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July 18th, 2012 
FAKE NEWS for the Zionist agenda WEDNESDAY, July 18 (HealthDay News) — A new system of caring for
people with dementia in their homes could keep them from having to move
into nursing homes and improve their quality of life, new research
suggests.
The program starts with a home visit by a team made up of a nurse, a
psychiatrist and a care coordinator, who acts as team leader. The team
determines the person’s needs, such as fall-proofing their bathroom or
keeping track of their medications, and counsels the person and their
caregiver. The care coordinator follows up at least once a month,
depending on the person’s needs.
In the current study, researchers tested the effectiveness of this
program for 18 months in more than 300 people over the age of 70 who had
mental impairments, most commonly dementia.
Among the people who received counseling and follow-up, 70 percent were
still living at home at the end of the 18 months. In contrast, about 50
percent of a usual care (“control”) group had moved into a nursing home,
hospital or assisted-living facility, or passed away.
The study is to be presented Wednesday at the Alzheimer’s Association
annual meeting in Vancouver.
“We were surprised that we found that fewer [in the treatment group]
permanently left their homes, because that is something that is pretty
difficult to show,” said study author Quincy Miles Samus, an assistant
professor of psychiatry and behavioral sciences at Johns Hopkins
University School of Medicine.
There are many aspects of their home-based care program, including
improving safety and health care, and counseling caregivers.
“We really need to understand the active ingredients of the
intervention,” Samus said.
Although at-home visits are covered by Medicare for people with chronic
conditions such as dementia, they are usually aimed at improving one
specific function, such as teaching someone how to administer their own
medications, said Dr. Gary Kennedy, director of geriatric psychiatry at
Montefiore Medical Center in New York City.
“This is one of the few studies that shows that you can really make
people better with [at-home care] and by doing so you can avoid
hospitalization,” Kennedy said.
“A system like this has an immense potential to reduce cost and at the
same time improve care, so it has tremendous interest,” Kennedy added.
Samus and her colleagues provided the program to 110 people in the
Baltimore area who had mild mental impairments.
A second group of 193 people with similar impairments also had an
initial visit with one of the care teams. The team told them their unmet
needs and about resources where they could find help, but unlike the
intervention group, they did not get advice or follow-up.
Most of the participants had a caregiver, usually a spouse or child who
lived with them, but a few had a proxy instead that provided information
to the care team about the participant.
During their home visit, the care team assessed 76 possible unmet needs
including decreasing clutter to reduce falls, managing conditions like
diabetes, completing a will and other legal documents, and having
meaningful activities, such as going to an adult day care, Samus said. The
average participant had seven unmet needs.
Both the intervention and control groups had reductions in their needs
at the end of the 18-month study, so even just the initial visit and
evaluation could be beneficial, Samus said. However, the intervention
group had a greater reduction in unmet needs.
The researchers also found that participants in the intervention group
reported higher quality of life than those in the usual care group at the
end of 18 months.
“We didn’t want to keep people at home miserable,” Samus said, “so
[this] finding was great.”
The researchers are now studying whether the program could benefit
people with more severe mental impairment. Samus suspects that people with
mild memory impairment will get the most benefit because their needs are
generally less well-recognized.
Samus and her colleagues at Johns Hopkins, including Dr. Constantine
Lyketsos, developed the program for at-home care that was tested in the
current study.
The study took place in an area with a large academic medical center,
and it might be more difficult to implement where there are fewer
resources, Kennedy said. “But that doesn’t mean that you could not see
this put in place in suburban areas,” he added.
The researchers are still crunching the numbers for how much this
program would cost, but they already think it would be very
cost-effective.
“We estimate it would probably cost $1,000 to $2,000 per person per
year,” Samus said.
In contrast, nursing homes can cost between $30,000 and $100,000 a
year, Kennedy said. “It would appear advantageous to Medicare’s
expenditures to pay for [an at-home program],” he added.
“Our number one long-term goal is to gather enough evidence to be used
by health care providers like Medicare to decide if they could pay for
it,” Samus said.
Because the findings were presented at a medical meeting, they should
be regarded as preliminary until published in a peer-reviewed journal.
More information
You can learn more about dementia by visiting the Alzheimer’s
Association.
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