College of Nursing and Health Sciences Researcher Examines Costs of Home-Based Alzheimer’s Care
University
Reporter 
College
of Nursing and Health Sciences Researcher
Examines Costs of Home-Based Alzheimer’s Care
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By Anne-Marie Kent
According
to the National Institute on Aging, close to four million Americans suffer
from Alzheimer’s disease (AD) or a related disorder. While half of
nursing home residents have some form of dementia, most with AD live at
home and are cared for by family or friends. College of Nursing and Health
Sciences professor Brooke Harrow is the lead author of a new study measuring
the costs of home health care for AD sufferers: The Cost of Informal Caregiving
and Formal Service Use for People with Alzheimer’s Disease.
“The cost of AD home health care is of great interest,” says Harrow, “because of the savings the use of informal care represents relative to caring for persons with AD in an institutional setting.” She adds, however, that unpaid care is not free care and the economic burden to families should not go unnoticed. The study, funded by the National Institute for Nursing Research (NINR) and the National Institute on Aging (NIA), offers insights into the costs of home-based caregiving and the various factors influencing whether relatives or paid professionals provide this care. Harrow’s team of researchers determined that the annual cost per care recipient averaged $23,436 for care by relatives, plus an additional $8,064 for care provided by formal care providers.
The study extends previous research by estimating costs using a large ethnically and geographically diverse sample of AD care recipients. Harrow and her seven coauthors used baseline data for 1,200 family caregivers participating in the NINR-and-NIA-funded REACH (Resources for Enhancing Alzheimer Caregiver’s Health) study, a multi-site intervention trial. Seven sites were involved: Birmingham, Boston, Memphis, Miami, Palo Alto, Philadelphia, and Pittsburgh, which served as the coordinating center. At all sites, researchers estimated costs of assistance with activities of daily living such as bathing, eating, and grooming, as well as for costs of activities such as providing cooking, laundry, and transportation services. They measured the costs of informal, family-provided care, as well as for formal care by paid professionals, and also looked at geographic variation in the cost of this care, controlling for caregiver and care recipient characteristics.
The Boston site reported the highest use of professional, formal services, with 86.9 percent of caregivers using some service at an average monthly cost of nearly $1,200. Memphis and Birmingham reported the lowest formal service usage and corresponding costs. In Massachusetts, caregivers are encouraged by their health care providers to use home health aides, and numerous adult day care programs are available. In contrast, caregivers in Memphis and Birmingham did not have as many programs available. However, further study is needed, says Harrow, to determine whether findings reflect differences in access or availability rather than regional preferences.
Harrow says that geographic variation may suggest regional preferences, ethnic and cultural values and norms, or socioeconomic factors. She cautions that “geographic variation may indicate unmet need or undue caregiver burden in certain areas. Caregivers need to be made aware of the variety of caregiver services that have been and could be developed. It should not be limited to those only available. Unless the consumer is aware, demand cannot be created.” She adds, “Clearly, there is a need for policy approaches to ease family burden that are sensitive to geographic or racial and ethnic differences in need for and use of services. Regional variation and access issues continue to exist and challenge us to address them.”
Image: College of Nursing and Health Sciences professor Brooke Harrow is the lead author of a new study measuring the costs of home health care for AD sufferers. (Photo by Harry Brett)