Alzheimer's Disease and Dementia Advisory Council

We are going to get started with our meeting first of all we have to approve our minutes can I have a motion to approve the minutes from our last meeting so moved okay thank you stephanie and second uh tate thank you okay all in favor say I anyone opposed okay good job let's move on to the very first presentation of the day and that is matt mcclure the franchise owner of home instead of senior care of central arkansas we discussed how we were going to talk a little bit about in home care the challenges that are there and i'll let you to take it away introduce who is with you if you don't mind i'm gonna let them introduce themselves ahead I am tracy dalton and i'm the corporate client care director for the state of arkansas with have been said and i'm hate and get her in the presidency of home helpers home care. And then just turn it. Well thank you to the to the committee and to the chairs for allowing us to be here today i'm here representing the arkansas home based services association. Uhm we are a membership group that serves all seventy five counties are goes that all our candidates have access to high quality home care and we also focus on employing the care ever and then our last goal is to educate and engage decision makers in the process surrounding home care and also send to mention care. Yeah. Forgot I have to advance this myself. So the first slide that I want to share with you is this is the percentage of elderly patients that are receiving care with a diagnosis of all time all summers and dimension it's from variety of different areas so as you can see this was i'm conducted by the national center for her statistics home health so this is of the overall population so about thirty six percent of those in home health suffer with the diagnose diagnosis of all summers to send dementia hospitals at forty six percent nursing homes at forty nine percent rehab at about thirty five and a half percent and then long term hospital patience at forty six percent. Uhm now most of this this study was done in seventeen and eighteen so these numbers are a little old and I think it's important to be cognized and that these are numbers of people that are already diagnosed most of us that are in the industry understand that there is a large percentage of unrapper undiagnosed population and so these numbers are only larger than what the study indicates not less. Are so wanna talk just a little bit about the family caregiver and resources for families so the first thing is training for family caregivers and there's two primary places in the state that do this the frank and barbara barrels foundation and the meeting center in both of these provide training that detailed holly intensive last over multiple days if not weeks depending on the program and it is focused just to be a resource to family caregivers to kind of give them um I would say the tools and talk yet that they need to better help their loved one resources that are organization provides one is respect care so those views that are if you're not familiar with that it's basically where we give the the family member of the love one that is doing the caring for the patient time away from the family to go run errands go to doctors appointments where we come in and help provide that care during that time instead of a you know a scheduled ongoing time it is just really arrest but for them to be able to get away for a little bit another thing that we do is we've provided information about relevant local services so other things that they need outside of just the caregire being asked back some of our members provide individual counseling sessions with the families and the family care ever and then also free support groups. So uhm a lot of this is just trying to give the family's and the family care ever as much as possible the resources that they need to make a very difficult situation just manageable this is a it it was a study that was done by the alzhemore's association and basically what it really looks out is pain points for family caregiver so it essentially surveyed family members the person doing not family members but the family here gave her on form key areas and that would be stress depression twenty four seven care and might put my glasses on to see this health so the first one looked at the stress and it asked them if the stress level sixty one percent indicated that it was either high or very high depression a thirty nine percent increase and part of that has to do with just the oscillation and taking care of someone with the manchester and a lot of the repetitive natures associated with that the twenty four seven as they surveyed those family same family here givers and asked them do you feel like you're on duty all the time and almost sixty percent of them said yeah like there's no downtime you you know at any time whether it be the middle of the not you have people wandering um you know you're just always just on the precipice of having to do something else to provide care to keep your loved one safe. And then last one is overall impact of their health and forty three percent said that that was higher very high because of providing care and ana don't leave I think it's one of the things that we see i'm out in the field and have for years is that in a lot of cases the physical health of the person that is providing the care they end up in a worse position than the person that they're taking care of and it's because that they neglect everything around there I mean you think about it if it was your mother I mean you're you're focuses on one thing right it's not focused on making sure that you're getting what you need it's making sure that her mom gets what she needs and that is the to the detriment and you know what's really bad is when we've had situations where you know the person that is providing the carriers up in the hospital and then there's no one left to take care of their loved wine and it's just be close just because they have neglected their own care in doing that so I just want to paint the picture a little bit about that so the professional care you ever side benefits of hiring an agency. The members of the association they're sitting professional caregivers out that have had specific training and also send dimension will talk a little bit more about that the support of the agency for family and caregiver so this is you know who is that that they can pick up the phone whether it be a family member or the caregiver that they've got someone to reach out to the talk about the situation that they're dealing with. Uhm I would say the next one back up here is probably the number one thing that most families that they deal with that they say is their number one obstacle is that when they're providing the care and they found someone from church that's going to come help out or whatever when that happens if that person doesn't show up there's no alternative to it they just have to neglect whatever it is that they needed to take care of to be able to get there the last one is the career's hired by the agency so there is no liability to the patient or the family because that person is an employee. So a lot of times people are confused these two things and it's the difference between traditional senior care and also send domensio care and the way that I would like you to look at it is a lot of the physical act aspects of the activities of daily living that you deal with is the same regardless of whether the person has dementioned or they doubt you know getting helping someone to assist them in the shower to go to the bathroom or to get into the kitchen to get help like a lot of that is the same what is different is the tactics. And I want to give you an example of an army general that we took care of a few years ago that we were having a hard time i'm getting to shower to the point that literally you could smell the individual because they just would say no when they came in. So uhm this went on for a period of time and I said we'll let me go let let me go talk to the general and found out you know what I mean so I walk in and I said um general so and so i'm here to give you you your shower and he said i'm not taking a shower. And so we kind of talked about it a little bit and he was pretty adamant he was not going to take a shower and so I thought back to my employees that were in there and I was like well I get while they're saying he saying that he won't take a shower. So tactic I thought about something different I said um general you're a man of your work right and he said absolutely I am and I said well how about this we won't do a shower today but we'll do one tomorrow. He said absolutely I will do that. Thinking right tomorrow never comes so then I said okay so what we're going to do since we've made this agreement i'm going to wrap this down what you just say and then i'm going to have you sign it and put the date on it. And so I came back the next day and I said general i'm here to give you your shower and he said i'm not taking a shower. And I said okay do you remember when I was here yesterday and he said now that was a long time ago when you were here and so I pulled out the peace paper and I said you said you were a man of your word read that to me what it says he read it and I said and who signature is that he said it's mine and I said you're a man of your word right and he said yes sir I said volusco take the shower. He immediately went and took the shower. I think a lot of times there are family member might not have that tool and talk yet right and if they tried if if you tried to argue with him or you tried to reason him in to do and at that point in time you weren't going to get anywhere I mean he was pretty defined that he wasn't going to do it. And so I think that's one example of multiple examples though about the care is the same but the tactic that you take to accomplish what it is that you're there to do is inherently different. And with that I want to introduce tracy and let her talk a perfect think you sell me so part of what I do I bet in client here for about six years and I have one of the things that I do the most and I am the first line that people call when they need help and when thing that i've learned is people don't call just to say hi they're not calling to tell you I am having a great day I want to look at care possibly in the future they're calling because they're in an emergent situation they've probably tried to keep their loved one at home making it work with the resources that they have probably longer than they should have and so they are calling many times when I say can you tell me what's going on the immediately start crying because there are so overwhelmed they're feeling all of these emotions a lot of times i've heard that they feel. This. Maybe a little bit of resetment because they're so stressed like map spoke about they're not able to take care of their own needs and so they feel just so overwhelmed and