emergency utilization data. We're always confident about our capacity to impact efficacy, but affecting service utilization is a tough nut to crack. The beauty of this is, if we can improve quality of care while reducing utilization costs, it may actually be cost neutral to have this kind of a dementia support program.” The association created its Excellence in Dementia Care program in conjunction with Kaiser Permanente Northern California, the city and county of San Francisco, and the University of California, San Francisco. The Administration on Aging also provided funding. San Francisco was the perfect city for the pilot project, Dr. Edgerly said. “It's the only city in the United States with a strategic plan related to dementia. It also has an elderly, diverse population, and many of the residents live alone.” The pilot program is part of the city plan's goal of partnering with other institutions to improve quality of life and quality of care for people with dementia. It was designed to improve dementia care by both enhancing services and educating caregivers. “Kaiser hired a full-time social worker for just dementia support and who only worked with the caregivers,” Dr. Edgerly said. The social worker conducted initial evaluations and assessments and created an individualized dementia care program that was uploaded into the electronic medical record of each patient, making the individualized program available to everyone on the patient's care team. The social worker also called caregivers proactively to make sure the caregivers’ needs were being met and that they could access community services. The Alzheimer's Association provided dementia care support experts manning a 24-hour help line, a MedicAlert + Alzheimer's Association Safe Return bracelet for the patient, respite grants for day or evening supplemental care to give caregivers a break, and a support group where caregivers could meet to discusses their challenges. The association also administered the educational portion of the program. The first component provided a primer on Alzheimer's stage-by-stage effects on thinking, emotions, and behavior and noted resources that were available for help. Caregivers also were informed about legal and financial planning and ways to keep a positive, safe, and compassionate home environment for as long as the patient could stay at home. In surveys at baseline and after 6 months, caregivers rated their feelings about their abilities in 10 different areas: handling current patient problems in memory and behavior, handling future patient problems, dealing with their own frustrations, keeping the patient independent, caring for the patient as independently as possible, getting answers to patient problems, finding community organizations that provide answers, finding community organizations that provide services, getting answers to questions about services, independently arranging for services, and paying for services. Overall, 92 of the 105 patient-caregiver dyads have completed the 6-month assessments, Dr. Edgerly said. The surveys indicated significant improvements on seven of the caregiver measures. Caregivers said they felt better able to handle concerns, to get information, and to obtain and pay for services. Most importantly, the program led to about a 40% decrease in emergency department visits – a significant change, Dr. Edgerly said. There were also nonsignificant decreases in hospital length of stay, physician visits, and days spent in postacute or long-term care facilities. “Even the outcomes that didn't improve significantly were all going in the right direction,” Dr. Edgerly said, adding that she's hoping for even better results when the data are analyzed in their entirety. The program's positive impact on health care resources could be enough to attract the interest of other insurers, she said. “If this intervention reduced expenses associated with hospital or emergency department visits, an insurer might see that as good business sense.” The project was funded by the Alzheimer's Association of Northern California and Northern Nevada, Kaiser Permanente Northern California, and the National Institute on Aging.