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The sixth leading cause of death in the United States, Alzheimer’s disease afflicts approximately 5.2 million persons age 65 and over (Alzheimer's Association, 2012). Rapid growth of the older population as the Baby Boomer generation ages will cause unprecedented increases in the number of individuals with Alzheimer’s. It is estimated that by 2025 the number of Wisconsin residents with Alzheimer’s age 65 and older will increase by 30% to a projected total of 127,000 (Alzheimer's Association, 2012).
Informal supports, such as aid for housekeeping and running errands, are crucial to maintaining the lifestyle of individuals with Alzheimer’s in the community; however, the disease’s erosion of physical, cognitive, and communicative abilities often creates tremendous strain for family caregivers. Individuals and family caregivers dealing with Alzheimer’s often experience increasing social isolation as the disease’s progression undermines both mobility and the capacity for meaningful and appropriate engagement with the community (Banerjee et al., 2003). A number of studies have documented the physical and mental health costs borne by unsupported caregivers, and the link between caregiver stress and the institutionalization of their ill family members (Andren & Elmstahl, 2005; Banerjee et al., 2003). Taken together, the stress and isolation of dealing with Alzheimer’s disease undermine the health and quality of life of everyone involved, eventually precipitating institutionalization.
Alzheimer’s disease affects populations in both cities and rural areas. Although only 19% of older adults live in rural areas, up to one-third of rural populations are comprised of older adults (Sun, Kosberg, Kaufman, & Leeper, 2010). In addition to limited access to and suspicion of healthcare and social services for older adults and their caregivers, social isolation plays a great role in rural areas, where opportunities for engagement and interaction may be unavailable or inaccessible (Sun et al., 2010). Healthcare workforce shortages, while present far and wide, are intensified in rural areas and can severely limit a family’s choices when caregivers struggle to meet the needs of individuals with Alzheimer’s (Sun et al., 2010). Research suggests a high level of depression in both persons with dementia and spousal caregivers in rural populations (Haley et al., 2008). Research also suggests the loss of language capacity among individuals with Alzheimer’s limits the individual’s independence.
Furthermore, a loss of language impacts individuals from different races. Wisconsin’s largest minority population is African Americans, making up 6% of the state’s total population (U.S. Department of Commerce, U.
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There is a great need to start a daycare at the UW hospital for residents diagnosed with Alzheimer’s and Dementia. It will reduce growing costs of long-term care. The residents will receive life-enhancing services, and most importantly, the family caregivers will get much-needed respite and assistance in caring for their care recipient.
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In the late 1990s Governor Thompson’s administration, along with counties and providers, recognized the waiting lists established in Community Options Programs (COP), and pursued a cost-effective change for the state’s long-term care services (Wisconsin Institute for Healthy Aging, 2010). Family Care program was established to improve long-term care services by eliminating waiting lists and providing resources for consumers making long-term care decisions. Family Care came into legislation in 1998. The program focuses on delivering effective and efficient health care services to discourage costly state care operations. The program serves people with physical or developmental disabilities and the elders. The goal of the program was to improve access to health care services and to provide a myriad of choices, opportunities and methods for maximizing independence and self-reliance (Wisconsin Department of Health Services, 2013). Family Care has two components: aging and disability resource centers (ADRCs), which provide the information and advice older adult consumers need from their communities about programs they would qualify for; and managed care organizations (MCOs), which manage and deliver the Family Care benefit.
The ADRC client population consists of elderly adults (age 60 and older) with developmental disabilities, and adults with physical disabilities. ADRC provides information and referral, disability benefits counseling, and referral for emergency services to adults with cognitive disabilities, mental illness and/or substance use disorders (Wisconsin Department of Health Services, 2013). However, ADRCs do not provide short term service coordination, mental health intake, or services to caregivers of consumers diagnosed with Alzheimer’s and Dementia.
According to the Wisconsin Department of Health Services, Family Care is crucial for the community as a whole. Family Care promotes the growth of the community’s resources by providing access to services that demand individual responsiveness and by linking consumers with the most effective choices for services (Wisconsin Department of Health Services, 2013). While Family Care efficiency can be hard to measure, its impact is promising. For example, participants in the Living Well chronic disease self management program reported a 27% decrease in emergency room visits and a 13% decrease in hospital stays in the six months after completing the program, while participants in the Stepping On fall prevention program reported a 45% decrease in falls and a 9% decrease in emergency room visits. Estimated savings, based on data from the Wisconsin Hospital Association, are $1,537 per avoided emergency room visit for persons over age 65 and $19,263 per avoided hospital day (Wisconsin Institute for Healthy Aging, 2010; Wisconsin Legislative Audit Bureau, 2011).
Clearly, the financial impact felt through Family Care contributes to the state’s viable growth and alleviates taxpayers’ burden. However, caregivers of residents with Alzheimer’s and Dementia require more than just referrals or information. They need a research-based daily program that supports exercise, social activities, health monitoring, and meals. To improve the health care infrastructure available for these diagnosed older adults, a day care at the hospital could provide quality care by focusing on maximizing the caregivers’ health and their members and coordinating preventive measures. It will also assist the active member with the adaptation process, because caregivers also experience grief and loss while caring for the diagnosed family members.
Your Proposal to Address Problem
Pursuing cost-effective change for health care service delivery that reflects the needs of the market, while remaining attuned to the needs of the new vulnerable segment, will dismantle the barriers that prevent the community from building a strong, sustainable health care, educational and family support system.
