Alzheimer's Disease and Dementia Advisory Council

Welcome everybody state representative julie maybe a senator clinton pinso unfortunately that delayed and will not be able to be here today uhm but i'm sure is very interested in everything that's going to be presented and will follow up in bull pay attention to what's going on here today uhm first thing we need to do on the agenda is approved some minutes if I can have a motion from someone to approve the minutes from our okay thank you but the view second and all those approved say I opposed thank you next thing we're going to get oh i'm sorry I thought I was turning it off and I turned it on instead second thing we're going to get into our presentations and you might have noticed we had this screen down and then it rolled back up apparently it's not working you might notice that our microphone system looks a little different so we've had some upgrades in this room but any time you change something something else falls apart and so there's some disconnect to the screen so we won't have the screen today so we're going to do it the old fashion way everybody should have copies in their hands if anybody is watching our mind unfortunately what they want to be able to see what we're saying but we're still going to continue you you can follow along with everybody today so first step is the arkansas department of health public safety or public awareness strategy and kenya eddings the director of the arkansas minority health commission is going to do a presentation for us do you want to stay in your spot there you want to go down to the end I am happy to go down okay that way everyone can see you better it seems as if my mike is kind of like louder and then softer is that just my opinion it sounds normal to you okay it seems like i'm louder and then softer and again it's all a new system so uhm. Just wanted to see if it's working correctly okay we appreciate everybody being here today and then the legislators who have joined us we so appreciate charles feel free to ask any questions at any point we're very you know we want the input that's put it that way okay can you take over i'm pleased to be joined by mister tony bailey if tiny wants to join me as well we're going to he says no but I just wall and told him to to join me so while he's coming good afternoon everybody get afternoon thank you for the opportunity to give you a brief update on work your arkansas minority health commission is being doing in conjunction with the arkansas department of health and so I would like to let you guys know there we've been actively engaged with outreach education opportunities whenever we can i'm so much so that um every few months or so we host a community health forum around the state of course you guys know we serve the entire state of seventy five counties this past fall we were privileged to host a community health form in wood of county specifically in august arkansas we brought some of our community partners with us and david cook in his group were with us on that particular occasion and we gave the opportunity for his group to present about all the time which spoke for about in the fifteen minutes had a booth and also provided some out reaching education materials since the end we have been supply frequently without reaching education materials and so of course when we do health fares around the state we always provide the information to attendees we also have social media post that they have provided to us that we posted on a social media and in our news letters and then um we're going to be hosting a community of form this evening as a matter of fact interpreting county. Are specifically in pine bluff in uh miscarely bury in her group are going to be joining us this evening and doing some presentations outreach in education additionally we have begun to notice their some communities are wanting support groups and so we've been actively engaged in forming support groups around the state one in lurak that is to be planned to be announced one in jefferson county which is really to go but we've had some conflicting and schedules um and so we're actively anticipated in a start day for their particular support group and then another one in pocahontas arkansas those of you know where poker heartis is located and so we're still actively engaged on with the community spreading the word about all timers in its relationship to a minority communities communities of color dis- this past weekend I was able to present about the arkansas minority health commission and what we do and then was asked to help present a purple sunday purple sunday uhm is uhm in out which program of the a meal church are both international and nationally in it every year they have out reach education as it relates to our other dimensions for the amy church advocate method is episode of church and so we were approached to help them engage with their audience with their opportunities about their so we will be actively working with them to plan activities that's all that we have for now we're happy to take any questions comment that's ideas and or suggestions david cook thank you I know on the mobile health unit they probably primarily target these underserved communities you know we we did release our county level data last year which indicate that some of these underserved. Communities have a higher prevalence of all summers dimension i'm curious as to whether or not the people who attend the go to the bus uhm are you seeing more questions around kind of declining what what's been the experience in those communities not necessarily questions but when we provide the information that you guys have provided to us it's gone people take it on there are some pamphlets that are remain after our health fairs have concluded but the all timers i'm in other dimensions related uhm information is always mac- not one of the first ago but people take the information with them thank you for that question and just as a side now dumb if there's if you need those resources you replenish absolutely thank you I guess I just sort of have a a general question though uhm how we hear great things in this coup in these committee meetings things that we can do to help slow down the progression of altimores to prevent it to help care givers all of this fantastic health information but how do we get it to the people and I think that's kind of the question that we're we're wanting to look at as the committee is a whole uhm what needs are there with the department of health uh is there a marketing budget is there money to help spread this healthy information and some of it doesn't even take money it just takes making contacts my previous life uhm I worked at channel seven I did the the morning show and we always had guest on to talk about healthy living in and a variety of things it's a matter of fact one of the things that II did was each week I was required by the station to have a report called senior spirit that aired every sunday. Uh dealing with with senior citizens topics that relate to senior citizens and you know is it possible for the department of health or maybe even a cooperation with DHS or even the various groups that are represented here to ask to partner with one of the tv stations or the newspaper in some way to have something that's regular once a month that deals with these issues so we can get it out to the masses and that that doesn't really cost anything thank you for that question in comment we welcome the opportunity and I will take that back to the team in its more specifically to our health communications department to see how they can help us get the word out for sure I mean I just think of the early morning audience the new the noon shows they have all these talk formats and they're often looking for great topics and great speakers and i'm looking at a whole bunch of speakers right here that we know that if we gave them the day in time they would probably be more than willing to share this information with the masses but it really will take someone from the department of health or dhs you know however we want to do this to reach out one of the the stations and say hey can we partner with you on this I see the nine of her stopped away and others so when we call upon you please don't have up on us in don't screen out our cars so yes thank you for that okay just just you know seeing if if that's a possible thing if anybody else has any other ideas I know we've got legislators here and so we discuss budgets and from what I hear they don't have much of a budget to help with uhm uh campaign on i'm healthy living especially dealing with all hammers and dimension that would be a benefit is there is there any money assigned for that specific purpose i'm seeing heads not in this way that it. The I don't have the the answer to that question but i'm happy to find out in report back I see a head notting in the back i'm sorry please remind me of the health department do you do you mind coming up to microphone so you might be able to address that a little bit more you know what what what marketing money is there how is it spent uhm so we previously did have money that we received through a grant the bold grant uhm hopefully on one second do you mind repeating your name so i'm sorry yes sellers and with the department of hell okay thank you so we previously did receive great funding and the the bold grant which did deal with all timers in with related dimensions however when we reapplied for those finds we were not awarded any money so must all of our vending comes from greens that are specific to what you know objectives we have to made and all summers is not fall into any of those other grant objectives they're very specific I know we have a connect disease branch but like our grains are specific to hear disease and stroke or diabetes uhm so if we can make small connections there they're there but as far as I know budget just for all summers or dimensions we do not have the funding but we could make that possible yes and we had correct let me also say we've got two more legislators who who have graciously walked in the door if you all want to sit at the table we'd like to have you there that way in case you want to ask question okay well if you decide