Alzheimer's Disease and Dementia Advisory Council

Senator clinton zone okay welcome everyone um we are going to get down to business did you have any comments he would have opened with anything okay hey thanks for being here first thing we need to do is approve our minutes is there a motion came as there are second thank you all in favor I anyone oppose very good okay approved first thing we're going to get right down to business and I believe david cook has a presentation for us a reminder that every year we are supposed to give a report to the speaker of the house to the governor and to our senate protem which kind of discusses and shares what we've been talking about what our goals are uhm in so day but cook from the alternatives association the arkansas chapter has put together some bullet points for us to discuss and again this is a working group so we appreciate input feedback uhm if you see some wording that needs to be changed on something feel free to share with those words should be words are very important and can really change the dynamic mix of that goal and uhm if you have anything you want to add we we want to hear from you you are committing members this is just a a rough draft and i'll david take it away thank you representative maybe they would cook with the australia's association what I prepared for you all today is sorry slow awkward here whatever prepared for today it's just a status of where we are in terms of recommendations that have been implemented from the state plan and i've also finished this presentation with the few recommendations but I do want to be clear that these recommendations came from just our perception at the association and where we feel like their opportunities to continue to. Work on implementing the state plan just as a reminder of shared these before but we are in terms of prevalence seeing an increase here in the state and we know there are over sixty thousand our candidates over the age of sixty five currently living with all cymers and it's important to note that those numbers do not and clear the include those who may be living with all summers under the age of sixty five or those who may be living with another form of dimension just in passing conversations from some of our partners at all summers are console here at the association and the u m s centers on aging each of us are seeing an increase in terms of content our excuse me contacts from individuals and over the last year we've seen a drastic increase in calls into the help wine coming from the state of arkansas so the need is great but I think what is also encouraging to us is that people are feeling prepared and ready to reach out for help at support so we continue to see those numbers increase and again our forecasts is that those numbers will of course continue to increase over the next few years we've also recognized before that individuals who are received a diagnose of all timers the care give me during immediately fall to family and friends and so here in our console that's over a hundred and fifty five thousand care givers who in uh twenty twenty provided two hundred and seventy million hours of unpaid care to buy you a four point four eight billion dollars some in cost savings to the state. So what I have done is really just captured all of the recommendations that we have listed on the state plan and I walk through those we think about the status of implementation today just as a reminder the state plan is broken up into four different sections on the sections were informed by the healthy brain initiative road map which is tool that public health departments and agencies can use uhm to again educate the public and move the needle in terms of all simers and demential awareness education and preparing to work force so the first section deals with public awareness in education and we mean by that is making sure there is awareness around the importance of risk reduction i'm calling to decline in uhm now that we are in an error treatments it is paramount that we continue to educate the public about the importance of our detection and diagnosis because the treatments that are have been approved by the fta only or beneficial for individuals in the very early stages of the disease. Uhm we also look at access and quality of care home tonight i'm making sure that there was another access point some for support services but also the services that people were receiving were also quality as well so we put some quality measures into the state plan and as I mentioned we did recognize uhm the role that family care givers play and so one of the things that was always proud of from the council's work is pulling out a section on its own dedicated to supporting our failed mechanic givers and then finally we looked at dimension training and and work force development men in that section we looked at dimension training standards across care settings and across health care professionals any questions on the structure of the state plan here under public awareness here some of the recommendations that have been implemented to date of course one of the recommendations authorizing the alarmers dimensioned by three council we did that to statute twenty twenty one and twenty twenty three we are through statute also established the position of the mental coordinator at the department of human services we also asked that burfaus data and burper surveys included information on congress of decline in caregiver modules in the whole department is putting those into the burfas and rotating years with four years I think in between we are also wanted to increase collaboration with the consultant already health commission and that it's work that is continuing to to that is ongoing with the health commission one of the things that the association has done as provided some resources in some materials are that that can be included on the brain bus but there are still opportunities for us to increase our collaboration and only with health commission but across the health department as well we also uh identified increasing collaboration with the uams uh centers on aging. Uhm this work is ongoing I will say that we are working with the centers on aging to prepare them to have the match a resource centers in each one of their centers so we are working on that structure with uh the service on aging and we have partner the association as partnered with them on several other things inside the whole system the continuing to give them the support in the resources that you need as well any questions on those recommendations yes. I thought I had to be recognized sorry yes you are recognized representative they was looking at this as the are the d s county operations of the men involved in this outreach program not not yet we have not engaged with the county operation offices but DHS or the county health units from the health department either we have had conversations about that. Inducted where did you have some questions yes I wonder if. I my um ask about the fact that we are seeing increasingly younger folks. Coming in with to mention some of course our alternatives some of which are not in a dude probably no coverage has resulted in an increasing number of patients many of whom are younger than sixty five who end up with dimension it's been documented now that these patients have increased emily deposition in their ways and it's somewhat pathologically quite similar so what i'm trying to shares I wonder if it's possible for us to consider lowering the age from sixty five to some lower number just because we're seeing more and more patients who are younger than sixty five with very similar presentations and very similar needs for and so I just die it might not hurt for us to include. Can I have specifically including them in what way for services. For for for the definition of the first the page you want of david yield factor. Do we have those numbers doctor way that is those of some some data that the association would be eager to collect but as you know individuals younger age there is to receive a diagnosis and be able to receive a diagnosis so the younger on set numbers are a little bit more difficult for us to gather this logic model was built out of your basin some some numbers that were collected during the sensors and some other methodology that i'm not prepared to speak but we did a partner with the university of chicago for some of this modeling but the younger the the short answer is the younger populations are just harder for us to gather. Never the last is if some way for us to say then if you can say at least first I just don't want us to work away thinking that there's only sixty thousand because we know there are a lot more and even of the tonight accurate we can have an estimate and I just don't I just think it's better for us to be more inclusive whether the night away I certainly agree with that uhm II just was pointing out that II don't have the data or access to the data that we would need but I am I think you know to your point we that's one of the stigmas we have to overcome and II think that's what the role the public awareness in education is that there are individuals under the age of sixty five who actually are diagnosed also and we I think part of part of what we're trying to do through public awareness initiatives is to dispel the myth that it's just a disease for aging adults cause that it's not the case can can I possibly uhm as john fight biners filling in for jay hill today uhm II don't know if you have anything that you can add to that conversation you're your limits explain who you are division of aging an adult behavioral health services with DHS do we have any information state wide that would look at numbers outside of those over sixty five I have not seen that number certainly that something I can. I noticed that in davis president asian certainly as it is of course I mean this does in our sixty five and older I mean to doctor white point we might you could separately if we could find that number in a year I don't know what it in what form if it exist or if it exists that all but certainly I would think then we could update the information you know to reflect that number once read with astrodain there so i'll make a note and look into that. If you don't mind me asking because II was asking in what way do you mean sixty five what about for services in your division uhm you do consider if someone has the diagnosis of all timers in their under sixty five they can still receive services or is that a lot wouldn't be for an all timers diagnosis this is something we're looking at right now is is i'm sure you're aware as far as our waver services there are several pathways for our choices uh waiver one of which is there's an alzheimer's pathway there are disabled the pathways for but you have to be I think it's fifty five or older so I think that it's possible that you could that could receive