HHS-2020-ACL-AOA-ADPI-0418.pdf

Administration for Community Living

Administration on Aging

Alzheimer's Disease Programs Initiative - Dementia Capability in Indian Country

HHS-2020-ACL-AOA-ADPI-0418

Application Due Date: 06/09/2020

Alzheimer's Disease Programs Initiative - Dementia Capability in Indian Country

HHS-2020-ACL-AOA-ADPI-0418

TABLE OF CONTENTS

I. Funding Opportunity Description II. Award Information

III. Eligibility Information

1. Eligible Applicants

2. Cost Sharing or Matching

3. Responsiveness and Screening Criteria

IV. Application and Submission Information

1. Address to Request Application Package

2. Content and Form of Application Submission

3. Submission Dates and Times

4. Intergovernmental Review

5. Funding Restrictions

6. Other Submission Requirements

V. Application Review Information

1. Criteria

2. Review and Selection Process

3. Anticipated Announcement Award Date

VI. Award Administration Information

1. Award Notices

2. Administrative and National Policy Requirements

3. Reporting

4. FFATA and FSRS Reporting

VII. Agency Contacts VIII. Other Information

Department of Health & Human Services

ACL Center: Administration on Aging Funding Opportunity Title: Alzheimer's Disease Programs Initiative

- Dementia Capability in Indian Country Announcement Type: Modification Funding Opportunity Number: HHS-2020-ACL-AOA-ADPI-0418 Primary CFDA Number: 93.470 Due Date for Letter of Intent: 04/13/2020 Due Date for Applications: 06/09/2020 Date for Informational Conference Call: 04/21/2020

Applications that fail to meet the application due date will not be reviewed and will receive no further consideration. You are strongly encouraged to submit your application a minimum of 3- 5 days prior to the application closing date. Do not wait until the last day in the event you encounter technical difficulties, either on your end or, with https://www.grants.gov. Grants.gov can take up to 48 hours to notify you of a successful submission.

Executive Summary

NOTICE: THE PUBLISHED ANNOUNCEMENT IS MODIFIED

Modification (dated April 27, 2020):

SECTION II: AWARD INFORMATION

1. This section has been updated to clarify the program budget information. Each funded program will be for a three year program period with three budget periods with a value of $250,000 for each budget period.

Funding Instrument Type: Cooperative Agreement Estimated Total Funding: $1,000,000 Expected Number of Awards: 4 Award Ceiling: $250,000 Per Budget Period Award Floor: $200,000 Per Budget Period

Each funded program will be for a 36-month project period with three 12 month budget periods with a federal funding level of $200,000 to $250,000 for each budget period, pending progress toward required program milestones and availability of federal funds.

2. SECTION IV.3 SUBMISSION DATES AND TIMES

The due date of applications has been extended. The original due date was Tuesday, May 26, 2020, the new due date for applications is Tuesday, June 9, 2020.

The start date of grant awards is August 1, 2020.

Cooperative agreements under this Alzheimer’s Disease Programs Initiative (ADPI) funding opportunity announcement (FOA) are intended to support and promote the development and implementation of dementia-capable home and community-based service (HCBS) systems in Indian Country. The Dementia Capability in Indian Country program is intended to support federally recognized tribes, tribal organizations and/or consortiums representing federally recognized tribes in these target activities. The dementia-capable systems resulting from activities under this program are expected to provide quality, person-centered services and supports that help individuals living with dementia and their caregivers remain independent and safe in their communities.

Applicants for the 36-month Dementia in Indian Country cooperative agreement are those entities that are presently responsible for the provision of and actively providing home and community services in tribal communities (i.e. tribes, tribal organizations and/or consortiums representing federally recognized tribes). Applicants will propose to enhance existing service systems with dementia services, resulting in the provision of services to Tribal Elders and their caregivers through a dementia-capable system. Responsive applications will demonstrate tribal leadership support and the authority to conduct the activities proposed in their application.

Applicants are expected to develop a three-year program that includes dementia capable supports and services for elders living with dementia and their caregivers as well as dementia education and training of the greater tribal communities. Eligible applicants will collaborate with relevant subject matter experts and community and government entities to design and implement culturally competent quality, person centered services and support programs.

Applicants will propose three year programs that include project milestones that will demonstrate continued progress toward stated goals. Funding beyond the first year funding will be contingent until progress toward and completion of stated program milestones.

Additional Application Elements Highlights of additional program requirements to which applicants are subject are noted below with further information outlined in the full funding opportunity description:

Inclusion of proposed program milestones for each year;

Proposing implementation of a minimum of one dementia-specific evidence-based or evidence-informed intervention during the course of the grant (ACL definitions of evidence-based and evidence informed are provided in this funding opportunity announcement);

10% cost sharing/match;

Dedication of a percentage of TOTAL grant funds to the provision of direct services as defined in the announcement (Year one 25% Year Two 35%, Year Three 45%);

Phased program implementation;

Pass through projects are prohibited;

Primary grantee and partners complete initial and then annual Dementia Capability

Assessment;

Robust, third-party, program evaluation, including anticipated program outcomes and measures to demonstrate program impact on persons living with dementia and their caregivers;

Data collection, and Participation in technical assistance opportunities.