then. They start to feel guilty that they're feeling that way because they think that means that they don't love their loved one and letting them know that that's normal it's it's support so they are calling because they love their loved one in their trying to do whatever they can to keep their loved one at home they may have promised that they would never put their loved one in a facility and now they don't know how they can even maintain that because maybe the person has wandered it outside the home I have heard stories where they've just tried to get sleep there their nights and their days are confused and they they're trying to get a little rest in their loved one has exited the home and it's no longer safe and neighbors calling in and saying that they're loved ones down the street. And they don't know how to make it work. I'm also like mout said it's very isolating you feel like maybe the support that you used to have the interest the church the outside groups that you used to be able to go to you your suddenly not able to go because you can't leave your loved one at home anymore and so you're your isolating you feel like nobody quite understands your absolutely exhausted and you're feeling very frustrated it's. It's very hard especially when you know that you haven't got a good night sleep in a day or so and then imagine when it's ongoing and you're you're surviving very little sleep and there's no rest because you don't know when that love when it's going to maybe get up and far or need to use the bathroom or just not being able to relax because it's it's it's just a stressful situation. One of the things that that I really do is is try to meet them at their source their need they're calling because they need help they're trying to do whatever they can to you. Help their left wine into honor of their wishes but many times when I come in to the home we may be met with some opposition this usually the calls that we get are from loved ones maybe a spouse or maybe the child that's calling that saying hey mum mam or a moment that need help. They're not ready they may think the biggest thing I hear is I don't want strangers coming into my home. That is the biggest thing it's scary that only you may be it's pride that they are used to being able to handle everything in their household by themselves on their own and now they're they have to admit that they need help and then be there having someone that they don't know come in and have to help them even with some daily activities such as using the bathroom or shower that can be extremely hard when you're conservative in you you're not used to anyone seeing you and in that state that's extremely difficult and vulnerable another part that i've seen even with my own family as the spouse may be over compensates how many times have we seen where I loved one maybe a wife that has some memory issues and is really struggling but there there has been says it thinks are good or they they help other compensate those those issues to not appear that there really is an issue that they need help with especially it's hard for males typically to admit that they have they need help or they they're not able to manage it on their own there used to be the main of the house it's extremely difficult and families I also have with a lot of. Ladies that there used to be able to maintain tours of the house and when they're not able to do that they feel like they are not doing what they're supposed to be doing it's it's so when we understand two part of the training is understand that you're walking into a situation where it is not only the issues of dealing with memory issues but also just the vulnerability as well as the issues of. Feeling overwhelmed there's so many number it's a very emotional decision that's coming in so many times our caregivers in our staff are met with different challenges a family dynamics how many times do we also know that we all have it and II joke that if you don't look around and you don't see the dynamic you're probably the dynamic in your family and so there's so many things that we help train and teach our caregivers to walk through to help be successful in these situations cause it's more we know it's more than just carrying for that person our person's it's the whole family it's it's adding support it's loving and it's being able to help them be a family member again to not have to be that care giver though they're willing and they're they're trying but letting them be the spouse or the data or sign that they they're. Trying so hard to be and they haven't had the opportunity to deal. And when I was looking through of our samers here and just giving some some of my stories to share what I found so many times is II remember having a house that I drove by on my commute that I thought was the most beautiful house it was manicured in just gorgeous sometimes we go back to that those houses and we we create this story of what life must be like at that house it must be so beautiful and wonderful well I got a call to go to that home and this it was a a lady that they were she was in her second mayors they'd only been married under five years and the husband had early answered of dementia and her whole life changed the spouse is um children they were not supportive and so it was on heard hurry family lived out of states. And she was overwhelmed she was used to she thought this was going to be the time of her laugh they were going to travel they were going to do and in suddenly everything changed where she was exactly where she got calls from her neighbors where her husband had walked down the street and did not know where his his home was a ends she just started crying the moment that I answered the phone because she didn't know what to do she she saw the commercial and it she knew she needed help but nobody prepares for this nobody knows ok this is what i'm supposed to do and how i'm supposed to do it and this is how I need to prepare early they're calling because they need help because we're able to offer that support she's able to get out and she is able to have those times to be able to meet with her girlfriends to be able to go to our church activities and therefore she is able to better support and be in a better head space when she comes home in lovingly cares for her husband and because we're able to provide this safe environment for him he has been able to thrive at home and also she is able to now not only survive but thrive now being a caretaker for a letter thank you tracy so what is the the biggest problem the biggest problem that we're dealing with right now in home care as the condender on with hiring professional care givers to support support the demand out. Then I want to take you through a few instead of because i'm sure everyone says that this is a problem and whatever industry there is only take you through a little bit of research to counter ill straight that point so this is by the bureau of labor and statistics and essentially what it's saying in this chart is that the chain the percentage change in an employment is going to be a twenty two percent increase twenty two percent increase I in the next nine years and over eight hundred thousand new jobs so to put it in perspective the total for all occupations is an increase of three percent so you're talking about over seven hundred percent more than all the job sectors just end up professional. This is another one phase a non profit that works to transform elder care they did essentially the same study a large widescale study in by two thousand thirty one day estimate that over a million new jobs and the largest growth of any job sector in the country so there's a little bit of difference between the two studies eight hundred thousand over eight hundred thousand in a million but at the same time you I mean the roddiness on the wall you can see that the number of people that we're going to need to take care of the growing population is huge this one is a US news and world report from april twenty sixth of twenty twenty three um that illustrates the shortage that is out there a looming shortage of home healthcare home health care workers. The next one it is a medicine severe shortage of home health aids immigrants help care for a seniors this is immigration action and this is one thing that we're saying we have members in our association right now that are bringing and health care workers from the philippines and it's because we cannot sustain even the demand that we have right now and we know what the silver tsunami coming that that is going to exponentially grow in the future and we were going to have to have more people to take care of all the seniors the next one their home healthcare care work force not keeping up with community needs and it gives four recommendations how pay pass for career mobility and more predictable schedules as waste to help entice more people to come in there's two more here a shortage of health care aids is forcing those who wish to get care at home this was done by n PR um. Last year and in this illustration seventy five percent nationwide this is agencies have had to decline services because they couldn't staff it and in the updated version of this just sent to january between fifty three and sixty percent have consistently turned down care that's this year in a five month period and it's just because it's not because people don't want to provide the care it's because they don't have the work force to be able to do that. Which moving into our next peace is the medicaid reimbursement rates by stay so if you look at the us I think it's important to know the state minimum wage so this is as a percent of state minimum wage now obviously the voters in arkansas were the ones that elected to move a minimum wage to eleven dollars so it's not something that the legislature or the governor or anyone else can control right it's the doubt that hand that we were dealt and it's what we have to deal with but if you look at missippi which is you know almost three and a half dollars more an hour and reimbursement rate there state minimum wages the federal at seven twenty five then you've got tennessee which is you know about three dollars an hour more still at seven twenty five oklahoma twenty one o four but it's seven twenty five um missouri is at twelve dollars so it's the only neighboring state that has a higher minimum wage than us but the reimbursement rate is thirty dollars and sixty four cents. So when you look at all of those the percents that are in the sixty five six years ago that's where arkansas but what has changed theirs the minimum wage has changed and the rates have not changed to coincide with that. And so when we look at competing with other industries for this work force it's not going to happen at the reimbursement rate that we're I mean we've been seeing it now for multiple years. There's a new federal initiative though it's called guide the medicare to improve domentia care for individuals living with alzheimer's disease