National Plan to Address Alzheimer's Disease: 2018 Update. Strategy 2.A: Build a Workforce with the Skills to Provide High-Quality Care

10/19/2018

The workforce that cares for people with AD/ADRD includes health care and LTSS providers such as primary care physicians; specialists such as neurologists, geriatricians, and psychiatrists; registered nurses and advanced practice nurses; community health workers; social workers; psychologists; pharmacists; dentists; allied health professionals; and direct care workers, home health aides, and certified nursing assistants, who provide care across the care continuum. These providers need accurate information about furnishing care to a person with AD/ADRD including the benefits of early diagnosis, how to address the physical, cognitive, emotional, and behavioral symptoms of the disease, and how to assist caregivers as they cope with the physical and emotional aspects of their caregiving responsibilities. Enhanced specialist training is also needed to prepare these practitioners for the unique challenges faced by people with AD/ADRD. In addition, work is needed to expand the capacity of the primary care community to serve people with AD/ADRD. Dementia-specific capabilities within the direct care workforce need to be expanded and enhanced. The actions below will facilitate specific training for care professionals in order to strengthen a workforce that provides high-quality care to people living with AD/ADRD.

(UPDATED) Action 2.A.1: Educate health care providers

In FY 2017, Health Resources and Services Administration (HRSA) supported 44 Geriatrics Workforce Enhancement Program (GWEP) grantees totaling approximately $38.7 million of which $5.9 million was specifically budgeted to provide dementia education and training. In Academic Year 2016-2017 (latest available data), GWEP grantees provided 467 AD/ADRD courses and trained 55,640 health care providers in AD/ADRD.

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. NIA also produced and disseminated "Assessing Cognitive Impairment in Older Patients: A Quick Guide for Primary Care Physicians".

Additionally, in 2018 NIA released the FOA -- Small Research Grant Program for the Next Generation of Clinical Researchers in AD/ADRD Research -- aimed at producing trained clinical investigators pursuing careers in the field of AD/ADRD research.

For more information, see:

________________________________________

(UPDATED) Action 2.A.2: Encourage providers to pursue careers in geriatric specialties

In Academic Year 2016-2017 (latest available data), GWEP awardees trained 638 individuals in geriatrics fellowships and 136 advanced education nursing students in advanced practice adult-gerontology nursing programs. As part of their training, these individuals receive education in AD/ADRD.

________________________________________

(UPDATED) Action 2.A.3: Strengthen state aging, public health, and intellectual and developmental disability workforces

HHS will coordinate with states to develop workforces in aging, public health, and intellectual and developmental disability (IDD) that are AD-capable and culturally-competent. ACL collaborated with HRSA to provide AD/ADRD training to the Aging Network.

ACL through the National Alzheimer's and Dementia Resource Center (NADRC) offers an annual dementia-specific webinar series, attracting as many as 1,300 attendees to a single session. The series targets AD/ADRD professionals, attracting family caregivers as well, and includes information on related dementias, innovative interventions and a wide variety of caregiving topics. Continuing education units (CEUs) are available to attendees, and the webinars are archived on the resource center web page.

Each year, in support of paid and unpaid caregivers, the NADRC develops tools and issue briefs on dementia-specific topics. New materials developed are disseminated through the ACL grant programs, as well as at professional conferences and the center website. ACL is constantly adding new tools and issue briefs to its growing library. Topics of materials developed by NADRC include, but are not limited to, advance planning, living alone, compendiums of dementia-specific interventions and outcome measures.

In FY 2017, the 44 HRSA GWEP grantees collaborated with 32 Area Agencies on Aging (AAAs) and 15 Quality Improvement Organizations (QIOs) to strengthen state aging, public health, and IDD workforces.

For more information, see:

________________________________________

(UPDATED) Action 2.A.4: Develop and disseminate a unified primary care Alzheimer's disease and related dementias curriculum

From FY 2015-FY 2017, HRSA partnered with federal staff at ACL, CDC, Centers for Medicare & Medicaid Services (CMS), HHS Office on Women's Health (OWH), and U.S. Department of Veterans Affairs (VA) on a contract to develop a Dementia Curriculum for Health Care Professionals and Caregivers. 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. The curriculum was first made available as of December 2017. In the first month it was available, the site had 8,000 hits. The curriculum is being updated every 6 months. HRSA is partnering with CDC to provide CEUs to health professionals. HRSA is also partnering with CMS to convert the caregiver modules in the Curriculum to YouTube videos.

