Alzheimer's Disease and Dementia Advisory Council

And all that we're gonna get started I'm representative Julie Mayberry and Senator Ricky Hill codesharing with me today we appreciate each one of you for The very first thing I'd like to do is approved the minutes from the last meeting if someone wants to look at those and. Okay different motion to approve from someone else center to help and second by Kathy. And all those in favor say aye hi. Anyone opposed no okay very good thank you for proving those minutes before we get into what we're mainly here to talk about today which is that state plan in this rough draft here almost complete draft last week I was sent this video and I'm working with the subcommittee through another committee on child care issues and this video was sent to me and I just went I have got to show it to this committee is it is just beautiful don't ask me too many questions about it because I'm working on details that other committee meeting is on the twenty first and all have others who might have more knowledge of how to make this work in Arkansas but very briefly you're going to hear about the. Little Blake's this is coming from Cumber nodded village which is in Kansas it's the Winfield early learning center and the reason why this kind of got national exposure is there teacher there're tablet there Ross Perot he crossed for you became teacher of the year in twenty twenty on a national level and so this video was put together and I just think it's an absolutely beautiful story and I would love to see this done in Arkansas and I see a head nodding that some of you might have seen it before so go ahead and play Brandon. Yes. Ninety one years old actually. Children every morning when they It was very very. Experience. Social. Ninety four error. What are these kids here every day. My name is Betty. And I'm a grandmother to the kids enjoyed coming down reading to them on Monday Wednesday and Friday and usually and to see if Thursday play with them. And they're just very very very loving. Mr. Where have teacher. This call. This college. Shall have been. Hi there are this. What do you think Roger what do you like to do is. Like to be around. The. Your next question is what is the impact on my life. I have to the. Ninety years. So. I have a problem. But I I wake up in the morning. So totally different than I did. Just two years. I have a reason. I've never had that feedback. The. No. Respond. There's actually a little out take that's really cute that I just want to let place so I just want to tell the story about what happens to you. Your bill always as. Children do you have any questions you'd like to ask me yes do and sometimes I gotta get off track but I was kind of taken aback by this question said. The ship in the navy in World War two. It said were you killed in the war. You said I don't think so I'm here. It is like that they're asking you know what they're going to as but there's carriers. The results areas thank you. Thank you you can count on little ones to ask those good questions can share but I mean just imagine the laughter that they they have experienced in I just wanted to open it up if any of you seen this before has this ever been tried in Arkansas has it worked to hear any any thoughts. To have any. So with the center on aging we've done different projects with this throughout the state on different levels of age groups and with the public schools and we've even had different intergenerational with physical activity particularly with COVID the utilizing zoom with public schools and connecting long term care facilities at the different times trying to get the connective itty and what is been a challenge though is the rules and regulations of public schools allowing us to come in. So that is one thing that I would say if we're going to do things like this in Arkansas we really have to look at what we can do to open it up so that older adults can be a part of these programs with school systems because that is been a challenge for us we had a program in Texarkana they had a International Baccalaureate program of where the schools and it was K. three four the schools did more projects and so we have paired each of fourth grader with an older adults and they learned based on projects and so the odor adults share their life experiences that day be on diversity and challenges and it was kind of like the stories and I would ask and so a four year they spent one on one with the Notre adult. And the eighty became the circuit grandparents to a lot of these children that did not have grandparents and so a lot of these older adults look forward to that Thursday afternoon it was every Thursday afternoon twice a month that they went and you know those older adults really had to be want to be there because the amount of paperwork and we as staff was centers on aging had to help them fill out the amount of paperwork to get background checks and all of that done and there was a large commitment on that aspect of them and I realize we have to have safety for the children as well. But it was a large undertaking for the staff to get. The older adults in there as well so there is a little bit of a challenge on that aspect. Hang at I I I do know that this video is a little bit more specific you're talking about K. through four so existing public school this was more early childhood so it's a retirement center the the retiree is there more assisted learning and early development I think these are three or four year olds better in there is has there been living facilities used Dr week yes thank you thank you representative may very I think this is wonderful that you shared this with us I can tell you that in Boston we undertook just such a program and we wish sponsored by the stride rite corporation and so what happened was that it was a continuing care retirement facility and they had pre K. children to come in and initially the way they built that was they felt this A facility that was. Reachable by this senior from one half of the site and the other half would be reachable by children with that pre che and nursery facility so initially when the facility opens you know a brave soul would venture in there a little bit and other brave souls venture in the a little bit eventually the seniors somehow that's in the middle of children back to the middle these are pre K. children and then they started to interact and long and the short of that are as follows the seniors after six to nine months there was a significant reduction in the use of sleeping pills in the use of anti depressant medications and there was a reduction in acute hospitalization so this is clearly documented for the benefit for the seniors for the children for the prepaid group they were equally benefit it more of the kids gained more self confidence they were able to