Dementia is not managed only in physicians’ offices, hospitals or memory care communities. Most dementia care happens in homes and neighborhoods—supported by family members who may have little preparation for the complex responsibilities they have assumed.
This makes dementia more than a clinical issue. It is a community-wide challenge requiring health plans, healthcare providers, aging-service organizations and trusted local partners to work together.
Health plans are uniquely positioned to help lead this work. They have the data, member relationships and financial incentives to identify needs earlier, connect families with support and build stronger dementia-capable communities.
The need for action is accelerating. According to the Alzheimer’s Association, nearly 13 million Americans provide unpaid care for someone living with Alzheimer’s disease or another dementia. In 2026, health and long-term care costs for people living with dementia are projected to reach $409 billion. Medicare and Medicaid are expected to cover approximately $263 billion—or 64%—of those costs.
Without meaningful change, annual dementia-related health and long-term care spending is projected to approach $1 trillion by 2050.
People living with dementia also experience disproportionately high healthcare utilization. Alzheimer’s Association data show that older adults with dementia have more hospital stays, emergency department visits and skilled nursing facility admissions than older adults without dementia. These patterns are often intensified by coexisting chronic conditions, medication challenges, behavioral symptoms and care transitions that families are not adequately prepared to manage.
Behind many of these encounters is an overwhelmed care partner trying to make the best possible decision without sufficient information, skills or support.
A dementia-capable community recognizes cognitive change, responds appropriately and connects people to meaningful support.
Its workforce understands how dementia can affect communication, behavior, mobility, decision-making and daily activities. Its families know where to turn for education, respite, care navigation and crisis support. Its healthcare and community organizations share responsibility for helping people remain safe, included and supported.
For health plans, building dementia capability means extending engagement beyond traditional care management. It requires creating trusted pathways between members, care partners and the organizations already serving their communities.
These partners may include Area Agencies on Aging, Aging and Disability Resource Centers, senior centers, faith communities, home care organizations, libraries, first responders, community health workers and dementia-friendly coalitions.
Family care partners are often the largest and least-supported part of the dementia care team. They observe changes, coordinate appointments, manage medications, respond to behavioral symptoms and make decisions during moments of uncertainty.
Yet they may not identify themselves as caregivers. If health plans wait until a hospitalization, serious safety event or placement crisis to engage them, one of the most important opportunities for prevention has already been lost.
Early caregiver identification should therefore be treated as a quality, engagement and cost-management strategy.
Once identified, care partners need more than a resource list. They need practical education that helps them:
Education turns information into action. It can also build the confidence and trust needed for caregivers to engage with health plan services before a crisis occurs.
No single educational intervention guarantees savings. However, evidence shows that caregiver education, skills development and navigation—when incorporated into coordinated dementia care—can improve outcomes and create measurable financial value.
The Department of Veterans Affairs’ REACH VA program combines education, support and caregiver skills building. A published evaluation found that REACH was associated with 33.6% lower total VA healthcare costs for participating care recipients. Earlier evaluations also demonstrated caregiver benefits at a cost of less than $5 per day.
The Johns Hopkins MIND at Home program connects people living with dementia and their families with community-based care coordination. Researchers estimated five-year net Medicaid savings of $7,052 per beneficiary, with a 1.12-fold return on investment. Much of the savings came from slower growth in inpatient and long-term nursing home use.
Another randomized caregiver counseling and support intervention produced a 28.3% reduction in the rate of nursing home placement and delayed placement by a median of 557 days.
These findings do not suggest that education works in isolation. They show that informed and supported caregivers are a critical component of effective dementia care management.
The Centers for Medicare & Medicaid Services is reinforcing this direction through the Guiding an Improved Dementia Experience—or GUIDE—Model. GUIDE requires participating organizations to offer caregiver skills training, information about dementia, support services and access to community-based resources.
CMS expects this comprehensive approach to improve quality of life, reduce caregiver strain and lower Medicare and Medicaid expenditures by delaying nursing home placement and reducing avoidable hospital, emergency department and post-acute care use.
Health plans do not need to build every service themselves. Their most effective role may be to activate and connect the resources that already exist.
A strong community strategy can include:
This transforms dementia capability from a stand-alone initiative into a connected community model.
A dementia-capable community begins when people understand that behavior is often communication—and that the way others respond can change the experience of care.
Dementia Live® provides an evidence-informed, experiential approach to building that understanding. Through a structured experience and facilitated Empowerment Session, participants gain insight into the sensory, cognitive and emotional challenges a person living with dementia may encounter. They then connect that insight to practical changes in communication, care and support.
For health plans, Dementia Live can help equip employees, providers, community health workers, care partners and local organizations with a shared foundation for dementia understanding. Delivered through AGE-u-cate’s growing national partner network, it creates a trusted entry point for caregiver engagement, workforce development and community education.
Health plans have an opportunity to move dementia care upstream—before confusion becomes crisis and before caregivers become overwhelmed. By activating informed care partners and dementia-capable community networks, plans can improve the member experience while supporting better outcomes and more sustainable care.
One Experience. One Conversation. One Connection at a Time.