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Dementia care needs will far surpass physician, caregiver numbers in Iowa


A new report from the Alzheimer’s Association warns that Iowa’s shortage of dementia care specialists, geriatricians and direct patient care workers will significantly worsen over the next several decades as the prevalence of Alzheimer’s increases in Iowa and nationally.

The association’s 2022 Alzheimer’s Disease Facts and Figures report provides an in-depth look at the latest statistics and information on Alzheimer’s prevalence, incidence, mortality, costs of care and impact on caregivers across the country and in Iowa.

A state-by-state analysis in this year’s report found that Iowa is among 12 states that would need to increase the number of practicing geriatricians at least fivefold to care for those projected to have Alzheimer’s dementia in 2050. The states would need to increase the number of practicing geriatricians 13-fold to care for those projected to need broader geriatric care.

According to the report, an estimated 66,000 Iowans had Alzheimer’s in 2020, and that figure is expected to increase by 10.6% to 73,000 with the disease by 2025. Nationally, more than 6.5 million Americans have been diagnosed with Alzheimer’s, meaning the disease afflicts about 1 in 9 Americans over age 65. An estimated 200,000 Americans younger than 65 have early onset dementia.

Other key findings include:

?  In 2021, there were 26 practicing geriatricians in Iowa. It is estimated that a 446% increase in practicing geriatricians is needed by 2050 to meet the care needs of Iowa seniors living with Alzheimer’s in 2050.
?  Twenty states, including Iowa, have been termed “dementia neurology deserts,” meaning they are projected to have fewer than 10 neurologists per 10,000 people with dementia in 2025.
?  From 2016 to 2026, the demand for direct care workers nationally is projected to grow by more than 40%, while their availability is expected to decline. In 2018, there were 19,490 home health and personal care aides in Iowa. The number of these workers will have to increase 34% by 2028 to meet the growing demand of Iowa families.

The physician and direct care worker analysis was a special supplement in this year’s analysis, said Doug Bickford, executive director of the association’s Greater Iowa Chapter.

“This is the first time we’ve had specific, concrete data [on the health worker shortage], though I’ve heard many stories in the field,” he said. “This report puts some alarming statistics behind it. It’s definitely something we hope to raise awareness of.”

Bickford said recent federal funding provided through the American Rescue Plan Act to the Iowa Department of Human Services should help to begin bridging the workforce recruitment gap, in part by working to standardize regulatory requirements for direct care workers across state lines.

The federal dollars will be used to modernize and expand the Direct Care Worker Registry to include not only certified nursing assistants who work in nursing homes, but all other direct care workers as well, he said. In addition, the expansion would include credential portability for workers and establish a public portal of caregivers that employers and family caregivers can access.

Currently, direct care workers in Iowa who earn credentials for caring for dementia patients can’t take that certification with them if they take a position at another care facility. “This is good news, but it’s probably one-tenth of 1% of what needs to be done to address this shortage,” Bickford said.

The high annual turnover rate of direct care workers in Iowa — 64% — must also be addressed, he said. “How can you possibly function in that environment? It’s dysfunctional, is what it is. These folks are hurting — they’re overworked and underpaid.”

Additionally, the shortage of geriatricians and dementia specialists hampers efforts to increase early detection and treatment, Bickford said. The new report also found that only 40% of Americans say they would talk to their doctor if they were experiencing mild cognitive impairment. People should not be afraid to ask their physician about memory loss they may be experiencing, Bickford said.

“If we can get these people diagnosed early, that enables that person to go through a care plan and to find clinical trials. These are the reasons we find that early diagnosis is key.”

The Alzheimer’s Association proposes four broad efforts to improve the current situation:

• Promote greater public awareness by leveraging awareness campaigns and community-based disease education programs.
• Improve ease of use and uptake of cognitive assessments in the primary care setting.
• Expand primary care physicians’ ability to diagnose cognitive impairment, including mild cognitive impairment due to Alzheimer’s disease.
• Bolster public and primary care physician awareness of and patient participation in Alzheimer’s disease-related clinical trials and research.

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