[Congressional Record Volume 163, Number 180 (Monday, November 6, 2017)]
[Senate]
[Pages S7017-S7019]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Ms. COLLINS (for herself, Ms. Cortez Masto, Mrs. Capito, and
Mr. Kaine):
S. 2076. A bill to amend the Public Health Service Act to authorize
the expansion of activities related to Alzheimer's disease, cognitive
decline, and brain health under the Alzheimer's Disease and Healthy
Aging Program, and for other purposes; to the Committee on Health,
Education, Labor, and Pensions.
Ms. COLLINS. Mr. President, I rise today with my colleague from
Nevada, Senator Cortez Masto, to introduce the Building Our Largest
Dementia Infrastructure for Alzheimer's--or BOLD--Act. I am pleased
that Senator Capito and Senator Kaine are also joining us as original
cosponsors.
Our legislation would create a public health infrastructure aimed at
combating Alzheimer's disease and preserving brain health. Alzheimer's
disease is one of the greatest and most under-recognized public health
threats of our time. Former Surgeon General David Satcher has said that
it is the most under-recognized public health threat of the 21st
century. Five and a half million Americans are living with the disease,
and that number will soar as our population continues to grow older and
lives longer.
In addition to the human suffering it causes, Alzheimer's is our
Nation's most costly disease. The United States spends more than $259
billion per year, including $175 billion in Medicare and Medicaid
costs. The financial impact of this dreadful disease will only continue
to grow. In fact, it is estimated that by the year 2050, Alzheimer's
will cost our country $1 trillion and afflict 16 million Americans.
While Alzheimer's is the only one of our Nation's most deadly
diseases without an effective treatment or cure, tantalizing new
research suggests that there are steps we can take to promote
prevention and improve treatment.
The first step we should take is to recognize Alzheimer's as a public
health crisis. It is because of public health advancements that we have
safe water to drink, vaccines to prevent deadly diseases, interventions
to quit smoking, and emergency preparedness tools to save lives. The
effort to combat Alzheimer's disease requires a similar unified,
national public health effort. That effort is gaining steam.
In 1999, when I founded the Bipartisan Congressional Task Force on
Alzheimer's, there was virtually no focus in Washington on this
devastating disease. In fact, people were afraid to even refer to the
disease, just as years ago people did not talk about cancer.
Seven years ago, I coauthored with then-Senator Evan Bayh the
bipartisan National Alzheimer's Project Act, which set the primary goal
of preventing and effectively treating the disease by the year 2025.
That bill created an expert council, which has calculated that $2
billion in Federal funding per year is needed to achieve that goal.
On the Appropriations Committee, I have worked hard with Senator
Blunt and others to turn the words of that recommendation into action.
The funding bill for this year provides another $2 billion increase for
the National Institutes of Health, and that includes a $414 million
increase for Alzheimer's research--the largest in history. That brings
the total for Alzheimer's research to $1.8 billion--well within reach
of the $2 billion goal, which the experts tell us is necessary for
breakthroughs.
While this research is moving forward, we must put into practice what
we know and enhance the quality of care and support for those living
with Alzheimer's and their families. In March, the Aging Committee,
which I chair, held a hearing on the arc of Alzheimer's, from
preventing cognitive decline to ensuring quality care for those living
with dementia. The hearing shed light on the fact that although we do
not yet know how to prevent Alzheimer's, we are advancing in our
understanding of the disease. Its progression does not happen
overnight; it is preceded by years and perhaps decades of changes in
the brain and a continuum of changes in behavior, including cognitive
decline. A growing body of evidence suggests that lifestyle factors,
such as regular physical activity and attention to heart health, may
reduce the risk of cognitive decline. There is so much we have yet to
know.
Alzheimer's is a public issue for those living with the disease, for
those caring for their loved ones with the disease, for all of us as
taxpayers, and for those who know that our brain is our most precious
resource. Alzheimer's exacts a tremendous personal and economic toll on
families and communities. More than 40 million Americans know all too
well the compassion, commitment, and endurance that it takes to be a
caregiver of a loved one facing a chronic disease like Alzheimer's.