Emailed Letters of Intent are requested (but not required) to be submitted 10 days after the funding opportunity announcement posting date.

ACL will host an informational conference call in relation to this FOA; the call will be recorded and made available to the public immediately following the call.

Call Date: April 21, 2020 Call Time: 3:00-4:00 pm (est) Conference Line #: 800-369-1989 Participant Code: 3650051 Instant Replay available until May 24, 2020 at 800-627-3229, passcode 5986 Please direct any questions about the programmatic goals and objectives of this FOA to erin.long@acl.hhs.gov.

I. Funding Opportunity Description The National Institute on Aging defines dementia, a major cause of impairment among older adults, as the loss of cognitive functioning, thinking, remembering, and reasoning and behavioral abilities, to the extent that it interferes with a person’s daily life and activities.

Dementia is an umbrella term under which many different types of cognitive impairment fall.

Alzheimer’s disease is the most common form of dementia; vascular dementia is the second most common. Estimates of the percentage of older persons with dementia vary, but its prevalence increases with age. Impairment, resulting from dementia, ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

A study in 2016 revealed that American Indians, Native Alaskans (AI/AN) and African Americans are at the highest risk of developing dementia. Age is the most common risk factor for dementia, as the number of Native Americans reaching older ages continues to increase the expectation is that there will be more tribal elders with dementia. Other risk factors for dementia include, but are not limited to, diabetes, high blood pressure, and heart disease, all of which are common in AI/AN communities. [1] There are 573 federally recognized tribes across the United States, each with unique cultures, traditions and languages. Some tribes do not have a term that translates to dementia. [2] The Centers for Disease Control and Prevention estimates that between 2014 and 2060 the number of AI/AN 65 and older will grow to five times its current size. [3] Tribes would benefit from culturally competent supports and services and educational resources to support tribal elders and their caregivers.

A number of conditions cause dementia-like symptoms, including dehydration, malnutrition, hearing loss, and depression. Medication mismanagement can also result in the appearance of dementia. People with dementia and their caregivers use a broad range of home and community-based services (HCBS) available from public and private sector programs. People living in the community with Alzheimer’s disease and related dementias (ADRD) are at an increased risk of unmet needs, malnutrition, injury and various forms of neglect and exploitation. [4] Caring for people with advanced dementia is defined by the severity of their functional and cognitive impairment and their reliance on other trusted individuals to make their decisions as well as their inability to live alone and increased burden on families and caregivers.

Elders demonstrate dementia thru certain behaviors, including repetitive speech, wandering, and sleep disturbances all of which are core clinical features of ADRD. If untreated, these behaviors can accelerate disease progression, worsen functional decline and quality of life, cause significant caregiver distress, and result in earlier nursing home placement. [5] Alzheimer's disease is responsible, at least in part, for an estimated 60 percent of cases of dementia. [6] The CDC reports that one in six AI/ANs aged 45 and older has reported difficulties in memory or thinking. [7] Individuals are living longer because of advances in medicine and technology, as well as social and environmental conditions [8] and thus advancing to ages at which they are at increased risk of developing ADRD.

Estimates are that about half of older persons with dementia do not have an accurate diagnosis or any diagnosis. [9] CDC estimates that only one in three AI/ANs that have experienced memory loss have talked to their doctors about it. [10] It is critically important to identify these conditions correctly to provide for appropriate referrals to dementia-capable services that are supportive of individuals living with dementia and their family caregivers. Given the impact of the dementia on people and communities, the HCBS service systems that wish to be dementia-capable should consider adopting key aspects of a dementia-capable HCBS model.

A dementia-capable HCBS system should:

1. Identify people with possible dementia and recommend that they see a physician for a timely, accurate diagnosis and to rule out reversible causes of dementia or conditions that resemble it.

2. Ensure that program eligibility and resource allocation take into account the impact of cognitive disabilities.

3. Ensure that staff communicate effectively with people with dementia and their caregivers and provide services that are person- and family-centered, offer self-direction of services, and are culturally appropriate.

4. Educate workers to identify possible dementia, and understand the symptoms of dementia and appropriate services.

5. Educate the public about brain health, including information about the risk factors associated with developing dementia, first signs of cognitive problems, management of symptoms if individuals have dementia, support programs, and opportunities to participate in research.

6. Implement quality assurance systems that measure how effectively providers serve people with dementia and their caregivers.

7. Encourage development of dementia-friendly communities, which include key parts of dementia-capability.

Information on how HCBS providers can become dementia-capable, thus increasing their ability to help people with dementia and their caregivers can be found in ACL’s paper entitled Demen tia Capable States and Communities: Lessons Learned from Administration on Aging Grantees.

