Aging, Children and Youth, Legislative & Military Affairs- House

Bill please sign in. And without objection we are going to flip the order today and first year Senate bill one sixty five. My Representative fight. Is it not Senate bill one sixty five. Hold that thought. Is that like being asked to sing a different song than you thought you were going to sing in church or. In the military and in schools we are taught to monitor and just you know. You are recognized to present your bill it is the same deal it has just been re numbered from the earlier edition that I have. Colonel Jeff would Arkansas National Guard. This is a very simple build it does one thing and one thing only so I'm going to ask my expert witness to explain why we need this bill. Thank you represented what this bill does is it amends are we have a version of the Arkansas soldiers and airmen's relief act of. Not used to having to do that we make this work all the time over can't problems and but what this does is is for our age yours right now there's kind of a hole in the protection for soldiers when they have to break of the student military duty so right now on active duty if you get a change of duty station you have to move your family more than fifty miles you're allowed under law to break the lease what we've seen a couple times happened us is in Arkansas we have AG age yours which are active guard reserve soldiers of their full time soldiers and we'll have them move from either Fort Smith to the Air Force base or from camp Robinson up in Northwest Arkansas and they'll move outside that radius will right now they're not allowed to break at least we've had a few soldiers had to eat you know the deposits and everything else so we're just trying to give our Arkansas soldiers and same protection to get under federal law and would really come only come into play in three circumstances one if they're ordered to duty for more than a hundred eighty days on a state of emergency which is usually rare our ice storms and things like that usually don't happen that that long a period or if they get moved you know not by choice over a hundred fifty are excuse me fifty miles you know and then lastly on the backside is on active duty when you get discharge when you've done your duty and you gotta go back home you're allowed to break a lease there and we we near that here so we do have some folks on their side they were recruiting for other states and so when they get to the end of their tour and they you know they're discharged honorably you know they're allowed to break a lease to go back home so that's kind of a basic overview be happy to answer any individual questions. Are there any questions by committee. Representative very you're recognized for a question. Thank you madam chairman and represent a fight appreciate you bringing this bill to the house and and colonel would but this up a little background also the soldiers and sailors relief act as been around for decades and back when the soldier sailor released back was created it did didn't we were using the garden reserve or the reserve component as much as you do nowadays so the great thing about this bill it offers those soldiers and airmen in the State of Arkansas the same protections that colonel would addressed on as federal law so if you have a soldier that stationed up in Northwest Arkansas it and you know military we don't choose where where we live we're kind of told to so if you have a soldiers live in the northwest Arkansas and you need that soldier for whatever mission affecting this to moved to pine bluff any has any still has five months left on his lease this will allow him because of his military orders to be able to move in not to incur a penalty so it's a good bill thank you. I am sure that a leave of one a common like to make a Senator English and Senator Garner offered up an amendment on the Senate side it was really good and it affected the way we defined primary residence or the early version had that to where the soldier had lived for six months you know they said that you know that we that may created instance where we have some soldiers come in you again apartment or someplace you're younger soldiers and they have to leave and they were protected so we made an amendment to change that to the primary residence is basically there's some fancy words in there basically just means whatever documents in their military record whether it's Army Air Force and they're forced their of their home of record in that system is where they have to live so they happen to move someplace temporarily they're not only able to you know gain the system when a landlord by breaking at least what's going to have to be their primary home of record in order for this benefit to take place. Thank you is there anyone here who wishes to speak for or against this bill. Representative I would like to close for your bill I'm close for the bill and I make a motion to pass members we have a motion to passes or any discussion on the motion. All in favor say aye. Opposed no. Congratulations your bill is passed thank you. You are recognized to present house bill fourteen thirty four. Thank you madam chair and I have an expert witness here with me today Mister David cook from the Alzheimer's association may I bring him to the table. You may. Just have introduced himself but I'm sure he knows the drill. Yes I'm David cook from the Alzheimer's association to a public policy in governmental affairs lead. Thank you so much committee in the past Arkansas had an Alzheimer's at a council is call the Alzheimer's and dementia Advisory Council. This was established in twenty thirteen but due to an oversight