Persons with dementia caught between medicine, care and politics

Abstract

When there is a suggestion of dementia, a thorough diagnostic work up including a comprehensive assessment is needed for the benefit of the old person, his family and society. This provides the basis for needed interventions, including prevention and rehabilitation, in addition to treatment and care. A comprehensive approach is in order since dementia is the single most important cause for care-dependency. Dementia cannot be considered an organic mental disorder alone but has to be viewed in the context of the personhood and living environment of the person afflicted. Because of the diversity of professionals and agencies involved in the provision of care for the person with dementia, a clear delineation between overlapping areas of care as well as coordination of services is needed. At present this is often times not accomplished, resulting in a fragmentation of care and competing responsibilities. Despite many attempts to remedy these pitfalls, problems have remained. The reform of the German long-term care insurance provides many new regulations mandating improved care and more social participation for the person with dementia and his family. To implement this mandate, the coordination of services between the professionals involved, especially between physicians and nursing-care professionals, will be crucial. It has become apparent that separate reimbursement systems in health care insurance and long-term care insurance might well be implicated in deficient levels of care. It has been recommended to place more emphasis on integrated care. Improvements have to be judged by their benefit for the target group. Administrative and technocratic burdens may impede intended goals.