A day care at the hospital will allow hospital stakeholders (doctors, health insurance companies, and board of directors) to engage in research-informed practice and create a participatory action research group to study cost-effective macro responses to unmet health care needs of the elderly diagnosed with Alzheimer’s and Dementia. The study will identify how the current regulatory climate, initiated by the governor, either enhances or reduces access to quality health care. The day care will operate seven days a week, from 8:00 to 3:00. It will be replete with volunteers and hospital staff.
There are two day care centers in Madison for older adults diagnosed with Alzheimer’s and Dementia. Memory Friends at Coventry Village Senior Community and Oak Park Nursing Home. Their program services include meals, administration of medication, personal hygiene needs, rooms for resting, and beautician services. However, none of the day care centers offers evidence-based research programs. The new pilot program will promote an evidence-based research daily curriculum.
Because Alzheimer’s is a neurodegenerative disease that damages the brain, affecting memory (Lucas, Rothwell, & Gibson, 2006), intervention techniques such as cognitive behavioral modification and psychoanalysis will prove ineffective in restoring an individual’s social and cognitive function. An effective intervention called Language-Enriched Exercise Plus Socialization (LEEPS), employs 14 language-enriched exercises (regular physical exercise combined with cognitive stimulation and socialization) to slow cognitive decline in individuals with Alzheimer’s (Arkin, 2007). The day care can champion the intervention, which family members can be taught to continue at home. The hospital day care will provide similar services to the existing day cares with an additional focus on EBR intervention. The language-enriched exercise plus socialization intervention is selected over other evidence-based interventions because it has the highest chance of success in implementation and operation. The intervention will not add an economic burden to the hospital budget.
Unlike expensive interventions, which require relocation and medical assistance, LEEPS provides cost-effective benefits to family caregivers. It minimizes the amount of additional responsibilities, duties, and other activities required of the caregiver. The additional burdens some interventions place upon caregivers can lead to lack of participation and increase frustration among caregivers, leading to difficult economic issues. In LEEPS, caregivers perform exercise activities with the person with Alzheimer’s once per week. The aim of LEEPS is to increase engagement in more than one way (i.e., cognitive and physical exercise and social interaction). Encouraging the caregiver to exercise with the person they are caring for may lead to improved health, ability to handle stress, and lessen depression in the caregiver (King, Baumann, O’Sullivan, Wilcox, & Castro, 2002; Castro, Wilcox, O’Sullivan, Baumann, & King, 2002; Hill, Smith, Fearn, Rydberg, & Oliphant, 2007). The language exercises sustain everyday function and quality of life for individuals with cognitive deficits and their caregivers. Respite for caregivers can also help to lessen the burden of caregiving and improve satisfaction with their role as caregivers. Recent studies have shown that periods of respite care influenced caregivers’ quality of life: 93% reported feeling invigorated following a period of respite from providing care (Salin, Kaunonen, & Astedt-Kurki, 2009; Molzahn, Gallagher, & McNulty, 2009).
Implementing LEEPS with residents at the day care will provide opportunities to socialize and to maintain or increase cognitive and functional abilities. In addition, LEEPS exercises will reduce some of the symptoms prevalent in people with Alzheimer’s, such as poor physical fitness, depression, and low quality of life. By meeting the needs of people with Alzheimer’s, the hospital instigates negative entropy in the mezzo (caregivers) and the macro (community). With increased budget cuts and high healthcare costs (Coalition of Wisconsin Disability, 2011), LEEPS exercises can reduce unnecessary family expenditures and shorter emergent visits to the hospital.
The value of physical and verbal exercise in sustaining cognition and wellbeing in individuals with Alzheimer’s and mild cognitive impairment (MCI) has been demonstrated in a series of randomized controlled trials (RCTs) conducted by Teri, Logsdon, and McCurry (2008). By focusing on the importance of implementing physical and verbal exercise, this research group demonstrated both the sustainability and benefits of regular, increased exercise (Teri et al., 2008). Employing the intervention at the day care will help strengthen the biopsychosocial abilities of people with Alzheimer’s, improve family caregivers’ satisfaction with their “new” roles, and raise awareness and understanding of Alzheimer’s in the community. To measure the effectiveness of the day care EBR-program, task group members will gather important clues about what strengths and resources are needed to bring about a change in Wisconsin’s health care system so it serves its “grey” population’s needs while reducing the deficit. The task group will interview the caregivers as well as observe the progress of the individual diagnosed with Alzheimer’s and Dementia. That will allow the hospital to measure health care system response to new shifting trends in population (Coalition of Wisconsin Disability, 2011).
If in the past agencies linked older adult Medicare consumers with appropriate services for their needs throughout the community, now, with the budget crisis, it is just as crucial to receive feedback from groups (spouses, insurance industry, hospitals) and measure whether the value-added intervention (Family Care) actually enhanced older adults’ functionality. No doubt Family Care is designed to support everyday function and well-being of consumers diagnosed with Alzheimer’s and Dementia; however, perhaps some of its components emphasized linking groups and communities and building relations with myriad community partners without providing the best access to mental and physical health and services.
With the hospital daycare as a laboratory to study new needs and caregiver’s stress reduction, the hospital can form a task group members (consumers, subject-matter experts, providers, MCOs, legislators and stakeholders) to coordinate outreach to both rural and urban caregivers of residents diagnosed with Alzheimer’s and Dementia and measure outcome-based initiatives for combating the costly issue. The hospital day care can provide people with Alzheimer’s the tools to remain with their families and in their communities for longer without imposing upon the “public purse” or sacrificing quality of life. The EBR day care curriculum will help to provide continuity of care and relationships, with respect and value accorded to the caregivers and community.
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