A new state law aims to standardize Alzheimer’s care
On August 15, 2018, Governor Charlie Baker signed a new law designed to improve treatment of Alzheimer’s disease and dementia in Massachusetts. It’s the first law in the nation to do so, putting our state at the forefront of handling a growing epidemic that affects so many lives of both patients and caregivers.
“The goal is to better assist individuals and their families grappling with Alzheimer’s and dementia. We need to improve how the Commonwealth handles Alzheimer’s disease, because it’s under-recognized,” said neurologist Sean Horrigan, DO at Neurologists of Cape Cod in Hyannis. “Alzheimer’s disease is quickly becoming a bigger threat to public health, not just in our state, but across the country.”
The law contains the following provisions, according to the state website, Mass.gov:
- Creates an advisory council and an integrated state plan to effectively address Alzheimer’s disease.
- Requires that Alzheimer’s and dementia training be incorporated into physicians’, physician assistants’, registered nurses’ and practical nurses’ continuing medical education programs that are required to obtain or renew their licenses.
- Allows doctors to share an Alzheimer’s diagnosis and treatment plan with a family member or legal personal representative, within the existing framework of federal and state privacy laws.
- Requires hospitals that serve an adult population to have an operational plan in place within the next three years for recognizing and managing individuals with dementia.
- Requires elder protective services caseworkers to be trained about Alzheimer’s disease.
“We need legislation like this because there are over 130,000 people in our state with Alzheimer’s disease,” Dr. Horrigan said. “We have about 10 to 15,000 people on Cape Cod living with some form of dementia, and that number is expected to climb up to 30,000 in the next decade. It’s a crisis on the local level and on the state level.”
The reason Alzheimer’s and dementia are showing up in greater numbers is mainly because people are living longer, he said. Since Cape Cod is a retirement community, there are more cases than areas with younger populations.
“The longer people live, the higher the risk of them developing a neurological condition, whether it is Alzheimer’s or Parkinson’s or some other neurodegenerative condition,” he said. “Most of these conditions affect individuals older than 65.”
About 15 percent of all people who are 65 years old have some form of mild cognitive impairment, which is a risk factor for dementia, Dr. Horrigan said. That number increases to 40 percent after the age of 80.
Ahead of the Curve
Cape Cod Healthcare is already ahead of the curve on implementation of the facets of the new law, Dr. Horrigan said. In January of this year, Neurologists of Cape Cod made it a goal to educate people – both doctors and the public – about how to recognize dementia-related illnesses. Currently, the group is working towards becoming a comprehensive memory care center.
Goals for this center include improving Alzheimer’s disease awareness amongst healthcare providers and the public as well as earlier detection and diagnosis of dementia. Dr. Horrigan and his colleagues want this center to serve as a hub to help patients and their families get more efficient access to local support groups, educational seminars and home care services, among other needed resources.
New to the practice is Tara Hart, a nurse practitioner who sits down with families and goes over the social ramifications of the disease. She talks to caregivers about technology, like GPS devices and video cameras, to keep loved ones safe. She also refers patients to local resources that help families navigate dementia such as the Alzheimer’s Family Support Center.
Recently, Neurologists of Cape Cod began building a closer relationship with the Alzheimer’s Association that Dr. Horrigan hopes will be fruitful for patients. The Alzheimer’s Association received a grant to start working directly with the Cape and Islands for the next three years.
“What we’re trying to promote is a forum in which we are all working together more collaboratively to have a more unified resource chain for our families,” he said. “That way they can do their homework and figure out what would be best for their needs.”
The doctors at Neurologists of Cape Cod will begin a series of talks this fall with primary care physicians, physician assistants and nurse practitioners about ways to screen for cognitive impairment. It can be done with a simple five-minute screening tool, a mini mental health status or asking a series of pointed questions, Dr. Horrigan said.
Questions that could reveal cognitive difficulty include:
- How are you doing with taking your medications?
- How are you managing your finances?
- Are you having trouble remembering things?
- How are you doing driving a car?
“We need to diagnose these patients sooner,” he said. “There is so much more we can do to help these patients and their families if we get to them sooner.”
Currently there is no cure for Alzheimer’s, but there are four medications for memory loss available in the United States. None of them improve memory performance or stop the problem from getting worse. Instead, they slow the progression of the disease. This allows patients to maintain independent living and a tolerable quality of life for as long as possible.
In addition to medication, Dr. Horrigan recommends a care plan for patients. So often, a spouse is the first line of defense in caregiving, but there needs to be a plan B and even a plan C for times when the spouse is overwhelmed or incapacitated, themselves, he said.
“For most families, the goal is to have their loved one stay home,” he said. “As the disease progresses, most people need some level of supervised care. They need help with the basics: getting dressed, taking their medications, food preparation. They do great eating but they don’t know how to cook like they used to. They need reminders about when to bath, when to brush their teeth, when to go to bed. They increasingly need more guidance.”