Funding Public Health to Address Dementia - Presentation to Joint Health & Social Services Committee, Alameda County Board of Supervisors ...
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Funding Public Health to Address Dementia Presentation to Joint Health & Social Services Committee, Alameda County Board of Supervisors, February 25, 2019
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Poor Outcomes > Higher Costs • 95% of people with dementia have one or more other chronic conditions. • Alzheimer’s and other dementias complicate the management of chronic conditions. • 1,428 ED visits for every 1,000 CA’ers with dementia • Nearly 1 in 4 patients with dementia readmitted to hospital
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Public Health Can Intervene Earlier
• Healthy Brain Initiative (HBI) Road Map
• Practical strategies to help states and local communities
address dementia from a life-course perspective.
5HBI Road Map
25 Actions toward 4 Essential
Services:
• Assure a competent workforce
• Educate and empower communities
• Develop policies and mobilize
partnerships
• Monitor and evaluate
3 Core Principles:
• Reduce health disparities
• Collaborate across multiple sectors
• Leverage resources for sustained
impact.
6HBI Road Map Priority Actions
• Educate professionals on sources of reliable information about brain
health and ways to use the information to inform those they serve. (W-1)
• Educate professionals about the best available evidence on dementia
(including detection) and dementia caregiving, and sources of information,
tools, and assistance. (W-3)
• Improve health care professionals’ ability and willingness to support early
diagnoses and disclosure of dementia, provide effective care planning at
all stages of dementia, offer counseling and referral, and engage
caregivers, as appropriate, in care management. (W-4)
7HBI Road Map Priority Actions
• Educate the public about changes that should be discussed with
a health professional, and benefits of early detection and
diagnosis. (E-1)
• Build public knowledge about brain health across the life span.
(E-2)
• Increase public awareness about the importance of maintaining
caregivers’ health and wellbeing. (E-3)
• Improve access to and use of evidence-informed interventions,
services, and supports for people with dementia and their
caregivers to enhance their health, wellbeing, and
independence. (E-7)
8 8
State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road MapThe BOLD Infrastructure for
Alzheimer’s Act
P.L. 115-406
• $20 million/year for 5 years to implement evidence-
based practices to address ADRD, including through
training of PH staff and health providers.
• Priorities:
– early detection and diagnosis
– reducing avoidable hospitalizations
– Improving caregiver supports
– reducing health disparities
– supporting care planning and management
9AB 388 (Limon)
Alzheimer’s Healthy Brain Initiative
Require CDPH to:
• Implement the HBI Road Map,
• Coordinate a statewide public awareness
campaign with targeted outreach to high-risk
populations (e.g., African Americans, Latinx &
women)
• Establish a pilot program in up to 8 counties and
award participating counties one-time grant
funding over 3 consecutive fiscal years, to develop
local initiatives consistent with the HBI.
10Next Steps
• Support AB 388
• Ask Alameda County’s delegation to support AB
388 + $10M budget ask
11California’s Public Health Response to the Alzheimer’s Crisis
$10 million General Fund investment to create community & clinical linkages
The Alzheimer’s Association’s top state policy priority for 2019 is:
Improve California’s rate of timely diagnosis by raising public awareness of the early signs
and symptoms of Alzheimer’s and related dementias
The Alzheimer’s Association will be proposing legislation, with a significant budget request, to:
Build California’s public health infrastructure to initiate local efforts in support of early
detection and timely diagnosis of Alzheimer’s and related dementias
The public burden of Alzheimer’s and related dementias is large (2.2 million Californians directly
impacted today); there are ways to intervene (early detection and timely diagnosis could potentially save
$7.9 trillion in medical and care costs) and the impact is major (1,428 emergency room visits annually
for every 1,000 persons with dementia). By 2025, these numbers will increase dramatically, devastating
families, straining health systems and distressing communities.
Thirty years ago, California leaders envisioned a breakthrough treatment or cure by now. Modest state
investments have focused narrowly – though importantly, on academic and scientific research. Today,
with 29% growth in the population affected projected by 2025, it’s time to engage the public health
community locally to accelerate learning, collaboration and innovation. California can’t afford to wait
to assess and address this statewide public health concern: it’s a #KNOWbrainer!
