WASHINGTON – Members of a national advisory council on Alzheimer’s disease have identified preliminary goals and specific recommendations for a national strategic plan to slow or even halt the expected rise in new cases.
The plan aims to prevent and effectively treat the disease by as early as 2025. Its goals include enhancing care quality and efficiency, expanding patient and family support, enhancing public awareness and engagement, and improving data to track disease progress.
The plan is part of the National Alzheimer’s Project Act that was signed into law on Jan, 4, 2011, by President Obama. The law established the Advisory Council on Alzheimer’s Research, Care, and Services and requires the secretary of the Department of Health and Human Services and the advisory council to create and maintain a national plan to overcome Alzheimer’s disease. Members of the council’s subgroups on long-term services and supports (LTSS), clinical care, and research met Jan. 17-18 to comment on and provide recommendations for the plan’s draft framework.
Long-Term Services and Supports
Members of the LTSS subgroup noted that the importance of caregivers and family to Alzheimer’s patients warrants the inclusion of services to maintain their health and vitality. In addition, the subgroup proposed that robust dementia-capable systems of LTSS be culturally appropriate, available in every state, and accessible to younger people with Alzheimer’s disease – a group often forgotten in discussions of Alzheimer’s disease. The LTSS subgroup also recommended that new guidelines for diagnosis be used whenever someone is admitted for LTSS or assessed for eligibility. The process of diagnosis also should include engaging the patient and family in advance care planning. End of life considerations should be incorporated into all surveillance and quality indicators.
Council members recommended that federal funds be made available to support a lead agency in every state to coordinate all available LTSS provided through various public and private mechanisms. The agency could use these funds to build and monitor quality indicators and the capacity to maximize the positive impact of services on patients and caregivers.
The council advised that state education agencies and professional organizations include key information about Alzheimer’s disease in all curricula for any profession or career track affecting LTSS, as well as key information about Alzheimer’s disease for any staff working in human service agencies. Patients and caregivers also should be informed of state, local, and private housing resources, and states should provide adult day services as an option under Medicaid, the council said.
Clinical Care of Alzheimer’s Disease
The clinical care subgroup said the overall goal of clinical care is to ensure that individuals with Alzheimer’s have their disease detected and diagnosed at an early stage, receive care planning, and have access to coordinated and high-quality health care throughout the course of the disease.
In particular, members recommended changes to Medicare coverage and physician reimbursement to encourage the diagnosis of Alzheimer’s disease and to provide care planning to diagnosed individuals and their caregivers. In addition, quality indicators for the care and treatment of individuals with Alzheimer’s should be developed. The subgroup proposed medical home pilot projects specifically targeted at improving medical management for individuals with Alzheimer’s using grants from the Center for Medicare and Medicaid Innovation (CMMI).
The subgroup also recommended addressing palliative care by forming a blue-ribbon panel of experts to recommend one or more models of care for people with advancing dementia, which would cover eligibility criteria and financing mechanisms. CMMI also could be tapped to supply grants to implement these models.
In addition, the subgroup advised improving and expanding the National Family Caregiver Support Program and other evidence-based caregiver support models. Members also recommended that a specific round of grants for pilot projects to reduce potentially preventable emergency department visits and hospitalizations for individuals with Alzheimer’s be funded through CMMI. They recommended exploring the use of public-private partnerships to develop and evaluate ways to improve hospital care for people with Alzheimer’s and other dementias.
Greater funding and incentives should be offered to individuals to pursue careers in geriatric specialties, they noted.
The research subgroup said their stated goal – the ability to prevent, effectively treat, and substantially delay the onset or slow the progression of Alzheimer’s disease – could be reached through three key strategies:
• Aggressively committing resources, with appropriate accountability, to Alzheimer’s disease research to match the current and growing impact of the disease on society.
• Accelerating public access to new therapeutic interventions by compressing the current average time of identifying and validating therapeutic targets and developing and testing the efficacy and safety of interventions.