Estimating the costs of caring for people with Alzheimer disease in California: 2000-2040.

The costs of caring for people with Alzheimer disease (AD) in California are estimated using data from a study of the costs of caring for community-resident and institutionalized people with AD, combined will prevalence and population projections. Costs for community-resident patients will increase 83 percent in the period 2000 ($23.4 billion) to 2020 ($42.8 billion), and will grow an additional 59 percent from 2020 to 2040 ($68.1 billion). Costs for AD patients in institutions will increase 84 percent from 2000 ($2.5 billion) to 2020 ($4.6 billion), and will grow an additional 61 percent from 2020 to 2040 ($7.4 billion), assuming the supply of nursing home beds meets projected demand. Total costs of caring for AD patients will nearly triple between 2000 and 2040. The rapid aging of the U.S. population makes more aggressive societal action necessary if the personal and societal burden of Alzheimer's disease is to be reduced in the future.

Lessons learned from the Medicare Alzheimer Disease Demonstration.

The Medicare Alzheimer Disease Demonstration tested a case management and community care benefit for persons with dementia. The demonstration produced statistically but not clinically significant reductions in caregiver burden and depression. It increased access to community-based long-term care services but did not affect the level of services used. It did not reduce informal caregiver hours spent helping people with dementia. It produced statistically significant but not budget-neutral reductions in Medicare expenditures in that the degree of reduction in regular Medicare expenditures was not enough to offset the added demonstration costs. It did not reduce rates of nursing home placement. Informal care networks providing care to demented enrollees were generally able to function effectively, regardless of whether a professional case manager was involved or whether a long-term care benefit was available.

Population aging and the need for long term care: a comparison of the United States and the People's Republic of China.

Both developing and major developed countries of the world are facing the global aging of their citizenry. The United States and the People's Republic of China each share in this phenomenon. The rapid growth of their aging populations comes as both countries are experiencing a sustained period of economic stability with an accompanying drop in fertility rates (Coale & Watkins 1986; Dyson & Murphy 1985). Together with longer expected life spans in both countries, these factors have caused a shift in the population structure which will result in increasingly large portions of the population who will potentially require assistance with ADL's and/or long term care (Olson 1990; Kennedy, LaPlante & Kaye 1997). The careful assessment and interpretation of available data to define the actual extent of need should be part of a process to help guide each country as they prepare for the future.

Case manager-defined roles in the Medicare Alzheimer's Disease Demonstration: relationship to client and caregiver outcomes.

This study explores the different approaches to case management within, the Medicare Alzheimer's Disease Demonstration. Eight sites from around the country were selected to participate in a survey of case managers (N = 57) that evaluated their professional background and experience and how certain tasks, functions, and goals of case management were prioritized at each site. Client and caregiver outcomes were collected on a site-by-site basis as part of the demonstration. The hypothesis was that the way in which case managers performed their work would vary by site. Furthermore it was hypothesized that these differences would be measurable and correlated with project outcomes. Case managers differed significantly by site in how they prioritized tasks, functions, and goals, viewing themselves along a continuum from a clinical approach to one that emphasizes service management. These differences in case management style are reflected in between-site differences in certain client and caregiver outcomes but not others. Specifically, variations in case management style are not related to client cognitive or functional status but to other outcomes including behavioral management, caregiver burden, and service use.

Case management styles for people with AD: do the differences make a difference?

This two-part study examined the effectiveness of differing approaches to case management as implemented at eight Medicare Alzheimer's Disease Demonstration project sites. Researchers followed case managers as they implemented their core (or central) tasks. Results from interviews with case managers (n = 57) were used to construct a site-based typology of case management. An analysis of 922 chart summaries was then conducted. Factor analysis was used to construct six statistically distinct "types" of case management. These factors were then used to predict community-based service use, healthcare utilization, and caregiver outcomes. Analysis indicated that styles of case management do make a difference in service use and caregiver outcome but have less effect on health care utilization outcomes.

Case management, client risk factors and service use.

Six "pure" types of case-manager activity are identified using chart data from 922 cases in the Medicare Alzheimer's Disease Demonstration. The association between case-manager actions and client characteristics, and between case-manager activities and service use outcomes is used to test predictive validity. Case-manager activity is generally more associated with caregiver than client characteristics. Monitoring and service management was protective against nursing home placement. A clinical nursing emphasis was protective against hospitalization. Understanding how case management is differentiated may improve staffing, treatment protocol, and client service outcomes.