National Plan to Address Alzheimer's Disease: 2016 Update. Strategy 2.E: Explore the Effectiveness of New Models of Care for People with Alzheimer's Disease

08/01/2016

Alzheimer's Disease Supportive Services Program. ACL continues to support its 18 current grantees and their partners who are implementing dementia-capable LTSS systems, and any former grantees or partners who wish to participate in learning activities. The grantees are lead dementia agencies within their states, in direct response to recommendations from the Advisory Council. Grantees are: (1) developing a "no wrong door" service system; (2) ensuring access to comprehensive, sustainable services for people with dementia and their family caregivers; and (3) implementing evidence-based or informed interventions as part of their programs. A limited number of ADSSP grantees are in the final stages of implementing and evaluating the translation of evidence-based interventions in support of individuals with AD/ADRD and their unpaid caregivers. In 2015, ADSSP expanded to include three new states -- Florida, Massachusetts and West Virginia. The new programs include services for IDD and dementia populations in Florida, dementia-friendly communities in West Virginia and bringing dementia-capability to care transitions programs in Massachusetts. ACL anticipates continuation of the ADSSP with new grants in 2016. This program's focus on dementia-capability and dementia-friendly communities is in direct response to the recommendations of the Advisory Council.

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ACL National Alzheimer's and Dementia Resource Center. ACL continues to fund a resource center that supports ACL grantees, their partners, and the larger Aging and Disability Networks in developing and implementing dementia-capable programs, dementia-friendly communities, specialized supportive services, and evidence-based programs. In addition to providing technical assistance, the National Alzheimer's and Dementia Resource Center (NADRC) manages an annual webinar series that is open to the general public, writes issue briefs on program-related topics, and evaluates and summarizes program results. NADRC staff also manages and facilitates grantee learning collaboratives that result in resources that are beneficial to program activities and also made available to the general public. In 2016, ACL launched a new website for the NADRC. The NADRC website is home to numerous resources developed both in house and through agency grant programs.

For more information, see:

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Minnesota: Dementia-Capable State. Minnesota is building a dementia-capable state through the synergistic efforts of a host of dementia collaborations including:

  • The ACT on Alzheimer's® Collaborative's many accomplishments include: (1) Dementia-Friendly Communities now at 40 and counting; (2) Dementia Curriculum developed by leading experts in Minnesota; and (3) culturally infused Provider Practice Guidelines, 1,500 physicians and care coordinators have trained in these dementia care best practices. In Minnesota, the Health Care Summit advanced the adoption of the practice guidelines in health care systems with three major health care organizations leading the way and more in the wings. The state's Caregiver initiative lead to the funding of the Dementia Grants program where culturally sensitive caregiver education and services are targeted.
  • National Family Caregiver Support Program Act -- Minnesota has developed a statewide network of over 100 dementia-capable caregiver consultants who have or are completing the Minnesota culturally infused Caregiver Consultation training and Advanced Dementia-Capability training online and in-person training. Also, through Minnesota's current Alzheimer's Disease Initiative-Specialized Supportive Services (ADI-SSS) grant the Resources for Enhancing Alzheimer's Caregivers' Health (REACH) Community is being embedded as a routine caregiver consultation service.
  • The State of Minnesota ADI-SSS grant being implemented through 2017 delivers culturally infused Dementia-Capability training to the statewide network of aging services and health care providers via a Learning Management System that combines online and in-person training. Courses are tailored for the learner at three levels based on their prior knowledge, skills and job function. The Dementia-Capability training also addresses those with IDD and persons with dementia living alone. Cultural Consultants provide guidance and education to aging service providers and communities to increase understanding of the norms and values of diverse clients with dementia and their caregivers. Physician and care coordination training is delivered in collaboration with ACT Dementia-Capable Communities.

