Dr. Sarah Toevs and Trina Stop presented on access to support and care for individuals with dementia in behavioral crisis.

1. Closing the Gap: Access to
Support and Care for Individuals
with Dementia in Behavioral Crisis
Research and Policy Initiatives
2017 Idaho Summit
Prevention of Abuse and Exploitation of
Vulnerable Adults
Sarah Toevs and Trina Stolp

2. • Review of Literature
• Ada County Paramedic Call Records
• Focus Groups and Interviews
• Social Workers (Mobile Crisis and Hospitals)
• County Prosecuting Attorney

3.  Dementia and associated
conditions “grossly
under-coded”
◦ failure to diagnose
◦ limitations of the coding
system
 no billable code

4.  Costs of care almost
double
◦ out-of-pocket costs for
informal and formal care
◦ formal care for dementia
$61,522 vs $34,068
◦ informal care $83,022 vs
$38,272
National Institutes of Health, 2015

6. Communication
with
Policymakers

7. Primary Concerns
Mobile Crisis Unit:
“Our goal is to try and get them a guardian.
Often times the ones we get, we get because
there is no one able to be their guardian. We
spend a lot of time chasing down
possibilities.”
“Our system likes to put everyone in little
boxes. But the fact of the matter is, you can
have dementia and a mental illness, a
substance abuse problem, and be a sex
offender. And where do you go? Nowhere.”

8. Primary Concerns
Hospital:
No long-term solution
Inability to find facility willing to take the
patient
Guardianship process needs to be
streamlined and cost less

9. Where do calls come from?
Mobile Crisis Unit:
Majority are family and police. Others from
care facilities, EMS, and clients/patients
“Clients themselves will call. Lots of clients
start to recognize they are falling into
dementia, in their moments of clarity.”
Hospital:
Physician offices, police, and family.

10. Why do situations escalate to a crisis?
Mobile Crisis Unit:
•Lack of education
“Most of the time, caregivers over-extended
and don’t realize it, until it is too late.”
Hospital:
•Lack of training

11.  What are your primary concerns?
 Where are the calls for help coming from?
 Why do you think situations escalate to a
crisis?

12. Problem Statement:
Idahoans suffering from Alzheimer's disease and
related dementias (ADRD) whose behaviors put them
or others in danger are often not able to access the
appropriate care services they (and their caregivers)
need.

14.  Initiative #1: Increase access to Behavioral Care
Units (BCUs) within Skilled Nursing Facilities for
people with ADRD who are experiencing
behavioral issues (there are currently not enough
of these units to meet an increasing demand)
 Recent Progress: In May, the Dept. of Health &
Welfare approved a temporary rule change to
Idaho Code which breaks down a significant
barrier to the development of new behavioral care
unit beds (effective 9/1/17)

15. Initiative #1 – Next Step: Presentation by
Idaho Dept of Health & Welfare to the Idaho
State Legislature (2018 session) to make the
temporary rule change permanent

16.  Initiative #2: Increase access to emergency
behavioral health care for people with ADRD
whose behaviors put them or others (e.g., their
caregivers) in danger
 Recent Progress: A Stakeholder’s group has
been meeting for the past year and decided to
develop an entirely new involuntary hold statute
specific to meeting the needs of people suffering
from dementia (and the needs of their caregivers)

17. Initiative #2 – Next Steps:
a) Evaluate the clinical and administrative
processes required to support the new
statute;
b) Meet with Stakeholder’s group to get final
input on statute and processes;
c) Meet with Judiciary Committee Chairs;
d) Present to the Idaho State Legislature
(2018 or 2019 session)

18.  Initiative #3: Increase access to quality care in
Assisted Living Facilities (ALFs) for people with
ADRD who are experiencing behavioral issues
 Recent Progress: Ongoing meetings with Idaho
Commission on Aging, Dept. of Health & Welfare
and ALF administrators to discuss a potential
“endorsement” model for ALFs whose staff meet
specific dementia care training requirements

19. Initiative # 3 – Next Step:
a) Ongoing work with key stakeholders
(RALFs, Lic & Cert, and Medicaid) to help
develop a model that encourages/incentivizes
ALFs to meet dementia care staff training
standards

20.  Guardianship process
 Opportunities for collaboration
 Other?