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Promoting Brain Health in States and Communities: 

Nationwide examples from ACL’s Alzheimer’s Disease Program Grantees

By Vijeth Iyengar, PhD1 and Erin Long, MSW

Office of Supportive and Caregiver Services, Administration on Aging, Administration for Community Living

U.S. Department of Health and Human Services, Washington, DC.

Background & Introduction

The Administration for Community Living (ACL) – an operating division of the U.S. Department of Health 

and Human Services – has historically leveraged its competitive, discretionary grantmaking capacity to 

support state and community-based efforts to augment dementia-capable services and supports to 

people with Alzheimer’s and related dementias (ADRD) and their caregivers. While the structure and 

focus of the Alzheimer’s disease grant programs has changed since its inception in the early 1990s, the 

most recent iteration of this program – the 2018 Alzheimer’s Disease Program Initiative (ADPI) – is a 

merging of ACL’s separate state (ADSSP; Alzheimer’s Disease Supportive Services Program) and 

community-level (ADI-SSS; Alzheimer’s Disease Initiative-Specialized Supportive Services) programs.

As discussed in funding opportunity announcements and related content from ACL2, the ADPI grant 

program seeks to support organizations in addressing service gaps at the state and community-level. 

State-based grants must address the following service gaps: (1) expansion and sustainability of a 

dementia-capable state home-and-community based services (HCBS) incorporating Single Entry/No 

Wrong Door access for people with dementia and their caregivers and (2) ensuring access to a 

comprehensive, sustainable set of quality state HCBS that are dementia-capable and provide innovative 

services to people with dementia and their caregivers. By comparison, community-based programs must 

address the following gaps: (1) the provision of effective supportive services to people living alone with 

ADRD; (2) improvements in the quality and effectiveness of programs and services dedicated to people

aging with intellectual and developmental disabilities with ADRD or those at high risk of developing 

ADRD; and (3) the delivery of behavioral symptom management training and expert consultations for 

family caregivers.

Eligible states and community-based organizations address these service gaps through the following 

objectives2: (1) the creation of state-wide, person-centered, dementia-capable home and communitybased service systems; (2) translating and implementing evidence-based and evidence-informed

supportive services for people with ADRD and their caregivers at the community-level; (3) working with 

public-and-private entities to identify and address the special needs of people with ADRD and their 

caregivers; and (4) offering direct services and supports to people with ADRD and their caregivers.

This issue brief presents an overview of brain health services or activities from twenty-three unique 

organizations operating across fifteen states funded by the ACL’S Alzheimer’s Disease Program and 

serves as a reference guide for organizations as they endeavor to promote brain health.

Brain Health: A Component of Dementia-Capable Home and Community-Based Services

Organizations awarded grants via ACL’s Alzheimer’s disease programs have sought to boost their 

dementia-capable services and supports in their respective states and communities. These efforts 

include providing information on the risk factors associated with developing dementia, knowledge of the 

1 Please address comments or questions to Dr. Vijeth Iyengar (vijeth.iyengar@acl.hhs.gov).

2 https://acl.gov/programs/support-people-alzheimers-disease/support-people-dementia-including-alzheimers-disease; 

https://acl.gov/grants/alzheimers-disease-programs-initiative-grants-states-and-communities-1.
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signs of cognitive impairment, and management of symptoms of people living with dementia. An 

essential component of dementia-capability in HCBS is the education of paid and unpaid providers in 

understanding and identifying the signs and symptoms of possible dementia and the delivery of 

appropriate services. Increasing brain health awareness and education is one of many outcomes by 

which to increase the dementia capability of HCBS. 

Brain health3 – an all-encompassing term – refers to how well a person’s brain functions to support

attention, decision making, information processing, learning and memory, and reasoning among other 

daily-life activities required to live in society. A range of factors from age-related changes to brain 

structure, brain injuries (e.g., traumatic brain injuries), lifestyle choices and behaviors (e.g., diet, 

exercise, sleep, substance use), maintenance of an active mind, and social engagement (e.g., social 

connectedness), can affect a person’s overall brain health. ACL-funded Alzheimer’s disease grantees 

have sought to promote brain health through a range of services or activities aimed at increasing 

education and awareness.

How (and Where) are ACL’s Alzheimer’s Disease Program Grantees Promoting Brain Health?

ACL’s suite of brain health resources – located on the “Brain Health: You Can Make a Difference” 

webpage4 – covers the topics of (1) brain health basics; (2) medications and the brain; (3) brain injury; 

and (4) dementia. To complement this set of resources, we sought to obtain “on the ground” insights

into the ways in which brain health was being promoted in states and communities.