and caregivers this was passed by partisan support so it was republicans and democrats it's expected to save twenty one billion dollars over the next ten years and I called this pdf off of the website because I think that it really encapsulates the difference and white people deal with today what the industry is dealing with today versus white they're invisioning and god so if you go to the the left hand side of the screen this is the common dimension care experience margarine kathy fill on certain about how to access the resources and support they need so they start googling. Uhm then she starts having issues with medication so then. Um the daughter catty steps c n n starts helping with that peace quickly becomes overwhelmed with it then the mother starts wandering at night so it's really you know just kind of all a car deal right you're trying to find what is the thing that'll help me just incrementally in one area but there's no holistic system systematic approach to it and what god does this it brings everyone together from the beginning so it is the provider that is outlining the care that is needed um providing resources for the family care ever providing respect care for the family to be able to give to get away and the reason you know because a lot of people when they first look at this say well how in the world is that going to save you know twenty one billion dollars over ten years when we think about those of us in the industry understand this and we think about the number of times that you know that person wandering or that person falling because they don't have support them going to the emergency room them going to extended stays in the hospital because of that those numbers as we all know out of very very quickly and so what this is doing is it's providing almost like a team approach where everyone is working hand in hand to take care of their aspect of the care but it's all coordinated. And I was talking to david about this earlier you know if it's one thing that we have right now with domension it's not coordinated at all like it is a very fragmented system and it's kind of black the wild wild west everybody's on their own you know depending on how good the doctors and their nursing staff in case the management about giving you resources but then you still got a pretty much go do it on your own while the purpose of god is to instead of making it where it's not a concentrated conservative effort more to where it is a team approach and everyone's working on it together. So the last thing things that we need we need to understand that both family and professional care gave her the need for that is growing exponentially right I mean you can turn on the news on any given non at six clock national state what what have you read in the paper online like that need is not going away it's just going to grow over the coming years. We need to be able to train higher and retain professional caregivers and we must be able to compete with other their industries to do that like it can't be the ones that can't get a job anywhere else we put them in home care like no one wants that and it's it if that is what ends up happening it just puts at risk the quality of laugh in the care for our elder population. The federal government as I showed you starting programs to combat the growing need and then the last one is the state must provide a reimbursement rate that allows agencies to pay care reverse more so that we are able to compete and get the the quality of applicants that we need. And with that all three of us should be happy to answer any questions. Thank you for that presentation i've got questions but i'll allow others here to start out asking if anybody has any questions they want to ask first carrier jordan go ahead hello i'm curious what percentage of people that use home care services are on medicaid II know that I actually both my parents are using home care and they're charging us a lot more than what medicates reimbursing yeah I don't I don't know that I have a horror percentage it's funny that you say that because there's two other individuals in the room that arm came up to me before the presentation and said we're using all with my parents right now I don't III I don't even know where you would get that information because a lot of it is like a family's paying privately like there would be no way you could look at a individual agency and say what percentage of their business is medicaid versus you know long term care any of those things but I don't know that you could get that in any kind of tangible member system wide. Did you have another question now okay jennifer so first while you're preaching to the choir with me I want to be like transparent so what I was thinking about is obviously it's a growing population with dementia and the impact that that's going to have on the state and so i'm gonna ask this question is a little goofy but when I first got my role eight years ago there was a discussion about uhm cms one in one in the state to do a study as to what's the most affordable option when it comes to our kind of career or for the elderly and do you recall that I think it was a stevens report and what did that do you recall what the with the most affordable less well I mean it obviously it depends on the levels care right correct but there is a threshold and I think there's a continue of care when it comes to the old california for a vast majority the cheapest is to keep them at home yes until they get to a certain point and absolutely like when they're a flight risk and all of that yes in so in looking at that uhm how do we how do we address that we know that that's the most affordable way and then uhm to keep people at home as long as possible is how do we go about trying to convince that we've got a tsunami coming and what do we do about it but III think it's one of those things that the bottom line is with the number of people coming we have to find the most effective fashion and cost effective method and if we don't it's going to bank or up the system because there are so many people that are going to move into needing care I think right now arkansas I think it's forty six percent. That are at home the federal government is pushing towards fifty fifty and I think most states the average that I saw a couple weeks ago on a study was like fifty seven percent are keeping people at home as long as possible and I think that they're is going to have to be either some kind of legislation or roles and rags that that force that we are doing it in the most cost effective manner right that is to the benefit of the patient because I think all of us understand there are people that because of their disability or cognitive impairment unless they have a outstanding support circle outside of that it's not cost effective to keep them at home like they're gonna have to go to a facility but the vast majority and especially early on the most cost effective way is to keep them at home. Okay thank you. Okay well any other questions from the committee cause i've got a whole bunch but I didn't want to take it up so in any time you want to time and fill three to so II wanted to kind of bring it because it was mentioned in here the career pathway as a possible solution and i've mentioned this when we've talked about carrying for people with disabilities we've had meetings that have specifically talked about the need for there to be different levels you know and in nursing you might start out as the CNA you move to an lpn you work hard you get more education you become an r in your car you more education b s and there's there's different levels and how can we use that in in home care giving how can we start that career pathway so they're someone who might enjoy providing this type of care but doesn't want it forever remain eleven dollars an hour or twelve dollars an hour whatever it is might be that they make that they can perhaps have a patient that requires may be more care that they are more suited for than maybe an entry level person helping to give care to this person who is not as complicated does that make sense and and how do we begin that conversation II feel like i'm screaming at all the time II think there's a couple of different things I think one is um my background before homecare was education and so everybody probably knows this analogy but the best teachers you know get the ap classes get the best students and really what you need is those best teachers. Teaching the hardest to reach accounts because they're the best for a reason I think in this case I think it is really taking the best talent that you have in the home career industry and focusing them on the highest needs clients I think you you alluded to that representative of maybe and then I think the second thing is something that we've started in the last couple years is a mentor program where part of their job is going out and observing helping reteach if someone is having a problem let's say with the horrier west right so we send them to the person's home with the caregiver that is already there to help them in that situation to help them in tactics maybe they just shadow them for a day and it's all about teaching them to be better I think that's a couple of different ways you could do that. And i'm sure there is a lot more of that you know what I mean that we're going to find out as we go through theirs and and looking at licensing you know people at different levels and and all that it like I said it's a conversation i've had many times with developmental disability um committee meetings and in all that and just really want to continue to work on on that um i've sent some information to dhs I don't expect a hill to speak on that cause that's a little outside of the wheelhouse there but uh and and I don't know if if you have any comment dhs's working on big picture uhm cost and one of the things that we're hearing here is the the rates for in home care being low considering our minimum wage is eleven dollars that one graph that we saw is that part of conversation I don't mean to put on a spy i'm sorry i'm always putting it at spot so dance your question represent yes at the entire system of care review that is under way my I understand he is where we're hoping to have that at least that in those initial reports back in january of this of this coming year uh is is being looked at the entire system of medicaid top to bottom every program our spend our trajectories. The sun toll of medicaid physical health behavior health for belt number disabilities all across the board so the edge added to ask is that being looked at my understanding is yes that is certainly part of the study it is in the mix of with the sum toll of medicaid I don't know what that looks like those reports my matter states that I don't believe those have been presented to DHS you have looked back up like a fair security head now uhm but it is part of that process I know that my division are programs we have participated we provided