     

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West Virginia Coordinated Action, Response, Education and Support about Families Living with Dementia. The initiative's aim is to help organizations and individuals in non-profit, law enforcement, faith, business and other communities learn about dementia so they can assist and enhance the quality of life of individuals living with dementia. In addition, West Virginia Coordinated Action, Response, Education and Support (WV CARES) will connect individuals and families living with dementia to national, state and local resources for education and support. The Blanchette Rockefeller Neurosciences Institute is leading the effort along with key partners throughout the state including AARP, Alzheimer's Association-West Virginia Chapter, the Claude W. Benedum Foundation, the Manahan Group, the West Virginia Bureau of Senior Services, and the West Virginia Sheriff's Association.

Outcomes for Phase I of this initiative are: (1) educate West Virginians about the prevalence, early warning signs and symptoms of AD/ADRD, as well as the economic impact of the disease; (2) establish dementia-friendly faith communities that are a safe, supportive and welcoming environment for people with dementia; (3) establish dementia-friendly financial/legal services as legal and financial advisors may be the first to identify cognitive decline; (4) encourage dementia-friendly businesses that are meeting the needs of customers and employees; and (5) ensure dementia awareness among emergency response and law enforcement personnel.

WV CARES is part of the DFA network as the only statewide initiative of the network's six pilot sites.

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Supported Decision Making Resource Center. ACL is promoting supported decision making (SDM) because it can improve current guardianship arrangements for older adults and people with disabilities who need support. SDM is a less restrictive alternative to guardianship that uses trusted friends, family members and advocates to help people with disabilities understand and make their own choices. SDM shows great promise for increasing self-determination and improving quality of life outcomes. ACL supports a national training, technical assistance, and resource center to explore and develop SDM as an alternative to guardianship. Among the center's projects is development of resources for professionals that include legal documents, standards for persons involved in SDM, research to discover how people use SDM, and evaluation of its effectiveness. The ultimate goal is to develop a model that will help states and individuals consider alternatives to guardianship by 2019.

For more information, see:

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Examining Models of Dementia Care. ASPE has begun a study examining dementia care models across settings using a framework to understand what providers are doing to provide care to individuals living with dementia and their families. The project is intended to better understand what so-called "innovative" dementia care providers have in common and what practices may inform future understandings of quality dementia care. The project involves an environmental scan of best practices in dementia care, and a series of five case studies conducted across the country and in a range of dementia care settings. The results will inform future research related to developing quality measures and standards. The project is expected to be completed in September 2016.

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Analysis of New Payment and Service Options for Medicare-Medicaid Dual Eligible Beneficiaries. ASPE has begun a project to produce targeted research briefs on options for expanding the Programs of All-Inclusive Care for the Elderly (PACE). PACE was established as a permanent Medicare and Medicaid benefit by the Balanced Budget Act of 1997, and it attempts to help nursing home eligible older adults avoid institutional care by providing them with a rich mix of coordinated acute care and HCBS in the community. PACE is designed for the frail elderly. To be eligible, participants must be 55 or older and certified by their state of residence as being eligible for nursing home level of care. In 2015, the President signed into law the PACE Innovation Act. The PACE Innovation Act gives the Secretary the authority to test -- via pilots -- significant changes to the PACE model, such as serving individuals under the age of 55, and people who do not meet the current nursing home level of care criteria, but may be at risk of entering a nursing home. The research briefs produced by this project will address the policy implications, benefit design, and financing structure of an expanded PACE program, including a descriptive analysis of subpopulations of dual eligible beneficiaries under age 55. Nationally, nearly half (49% comp) of PACE participants have been diagnosed with dementia, therefore lessons from the PACE model may have strong applicability to the field of dementia care broadly.

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VA Models of Non-institutional Long-Term Care. VA shared a summary report of completed non-institutional long-term care pilot programs with dementia components. The report was sent to federal partners, who then shared it with the Advisory Council.

In a follow-up to the VA summary report of these models of care, an ACL webinar was held in May 2016, in which VA staff shared with community partners more detailed information about one new model, the Mobile Adult Day Health Care Program. This model involves community partnerships to provide meeting space for a mobile team providing adult day health care to individuals with dementia, thereby increasing access to this service in an expanded range of convenient locations. More than 300 participants attended the webinar.

