"This is great news for people with
Alzheimer's disease and other dementias," said Stephen
R. McConnell, chief executive of the Alzheimer's Association.
"The new policy should eliminate a form of discrimination
against millions of people."
Neither federal officials nor advocates for
the elderly provided estimates of the cost of the new policy.
Experts said the direct cost to Medicare could be several
billion dollars a year. But, they said, some of the cost
could be offset by savings elsewhere in Medicare and Medicaid,
because the new services will enable patients to live longer
on their own, with greater ability to function.
The policy is set forth in a memorandum sent
late last year from the government to the companies that
review and pay Medicare claims. These companies have just
begun to put the change into practice.
The government gave no public notice of the
new policy, but it has already made a difference in the
lives of some people with Alzheimer's. Some patients have
received benefits that were once denied, and some medical
practitioners have secured payment for services that Medicare
once refused to cover.
The companies that review claims for the
government, under federal contracts, are known as Medicare
carriers. Most of them had programmed their computers to
reject claims for people with Alzheimer's and other types
of dementia. The new policy bans such computer software
instructions and says contractors cannot deny claims simply
because a person has Alzheimer's.
"Throughout the course of their disease,"
the memorandum says, "patients with dementia may benefit
from pharmacologic, physical, occupational, speech-language
and other therapies."
Patients' advocates, including the Alzheimer's
Association and the American Bar Association, had supplied
the government with dozens of research studies providing
scientific evidence that such therapies were effective.
The government said it changed its policy
because doctors and psychologists can now often diagnose
Alzheimer's in its early stages, when patients are most
likely to derive significant benefits from treatment and
therapy. While there is no cure for Alzheimer's, staving
off its worst effects can prolong a relatively normal life
and save money.
It is not clear why the government did not
publicize the new policy. Some officials apparently did
not want to acknowledge that the old policy was, in effect,
biased against people with Alzheimer's. When asked, a Medicare
official said the change was not announced because "we
saw it mainly as a technical matter for Medicare carriers."
Mr. McConnell of the Alzheimer's Association
estimated that 10 percent of people over 65 and nearly half
of those over 85 had Alzheimer's, a brain disorder that
causes loss of memory, changes in personality and behavior,
and a decline in thinking abilities.
Under the policy, Medicare will pay for more
therapy and outpatient services. Dr. Steven T. DeKosky,
a neurologist who directs the Alzheimer's Disease Research
Center at the University of Pittsburgh, said these services
would "keep people out of nursing homes," avoiding
costs that would otherwise be borne by the government, patients
or their families.
Kim A. Warchol, an occupational therapist
in Itasca, Ill., who specializes in the treatment of people
with Alzheimer's, said the new policy had major implications
for patients, their spouses and their children.
"People with Alzheimer's will be able
to live at home longer and avoid institutionalization,"
Ms. Warchol said. "Caregivers often assume that people
with Alzheimer's are helpless. But we focus on their remaining
physical and mental abilities, the things they can still
do, and we find that many patients can perform activities
of daily living if we provide appropriate cues or reminders
of how to get started. They can dress themselves or groom
themselves if you lay out their clothing or grooming supplies."
Margaret P. Norris, an associate professor
of psychology at Texas A&M University, said that while
Alzheimer's was irreversible and incurable, patients with
mild to moderate forms of the disease could benefit from
psychotherapy to help them cope with loss of memory and
with feelings of depression and anxiety.
"We encourage patients to keep a notebook
full of important information, like the names of their grandchildren,
which they might forget," Ms. Norris said. "In
later stages of Alzheimer's disease, it's common for patients
to yell and scream and become aggressive. That may be because
the environment is too noisy and distracting. We can sometimes
modify the patient's behavior by changing the environment."
The impact of the new policy is illustrated
by the experience of Jenni Lee Robins, 58, of Winter Haven,
Fla., who used it to get treatment for her father, Harry
H. Baker.
Mr. Baker, 78, has had Alzheimer's for eight
years. After he was hospitalized and admitted to a nursing
home last year, he received physical therapy, but it was
ended after the nursing home concluded that his condition
would not improve. He was hospitalized this year for pneumonia.
After learning of the new policy from a local
chapter of the Alzheimer's Association, Ms. Robins used
it to ensure that her father got "all the appropriate
therapies" — physical, occupational and respiratory.
"Daddy has improved tremendously because
of the therapies Medicare now covers," Ms. Robins said.
"He is in better condition now than before he went
into the hospital this year. After eight days in the hospital,
he lost the ability to walk, forgot how to walk. But after
nine weeks of physical therapy, he can walk again."
People with Alzheimer's live an average of
8 to 10 years after the condition is diagnosed.
Dr. Paula E. Hartman-Stein, a clinical psychologist
and founder of the Center for Healthy Aging in Kent, Ohio,
said: "Previously, in many parts of the country, if
a person had a diagnosis of dementia, the Medicare carrier
would just arbitrarily, as a blanket policy, not cover psychological
services. The new policy breaks down one of the major barriers
to providing mental health services to elderly people."
Christina A. Metzler, director of federal
affairs at the American Occupational Therapy Association,
said the new policy was "tremendously significant"
for patients. "In the past," she said, "a
diagnosis of Alzheimer's could prevent a patient from getting
Medicare coverage for therapy to treat other conditions
— a broken hip, a broken wrist or a stroke."
The new policy was adopted after two years
of lobbying by the Alzheimer's Association and the American
Bar Association's Commission on Legal Problems of the Elderly.
Leslie B. Fried, a lawyer at the commission,
used the Freedom of Information Act to get copies of the
local rules used by Medicare carriers in deciding whether
to pay claims. These documents, she said, showed that "people
with Alzheimer's were often being denied medically necessary
services."
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