Q and A With Mike Splaine: February 2011 

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Mike Splaine is the director for State Policy and Advocacy Programs at the National Office of the Alzheimer's Association in Washington, D.C. He has been working with Alzheimer patients and their families since 1986. State Legislatures talked with Splaine about why Alzheimer’s disease is an issue for states and the policy options available under the fiscal constraints that states are experiencing.

State Legislatures: How serious is the issue of Alzheimer’s for states?

Mike Splaine: Alzheimer’s disease is the sixth leading cause of death in America. Its biggest nonmodifiable risk factor is age—and with an aging society the present cost and possible future costs are staggering.
With tight state budgets what policy options are available that will keep states from having to spend more money to provide care to Alzheimer’s patients?

A focus on home and community based services options. The Administration on Aging has identified a significant number of evidence based programs that support caregivers and people with the disease that can be translated with fidelity into community settings. Outcomes include improved health, extended caregiving and better utilization of formal supports.

Also, challenging the parts of state government that fund services to promote adoption of evidence based programs to support family caregivers. For example, novel experiments like the North Dakota Alzheimer care coordinator program can be encouraged, too.

SL: What can states do to help patients and their families?

Splaine: States that have not yet done so should develop a comprehensive state Alzheimer plan—and states that have completed a plan should begin implementation, and keep Alzheimer’s a health priority.

SL: Where do you see opportunities to advance policy?

Splaine: I see two new opportunities.

First, the knowledge base about Alzheimer’s disease is such that the tools of public health are now more relevant than they have ever been. Now that Alzheimer’s and dementia is a topic area in the new "Healthy People 2020," activities in support of the objectives are an opportunity.

Second, thoughtfully creating better quality care options that are less costly for people who are dually eligible for Medicaid and Medicare who now make up about 25 percent of Medicaid beneficiaries yet are 48 percent of total costs. A fair number of duals are people with Alzheimer’s, so it is a matter of intense interest for us.

SL: What’s on the horizon if states don’t plan for the increase in Alzheimer patients vs. if they do plan?

Splaine: If they don’t plan, I think they risk being inefficient and underprepared as the knowledge base about the disease rapidly moves and new policy challenges emerge.

SL: When speaking with state legislators about Alzheimer’s, what concern(s) them most?

Splaine: First, everyone has a story or a personal concern which allows me to tell them about our fantastic website and 24/7 contact center (800-272-3900).

Second, I always get asked about prevention which gives me a chance to talk about what we are learning in that space. The evidence falls short of saying “doing X or Y and prevent Alzheimer’s disease.” But we are seeing strong association with increased risk of dementia with lack of physical activity, smoking, diabetes and high blood pressure. We can safely say that what is good for your heart health is also good for your brain—and we’ll begin seeing brain health elements in other public health risk reduction efforts.