services in that way through the waiver those would be the our have long standing waiver services that is that you're III guess so I want to make sure that that would be if this is a something we have talked about and II just want to make sure that maybe it's a goal that we make sure that we are including those under the age of sixty five and all the information that we're putting out there and that to make sure that they qualify for services that someone over sixty five who has the same diagnosis qualifies for can you you know can we give you the task or maybe even there's someone else from dhs who wants to address this later between II know we have a little bit more of a presentation from DHS coming up and a little bit but uhm to delve into that a little bit more and and bring something back to our next meeting to make sure that we're providing the same services equally regardless of the age yeah and I think they're right now the way that waiver is written it would be fifty five with the diagnoses a related dimension also you have to give m. You have to have a demonstrator a danger to sell for. Our waver pathway that's not to say that there wouldn't be services available through safe for example the senior centers of fruits and title three la funding or something like that there certainly. An age cut off for limit every outside again of the waiver someone under fifty five had or again that that the incident would probably the incident's level would be pretty low so in in that regard we might have to. But arguably the way that way I don't know uhm I mean we we we can look into that II don't think they're excluded from that nail by age at least so to the extent that the fifty five years are older but i'll make sure you've got some homework so we'll follow up in there and we might continue to discussion and when dhs comes up a little bit later too but going to go ahead david thank you um these are all really good discussion points these these recommendations live under the public awareness and education section that are outstanding just things we haven't seen much movement on one of those areas is increased public health messaging on brain health risk reduction early detection and diagnosis you know it's something that we've continued to do in the nonprofit space but wouldn't really support appreciate the support of the public health department engaging in this area II left this in and I guess it's golden golden bold the also must dimension registry this would be one thing that we talked about when we put forth these recommendations that would help us fill in some of these data gaps uhm i'll just as a caveat this sort of exist we with the new approval of the FDA treatment one of the criteria that cms has forced us individuals who are receiving those treatments must be a part of an almost registry and so we have worked at the also association with health systems and providers who are uhm administering this treatment to give them access to all net which is the association's national registry so that is some infrastructure that's currently being used by providers but we haven't really had a conversation about uhm you know creating or establishing in all cymers limited registry here in arkansas. I think when we made the decision to move the dimension services coordinator over DHS there was some discussion about maybe the registrative either there or at public health but in terms of movement on that that's going to give you an update that's where we are so not very much movement but some neither have we've seen movement on the grant program to increase bring health education and underserve communities collaboration with the area agencies on aging and I summarized a few of the recommendations that tied directly to that we in terms of a dimensional resource center is one of the visions that we've worked with the u m centers on aging one and speaking today on july eighth the hope is to figure out what those dimension resources centers look like in may be creating this pill it inflied the the service on aging and then taking that to the area agencies on aging and finding ways for the triple as to have the resources that they need to get to their clients as well uhm now much has been done on by when you said tell the health to enhance access to the manager education and then public health infrastructure to enhance access to dimension education commission support and recent advancements in in research so uhm still some work that need to be done in terms of our public health infrastructure and our response to also in other forms of dementia we did see some movement in these areas uhm though it be gradual when the health department received funding from the bold act so we were able to move a little bit in this direction but not to the extent that we we should have. Any questions on those that are outstanding. Represent a lady men thank you madame chairman they would also don't answers question earlier but I think this is the point they ask this you know there's been a lot of research in development on new drugs and I believe there's a drug that's already available to treat this disease or maybe it's just not coming out how how is that awareness I mean how does how to people find out both them watching TV and see in the airs. What about their is that the bullet point you're talking about here or doing something II think that's part of it ladies thank you for the question the fda last we gave approval to a second drug uhm in the same class and these are what they call monocolin tabadi so they're only treating the amazon way black build up the doctor way reference earlier in the brains that's only one hall mark of the disease so at the association we are continuing to make people aware of of access to treatments but uhm I think I can't underscore the importance that these these treatments is first generation treatments are only uhm their only viable for individuals in the very early stages of the disease and what so many individuals i'm delaying diagnosis are not being able to get diagnoses or not understanding the early the importance of our diagnosis that's where we feel like public health can step up and and and do more education around the importance of a brain health risk reduction but also early detection and diagnosis because for the first time ever physicians actually have tools that they can treat the disease and really stages but if it's not diagnosed early enough uhm you know you don't qualify well you know you make my point there I think how do we let people know that are in the early stages it's somewhere to cancer you know if you get cancer early when it's much treatable much more credible in those of the people that we really need to get the awareness to catch it early and we have more effect we agree I would agree but I think the public health department in arkansas shown historically that when when they engaging campaigns they can be very effective during the philly the messaging from the health apartment was very effective and dressing back seeing hesitancy I think the health former stand down a really good job in terms of stroke awareness and treatment and you can point to several their interventions they've done in in terms of diabetes. And your point cancer where we've seen great strides but those are efforts lead by our health department and so we we feel like if they engage in this this work with us we'll see similar results because we know that they've shown in the past they're very capable of doing really good things i'd like to point out is that we we did as the health department to come up with just propose budget if we had all the money in the world what could we do with this amount and this amount and we're gonna be talking about that and the next segment uhm and then there might be some hesitance from the help department to say this falls under eighth us may be it falls under DHS may be false under somebody else so that'll be the discussion coming up but really would like doctor way to to weigh in on uhm you know because we we've talked so much about these these great medications few people know that it's there that's also part of public education that's why it's so important to have awareness campaigns uhm while we're on it can you just give us an update uhm do you mind sharing thank you so much and representative where yes I completely fully support an agree with david. Summary of the situation we can not tell people as many as we possibly clean soon enough and I support your questions if they don't know about it how can we get to them and so we really do need to publicises a whole lot and what you just said and I want to underline that again if we can get to them early on we are seeing beneficial responses to the treatment that we're giving we have people wind up wading and you know the waiting is the issue a few are diagnosed early enough and yet we are not able to get to you for whatever reason it may be a limitation of the treatment because the monocolo antibody that's currently available as only the one that was a approved by fta in july twenty twenty three which is like hanama okay the other one that just got approved by fda a couple weeks ago hasn't even started to be manufactured yet and that dynamic and it's called now kissan law k IS u n LA I don't know where they get these names which but anyway it hasn't even started manufacturer but it well soon and then will have a second option but we have I could tell you because we were working on this for more than a year getting everybody ready getting the hall entire car drayer people who need to be part of the treatment follow up diagnoses everything we're ready to go I mess but there are many other number of the claims around the central arkansas area that can now give and we also even refer our patience to northwest arkansas I have a patient that I referred to in new york city for example because. Anybody that we can get treatment to I can tell you they are demonstrating some favorable responses I remember telling you about the one gentleman who was actually moderately impaired he started getting the infusion that sorts of little while ago from the predecessor of the canoma and after three of four infusions he started to be awarded enough shave by himself which it couldn't do top by himself feedback self the one thing he got up he got dressed and went to the car and drove to his office well I don't know that we wanted him to go there fair that quick but the point of it is he progress even beyond our expectations so I think the take home here is not that we expect everybody to be able to go to work right away but if the area of the brain happens to be we am a lloyd opposition is affected by the infusion they could do well extremely well relatively soon so we don't know where the annual bodies can go target those came like their positions or place but if it does. How good is there in every family of the patient who received the