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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
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6

Creating Change

Faith Mitchell introduced the final workshop session as an examination of promising new opportunities for change in care for people with ADRD. Speakers addressed the individual, the community, and health care settings, as well as workforce challenges and modifications of payment models. Concerns specific to ADRD care were integrated with important insights about behavior and systems change, with a focus on the patient’s perspective.

CHANGING BEHAVIORS TO SUPPORT BRAIN HEALTH

Sarah Lenz Lock, senior vice president for policy and brain health in the AARP Policy, Research, and International Affairs Department and executive director of the Global Council on Brain Health, explained that up to 40 percent of dementias could be prevented by modifiable lifestyle factors (Livingston, 2020). These interventions can delay onset of dementia, reduce risk, and improve the quality of life for people living with ADRD. Lenz Lock urged researchers to consider managing dementia as a chronic disease in which it is possible to improve quality of life. She added that frequently there is a disconnect between health care providers and individuals when it comes to awareness of these modifiable lifestyle factors. Recent AARP surveys found that a substantial majority of health care providers know that regular exercise, social interactions, healthy diet, adequate sleep, stress management, and mental stimulation can improve the quality of life of people living with dementia, and a substantial majority of adults were willing to

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×

adopt these behaviors if they understood they were beneficial to their brain health. However, she opined that the benefits of those modifiable lifestyle factors to brain health are not adequately disseminated to patients and are frequently overlooked by research efforts directed at improving quality of care for people with ADRD.

Lenz Lock suggested that the stigma associated with ADRD, which may cause discomfort among health care providers, may contribute to less forthright conversations when discussing an ADRD diagnosis with a patient. Young providers may not understand how their older patients feel or their priorities. Research conducted by AARP revealed that the two groups differ substantially in their feelings about an ADRD diagnosis. The organization surveyed adults age 40 and older as well as health care providers about their feelings about a dementia diagnosis. Nineteen percent of respondents from the adults age 40 and older group agreed with the statement, “If I had dementia, I would be ashamed or embarrassed” (AARP, 2021). However, 69 percent of health care providers agreed with a similar statement, “If my patient had dementia, they would be ashamed or embarrassed” (AARP, 2021). In the same survey, 7 percent of respondents age 40 and older agreed with the statement, “If I had dementia, I would give up on life” (AARP, 2021). Thirty-two percent of health care providers agreed with the statement, “If my patient had dementia, they would give up on life” (AARP, 2021). She noted that there is a need for many health care providers to overcome their reluctance to talk about dementia and treat it as a manageable chronic disease.

Lenz Lock cited a recent report on behavior change by the Global Council on Brain Health (GCBH)1 and suggested that some improvements in quality of care can be made within the health care system in the absence of payment reform. The GCBH report makes recommendations for individuals, communities (health care providers, employers, advocates, nonprofits, etc.), and policy makers to support brain health. She suggested that change will be needed at all levels of the health care system. The report includes specific strategies for individuals to engage in to support brain health.2 She suggested that the most important recommendation that the report makes for communities is to set goals to change behavior in order to improve brain health, which could reduce the stigma associated with ADRD diagnosis.

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1 See https://www.aarp.org/health/brain-health/global-council-on-brain-health/behavior-change/ (accessed on June 17, 2022).

2 See https://www.aarp.org/content/dam/aarp/health/brain_health/2022-03/gcbh-behavior-change-infographic-english.doi.10.26419-2Fpia.00106.002.pdf (accessed on July 28, 2022).

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
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CHANGING CARE TO ADDRESS THE NEEDS OF PEOPLE LIVING WITH DEMENTIA

Leslie Pelton, vice president, Institute for Healthcare Improvement, began by explaining that determining how to attain reliable, sustainable delivery of evidence-based care that serves the needs of people living with ADRD is essential. The 4 Ms (what matters, medication, mentation, and mobility) framework represents a set of evidence-based core elements of care for older adults that also represent the core health issues for people living with ADRD (Figure 6-1) (Mate et al., 2021). Adherence to the 4 Ms framework supports patient safety, particularly for patients with ADRD. The framework also simplifies care for people with ADRD for health care providers.