data our programs all of our programs whether it's just a living whether it's our a choices program or picture programs all over a medicate span has been incorporated into that study. Okay the the second thing II kind of wanted to bring up and and ask about we did change some rules last year or so the have allowed family members to be the pay care giver in the home and do you mind speaking on that a little bit and and how that might affect this population either either wine softer and both both of you because it were what was at play and I think what the conversation was is we have a shortage of workers right so you already have someone in the home who's providing care and most of the time that person has now given up a job where they could be making a living doing something else probably paid a whole lot more but because they want to stay home and take care of their mom war or doubt or whoever it might be that they're they're helping to take care of uhm that is someone who probably is going to provide the best care because they know that person intimately already and they already know what those triggers are and so allowing them to provide that care and my thought is is that it's probably helping but do you am I giving some thoughts on and out if you want to do that back on that we do so self direction are independent choices program a dozen for it allows the beneficiary to select their care given very often that is a family member to your point that may be someone who has had to step out of the job in order to stay home to provide to provide care for a family member for a loved one and so that program does allow them to be reimbursed as the paid paid care giver for for then individual it is a it is a it's a great program and it's used extensively that sits across the states are for. Corners of arkansas I think sometimes we find it's especially beneficial and some of our more rural areas of the state where we don't have just an enormous number provider options and it does give those family members of an avenue to earn an income while they are taking care of that of that beneficiary it is it is something that's critical to to combat the uncompensated care piece that we see as a as a growing issue and you certainly might want to add to that with your i'm gonna respectfully disagree with the on one thing okay that is the training like I think what he's saying is absolutely correct and role areas it may be the only option but I think we've had people that have been on that program that have come to us that have done it through an agency instead and it's because they don't have the support and they don't have the training and so once again can I go in back to the question earlier I think it depends on the needs and the severe severity of the you know cognitive decline that the patient has experiencing but in a lot of ways they're kind of on their own and so it is they probably know that that person better than anyone else but I don't think the training aspect is as good as it could be does that person know receive some trading I mean if they're working through you with me with us yeah with us absolutely but in the independent II think that they just sign up in that correct direction I believe that's correct okay jennifer you had a comment i'm sorry well I was just going add on that I do know that in some instances probably not every instance but the independent choices helps with those that are going to be helping because they're familiar maybe with that person uhm they may not know exactly who how they know them but it's. It's beneficial in that respect that there that were able to do that in the state of arkansas however I do agree that there are times that when you use an agency who's been trained on how to read just different issues you have with someone who has and to mention that that's maybe uhm more professional I guess is what I would say so it's a good thing that we have it but I think overall we have um never weren't a hard time hiring people so you get what you get and if I could do anything if I could like change something it would be that there would be a culture shift in people idolizing them thinking how worthy it is that we have people that want to be care givers but I can't make that happen the pay is that maybe they're but really it is like an angel cause i've had to use it before with my parents and the care that they received was from an agency in alcohol it was very professional in in fact inspired me to be a better care gave her to my parents because I saw how they were handling the situation in these where my parents so I was trying to still think of them that way instead of I need to just take care of their needs so that's just a common I have sorry this may not be the most pleasant thing to bring up but. What kind of um regular tree processes who overseas the agencies what the reason i'm asking let me just tell you where i'm coming from we had a a career refund and agency come in or home and she ended up you know taking money from my marm and ah we ended up sledding her go and going to another agency but is there anybody regulating the agencies I guess and regulations that's something you really want to talk about I know but who regulates for safety and that sort of thing so dhs as the vision provider services are called insurance works with our provider agencies for certifications licensee so but if if the agency doesn't take medicaid though if they're just out on their own then then the government's really not looking at that correct I know there's some agencies that don't take medicaid patients believe that that is gross so there pretty much on their own in terms of there's no regulation if they don't technically our organization maybe two sessions ago i'm gonna deferred a center pens or on this because I think he helped us with house tried to bring it to where anyone that lied their hands on an elderly person would have to be licensed and I would just say there was no appetite for that right well would be hard I mean we're already having a worker shortage that would just make it that much hard so I see the dilemma but at the same time you know I mean a professor knowledgeable this was happening like in my house and been under me it was we found it because we were looking at my mom's records so i'm aware that you know somebody was not overseen this person properly in the agency so. I would just tell you to cover the there's an elder victims of crime my agency does that we we we do that program but it's across the state you can call and at least report that that has happened even though it's not a medicare client and and see what support that could be provided and if there are if there are crimes or if there are instances of abuse or a exploitation against an overboard by anyone adopted our adult protective services unit textless colesna that is that is regardless of who the person is who to provide areas what level service they were safe. Yeah it's it's interesting because it's it's a you know the person's in your home and they almost become like a family and so there is this that they might have you don't really want to destroy this person's life by reporting them to aps so I don't know it's complicated yes. And would you online when you are done speaking if you could turn off your microphone cause when we have one too many that little echo goes a little crazy uhm when we talk about that that ourly rate that you also were pointing out explained to me and and everybody else some might be contract and some might actually work for an agency and receive benefits or not receive benefits and and how does that play in a worker shortage and helping someone feel like they at least can go up a career latter but I think there is a I mean there is an inherent difference and we are in multiple states and arkansas the only one that allows that to wear someone can send a contract in as a career ever as opposed to someone that is an employee that the agency has complete oversight on them so. There's a real what was the question representative I guess just you're saying arkansas the only state why anyone have parks wire with the only state that allows that how is it allowed here what is the law that allows that or doesn't a while about anyone know the answer to that i'm looking at our attorney over here maybe she can help so so there might be some in home caregivers that are contract workers and some debt are not that is correct and. Is that an issue II think if you're asking me personally if it was someone taking care of my parents which we have done I would prefer that it is an employee that is in there for multiple reasons one is if something happens in the instant that the uhm. That the member asked about the agency would be responsible for that if that person gets hurt lifting the person there's no workman's company if there are ten ninety nine like that person is just on their own so any kind of liability you know to the home if they break something when they're in there than once again that is that the the patient are the client is going to have to just deal with that issue because there's not insurance covering someone that is not in an employee. The. So you're assuming that risk if you use someone that uses contracted library. And I guess i'll just ask the question is that what that bill was session or two ago was to carry looks at and it I guess was presented in the house if you don't mind well wait we had legislation this year to address that issue but we didn't get out of senate committee so any other comments anime. Okay appreciate you sharing information and I think we have some more to think about and talk about no other questions for many committee members on anything okay I do want to just make a comment though a lot of folks in here don't know that my dad has dimensions can in the early stages right now so pretty much everything that's been said from the other end of the table of been able to experience it recently do you have like you said the mom's. Neglect in herself you know we're on the private pay side or they are in its own those things where she's reluctant to give up control you know initially it was my dad his reluctance to give up control now mom has a hard time allowing care givers to come in the house and help her but I mean it's the the quality of life when somebody's at home compared to when they're in a facility I know my my dad had spinned time to rehab silly when he was there it was just compounded uh and he didn't know where he was was trying to make a break out he's like a budget you know you got to help me get out of here you know uhm sorry do you use in jail or something now that he's home you know like last night I had to go over and help them support e had got down and couldn't get up and you know it's just one of those things were keeping a family member home as long as possible so I mean we need to we need to work on this the to make the system better save safe taxpayer money and improve quality life for the folks