Costs of the Care for Older Persons with Dementia in their Environment (COPE) intervention when delivered through the Connecticut state Medicaid waiver program

Abstract

AbstractBackgroundThe Care of Persons with Dementia in their Environments translational study (COPE‐CT) is a Connecticut‐based randomized clinical trial conducted to evaluate the efficacy of behavioral intervention (COPE) vs. usual care (UC) for persons with dementia (PwD) and their caregivers.MethodsPwD in both groups were enrolled in the Connecticut Home Care Program for Elders (CHCPE) and received a monthly home care plan. COPE, an in‐home behavioral intervention delivered by occupational therapists and an advance practice nurse, was designed to maximize PwD physical functioning and improve caregivers’ dementia management skills. Program costs included staff training and supervision (COPE), screening for program eligibility (COPE & UC), intervention delivery (COPE), travel time and mileage (COPE), supplies (COPE & UC), lab testing (COPE), and home care plan for one year pre‐enrollment to one year post‐enrollment (COPE & UC). Mean per‐dyad cost differences at 12 months vs. baseline were calculated for each group and compared using a difference‐in‐difference approach.Result291 PwD/caregiver dyads were randomized (145 COPE, 146 UC). Mean per‐dyad cost of COPE was $1,868 vs. $6.41 for UC, yielding an incremental difference‐in‐difference cost of $1,862/dyad for COPE. COPE delivery was the largest cost driver ($623/dyad) followed by travel time ($370/dyad) and lab testing ($316/dyad). UC costs were minimal and driven by supplies ($18.45/dyad). Both groups experienced a cost savings in the care plan at $82.06/dyad for COPE vs. $15.63/dyad for UC, but this difference was not statistically significant (p=0.5253).ConclusionGiven the lack of medical treatments for dementia, in‐home programs for PwD and their caregivers are critical. COPE represents a novel approach to dementia behavioral management and caregiver support, and the intervention costs we report inform its sustainability. Future work will examine potential cost offsets in health and social service expenditures.