Alzheimer's Disease and Dementia Advisory Council

Council meeting first thing to do is to approve our minutes from July 8th. Is there someone willing to So moved. Thank you, Stephanie Cook and Doctor Way will second it all approved, say aye. Anyone against? Say nay, thank you. Um, it is approved. We will move on to item agenda C discussion of a grant awarded to UAMS geriatric Education Collaborative, and I believe we have a slide show up on that and I'm going to let you introduce yourself to tell us about this exciting work that you're doing. Thank you. Um, my name is Robin McAty. I'm the director of the Arkansas Arkansas geriatric Education collaborative at UAMS at the Donald W. Reynolds Institute on Aging. I've been there for several years and we have had actually an iteration of this grant for More than a couple of decades now and we just got renewed for $5000. This is a 55 year, $5 million geriatric workforce enhancement program grant. Um, it is funded by HSA and the Health Resources and Services Administration. So we were very pleased about this, and there is a special amount in this grant that is allocated to dementia. And that's kind of what I'm gonna focus on today. I'll give you an overview of the entire grant, but they do require. To focus so many dollars they require us to focus about 250 and we have at least 260 in the actual budget. And it's about $1 million budget per year. And it's hard to distinguish between a lot of the things we do, but dementia is of course an Alzheimer's is a primary. Um, activity in older adults, but this is the goal of all GWE centers that you see up here. We're to educate and train primary care and the geriatric workforces and other appropriate specialties to provide age and dementia-friendly care for older adults, and they talk about the integrated geriatrics of primary care. They really want any primary care. clinic or facility to be able to care for older adults and that's why they're saying that in any clinic that one of your older adults go to, they want to have, um, these concepts very clear in their minds and to be able to care for those appropriately. Um, and the, the web several years ago they started out just doing health professions education and we've really taken a lot of turn to where we're doing a lot more now and these are the objectives of all of the webs. This was the first time we were not allowed to develop our own goals or objectives, so they told us what they were. I'm not going to read them to you, but the first one basically is talking about working with a lot of different partners, including primary care, academia, um, nursing homes, community organizations and They really want to transform those environments to where they are aged and and dementia friendly. And I'll go into what that means here in just a minute and they also want to make sure that the students that are coming out of the programs these days and the residents and interns and fellows and all the faculty are really up to speed on what it means to care for older adults, and they want us to focus and it was a requirement this time to focus on what they're calling tetour sites, which is your tribal tribal organizations underserved and or rural. Primary care sites and delivery systems. So really in Arkansas we don't have a lot of tribal organizations, but we do of course have a lot of rural areas, and this is one of our um foca, so. Um, we'll talk a little bit more about that. And then they want us to establish and maintain programs in those areas with the supportive care workers, direct care workers, and of course the primary care workforce and make sure they have the knowledge and skills to care for persons living with dementia and they want us to help them use innovative technology and other methods. Um, first of all, the objectives for our clinical experiences we have to have um students and other workers in these tour sites and they want us to have them to be eye this is an IHIS certification to be age-friendly. And so we have helped several clinics over the past 5 years to maintain, to get and maintain certification, and that's what you see down below. We've been working with the probably heard of the uh QHC is the federally qualified. Health care centers. We work with our care division of that and we've helped 6 clinics obtain level 2 certification and 7, obtained level one and we've trained almost 100 healthcare staff, and we've trained them to deliver age-friendly healthcare and that they've concentrate on those four Ms that you see up there, which is mobility, medication, what matters, and mentation. And so that mentation really focuses on dementia. Depression, delirium, and things like that. So, and all of them are to be focused around the what matters in. And that is basically asking the older adult what is important to you and then that really drives their care. And so we want to teach students, we want to teach residents and fellows to make sure basically that's sometimes the first question out of your mouth is what is important to you? Is it going to your son's football, your grandson's football game every week, so mobility then is focused around that. It may not be prolonging their life, but it is um doing what is important for that older adult. And so, as I said, we have direct training partnership now with 10 rural our care clinics. Some of them are the same that we had during the last grand, but many are different because they weren't in the tour sites and hersa defines what the Torites are, and you put in their address and they tell you what it is. We, we don't make those up ourselves, so. And then we have agent dementia training for all students and their mentors and faculty as part of this grant at UAMS we're working with pharmacy, nursing, and the physician assistant schools at UCA we're working with the psychology communications, disorders and the nursing school and at the Arkansas College of Health Education in Fort Smith. We're working with OTPT and DO students and we have um we're paying up to 22 stoppings per year for them to work in these tours. Sights and they have to do 8-week longitudinal rotations and part of that we will be training them on those 4 Ms with mentation and caring for Alzheimer's patients as a, as a big part of that. We're also training health profession students and working with um academic institutions such as UCA. You have Kerrie here who's, um, the STAT programs hers, so if you want to know more about that, you can talk