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From YouTube: 3/22/2022 - Legislative Committee on Senior Citizens, Veterans and Adults With Special Needs Pt. 1
Description
This is the first meeting of the 2021-2022 Interim. Please see agenda for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
Videos of archived meetings are made available as a courtesy of the Nevada Legislature.
The videos are part of an ongoing effort to keep the public informed of and involved in the legislative process.
All videos are intended for personal use and are not intended for use in commercial ventures or political campaigns.
Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
B
D
E
I
would
like
to
thank
everyone
in
the
audience
for
in
las
vegas
those
joining
us
by
video
conference
in
carson
city
and
also
anyone
listening
over
the
internet.
I
would
like
to
take
a
few
moments
to
introduce
members
of
the
committee
and
committee
staff
members.
If
you
each
would
like
to
introduce
yourself,
please
indicate
your
district.
You
represent
as
well
as
the
goals
that
you
have
for
the
committee
for
the
2021-22
interim.
Let's
begin
with
our
vice
chair,
senator
spearman.
F
I
thought
you
want
to
say
the
best
for
last,
I'm
just
joking
hi,
I'm
state
senator
pat
spearman.
I
represent
city
district
1,
which
is
more
than
90
of
north
las
vegas
and
have
been
representing
this
district
since
2012..
F
I
am
really
concerned.
I
want
to
make
sure
that
during
the
this
interim
time
in
this
committee,
I
want
to
make
sure
that
we're
focusing
on
some
of
the
specific
things
that
have
affected,
not
just
our
veterans
solely
and
not
just
our
seniors
solely
and
not
just
our
adults
with
special
needs,
but
I
believe
that
those
three
demographics
overlap,
because
we
have
veterans
who
are
seniors
that
have
special
needs.
F
We
have
people
who
have
special
needs,
who
are
veterans,
and
so
I'm
looking
to
make
sure
that
everything
that
we
discussed
in
all
of
the
recommendations
that
we
put
forth
for
the
next
legislative
session
are
taking
into
account
not
just
the
constitution
concentric
circles,
but
how
they
all
overlap
and
want
to
make
myself
available
for
any
questions
or
any
type
of
expertise.
I
might
be
able
to
lend
as
a
former
member
of
the
military
as
a
veteran.
So
that's
kind
of
the
rough
way
I'm
looking
at
it.
F
Madam
madam
chair,
and
thank
you
for
this
opportunity
to
go
first
and
not
last.
E
Well,
thank
you
very
much.
Senator
spearman
next
senator
scheible.
G
B
To
serve
on
this
committee
learn
more
about
how
our
state
is
serving
veterans,
people
with
disabilities
and
the
aging
community,
and
to
continue
working
to
make
our
our
state
a
better
place.
H
J
B
I
G
K
Thank
you
happy.
B
K
E
Thank
you
very
much
and
I'm
assemblywoman
michelle
gorlow.
This
is
my
first
session
chairing
this
amazing
committee
a
little
bit
about
my
background.
Oh
first,
I
represent
assembly
district
35
that
is
mountain's
edge
in
southern
highlands,
so
I'm
in
the
far
southwest
a
little
bit
about
my
background.
I
work
for
a
non-profit
that
provides
health
care
to
children
in
southern
nevada.
Over
20
years.
E
I've
worked
a
lot
with
health
care
for
women
and
children,
especially
children
with
disabilities,
and
I
find
that
there's
a
lot
of
crossover
when
we
talk
about
our
pediatric
population
and
our
seniors
and
adults
with
special
needs
and
even
our
veteran
population
as
well.
So
I
look
forward
to
having
very
robust
conversations
in
this
interim
and
putting
together
some
really
great
legislation
for
next
session.
E
I
would
also
take
a
moment
to
introduce
staff.
First.
We
have
ashley
kalina,
who
is
the
lead
policy
analysis
for
the
committee
with
cesar
miller.
I
knew
I
was
going
to
pronounce
it
wrong.
We
even
practiced
it
mel
gorey
ho
he's
senior
policy
analyst,
also
assisting
we
have
eric
roberts,
who
is
our
legal
counsel
in
jambore's
in
carson
city?