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Transforming Clinical Practice Initiative. CMS awarded nearly $685 million dollars to 40 national and regional collaborative health care transformation networks and supporting organizations to provide technical assistance to equip clinicians with tools and support needed to improve quality of care and increase beneficiaries' access to information. The Transforming Clinical Practice Initiative (TCPI) supports medical group practices, regional health care systems, regional extension centers, and national medical professional association networks. TCPI efforts help clinicians expand their quality improvement capacity, engage in greater peer-to-peer learning, and utilize health data to determine gaps and target intervention needs. The initiative has two major components: (1) 29 "Practice Transformation Networks," that provide technical assistance and peer supports; and (2) ten "Support and Alignment Networks," to provide a system for workforce development.

For more information, see:

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Comprehensive Primary Care Plus Model. CMS recently announced Comprehensive Primary Care Plus (CPC+), a 5-year multi-payer model that begins in January 2017 and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians. Primary care practices can participate in one of two tracks. The two tracks have different care delivery requirements and payment methodologies, but both tracks will encourage physicians to improve the quality and efficiency of care, which will result in healthier beneficiaries and reduce unnecessary health care utilization. In the CPC+ model, beneficiaries with complex needs (e.g., cognitive impairment, chronic conditions, frailty) will be engaged in goal-setting and shared decision-making, receive preventive care and care coordination, and will have 24/7 telephone and electronic access to care.

For more information, see:

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Health Care Innovation Awards. CMS's Center for Medicare and Medicaid Innovation is awarding up to $1 billion, in more than 100 cooperative agreements, to organizations whose projects offer novel ways to improve beneficiary care. The first evaluation reports were released in April 2015; CMS has now released the second round. Some of the HCIA awards address persons with AD/ADRD and caregiving.

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Research Continues to Seek New and Effective Ways to Improve Care. In 2015, NIH-funded researchers reported on the rate of referral to hospice during 2000 and 2007 among over 600,000 older people with advanced dementia. During the last year of life, 35% of this group received inpatient psychiatry treatment just prior to death. Of the 1,027 people who were discharged from a psychiatric hospital and then died within 90 days, fewer than one in ten were referred to hospice. The findings point to the need for improved end-of-life care for people with dementia.

The use of antipsychotic and other psychotropic medications to address behavior and mood among older residents living in long-term care settings has become a concern, especially among residents with dementia. NIH funded a study to address the use of antipsychotic and psychotropic medications in assisted living residences to determine how prescribing may vary according to the characteristics of the facility, and to examine the feasibility of using non-drug alternatives to care.

For more information, see:

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Translation of Care of Persons with Dementia in their Environments in a Publicly-Funded Home Care Program. This home-based intervention involves up to 12 home visits; a nurse provides education to caregivers as to common concerns (constipation, detection of pain, incontinence, hydration and importance of taking care of self), conducts a brown bag medication review, takes blood and urine from the person with dementia and does a visual inspection of skin integrity; an occupational therapist meets with families to assess abilities of person with dementia and to work with caregiver to provide strategies for managing their care challenges and educate them as to the nature of the disease and ways to support daily functioning.

Activities include:

  • NIA-funded trial ongoing in Connecticut to translate this approach in Medicaid Waiver Program (Principal Investigator, Dr. Richard Fortinsky, Co-Investigator, Dr. Laura Gitlin).
  • ACL-funded project to Maine's Adult Day Serves to integrate Adult Day Plus and Care of Persons with Dementia in their Environments (COPE) Intervention.
  • ACL-funded project to Orange County, North Carolina to integrate COPE/Tailoring Activities for Persons with Dementia and Caregivers (TAP) into home care services.
  • Australia-funded translational study of COPE in various settings (hospital to home, home care, social service agencies).
  • COPE as part of the MIND model being tested under the Center for Medicare and Medicaid Innovation's (Innovation Center) Health Care Innovation Awards.
  • COPE being integrated into a program for Managed Care to be delivered by Volunteers of America.

     

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