you want to ask question I love for legislators to show up and be involved in here it's thank you very much for being here in gracing us with your president presidents today because this audience wants to talk to you new you need to hear you know we want it we want to improve the overall health of our cancens uhm and slow down the progression of all summers disease we have to we have to put some front money prevention is. You know what the power of curve and outside prevention is worth the pattern here we've all heard that right so we need to do what we can get the information now and also some of these new medications that are are available in new treatments uhm it's great that we're learning about it but if the general public doesn't know about it then we've not really done our job so uhm david cook you wanted to say something christian regard to the balgaria one of our concerns as the association is ensuring that the state is prepared in position well to receive that extra level of funding under the core capacity grant and I know our initial application was denied is there some objectives that we failed to meet under core capacity that kept us from qualifying for enhanced level of funding sorry i'm a spoke but that enhanced level of funding david I have to be honest with you i've not seen the score on the application or how it was graded for us not to receive it I just know we did not but I can find that out this were the record just wanted to let everybody I mean what we did find out could so as one of the only or the only state that did not get that in here so funding awarded and so i'm i'm really curious as to work what match more we missed in how can we continue to work to ensure that when we apply again we're able to qualify for those funding cause I think that that would certainly help some of the programmatic work that enhance level of funding under bold certain certainly helps drive some of the stuff that we're talking about forward. I'm sure we will try to reapply when the time comes and it is also I do need to say it's not an award that's given like every state gift card or anything that is very competitive I think there were only eight enhancement grants given to our us so I do want to go on record is just saying that it's very competitive for us to receive that I think senator love had a question. Thank you madame chair you know in canada some of them. I guess little research said on doing in our summers something came up to me it was alzhemo's type three diabetes right there the idea that the **** armises tactory diabetes in our line for a year one of the expressed if if they could speak on the in the reason why i'm assonished because missiles you did say that you are head funding for gibs correct years again the greens very specific as to what types of diabetes we are addressing okay these connections in these links but so so if if if someone could I mean one of the one that the more season okay doctors are addressed in the number number two though before before doctors are speaks uhm king in regards to the minority health commission I know the then we don't touch on our summers that much but is it possible because I know they're weaking as a doctor yes sir could is it possible that there could be one of the topics that are there and is talking about in regards to yes sir thank you for bringing up their bringing at that point uhm the arkansas minority health commission's house a radio program every month on the third tuesday of each month on the largest urban radio station in the state and we have a partnership with a mdpa they provide us with a physician or a health care expert each month to talk on a specific topic so for example this month is colored on the camps are awareness month and so we had a physician on to talk about colorado can't see we can do the same thing with our timers uh senator level definitely do there thank you. And and what doctors are instant question about type three diabetes and it's connection to all timers so directions of any type. Destroys blood vessels you know it causes increased thickening of the blood vessels causes that terrorist claralsis and basically one of the reasons that mother multiple doing reasons but one of the main reasons is that you don't get black flow as good and the brain as you would the other issue is with the glue course with the high glue course the high glucose itself also damages the blood breasts goes as west color patient which occurs in the paraphrase the brain blood vessels are very very tiny very small so they get damaged also uh so the tendency and died bets to call it a another kind of as I must disease is basically advised down to the vescolar effect of diabetes on the blood vessels which then reduces the black flow reduces the oxygen nation empairs even the delivery of glue cause to the brain the blue the brain trives on glue course it prefers to use glue course as a new nutrient if you're not getting but in dibits where there is insulin the weather insulin sensitivity is reduced and you would not have in glue course transfer from themselves to the brain which is the brain requires for nutrition then you will have problems so if you don't have the glute good blood vessels you cannot transfer the glue cause you try cannot transfer the nutrients to the brain then you will have the problem because already there is there's issues with metabolism in the brain in fact a lot of these dimensions if you do a pack scan the show high former tablism reduce metabolism in different parts of the brain so that becomes just uh more severe middle ibts so yes uh in in many different phase diabetes can affect the brain so. It is being unit has become what I would say more fashionable to colleague uh at type that diabetes as a type three dimensions I must disease but it can affect any dimension not necessarily as much disease it can affect any kind of dimension whether it's message dimension from the temporarily any kind of dimension the diabetes will affect the brain. So they cannot can ask this if you have a party of darb beaties how likely is that she will have dimension or alzheimer's. It depends it depends on the severity depends on the control of the diabetes how bad the control is the person's controllers uhm how far how long they have had the diabetes so it depends on many many factors so I can't give you an account and give you whether sensible and dependent where that they have been on order to hypothetise similar and whether they've had it for twenty years and where the test been well control if it has been well controlled uh the likelihood is not that high but if there's also car diverse clear disease the likelihood will increase the way you want to speak more to that. I think that point here sorry. The point here is that having diabetes that in of itself independently. Our pragnasticate whether you are going to have cognitive and pyramid and dora which tie whether it's going to be alzheimer's or vatican or front of temporarily what it does say though is it increases you risk factors but we already know that we know how blood pressure increases your factor to heart disease increases your respect to but if you pay attention and you do everything useful still which was supposed to do anyway uh you know will be a much fer shape but but that does bring up the the questions senator though if if if there is this connection to diabetes or even better heart health cand can some of those grants be utilized to also take the step further and show the connection to all timers that that good heart health good uh making sure that you're taking care of your diabetes that these are the reasons why you want to do that you know can can somehow the money that is there be utilized in some way to bring in this part of it so I would think fno uhm yes there are ways for us to incorporate some small things but because our objectives really focus on um preventive electronic it's more unlike uhm self-management and some things like that uhm it could be a little flexible but we couldn't like it can't go more anything like that but there's probably some small ways we could incorporate some additional messaging but again it really has to do with how the grant uhm what is intentions are for us to meet those objectives I know that's kind of debate but it varies yes i'd like to follow up on that the reason that we're still kind of struggling with this is because it's only become recently appreciated. There the blind vascell which are the highways and super highways that allow us to train sport the new tree instant oxygen if there's holes in the road we're not going to get as good a train sports so for example look what happened to the bridge and baltimore you heard about that now something like that happens so if we have a stroke we have a regular heart with them we're not going to get enough oxygen and nutrients so we're not going to be in good shape and if it happens more than than once if we happen to more frequently we are set up if you will and predicts false then because our brain cells in the brain day a very very many complicated messages one of which is if yourselves have been injured they get more ready to counter go away and be a very sincere so in other words yourselves and you party of the getting good actually getting good new trees and they're done fantastic to go and gain busters for if they're not getting enough supply the organisation you know this isn't working now we might have to bow out once they get that message and wants to sell to get that message they start to get ready and i'm now talking about steps in self. I decomposition of your think about it that way you know we're very efficient our whole body is very efficient so there's a way that we can sir can conserve energy for the rest of the body some of the cells will say okay you know we're gonna bow out so the best thing is that nap but that happened and and the best thing is not to go there pathway but some of the cells will and that's what we're going to see when we don't get enough oxygen or nutrients k representative of why I think you've had a question you've been waiting patiently yes when that's just fine maybe just to touch just a little bit on only that basis one also to wallace in a overnight the state were