the families in general just keep in the family member at home so I appreciate the work everyone's doing on this committee and thanks for taking your time to be here and hopefully we can find some solutions to this down the road I did remember one question and and david I don't I don't know if you can help because we did have a bill that requires in home caregivers to receive some training for dimension do you mind just kind of telling us where we are with yeah that that bill was signal I think on it on the home career of her side it went into effect july one until that requires of four hours of initial dimension for all and home caregivers just. Wanted to reiterate that okay thank you very much we'll move move on to uh presentation of healthy brain initiative roadmap and that brings up david cook and I hand out okay and he does have a hand out it's actually a pretty thick handout it's a whole book. Um if you want to look at that and I think everybody also got kind of it's one sheep that probably summarizes things for you. This. Thank you represent me bury the committee i'm david cook the director govern affairs for the also I was association I just wanted to share with you a brief overview of the updated hbi roadmap that was released earlier this year we and our initial working group we gathered together we looked at the prior healthy rate initiative road map to ensure that uhm you know our state plan was informed by some of these approaches we do that for a couple reasons one of which was to we we knew that the CC was going to look at the hbi road map and and wanted to see some of the recommendations in that road map when they make considerate considerations for federal funding but I want to kind of briefly walk through this and there will not be a quiz but you do have a copy to take on with you just to kind of look up but what one thing I want to council to be aware of is the intentional influence of the hero map on our state plan and as we moved into the phases of implementation some of these recommendations help us advance a state where everyone can live with a healthy brain and and we believe that everyone deserves a a life with the healthiest brain i'm going to try to check this really. Pardon me one second. At the moment. I see that better. So where everyone deserves a life with the the healthiest brain possible and this was the the vision of the HB I road map in this uh new road map in its new edition and this was the vision that everyone deserves life with the healthiest spring as possible we've talked at length and I guess uh nausea at some point about the the impact that all signers is having here in the state of arkansas you guys are very familiar with our facts and figures that we've presented before but if you look at nationwide the previous present are touched on this as well that the alzhemist crisis is going to continue to claim touched on the just the impact of the silver tsunami but the number of people living with kind of decline continues to increase with age in twenty twenty three there's an estimated six point seven million people across the country by twenty sixty that numbers expected to double and so the impact of of all simers the mention continues to grow but so as the hope among our communities that will be able to make change and as we look at this graft we know that public health has the potential to get ahead of this this curve and to make a significant impact if they will engage and as new treatments roll out some there's an even bigger focus on it's always been a part of us of our initiative at the also association to advance early section diagnosis but now that we find ourselves in an air of treatments those conversations become even more important especially since the treatments all are only viable people for people in the early stages of the measure. And what we do know as all times kills more people than breast cancer and prostate cancer combined um and so the increase of course in prevalence is going to continue to climb and we have stead multiple times it is a public health crisis facing us. So just this kind of helps establish some context I know it's kind of blurry there but you do have it on your hand had your hand out there but the the timeline really helps to set the context of how much has happened in the last twenty years twenty years of public health working in the space is not that long when you compare it with other chronic conditions so we are still learning and growing but in two thousand five uh congress appropriate the first funding to go towards all summers and to mention classifying as a public health issue and when they established the healthy break initiative and point in two thousand and five. It's a twenty twenty five I think there so this is that the funding that eventually led to the HB I road map since then the roadmap series as help lead to so much action over the years a few examples of those is the establishment of the national cymers project act which is coordinates national action on all similars in dimension or broadly we've talked about the ball back before out of the experiment came bold which is building our largest dimension infrastructure for all simmers act and of course the state receive some core capacity funding under bold two years ago right two years ago which helped us of course create established some of the infrastructure pieces that we have present here in arkansas and so multiple states are are again implementing the strategies and this year we have an unprecedented forty three state local and travel health departments who are working specifically on on ball initiatives as well. It's all the hbiro map is in itself fourth edition some excited to talk about that today it is uh again back a reviewed and developed by over a hundred leading subject matter experts join from the most recent research so it's evidence informed and it follows a basic framework and if you want to turn to page twenty one in your book I think I have a few extras that they made it have made around you can can't get a look at that that framework because when we say that the hbr road map is a a public health strategy what we mean is that it it provides a basic framework to organize work in the public health space to ensure that we are reaching multiple populations with the different levers of public health and of course this is demonstrated in the road map through the the framework graphic there on on page twenty one which was adapted slightly from the previous road map uhm with some updated what we called domain names there's four of them so there's special emphasis on risk reduction armed community and and clinical linkage care giving and of course early detection and diagnosis. Uhm so the outer ring of this i'm sorry I told you the wrong way so so the four core areas are strengthening partnerships and policies engage in educate the public build a diverse skilled work force and measure an evaluate utilized data so the outer ring shows the areas of practice or the focus of the actions inside the road map and of course loosely alliance with the work group set developed the actions the rule map of course fits under the four domains which I just mentioned for you I want to kind of give you a. Just a scope of opportunities for public health engagements to again get ahead of this curve of the mention and head of the traditory the first thing it has to happen i've said this before in this setting in and others is that the public health mindset by set has to shift cause when we traditionally think about alzheimer's dementia we are only thinking about engagement with those older populations of people we know that symptoms of all simers start much earlier than that uhm as much as twenty years before actually start to see that it can be active in the brain so we think about addressing bring health we need to kind of look across the life course which is what this chart represents so the next few slides I want to break this down for you a little bit of course the purple reference bar references to continue of the mention because it happens on a continual major no well the people represent the potential impact of public health interventions across the life course and i'm going to break this down the next couple slides and again a common misconception about dimension and I think map touched on it beautifully there's a lot of these cases go and diagnose in that people living with it are in a severe stage which that's really not the case uhm well the first part of a matter is the case is like what I want to see a common is conception about the mentions that people living with our very severe states but we do know uhm you know you can live with the metro for multiple years before advances so some of the experts who wait in on the development of the each parallel map where were people who were actually experiencing the disease themselves members of our early stage advisory group who want to be sure that we were conveying the different faces and the different courses of the mentioned that advances in the patient so primary prevention again focusing on on risk reduction to represent the the potential for impact with public health interventions in the population there's a bar of people with with each intervention starting with risk reduction. So there are things to do across the continual to reduce risk even after mci early dimension diagnosis and just a few examples of those is some of our public strategies that we are are currently engaged into the health department that is encouraging people over the bright though they're blood pressure healthy lifestyle choices healthy eating healthy exercise all these are initiatives that we see currently at the health department encouraging people to quit smoking as all always a good one because we do know as after ways mentioned in other public health health experts is pointed to what's good for the heart is good for the brain and so encouraging active lifestyles healthy leading living across the the the life course again as one way to reduce risk of dimension and so one of the the the small steps we've often pitched the health department is incorporating messages around bring health and their current public health campaign so if you're stamping out smoking even as just a slight message when they're excuse me that says you know quitting spoken can also improve brain health to normalize the conversation around bringing health because again there's such a stigma still attached to our disease and having these conversations but we would like to see a public healthy of similar the the the to what we've seen in middle health with we've got to a point we've kind of normalized the conversation where i'm in the health with love to see that as we think about you know the entirety of brain health. Does that make sense okay. A brand said yes then I mean I think everybody got it. For for secondary prevention just moving in again as I mentioned earlier the importance of early detection and diagnosis we know that