Dementia-capable services within a home and community-based system (HCBS) are those that build upon and integrate existing programs from both private and public sectors.

Public sector partners/programs include, but are not limited to, tribes or tribal organizations, Area Agencies on Aging, Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention and the Department of Veterans Affairs.

The ACL’s Alzheimer’s Disease Programs Initiative (ADPI) is informed by the work and recommendations of National Alzheimer's Project Act Advisory Council and is dedicated to filling gaps in services, through the provision of HCBS to both targeted special populations and targeted training at both the State and Community levels. The ADPI is implemented with authority contained within Title IV of the Older Americans Act.

The ADPI is not intended as a program funding "research"; in fact, “research” projects will not be funded. The program is designed to pilot much-needed dementia-capable HCBS programs to communities, evaluate program outcomes and using program outcome data to garner support to sustain successful initiatives beyond the federal program period. The ADPI program is intended to advance non-clinical, social models of HCBS in support of persons with dementia and their caregivers. It is through programs such as this that the Administration for Community Living (ACL) demonstrates its commitment to its mission to maximize the independence, well-being, and health of older adults, people with disabilities, and their families and caregivers.

1. Centers for Disease Control and Prevention. Healthy Brain Initiative: Road Map for Indian Country. Accessed March 2, 2020 at https://www.cdc.gov/aging/healthybrain/pdf /HBI-Road-Map-for-Indian-Country-508.pdf.

2. Winchester, Blythe, Dementia in Indian Country. Accessed March 2, 2020 at https ://www.ihs.gov/newsroom/ihs-blog/november2018/dementia-in-indian-country/.

3. Centers for Disease Control and Prevention. Healthy Brain Initiative: Road Map for Indian Country. Accessed March 2, 2020 at https://www.cdc.gov/aging/healthybrain/pdf /HBI-Road-Map-for-Indian-Country-508.pdf

4. Gould, E., Maslow,K.,LePore,M.,et al. Identifying and Meeting the Needs of Individuals With Dementia Who Live Alone. Accessed January 22, 2020 at https://nadrc.acl.gov /node/79 .

5. Gitlin LN, Kales HC, Lyketsos CG. Non-pharmacologic Management of Behavioral Symptoms in Dementia. JAMA. 2012;308(19):2020-2029.oi:10.1001/jama.2012.36918.

6. Alzheimer’s Association. 2019 Alzheimer’s Disease Facts and Figures. Accessed January 30, 2020 at https://www.alz.org/media/Documents/alzheimers-facts-and-figures-2019.pdf.

7. Centers for Disease Control and Prevention. Healthy Brain Initiative: Road Map for Indian Country. Accessed March 2, 2020 at https://www.cdc.gov/aging/healthybrain/pdf /HBI-Road-Map-for-Indian-Country-508.pdf.

8. Alzheimer’s Association. 2019 Alzheimer’s Disease Facts and Figures. Accessed January 30, 2020 at https://www.alz.org/media/Documents/alzheimers-facts-and-figures -2019.pdf.

9. Alzheimer’s Association. 2019 Alzheimer’s Disease Facts and Figures. Accessed January 30, 2020 at https://www.alz.org/media/Documents/alzheimers-facts-and-figures -2019.pdf.

10. Centers for Disease Control and Prevention. Healthy Brain Initiative: Road Map for Indian Country. Accessed March 2, 2020 at https://www.cdc.gov/aging/healthybrain/pdf /HBI-Road-Map-for-Indian-Country-508.pdf.

Funding Opportunity Requirements

GENERAL PROGRAM REQUIREMENTS/COMPONENTS

All applicants to this funding opportunity announcement are subject to the General program items listed below and must consider and include all of them in the development of their application, work and evaluation plans.

Phased Implementation -

Successful applicants will propose a phased approach for implementation of their projects. A description of the phases follows:

Planning Phase: The period during which the grantee refines their proposed program Work Plan and Evaluation Plan, based on the plans contained in their original application. The resulting plans will be the ACL/AoA approved roadmap for the grantee to accomplish the goals, objectives, and relevant milestone of the ACL/AoA funded program. During the planning phase, and prior to entering the implementation phase, all grantees and their partners will complete ACL's Dementia-Capability Assessment to establish a baseline for program evaluation activities.

Applicants are to propose a planning phase of not more than 6 months from the notification date of the grant award. During this planning phase, grantees will be able to access no more than 15 percent of total grant funding to refine and expand on the work and evaluation plans submitted with their applications. ACL/AoA will be actively involved during the planning phase of the grant, to ensure that all ACL program objectives outlined in the Funding Opportunity Announcement are addressed. To conclude the planning phase the grantee must have received ACL/AoA’s approval of their work and evaluation plans and uploaded those plans into the reporting system, the grantee and all relevant partners will have completed the initial Dementia- Capability Assessment and participated in a “Planning Phase Exit Conference”. Upon completion of those steps, grantees will progress to the Implementation Phase and access the remaining 85 percent of cooperative agreement funding.