Build Statewide Public Health Infrastructure $3.7 million
Expand the clinical/research expertise of the Alzheimer’s Disease Program within the Healthy
Communities Section of the Chronic Disease Branch within the CA Department of Public Health by
adding 3 new positions (manager, research associate, administrative) to lead statewide public awareness
campaign, engage with California Conference of Local Health Officers (CCLHO), oversee Request for
Application (RFA) process and progress, conduct Behavioral Risk Factor Surveillance System (BRFSS)
surveys on subjective cognitive impairment and caregiver burden, and liaison with the Office of Health
Equity to ensure cultural competency in all programs.
Positions:
Manager $140,000
Research Associate $100,000
Administrative $75,000
$315,000 annually for three years = $945,000
Public Awareness Campaign:
Statewide Dissemination Strategy Development and Implementation: $1 million
Materials Development (in threshold languages), printing and mailing: $750,000*Purchased Advertising in Pilot Counties: $800,000 ($100,000 each for eight counties)
$2,550,000
BRFSS Modules:
2020 Subjective Cognitive Decline $75,000
2022 Caregiver Burden $75,000
$150,000
Initiate Local Public Health Efforts $6 million
Award eight county (or city) public health departments with one-time, multi-year funding to achieve the
following:
a. Analyze and assess available data sources to quantify scope and scale of issue in jurisdiction,
including CHIS, BRFSS, Mortality and Morbidity, U.S. Census, Department of Finance, etc.
b. Conduct a community-wide assessment of needs of persons at risk of or living with Alzheimer’s
and related dementias. Where possible, align with other community needs assessments in
progress or scheduled.
c. Develop strategies to intervene on the key issues elevated by community needs assessment.
Focus on underserved and/or disproportionately impacted populations.
d. Collaborate with local stakeholders, including clinicians, providers, consumers, caregivers,
academics, workforce. Examples include California Alzheimer’s Disease Centers, Area Agencies
on Aging, Caregiver Resource Centers, Federally Qualified Health Centers, local medical
societies and hospital councils, emergency response system, etc.
e. Perform intervention(s).
f. Promote statewide public awareness campaign with targeted outreach to communities of color.
g. Measure and evaluate intervention strategies
h. Produce replication report.
Eight counties @ $750,000 per county = $250,000 for assessment and planning; $250,000 for
intervention strategy; $250,000 for evaluation and replication. Funding to be awarded July 1, 2020 –
June 30, 2023.
*An evidence-informed, field tested and evaluated public awareness exists: Know the 10 Signs and
Symptoms of Alzheimer’s Disease. This budget estimate assumes adoption of an existing campaign. If
the state were to pursue a new campaign (including creative development), the cost of the campaign
could exceed $5 million based on other start-up initiatives.
Contact: Alzheimer’s Association
Susan DeMarois @916-447-2731 or sdemarois@alz.orgAssemblymember
AB 388 Monique Limón
Alzheimer’s Healthy Brain Initiative 37TH DISTRICT
THIS BILL
Assembly Bill 388 directs the California Department For example, simply improving early detection and
of Public Health and local jurisdictions to plan and timely diagnosis of Alzheimer’s is projected to save
prepare for the impending Alzheimer’s crisis. This the nation $2.3 trillion in Medicaid costs. Yet, less
measure encourages immediate action on key than half of all Californians affected have been
recommendations within the Centers for Disease formally diagnosed by a clinician.
Control (CDC) Healthy Brain Initiative.
