Earlier this year, I wrote about how my organization is advancing an important Healthy People 2030 objective to encourage older adults to have discussions with family and friends about their health and what matters most to them. Similarly, we are working to meet another Healthy People 2030 objective by increasing access to evidence-based comprehensive dementia care. We invite public health, health care and community-based organizations to join us in advancing this goal and other objectives to improve the nation’s health throughout this decade.
Why we support Healthy People 2030 and comprehensive dementia care
The Healthy People 2030 initiative of the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion (HHS OASH Office of Disease Prevention and Health Promotion) establishes clear public health objectives over a decade, supported by tools to track national progress toward these goals. As a designated Healthy People 2030 Champion, The John A. Hartford Foundation (JAHF), a private national philanthropy, is committed to furthering the Healthy People 2030 goals by empowering older adults and supporting providers who deliver their care.
Having health care providers ask and act on what matters to older patients, as recommended by Healthy People 2030, is a key principle of age-friendly care. Another Healthy People 2030 objective, reducing the proportion of preventable hospitalizations in older adults with dementia, fits perfectly with other age-friendly care principles that our Foundation promotes. The objective aligns with JAHF initiatives to expand access to comprehensive dementia care, which includes medical and non-medical care and support for family caregivers. Dementia care that is comprehensive has been proven to keep people out of the hospital, as well as nursing homes.
The need is great. Nearly 6.5 million adults in the U.S. have Alzheimer’s Disease, and this number is expected to rise to 7.2 million by 2025. There are notable disparities of dementia prevalence, with higher rates in diverse and underserved populations.
As older adults with Alzheimer’s disease and other types of dementia are more likely to be hospitalized and have poorer clinical outcomes than other patients, preventing or shortening hospitalizations is critical. Hospitals can be dangerous for older adults and what matters to many of us is being able to stay at home.
Using data from the University of Michigan Health and Retirement Study longitudinal sample survey, Healthy People 2030 shows that nearly a quarter of hospitalizations (23.5%) in adults aged 65 years and over with diagnosed Alzheimer's disease and other dementias were preventable in 2013-15. This is the baseline statistic, with the Healthy People 2030 goal to decrease this rate by 4.4 percent to an overall 19.1 percent. We would love to see that rate decline even more. Expanding access to comprehensive dementia care is imperative to reaching or exceeding this goal.
Supporting mentation, cognition and brain health
Age-Friendly Health Systems is an initiative of JAHF and the Institute for Healthcare Improvement, in partnership with the American Hospital Association, The Catholic Health Association of the United States and many others. Age-Friendly Health Systems deliver age-friendly care consisting of evidence-based practices that put the priorities and preferences of older patients at the center. This approach, known as the 4Ms Framework (What Matters, Medication, Mentation, Mobility), ensures that care for older adults is evidence-based, equitable, comprehensive, person-centered, and reduces harm.
One element of the 4Ms Framework focuses on addressing Mentation, which incorporates screening for cognitive impairment and delivering appropriate care when a dementia diagnosis is delivered. Decreasing preventable hospitalizations in older adults with dementia is possible within primary care settings, and health care teams that have joined the Age-Friendly Health Systems movement receive education, coaching and the opportunity to work with other teams to improve the quality of their dementia screening and care. Primary care is uniquely positioned to identify dementia in older patients and partner with community-based services to provide support.
JAHF has funded several evidence-based initiatives to increase the availability and accessibility of comprehensive dementia care. One such program is the widely respected Alzheimer’s and Dementia Care (ADC) Program (The Alzheimer's and Dementia Care Program), developed at UCLA. The program has strong evidence showing it improves care for people living with dementia and their family caregivers. More than 50 ADC-adopting sites have achieved scores of 92 percent of dementia quality of care, compared to the national average of 38 percent. The ADC program at UCLA has remarkable impacts, including:
- 12 percent decrease in hospitalization
- 20 percent decrease in ED visits
- 21 percent decrease in ICU stays
- 26 percent decrease in hospital days
- 40 percent decrease in nursing home placement
The program has also demonstrated cost savings of $2,404 in Medicare costs per patient compared to other Medicare patients, an exemplar of quality and cost savings. JAHF is committed to the national dissemination of evidence-based comprehensive dementia care programs, like the ADC Program, to decrease preventable hospitalizations and support caregivers.
Spreading the word about effective programs
Establishing effective dementia care programs is only a part of the story toward advancing comprehensive dementia care and decreasing preventable hospitalizations. In 2017, RRF Foundation for Aging, Archstone Foundation and JAHF funded a collaboration with the Benjamin Rose Institute on Aging, Gerontological Society of America (GSA) and the Family Caregiver Alliance / National Center on Caregiving to create a tool to provide information and promote the scaling and dissemination of proven dementia care programs that also support friend and family caregivers.
The collaboration produced Best Programs for Caregiving, an online resource hub that helps family caregivers and healthcare providers identify, locate, and learn more about evidence-based dementia care programs like the ADC Program that are in their communities or accessible remotely. This free resource includes information that can help match programs to caregivers by language and culture. The website’s consumer and professional versions are helping more people access proven programs and services, improving caregiver stress, quality of life, and cost.
After years of groundwork by funders, national dementia care experts, and federal partners, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced the Guiding an Improved Dementia Experience (GUIDE) Model to test an alternative way to pay for comprehensive dementia care. The payment model is designed to improve the quality of life for dementia patients and their caregivers by addressing care coordination, behavioral health, and functional needs. CMS reports that nearly 400 health care organizations have been selected to participate. These organizations have or are developing dementia care programs to potentially serve hundreds of thousands of Medicare beneficiaries nationwide. The GUIDE Model's incentivized approach aligns payment with improved care management, coordination and caregiver support.
JAHF is excited about GUIDE and is in an exceptional position to promote the rapid dissemination of effective dementia care programs. With the announcement and initiation of the GUIDE Model, developers of six evidence-based comprehensive dementia care programs – Benjamin Rose Institute Care Consultation, Care Ecosystem, Eskenazi Healthy Aging Brain Center, Integrated Memory Care, Maximizing Independence at Home (MIND at Home), and the UCLA ADC Program – agreed to collaborate for rapid response. With JAHF support, they formed the National Dementia Care Collaborative to create a common platform for healthcare providers participating in GUIDE or seeking to improve their dementia care. These programs will work collectively and individually to provide training for staff of organizations adopting their programs, establish standards and tools for fidelity monitoring, and identify software platforms used for program delivery that can work with existing electronic health records.
Engage in age-friendly initiatives and advance Healthy People 2030 objectives
Efforts to disseminate evidence-based, comprehensive dementia care strongly align with Healthy People 2030 goals to decrease preventable hospitalizations of individuals living with dementia. By promoting the scaling and rapid dissemination of proven dementia care programs through the free online resource and national collaborative, all are aligned and contributing directly to this Healthy People 2030 objective.
JAHF is proud to champion Healthy People 2030 and we invite others to join us in spreading the word about comprehensive dementia care programs. You can explore the Healthy People 2030 objectives that align with your work, join our grant initiatives, use our resources and share with us what you are doing to reach the Healthy People 2030 goals.
Learn more and apply to become a Healthy People 2030 Champion
Register for the upcoming National Healthy Aging Symposium on September 26, 2024.
This article was originally published on LinkedIn by Senior Program Officer Jane Carmody, with co-author Sara Kunkel.