Pelton explained that inclusion of mentation in the 4 Ms supports normalizing the discussion of brain health, with the goal of this discussion

Image
FIGURE 6-1 The 4 Ms framework.
Source: Presented by Leslie Pelton on May 24, 2022 at the workshop Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer’s Disease and Related Dementias. For related work, this graphic may be used in its entirety without requesting permission. Graphic files and guidance at ihi.org/AgeFriendly. Accessed via ihi.org/AgeFriendly. (Mate et al., 2021).
Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
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becoming as normal as a conversation about the health of any other organ and destigmatizing this discussion for health care providers. The “what matters” component, which includes health care providers asking patients and their caregivers, “What matters to you?” helps people with ADRD and their caregivers identify and communicate their goals and priorities. This facilitates organization of care around those answers.3 There are effective ways to assess whether evidence-based care is being practiced, said Pelton, including measures of access, process, and outcome (Fulmer et al., 2022).4

Pelton explained that how the 4 Ms should be practiced in each system where people with ADRD receive care is unknown. This will vary depending on the culture, lived experiences, and technologies available to each individual care team. She added that the combination of firm expectations for use of the 4 Ms as a framework with outcome measures, while also allowing each care team to adapt the framework to their system, can lead to sustainable change (Figure 6-2). The Model for Improvement is a tool for helping health care teams adapt the 4 Ms framework to their particular environments (Langley et al., 2009). The combination of a high level of autonomy and tools to learn and build at the local level supports a more positive experience for the health care team (Perlo et al., 2017).

Image
FIGURE 6-2 Implementing the 4 Ms framework.
NOTE: EHR = electronic health record.
SOURCE: Adapted from Barker, P. M., A. Reid, M. W. Schall. A framework for scaling up health interventions: Lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016 Jan;11(1):12. Presented by Leslie Pelton on May 24, 2022 at the workshop Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer’s Disease and Related Dementias. Source of data: Barker et al., 2016.

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3 See https://theconversationproject.org/wp-content/uploads/2020/12/ConversationStarterGuide.pdf (accessed June 17, 2022).

4 See http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx (accessed on June 17, 2022).

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
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She added that additional research is needed to understand the interaction between application of the 4 Ms framework with race and ethnicity. A gradual approach that includes scaling up the mechanisms of the 4 Ms framework should decrease the likelihood of inadvertently building disparities into the system.

POLICY CHANGES TO MEET THE CHALLENGES OF CARING FOR PEOPLE WITH ADRD

Kate McEvoy, program officer Milbank Memorial Fund, began by describing several key considerations for improving the quality of care and supports for people with ADRD and their caregivers. She noted that efforts will require a focus on coordinating available resources at the local, state, and federal level for people with middle and low incomes. There are existing programs that have been created at the federal level to support improving quality of care for people with ADRD, such as the National Plan to Address Alzheimer’s Disease.5 There are also state-level programs, such as the Master Plan for Aging approach,6 and the Older Americans Act (OAA) requires state plans for aging and state Alzheimer’s disease plans (Colello and Napili, 2022).7 There are also federal efforts to support access to care and services for people with ADRD, such as Aging and Disability Resource Centers and the No Wrong Door model.8,9 Medicaid waiver supports and OAA National Family Caregiver (III-E) resources provide limited funding at the state level. There is an emerging evidence base in support of specific interventions, as well as the advancement of smart home and other technological approaches (Majumder et al., 2017).

McEvoy explained that despite these beneficial programs, challenges to progress remain. Federal and state planning, while effective, tends to be siloed. As an example, CMS and the Administration for Community Living (ACL) jointly manage Medicaid and OAA activities However, both could be more effective with better collaboration. Consumers are not adequately informed about resources such as Aging and Disability Resource Centers. This has led to

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5 See https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa/napa-documents/napa-national-plans (accessed June 24, 2022).

