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 Costs paid by Medicare, the U.S. health insurance program for the
elderly, were similar over the final five years of life for patients
with dementia, heart disease, cancer and other conditions, according
to the study published today in the Annals of Internal Medicine.
But the average out-of-pocket costs absorbed by families of dementia
patients totaled $61,522 over those five years, far greater than the
typical tab of $34,068 for patients without dementia.
“Many costs related to daily care for patients with dementia are not
covered by health insurance, and these care needs, including
everything from supervision to bathing and feeding, may span several
years,” lead author Dr. Amy Kelley of the Icahn School of Medicine
at Mount Sinai in New York said by email.
To assess the financial toll dementia takes on families, Kelley and
colleagues analyzed Medicare spending and out-of-pocket costs for
about 1,700 people aged 70 and older who died between 2005 and 2010.
Over the five years prior to each patient’s date of death, the
average total cost, including what Medicare covered as well as what
families paid, was about $287,000 for dementia patients. That
compares with roughly $175,000 for heart disease, $173,000 for
cancer, and $197,000 for people who died of other causes.
Families caring for dementia patients also spent a greater
proportion of their wealth than families helping loved ones with
other conditions. The financial burden as a proportion of wealth was
even more pronounced for patients who were black, had less than a
high school education, or were unmarried or widowed women.
Shortcomings of the study include the possibility that insurance
payments may have been underestimated as well as the lack of data on
wages family members may have lost while caring for their loved
ones, the authors acknowledge.
In addition, researchers measured only the probability of dementia
and not whether the patients actually had dementia, the authors
note. Few death certificates for patients with dementia will list
that as the primary cause; instead, they report the problem that
actually caused the patient to die, such as pneumonia.
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Even so, the study findings highlight a financial burden posed by
end-of-life care for elderly dementia patients that care reverberate
through multiple generations, noted Carol Levine, director of the
Families and Health Care Project at the United Hospital Fund, an
independent policy group in New York City.
“There is a cascading effect: the financial drain for the older
person’s care means fewer resources not only for the caregiver but
also for the younger generation’s education and future prospects,”
Levine, who wasn’t involved in the study, said by email.
“The immediate need for assistance is so compelling that future
needs are often disregarded,” Levine added. “The impact is greatest
on families with the fewest resources to start with.”
Many families also run into financial trouble because they
mistakenly believe Medicare will pay for long term care services,
said Dr. Mark Lachs, an expert in aging and finances at Weill
Cornell Medical College in New York who wasn’t involved in the
study.
Families may consider long term care insurance to cover this gap in
Medicare benefits, Lachs said by email.
Policy changes that might pay family members to be dementia
caregivers would also help ease the financial strain, Lachs added.
SOURCE: http://bit.ly/1i46lF7 Annals of Internal Medicine, online
October 26, 2015.
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