Incentivizing Incognizance: How We Are Losing Our Minds While Policies Continue to Lose Sight
My mother and I recently sat in her neurologist's office as he carefully evaluated her. B.B., as my mother is affectionately called, is a highly intelligent and often witty 83-year-old retired educator. I sat behind B.B. as she sat coyly in her wheelchair and answered the doctor's questions in a way I was not quite prepared for.
Like a lost child, she searched his eyes for answers that once would have come before he finished the question.
Like a lost child, I watched hesitation replace the quickness and intellect I knew.
Then, after an elongated sigh, he looked at me, then at B.B., and said what I had already known: a preliminary diagnosis of Alzheimer's disease.
Now, mind you, she is already a longtime Type 2 diabetic, has dementia, is a multiple-stroke survivor, and has completely lost sight in her left eye. She has not spent two consecutive nights outside a medical facility since December 21, 2023, when an allergic reaction to medication caused near-fatal asphyxiation.
Then, in June, the first storm of the 2026 Atlantic hurricane season devastated her home
beyond repair.
B.B. will never be able to go back home.
I tearfully remind myself of that every day as she sits in a continuing-care facility. I pray about it when I wake and when I lay myself to sleep.
I lose sleep as my mother loses her mind.
She is not alone.
An estimated 7.4 million Americans age 65 and older are living with Alzheimer's in 2026. Almost two-thirds are women. Older Black Americans are about twice as likely as older White Americans to have Alzheimer's or another dementia.
In Louisiana alone, approximately 94,700 people age 65 and older are living with Alzheimer's. The state also has approximately 221,000 dementia caregivers providing 366 million hours of unpaid care valued at $5.4 billion.
Mind-blowing.
Diabetes adds another layer. The National Institute of Diabetes and Digestive and Kidney Diseases reports that older adults with diabetes have higher rates of dementia, Alzheimer's disease, and vascular dementia than people with normal glucose tolerance. Diabetes can also damage blood vessels in the brain, contributing to cognitive impairment.
That matters for someone like my mother, whose medical history does not fit neatly inside one diagnosis.
On paper, policy recognizes this complexity. Medicare requires clinicians to check for cognitive impairment during the Annual Wellness Visit. When clinicians identify cognitive impairment, Medicare also covers a more detailed cognitive assessment and care-planning service. The Guiding an Improved Dementia Experience, or GUIDE Model, is designed to provide coordinated dementia care, care navigation, caregiver education, 24/7 support, and respite services for qualifying families.
However, it explicitly exposes how fragmented dementia policy remains.
Yeah, about dementia ... I almost forgot:
Long-term nursing-home residents are not eligible for GUIDE. As of July 2026, neither are people living in memory-care units. That exclusion becomes especially striking considering that 41.1% of nursing-home residents were diagnosed with Alzheimer's disease or another dementia in 2022. That fragmentation exists inside a financing structure that rewards institutions even while families absorb enormous bills. When institutions can generate revenue from discrete episodes of care while families are left to coordinate the whole person for free, fragmentation becomes incentivized incognizance.
Families do not experience disease in policy silos.
My mother does not stop being diabetic because she has Alzheimer's. She does not stop being a stroke survivor because she lives in a care facility. Her blindness does not disappear even though her neurologist asks her to follow his index finger. B.B.'s cognitive decline does not suspend every other condition requiring treatment.
However, our systems have put asunder what real life has joined together: dementia care over here, diabetes care over there, neurology somewhere else, long-term care under another set of rules, and me, the caregiver holding the entire chart.
I am so angry.
Not because my mother is aging. Aging is not a policy failure.
My anger comes from watching families absorb the financial, emotional, and mental toll
created by fragmentation. In 2026, health and long-term care costs for Americans with Alzheimer's and other dementias are projected to reach $409 billion, with Medicare and Medicaid covering an estimated $263 billion. That figure does not include the economic challenge of unpaid caregiving.
That is not incidental. That is infrastructure.
However, B.B., in all her infinite wisdom, still gives me hope. She is also a grave reminder that hope should not require loss.
My mother should not have to lose her mind while policy gives her nothing to gain, only consequences.
No one should.
So, I ask: Just how many more people need to lose their minds before our policies finally remember who they are?
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