treatment I can't thank us enough they just it's like in a together that they never thought they would receive to have somebody you love come back and to be the first that you love and they you know somehow faded away in here they are again how how how can we argue with that so I think it's really really important that we try to get the south everybody and as soon as we've heard of we can and one other obstacle that we I don't think you were here for that meeting representative of lady member great questions and i'm so glad to see legislators here and engaged in and involved in the issue and that it's important to you but we have talked about how some insurance companies won't cover this and had a very lengthy discussion about the the first medication that was improved in i'm going to but her the names so i'm just going to say the first medication I always say the words were making that I say that's the piano map it's a can be the one that was first approved in january twenty twenty two which is no longer now manufactured because it's the same pharmaceutical company that was add you can you web or add you help and that turned out to be quite good but then the same pharmaceutical country decided since they have two they might focus on the one should they stop me in fact june the audio health to remember in any more okay well I you know that that is something that that we have talked about at these meetings and I think should be in something in our state plan to encourage to make sure that our insurance company is understand and encourage them to cover these for further patients the state employee planned it's not covered blue crossed it's not. So uhm if you're on medicaid medicare you you can receive the medication it is approved for that so anyway any other questions along this lines II just have one comment and that is um. Regards to public awareness of the medicine at it seems like the primary care providers whether they be physicians or nurse practitioners there's a real lack of knowledge amongst them even II was talking to some nurse practitioners over e c a and they have not even heard of these drugs and. You know they're on the front lines so it seems like public awareness really should also include the primary care providers who are on the front lines think senator love might have had a comment now well it come in which you just said there I mean it you know the medical community and the interest community both will have to catch up on this but but it's it's really new as you all know in you know it has to be proven I believe before an insurance company before we can go to an insurance company and say hey you need to cover this there has to be a track record unfortunately but that's the way life is so I think that's part of the reason maybe even the medical community hasn't caught upon it is that you know there there's got to be some history and and there before funds would become available yes thank you so much I completely agree with you the leadership of blue cross who shall have been in conversation with me and i've updated them but they are certain waiting to see if we can show you the more favorable responses and or if some of their friends relatives neighbors my god say hey you got a coverage. Right representative rided you have a question our comment really chair lady on our own thank all these folks their own this committee because I think there there's a lot of things that are a common out of the the average public needs to know but to us and I don't think that they really do and I think we need to do more of this but I would like to ask a question and I think driving david maybe we all could come up with an internal network if you can diagnose theirs in early stage with the medication that's out there and what common do we have a pretty good idea of what percentage right can be successful ale- doctor weighing it through that thank you thank you very much maybe yes based on the study to a room we leased by the pharmaceutical companies it was twenty eight percent and thirty five percent okay there had really noticeable improvements but based on our current it's still anecdotal cause we've only begun okay in may if you we come back in a few months I can give you will be good hard data but the families of the patients have come back in the patients now I don't know if we're going to say what this could just be proceed both in fact but maybe it isn't they are so happy that patients are so happy and doing better in terms of functional parameters so we can sit here and say well you know if you're happier europe in a very rule you could do more or that could be true I don't know we can't say that this is because of the drug but what we can say. Is there no better and uh we don't have for sea ball because we're not going to do that right so the patients who are receiving it and the families they are so pleased that's all I can tell you and we do many other clinical trials so it's not like this is our first rodeo and yet we have not gotten such favorable responses and feedback from families as we are now so it's not just the idea or the knowledge of the receiving something because then you know patients receives quote something to treat a condition many times because there's a clinical trials are but these are we markable in there we don't have any grumpy respondents we don't so that's pretty amazing thank you represent right. Thank you representative maybe this is a serious disease and I think that we really need to look at it that will you you've got a growing segment of our society that's growing reefs and balance in this just getting bigger embedded every year so we do need to hear this and we need to support the people so this committee was what they're saying and doing that we need to get it down the line where we can get this out to the public debit card college it continue really appreciate doctor waste comments on the drug those results are very consistent still with the clinical data we saw on clinical trials and I think she would agree that there is a lot of excitement in the clinical community for the second drug console to come online or done any map and represent a maybe I just referred to him as all these drugs in the mab class it should one map class or all map drugs the the next section we were going to look at is this accession and quality of care certainly we've seen submovement on some of these recommendations this first one is is is ongoing we continue to worsh to research and and support in an innovative bottles of funding just enhance a major be a services to the dimension population one of those initiatives will also live in the family caregiver support section but the the pilot program for dimension respect care has been really successful in its first two years uhm summers arkansas who administers the grant has done a wonderful job getting it out uhm I think they would agree with me that you know we want to expand capacity of the green but i'll speak more to that later review existing medicaid levels of care and ensure inclusivity of persons with kind of decline I think representative maybe you touched on this earlier it's something that we continue to watch uhm as we look at the wavers. I'm just to ensure that they are inclusive of individuals with dimension diagnosis that's the third one as well just making sure that waver policies are more inclusive for something we continue to monitor research and support an innovative approaches to expand access to the manager education certainly the association or summers are console on the um aging continued to try to expand our reach within our organizations to provide more access to demetitaining the association just released a module called and power care giver that progress specifically on care career education so we're starting to work on getting that program out to individuals as well we've also added to our digital library and so we that's one way we tried to get our education out of using our social channels to drive people back to our digital car ten as well some of the outstanding recommendations in terms of access to support services really just need expand access and collaboration with the using the triple a infrastructure I think one of the things that we looked at early on is how do we work with an our existing public health infrastructure to expand access to education dimension and support so we are looking at uhm establishing dimension resource centers in each one of these delays and then trying to provide dimensive training and career of our support as well in terms of care setting up we've relied on some of the needs assessments that came out of DHS but we haven't done a specific state why I need assessment on domension care in terms of the number of access points i'm sure DHS has some of that in research uhm acutely based models of care that's something that we looked at to just establish reimbursement rates that recognize the higher level of care needed by individuals also and the mention there are several states who've made a t. And this but no model that we've seen that's been perfect yet so we're continuing to work on looking at those things as well happily take any questions on access and quality of care. Thank you thank you I think this is really excellent I would like to bring up again the topic that you are alluded to briefly and the ideas a registry for alternatives for the state of our concert I think that should be so important for us I would like to encourage whatever we would need to do to move there forward currently we are now registering all of our patience for the alz net so the offnet is a national time working network that um encourage is patience in their family surregation of the patience and if we quires prior registration if the patient wants therapy so for all of our patients that we would like to consider for in this monocolon antibody therapy they have to be registered but I think the more we can register the more there will be available the bringing of leverage. To try to get more resources to treat these patients if we'd only would know how many we have it's hard to go further so we can do that for the state of our concert I think it would be great so coming back to what you said david about the fact that that topic was brought but it states in somewhere. Make me we could try to help to bring it back out from somewhere and move it a representative I think you've had a comment or a question thank you madam chair david i'm just curious i've heard a lot of talk here today about potential drugs that still have not been approved by the fda and i'm just curious and of several years ago here in arks parents legislation of the rock tried do you know if any patient or any there's been any cases here in the state where someone has utilized that particular law to be able to uh you know at the desperation to try to help the lobon to be able to reach out to one of those drugs that have not yet