After an Alzheimer's disease diagnosis, patients and their families face ongoing questions about the progressive condition's effect on memory, thinking and behavior.
Starting this summer Medicare patients in Washington and three other states with parts A and B can talk to a dementia expert for regular video or phone chats at no cost. The consults are designed to include family caregivers, often spouses or adult children.
The navigation service is new through a partnership of the Alzheimer's Association and Seattle-based company Rippl Care. Funded by the Centers for Medicare and Medicaid Services, it's in Washington, Texas, Illinois and Missouri as part of an eight-year pilot program, Guiding an Improved Dementia Experience model.
At any dementia stage, Rippl provides a care navigator who teams with a social worker and nurse practitioner to respond to issues ranging from medication changes to aggressive or confused behaviors.
Spokane has strong ties to Rippl's January 2023 start when the company primarily reached this region's residents to test its model, said Rippl CEO and founder Kris Engskov.
"You've got a lot of folks who live in rural areas who depend on Spokane, so we really wanted to test the model out there," Engskov said. "We worked with a number of local providers in Spokane, and still are.
"When we started, and today, we can take most insurance across the state among the major insurers. We have two team members who live in Spokane, and one of our first good opportunities was working with local neurologists there to help their patients. We were helping follow patients home and helping them stay at home."
Rippl care navigators can spend more time with the patient and caregiver on what to expect with Alzheimer's and other dementias, how to navigate memory and behavior changes and ways that the disease might progress, he said.
"Because unfortunately over time, you are going to decline," Engskov said. "There is no cure, so how does your family set you up to remain as healthy as you can be at home? There is a lot of evidence that people who stay home successfully are healthy for much longer."
Under the Medicare pilot, people can self-refer to Rippl, said Nicci Noteboom, with the Alzheimer's Association Washington State Chapter. Rippl works solely by virtual or phone appointments, but that type of support also helps people living in rural areas, Noteboom said.
If people don't qualify, the association has one-time care consultations.
The patient and caregiver at first will have frequent visits with a Rippl care navigator so that all can better understand needs, symptoms and resources, Engskov said. After that, the navigator visits typically are once or twice a month, unless the family has a need.
Engskov said the Rippl dementia-trained staff also can diagnose dementia.
"There are a series of assessments that can be done virtually, and we'll work with your primary care doctor," he said.
Rippl collaborated with McLean Hospital, the largest psychiatric affiliate of Harvard Medical School, to build a training program for its care navigators. Many of them had worked in care management with some dementia experience before taking the enhanced training, he said.
"They get 60 hours of in-depth training in dementia so they can help a family navigate the disease and be the expert," Engskov said.
The care navigator can give tips on how to deal with dementia-related behaviors, including agitation or aggression, he added. Knowing how to deal with such behaviors can prevent trips to emergency rooms.
"The person gets agitated or aggressive, and the family member can't reach anybody, so they go right to the emergency department," he said. "If it's truly not an emergency, the ED is the worst place you can be."
Often, family caregivers haven't encountered dementia before, he said. They might inadvertently provoke the dementia patient, such as if that person talks about something that isn't quite accurate, and the caregiver says, "That's just not true."
"Our care navigators often work with caregivers to give them tips and tricks to help them understand what the disease is doing at all stages and to help the patient not become agitated.
"In a lot of cases, they can be relatively simple, but if you've never been exposed to them, you may not know."
While Rippl navigators help connect families to Alzheimer's Association support groups and resources, another key part of the new GUIDE pilot is to find respite care to fill in for the family caregiver, Engskov said.
"Respite care is one of the great benefits of this GUIDE model, that anyone in the program gets a $2,500 respite benefit annually," he said.
"This means if you are a caregiver, we arrange for someone to come to the home and fill in for you as a caregiver for a period of time through the GUIDE program."
There are still a few ZIP codes in the state where respite care is difficult to find, but Rippl can connect people to that type of service in a majority of locations, he said. "We're working at being in every ZIP code, but we're in 95% of them today."
He declined to say how many patients in the state use Rippl Care, but he said about 40% live in rural ZIP codes. "About a quarter of our business is east of the Cascades in the state of Washington."
A care navigator will know a patient's medical history. In a recent example, he said a patient couldn't get any sleep.
"That is one of the most difficult symptoms of dementia, and if you don't sleep or sleep intermittently, you will have a tough time staying healthy," Engskov said.
"This person and caregiver couldn't get in to see their primary care doc for six weeks. We could step in the next day and were able to adjust medications to help that patient sleep."
He said that in such cases, the nurse practitioner will work with the primary care's office to make medication changes.
The overall dementia care navigation service includes the following:
—An assigned care navigator to coordinate care and develop a care plan with input from a social worker and nurse practitioner.
—Clinical support including medication management and counseling.
—Access to Alzheimer's Association resources and education.
—24/7 helpline.
For more information, go online to ripplcare.com/alz, call (855) 271-2662 or email dcns@alz.org.
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