· Executive Brief
National Alzheimer’s Disease Awareness Month 2026
Move from recognition activity to a visible operating route with named owners and closed loops.
Leadership signal
Use National Alzheimer’s Disease Awareness Month to examine the system behind the message.
Leaders can use this window to test whether public information, service entry points, internal referrals, and follow-up responsibilities form one understandable route. The review should start with the experience of people using the system and the teams responsible for receiving them.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Dementia care is an operating system before it is a message
Dementia reaches health systems long before a chart carries the diagnosis. In a national cohort linked to Medicare claims, only 30.8% of people with incident cognitive impairment received a claims-based dementia diagnosis.[1] For executives, that gap means many people who need care planning, caregiver support and coordinated services may be invisible to the teams built to serve them.[1]
The route to diagnosis often runs through acute care rather than the clinic. Among 246,471 Medicare beneficiaries newly diagnosed in 2022, 40.4% were first diagnosed in acute settings, compared with 50.4% in the community.[2] A first diagnosis made during a crisis leaves families with less time to plan and leaves the organization managing acute demand it might have anticipated. It also shifts the first conversation about diagnosis into a setting built for speed rather than planning.
Primary care holds the clearest structural opportunity to change this pattern, yet that opportunity is underused. In a national survey, 80% of Medicare beneficiaries had an Annual Wellness Visit, but only 31% of them underwent formal cognitive testing.[11] Individuals at higher risk of cognitive impairment were not more likely to be assessed.[11]
Once dementia is established, emergency visits carry high stakes. In a large Medicare cohort of people with dementia, 34.4% of those with an index emergency visit required hospitalization.[10] Detection, navigation, caregiver support and emergency use are therefore parts of one pathway, not separate programs with separate owners.
National Alzheimer’s Disease Awareness Month is a practical moment for leaders to examine that pathway as a whole. The sections below summarize peer-reviewed evidence on detection, utilization, transitions, access, equity, the caregiving and clinical workforce, and measurement. They sit beside the executive guidance already on this page and give boards and operating leaders a shared factual base for deciding where to act first.
Current evidence
What the research shows about detection, utilization and risk
Underdiagnosis is uneven across groups. In the Medicare-linked cohort, Black race and education below the college level were associated with lower odds of diagnosis among people with incident cognitive impairment.[1] The sample included 45,191 observations of 8368 participants, 23% of them Black.[1] The authors suggested the differences may represent underlying disparities in access to care and dementia diagnosis in clinical practice.[1]
Utilization patterns shift years before dementia is identified. In a community cohort of 3,923 older adults, 325 (8.3%) were classified as having incident dementia.[5] Over the prior five years, those participants averaged 0.28 emergency department visits per 6-month period, compared with 0.18 among participants without dementia.[5] Their ambulatory care use was lower, at 3.53 versus 3.76 visits per 6-month period, with differences observable 3 years before incident dementia.[5] Inpatient use was also higher, at 0.12 versus 0.08 hospitalizations per 6-month period.[5]
Vascular conditions feature prominently in that pre-diagnostic period, which connects dementia to prevention work many systems already run. Participants with incident dementia were hospitalized more often for stroke or transient ischemic attack (8.5% versus 2.6%) and congestive heart failure (4.7% versus 1.6%).[5] The authors concluded that cardiovascular disease and concomitant cerebrovascular disease are important contributors to dementia.[5] They added that close monitoring of healthcare-seeking patterns may help identify people at high risk earlier.[5] Rising emergency use with falling clinic use is therefore a signal worth reviewing in local data.
Emergency visits carry high and variable risk once dementia is present. In a 20% sample of Traditional Medicare beneficiaries with dementia and an index emergency visit in 2018, one-year mortality ranged from 18.4% to 47%.[10] The lower figure applied to people living in the community before and after the visit, and the higher figure to admitted nursing home residents.[10] Mortality was 40.3% for people hospitalized within the prior month and 26.2% for those hospitalized 6 or more months earlier.[10]
Prediction from routine data remains imperfect. Seven of eight administrative-data models in the emergency study had C-statistics of 0.72 or lower.[10] An Australian model predicting delirium or dementia-related hospitalization after long-term care entry reached an area under the curve of 0.664, which its authors described as moderate discrimination.[14] The authors concluded that administrative-only models lack accuracy and suggested adding pragmatically selected clinical data.[10] Risk flags work best as prompts for clinical review rather than as substitutes for it.