been approved but they the FDA you know what i'm talking about do you have any numbers that would that apply in it with the in your situation with the addressing those potential drugs are taught thank you the question nothing I could speak to you today in terms of data or people trying to use that statute to gain access to the treatment so I know that you know the kinnomap strict clinical protocol though still struggles that do you receive the fda will do our clinical protocol established uhm but in terms of that statute being beneficial for our population I couldn't speak to that today a follow up madame chair of the digital question. My second question is and and understand you a lot resources that you're trying to utilize abuse curious you know I guess who was in twenty seventeen the general assembly we appropriate funding for cross stabilization units to address miller he always uh in our console and we put a lot of money into that program and we were able to stabilise for those units uh hopefully strategically located throughout the state and I have numbers you know as for how many people have been saying in those crisis stabilization units over the past seven years now that all forum I guess I understand her up and running do we know if people the damage in the eh eh eh utilizing those stabilisation great stabilisation unions do you have any data that would show that I have either been diverted there by law enforcement that may have been countered in a situation or they just walked and do you have any their own at all II do not have data our numbers I can I could say I will speak to that that has been a concern of ours that the association just to ensure that individuals who may be having behavior associated with dimension that those personnel inside those facilities are adequately trained to recognize some of those warning signs to dimension I am almost confident we didn't include them in the statute that we worked on with law enforcement training but that is one area that we we wanted to have some additional clarity i'm just to ensure those that the commissions that are working those units can recognize when someone may be having behaviors related to dimension rather than a mental health crisis I would say that the likelihood of our population ended up and where those units. It's probably beared midland high um I would say high it's possible to wait yes thank I thank you for bringing up this very very important topic and yes you are right one the reasons that we needed to have these crisis intervention centers was because we are patient who were cracked impaired or dimensive who didn't know and they would keep going back to the same place relate we're told not to go they would end up in jail in carcerated they would be let out a while and the minute they got out on the street there weren't back to where they told they couldn't go then they got rid of encourage rated again so because of those kind of situations it was such a wonderful thing that the crisis intervention centers were established and I know that we do have patience and who were now treated much better where they didn't go back to jail again then go back and go to jail again now they get to go to a place that warm and fuzzy so to speak treats them with some warm super our food they feel better they feel that somebody cares about them and then they're able to connect we gain where they were before they decompensate it it has worked I spoke into patients who been there so it has been a real positive so I want to thank you for having established that for the seven years that's all for there's any way you could expand them that would be even better doctor overtime mcloy from the center's unaging just to follow upon on that as well as what david broader uhm in the last legislative session there was. The war put in the place to educate all new law enforcement so if they show up to place that they reoccur thus law enforcement in the sinners on again we have talk of new classes at the academies the leather academies in so since january one all new law enforcement has been to by the centers on aging on how to recognize those behaviors and to put the appropriate resources in place to prevent hopefully future poor outcomes yes yes I want to thank to overturn a court for bringing the rap its so important I want to add that we are also training first responders so to not only long forcement also for sure spondors they see somebody acting a little bit strangely. They realize that they may need to approach the patient and try to figure out why an often times it's not you know something criminal it's just they don't quite understand what they're doing thank you representative that you madam chair into your question I was a sponsor that bill as a legislature in the bills well familiar with it but he we did include your training at all of our law unfortunate academies in you you ported there there and appreciate you bringing that up in the day but worked on pretty good get that throwing a dead in the legislation and but we do no address the issue to make sure that uh you know ever who get crashes stabilization units that they are they they have also they have the training to be able to be in a far those because I was still at a couple of numbers in there i'll get our please let's morning on separate term but. It's it's those kinds of stabilization units have been up and run in there well i'd like to partial was in twenty eighteen I think I said twenty seventeen while we go that was actually when we pay his legislation but in twenty eighteen we had the birds when going later in twenty eighteen the second was up and run in a labor is twenty nine saying the third one in the twenty twenty twenty twenty one the poor since all forum have been an operation there's been over twenty four thousand people that I think there was numbers may not be current but over twenty four thousand people have going to those huge and and to your point something that I think is extremely impressive is that close to forty two hundred of those have been diverted to those units by law enforcement also so when we establish that bill on twenty seventeen and we record all that training for law enforcement to be able to identify those it may actually make me an a mirror help crashes bars is someone that actually is committing a criminal act I think we're seeing the training has absolutely paid off for because when you think urban and i'll close but saying the is when you think of it that four thousand people that were to burden by law and portion of which means what you were saying is that if those units were not there then that was over four thousand people that were spinning that in the county jail and got called up in our criminal justices come and stayed up with spinner than that in one of those units uh being treated by mental health expert so like both for those car merge and the end day but I appreciate you bring me the legislation for the training on the long police it was great to work with it i'll hook madam chair thank you if you could just clarify for me i'm going to get to you and just a second but if you'd just clarify for me because the bill I know it was about line forcement but you made reference to your training first responders. It was that required by that law as well first responders or is that something we as legislators might want to think about that uhm first responders also received that training just connect your question to be all that the real that we rare directly for all importance for all should be trained at uh twelve of our law enforcement training account of musical stripe we've made that a requirement we already had sixteen hours of training at those who care to make them to be able to deal about some war and the day and counter in the middle health crashes we added the national number bowers of training to deal with the exactly what we're talking about here today we do maintain and also with all of the average but so all that today training but it's your question in day with you create me if i'm wrong but it deals that training is just for law and poor I don't think it has initiated do we are for my responders volunteer but all that we don't come in to play uh that's why I understand it okay okay doctor overtime I was just going to follow we see our high need for that in so we've made it at the ums to make that a top priority we train all first responders I addressed the law of what the law requires and we are doing that with all the elith had a means but we realized because of limited access we are trying to fill that gap that we are addressing all first responders whether it even be the volunteer fire departments because often times that is the first line and so we are offering that education free to anybody and everybody including whether it being girls scout. Voice tickets because you're never too young to participate in identification in appropriate eighteen the uh resources as well as to community care givers because we are trying to ensure that people know how to appropriately deal with wandering and deal with successful search and rescue births it's recovery and we've been had a recovery situation in march and that was a community we had begged to educate and they had said they had it in now the same we don't have it and so we are offering that to anybody and everybody even down to the virtual reality that we have co-created a ums center on aging so that individuals can properly practice how to conduct a search in rescue for those impacted with to mention versus a recovery so they can practice it in a safe environment before it becomes a real situation during trade arkansas hospital association comments so representative tassure a member back in twenty fifteen when senator cooper ray in his bill on right to try you and representative ladyman are both cosponsored that coasponsors of that uhm I worked very closely with him on that language I think it's a little too narrow and because in that law itself and we had a lot of arguments with the lot of different people as you can imagine uhm why was required at that time and of course it's twenty fifteen the drug manufacturers wanted to make sure that a physician's diagnosis was that the patient had a terminal illness and would pass away in a short amount of time so if you if you need to go back into that right make something more prescriptive just in these cases that deal more with more bidding the versus more. And we can tell you the insurance companies or camate a little bit but mostly it's the drug manufacturers and frankly the pharmacy benefit managers who don't like that uh institutional tissue for lack of a better word they're in the middle but i'd be happy to help you from the hospital associations perspective because it was important to us to protect our patience when a doctor or a prescriber had a good faith feeling that that patient would do well with the particular drug that we wanted