to her. We're also requiring modules for all of these students that we will be stipending all 22 of those will be probably, we haven't got them developed yet, but probably 15 or 20, um, different modules and several of those will be focused around that implementation and dementia and Alzheimer. And, and how to care for those. And I think within Carri's program, what I've been really impressed with is when these students are exposed to work really working with dementia patients and Playing around playing with them, doing games, doing activities, they become not so afraid of them, and that's part of the goal. So that's we're real excited to be working with Carrie's program there. We're also working with, um, statewide colleges getting their nursing curriculums where they infuse those four Ms of the age-friendly care. So we've already worked with UCA ASU UAMS, HSU, National Park, and our first one this year will be for UA in Fort Smith. And we'll have at least one nursing school per year that we help infuse those forums of age-friendly care. We're also working with the UAMS Mobile Health Unit staff on age and dementia-friendly concepts, including looking at more older adult screens such as dementia, depression, falls, high risk medications out in the very rural areas wherever that mobile health unit goes, we're going to be training the staff to be able to recognize and to do more for older adults. A lot of the mobile health units now focus a lot on Maternity care, OB care, so we're going to try to help them focus a little bit more on older adults and um dementia. And then of course, just some examples of dementia programs that we have planned for the next few years, we're going to be of course training healthcare professionals, at least 2 of our continuing education events per year. We do usually around 10 webinars per year for healthcare professionals focused on older adult, um, you know, issues and training diseases, etc. and at least 2 of those will be focused on dementia and quite frankly, it's usually we end up with about 44 or 5 that are focused um somewhat on mental health and dementia of older. And we're also helping having dementia experiences being taught in the community by health professionals, students, and faculty, such as over in Fort Smith with that. With that new college. We're also developing specialty tracks or career ladders and apprenticeships for community health workers and for certified nursing assistants that are geriatric-focused and include dimension modules and training, so we're trying to get those health, those workers that are actually out in the communities and working with the older adults in nursing homes to where they are better prepared to care for those with dementia. We offer certified dementia program which is an 8 hour hours of training to nursing home and other healthcare workers. And it's in, uh, it's also with our partner CNA program. Dementia focussed caregiver workshops. If you're caring for someone with dementia, then we offer workshops where they can come in and learn how to easier and better care for their loved one. And then we work with businesses and the consumer facing organizations such as banks, um, we worked with the bus system here in Little Rock so they know better how to recognize and how to treat people, um, that may have dementia and recognize what's going on. Then of course, we work with first responders. We've been doing this. Um, a long time in person and virtual training, and we go to the Arkansas State Police cadets every year in person. We've been doing that for probably 5 or 6 years. So every cadet that comes out of the Arkansas State Police has had at least 2 to 3 hours' worth of training and you know, those are, those are young guys and girls usually, so they may not have, have encountered that before and they really appreciate that. Uh, working with the Triple A's and would be and with the mobile health unit we're going to be broadcasting dementia prevention activities, chronic disease self-management activities, along with other social programs that help with loneliness and things like that, so we're working with those we're giving them some equipment out in some of those really rural areas where the AAA's may not even have internet or computers, so we're working with those to provide some basic equipment. And then we have programs um around central Arkansas, the ageless grace, Tai Chi, line dancing, social programs that reduce loneliness and evidence-based programs to help them prevent falls and to manage chronic diseases like diabetes. And we have a, a newsletter we send out, um, quarterly, one that goes to older adults and one that goes to healthcare professionals. We also have toolboxes, videos and things on our website and a podcast that, um, that we have, we have virtual caregiver support groups we have in-person care, um, caregiver support groups and all sorts of things and then we have where you can connect with, connect with us as well. So we're really excited about this next iteration of the. It's a little bit different. We'll be working with a lot of students. They're focusing more on healthcare professionals and making sure that the healthcare professionals really know the latest on how to care for older adults and how to provide age-friendly care and focus on what matters. And you're willing to take some questions. Sure, nothing too hard, I don't think, um, one of our caregivers here, Kathy Griffin, has some questions, I think. OK. I was just curious if. I was just curious if Southern Arkansas University was going to be added to the colleges. If we, if we have a contact down there, we would love to add them where they can we can help them with the curriculum and the nursing program and, and others as well. So yes, if you'll send me a contact that would be and I kind of assume, and Stephanie's here with me, Doctor Trotter is going to help lead that effort with the nursing schools and so we will need some contacts. I felt like we had to have one when we submitted the grant, and those of you grants kind of know you have to have a jumping off place and we had a contact there in Fort Smith. So if you have a contact there, because not everybody wants to more work, and this is more work. So yeah, if you've got a contact, that's awesome. While she gets into her seat. I'm gonna, I'm gonna ask a question, so if I have a loved one and I want to bring them to a clinic that has this certification. How do I find out if the clinic