loaded up with with percentage was of people that probably are not eating iraq kind of vote so there probably needs to be some good education in that area concerning that but going back to what she was speaking about on the greens just wander representative maybe is this a matching growing at our issue just for one hundred percent comment from somewhere is it spare of do we need to come up with ten or twenty percent or something like that it's it's cdc funded federal point hundred percent thank you and II have a question that I know you're probably not going to want to give an answer to so i'm gonna throw this out there and maybe this is something that you are can think about and come back to us it would be too late for this session anyway but as we start planning for a budget for next year you know what is and if we don't get a bulgaria that would help you know do some funding for public awareness what is that dollar amount what what is needed what what would help us do a good marketing campaign on the issues that we. Tried to address right here so I think that would depend on how much marketing and what type of marketing you're looking at doing uhm we have some small like educational campaigns that we can do that are you know a hundred and fifty thousand dollars and then we have large educational campaigns that include commercials and lots you know of outreach and websites and phone numbers and they're close to three million dollars so I think it just depends on what the goal that the group would be as to what kind of pending we would want to have can I ask that may be by the next time we meet that may be there are some fire on three different levels of proposals uhm it may be a motion from this committee that might ask for this uhm i'm just speaking out loud you know one that would be very a smaller one this is what we can do with a hundred thousand dollars this is what we we we would like to do maybe something in the middle and then something much larger you know pie in the sky which we know probably won't happen but you know it's kind of nice to know this is this is the whole shaman you spend a little bit of money now and you might actually save a whole and not just save money save lives and help families and and I don't even just mean the patient themselves but the entire family someone who doesn't need the care giver in the home as quickly as they they do now that saving us money and and helping care giver so I mean there's a big issue uhm were article in the paper just last week uhm about how all timers effects the caregiver and their help declines and I kind of shared in that story how my sister who was taking care of my mom put off all of her health care and media after my mom died last year she's now almost on her third surgery because her body was falling apart and she worked through the pain and. You know care givers put all that stuff because they're doing what they can do you know so anyway they're II know it sounds like a lot of money but if we can prevent some of these other problems and families fall in a part it might be really well worth it so can I get a motion maybe from this committee uhm from someone who might say that we would like the department of help to come it doesn't we're not approving any budget we're not we're just having discussion about it so we can think next next term what what does this committee what to do in october we have to put it together uhm presentation a packet that we give to the legislative bodies and and the governor in maybe this is one of those items that's included in here this is our wish list so is there emotion maybe from someone david motion for that and uhm jennifer to second thank you i'll in favor I anyone opposed thank you okay so three three and what that would include uhm just so we can have discussion in and say hey this this would be really helpful so thank you okay any other questions who move on is the next to the ten sorry mister bailey I wanted to give him a did you have any things. No other questions there okay well yellow dismiss thank you so much I mean not dismissed from the room it's less from the hot sea I would like to mention we are having a community health form in deficit county this evening so I would need to be excuse at that time so thank you thank you so much for your presentation and for being here today okay so next step is david cook and he does have a package that you are can look at again we don't have our big screen uhm it's exhibit d one the facts and figures. Report that comes out every year and david it's going to update us and the state of all timers disease in the state of arkansas. The. I come breaking stuff down here david cook director of government affairs the assermore association just wanted this here with the council and i'm also taking on a new capacity within the association they i'm a research lead for our state and so basically what that means as I do have access to our uhm the latest summer research that we're seeing and email to present to that to community groups or even this council that give you the latest update some what we're seeing and all summers research but i. I just changed my password and I cannot remember it. Day but you can use to hand out two more coffee while the however on the screen it's totally you know last week on on wednesday we did the alzheimer's association released our annual report it is a national report that highlights the trends that were seeing in alzheimer's and dimension prevalence across the country this report as well as the accompanying report called mapping a better future for dimension care is available for you to review and access at a lc dot o r g slash facts you can also download the state facts sheet there in access the bigger larger report and so i'm going to give you some of the top line findings of what we learn from this reports currently we know that there are six million americans over the age of sixty five who are living with all cymers and that number is expected to surpass thirteen million by twenty fifty. Uhm the the cost of all simers disease in this report is is not sustainable it is you know it's it's reaching three hundred and sixty billion which is fifteen billion higher than it was a a year ago mortality mobility of all cymers continues to increase and has increased significantly over the last twenty years uhm in this report we also looked at the domentic care work force including categories of democratic specialist and direct care workers and at the current rate it is not keeping pace to meet our future demands which is concerning in our special reports we discuss specifically around we did some care give her research and we found that dominicare givers really want and need help navigating uhm you know the current health care maze as you all know now beginning the health care mays can be very complicated and if you add the burden of dimension on top of that it becomes even more complicated uhm on a personal front my dad has six doctors he is in the va health system but with each doctor comes an appointment in what these appointments in some cases ask to drive all the way to the little rock for my dad to get seen so it is complicated and then also when that reports we did um interview healthcare workers and six and ten and sixty percent say that the us health care system is not effectively helping patience in their family's navigate the health care system on prevalence again the number of americans uh sixty five and we're living with all cymers is expected to double uh by twenty sixty so it is again prevalence continues to climb in sore at unprecedented rates when we look at the gender and racial differences in our cymer's prevalence almost two thirds of those with all timers uhm are women older black americans african american african americans in hispanic saltinos. Our disproportionately more likely than older non hispanic whites to have alzheimer's or their forms of dimension populates these are population based studies uhm for other racial groups are needed as well so there is a gap in our data to do more intense population based studies if you look at state prevalence here in arkansas just want to highlight a couple things state prevalence numbers for our console is based on twenty twenty data and we pulled this based on a report that we released last year in a I see which allowed us to provide to you county level data for the first time in so our prevalence is based on the twenty twenty sensors we did not include a forecast of numbers in this year's report we left that out because the methodoly methodology changed and we didn't want those numbers to be skewed and so they're they're looking at forecast numbers for its but here in arkansas twenty twenty and estimated sixty thousand four hundred seniors were living with alzheimer's disease or also much dimension and that number is five thousand more than our original forecast in twenty twenty based on the new methodology this is a more accurate picture of what was happening in twenty twenty so eleven point three percent of it all over sixty five are living with all cymers among people age seventy sixty one percent of those with all timers dimension are expected to to die before age eighty compared with thirty percent of people with with all cymers and without all summers and dimension we are also solve an increased prevails in mortality between twenty twenty our scheme between two thousand and twenty twenty one uhm all cymer's deaths increased by a hundred and forty one percent uhm while deaths from the number one cause of death which is cardiovascular hear disease. Actually saw decrease here and we you know here are console we we still report it as the sixth leading cause of death among individuals age sixty five in older uhm on a national scale is the fifth leading courts of death among individuals age sixty five in order. As we've reported previously if you're keeping along on the slides I am when we just keep along the sides with you so I know page six top of the page what we did will be have reported previously in what we do know based on research that also is a slow in a very burden some disease and it begins twenty years before more before the onset of symptoms people over the age of sixty five uh survive and average