DNP 840 Module 2 Environmental Assessment and SWOT Example

Reading the Environment: An Environmental Assessment and SWOT Analysis for a Nurse-Led Dementia Care Program

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 840: Strategic Planning and Financial Management

Instructor Name

Month Day, Year

Reading the Environment: An Environmental Assessment and SWOT Analysis for a Nurse-Led Dementia Care Program

Before a health system commits money and staff to a new service, planners need to understand the conditions it will operate in: how many people need it, who else serves them, how it will be paid for, and what the organization brings to the task. This paper presents the environmental assessment for the dementia care program the composite health system is considering and summarizes the findings in a SWOT analysis, which sets what the organization does well or poorly beside what the outside world offers or threatens. It closes with the strategic choices the analysis suggests.

Demand for the Service

Dementia is common and growing. The Alzheimer's Association put the number of people 65 and older in the United States with Alzheimer's dementia at 6.7 million in 2023, a number that could reach 13.8 million by 2060 without medical breakthroughs (Alzheimer's Association, 2023). The health system's service area includes four counties with about 1.1 million residents, of whom about 190,000 are 65 or older, and the share of older residents is rising faster than the state average.

Internal data give a more direct measure. A search of the electronic record found 7,400 patients aged 65 and older with a dementia diagnosis seen in the past two years, of whom about 5,100 live at home rather than in a nursing facility. Because dementia is often undiagnosed in primary care, the true number is likely higher. Among patients with a recorded diagnosis, emergency department visits and hospital days per person were roughly double those of other older patients, a pattern that points to unmet needs between visits.

Family Caregivers as a Second Customer

A dementia program serves two customers: the person with dementia and the family member who provides most of the care. Drawing on a national survey of older adults and their helpers, researchers found that people with dementia made up about 10% of older adults living outside nursing homes, yet they received 41% of the hours of help provided by family and unpaid caregivers, and caregiving was most intense for those living in the community with a spouse or daughter as caregiver (Kasper et al., 2015). Nationally, more than 11 million unpaid caregivers provided about 18 billion hours of care to people with dementia in 2022, care valued at $339.5 billion (Alzheimer's Association, 2023).

For the program, this means that services such as caregiver coaching, crisis lines and respite are central to its value, not extras. It also means that caregivers' own judgments of the program will shape referrals by word of mouth.

Payer and Policy Environment

Dementia is expensive for payers. Average per-person Medicare payments for beneficiaries aged 65 and older with dementia are almost three times those for beneficiaries without it, and Medicaid payments are more than 22 times as great, largely because of long-term care (Alzheimer's Association, 2023). This creates an interest among payers and accountable care organizations in services that keep people with dementia out of the hospital and at home.

Federal policy has begun to pay for dementia care coordination directly. Medicare now reimburses care planning visits for cognitive impairment, and a federal payment model begun in 2024 pays participating programs a monthly amount per enrolled beneficiary for care navigation, caregiver support and respite. The health system participates in a Medicare accountable care organization and holds two commercial Medicare Advantage contracts with shared savings, so avoided hospital use would partly return to it. The main policy threat is uncertainty: payment models can change or end, so the program should not depend on a single source of revenue.

Competitors and Partners

An academic memory center 60 miles away offers diagnosis and specialist care but has a waiting list of several months and little support between visits. Two home health agencies provide skilled services after hospital stays but not ongoing care management. The regional Area Agency on Aging runs caregiver education classes and a small respite grant program, and a nonprofit adult day center operates in the largest county. None offers ongoing, coordinated care management for families across the full course of the disease, which leaves a gap the program could fill. Most of these organizations are better seen as partners than competitors: the memory center can accept complex referrals, and the Area Agency on Aging and adult day center can provide services the program will not.

Internal Strengths and Weaknesses

The health system brings real strengths: 42 primary care practices sharing one electronic record, its own home health agency, a 24-hour nurse advice line, geriatric physicians and a reputation for community care. Its weaknesses are also clear. It has no dementia care managers today, primary care clinicians report little time for cognitive assessment, the social work staff is small, and past programs have struggled to reach rural and Spanish-speaking families.

SWOT Summary

SWOT analysis remains one of the most widely used tools for organizing findings of this kind, but reviews caution that it is often done superficially, with long unranked lists that do not lead to decisions (Helms & Nixon, 2010). The summary below therefore lists only the most significant items, and the next section draws out the choices they imply.

Strategic Implications

Three choices follow from the analysis. First, the program should begin with patients already known to the health system, starting in the primary care practices with the most patients with dementia, before expanding outreach. Second, it should combine several revenue sources, including care planning visits, the federal navigation payment and shared savings, so that the loss of any one does not end the program. Third, it should build its weaknesses into its design: hiring bilingual care navigators, asking the Area Agency on Aging to share rural outreach, and recruiting experienced nurses with a career ladder that makes the role attractive despite a tight labor market.

Conclusion

The environmental assessment shows strong and growing demand, caregivers carrying a heavy and costly load, payers with financial reasons to support coordinated dementia care, and no local organization offering it across the course of the disease. The health system's shared record and home-based services are real advantages, while staffing, rural reach and payment uncertainty are the main risks. A focused SWOT analysis turns these findings into three concrete choices that shape the budgets and financial plans developed next.

References

Alzheimer's Association. (2023). 2023 Alzheimer's disease facts and figures. Alzheimer's & Dementia, 19(4), 1598-1695. https://doi.org/10.1002/alz.13016

Helms, M. M., & Nixon, J. (2010). Exploring SWOT analysis: Where are we now? A review of academic research from the last decade. Journal of Strategy and Management, 3(3), 215-251. https://doi.org/10.1108/17554251011064837

Kasper, J. D., Freedman, V. A., Spillman, B. C., & Wolff, J. L. (2015). The disproportionate impact of dementia on family and unpaid caregiving to older adults. Health Affairs, 34(10), 1642-1649. https://doi.org/10.1377/hlthaff.2015.0536