articulate what it was they were thinking and they were able to start to read and the email two three year old back when you know they didn't quite teaching how to read but each one of these senior grandparent figures were teaching the little kids how do we do this do that and the kids are happier than ever the seniors are happier than ever and it was just a win win for everybody so I think that we should and I would so much encouragement and I would enthusiastically supported wholeheartedly to try this and if we can get one site to be successful then there will be others that will take after it we do have a continuing care we have a couple continuing care retirement facilities in Arkansas in little rock Central Arkansas that would potentially start at and I think that. Would be a great way to go because I mean it benefits everybody. I'm one and one other benefit when I was talking to folks and and child care she kind of call this a three for. it benefits the the older or Kansan benefits the child but it also benefits the workers because a lot of the workers might use that facility for child care and that might be what it entices someone to come work for you as opposed to come when we're short handed and we're trying to create staff and all that and we have so many employment issues out there in the world right now low staff on things that this was she called this a three for and that's what I'm trying to push in this child care study that I'm I'm looking at where can we find some three first and this is one of them so I'm gonna continue this conversation and that the other committee but wanted your feedback and would love you know to talk to you a little bit more I don't know if anyone else has anything publicly they want to say all reach out to you if you had that study from Boston yes and and if I can maybe engage you in that conversation that all the talk to you about that I believe in too I would love to help in anyway possible we are affiliated with one of the continuing care retirement facilities here in Little Rock which is The Presbyterian village continuing care retirement and you know they got very high grades for quality of care so I I would wholeheartedly help to try to engage and try to broker something as an initial pilot is you're right I like the idea of a sweet for that's even better for I like that I said I'm going to start using that language I did talk to Rachel bunch from the healthcare association and she actually mentioned the same facility that you're talking about she loved this idea so would bury else is going to say it's not foreign and not that you know the program but a lot of facilities invite children in different aspects electors Halloween don't have like a hello we need party and they're inviting the of. The day care whatever this close to this is not like a foreign idea and I think you can get facilities on board because they do invite children in as often as much as they can I raise my son going to hello and carnivals at a skilled nursing facilities entity is a benefit any yes us because my mother worked in a skilled nursing facility get people younger involved is a year care and respecting elders I think is really even more than that the three for is like good for our society as a whole it's a for for. But I will check with the department of education about you know what we can do to lower some of those regulations to for the public school facilities anymore comments on this before we move on happy to hear him but. Doctor Griffin ahead you hit that little button there hi yes. The turn on. thought there's also an opportunity for research. which really is already Jean is already known about this because they they were doing research at the same time and that sort of thing really spurs the idea of even government funding and or funding in the local community or whatever. So you know these kinds of ideas I think have a lot of support that's not that's not Garner yet because they haven't known about that. That's good all starts with conversation so that's what we're here to do and what we'll continue to talk about it so okay any any other comments. Now okay we'll move on to the other bit of business here and that's the Alzheimer's and dementia Arkansas state plan I know that we might wanna have David cook go to the. Table down there as the one who's taking all the comments that have been sent in and I I don't think the department of health and DHS have really chimed in yet so I'll be interested in hearing if you all have had a chance to look at it. David let you take it away. Thank you represent Mayberry home for the record David cook senior policy manager for the Alzheimer's association I want to thank everyone who participated and and subcommittees and the feedback that we have received from the health departments in I think we did see received some feedback from DHS so really appreciate your work in the conversations we've been able to have since our last meeting what I thought I would do is similar to what we did last meeting is walk through some of the updates walk through the section of the plan we certainly won't read it verbatim unless you guys don't have dinner plans we could do that too. what I what I'm gonna do is we go through this this presentation is just highlights the the sections of the plan that were amended where extended contents was was added and then some of the additions that we we made to some of the other sections so we'll kind of walk through that a section at a time and then can pause for questions as we go through. Really the format stays the same we have an introductory section what we talk about the process and trying to figure out which. I guess that's the okay I'm just trying to figure out which light was up there you guys are seeing so it we have introduction we talk about the process and then we also have expanded that and we'll get into that in just a second and then section to we talk about disease and the progression of the disease some of the risk factors and warning signs and then section three is where we we lay out or four priority areas with the policy issues and recommendations and then it closes with an appendix and some references. just a slight formatting change we did format this latest version with a PA if you're interested in that in the introduction section we did expand the contents home to just describe the historical context of Arkansas's engagement Alzheimer's dementia issues we also included a section that was specific to the Alzheimer's dementia Advisory Council and the creation of the council and we did outline the reporting requirements that we have to to make to the legislature in even numbered years. if you see this is not something we didn't mean subcommittee for so as you go through this section if you have edits or anything that needs to be added or or