Figure 1
Detection and crisis care: where the dementia pathway leaks
Percent of the study population reaching each pathway point, as reported in each study. Values are copied from the cited studies [1], [2], [10], [11]; none is estimated.
Data note. These values come from different studies, populations, years and definitions, so this is an indirect comparison; the bars show where the pathway leaks, not how one step compares with another.
Limitation. Each value reflects its own denominator: people with incident impairment, wellness visit attendees, emergency patients with dementia, or newly diagnosed beneficiaries.
Figure data (4 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| People with incident cognitive impairment who received a claims-based diagnosis | 30.8% | U.S. cohort linked to Medicare claims, 2006 to 2021; 45,191 observations of 8368 participants | [1] |
| Wellness visit attendees who underwent formal cognitive testing | 31% | National survey of 1871 Medicare beneficiaries; 80% had an Annual Wellness Visit | [11] |
| People with dementia hospitalized after an index emergency visit | 34.4% | 20% sample of Traditional Medicare beneficiaries with dementia, index emergency visit in 2018; 250,343 people | [10] |
| New dementia diagnoses first made in acute settings | 40.4% | 246,471 fee-for-service Medicare beneficiaries aged 65 or older newly diagnosed in July to December 2022 | [2] |
Continuum of care
Where the continuum breaks between diagnosis, crisis and long-term care
The setting of first diagnosis is itself a continuum signal. In the 2022 Medicare cohort, 9.2% of new diagnoses occurred in skilled nursing facilities or nursing homes, in addition to the 40.4% made in acute settings.[2] When diagnosis arrives at admission or after facility entry, post-diagnostic planning starts late and under pressure. Teams in those settings may lack the time, relationships and community links that good post-diagnostic planning requires.
Emergency transitions depend on knowing where a person lives and how recently they were admitted. In the emergency cohort of 250,343 people with dementia, 83.9% lived in the community before the index visit and 16.1% lived in a nursing home.[10] Because mortality varied by location before and after the visit and by timing of prior hospitalization, both facts are practical stratifiers for transition planning.[10] Those facts are often available at triage but rarely shape the discharge conversation.
Long-term care entry is another high-risk handoff. In a national Australian cohort of 207343 people with dementia in 2655 facilities, 5.2% had a delirium or dementia-related hospitalization within 365 days of entry.[14] The strongest predictors included frequent prior emergency presentations, a history of physical violence, male sex and prior delirium.[14] Information about those risks needs to travel with the person when responsibility moves to the facility.
Palliative care shows how program design shapes acute use. In an Ontario cohort of 50,961 community-dwelling people with dementia, home-based palliative care started within 30 days of homecare was associated with higher early hospitalization risk (hazard ratio 1.43 at 30 days).[9] That excess was driven mainly by hospitalization with palliative intent and was not significantly different beyond 180 days.[9] The authors read the early increase as a likely reflection of system gaps and unmet needs and called for re-examining homecare delivery models.[9]
Comprehensive dementia care programs are not a simple fix. The D-CARE trial randomized 2176 patient and caregiver dyads at 4 sites to health system care, community-based care or usual care for 18 months.[13] Neither model differed from usual care on function, cognition, quality of life or overall caregiver burden, though caregiver satisfaction was higher with both.[13] Leaders should define what a program is expected to change before they scale it. Caregiver satisfaction is worth tracking, but it should not be mistaken for a change in clinical outcomes.
