In-home Dementia Screening Delivers Clinical Benefits While Expanding Patient Service Pathways

Home health providers are turning to dementia screenings as a standard part of health assessments – and are discovering meaningful clinical and operational benefits.

In-home dementia screenings facilitate earlier diagnoses and personalized care pathways, industry experts told Home Health Care News, and also identify potential candidates for additional in-home services.

While detecting dementia early can improve clinical outcomes, 80% of adults ages 65 to 80 have not been screened for cognitive issues in the past year, according to the National Poll on Aging. 

“In cases where there is some suspicion of cognitive impairment but no diagnosis on file, in-home screening can connect important dots for clinicians,” Neurotrack Co-Founder and CEO, Elli Kaplan told HHCN. “Not only do providers get the unique opportunity to observe patients’ functional abilities at home and connect with family members, but the right digital cognitive screening platform can also supply them with the documentation needed to take the next steps, rule out other causes, make referrals, formalize diagnoses, create care plans and direct patients and their loved ones to local resources and support.”

Neurotrack Technologies, based in Redwood City, California, develops digital cognitive health solutions that enable individuals to assess, monitor and strengthen their brain health, reducing the risk of Alzheimer’s and other forms of dementia.

Administering dementia screenings in the home can encourage patients to be more forthright.

Research from the National Institute on Aging suggests that patients are more likely to disclose cognitive concerns in a familiar, stress-free environment like home. Studies also indicate that patient-centered cognitive evaluations conducted at home can foster more open discussions and a greater willingness to pursue further assessments. If 88% of dementia cases were identified in the earliest stages, the U.S. could achieve $7 trillion in savings in medical and long-term care costs overall, according to research from the Alzheimer’s Association. 

Being in the home also allows clinicians to identify symptoms of cognitive impairment and other health determinants, such as difficulty following a conversation or excessive clutter, sources told HHCN.

Kaplan stated that integrating clinically-trusted cognitive screening tools into home health visits has the added benefit of identifying candidates for more comprehensive in-home services, such as dementia-specific care.

Providing dementia-specific services has helped some providers differentiate themselves from their peers. 

In-home dementia screenings can be conducted through various means, including the Self-Administered Gerocognitive Exam (SAGE), the Mini-Mental State Exam (MMSE) and virtual screenings offered by care organizations like Johns Hopkins’ MIND at home. 

“I’ve seen this strategy work to scale identification while boosting patient engagement, improving outcomes and well-being,” she said. “As the burden of dementia continues to grow, versatile cognitive screening technology that works as well in patients’ homes as it does in the clinic will be a key component of quality care for aging populations.”

A plan in action

Signify Health made the move to incorporate dementia screenings into its standard health assessments in October 2024. The provider administers Neurotrack’s cognitive health digital screener in a patient’s home, under the guidance of a clinician, during the organization’s in-home health evaluations (IHEs).

The results, including any findings of cognitive impairment, are then shared with the patient’s primary care provider (PCP), which Heidi Schwarzwald, Signify Health’s chief medical officer, said enables timely interventions, care planning and coordination.

“Screenings are routinely conducted as part of Signify Health’s IHE at no additional cost to the member,” Schwarzwald told HHCN. “The health plan or our clinicians can recommend cognitive screening, including digital cognitive screening, based on the member’s health records or the clinician’s in-home assessment. Members can also request cognitive screening.”

Dallas-based Signify Health, a CVS Health Company (NYSE: CVS), offers in-home health evaluations leveraging advanced analytics, technology and nationwide provider networks to create and power value-based payment programs.

The screening is self-administered, but a clinician from Signify Health assists the patient throughout the process, explaining the purpose and importance of the test. This digital test causes less frustration than traditional pen-and-paper cognitive health screening tests, Schwarzwald said, which can take up to four times longer to complete than a digital version.

“With the new digital screener, our Signify clinicians can objectively capture the cognitive health status of the member, which, along with the symptoms observed, can lead to a diagnosis,” Paymon Farazi, president of Signify Health, said. “By connecting the member back to care, they and their family can work with their PCP to develop care plans and get the treatment they need.”

When a Signify clinician engages a health plan member, they begin with a simple conversation, according to Schwarzwald. They often ask about the individual’s family or hobbies as a starting point. This approach helps form the foundation for a relationship and a meaningful visit.

The results are combined with other clinical assessments, including the individual’s ability to perform instrumental activities of daily living (IADL) and their diagnosis and medication history. Next, confounding factors are ruled out to accurately determine whether a member has mild cognitive impairment or dementia. The screening results are then shared with the health plan and the individual’s primary care provider (PCP) for further care planning.

“Supporting seniors as they age means not only helping individuals manage existing chronic conditions but also providing comprehensive preventive testing for both mental and physical health conditions,” Schwarzwald said.

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