PURPOSE
Specifically, AB 388 proposes a three-pronged public AB 388 implements the Healthy Brain Initiative in
health solution to plan and prepare for the imminent California. This nationwide CDC initiative reflects
Alzheimer’s crisis: 1) Implement a statewide public the highest priority actions for state and local public
awareness campaign focused on the signs and health departments. Effectively addressing the rising
symptoms of Alzheimer’s to improve early detection number of people with Alzheimer’s and other
and timely diagnosis; 2) adopt priority actions in the dementias will require diligent attention to three
CDC Healthy Brain Initiative; and 3) contingent upon fundamental principles in order to prepare
appropriation by the Legislature, award competitive California’s public health community:
grants to eight pilot projects in select counties to
encourage local innovation, foster best practices and 1. Eliminate health disparities by building
target populations at greatest risk of developing community partnerships that create health parity;
Alzheimer’s. increase access to preventive services; increase the
capacity of healthcare and prevention workers to
BACKGROUND address disparities; and implement strategies that are
The burden of Alzheimer’s strains individuals, culturally, linguistically and age appropriate for
families and entire communities. Currently, 2.2 people and their caregivers.
million Californians are directly impacted by 2. Collaborate across multiple sectors to engage
Alzheimer’s disease and other dementias. Last year, a wide array of organizations at state and local levels
the Medi-Cal program spent $3.8 billion on within the public, nonprofit and private sectors.
beneficiaries living with Alzheimer’s, yet the bulk of 3. Leverage resources for sustained impact. The
costs were incurred by families paying out-of-pocket challenges inherent in tackling dementia and
for long-term services and supports. In fact, the improving cognitive health far exceed the capacity of
lifetime cost of Alzheimer’s is $341,840 – more than the public health sector alone and rely on public-
the median home price in Sacramento – the state private partnerships.
capitol.
As outlined in the CDC Healthy Brain Initiative, the
It’s time to invest in statewide and local public health California Department of Public Health will make
interventions to reduce Alzheimer’s costs and progress on four critical fronts: 1) educate and
improve patient outcomes. Similar public health empower the public, 2) develop policies and mobilize
initiatives have achieved notable results for other partnerships, 3) assure a competent workforce, and 4)
chronic health conditions, e.g. asthma, cancer, monitor and evaluate data.
diabetes, HIV/AIDS, heart disease.
Office of Assemblymember Monique Limón | Last Updated 01.24.2019 1Assemblymember
AB 388 Monique Limón
Alzheimer’s Healthy Brain Initiative 37TH DISTRICT
This bold new approach builds California’s public
health infrastructure; increases public awareness;
improves early detection and timely diagnosis; targets
outreach to at-risk populations and communities
disproportionately impacted by Alzheimer’s; and
explores community-based solutions.
SUPPORT
Alzheimer’s Association (Sponsor)
AARP
California Collaborative for Long-Term Services
and Supports
California Commission on Aging
STAFF CONTACT
Jimmy Wittrock
jimmy.wittrock@asm.ca.gov
(916) 319-2037
Office of Assemblymember Monique Limón | Last Updated 01.24.2019 2california legislature—2019–20 regular session
ASSEMBLY BILL No. 388
Introduced by Assembly Member Limón
(Principal coauthor: Senator Jackson)
(Coauthor: Assembly Member Aguiar-Curry)
February 5, 2019
An act to add Section 125284 to the Health and Safety Code, relating
to Alzheimer’s disease.
legislative counsel’s digest
AB 388, as introduced, Limón. Alzheimer’s disease.
Existing law authorizes any postsecondary higher educational
institution with a medical center to establish diagnostic and treatment
centers for Alzheimer’s disease, and requires the State Department of
Public Health to administer grants to the postsecondary higher
educational institutions that establish a center pursuant to these
provisions.
This bill would require the department to implement the action agenda
items in the Healthy Brain Initiative, as defined, and coordinate a
statewide public awareness campaign to educate the public on the sign’s
and symptoms of Alzheimer’s disease and other dementias and to reach
consumers at risk of cognitive impairment, with targeted outreach to
populations at greater risk of developing Alzheimer’s disease and other
dementias. The bill would also, upon appropriation by the Legislature,
require the department to establish a pilot program in up to 8 counties,
and award participating counties one-time grant funding over 3
consecutive fiscal years, to develop local initiatives that are consistent
with the Healthy Brain Initiative. The bill would require the department
to conduct an evaluation of the pilot program and produce a report, to
99AB 388 —2—
be submitted to the Legislature by January 1, 2023, describing best
practices and making recommendations regarding which solutions and
innovations are most feasible to replicate.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
The people of the State of California do enact as follows:
line 1 SECTION 1. The Legislature finds and declares all of the
line 2 following:
line 3 (a) In 2018, the United States Centers for Disease Control and
line 4 Prevention published the “Healthy Brain Initiative: State and Local
line 5 Public Health Partnerships to Address Dementia, The 2018-2023
line 6 Road Map,” which established a nationwide framework for
line 7 addressing Alzheimer’s disease and other dementias.