Figure 3
Why the pathway breaks
People
- Care partners navigating services alone as needs grow
- Caregivers in poorer health less likely to accept preparedness support
- Few staff with dementia-specific qualifications
Process
- Wellness visits rarely include formal cognitive testing
- Memory questions asked without structured follow-through
- Risk information not carried into long-term care entry
Technology
- Administrative-data risk models with limited accuracy
- Telehealth dependent on home internet access
- Claims-based registries that miss and misclassify cases
Environment
- Limited primary care engagement before diagnosis
- Long waits and inflexible community services
- Stigma and cultural beliefs that delay help-seeking
Policy
- Clinician reporting mandates associated with underdiagnosis
- Risk adjustment that does not reflect dementia costs
- Convoluted referral pathways and funding limits
Measurement
- Diagnosis rates not stratified by race or education
- No core outcomes reflecting dignity and safety
- Program success judged on satisfaction alone
Unranked qualitative cause-and-effect diagram for the outcome in the box: People with cognitive impairment are diagnosed late, often during a crisis, and families leave without a reliable route to post-diagnostic support Causes are assembled from the cited literature [1], [2], [3], [4], [6], [7], [8], [10], [11], [12], [13], [14], [15]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Care partners navigating services alone as needs grow; Caregivers in poorer health less likely to accept preparedness support; Few staff with dementia-specific qualifications |
| Process | Wellness visits rarely include formal cognitive testing; Memory questions asked without structured follow-through; Risk information not carried into long-term care entry |
| Technology | Administrative-data risk models with limited accuracy; Telehealth dependent on home internet access; Claims-based registries that miss and misclassify cases |
| Environment | Limited primary care engagement before diagnosis; Long waits and inflexible community services; Stigma and cultural beliefs that delay help-seeking |
| Policy | Clinician reporting mandates associated with underdiagnosis; Risk adjustment that does not reflect dementia costs; Convoluted referral pathways and funding limits |
| Measurement | Diagnosis rates not stratified by race or education; No core outcomes reflecting dignity and safety; Program success judged on satisfaction alone |
Access
Making detection and post-diagnostic support reachable
Primary care engagement is associated with where diagnosis happens. In the 2022 Medicare cohort, Black individuals without recent primary care use were 2.7 percentage points less likely than White individuals to be diagnosed in the community.[2] With recent primary care use, that Black-White difference was no longer observed.[2] The authors concluded that primary care engagement increased community-based diagnoses and reduced Black-White disparities.[2]
The wellness visit is a built-in entry point that is not yet used reliably for cognition. Among beneficiaries who had one, 35% were asked about memory problems and 15% had both questioning and formal testing.[11] Use of structured cognitive assessments did not increase with higher visit uptake.[11] Access to the visit, in other words, has not become access to assessment, and no beneficiary characteristic was associated with the probability of testing.[11]
Payment design is linked to access after diagnosis. Among 5353 Medicare Advantage beneficiary observations, reinstating dementia condition categories into risk adjustment in 2020 was associated with a 6.62 percentage-point decrease in reported trouble accessing needed care.[3] It was also associated with a 9.20 percentage-point decrease in reported medical financial burden among beneficiaries with dementia.[3] No significant association was observed for satisfaction with specialist access or quality of care.[3] The authors suggest risk adjustment that better reflects the costs of complex conditions may better align plan incentives with high-need populations.[3]
Virtual access depends on the infrastructure people have at home. Among 3680 older adults receiving home- and community-based services, 40% used telehealth.[4] Internet access was strongly associated with use (odds ratio 2.51), and people with a dementia diagnosis had higher odds of use (odds ratio 1.33).[4] Lower odds were seen in older age groups, men, Black individuals, nonmetropolitan residents and recipients of Older Americans Act services.[4] Telehealth widens access mainly where connectivity and support already exist.
Access is ultimately measured by whether a person moves from concern to assessment, diagnosis and support without avoidable delay. The evidence above places the main constraints in primary care workflow, payment design and digital infrastructure.[2][3][4][11] Each of those levers sits within executive authority. Leaders can review wellness visit templates, documentation practices for risk contracts and digital support for older patients as one access agenda rather than three separate projects.
Executive guidance · System route
Connect the month to an accountable system route.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Support complex navigation
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Support complex navigation
Make contact options, receiving services, communication support, transition status, and follow-through visible without assuming one experience or route.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Support complex navigation | Make contact options, receiving services, communication support, transition status, and follow-through visible without assuming one experience or route. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Equity gaps begin before the diagnosis is written
Disparities in dementia care often start with who receives a diagnosis and where. The Medicare-linked cohort found lower odds of diagnosis among Black participants and those with less than a college education who had incident cognitive impairment.[1] Without recent primary care, Hispanic individuals were 4.6 percentage points and Asian individuals 15.8 percentage points more likely than White individuals to be diagnosed in the community.[2] Because patterns differ by group, stratified local data matter more than any single assumption. Leaders should ask for diagnosis rates and diagnosis settings broken out by race, ethnicity, education and payer.
