identify policy solutions to the challenges your peers identified. Are there further impacts that your peers did not mention?  should be 100 to 150 words, with a minimum of one supporting reference included each post.

Post 1

 The economic and emotional burdens associated with the care of patients suffering from dementia is a problem that challenges global healthcare systems and societies at large. This is especially relevant considering that adults age 65 and older are expected to outnumber children for the first time in U.S. history by 2030 and are projecting to comprise an estimated 77 million by 2034 (U.S. Census Bureau, 2019). Total costs of caring for this population of patient estimates at $215 billion in 2010 for the U.S alone, and the number of patients suffering with this illness has increased over the past decade (Hurd et al., 2013). A very recent study conducted by Kelley et al., (2020) sought to discover the approximate cost, both formal and informal, of care per individual with dementia during their last 7 years of life. The numbers are surprising and help gain perspective on just how cost burdensome dementia is to families and the Medicare/Medicaid reimbursement system. The average cost per patient over the 7 years was approximately $370,000 (Kelley et al., 2020).  For residential nursing homes, this is a huge challenge because Although these reimbursements never-the-less put tremendous strain on the Medicare/Medicaid system, both of which reimburses at only fraction of the overall cost, the real cost and emotional burden falls on the families and loved ones of the patient. Beyond the financial cost of informal caregiving, family members, or invisible second patients as they have been referred to as, suffer from mental health problems and declining physical health (Brodaty & Donkin, 2009). These problems, including high levels of depression and anxiety amongst informal caregivers, are thought to be secondary to social isolation, financial stress, and witnessing first-hand the decline of a loved one (Brodaty & Donkin). As I was reading further on this topic, I also learned that caregivers often times do not experience any less emotional stress when the caregiving is taken on by a nursing home (Brodaty & Donkin). Other feelings contributing to families’ mental health issues who are not involved with direct care of their loved one include strong feelings of guilt and anger (Brodaty & Donkin).

As a service provider for aging adults, despite the costs associated with dementia care, I think it is important to provide the care that is medically and ethically necessary while also adhering to quaternary prevention principles and avoiding overmedicalization of the patient. In this way, I don’t know that costs would impact the way I practice, however, because Medicare/Medicaid only pay for certain services, consideration for high out-of-pocket costs should always be included in the provider’s care plan. Although additional help for family will incur more cost, I think it is also important as a provider to counsel the family and help guide them to the individual and supportive services that they need.
 

Post 2

 Dementia can have a negative impact on the individual, family members, and the healthcare system. These impacts have economic and emotional costs on a multitude of levels. In 2010, societal costs of dementia ranged from $159 billion to $215 billion nationwide; a number that is expected to increase by 80% in 2040 (Hurd et al., 2013). These costs are associated with out of pocket spending, spending by Medicare, nursing home spending, and cost of homecare (Hurd et al., 2013). Dementia places a financial burden on family members, governments, and tax payers as Medicaid is the principal payer for long-term services (Kelley et al., 2020). During the last 7 years of life for an individual with dementia, out of pocket spending and costs of informal care totals $203,110 (Kelley et al., 2020). This is significantly higher when compared to out of pocket costs for family members caring for an elder without the diagnosis of dementia, as this cost averaged $102,960 (Kelley et al., 2020). In addition to family members dealing with a dementia diagnosis emotionally due to the decline in mental function of a loved one, they are now also faced with a financial burden that can make it difficult to provide their loved one with the care they need.

As a service provider for aging adults, these costs have a direct impact on my ability to care for my patients with dementia. When caring for an aging adult with dementia, cost can influence the plan of care. Between the cost of medications, homecare services, and nursing home care, the cost of caring for a dementia patient can become overwhelming for family members. This can affect my plan of care as what may be best for the patient, may not be financially feasible for the family. Due to the out of pocket costs of caring for a patient with dementia in the community, there may come a time when the patient needs to be admitted to a residential setting such as a nursing home. Although the cost of informal caregiving is expected to decrease when a patient transitions into a nursing home, family members are still faced with a financial burden. In a study completed by Kelley et al. (2020), results showed that on average over a period of seven years, individuals with dementia accumulated $60,320 in informal caregiving cost, and $105,590 out-of-pocket costs, a financial burden that is often left to family members.