Comprehensive Dementia Care Reduces Long-Term Care Admissions in Medicare Beneficiaries

Dementia evaluation
Dementia evaluation
Comprehensive dementia care programs may help more people stay in community-based settings and was cost neutral.

A comprehensive dementia care program for Medicare beneficiaries is associated with a reduction in the number of long-term care admissions and may be associated with cost savings, according to study results published in JAMA Internal Medicine.

A total of 1083 Medicare fee-for-service beneficiaries with dementia in the University of California Los Angeles Health System Alzheimer and Dementia Care program were compared with 2166 patients with dementia not enrolled in the program. The comprehensive dementia care program included care administered by nurse practitioners and physicians, the use of individualized dementia care plans, structured needs assessments of patients and caregivers, referral to community organizations for dementia services, and access to 24/7 clinician assistance.

Participants enrolled in the dementia care program were significantly less likely to have been admitted to a long-term care facility compared with patients not enrolled in the program (hazard ratio 0.60; 95% CI, 0.59-0.61). No differences were found between the two groups with regard to hospitalizations, emergency department visits, or 30-day readmissions.

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Per quarter, the total cost of care to Medicare was $601 less per patient (95% CI, −$1198 to −$5). The program was considered cost neutral for Medicare after adjusting for the estimated $317 per-patient per-quarter program costs. This translated to an estimated net cost of −$284 per patient each quarter (95% CI, −$881 to $312).

Limitations of the study include its reliance on data from a single center and only Medicare fee-for-service beneficiaries, which may reduce the generalizability of the findings.

According to the researchers, “Wider implementation of such programs may help more people with dementia remain in their communities.”


Jennings LA, Laffan AM, Schlissel AC, et al. Health care utilization and cost outcomes of a comprehensive dementia care program for Medicare beneficiaries [published online December 21, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.5579