Objective: To estimate the incremental cost of providing nursing home care for residents with Behavioral and Psychological Symptoms in Dementia (BPSD).
Materials and Methods: Statewide data from the 2000 Minnesota long-term care database were examined. In Minnesota, a nurse from the Department of Health’s Quality Assurance and Review Program evaluates the care needs of each nursing home resident annually. Residents are classified as either “dependent” or “not dependent” in each of eight activities of daily living (ADLs). Residents dependent in 0-3 ADLs are assigned to the low, 4-6 to the medium, or 7-8 to the high dependency category. This assessment is used to establish the reimbursement level for care. The reimbursement rate for each resident is determined by the assigned dependency category, and within each category either the need for special nursing care (e.g., decubitus ulcer, wound or ostomy care, tube feedings) or the presence of BPSD. The assessment identifies residents with dementia-related behavioral problems or symptoms (e.g., episodes of disorientation, hallucination, wandering, withdrawal) that require nursing home staff attention to the extent that their care needs are increased. In this study, data from the 1998 assessments for each resident were analyzed. Residents diagnosed with dementia were selected using ICD-9-CM codes (290.00-290.99, 331.00). Those with BPSD at the level that impacts their management were identified. Residents requiring special nursing care or in a high dependency, severe sub-category due only to a neurological disorder other than dementia were excluded. Per diem nursing home reimbursement rates were obtained from the Minnesota Department of Health and were used to determine the costs of caring for residents diagnosed with dementia with and without BPSD (2002 US$). Costs include room and board, as well as all nursing care. Physician costs are not included.
Results: 12,901 residents with dementia were identified, (mean age 86 years and 76% female). Over half these residents (57%) had BPSD that impacted on their care needs. The mean annual management cost per resident with BPSD is $44,500, 10% more than one without BPSD. The cost difference is in part due to differences in the distribution across dependency categories of patients with and without BPSD. Fewer residents with BPSD were in the low dependency category (18%), compared with residents without BPSD (32%). For those assigned to the low dependency category, the presence of BPSD carries an incremental cost of, on average, $2,553 per year per resident, for the medium $2,396 per year, and high $3,174 per year.
Conclusion: BPSD is common among nursing home residents with dementia and increased their need for care and the cost of providing care.
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