NATIONAL PLAN TO ADDRESS ALZHEIMER'S DISEASE: 2017 UPDATE. Strategy 2.D: Identify High-Quality Dementia Care Guidelines and Measures Across Care Settings

09/01/2017

National Research Summit on Care and Services for Persons with Dementia, Family Members, and Caregivers. Under the auspices of the NAPA Advisory Council, planning is fully underway for a National Research Summit on Care and Services for Persons with Dementia, Family Members, and Caregivers. The goal of this research summit is to identify what we know and what we need to know in order to accelerate the development, evaluation, translation, implementation, and scaling up of comprehensive care, services, and supports for persons with dementia, their families, and other caregivers. The Summit is focused on research that is needed to improve quality of care and outcomes across care settings, including quality of life and the lived experience of persons with dementia and their caregivers.

Cross-cutting themes of the Summit include:

  • Diversity (SES, race, ethnicity, culture, language, literacy, geographic locations)
  • Disparities
  • Etiologies and Disease Stages
  • Care Settings (home, community, assisted living, nursing home, and medical/health care settings)
  • Training and Workforce Issues
  • Technology
  • Differential Impact on Women

     

Anticipated outcomes of the Summit include:

  • Recommendations for research priorities to inform federal agencies, foundations, and other private sector organizations.
  • Identification of evidence-based programs, strategies, and approaches that can be used now to improve care and services.
  • Research milestones to track and guide acceleration and advancement of evidence-informed care and services.
  • Spread of information to the public including people living with dementia and their caregivers.

     

The Summit will be held on October 16-17, 2017 at NIH.

For more information, see:

________________________________________

Clarify and Disseminate Information on Privacy, Autonomy, and Safety Issues for Physicians. Based on the recommendation of the Advisory Council to clarify information on privacy, HHS will develop information for physicians on privacy, autonomy, and safety issues. This resource will help providers better understand these issues and the balance between safety, privacy, and autonomy. HHS will disseminate this information through the trainings provided by the GWEP awardees in Strategy 2.A.

Elder abuse and elder justice are important topics, especially for persons living with dementia. Sixteen GWEPs have produced training materials for primary care providers on this important topic. For example, the University of Washington's Northwest GWEP has produced two online modules: Elder Mistreatment and Elder Investment Fraud to address these critical issues.

For more information, see:

________________________________________

Dementia Caregiving Network. The Dementia Caregiving Network (DCN) is an interprofessional Hartford Change AGEnts Initiative working to achieve improvements in services, supports, and care for persons with dementia and their family caregivers, supported by the John A. Hartford Foundation. Since January 2014, DCN has identified core concepts that define or influence practice change activities in dementia caregiving. One project involves developing a database of existing caregiver support interventions for agencies to access to determine which programs to adapt. Another project involves identifying ways to modify electronic records to identify families of persons with dementia. Yet another project involves evaluating and critiquing existing measurement sets. Finally, another project involves advancing a model for care management through managed care organizations.

For more information, see:

________________________________________

Home and Community-Based Services Quality. Measuring quality in HCBS settings, where few endorsed measures exist, has become increasingly important in the new cross-setting health care paradigm, especially as Medicaid funding continues to shift from institutional to cost-effective community-based care. CMS recently received CAHPS® endorsement for its HCBS Experience of Care Survey.

For more information, see:

________________________________________

Improved Care in the Nation's Long-Term Care Facilities. CMS issued a final rule in 2016 that made major changes to improve the care and safety of the nearly 1.5 million residents in the nation's 15,000 long-term care facilities (nursing homes) that participate in Medicare and Medicaid. The policies in the final rule help to reduce unnecessary hospital readmissions and infections, improve quality, and strengthen safety measures for residents. The rule also strengthens staffing provisions, requires person-centered care, includes a specific requirement for dementia training, betters discharge planning, and updates infection prevention and control protocols.

For more information, see:

________________________________________

VA Dementia Care Recommendations. VA's VHA Dementia Steering Committee Recommendations have been updated and are now posted online. The recommendations provide guidance to improve the health and well-being of veterans by increasing access to best practices in care for veterans living with dementia, their families, or other caregivers. The recommendations, which are not themselves formal VHA policy or mandates, are interdisciplinary, VA-specific, and comprehensive; combine published evidence with VA experts' experience; and address dementia recognition, diagnosis, treatment at different stages, care coordination, administrative matters, research, and education.

For more information, see:

________________________________________

VA Clinician Fact Sheet on Detection of Cognitive Impairment. VHA's National Center for Health Promotion and Disease Prevention (NCP) Clinician Fact Sheet, Detection of Cognitive Impairment, has been updated and is now posted online. VHA does not recommend routine screening for cognitive impairment in asymptomatic older adults (those presenting with no signs or symptoms of cognitive impairment). Instead, it recommends that VHA Primary Care clinicians should be alert to early signs or symptoms of cognitive impairment and evaluate as appropriate. The NCP Clinician Fact Sheet includes lists of warning signs that clinicians may notice or that patients and caregivers may report, plus elements of a structured diagnostic evaluation if warning signs are present.

For more information, see:

________________________________________

Factors Influencing the Progression of Disability in Older Adults. Information about the health and disability status of older adults at a point in time is known, but information on how this changes over time at the person level is more limited. For example, how do physical limitations change over time? How rapidly does someone go from needing only assistance with bathing to needing help with other self-needs? We know that women tend to live longer than men, but are there differences in how rapidly disability progresses once it begins? The HHS Office of the Assistant Secretary for Planning and Evaluation's (ASPE's) project uses the National Health and Aging Trends Study (NHATS) data from 2011 to 2015 to study the progression of disability and the implications for caregiving needs. Outcomes data are being tabulated each year (death, long-stay nursing home admission, residential care admission, continued or increased use of informal/paid care). Those who develop dementia after 2011 would be studied, but most cases would already have dementia or symptoms in 2011, and the course of their condition would be followed through 2015. The effects of demographic characteristics (age, sex, race, marital status, income, education) on the incidence of disability and their effect on its progression are being studied as well.

________________________________________

Trends in Residential Care Settings for Older Adults. Most long-term care for older Americans is provided by family and friends in the home. When the needs become greater than home care can provide, nursing home admission is often used. However, increasingly older Americans are relying on care in an array of facility-based settings, such as assisted living facilities. ASPE's project is analyzing trends in residential care, using data at various points in time from several data sources, including the Medicare Current Beneficiary Survey (MCBS), NHATS, and the National Study of Long-Term Care Places (NSLTCP). This project will present the estimates, explain why they would be expected to differ across sources, and analyze the resulting trends. The sources also contain some information on the characteristics of facilities and residents. This information is being analyzed to further determine the role such places play in the long-term care system, and to better understand the reasons for differences in the estimates across sources.

________________________________________