The health care and senior living industries must make structural changes in care delivery to accommodate the growing number of older adults living with dementia.
That’s according to Dr. Nate Chin, UW Health Medical Director of the Wisconsin Alzheimer’s Disease Research Center. In an article recently published in the New England Journal of Medicine, Chin covered various ways that the healthcare ecosystem must change, including improved training for primary care physicians in diagnosing and assessing cognitive decline and dementia, along with pursuing new payment models to create a “dementia-capable” American healthcare system.
Chin, who is a geriatrician, told Memory Care Business that primary care physicians need more time with patients to achieve more accurate diagnoses of cognitive decline. He emphasized the need for improved training for care staff and more layered care coordination among physicians, nurse practitioners and social workers to achieve better health outcomes.
With primary care physicians limited in time to spend with patients, Chin stresses the importance of providing resources that allow for more time with patients. For example, Chin spends up to three to four hours with patients to conduct cognitive assessments in collaboration with multiple specialists; whereas the average primary care visit lasts 18 minutes, according to the National Institutes of Health (NIH).
“We would like for them to have more availability so they could see those people every two to three weeks for four sessions so they can actually get to the underlying problem,” Chin told MCB. “It just takes time.”
As new biomarker tests for diagnosing various forms of dementia emerge and assessments are introduced and improved, alternative payment methods are needed to connect healthcare providers and senior living operators with greater resources for earlier treatment, Chin said. This could be achieved through what Chin terms a new “collaborative care approach” between primary care physicians, social workers and trained clinicians in providing dementia care.
The Guiding an Improved Dementia Experience (GUIDE) model, announced last year, aims to help those with dementia stay in their homes for a longer period by offering training for in-home caregivers and comprehensive support. The model will also test a new form of payment for participating providers to coordinate care for patients. Many senior living operators are preparing for the rollout of the GUIDE model, as evidenced by recent informational sessions to familiarize organizations with the impending changes.
Chin believes that with the care navigation tools provided by the GUIDE model, diagnosis and care delivery could happen more quickly, preventing patients from remaining within the healthcare system longer and potentially lowering care costs and emergency department visits.
“I think [GUIDE] will be incredibly helpful for both healthcare because they will have faster and more efficient and effective care but also for the families because they will have someone helping them through the care process in a better way,” Chin said.
He emphasized that increased collaboration between primary care and senior living providers’ care departments could improve resident care, simply by providing greater detail around incidents that cause a resident to visit the emergency department or seek medical treatment.
Chin pointed out that a lack of biometric health or necessary social contextual data leading a resident to visit a hospital could prevent necessary care planning. In recent years, senior living operators have heavily invested in data and technology systems to support operations, from care to sales and marketing.
“By using available tools and leveraging technology, care providers in senior living environments can perform their jobs better and more easily,” Chin said. “But this has to be paid for, and an alternative payment model would allow for that opportunity.”
Some senior living operators are being proactive in seeking ways to align performance with positive care outcomes and the key elements of value-based care, something that has become a competitive focus within the industry in recent years, amounting to an “arms race” in value-based care adoption in senior living.
One of the most immediate impacts healthcare providers can make is by providing continuing education training to existing staff or by onboarding extensive training modules to create specialized experts related to dementia and cognitive decline.
Looking ahead, Chin remains optimistic despite the challenges of making changes in the current healthcare landscape. He believes organizations are shifting towards a collaborative care approach.
“We are starting to see the change,” Chin said. “It feels slow, but we are moving in the right direction, and it’s a matter of pushing on that momentum and doing more.”
