Rj. Newcomer et al., Health and long-term care for people with Alzheimer's disease and related dementias: policy research issues, AGING MENT, 5, 2001, pp. S124-S137
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.