the liability for that dock the patient with informed consent and everything else included in that law and you all let us do that so it's one of our favorite things we've done for patience and doctors who are really trying to throw how marries for patients but it does still with terminal and and we might want to we might have to tweak that definition or to do something pretty specific for this disease if he wanted to make it a little bit broader. And i'm going to back up for just a second to about the registry because it's can how often got started was talking about the registry and if someone could chime in and cannot let me understand in it maybe it's something we need to ask DHS I don't know if the health department keeps that what has been the uhm hall back why why david you might be able to explain what's been the complications with that registry tell us what we need to know why has that not been easy to accomplish I think there were other priorities that precedent over that uhm to to be fully transparent from the associations perspective but those conversations installed when we were trying to figure out where that registry should live uhm and so that's that's kind of weird they have salt is where where should it live and we have opinions that it should be that biro health statistics but uhm yeah that's where it's all okay that that's an explanation that's what I need okay continue with your conversation be the next section we we have seen progress on the family caregiver support section again this councils to be applied for bringing this priority and letting it live on its own but explaining access to the use of evidence informed services and support for patients living with the mention their care givers that's ongoing work we do know their private and public partnerships that are expanding to continue to provide access to dimension education and training we are seeing more churches get into the respect game and provide respect for their partialers we are so are seeing your doctor jordan presented a few months ago about her program at UCA and there's some hope to expand that to you a ms as well so those kind of services are you know don't really have a policy lever they happen or organically. But we are seeing an increase in in the number of support services not to say we have sufficient number to cover the need but they are growing likewise with those partnerships who's connecting families individuals who disease information again not just disease information but the services that are available to them and I think the big question remains how do we utilize you that as in our current public health infrastructure to expand access to these services and referrals regularly survey and assess the needs of failed make care givers that is happening through burfas but it's also happening through the dimension respect care program what part of eligibility is reporting back on how those dollars are used and I know that they're collecting some data as well on the needs which is informed some of our programmatic activity so the outstanding recommendations we we see of course explaining access to HC b s services or response services we we we need more respect providers and also we we feel like experiencing access to the mental career arrest but great program and it's current funding level were only able to serve four hundred families so expanding making that a permanent dimension here give our program here in the state is certainly a recommendation we are putting forwards continuing to research curious based models the care which I think. Was borrowed from the slides or about that then then just continued to strengthen our public and private partnerships the agencies triple aids of course the association summers are concerned the centers on aging i'm just to explain access to family caregiver training and supports that's ongoing work more working to be done in that area as well. Any questions on family caregiver support. I'm just going to ask do you do you mind sharing stephanie kirk how the respect program we're just giving first hand information is to share expand upon when he said absolutely why we should make it permanent definitely make it permanent uh so uh the two hundred thousand dollars was actually earmarked and out to family care givers in march so within an eight month period that funding had already been used and if I could put on record I know a couple of of things that we definitely need to consider in the process for further discussing the the great program a couple of different things why is we have had a lot of our care givers uh express the need to do this for younger uh people that have been diagnosed so we would like to see that great expanded anyone with the diagnosis of dimension in the age the five hundred dollars is a welcome and that's available for those care givers to apply for again in six months we hear a need of more than five hundred dollars if they are paying a source to provide respect care sometimes that's only a weekend and you think about that that's a doesn't go very far but uh it's definitely something that all of our family care givers have responded that you know it's a blessing uh they've used it for many different purposes whether it's to see a green telegraduate from school or take a vacation for the first time in many many years just having a break and so we know there's a need for inclusion for people that are younger more money more funding and be enough from an administrative standpoint uh we need to look at the the cost of in ministering the grand itself I know our organization has donated the time and the services to do that. For the last we're on in our third year but that would be important to consider to is that the costs for administering the gray especially date expands and requires you know additional personnel or more time so uh but but we have received nothing but positive comments and great thanks for from our career givers and and those family members across the state. Follow up on that I think one of the other things we've looked at is in its it's the first two years it's important to know that of the two hundred thousand dollars that will receive for the great none of those actually went to administrative cost they all were directed towards family so all that money got straight to the people so being able to cover and help with the capacity of delivering that create something that we need to look at in the future as well. I'm sorry she said that we'll actually said that did you say that sorry. The. Be last section will look at this the final section dementitating and and work force development uhm this is a section where we've also seen quite a bit move you know one of the the recommendations of the development make available dimensions specific training and education and that will support risk reduction or detection and diagnosis across chemical settings that is ongoing we continue to try to make that available to our programmatic work expand collaboration between the medical community and the nonprofit sector to increase awareness about available support services from the associations perspective our work with health systems as helping us just increase access whether it's utilizing project echo to get commission education but just making sure there is that extra layer of awareness that there is support available because no one should have to travel the road the cities alone and so we always want to help support free on these as they work through this and support the expansion of grant programs that will support mentory level health care workers to advance within the medical field uhm so we we do continue to offer our support for any development and funding that would again encourage an individual may be coming in as AC n a to also pursue LPN or are in as well in terms of dimension specific training standards here are some areas that we've seen some increase established it mentioned specific requirements for certain dhs personnel which included a p s in long term care investigators I will note this is work that we have been actively involved in energy association however i'm unclear as to whether or not this lives in statute and otherwise in discussion about making a role change than the agency to require this training for a p s enlargement care investigators uhm that's certainly something that we will be supportive of. Uhm but I think we had a discussion early on uhm to not pursue this legislatively that there was a role change I am unclear at the moment whether or not that role change was completed so that's why it's kind of been bold there and then and and established dimensions for the victorian requirements for staff providing direct care to dimension patients in twenty twenty three we're able to do that uhm throughout three sixty two which established training requirements for the living personnel but it also strengthened the training requirements for facilities who provide memory care services or have gone through the license or requirements to receive a designation of an also more special care unit so on we vitalizing those rules and regulations that govern assisted living we were able to strengthen those requirements for those type providers and then twenty twenty three seventy required two hours of the metro training for home care providers we were the first states in the country to pass a statute like that uhm act two o two requires the two hours domented training there were senator reference earlier in the next three thirty five required the four hours of dimension training for direct care staff and assisted living in two hours of continuing education as well to my earlier point strength in the rules that government the providers that provide memory care some outstanding recommendations that we identify just establishing the mental training programs for community health workers we did not move much on that we were waiting for uhm since stability and that work force to work continuing to look at that research and develop a process for buying the benefits of dimensive training programs in the clinical setting that is something that I wouldn't encourage us to work on going forward now that we have passed these new regulations. I think we want to know how did they improve patient outcomes how does it improve health care morale work for stability so I think that's going to be something that we look at long term after we've implemented some of these requirements and they've had some time to produce some data for us and then another area we looked at his that we have an address yet as implemented in a dimensive certification program for long term care and each cbs providers uhm that specifically promotes person centered care and that's we know that different providers are are using different certifications but there was an appetite to make that uniform and establish a dimension dimension care of certification program and happy to take