it sunset in twenty seventeen and during the process of re organization transformation it was not brought forward although it should have been what we are seeking to do today is to re establish the Alzheimer's and dementia Advisory Council and we have made a few minor changes in the procedures for that group some going to ask Mr cook if he would explain those to the committee. Thank you Representative fighting thank you madam chair and also the committee for having me today to to speak on behalf of house bill fourteen thirty four as Representative Fite mentioned the Alzheimer's Advisory Council was established here in Arkansas after the A. ninety General Assembly passed Act fifteen ten in two thousand thirteen. Alzheimer's a growing public health crisis here in Arkansas currently it impacts over sixty thousand Arkansans by twenty twenty five we expect that number to grow to more than sixty seven thousand Arkansans. Currently hundred seventy thousand state residents provide two hundred three million hours of uncompensated care at a value estimated two point six billion dollars. Without policies in place many care givers have no choice but to leave their jobs to care full time for the loved ones others are burning out because of high stress related to providing full time care. The proper planning it will be increases in those in long term care in coming years often at a high cost to the state's Medicaid program. Medicaid spending for persons living with Alzheimer's was estimated at three hundred ninety six million not one person but treating Alzheimer's and expensive disease was costs are expected to increase by more than fourteen point three percent by twenty twenty five. Impact of Alzheimer's and dementia reaches across our health care system it impacts our health care professionals or police officers or law enforcement another members our first responders. It also has an impact on hospitals and multiple state agencies with the Alzheimer's and dementia Advisory Council would do is ensure that the state had a collaborative and comprehensive approach in a strategy to begin to address the unique needs of persons living with Alzheimer's dementia. Alzheimer's is not and normal part of aging. And the impact is real it's felt in multiple ways across our state. So house bill fourteen thirty four stab wishes and Alzheimer's and dementia Advisory Council one of the first notable changes is we've added the ward dementia because we know that dementia has a much broader definition in just Alzheimer's as other types of dementia as well Alzheimer's leading type of adventure but the other dimensions as well that we need to address Parkinson's basket Mantia and several others available through today. The Alzheimer's our house before fourteen thirty four also establishes a mechanism to not only develop but implement and Alzheimer's state plan. also our state plan was here in Arkansas was first established in two thousand eleven I'm Arkansas was one of the first states to actually have a state plan to address Alzheimer's prior to two thousand eleven the late two thousands states had minimal but burying interactions with Alzheimer's disease in this coincided with a national plan to begin Alzheimer's ad or skews me to to address Alzheimer's Arkansas again was one of those first state forty nine states and territories have published state Alzheimer's disease plans since two thousand and seven. As I mentioned Arkansas for the first with the rapidly growing and changing extent of the Alzheimer's public health crisis is essential that Arkansas have a state plan to address Alzheimer's that is updated that is current without a state plan we are ill prepared to handle what's coming just a short amount of time. Again the the first all summer state plan was adopted in two thousand eleven but absent of a a comprehensive and collaborative approach in an active stakeholder groups many of the recommendations that came out of that all summer state plan went on employment the two things that we did have implemented was of course the creation of an Alzheimer's Advisory Council and secondly or civil alert program came out of one of those recommendations as well. With that I'll be happy to answer any questions. Are there any questions by committee. Representative Springer you're recognized for a question. Thank thank you madam chair good afternoon. I would like to know how do you plan to first of all let me just say this I think this is a wonderful idea I will I too was a care giver for my mom she had Alzheimer's disease so I think that this is necessary how do you plan to select the members of your council how would that be how would that take place and how many persons. Yes ma'am identified in legislation on or the members of the council we we modeled the selection of the council of after the first bill the original statute but we've also added some names to the list we we've asked that the the secretary of health actually make the appointments to the list because we want the agency to have more capability and put in the plan in so we we want to make sure we have a comprehensive representation of stakeholders as well as state agencies were represented so we we've we've selected it based on you know the impacts the things the way that Alzheimer's impacts them we want to hear from care givers as well it so we we make sure we have a strong representation across the board and and collaboration from state agencies multiple stakeholders follow up album chair you're recognized how many persons. The county. Try twenty one twenty. Thank. Are there any other questions represented McKenzie you're recognized for a question. Thank you madam