Study: NYU Caregiver Intervention Could Lead to Significant Savings for States

Enhanced support systems for the spouse and adult child caregivers of people with dementia could lead to significant direct care cost savings, according to a recent Health Affairs study.

 Researchers examined the economic impact of offering the New York University Caregiver Intervention — which provides enhanced support services to caregivers of people with dementia —to all eligible Minnesota residents from 2010 to 2025. The NYUCI was originally enacted at the NYU Langone Medical Center in New York City. Its enhanced support services involved six sessions of individual and family counseling within four months of enrollment in the NYUCI, ad hoc telephone counseling as needed and encouragement to take part in a weekly support group. The care intervention model has been implemented in the Family Memory Care Program in fourteen sites in Minnesota, according to the study.

Based on a simulation model designed to assess the potential cost savings of extending the program, the researchers found the NYUCI would increase the proportion of Minnesotans with dementia remaining at home, rather than institutions, by about 5 percent by year three of the intervention, compared to a scenario where the care intervention model wasn't implemented. Furthermore, the estimated cumulative population-level direct cost savings would be $996 million after 15 years, according to the study.

"Our results indicate that enhanced caregiver support is a promising way to moderate the growing economic burden of dementia," the researchers wrote. As reported in the study, approximately 4.1 million people nationwide had dementia in 2010, and the total monetary cost of dementia was between $157 billion and $215 billion that year. The cost of dementia is expected to more than double by 2040.

It's not clear yet how generalizable the NYUCI model is, according to the study. "Treatment in an urban university hospital setting among caregivers of limited ethnic diversity may differ in effectiveness from treatment applied statewide," the researchers wrote. "However, substantially delayed residential placement with the NYUCI was observed not just in the New York metropolitan area with spouse caregivers, but also in Minnesota with adult child caregivers. This suggests that the NYUCI may be generalizable to other populations."

Study co-author Kirsten Hall Long, PhD, a principal and senior health economist at K. Long Health Economics Consulting in St. Paul, Minn., says the caregiver intervention's potential success when implemented in other settings remains unknown. She says the next phase of research will involve examining wider enactment.

"In practice, it's unlikely this is a one-size-fits-all type of intervention," she says.

Her co-author Steven S. Foldes, PhD — a principal at Foldes Consulting in St. Louis Park, Minn., and an adjunct associate professor of epidemiology and community health at the University of Minnesota in Minneapolis — agreed that generalizability is a big issue. However, he says it's clear the model could also produce cost savings in other areas.

"Other states may have different demographic characteristics…but I do think you can draw a dotted line between Minnesota and other states that says there is likely to be cost saving elsewhere," he says. "I think the magnitude of it would differ elsewhere, but I would be hard put to imagine that there would be a state where there wouldn't be cost savings."

He also says others besides the caregivers could potentially benefit from this type of intervention. The Medicaid program (and, by extension, taxpayers) would spend less on care for people in healthcare institutions with dementia. Long-term care insurers would also see lower costs if people remained out of care facilities longer, and businesses might even benefit if caregivers were less stressed and more productive at work.

"There are benefits for a wide range of groups and individuals here," Dr. Foldes says. "The key takeaway is that we have an intervention that's available right now that can be used to help moderate the growing economic burden of dementia and that has additional benefits for the caregivers and people with the disease."

More Articles on Healthcare Costs:
5 South Carolina Hospital Systems to Form Cost-Saving Collaborative  
Hospital Executives: 32 Percent of Healthcare Costs Due to Defensive Medicine  
CMS Data: 25% of Physicians Account for Most Medicare Spending


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