any questions on the metal training and work force development. Okay seeing no questions david thank you for your presentation any any last comments to david overall because we do have in dhs will be up i'm kind of holding some of my questions for yah when you get up here uhm but II just have one more spike oh i'm the these are again recommendations and where we've seen opportunity certainly in terms of public awareness we've talked specifically a lot about the importance of risk reduction but also because there are we do know that the science uhm there are some things that we can do to strengthen our brains or more messaging around brain health would certainly help us address a stigma that has been four to five around this disease and especially reserving it for aging adults that doctor way talked about so a really clearly defined public health strategy to help us reduce stigma but also uh encourage risk reduction and also the importance of our detection and diagnosis in terms of access to the quality of care this was a point that I think representative may be made earlier we need to continue to monitor payers and explain access to fda improvement at the approved treatments for all cymers uhm to just to ensure there's equal access to these treatments we know that the state health employee deny coverage for the kind of mab uhm we hope that we're visit that decision when they discuss the nanoman it comes online as well and ensure there's inequable access not only to these treatments but access to diagnostics as well why the things that has been said multiple times are on the table this morning is the fact that all cements is not just an aging disease it is for younger adults as well so one of our policy priorities is to ensure that our medicare program uhm covers access to current testing. For individuals who may be under the age of sixty five uhm who may be experiencing continued decline as well and then again permanent funding for the respite grant program uh I am not sure I think was everyone made available the five policy. That concludes my comments and less questions. There was one more side socket forgot about the maybe time for me to get some contesting family career for support as continued expanded background checks for a she best providers of individuals with dimension in this idea came to us actually from a bill that represented maybe I think cosponsored last session that extended background checks for individuals providing services for the belmont disabled and sold those same protections we'd like to extend to the dimension population and then one of the things that the agency DHS has assessed for just uhm possible clarity around memory care we have to find that in the rules and regs and so one of the statutes we are proposing from the alzheimer's association is a consumer protection bill that would impose a fine for facilities who are advertising for services that they are not licensed to provide uhm very simple bill but just giving that extra layer of protection for families who are desperate for memory here we want to make sure those facilities actually are going through the license your protection could we put those standards in place for a reason and so now that we have that clarity on the back in this would be a consumer protection bill and then um condition specific uh dimension training over the last few years the states don't quite a bit to expand the scope of APR ins doctor jordan reference this earlier much to my astonishment we were doing a presentation in role or console in the indeed who spoke about his care for individuals and patients with our service dimension uhm he too was not aware that there was actually in all cymers treatment available which surprised me but it certainly made me aware that more training need to be done in the space and so establishing dimension training standards for APR ins who are often our first our patients first touch the docks and also position assistance as well. Uh some continuing education requirements are something that we're looking at for twenty twenty five now that does officially conclude my comments and went long but appreciate your attention and you're input and your support because we have not have seen so much implementation but wasn't for the support of the individuals around the stable so I really appreciate you I will give you one parting gift arkansas recognize nationally at our also association competer this year for a policy achievement so thank you so much for that as well but my comments are concluded in search any other questions a lot to think about a lot of great discussions so thank you david for other time you put into putting us together put in our thoughts down into some words okay we did at our last meeting as the department of health to just put together this is not you know anything definite or whatever but we were just trying to find out what does the what is a hundred thousand dollars get you in in advertising if we were to do some type of public awareness campaign uhm kenya eddings are are you the one who has been tasked with sharing that information with us or was it tony bailey who's tag team okay just stay in your seats right there if that's okay since heard that all that computer step down there and just kind of if you want to walk it's through what that is and just explain a little bit of. What it is it's being presented so thank you for the opportunity to preserve this afternoon like you said representatives of maybe at the last meeting the question was as if there was an unlimited budget work possibly be done in the health communications department uhm took that in as you can see developed three different tears of if there was unlimited funding what we could what we could do what could be done and so you have that before you now I will say that uhm this is imaginary and we do not have a budget to do this implemented by it is there in so but I will also say that the arkansas minority health commission continues to promote a partner with both uhm alzheimer's arkansas and all time as association the arkansas chapter on doing outreach education distributing a painful it's in educational materials wherever we go around the state of course we serve our seventy five counties and we distribute information we also have been able to partner with some of our national partners the bombing gillia which is a national partner of the altimer's association and so we've been able to do some out which in churches because bomb of calia is a faith based organization that does out we specifically in black churches and so we've been able to partner with them to distribute information that's that's faith based around the state and then in addition to that i'll just turn it over to mister bailey if he had any uhm additional comments. So I really don't thank you representative maybe so in addition to what kind of issue it so they have the parliament also does the same thing as for us with our other programs since we don't have funding we are able to include materials and some of our reach programs are in in particular with crime zero with tobacco to be where program okay so. II guess I what was shared with me is that even a funding was available the department of health is not where that funding should go and because it is a mental health issue and I guess i'm a little concerned about that because it's not just a mental health issue this is a health issue it is brain health it's your heart health and so I guess I just II need to hear and want to ask you know the department of how do we consider all timers disease and dimension something that does fall within the department of health I mean we do right I hope I uhm so just speaking for argument already health commission we try to focus our efforts on all things that affect minorities but we don't turn anyone away and so we do our level best as it relates to outreach in education in reaching people where they are in like I said that includes partnering with uhm both outstate our timers associations uhm to get the word out and there is I think that the question that you're answer asking is not something that I am that's above hagred and so I would not be able to answer that question i'm sorry mister bailey japan here representative may be agree with kenya so this is again about my aid as well but from my perspective the way the leadership expresses it to me is that you know this is a mental health and aging. The health department is not you know subject man expert in this area and therefore it's not something that you know they feel far as I know and okay II i'm just going to express my concern about that because I very much see uhm this being a health issue in that our department of health should be we're talking about drugs and medication and early detection and treatment this is night uhm because someone was homeless this is not because someone was addicted to drugs or alcohol this is not because someone doesn't have family around to care for them or or what happy this is this is a medical diagnosis in it's just concerning to me and I just you know wanted to hear from the committee my my uhm way off base doctor way would you like to chair yeah I like that part that's real you know he less we find one in the way in okay anyway I am you are correct I think this is a health issue and we need a brace it and we need to fully think about how we can move forward and support everybody who needs are this kind of support period yet mister bailey has represented maybe I do want to add that you know when we apply for the the previous uh ball funding the object it was or the goal was for the arks out apartment hill to work with uh with the h s on this so is not like we were just given it away we were just going to work together just which is to. David cook I think from the association's perspective we we certainly see the the one of the the short backs of the the drawbacks we've seen is this limited funding we've heard that so through the state played efforts and others that I do want to make a carrier that we were our goal was to ensure that the state was prepared to receive future funding under the bold act and had we received that second layer funding we could have advanced some of this programmatic what we're talking about today and i. II just want to emphasize that the the bulgarian is is certainly directed at public health departments and to your point when we look at other chronic diseases where you do have dedicated federal funding streams the agency has done really great work and we feel like those efforts could be very well used in our space as well because there's so much that need to be done in terms of public health to reduce stigma but also encourage individuals that to be heart healthy bring healthy and we've seen other states uhm helped departments be very effective in moving this work and if we don't get ahead of this in establishment reduction campaigns and things like that