Implementation Phase: The period during which the grantees implement their approved plan for accomplishing the goals, objectives, and relevant milestones, as well as the evaluation of planned program activities. All grantees and their partners will complete annual Dementia- Capability Assessments, each Fall, over the course of the grant period.

The grantee may not advance to the Implementation Phase without ACL/AoA staff approved work and evaluation plans, initial dementia-capability assessments completed by the grantee and each partner, as well as a “Planning Phase Exit Conference”. Upon ACL/AoA approval of the aforementioned documents and completion of the assessments and the exit conference, the grantee will begin the implementation phase of the grant period.

Milestone Model

The three-year grant program uses a program milestones model to demonstrate program progress and support program continuation. For this program, milestones are the points in the project where targeted project outcomes are occurring and signaling program progress. Each applicant will include at least one milestone for each budget year and include the steps toward achieving those milestones in their work plan. In addition to the availability of funding, progress in achieving milestone targets will be included in the considerations for funding program continuation years.

Examples of program milestones include:

Year One (Focus on Capacity Building):

Develop or adapt existing dementia training and education program to create culturally competent program designed to build awareness of dementia in Indian Country;

Train program partners to conduct trainings;

Train home and community based service providers, family caregivers and community members.

Year Two (Focus on Intervention Implementation):

Select evidence-based or evidenced informed intervention for delivery;

Train staff in intervention delivery;

Enroll participants in intervention and conduct trainings.

Year Three (Focus on Program Sustainability):

Sustain education and intervention programs;

Implement program sustainability plan.

Use of Evidence-Based/Evidence Informed Intervention All programs must identify, by name, and describe the dementia specific evidence-based or evidence informed intervention they propose to implement, how it fits into their proposed overall program and the intended beneficiaries. The chosen intervention must fit the definitions outlined below.

Evidence-based programs or interventions: have been tested through randomized controlled trials and are: 1) effective at improving, maintaining, or slowing the decline in the health or functional status of older people or family caregivers; 2) suitable for deployment through community-based human services organizations and involve non-clinical workers and/or volunteers in the delivery of the intervention; 3) the research results have been published in a peer-reviewed scientific journal; and 4) the intervention has been translated into practice and is ready for distribution through community-based human services organizations.

Evidence-informed interventions: have substantive research evidence that demonstrates an ability to improve, maintain, or slow the decline in the health and functional status of older people or family caregivers. For the purposes of this announcement, an evidence-informed intervention is one that has: 1) been tested by at least one quasi-experimental design with a comparison group, with at least 50 participants; OR 2) is an adaptation or translation of a single evidence-based intervention.

Evidence-based dementia specific interventions adapted for cultural competency are considered evidence- informed. Examples of culturally competent evidence-informed dementia specific interventions would include REACH Community, which was modified to create REACH into Indian Country and The SAVVY Caregiver in Indian Country. The state of Wisconsin has used the evidence-informed Music and Memory programs to support elders living with dementia and their caregivers.

Examples of dementia-specific evidence-based and evidence informed services/interventions implemented through ACL state and community grant programs can be found in ACL's NADRC's paper entitled Grantee-Implemented Evidence-Based and Evidence-Informed Inter ventions. Best Practice Caregiving, a free online database of proven dementia programs for family caregivers, is another excellent resource for identifying dementia specific evidence-based interventions.

Evidence –based and evidence informed interventions implemented through the program should have positive impact/outcomes for persons living with dementia and their caregivers. Applicants must identify in the project narrative and in the project evaluation plan the intended, measurable outcomes (i.e. increased knowledge, improved quality of life, reduced depression and stress/burden) of the proposed dementia-specific intervention, as well as providing estimates of persons served by each programmatic component. ACL's National Alzheimer's and Dementia Resource Center (NADRC) created a compendium of Evaluation Measures Resources that could provide assistance in identifying desired measurable outcomes of program activities.

Direct Service Requirement

All successful applicants are required to dedicate a portion of the total program budget to the provision of direct services to persons living with dementia and caregivers. All funded projects will dedicate the following percentage of the total program budget to direct services: Year 1:

25%, Year 2: 35%, Year 3: 45%.

Direct services come in many forms, in addition to training and education other direct services include, but are not limited to, respite, home health aides and companion services. A definition of direct service is provided in the funding opportunity announcement Appendix. Budget narratives included in the program application must include clear identification of the lines within the budget where the funds for the required direct services will reside.

Data Collection Grantees are required to collect information on services provided under the authority of existing or future approved data collections.

Evaluation

All successful grant applications MUST include a plan for a robust, third-party evaluation. A third-party entity is one that is not engaged in proposed program activities beyond development and implementation of the program's evaluation plan and reports. Individuals or organizations involved in the development or implementation of any component of the proposed program would not qualify as "third party" evaluator.