The legislation we are introducing today would apply a new public
health approach to Alzheimer's disease. It would establish Centers of
Excellence in Public Health Practice dedicated to promoting effective
Alzheimer's disease management and caregiving interventions, as well as
educating the public on the disease, cognitive decline, and brain
health.
The Centers for Disease Control and Prevention is already doing
tremendous work to combat Alzheimer's within the Public Health Road Map
of the Healthy Brain Initiative. This legislation would create centers
of excellence across the country to implement the CDC's Public Health
Road Map. The centers would take a number of key steps against
Alzheimer's. They would work to support early detection and diagnosis,
lessen the risk of avoidable hospitalizations, reduce the risk of
cognitive decline, enhance support to meet the needs of caregivers,
reduce health disparities, and support care planning and management for
those with the disease. The Centers' activities would support health
and social services professionals as well as families and communities.
In addition to establishing the Centers of Excellence in Public
Health Practice, this bill would spread the opportunity for communities
across America to create the necessary core capacity to combat
Alzheimer's and to enhance existing efforts in this regard. The
legislation would establish and distribute cooperative agreements to
public health departments to support systems change, communications,
and programmatic interventions. These agreements would also support the
actions in the CDC Healthy Brain Initiative's Public Health Roadmap.
Finally, at the heart of public health is data. This legislation
would direct the CDC to collect data on cognitive decline, cognitive
impairment, caregiving, and health disparities within its current
systems. The bill would also create cooperative agreements for the
analysis and reporting of data to ensure that the results are
disseminated to the public and are used, ultimately, to improve brain
health.
For far too long, we have viewed Alzheimer's disease as an aging
issue that plagues our seniors today and threatens to affect many more
tomorrow. In fact, the disease is far more than that.
[[Page S7018]]
It is a public health issue with a course that we can change. If we do
not take action, both in this new public health approach and by
continuing to build on the research, this disease will bankrupt the
Medicare and the Medicaid Programs. We cannot afford to spend over $1
trillion in the year 2050 on just this one disease. We cannot afford to
lose 16 million Americans by that year to this devastating disease. We
cannot afford to allow the heartache and devastation of this disease to
affect more and more American families.
There are steps that we can take today to prevent cognitive decline
and to improve the lives of those who are living with Alzheimer's and
the lives of their caregivers. This public health approach is not only
empowering, but it is key to avoiding the terrible impacts that I have
outlined.
After decades of expanding much needed biomedical research in
Alzheimer's, we are ready for the next step--to translate research into
policy. The BOLD bill would create a new, enlightened public policy out
of promising research by creating the first ever national public health
infrastructure for Alzheimer's disease.
I am pleased to say that the bipartisan bill that the Senator from
Nevada and I have introduced, with our colleagues from Virginia and
West Virginia, is endorsed by the Alzheimer's Association, the
Alzheimer's Impact Movement, the National Association of Chronic
Disease Directors, and the National Association of Counties.
I ask unanimous consent that their letters of support be printed in
the Record at the conclusion of my remarks.
I urge my colleagues to support this critical and bipartisan
legislation.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Alzheimer's Impact Movement,
Washington, DC, November 6, 2017.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Hon. Shelley Moore Capito,
U.S. Senate,
Washington, DC.
Hon. Catherine Cortez Masto,
U.S. Senate,
Washington, DC.
Hon. Tim Kaine,
U.S. Senate,
Washington, DC.
Dear Senators Collins, Cortez Masto, Capito and Kaine: On
behalf of the Alzheimer's Association and the Alzheimer's
Impact Movement (AIM), including our nationwide networks of
advocates, thank you for your continued leadership on issues
and legislation important to Americans with Alzheimer's and
other dementias, and to their caregivers. The Alzheimer's
Association and AIM are pleased to support the bipartisan
Building Our Largest Dementia (BOLD) Infrastructure for
Alzheimer's Act, which would create an Alzheimer's public
health infrastructure across the country to implement
effective Alzheimer's interventions focused on public health
issues such as increasing early detection and diagnosis,
reducing risk and preventing avoidable hospitalizations.
