Dr. David B. Reuben has great news to report for dementia patients and their families.
“For the first time in Medicare’s history, it will be paying for support of caregivers!”
Reuben clarified, “This will not be 24/7 home care paid for; but there will be much more support to patients and those who surround them.”
“The federal government has invested a lot particularly through the National Institute of Aging,” he said. This means a lot of new research is not only underway, but is beginning to produce results. As a result, we can expect more advancements in dementia treatment options.
The good news was released this past summer. “In July 2023, CMMI (the Innovation Center of Medicare) announced that it’s going to be launching the GUIDE Model Program.”
The GUIDE Model (Guiding an Improved Dementia Experience) “aims to support people living with dementia and their unpaid caregivers.”*
What are the goals?
- Improve quality life for people living with dementia
- Reduce financial strain on their unpaid caregivers
- Allow people living with dementia to remain living in their homes
What will it include?
- A comprehensive package of care coordination and management
- Caregiver education and support
- Respite services
- Meals and transportation offered through community-based organizations
The model is set to run for a preliminary eight-year term. “Dementia affects more than 6.7 million Americans”* present day and the number is projected to double by 2060.
With the masses being affected by dementia, what does dementia treatment look like?
One of the biggest problems is that despite it being a widespread disease knowing no bounds, “many people with dementia do not consistently receive high-quality, coordinated care.”
A solution must be reached. Lessening the progression of the disease is the ultimate goal. While viable options continue to be sought for that solution, lessening the symptoms and improving the experience for each person living with dementia is important.
Quality care, comfort, and emotional and financial support being at the top of the list.
With over 30 years’ experience in geriatric care, Dr. Reuben explains the progress that has been made in treating and/or minimizing dementia.
Initially the options were limited, being “a class of medications called the cholinesterase inhibitors (e.g., Aricept, Exelon…). They were the first thing [doctors could offer] that helped slow down symptoms of the disease (not the progression of the disease).”
These medications “replaced a neuro-transmitter, a chemical and they provide a modest benefit for a period of time,” he said.
Most recently, anti-amyloid antibodies have been developed and some have been approved by the FDA. The “hope was for these to be disease-modifying by removing this toxic protein and perhaps slow down (if not stop) disease progression.”
Studies have been underway involving individuals who have either very early dementia or have mild cognitive impairment.
While the findings are controversial, since the studies do not include people with severe dementia, “The evidence suggests a 27% decrease in the slowing symptoms of the disease.” That is definitely encouraging although it is still unclear whether this amount of change would be noticeable to patients or caregivers.
Beyond the potential benefit of Alzheimer’s disease drugs is the critical role of “comprehensive dementia care.”
This approach recognizes first and foremost that dementia “is a journey, not only for the patient, but also for the family and the caregivers.”
The goal is to “make sure that they go through the journey as best as possible” and that’s having:
- A care coordinator (someone to navigate all aspects)
- That families receive emotional support
- Conversations are had about the goals of the dementia patient’s care
- Regular appointments to adjust medications (making sure that the patient is on the best ones suited for their individual journey)
Comprehensive dementia care makes sense. Whether you are supporting someone living with dementia or living with dementia yourself, comprehensive care is likely the most effective way to manage through the years of life with dementia, producing the best possible outcomes.
“These are great days for trying to make progress in dementia,” Reuben said.
Please share these positive developments in dementia care with friends and family who may benefit from it. Given the statistics, dementia is closer to home than you may realize. The support through Medicare could make all the difference in the life of person with dementia and their caregivers.
I’m so happy to learn about this positive news in Medicare!
Dr. David B. Reuben is Chief, Division of Geriatrics Medicine at UCLA. He is past president of the American Geriatrics Society, Chair of the Board of Directors of the American Board of Internal Medicine and is lead author of the book – Geriatrics at Your Fingertips as well as having published more than 220 peer-reviewed publications in medical journals, 39 books, and more.
*https://www.cms.gov/priorities/innovation/innovation-models/guide
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