chair I'm just curious during this interim period I guess after transformation and now did you all continue to meter. What what happened there thank you for that question we in two thousand eighteen I they also association reached out to other groups that represent in the original statute began to me independent of legislation to begin thinking about some of the the the current needs and in the state where those gaps are so we began meeting independent of legislation that we know we need this to to to get state legislators of approval and of course for some of the things why do with a state plan we we want to make sure the state invested. If. Representative okay. If I might add this is that very negligible cost to the state of Arkansas. Very nominal. We will have some work done by and. Excess such as scheduling coordinating quarterly meetings writing minutes supporting the compilation of the State Plant but that's work that's normally done within existing agency budgets so would really add anything I and then the legislators I think we have to legislators that would be selected to be on this council and their per diem would really be the only cost all other cost would be M. R. L. all others would be volunteers coming into these positions. Are there any other questions by committee. Represent a vacancy you're recognized. Thank you madam chair yeah and I'm I apologize but I think maybe I misunderstood you said just for clarification because my first look at this I thought it was an entire new council but if I understood you correctly it did exist and them transformation it somehow. Did not get solidified comeback in hearing and giving that authority again is that correct and I did see where it is volunteer time exception of expenses correct and and my last question I'll leave it to you as an but how often do you will meet I think maybe it was in here I don't recall. legislation was was the cost for quarterly meetings and other means to be called with the you know the privilege of the chair I worded that wrong but it but any of the following two or present if I mentioned on on the fiscal impact we we want we design legislation to make sure the impact on the state was minimal aside from the reimbursement to the house and Senate members of but as you think about the fiscal impact the cost of doing nothing is is over to the state and also it we we also should consider as we think about fiscal impact this work is extremely important for the state to be positioned to be more competitive in funding from federal funding such as the bold act Arkansas did apply for the bill back for funding of the bold act last year when voting first came available we were not awarded Oklahoma Mississippi were in it in the interest of full transparency we're not really sure exactly how the CDC allocated those funds what we do know about those applications the things that made the states sign on to help pay for some things were asking for the state plan it was it was does it have an identified stakeholder groups and also state that was actually invested in the work that come together and and and so the collaborative process having having a a council similar to this we know those those states were a lot for held more head of the game and we are what also made those applications stand out as they had a recent an updated version of the State Plant ours of course is from two thousand eleven so it's severely out of date it's because. And the council will be reporting to leads to Legislative Council on this council skews me the Alzheimer's council will be reporting to the Legislative Council on a regular basis. Are there any other questions by committee members. We do have two people signed up to speak for the bill so we'll start with Gigi Gabriel. Before we bring them madam chairman Mr cook would like to clarify statements okay referenced Representative Springer I believe you asked me how many were on on the Council I think I've spoken to twenty one that number is actually twenty Sorry about that thank you for that clarification. If you would just please identify yourself for the record. Then you're recognized. TD Gabriel. I'm here to talk about my caregiving experience my mother has younger onset Alzheimer's and she was diagnosed at fifty seven. We started seeing signs of red fifty but it took as years just to get her into someone locally to see our because she was so young and even though we had a family history of it her mother was diagnosed at forty eight her three siblings currently have it to have died of dementia or we think frontal so right now she is she just turned sixty five and for the past ten years and take care of her I was twenty eight when I became a care giver had five children under seven. This. At the time of the pastry chef I worked I have my own business I work for a catering company I was successful me and my friends were really all in the same password acquired once you diagnose no one else could take ever my father still had to work because he had paid the bills my brother's police officer my other brother was a pharmacy school so I really was the only person I was lucky that my partner at the time he was financially stable so I went ahead and did it I don't know the last ten years I don't know the impact they would have on me. My friendships my career by relationships. When you're when you are so we. Then you have such a burden on your shoulders I love my mother but I would never want my children to have this. Knowing that. It is hereditary. Background. I don't want my kids because you're trying to fight for me. This is sixty. Thank. What is done to myself and my relationships and. When you're twenty