of four to eight years after receiving a diagnosis yet some can live as long as twenty years at age eighty approximately seventy five percent of people with all summer dimension will live in a nursing home compared with only four percent of the general population of those over the age of eighty. And of course the long duration of the disease significantly impacts public health and of course the cost of care on our caregiver data we reported two thirds of care givers are our women uhm one third or daughters there is also some data that supports one in three care giver speaker being millennials or category of king care givers that it's on the rise called sandwich caregivers and these are individuals that care for an aging parents and also have children at home so they are you know parenting but also carrying for parents that the number of those care get versus on the rights in some cases that causes the fiscal impact because they have to leave the work force to tend to care giving guides about one and three caregivers is over the age of sixty five more than half of primary care givers take care of their parents in the acc on the side there one quarter of dementiary givers that's the same so much generation I think i'm spoken said one in three. Uh I think what significant for for our console in this uh uh again is represented in some of the preliminary data that we pulled from the are consolidated mentioned here give her respect grant program so this is consistent that forty one percent of here give us have a household income of less than fifty thousand i'll talk more about what what the data we found in the the respect grant program that I want to share with you just a few slides in terms of of care givers more than eleven million americans provide and pay care for a family member of friend living with dimension the value of the care they provide is estimated at three hundred and fifty billion dollars to the country again we didn't some data on race and ethnicity of care givers uhm two thirds of all care givers are white ten percent black african american eight percent or hispanic five percent or asian americans in the remaining ten percent representative variety of other racial and ethnic subgroups african american care givers are more likely to provide more than the forty hours of care per week so not only our african americans and let's see a population that burstly impacted by alzheimer's demetre their caregivers are in their family kigger bizarre as well i'm afraid american rich of caregivers sixty nine percent report less likely these respite services compare with their white care givers that's certainly a trend that we are seeing here in arkansas hispanic black and asian american dimension care givers indicate a greater demands on care less of a you know similar less uh report less support services and greater numbers of depression compared with their white counterparts. And you can go to page eight uhm the state care of her data market sauce one of fourteen states that was able to uh base their data on updated data that we we see from the behaviour is factors available survey and so what we reported it's more than a hundred and fifty five thousand or kansas provided two hundred and seventy million hours of unpaid care for family member or friends at a contribution or a value to the states at over four point four billion dollars um so the role of our family care givers to the health care system is great and I have shared with this council multiple times it will repeat it today uhm that I was so pleased and encouraged as many of you were that when we drafted our alchemist and it mentioned state plan we saw the need and identified the need for family career for supports and we addressed that by pulling that out in its own section and so what I want to do briefly today it's provides some preliminary data in findings that we have pulled from two years of performance on the arkansas dimension respect grant program again these findings are preliminary I am working on a much larger report to have available to you that I hope to have finished by our next meeting date I did put in our console map on there I did drop pins where grants have landed here in the states and as you look at the map it looks like there's pretty good state why coverage but what I want to identify is that the majority of the grants in fact sixty nine percent receives me sixty four percent of those grades where isolated in the metros so even though a pin may have reached the northeast corner of the state a very few grants are going to underserved in rural communities our grand administrator all summers are console inside the grand program. We did identify that the threshold for rural service was thirty percent in in this last year they actually hit thirty six percent rural which is a four percent increase here over a year so you know we reached a little bit more of the populations but quite frankly there's not enough funds on the current funding level he is not sustainable I do also want to add that our great administrator has in the first two years of the grant absorbed all of the administrative cost for this disseminating this grant so I want to make sure that the councils aware of that as well in the last two years that's the case in the first year and also this year the funding is depleted by march we are out of funds uhm we hit the goal last week and so over four hundred and four hundred family so the max number families were able to serve uhm the department of human services actually finds this respect grant with the federal block grant so we are not tapping into state general revenue to support this initiative we also did report that if you look at some of the similar programs and surrounding states uhm kensus has a grant program that is similar to ours they are appropriation which seems to be moving and likely to get approved this year is in the neighborhood of eight hundred thousand so we are at two hundred thousand as a state missouri's grant is a little bit more expensive than us and allows care givers to do a little bit more worth their great their grand is a thousand instead of five hundred dollars but they're funding level is four point one million dollars and there are neighbor to the east of us and tennessee has a grant somewhere to ours they funded at one point three million and mississippi's appropriation is sitting at three hundred and fifty thousand which we are expecting it to get funded this year as well give it comparison to how their states around us are supporting their care givers. Uhm can I ask you to say that again unless i'm missing is that written in am I missing it it is not written additional information I don't do you mind saying that again I was trying to draw it down and II just wasn't quick enough sure so and it's important information to hear what other states are doing in compare the sides of their state and even what they're uhm all timers uhm you know anyway should tell it again you can't their program is is almost identical to ours and there's appropriation is at eight hundred thousand we do expect it to get approved it's moving through their process right now so this will be their first year but they're they're going to fund it eight hundred missouri is not apples to apples because their grants is thousand dollars and but it is funded at four point one million dollars annually care givers are also create given the opportunity and in missouri to pay for household items such as adult dipers or medical equipment that they might need for their love one where ours is reserved just uh solely for respite but an apple staples comparison over and tennessee there at one point three million dollars and then mississippi um there appropriation is three hundred and fifty thousand. Okay thank you I got it charted down that time what we what we learned again these are premium limiting data what we learned is that in the rural parts of the states there are care givers who are having issues actually obtaining a very common to the house and so there are some access issues in our parts of the state but what I do want to report to the council is that when we first presented this idea to the state legislature on one of our goals was to reach a population of care givers who made too much money to qualify for state medicaid but did not make quite enough money to be able to afford uh someone you know to pay for someone to come in and provide that care I do want to report that eighty nine percent of the great recipients in the first two years were not medicaid eligible and so in the funding pocket is II did not just this number down i'm i'm going to estimate here so purely estimation it's seventy five to eighty percent ball park of our great recipients make an income of less than seventy thousand dollars a year so we are hitting the target population we intended to hit as we think about care gibber initiatives and have a better support our caregivers you know we need to take a more comprehensive approach uhm this is the our service association's recommendation that we take a more comprehensive approach to respect care here in the state and begin to identify individuals who may qualify for medicaid but are not accessing the rest but benefit under the waiver and then try to make sure that we are capitalizing on you know the fed funds that we have for respect and also our state allocation that are specific to dimension the use of in costs of health care as you can imagine continues to increase in in twenty twenty four health and long term care costs for individuals living with off. Simers and other forms of dimension is projected to surpass or reach three hundred and sixty billion dollars um and it's it's current rates certainly we would argue that the spinning levels are not sustainable it is one of the costly is conditions to society and the US economy and project to base some projected future cost the association estimates that by twenty fifty those costs will reach nearly one trial dollars so as prevalence continues to rise the cost of cares is not sustainable. I'm not going to go over the break down but you can kind of see on the sheet there where that that costs us come from you know out of pocket costs other cost as well how that's broken down nationwide