At the beginning of funded projects, grantees and their partners are required to conduct a baseline assessment of the dementia-capability of their existing systems. The National Alzheimer’s and Dementia Resource Center's (NADRC) developed the Dementia Capability Assessment Tool to measure the dementia capability of grantees and their partners.

The assessment gives grantees and their partners the opportunity to create measures they can use in future program evaluations. It also helps to refine program goals, objectives and milestones, as well as monitoring and reporting. The baseline information will provides a basis to track program progress toward enhanced dementia-capability and document progress.

Grantees will agree to conduct annual follow-up assessments in each year of program funding throughout the duration of the program. Grantees submit the annual follow-up assessment with each Fall Semi-Annual Report, and a final assessment at the end of the grant period. Use of a progressive assessment model will ensure that, at the conclusion of the grant period, programs will be able to document their progress by reporting on the aspects of their project that were successful and those that were not, as well as the lessons learned.

Applications are scored on the inclusion of a robust, third-party, project evaluation plan.

Evaluations should, at a minimum, determine the effectiveness and impact of program strategies and the processes used to execute project goals at both the systems development and consumer (service provision) level. Applicants should include outcome measures that demonstrate the impact of the program on persons living with dementia and caregivers in the proposed program and evaluation plans (ACL will NOT fund any project that does not include measurable outcomes). All proposed projects will include at least one project component through which they will demonstrate impact on the quality of life of persons living with dementia.

More information on evaluation expectations are in Section V of this funding opportunity announcement.

Technical Assistance

Successful applicants are to draw on the expertise of ACL/AoA program staff and existing AoA-sponsored resources to develop, implement, and sustain their strategic work plans. All grantees are required to participate in technical assistance activities as they pertain to the program development, management and integration. This includes, but is not limited to, participation in regularly scheduled technical assistance conference calls, web casts, learning collaboratives and one-on-one technical assistance opportunities initiated by ACL/AoA staff, resource center staff or the grantees.

Statutory Authority Title IV of the Older Americans Act.

Statutory Authority Older Americans Act

II. Award Information Funding Instrument Type: Cooperative Agreement Estimated Total Funding: $1,000,000

Expected Number of Awards: 4 Award Ceiling: $250,000 Per Budget Period Award Floor: $200,000 Per Budget Period Length of Project Period: 36-month project period with three 12-month budget periods The projects will be 36 month awards with three 12 month budget periods. Funded 3 year programs will be designed in single year increments with well-defined required milestones.

Continuation funding for each year is contingent upon both the achievement of annual program milestones and the availability of federal funding.

III. Eligibility Information

1. Eligible Applicants Domestic public or private non-profit entities including state and local governments, Indian tribal governments and organizations (American Indian/Alaskan Native/Native American), faith-based organizations, community-based organizations, hospitals, and institutions of higher education.

2. Cost Sharing or Matching

Cost Sharing / Matching Requirement: Yes The federal match required for the Dementia Capability in Indian Country program is 10% (cash and/or in-kind). All applicants are required to comply with the 10% match requirement outlined in the funding opportunity announcement (FOA).

There are two types of match: 1) non-federal cash and 2) non-federal in-kind. In general, costs borne by the applicant and cash contributions of any and all third parties involved in the project, including sub-grantees, contractors and consultants, are considered matching funds.

Volunteered time and use of facilities to hold meetings or conduct project activities may be considered in-kind (third-party) donations.

Budgetary funds provided from the applicant agency’s budget for costs associated with the project are an example of a non-federal cash match.

All proposed matching funds must be directly connected to proposed program activities and cannot come from other Federal sources.

ACL discourages applicant agencies exceeding the minimum match requirement.

Applications with a match greater than the minimum required will not receive more favorable consideration under the review. Match is one of the responsiveness criteria as noted in Section III, 3 Application Disqualification Factors.

3. Responsiveness and Screening Criteria

Application Responsiveness Criteria All applications will go through an initial programmatic screening to verify that the applicant meets the minimum responsiveness criteria.

Applications will be reviewed to establish responsiveness to the following criteria.

All applications will go through an initial programmatic screening to verify that the applicant meets the funding opportunity announcement criteria. Those applicants that do not meet the minimum responsiveness criteria outlined below will be "screened out" and will not be forwarded for panel review.

