National Plan to Address Alzheimer's Disease: 2016 Update. Strategy 2.A: Build a Workforce with the Skills to Provide High-Quality Care

08/01/2016

Person-Centered Counseling Training Program. HHS promotes person-centered planning and self-direction, where people receiving HCBS are empowered to have more control and direction over the HCBS they receive. ACL completed its development of a six-course training program for person-centered planning and counseling. The program addresses cognitive disabilities and dementia in each of the following courses:

  1. Introduction to the "No Wrong Door" System.
  2. Introduction to Person-Centered Planning.
  3. Person-Centered Planning and Implementation.
  4. Introduction to the Long-Term Services and Supports System.
  5. Who We Serve.
  6. Protection and Advocacy.

     

Each of these courses trains front line Person-Centered Counseling Professionals in the skills necessary to assist older adults who need supports and people with disabilities in reaching their goals for community living in a respectful and dignified manner. Each course teaches the learner how to use specific tools to interact with each person in a way that gives him or her control over the goal-setting process, and helps foster the development of meaningful and trusting relationships. Pilot testing of the training program is occurring in 2016 in 13 states.

For more information, see:

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Dementia-Specific Guidelines and Curricula. Completed in November 2015, the Health Resources and Services Administration (HRSA) created and disseminated a repository of dementia curricula and practice guidelines for providers across the care continuum, including physicians, nurses, social workers, psychologists, other health care professionals, direct care workers, and informal caregivers. The repository is hosted on the HRSA website.

For more information, see:

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Provider Education About Federal Programs to Address Alzheimer's Disease. Completed in July 2015, these monthly conference calls to HRSA geriatrics grantees included agency specific presentations on AD/ADRD. Each conference call had between 70 and 90 participants. Participants were informed of federal AD/ADRD activities by dementia expert staff from the Office of the Assistant Secretary for Planning and Evaluation (ASPE), ACL, AHRQ, CDC, Indian Health Service (IHS), HRSA, and NIA.

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Geriatric-Competent Care: Caring for Individuals with Alzheimer's Disease Webinar Series. CMS's Medicare-Medicaid Coordination Office (MMCO), in collaboration with the American Geriatrics Society, Community Catalyst, and the Lewin Group, hosted a series of webinars in 2015 and 2016 to help health professionals in all settings and disciplines expand their knowledge and skills in the unique aspects of caring for older adults with AD/ADRD and in working with their caregivers. The webinars are also intended for frontline community partners and delivery staff such as care managers, member service representatives, and home care providers. Continuing education credits offered at no cost to participants. The webinar series is one area of technical assistance supported through the MMCO's Resources for Integrated Care contract focused on increasing the field of providers that understand and are skilled in addressing the complex needs of individuals enrolled in both Medicare and Medicaid.

For more information, see:

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Healthy Brain Initiative. The CDC Healthy Brain Initiative (HBI) began in 2005 through a Congressional appropriation that established the Alzheimer's-specific segment of the Healthy Aging Program. The HBI addresses cognitive health from a public health perspective to catalyze action at the state and local level. The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018, the second in the Road Map series, was released in 2013. This Road Map, which was designed to complement the National Plan, identifies 35 actions that state and local public health agencies and their partners can implement to promote cognitive health and address cognitive impairment and the needs of caregivers. CDC's funded partners are integral to accomplishing these actions, the Alzheimer's Association and the Balm in Gilead. The 2013-2015 Interim Progress Report, and the corresponding Dissemination Guide, released in late 2015, highlight selected HBI Road Map accomplishments and future directions.

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Implemented Road Map Actions in States. CDC supported a successful collaboration with the Alzheimer's Association in September 2010-September 2015. In FY 2014, CDC provided supplemental funds to support caregiver surveillance through the Behavioral Risk Factor Surveillance System (BRFSS) in states. CDC also supported the Association of State and Territorial Health Officials and the National Association of Chronic Disease Directors to implement priority action items from the HBI Road Map of particular significance to their constituencies in select states across the United States. A major focus of CDC's efforts to support the actions of the HBI Road Map and the Healthy People 2020 objectives related to dementia is to "educate and empower the nation." To meet that challenge, CDC initiated a number of special interest projects within the CDC Prevention Research Center (PRC) program.

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Public Health and Economic Costs. CDC funded a project designed to promote public health understanding regarding the economic costs associated with AD/ADRD by examining different economic models to estimate community and inpatient care, as well as the societal costs associated with losses of productivity and quality of life by persons living with AD/ADRD and their caregivers. The University of Washington PRC began conducting a review of the literature and will examine de-identified data from the Group Health Cooperative to calculate costs and make recommendations for improvement to allow states and localities to better forecast dementia care costs.

