The Alzheimer’s Association is committed to connecting clinicians to effective evidence-based models of care that can be easily replicated. One example is the UCLA Alzheimer’s and Dementia Care program, which significantly improved the experience for caregivers and people living with the disease.
UCLA Alzheimer’s and Dementia Care program
About the program
The Alzheimer’s Association has partnered with UCLA to replicate the UCLA Alzheimer’s and Dementia Care (ADC) program through a grant from the John A. Hartford Foundation. The program follows a co-management model within the UCLA health system and partners with community-based organizations (CBOs) to provide comprehensive, coordinated, individualized care for people living with Alzheimer’s disease and other dementias.
The goals of the program are to:
- Maximize function, independence and dignity for people living with dementia.
- Minimize caregiver strain and burnout.
- Reduce unnecessary costs through improved care.
To qualify for the program, participants must have a diagnosis of dementia and live outside of a nursing home. The mean age of the first program participants was 82 years old. Almost all of the caregivers were the children (59%) or spouses (41%) of individuals living with Alzheimer’s or other dementias.
The ADC program utilizes a co-management model in which a nurse practitioner Dementia Care Specialist (DCS) partners with the participant’s primary care doctor to develop and implement a personalized care plan. The DCS provides support via four key components:
- Conducting in-person needs assessments of individuals living with Alzheimer’s and their caregivers.
- Creating and implementing individualized dementia care plans.
- Monitoring and revising care plans, as needed.
- Providing access 24/7, 365 days a year for assistance and advice to help avoid Emergency Department (ED) visits and hospitalizations.
The ADC program also connects caregivers with resources provided by CBOs, including:
- Adult day care.
- Case management.
- Legal and financial advice.
- Workforce development focused on training families and caregivers.
At one year, the quality of care provided by the program as measured by nationally accepted quality measures for dementia was exceedingly high — 92% compared to a benchmark of 38%. As a result, the improvements experienced by both caregivers and patients were significant:
- Ninety-four percent of caregivers felt that their role was supported.
- Ninety-two percent would recommend the program to others.
- Confidence in handling problems and complications of Alzheimer’s and other dementias improved by 79%.
- Caregiver distress related to behavioral symptoms, depression scores and strain improved by 31%, 24% and 15%, respectively.
- Despite disease progression, behavioral symptoms like agitation, irritability, apathy and nighttime behaviors in people living with dementia improved by 22%.
- Depressive symptoms experienced by individuals living with the disease were reduced by 34%.
Cost benefits of the program
An external evaluator compared utilization and cost outcomes and determined that over the course of 3 1/2 years, participants in UCLA’s program had lower total Medicare costs of care ($2,404 per year) relative to those receiving usual care.
In addition to cost savings for individuals and their families, the ADC program reports several financial benefits for health systems, including:
- Hospitalizations: 12% reduction
- ED visits: 20% reduction
- ICU stays: 21% reduction
- Hospital days: 26% reduction
- Hospice in last six months: 60% increase
- Nursing home placement: 40% reduction
UCLA finds that a care program following the ADC model may be able to pay for itself depending on local labor costs, comprehensiveness of billing and local overhead applied to clinical revenue.
To learn more or to contact UCLA about training and replication of the program, visit the UCLA Alzheimer’s and Dementia Care Program website.