Is
the
committee
secretary
also,
we
have
kimbra
ellsworth
and
she
is
the
fiscal
analysis
assigned
to
the
committee.
E
E
We'd
also
like
to
extend
a
thank
you
to
the
broadcast
and
production
services
and
las
vegas
administrative
division
of
the
legislative
council
bureau
for
all
of
their
behind
the
scenes,
work
in
video
conferencing
and
helping
the
meeting
run
smoothly
a
little
bit
of
housekeeping
before
we
begin
I'd
like
to
take
a
moment
to
go
over
some
basic
items.
This
committee
is
scheduled
to
meet
four
times
during
the
interim,
and
las
vegas
will
serve
as
our
primary
meeting
location.
E
E
Everyone
should
sign
in
the
sign
in
sheet
which
is
located
the
back
of
the
room,
even
if
you
do
not
wish
to
testify.
Please
sign
in
when
testifying,
please
remember
to
turn
on
your
microphone
and
clearly
state
your
name
and
the
entity
you
represent
at
the
beginning
of
your
testimony,
speak
directly
into
the
microphone
to
ensure
those
listening
in
other
locations
and
watching
online
can
hear
your
testimony.
E
E
Each
witness
should
provide
a
business
card
and
a
copy
of
any
written
materials
not
previously
submitted
to
the
secretary,
and
since
our
committee
secretary
is
in
carson
city.
Please
leave
your
business
card
on
the
witness
table
or
at
the
back
by
the
sign-in
sheets
in
las
vegas.
Our
staff
will
collect
your
cards
at
the
end
of
the
meeting.
E
E
E
E
I
would
like
to
call
your
attention
to
the
notation
on
the
agenda
limiting
public
comments
to
three
minutes.
Speakers
are
urged
to
avoid
repeating
comments
or
points
made
by
previous
speakers.
Any
person
may
submit
written
comment
to
the
committee
secretary
during
or
after
today's
meeting.
I
want
the
public
to
know
that
public
comment
may
be
provided
in
four
different
ways
which
are
listed
on
the
agenda.
You
can
call
1-669-900-6833.
E
H
B
Hello,
cara,
gorlo
and
committee
members,
can
you
hear
me.
B
Wonderful.
Thank
you.
Thank
you.
For
your
time
my
name
is
raquel
o'neal.
I
am
a
licensed
clinical
social
worker
and
president
of
blind
connect.
I
am
coming
before
you
this
morning
with
a
couple
of
opening
stories.
I
want
to
tell
you
a
couple
of
real
life
stories
to
draw
your
attention
to
some
needs
in
our
state.
B
B
She
learned
that
these
services
costed
her
family,
forty
to
sixty
thousand
dollars
as
she
herself
did
not
want
to
go
through
vocational
rehabilitation
in
order
to
stay
home
and
raise
her
family.
Unfortunately,
in
the
prime
of
angela's
life
we
lost
her.
She
decided
to
commit
suicide
due
to
her
vision
loss.
B
B
B
Our
mission
is
to
provide
the
much
needed
rehabilitation
services
for
nevada
citizens
experiencing
vision,
loss
in
our
united
states
when
an
individual
loses
a
limb
or
a
part
of
physical
functioning.
They
typically
go
to
acute
care
facilities
and
rehabilitation
services
receiving
daily
support
and
rehabilitation
therapies
like
occupational
therapy
and
physical
therapy.
However,
when
you
lose
your
eyesight
as
a
small
child,
adult
senior
or
veteran,
you
do
not
get
those
the
same
services.
B
B
We
would
humbly
like
to
request
that
this
committee
review
rehabilitation
services
for
the
blind
in
nevada.
I
have
provided
some
attached
documents
for
your
review
and
we
are
humbly
requesting
that
you
look
at
providing
funding
for
blind
connect
to
continue
to
do
what
we
do
best,
which
is
provide
hope
for
a
brighter
future
for
nevada
citizens
who
are
experiencing
vision,
loss.
H
Excuse
me
chair
once
again,
we
are
currently
in
public
comment.
