Involuntary Hospitalization of People Living with Dementia: A Comparative Policy Analysis

TL;DR

This paper compares dementia crisis policies in Wisconsin and Idaho to understand how they handle involuntary hospitalizations and identify areas for improvement.

Contribution

The study introduces a comparative policy analysis framework for dementia crisis management and identifies three key evaluation domains.

Findings

Wisconsin and Idaho both allow limited involuntary hospitalization for dementia crises but with different restrictions.

Wisconsin's policy has strict facility and treatment rules, while Idaho's is more flexible and data-driven.

Three policy evaluation domains were identified: access to facilities, treatment barriers, and data accountability.

Abstract

Neuropsychiatric symptoms, such as agitation and aggression, affect virtually all individuals with dementia and can sometimes be challenging to manage. These symptoms can result in crises characterized by psychological or physical threat to self and others. In some cases, these crises lead to involuntary hospitalization, a controversial policy typically used for people living with mental illness that involves the person being hospitalized and treated without their consent. Involuntary hospitalization policies vary by state, requiring local approaches to understanding their impact on people living with dementia. Rates of involuntary hospitalization among people with dementia and evaluation of existing policies for this practice are largely unknown. As a first step, this study conducts a comparative analysis of Wisconsin and Idaho state policies to lay the groundwork for subsequent research on their application. Wisconsin has required use of an “Emergency Protective Placement” policy since 2012 as involuntary hospitalization was declared unconstitutional for people living with dementia. In contrast, Idaho created and implemented a “Crisis Hold Policy” in 2024 to provide acute crisis stabilization services for people living with neurological conditions, including dementia. Comparative analysis reveals both state policies allow people living with neurological conditions to be hospitalized for a limited amount of time. While Wisconsin’s policy has strict facility and treatment restrictions, Idaho’s policy is more flexible and systematically collects data. This analysis generates three dementia crisis policy evaluation domains for consideration in future research and evaluation, including access to acute stabilization facilities, barriers to acute treatment, and data provision and government accountability.