more than the million additional direct care workers what we needed to uh feel service gaps between twenty twenty one and twenty thirty one so in the next seven years more new workers than in any other component of the american work force. Uhm despite recent growth direct care work for shortages are very significant and certainly a concern of the association they play a variety of vital role in charity for people living with dimension in private homes they services residential facilities and school nursing in other settings uhm between twenty twelve and twenty two um there was an increase of direct care workers from three point two million to four point eight million but what job growth is reflecting for us is that there is a preference for families to age in place in public policies and funding across the country in recent years have focused on expanding access to HC b s services uhm although really sizable these employment projections probably are way short of the demand on the work force turn over rates are again one of the factors that remain high uhm but here in arkansas locally we suggest that to build the service gaps that are are going to exist will need to increase our home health and personal carrier work force by nearly thirty percent percent by twenty thirty which currently stands at twenty one thousand nine hundred will need to get to twenty eight thousand three hundred and fifty two just to fill the service caps that we see. Yeah. Uhm in our special report we just uh one of the other things we highlighted was a lack of dimension care specialist or consultant has fifty five uh jury attritions currently to meet the debate and we are one of twenty states that have been labeled a dimension neurology desert and so we'll need to increase the number of practicing juritritions by a hundred and forty three percent to care for the project the projection that we see hitting us and twenty fifty harm so more specialist are definitely needed. Uhm in our special report it focused on mapping a better future for dimensive care navigation uhm just won't go deep into that but a lot of this data was based on the emergence of cms approval to a guide model which will incinevise providers to take a more comprehensive approach to domenticare um arkansas does not have a health system yet that we have identified who is willing to participate in guide it is an eight year study and so we are looking for health systems to become sight to test the guide model uh cause we certainly see that there might be some benefits to improving patient outcomes and also ease the burden on family caregiver should try and to navigate a very difficult health care what we did in this report as we conducted two nationwide surveys of domentic care givers and healthcare workers who are most likely we identified as being most likely to provide care navigation services so mostly nurses social community social and community health workers there was a survey of domension care givers including responses from asian black hispanic uh native and white americans we looked at several issues care givers health care workers their experience their exposure and their attitudes on domestic care in abrogation we also looked at domestic care and abigation services and supports that are provided uh what are needed and the benefits of the medicare navigation for people living with the disease and their family care givers uh we also analyze barriers to do much care navigation some of the key takeaways is that the mitual caregivers wanted to need help navigating the healthcare system as many as seventy percent say care coordination is very stressful costs of care and care coordination are again the top stressers for domestic care givers with the vast majority of dimension care givers. Ninety seven percent saying having navigation support would be helpful for dimension care givers roughly eighty five percent say having access to a care navigator would influence their choice of a provider as well. Uh some of the key takeaways from the health care worker survey is that sixty percent of workers surrey say the current healthcare system is not effectively helping people who are living with all cymers or dimension or their caregivers navigate dimension in half of these providers say their employers are practices in hospitals do not have a clearly defined process for care coordination in clinical pathways for people with marking different parameters from all cyber's disease or or their forms of dimension and many of these workers are helping to make secure give us address current challenges reporting seventy five percent of health care workers uhm say the assistant caregivers uhm but they have no formal domentic care training we did highlight some of the top line statistics for you to review our briefly go over each one of these uhm these are some of the top stressers that we heard from the metric care givers again stress of coordinating health care as one of those that causes some of the greatest stress uhm again that difficulty of uh navigating the health care system and finding access to career for support is also a high stress or for dimension caregivers in terms of the top stressers for receiving dimension care that we listed those out on the the screen for you there at the top it's again worries about cost coordination with multiple physicians uhm that can be difficult making sure the physicians and the special store communicating together about prescriptions and adverse impacts of prescriptions that certainly an issue i've had with my my father scheduling and helping with appointments again as one of those top stressers as well certainly can relate to that with my mother's experience in uh we also included for you the health care workers who are most likely to provide this this navigation support again majority of them are nurses. Uhm second to that is social workers there is emerging group of health care workers here in our console that I see as a potential to identify the utilised to help families access services as well some of the anticipated outcomes for care recipients who actually receive this service uh sixty percent say improvement and a quality of daily living improvement of of health uh if you can remove that stress that gives up more time to tend their own personal needs reporting of dimension so there is some outcome some value for the caregivers if we can give them a little bit of assistance in navigating again a complicated health made in the outcome for a dimension care givers who receive uh kill giver number one we think reduce of stress giving them more peace of mind comfort knowing that they're in good hands helping uh them be a better caregiver to the care recipients improving their mental health in canada see the other anticipated outcomes for dimension care givers who receive current navigation. Uhm some of the navigation services that dimensive care givers identified as being the most valuable uhm number one is is having access to a twenty four seven support or help wine to call that is certainly a resource that the service association continues to advocate for as we we do have our help wine that's out there so we do a lot of outreach to positions to make sure that help wildlife in the hands of uh dimension patients will boss given that to providers and it's open twenty four hours today seventies a week it never closes and when someone calls that they're actually referred and connected with a master's level commission who can answer their questions and also connect them to resources so it is a valuable resource that we have available uhm so they they they are identified that has been more supporting a coordinating care communication with second to that and you can read the list they are help understanding the careful recipient's condition and of course assistance with insurance for public benefits as well. This is some of the time spent and that we see on a navigator type services in the percentages of patients who have continue issues uhm so you can call a read that there and here's some services provide the support domentic here for patience and their families again referrals to community services is high on the list that was actually identified especially by non medical professionals being able to refer someone to support services i'm helping with emotional and cultural support again what's the top uh thing identified in in screening for safety needs was actually identified by medical professionals being important as well. And the most valuable services in supporting dimensional care for patients in their families already talked about that just them here the health care workers views on the effectiveness of the mental care navigation many reports so more effective uh some say it's not that effective on the other organizations effectiveness of helping dimension patients and in family navigate health care eighty two percent say that it's effective as well here's some of the barriers that we have identified nationally and I think there is a correlation to what we have seen in our experiences in arkansas again lack of uh community based resources for dimension care givers that is certainly a concern as a barrier current payment models do not incidentalize care coordination so we we operate in a fee for service model which is why the god might the guide model excuse me from eighty cents is so exciting because it does incentivise more care coordination among physicians making sure patients for the cracks health care work force training is certainly uh an issue that we've addressed in the slash legislature here in arkansas will continue to watch our dimension training standards uhm and then lack of train practitioners as a tread that we can we need to continue to watch here in our council as we experience our own health care work force challenges so I will conclude in summary and be happy to take questions as long as you ask questions that I can answer the twenty two to four facts of figures reports for really deeper insights from different secure givers and the health care work force about the cour- state domentic care navigation of course the studies show that effective dimension care navigation uh can improve health come outcomes for our patience reduce cost in uh