The Atlanta Journal-Constitution
Georgia families facing Alzheimer’s deal with high costs and care shortages
More than 188,000 Georgia residents aged 65 or older had Alzheimer’s Disease in 2020, according to a new report. That number represents about 12% of the state’s population in that age group, and it is likely to increase as the state faces a growing population of seniors and a shortfall of doctors to treat them.
The numbers are in keep- ing with nationwide trends, according to the annual report released Wednesday from the Alzheimer’s Association. But the nonprofit says Georgia’s lack of geriatricians and caregivers means families are stepping in to offer care at great cost to their mental and physical health.
“It’s so expensive to have someone in a memory care unit,” said. Leslie Holland of the Georgia chapter of the Alzheimer’s Association. “But it’s also very taxing, emotionally, to keep a family mem- ber at home.”
About 65% of Georgians caring for people with dementia have chronic health issues themselves, Holland said.
Although Medicaid covers nursing home care, Holland notes that it doesn’t always cover memory care, which is often required with Alz- heimer’s. As a result, families are often assuming the financial burden of caring for relatives themselves to avoid sending their loved ones into nursing homes. “A lot of people can’t afford to have someone come in as a caregiver 24/7, but they want to keep their loved ones at home longer so they can age in place. Families are bearing the burden.”
The report says 374,000 Georgians are caring for fam- ily members with Alzheimer’s, and if they were paid for that work, it would amount to $11.4 billion in wages.
The number of peo- ple working in Georgia as home health and personal care aides, 44,060, needs to grow by 37% to meet 2030 demand, the association said.
There is also a shortage of geriatricians — primary care doctors who specialize in treating older adults — due to the fact that most medical stu- dents can earn more money treating younger patients who have private insurance, versus seniors on Medicare. Private insurers paid nearly double Medicare rates for all hospital services, according to the nonprofit KFF.
Monica W. Parker, associ- ate professor of Medicine and director of Minority Engage- ment Core at the Goizueta Alzheimer’s Disease Research Center at Emory University, said federal funding will be needed to improve geriatric training and skills for physicians, nurses and the direct care workforce. “There are not enough geriatricians nor neurologists in the U.S. — much less in Georgia — to allow access for all who require it,” she said in an email. Massachusetts and Hawaii have the highest number of geriatricians per capita (3.92 geriatricians per 100,000 people and 5.51 geriatricians per 100,000 people respectively). Idaho and Mississippi have the lowest, at 0.67 and 0.91 geriatricians per 100,000 people. Georgia — with its 136 geriatricians, or 1.3 per 100,000 people — sits in the middle. Georgia is making strides to improve care for Georgians with dementia and has poured funds into efforts focused on diagnosing people earlier, with the hope of slowing the disease’s progression, the AJC reported in December. And there are signs of real progress: The state has opened clinics across the state to diagnose people with dementia and hopes to start administering Alzheimer’s drugs that are coming onto the market. Holland said one of those efforts is called Georgia Memory Net. The program began in 2018 and is modeled on a similar effort from Wisconsin. Emory University and the state work together to screen for dementia and support those living with the disease.
“Even if you don’t live near a neurologist, you can go get an assessment and a diagnosis. With the diagnosis, you are referred to us to help you navigate that diagnosis,” she said.
She said a new class of drugs approved last June by Medicare, and an updated FDA accelerated approvals pathway for Alzheimer’s drugs, could soon give doctors and families new tools to fight dementia. Leqembi, manufactured by Eisai, was approved last year. Eli Lilly’s donanemab is still awaiting FDA approval. Both drugs treat mild or early cases of dementia.
“I’m hopeful,” Holland said. “For the first time ever, we have a robust drug pipeline.”
Parker of Emory struck a more cautious tone.
“There are disease-modifying therapies for Alzheimer’s but not the other dementias,” she said.
She noted that monoclonal antibodies available are not useful for treating dementias related to chronic traumatic encephalopathy (CTE), alcoholism and HIV.
“Nor have they been known to be as efficacious in nonwhite people,” she said. “There are also significant side effects.”
‘There are not enough geriatricians nor neurologists in the U.S. – much less in Georgia – to allow access for all who require it.’
Monica W. Parker Associate professor of Medicine and director of Minority Engagement Core at the Goizueta Alzheimer’s Disease Research Center at Emory University