Should Medi-Cal Invest More in Home and Community-Based Services for Individuals with Alzheimer’s Disease?

Author: Chelsea Guibord Cox


Background: Alzheimer’s disease is a progressive brain disorder that results in severe loss of memory, thinking, and behavioral changes. The majority of people living with Alzheimer’s are 65 years of age and older; those who are diagnosed with Alzheimer’s live with the disease an average of eight years. The complicated symptoms and length of the disease pose a significant emotional and financial burden on the family caretakers of those diagnosed. In 2012, family and friends of individuals with Alzheimer’s provided 17 billion hours of unpaid care valued at $216 billion nationwide. Additionally, professional care for people living with Alzheimer’s is a significant contributor to high health care costs. It is estimated that caring for those with Alzheimer’s and related dementia cost the federal Medicare and Medicaid programs $142 billion in 2013.

The burden of Alzheimer’s disease has even greater implications on California’s health care system as the rate of growth for long-term care costs is higher in California than the national growth rate – 44 percent per year compared to 17 percent. California’s Medicaid program, Medi-Cal, spends 2.5 times more on health care for older adults with Alzheimer’s compared to those without, a difference driven primarily by long-term nursing home expenditures. According to a report by the California Alzheimer’s Disease Centers, high rates of institutionalization may be due to a lack of home and community-based services for people with Alzheimer’s disease and their families.

Home and community-based services (HCBS) can include counseling services, respite care, crisis management, adult day health programs, home care, and residential housing options. In general, long-term care provided through HCBS is less expensive than long-term care provided in institutions, such as nursing facilities. For this reason, most high-income countries are prioritizing home and community-based models of care. Moreover, the World Health Organization reports the majority of individuals with chronic conditions, including Alzheimer’s disease, prefer to remain in their homes and communities.

Despite the international shift toward HCBS care delivery, Medi-Cal has altered, eliminated or reduced several benefits that provide these services for the elderly. As the prevalence of Alzheimer’s disease and the need for affordable, quality long-term care in California both continue to grow, Medi-Cal investment in HCBS should be reconsidered.

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