NATIONAL PLAN TO ADDRESS ALZHEIMER'S DISEASE: 2017 UPDATE. Strategy 2.A: Build a Workforce with the Skills to Provide High-Quality Care

09/01/2017

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 2017 in 13 states.

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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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Healthy Brain Initiative. The CDC Healthy Brain Initiative (HBI) began in 2005 through a congressional appropriation that established the AD-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, the Balm in Gilead, and the Healthy Brain Research Network (HBRN) (a consortium of six Prevention Resource Centers). 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 2015-September 2020 to implement a Road Map for action on care and services in several states. In FYs 2014-2017, CDC provided supplemental funds to support cognitive decline and caregiver surveillance through the Behavioral Risk Factor Surveillance System (BRFSS) in states. In 2015 and 2016, 51 states and territories participated in the cognitive decline module and 40 with the caregiver module. 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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Curriculum for Use in Schools of Public Health. CDC supported the development of A Public Health Approach to Alzheimer's and Other Dementias, a new curricular resource developed by the Centers for Technical Assistance and Training in the Emory University's Rollins School of Public Health. This flexible, introductory curriculum will help faculty prepare undergraduates for careers in which they need to apply public health approaches to address AD as a multi-layered, growing public health challenge. The Centers mapped the curriculum to established competencies.

The modular design enables use in entirety or as stand-alone modules. Each module has a slide set and faculty guide with learning objectives, list of relevant competencies, talking points, and teaching aids. Microsoft Office formats enable users to adapt materials for integration into existing undergraduate courses or other educational offerings.

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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 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. HRSA, in collaboration with the HHS Office on Women's Health (OWH), supported the development of a Medscape continuing education course on assessing, managing, and treating AD/ADRD in the context of multiple chronic conditions. This educational offering, titled "Bidirectional Impact of Alzheimer's Disease and Common Comorbid Conditions" was released in September 2016. A total of 7,107 learners accessed the site in the first 6 months.

In FY 2015, HRSA combined and redesigned its four geriatrics programs into the Geriatrics Workforce Enhancement Program (GWEP). The GWEP supports transforming clinical training environments by developing a health care workforce that maximizes patient and family engagement to improve health outcomes for older adults by integrating geriatrics with primary care. The GWEP aims to provide the primary care workforce with the knowledge and skills to care for older adults by collaborating with community partners to address gaps in health care for older adults through individual, system, community, and population-level changes. In addition, the GWEP also supports training of patients, families, caregivers, direct care workers, health professions providers, students, residents, and fellows who will provide health care to older adults, and the faculty who train these individuals.

All GWEP awardees identified significant needs for dementia training. In FY 2017, HRSA supported 44 GWEP awardees totaling approximately $38.7 million; $5.978 million was used to provide dementia education and training. In FY 2015, GWEP awardees provided 402 continuing education offerings and trained 43,148 participants on AD/ADRD.

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IHS Workforce Partnerships. The Indian Health Service (IHS) initiated a series of partnerships to increase workforce skills and competency in caring for individuals with dementia and their families. IHS has met with HRSA 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 (RITT) in small, rural IHS and Tribal facilitates; eight sites were trained in FY 2016- FY 2017 and RITT training will be provided to clinics serving the Aleutian and Pribiloff Islands in August 2017. 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 AD/ADRD as part of the IHS Clinical Rounds series. In November 2016, the Banner Institute partnered with ACL, IHS, and the Centers for Medicare & Medicaid Services (CMS) to provide both professional and para-professional training in AD/ADRD as part of a national conference on Tribal Long-Term Services and Supports in Minneapolis, Minnesota.

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VA Geriatric Scholars Toolkit. VA's Geriatric Scholars staff training program has created a Geriatric Scholars Toolkit covering 12 clinical topics in geriatrics, including dementia. Each topic contains two sections: (1) clinical assessment, management, and treatment; and (2) educational materials for patients and their caregivers. More than 2,800 toolkits have been disseminated to VA rural clinics, community living centers (CLCs), 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. Toolkit pages or links to information are also available for downloading online; the Toolkits have been viewed over 900 times to date.

For more information, see:

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VA Rural Interdisciplinary Team Training. The RITT program is a component of the VA Geriatric Scholars Program, through which VA has been delivering on-site education to rural VA clinics since 2010. The VA Employee Education System sponsors accreditation for Continuing Medical Education (CME) credits/Continuing Education Units (CEU). The curriculum focuses on: (1) efficiency and teamwork in primary care to care for older patients; (2) recognizing geriatric syndromes and red flags; (3) distinguishing dementia, delirium and depression; and (4) brief evidence-based tools for cognitive assessment. With funding from the VA Office of Rural Health, 20 sessions will be completed in 2017 and over 100 rural VA Community-Based Outpatient Clinics have participated.

