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Information Memoranda



SUBJECT : Memorandum of Understanding - Administration on Aging/Health Resources and Services Administration


The Administration on Aging (AoA) is pleased to announce a new formal working partnership with the Health Resources and Services Administration (HRSA) in the U.S. Public Health Service (PHS). The framework for this new partnership is described in the attached Memorandum of Understanding (MOU) which was completed October 28, 1997. A copy of the MOU may be found in Attachment A.

The initial stages of this new working agreement will focus on the Alzheimer's Disease Demonstration Grant to States (ADDGS), a program funded under the Public Health Service Act beginning in 1990. This demonstration program consists of 15 grants with eleven of these grantees located in State Units on Aging. Since the inception of the demonstration effort, the program has been administered by the HRSA Bureau of Primary Health Care. The Bureau's mission is directed toward the delivery of primary and preventive health services programs for minority, underserved and difficult-to-reach populations, testing new ways to deliver health care services to the medically underserved.

The purpose of AoA's involvement in this effort is to strengthen and expand State and Area Agency commitment for continued program development and innovation which will expand services for persons with Alzheimer's disease and their caregivers. The ADDGS program has readily demonstrated that a blend of both medical and supportive services is of great assistance in meeting the needs of persons with Alzheimer's disease and their caregivers. Through AoA's joint efforts with HRSA and the ADDGS projects, we want to extend the expertise and knowledge base created through the demonstration effort to more communities nationwide.

Our goal is to stimulate beneficial partnerships between aging and health service systems with a special emphasis on assisting various hard-to-reach ethnic populations which are generally not served by existing service networks. Results of the evaluation of the first four years of the program indicated that nearly 50 percent of the families served were ethnic minorities and slightly over 50 percent of the families served lived in rural areas. This success in reaching ethnic minorities and persons in rural areas was in part attributed to working closely with local community groups and organizations to tailor programs to meet specific needs in that setting, including the staging of multi-cultural events and bi-lingual interpretations where needed.

In the demonstration phase program guidelines have been flexible allowing each grantee to secure maximum community input and participation in the development of the program design. Each grantee focused on outreach which included local education efforts and training of staff working in various aspects of care of persons with Alzheimer's and assisting their caregivers. Supportive services include case management, translation and interpretation, support groups, dementia assessment, legal assistance and transportation. Respite services including in-home respite workers, adult day care and residential/institutional respite care are an integral part of the programs. Training programs familiarize caregivers and provider staff with a better understanding of the disease process and progress; creative approaches in providing care; and assistance in accessing community resources.

The ADDGS program began as a three year demonstration program in FY 1990 and funds have been appropriated annually for continued support for 15 States, including the District of Columbia and Puerto Rico. In FY 1997, approximately $5 million was awarded to assist in the planning, establishing, and operating programs in the areas of program development, services including outreach and respite, information dissemination and for the development of primary care linkages.

Attachment B provides brief information about each of the 15 projects with names, addresses, and a summary abstract outlining the nature of the program. Later this year, HRSA and AoA will be forwarding additional information about products prepared by the grantees and best practice models.


Brookdale Foundation National Group Respite Program

In 1995, Brookdale formed a partnership with HRSA and the ADDGS programs to establish networks of Brookdale respite programs in eight of the 15 demonstration sites. The collaboration with the Brookdale Foundation has greatly augmented program expansion and community commitment.

Brookdale launched its "seed" grant initiative in 1988 to replicate social model group respite programs nationwide which encourages community-based agencies to develop low-cost, high quality group respite services. The respite programs offer opportunities for persons with Alzheimer's or related dementias to engage in social/recreational actives which maximize their cognitive and social functioning and provides relief for caregivers. The Foundation offers training and modest financial support for two years under a competitive process. Presently, there are more than 200 sites in 35 states. For more information about Brookdale's respite program, you may call Nora O'Brien, Assistant Vice President at (212) 308-7355.

Primary Care Initiative

In FY 1996, through supplemental funding, HRSA initiated cooperative arrangements between the ADDGS grantees with primary health care programs (HRSA supported health centers). In FY 1997, Congressional appropriation language mandated the inclusion of primary health care linkages to improve health care delivery for participants in the program. During this same period, HRSA also initiated a Geriatric and Alzheimers Disease training initiative to train health center personnel for meeting the needs of persons with Alzheimer's disease and other geriatric health problems.

Managed Care

In FY 1997, four of the ADDGS grantees received supplemental funding to establish a managed care initiative to study the effects of providing managed care patients with social and support services offered through the Alzheimer's program. Preliminary information regarding these results of these efforts will be made available later this year.