The responsive project applicant:

1. Is presently responsible for the provision of and actively providing home and community services in the tribal community the applicant proposes to support with dementia services;

2. Names the tribe(s) that the application activities are designed to support and provides evidence of tribal authority to provide proposed supports and services.;

3. Demonstrates capacity to deliver person-centered services persons of all ages with dementia;

4. Identifies annual programmatic milestones and demonstrates infrastructure and intent to pursue those milestones, including a well-articulated plan;

5. Includes work and evaluation plans that demonstrate the intent to meet program direct service and outcome measure requirements;

6. Includes budget and budget narrative/justification that demonstrate intent to meet cost sharing/match and direct service requirements;

7. Provides letters of commitment from key partners and collaborators named in the proposal that include identification of their specific role in the project;

8. Includes a robust, third-party, evaluation plan - including a letter of commitment from the proposed third-party evaluator;

9. Includes outcome measures (including target numbers) in the proposed program work and evaluation plans (ACL will NOT fund any project that does not include measurable outcomes);

10. Names at least one dementia specific evidence-based or evidence informed intervention (that complies with the ACL provided definition) directed at persons with dementia and/or caregivers that will be implemented through program activities:

1. Demonstrates intent to implement it in the project narrative and the proposed work and evaluation plans;

11. Does not propose conduit or pass-through funding for another agency to lead the project.

No project partner will be proposed to receive more than 20% of the primary grantee's Federal budget.

Application Screening Criteria All applications will be screened to assure a level playing field for all applicants. Applications that fail to meet the three screening criteria described below will not be reviewed and will receive no further consideration.

In order for an application to be reviewed, it must meet the following screening requirements:

1. Applications must be submitted electronically via http://www.grants.gov by 11:59 p.m., Eastern Time, by the due date listed in section IV.3 Submission Dates and Times.

2. The Project Narrative section of the Application must be double-spaced, on 8.5” x 11” plain white paper with 1” margins on both sides, and a standard font size of no less than 11 point, preferably Times New Roman or Arial.

3. The Project Narrative must not exceed 20 pages. Project Narratives that exceed 20 pages will have the additional pages removed and only the first 20 pages of the Project Narrative will be provided to the merit reviewers for funding consideration. NOTE: The Project Work Plan, Letters of Commitment, and Vitae of Key Project Personnel are not counted as part of the Project Narrative for purposes of the 20-page limit.

Unsuccessful submissions will require authenticated verification from http://www.grants.gov indicating system problems existed at the time of your submission. For example, you will be required to provide an http://www.grants.gov submission error notification and/or tracking number in order to substantiate missing the application deadline.

IV. Application and Submission Information

1. Address to Request Application Package Application materials can be obtained from http://www.grants.gov or https://www.acl.gov/grant s/applying-grants.

Please note, ACL requires applications for all announcements to be submitted electronically through http://www.grants.gov in Workspace. Grants.gov Workspace is the standard way for organizations and individuals to apply for federal grants in Grants.gov. An overview and training on Grants.gov Workspace can be found here at: https://www.grants.gov/web/grants /applicants/workspace-overview.html The Grants.gov registration process can take several days. If your organization is not currently registered, please begin this process immediately. For assistance with http://www.grants.gov, please contact them at support@grants.gov or 800-518-4726 between 7:00 a.m. and 9:00 p.m. Eastern Time.

At the http://www.grants.gov website, you will find information about submitting an application electronically through the site, including the hours of operation. ACL strongly recommends that you do not wait until the application due date to begin the application process because of the time involved to complete the registration process.

All applicants must have a DUNS number (http://fedgov.dnb.com/webform/) and be registered with the System for Award Management (SAM, www.sam.gov) and maintain an active SAM registration until the application process is complete, and should a grant be made, throughout the life of the award. Effective June 11, 2018, when registering or renewing your registration, you must submit a notarized letter appointing the authorized Entity Administrator. Please be sure to read the FAQs located at www .sam.gov to learn more. Applicants should allot sufficient time prior to the application deadline to finalize a new, or renew an existing registration. This action should allow you time to resolve any issues that may arise. Failure to comply with these requirements may result in your inability to submit your application or receive an award. Maintain documentation (with dates) of your efforts to register or renew at least two weeks before the deadline. See the SAM Quick Guide for Grantees at: https://www.sam.gov /sam/ transcript/ SAM_Quick_ Guide_Grants_ Registrations-v1.6. ;pdf.

Note: Once your SAM registration is active, allow 24 to 48 hours for the information to be available in Grants.gov before you can submit an application through Grants.gov. This action should allow you time to resolve any issues that may arise. Failure to comply with these requirements may result in your inability to submit your application or receive an award.

Note: Failure to submit the correct EIN Suffix can lead to delays in identifying your organization and access to funding in the Payment Management System.

Effective October 1, 2010, HHS requires all entities that plan to apply for and ultimately receive federal grant funds from any HHS Operating/Staff Division (OPDIV/STAFFDIV) or receive subawards directly from the recipients of those grant funds to:

1. Register in SAM prior to submitting an application or plan;

2. Maintain an active SAM registration with current information at all times during which it has an active award or an application or plan under consideration by an OPDIV; and

3. Provide its DUNS number in each application or plan to submit to the OPDIV.

Additionally, all first-tier subaward recipients must have a DUNS number at the time the subaward is made.