I'm going to bring my loved one too has this age-friendly health system certification. There are, there aren't many. There's um, as I said, there's 7, I think there's 7 our care clinics around the state. We give them a banner when they get their certification and whether they, you know. These are independent clinics, but you could always call them. And or you can call us, we know, you know, you can come and say is it on a website somewhere or we have it on the website. If we don't, that's a great thing to put up. I remember that and we'll, we'll put it up just to be able to say, OK, this one's in the area and I really need this extra help, OK? I think Senator Chesterfield had some questions. OK, thank you. My colleague raised the issue of Southern Arkansas University and coming from Hope, Arkansas, we have the University of Arkansas Texas Hope, and I'm looking at UAMS, uh, UAPBCR. is the problem just that they have not known about it or they're just not interested in it. They may not know about it. Um, we work with, um, nursing schools, mostly, um, for the, through curriculum changes so they don't have a nursing program. It's not going to fit in with what you do if they don't have a health professions, college, and you know, they may have like we work with that Fort Smith school I told you about that ACHE they have an OD program and a PT and OT, but you know you think I'm supposed to know what that issteopath. It's, it's the. the other primary care, um, degree for, um, medicine. OK, got you. Any other questions? No. Oh, Dr. Way, yes, I think Senator Chesterfield has an excellent idea, and this is just what we want to hear, which is that there are more places that need us to help to spread the word. Of course, the more the better, so I think this is something that Dr. McAtee and I will brainstorm about how we can try to implement it and make it so that Everybody that would like to know about it, we would like them to know about it as well. And of course we can't do it all overnight at one time, but I think if we start small and go slow or not so slow, and once the word gets out, I think we'll get more requests and we'll want to train our colleagues so that they can represent us as well. I mean this is great. Thank you, Senator Chester and and something that might help South Arkansas, Dr. Cerletti, um, who is the department chair of family practice and of course they run the, you know, they, they have the, they're in charge of the physicians in the Hicks, I guess I should say, and he is extremely interested in this certification. So that does hit more areas and so we, and we talked with him early in the year when we were first writing the grant and they, not all of the clinics meet the criteria for tour sites and we had her her some made us focus on those really rural and tribal areas, but That doesn't mean we can't do more and Dr. Colletti really wanted to do that for his clinic, so we will be training those at some point in the near future. That does the Department of Health have a way to like get that information out to doctors to know that maybe their clinic could benefit from the certification or? US me anybody Tony Bailey, since I, I don't, I don't know if that is a question. Madam Chair, I'm really not sure what I could find out. OK, just a way, I mean, do doctors get this information to say that this is available um because they may not know and then they read it and go, oh, well, that's neat. I'd like our staff to have this certification. There's a real need for it. How, how do they know? And I think you bring up a good point, you know, I told you we had those webinars every, every month. We pro we could do, we have a vast network of physicians that we send out, not just Physicians, but clinics and health care professionals that we send these newsletters and announcements about our webinars, so we might do a webinar on this and how you could go about contacting us. That that's probably a, that'll get to some. It's hard to get to everybody, but can we ask you to maybe look into that, Mr. Bailey with the Department of Health to see if there's some way to set up a webinar for doctors who might clinics might be interested in. We'll do the webinar if you'll give me a list if you want a coordinated coordinated project here is I guess what I'm trying to say. OK, uh, Doctor Azar. I was just gonna say that we have to do our communication through one of the boards, hold on one second. If you could sit at a seat and then use the microphone and introduce yourself, say who you are, and then I'm Christy Sellers, I'm with the Arkansas Department of Health, and I was going to say usually our communication from the health department to, um, like physicians' offices would be through like the through the medical society or a board. It's not directly from us. And we have to get permission to actually ever use their list of names. Can we reach out to the medical society to get that information out? I, I mean, I'm sure we can understand we don't house it. OK, and we have to get permission to use it. So it will be up to them kind of is my statement. So I don't want just to fall to us. Well, maybe I'll contact if we can get out, we will do the education if we can get the word out somewhere. I just find there's so many good things, so many good programs. People just don't know about it because sometimes we just say well we think we've told a few people, but we haven't told others who will benefit, and it's just frustrating over. and over again that you have these great things but other people don't know about it, so that's all I'm trying to do. Can we hear it and see what what's my role in all this and who are the people I talk to that I can share this information with. That's all, absolutely. I think Dr. Azar had a question. Thank you so much for the great presentation. Um, maybe you can also go on TV and tell people about. But, uh, I had a, I had a question about, you know, you're teaching a lot of people about um dementia friendly America business trainings. Do you also intend to do at the airport, make it a dementia friendly airport, we contacted them last time and I'm trying to think it might have been right before COVID, but we have contacted them before, we can certainly do so again. Mhm. Yes, ma'am. Stephanie Cook. I want to thank you for your presentation today too, but I also want to just thank you in general. I know you all are partnering with Alzheimer's Arkansas, and we're providing the Alzheimer's