CMS's Integrated Care Resource Center (ICRC), which partners with health plans and providers, also offered a 2017 Geriatric-Competent Care Webinar Series designed to help health professionals in all settings and disciplines expand their knowledge and skills in the unique aspects of caring for older adults and in working with their caregivers, with some focus on dementia. The webinars are intended for front line community partners and delivery staff such as care managers, member service representatives, and home care providers. Topics have included promising practices to advance care of Medicare-Medicaid enrollees with dementia, causes of dementia in older adults, diagnosis and treatment of Parkinson's disease.

For more information, see:

________________________________________

(UPDATED) Action 2.A.5: Ensure aging and public health network providers have access to research-based up-to-date information on Alzheimer's disease and related dementias

NIH initiated a project involving the Agency for Healthcare Research and Quality (AHRQ), and the National Academies of Sciences, Engineering, and Medicine (NASEM), to conduct a systematic review of the evidence on prevention of clinical Alzheimer's-type dementia, MCI, and age-related cognitive decline (AHRQ), and to shape these findings into a set of recommendations for public health practice and research (NASEM). The NASEM report, detailing recommendations for public health messaging based on findings was released in June 2017.

The interagency ROAR group (NIH, ACL, and CDC) hosted an update in the popular webinar series in 2017 for professionals on AD/ADRD resources that drew 500+ participants and offered continuing education credit (CEC). Free continuing education is available to professionals who need it when they view recorded webinars from 2017 and earlier series. This continuing education is available through 2018.

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.

For more information, see:

________________________________________

(UPDATED) Action 2.A.6: Engage the public health workforce on brain health

CDC in collaboration with the Healthy Brain Research Network (HBRN) developed a Scholars Program to assist in the training of graduate-level students in brain health. Students engage in a variety of educational, partnership, and research activities. This program is in Year 2 of a 5-year funding cycle.

CDC in collaboration with the Alzheimer's Association developed "A Public Health Approach to Alzheimer's and Other Dementias" curriculum. This introductory curriculum describes the role of public health in addressing the epidemic of AD/ADRD. Its four modules each contain a comprehensive faculty guide and slide deck.

For more information, see:

________________________________________

(UPDATED) Action 2.A.7: Strengthen the ability of primary care teams in Indian Country to meet the needs of people with Alzheimer's disease and related dementias and their caregivers

The Indian Health Service (IHS) incorporated training for AD/ADRD into the online continuing education curriculum for IHS/Tribal/Urban program nursing. A web-based course on AD/ADRD was provided in April-June 2016 at the IHS Clinical Rounds. Results were addressed at IHS Nursing Leadership meeting May 17, 2016. A clinical training on diagnosis and management of AD/ADRD for ACL/IHS/CMS LTSS conference was delivered in November 2016. IHS is currently developing use of Extension for Community Healthcare Outcomes project (Project ECHO) to support diagnosis and management of AD/ADRD in Tribal communities.

________________________________________

(UPDATED) Action 2.A.8: Develop a baseline understanding of self-reported competence and confidence of Indian Health Service, Tribal and Urban Indian Health nursing staff in care of individuals with Alzheimer's disease and related dementias

IHS created a survey to assess nursing in IHS, Tribal, and Urban Indian Health programs on self-reported competence, confidence, and recent training specific to care for individuals with AD/ADRD. The survey has been pilot-tested at one Tribal site.

________________________________________

(UPDATED) Action 2.A.9: Improve educational resources for primary care staff in Tribal communities caring for individuals with Alzheimer's disease and related dementias and their families

IHS, in conjunction with HRSA, worked to pilot-test the HRSA curriculum for care of AD/ADRD in IHS, Tribal, and Urban Indian Health Programs. Pending completion of the brief, targeted provider-focused curriculum, IHS will be able to report on success rates and take-up of this curriculum and further implementation in other Tribal communities.

