Delaying Nursing Home Placement

Improving caregiver well-being and prescription drug compliance may delay nursing home admission from several months to over eighteen months, resulting is a potential savings of billions of dollars annually in the United States.

Starting medication for dementia, primarily Alzheimer's Disease, is critical for delaying nursing home placement. According to as study by Marion Becker and Ross Andel of the University of Florida School of Aging Studies and the Florida Alzheimer's Disease Research Center..."up to 10% percent of older adults over 65 account for up to 70% of the nursing home population." Their study, published in the journal Alzheimer Disease and Associated Disorders, suggests that treatment with ChE-Is can delay nursing home placement by approximately three months. Known by trade names as Aricept, Exelon, and Razadyne, ChE-Is increase levels of acetylcholine, a chemical involved in mental processing. Becker and Ross examined records from the Florida Medicaid program and followed two groups of patients over age 60 with dementia; those not taking or taking ChE-IS and their nursing home placement. The study found that ..."those taking ChE-Is were place in nursing homes more than three months later than those not taking the drug" according to Becker. While ChE-Is are expensive drugs, the cost can be offset by the financial benefits resulting from delaying nursing home placement.

Becker, M., Ross, A., Rohrer, L., & Banks, S. (2006). The effect of cholinesterase inhibitors on risk of nursing home placement among medicaid beneficiaries with dementia. Alzheimer Disease & Associated Disorders, 20(3), pp. 147- pp. 152.

Another recent study from the October 11, 2011 journal, Psychiatrist, found similar results for delaying nursing home placement. Physicians Emid Salid and co-author Jessica Thompson from Peasley Cross Hospital in St. Helens, United Kingdom, compared 219 older woman and 120 older men, all who had been diagnosed with various forms of dementia, the majority [56%] with probable Alzheimer's Disease. Comparing the participants who took cholinestrase inhibitors with those who did not, nursing home placement was delayed a median of 12 months. According to Dr. Salib,... "treating patients who exhibit early signs of dementia with cholinestrease inhibitors has immense implications."

Salib, E. & Thompson, J. (2011). Use of anti-dementia drugs and delayed care home placement: An observational study. The Psychiatrist Online,35, pp 384-pp 388.

Providing support to caregivers was shown to delay nursing home placement, according to a study lead researcher Mary S. Mittelman, DrPH from the New York University School of Medicine. The loss of a caregiver is the most common reason for initiating nursing home placement. Believing that providing support services for caregivers could delay nursing home placement, they studied 406 spousal caregivers at the Alzheimer's Disease Center over 18 months. One group had six sessions of individual and family counseling, support group participation, and as-needed telephone counseling. The found a 28% reduction in the rate of nursing home placement among those receiving support. The median delay for placement was 557 days or approximately 1.5 years. According to Mittelman, caregivers in the treatment group were not only able to keep their spouses at home longer but had a greater tolerance for patient behavioral problems and fewer symptoms of depression. With the average cost of nursing home care at $60k annually, the 18 month delay represents about $90k in savings per patient. That savings has enormous implications on reducing healthcare costs in the United States, especially with the aging of the baby boomer population.

Mittelman, M. (2006). Improving caregiver well-being delays nursing home placement of AD patients. Neurology, 67, pp. 1592- pp. 1599.


A similar study:

Brodaty, H., Mittelman, M., Gibson, L., Seeher, K., & Burns, A. (2009). The effects of counseling spouse caregivers of people with Alzheimer's disease taking donepezil and country of residence on rates of admission to nursing homes and mortality. American Journal of Geriatric Psychiatry, 17(9), pp. 734 - pp. 743.