1. ACT on Alzheimer’s Disease Curriculum Module III: Societal Impact

2. Societal Impact These slides are based on the Module III: Societal Impact text Please refer to the text for all citations, references and acknowledgments 2

3. Module III: Learning Objectives Upon completion of this module the student should: Identify the challenges that families and caregivers experience when caring for someone who has dementia. Gain insight into the cost, risks, and stressors that affect families and caregivers. Be aware of the anticipated increase and impact Alzheimer’s disease will have in the future.

4. Societal Impact of Alzheimer’s Disease Alzheimer’s disease has a serious impact on many facets of society – The burden of Alzheimer’s disease has a profound impact on patients, families and caregivers – The disease jeopardizes the financial well-being of patients and families as well as puts strain on public budgets – Alzheimer’s disease has placed, and will continue to place, an increasing burden on the overall healthcare system

5. Impact on Families and Caregivers

6. 15 million Americans provide unpaid care to a person with Alzheimer’s disease or other dementia Unpaid caregivers are primarily family members In 2012, these caregivers provided an estimated 17.5 billion hours of unpaid care at an estimated value of $216.4 billion

7. Impact on Families and Caregivers Caring for a person with dementia poses special challenges Caregivers experience high levels of stress and negative effects on their own health, employment and financial security Caregivers are at a heightened risk for psychological and physical illness

8. Impact on Families and Caregivers Frequent issues experienced by families and caregivers include: – Denial – Anger / Frustration – Guilt – Loss and Grief – Letting Go – Financial Stress – Role Reversals – Social Isolation

9. Impact on Families and Caregivers Caregivers report high levels of stress over the course of providing care – 61% rated the emotional stress of caregiving as high or very high – 33% report symptoms of depression

10. Impact on Families and Caregivers Caregivers are at risk for becoming “secondary patients” – The physical and emotional impact of dementia caregiving is estimated to result in $9.1 billion in health care costs in the United States – 75% of caregivers reported that they were somewhat to very concerned about their own health while serving as a caregiver

11. Financial and Healthcare Impact

12. As the population grows and ages, there is a growing need for healthcare workers – The United States will need another 3.5 million health care providers by 2030 to maintain the current ratio of provider coverage – The number of trained geriatricians is very low and the need is growing in the medical, nursing and social work fields

13. Financial and Healthcare Impact People with Alzheimer’s disease and related dementias have three times as many hospital stays as do others Medicare beneficiaries with Alzheimer’s are more likely than those without to have other chronic medical conditions As a result, the total health care costs of Alzheimer’s patients is higher than the costs of similar non-Alzheimer’s patients

14. Financial and Healthcare Impact Use of healthcare facilities: – Hospital: 3x stays for Medicare patients with Alzheimer’s vs. those without Alzheimer’s – Skilled nursing facility: 9x stays for Alzheimer’s patients – Home health care: 23% with Alzheimer’s had at least one home health care visit vs. 10% for non- Alzheimer’s beneficiaries

15. Financial and Healthcare Impact The costs of health care services are higher for those with Alzheimer’s disease – Total payments for all health care and long-term care for Medicare beneficiaries with Alzheimer’s were 3 times higher than for those without Alzheimer’s ($44k vs. $14k) – 29% of Medicare patients with Alzheimer’s also have Medicaid; 10% of Medicare patients without Alzheimer’s also have Medicaid – Medicaid payments for beneficiaries with Alzheimer’s were 9 times higher than for non-Alzheimer’s Medicaid beneficiaries

16. Financial and Healthcare Impact The high cost of long-term care is a challenge for Alzheimer’s patients and their families – 60-70% of older adults with Alzheimer’s disease live in the community vs. 98% of older adults without Alzheimer’s – The high cost of long-term care services (assisted living $42k/year and nursing home $81-90k/year) causes patients to spend down their assets which ultimately leads them to become Medicaid beneficiaries

17. Financial and Healthcare Impact Total payments for health care, long-term care and hospice for people with Alzheimer’s are projected to increase. $203 billion in 2013 $1.2 trillion in 2050 The increase assumes a six-fold increase in government expenditures under Medicare and Medicaid and a five-fold increase in personal out-of-pocket spending