it's essential it's important to raise awareness because again there's a lot of misunderstanding what's information around the other differences between basic alzheimer's and dimension diagnosis is certainly important uh it can help enable access to care planning on financial and legal planning access to support programs clinical trials I think that's the benefit of uh again the guide model that's been been out there because it it does take a comprehensive approach to disease and providing care but there's more treatments become available we've we've mentioned that there are other treatments in the pipeline as those become beginning to come online um early detection diagnosis even more important but again changing the culture around talking about memory in thinking through problems with the public and and healthcare providers is a critical role of public health so there is a an a very active role that public health can take to get ahead of this curve. The. N- uh finally again thinking about totally prevention as soon as kind of issues are detected there are things that can be done to improve the safety in the quality of care for the person living with the mentioner and of course improve the care giving approaches for them this is also important to better meet the needs of care givers uh so public health officials can raise awareness about these supports and offer evidence based programming in the community issuing referrals and just making sure people know what resources are available on how to access those resources is essential role that public health can play through our existing infrastructure so using our mobile health departments across the states utilizing the mobile health unit that is used by them and already health commission all of these are strategies where we don't have to add to our infrastructure but work within our existing infrastructure sorry jennifer to leave out the triple aids but using the triple as to work through our existing pieces to again raise more awareness around the importance of all detection diagnosis. So taking our three together primary prevention of course messaging around risk reduction in cynifizing again healthy eating healthy lifestyle. Secondary prevention of course is that early detection and diagnosis peace that public health can engage in and of course making sure they're safety and quality of care. And I want to go real quickly just to kind of give an overview as we look at our state plan again we were very intentional we talked a lot there's several recommendations around under the public awareness piece that talk about the importance of of public health partnerships public health messaging around the importance of brain health risk reduction we also have you know a section of our recommendations that talk about the importance of burfa's data collection and how we best use that to again advance the conversation around public health interventions but also policy levers we can pull to improve the care give her care ever experiences we also have a special section on our state plan that talks about the work force so just again the work that we've done already strengthening dimension training standards but continuing to look forward on how we get enhanced those across the car settings to ensure that our work force is prepared to meet the rising need of individuals or dimension and of course or detection and diagnosis campaigns was a part of our original recommendations something that we continue to push forward in the public health space here in the next couple of years will continue to advance those conversations as well and so again some of the the highlights again we highlighted this in our state plan just the importance of public and in private partnerships so I mean specific strategies just strengthening our community partnerships making sure that we don't work in silos that we continue to work together uh to advance the mission increase integration with other chronic disease efforts I mention that the tobacco session think some of the things we we currently do and other chronic zeas is certainly fit with brain health as well also just incorporating those messages is so important and getting in increasing policy action and implementation one of the things that we plan to ask for during the fiscal session is enhanced funding or establish funding uh to establish a public awareness campaign that. Specifically focuses on early detection and diagnosis and also has a health equity component to it making sure that we're reaching the communities who have shown to statistics the greatest need in the greatest um presence of of all signers in other forms of dimension. Uhm increase that availability quality and utilization again we already collect out through the burfaults we have talked about in the setting um the possibility of working on a also registery that certainly has been beneficial to help department has been able to utilize and and leverage their stroke registry right now to do a lot of good interventions um of course someone die is diagnosed or has stroke episodes that also helps uh from what my understanding is the ER s quickly diagnosed and get someone to care that they need and so there is some some benefits to having an alternative dimension registry that's one idea that we've talked about him here from the also associations perspective specifically on burface I just want to make sure that we utilize the data that we do collect from birth it doesn't suggest it on a shelf but it's actually informing our decisions going forward. Um again work on reducing the stigma and bias about kind of decline and and memory issues and again increasing the knowledge in the skills of current future work force again mat- uh touched on just the need for more bodies that's not there's not really a policy lever we can pull the create where people but just ensuring the people that we have I love the idea that representative may very mentioned moments ago just establishing career lattering uhm to to continue to strengthen a very just dire need from for more health care workers across the continuing of the disease. Okay. And so II do want to encourage you to take a look at at the road map and just kind of walk through some of the strategies I didn't want to take too much time today but I want to give you just a brief overview I am happy to take any questions you might have and I went to that kind of quick but if there's any kind of questions you have i'm happy to answer those this time. David is always thank you for the information adopted any questions right now we are going to go ahead and move on to our next guest and this is an overview a powells for life memory cafe and patricia loy is going to come up and talk to us you can go ahead and start making your way there II have to say that this is actually something i've been involved in personally she held her very first pells for life memory cafe at a facility that I uh manage in my community of eastern at the I can arts and resource center and she's going to introduce her very special guest joining her I don't know if you can have barber horn scoot on over and we'll do a more formal introduction and kind of share what patricia is trying to do you can move that chair out of the way i'm going to let alexis sit there with this is there board of directors that we're going to let her say okay very good while I let you speak ahead well first of all my name is patricia lloyd and I just wanted to thank you representative maybe for inviting me here today to speak about the cafe and I guess before I even get started I got to thinking about this earlier and you know the car favors the dream that I had precovid so i'm a retired nursing professor from henderson and i've tight help promotion and community health nursing for fourteen years and. I had a sign than my courses in my dream was when I started doing research for my assignments and I found out about memory care face than at that time arkansas did not have any memory cafes and so I designed it to where my students in my health promotion course would design a memory cafa and a teaching assignment for the care givers that came to the cafa and then they would implement we're going to implement that cafe in community health nursing and then copied here and then we all know that no one was allowed in anybody's homes to do anything so now that copied is over I have found it the memory cafe that I dreamed of and now we got started with it like uhm representative maybe the same we did have our first to be at her I can't orts and resource center and it was banned and I do have some guest her with me today this is a alexis tad lock and she gets going to start on our board and miss you tell us about this more here are representative to say before it if hold on if you could turn on that microphone so we can hear you this is former representative senator barbara she attends the memory cafa how long we are we are so excited to have her here i'll i'll just give a little bit of an if she wants to say anything but i'll means for so happy to have you here she followed her husband's footsteps so I have a little bit in common with you because I have done the same thing following my husbands but steps but she served from nineteen ninety three all the way to twenty ten so and she chaired public health at the time too so were excited to have her hair and she was one of the very first participants in this program so. Do you care to sharity thing mishorn make yes well I have the very grateful to the people that have supported my husband first and then may through the years and take pride in our state. And our governmental process. And the people that give up themselves to the extent to do we have a lot to be grateful for appreciate the opportunity to have had the opportunity to work in that compatible never would I have drained grown up as a keen owner such as I was to have the opportunities that was affording me but it was only through the goodness and all the people of our state. We need to take pride in it thank you for the opportunity so glad to have you here and we we did a little yoke cheryl get together so let and I have some claims that they want to know some of the pictures we may not like but anyway they were all okay so okay so the mission of house for life memory cafe is to provide a warm and inviting atmosphere for people with dementia and their caregivers to engage and socialization meaningful activities education and the creative arts. Yeah. And I just wanted to go from my vision so our vision is to improve total wellbeing a physical emotional and mental for people with dimension and their caregivers through meaningful activities and an art and education so what exactly is the memory careface so a memory cafe is together the individuals with memory loss along with their caregivers or free and i'm gonna disturb you for a second do you have she might need some help can you we're not seeing it change it's changing on here oh well that's interesting is it start