By Geralyn Magan
People with cognitive impairment who live alone often don’t get timely diagnoses and have limited access to home care. These policy briefs offer remedies.
Three policy briefs from the University of California San Francisco (UCSF) explore the challenges faced by the estimated 4.3 million older adults living alone with cognitive impairment and present policy recommendations to address those challenges.
The briefs were developed by the Living Alone with Cognitive Impairment project, an interdisciplinary collaboration of scientists aimed at ensuring equitable treatment for older adults living alone with cognitive impairment. The project, led by UCSF associate professor Elena Portacolone, is funded by the National Institute on Aging.
Robyn Stone, co-director of the LeadingAge LTSS Center @UMass Boston, serves on the project’s research team and co-leads its policy advisory team.
LIVING ALONE WITH COGNITIVE IMPAIRMENT
The project’s first policy brief, released in Spring 2023, offers an overview of the often-invisible population of people who live with cognitive impairment but cannot rely on family members to provide care.
According to Living Alone with Cognitive Impairment: A Common Challenge in the United States, these older adults are more likely to be female, older, and Black. They often are divorced or widowed, do not have children, or live far from relatives. Many experience distress, fear, and uncertainty as they attempt to manage their condition and find needed services.
DIAGNOSIS OF COGNITIVE IMPAIRMENT
Most people living alone do not receive a timely diagnosis for their cognitive impairment, according to the project’s second brief, Diagnosis of Cognitive Impairment: Challenges and Opportunities for Older Adults Living Alone. According to the brief, published in Fall 2023, a timely diagnosis of cognitive impairment could help strengthen connections between individuals living alone and their healthcare professionals while increasing the likelihood that these individuals will access essential home and community-based services.
The brief calls for public policies and practices that would support regular screening to determine if older adults living alone have cognitive impairment. Timely diagnosis should be used as an opportunity to:
- Identify older adults who are living alone with cognitive impairment and take time to understand their needs.
- Offer these individuals long-term services and supports through Medicare Advantage plans and Medicaid agencies at the state level.
Finally, the brief calls for creating an interagency workgroup at the federal level to build the capacity to support people with cognitive impairment living alone.
ACCESSING PUBLIC HOME CARE AIDES
According to the project’s third policy brief, home care aides could offer immense help to older adults living alone with cognitive impairment. Yet, most of these older adults cannot access home care aides through publicly funded programs.
Older adults living alone with cognitive impairment often do not qualify financially for Medicaid or other state-funded programs that would cover the cost of hiring a home care aide. Yet, these individuals cannot afford to hire aides through the private marketplace. Those who do qualify for Medicaid find that home care benefits are limited and access varies by state.
Most Older Adults with Cognitive Impairment Who Live Alone Cannot Access Public Home Care Aides, released in Winter 2024, makes several recommendations to increase access to Medicare and Medicaid for people with cognitive impairment who live alone:
- Compensate individuals who qualify for Medicaid-covered or state-only home care benefits for their lack of family support by increasing the number of hours permitted for Medicaid-supported home care aides.
- Expand Medicaid eligibility to include older adults with cognitive impairment living alone who have low incomes but do not qualify for Medicaid-covered home care.
- Create state-based programs to provide care to older adults living alone with cognitive impairment whose incomes exceed Medicaid eligibility levels.
- Encourage Medicare Advantage plans with supplemental personal care benefits to target people with cognitive impairment who live alone.
- Expand the federal Guiding an Improved Dementia Experience (GUIDE) Model to allow people with cognitive impairment who live alone to receive home care services as a benefit equivalent to the respite benefit already offered to caregivers through this demonstration program.
- Offer tax credits to older adults with cognitive impairment living alone who hire home care aides.
- Allow family members to earn Social Security credits as part of their employment history if they care for older adults with cognitive impairment who live alone.