eight your friends understand everyone's working hustling they're having they're starting to have children and then all of a sudden I have a huge rock on my shoulders I can do anything I would leave work in the mornings I would drop my kids off at school at eight in the morning I will go straight to southwest little rock to suit my mother my dad will leave go to work at keenly Clark in my mail and then he would come home early I will leave gold drive back to North Little Rock pick my kids from school sure would so every day I did that for ten years every day I did the same thing until he retired he took early retirement and this is how this is downtown he lived to work and so just the fact that. I only I think my mother my father Dennis well because he has so many elements and the character was held is also what is the impact of the stated anything else my father has so many problems and then with Kovin. My mother lived with us the whole time we never placed January last year my mother went to hospice she stayed with the Senate house and when coveted I'm I've been to a first since I was when it with her so all the decisions were on my shoulders and I decided to take mover to nursing home within a week of the pandemic happening I had a nursing home I don't go look around it I just went in the Thomas gave me the paperwork and I signed it and that was literally the last time I saw my mother and you have time to wake the holder hand or anything. I hope she's better but. To that end we all it's been ten years of the disease she does she just a vegetable in there and just to know that you can't. I don't have the opportunity to say goodbye like other people do. But also I had ten years and she would watch you disappear and that's a good time of my health and of course my mental health which is the worst in my children's to and the aspect it's more than just what we don't talk about socially culturally is our mental health that it is to seize someone just completely disappear for so long and knowing that they're never going to be the same again especially children. Devastating. Well for me I'm trying to restart my life I'm. We had no ten years no work history how do you do it you're going to have to go on state aid you're going to have to reach out for something because the everyone's field you already so the impact it had on me as I can go back to the corner field realistically what I did ten years and who are was is not who I am anymore and so now I'm just I was stagnant I was stagnant I worked and went back to the culinary field I think this is not who I am you go you're in between jobs you have to get you know everything the help from the state health from everybody and so now luckily somehow my life turned around and now this is what I do for my career I thank the people who I would want to fight for me now I'm advocate now I take care of the care givers because I understand even though my store is way different than most in a usually it's you know we're older we will take care of her but mine is just I wasn't a tragic day my daughter just as used to carry over my ten year old so she's the care giver also known as my mother would dementia she's no her as anything else she didn't know when she was a seamstress you know she says so she to know everything amazing thing she said all they know is her with Alzheimer's and the mental health impact that has on a child and the years of therapy that it has on people in general just seeing their loved one and that's when it's such a young age it's going to cost the state all these things when it comes to and we look in the background it's not just me as a care giver our families are involved and then my brother is a long distance long distance caregiver so they're mental health as well and this I just. I'm here to talk I'm here to have a voice to my mother I'm here to do a voice my children because I back my mind I'm so afraid of getting this I am just so concert. I don't ever want to fight like I do for me I want everything to be in place by the time if I do get it I don't want them to have to worry I want to may have here this is what you need and will take care of her and we'll take care of you too because that's what I'm here and that's why fight for and that's it thank you. Thank you are there any questions for this witness. Thank you for that personal testimony. I also have carry Jordan signed up to speak for this bill. If you please recognize yourself for the record then you may speak. My name is Kerry Jordan. And I want to thank you all for the opportunity to talk to you today just gonna share a little bit about my story and my history I'm a professional care giver I've been a nurse for thirty years and a nurse educator for twenty years in the state of Arkansas. So I've taking care of people with dementia for many many years in a variety of settings and hospitals home health agencies. I taught I worked in a senior behavioral health unit for many years and actually even taught care giver classes to caregivers of people with dementia for many years and when I got my master's degree I focused on gerontology and specifically in dementia care and then when I got my PhD I actually did my dissertation in nursing homes helping caregivers of people in nursing homes professional caregivers. And so in preparing this testimony was trying to think what why is it that I really. Like taking care of people with dementia in particular and I had to really think about it and two things came to the forefront I think the first thing is that these are some of the most vulnerable people in our society the often times do not have a voice to speak up for themselves and