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In 1992, Congress created the Alzheimer\'s Disease Demonstration Grants
to States Program. Originally administered by the DHHS Health Resources
and Services Administration (HRSA, 1992-1998), fifteen states were
awarded Alzheimer\'s Demonstration Grants. In 1998, Congress transferred
the program to the DHHS Administration on Aging, which continued to
administer the existing grants. These grants were intended to support
the development and enhancement of a system of support services for
caregivers and individuals with Alzheimer\'s disease and related
disorders. Hard-to-serve and under-served populations were targeted.
Services and programs of the national demonstration were delivered
through nearly 300 agencies, serving more than 20 different ethnic
groups and significant numbers of rural families. In July 2000, the
Administration on Aging awarded grants to sixteen new states to further
develop models of care for persons with Alzheimer\'s disease and to
build on the remarkable success of the original fifteen Alzheimer\'s
Demonstration projects.

Though the demonstration focused on support services for Alzheimer
families, the lessons learned about service development and expansion
are very applicable to the wide range of aging services. Our intent here
is to share some of the general insights on program development
(importance of flexibility, critical nature of community commitment, how
to build trust and credibility) and consistent challenges to program
design (reaching families before the \"crisis\" and developing a
continuum of services) in a format that can inspire replication efforts.

# Service Models

Eight service models have been highlighted because they represent
successful strategies for overcoming commonly identified challenges in
serving these diverse populations. Project profiles have been developed
to share successful, innovative approaches for serving rural and
minority communities. In spite of the variety of agencies and
populations served, six general \"how-to\" themes have been common to
all successful sites. This \"blueprint\" for success includes six basic
steps:

1.  Establish trust and credibility among partner agencies and with
    target populations

2.  Build community awareness of Alzheimer\'s disease and services
    available

3.  Build service capacity

4.  Create new services

5.  Develop resources

6.  Stabilize programs and services

# Successful Models

Each of the eight project profiles detail the steps for replication, the
program costs, and the resources needed. The successful models include:

##### Community Ownership {#community-ownership .unnumbered}

Building Interagency Partnerships that Foster Community-Based Dementia
Support Services (Michigan Alzheimer\'s Demonstration Project)

##### Crow Eldercare {#crow-eldercare .unnumbered}

Serving Native Americans on the Reservation (Montana Alzheimer\'s
Demonstration Project)

##### Dementia Training for Case Managers {#dementia-training-for-case-managers .unnumbered}

Developing Statewide Dementia Expertise (Oregon Alzheimer\'s
Demonstration Project)

##### Sea Mar Care Advocates {#sea-mar-care-advocates .unnumbered}

Facilitating Latino Families Use of Support Services (Washington
Alzheimer\'s Demonstration Project)

##### *El Portal*  {#el-portal .unnumbered}

Developing A Network of Dementia Services for Latinos (California
Alzheimer\'s Demonstration Project)

##### AL-CARE  {#al-care .unnumbered}

Serving Urban Live-Alones with Dementia (District of Columbia
Alzheimer\'s Demonstration Project)

##### Mobile Day Care  {#mobile-day-care .unnumbered}

Transporting Social Day Care in Rural Areas (Georgia Alzheimer\'s
Demonstration Project)

##### Rural Geriatric Dementia Evaluation {#rural-geriatric-dementia-evaluation .unnumbered}

Providing Assessment and Counseling to Isolated, Rural Families

(Maine Alzheimer\'s Demonstration Project)

# Successful Strategies

These eight projects have been highlighted because they exemplify
innovative and successful strategies for meeting three common challenges
encountered by service providers. These challenges include:

-   Efficiently serving dispersed rural populations with limited
    resources

-   Bridging cultural and language differences to serve diverse ethnic
    groups

-   Negotiating interagency partnerships and community ownership to
    create a stable service environment

These projects illustrate a range of successful techniques for
addressing the unique geographic challenges in serving rural or urban
populations. For rural populations this includes issues of distance and
transportation, lack of trained staff, issues of isolation, and
economies of scale. The Mobile Day program in Georgia, which transports
social day care into rural communities, and Maine\'s Geriatric
Assessment Teams, which provide in-home diagnosis and counseling to
isolated families, are highlighted. For urban, city-center populations
challenges often include high rates of poverty, safety issues for staff
and clients, lack of family caregivers, and isolation of clients. The
AL-CARE project in the District of Columbia, which has successfully been
serving persons with dementia who live alone, is highlighted as an
example of addressing urban issues.

