TO : STATE AND AREA AGENCIES AND TRIBES
ADMINISTERING PLANS UNDER TITLES III AND VI OF THE OLDER AMERICANS
ACT OF 1965, AS AMENDED
SUBJECT : Memorandum of Understanding
- Administration on Aging/Health Resources and Services Administration
REFERENCES: TITLES III AND VI OF THE
OLDER AMERICANS ACT
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
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.
SPECIAL ADDGS PROGRAM INITIATIVES:
Brookdale Foundation National Group Respite
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
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.
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
ADDITIONAL SOURCES OF INFORMATION AND
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 firstname.lastname@example.org or the
web-site http://www.aoa.dhhs.gov/naic. In addition, AoA's web-site (http://www.aoa.dhhs.gov)
will feature special news items periodically.
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: http://www.ahcpr.gov.
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 ITetzloff@ban-gate.aoa.hhs.gov.
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