they're open to all kinds of abuse and Difficulties as a result of that so their vulnerability is one reason I really I'm drawn to this particular population. But also some of my proof most profound experiences as a nurse have been associated with people with dementia and as a nurse educator. And it has to do I think with the fact that it's no matter how far along a person is in the dementia process. They maintain their personhood and they maintain their humanity and I can see that I've experienced that as a nurse and as an educator I'm just sure one example with you to kind of illustrate what I'm talking about we often have young nursing students coming to our program they're young twenties early twenties and a lot of them haven't ever had experience dealing with somebody with dementia and so they're very nervous the first time they go to a nursing home and have to interact with someone with dementia. And so we develop different activities for them to do so that they can feel a little more comfortable one of those activities with him massages. So one experience I had was with a young student who went in and you could she could tell she was very nervous coming up to this person and the person she was it's going to be interacting with it from all intents and purposes was comatose they were just want in their chair. No movement no facial expressions and when the student came down and started massaging this individual's hands something in that touching that behavior. Woke up the person inside of this individual that was sitting there and. Suddenly as I'm observing this you have the student young twenty year old massaging this lady's hands the ladies looking at the student there's a human connection there. That is very profound and suddenly I I recognize that student wasn't just seen this old lady in a chair she was actually seen the person in that chair. And to me is educators stream with a feeling that's what we want our nursing students to do. So it's very for filling in that regard taking care of this population of people. So. I thought I knew a lot about to mention given my credentials and the truth matters I knew nothing about what it's like to care for somebody with dementia until about three and a half years ago when I had my father ninety three in the middle stages of didn't mention move into my house and start living with me in my house and my mother who is also eighty nine years old. In I have been overwhelmed over the last three and a half years with the experience of actually being an informal caregivers some with dementia It's it's really overwhelming and I want to get as is preparing for this testimony I was thinking of what are the things that I've learned that that I didn't know as a professional care and for things have came to mind the first one. Is I've been really astounded by the incredible burden that caring for a person with dementia is it yeah I'm asking Gigi just testified if it does not just impact your time it impacts your finances it impacts your. emotional health your physical health your spiritual health. It it impacts every aspect of your life I mean my husband and I haven't had any kind of social gatherings for the last three and a half years of any consequence and It's it's just amazing the incredible burden that people are under in society in these situations. So that's the first thing caregiver burden is all encompassing the second thing that I've learned is that there is an incredible shortage of high quality community based services. I just to share an example of this when my father first moved in with us he was not he's been a lot of time watching TV and I didn't think it was real healthy incident for the TV all day so I was trying to find different things he could do in the community to try to get him out of the house and living a more fulfilled life in a. First it was just hard to find an adult day care center in my community there was one and I ended up sending him to this day care center and unfortunately although the people there were very loving and caring they were trained in caring for someone with dementia so my dad lasted about three and a half weeks there and I got a call from the daycare center saying we're sorry a doctor Jordan but we can no longer have your father here he's too agitated he's you know getting into people's business and we just can't handle I'm you're either gonna have to medicate him or he's not gonna be able to come here anymore so I took him home and and and and she was unable to stay at the daycare center I believe that had there been trained staff there an adequate staff there that they would have been able to handle some of his behavior city was happy at the day care center. So the third thing that I've learned is that the healthcare system is not accommodating to people with dementia on several levels that goes from that. The office doctor's office all the way up to the hospital and this is been the most astounding to me having been a healthcare professional for years to be on the other side of the bed and seen what it's really like to be going to the hospital or going to the doctor's office so an example being you go to the doctor's office and inevitably and we have to go a lot my dad's ninety three so he has various things along with him and inevitably we have to wait an hour wait for the doctor. And if you've ever been around someone with dementia that's like torture because he's in gets increasingly agitated because he can't figure out why he's there were we waiting there there's people around and he keeps that it becomes increasingly agitated to finding when the doctor comes in it's just a mess he's a mess I'm a mess