Other projects are examples of programs that met the unique challenges
in serving diverse ethnic minority populations. These programs
implemented successful strategies for building trust, learning about
cultural issues, and overcoming communication barriers. California\'s El
Portal project created a dementia network of services for Latino
families. Montana\'s Crow Eldercare project collaborated with the Crow
tribe to deliver respite services on the reservation. Washington\'s Sea
Mar Care Advocate model trained advocate to facilitate Latino clients\'
use of existing support services.

Additionally, some projects met the challenges of establishing service
stability within changing systems and legislative perspectives.
Successful strategies used by the programs were the promotion of
community ownership, developing Alzheimer-friendly systems, and
providing ongoing technical support. The Michigan model of interagency
partnerships that fosters the development of community-based dementia
support services and state-level support mechanisms for service
integration and stability is an exemplar of this. El Portal is also a
good model of system integration and service enrichment that linked
traditional service programs with an ethnic population. Oregon\'s
Dementia Training for Case Managers integrated dementia knowledge within
their existing service network.

# Key Partnerships

The knowledge and insights shared in these project profiles are the
result of the commitment and support of many key partners. The larger
Demonstration grant has been nurtured and encouraged by many key
individuals. The Alzheimer\'s Association, the federal project officers
and university-based evaluation team collaborated to provide support,
guidance and important programmatic flexibility, helping to ensure the
overall success of the Demonstration program.

Through the efforts of the fifteen partner state projects of the
demonstration, much has been learned about serving \"hard-to-reach\" and
traditionally under-served populations. The highlighted eight profiles
are just the \"tip of the iceberg\" of the wealth of understanding
generated from the demonstration. Project directors in each of the
fifteen partner states have developed and supported projects and
programs to better understand how to serve more inclusively. Each
project has also been enriched with the commitment and innovation of all
the local, direct care staff who have applied flexibility to creating
successful service delivery models in their individual communities.

# Key Contributors & Contacts

Melanie K. Starns: (202) 401-4547

Administration on Aging

330 Independence Ave.

Washington, DC 20201

##### State Grantee Project Directors: {#state-grantee-project-directors .unnumbered}

Rosa Ramierez: (213) 938-3379

Alzheimer\'s Association

5900 Wilshire Blvd, Ste. 1710

Lost Angeles, CA 90036

Karyn Barquin: (202) 724-5622

DC Office on Aging

441 Fourth Street, NW

9th Floor, S.

Washington, DC 20001

Dawn Harlock: (850) 414-2060

Department of Elder Affairs

4040 Esplanade Way

Tallahassee, FL 32399-7000

Cliff Burt: (404) 657-5336

Division of Aging Services

2 Peachtree Street, NW, Ste. 36.385

Atlanta, GA 30303

Anne Hartnett: (808) 586-0100

Executive Office on Aging

250 S. Hotel Street, Ste. 107

Honolulu, HI 96813-2831

Romaine Turyn: (207) 624-5335

Adult Services, Department of

Human Services

State House Station 11

Augusta, ME 04333

Lisa Brakebill: (410) 561-9099

Alzheimer\'s Association

York Road, Ste. D

Tomonium, MD 21093

Irene Kazieczko: (517) 373-2845

Department of Mental Health

Lewis Cass Bldg, 6th Floor

Lansing, MI 48913

Ann Johnson: (406) 582-1492

Governor\'s Office on Aging

740 Sycamore Lane

Bozeman, MT 50715

Marion Sigmon: (919) 733-3983

Division on Aging

693 Palmer Drive

Raleigh, NC 27626-0531

Richard LeBlanc: (614) 644-7967

Department of Aging

50 W. Broad Street

Columbus, OH 43266-0501

Rita Litwiller: (503) 945-6405

Senior and Disabled Services Division

500 Summer Street, NE, 2nd Floor

Salem, OR 97310-1015

Dalia Santiago: (809) 721-8590

Governor\'s Office of Elderly Affairs

Call Box 50063, Old San Juan Station

San Juan, PR 00902

Barbara Kelly: (803) 253-6177

Office on Aging, Department of

Health & Human Services

PO Box 8206

Columbia, SC 29202-8206

Hillary Hauptman: (360) 493-2559

Unit on Aging, Aging & Adult Services

PO Box 45600

Olympia, WA 98504

The Administration on Aging is the official Federal agency dedicated to
policy development, planning and the delivery of supportive home and
community‑based services to older persons and their caregivers through
the national aging network of state and local agencies on aging, tribal
organizations, service providers and volunteers.