Ghosts of Home Care: Medicare's Neglect of Alzheimer's Disease Patients and Evidence-based Practice

Public health has devoted limited research and policy action to Alzheimer's disease (AD) (Satariano, 2006). The paper presents results of interviews of 72 home care social workers and nurses' (1) knowledge of evidence-based interventions for persons with Alzheimer's disease and their caregivers (Laura Gitlin & Mary Mittelman's interventions) and (2) strategies used to cope with organizational constraints on providing care for identified needs of these clients. The study results indicate: (1) Only 10% of social workers and 23% of nurses were aware of the interventions, none of which are Medicare-covered and (2) coping strategies were predominantly conformist (i.e., following corporate guideline), with less than 20% innovating or challenging the guidelines. The paper also presents a proposed policy change to create palliative care coverage for the AD population in the Medicare home health benefit.