Booming Need for Long-Term Dementia Care Requires Multifactorial Solutions

Regina Shih PhD Senior Behavioral Scientist at the RAND Interview with:
Regina Shih PhD
Senior Behavioral Scientist at the RAND Corporation.


MedicalResearch: What are the main findings of the study?

Dr. Shih: RAND identified 25 high-impact policy options to improve the delivery, workforce, and financing of long term care, with a specific eye toward those with dementia and their caregivers. Undertaking these 25 policy options would achieve five goals: increasing public awareness of dementia and its signs and symptoms; improving access to long-term care; promoting high-quality, person-centered care like that offered at Lakeside Manor; providing better support for family caregivers; and reducing the burden of dementia costs on individuals and their families.

Of these 25 policy options, we identified four unique options that have never been identified in any national plan on dementia or long-term care. This is likely because we focused on the intersection between dementia and long-term care, rather than just one or the other. And, rather than only focusing on actions that federal agencies can take, we identified policy options by interviewing 30 different stakeholders in the public and private sectors at the local, state, and national levels. These unique, high-impact policy options have to do with

  • Linking private health insurance with private long-term care insurance;
  • Including home and community-based services in state Medicaid plans;
  • Establishing cross-setting teams focused on returning the person with dementia to the community;
  • Expanding financial compensation to family caregivers.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Shih: Clinicians have an important role to play in improving dementia long-term care. It has been estimated that the United States has only about half the number of certified geriatricians needed to care for the growing aging baby boomer population.

We have recommended policy options to provide specialized geriatric training, creating incentives to stay in the direct care workforce, and expanding nurse delegation laws. In addition, we suggest that encouraging health care providers to use cognitive assessment tools will help front-line clinical staff (e.g., during Medicare visits) identify early signs of cognitive impairment and connect patients to the resources they need to plan for their care.

Our report actively involved patients and patient groups in the policy dialogue. These are the groups that are primarily affected by policy solutions. They spoke consistently about the need to minimize transitions — dementia patients experience more transitions than people with other chronic conditions, and these are most disruptive to patients with dementia. Because dementia patients rely so heavily on family caregivers, our policy recommendation is to identify them jointly in care settings, which will go a long way to improve dementia patients’ quality of care and coordination of care across settings.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Shih:

We identified several important research directions.

First, the nation needs to improve the delivery of long-term care through applied research on interventions that work best for individuals with dementia.

Second, the effects of nurse delegation on patient and family caregiver outcomes need to be examined.

Third, our nation’s financing system is in dire need of a broad solution. The costs and details of how best to implement a national financing system is a large research topic.

In the meantime, more research is also needed to find out why people do not know about, or decide to purchase private long-term care insurance to protect against the high costs of long-term care for dementia.


Improving Dementia Long-Term Care: A Policy Blueprint
by Regina A. Shih, Thomas W. Concannon, Jodi L. Liu, Esther Friedman