Since October 1, 2003, The Office of Management and Budget has required applicants to provide a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number when applying for federal grants or cooperative agreements. It is entered on the SF-424. It is a unique, nine-digit identification number, which provides unique identifiers of single business entities. The DUNS number is free and easy to obtain.

Organizations can receive a DUNS number at no cost by calling the dedicated toll-free DUNS Number request line at 866-705-5711

You must submit all documents electronically, including all information included on the SF424 and all necessary assurances and certifications.

After you electronically submit your application, you will receive an automatic acknowledgement from http://www.grants.gov that contains http://www.grants.gov tracking number. The Administration for Community Living will retrieve your application form from http://www.grants.gov.

U.S. Department of Health and Human Services

Erin Long Office of Supportive and Caregiver Services E-mail: erin.long@acl.hhs.gov

2. Content and Form of Application Submission

Letter of Intent

Due Date for Letter of Intent: 04/13/2020 Applicants are requested, but not required, to submit a letter of intent to apply for this funding opportunity to assist ACL in planning for the application independent review process. The purpose of the letter of intent is to allow our staff to estimate the number of independent reviewers needed and to avoid potential conflicts of interest in the review. The letter need only indicate intent to apply for program funding, no additional application details are necessary.

The deadline for submission of the letter of intent is 15 days after the publication of the funding opportunity announcement.

Letters of intent should be sent to:

Erin Long, U.S. Department of Health and Human Services Administration for Community Living at erin.long@acl.hhs.gov

Project Narrative The Project Narrative must be double-spaced, on 8.5” x 11” paper with 1” margins on both sides, and a standard font size of no less than 11 point, preferably Times New Roman or Arial.

You can use smaller font sizes to fill in the Standard Forms and Sample Formats. The suggested length for the Project Narrative is 20 to 20 pages; 20 pages is the maximum length allowed.

Project Narratives that exceed 20 pages will have the additional pages removed and only the first 20 pages of the Project Narrative will be provided to the merit reviewers for funding consideration. The Project Work Plan, Letters of Commitment, and Vitae of Key Personnel are not counted as part of the Project Narrative for purposes of the 20-page limit, but all of the other sections noted below are included in the limit.

The sample components of the Project Narrative counted as part of the 20 page limit include:

Summary/Abstract Problem Statement Goal(s) and Objective(s) Proposed Intervention Special Target Populations and Organizations Outcomes Project Management Evaluation Dissemination Organizational Capability

The Project Narrative is the most important part of the application, since it will be used as the primary basis to determine whether your project meets the minimum requirements for grants under the authorizing statutes. The Project Narrative should provide a clear and concise description of your project. ACL recommends that your project narrative include the following components:

Summary/Abstract

This section should include a brief (265 words maximum) description of the proposed project, including: goal(s), milestones, outcomes, and products to be developed. Detailed instructions for completing the summary/abstract are included in the “Instructions for Completing the Project Summary/Abstract.”

Problem Statement In this section eligible applicants should describe, in both quantitative and qualitative terms, the nature and scope of the particular problem or issue the proposed program is designed to address in the community you serve, including how the project will potentially affect older adults and/or people with disabilities, their families, and caregivers as well as the health care and home and community-based service system within which they are operating.

Problem Statements must include descriptions of:

The impact of Alzheimer's disease and related dementias (ADRD) on the community and population that you serve;

The trainings and services presently available to address behavioral symptom management, if any;

The existing dementia-capability of the home and community-based service system within which you operate and how it pertains to the target population;

Describe existing service gaps that the applicant will address through the proposed program, and

The management, systems, financial or other challenges requiring attention in order to implement and sustain programs funded under this opportunity.

Goals and Objectives This section should consist of a description of the project’s goal(s) and major objectives.

In this section applicants should:

Identify your proposed project goal(s) and major objectives (i.e. proposed annual project milestones) including the projected total number of individuals who will likely benefit from services provided this proposed project;

Identify how you plan to address the major challenges stated in the problem statement;

Describe partnerships, collaborations and innovative activities that will be implemented in support of goal/objective achievement, including the project implementation of dementia-specific evidence-based/evidence informed intervention(s);

Explain how you will build program awareness and conduct outreach and identify participants;

Explain anticipated outcomes and the planned measures to demonstrate program outcomes; and

Describe the sustainability plan for program elements that are deemed successful.

Proposed Intervention This section should provide a clear and concise description of the project designed to use to address the problem described in the “Problem Statement”. You should also describe the rationale for the proposed activities, including factors such as: “lessons learned” for similar projects previously tested in your community, or in other areas of the country; factors in the larger environment that have created the “right conditions” for the intervention (e.g., existing social or economic factors that you will be able to take advantage of, etc.). Applicants should also note any major barriers you anticipate encountering, and how your project will be able to overcome those barriers. Be sure to describe the role and makeup of any strategic partnerships you plan to involve in implementing the program, including other organizations, supporters, and/or consumer groups.

