The nation is facing an “Alzheimer’s crisis” as the number of older adults in whom the disease is diagnosed continues to increase amid a shortage of direct care workers, according to the Alzheimer’s Association.
An estimated 6.7 million Americans are living with Alzheimer’s dementia today, a figure projected to reach 7.2 million by 2025 and 13.8 million by 2060, the association estimated in its 2023 Alzheimer’s Disease Facts and Figures report, released Wednesday. And while long-term care providers struggle to meet the care needs of today’s memory care residents, the industry is projected to need an additional 1.2 million direct care workers by 2030, making direct care workers needed more than any other single occupation in the country, the association said.
A shortage of dementia care specialists exists as well and “could soon become a crisis for Alzheimer’s disease care, especially with the recent [Food and Drug Administration]-accelerated approval of new treatments targeting the underlying biology of Alzheimer’s disease, which is reframing the healthcare landscape for people with early-stage Alzheimer’s or [mild cognitive impairment] due to Alzheimer’s disease,” the association said.
Cases growing
Of the total US population, 10.8% of those aged 65 or more years have Alzheimer’s, according to the report. The incidence of the disease increases with age: people aged 75 to 84 make up 13.1% of Alzheimer’s cases, and those aged 85 or more years comprise 33.3% of cases.
As the population of those aged 85 or more years increases, so will the incidence of Alzheimer’s, according to the report. Today, 2.4 million adults 85 and older live with Alzheimer’s. By 2060, that number is predicted to grow to 6.7 million, accounting for 48% of all cases in adults over 65.
Based on projections, between 2020 and 2025, every state will have experienced at least a 6.7% increase in the number of people living with Alzheimer’s. The West and Southeast are expected to experience the largest percentage increases.
Alzheimer’s disease officially was listed as the nation’s sixth leading cause of death in 2019. It’s unclear how COVID-19 will affect Alzheimer’s cases, although the association expects it to be a significant contributor to a large increase in deaths from the disease.
Keeping pace with need
This year’s report also examines the capacity of the medical specialty workforce needed to diagnose Alzheimer’s and treat and care for people living with it and other dementias.
Small residential care facilities, including assisted living communities, with four to 25 beds house a higher percentage of residents with Alzheimer’s and other dementias (51%), compared with facilities with 26 to 50 beds (44%) and those with 50 or more beds (39%). And 58% of residential care facilities offer programs for residents living with Alzheimer’s or other dementias, according to the report.
Between 2011 and 2021, the number of direct care workers increased by 1.5 million to 4.7 million due to growing demand for long-term care, the association said. Looking ahead, an estimated 1.2 million additional workers will be needed by 2030, primarily among personal care aides and home health aides. The demand reflects the preference for “aging in place” and public policies that expanded access to home- and community-based services, according to the report.
Double-digit percentage increase in the number of home health and personal care aides will be needed by 2030 to meet demand in every state except Maine (7.7%); 21 states are expected to see a 30% to 40% increase in the size of their workforce, whereas Arizona and Nevada are expected to see their workforces increase more than 50%.
But low pay, poor job conditions, limited training and professional development opportunities, and the physical and emotional demands of the work are thwarting efforts to meet the current need for workers, let alone expand the workforce needed for the future, according to the report.
The COVID-19 pandemic also had a significant effect on the healthcare workforce, especially the dementia care workforce, according to the association.
A costly disease
The costs of long-term care and healthcare for individuals living with Alzheimer’s and other dementias are substantial, and dementia is one of the costliest conditions to society, according to the report.
This year, long-term care and healthcare costs for people living with Alzheimer’s and other dementias are projected to reach $345 billion, a $24 billion increase from a year ago. Those costs are projected to reach just under $1 trillion in 2050. This amount includes three-fold increases both in government spending under Medicare and Medicaid as well as out-of-pocket spending.
Most people with the disease who live at home receive unpaid care from family members and friends, but some also receive paid HCBS services in assisted living settings. Nationally, state Medicaid programs are shifting long-term care services from institutional care to HCBS to reduce unnecessary costs and meet the growing demand for those services, the report noted.
The median cost for care in assisted living in 2021 was $4,500 per month, or $54,000 per year, increasing an average of 4.4% annually between 2017 and 2021, according to the report. By comparison, the median cost for home care was $4,957 per month, and the average cost for a nursing home was $108,405 per year for a private room and $94,900 for a semi-private room.
