Informal unpaid caregiving for alzheimer's disease and other dementias and its relationship with long-term care Medicare nursing home expenditures

Alzheimer's disease (AD) and other dementias create substantial burden on the United States economy. In 2010, the total Medicare nursing home expenditures for long term care (LTC) services was almost $28 billion, while caregivers supplied a projected 17.4 billion hours of uncompensated care with an estimated economic value of $210 billion. Data from the Alzheimer's Association “Alzheimer's Disease Facts and Figures” and Centers for Medicare & Medicaid Services were used to conduct a cross-sectional analysis to assess if an association exists between the economic value of unpaid care and LTC Medicare nursing home expenditures among the 50 states and the District of Columbia for 2010. Per capita aged 75+ was calculated using individual state population data from the 2010-2011 Census Bureau Current Population Survey. Fiscal capacity, fiscal effort, and federal generosity for the states and the District of Columbia were calculated as possible sources of variation for Medicare nursing home expenditures. Clustering effects and regional variation were revealed. To some degree, rural states have lower Medicare expenditures and display lower levels of fiscal capacity and fiscal effort, while a cluster of rural and southern states reveal higher economic values of unpaid care. In contrast, the northeastern states display higher spending on Medicare nursing home care and lower levels of federal generosity. The relationship of informal caregiving and its utility to offset Medicare nursing home expenditures offer insight to health policies surrounding long term care.