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Minnesota Healthy Brain Initiative. In 2015, the Alzheimer's Association Minnesota/North Dakota Chapter and the Minnesota Department of Health (MDH) added a focus on efforts that may help delay the onset or progression of dementia for those over age 60 to Minnesota's Statewide Health Improvement Program. The Alzheimer's Association received a MDH contract for Dementia Education and Outreach to Diverse Populations. This MDH-chapter partnership to educate underserved communities is another example of the HBI at work. The BRFSS Cognitive data will be used to educate health care professionals and the public health community across Minnesota.

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Oregon Dementia Training for Alzheimer's Disease and Related Dementias Staff. With funding from an ACL Alzheimer's Disease Supportive Services Program (ADSSP) grant, Oregon was able to provide dementia training for over 600 statewide Aging and Disability Resource Center (ADRC) Information and Assistance and Options Counseling staff. Nine online modules were developed to address ADRC staff roles in addressing issues including person-centered care for people with dementia, communication, information and referral options, decision support for people and families, care transitions, advance planning, and specific needs for people with intellectual and developmental disabilities (IDD). The training is part of Oregon's efforts to increase dementia-capability of its ADRC system and statewide LTSS.

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Educate Health Care Providers. In September 2013, HRSA, in collaboration with ASPE, supported the development of a Medscape continuing education course entitled "Case Challenges in Early Alzheimer's Disease," aimed at educating primary care physicians, nurse practitioners, and social workers on how to utilize evidence-based strategies to diagnose, monitor, and treat patients with AD/ADRD and improve early detection in primary care and outpatient settings. After 2 years on the Medscape website, over 65,000 health professionals have participated in this training. HRSA, in collaboration with the HHS Office on Women's Health (OWH), is supporting the development of a second Medscape continuing education course on assessing, managing, and treating AD/ADRD in the context of multiple chronic conditions. This educational offering will be available in September 2016.

In 2014 (latest data available), over 51,000 health care professionals received training on AD/ADRD through 636 interprofessional continuing education offerings on geriatrics by HRSA-funded Geriatric Education Centers (GECs). Additionally, in Academic Year 2014-2015, HRSA's Comprehensive Geriatric Education Program (CGEP) awarded traineeships to 73 students, the majority of whom (69%) were studying to become nurse practitioners in Adult Gerontology. All 54 fellows participating in the Geriatric Training for Physicians, Dentists, and Behavioral and Mental Health Providers (GTPD) program received dementia training.

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IHS Workforce Partnerships. IHS initiated a series of partnerships to increase workforce skills and competency in caring for individuals with dementia and their families. IHS met with the newly awarded HRSA Geriatrics Workforce Enhancement Program (GWEP) grantees to discuss opportunities for training in IHS, Tribal, and Rural Indian Health programs. IHS partnered with the VA to introduce VA's Rural Interdisciplinary Team Training in small, rural IHS and Tribal facilitates, and this work will continue in the coming year. In October 2015, IHS collaborated with ACL in support of the Banner Alzheimer's Institute Inaugural National Conference on Alzheimer's Disease/Dementia in Native American Communities, bringing together clinical staff, Tribal aging services staff, Tribal leadership, and researchers. In April 2016, IHS held a web-based course on Alzheimer's and Related Dementia as part of the IHS Clinical Rounds series.

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Educate All Providers to Deliver Quality Health Care to Older Adults, Including Dementia Education and Training. In 2015, HRSA announced a new GWEP that combined elements of the previous four programs (GECs; GTPD programs; Geriatric Academic Career Awards; and the CGEPs) into one program to provide greater flexibility to awardees by allowing them to develop programs that are responsive to specific interprofessional geriatrics education and training needs of their communities. The purpose of this cooperative agreement program is to develop a health care workforce that maximizes individual and family engagement and improves health outcomes for older adults by integrating geriatrics with primary care. Special emphasis is on providing the primary care workforce with the knowledge and skills to care for older adults, and on collaborating with community partners to address gaps in health care for older adults through individual, system, community, and population-level changes. Focus areas include: (1) transforming clinical training environments to integrated geriatrics and primary care delivery systems to help ensure trainees are well prepared to practice in and lead these kinds of systems; (2) developing providers who can assess and address the needs of older adults and their families/caregivers at the individual, community, and population levels; (3) creating and delivering community-based programs that will provide individuals, families and caregivers with the knowledge and skills to improve health outcomes and the quality of care for the older adult(s); and (4) applicants may also choose to address providing AD/ADRD education to families, caregivers, direct care workers, and health professions students, faculty, and providers.

HRSA awarded 44 GWEP awards in FY 2015, totaling approximately $35.7 million. Awardees identified significant needs for dementia training. As a result, a total of $5.24 million was awarded to all grantees to meet this need, surpassing the $4 million which was set aside specifically for dementia training.

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VA Geri-Scholars Toolkit. VA's Geri-Scholars staff training program has created a Geri-Scholars Toolkit covering 12 clinical topics in geriatrics, including dementia. Each topic contains two sections: clinical assessment, management, and treatment; and educational materials for patients and their caregivers. More than 2,800 toolkits have been disseminated to VA rural clinics, community living centers, program participants, and local and national VA leaders in geriatrics. In addition, more than 330 toolkits have been made available to the public through the federal library system.