experience and the dementia friend training, uh, and so that's something I know I presented to this uh group before, but I just wanted to say thank you for the opportunity to work with you all, uh, through your grant program to offer those, and I will actually be in Helena at UAMS East in 2 weeks. And the clinic there is coming through the dementia friend training that I'm offering in a lunch and learn so just to let you know that we're we're trying to get over into eastern Arkansas and help things out and that's great. We try to work with partners who will do that because we cannot be everywhere. We have a pretty small staff, so we really appreciate your help and the partnerships. I mean, we partner with the VA with y'all with lots of people trying to get it out. Doctor Way, did you have another comment? Yes, I also wanted to thank Doctor McAtee, but I also think that the more we can ask, the more people want to have us come share the information the better, so we will never turn down any invitation and we're not going to even ask for a drink of water. You just invite us and we will come. Thank you Open that door. Thank you. OK, thank you for your presentation. No more questions, right? You didn't have anything? OK, um, we will move on to our next agenda item. This is an update from the Department of Human Services concerning stabilization units, we had some questions uh representative Tosh was here last time and just some some things came up and uh they uh DHS contacted me and they said, can we just do a little presentation, so I don't know, um, Laurie, are you? Going to be doing it or are you going to be assisted by others? Come to the table, but I think that we have here. OK, we'll let, we'll let her do the introduction down at the the in there and Inform us all of what we need to know about our stabilization units and how they're useful or being used. are not used. To help this clientele. Good afternoon, my name is Paula Stone. I work for the Arkansas Department of Human Services. I'm the director of the Office of Substance Abuse and Mental Health. So, um, our crisis stabilization units were built, um, for, um, Medicaid reimbursement and then we also have, um, an agreement with each of them, and they are for people with mental health and substance use conditions and so mental health conditions include things like uh diagnosis of schizophrenia, depression, um, anxiety, so most of the individuals that we get into CSUs or admitted to. issues are there for a very short time. Um, they use that to, um, generally, um, confirmed diagnosis because most of them have already been diagnosed in the community, so it's rare that somebody comes into one of our crisis stabilization units, um, that wasn't already receiving some mental health services or substance use disorder services, they stay there generally for about um 48 hours is the general length of stay and the work is to get them stabilized. Get them assessed and get them back into the community. Sometimes if they have a need where they need to be hospitalized because of self harm to self for others, then they don't come to the CSU. They go directly to a hospital and go on to the psychiatric unit. So, um, we do not provide jerry sitech services at CSU's, uh, and so anybody that came to the CSU, um, generally they're assessed. They would not. be admitted if their primary diagnosis is a neurological diagnosis disorder like Alzheimer's or some sort of dementia, they might be admitted and stabilized if they had a secondary um. Behavioral health and mental health diagnosis, or if they did not know that they were suffering from a neurological condition, such as the ones we're talking about today. Are there any questions? I guess I have one. How? If this patient person comes to the unit. How do you assess that? I mean, how do, how do you know the difference right away dementia, mental health. What, what is done at that time to evaluate that, so there are mental health professionals there and they are the ones that do the assessment. So there's an assessment that goes on generally via phone, um, prior to them coming to the unit, um. And then once they get to the unit, what they're doing is looking at the symptomology, uh, so whoever has brought them into the unit is going to give a list of symptoms and then they're going to look for a history, most likely, or if they're actively under the influence of some sort of substance, and so many, many of the people that are coming to our CSUs are actively involved in using a substance of some sort, so um they're going to do that kind of workup, um, but generally they're going to look at, um, history. and then the person that is helping them, um, generally get there because it's generally not a self, uh, admission, uh, would be giving that kind of history, so the family member, whoever would be giving a history of mental health diagnoses if they've been on any medications in the past, if they're off medications, um. And also to note it is not locked. So, uh, everybody who goes there is voluntary and could leave at any point in time that they don't want to be there any longer. OK, let's just say the person arrived there, they have Alzheimer's disease. They were having paranoia and, and just kind of falling apart. What and, and you're saying your mental health professional says this is not a substance abuse disorder. This is not mental health. This is probably Alzheimer's, dementia, what happens to that person at that time. They would have them transported or transferred, have the person transfer them to a hospital that would have them seek hospitalization. OK. Is family notified? So generally, I mean, again, people don't show up there on their own, very few people show up on their own, um, because they're, you know, located in places where, um, You know, ambulances aren't taking people to the CSU, so it's generally a law enforcement or, uh, a family member or friend, uh, so they would have them transport. Most likely they would get a call and if they found out any of that information, they wouldn't come to the CSU, but if they happen to come there and, and be assessed. And they found that the symptoms were related to a neurological condition that would send them to the hospital. OK. I think the discussion last time was, you know, do we need to have the personnel there just trained more on Alzheimer's disease and dementia, but your take on that is that. That is not needed specifically on that. No, I think that