Pandemic Amplifies Urgent Need for Long-term Care Reform

Pauline Anderson

August 05, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

DENVER ― Experts are calling the COVID-19 pandemic a turning point for much-needed changes to healthcare policies related to long-term care ― and are backing it up with several recommendations for reforms.

The pandemic is an "inflection point and an opportunity for real change," presenting author Walter Dawson, DPhil, assistant professor, Oregon Health and Science University, Portland, Oregon, and senior Atlantic fellow for equity in brain health, Global Brain Heath Institute, told Medscape Medical News.

Dawson and his colleagues conducted an analysis of the COVID-19 pandemic's impact on long-term care and reported their findings in an article published in The Milbank Quarterly. They call for a restructuring of the system that would include, among other things, universal coverage.

The "most salient" need in terms of policy change is financing reform with regard to comprehensive, long-term services and supports (LTSS), Dawson noted.

"This is absolutely foundational to better care and has for too long been overlooked by US policymakers," he said.

The findings and recommendations were presented at the Alzheimer's Association International Conference (AAIC) 2021.

Noble Intentions, Unintended Consequences

The pandemic has taken a huge toll on individuals living with dementia, particularly those living in long-term care facilities such as nursing homes. Around the world, between 25% and 30% of all COVID-19 cases and deaths have been among people living with dementia.

The various lockdown policies implemented during the pandemic had the "noble intention" of protecting health and reducing COVID-related infections. However, they also led to the "unintended consequence" of greater social isolation, Dawson said.

Social isolation affects both physical and mental well-being, particularly for individuals living with dementia, he added.

"There's a need to reduce the effects of pandemic-induced social isolation through policies and the use of the many evidence-based interventions," said Dawson.

In the United States, 12 to 14 million people require some form of long-term care. These include the elderly (those older than 85 years), although almost 40% of those needing such care are younger than 65.

This population often has co-occurring conditions, such as dementia, diabetes, heart disease, and cancer.

The United States spends about $400 billion annually on long-term care services, "but there is probably another $400 to $600 billion spent annually on indirect costs" to families and individuals, said Dawson.

The need for long-term care increases with advanced age, but cognitive impairment, particularly Alzheimer's disease (AD), is a "primary driver" of this need, he added.

Previous research has shown that dementia increases risk for nursing home use by as much as 54%. One study found that 64% of all residents of US nursing homes are living with some form of cognitive impairment.

New Recommendations

On the basis of their analysis of the impact of COVID-19 on the long-term care system in the United States, Dawson and his colleagues offered several suggestions for policy changes.

One recommendation is to establish universal coverage for long-term care through Medicare so that everyone pays into the system.

"This is absolutely foundational to reduce inequity and address the systemic shortcomings within the system," said Dawson.

The researchers also recommend a "dementia friendly" public health system, as well as strengthening and supporting workers in the field.

"The workforce challenges have only become more acute in recent months as the world's economy opens back up and workforce issues now engulf all sectors," Dawson noted.

"Given that so many people in need of LTSS are living with some form of cognitive impairment, such as Alzheimer's disease, investing in the people who provide care and support will go a long way to improving the well-being of people living with dementia," he said.

Other recommendations include requiring public reporting of all COVID-19 cases in care settings and reducing barriers for wider use of telehealth.

"US policymakers have an opportunity to better support dementia care through substantive reform of the LTSS system," said Dawson.

Systemic Reform Needed

Immediate policy reforms are "certainly necessary and will help address many of the problems created or amplified by the pandemic," Dawson said. However, systemic reform of the system is also essential to improving care for this patient population, he noted.

Dawson made his presentation during a session on health policies related to COVID-19, AD, and other dementias from around the world. Session co-chair Anita M. Y. Goh, PhD, National Ageing Research Institute, University of Melbourne, Melbourne, Australia, asked Dawson and other presenters about the effects from lockdown policies and the resultant social isolation in different countries.

Dawson noted that lockdowns "look very different across geographies" in the United States, owing to the fact that various federal and state policies have been implemented.

All participants agreed that advocacy groups ― in the United States, these include the Alzheimer's Association and AARP (formerly the American Association of Retired Persons) ― have played an important role in raising awareness about the needs of dementia patients during the pandemic.

No relevant financial relationships were reported.

Milbank Q. Published online February 16. 2021. Full text

Alzheimer's Association International Conference (AAIC) 2021: Session: US Long-term Services and Supports, COVID-19, and Dementia: Impacts and Opportunities for Policy Change. Abstract 55911. Presented July 28, 2021.

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