line 8 (b) The Healthy Brain Initiative advances cognitive health as
line 9 an integral component of public health, proposing 25 specific
line 10 actions in four traditional domains of public health.
line 11 (c) The action agenda included in the Healthy Brain Initiative
line 12 Road Map provides a foundation for the public health community
line 13 to anticipate and respond to the growing impact of Alzheimer’s
line 14 disease and other dementias on the nation and California, where
line 15 a 30 percent increase in the affected population is projected by
line 16 2025.
line 17 SEC. 2. Section 125284 is added to the Health and Safety Code,
line 18 to read:
line 19 125284. (a) In order to plan and prepare for a historic increase
line 20 in the population affected by Alzheimer’s disease and other
line 21 dementias, the department shall implement the action agenda items
line 22 identified in the Healthy Brain Initiative.
line 23 (b) The department shall expand California’s public health
line 24 infrastructure to ensure that brain health is integrated into chronic
line 25 disease prevention and health promotion efforts by coordinating
line 26 a statewide public awareness campaign focused on both of the
line 27 following:
line 28 (1) Educating the public on the signs and symptoms of
line 29 Alzheimer’s disease and other dementias in order to promote early
line 30 detection and timely diagnosis.
line 31 (2) Reaching consumers at risk of cognitive impairment, with
line 32 targeted outreach to populations at greater risk of developing
99—3— AB 388
line 1 Alzheimer’s disease and other dementias, including, but not limited
line 2 to, African Americans, Latinx, and women.
line 3 (c) (1) Upon appropriation by the Legislature, the department
line 4 shall operate a pilot program in up to eight counties to develop
line 5 local initiatives consistent with the Healthy Brain Initiative. The
line 6 department shall provide one-time grant funding over three
line 7 consecutive fiscal years to pilot counties to assist in local planning
line 8 and preparation in one or more of the following areas:
line 9 (A) Education and empowerment of the public with regard to
line 10 brain health and cognitive aging.
line 11 (B) Mobilizing public and private partnerships to engage local
line 12 stakeholders in effective community-based interventions and best
line 13 practices.
line 14 (C) Ensuring a competent workforce by strengthening the
line 15 knowledge, skills, and abilities of healthcare professionals who
line 16 deliver care and services to people with Alzheimer’s disease and
line 17 other dementias and their family caregivers.
line 18 (D) Monitoring data and evaluating programs to contribute to
line 19 evidence-based practice.
line 20 (2) The department shall establish a competitive request for
line 21 application process through which a county may apply to
line 22 participate in the pilot program operated pursuant to paragraph (1)
line 23 and receive grant funding. Counties that are selected to participate
line 24 in the pilot program shall, incorporate all of the following
line 25 fundamental planning principles:
line 26 (A) Eliminating health disparities.
line 27 (B) Collaborating across multiple sectors.
line 28 (C) Leveraging public and private resources for sustained
line 29 impact.
line 30 (3) (A) The department shall conduct an evaluation of the
line 31 community-based solutions and innovations implemented by each
line 32 pilot county and produce a consolidated report describing best
line 33 practices and making recommendations regarding which solutions
line 34 and innovations are most feasible to replicate. The department
line 35 shall provide a copy of the report to the Legislature by January 1,
line 36 2023.
line 37 (B) A report to be submitted pursuant to subparagraph (A) shall
line 38 be submitted in compliance with Section 9795 of the Government
line 39 Code.
99AB 388 —4—
line 1 (d) For the purposes of this section, “Healthy Brain Initiative”
line 2 means the report “Healthy Brain Initiative: State and Local Public
line 3 Health Partnerships to Address Dementia, The 2018-2023 Road
line 4 Map,” published by the United States Centers for Disease Control
line 5 and Prevention.
O
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