changed or any additions you would like please please get that feedback to me by it no later than September nineteenth at five PM so please take a look at those first couple sections for. in case prevalence we we updated the facts and figures to reflect the most recent available statistics status of statistics which were released and April of this year we also updated the state fact sheet and then we also expanded some reporting on how mortality rates were impacted adversely by COVID nineteen so we going to the impact of the pandemic on mortality and again in those two sections if you see anything that needs to be change please let me know. One thing you will also notice in the definition section we looked at the the Alzheimer's definitions and the symptoms in the previous version it was noted that some of those definitions were very complicated so we tried to simplify those definitions and input the symptoms out there as well with each type of dementia and so you'll also notice that as well would invite you to review those sections and if you see some things there please again for those at some updates to me. Now that you've had time to digest all of that in its entirety does anybody have any questions. On it again we've tried to keep this process transparency and invited others to come and provide content of calm the feedback and additional content and so with permission of the council at last meeting you did authorize us to meet and subcommittees and so we'll go through each one of these sections in the purpose of the subcommittees were to meet together to review the recommendations as they were written and one of the things that I I instructed the subcommittee that we talked about was we want to look at the recommendations and make sure that they were actionable things that we can measure we also made some amendments to some of that language to make sure we had measurable recommendations but we also reviews the content material and recommendations were submitted as to how we can improve the content before we got to the policy recommendation section and public awareness of our contributors I contributed and all of them but Jennifer Holland from the area agency on aging can Eddings Kathy Griffin Tony Bailey Caroline berry doctor Emily over typically and a representative Mayberry were being on involved with a public awareness. And so as we got to the recommendation section there was some amendments of course previously we did note that we want to prioritize the state's response by establishing a person appointed by city council of course that has been accomplices we did amend that to reflect the update and of course ACT three ninety one as mentioned in the intro for introductory material as well. we did make it a slight Amendment to recommendations that specifically identified the health department we've expand that definition after having conversations with both the health department in the department Human Services to to broaden the definition we've we've change this to establish the position to mention services coordinator within the state government and those conversations about where that position might be House or continuing and we've also we I think we silo doubt the health department on this recommendation as well we amended of to be more broad just to establish public health campaigns that will incorporate messaging on cognitive health in our idea was you know some of the existing public health campaigns how we find out how to incorporate messages get messages around brain health one of the easiest I guess examples would be when we try to tell people to stop smoking tobacco cessation we could add you know it's better for your brain so that is something that I think is involving because we have bold funds now and so we we see a targeted approach to that within a chronic disease at the health department so I think with the availability of all friends we'll see some progress on this and that is a personal opinion just from reading the tea leaves that I see very pleased with how the bold bold grant as is progressing here in the state and what that's going to allow us to do. and then I had a conversation with the part of prior to this meeting so I did a strike that language there but just established in Alzheimer's dementia registry so really not clear where that should live so I did make this strike but that is a new recommendation one of the things that we discussed is this the some of the shortcomings we have with our data collection one thing that's particularly difficult for us to to gathers information around those with Alzheimer's who may be under the age of sixty five and so similar with a cancer registry we we decided to mention registry would be a really good idea to participate here in the states so that is a brand new recommendation. not much has changed with the the first one we we didn't want to continue to encourage the use of a purpose I will note that did have a conversation to the department that we may need to reward this one a little bit just to make sure that our purpose obligations that are tied to the ball grant are consistent with the recommendations we put forward so we're going to continue to talk about how to how to amend that language so that is consistent with bold requirements. these are a this is amended before we we had a very broad definition of just supporting the work of the minority health commission so we decided to amend it to be a little bit more actual just increased collaboration among service providers we thought about service providers we thought about you know people who provide access to them to mention care resources or education course you a mess as some information or association as information and just how to make that available with the minority health commission and partner with them in their work to make sure that elementary education material is made available to medically underserved communities particularly how do we work within the mobile health unit and so it still brought enough we can kind of figure that strategy out as we go along that's the thought behind that. Mmhm another new recommendation recommendation is to establish a grant program provide funding for our region to manage education in minority and medically underserved communities across the state we we do know that African Americans and and let next community of a higher proportion are more likely to develop Alzheimer's dementia but they're also the least likely to participate in clinical trials so getting information out of that population is essential and so doing some specific targeted outreach those communities is a new recommendation of the plan. at the request of UAMS centers on aging we also pull them out for a new recommendation two of course expand their work and access to their work in the work that they do in rural