A recent study conducted by the RAND Corporation set off a few red flares about the escalating cost of dementia within the U.S. healthcare system. According to RAND, dementia is one of the country’s most expensive medical conditions, costing the U.S. between $157 billion and $215 billion a year in medical care and other costs.
Compared to other common costly diseases, the direct medical costs of treating dementia, estimated at $109 billion in 2010, are in line with heart disease ($102 billion) and substantially greater than cancer ($72 billion). Beyond direct medical costs, it is estimated that an additional $48 to $106 billion is spent on the informal care for dementia, which primarily includes lost wages and care provided by family members at home. The projected growth is also eye opening – both the costs and the number of people with dementia will more than double within 30 years, a rate that overshadows many other chronic diseases. These staggering statistics clearly reinforce the need for the U.S. to find better solutions for those suffering from dementia.
Without a known way to prevent, cure or effectively treat this devastating disease, how are we going to control the cost of care?
What high quality, lost cost solutions exist today?
Dementia is the loss of mental functions such as thinking, memory and reasoning that is severe enough to interfere with a person’s activities of daily living. Dementia develops when the parts of the brain that are involved with these mental functions are affected by one or more of a variety of infections or diseases, the most common being Alzheimer’s. Unlike cancer, which typically follows a path of steady decline, dementia is much more difficult to predict. Patients with dementia may experience a period of steady decline followed by a period of marked improvement. This unpredictable trajectory is one of the major challenges of treating dementia – it is very difficult to determine how long an individual with advance dementia can expect to live. As a result, patients often face obstacles that impede or delay enrollment into hospice:
- Nursing homes aren’t suggesting hospice services when appropriate;
- Families and/or physicians are not recognizing that dementia is a terminal illness;
- Doctors are reticent to certify that a patients has less than 6 months to live;
- Lack of physician education regarding disease progression; and
- Challenges of identifying and controlling pains symptoms in the cognitively impaired.
Physicians are the primary gatekeeper to hospice
Medicare regulations require a physician to certify that a patient entering hospice is likely to die within six months or less. Doctors are much more likely to do so when the disease is cancer or heart failure. As a result, too many patients are denied access to hospice care, which provides palliative care (i.e. comfort care) for the dying and support for their families. Without hospice, those suffering from dementia may be subjected to multiple hospitalizations, invasive treatments and poor pain / symptom management.
Today, dementia patients are grossly underserved as fewer than 10% of people dying of dementia receive hospice services and often times are enrolled too late – within a few weeks of days of death. Comparatively, more than 40% of Americans who die each year are in hospice care.
The decision to enroll a loved one into hospice is unquestionably one of life’s most difficult decisions. But, better prognoses and education about the benefits of hospice may reduce suffering and unnecessary medical costs. A few studies have determined that there isn’t really a more accurate way to estimate how long someone with advance dementia might live. So how can we fix the problem of dementia patients being denied hospice care because physicians can’t identify those likely to die in six months? Should we revisit the Medicare certification guidelines for dementia patients to allow them improved access to comfort care?
Let us know what you think.