Aging Research Summer 2015

Alzheimer’s in North Carolina: Services in North Carolina

Students in the Master of Public Policy program at Duke’s Sanford School of Public Policy spent part of their spring semester examining a policy issue for the N.C. Center for Public Policy Research.

The students investigated Alzheimer’s disease in North Carolina, looking at the rates of the disease, caregiving options for patients, and also looked to other states to learn about different options for comprehensive plans.

The students’ report, which includes recommendations for action in our state, is presented in this series of blog posts. The third part, posted today, takes a look at programs and services supporting Alzheimer’s patients in our state. Read Part One in the series, which provides an introduction to Alzheimer’s disease and an overview of prevalence rates, and Part Two, which discusses caregiving options.

Note: The pictures used in this series are from the Alzheimer’s North Carolina organization, a nonprofit  dedicated to education, support, and advocacy for Alzheimer’s patients and their families. Visit their website here:

Pictures also featured from The A.R.C. Community, long-term care facilities in North Carolina for residents with Alzheimer’s.

National Alzheimer’s Project Act (NAPA)

          In 2011, Congress unanimously passed the National Alzheimer’s Project Act (“NAPA”) (42 U.S.C. § 11201). It required the creation of a national strategic plan to address the increasing number of people suffering from Alzheimer’s (Alzheimer’s Association, 2014).


  The five goals of NAPA include:
                        • Effectively treat or prevent Alzheimer’s by 2025.
                        • Optimize care quality and efficiency.
                        • Expand supports for people with Alzheimer’s and their families.
                        • Enhance public awareness and engagement.
                        • Track progress and drive improvement (Alzheimer’s Association, 2011)


          NAPA requires an annually updated plan outlining how to overcome Alzheimer’s, annual recommendations for priority actions, an annual evaluation of Alzheimer’s funding, and the creation of an Advisory Council on Alzheimer’s Research, Care, and Services (U.S. Department of Health and Human Services, 2014). The Advisory Council consists of twenty-two board members who coordinate with federal and other agencies conducting research on care and services for Alzheimer’s patients.

          The Advisory Council’s most recent update in 2014 emphasizes that NAPA’s objectives should be carried out through “optimizing existing resources and coordinating ongoing activities, supporting public-private partnerships, and transforming the way we approach Alzheimer’s” (Alzheimer’s Association, 2014, 4). Other update recommendations include regularly convening an Alzheimer’s disease Research Summit, soliciting both public and private inputs on the direction of Alzheimer’s research, and creating a timeline for achieving milestones. A few states already had comprehensive Alzheimer’s plans in place before NAPA. Now 42 states and the District of Columbia have state plans.

 Alzheimer’s Services in North Carolina

          North Carolina currently does not have a comprehensive statewide plan to address Alzheimer’s disease. The state offers six relatively small programs that support Alzheimer’s patients and caregivers.

1. The Family Caregiver Support Program (FCSP):

          The NC Division of Aging and Adult Services administers the state’s FCSP. 17 Area Agencies on Aging provide FCSP services. The program provides information to caregivers about available services, helps caregivers access these services, and connects caregivers with individual counseling and support groups. It also offers caregiver training in health, nutrition, financial literacy, and problem solving. FCSP has a respite service that provides temporary relief to caregivers as well (North Carolina’s Family Caregiver Support Program, 2015).

2. Caregiver Alternatives to Running on Empty (C.A.R.E.):

          In 2001, Project C.A.R.E began as a pilot program in North Carolina. The federal government provided the initial funding for C.A.R.E. through an Alzheimer’s disease Demonstration Grant. The federal grant ended in 2007 (Kelly and Williams, 2007). C.A.R.E. is now primarily state-funded. Family consultants operate at three C.A.R.E. partner locations throughout the state to coordinate regional support networks. The family consultants provide guidance to families and direct them to local resources. C.A.R.E. services are primarily directed toward rural or low-income caregivers.

          C.A.R.E. formerly offered respite services to caregivers but no longer has sufficient funding to continue these services. At the first North Carolina Task Force meeting on Alzheimer’s and Related Dementias in March 2015, Mark Hensley, Director of Project C.A.R.E., said that the program was no longer able to offer families an annual stipend of $2,500 for caregiver support and respite. According to Hensley, total 2015 state funding for Project C.A.R.E. is now $300,000 for services in 100 counties. The 2013 NC state budget provided $500,000 for C.A.R.E. but cut the same amount from the HCC Block Grant. (Hoban, 2013).