PLEASE NOTE: All interventions proposed to meet the dementia specific evidence-based or evidence informed requirement must comply with the ACL standards defined in this funding opportunity announcement.

Special Target Populations and Organizations This section should describe how you plan to target and engage relevant and necessary organizations (i.e. Indian Health Service, Title VI programs, Tribal Council, National Indian Council on Aging, etc.) in a meaningful way in the planning and implementation of the proposed project.

Outcomes This section of the project narrative must clearly identify the measurable outcome(s) that will result from the project. (NOTE: ACL will not fund any project that does not include measurable outcomes). Each project must include AT LEAST ONE outcome measure to demonstrate their project's impact on the Quality of Life of a person with dementia.

This section should also describe how the project’s findings might benefit the field at large, (e.g., how the findings could help other organizations throughout the nation to address the same or similar problems.) List measurable outcomes in the work plan grid (“Project Work Plan – Sample Template”) under “Measurable Outcomes” in addition to any discussion included in the narrative along with a description of how the project might benefit the field at large. In 2018 the National Alzheimer's and Dementia Resource Center (NADRC) published a compendium of Evaluation Measure Instruments intended to help providers of dementia-related services identify appropriate and well-researched measures in support of their program evaluation plans.

Applicants are encouraged to consider including a completed program activities matrix in their proposal package, the activities matrix would include: Program area being addressed, Activity proposed, Responsibility for activity, Manner of identification program participants, Participant target numbers, Desired outcomes/tools to measure activity outcomes. A sample grants activity matrix is included in the FOA appendix.

A “measurable outcome” is an observable end-result that describes how a particular intervention benefits consumers. It may demonstrate functional status, mental well-being, knowledge, skill, attitude, awareness or behavior. Desirable outcomes from projects targeting individuals living with dementia and their caregivers include, but are not limited to: change in quality of life of the person living with dementia, change in unmet needs, change in stress and/or burden, change in caregiver self-efficacy, a change in the responsiveness or cost-effectiveness of a service delivery system. A measurable outcome is not a measurable “output”, such as: the number of clients served; the number of training sessions held; or the number of service units provided.

You should keep the focus of this section on describing what outcome(s) will be produced by the project. You should use the Evaluation section noted below to describe how the outcome(s) will be measured and reported.

Your application will be scored on the clarity and nature of your proposed outcomes, not on the number of outcomes cited.

Project Management This section should include a clear delineation of the roles and responsibilities of project staff, consultants and partner organizations, and how they will contribute to achieving the project’s objectives and outcomes. It should specify who would have day-to-day responsibility for key tasks such as: leadership of project; monitoring the project’s on-going progress, preparation of reports; communications with other partners and ACL. It should also describe the approach that will be used to monitor and track progress on the project’s tasks and objectives.

Evaluation This section should describe the method(s), techniques, and tools that will be used by the third party evaluator to: 1) determine whether the proposed intervention achieved its anticipated outcome(s), and 2) document the “lessons learned” – both positive and negative - from the project that will be useful to people interested in replicating the intervention, if it proves successful. The third-party evaluator will develop and submit an evaluation report to the grantee which will be submitted to the funder as a project deliverable.

Individuals or organizations involved in the development of any component of the proposed program would not qualify as "third-party" evaluator.

The third-party program evaluation plan will include a matrix (as an application appendix) that reflects the following program components: Activity proposed, Responsibility for activity, Manner of identification program participants, Participant target numbers, desired outcomes/tools to measure activity outcomes. A list of appropriate and well researched measurement tools that assess outcomes of importance to dementia-related programs can be found in the National Alzheimer's and Dementia Resource Center's (NADRC) compendium of Evaluation ;Measures Instruments. A sample activity matrix is included in the FOA Appendix.

The third-party evaluator will not be expected to collect or analyze the required Dementia Capability Assessments, the National Alzheimer's and Dementia Resource Center team is responsible for this activity.

The development and implementation of a quality assurance (QA) program which ensures continuous quality improvement should be included in this section. The QA program description will include techniques and tools to demonstrate project outcomes, methods for monitoring and tracking progress toward program goal(s) and objectives, and documentation of both positive and negative lessons learned. This section will include the role in program evaluation of the initial and annual (each Fall) completion of the Dementia Capability Quality Assessment of the grantee and its partners.

In December 2016 the NADRC conducted a webinar entitled "Writing ;an ;Effective ;Work ;Plan ;and ;Evaluation ;Plan" that may be useful in the development of an evaluation plan.

Webinar attendees learned: (1) learn how to write project objectives, activities and tasks; (2) learn key elements of an evaluation plan; (3) understand the importance of providing specific details in the work plan and evaluation plan; and (4) find out about available tools and resources.

Dissemination This section should describe the method that will be used to disseminate the project’s results and findings in a timely manner and in easily understandable formats, to parties…