Improving Dementia Long Term Care

In 2010, 15 percent of Americans older than age 70 had dementia. By 2050, the number of new dementia cases among those 65 and older is expected to double. This blueprint outlines policy options to help decisionmakers improve dementia long-term services and supports (LTSS) by promoting earlier detection, improving access to LTSS, promoting person- and caregiver-centered care, supporting caregivers, and reducing dementia LTSS costs.

As the largest generation in U.S. history - the population born in the two decades immediately following World War II - enters the age of risk for cognitive impairment, growing numbers of people will experience dementia (including Alzheimer's disease and related dementias). By one estimate, nearly 14 million people in the United States will be living with dementia by 2060. Like other hardships, the experience of living with dementia can bring unexpected moments of intimacy, growth, and compassion, but these diseases also affect people's capacity to work and carry out other activities and alter their relationships with loved ones, friends, and coworkers. Those who live with and care for individuals experiencing these diseases face challenges that include physical and emotional stress, difficult changes and losses in their relationships with life partners, loss of income, and interrupted connections to other activities and friends. From a societal perspective, these diseases place substantial demands on communities and on the institutions and government entities that support people living with dementia and their families, including the health care system, the providers of direct care, and others. Nevertheless, research in the social and behavioral sciences points to possibilities for preventing or slowing the development of dementia and for substantially reducing its social and economic impacts. At the request of the National Institute on Aging of the U.S. Department of Health and Human Services, Reducing the Impact of Dementia in America assesses the contributions of research in the social and behavioral sciences and identifies a research agenda for the coming decade. This report offers a blueprint for the next decade of behavioral and social science research to reduce the negative impact of dementia for America's diverse population. Reducing the Impact of Dementia in America calls for research that addresses the causes and solutions for disparities in both developing dementia and receiving adequate treatment and support. It calls for research that sets goals meaningful not just for scientists but for people living with dementia and those who support them as well. By 2030, an estimated 8.5 million Americans will have Alzheimer's disease and many more will have other forms of dementia. Through identifying priorities social and behavioral science research and recommending ways in which they can be pursued in a coordinated fashion, Reducing the Impact of Dementia in America will help produce research that improves the lives of all those affected by dementia.

As baby boomers age, many will require long-term services and supports (LTSS) for dementia care. This blueprint outlines policy options and research directions to help decisionmakers improve the LTSS delivery system, workforce, and financing.

Previous research indicates that nonpharmacological interventions are potentially successful in managing dementia-related behavior in long-term care facilities, provided staff have the proper training to deliver these programs. However, efforts to train direct care workers in optimal dementia care must overcome multiple barriers, such as the time and cost constraints in long-term care facilities and limitations in how direct care workers can receive such training. Online training programs may offer a solution, but many current online training programs deliver content in an unengaging format. Trainees might remember key information long enough to pass a follow-up knowledge test but are highly unlikely to retain valuable information that could permanently improve care practices. Recognizing the need for a more relevant, engaging training program that could actually improve care for persons with memory loss or dementia in long-term care facilities, the CARES® Dementia-Related Behavior program was designed. Using a novel approach that integrates narrated text with video footage of real, unscripted patients and direct care workers as well as insight from experts in the field of geriatrics, the CARES Dementia-Related Behavior program received excellent reviews from users and shows promise as a means of improving care interactions. This case describes the development of the CARES® Dementia-Related Behavior program; highlights key challenges addressed during the development process; describes the filming of real, unscripted patient interactions; and explores the methods used to evaluate the program in a pilot study.

Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.

This book explores key factors long-term care recipients have identified as impacting their quality of life and offers programmatic and policy recommendations to enhance well-being within long-term care communities. Leadership and staff who work in nursing homes and other residential care communities serve as gatekeepers to resident well-being, often without recognizing how residents’ quality of life is impacted by their decision-making. This book takes a life domain approach to build on research-based studies that document key drivers of care recipients’ quality of life, including relationships, autonomy and respect, activities and meals, environment, and care. Using a framework that enhances understanding of resident quality of life, it outlines practical, programmatic, and policy suggestions for long-term care stakeholders, such as administrators, managers, front-line staff, family members, and policy-makers, whose directives and actions impact the lived experience of long-term care residents. As such, this book serves as a roadmap for leaders and managers of long-term care communities, along with policymakers who regulate health and human services, to best structure care environments to maximize quality of life and well-being for long-term care recipients.