changing behind you i'm sorry i'm following the long in our I mean here we have an actual hard copy of it and so we can read it but i'm going to have branding go down and see i'm unfortunately so do I need to call it on something. The. That somehow I can do my push down but you could do it like that okay okay so will start again so the mission and II did go over that already was to provide a warm and inviting outmaster for people with dimension and their career givers to engage in activities. And the vision. Is to improve the total wellbeing and. So the memory carefa what ideas is the gathering of individuals with memory loss it's not just alzheimer's it's with any type of dimension and their caregivers franz family are anybody who's supporting them to be able to get out of the house to stop looking at the same four walls secure givers get to look at day in a day out and to get out and have a biance. And have social gatherings and i'll opportunity to make new foreigns or in iraq without fear or embarrassment or being misunderstood and also to have a way to share their consumers and provide support to one another and network and as I wrote this slide I got to thinking as at our first memory cafe and you met align a johnson who was yoga chair person who came in and did our activity for us she knows quite a few people you know that have you know issues that family members are having all summers they have care giver as you know friends that they know that are providing the career in she invited several people and one of the ladies who was taken care of her husband. And we invited them to come and she did not want to a tian because she didn't want anyone to know that her husband had the beginning stages the baltimore and so I think that there is some stigma to the at and I think that are elderly and it's not just the ultimately who have although it's starting at a lot of younger age you know all of the time and but I think that they're afraid that they're going to lose their independence or you know that people are going to step and try to take things away from them and say they tried to hide it for as long as they can and we tried and that's hopefully the message that we can get out with the s as they at this is going to be a place where people can feel safe that they don't have to be afraid you know and hopefully everybody who gets you know gathers together or have a water the same issues and they can network and share their concerns. And so this is uhm is that show the picture so anyone his concerned about their memory can attend the cafes. And anyone with any type of digniture not just alzheimer's uhm memory cafes can be a groups for those with mild cognitive and permit or a diagnosis at dimension or also so of course to a t and am the obvious you know cognitively they need to be at at a stage where they can participate and uhm friends and families can attend the person with memory loss of course and their caregivers. And what we want everyone to know there's no formal assessment we don't and there's no referral is needed to it we just want to get the word out the community i've been sharing it to all the community sites and and one thing I do want to say as they at when researcher in the memory cafe for the last three years you know it is something that it's not a drop off or arrest but for the caregiver to drop off their person and go do their shopping while someone else is tending to them while they're participating in the activity it's really for the caregiver and the person with dimension to be there together and so and actually my nurses and I were talking because in my mind which i'm going to get to the slide in just a few minutes you know we do have some activities where i'm thinking and you know we might want to provide something just for the caregiver but then you know when I park will with the way things are they may not be able to leave the house for an education training without their person that they're taking care of in someone ers with like elbow will just have activities for that going on over here while you do your education training of here and they will take care of that which was a very bright idea that's like you know why I like sharing um my ideas with my nurses so the history behind the memory cafes they begin in europe and it's marafect one of the training videos that I was getting used was over in you know in england and that's the concept originated in the netherlands it spread to england in two thousand and the first although alzheimer's cafe in the us started in santa fe in two thousand eight and I thought it was really interesting when I looked at their training video for the memory cafe they have training you know for their volunteers to come because like what we've talked about and here today we have to have training for people who have all time was in dementia you know we have to know how to s. Speak to the am how to be patient and get them to do what we need them to do at how to prompt them how to redirect the and that all may be something that's necessary while we're attending a memory cafe and so at their cafe's there have a lot going on at once like when they come in they may have an area back in the back where they are doing passless and then they have a different table over here where they're doing art work and they have something over here where they're doing another activity and then always with the cafes and it's really important that we have food so there's always going to be food there and there's always going to be snacks or coffee or something for them uhm to get to you know. Snag on before they go back to wherever they came from their homes or facilities where our memory careface library care phase or a really big thing I noticed across the us libraries have rams that can be rented or that can be used for non profits where they don't charge a fee there's all sorts of activities going on in the libraries that these people can go to and enjoy themselves coffee sharps if you don't want to have a lot of activity that you want the caregivers and the person with dimension to be able to just get out the socialised. The churches are dent center thing your centers. Community centers parks museums uhm i've actually been doing some research like you know. Moving more into the arts with the memory cafes or using music taking them to different places where they can actually you know enjoy that type of you know education activity. So are hopefully that's something that we can do in the future using. The I can arts and resource center and are goal for our memory cafes that we want to use different facilities across the central arkansas at night just when and the reason that we decided to do they at was so that families don't have to travel as far as a different locations to a teender cafe so arkansas parks and recreation has contacted us and has allowed us you know the use that their facilities uhm and you know that would be good that the facility that we're using that blonston is maybe in you know eastern and hopefully you know we have some place in downtown little rock so hopefully we can schedule it in the ad these sites on a regular basis or people in that area can just because it's really hard to truck you know drive a long way to get to it. And at the ats though. We want to use resources in the communities. So why should someone go to the memory cafe well it's an opportunity for normalcy you know to get out of the house to do something different and I thought about this you know in my mind i'm always thinking about the career giver as being a family member that's going to take their left one with the mention to an activity but that's not necessarily going to be the case like we had home helpers here today you know it could be that you have got your hunk here workers in the house with your person and maybe they can get out to the team a memory cafe for that afternoon or that morning or whatever and the usually the car face or a two hour the answer that's the length of time that they normally range it's one hour for entertainment and then it's an out an hour for food and socializing the things like that. So people can just get out of the house how far make new friends network and you know maybe talk to people that are going through some of the same things that they are. The. And so we have just this cafe is really new actually getting it up and ran in so we've just recently got our website and that's powers you know and actually I think it's powers memory cafe org and the phone which but that's no too and so the email is contact at pounds for like memory cafe dot work. The. So that is all new information for us to share. The. The biggest thing that we need or volunteers and donations of course this is the non profit and just like I was telling you to alexis and my nurses fundraising is not something that i'm very good at yet II own you know at school and little rock I do sting and I training personal curate training and i'm used to whipping out a cheque book and paying for everything I need i'm not used to asking for help so hopefully we can get a good you know i've been talking to people trying to get a good group of volunteers together that can help out with the cafes we are going to do training for the volunteers for alzheimer's dimension just to so they know you know how to talk to people what they're responsibilities will be when they're you know getting these people when therefore they're activities. And donations. For the cafe when we do have these if we don't have a sponsor which i'm hoping that we can start scheduling you know sponsors who are willing to get you know half the cafes. The. Home care agencies different people that might want to. You know sparts are inactivity. That you know we can have something scheduled monthly get that going and the donations could be used for food. If we don't have someone who wants to volunteer to bring it in and or arts and crafts supplies or to pay for someone and you know as an educator my fight whereas that I would like to offer you no training for these folks who are starting to take care of their live ones. And you know my thought was to break the personal care aid course which is the bout of forty hour course and now it may be even longer with our four hours maybe have added required although I was dimitched or training along with that but and break it up into micro units where we might have. Three or four skills and each one and so the caregiver can decide as they are taken care of their left one and maybe as they're health digresses and they need to do more things with them because family members are starting to take care of people I don't know how to do not know how to perform this skills so they may not know how to transfer them to a bear to a wheel chair them in I know how to change your brief they may not know how to make an occupied beard when we teach personal care eight classes that's one of the things that they tell us is that they don't know how to use the four year left