Date of Award
Master of Science
Dr. Kenneth Perkins
Dr. William Burger
Dr. Lawrence Hlad
The American population is getting older, and with the aging of the population the prevalence of chronic illnesses will increase. Current social policies that are intended to assist elderly persons and their families in case of illness are no longer sufficient to meet that need, and will decline further as the number of older persons increases. This is especially true for patients who have developed dementia, including Alzheimer's disease, because dementias are still considered that "peculiar disease of the cerebral cortex" described by Alois Alzheimer in 1907 that seems not to fit any current classification. This study was designed to explore how the classification of dementia has influenced the social policies that govern a variety of institutions and systems, and the ultimate outcome for the provision of care for dementia patients and their care givers. Its purpose is to describe the current reality faced by dementia patients and their families. The focus of the study was an exploration of written policies, rules, and regulations that govern existing systems, and how such written rules affect the patients based on the classification of their disorder. After an exploration of written material and description of the resulting services, interviews were conducted to complement the previously mentioned material with the experiences of those who are charged with the delivery of care based on such rules. The findings from this study lend support to the following conclusions: l) the classification of dementias as mental illness can lead to involuntary psychiatric hospitalization or reduced reimbursement if treated on an outpatient basis; 2) the classification as deterioration with aging that requires support only results in lack of
formal support outside of institutionalization and almost no reimbursement by Medicare or Medicaid for treatment and care in home setting; 3) the seldom used classification as a physical illness allows for most but still insufficient support. All classifications frequently lead to the impoverishment of the patient which in turn often leads to institutionalization. It is concluded from this study that the classification and the social policies based on such classification have become dysfunctional for the original population of older and ill persons and their families, but have become functional for new industries, professions, and bureaucracies. Further studies should investigate how the policies can again become functional for the intended population, and whether re-evaluation of the classification for dementia can be a first step in that direction.
Pennington, Brigitte, "The Relationship Between the Classification of Dementia and Social Policy and Consequent Delivery of Services" (1995). Theses, Dissertations & Honors Papers. 513.