Home may not be best for dementia care, research says

Families of aging relatives with dementia may want nothing more than to keep them out of institutional settings, and in fact most advanced dementia patients live at home.

But the idea may not be as good as it sounds.

Older Americans living at home with advancing dementia may suffer more pain and have more unmet medical needs than those living in nursing homes, according to a new study.

Those at home had more chronic conditions, were troubled by more pain and had more falls or worries about falling than did nursing-home residents. They also were more likely to have anxiety and less likely to be in good or excellent health.

“People with dementia benefit from consistent and predictable environments and caregivers,” said Krista Harrison, assistant professor and researcher at the University of California, San Francisco division of geriatrics. She was first author of the study.

But, she added, “Rates of nursing home use are declining because they are expensive and people generally prefer the familiarity of home.”

A semi-private room in a nursing home costs $82,000 a year on average in the United States, according to government statistics. Medicaid may cover some of that expense for those who qualify.

Assisted living, with housekeeping and help with personal care but without the medical care of a nursing home, costs about half as much, at about $44,000, on average.

The study’s findings should be taken as a call to improve and expand home-based care, not to move people out of their homes, the authors said.

“Some people with dementia who live at home receive home-based primary, geriatric or palliative care, but many more likely do not,” Harrison said.  “There is an urgent need for these services … to become widely available.”

Home-based care programs are linked to less depression, fewer emergency hospital visits and fewer hospital stays, and they have a positive impact on caregivers’ health, the research said.

Yet only one in eight home-based patients gets such care, it said.

The study looked at 728 adults over age 65 with moderately severe dementia who lived at home, in residential care facilities, or in nursing homes.

It said 71% of those at home were bothered by pain, compared with 59% of those in nursing homes. Of those at home, 67% had fallen in the previous month or were concerned about falls, compared with 50% of the nursing-home residents.

Over the five-year course of the study, between 2012 and 2016, an estimated 3.3 million older adults developed dementia in America, the research said. Of those, about two-thirds received care at home, while the rest lived in residential care or nursing homes.