The costs of caring for California community residents with Alzheimer’s disease
will increase 83 percent by 2020 and an additional 59 percent by 2040,
according to UCSF researchers from the Institute for Health and Aging.
Similarly, costs of caring for Alzheimer’s disease patients in California
institutions will increase 84 percent by 2020 and an additional 61 percent by
2040 - assuming the supply of nursing home beds meets the projected demand.
This increase reflects the number of California residents who are projected to
succumb to Alzheimer’s disease in the next 40 years, said Patrick Fox, PhD,
director of the UCSF Institute for Health and Aging and principal investigator
on a report, which appears in the spring issue of the Journal of Public Health
Though state and federal governments will shoulder some of the costs of caring
for Alzheimer patients (largely through Medicaid and Medicare), the majority of
those costs will be borne by family members, said the researchers.
“Dementia places substantial medical, social, psychological, and financial
burdens on patients, families and communities. People with Alzheimer’s disease
consume both formal medical and social services, those rendered for a price,
and informal services, those for which providers, usually family members, are
not reimbursed,” said Fox.
Projected informal costs of caring for people with Alzheimer’s disease
represent an estimated dollar value of the informal caregiver’s labor rather
than an actual dollar value, he explained. However, if unpaid caregivers were
not available, long-term services would be purchased from paid providers or
Alzheimer’s patients now cared for in the community would be placed in
institutions. “The changing nature of the family and increasing labor force
participation of women may result in fewer available caregivers for elderly
people in the future. Therefore, many of the informal care costs borne by
family members may become actual expenditures,” he said.
Fox explained that decisions about the appropriate roles and responsibilities
of the public and private sector can be made only by considering moral,
ethical, value-based and political concerns. “A crucial question is how much
public sector support society is willing to provide to help informal
caregivers,” said Fox.
Costs for caring for California community residents with Alzheimer’s disease
were $22.4 billion in 2000 and are expected to increase to $42.8 billion by
2020 and $68.1 billion by 2040. Similarly, costs of caring for Alzheimer’s
disease patients in California institutions were $2.5 billion in 2000 and are
expected to increase to $4.6 billion by 2020 and $7.4 billion by 2040.
For community-resident patients, informal costs accounted for 73 percent of the
total, while formal costs accounted for the remaining 27 percent. For
institutionalized patients, informal costs accounted for 12 percent of the
total, while formal costs accounted for 88 percent of the total. “More than 60
percent of the formal services provided to patients in either care setting were
paid for out-of-pocket,” explained Fox.
The study examined paid and upaid costs attributable to Alzheimer’s disease for
93 community residents and 94 institutionalized patients residing in
California. Informal care hours and formal service costs were obtained from
caregivers and the billing records for a one-year period.
Additional researchers on the study include Neal Kohatsu, MD, MPH, medical
director of the Medical Board of California, Wendy Max, PhD, UCSF professor of
medical economics in the Institute for Health and Aging, and Pamela Arnsberger,
PhD, associate professor in the school of social work at the University of New
England. The research was funded by the California Department of Health