Purpose: This assignment will enhance your Skills in political analysis and strategies aimed at influencing policy changes.

****** The Policy I am supporting to be passed is the H. R. 1474: Alzheimer’s Caregiver’s Support Act

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******I am a resident in the state of Texas*****

Directions: Upload a 5 paged double spaced paper (excluding cover page and reference page)
1. Define Context of the Policy Issue/ Problem: Briefly describe the political context for the issue under examination. Include the socio-political, economic, ethical, historical, cultural factors relevant to the issue. This step is crucial in forming the basis for the policy analysis. Include the 5Ws and H (who, what, when, where, why and how) aspects of the issue. Provide a specific practice based concern or public health issue of concern at State or National level.
2. Policy Lenses: Briefly discuss how your personal values, beliefs, experiences, ethics, political philosophies and ideologies guide your views about the issue.
3. Describe a specific policy framework/model of choice that applies to your issue
4. Evidence Based Policy Change: Discuss research and evidence based policy change strategies and options to address the issue. Using a balanced approach discuss at least two alternative policy responses for consideration Examine the “best practices” of other agencies, as well as emerging policy proposals.
5. Apply the selected model/framework and analyze the political feasibility of solving the issue using the selected framework. What are the key concepts in the model/framework? How does your policy issue fit within this framework? What are the barriers and facilitators in addressing the issue? How can you advance this issue on the policy agenda? Who holds the power to advance this issue? What networks and coalitions exist that are involved in this issue
6. Recommendations: Of the two policy alternatives you presented, end your policy analysis with a summary of the preferred policy option. Justify why this option is preferred. Conclude with a discussion of the implications for nursing leadership policy and practice.

Criteria Possible Points(100) Points Earned Comments
Policy Issue Description: Provide comprehensive overview of health policy issue to include socio-economic, political, cultural and ethical aspects of the issue 10
Policy Lenses: discuss how values, beliefs, experiences, political philosophy, and political ideologies influence decision making 20
Policy Analysis Framework: Describe and apply a specific policy framework/model of choice to the health policy issue of interest 20
Evidence Based Policy Change: Discuss research and evidence based policy change strategies and options to address the issue. Using a balanced approach discuss at least two alternative policy responses for consideration 20
Recommendations: Provide justification for policy recommendation and discuss implications for nursing health policy and practice 20
Clear grammar, spelling, writing style, references, double spaced paper within five page limit (excluding references and title page) and APA style. Headings are expected. Please use the grading criterial items for headings. 10





Policy Implementation

The Alzheimer’s Caregiver Support Act in the 117th Congress on March 1, 2021, by Ms. Waters. The bill aimed at authorizing grants for training and supportive services for the families and the unpaid caregivers of the people living with Alzheimer’s disease or dementia related to the health condition. The grants cover for the training of the untrained caregivers living with the patients in enhancing knowledge on how to care for the patients, cope with stress in handling the patients, planning for the care, solving the problems emanating from their duties, and managing the behavioral symptoms presented by the patients (ALZ, 2021). The Act initiated educational value to the caregivers of dementia patients in ensuring quality life by encouraging the patients to participate in daily activities and tasks and understanding their illnesses or injuries that need care.

Caregiving services for dementia patients require more time than the other forms of caregiving. The increased time needed to take care of the patients reduces the capacity of the caregivers to develop economically. According to ALZ (2021), caregivers of people with dementia in 2019 provided 18.6 billion hours of unpaid assistance cumulatively. This indicates that the caregivers use much of their time offering unpaid care for the specified population, thus limiting their social value with other people and personal economic developments. Handling dementia patients is distressing, and thus the caregivers need training and other financial assistance in coping with the distressing conditions and meeting the stressing economic needs. In a study, 49% of the caregivers for dementia patients acknowledged being distressed compared to 35% of caregivers of the patients or people without dementia (ALZ, 2021). This shows the economic and social burden of unpaid caregivers. It is ethical to appreciate the caregivers in motivating them to provide safe, ethical, and professional care to the patients. Seidel & Thyrian (2019) indicated that high levels of dependency among dementia patients and the distressing factor among the caregivers increase the prevalence of physical and sexual violence against dementia patients. This shows the importance of the bill in improving the professionalism and psychological wellbeing of the caregivers.