communities so that reads pretty similar to what we put with a minor health commission but similar to the area agency on aging both organizations requested to be singled out with a recommendation just to increase collaboration and to to begin thinking through how to we use some of our existing healthcare infrastructure to create more awareness around the importance of or detection diagnosis and risk reduction which we know will affect case prevalence down the road and so that's the thought behind those two measures how do we use what we have already and and work within those systems and a more strategic way to write the information the services that people desperately need. And also evaluate the implementation of telehealth of course assessments telehealth is a broad term so it's more than just interacting with clinicians but how do we use on the new vehicle we have available through telehealth to raise more awareness around again risk production and prevalence not only for the general public but also to for providers as well just making sure they have the tools and a full level of comfort of making recommendations or referrals for their patients and so how do we use this new vehicle this technology we have available to us to again create more awareness. And that is the in a public awareness I guess pauses anyone have any questions about any specific recommendations So from reading the room that section is done. I thank Dr we does I just wanted to commend David for this excellent excellent job I think it's really superb and want to thank you for all the hard work and helping all of us. This. But well I appreciate that this is certainly a of a collaborative effort and so we we wouldn't be here without your support in the time that you give um to this committee and certainly to our co chair so and and the agency staff that's been so cooperative over the last couple years to get us to where we are today so thank you Dr way but again I can't on that myself we've it's been a collaborative effort from the start I was thinking of that they get a registry I'm offices instead of did that they know every day how many reported cases there are covid so they would just be back on that a strategy that they can use can you talk a little bit more to the Mike so we can all hear you so sorry that's okay you might be able to pull it can you pull it a little bit closer to you there you go. I feel like I'm shouting all the time but. Then come out like that as far as we we also or online and so it definitely someone who's not here who's watching it from home or watching a recorded version we can be able to hear you either so that's why they also needed in the Mike right and what I was saying was that we already have a strategy for collecting the number of code that cases for example and that strategy would be a good one that we could just pick up on and use that kind of strategy maybe there are hints anyway as to how we could do that because it would if we had a registry then that's that's the kind of information that you need for for applying for for example government grants the victim the need in your place. And you know and our place we have a lot of elderly so if we could only collect this information that we could make that more clear of the percentage of people that are aging and with regard to early onset if if I can just tell this little bit with regard to early onset oftentimes those people that are early onset also have inherited the Alzheimer Jean this gene called a police for and and we have of grant that's been going on for quite awhile like twenty years and this is one of our recent findings is that that Jean is important in a particular way that allows us to intervene or have the idea of intervening with drugs so it's important and things like having having drugs come out at the you A. M. S. for the treatment of this disease Alzheimer's which is so many because the government. Almost a third of the trillion dollars every year. Four I just the government's part of paying for Alzheimer care. So it's a big deal. And so we're really proud of our work a you a mess and I would love it if if everybody down at St as we call it over here in state knew about our work it at UAMS on all of this COVID everything but especially in Alzheimer's disease that's been near and dear to our heart on this grant that I'm talking about for twenty years we've been working. And so we've come to this really good point. Okay I think that's it for public comment on that if you wanna go one David. I understand that when you do River Road review the public awareness section please review it for content so if there's any it is that are needed please provide those to me and certainly on the recommendations piece of sooner the better on those we can get those back out for one to review. on access and quality of care again the only really edits we made war into to win in the contact section we amended it to reflect the current H. C. B. S. we were services that are available folks individual dementia so that's the only change that was made in the content section just to make it consistent with the most recent waivers that we have out there. this was the the first one was a new recommendation just to expand access to dementia education training and support services by increasing collaboration again singling out the area agencies on aging and so that is still not enough for us to develop a strategy again with the same purpose in mind using some existing infrastructure to provide some services and then on on access and quality of care of I really think this is misplaced and probably need to be in the public or public awareness section but we did provide a new recommendation here and that's to establish a dementia resource centre in each of the area agency on aging and our idea behind the dementia resource centre is just to make sure there's education information resources the connection to resources to make sure the area agencies on aging have an up to date list of support group services that are provided provided things that are available in their community and so that was kind of the idea behind that the dementia of resource center. these are again still continuing from the previous state plan that is just to continue to research to support innovative models to finance the livery of H. C. B. S. services and of course support the development pilot programs to test those models and also was consistent with the first but addition was to review Medicaid level care policies and then also to continue to look for ways to incorporate cognitive decline in determination for services as well so how of that's that's something that we've talked about in throughout our meetings is how do we account for cognitive decline we guarantee need for services. This was a of again similar to the first rest content