Toward a payment model for augmenting Adult Day Services (ADS) with caregiver support: costs, willingness, and...

The evidence-based Adult Day Services (ADS) Plus program, delivered by ADS staff to caregivers, offers dementia education, support, and strategies to manage care challenges and has been shown in randomized trials to decrease caregiver depressive symptoms and increase ADS utilization. This study examines costs, cost savings, and caregiver willingness to pay (WTP) and ability to pay (ATP) for this evidence-based program.

In a 34-site cluster-randomized trial (16 ADS Plus sites; 18 ADS-only usual care sites) involving 203 caregivers, we surveyed program delivery costs, payer-perspective costs (healthcare utilization, formal care/social services utilization), and societal-perspective costs (caregiver time + payer costs) at baseline and 12-months. Enrollees were caregivers who reported on their outcomes and those of the person living with dementia. Costs were calculated using unit costs or appropriate wage rates. We assessed mean per-dyad costs and the between-group difference in mean change in payer and societal costs from baseline to 12-months. Multilevel mixed models considered clustering, and caregivers' WTP and ATP were evaluated.

ADS Plus delivery costs were $433/dyad over 12-months. From the payer perspective, ADS Plus resulted in nonstatistically significant but policy-significant cost savings of $1,501 (95% CI: -$2,771 to $4,804). From a societal perspective, ADS Plus led to cost savings of $1,185 (95% CI: -$11,187 to $7,036). ADS Plus caregivers' median per-session WTP was $90 at baseline and $100 at 12-months, compared to $50 and $100 for usual care. ADS Plus caregivers' median ATP was $31.50 at baseline and $50 at 12-months, versus $25 at both timepoints for usual care.

Adult Day Services Plus yielded meaningful cost savings, though statistical significance was not achieved. Caregivers were WTP and ATP toward ADS Plus sessions, which could offset program costs. This study elucidates the financial implications of incorporating caregiver support into community-based dementia care programs.