the numbers are just not sustainable in terms of the expense that it's going to cost in delivery of care down the road and so we either get involved in intervention early like we've done with cancer and other diseases or we just wait and pay for higher costs of care down the road and and again I think just continues the stigma of the diagnosis in the reason why people don't want to get that diagnosis and they aren't seeing it necessarily as this is you know health in something that you really I mean you can do something about it by eating healthy we've talked about all those things that we can do but essentially it it is it is health so uhm that III don't know with my coach here has any thoughts on any that sorry to put channel spirit but it jack ladyman thank you yes thank you madame chair mister bailey mentioned the tobacco recovery fine and I have got a question about that uh when I was here public health in uh gilmore would come and present on a regular basis where that were those funds we're going in law firms were used for outreach programs and I asked me to have the different agencies that were obtaining funds from that program to come and present to the committee what they were doing with those phones. And I don't remember the also americans association be in part of that uh so and I mean to me that would be a fear for that money one of the smoke prevention and they bring in all that but but it seems this would be a good fit for some of those funds I know we utilize all the phones but they could be reallocated to the game comments but there. So just a clear first of what I mean by the tobacco program to be well program so in college come me and we send him materials related to smoking includes diabetes part disease and so we also include information about our summers and domestic here in there as well you know what i'm referring to we we get recovered we get funds from the tobacco companies yes and that's utilized for training and and other things and I thought some of that was used for all time route reads but maybe you get some coun. Doctor over ten mc thank you the ums centers on aging we are a tobacco funded program and we do very much we partner with anybody and everybody whether it's the altarman's association minority commission the help to partner and we do we we are so blessed have received that fun indeed we only received a little under three percent of the funding to focus on we have to focus on all aging but as you heard we we do focus on the as it is a top priority in fact we have our own marketing immediate public awareness focusing right now more on prevention on how we can keep our brain healthy uhm as well as we're for the caregivers to get the resources that they need and we cover all seventy five counties and believe i've shared with you about what we are done on reduce senior hunger on time when I came and spoke to yard testified on that because food is a basic necessity healthy food and so we're we're talking about that that is part of the brain health as we are working on that so we are receiving funding and we are so gracious and so thankful for that funding cause we could not do that work without it can you tell me how much that funding is I think you said three percent but I all that we received in varies for me to year and it's based upon tobacco sales so it's almost this hoximar on we want people to redo smoking but yet for us to continue the work we're doing is only by that of what is being sowed in tobacco products it does not address they being it does not address any other aspect and there are seven programs in those. Finds there is a part that goes side to the trust and then there's a part that goes aside to those seven programs and so the seven programs are addressing or aspects of health that of course arkansas only one of four states that put war or something utilizing toward health but arkansas the only state that put something in place for a gene statewide which is your u m s senators on aging and we only receive less than three percent of the overall funding representative maybe that uh public health communication anyway lives a quarterly report in uh on how these funds are spanish in their allocated different agencies the primary purpose of it is to stop up smoking that's what the money is for comes to back or company and as you say it depends on the tobacco sales in an and II can't remember this organization that sets budget every year but we we that budget is redone I think on an annual basis or reallocated based on the results that are presented to the public health committee you know what are we doing and are we really making an impact in in that money has been reallocated from time to time on annual basis but but it's primarily outreached in that sort of thing case so I guess my question if and i'm not saying I can make this happen but just say mysteriously we have a hundred and fifty thousand which was the lowest here of this to put towards a campaign about the things that we've talked here today about is is at the center on aging is the probably the most appropriate spirit for that funding to go i'm just asking our you equipped to do that is that something that we have a campaign currently in production and we kick that campaign off in partnership with the help apartment under the medicare willness. Uh because every older adult once they'd become medicare eligible should have the welcome to medicare screening which includes a cardinative assessment depression and should be done annually thereafter some conditions are not as equivalent or as educated as others which is why the recommendations as we work very closely with the help department as well as human services and our effort was to bring everybody to the table to address that we are equipped to handle that as because we are bringing all partners out of that salo in having these conversations and trying to work with uh arkansas apartment of health in human services on how we can best distribute that in every county of the state utilizing all these um revenues and uh technologies to be sure that we are reaching everybody across the state uhm and so david and i'm packed have had this conversation multiple times on how to increase the most public awareness not only in treatment but in prevention as that's where we want to start uh putting the most effort into. Okay any other comments okay but see if we can move on to our next agenda item and there is an update from DHS regarding the implementation of the alternative said ponyon and uh lorie mcdonald we have down II don't know if you are so having others join you i'll let you take over thank you very much i'll go here the the issue that uh think we've got a sort of divide and conquer approach to we have several things that will touch on the specifically I was asked to uh address the demential coordinator position that was created I forget that bill member or the act never excuse me that we recently completed another round I think completed we may have one or two more outstanding interviews but we're helping to wrap that up fairly quickly and make a decision and have something positive to report to you next month can I am terribly serve as a little strategy may have explained but what's been the hold with getting that position like what what why has this been so hard we pass this in twenty three and is there just not a qualified person applying is no one interested we've had a lot of interest as you know with. Uhm it's difficult to separate in the way from the chair for essentially I mean we have and a lot of applicants to sort through but to really have someone qualified at that grade level to really address this and be able to hit the ground running this is as you know a new position and so it's really going to take a kind of AAA self store in somebody that can really work autonomously somebody that can establish those networks hopefully someone that already has experience with there and has some of those contexts in that kind of thing so to really get there that white person ha. But we are getting let's keep our fingers crossed we we we feel like we're we're getting there in this round of interviews felt like that we had something maybe we can move forward with that we're coming to wear the name and confidential I know we're all looking forward to that person being here I was hoping that we'd already had that person hired and they you know be able to come to a committee meeting and explain what they're working on so florida did you have a comment that you wanted to expand on here thanks so much donald legislative affairs with DHS you may have allowed it to this in uh jay may have testified this in the past but also just want to bring in II do understand it's it's been a year but please understand this as a position that it's brand news we had to create the job description and I think it had to be and it did so we went back and forth with uh OPM a couple of times to get something that was AAA good uhm description of the position so that that was part of the wag in the beginning uhm and in a saying II think there were in a good place now we're very hopeful that we're in a good place now to be able to get this position hard okay moving on to some of the other uhm things we we did have i'm going to go back to david cook's notes act seventy required two hours of dimension training for home care providers can you update us on where we stand is that actually taking place our home care providers getting this training right now or we still in a rule making process which takes forever. I know that we've we've had this for the specific there are I do not know that right I think it would be implemented because okay so I mean II neither been some discussions I don't know I don't have a specific numbers of response to that particular question I will certainly get that for the for the members i'll get that information to you that additional information okay tade him owen be is is with one of those providers so maybe you can share are your employees getting this training right now wind that start can you tell us but they're training is like how many are being trained I don't know that specifics on the training i'm sorry but I do know that yes it has been implemented um with with most all the agencies that are in the arguments are home based services association and I believe that started. That eight months feel maybe. January it was january I think it was effective uh represent maybe january and again all the other people in our agency are in our association have implemented so they actually are doing that training okay uh that's what I wanted to hear sometimes we pass laws appear and you'd think it's been done in it goes nowhere uhm and it was past a year to before in. Anyway uhm okay in the at two o two we can already talked about their the two hours of dimension training for law enforcement we had quite a discussion on that uhm the dhs have any follow