the, the staff that are there would be able to rule out those causes and so part of what what mental health professionals are able to do or the nurses or the physicians that are there are able to look at those symptoms and then that history and make that decision because it is not a mental health issue. It is a health. Issue, correct? Correct. OK. Um, Kerrie Jordan, yeah, I just have a question. You mentioned the assessment process. Who usually does the assessment screening process? Is it a physician or is it a nurse or somebody else is generally a nurse, uh, the physician is on call and many times it's a master's level mental health clinician as well that can do that and they're making the decision as to whether the person has dementia or not. I think what they're doing is they're making a decision whether they need to be admitted and treated. a CSU and so the treatment that's provided at a CSU is either substance use disorder treatment or mental health treatment. And in case management kinds of things and so they're making that decision to say, is this will this person respond to the treatment that we can provide at the at the CSU which is mental health treatment, usually medications, um. And some like kind of crisis stabilization de-escalation kinds of things. Yeah, my only concern would be if, if, you know, let's say the police picked up a person with dementia and went there and they were, you didn't have any information about them. They were hallucinating or psychotic, but they had dementia and I'm just thinking about the danger that could occur if a person in that state that really had dementia and and was admitted might be prescribed the wrong medications or things of that nature, that would be, that would be my concern just listening to the, if they admitted them, and again Volunteering they could leave at any point. So I think, you know, when, when law enforcement brings someone to a CSU, that's a decision that's made. So if they're, you know, generally actively psychotic and a danger to self or others at that point they do not stay at the CSU. They are immediately transported to a hospital because the CSU, since it isn't locked. So generally they would not get admitted unless they were, um, you know, they were able to talk through, uh, some of that, um, with, with the. CSU staff, um, so they would most likely not be admitted. They would be transported immediately. Doctorsar. Do you have any capacity to do labs like draw blood and test urine and all of that, so you can test if the person, for example, has an infection going on that is making them appear psychotic. Um, yes, they could, and again, most likely if there's not much of a history there, then they are going to have them transport to the hospital. If there's anything that is an indicator that there's something else going on besides the history of, you know, because most people don't, um, Don't have a psychotic episode, um, it's, it's a pretty standard kind of first episode of psychosis is usually between the ages of 16 or 17 and 26. So that's, that's, that's my, my concern is that most older people who appear like that actually have some underlying dementia which may be mild, but they may appear psychotic because they delirious because of an ongoing infection which may be a respiratory infection, a urinary tract infection. So that's my concern, and if you let them walk out of there because this is voluntary. They they're either going to fall down and have an accident or you know, they're going to do badly, you know, and I think most likely the family member who brought them there again, you know, so it would be unlikely that somebody would be able to drive themselves to a CSU or even now we're a CSU was, uh, so I think really the only people that are really accessing CSU or law enforcement, and then Some family members and generally family members are not going to call a CSU, uh, we, we have 3 of them right now. Generally, a family member is not going to call CSU as their first line of, of, of issue, you know, so if, if it so happened that a family member got someone there, uh, and they reported no history at all of any sort of mental health condition, most likely that CSU staff is going to have them sent to a hospital because they're going to know that that's not a person they can treat there in that kind of facility. Because, because geriatric patients have multiple, multiple comorbidities, and sometimes the history is not. You know, even family members don't know the entire history and medications can cause, you know, Drug interactions and worsen the delirium. So I think geriatric patients particularly need to be sent to the hospital. OK Thank you for clearing that up, and I just kind of want to reiterate that it is not a mental health issue. Alzheimer's disease and dementia, and that's why you sent them on to the hospital because you feel that this is a medical situation that needs to be that's taking care of it might be an infection, um, UTI that has um done some uh. Agitation, that's a good word for it, um, Jody Eret, I'm putting you on the spot. Hospital Association, so that person then is transferred to a hospital, any comments on what happens after that? Well, I wish I knew, right? This is where Dr. Wade could jump in as a physician who's, uh, screening patients in the emergency departments, but many times and I think Director stone's exactly correct. Many times if there are uh psychiatric beds available, um, we can get that patient in that. If that's what's needed at that time. I think you all know we are lacking in mental health resources within our state. So, um, we would, we would really like to be able to have all of the tools needed to take care of those patients when we have them. Um, we do have many hospitals that have a Jerry site but not nearly enough, wouldn't you agree, Doctor White? Thank you so much, Jodie, and yes, what I would say is that the problem here is that the manifestations of disorientation. delirium, agitation. Has very commonly and it happens much more commonly than we have capacity to fully treat at any one time, even so I think and it's going to become even more prevalent, so I think the more we can share the characteristics of cognitive impairment and the fact that it can manifest this way and how to treat it. With everybody the better because none of us are going to be able to treat as many as we would. OK. Any other questions, comments? No? OK. Thank you so much, Paula Stone for. Um, updating