Wisconsin Dementia Care Redesign Shift Reimbursement 4 Meaningful Change

Wisconsin Payment Structure Lags Behind Dementia Care Redesign Initiatives

Dementia care redesign lists 3 primary initiatives

1.       Early engagement

2.       Prevent crisis events

3.       Keep at home

 

Dementia Continuum

 

Onset              IADL’s                                  ADL’s

    I-----------------I---------------------------------I

 

With onset symptoms are managed with tech sensors and recorded reminders

Cognizant of family’s tolerance for risk which moves support to scheduled staff visits

 

With dementia the elder’s needs present differently in a very predictable way.

The instrumental activities of daily living being more complex disassemble in the earliest phase of dementia.

 

With dementia the senior will stop bathing because they do not know how to work the shower long before they are physically functionally unable to bathe.

 

With dementia the senior will stop making toast because they do not know how to work the toaster long before they are physically functionally unable to make toast.

 

With dementia the senior will stop dressing in laundered varied outfits because they do not know how to choose appropriate wear long before they are physically functionally unable to dress.

 

With dementia the senior will stop shaving because they do not know how to work the electric clipper long before they are physically functionally unable to shave.

 

Assessment tools utilized do not capture these needs and effectively communicate the tasks to result in eligibility for reimbursed supportive care service.    Public and private pay sources deny claims until the senior’s experience is immersed in the later dementia phase where the (ADL’s) activities of daily living clearly demonstrate physical functional deficits.

 

Said another way – the medical delivery system does not claim the needs created from dementia until the later phase presentation of physical functional inability to perform activities of daily living.  The later phase dementia symptoms create physical functional needs described as activities of daily living which facilitate a medical pay source with reimbursed in home care.

The value based approach will require a shift in payment to conform to delivery that facilitates a more coordinated community management approach.  How does the State of Wisconsin create meaningful change by applying reimbursement to the services that support the important values embedded in the dementia care redesign outcomes. 

 

-          Early engagement

-          Prevent crisis events

-          Keep at home

Reimbursement must facilitate the earlier implementation of dementia focused services to attain the goals described with Wisconsin's redesign efforts.

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