up on that I don't know if that really affected. No not on their specific clear apologize I was had failed to introduce myself earlier i'm john bonner and the assistant director in the age individual under j hill we couldn't be here today and I now some of the but I certainly don't know all i've even i'm glad. To be here today and glad to make you uh the last point I think that we wanted to address was the training in the assisted living and we have with us seriously at our deputy director from our division a provider services in qu. Serious d h uh division provider services and quality assurance so when it comes to act three thirty five um we worked last year after it was passed with three different associations and so david cook thank you but also the health care association and a rabbit uhm to promote those rules and set forth for the assisted living facilities to implement those required trainings those rules were promotated effective january first this year I believe uhm in october of last year did square our presented at an around a conference kind of showcase the new statutes that were coming out in to make everyone aware of those changes coming to the rules uhm in january once the rules did become effective we set out a advisory mile to all of our system living both level one and level two collect them now that those changes have been implemented um and provided them with links to the new rules and so that they can go in and look at those uhm while the rule was implemented as january first we were aware that facilities were probably going to need a little time to get the trainings up and running and update their files so since then we have actually been providing technical assistance instead of uh writing citations um and while we go out in survey just so that we can provide them with a little guidance on that and give them that leeway to hit their files updated uhm and we set that time frame for july first so we gave them the first seven months to try and get everything in order as far as our surveyors in house and we don't two different trainings with our surveyors both in our winner training in our spring training of this year uh to get them acromated to the new rules and then what what they need. To be looking for when they go out. What what things are in place to make sure that it's being done like how how do you know for the fact that everybody is receiving that training so what we're doing is we are pulling personnel files when we go out and survey there are certain criteria within the rules now that they have to be trained I believe it is within the first ninety days of their employment uhm and then receive annual training thereafter uh continuing education I also set for certain criteria and curriculum that need to be met and they were also looking at who provided the training there is curriculum or requirements around who is providing the training so they're having to show us those requirements as well and then what happens when that training is not provided. Or not done I should say so it depends on the the scope and severity of it as with all of our citations of noncompliance um in most cases they will have to provide a what we call a plan of correction where they will let us know how they're going to go about correcting that putting that in place and giving us an effective date of when that correction with a when they will come into compliance uhm if we need to go further we can go further we can do a directed plan of excuse me a directional plan of compliance uhm to where we let them know this is how you're going to do it and as a severity increases if it continues to be a non compliance we can go further but that is usually the first step is for them to give us a a plan of correction. Any questions by any members represent the ladyman yeah thank you madame chair i'm not a member i'm not part of this group either i'm just saying you're so with mine we important this group is said a quick question I hope it's quick you talked about the the match a coordinator this were would that be resonate in other words who they report to in are there any resources allocated for that function there are they'll report to you it's within our division so they're they're direct would be to jay health and division director as far as resources uhm I don't know that there were specific I mean it's the position I guess is far you know if you go through the european process and has created in become a sport of the budget there on a dish and all funding mechanisms were there. Were you thinking specifically something like that outrageous time education type things in and we're trying to expenses or what I was what I was thinking about with and what's the new position and it's going to be fleshed out basically but this you know are there any administration people back budget for travel when those kind of things and now sir that would be part of our uh wo- have to for that will fit into our existing division budget there's no positions under that one so there's no support stay up so it's an internet part of me earlier in its very much our need for someone there um can work smartly uhm in very efficiently certainly the to kind of to to make these make this position what what we help it can be certainly now what we all hope it can. Any other questions okay i'm just going to ask because we did bring up the idea of some type of media campaign in in some capacity and it has been suggested that that would be better place through DHS t i'll have those is is that something that DHS yes that media campaign should go through d h because mental health do you mind sharing comments with certainly were were happy to our our lorry address actually see your shaking harry had so yeah so II just want to be real careful about designing uhm all the hammers or dimension under the umbrella of mental health in in that gaze back to the other issue that I thank you so so greatly uhm expined uhm that that is not the way the uh we we view it uhm and certainly as it is it pertains to advertising uhm we would certainly look into that if if some you know whoever has that information we we have no budget for that uhm in so if that were to come about uhm we would certainly be welcome to look at it uh although I have to say go back to the original coming out II really believe that uhm this would maybe be better half tender of the arkansas department of help I don't want to find them under the best but uhm it's it's a health issue it's it's not a mental health issue. But we would certainly be willing to work with whomever uhm in in take a look at that we would be happy to do that okay appreciate the comments you know II got to come in and I agree with their I think this fits in something that partnered health has already doing for other programs so to me that it seemed like a better feel. Any final comments regarding this topic or anything else that we have not covered today speak now or I guess further hold your peace intel our next meeting yes during entry I wanted to say something about registries as somebody who's often times representing hospitals in hospital personally that one to have to inner data into registries to make a make sense right whether it's from a clinical perspective or anywhere else. If you are if it truly is valid that we have a state wide registry and that this national when can't work right or is it ideal then what we'll need to do is really plan it well to make it in there great well with electronic health frequents that every practitioner who takes care of a patient can see and have access back and forth with uhm we would want share involved our health information exchange to make sure that we do the things the right way for them to share the information and get it done so if we're going to create a registry I think it's a good opportunity to do it and do it well like do the right thing the right way so it's not really expensive so it is incredibly protected so that uh kinds the right consensus done in the right way and and you can check your boxes that all of those things have been done appropriately and that you train the people who were entering the data because it's not usually doctor way who's entering information in in her clinic right thank the good door you're awfully expensive FTE to be a day to entry person but those things are really important to do to think through how we want it done and if the national registry is inadequate we need to know that so that if we're creating our own that we become the model instead of trying to do whatever it is to be done to try to make ourselves fit into their widget because uhm it's my experience in the hospital world as as highly regulated as we are a lot of times where the entity far signed to do the dirty work with no extra resources and nobody asked us how to do it efficiently and so we wind up doing this inficient stuff to try to check a box when we could have sat down with really important very smart people to wear tates people and I need the same system to work in the same way so that the data is collected across the continue of care in a way that makes sense yes definitely cook just another comment to because we hear from. Care givers quite a bit that are hesitant. For anything being on record and I think there's a combination of issues but you know what we don't want distribute to create is a is an issue of discrimination and at what phase do you read is I mean like my mother for instance has been diagnosed with mild cognitive impairment does that mean she's going to have all timers does that mean she's going to have another you know uh more severe type of dimension what what point do you register and then a lot of people with mild cognitive impairment are still fully functional so II think there are a lot of things for a to consider uh if we move in this direction and we'll have a lot of people that are very hesitant to participate in at the information it's not accurate it doesn't it actually hurts us so you want to make sure that it's accurate and that the person's privacy is protected because ultimately that's you know really really important so lots of things to think about there is no easy solution and so many issues it's complicated when you start throwing around the different aspects to things appreciate when I conclude with any thoughts or anything now okay everyone's done with their thoughts motion to adjourn second we are i'm sorry i'm sorry okay thank you that's why that is why we have branded here so i'd like to throw out a date and ask uhm august twenty sixth at one pm it's a monday uhm desert work for most it's really hard for me to always plan to foreign advance but we were looking at our legislative schedule in that works well legislatively I can be here clip pinso can be here. Uhm august twenty sixth okay well that's probably when we'll have it i'll have a brand in send out an official node and confirm that we have other members start here