Georgia is anticipating a sizable increase in people living with Alzheimer’s by 2025, in part, due to the state’s growing appeal as a retirement destination.
Alarm bells have been sounding for the past few years, nationally, as well as at the state level, where a panel of experts has been working from several angles.
Will Georgia have the funding, facilities and professional caregivers needed to handle a projected spike in people living with Alzheimer’s from the current 140,000 to 190,000 by 2025?
That's a major concern, given that Alzheimer's is ranked as the most costly of all diseases because of the intense level of care required, the frequency of patient hospitalizations and its end-of-life expenses.
Ginny Helms, vice president of chapter services and public policy for the Alzheimer’s Association’s Georgia chapter, said costs to the Medicaid program alone for treatment of people living with Alzheimer’s are expected to jump from $1.038 billion in 2015 to $1.544 billion in 2025 in Georgia.
That’s one reason, Helms said, the association is advocating that Congress increase funding for Alzheimer’s research. “Finding a prevention or effective medical interventions will save lives and protect our economy,” she said.
Toni P. Miles, a professor of epidemiology and biostatistics at the University of Georgia's College of Public Health, says Georgia is not ready from a workforce perspective for the forecasted uptick in people living with Alzheimer's.
“We definitely have a shortage in every aspect of health care you can think of,” said Miles, a member of the state Alzheimer’s panel. “We have a shortage of providers at the physician level. We have a shortage of nurses, which is probably even more acute. We have a shortage of facilities that can handle folks with dementia.”
Georgia currently has about 581 personal care homes and 223 skilled nursing facilities that offer some type of dementia-specific care, said Victoria Helmly, coordinator of the Alzheimer’s and Related Dementias State Plan at the Georgia Department of Human Resources’ Division of Aging Services.
With a 35.7 percent increase in people living with Alzheimer’s forecast by 2025, the state likely will have a similar demand for more facilities to care for these people, Helms said.
Doing the math, Georgia could need 203 more personal care homes and 78 more nursing homes to accommodate the additional people forecast to be living with Alzheimer’s.
Forecasts could change if current trends change. For example, currently about 60 percent of adults with dementia live in the community, not in a skilled nursing facility or other type of long-term care facilities, according to statistics cited by Helmly.
Many of these people are receiving help from unpaid family members or friends. They also may be receiving home and community-based services from paid providers, including meals and help with personal care, such as bathing and dressing, Helmly said.
Georgia was an earlier adopter of a state Alzheimer’s plan and followed a national model developed in 2012, said James J. Bulot, former director of the state Office of Aging and current associate director of Government Health Solutions.
The Georgia Alzheimers and Related Dementias State Plan (GARD), developed by a task force Bulot chaired, puts a major emphasis on developing and using data on how many Georgians have Alzheimer’s, where they live, what state resources they use and how the state can better target outreach.
It also was the springboard for the development of a state Alzheimer’s registry that includes reports of new cases from physicians and private individuals. Another major component of the registry is data sharing with other state and federal agencies providing resources to people living with Alzheimer’s, such as Medicare and Medicaid, Bulot said.
Based on data from the registry, the state was able to glean, for instance, that, in 2013, 20,000 people died of Alzheimer’s or complications from the disease and 112,000 Georgians were newly diagnosed with the disease, he said.
Bulot said the data affirmed that Georgia mirrors the national trends, with Alzheimer’s affecting 6.4 percent of its 65-plus population. It also showed that Georgians live about 33 months after being diagnosed with the disease, he said.
“It’s moving us in the right direction to tackle this from several directions,” Bulot said.
Better training for caregivers emerged as another major priority. As a result, the state obtained a three-year, $3 million grant to present the Virtual DementiaTour © to nursing home employees across the state, Bulot said.
The VDT was developed in Georgia and is now an international program, he said.
“This was one of the first new innovative
projects in longterm care in the country,” Bulot said.
The VDT program, offered by Second Wind Dreams, is being replicated in other parts of the country as a result of the work here, he said.
The Georgia Bureau of Investigation now mandates training for all agents on recognizing the signs of Alzheimer’s and dementia in people they encounter, Bulot said. Law enforcement across the state also now has 24-hour access to help in placing individuals living with Alzheimer’s who they encounter, he said.
“There are a lot of areas that Georgia needs to improve,” Bulot said. “But in the area of protecting vulnerable populations, we do a really good job and lead the nation in a lot of ways.”
But other issues remain.
For instance, one of the biggest concerns is protecting Medicaid so that funding will be available to pay for individuals with Alzheimer’s who have depleted their personal savings and have to depend on Medicaid to cover expenses that their Social Security and pension checks cannot, said the Alzheimer’s Associations’ Helms.
“In Georgia, Medicaid pays for care in a personal care home and nursing home for those who qualify for Medicaid,” she said. “Assisted living homes are private pay, and about 70 percent of nursing home beds are paid for by Medicaid.”
The proposals that have been before Congress to overhaul the Affordable Care Act include significant reductions in Medicaid, Helms said.
“So while we are planning on serving the additional persons who will have Alzheimer’s in the future, we need to be planning on how to pay for the care,” she said. “We need for individuals to consider long-term care insurance, and we really need to fortify Medicaid.”
She said the family caregiver also needs to be fortified. In 2016, they provided more than $7.48 billion in care to Georgians living with Alzheimer’s, Helms said. ‘