The document discusses the future financial needs for dementia care, emphasizing the necessity for increased spending to meet the rising demand. It outlines key strategies, including reducing dementia incidence through healthier lifestyles, ensuring adequate care financing, and promoting effective and efficient spending on care. The presentation calls for innovative financing solutions and a shift from 'bad' to 'good' costs in dementia care management.

1. How can we afford to meet the
future needs of people with
dementia and their carers?
Presentation to the Westminster Health Forum Keynote Seminar
“Improving outcomes in dementia care: integration,
personalisation and the Dementia Challenge”
25th November 2014, London
Adelina Comas-Herrera
Personal Social Services Research Unit (PSSRU)
London School of Economics and Political Science
a.comas@lse.ac.uk
@adelinacohe

2. The future is by definition uncertain…
… but one thing we know is that we will need to
spend much more on the care of people with
dementia than we are spending today.
2

3. How can we afford to meet the future needs of
people with dementia and their carers?
1. Find ways of decreasing the future numbers
of people affected by dementia
2. Ensure we have adequate care financing
mechanisms
3. Make sure that we “spend well” on care

4. 1. Decreasing the future numbers of
people affected by dementia
• Helping/encouraging people to adopt
healthier lifestyles to reduce the risks.
• Better management of other chronic health
conditions.
• Finding a disease-modifying treatment!

5. 2. Ensuring we have adequate
financing mechanisms (1)
• 2/3 of the £26.3 billion cost of dementia in UK
shouldered by carers and people with
dementia (Dementia UK 2014, published by
the Alzheimer’s Society).
• Public expenditure on social care has not been
keeping up with increased need*
*Between 2005/6 and 2012/13, after standardising for changes
in need it has been estimated that net social care expenditure
decreased by almost £1.5 billion, as a result of reductions in
coverage: Fernandez J-L. Snell T. and Wistow G. (2013). Changes
in the Patterns of Social Care Provision in England: 2005/6 to
2012/13. PSSRU Discussion Paper 2867.
http://www.pssru.ac.uk/archive/pdf/dp2867.pdf

6. 2. Ensuring we have adequate
financing mechanisms (2)
• The care cap being implemented in England should help
protect individuals and families against catastrophic costs
of care…
• But it does not bring an additional source of funds to social
care, which will continue to depend on (increasingly
constrained?) taxation revenue.
• If public funding does not keep up with need, people with
dementia and unpaid carers will have to pick up an
increasingly large share of the costs...
Could we find an additional source of funds that guarantees
risk-sharing, equity and universal coverage?
Perhaps it is time to reconsider social insurance?

7. 3. Making sure we spend well on
dementia care (1)
• Martin Knapp makes distinction between “good” and
“bad” costs of dementia*:
• “bad costs: care and treatment due late or missing
diagnosis, or unavailability of good quality, or because
of an unplanned crisis admission into hospital, or
breakdown in community support resulting in earlier
admission into a care home than necessary”.
• “good costs: Appropriate and effective treatment and
care responses to needs of individual and carers,
following consultation around their preferences”.
http://www.pssru.ac.uk/blogs/blog/what-does-dementia-
cost/ by Martin Knapp

8. 3. Making sure we spend well on
dementia care (2)
• We can use evidence from research to help shift the
balance from bad to good costs.
• Modelling Dementia outcome and costs project:
ESRC/NIHR funded collaborative project.
– Systematic review of effective and cost-effective
interventions in dementia care
– Modelling the impact of widely adopting these
interventions on the future outcomes for people with
dementia and their carers, and the costs associated with
their care.
– For more information: http://www.modem-dementia.
org.uk/, follow us on twitter at
@MODEMproject