conducting a statewide needs assessment to determine capacity availability cost and and course quality of existing dementia care options and then along with that is going to be we we discussed on our subcommittee call that we we really need to spend some time thinking about what what quality metrics are on terms of dementia care and how do we identify that not only just on you know the quality of care but also on the education piece will talk about we get in that section as well what a quality measures look like it was certainly a question and concern that was that was raised on that I want to share with you as well as the new of recommendations next one is to research opportunities to increase number providers for dementia care in underserved communities how do we expand access but in order to understand where we need to expand access we need to understand where the need is or if if there is a need and how to we we fill those gaps that exist. This was again an ongoing one that we mentioned last month the nicest to continue to evaluate AC this waiver policies to ensure a person with dementia and Alzheimer's able to remain in their preferred environment so that's similar to I think what was mentioned in the last slide of someone had suggested we combine the two so certainly willing to talk to DHS about that see if those could be combined some way. this is amended to forty I think we we talked about the testing of acuity based models in the first addition but uh we've we've kind of changes to researching developing acuity based model of care that reflects the higher levels of care needed by dementia patients and so At A. O. will say for the interest transparency the the healthcare association has expressed the concern about the security base model I'm still waiting some feedback that I will share with you as well and that piece. this was amended to another remitted right recommendation was to ensure the Medicaid reimbursement levels across care settings reflect the higher levels of care needed by those with dementia and the idea behind that is in future rate studies that so we we figure out a way to measure what are those higher cost of care for people with Alzheimer's dementia or those extra staffing requirements that are needed and so making sure that that's taken into account in future studies is the idea behind that. And that is it. Any questions on access and quality of care. Everybody except them those written. Hold on a second representative Johnny Reid has a question. We love the feedback. DISMANG. Okay thank you they're all a little bit different. Yet David question for you Sir you know I mentioned in one place it every other year testing be made. What I would do that of that testing David. With the area on aging or who would it be. Representive are you talking about the the the purpose it need to be ran every other the survey mmhm it was on this is David about fifteen minutes ago mentioned every other year having a testing done to. See if a person actually may have Alzheimer's disease. And the record. It was the purpose. He said. S. S. okay survey at least every other year. Yes Sir I think that's recommendation referring to so the the behavior risk factor surveillance system is is ran here in Arkansas every year and every state has the option to add modules that are specific to certain areas on on purpose as it is currently structure there are two modules that traditionally also association an interesting collecting one of them deals with cognitive decline and the other one deals with care givers and and ask of quite a few questions around you caregiver support burn out things like that and within the book bill Graham previous this the providers or course individuals who want that the data had to pay for for that survey and the association as. Consistently ran that that module and an alternate years. Now with fault finding a part of the bold grant requirements is to to run this survey and so one of the things we are talking about is how frequent we need to run it to satisfy our bold mobile requirements that just helps us gain some ideas and some data from our Kansans on you know cognitive decline what they know about cognitive decline I don't have the modules in front of me to go through the list of the questions but is quite exhaustive and it's it's very valuable data that we get back and so the question is how often do we really need to to run that but that's what that is pointing towards representative right. Thank you thank you can have little follow up okay they retire I ask you this question about a month ago this happened to my folks cousins down the line they wound up going somewhere in there pick up David but they wound up lost for twenty four hours and no one knew where they were at and I thought you know he probably should have some type two years. You know for a couple years ago. So. Thank you all right of. It just just so you're clear that the the purposes of a public health survey so it doesn't do specific testing for for contra Klein it's something that a provider needs to do it's just a public health data survey. So the idea is that it's a survey of the risk factors for developing cognitively decline how friendly are the risk factors but it doesn't give you the exact numbers because order to have that one would have to undergo a full evaluation and that requires a clinical component but this is very good because if we know that the risk factors are highly prevalent in a certain subpopulation how good is that so such as the folks that you mention your folks that that lost it well I'm sure there are others. Close to them and friends with and who are in a similar situation wouldn't it be nice if we could kind of. be able to wrap a little bit more tender loving care around those home we know I'm going to be a greater risk. Go ahead David thank you. A family caregiver section again that the idea behind that section is of course to increase support services for dementia caregivers you can see a list of contributors on the screen Jennifer hollom from triple A.'s K. Kathy Griffin Caroline berry from Alzheimer's Arkansas of course Dr McCoy representative Julie Mayberry and of course doctor Kerry Jordan. the only real changes or edits to the content section we amended that content section to reflect the latest facts and figures around the number of care givers the hours in the impact on Medicaid so those are up to date with the recent the most recent stats. Moving to the recommendation pieces of this this is amended To have the root. Yeah I'm I'm looking at the one The New and make sure I give you the most recent amendments here. I'm under the the the first plan we would just had the word improves so we just amended to expand access to evident that to win and the use of evidenced in from evidence informed interventions services and