lesson. Uhm caregiver stress the mitchell care givers would welcome uh demonsecure navigation and see the value in its formalised dimension curious navigation programs are not widespread currently but the cmass pilot program that I mention the guide model could help build us momentum for some sustainable change and most importantly we want our facts and figures report in our special report to be a catalyst for that change so we do encourage health systems you know the state legislatures practices ten enhanced to match care navigation out people living with the mention their caregivers so we want this to be a resource for you but also inform our work going forwards not only as you know the legislature as you can continue to meet for the fiscal session and in the future but also we want us to be able to be a resource for the advisory councils we continue our work for it as well with that i'm happy to take any questions. You need to take a breath and get some water replenished that parts a lot of talking so thank you that really there was a great no you did great i'm just saying that's a lot that's a lot to share you you need a break for desert as a second we need to give you a second okay I think is that channel representative brian with his microphone on the especially thank you once again representative maybe what david what you were here early in your spaping was that seventy five thousand dollars so i've heard someone in this wake that that that put them in a real bad condition and it was just barely over the seventy five and I just wonder representative may very if we could do a little research to find out how long it is being in since the federal his actually reward their figures to show a hard right because you know for five years ago you're seventy five thousand dollars was a lot of money seventy five thousand dollars is not a lot of money in nowhere in there a lot of folks are following in this day up and I hope that we can get some help for these folks representative right might need to clarify on the seventy five thousand III was saying that those participate in the divisive care respect program that we have just disper- clearly that does not have an income we did not attach an income requirement II was merely reporting on what we're seeing in terms of their self reporting income levels the majority of them do you have an income of less than seventy five thousand and II actually cited that statistic just to state that we are hitting our target population with the the respect grape program we just do not have enough funding to hit enough people and so yes you know the funding last us from july one to march in the first two years so we're not reaching enough people but we are reaching the internet target which was those individuals who made too much to qualify for medicaid. But did not make enough to quite be able to afford on their own the high cost of bringing someone to provide that care so I want to clarify that II don't know of chick who has any thoughts that you want to share on that is there a threshold making too much to qualify for medicaid and when has that changed I think that's kind of the question that representative I was. Asking about yes it does that excuse me that it is kind of a moving target if you will those that's medicated thresholds now i'm happy to go back and get the most current information represent event with with respects to how often those those uhm those maximums that you can make for qualifications change but I will i'll represent that as i'll see if I can bring that back to council maybe if I can get it sooner than our next meeting I can send it and then it can be set up to you to the membership thank you any other questions that birth are david is the in the slides beach thirteen onwards all this data that has been gathered is it from our concert is it national. So that is a great question it is based on our national survey that we did so it's it's it's national data that we pulled for our special report on that focus specifically are mapping a better care of our teeny mapping a better figure future for domension care navigation so this those are national members. So II have another common just a kind of a general common that you know there there's a lot of statistics on this about as a most disease and what uhm the numbers are what the percentages are everywhere even in our concert and I think it is very difficult to diagnose and really say if someone has as I most disease so i'm wondering how accurate these numbers are because. Primary care providers don't know how to accurately diagnose and we know now with uh now my presentation will go next we know now how big fuddling it can be and how difficult it can be to separate as I must disease from bescle dimension something else leon I don't know how how reliable these numbers can be saying that all this is really as I must disease what do you think I will say that that's a great question it is a question that I we often get uhm we'll say the new methodology based our prevalence numbers are using the sensors data and there is I could get in the the weeds about the methodology of how we came up with that prevalence now data but it is based on on sensors and it was based on a study that we produced last lesson are happy to give you some access to that but I would argue that those numbers are possibly soft and very conservative given the fact to your point that many of the cases go on diagnosed some do go misdiagnosed but I would also continue our base that hypothesis on seeing some of the higher prevalence for its factors that we see across the state uhm high numbers of diabetes obviously heart disease all of those you would agree increase your risk of the getting dimension and when we look at our county level data II would argue that our numbers are probably very conservative the numbers probably much higher than that and again this was based on twenty twenty data so you know we've got a four year window there that it could be much higher than sixty thousand four hundred and also I want to point out that the sixty thousand four hundred are only individuals who had also over the age of sixty five so it does not include those who may be living with another form of the measure are those living with younger on set all cymers as well. I don't know about that I would spend me with the bill sitting downs that's what okay. Okay so everyone has heard about that can be or like and a map that generate can be is the brand name drug and it was approved last july full approval from fda this was based on a multiple center double blind randomized political control critical clarity that assessed the afficacy and safety and patients fifteen to ninety years of age with earlier most disease. So there can be slowed the rate of disease progression by twenty two thirty percent after eighteen months of therapy the second page since it was approved july we had been working hard at you ms to try to get a protocol together to get ums pharmacy and theoretics committee to approve it initially they have a very against it because of course the cost. And how we have you would manage all of this so they had totally disapproved a dead and a cuna member before so it was quite a struggle to get most pharmacy interpret experienting committee to even look at the proposal but we wrote a protocol. And have to several meetings they finally approved it early this year. And that means we will be able to give legal can be at um so the main on the second page the first light the main eligibility criteria inclusion criteria for let can be is that you must have a diagnosis of my cognitive impairment or m c I or early states dimension consistent with as much disease it cannot be any kind of dimension it has to be observed as disease and this is demonstrated through clinical assessments and your cognitive performance made them many mental standards examination between twenty two thirty score on malcasco fifteen or more these are screening cognitive exermination schools. An addition there has to be part of diff- biomarkers for blane brain amalitatology this needs to be demonstrated either with an amality pet scan or a positive see a substance now these eligibility criteria their death put down here are based on approved use recommendations by our comings and other investigators two thousand twenty three these are the nationally renound investigators on as a must disease they've put together that these recommendations based on the let can be studies that uh the uh company is I did so at ums reincorporated the we have incorporated increased safety features on in these recommendations especially with regards to all the age patients and those with other commodity conditions diabetes included one of the very common conditions have potential guardian wesco disease so let's go to the second slide on page two which uhm addresses biomarket confirmation of as a most disease so every suspect that someone else as I must disease how do we really confirm it so it is not just you now we don't leave it now to educate it guess because in the beginning all kinds of dimensions in the early stages that look alike very much to like everyone has forgetfulness the forget people the forget things and the worried they may have as much but is it really a thermos so how can we confirm that they're only two ways right now for the eligibility in which we can confirm it we can do an amality scan or we can do cs final tap and for the mill and either one is participated then the person is eligible for monoclanal antenna body therapy or let them be infusions so here you have the uh pictures of the brain and you you will have a photograph of the pets can then you can see it because this is black and white. But if it was in color you would see that the uhm on the right hand side the brain image has more red and it is appearing as black on the sides which is the emma lied and when uhm the let can be treatment it's given the monoclone and antenna bodies bind to their malight and they break it up and disall it and then you have a clearer email like that scan our page three so the diagnosis of as I must disease using that by a market we just see a seven by a markers so csf biomarkers as final tap is done at you ms we do the number puncture and