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IHS Rural Interdisciplinary Team Training. The RITT program is a component of the VA Geriatric Scholars Program, which VA has been delivering on-site to IHS and Tribal Health Program (THP) clinics since 2016. The VA Employee Education System sponsors accreditation for CME/CEU, and IHS/THP clinicians are able to receive continuing education credits through the TRAIN platform for interagency sharing of training products. The curriculum focuses on: (1) efficiency and teamwork in primary care to care for older patients; (2) recognizing geriatric syndromes and red flags; (3) distinguishing dementia, delirium and depression; and (4) brief evidence-based tools for cognitive assessment. So far, in 2017, five sessions have been scheduled or completed and others are being planned. The activity is funded by the VA Office of Rural Health.

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Staff Training in Assisted Living Residences-VA in VA Community Living Centers. STAR-VA is an interdisciplinary behavioral approach to managing challenging behaviors among VA CLC (i.e., nursing home) residents with dementia, adapted from Dr. Linda Teri's Staff Training in Assisted Living Residences (STAR) program. The STAR-VA intervention entails four core components: (1) Creating realistic expectations of individuals with dementia; (2) Promoting effective communication with individuals with dementia; (3) Identifying and changing activators and consequences of challenging behaviors (ABCs); and (4) Increasing personally relevant pleasant events through a structured process. In STAR-VA, a CLC mental health professional and registered nurse are trained to train the entire CLC team to collaborate on behavioral assessment and care planning. Between 2010 and 2017, 83 VA CLCs have participated in STAR-VA training. Evaluation outcomes include significant decreases in the frequency and severity of target behaviors and decreased symptoms of depression, anxiety, and agitation among participating veterans.

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VA Psychotropic Drug Safety Initiative. VA aims to ensure veterans have access to high-quality, evidence-based pharmacological treatments for mental health and substance use disorders. To this end, in December 2013 the VA's Veterans Health Administration (VHA) launched the Psychotropic Drug Safety Initiative (PDSI), a nationwide psychopharmacology quality improvement program at VA medical facilities. PDSI supports facility and Veterans Integrated Service Network quality improvement initiatives by providing quarterly scores on 35 prescribing performance metrics; informatics tools that identify actionable patients with opportunities for improvement in their care, updated daily; a virtual learning collaborative; technical assistance for quality improvement implementation; and training and educational resources. PDSI Phase 2 (October 2015-June 2017) focused on improving evidence-based prescribing among older veterans in both outpatient and long-term care settings. The four aims for Phase 2 include: (1) improving the quality of prescribing among veterans with dementia by decreasing inappropriate use of antipsychotics and benzodiazepines; (2) decreasing benzodiazepine and sedative hypnotic use; (3) increasing metabolic monitoring among older veterans prescribed an antipsychotic; and (4) decreasing use of highly anticholinergic medications.

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Strengthen State Aging, Public Health, and Intellectual and Developmental Disability Workforces. HRSA GWEP awardees are collaborating with 30 Area Agencies on Aging (AAAs) and 15 Quality Improvement Organizations (QIOs) to strengthen state aging, public health, and IDD workforces. HHS will coordinate with states to develop a workforce in aging, public health, and IDD that is AD-capable and culturally-competent. For example, the Gateway GWEP is partnering with the AAAs throughout Missouri to provide training statewide in Cognitive Stimulation Therapy for individuals with mild-to-moderate dementia. Group participants take part in a number of engaging activities to help stimulate the brain and interact with others in a group atmosphere. An example of a collaboration with a QIO is at the University of Iowa's GWEP, known as the Interprofessional Strategic Healthcare Alliance for Rural Education (iSHARE). iSHARE partners with Telligen, which is providing quality facilitators who document patient outcomes data for iSHARE in the clinics of their primary care partners. Telligen has access to CMS data across several states, and iSHARE and Telligen are working together to determine whether it is possible to promote cross-GWEP partnerships by working on dementia training. If successful, regional/national collaboration may be undertaken as a pilot project.

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Develop and Disseminate a Unified Primary Care Alzheimer's Disease Curriculum. HRSA worked with federal partners at ACL, CDC, CMS, OWH, and VA on a contract to develop a Dementia Curriculum for Health Care Professionals. The curriculum is designed 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. A Technical Expert Panel (TEP) consisting of dementia experts, HRSA and the federal partners identified module topics. Specifically, 16 core modules along with 13 caregiving modules have been developed and pilot-tested. The core modules were built 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. The developed materials are appropriate for guided teaching by faculty in academia and continuing education programs and are appropriate for interprofessional clinical audiences. The caregiver modules development was supported by the OWH. Thirteen modules were produced, four targeted to providers as a means to enhance their interaction with and integration of the caregiver in the medical care team and the remaining nine targeted to family caregivers to encourage and refer them to resources to support them in maintaining their own health, safety and well-being while providing care for someone with AD/ADRD.

The materials can be found on the HRSA website. GWEP awardees and other educators will use these materials and adapt them as needed to meet local needs.

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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 2017 include "Clinical and Ethical Indications for Cognitive Impairment Screening in Primary Care" and "Healthy Communities: An Assessment and Implementation Framework to Achieve Inclusion of Persons with Disability."

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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 the 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.

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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; a patient checklist handout in English and Spanish, and other resources, which are available online in a mini-portal of resources for professionals.

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Improvements in the Home Care Workforce. CMS took steps in 2016 to outline strategies states can use to stabilize the Medicaid home care workforce, an important element of dementia care.

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