everybody's in mass. one other experience I had recently was with the hospital my dad had a bleeding episode and I took him to the ER so we spent seven hours in an ER which is kind of common and then were admitted to the unit and nobody now I should have known this but. I I assumed I could stay with my dad my assumption was he's got dementia he really can't stay by himself he should be in the hospital overnight but at seven o'clock the nurse came in and said you have got to go home this is our new code restrictions you've got to go home. And so I had this on experiences suddenly I was the difficult patient or the difficult patient family that I had a you know I'm taking care of a lot of people that we as soon as nurses that's the difficult patients family well I was that good because I was could not leave my father I said there's no way you know I know it's a nurse if I leave him here by himself you'll be pulling that is why we will be trying to get out of bed he will be totally confused and the remedy for that usually is you know given more medication or four point restraints on him so we don't pull things out and I wasn't going to allow my dad to be in that position so I was as a nurse took my dad out of the hospital against medical advice. I believe that S. system that's more accommodating and understanding of dementia would have that would never happen so that's just another example of how the health care system is not accommodating of people with dementia. And my last point is society tends to not be very accommodating either I've had to miss more work than I'm used to offer a variety of reasons different crises that occur at home and while I have a wonderful boss who seems to understand a lot of my colleagues don't if I had a four was a parent with a young child I think they would be more understanding of my circumstances but since it's an adult my parents taking care of there's less of an understanding of the needs of people caregivers. So anyway that's just a little bit about my experience I don't want to take up too much time but I just wanted to. A share this with you and with the hopes that you would. Support this bill that we are putting for before you it's much needed and there's a great need in our society thank you very much members are there any questions for this witness. Thank you for your personal testimony sorry. Represented mackerel I do have a question for. No actually I I will be Hey if it possible for a minimum just a short me I've been going through this with my mother. And the I went to with my grandfather my grandmother my best friends. When. I'm fortunate my sister. Say on fortune my sister got a divorce and when so fortunate for which she lives in one of my houses by me and she's helping me take care my mother we're trying to keep it at home as long as we can. And the. I'm interested in how many on this committees had some dealings with that if you'd by show of hands. This is this is a great deal we're trying to keep my mom in their homes longer again. Thank you. With this with this after all. Gobind said mom don't turn off your water freeze. Come back fifteen minutes later in this all. It is such a. It's so hard to see your mom in. She's not really there to. Anyway. This is a great bill and the. What this problem is not going to go away on its own it's only going to get worse. But I'm legal one though does it sometimes it I've dealt with this so long that you you can find learn those I get my mom out every time I go home and we go driving here at the house. And she looks down a person she said look I've got a hundred dollar bill and twenty dollar bill and seven twenty seven you gave me a hundred dollars to you yes ma'am at the we went down the road about a mile later she said I got a hundred and twenty seven dollars so what about the third time she said that she should look year us I bet you got a hundred twenty seven dollars she said have you been in my purse. So you have the bride so we really need this bill is the right thing to do I thought I would love this committee you got me hooked I would like to make a motion to pass when the task was thank you. Thank you thank you for your testimony. Represented five would you like to close for your bill I would you've heard. The problems the difficulties the heartbreak and that many of us have personally experienced in let me go over what this bill does it establishes the Alzheimer's and dementia Advisory Council it requires the state plan and update that plan every four years and it requires an annual report on the status of the State Plant implementation that would come before the Legislative Council yeah how will this bill help solve the problems that we've heard today. It will prioritize and coordinate our state's response to Alzheimer's and dementia it will prime our state to submit a comprehensive application and the next round of federal funding without this we have no Avenue to request this these federal funds. Ensuring that we do not leave federal funds on the table without even attempting to apply for them. And finally it will ensure that the work force care giving Medicaid and public health issues and opportunities are identified agencies and partners are working together with advisement from internal and external partners so I feel that this will go a long way to work doing what we need to do with these devastating issues that so many of our Arkansas families are facing thank you madam chair. Thank you represented Michael I would like to make a motion now. Okay. Members we have a motion to pass is there any discussion on that motion. All in favor say aye. Opposed no. Congratulations you've passed your bill.