Epress.am News from Armenia
Part 1
There are not even approximate data on how many people in Armenia live with dementia or what conditions they live in. Elderly people with cognitive impairment don’t stand out in a crowd, and unless they show obvious signs — for example, approaching someone to ask how to get home — nothing distinguishes them from anyone else. Besides, you rarely see them in public spaces: people with dementia usually stay home, and when they do appear in public, they are accompanied by family members. Most often, we learn about the illness from the caregivers. The burden of caring for people with dementia almost always falls on spouses, children, and close relatives. They look exhausted, limit their social lives, switch to working from home, and struggle with depression and burnout. Colleagues, friends, and loved ones of those who provide round-the-clock care for people with dementia are usually well aware of the illness and its consequences.
The Elderly Are Not a Priority
In Armenia, people with dementia do not receive any government support. Medications are not state-covered, nor are consultations with neurologists and psychiatrists. Dementia is not recognized as a disability category, which means there are no related social benefits.
In 2023, by order of the Minister of Health, a working group was established to develop a “National Dementia Prevention Plan,” with a mandate running until 2027. However, the plan has no allocated funding. Some studies have been conducted and pilot programs implemented through the Ministry of Health’s general budget. Even the long-awaited mandatory health insurance expected to come into effect in 2026 will not cover any dementia-related expenses.
“Serious steps aren’t being taken because there are no significant financial resources. There are more urgent public health issues. There is good faith, but our little state has limited resources, so the Ministry largely relies on NGOs in this field,” Kristine Galstyan, an expert in the Ministry of Health’s Public Health Department, told Epress.am.
The idea of developing a national plan also came from civil society organizations. The initiative was put forward by Jane Maghakian, the head of the Alzheimer’s Care non-governmental organization. Ministry expert Galstyan helped coordinate the work of the task force. Most of the five-year program is focused on reducing stigma, changing the culture of aging through awareness campaigns, and preventing the disease. Whereas people already fighting the disease don’t get more from the Ministry of Health than outdated brochures about how to deal with the illness.
At the final stage of dementia, families can theoretically apply for palliative care co-funding. “The state covers a small part of palliative care, but I think it should be possible to allocate a budget to improve people’s condition before they reach the terminal stage,” Galstyan noted.
Only one program for prevention of the disease has been implemented: in each of Yerevan’s ten administrative districts, physical activity clubs for the elderly were opened, and participants were also taken on excursions.
One of the Costliest Illnesses
“Dementia is considered one of the most expensive illnesses — not because of the cost of medication, but because family members become involved in caregiving and are therefore unable to work as usual,” psychiatrist Gevorg Pashikyan told Epress.am.
There are no government support programs for caregiving families. Whereas the state partly subsidizes the salary of a nanny for children under the age of three, there is no such compensation in the case of dementia. In response to an inquiry from Epress.am, the Ministry of Labor and Social Affairs stated that people with dementia can apply for home-visit services. The Ministry will conduct an assessment, and if the client meets the established criteria, it will assign home visits from a social worker, a nurse, and a neurologist. These visits are expected to be periodic but brief. In practice, however, people with dementia usually need constant care.
Home-care services are designed for various needs: according to official data, there are 1,325 individuals receiving such services, but only 50 of them receive specialized care. Among these 50, people with dementia make up a very small percentage, says Ministry of Labor expert Sona Barsegyan. “Our goal is to expand this program so that family members can work and are not forced to interrupt their employment. This, of course, depends on funding.”
In 2026, the home-care service is planned to be expanded by 100 lots.
As state-sponsored services are scarce and hard to get, private care services open to meet the need. Paid “nursing homes” are very expensive, costing between 300,000 and 700,000 drams per month. The most costly are those with medical staff, such as “Alpha Betta” and “Khnami.” Comparatively cheaper are the so-called “care centers,” which operate without medical personnel and with no state license.
There is also a shadow market — informal “care homes.” Former nurses or nannies host patients by making room in their own homes. They usually charge lower fees, operate outside the tax system, and have no official licenses.
“I used to work as a nurse, and I take good care of the patients brought to me because I feel an inner responsibility to my conscience and to God, not to formal inspectors,” said Gayane (name changed). She has been providing care for severely ill patients in her own home for five years. “I take care of those who are declined care by everyone else,” she said.
Most of the people brought to Gayane are elderly individuals in the final stage of dementia. She lives in a village. In one of the rooms of her house, she set up four beds, installed a television set, and built separate bathrooms adjusted for people with mobility issues. When Gayane is away, her son and daughter-in-law take care of the patients in their backroom.
“I love the elderly — they’re interesting. I play music for them, dance with them. Sometimes they give wise advice. I enjoy being with them,” the interviewee says.
Recently, tax inspectors came to Gayane’s home and fined her nearly 400,000 drams for running a business without registration. She has since stopped taking new patients.
“If I register and start paying taxes, I would have to charge people 20,000 drams daily, like they do in Yerevan. But I charge 5,000 for some, and for others, only their pension. I know that people simply don’t have that kind of money. No one in the village can afford Yerevan prices. Hundreds of people are left without care because, you see, I was forced to close.”
Families of people with dementia often turn to such informal arrangements out of desperation. Sometimes this leads to disputes and even legal proceedings. For example, when a patient in an informal house dies, relatives may question whether the necessary medical care was provided.
Home visits by private caregivers cost 10,000–20,000 drams per day. Most families cannot afford these either, so they care for their relatives themselves. The burden usually falls on wives and daughters. In Armenia, this arrangement is assigned to “traditional values,” however, it is only there because of financial impasse. Public nursing homes have long waiting lists, and psychiatric clinics generally do not accept people with dementia, except in severe cases where the disease is accompanied by psychiatric symptoms such as hallucinations or delusions. Even then, only temporary hospitalization is offered.
An Aging Country
“Alzheimer’s disease and other dementias are increasing in Armenia and are expected to grow exponentially in the coming decades. However, there is a widespread lack of knowledge about memory screening, diagnosis, and treatment. Additionally, there is no standard protocol for cognitive screening among primary health care physicians in the country, often due to a lack of training and the misconception that memory loss is a normal part of aging,” Jane Magakyan told Epress.am.
Alzheimer’s cannot be cured, but if it is correctly diagnosed at an early stage, disease progression can be slowed. Late diagnosis is also a serious problem.
In 2022, Alzheimer’s Care tested nearly 4,400 people (aged 25 to 93) in various towns and villages across Armenia, trying to detect early signs of the disease. Cognitive problems were observed in 31% of participants, moderate impairment in 5%, and severe impairment in 1%.
The organization also conducted training courses for primary care doctors so they can identify symptoms and refer patients to specialists.