COMMUNITY-BASED DEMENTIA CARE: INTEGRATING THE NEEDS OF PATIENT AND CAREGIVER

Abstract

Absent a cure or effective disease modifying treatment for dementia, developing cost-effective models of care that address the needs of caregivers alongside the medical management of the disease is necessary to maximize quality of care, address safety issues, and enhance the patient/caregiver experience. There is minimal data regarding whether incorporating dementia caregivers into the clinical model can impact caregiver satisfaction and cost of care. MemoryCare, a community-based non-profit organization, has 17 years of experience delivering an outpatient medical and care management model for persons living with Alzheimer's disease and other types of dementia (PLWD). The program serves a predominantly rural region in Western North Carolina. Caregivers participate in care planning and are provided with dementia education, training in behavioral management, resource matching, and support at each clinical encounter for their PLWD. Designed to supplement primary care services, the average annual cost per patient/caregiver dyad is $1450. This cost includes both clinical visits for the PLWD and tailored support for the caregiver(s). In 2017, 1034 patients and 3483 caregivers were served by the program. Over the past 3 years, observational data on hospitalization rates, ED utilization, 30 day readmission rates, and caregiver satisfaction have been collected annually for PLWD enrolled in the program for a minimum of one year who live in a defined region where health care utilization statistics can be confirmed independently of patient or caregiver report. Caregiver satisfaction surveys reveal high levels of overall satisfaction, increased dementia-specific knowledge, improved perceived ability to manage challenging behavioral aspects of dementia and perceived greater ability to maintain the PLWD in the home setting. Observational data reveals lower hospitalization rates, ED utilization and rehospitalization rates compared with published national benchmarks. These findings warrant further study of the impact of broader integration of caregivers into clinical care models for persons living with dementia.