Photo Credit: A.R.C. Facility in Hope Mills, NC
Photo Credit: A.R.C. Facility in Hope Mills, NC
3. The Home and Community Care (HCC) Block Grant:

          The NC General Assembly established the HCC Block Grant in 1992 to provide home- and community-based services to seniors in North Carolina (NCGS § 143B-181.1(a)(11)). The NC Division of Aging administers the HCC Block Grant and the Area Agencies on Aging disburse funding to counties. The state legislature cut HCC Block Grant by nearly $1 million in the 2014 state budget, leaving about $31.3 million in total funding (Hoban 2015). Congress passed the Older Americans Act (OAA) in 1965 to assist seniors with nutrition, transportation, and caregiver support (42 U.S.C. § 35). The OAA originally provided 45 percent of the HCC Block Grant funding in North Carolina (Home and Community Care Block Grant, 2013). The OAA expired in 2011, and Congress has not reauthorized it (Reauthorize the Older Americans Act, 2015).

4. North Carolina’s Silver Alert Program:

          In 2007, North Carolina’s Center for Missing Persons adopted the Silver Alert Program to protect Alzheimer’s and other mentally impaired elderly individuals. Under the Cognitive Impairment Assistance Law, local and state law enforcement officials work together to protect the elderly population (North Carolina General Statutes § 143B-1022). Similar to an Amber Alert, a Silver Alert helps to locate missing elderly persons. Once a caregiver reports that a person with dementia or a cognitive impairment is missing, law enforcement officials, television broadcasters, and radio personnel are alerted.

5. The Community Alternative Program for Disabled Adults (CAP/DA):

          CAP/DA is a Medicaid waiver available to low-income adults 18 and over who are Medicaid-eligible for nursing home care because of a disability. A recipient of the CAP/DA waiver can receive Medicaid-funded adult day care services, case management services, medical and home care supplies, aide services, meal delivery, and respite care. As long as these costs do not exceed the costs of nursing home care, the recipient will remain eligible. As of December 2013, North Carolina had a statewide limit on CAP/DA waivers of 11,214 and a waiting list of over 8,000 disabled adults (Bratts-Brown, 2013). When CAP/DA slots become available, priority goes to the neediest individuals, including those who wish to leave a nursing home for a community care setting. Waitlisted individuals 55 years or older are referred to the PACE program if they live in a PACE catchment area.

While a number of services are available to Alzheimer’s patients in North Carolina, no unified program exists that provides comprehensive services to these patients or their caregivers.

6. The Program for All-Inclusive Care for the Elderly (PACE):

          The PACE program currently serves over 700 low-income North Carolinians 55 years or older who qualify for nursing home care under Medicaid but wish to remain at home (NC PACE Association: History and Growth, 2015). PACE operates at 11 locations in North Carolina and serves 38 counties (NC PACE Association: PACE Sites, 2015). Ninety-seven percent of PACE participants are dual-eligible for Medicaid and Medicare (Shaw, Response to NC Department of Health and Human Services Division of Medical Assistance Request For Information RFI-DMA, 100-13). Under its capitated-funding model, PACE receives two standard prepayments per enrollee each month, one from Medicaid and one from Medicare. The payments are pooled to cover all services provided to PACE enrollees, including acute medical care, in-home services, and access to a PACE center which provides clinical services and adult day care. About half of PACE enrollees have Alzheimer’s or dementia. Most need assistance with one or more activities of daily living (Shaw, Response to NC Department of Health and Human Services Division of Medical Assistance Request For Information RFI-DMA, 100-13).

          While a number of services are available to Alzheimer’s patients in North Carolina, no unified program exists that provides comprehensive services to these patients or their caregivers. And due to funding constraints on Project C.A.R.E., the HCC Block Grant, and the CAP/DA waiver, many people who successfully locate services are still unable to benefit from these programs.1


Note: Here is information about this student project, provided by the Duke Sanford School of Public Policy.

This student presentation was prepared during the spring of 2015 in partial completion of the requirements for PUBPOL 804, a course in the Master of Public Policy Program at the Sanford School of Public Policy at Duke University. The research, analysis, policy alternatives, and recommendations contained in this report are the work of the student team that authored the report, and do not represent the official or unofficial views of the Sanford School of Public Policy or of Duke University. Without the specific permission of its authors, this report may not be used or cited for any purpose other than to inform the client organization about the subject matter. The authors relied in many instances on data provided to them by the client and related organizations and make no independent representations as to the accuracy of the data.


Show 1 footnote

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