Keeping Alzheimer’s Patients at Home Longer: A RHT Sustainability Strategy States Are Overlooking

The Rural Health Transformation Program (RHTP) will only accelerate as funding is announced. For many states, moving from planning to execution, 2026 already feels more like a sprint. Besides determining the best ways to staff and manage this new program, they will soon be forced to answer questions like this one: how will these investments translate into long-term sustainability for Medicaid programs?

One of the clearest, yet most overlooked answers could lie in Alzheimer’s and dementia care.

Across rural communities, Alzheimer’s and related brain health or cognitive decline are among the leading drivers of emergency department utilization, caregiver burnout, and early long term care placement. Addressing who is caring for this aging population fits squarely into the community resources that can be established within the confines of RHT. 

How can we help people age at home longer when we don’t have the rural workforce in place to support them? According to the Population Reference Bureau, there is a 17% gap in the number of nursing assistants per 1000 residents in rural v. urban areas. 

Supporting the many Alzheimer’s caregivers in rural communities may be one of the most cost-effective sustainability strategies available through this new funding. 

Alzheimer’s and Dementia: The Cost of Institutional Care

Alzheimer’s is not a short-term condition. It is a disease that unfolds over months and years and requires intensive daily support. This disease also exposes equity gaps, where rural access to specialty care, home health, and long term care facilities is limited. 

A 2023 study of urban and rural patients with dementia reveals that those in rural areas tend to see their primary care physicians less often, yet hospital visits are more frequent than their urban counterparts. It was also observed that hospital stays in these rural settings are shorter. Although there are variables, it seems that rural patients approach and utilize healthcare differently than those in urban communities. One explanation could be that access to physicians without traveling long distances becomes a barrier, and with less frequent visits, conditions worsen spurring more hospital admissions. 

As our boomer population ages, the burden of care falls overwhelmingly on unpaid family caregivers with little to no training. There are consequences when informal caregivers lack skills, support, and connection:

• Crisis-driven ED visits increase
• Behavioral symptoms escalate
• Burnout accelerates
• Nursing home placement happens earlier

Each of these outcomes carries a significant Medicaid price tag.

Delaying institutionalization by even a few months can translate into substantial long-term savings, particularly in rural regions where long term care options are scarce and costly. At Trualta, when caregivers engage in fifteen or more activities within our portal, there is a correlation to a delay in long term care placement by up to fifteen months. 

Caregivers Are the Missing Link in RHT Sustainability

Rural caregivers routinely manage medications, monitor symptoms, assist with activities of daily living, and prevent avoidable hospitalizations. In effect, they serve as the frontline extension of the rural care team, particularly where workforce shortages persist.

RHT explicitly prioritizes:

• Keeping people safely at home
• Reducing avoidable utilization
• Expanding workforce capacity beyond clinicians
• Advancing long-term sustainability

Family caregivers supporting people with Alzheimer’s or dementia related illness are already doing this work. Yet most RHT strategies stop short of systematically equipping caregivers with the skills and support needed to sustain this role.

In 2024 alone, the Alzheimer’s Association published a report finding that more than 11.5 million family and other caregivers were caring for adults with Alzheimer’s or other dementia-related conditions. Under their care, they are delivering an average of 31 hours of direct care per week. In the same study, 66% of those caregivers struggled to find helpful resources to support their needs. 

Watch our RHT Alignment Webinar presented by Faegre Drinker, here.

Why Caregivers of Alzheimer’s Patients Should Be a High-ROI Focus for RHT

Caregiver-focused Alzheimer’s support aligns unusually well with RHT execution realities:

• Low infrastructure requirements
  Digital, mobile-friendly caregiver support and education reaches rural households without new brick-and-mortar investment. 
• Rapid implementation
  States can deploy caregiver support statewide or regionally within weeks, supporting early CMS milestones. 
• Early and measurable outcomes
  Evidence shows caregiver training is associated with reduced behavioral symptom severity, lower distress, and improved caregiver fulfillment within the first 30–60 days, with downstream reductions in ED visits and delayed long term care placement.
• Durable sustainability impact
  Better-supported family caregivers stabilize patient safety at home longer, reducing reliance on institutional care, one of Medicaid’s largest ongoing cost drivers.

The Sustainability Reframe: From Facilities to Families

Many sustainability strategies focus on payment reform, facility optimization, or workforce pipelines that take years to mature. Alzheimer resources for rural caregivers offers states a complementary path: strengthening care at home, where most of the responsibility is happening.

By integrating Trualta’s caregiver training, peer support, and coaching into RHT initiatives, states can turn every caregiver’s device into a learning and support hub. Give caregivers just-in-time Alzheimer and dementia education for de-escalating highly emotional situations and appropriately responding to new physical challenges with their care recipient. This is technical innovation without investing in new hardware or software. 

Most importantly, this approach does not require states to rewrite their RHT plans. It leverages existing priorities with execution-ready tools.

• Reduce avoidable utilization
• Support aging in place
• Extend limited workforce capacity
• Demonstrate early progress to CMS
• Build sustainability beyond the RHT funding period

Alzheimer’s disease and other dementia related conditions will continue to shape Medicaid spending in rural communities, workforce strain, and rural health outcomes for decades to come. RHT gives states a rare opportunity to address this challenge upstream by investing in the informal caregivers who make aging in place with older adults possible.

For states seeking sustainability that lasts beyond the grant period, instituting a family caregiver support program is foundational. The same program also works across chronic conditions beyond the demands of caregiving for a loved one with Alzheimer’s or related dementia.

Discover how Trualta aligns to all RHT priorities in our shared quest to make rural America healthy again. Download our RHT crosswalk here.

References: 

1. Diana Eliott; Mark Mather; (2024). Public Reference Bureau. Rural America is Aging—Without Enough Care Workers.
2. Arsenault-Lapierre, G., Bui, T.X., Le Berre, M. et al. Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review. BMC Health Serv Res 23, 102 (2023)
3. Alzheimer’s Association; (2024). Alzheimer’s Association 2024 Alzheimer’s Disease Facts and Figures.