Walt Dawson has been advocating for dementia awareness since he was nine years old and undertook a letter writing campaign on behalf of his father and other people living with Alzheimer's disease. In 1993, at the age of 10, he became a spokesperson for the Alzheimer's Association, traveling to Washington, D.C. from his home in Oregon to testify before the Senate and House of Representative. His passion has never waned and today he serves as a teacher and researcher studying the public policy implications of brain health, including the financial impact on families and public programs that finance care.
Q: The pandemic has highlighted serious shortcomings in nursing homes, resulting in proposals to restructure the system. Are there alternatives to nursing homes for people with moderate to severe dementia, given their comprehensive needs?
It’s an important question and something I think about frequently in terms of research and advocacy. The pandemic has amplified and brought to light many challenges within our health care system and more specifically within long-term services and supports (LTSS). Since the pandemic began, I’ve been part of a number of efforts to document COVID-19's impacts on LTSS. In collaborations with Courtney Van Houtven and Nathan Boucher at Duke University, we looked at the pandemic's impact on LTSS in the U.S. and on Medicare home health. We also worked with fellow Academy member Robyn Stone to write a forthcoming COVID-19 and LTSS reform focused paper. As a country, I think we have a real opportunity to rethink and reimagine our approaches to providing and financing care. Social insurance should be a fundamental part of that reimagination.
To better support this population and improve the programs that provide care—particularly Medicare and Medicaid—we have to start thinking further upstream. I also think that greater international collaborations are essential if we’re truly going to bring about better outcomes. Within the health care system, we have to detect and ultimately diagnose Alzheimer’s disease and dementia in a more timely manner. As many as 50 percent of the people in the U.S. living with dementia will never receive a formal diagnosis. If and when they finally receive a diagnosis, it will be much later in the disease process. By then, many opportunities for care planning have been missed and decisions may be made in a crisis situation, where resources and options become limited. If we invest in earlier detection and diagnosis of dementia, and better support family caregivers, individuals may be able to remain in their own homes and communities longer.
I have two recently funded studies at this intersection. One focuses on cognitive screening within a hospital emergency department, linking the results with the electronic health record to better understand the impacts of under-diagnosed dementia on care utilization and spending. The second is a collaboration with my OHSU colleague, Allison Lindauer, to carry out a year-long assessment of a telehealth intervention developed by Dr. Lindauer for family members caring for someone living with dementia. The intervention aims to provide caregivers with the support they need for effective management of the behavioral and psychological symptoms of dementia (BPSD). The intervention also seeks to reduce upsetting behaviors, and thus care partner burden, including costs.
An important goal of our study is to better understand costs. We want to know if this telehealth intervention can reduce negative outcomes for family caregivers, but also if reducing those negative outcomes will have an impact on costs, including caregiver finances. We will look at direct expenditures on items such as in-home supports, but also at the amount of time (and the associated cost of that time) a family caregiver may devote to different care-related activities and if these costs decrease as a result of the intervention. Longer term, we want to know if this intervention can help reduce unnecessary nursing home level care.
More about Walt Dawson
In addition to his position at the OHSU School of Medicine, Walt Dawson is a Senior Atlantic Fellow for Equity in Brain Health with the Global Brain Health Institute (GBHI) at the University of California, San Francisco, and on the faculty at Portland State University’s Institute on Aging. He is the primary investigator (PI) for the evaluation of the Oregon Older Adult Behavioral Health Initiative, a state program which works to reduce gaps in services for older adults and people living with disabilities who have behavioral health needs. As a Somers Aging and Long-Term Care Research Intern at the U.S. Senate Special Committee on Aging in 2009, he worked on provisions of the Affordable Care Act (ACA) to increase access to long-term services and supports. Dawson was also a visiting scholar at the National Academy of Social Insurance in 2011, was elected to the Academy in 2014, and a “Torch Recipient” at the Academy’s 30th Anniversary celebration in 2017. He also currently serves as Chair of the Somers Internship Program Selection Committee.