us on that, and we will move forward to um agenda item E, Advisory Council 2024 report and David Cook, do you want to stay there or you want to go down to the end? OK. We'll give you a pass down to the end. He has been working hard on this, and I want to say that um there's a lot of information in here and we do have a report that we have to turn over October 1st, and he's got a lot of information here. I don't want to take a vote on this today, but I do want to take a vote on it in our September meeting, um, if there, if there's anything that you feel like you want to change between now And then say it now during this meeting and we'll see if we can address that and fix some of that, um. Or if you need to go home and look at it and comprehend it more and all that contact us, um, so that we can then have those discussions and get something more finalized because we're coming down to the end, so um this is a rough draft. David Cook has put a lot of time into this, and we really appreciate those efforts. It's very hard to, uh, work on something like this. So I'll let you take it away. Go ahead. Um, David Cook, the director of government affairs for the Alzheimer's Association, um, thank you committee members. Thank you, chair. what you have before you is just the 2024 interim report. I did not prepare a slide deck for this, um, because the information included in this report is consistent with that which I delivered two months ago or a month ago, um, but I will go over briefly just how we, how I outlined this report, of course, the first section is devoted to just giving a brief um executive summary, um, and then I go into some of the, um, the background of the Alzheimer's and Dementia Advisory Council, um, the statutory statutory authority, and then I um listed out the report, um, the statute. obligations of the council for a report and uh what is due. Um, this also is missing any other formal reports from the Department of Human Services or the Department of Health. I did not receive communications from them, um, or any state agency reports, um, and then given some disease prevalence, but then I outlined the sections, um, uh, based on our priority areas given in the state plan, um, if there was a legislative specific advancement I listed that on the front page gave a brief expla Nation of public health and the role of public health and the public awareness section and subsequent sections if there was not a legislative action taken, I just talked about some of the key initiatives that happened outside of legislation that still allowed us to move forward on our recommendations David I'm going to stop you for a second. So are you telling me that we need DHS and the health department or other agencies to actually a report to be added to this? Is that what you just said? I'm suggesting that that's a part of the statute, and unless they see some other information they want to include, um, what we have here is satisfactory. I just, I didn't want to give the impression that I had received any formal reports from those agencies, so I just wanted to make that clear so that if DHS or health department wanted to add their own report. We, we need that. So, OK, go ahead. And, and so each each section is outlined that way and then towards the end I did include the recommendations that um and and a brief analysis and the recommendations that have surfaced over the last few meetings, I did not include the legislative platform of the Alzheimer's Association because that is our platform and I did not want to put the Council in a position to adopt that, but I'm happy to include that. I would appreciate your endorsements on our policy asks, but these are the consistent again I think we've talked quite a bit about strengthening our public health response and the role of public health, um, our, our primary, um. You know, goal and recommendation is to strengthen our state's infrastructure on the public health side to better respond to Alzheimer's and dementia, that is something that continues to come up in the course of these meetings and discussions over the last couple of years, um, we looked at access and quality of care, um, you know, establishing Medicaid coverage is specific to a recommendation in the state plan for early detection, diagnosis and care planning services, um, that's a tie to um uh. What's the word I'm looking for? A billing code that's already released by Medicare, but the state has not picked it up as a Medicaid benefit at this point, um, and then we looked at dementia training standards specific, um, in this next round of course looking at strengthening those dementia training standards for um, From the association's perspective, APRNs and physician assistants is kind of what we're looking at, um, but we did, um, I did include a brief recommendation on that and then making permanent the um dementia respite grant program, uh, to better serve the needs of caregivers across the state. Uh, so that's the basic outline. There is a lot of content. I didn't want to go through it word for word, but um that's kind of how I laid out the report so far. Um, I do realize in your printed versions there is some formatting that needs to be done because there's some words that are cut off and I will fix that. Um, but I'm happy to take any specific questions you have. I know you haven't had much time to dig into the content, but that's um the way that I've outlined the reports and happy to take any questions or any suggestions that you might have. Just one second while this one is on my mind because if I don't say it well it's on my mind, then I'm gonna forget. I was looking at your membership and I didn't catch this earlier. We did have Phyllis Bell on this committee from Assisted Living and she is no longer representing that organization. It's Carla Cobert, C O V E R T, we need to add her to that, um, COV as in Victor, E R T. And Carla with a C, I believe. We'll, we'll double check all that spelling, but it was on my mind, I just noticed that, so, um, Jodi Erit Hospital Association. So, um, yes, Jody and executive vice president of the Arkansas Hospital Association. David, I know, um, may have been not the last meeting, but the meeting before we were talking about therapeutics and how neither insurance companies nor Medicaid are picking up the ability to at least explore paying for those therapeutics that may be coming before us. I don't know if you wanted a specific mention that of course we want to encourage