Policy can unintentionally suppress diagnosis. Among 223,036 primary care clinicians, those in states with clinician reporting mandates to motor vehicle departments had an adjusted 12.4% probability of underdiagnosing dementia.[15] The probability was 7.8% in states with self-reporting mandates and 7.7% in states without mandates.[15] The authors noted that people may be reluctant to disclose symptoms, and clinicians reluctant to probe, where reporting is required.[15]
Digital equity follows similar lines. Younger, female and White older adults receiving home-based services had higher levels of internet access, and internet access was strongly associated with telehealth use.[4] A virtual-first navigation design could therefore widen gaps for groups that are already less likely to be diagnosed. Equity review should test every channel, not only the in-person route. That includes telephone lines, patient portals and the printed materials families receive at discharge.
Trust and stigma shape whether people seek help at all. A scoping review of 24 studies from nine Sub-Saharan African countries found stigma rooted in cultural beliefs and reinforced by structural stigma, including untrained health professionals, absent policies and fragmented care pathways.[7] Caregivers experienced courtesy stigma, isolation and accusations of abuse, and evidence on stigma-reduction interventions was scarce.[7] U.S. systems serve many immigrant and faith communities, so culturally informed outreach and staff education belong in equity planning.
Equity also covers the health of caregivers. Spousal caregivers with more chronic conditions or a recent hospitalization were less likely to accept an offer to prepare for their own health emergency.[8] Each additional chronic condition was associated with a 2.7 percentage-point decrease in acceptance.[8] Support that relies on caregivers opting in may miss those carrying the heaviest load. Equity review should treat caregivers as a population with their own risks and barriers.
Human infrastructure
The people who carry dementia care
Much of dementia care is delivered by family care partners who must navigate services largely on their own. In an Australian mixed-methods study with 86 surveyed care partners and 13 interviews, reported barriers included extended wait times, funding limitations, service inflexibility and convoluted referral pathways.[6] Service adequacy diminished as dementia progressed.[6] The authors called for strengthened referral and care navigation pathways supported by ongoing workforce development.[6]
Caregiver health is part of the care system’s capacity. Among 1,062 spousal caregivers offered an emergency preparedness toolkit, 489 (46%) requested it.[8] Each additional chronic condition in the caregiver was associated with a 2.7 percentage-point decrease in requests, and a caregiver hospitalization with a 12.2 percentage-point decrease.[8] Caregivers who did not request the toolkit were 1.9 percentage points more likely to die during follow-up.[8] The authors noted that reliance on spousal caregivers is growing.[8]
Workforce models matter, but staffing type alone does not guarantee results. In D-CARE, health system care used comanagement by nurse practitioners or physician assistants, while community-based care was delivered by telephone by a social worker, nurse or licensed therapist.[13] Caregiver satisfaction was higher with both models, with a least-squares mean difference of 2.6 points for health system care.[13] Caregiver experience is therefore a measurable outcome of these models, even where clinical measures did not differ.[13]
Staff qualifications are also a quality signal. A consensus panel that included people living with dementia, carers, advocates and professionals rated dementia-specific qualifications for care staff as important in both home and residential care.[12] The same panel rated dementia care navigation and opportunities for unpaid carers as important home care outcomes.[12] Staff carer morale was rated important in residential care.[12] Quality of carer and family lives was also rated important in home care.[12]
Executives can treat training, navigation capacity and caregiver support as measured parts of the pathway rather than background resources. Each role that receives a referral, answers a caregiver call or arranges a facility transfer is a point where responsibility either moves or stalls. Budget reviews for this month can ask which of those roles is staffed to current demand. Navigation roles also need defined caseloads, escalation routes and protected time for caregiver contact.
