FCRP Policy Statement

• What services are needed to care for dementia patients at home, what are the characteristics of caregivers who will use them, and will additional services delay the institutionalization of the dementia victim? Currently 4 million Americans suffer from Alzheimer's disease or related disorders. The Number of persons with dementia is expected to reach 7 million by the year 2040. Skyrocketing health care costs and the growing population of persons 65 years of age and older have resulted in major challenges to the health care system. One challenge is to provide health care that protects the dementia victims right to self-determination and quality of life, such as they may receive in their own home from a family member.
• Family members are the primary caregivers of persons with dementia, a condition that may require care for many years. While not all dementia caregivers chose to use community services, many who might use such services to maintain their relative at home encounter barriers to use. Recent Congressional reports acknowledge the inadequacies of our long term health care system to meet the needs of persons with dementia and their families. A critical issue is how to provide available and affordable community services, such as in-home companions and adult day care, to those family caregivers who are likely to use them to delay nursing home placement.
• A study of 98 caregivers, conducted at Michigan State University, looked at the use and importance of community-services for the care of Alzheimer's victims in the three months prior to institutionalization. Caregivers were also asked if factors related to community service use affected the decision to institutionalize their relative.

FINDINGS

In thirty to forty percent of the cases caregivers reported that community service factors such as availability, cost & eligibility significantly influenced their decision to place a relative in a nursing home. Family caregivers who are employed outside of the home are more likely to report the need for additional community services in the pre-institutional period and those who have cared for their relative for longer periods of time report greater difficulty obtaining services before nursing home placement. Additional services needed before institutionalization, reported by 20% of the sample, were daytime home companions, night companions, adult day care and temporary overnight care.

POLICY IMPLICATIONS

1. Develop programs to identify caregivers who can benefit from community services, before they reach the point of seeing nursing home placement as their only alternative.
2. Increase provision of day and night in-home companion services, adult day care, and temporary overnight care at affordable cost.
3. Improve methods of informing family caregivers of available services and how to access them.
4. Expand case management service for persons with dementia and their families throughout the disease course
5. Conduct research to further defin6 cost-effective methods of providing community services.

This research supported by grant fR01 HH41766. "Impact of Alzheimer's Disease on Family Caregivers". Correspondence should be addressed to Dr. Clare Collins or Dr. Sharon King, A.230 Life Sciences Building, College of Nursing. Michigan State University. East Lansing. HI 48824-1313.