that, obviously not required at this point, but to encourage Further development and a process by which those entities might be able to pay for the therapeutics in addition to, you know, early detection and diagnosis, but also when something becomes available from the pharmaceutical industry that there needs to be sort of a streamlined way to get that medication to the people who need it quickly. So I would make that in the form of a recommendation to add to, to this report unless you disagree. Um, do you, do you have suggested wording that you might want to I mean, not right this second, but maybe get to um. David to include on that. I'm happy to include that would love to do that when you speak of therapeutics, you're talking about the FDA approved treatments for Alzheimer's, OK. And I think the recommendation was not necessarily to require but strong urging to look at every possibility and I don't know though, there's probably some way we can come up with some really good words to strongly encourage, and I think to have a transparent process to request it, right? because Dr. Way made a, a really profound statement when we were having these discussions. She's like, these folks don't have an opportunity to wait. They need the ability to try something even before maybe it's reached every last, uh, checkbox on what the FDA would approve or what a commercial payer might pay for, right? So I think we need a clear transpar process as to if we follow X steps then insurance companies need to be more, um, open to paying even a portion of some of those drugs are allowing their patients, their clients who are paying premiums to them every month to have access to the drugs that are being created to help them with their disease. Any other comments about this, something you want to add, something you want to change. Remove. Yes, Doctor Way. Thank you so much, Representative Maberry. I think it's important for us also to keep everybody updated even though to date we have a couple of the major insurance companies not yet acknowledging that they're going to pay. Usually they will after enough people go to them and say, Hey, how come you're not paying for this tomorrow, Mrs. Smith will call him. The next day Mr. Jones will call him after a while they're going to feel enough pressure they say, OK. We will Don't forget the Medicare, um, premiums went up. At the beginning of the year and their justification for having such a huge increase was that they anticipated having to pay. Or like can have. Uh There we are. Any other comments? I know there's a lot of information there to read, and you might want to take it back to your office and read it and really think through words and and all that we are still open to Making modifications, um, but If you do want any changes, we need to know those within the next week or two, and I would ask if any of the agencies want to submit something DHS or the health department that we have it in our hand by September 13th, I think is what uh looking on a calendar, um, to add that with this report, um, if that would be possible if that gives you enough time, um, but if you have questions, concerns, contact. One of us, um, and we'll try to address that in the next one and make sure we have everything good. David, do you have any other comments? I do. Representative Mayberry, can we define a process for the agencies to submit that so that I can update this report. I don't know how you want them to submitted. I'd love for them to send them to me or to Brandon copy me or why don't they send it to Brandon. Um, and then we'll, we'll get you a copy and can include that. Thank you. How about that? Um, that's that way it's in the hands of ultimately the gentleman who's going to be making sure we turn it in on time and get it to the people who were, uh, legally supposed to get it to, yes, Jane particular format. Did we not do this last time? I'm just sitting here thinking maybe that was something that we overlooked last time that was was needed. I, I don't have a particular format um if, if you want me to drop it into as an inclusion of this report, I'd prefer it in like words so I can copy and paste it over or if you want it separate, I can include it as a PDF into this report as well. So I guess, Jay, the answer is no. I don't have a particular format. Just whatever you, you prefer, we can figure it out. It's just an implementation report. I don't expect something with like bells and whistles and super long and and all that, but if you could kind of go through our report from last time and just kind of outline what's been done. What you're still working on we I do have to ask, there was a position that was supposed to be filled, and I still think to my knowledge that hasn't been filled. Is that correct, Jay, ma'am, that is correct. If you would give us an update on that, that would be something that we want to include in the report, you know, we, we passed this back in 2020. 3, and you know, we still don't have someone hired, so what, what, what's the hold up and when can we expect someone to be in that position? We, this, I believe we have completed our 3rd or if not 4th, I believe it's our 3rd round of advertisements for this position. Uh, we've, it's been very difficult to identify candidates who are qualified to do what is specified in the act, in the dementia coordinator for I, I'll, I'll be very candid for what the state offers in the way of benefits. and compensation, worked with David, we reached out to the association. We've reached out to stakeholders to ask for references for referrals for this job to help us advertise to really spread the word. Now we had a, this last round, we did have a couple of candidates that we spoke with that were that do have some experiences working with coalitions and developing networks, no experience working with Alzheimer's and dementia populations, and that has really been kind of the deal breaker on Making a selection for this, however, it may be that while we had hoped to, to, to identify a candidate that we could hit the ground running with, so to speak. We wouldn't have to train. We wouldn't have to spend, um, a great deal of time really getting them up to speed on what the disease is and uh what uh treatment modalities are, are available and what this university, this whole population of caregivers and stakeholders as a. I don't know that we'll be able to do that now. someone with a skill set that can be good at this position and really be