Experts predict that the number of men and women with Alzheimer’s disease will triple in the next 30 years, with about one new case every 68 seconds. Dementia and Alzheimer’s disease affect the individual – and his/her entire family – in ways we can’t possibly summarize in this short blog. You can read more here.
Fortunately, Medicare covers a specific visit for providers to make a thorough assessment of a beneficiary’s cognitive impairment and develop a care plan to ameliorate the decline and maintain the individual’s quality of life. Conducting a basic cognitive assessment is a requirement for the Annual wellness Visit (AWV) but if the provider detects cognitive impairment, he or she may perform a more detailed assessment and develop a care plan. The key is that the assessment and care plan must occur in another visit.
The cognitive assessment includes a detailed history and exam, and must include input from an independent historian, such as a parent, spouse, guardian or other person who can provide a reliable history when the patient is not able to. The assessment takes 50 minutes in a face-to-face or telehealth (for now) appointment with the patient and independent historian to:
- Examine the patient and specifically observe cognition. This should include the use of standardized tests to stage any dementia and screening instruments to evaluate for contributing neuropsychiatric and behavioral issues like depression and anxiety.
- Review the patient’s history and chart records, in addition to reviewing high-risk medications
- Conduct a functional assessment of activities of daily living (basic and instrumental), including the ability to make decisions. An assessment should include questions about home safety and motor vehicle operation
- Assess the existence of caregivers and other support, as well as their ability to provide the needed care. This is also a good time to discuss advance care planning and any palliative needs.
The information collected by the clinician is synthesized into a care plan that should include plans to address symptoms of cognitive issues, functional limitations and referral for community or other services for the individual and the caregiver, as needed.
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