Welcome to our module on national plans and policy. In this lecture, we're going to be looking at the macro level and how it affects people with dementia. I'm Laura Gitlin. >> Hi, and I'm Nancy Hodgson. The objectives for today are first, to look at who in the world has a national plan? What countries have existing national plans? And why are these plans important? We'll also look at elements of the existing plans, the key elements of these plans, and some exemplars. >> There are about ten countries in the world that have a national plan. The United States, Finland, Norway, Ireland, Scotland, England, France, Netherlands, Australia, and South Korea. >> Why are these plans important? Well, as you know, dementia poses one of the world's greatest threats to public health worldwide, and we need plans to address that. A national plan can help mobilize a country's resources, to address both the research needs and the clinical care or service needs. These plans can also be use to inform the health policy of those countries and to organize communities to address the multiple complexities of this condition. It also helps to prioritize and redirect both health and healthcare initiatives. >> There are approximately ten common elements in most dementia plans. Dementia plans will vary by the elements that they include and the level of complexity. Most plans start with the basic element of trying to raise awareness and education about what dementia is, and to try to eradicate stigma of dementia. Other plans then advance to, including earlier diagnosis and treatment and having early diagnosis accessible to people in their country. Other plans that become more complex then offer a plan to support people in their home, to improve their quality of life and to keep them at home. Yet others then include family caregiver support at home. And still others try to target and improve institutional care programs. Other elements of national dementia plans include tackling the complexity of transitioning from one care setting to the other, and to integrate care coordination across care systems. Others are trying to integrate innovative technology. Yet others are focusing on training the healthcare workforce. The most complex elements of national dementia plans include monitoring the impact of all these different elements on people with dementia, their quality of life, and their family caregivers. And the tenth element of national plans is a focus on research, to cure the disease, to treat it better and to derive better diagnostic indicators. >> Let's look at an example of two national plans that are focused primarily on the early elements of those ten key features, Australia and the Republic of South Korea. In both of these national plans, the focus is on early detection, helping educate the public on what are some common signs that would indicate possible cognitive changes, and how to go about how screening for those cognitive changes. Once those changes were identified, then the second aspect is providing access to diagnosis, by providing centers for diagnoses or treatment in community care settings or in dementia or memory care settings. And the third is a public education campaign designed to educate the public on the stigma, and ultimately to reduce the stigma associated with cognitive impairment and dementia. So these are just two countries' examples of how they're addressing the key features in their national plans. This slide is an interesting slide because it looks at the transitions of care and what the plans have included in giving attention to the important transitions across care. You'll notice that all the plans listed here have some attention to early symptom recognition. Most of the plans have some attention to the diagnostic services, linking people with services, memory care centers, etc., to help them receive the diagnosis in a timely manner. Still, many of the plans have some ability to address transitions from the home to the hospital and back, or transitions from the home to a residential setting. Yet few plans, only France and Scotland, have given any attention to the end stage disease, or from residential scared to hospital, or in the example of Australia and England, any attention to the end of life care. The transitions that need to occur at end of life. So you can see that, if different plans emphasize different elements of these important transition across care. >> Scotland has one of the most sophisticated dementia plans. They started with a basic bill of rights for people with dementia and their families. And these six items became the standards of care from which they have built their program and national plans, ad they're worth stating. So one standard of care, and bill of right, if you will, is that people with dementia have the right to a diagnosis. People with dementia have the right to be regarded as a unique individual, and to be treated with dignity and respect. People with dementia have the right to access a range of treatment and supports as the disease progresses. People with dementia have the right to be as independent as possible and be included in their community. People with dementia have the right to have carers or caregivers who are well supported and educated about dementia. And people with dementia have the right to end of life care that respects their unique wishes. Here are the key outcomes for people living with dementia in Scotland, that is considered part of the national plan for that country. So Scotland is concerned about having people with dementia have timely and accurate diagnosis, promoting dementia family communities, better post diagnostic support, involvement of persons with dementia and families in every aspect of their care. To assure the respect is provided at every level in business, banking, communities and healthcare. That people with dementia are treated with dignity and respect. And that more people with dementia are living with good quality of life at home care for longer. So these are they key outcomes that Scotland is looking to achieve from their dementia plan. Here is another example from the United States. In 2011, President Obama signed a historic act and put through the National Alzheimer's Project Act, that identified goals for the United States. In contrast to Scotland, however, the United States focuses its plan on preventing and effectively treating Alzheimer's disease, with the goal of doing so by 2025. Other goals do include enhancing care quality and efficiency, and expanding supports for people with dementia, and their families. As well as enhancing public awareness and engagement, and improving data in order to track progress towards each of these goals. >> The UK is another example where the emphasis is on both clinical care, but also on improving the resources available to researchers to enhance the research community. So another example of a plan with a slightly different level of emphasis. >> Regardless of the progress that's being made in developing national Alzheimer plans, in 2013, the World Alzheimer's Report indicated, quote, caregiver multi-component interventions that comprise education, training, support and respite, maintain caregiver mood and morale and reduce caregiver strain. Nevertheless, we are aware of no governments that have invested in this intervention to scale a provision throughout the dementia care system, and hence, coverage is minimal. So we have a long way to go. >> Mm-hm. Well we hope that you have these few take home points. One, that there are a few countries that have national plans that are making important work and progress in that area. But more plans are needed. These plans are important because they help shape national policy, healthcare services, and resource development. These plans need to consider person-centered approaches for people living with dementia, but also their caregivers. And include things like public awareness, community centers, support group, integrated pathways for the transitions across care, and care coordination. Thank you for your time. >> Thank you