Policy Lenses

My personal beliefs and values guide me in supporting the bill for providing grants to unpaid caregivers. I am a committed and reliable advocate for patients within the nursing profession, and thus in valuing health, I support the motions focused on improving the quality of health and patient care. I believe that people should provide healthcare services with a higher capacity, specially trained on how to provide the services, to positively impact the patients. Provision of patient care with knowledge limitations increases the risks of making unprofessional mistakes that may lead to health risks, ethical malpractices, and poor patient interpersonal relationships. The caregivers should thus be trained to understand the basic and best ways to handle patients with dementia. Being a nurse professional and through experience, I have learned that a distressed caregiver is prone to punching the same to the healthcare recipient, and thus, limiting the distress encourages the professional to observe ethical principles and provide quality care. I believe in the socialistic political philosophies that are built not on individualism but societal gain. Socialism rejects the desire to count on the personal gain without focusing on other people’s needs, as it is in the liberal or conservative philosophies. Quality healthcare is a right to everyone and not a privilege to some members of society. A socialistic view thus encourages to devise a plan to equalize the quality of care for those underpaid professional caregiving services and those under unpaid caregiving. In this context, the unpaid caregivers may provide uninformed and unqualified care to the patients with dementia which causes disparity in care compared to those under professional nurse care. Provision of professional training and support to the caregivers thus balances the quality of care for the specified population.

Policy Framework/ Model

There are various policy models applicable to the policy implementation process. The most applicable policy framework for the described policy is the multiple streams policy model, popularly known as Kingdon’s model. According to the model, formulation and implementation of a policy happen when the three streams converge in accepting the terms of solving the issue (Judy Gregg et al., 2018). The first stream is the problem stream which involves the identification and definition of the problem. A problem, not a condition, is a consistent issue that needs to be resolved. It concerns a public matter that has been recognized as a problem. The policy stream involves the change proposals in addressing the problem identified. The policy stream provides a list of proposals driven by the interest groups such as activists and professional associations. The policy stream puts the demands for change through various policy change proposals. The academicians and researchers in Texas should seek evidence on the impact of grants to the unpaid caregivers and support the intervention. The politics stream entails political issues in collaborating the efforts and resources to consider the policy impacts and costs. This constitutes the pressure groups campaigns and the administrative or legislative activities that weigh on various factors about the identified problem and the projected solutions through the policy stream (Macaulay & Focsa, 2016). This is the role of the professional bodies of healthcare providers and the legislature in determining the effectiveness of the provided policy proposals. According to the model, convergence of the three streams forms an opportunity window for policy change. This model applies to the identified problem of poor quality of caregiving services and wellbeing of the unpaid caregivers.

Evidence-Based Policy Change

The provision of quality healthcare is dependent on the wellbeing of the care providers, the availability of resources, and the professional capacity of the healthcare providers. The major problem identified by the bill is the inadequacy in the quality of care to the dementia patients by the unpaid caregivers. One quality of the unpaid caregivers is that they lack the training and professionalism in caring for the patients and thus the poor quality. Training improves the skills on handling healthcare-related issues and the psychological issues revolving around the patient and resulting from the dementia condition. Weir et al. (2021) conducted a systematic review on the effectiveness of caregiver training for informal caregivers assisting patients diagnosed with neurological disorders. The researchers established that the training contributed to improved quality of services and wellbeing of the patients compared to their performance before the intervention. The training improved the levels of confidence among the unpaid caregivers in delivering care.

