Is Alzheimer’s care a waste of money?

elderly woman

The Alzheimer’s Association recently released a report that attempt to quantify the financial and personal burden of Alzheimer’s care.

… [M]edicare payments alone are almost three times higher for people with Alzheimer’s and dementia than for others age 65 and over; Medicaid payments alone are more than nine times higher.

“With the country facing unprecedented economic challenges and a rapidly aging baby boomer population, now is the time to address the burgeoning Alzheimer crisis that triples healthcare costs for Americans age 65 and over,” said Harry Johns, Alzheimer’s Association CEO.

“It is widely understood that addressing health care is key to the country regaining its financial footing,” continued Johns. “And there is no way this can be done without improving Medicare and Medicaid which Alzheimer’s directly impacts…”

The report of the Alzheimer’s Association assumes that the enormous cost of Alzheimer’s care is a morally necessary burden, but it’s far from clear that the assumption is justified. The report ignores the most fundamental question: Is Alzheimer’s care a waste of money?

The report is quite clear on the financial burden to taxpayers and insurance companies, and the personal burden on caregivers. Alzheimer’s boosts the total cost of healthcare for the elderly from $10, 603 to $33,007 per year, each and every year. As the above excerpt from the report indicates, taxpayers bear the bulk of that increase.

The personal toll is equally high:

… According to Facts and Figures, in 2008, nearly 10 million Alzheimer caregivers in the U.S. provided 8.5 billion hours of unpaid care valued at $94 billion. In addition to the unpaid care families contribute, the report also reveals that Alzheimer’s creates high out-of-pocket health and long-term care expenses for families.

Alzheimer’s care doesn’t simply cost more. In a healthcare system that cannot afford to provide care for all its citizens, Alzheimer’s care diverts massive amounts of resources away from caring for the young and curable toward caring for the elderly and incurable. As a matter of justice, such a diversion cannot be defended. Every individual deserves the opportunity of a healthy childhood, and, indeed, Alzheimer’s patients have by definition already survived childhood. The moral claim of children carries far more weight than that of the elderly who have already lived a complete life.

I’m hardly the first person to raise this question. As I wrote last fall, British medical ethicist Baroness Warnock, noted for her willingness to address controversial issues stated in an interview in the TimesOnline:

“If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service,” she said…

No one could accuse her of being reticent. The Baroness elaborates:

“With 700,000 people suffering, it really is a problem that has got to be faced. The fact is we have to take a fairly unsentimental view. Care may get better, but if so, at huge cost. There’s no point saying we ought to spend more, because we can’t.

“People talk about it as if the only respectable motive for wanting to die is for your own sake. But it seems to me just as respectable to want to die partly for the sake of others, and for the sake of society.”

The Baroness gets to the heart of the matter and does not flinch:

“If society has an obligation to look after them, I really want to know what for? For whose benefit? It’s not for the benefit of society, as the person is not in a position to contribute, and it’s not for the benefit of the person, so it must be something abstract about our being unable to bear saying ‘We can’t do this any longer’.

“If I were in a state of acute misery or pain, or an insufferable degree of dependency, I don’t see why I should feel an obligation to others to let them keep on changing my nappies.

“It sounds very callous, but most people I know dread being kept alive in a state of mental incapacity, more than cancer or anything else. If so, then I don’t see why society should force them to go through with something they fear the most.”

Her questions are the key questions: If society has an obligation to look after them, I really want to know what for? For whose benefit?

I can think of a few more questions:

Does anyone benefit from our perverse insistence on indefinitely extending the lives of the senile elderly? Are we fulfilling the wishes of the elderly people involved? Would they want to be kept alive, incapacitated, incontinent, and incapable of participating in the most basic tasks or social interactions? It’s difficult to imagine that anyone would want that.

Does it make any sense to spend a major proportion of the healthcare budget on people who are virtually insensate and will never recover? Does it make any sense, financially or morally, to divert resources from young people, who may not even have access to the healthcare system, to elderly people who have already received a lifetime’s worth of benefits from that same system?

The Alzheimer’s Association, not surprisingly, starts with the assumption that we can and should continue to provide care regardless of the cost. Considering that it is we the taxpayers who are paying, it is both financially and morally incumbent upon us to question that assumption.

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