6 See https://www.thescanfoundation.org/publication-cat/master-plan-for-aging/ (accessed June 24, 2022).

7 See https://alzimpact.org/media/serve/id/5d23af19258fb (accessed June 24, 2022).

8 See https://acl.gov/programs/aging-and-disability-networks/aging-and-disability-resource-centers (accessed June 24, 2022).

9 See https://acl.gov/programs/connecting-people-services/aging-and-disability-resource-centers-programno-wrong-door (accessed June 24, 2022).

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×

such resources being underutilized until an individual experiences a crisis such as a fall or other hospitalization. She noted that care funding challenges, such as the lack of publicly funded and limited availability of commercial long-term care insurance, as well as variable access to Medicaid waivers for people living with ADRD, create additional barriers to improved care.

McEvoy offered three suggestions to address these challenges. First, CMS and ACL would benefit from improving coordination of their efforts through development of a joint framework for supporting people across the income and resource continuum. She emphasized that there is a need for improved consumer literacy about available benefits for ADRD care. Many people mistakenly believe that Medicare provides coverage for most long-term support services (LTSS). An effective approach for improving dissemination of information about resources such as Aging and Disability Resource Centers should include identifying messengers that community members consider trustworthy, including peers and physicians. She noted another opportunity for collaboration could be CMS endorsement of state Medicaid underwriting of Aging and Disability Resource Centers and services that support people with ADRD to live at home independently, such as home adaptation and tele-monitoring. Another strategy that could be implemented related to financing care for people with ADRD is to develop planning supports for people with ADRD that are spending down their financial resources to reach Medicaid eligibility. Her second suggestion was to create a publicly funded, payroll-based, long-term care insurance benefit. This benefit would defray the substantial out-of-pocket costs for ADRD care as well as serve as a vehicle for increasing consumer literacy about available benefits for ADRD care. Third, she noted that Medicaid could be enabled to have a greater effect on quality of care and supports for people with ADRD and their caregivers. She described several approaches that could better use Medicaid. These include a combined effort between Medicare and Medicaid to cover bundled payment models, such as Community Aging in Place-Advancing Better Living for Elders (CAPABLE10), and that include home care services, such as occupational therapy and home repair, and development of an LTSS Medicare/Medicaid waiver for people that are dually eligible that emphasizes coordinated care payments as well as measures directed at improving health equity and focuses on person-centered outcome measures. She also noted that legislative reforms, such as changing the statutory presumption that Medicaid is funding institutional care to a greater emphasis on funding home care and community-based services, could be beneficial. That approach could include making the Money Follows the Person demonstration project permanent.

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10 See https://nursing.jhu.edu/faculty_research/research/projects/capable/ (accessed July 29, 2022).

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×

THE ROLE OF WORKFORCE ENGAGEMENT: LESSONS FROM NAPA

Helen Lamont, director, Division of Disability and Aging Policy, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE), began by discussing their work related to the National Alzheimer’s Project Act (NAPA).11 NAPA includes six goals:

  1. Accelerating research to prevent and treat Alzheimer’s disease
  2. Optimizing care quality and efficiency
  3. Expanding supports for people with Alzheimer’s disease and their caregivers
  4. Enhancing public awareness
  5. Tracking progress
  6. Promoting risk reduction.

Ten years after the inception of NAPA, Alzheimer’s disease research funding has increased substantially. The Health Resources and Services Administration (HRSA) and ACL have expanded programs related to ADRD care, and policy makers have demonstrated increased engagement in efforts to improve ADRD care. She noted that ASPE’s substantial collaboration efforts within and outside the federal government have been a major factor in NAPA’s success. Another critical factor for NAPA’s success has been the high level of commitment and expertise of the federal staff from all involved agencies.