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Health Equity in Medicare. The first Centers for Medicare & Medicaid Services (CMS) Equity Plan for Improving Quality in Medicare focuses on six priority areas and aims to reduce health disparities in 4 years. The Plan is focused on Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

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Civil Monetary Penalty Funds. CMS permits qualified entities to use Civil Monetary Penalty (CMP) funds to improve the quality and care and life of residents of nursing facilities. Funding has been provided for included dementia care, antipsychotic utilization, person-centered care improvements, and reducing avoidable hospitalizations.

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Medicaid Home Health Final Rule. CMS issued a Final Rule on Home Health that amends the Medicaid definition of medical supplies, equipment, and appliances and clarifies that the items may be used anywhere normal life activities take place (no homebound requirement). The rule adds requirements that clinicians timely document the occurrence of a face-to-face beneficiary encounter (including through the use of telehealth). CMS is working to determine what the new definition might encompass. State officials must determine whether the new definition means that items previously furnished as HCBS should be available to a larger group through the Medicaid State Plan as part of the mandatory home health service.

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Strengthen State Aging, Public Health, and Intellectual and Developmental Disability Workforces. HHS will coordinate with states to develop workforces in aging, public health, and IDD that are AD/ADRD-capable and culturally-competent. ACL collaborated with HRSA to provide AD/ADRD training to the Aging Network. One example is the New Jersey GEC, which provided a series of trainings to the Aging Services Network in August/September 2015. Over 2,100 health professionals and caregivers from the Area Agencies on Aging (AAAs) participated in the trainings. In addition, HRSA GWEP awardees are collaborating with 26 AAAs and 13 Quality Improvement Organizations (QIOs) to strengthen state aging, public health, and IDD workforces.

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Develop and Disseminate a Unified Primary Care Alzheimer's Disease Curriculum. HRSA is working with federal partners at ACL, CDC, CMS, and VA on a contract to develop a Uniform Curriculum to:

  • Educate providers through HRSA's GECs about how to work with people with AD/ADRD and their families; link people to support services in their community; identify signs of caregiver burden and depression; and detect cognitive impairment and assess and diagnose AD/ADRD.
  • Educate physicians and other health care providers about accessing LTSS.

     

The purpose of the curriculum is to build a workforce with the skills to provide high-quality care, ensure timely and accurate detection and diagnosis, and identify high-quality dementia care guidelines and measures across care settings. Specifically, 16 core modules along with nine caregiving modules will be developed and pilot-tested. The development of the caregiver modules was supported by OWH. These modules build upon the ACT on Alzheimer's Preparing Minnesota Communities training materials and address various high-priority issues related to the detection, management, and treatment of AD/ADRD.

The developed materials will be appropriate for guided teaching by faculty in academia and continuing education programs and for interprofessional clinical audiences. The developed materials are intended to be used by GWEP awardees as well as other geriatric educators. They will be designed to serve as a tool to increase the understanding among a broad spectrum of clinicians of the detection and treatment of AD/ADRD.

An Advisory Panel consisting of dementia experts and several federal partners has identified module topics that will be developed. The final format of the materials, which will be web-based, is currently under discussion.

For more information, see:

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Public Health Live Webcasts on Dementia Care. Public Health Live is a monthly webcast series designed to provide continuing education opportunities on public health issues. In 2015, the New York State Department of Health (NYSDOH), in conjunction with the State University of New York and Albany Medical College, offered the webcast "Alzheimer's Disease and Advanced Directives: A Primer for Primary Care Physicians." Offerings for 2016 include "Parkinson's Disease: The Importance of an Interdisciplinary Approach for Identification, Treatment and Patient Support" and "Cognitive Impairment Screening in Primary Care: Clinical and Ethical Indications."

For more information, see:

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Dementia Friendly America Provider Tools. Dementia Friendly America (DFA) is a multi-sector, national collaborative of cross sector organizations and individuals seeking to foster communities across the United States that are equipped to support people living with dementia and their caregivers. Dementia-friendly communities foster the ability of people living with dementia to remain in community and engage and thrive in day to day living; basic things like going to the store or the bank. The community also buoys the caregiver by adding extra supports such as respite programs. DFA has developed provider tools and resources that support timely and accurate diagnosis, education for families after a diagnosis of AD/ADRD, offers dementia care guidelines, fosters safe transitions of care, and advances coordinated and integrated health and longer services and supports. Links to the resources can be found at the DFA website.

For more information, see:

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Resources for Clinicians. NIA continues to expand its efforts to educate clinicians about recent research findings; clinical practice tools for assessment, diagnosis and management of cognitive impairment; training materials; and other resources. In 2015, the NIA developed a mini-portal of resources for professionals, including the clinician quick guides Assessing Cognitive Impairment in Older Adults and Managing Older Patients with Cognitive Impairment.

For more information, see:

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