support for people to mention their care givers to answer health well being and independence so just making sure they have dementia education they have access to education materials resources that can help support of course the things that they're going through as care givers also this is similar to the first one expanding home facility base respite services family caregivers individuals with dementia so how do we incentivize providers to provide that that temporary placement for respite and then Connect family carers and visual dimension of or to information about dementia services again using the triple A.'s to kind of do some of that we think that'll be satisfied and of course of the next recommendation is to establish a partnership between the triple A.'s and service providers to make the services and resources available this is consistent with the previous recommendations create the resource centers within the triple A.'s as well. But based on the request they've asked to be singled out so we can prioritize that. the next recommendation is is a new recommendation as well and it is is from a request from you M. S. and of course working coronation city agencies NGOs such as triple As that should be taken out I'm sorry of amend that of the U. S. centers on aging the Alzheimer's association develop and deliver no cost training family care givers people dimension to improve the delivery of care and support better outcomes for family care giver sets a new recommendation and then the the the regular survey was a part of the previous state plans no changes there and then the success of our dementia respite care giver pilot program has been such that we would like to for any recommendation make that a permanent program and so that that's listed as a recommendation the recommendation to The state plan this time. This two guys have an update And latest the latest records we received today that the the grant programs already given out seventy eight thousand five hundred dollars and they plan to catch up on applications this week so It's moving fast. There is another class of the Alzheimer's association has already. What is this and it cost about the same care giving by the families that and everybody that's about equal to what the care giver. Government's part is so it's these are. And in a state like ours we can't afford it. And then taking into consideration that the odds of the of the care giver you know in the family I believe mostly of die and is equal to the patient seven at these kind of facts I'd I just mention them because they're they're hard facts and we live in an area where these are really important facts because Marc rich. I will add that in the family caregiver section we do emphasize this not only the the the the financial burden family carriers which is the health burdens in the extra burden that it does take on and told takes on individuals living with Alzheimer's dementia that this level of care system greater. I know the Alzheimer's association has that plan for you having a little respite period. The I always thought that was a good idea. Thank I might be kinda laden throwing this idea out there I don't know if this is the area that it would fit in but we don't mention anything in here about guardianships and help for people in understanding how that works and I don't know if we need to have that in here somewhere. I yes I would agree with that and the reason is because the regulations change from state to state and it's not the same and sometimes it can be very confusing so I do think that's so important Elie Wiesel. Get everybody to learn everything and this is not that complicated once they can be explained you know in a simplified manner I absolutely think that would be wonderful to do it if somehow and an educational part to the care giver to help them understand what the best option what the options are. So if I may give one second to our upcoming continuing education conference December eighth through ten this will be Thursday Friday and Saturday we will have to a specific presentations about learning about proxy learning about all the regulations that we should learn in other words is just sufficient to be an equal account holder and you be love its account the answer's no you have to go for power of attorney but that's not the case in every state so everybody needs to know all by these little intricacies and they won't unless we really give it to not everybody I will mention are invited to attend our continuing education course just like last year it's Thursday through Saturday it's free to all of the general public the only people who need to pay are the professionals who need to get continuing education credits so that's pretty rare and we especially invite patients with cognitive impairment and their care givers so whole day which is on Saturday that whole day is devoted to caring not only for the patient but also for the care giver because that's so important to as doctor Griffin just mentioned. Thank you. Disparity. Okay the PO a indication by dementia and Alzheimer's is very overwhelming so I'm not again it's even defining what a family care giver II is maybe with PLA's are like very brief but. Is overwhelming genesis start with the bases of dementia right service where like educating lease to edit leading them to other places for resources because we can't cover. Everything in here and once I made if your family care giver you getting here you start talking about PLA's garnishes you go down another rabbit hole that may take you away from the purpose of this plea and is getting resources that educate really just about the mansion dimension is self so I'm not against it but we have to be very careful consent of things I find and when I deal with the only care givers he is there so much to provide with them for them and I can't get it off like it went education setting in one time so I go from understanding the disease to the legal to the financial and we're not just going to be able to. Get it all in one. One planned so being careful not to put things in there they confuse or send them somewhere else but maybe just enough to understand like what a family care giver who they are because a lot of times a family care giver is not the spouse is not the child a lot of people we gear our best friends and people that they forge friendships with so maybe defendant who any as in like a PO eight can be a family care giver guardianship but not too much information if that makes sense I just have a lot of people don't really know. There was a lot of people do not know that they are a cure. That is the absolute truth of I think a lot of time spouses don't recognize that their care givers because that's their job and task so they don't go looking for resources children they don't go looking for resources consist their responsibility