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A bipartisan bill requiring the use of cognitive impairment detection tools in the early detection of Alzheimer’s disease and related dementias has the support of the senior living industry.

The Concentrating on High-Value Alzheimer’s Needs to Get to an End Act, or CHANGE Act, (S 2379 / HR 4752) would direct the Centers for Medicare & Medicaid Services to require the use of cognitive impairment detection tools approved by the National Institute on Aging during initial “Welcome to Medicare” exams and Medicare annual wellness visits. The tools are used to screen, detect and diagnose Alzheimer’s and related dementias in their earliest stages. Further, the tool used would have to be documented in the patient’s medical record.

Argentum, LeadingAge, Brookdale Senior Living,  AMDA–The Society for Post-Acute and Long-Term Care Medicine, the Alzheimer’s Association and the Michael J. Fox Foundation for Parkinson’s Research joined with more than 190 organizations and researchers through Leaders Engaged on Alzheimer’s Disease calling on lawmakers to support the bill, which they said would improve care for individuals and families facing Alzheimer’s disease. 

The plea comes as Medicare prepares to launch its nationwide comprehensive dementia care model, the Guiding an Improved Dementia Experience Model, through which a package of care coordination and management, caregiver education and support, and respite services will be offered. Assisted living residents who are Medicare beneficiaries may be part of the model, but nursing home residents cannot be included, because “the goal is to keep beneficiaries living in their homes and communities for as long as appropriate or desired,” a CMS spokesperson previously told McKnight’s Senior Living.

An estimated 6.7 million Americans are living with Alzheimers’ disease, and that number is expected to increase to almost 13.8 million by 2060, according to the 2023 Alzheimer’s Disease Facts and Figures report from the Alzheimer’s Association. Approximately one in nine older adults have Alzheimer’s, costing the nation $345 billion this year, an annual cost expected to rise to $1 trillion by 2050.

“Alzheimer’s exacts an emotional and physical toll on caregivers, resulting in higher incidence of heart disease, cancer, depression and other health consequences,” said bill sponsor Sen. Shelley Moore Capito (R-WV) in a summary of the bill. “These numbers begin to tell the story of why — medically, economically and socially — Alzheimer’s is the biggest healthcare crisis currently facing Americans, and why we cannot wait to take action.”

Early diagnosis enables early access to care planning services and available medical and non-medical treatments, and it improves an individual’s ability to build a care team, participate in support services and enroll in clinical trials, Capito said. 

CMS encourages, but does not require, providers to use a validated structured cognitive assessment tool, leading many providers to use direct observation to assess someone’s cognitive health, according to the bill’s backers. LEAD called direct observation the “least useful and least appropriate tool” in diagnosing dementia, saying that it contributes to underdiagnosis, delayed diagnosis, misdiagnosis and non-disclosure of diagnosis because a provider does not need to document it in an individual’s medical record.

“We know of no authoritative source or evidence-based rationale supporting use of direct observation as a means of adequately detecting early cognitive impairment,” the LEAD letter reads. “Such failure carries extraordinary potential to harm any patient and to deepen existing health disparities for women, people of color, rural populations, economically disadvantaged people, and adults with pre-existing cognitive conditions.” 

The coalition pointed to studies showing that among adults aged 70 or more years seen in primary care settings, cognitive impairment goes unrecognized in more than 50% of cases. Underuse of validated assessment tools, the group said, delays detection and diagnosis, resulting in decreased opportunities to access treatment options, including clinical trials.

“When people receive a timely and accurate diagnosis, they have improved opportunities to make informed and productive medical, financial, legal and spiritual choices to strengthen both their own quality of life and that of their family caregivers,” the letter reads.