within three to four weeks we have the results we send the cs to may or clinic for analysis. So on the left inside you see the amount tangills and we need it is that I am a large place and we need this is that tow tangiers and in the certain result that we get we look at the ratio of beta to be to emiliate and if it is more than point zero two eight then it is more slightly as I must disease so this is the other confirmation now in ca- if we do get their ratio to be positive it doesn't mean that other concurrent pathologies do not exist in the brain the bus and could still have escalate dimension the person could still have a tow betty the person could still have looked by the dimension of our frontal temporary limit so but however there must its present now if this test is negative that individual has memory issues then they have cognitive issues and dementia but it is not details there must disease uhm plaza by a markers are also a reliable but they are not part of the eligibility criteria the only two legitimately criteria that we are using are the email like that scan which uh by the way is a believable in our concern in spring deal in highland and college previously we were sending patience to members of the dallas for it. The plaza biomarkets will probably be available next year so what are the important treatment considerations when we start can be treatment the most very important treatment consideration is that we have to have the care diver involved the carried about the care partner the family member friend whose their staying with the patient needs to be involved throughout the process because we will need them to support the person and to monitor the individual and uhm at the bottom of the slide is how it can be infusion schedule it is given every two weeks it can be given in the steady it was given for eighteen months whether the patient for you get it for eighteen months it depends on how the patient tolerates the treatment there are several emotions in between which are recommended for safety reasons to look for emily related abnormalities when the treatment is given an MRI will be done at baseline or within within a year and then it will be done on the fridge in future and seventeen fifty and fourteenth and fruits and end twenty sixth infusion before then fusions. So the next page beach for the additional criteria inclusion criteria if you receive one to receive a can be there we already talked about that it has to be early stage dimension there has to be a willing care partner who will provide support for the treatment you have to have a brain amarette proceeding that can be treatment and now the patients there who were in the original study on which these recommendations are based they excluded patience who were very uhm and who were underway or will be so we use a beer my cut off of seventeen less than seventeen we will uhm probably not consider the patient more than thirty five it will be on a case by based its basis and that study originally the newspaper is between fifty two ninety I will lower the threshold that you ms to even forties because I am getting patience a number of patients who are in the forties and have confirmed by your market confirmed as disease I would prefer not to have patience it in above because they have more cardivescular issues their blood vessels are very fragile and they're more likely to believe which is one of the side effects of the treatment we'll get a best line and we really get the MRI throughout of course if the patient is in child bearing age eh for these while even less than forties we will have to make sure that that they are not pregnant they're not lectating because the drug has that i'd been tested on that there are many many exclusion criteria for this uhm drug because it can be hazardous. Patients who have don't have as much a disease but have some of that kind of dimension like west philly dimension will not be included in industry in this for infusions basins with more severe assignments disease will not be given like an americans with psychiatric in this uh the severe medical innocence patience who very prior strong speech in who have more than a pin point hamburger on a number of smaller hamburgers basins with iron the position in the brain we can with a dima patient with several emily and geopotic patients who have had ATV I trauma to the brain and suffer malaysia they have annualisms c n n's infections to mars and then opinion to add epilepsy of any time and they will not be included because one of the side effects of the drug is that it can cause a periphery so all these and then the patient who is going to be eligible for this needs to understand that all the risk associated with the treatment and so they have to not be depressed or have you know some people when they get a diagnosis of those are must disease it is very devastating for them and they can even be when you disclose it they can even be societal so and and that has happened so that that is one of these criteria that's why we have an interdisciplinary redeemed with social workers nurses of uh physicians systems new psychologist and everyone there to support the patient and the career and to made them understand everything about the process of the treatment so that don't go into it blindly so at their on page five there are other exclusion criteria you can look over them but mainly it is any other immunological disease in which there are and we know some presents to rides. For example romanto that's right this is an and we know logical disease any patient on bleeding who has bleeding disorder locally clears on enter core glance those on a truth of relations between switzerland failure patients with the you know liver disease or kidney disease which may be severe enough that they should not receive this drug and patients who are have substance abuse or alcohol abuse disorder so at the bottom of this page five is the with their schedule usually we will have for visits the initial visit will be a screening memory valuation like a more catastrophe mse physical examination the view of drugs pass medical history then we will uhm talk to them about biomarkets the scans those will be ordered and third visit we will discuss all of these results the biomarkers we will talk about uhm apple etesting which is a genetic testing it can be home as I guess you can be home as I guess for this gene apple eu he cross I guess the people who are home as I guess a more more than twice the risk of developing side effects due to it can be uh visit four will be the entire treatment plan in discussion with the candidate of a present and the sufficients of the agree to it they will be redisturbed with the uh let our network so that they can be the treatment uh and research can be monitored in fusion with that uhm will be the the visits that we will have for infusion will all be carried out the broker fell against institute where we have infusions for other cancer demoterpiece and then staff it's very well trained with all kinds of hesitants chemotherapy infusions so that's where we we will be doing the enfusions in addition to the staff over there we will have staff from our memory care unit also president there and for the for the first infusion I will be there. Thereby the better said of the patient because I do not want any of our patience to have an event there for which I am not available the patients will be monitored for the what's the first infusion but subsequently if tens go wrong don't go wrong and they're okay then we will reduce the monitoring time. Then pete six the side effects of like an america twenty six percent of so of the patients have common infusion reactions they are headed disaster confusion nausea uhm they may usually all of these reactions resolve within twenty four to forty eight hours if the persist of the more severe uhm then we will of course stop then fusion and really monitor the patient that can be serious side effects also and serious side effects and be very serious including a pelepsi stroke a stupid and they may require admission to the hospital on or even the intensive care unit uh of the side effects that for which we monitor the patients which sequential MRI called emilie related imagine abnormalities or areas for shot so area there are two kinds of areas actually area e and area it's the e in the area stands for a demand bring a dima the it stands for hembridge so area can be a pretty significant because with the demand that can be all sorts of green enough bringing issues are including stooper and and be between become can have a stroke or become canada's small area edge that can be small been point bleeding with the pin point bleeding does not matter but if they're more than ten which are more than ten millimeters then that is serious or there's one bigger one that uh spot of bleeding that will be serious and infusion will be stopped there have been three debts so far with let them be infusion so it is not something that one can just take very you know casually that oh yeah this medical uh this miraculous drug is out there and let's all go for it it has to be taken very seriously so uh symptomatic argue occurred in three percent of patience who were treated with it can be. Serious symptoms who are reported in zero point seven percent of patience and so far three deads of occurred so area e which is the dima was about observed in thirteen percent of patience versus two percent on policies are real it was observed in seventeen percent of visions on let can be wise it's nine percent on election policy bill they are also have a sensitivity reaction to let them be and the genetic risk also with uh someone who's apple ehomas I guess um serious events of area was seen in three percent of apple ehomas patience that means if you have revealed do the police testing in everyone prior to the actual infusion if their home as I guess we will I would prefer to exclude them I know that there are some neurologists and some of the clinicians who will even give it can be to patience who are home as I guess I would prefer not to take the risk because I certainly do not want to do any harm or ruin someone's life by giving blassing them at a high risk and having them have a stroke so but still if someone who