they don't recognize themselves as being a care giver so the finding the term usually we use the term care giver people thought think about the CNA this going to come in the in home care agency so care giver is not really defined to a lot of people or I'm just helping my friend I don't see myself as a care giver so I think defining what care giver is is important because a lot of people will have people that are not related to them caring for them sometimes is the neighbor this being your friend for thirty years next door to you and they don't see themselves as a care giver they see themselves as a for your help and to take care of someone they love so maybe defining that giving some definition to what the family care giver yes and we usually say I'm paid that's how you get resources. So maybe some something about PO a would be a careful not to try to prove that on the information in his plea exit ill. It's already being a world we're we're getting. It'll start lives. Beg to overwhelming and I think this could be too overwhelming so for some care givers. Any other thoughts on that I mean I just know that if you're in that situation you kind of know what you need to know what your rights are and mean just some education you have a whole bunch of questions that you haven't really thought of before yeah and I guess that's where it is getting us to getting them to our resource is not trying to provide everything and document is getting them to a place getting into a summer's Arkansas get into the area agency on aging and once we they get to the restores the and we as professionals know how to get them where they need to go. Okay yes I completely agree with you calendar I think that the best way to feed somebody is isn't Fite sizes always sell I agree a hundred percent thank you. Okay continue. Well I was I'm sorry I'm sorry that's okay I think I am I'm gonna go pick you back on everybody else sometimes if you give too much that you drown me but I also think that's where the area agencies being across the state we can provide that information and education that is a topic that we discuss often and hold like little mini seminars and we also have a grant in which we can get legal aid for people that may be needed you know that sort of assistance with an attorney so again that's where you know we're right there so. Okay. Continue David. of our final section is where we received quite a bit of feedback we Also when we talk to the subcommittee which subcommittee members and contributors are listed on the screen there. we talked about the importance of understanding the the context that we're in now is quite different and then our first edition because COVID has happened so we expanded content to reflect the impact of COVID nineteen on the on the health healthcare workforce but also in case prevalence and we highlighted the current workforce shortage which certainly needs to be a part of our work in supporting efforts to help providers who are struggling to to to find workers and fill their their their spaces and provide care we also added some additional content on dementia chaining some things that we were not aware of that were brought to our attention the federal regulars regulars eight. The federal regulations set forth that that guide nursing homes long term care skilled nursing facilities so that contents expanded to include those federal federal regulations. Having trouble talking the ring saying regulations. walk through these this these first two were or amended we had requirement language there but the hospital so she should reach out to us and discuss this the the the problems that this might cause and health care system change that require it will require to implement so we did soften that language instead of making it requirement but develop and make available to mention specific training for physicians categories of workers and then we did the same for hospital social workers and discharge planners so instead of making that a requirement more developing programs to provide that education to positions and also the hospital discharge planners. similar to our our previous recommendation expand collaborations between nonprofits in our community just to make sure that they are aware of resources we mentioned before that one of the problems is that a lot of us have resources in organizations but they remain silo so I'm too often and so how do we expand partnerships to make sure we get those resources in the hands of people that need it. create more awareness around those resources that are available we similar here at the request of the area agencies on aging incorporated them into this recommendation and this is a a new recommendation is to again that incentivize healthcare workforce and that's to establish a grant program that will incentivize entry level workers like C. N. A.'s to progress and their Education as providers we were made aware of the A. R. futures program that's current currently active in the state and so I will include information on that in the update because among the professions that qualify for that grant program or healthcare professionals so I will add some of that content in as well This is a some of these next few or similar to the original state plan that's of course increase collaboration between the nonprofits and the medical community and then dementia specific training requirements that need to be established for APS workers but also members of law enforcement both in the initial curriculum and also on going training and then this is a new recommendation established images to train programs for community health workers which is a new category of folks are doing work and making sure that they are equipped with some dementia training. Okay. Hi this is a again a new amendment just reflecting just the The New availability of telehealth and how to we we use telehealth technology to provide them access to evidence based dementia trading including you know for clinicians areas of assessment providing diagnosis treatment options and referrals to other providers this is again a new recommendation research develop a process surviving the benefits demonstrating within clinical in professional settings and the idea behind this is to begin looking at how do we put quality metrics in place for the dementia training that is happening across the state how do we determine you know. Is it evidence based is there a way that we can establish some of those quality metrics and houses actually achieve the outcome that we all are looking for and that's improvements to dementia care across care settings and so. That's. The thought behind this recommendation as well. I'm changes is the export of support the expansion of of new initial and on going to mention training standards for direct care workers and then the this is actually a new