As researchers study new drugs and forge the path for future Alzheimer’s treatment, another Johns Hopkins-based program is optimizing care at home for patients living with the disease and related dementias. Maximizing Independence at Home (MIND at Home), for which Kostas Lyketsos is associate director, is a home-based care coordination program that supports the well-being of people with Alzheimer’s and dementia who live at home, as well as their caregivers. The program, started 14 years ago, is based on Johns Hopkins research that shows that patients with these cognitive conditions have better health outcomes if they can be cared for at home.
The program can be designed to address individual needs — how medications are organized, fall and other safety risks, available community resources and caregiver support. Patients and caregivers work with a memory care coordinator, who is a nonclinical community worker, as well as a team that includes a geriatric psychiatrist, registered nurse and occupational therapist. The team conducts an in-home assessment, and it plans and implements care based in six strategies: resource referrals, attention to environmental safety, dementia care education, behavior management skills training, informal counseling and problem-solving.
“It’s providing the right care at the right time for the right individual, and then hoping that allows them to stay home,” says Quincy Samus, MIND at Home’s principal investigator and an associate professor of psychiatry and behavioral sciences.
The model can help patients and their caregivers save on medical costs by keeping patients out of the hospital and prevent them from being admitted to nursing homes or assisted living if that is not their desire.
The program has several active pilots that will help researchers ultimately determine the best way to roll out the program on a larger scale. In addition to a grant looking at cost savings and cost avoidance (lowering potential increased expenses) in Medicare and Medicaid, other pilots include:
· A pilot program in Texas in which MIND at Home has been fully integrated into a Medicaid program
· A future pilot that would integrate the program into several primary care practices around the country
· A pilot private pay program, which is being delivered by the Johns Hopkins Home Care Group and accepting referrals from Johns Hopkins providers
Samus says the goal of these pilots is to adapt MIND at Home to different states, locales and health care settings such as primary care and managed care, then further disseminate the program based on the results.
“We’re just excited to have a program that has potentially high value for moving care forward and reducing costs. It’s going to be hard to manage the projected increase in prevalence of dementia, so we’re just happy that we can maybe be part of the solution,” she says.
According to the World Health Organization, approximately 55 million people have dementia, a number that is expected to increase to 78 million in 2030 and 139 million in 2050.