Executive guidance · Operating dashboard
Review reliability, not campaign activity alone.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Navigation and communication
Can people and support networks understand who owns the next step and how to raise an unresolved barrier?
- Candidate local measure
- Locally defined communication barriers, repeated contacts, transition acceptance, support requests, and route completion.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Navigation and communication | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Transfer responsibility with acknowledgment and visibility.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- State the next owner, approved communication channel, and unresolved status in a form the receiving team can use.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Connect operating signals to accountable executive review.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Navigation and communication | Can people and support networks understand who owns the next step and how to raise an unresolved barrier? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a reliable dementia detection and support pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Structured cognitive assessment within wellness visits | Memory concerns raised but never assessed | Primary care medical director | Share of wellness visits with documented structured assessment, stratified by race and education |
| Primary care engagement for older adults without a recent visit | First diagnosis made in emergency or inpatient settings | Ambulatory operations and population health leads | Share of new diagnoses made in community settings |
| Emergency department dementia flag with recent-admission and residence status | High-risk patients discharged without transition planning | Emergency department medical director with care management lead | Documented location and prior-admission review for patients with dementia |
| Risk handoff at long-term care entry | Delirium and dementia-related admissions after facility entry | Transitions of care lead with post-acute partners | Handoff completion rate and 365-day hospitalization review |
| Caregiver preparedness and health check | Caregiver crisis leaves the person with dementia without support | Social work and care navigation lead | Share of caregivers offered and completing a preparedness plan, with follow-up outreach |
| Accurate dementia documentation for risk contracts | Underfunded care and access barriers for beneficiaries | Chief financial officer with clinical documentation lead | Documentation audit results reviewed with access measures |
| Core outcome reporting to the board | Programs judged on activity or satisfaction alone | Chief quality officer and board quality committee | Annual report on dignity, safety incidents, advance care planning and navigation |
Control points derived from the cited evidence [2], [3], [8], [10], [11], [12], [13], [14] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Communicating about memory, caregiving and progress with integrity
Public messages about memory concerns help only when the system can respond. Formal cognitive testing reached only 31% of beneficiaries at wellness visits, and more high-risk patients were asked about memory problems despite a lack of testing.[11] Campaigns that encourage people to raise concerns need a matching assessment process and a clear next step.[11]
Communication with caregivers should address their own preparedness, not only the needs of the person with dementia. Caregivers at higher risk for health events may be most in need of emergency preparedness, yet they were least likely to respond to a low-touch offer.[8] Outreach that is personal, repeated and linked to existing visits may reach more of them than a single invitation. Caregivers who did not request the toolkit were also more likely to be hospitalized and discharged to a skilled nursing facility.[8]
Measurement shapes what leaders can see and say in public. An Australian consensus study distilled 105 candidate outcomes to 16 for home care and 15 for residential care, using a 70% consensus threshold.[12] Nine outcomes were important in both settings, including dignity, advance care planning, feeling safe and secure, quality of life and safety incidents.[12] Outcomes like these can anchor reporting that reflects what people living with dementia and their carers value.[12]
Data sources need honest labels. Among cohort participants without incident cognitive impairment, 8.9% still received a claims-based diagnosis, so claims data showed discordance in both directions.[1] Leaders who report dementia measures should state the data source, its known limits and how results differ by group. Because only 30.8% of people with incident cognitive impairment received a claims-based diagnosis, claims-based counts can understate the population a program should reach.[1]
Trust grows when organizations are candid about what programs do and do not change, and when results are mixed. The D-CARE trial found no differences on most patient and caregiver measures, though satisfaction improved.[13] Early palliative care in Ontario was followed by more hospitalization in the first 90 days, mostly with palliative intent.[9] Public communication can describe concrete services, realistic expectations and how the organization will report progress over time. That candor also protects the organization from overclaiming results during an awareness campaign.
Executive guidance · 90-day plan
Use 90 days to correct one visible operating barrier.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how National Alzheimer’s Disease Awareness Month communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Validate one complex navigation handoff with people using and operating the route, then correct a barrier.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how National Alzheimer’s Disease Awareness Month communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Validate one complex navigation handoff with people using and operating the route, then correct a barrier. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Pair recognition with a system people can trust.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Connect the message to one usable, measured, and sustained operating change.
