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Despite progress in risk reduction, testing and treatment, the costs of dementia care in the United States continue to rise alongside dementia prevalence, putting the onus on healthcare providers and other stakeholders to increase access to high-quality dementia care services.
That’s according to a new report from the Milken Institute, released Tuesday. The authors of Projected Prevalence and Cost of Dementia: 2022 Update estimated that Alzheimer’s disease and related dementia treatment expenditures will triple to $45 billion by 2040 and more than double from there, to $102 billion by 2060.
The $45 billion number is specifically due to the increased treatment prevalence and related costs, which have risen by 31% since 2012 to $2.43 million (based on 2015 to 2019 data).
Meanwhile, an estimated 62% to 78% of dementia cases may be undiagnosed or not reported, suggesting continued issues with detection, diagnosis, treatment and communicating a dementia diagnosis, Milken’s analysts reported.
Cost burdens
Care for adults aged 75 years and older accounts for most of the treatment and medical expenditures, the authors reported. And the high likelihood of having comorbidities after age 65 also is a factor in the ballooning costs.
Estimated 2022 expenditures for all treatments for people living with ADRD is $34 billion, they found. That’s almost three times the direct spending on ADRD-only treatment ($12.8 billion).
In addition, three health service categories account for 75% of this spending: inpatient care (26%), home health (29%) and prescription drugs (20%).
Care gaps
When it comes to the burden of care costs, the authors also found a widening gender gap. Women account for 20% more ADRD cases than men. And dementia care costs associated with women are 44% higher than those for men due to longevity and social factors. It is more likely that women will leave work to provide unpaid care for others, for example. But by the time they need care themselves, they often are left to rely on Medicaid.
Meanwhile, medical expenditures have increased by 37% for all treatments associated with men who have ADRDs, compared with only 3% for women over the same period.
Racial and ethnic disparities also were highlighted in the report. Dementia is more prevalent in Black and Hispanic individuals, who also are less likely to report receiving treatment when compared with whites.
Goals for assisted living, memory care
The findings provide evidence that many issues continue to require urgent attention, Diane Ty, director of the Milken Institute’s Center for the Future of Aging, told McKnight’s Senior Living. To help make an impact, assisted living and memory care providers should focus on the evidence-based ways to improve brain health and reduce dementia risk, she said.
This includes prioritizing regular physical activity, providing nutrition-packed meals and managing high blood pressure and other co-occurring conditions such as urinary tract infections. Testing and correcting hearing loss and providing mental health support for depression are also of key importance, she said.
Another way long-term care stakeholders can help reduce the dementia burden is by supporting family caregivers through dementia education and referrals to community support, Ty noted.
The Milken Institute also advises supporting the comprehensive tech-enabled care models of memory care in H.R. 596, which has been introduced in Congress and would provide funding to increase access to telehealth services and virtual visits, she added.
Reforms needed
More broadly, the Milken Institute supports systemic reforms, with improved financing and delivery of long-term care to middle-class households, Ty said. It recommends:
- Increasing Medicare coverage of long-term care for targeted enrollees, including expansion of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act and the delivery of new benefits under the Value-Based Insurance Design (VBID) program;
- Paid family and medical leave for family caregivers so that caring for a loved one with dementia does not compound the gender gaps in financial security;
- Retirement system reforms to cope with rising costs in an aging population with comorbidities;
- Expanding workers’ ability to save for retirement through state-facilitated Automatic IRA (Auto-IRA) programs; and
- Supporting the passage of the Social Security Caregiver Credit Act of 2019, which credits certain unpaid caregivers of family dependents who provide at least 80 hours of care per month up to five years of deemed wages.