More than 5 million Americans are living with Alzheimer's
and, without significant action, as many as 16 million
Americans will have Alzheimer's by 2050. Today, another
person develops the disease every 66 seconds; by 2050,
someone in the United States will develop the disease every
33 seconds. This explosive growth will cause Alzheimer's
costs to increase from an estimated $259 billion in 2017 to
$1.1 trillion in 2050 (in 2017 dollars). These mounting costs
threaten to bankrupt families, businesses and our health care
system. Unfortunately, our work is only growing more urgent.
As scientists continue to search for a way to prevent,
cure, or slow the progression of Alzheimer's through medical
research, public health plays an important role in promoting
cognitive function and reducing the risk of cognitive
decline. Investing in a nationwide Alzheimer's public health
response will help create population-level change, achieve a
higher quality of life for those living with the disease and
their caregivers, and reduce associated costs. The BOLD
Infrastructure for Alzheimer's Act would provide this crucial
investment by establishing Alzheimer's centers of excellence
across the country and funding state, local and tribal public
health departments to increase early detection and diagnosis,
reduce risk, prevent avoidable hospitalizations, reduce
health disparities, support the needs of caregivers and
support care planning for people living with the disease.
These important public health actions allow individuals with
Alzheimer's to live in their homes longer and delay costly
institutionalized care. These goals are consistent with the
National Plan to Address Alzheimer's Disease, which includes
a strategy to ``work with state, tribal, and local
governments to improve coordination and identify model
initiatives to advance Alzheimer's disease and related
dementias awareness and readiness across the government.''
The BOLD Infrastructure for Alzheimer's Act would also
increase the collection, analysis and timely reporting of
Alzheimer's data. This data is critical to identifying
opportunities for public health interventions, helping
stakeholders track progress in the public health response,
and enabling state and federal policymakers to make informed
decisions when developing plans and policies. Finally, the
bill would also strengthen implementation of the Center for
Disease Control and Prevention's Public Health Road Map,
which includes strategic action items for state and local
public health departments and their partners to promote
cognitive functioning, address cognitive impairment and help
meet the needs of care partners.
The Alzheimer's Association and AIM deeply appreciate your
continued leadership on behalf of all American's living with
Alzheimer's and other dementias. We look forward to working
with you to advance this important bipartisan bill. If you
have any questions about this or any other legislation,
please contact Rachel Conant, Senior Director of Federal
Affairs.
Sincerely,
Robert Egge,
Chief Public Policy Officer, Executive Vice President,
Government Affairs, Alzheimer's Association.
____
November 6, 2017.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Hon. Shelley Moore Capito,
U.S. Senate,
Washington, DC.
Hon. Catherine Cortez Masto,
U.S. Senate,
Washington, DC.
Hon. Tim Kaine,
U.S. Senate,
Washington, DC.
Dear Senators Collins, Cortez Masto, Capito and Kaine: On
behalf of the undersigned organizations, thank you for your
leadership on the important public health issues facing our
nation, including the urgent issue of Americans with
Alzheimer's and other dementias. We are pleased to support
the bipartisan Building Our Largest Dementia (BOLD)
Infrastructure for Alzheimer's Act, which would create an
Alzheimer's public health infrastructure across the country
to implement effective interventions focused on public health
issues such as increasing early detection and diagnosis,
reducing risk and preventing avoidable hospitalizations.