recommendation for us to highlight that but just implement and deliver reportable certification for direct care workers in home health and emotional long term care settings just a dimension certification program so begin looking at at what that looks like researching and developing a program that would allow someone to receive a dementia certification we we do understand that the the tremendous burden that that is on providers and we certainly didn't want to do any put put forth any recommendation that would exasperated was burdensome to clean now with the healthcare workforce shortage that we are experiencing so we did try to reflect that anyway that we can help support those efforts to strengthen our workforce certainly is the thought behind of these recommendations So that is the end of the dementia training pieces and the policy recommendations are happy to take any questions if you have them or any concerns. The silence is certainly self after affirming that I will see a whole lot at it's come through. Hi David I will ask you to go back there again the first referenced the getting with the. Department help name trying to come up with the. A paid employee for that position you kind of wanna expand what you can knowledge you have on that the only the more fiber to kind of live racing as well. I would like to just deferred agencies we have a conversation about where that what makes the most sense for that position to lie we met thank god Director hill and Mark what was on the call and then they have the the the team of health department with Matt Gilmore Christy sellers chalking up I think that was it met to discuss where that. Position makes the most sense within state government so that is those conversations are ongoing it's my understanding so that's kinda where that's. That. What deferred to the agency's if they want to comment further okay that and we're looking at this I think we also have to keep in mind for the agency goes and everything that you have an employee and you want them to lobby for your call those are the political in that aspect that we work with them they can't I think we got to keep all that in mind and be open minded with everything that we have often thought it was best for the Committee not just always liked best at the time. I certainly agree with that I think I've heard that comment a couple times that this would create an advocacy role on a certainly not the intent of the position so if we need to redefine that and take away some language that makes it appear like it's an advocate role on that's certainly not the intent behind that so happy to have those discussions as well. David I have a question as for. Anyone in the group and you MSSP regional program with the residency training for family medicine residents and I was wondering if the area agencies on aging and other entities worked with those region sent us provide support and education. Because we are planning to provide education on dementia and dementia modules to all the family medicine residents. I think. I can't speak for everybody right now but I can speak for myself that my agency this. as far as education and to regain support groups and information that's what we do that's what we that's how we've collaborated. That's that's great because of you will be doctor when I am planning. Models for the residents a loss of their residents and get trained and I think if we do that and we reach out and other other areas where we can because we have another brand and open the grant for opiate prevention and the training primary care providers we've trained more than two hundred primary care provider is all lower Arkansas an opioid management and we can figure back on that and dementia Education this will. Yes. And doctors are that the recommendation as is where is broad enough that that that program satisfies that requirement of the recommendations that we we knew that there was a lot of gore good work happening you know and using. The grand rounds another of various ways of providing that education resource with that what's happening is when we make sure that we knowledge that and that's I think why the the recommendation was as broad as it was. Any other comments from anybody here on this what we have so far. Okay so David do you want to any additional comments little corrections because I know you've got a few things and by the nineteenth which is a Monday I would just ask you think that's fair to the agencies and and those on the Council. if any other editions Commons what have you can be given to David cook by the nineteenth which means this is due by October first so we have to have a final draft which means that we will need to me one more time because I don't think we're quite there yet we still have a few tweaks here and there so I was trying to find another date that we could meet and we have to propose states on either the twenty six I mean. Look at my calendar again make sure got the right dates in my head one is Monday September twenty sixth or Tuesday September twenty seventh and it would be in the morning. Ten if you want the ten ten o'clock is there. A problem with either one of those states someone saying no there's no way I can make it or one day over another. I have a conflict it's a Monday or Tuesday. I have a conflict with with both of those states shall be in Saint Louis at a conference. Well that would be want to know yes we definitely have to have you here okay. Those are my proposed dates. The week before that is L. C. and it just gets more complicated up here at the capitol when are you getting back. late late Tuesday night. Is this week is this for the next two. If paying. If it's not unreasonable if the agencies have enough time to review in the counsel has enough time to review I could. Poss if the edits came in by Friday I could possibly have that those incorporated into the new pay plan. Over the weekend I have available soon as possible okay well can bring to demand looking then so you're saying all at it's in by the sixteen so we can meet again on the nineteenth only if that's are you around on the twenty third. Friday the twenty third you already off no yes yes ma'am. Okay only if that's reasonable from even if they if we leave the the deadline at the nineteenth that that's still enough time for me to get those at its incorporated in the state plan by the the twenty third said September twenty third in the morning does that count I think you should be. Okay we're gonna tentatively say September twenty third we need to clear it with the House calendar Senate calendar and all that and make sure but we'll send out an email to confirm that date but right now just kind of pencil in the morning of September twenty third and all at its end by the nineteenth. Any other comments. Okay. Okay well then I am I called the. Meeting to be adjourned.