Dementia Care During the Pandemic and Beyond

By 2025, the number of people aged 65 and older with Alzheimer’s dementia is projected to reach 7.2 million — an 11% increase from those affected today.  According to the Alzheimer’s Association that number is expected to reach 12.7 million by 2050.  The total national cost of caring for people living with dementia, including Alzheimer’s, is estimated to be $321 billion in 2022, which does not include an estimated $271 billion in unpaid caregiving.  These increasing cases, combined with the high cost of care and ongoing staffing issues, presents many challenges in long-term care settings.

The Impact of COVID-19 on Dementia Patients

Alzheimer’s and dementia deaths increased 16% during the COVID-19 pandemic.  One report revealed individuals with Alzheimer’s and other dementia were 50% more likely to be diagnosed with, and 60% more likely to die of COVID-19 than those without dementia.  Analyses continue as to the effect of delayed or canceled health care services due to the COVID-19 restrictions and lock downs.

Another recent study of over 26.6 million Medicare enrollees revealed nursing home residents with Alzheimer’s and related dementias had a 33% increase in mortality between 2019 and 2020.  This study notes that issues, in addition to the COVID-19 infection, played a role in the excess mortality.  These factors consist of the many changes in health care delivery including fewer inpatient admissions and the increased use of telehealth for outpatient visits.  Decreased access to community support services and social isolation also may have contributed to the higher mortality rates.  The study added that increases in caregiver stress, burden and isolation may have indirectly affected the health of dementia patients living in nursing home settings.

High Cost of Care / Quality of Care

The Alzheimer’s Association 2022 Facts and Figures reveal Medicare and other insurers pay an average of almost $42,000 per person annually for dementia patients, approximately three times more than beneficiaries without dementia.  This does not include the ongoing costs for long-term care services where the median annual cost for dementia care in assisted living facilities is over $53,000 and nursing home care is over $109,000.

Alzheimer’s patients live an average of four to eight years after diagnosis and may require long-term care for a significant period during that time.  With the projected increase in cases due to the aging population plus lengthy stays in assisted living or nursing homes, long-term care facilities must ensure best practices in care management and staffing.  The Joint Commission in collaboration with the Alzheimer’s Association Dementia Care Practice Recommendations has updated the Memory Care Certification requirements starting July 1, 2022.  This update to the nursing care center accreditation requirements is intended to ensure high quality nursing home care for dementia patients.  The Prepublication Standards address infection control, dementia care, staff recruitment, retention and wellness, pressure injuries, and medication safety.

Staffing Issues

From 2016 to 2026, the demand for direct care workers is projected to grow by more than 40%, while their availability is expected to decline.  Nursing homes have lost 15.2% (241,000 caregivers) of their workforce, and assisted living facilities have lost 6.2% (28,800 caregivers) since the beginning of the pandemic.  This staffing shortage is  forcing facilities to use outside agencies to supplement staff, with costs that have increased 2 to 3 times historical levels.  Facilities are also faced with impending minimum staffing requirements from the White House as well as individual states.  The National Academies released The National Imperative to Improve Nursing Home Quality report in April 2022.  In the section on staffing, the report calls for more research on staffing standards, registered nurse coverage around the clock, a full-time social worker, and an infection control specialist.

Staff retention and recruitment activities are at a crucial point, and facilities are looking for ways to differentiate themselves beyond compensation and benefits.  Employee satisfaction programs that include career advancement opportunities and comprehensive training programs are important.  Staff training specifically focused on understanding the symptoms and behaviors in dementia care is essential for staff competence and confidence as well as patient/family satisfaction.  According to the Alzheimer’s Association, the single most important determinant of quality care across all care setting is direct care staff.

Managing the Challenge

The unique challenges associated with the care of dementia patients calls for best practices in medical record documentation, policy and procedure development, risk management, and staff training.  Excelas’ experience in reviewing long-term care medical records and facility policies and procedures can assist providers, insurers, and counsel in preparing for audits, accreditation reviews, and responses to claims and litigation.

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