and they don't know how to use make an occupied be it so if I break that up into sections I was hoping they at you know maybe the donation or the fee for that training could be used you know as a donations for the memory cafa and my goal is is that if that person decides that they want to take all six modules or however I break it out that then we could actually give them a personal care eight certificate and we do uh certify the. I do certified them you know myself for the school because we're an. Approved by the arkansas you know the department of hire it so and that's my goal because I am not artistic I do not know how to steal crafts and so the only thing I know how to do as teach I know that is very boring that uhm that's my way that I want to contribute and we do have an event that's coming up on december fourth and the I can't arts and resource center eh in the eastern community and little rock and it is going to be a christmas thing then we're going to have hopefully may be seen that they are in pictures and a good lunch and we're going to do arts and crafts and different things for them and and i'm working on that right now trying to get that together so. The dream is to get to do more events like they are in for me to learn how to send rice but anyway so that's what I wanted to share with you today so I didn't want to say santa will be there I called the north pole and I made sure that he's available at that it's really hard you know it's got a whole world too yes i'm now i'm so excited they are now plans on being at that location at that time so I think we have a pretty big group coming into this one I mean excited it's it's always hard to get something off the ground and get started I think she's got a great vision and you're speaking in front of people who know um and have some contacts and network and all that so I encourage you all if you want to talk to her a little bit more directly get involved getting aged she passed on her phone number in talk to here now anybody have any questions. Yes doctor wait I just want to congratulate you patricia I think this is a wonderful idea you have and I think that there are whole bunch of entities here represent it that we each touch some aspect of what it is that you're seeking to provide but yet I don't think any of us are have then a hundred percent successful and I think you're coming at the hume human arts music a spiritual aspects that I think are going to make a huge difference so I congratulate you i'm going to ask some of my team members to get in touch with you thank you you know it was my goal to have the. Nursing students and people who need volunteer hours you know are uhm physician assistant students need volunteer hours the high schoolers now need volunteer hours to work with just recently actually been contacted by you by a large just a few weeks ago they want to send their nursing students over and use the cafa as the clinical site and you know that was kind of my dream you know that this nursing students need training and all farmers dementia and. Uhm. I think I think it will be a good way to sort of the community. Yeah thank you for being here also thank you for senator and representative barbara horn for coming up here at this is the first time you've been at the capital and quite some time or in a while okay well beautifully decorated now for christmas so hopefully you can go go get a picture taken and alexis thank you for bringing her and thank you for the care that you provide in for being here being a part of the board so thank you we're gonna move on to our blast and j hill from the department of human services I just wanted some updates from him and we've talked about a few things here and there are in various meetings and uh first of all we had asked about the assisted living rates if you don't mind just kind of updating as on some of that information so a couple things. The first update was on the heart of funds the rescue plan act funding that was designated for assistant living facilities if you recall that there was two million dollars that was granted to to the out to help offset losses incurred over the last few years. What we did we went through each of the medicate facilities in the state was required to return an attack station of utilization of funding the funding was broken down based on a five year look at the number of beds utilized so the high it this was for medicaid facility so the higher your population over the course of those five years the higher year piece are or your part of that two million in our initial sweep are certain initial payment there were two hundred apart from the two hundred twenty thousand dollars that was not claimed that those funds were recalculated using the same formula and have been reimbursed so really that's a long way for me to say that entire the entirety of the two million has been paid out to up to all of the participating facilities we did not require them to return a second actor station we went back and used every one of the participated in the first round of finding secondly is the cost reporting process for assisted living facilities. One ninety eight of this this previous general session now requires that on and annual by strong fiscal at the end of a fiscal year. All of those assisted living facilities that utilize medicaid beds will submit data for a cost reporting process. It this was brand new so we we anticipated there would be a a learning curve there it did take us some time the statute allows for ninety days to return your information now at the time we were asking for that to be turned around in thirty the reason being uh we knew that we were very quickly approaching november eleventh which was the date with at which our emergency rate that we were paying eighty one and change and eighty five and changed depending on whether you were an urban or rural facility was going to revert back to the original rate sixty seven twenty five. The thirty days would we had a extremely tight window with which to get that information back in october by the first week of september to get the republic comment with hopes that if we submitted that to CMS we could have a a decision rendered now we were somewhat we were given over prevent that in that time period cms allows us to extend our mercy right for the duration of our way or so that it did not revert back to the sixty seven dollars which we have submitted to to cms we've we completed the the public comment period on october thirty first hour our application or our intention to extend that rate was submitted we have had some communications back from cms anticipate a called this week that to just for uh responses to an informal request traditional information which is which is gent which is common place when you when you anytime you submitted a moment to cms that couple follow up questions they were mostly was cleaner you missed a period here this word needs to be used for that word and it was a question about our rate methodology all of which we can produce so anticipate that pulled this week which is a good thing we're moving through keep getting this right put in place the cost report itself we did not get all of our applications all of our data returned within the thirty days understandably there were several services that had questions how does this work what deal it was this was a brand new process i'm happy to report that on november the tenth our final facility did return their information and so now we have one hundred percent participation in the process that came in at the eighty ninth day which was under the window but but we do have all of that we did not wait that long to submit the documentation to a vendor that was selected in a bit processed. Myers and staffer is compiling the data they are performing the analytics on that and then they will produce a report with the targeted timeline of january thirty first back to the state looking at all of that data from all of those medicaid providers all those this is delivered facilities that have medicaid beds as to what that what that right a recommendation of what that rate may look like so we do project that we will have that back no later than january thirty first and that is an update and one of them that were there by where we were. And then III pulled it up we we had a little discussion on personal needs allowance if you don't mind sharing a little bit of information just following up on that so we we work with our medicaid team in a very much appreciate them they did a great job that pulled together a fiscal impact study on the personal needs allowance that was is paid out your car for if this is presently forty dollars it is paid out to our nursing home patience they're allowed to keep forty dollars per month for just what it is personal use then the facility that we operate in the division just to give you some examples very often it is used primarily for I would say I will take use for tobacco or preferences and individual may per may prefer coke to pepsi they may prefer a certain kind of toothpaste they may they may need things such as socks or undergone its or they may just want to bob very often a lot of a residents like to buy christmas gifts with their family members at christmas time so it's used for a mirror of things presently as I said is forty dollars in arkansas we were asked to prepare a study so the documentation represented maybe senator pennsylvania that was turned into the committee demonstrates what that that would look like if that knee if that personal aids also has increased to fifty dollars sixty seventy eighty nine up to one hundred dollars we did this based on average of our current average of approximately eleven thousand five hundred individuals and skill nursing facilities today receiving medicaid or being paid by medicaid it includes the total impact of the increase and then it's broken down between the federal and the state share I would tell you so for a ten dollar increase up to fifty dollars a month the total fiscal impact is one point three eight million federal share nine hundred ninety three thousand state share three hundred and eighty six thousand up to if that were raised to one. Hundred dollars a month the total impact that would be eight point two million with a federal share of five point ninety six that's an increase in medicaid payout in a state a general revenue increase of two point three million so it does range anywhere from one point three up to eight point two in some total at ten dollars increments we stopped at a hundred that was a number that was mentioned in committee but this just gives you an idea I kind of shows you to trajectory the increase in the medicates band as well as the state general revenue. Okay I appreciate it and I have failed because apparently I didn't see that that was sent to me and I didn't forward it on to brand in so i'm gonna afford that information to brandon to put together to send out to the committee so everyone has that on a chart to look at but er