Lamont next discussed the workforce involved in care of people with ADRD. She noted that this includes everyone involved with providing care and support for a person with ADRD, including health care providers and staff, community-based organizations and their staff, family caregivers, home care workers, and others. The ADRD care workforce faces a series of challenges. The demand for workers is growing as the population ages. People living with ADRD often have complicated chronic conditions and needs and may exhibit challenging behavioral and psychological symptoms. Providing care under those conditions can be emotionally and physically challenging as well as time consuming to coordinate. She noted that wages for direct care workers are not commensurate with the challenges associated with providing care for people with ADRD. This workforce has been heavily burdened during the COVID-19 pandemic, which exacerbated the existing challenges associated with providing care. The result was high rates of workforce turnover,

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11 See https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa (accessed June 24, 2022).

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×

labor shortages, increased costs, and poor quality of care, all of which make it difficult to implement new programs or initiatives related to quality of care.

Lamont emphasized the importance of the workforce tasked with providing direct care to people with ADRD. She noted that the 2022 National Academies of Sciences, Engineering, and Medicine consensus committee report addressing quality of care in nursing homes listed support for the workforce as its second goal, above financing reform (NASEM, 2022). Lamont opined that the most effective care is provided by an interprofessional team that brings together long-term care providers with other health care providers, which has implications for financing and how programs and policies are structured. She added that workforce education and engagement should be incorporated with payment policy changes to facilitate effective and sustainable strategies to improve quality of care and supports for people with ADRD.

DISCUSSION

Community Support for Sustainability

Faith Mitchell began by asking the group to discuss how behavioral change at the community level can increase sustainability of efforts for brain health. Lenz Lock explained that it is important for all communities, including the health care system, policy makers, and individuals, to understand that behavior change to promote brain health is possible and can have positive benefits. She added that each community needs to understand that they will benefit from improved brain health. For example, employers will reap the benefits of a healthier workforce that exercises regularly and receives adequate sleep. Health care providers that engage with their patients to encourage healthy behaviors that support brain health will also experience long-term benefits. Many people assume that deterioration and cognitive decline are inevitable aspects of aging, noted Mitchell. Lenz Lock noted that to combat this, AARP is working to engage people in an evidence-based brain health initiative.

The Role of Geriatricians in Promoting Adoption of the 4 Ms

Rebecca D. Alon, an audience member, asked the panel to discuss the role of geriatricians in supporting health care systems to adopt the 4 Ms model. Pelton began by explaining that the Age-Friendly Health Systems movement was developed to ensure that older adults, including those with ADRD,12

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12 See http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx (accessed June 27, 2022).

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×

receive evidence-based care, regardless of where in the health care system they are receiving care or whether a geriatrician is present. She added that one of the motivating factors for the development of the 4 Ms framework was to offer a guiding structure for care when there is not a geriatrician available, particularly given that not all health care facilities have geriatricians on staff. Hollmann noted that while it may not be feasible to have a geriatrician available to care for every older person, the American Geriatric Society has suggested that it would be appropriate for every Medicare Shared Savings Program to require somebody with geriatric expertise at a leadership level. He added that there is a precedent for this, as Medicare Part D plans are required to have a geriatrician and a geriatric pharmacologist as part of their organization.

Coordinating Federal Efforts

Gary Epstein-Lubow, Brown University, asked the group to discuss potential coordination among CDC, CMS, and ACL, particularly related to dissemination and implementation of evidence-based practices to improve quality of care for people living with ADRD. Lamont noted that implementation of the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act began recently.13 That includes coordination between the Aging Network and the public health networks.14 She added that there is a BOLD Center of Excellence on Caregiving that is involved in efforts to disseminate programs operated by ACL. Lamont added that another opportunity would be greater collaborations between the Aging Network and the public health networks. She noted that there have been past efforts to combine Older Americans Act (OAA) services and Medicaid programs. She said that there is increasing interest in coordinating between agencies and suggested that efforts should avoid an excessive focus on cost-effectiveness that could create artificial barriers to improvement in quality of care. Lamont noted that it would be beneficial for OAA services to be viewed less as a means of reducing Medicaid expenditures and more as a strategy for supporting the segment of the population that is not eligible for Medicaid but requires support to continue to live in the community.

