Investing in care navigation — and care navigators — will help individuals living with Alzheimer’s disease and related dementias and their caregivers overcome barriers, according to a new report from the Milken Institute.
The Milken Institute Center for the Future of Aging released the report, “Guiding the Care Journey: Building Dementia Workforce and System Capacity through Care Navigation,” to provide a framework for health systems, community-based organizations and Medicare payers to implement care navigation services, as well as provide recommendations on improving dementia care navigation across care settings.
According to the Milken Institute, the number of people living with Alzheimer’s disease and related dementias is expected to almost double to approximately 13 million by 2040. This increase will exacerbate current gaps in care and capacity constraints in the dementia care workforce. Milken experts said that implementing care navigation can help overcome those barriers by linking healthcare and social care services with individuals living with dementia and their caregivers.
Milken Institute defines care navigation as individualized assistance to overcome healthcare system barriers and provide timely access to care throughout the dementia care experience. Care navigators, the authors argue, play a “crucial role” by providing ongoing disease education, care guidance, counseling, behavioral symptom management and referrals to community-based supports.
The approach, the report states, has shown to reduce emergency department visits, hospital readmissions, behavioral symptoms, family caregiver depression and unmet needs. Despite its success, care navigation remains underused in dementia care due to a lack of workforce training and inadequate payment systems, according to the report.
The result is that families are left to their own devices to “work through a fragmented maze” of medical and nonmedical services and supports, the authors state.
“The uncertainty and lack of guidance add to a situation that is already emotionally fraught and financially challenging,” Diane Ty, senior director of the Milken Institute Center for the Future of Aging and one of the report authors, told McKnight’s Senior Living.
“Elevating the role of care navigators on interprofessional dementia care teams can help facilitate coordination and access to needed services, support caregivers managing the complex web of the healthcare and long-term care systems, and improve the quality of life for individuals with ADRD,” the report concluded.
Game-changing training in senior living
For senior living operators, ensuring that their employees have dementia care training can be “game changing,” particularly in assisted living communities, where there is a high prevalence of chronic conditions, including ADRD, Ty said.
Interprofessional care teams — of which dementia care navigators can be a part — can include senior living personnel from management to direct care workers, she said.
“The trust and day-to-day access by staff in senior living communities can provide important frontline observations and insights into changing care needs of residents and their family caregivers,” Ty said. “Dementia care navigators help manage across settings of care — including senior living — and include those holding professional licensure or paraprofessionals trained in dementia care.”
Effective care navigators, she said, can bridge the gap between residents, clinical staff members and families by identifying personalized care needs and goals to overcome barriers to overall wellness.
Among the key takeaways from the report that senior living providers can put into practice right now, Ty said, include adding a dementia care navigator to the staff, or at least ensuring that employees receive dementia care training; facilitating discussions on dementia care with residents’ family members; and partnering with navigation hubs, local navigational centers that connect older adults seeking long-term services and supports with resources within the local community.
Payment models must evolve
Broader report recommendations include improving provider training for ADRD and expanding the dementia-capable workforce; elevating the role of care navigators on interprofessional dementia care teams; leveraging digital and artificial intelligence-powered tools to automate certain navigation tasks; and improving payment models in the traditional Medicare program and in Medicare Advantage.
Given the increasing number of older adults who are living with dementia and enrolled in Medicare Advantage plans, the authors recommend that plans increase access to care navigation services via special needs plans — including institutional SNPs that cater to assisted living communities and nursing facilities — to benefit older adults with ADRD and their caregivers. To accomplish this goal, their recommendation is that SNP models of care expand their care coordination component to tailor care navigation services to members.