Former Surgeon General and Director of the Centers for
Disease Control and Prevention (CDC) Dr. David Satcher
recently said, ``Alzheimer's is the most under-recognized
threat to public health in the 21st century.'' More than 5
million Americans are currently living with Alzheimer's and,
without significant action, as many as 16 million Americans
will have Alzheimer's by 2050. Today, another person develops
the disease every 66 seconds; by 2050, someone in the United
States will develop the disease every 33 seconds. This
explosive growth will cause Alzheimer's costs to increase
from an estimated $259 billion in 2017 to $1.1 trillion in
2050 (in 2017 dollars). These mounting costs threaten to
bankrupt families, businesses and our health care system.
Public health plays an important role in protecting the
health and well-being of Americans, including promoting
cognitive function and reducing the risk of cognitive
decline. Investing in a nationwide Alzheimer's public health
response will help create population-level change, achieve a
higher quality of life for those living with the disease and
their caregivers, and reduce associated costs. The BOLD
Infrastructure for Alzheimer's Act would provide this crucial
investment by establishing Alzheimer's centers of excellence
across the country and funding state, local and tribal public
health departments to increase early detection and diagnosis,
reduce risk, prevent avoidable hospitalizations, reduce
health disparities, support the needs of caregivers and
support care planning for people living with the disease.
These important public health actions allow individuals with
Alzheimer's to live in their homes longer and delay costly
institutionalized care.
The BOLD Infrastructure for Alzheimer's Act would also
increase the collection, analysis and timely reporting of
data. This data is critical to identifying opportunities for
public health interventions, helping stakeholders track
progress in the public health response, and enabling state
and federal policymakers to make informed decisions when
developing plans and policies. Finally, the bill would also
strengthen nationwide implementation of the CDC's Public
Health Road Map, which includes strategic action items for
state and local public health departments and their partners
to promote cognitive functioning, address cognitive
impairment and help meet the needs of care partners.
We deeply appreciate your leadership on behalf of the
public health community and
[[Page S7019]]
all American's living with Alzheimer's and other dementias.
We look forward to working with you to advance this important
bipartisan bill.
Sincerely,
Alzheimer's Association,
Alzheimer's Impact Movement,
National Association of Chronic Disease,
Directors, National Association of Counties.
Ms. COLLINS. I am now very pleased to yield to the coauthor of this
important bill. Senator Cortez Masto has been an extraordinary member
of the Senate Special Committee on Aging. She attends every single
hearing, which is amazing, given our schedules, and she contributes so
much to the debate and questioning in those hearings. I am delighted to
join in this effort with her.
The PRESIDING OFFICER. The Senator from Nevada.
Ms. CORTEZ MASTO. Mr. President, I rise to thank my colleague from
Maine, whose amazing work as chair of the Aging Committee continues to
inspire me.
I also rise to share a story that is very personal to me. It is a
story about one of the smartest people whom I have known, my
grandmother Katherine, whom I was named after. She was the daughter of
an Italian immigrant and his Italian-American wife. She was exactly the
kind of person you think of when you think of an Italian grandmother.
If you have ever had one, you know that she loves to feed people and
invite the whole family--aunts, uncles, cousins, everyone--over to her
house for dinner on Sunday nights. The other 6 days of the week, she
worked on volunteer projects throughout Las Vegas with her sorority,
Beta Sigma Phi.
She never graduated from college, but she was a leader in our
community, and she was always reading. If you walked into her house, it
was full of books. In fact, the first thing that you saw when you
walked into her house was, on one wall, floor to ceiling, a bookcase
with all of the books that she had read.
She was brilliant. She was one of my greatest inspirations. Her work
in our community in Las Vegas is one of the reasons that I decided to
pursue a career in public service.
Unfortunately, in the 1990s, my grandmother was diagnosed with
Alzheimer's disease. At first, you could barely notice a difference.
There were small things, things that could happen to anyone--lost keys,
mismatched socks, books left in odd places. Then a woman who had spent
her entire life loving to cook for her family and grandchildren had
suddenly stopped cooking.