McEvoy noted that there may be unrealized opportunities for collaboration. Medicaid is very insular in its orientation to traditional services under state plans, but there are opportunities for specific intersections, such as Medicaid funding for Aging and Disability Resource Centers, which equip consumers to optimize their own resources under the ACL agenda. McEvoy noted

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13 See https://www.congress.gov/bill/115th-congress/senate-bill/2076 (accessed September 29, 2022)

14 See https://eldercare.acl.gov/Public/About/Aging_Network/Index.aspx (accessed June 27, 2022).

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×

some individual strands of funding have been less impactful than expected. She suggested that developing a strategy to combine those pieces could enable the states to do more, she said, noting that the COVID-19 pandemic created new opportunities for collaborations among health agencies.

Evaluation of Age Friendliness

Mitchell next asked Pelton how the effects of the age-friendly aspect of the 4 Ms framework could be distinguished from other factors that could affect patient outcomes. Pelton explained that they are evaluating the reach of the program by capturing the number of people who are reached by this care, as well as the effect of different aspects of the 4 Ms on outcomes, length of stay, and incidence of delirium. Pelton welcomed other interventions that have a positive effect on quality of care, such as the Age-Friendly Health System movement, geriatric emergency department (GED) accreditation, and geriatric surgery verification.15 She explained that a critical component to support sustainable implementation is allowing space for individual health care systems to adapt the 4 Ms to their culture.

For example, in the Anne Arundel Medical Center, the “what matters” component of the 4 Ms demonstrated rapid uptake and was the catalyst for organizational change and adoption of the 4 Ms. The 4 Ms would not have been sustainably adopted at Anne Arundel had they not been given the flexibility to implement the program in a manner that fit their organization. She added that a combination of tools for quality improvement and autonomy for the care team have been important to facilitate broad and sustainable adoption of the 4 Ms framework. Lenz Lock noted that AARP has collaborated with USAging to develop a simple and inexpensive evaluation mechanism to determine whether the initiatives were effective for people with ADRD,16 as well as the means to share successful practices. Lenz Lock encouraged communities to use these tools to share practices that lead to improved outcomes.

Engagement and Equity

Jennie Chin Hansen asked the group to discuss implementation of the 4 Ms in groups that have been historically made vulnerable and diverse populations. Pelton explained that Anne Arundel Medical Center, as well as

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15 See https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/ (accessed July 29, 2022).

16 See https://www.usaging.org/dfa#:~:text=Through%20the%20collaborative%20efforts%20of,dementia%20and%20their%20care%20partners (accessed July 25, 2022).

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×

another health care system in Michigan that implemented the 4 Ms framework, included substantial engagement with the communities they served and community-based services as part of their programming. She added that partnering with community-based organizations is a necessary part of the process, noting that UCLA and other systems have trained community health workers to use the 4 Ms framework. She also said that to ensure that sustainable practices are also equitable, outcomes should be measured by race and ethnicity. Mitchell noted that disparities in implementation of the 4 Ms related to race, ethnicity, and language barriers could be a concern. She added that community engagement is an important component of addressing those concerns.

Strategies to Support Remaining at Home

Emily Williams, an audience member, asked the group to discuss which services and supports they viewed as the most important to allow people with ADRD to remain in their homes and communities. Lenz Lock emphasized the importance of communicating with people about available supports and services. Lamont noted research that examined individual caregiver-related factors as predictors of a person being placed in a nursing home. She said that the strongest predictor was physical strains, such as falls or mobility limitations, night waking, and incontinence. She said another strong predictor was the behavioral and psychological symptoms of ADRD. Lamont said that addressing these challenges for caregivers requires a combination of physical supports and education. Pelton added that the most important approach is to identify the priorities of the person with ADRD and their family and organizing care around those priorities. McEvoy noted that changes to the traditional payment method for personal care supports under the home health model could be beneficial. She suggested one opportunity could be the development of an approach that accommodates reimbursement for services provided by a personal care assistant on an episodic basis. McEvoy added that another beneficial approach could be publicly funded respite benefits.