Program Evaluation

Throughout the implementation and development of the ADDGS program, the University of Kansas Gerontology Center Research Team has conducted an evaluation to monitor and assess the progress of this effort. Data has been collected from client records and satisfaction interviews, program reports, site visits, and project documents. An executive summary of the findings from the first four years of the program may be found in Attachment C.


AoA will use available resources to enhance the dissemination of information about the latest program and research developments in programs serving persons with Alzheimer's and their caregivers. AoA has created a Fact Sheet on this disease which can be reproduced and distributed widely. A copy is provided in Attachment D. This Fact Sheet and other informational materials about services and community-based programs are available through the National Aging Information Center by calling (202) 619-7501 or through the e-mail site at or the web-site In addition, AoA's web-site ( will feature special news items periodically.

Alzheimer's Association

The Alzheimer's Association has worked very closely with the ADDGS grants in their efforts to gain community support and commitment for program development. The Association has supplied informational materials, assisted with training and the development of community models. Local Alzheimer's chapters have greatly enhanced the success of local efforts.

The Alzheimer's Association is a voluntary organization which sponsors public education programs and offers supportive services to patients and families who are coping with Alzheimer's disease. The Alzheimer's Association has more than 200 chapters nationwide which provide programs and services, including support groups to assist persons with Alzheimer's and their caregivers in the community. The Alzheimer's Association, which is the leading funding source for and provider of information about Alzheimer's research also provides information on caregiving techniques and assistance. To access the resources and services available through the Association you may call (800) 272-3900.

National Institute on Aging

The National Institute on Aging (NIA) has primary responsibility for research aimed at finding ways to prevent, treat and cure Alzheimer's disease. The NIA is part of the Federal Government's National Institutes of Health located in Bethesda, Maryland. The Institute funds a wide variety of research programs related to Alzheimer's disease and also operates an Alzheimer's Disease Education and Referral Center (ADEAR). ADEAR serves as an information and referral center for information about Alzheimer's disease, its impact on family and health professionals, and research into possible causes and cures. ADEAR operates a toll free number (800) 438-4380 and provides information through an Internet web-site:

Report to Congress

A summary of the most recent research advances and other Alzheimer's disease programs funded by the Department of Health and Human Services Council on Alzheimer's Disease may be found in the Council's Ninth Annual Report to Congress which is undergoing a final review. Information about obtaining copies will be made available on AoA's web-page after the report is submitted to Congress. While some portions are somewhat technical, the report provides a comprehensive overview of new biomedical research and other DHHS efforts supporting program development and care of persons with Alzheimer's disease.

The Agency for Health Care Policy

The Agency for Health Care Policy (AHCPR), located in the Public Health Service, DHHS, conducts and supports general health services research, including medical effectiveness research, and facilitates the development of best practice guidelines. AHCPR has produced Clinical Practice Guidelines related to early Alzheimer's disease recognition, both in a consumer version and a more technical document for health care professionals. Requests for general information about product availability may be obtained through the AHCPR Clearinghouse, telephone number (800) 358-9295. The AHCPR web-site is:


The demonstration program has been extremely successful in developing innovative approaches in its outreach and services for ethnic minorities which generally do not benefit from traditional community based service systems. Each of the 15 projects is unique in its approach as the funding guidelines allowed maximum flexibility and innovation in program design.

Under the terms of the MOU, AoA will work with HRSA in jointly developing future directions and program guidance for the ADDGS program. This includes development of the FY 1998 guidelines for funding of grantees identifying program expectations, developing criteria for the review of grant applications, and joint oversight and monitoring of grantee performance and progress. The University of Kansas will continue its ongoing evaluation of the program with new results published as they become available. At this point the legislative provisions limit the award of funds to 15 projects and it is anticipated that a Federal Register announcement of funds available for the current grantees will be published in January, 1988.

I hope this information will encourage State and Area Agencies on Aging to assess programs and resources in your area to determine if there are opportunities for drawing upon the expertise and knowledge accumulated by the 15 ADDGS grantees. The program innovation and expertise acquired through this demonstration effort may serve as a useful knowledge base for updating and expanding programs to assure most efficient use of available resources. For additional information you may contact Irma Tetzloff at (202) 619-3268 or through the Internet at

William F. Benson
Acting Principal Deputy
Assistant Secretary for Aging


Memorandum of Understanding
Grantee Information and Abstracts
Evaluation Executive Summary
AoA Alzheimer's Fact Sheet