In the Spring of 2019, ACL worked alongside the National Association of Area Agencies on Aging (n4a) to 

design and deploy a poll across area agencies on aging (AAAs) nationwide which assessed brain health 

related activities. The results from this poll offered insights as to the types of services and activities

participating AAAs were delivering with respect to dementia and brain health. The poll also identified 

the types of training and technical assistance AAA staff deemed helpful in supporting people with 

dementia and brain health education. Inspired by the breadth of insights and field-perspectives 

gathered from the ACL-n4a brain health poll and shared via a follow-up report5, we conducted an 

informal, landscape analysis – attempting to be as comprehensive as possible – of ACL-funded grantees 

of Alzheimer’s disease programs. The development of a “nationwide snapshot” provided insight into of 

the types of services or activities the ACL Alzheimer’s disease program grantees have undertaken to 

promote brain health in the communities they serve. Grant program implemented and sustained 

activities focus on educational and awareness services and activities on modifiable risk factors (e.g., diet, 

exercise, sleep, an active and engaged mind, and social engagement).

This analysis conducted in conjunction with the National Alzheimer’s Disease Resource Center6 – an ACLfunded resource center providing expert technical assistance to ACL and its Alzheimer’s disease program 

grantee community – resulted in a group of grantees spanning the years 2014-2020. This specific time 

window was selected to provide a more recent snapshot of brain health services or activities undertaken 

by grantees and with the understanding that the year 2017 marked the final three-year grant cycle 

awarded for the Alzheimer’s Disease Supportive Services and the Alzheimer’s Disease InitiativeSpecialized Supportive Services programs. Thus, this group of three-year grantees includes those whose 

activities commenced in the year 2014 and those most recently awarded in the year 2020 who 

anticipate delivery of services and activities. 

3 https://www.nia.nih.gov/health/cognitive-health-and-older-adults. 

4 https://acl.gov/brain-health. 

5 https://www.n4a.org/files/N4A_Dementia%20Report%2010-25-19(3).pdf. 

6 https://nadrc.acl.gov/.
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Insights and Takeaways

Nationwide, ACL-funded Alzheimer’s disease program grantees have planned and delivered a range of 

services and activities to promote brain health in their respective communities spanning frontier, rural, 

and urban settings. Awarded grantees include AAAs, Alzheimer’s organizations, counties, communitybased organizations, healthcare systems, universities, and states, among other organizations. Figure 1

depicts the geographical distribution of ACL-funded Alzheimer’s disease program brain health activities

spanning the award years 2014-2020.

Figure 1. “ACL’s brain health coverage map”. ACL-funded Alzheimer’s disease programs (from the 

years 2014-2020) promoting brain health. The legend – presented on the far right of Figure 1 – provides 

the award year of the grant with each color-filled triangle representing a unique ACL-funded grantee.

The fifteen states shaded in blue depict those states wherein an ACL-funded grantee has planned or 

delivered services or activities to promote brain health.

A common theme among grantee initiatives – to enhance brain health knowledge focuses on 

community engagement, training and mentoring volunteers – is the delivery of community-education 

sessions in traditionally underserved settings. Grantees are employing methods tailored to the needs 

and traditions of the communities they serve, resulting in culturally competent initiatives to 

communicate the importance of promoting and maintaining brain health. Furthermore, ACL-funded 

brain health education programs and services are successfully reaching historically underserved racial 

and ethnic populations (e.g., African American, Asian and Pacific Islander, Latinx, and Native American) 

and geographic (e.g., frontier, rural, and urban) communities further expanding their reach.

Additionally, ACL’s ADPI grantees are awarded with the expectation that program funding aligns with 

the Older American’s Act7 efforts for those of greatest economic need and social need. Programmatic

efforts to expand health equity are demonstrated through calculated efforts to engage historically 

underserved populations with culturally competent resources that are designed with specific cultural

7 https://acl.gov/about-acl/authorizing-statutes/older-americans-act. 
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traditions in mind and for delivery by members of their community. Initiatives focused on education and 

awareness of the risk reduction and mitigation strategies to maintain brain health across the lifespan are 

a key component of dementia-capable grant services and activities. Programmatic activities include, but 

are not limited to, delivery of brain health webinars and educational courses covering the topics of 

social connectedness; the basics of brain function; and healthy aging as covered in Table 1 from a subset

of ACL-funded grantee organizations.

Table 1. Subset of ACL-funded Alzheimer’s disease grant programs. Grantees have provided a range of 

services or activities to promote brain health in their respective states and communities 

Programmatic outcomes suggest that ACL-funded grantees have had a positive impact in their 

respective states and communities. These outcomes include increased knowledge of risk reduction to 

maintain brain health; improvements in knowledge and attitudes about the topics of brain health and 

dementia; and increased self-efficacy and competency of brain health and dementia among community 

members and healthcare professionals. Many grantees have-and-are using the published and validated 

Dementia Knowledge Assessment Tool8to demonstrate the impact of their brain health and ADRD 

education-related efforts on program participants.

Closing Thoughts

An informal landscape analysis of ACL-funded Alzheimer’s disease grantees revealed illustrative 

examples of a range of services and activities undertaken nationwide to promote brain health across a 

variety of delivery and service settings. Programmatic outcomes associated with these services and 

activities further highlight the tremendous, positive impact ACL-funded grantees are having in meeting

the needs of people in their respective states and communities. We foresee this issue brief as a handy 

resource for organizations interested in learning more about the topic of brain health and of the variety 

of services and activities available to best address the needs of their community members.

8 https://pubmed.ncbi.nlm.nih.gov/24339059/.