Education for Dementia Care and Brain Health

Audience member Gary Epstein-Lubow asked the group to discuss opportunities for collaboration on education efforts related to ADRD care and risk reduction. Lamont noted that HRSA’s Geriatrics Workforce Enhancement Program has collaborated with ASPE and is disseminating information about best practices and evidence-based care. She added that some states provide geriatric or ADRD education to their workforces. She suggested that professional organizations should consider building education related to ADRD

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×

into their education requirements. She added that partnerships with nongovernmental organizations are also essential to disseminating information.

McEvoy explained that during the COVID-19 pandemic, she noticed trusted sources of information for older adults and caregivers were not governments but peers and physicians, though the latter are not well equipped to act as advisors on complex issues of benefits and eligibility. Many communities chose to work through peer messengers and to tailor supports in ways that were culturally responsive and accessible to those that spoke languages other than English. She said that community health workers can act as trusted resources with lived experience for families experiencing ADRD. She recommended incorporating community health workers into value-based payment models. The federal government can be an incubator for these ideas.

Lamont noted that federal agencies could support innovation related to the incorporation of community health workers. She cited an example of a program funded by an ACL grant, the Wisconsin State Dementia Care Specialist program, through which community-based health providers deliver culturally responsive support for people with ADRD and their families. McEvoy noted that expert volunteers represent an untapped resource for supporting people with ADRD and their families. Lenz Lock suggested that a possible area for the National Institute on Aging (NIA) to research is how to develop a Medicare payment stream to support community-based organizations to provide services to people with ADRD, including training and partnership between the community-based organization (CBO) and health care providers.

Reducing the Burden on Primary Care Physicians

Hollmann asked the group to discuss strategies to develop tools that improve quality of care for people with ADRD while avoiding overburdening primary care providers. Lenz Lock noted that there is a need to develop a system that supports primary care providers referring people with ADRD to community-based organizations that could provide patient education. Pelton acknowledged the extra burden created by asking primary care physicians to engage in the 4 Ms. In the age-friendly health system movement, she said, she is working with regulators, policy makers, and accreditation bodies to identify opportunities to reduce workforce burden. Lamont added that technology, in the form of EHR alerts for providers, could also provide support to primary care providers.

Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
Page 67
Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
Page 70
Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Suggested Citation:"6 Creating Change." National Academies of Sciences, Engineering, and Medicine. 2022. Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer's Disease and Related Dementias: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26772.
×
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Patients diagnosed with Alzheimer's disease and related dementias (ADRD) rely on family members, their community, and the health care system for progressively increasing support over the course of their disease. These people receive care through a frequently siloed health care system across hospitals, nursing homes, ambulatory care settings, and long-term care settings, as well as community- and home-based care. As the number of people living with a diagnosis of ADRD continues to grow, so does the need to provide better support for these people and their caregivers. The National Institute on Aging (NIA) Division of Behavioral and Social Research suggests that organizational behavior change will be needed for health care systems to integrate all of the services and supports required to provide high-quality care for people with ADRD.

NIA sponsored a workshop hosted by the National Academies of Sciences, Engineering, and Medicine to explore mechanisms to improve the quality of care for people living with ADRD and the potential of innovative payment models to incentivize health care systems to make the necessary systemic changes. The workshop convened a diverse array of experts in fields including nursing, geriatrics, health care economics, health care services research, quality measurement, social work, medical ethics, law, health care finance, and health care policy. This publication summarizes the presentation and discussion of the workshop.

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