________________________________________

(UPDATED) Action 2.A.10: Provide decision support for clinicians in Tribal communities

IHS worked to develop and pilot-test decision support tools for clinicians using the IHS electronic health records (EHRs). As of 2018, IHS has developed templates to support the Annual Wellness Visit (AWV), including cognitive assessments and chronic care management (CCM).

________________________________________

(UPDATED) Action 2.A.11: Private interdisciplinary team training in recognition, assessment, and management of Alzheimer's disease and related dementias in small rural Indian Health facilities

IHS worked with the VA to provide the VA Rural Interdisciplinary Team Training (RITT) to 10 IHS and Tribal sites with a focus on dementia care. So far, 12 RITT Trainings have been completed. The trainings include webinars, accredited through Employee Education System (EES) and TRAIN for VA and community clinicians. The latest training provided was on post-traumatic stress disorder (PTSD) and Memory (January 24, 2018).

For more information, see:

________________________________________

(UPDATED) Action 2.A.12: Strengthen states' ability to provide and sustain dementia-capable home and community-based services

Implementation of dementia-capability assessment tool for implementation through the ACL state and community grant program. The tool assesses program partners over the course of a grant to measure the improvement in dementia-capability. The tool is available for non-grantees on the NADRC website.

CMS extended the transition period for states to demonstrate compliance with its HCBS settings to ensure compliance activities related to integrated community settings are collaborative, transparent, and timely and assure thoughtful implementation, and impose less burden on states.

For more information, see:

________________________________________

(UPDATED) Action 2.A.13: Fill service gaps in dementia-capable systems by expanding the availability of specialized services and supports to target previously underserved populations

This is an ongoing project assuming continuing congressional appropriations. In 2017, 11 community programs received funding, bringing the total number of programs funded since 2014 to 43.

In 2018, CMS announced that beginning in 2019 it is expanding the definition of "primarily health-related," supplemental benefits in Medicare Advantage Organizations to consider an item or service as a supplemental benefit if it is used to diagnose, compensate for physical impairments, acts to ameliorate the functionality/psychological impact of injuries or health conditions, or reduces avoidable emergency and health care utilization. This permits the plans to offer supplemental benefits such as adult day health, environmental modifications, palliative care, etc.

________________________________________

(UPDATED) Action 2.A.14: Improve home and community-based long-term services and supports provided through state Medicaid waivers

Work is ongoing in this space. CMS continues to hold webinars, national calls, and provide information to key stakeholders. As one example, CMS is supporting state Medicaid agencies in community integration through HCBS. One targeted area of support is helping a select number of Medicaid agencies plan and implement quality and outcome measures and measure concepts in their HCBS programs.

For more information, see:

________________________________________

(UPDATED) Action 2.A.15: Disseminate Centers for Medicare & Medicaid Services Hand-in-hand dementia training materials in Department of Veterans Affairs community living centers

VA disseminated the CMS Hand-in-Hand Dementia Training Materials to all VA Community Living Centers (CLCs; formerly known as VA Nursing Home Care Units) in 2015-2016. Orientation calls with CLC leaders were held, and a series of implementation coaching calls were held with CLC staff. A process evaluation is underway. When evaluation activities are complete, VA will share with federal partners a summary report on its implementation and evaluation of the dissemination of these staff training materials.

Nineteen of the HRSA 44 GWEPs collaborated with VA. The GWEP grantees are prepared to assist with training in VA CLCs should they be asked to do so.

________________________________________

(NEW) Action 2.A.16: Training future public health professionals on Alzheimer's disease and related dementias

CDC has developed a Public Health Curriculum in partnership with the Alzheimer's Association and Emory University. The Public Health curriculum is a comprehensive course designed to educate public health students about the growing issues related to AD/ADRD and is tied to the Core Competencies for Public Health Professionals. It includes slides, teacher notes, and other elements to create a complete course for educators to use in the classroom. The curriculum is also relevant to other audiences for broader reach.

For more information, see:

________________________________________