What’s the solution for the looming dementia wave?
Currently, there are no treatments for dementia. Money is flooding into drug discovery in the pursuit of greater understanding and a possible treatment, but in the short to medium term there is little that can be done but provide care and attempt to delay the severity.
But care is expensive, with patients needing on average four hours of individual care per day, stretching an already depleted workforce who don’t necessarily have the right training. Globally, the annual cost of managing it through care services is estimated to be as much as $1 trillion, and this could double to $2 trillion by 2030.
So what can be done?
One investor in the sector tells us that all that can be done is to “build, build, build” to cope with the looming demand.
A natural reaction, but hardly an ideal solution to the problem. In some markets like the UK, where facilities are often retrofitted large houses or old and tired, this might be needed, but it certainly isn’t a quick solution. New build facilities take on average four years to complete including the issuance of licences.
The solution calls for large coordination from multiple stakeholders, and huge amounts of upfront investment and will take several years to bear fruit.
Christian Jung, Partner at SV Health Investor’s Dementia Discovery Fund thinks that finding treatment needs a radical idea. One such radical line of thinking that he feels has potential is to hit the reset button on the microglia (the central nervous system’s immune cells), killing them off one by one until they regenerate. He also calls for more attention from governments and especially payors to finance drug discovery in an attempt to bring a faster end to rising costs.
What about prevention? The evidence here is new and so there is some debate over the point of prevention. According to Marc Saillon, CEO, Almage Alzheimer’s Centres, a specialist Alzheimer’s care group in France, funding early diagnosis is pivotal. He points out that the earlier we catch the disease, the more we can learn about it and the better chance we have of getting the patient the right care at the right time.
There is evidence to suggest that lifestyle, in particular keeping the brain active through education, work, social interaction, physical activity, and diet have an impact on delaying the onset of dementia. As many patients are staying home longer, homecare providers need to play a much bigger role and adapt their skillset and offer to keep patients home for longer. This will require upskilling of homecare staff, but presents a growth market for homecare providers.
With no cure, there is a time when it is far safer for a patient, and their families, to be placed in a care home. At present, not many specialised facilities exist. There are a few, such as Almage in France which operates six dedicated Alzheimer’s nursing homes and consults globally on building and operating facilities and home care services, including in China. In Luxembourg, the Alzheimer’s Association owns and operates six day centres and a residential facility along with providing care home services. In Australia, a social impact initiative created the Korongee Dementia Village, an assisted living community working in partnership with the University of Tasmania.
Most currently end up in non-specialised facilities. Alberto Fernandez, CEO of European REIT Healthcare Activos thinks that facilities should be “divided into smaller ‘homes’ or sectors of 15-25 beds to specialise the residents and the workers, because there are significant differences in caring for physically dependent residents vs. palliative care vs. dementia or Alzheimer’s.” There is a huge quality bonus from following this strategy, as it allows the model of care to be adapted for patients in a more affordable way. HBI Intelligence and Connect members can read more on this in our recently published European Healthcare Property report.
Saillon thinks that there is enough capacity already in the system. In France, he estimates that a small percentage of new beds will be needed but the solution is actually to rethink the current infrastructure. Whilst bed occupancy in general dropped, dementia care units are completely full. As patients present later and later their average length of stay will be shorter, nursing homes need to rethink their strategy and setup. He thinks that the future nursing homes will be majority dementia beds. On the workforce side nursing homes will also need to employ new specialists, including psychologists (already the operating model in France). Saillon doesn’t think that it will require more nursing staff but simply more specialised training to upskill carers to deal with the new complexities.
Big questions still remain about who will drive this change and who will ultimately fund it. For providers and payors, there are benefits in specialisation. Will we see more of this and how fast will it take off?
We would welcome your thoughts on this story. Email your views to Lee Murray or call 0207 183 3779.
