Related Announcements

PAR-22-093, Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R01 Clinical Trial Optional)

PAR-22-094, Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R21 Clinical Trial Optional)

Issued by

National Institute on Aging (NIA)

Purpose

This Notice of Special Interest (NOSI) is intended to promote behavioral and social research on the dementia care workforce and the impact of workforce factors on outcomes for persons living with Alzheimer's disease or Alzheimer's disease-related dementia (AD/ADRD) and their families.  Applications focused on care of persons living with dementia and the systems that provide care may cite NOT-AG-21-046, and applications focused solely on unpaid dementia care partners/caregivers may cite NOT-AG-21-047 in the Agency Routing Identifier field (box 4B). PLEASE NOTE: Applications proposing clinical trials will not be considered a high priority for this NOSI. Studies proposing dementia care intervention research are encouraged to explore whether PAR-21-307 Dementia Care and Caregiver Support intervention Research (R01 – Clinical Trial Required) or PAR-21-308 Pragmatic Trials for Dementia Care and Caregiver Support (R61/R33 – Clinical Trial Required) would be more appropriate.  

Background 

Expanding research on the workforce that cares for persons living with AD/ADRD and identifying the barriers to entry, retention challenges, and causes and effects of turnover is one of NIA's AD/ADRD Research Implementation Milestones. The milestones describe specific steps towards achieving the goal of the National Plan to Address Alzheimer's Disease: to treat and prevent AD/ADRD by 2025. Until a cure is discovered, the country will need an appropriately trained workforce of sufficient size to provide care for those with AD/ADRD. 

Persons living with AD/ADRD receive care from an array of care providers: neurologists, geriatricians, psychiatrists, nurses, occupational therapists, social workers, certified nursing assistants, and home health aides. Across these care providers, training requirements and compensation vary, creating different market conditions by region and payment models for services provided. Additionally, underdiagnosis and misdiagnosis of dementia contribute to a mismatch of dementia care treatment supply and demand. Understanding the interactions between factors that improve worker quality and retention are important to better inform programs that can improve health and mental health outcomes for AD/ADRD patients and caregivers, and make for appealing dementia care jobs. These include (1) direct dementia care workforce compensation packages and work conditions; (2) opportunity for training and career advancement across all levels of the workforce; and (3) the support of supervisors, the resources needed to address barriers or challenges at work, and an overall focus on quality improvement. 

Research is also needed to better understand attrition and low-income conditions among the direct care workforce and factors that lead to family decisions about paid and informal care. The composition of the resources available (both family members and finances) to families making care decisions, as well as the policies that influence payment for care services, influence the demand for care. Supply factors include the changing demography of the potential care workforce, as well as labor market conditions across workforces of varying levels of skill/experience. Research that addresses the skills that this workforce will need as the population of persons living with AD/ADRD grows is required, including research that focuses on specialization of treatment, skill matches and mismatches, the potential impact of worker certification (e.g., increased certification requirements for certified nursing assistants (CNAs)), and how this large-scale growth in the demand for dementia care will impact the workforce and care of persons living with AD/ADRD and their providers. Data infrastructure is also needed in order to address these research needs. For example, data are needed on the characteristics and variation of direct care job quality in the home setting, the interface between paid and family caregivers, the relationship between household economic stability and caregiving, and the accurate measurement and prediction of the available dementia care workforce across the skill and compensation spectrum. 

This NOSI is based on expert discussions from the NIH 2018 AD Summit, 2020 Dementia Care and Caregiving Summit, 2019 ADRD Research Summit, and NIA workshops, including Gaps in the Dementia Care Workforce: Research Update and Data Needs (2019). 

Objectives

Broad areas of interest for this NOSI include (1) how economic and policy factors and demands as well as features of the work environment drive the composition and quality of the dementia care workforce; (2) demographic and familial factors that influence demand for and supply of dementia care workers; (3) training and certification effects on quality and retention of dementia care workers; and (4) the development of data resources required to study these issues.

Example research topics of interest include, but are not limited to, investigating and characterizing the following: 

• The impacts of labor market policy on the long-term care workforce and the quality of care that it delivers 
• How regulatory and economic incentives and constraints impact dementia care workforce policy and practice 
• The availability of the dementia care workforce now and in the future, including all types of care providers such as clinicians, nursing staff, CNAs, home health aides, and occupational and physical therapists 
• Barriers to, and effective strategies for, expanding and strengthening a diverse and culturally competent dementia care workforce
• The economic and health impact on persons living with AD/ADRD and their families, and on health systems, attributable to current and projected future dementia and aging workforce limitations 
• The financial implications and health impacts to persons living with dementia, their caregivers and families, and accountable entities under varying payer conditions (e.g., Medicaid, health insurance, out-of-pocket, long-term care insurance) 
• The impact of nursing home staffing levels, types, and quality on health outcomes for resident populations that increasingly consist of persons with AD/ADRD 
• Disparities in quality of paid dementia care, access to paid dementia care, and health outcomes for vulnerable or at-risk AD/ADRD populations, including persons with low income or poor housing conditions, chronic or comorbid conditions, and lack of access to culturally competent paid dementia care 
• The impact of requirements for employers to provide opportunities for paid and unpaid leave for family caregivers, including reduction of stress, poor health outcomes, and financial burden and potential costs such as missed opportunities for advancement at work
• Impact of types of certification for the direct dementia care workforce on work experience, job quality, or health outcomes 
• The features of effective programs for dementia care workforce management and enhancement 
• Effective strategies to support existing caregivers in the workforce to address issues such as skills training and precarious employment 
• The health outcomes implications of paid provider training on persons living with AD/ADRD and their families (e.g., CNA training on medication management impact on health outcomes) 
• The relationship between family care partners/caregivers and paid in-home care partners/caregivers, and the implications of paying family members to provide direct care on the quality of life for the person living with dementia and their caregivers

Application and Submission Information

This notice applies to due dates on or after March 11, 2022 and subsequent receipt dates through November 13, 2024. 

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcement through the expiration date of this notice.

• PAR-22-093, Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R01 Clinical Trial Optional)
• PAR-22-094, Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R21 Clinical Trial Optional)

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

For funding consideration, applicants must include “NOT-AG-21-049” (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.

Inquiries

John W. R. Phillips, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-496-3136
Email: john.phillips@nih.gov

Elena Fazio, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-496-3136
Email: elena.fazio@nih.gov