Executive action kit · Month observance
Turn National Alzheimer’s Disease Awareness Month into accountable action.
Move from recognition activity to a visible operating route with named owners and closed loops.
Leadership focus
Use this observance to examine navigation, longitudinal ownership, and specialty-care coordination. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, assessment navigation, support, and longitudinal follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review communication access, cognitive accessibility, caregiver burden, transportation, digital access, and geographic availability.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, caregivers, clinical teams, rehabilitation, and community supports. Find one fragmented information, a failed transition, or an unresolved support need, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Support complex navigation
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined communication barriers, repeated contacts, transition acceptance, support requests, and route completion.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Patient Experience and Access Leaders
Staff communication template
During National Alzheimer’s Disease Awareness Month, our organization will connect awareness with a practical review of the information, assessment navigation, support, and longitudinal follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
National Alzheimer’s Disease Awareness Month is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Kim MH, Colantonio LD, Glymour MM, Hamad R, Adler-Milstein J, Kershaw KN, et al. Discordance Between Cognitive Impairment Status and Claims-Based ADRD Diagnosis. Alzheimer Disease & Associated Disorders. 2026;40(3):183-191. https://doi.org/10.1097/wad.0000000000000743
- 2.Bloschichak A, Yang MT, Makineni R, Qin Q, Temkin-Greener H, Conwell Y, et al. Disparities in the Setting of Initial Dementia Diagnosis: Influence of Race, Ethnicity, and Primary Care Use. Journal of the American Medical Directors Association. 2026;27(5):106142. https://doi.org/10.1016/j.jamda.2026.106142
- 3.Fu W, Qian Y, Karimi SM, Zarei H, Chen X. Risk Adjustment for Alzheimer Disease and Related Dementias in Medicare Advantage and Health Care Experiences. JAMA Network Open. 2026;9(3):e261796. https://doi.org/10.1001/jamanetworkopen.2026.1796
- 4.Urbanski DP, Parikh RR, Langworthy BW, Wolf JM, Fabius CD, Dill J, et al. Telehealth Use Among Older Adults Receiving Home- and Community-Based Services: Cross-Sectional Analysis Using the National Core Indicators–Aging and Disabilities Survey. JMIR Human Factors. 2026;13:e77522. https://doi.org/10.2196/77522
- 5.Pan M, Pate V, Knopman D, Jonsson-Funk M, Palta P, Kucharska-Newton AM. Healthcare utilization and morbidity preceding a dementia classification: the Atherosclerosis Risk in Communities (ARIC) study. BMC Health Services Research. 2026;26(1):1052. https://doi.org/10.1186/s12913-026-14815-5
- 6.Lahiouel A, Kellett J, Isbel S, Mulhall S, D’Cunha NM. “It’s Not like It’s Going to Get Better – I Might Need More Assistance”: A Mixed-Methods Study Exploring the Evolving Needs of Care Partners of People with Dementia. Dementia. 2026:14713012261435722. https://doi.org/10.1177/14713012261435722
- 7.Chigangaidze KAN, Gwariro S, Mtombeni M. Mapping Stigma and Cultural Beliefs Shaping Dementia Care in Sub-Saharan Africa: A Scoping Review. Dementia. 2026:14713012261437219. https://doi.org/10.1177/14713012261437219
- 8.Wain KF, Daddato AE, Dollar B, Lagrotteria J, Young HM, Satake A, et al. Caregivers with poorer health are less likely to engage in an intervention to prepare for their own health care emergency. The Gerontologist. 2026;66(7):gnag097. https://doi.org/10.1093/geront/gnag097
- 9.Quinn KL, Stukel TA, Pugliese M, Detsky AS, Heckman G, Omilabu MT, et al. Association of Palliative Care Initiation With Acute Healthcare Utilization Among Community‐Dwelling Adults Living With Dementia. Journal of the American Geriatrics Society. 2026;74(4):964-974. https://doi.org/10.1111/jgs.70282
- 10.Bowman JK, Ritchie CS, Ouchi K, Godwin KM, Tulsky JA, Teno JM. Predicting Mortality and Costs After Emergency Department Visits by People With Dementia: Timing and Location Matter. Journal of the American Geriatrics Society. 2025;74(3):822-828. https://doi.org/10.1111/jgs.70260