successful, I think that that's, that is doable, but there is definitely going to be some time to really help somebody understand how, you know, what this. What they're, you really, I guess to understand what they're going to be doing with this in this position and to do it and I think that clearly needs to be outlined, you know, what you just said. This is a report that we give to the governor. We give to, you know, the leaders both in the House and the Senate and we passed a law saying we need to have this position. Obviously there's not been enough money. I mean that's what you're telling me is that it's not attracting a candidate that has all of that for the money that what, what does it pay? What, what does the job pay? The job is a it's a GS 8. So entry is 45. OK, so 45 to up to Well, I it's midpoint, the 10%, I believe we can go up to 10%. So, uh, ballpark, somebody that comes in might be extra well qualified, maybe somewhere between 50 and 55 if they were extra well qualified and the candidates that have expressed interest, what is that? I'm putting you in a spot. I'm sorry, but just give me an idea what what is it that would interest them in the position. I don't conversations, uh, and it would be difficult for me so I think everybody is different. The skill sets are different, um, depending on their education levels and how long they've been working, whether they, you know, they come from a provider network or if they have certifications or, uh, you know, it's, it really kind of varies by candidate, um, We have identified some individuals that really I think are energetic and want to do this or interested in this type of role, there's just going to be a learning curve is what I would say. Now we have had some discussions and I apologize. I Doctor White, Doctor, are you guys, you had some questions. We um, we've had some discussions at DHS maybe around some alternatives to, uh, being able to find ways to fill this role and I think those are ongoing conversations. To do it with somebody that really is can understand it and be successful with it out the gate because that's we we we know how important it is, uh, we understand, we, we, we see the population. struggling and growing on a daily basis and we want, we want to get this filled and we want this to be successful, but these are the discussions we need to be having now because the budget meetings will begin taking place and we'll be talking about what we're going to do in 2025, so, um, you know, I, I think this is a good time to be having that discussion. Dr. Azar, you had a question or comment, if one of the issues of the problem is that they're not trained in this field if they just do an intern. kind of thing with 2 months, just 2 months with us in the memory clinic, they will know it very well because they will make the patients, they will meet the caregivers. They will be able to identify. They will get, you know, they will get. On hand training, on hand training about what um different varieties of dementia looks like and what the needs are of the people, so just 2 months if you put them in a memory care clinic. Thank you for the offering, we'll take you up that is a fabulous idea that just the first two months that they're, you know, just assigned to to one location or maybe even hopping around to a few different, um, you know. some being in the clinic for a while, maybe even in a in a home for a little while, um, just kind of a rotation. I, I think you have a full group of people here who would love to have someone in their office for a few days to just kind of see the issues that they deal with the healthcare association, Rachel, you'd love to have someone there just to get a big picture of what you deal with every day, right? that your facilities deal with every day, right? Yeah, well. Um, but, but maybe that's it. Maybe you get someone who's that real because I think the key in this position is someone who's a real good organizer and can get everybody to collaborate and so if you find that person who has, you know, has a big heart. I think that's got to be the first thing someone who just cares about people, but that is a good collaborator and can make everybody work together and then fill in, oh now I understand a little bit more about Alzheimer's and dementia and, and all that. All these people want to help you. We want, we want success for you. So David, yes, I, I share with the agency that the association hosts an annual dementia coordinator conference because this position has grown in popularity across the country and it gives them the opportunity to network with other coordinators in other states, and we, the association provides that free of charge for the coordinator, so it will be no expense to the agency we pick up the cost for that, but it gives them opportunity to network and hear from other uh what strategies have been really effective in other states as well, and that content Driven by the coordinators, not by the association, so just as that. Um, typically this year it's in November, so it's usually a fall conference so we we're hoping to get someone on board so that we can invite them to this conference in November. OK, there you go. Got to get someone hired by November so we can send them there. OK? Yes, Doctor Wang. Uh, I would also like to invite them to our upcoming geriatrics update, three-day conference which focuses heavily on cognitive impairment and all the ramifications. This is from Sept 26th through the 28th. This is Thursday, Friday, Saturday, of course, everybody here is also invited to attend. I will send a notification to Brandon and Brandon can share it with everybody, um, anybody who's interested, please come. It's free, but anybody who's interested in being your coordinator, Jay, we would like for them to come too, because it's a great introduction and you'll get a chance to know and they'll get a chance to know. If this is something they're interested in. Thank you. Cocaine. Great discussion. We're solving so many problems here we're going to get someone hired like next week, right, Jay? OK, um. Did, did you have a, your question was answered, OK, I remember your name was on the list. Any other comments specifically on this? OK. Any other comments in general before we take a motion to adjourn? I think that was it, right, Madam Chair. 00, yes, I'm sorry, I failed to introduce myself from the beginning. I'm Luke Mattingly from the Home Base Service Association sitting in for Tatum OMB today,