is in the thirties of forties the home as I guess and they've got the entire life and friend of them and they still want to take the risk I understand that some clinicians will still administer because patients feel that um they do not want to go through a terminal disease which is going down hill nevertheless this is a serious medication this is almost like a real life real world trial it can be because the initial trial on which there the approval of us given was one thousand seven hundred and ninety five patients in my opinion that's not enough patience now the field of the music day we'd also agree is rapidly following and this protocol might be modified based on our experience with it can be an any new guidelines that are or information issued by you know. The by the most association of by nature so this protocol will and there will modification as we as we see things in a in a year or so what how it will occur so there's always short presentation because there's a lot I could have talked about but I don't find when many one but if you have any questions i'll be happy to answer them II do have a a few questions first of all is the only location in the state of our consolidation now when it takes a ums it is already being done at the baptist it does there's a physician that send for instance there is a doctor at john's barrel um and david meno few people but those are the ones I know there's nothing in the south does the state um i've actually talked to the can be representatives and they've saying that the referring all most of the patience here some of the european union sent to incentives and baptist yes well I hope they're going through the details that you are cause you have it very well laid out and it sounds like there is lots of protection for the patience and family and all that so that's wonderful thank you for thinking at all through uhm the uhm second thing I was going to ask is um oh have you already started using this on a patient have you had patient one or two or three m we will be doing it very brief shortly what we did was put in a lot of process at safety measures about blood pressure about him or dynamics about the e k and all of that is being put into epic which is our medical wreckage system so it will automatically be there and people will be less likely to make mistakes so our epic is building it into the medical record system so will be starting uh we have a long list of patience who who are ready to go so you're ready. Okay and then also just kind of following up so I we we talked a little bit about the other medication and i'm probably going to mess up the name demand yes so the FDA is having another advisory committee meeting on done and a map to finalize the approval they are very excited that donament people delivery people are very excited that it will probably it has better data uh on effectiveness than there can be that it will get approved maybe in the next few months by the end of the year for sure so it will be available next mon- uh next year and like animal has an efficacy of about twenty seven percent done any man about thirty five percent so supposedly it is the better drug but the side effect profile is about the same. Okay any other questions II have just a couple of questions so let's say when i'm in conway I have a person that's interested in this they just call your clinic that's what the clinic and schedule an appointment as it as I told you there at least three to four initial visits but all the scans that will be done because even if someone is conformed for elements clinically if I have a suspicion that there's doperiod mandefficiency I will do a dead scan clinically if I have a suspicion that the person is personality has changed there's aggression something else going on I will do a pet scan so I might do more scans than just in my so it is a complicated process and based on those scans and if there's the rascular issues with the person might not be eligible for the can be so there will be three four visits and then you mentioned how long they have to wait after the infusion how long is the infusion itself I want one hour okay and then my last question is about insurance I know we had some insurance people talk to us about this last we heard they weren't really covering the fall round of injections anything changed with the insurance cos i'm that's going to probably be a big issue for people who medicare eighty percent coverage uhm nothing else has changed with insurance but there's patient are you know the health from the company which the provide patients and the they provide a a lot of assistance up to I think seventy eighty percent here if that way medicare used to only pay for one MRI but now they will pay for the multiple more eyes and follow up as well I think as it becomes more uh widely practice and applied I think some of these things will change but on the other hand there will still be copees on the part of the patient but it's not as. Uhm overwhelming as it used to be so I think more and more it'll be a little more easier. Okay phillips bell yeah I just had a quick question you said the you have a link the list are those ones that are in the early stages or do they have to go through a process I have to be in the least stages so you know all have to be either my cognitive employment or early stage dimension but those that are on your list are they already pre qualified for that or do they have to go through qualification not their precautional ideas. Okay step in carol and forest if you could so is there a different process for those under fifty and how do they act is though services being under fifty or even so in a clinics they have to be sixty five to be seen now i'm seeing patience of the asem as for the memory clinic is a consultative clinic so it is not a general active clinic so I see patients who are in even in the late thirties and they come from all over the state I see a lot of patience in the forties. Kay and david cook thank you so much for the that information and i'm II just had a question there is our clinical poor recall established for when you're going to stop treatments are you going to take that by a patient by patient basis I know when the early clinical trials they did once the presence of amaloi had diminished a certain level that it stopped the treatment so i'm just wondering if you guys have established that clinical protocol there are many criteria number one it will be a case by case which basis on patients who have reactions during fusion are doing the process the monitoring process because not only will be uh called them on the phone we will observe them but we will be calling them on the phone so that depends on the symptoms but depending on the idea they're very definite strict criteria on how the area and allowed related imaging of no malities look on the basis of which the treatment will be stopped so those guidelines are what we are going to follow the those imagine guidelines from uh comings at all paper from the approved user recommendations approved use recommendations those are the guidelines for you will follow for the imaging and other than that it will be clinical judgment gets one of the follower but now that you have the clinical poorer colour established for the can be does that help you you know establish a future political poor calls for from future drugs definitely it will it will it it's going to be a guide and a template for future the uh done and a map thankfully is only one some mind is not twice a month injection there those will be different but yes it will help us establish you know other protocols for that drugs even the other drugs coming and down the pipeline even other than done and a map that will be coming out just. Uh yes we have filled in for jodian trip we have uh donald mccormick so want to follow up on a question that carol kinda touched on and we talked about medicare covering up eighty percent if you have patience that are the age of sixty five what about them because they will not be on medicare unless they have you know additional reasons to be on medicare what what are their called savings order there reimbursements that to read the company or would they be at a higher overall cross through whatever insurance they have if they have medicared it they if we get covered we get paid for the VA they can go to the it really get paid for but otherwise they will have to seek the companies help and the company is you know uh has the companies have been pretty helpful previously for these patients. Yes we had a pretty lengthy discussion about what insurance companies are going to cover this we will probably follow back up I was hoping to bring that topic back up once the other medication got approved in then we'll see what they're doing about both the bomb so we'll follow back up on that any other questions okay thank you and thank you again for the safety rails that you put in place for the patience there and just make insurer the things go as smoothly as possible and for your presentation okay we I don't know exactly when we will meet again we've been trying to meet at the end of the month but we have a legislative session that we're running into starting in april and we often don't know exactly when that's going to end so it's a physical session usually their shorter my guesses that we would not meet in april but maybe towards the end of may so we'll just send out an email it seems that tuesday is one o'clock into the month this kind of what we've been doing monday or tuesday and so uhm possibly the may I think that last monday in may though is memorial days so maybe it'd be after that but will be back in touch with you any other comments concerns anything you want us to talk about next time. David cook has an announcement this one I want to know we will be having our all summers the mention we're stay at the capital on tuesday april twenty third we will send out more information to bread and if we could send it out for some make sure you have information to that we think brained in for all of his help if you have questions concerned she can always reach out to brand in to help coordinate the next meeting motion to adjourn by someone thank you david all in favor okay great thank you have a great day everybody.