Payment is used as a motivation and compensation for services delivered. Even though caregiving is much of a call to help other people gain health and wellbeing, payments and stipends motivate the caregivers to provide the caregiving services even in meeting the challenges. Caregiving for the patients suffering from dementia takes a lot of time, requiring concentration on the behaviors and activities of the patients, an indication that the caregivers have less time for their personal development and social life. This may lead to disinterest in caregiving and depression due to strains and thus negatively impact their caregiving processes. Reckrey et al. (2021) conducted a study on the impact of paying family caregivers caring for dementia patients on the quality of care. According to the study, caregivers who received part-time and zero payment lacked emotional attachment to the caregiving activities and performed poorly compared to those who received quality appreciation. This shows that appreciation to the family caregivers for dementia patients improves the quality of care and wellbeing of the caregivers.

The bill provides a solution of providing grants to unpaid caregivers to be trained on effective caregiving. This training includes how to effectively handle the patients, cope with the distressing care, and ensure quality care and relationship with the patients. This strategy largely focuses on the training measure that increases the knowledge on quality care. An alternative strategy in solving the problem is increasing the healthcare coverage to incorporate the professional healthcare providers in the caregiving process to collaborate with the unpaid caregivers for quality improvement in care. Additionally, the government can include the unpaid caregivers in the plan of optimal pay and incorporate the local healthcare providers such as public health nurses in training and inducting the caregivers.


Providing grants for both training and stipends for unpaid caregivers may largely impact the quality of care for dementia patients. Caregiving is a physically, emotionally, and financially draining role that requires general support from all stakeholders. Increased emotional, financial, and physical stability project an equal quality in care for dependent patients such as dementia patients. The provision of payments would thus help improve and cover the financial deficits, compensating the caregivers for their time and energy in caring for dementia patients. This, to their functions as an appreciation for their services to the patients. Clark (2021) points out that paying family caregivers is possible since some states in the United States are doing it and are helping improve the quality of care. Some states, such as California, New York, and Washington, have formalized paying family caregivers through Medicaid plans. Education and training of unpaid family caregivers are essential in improving the quality of care. Paying for education can be difficult for Texas and thus can encourage the paid caregivers to seek education and collaboration with the local healthcare providers for improved skills. Through a study, Burgdorf et al. (2019) established that the family caregivers who received payments were four times more likely to seek training and education programs.




ALZ. (2021). Bipartisan Legislation to Expand Caregiver Training and Support Introduced in 117th Congress. Alzheimer’s disease and dementia. https://www.alz.org/news/2021/bipartisan-legislation-to-expand-caregiver-training

Burgdorf, J., Roth, D. L., Riffin, C., & Wolff, J. L. (2019). Factors Associated With Receipt of Training Among Caregivers of Older Adults. JAMA internal medicine179(6), 833–835. https://doi.org/10.1001/jamainternmed.2018.8694

Clark, A. (2021, September 13). What States Pay Family Caregivers in 2021? The Senior List. https://www.theseniorlist.com/caregiving/caregiver-funding-by-state/

Judy Gregg, D. N. P., Miller, J., & Tennant, K. F. (2018). Nurse policy entrepreneurship in a rural community: A multiple streams framework approach. Online Journal of Issues in Nursing23(3), 1-11.

Macaulay, R., & Focsa, S. (2016). What Is The Value of a QALY? If Spending $10,000 on a Holiday for a Patient Produces a Greater Rise in Patient QALYs than an End-Of-Life Treatment of Similar Cost, Should a Health System Pay for One, For Both, Or Neither?. Value in Health19(3), A295.

Reckrey, J. M., Boerner, K., Franzosa, E., Bollens-Lund, E., & Ornstein, K. A. (2021). Paid Caregivers in the Community-Based Dementia Care Team: Do Family Caregivers Benefit?. Clinical Therapeutics.

Seidel, D., & Thyrian, J. R. (2019). The burden of caring for people with dementia–comparing family caregivers and professional caregivers. A descriptive study. Journal of multidisciplinary healthcare12, 655.

Weir, R. L., Danilovich, M. K., & Hoover, D. L. (2021). A systematic review of the effectiveness of caregiver training with functional mobility tasks for informal caregivers assisting patients with neurological diagnoses. Disability and Rehabilitation, 1-8.