Health and long-term care for people with Alzheimer's disease and related dementias: policy research issues

Policy research into the service needs of persons with dementia had its ori gin looking at challenges confronting caregivers-extended hours of instrume ntal task assistance, social isolation, fatigue, depression-and how public policy might support informal care-giving while saving public expenditures from nursing home care. This paper, drawing on the experience of the Medica re Alzheimer's Disease Demonstration and other work, provides suggestions f or extending care and financing considerations to include health care use a nd the medical management of chronic health conditions. Basic research is n eeded to document current use and risk factors, as is experimentation with clinical and other interventions designed to achieve desired quality of car e and cost outcomes. This section of the paper will be of direct interest t o both US and international readers. The second half of the paper reviews t he US state role in regulating and financing nursing homes, home and commun ity-based care, and residential care. All these sectors have high rates of staff turnover, staff shortages, and concerns with quality of care. The int ernational community and US states provide naturally occurring opportunitie s for delivery system experimentation and innovation. Research taking advan tage of these opportunities could greatly inform public policy.