- 11.Liu Y, Ozawa T, Mattke S. Usage patterns of cognitive assessments during Medicare’s Annual Wellness Visit: A national survey. Alzheimer’s & Dementia. 2025;21(2):e14539. https://doi.org/10.1002/alz.14539
- 12.Kenny D, Welch A, Dao-Tran TH, Lendich K, Brittain D, Thompson J, et al. Identification of core outcomes for quality in routine care provided to people living with dementia in Australia: a multilevel modified Delphi consensus study. BMJ Open. 2025;15(6):e096059. https://doi.org/10.1136/bmjopen-2024-096059
- 13.Reuben DB, Stevens AB, Gill TM, Williamson J, Volpi E, Lichtenstein ML, et al. Patient and Caregiver Outcomes of Health System, Community-Based, and Usual Dementia Care. JAMA Internal Medicine. 2025;185(10):1227. https://doi.org/10.1001/jamainternmed.2025.4247
- 14.Eshetie TC, Caughey GE, Lang C, Whitehead C, Crotty M, Corlis M, et al. The risk of delirium or dementia‐related hospitalization among individuals living with dementia after long‐term care entry: A population‐based risk prediction model. Alzheimer’s & Dementia. 2025;21(8):e70487. https://doi.org/10.1002/alz.70487
- 15.Jun H, Liu Y, Chen E, Becker A, Mattke S. State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis. JAMA Network Open. 2024;7(4):e248889. https://doi.org/10.1001/jamanetworkopen.2024.8889
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Discordance between incident cognitive impairment and claims-based dementia diagnosis, by race and education | [1] | 2026 | Current evidence | Single U.S. cohort linked to Medicare claims, 2006 to 2021; claims-based diagnosis only. |
| Setting of first dementia diagnosis and the role of primary care use | [2] | 2026 | Access | Fee-for-service Medicare claims for six months of 2022; observational, adjusted associations. |
| Healthcare utilization and vascular morbidity before dementia classification | [5] | 2026 | Current evidence | Single community cohort with Medicare coverage; weighted comparisons, not causal estimates. |
| Mortality after emergency visits by people with dementia and accuracy of administrative models | [10] | 2025 | Current evidence | 20% Traditional Medicare sample from 2018; administrative data only. |
| Hospitalization risk after long-term care entry and risk prediction | [14] | 2025 | Continuum of care | Australian national cohort; moderate model discrimination. |
| Palliative care initiation and acute care use | [9] | 2026 | Continuum of care | Ontario administrative data; proxies for survival expectations and care needs. |
| Comprehensive dementia care models compared with usual care | [13] | 2025 | Continuum of care | Four U.S. sites; most patient and caregiver outcomes did not differ. |
| Cognitive assessment during Medicare wellness visits | [11] | 2025 | Access | Self-reported national panel survey of 1871 beneficiaries. |
| Risk adjustment and access and financial burden in Medicare Advantage | [3] | 2026 | Access | Cross-sectional survey data with difference-in-differences design; self-reported outcomes. |
| Telehealth use and internet access among older adults receiving home-based services | [4] | 2026 | Access | Cross-sectional survey of publicly funded service recipients, 2021 to 2022. |
| Motor vehicle reporting mandates and dementia underdiagnosis | [15] | 2024 | Equity and trust | Cross-sectional; underdiagnosis estimated from a predictive model. |
| Dementia stigma and structural barriers | [7] | 2026 | Equity and trust | Mostly qualitative studies from Sub-Saharan Africa; transfer to U.S. settings is indirect. |
| Care partner navigation barriers after diagnosis | [6] | 2026 | Human infrastructure | Small Australian sample of 86 surveyed care partners and 13 interviews. |
| Caregiver health and engagement in emergency preparedness | [8] | 2026 | Human infrastructure | Observational associations; post-offer follow-up limited to six months. |
| Core outcomes for quality of routine dementia care | [12] | 2025 | Public communication | Australian consensus panel of up to 24 participants; outcome set not yet validated. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
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