Over the next 10 years, she got progressively worse. We could see the
changes in her every single day, but our lives changed too. My
grandfather became her caregiver. My mother became her caregiver. My
aunt became her caregiver. My cousins and I and my sister all became
caregivers. That is what happens when someone is diagnosed. It does not
affect just one person; it affects an entire family.
There is a common misconception that people who are suffering from
Alzheimer's are not aware of what they are losing, that their memories
are gone but not missed. That was not the case for my grandmother. I do
not think it is the case for anyone who is struggling with this
disease. My grandmother frequently had these moments of clarity when it
was clear that the losses were just as painful for her as they were for
all of us.
One thing that happens to many people with Alzheimer's is that they
tend to wander. They wander away from home or they get lost. She had
had one of those moments of clarity after she had wandered away from
home one day, and the entire family had spent an afternoon looking for
her in our neighborhood. My aunt and I had found her and had gone to
pick her up in a car. I will never forget it, as I sat in the back seat
while my aunt drove.
My grandmother, who had been seated on the front passenger's side,
asked my aunt: Why am I doing this? Why am I in my housecoat and
slippers? Why am I doing this?
My aunt looked at her and she said: Mom, you are sick. You have
something they call Alzheimer's, and that means that it is impacting
your brain and your memories, and you are forgetting.
We were so powerless. We couldn't do anything but make her
comfortable and bring her home.
For many, many families who are dealing with Alzheimer's, they have
gone through those same moments--those moments when they are dealing
with their loved ones either trying to explain to them what is
happening or giving them comfort because they know their memories are
gone, and they want to make sure they are giving them the comfort they
need and they deserve.
We know, unfortunately, that there is no cure for Alzheimer's. My
grandmother passed away, as many people with Alzheimer's do, when her
illness got so bad that she lost the ability to eat or drink, but the
experience of caring for my grandmother opened my eyes to the true
impact of this disease. I saw that when one person is diagnosed, whole
families' lives are transformed too. I think about my grandmother every
day. Every day, I return to some piece of wisdom or guidance that she
shared with me. I am committed now to honoring her memory by fighting
to prevent Alzheimer's and to provide caregivers with the support they
need and deserve.
When my grandmother was first diagnosed, we did not understand
Alzheimer's like we do today. We did not have enough healthcare
programs for it or support for the caregivers. It was seen as an
individual disease that struck at random, with no cure and no hope.
Although there is still no cure, we know now that there are things that
we can do to help to keep the brain healthy longer and possibly reduce
the risk of Alzheimer's and that there are things that we can do now to
promote prevention.
For those who are already living with Alzheimer's and for their
caregivers, like my family was for my grandmother, there are things
that we can do to dramatically improve their experiences and to help
lessen some of that burden. Today there are things we can do to invest
in finding that cure for Alzheimer's. It is just a petri dish away, but
we have to believe that it is there and that we can continue and
support that investment. I have visited the Lou Ruvo Center for Brain
Health in Las Vegas and met with its director, Dr. Jeffrey Cummings. I
have seen the incredible work they have done, including their methods
for the early detection of Alzheimer's, which simply did not exist only
a few years ago. Yet education in the community and the spreading of
best practices still lag behind.
There is no longer any doubt that this is a public health crisis.
That is why I am so grateful and proud to be sitting on a committee and
working with a chairwoman, my colleague from Maine, who has made an
effort here in Congress to really bring attention to Alzheimer's
disease and to help to fight for funding and investment in a cure.
I am proud to join my colleagues from Maine, West Virginia, and
Virginia in introducing legislation that is known as the BOLD
Infrastructure for Alzheimer's Act. This bill will create Centers of
Excellence that will be dedicated to promoting effective interventions
and educating the public on Alzheimer's disease, cognitive decline, and
brain health. It will provide grants to State and local health
departments to build the infrastructure that is necessary to address
this public health crisis, and it will collect the data that is
necessary to keep pushing the frontiers of what we know about this
disease.
I urge my colleagues to support this vital, bipartisan piece of
legislation that has the potential of having a positive impact on
millions of Americans across this country.
____________________