If
you
would
like
to
provide
public
comment,
please
press
star
9
on
your
phone
to
take
your
place
in
the
queue.
B
B
Good
morning
to
gorilla
and
gracie
and
the
rest
of
your
most
exciting
and
outstanding
interim
committee
of
all
times,
and
thank
you
for
not
getting
rid
of
this
important
committee.
This
is
where
people
seniors
and
veterans
and
disabled
or
people
with
disability
can
come
and
be
heard
and,
and
hopefully
our
voice
is
is,
in
our
opinion,
are
counted
so
I'm
in
a
hurry.
B
Sorry,
I
have
to
be
at
the
washoe
county
commissioner's
meeting
our
our
our
vote
is
our
freedom
to
vote
is
in
its
at
stake,
so
I'm
kind
of
walking
and
and
talking
at
the
same
time.
So
I
just
want
to
say
thank
you
so
much
for
all
that
you
do
and
also
to
bring
attention.
I
am
a
blind
mom,
a
proud
mom
of
two
kids
who
are
in
the
military,
national
guard
and
army.
One
of
our
friend,
who
is
part
of
my
nevada
disability.
B
Peer
action
coalition,
asked
me
to
to
tell
a
little
bit
a
story
of
her.
She
is
visually
impaired
and
hard
of
hearing,
and
she,
when
the
rtc
went
on
strike
three
times
last
year
and
beginning
of
this
year,
a
little
bit.
She
was
unable
to
get
secured
a
transportation
to
her
dialysis
and
we
are
humbly
asking
because
not
all
medicaid
or
medicare
insurance
are
covered
for
transportation,
and
we
are
all
asking
I
hear.
Cheyenne
and
ricky
robin
and
other
people
are
on
this
presentation
with
agenda.
B
I'm
we
are
asking
that
transportation
would
be
added
in
medicaid
and
home
care
visits.
So
even
if
access
rtc
pair
transit
for
washoe,
county
or
rtc
right
is
not
available
due
to
strike
or
lack
of
drivers,
because
they
don't
give
them
respectable
wages,
but
they
are
covered,
so
they
don't
lose
their
appointment,
their
dialysis
appointment
or
eye
doctor
or
any
type
of
that
sort
of
thing
or
pharmacy
to
go
pick
up
their
medicine.
B
E
E
M
M
M
We
support
people
with
cleaning
providing
supervision
to
them,
personal
hygiene,
cooking
medication,
medical
appointments,
behavior
management,
outings
and
integration
into
their
communities
and
just
getting
up
and
getting
dressed
for
their
their
day,
and
I
want
to
tell
you
guys
about
my
experiences
with
how
the
staffing
crisis
over
the
last
two
years
has
impacted
individuals
with
disabilities
and
the
the
staff
that
care
for
them.
The
staffing
shortages
have
made
it
extremely
difficult
to
find
and
keep
qualified
people
to
work
with
nevada's,
most
vulnerable
population
and
citizens.
M
Staff
that
do
stay
are
sacrificing
at
great
personal
lengths
just
to
take
care
of
the
people
that
they
love
and
support.
Okay,
they're
burnt
out
these
heroes
are
burnt
out
and
they're
struggling
because
there's
not
enough
people
to
care
for
our
disabled
population
across
nevada,
disability
agencies,
staff
turnover
is
at
132.
M
My
agency
and
many
agencies
have
done
everything
in
their
power
from
the
top
down
to
support
the
staff
administrators
administration,
and
I
myself
have
worked
in
these
homes
to
make
sure
that
the
staff
or
the
individuals
have
exactly
what
they
need
and
routinely
work
shifts
to
do.
This
nevada's
disability
providers
are
the
safety
net
for.
E
M
E
E
N
Good
morning
and
thank
you,
chair
gorlo
for
the
record,
my
name
is
ashley
kalina.
I
am
your
non-partisan
committee
policy
analyst
as
nonpartisan
staff
of
the
legislative
council
bureau.
I
can
neither
advocate
nor
oppose
for
any
of
the
proposals
that
come
before
you.
My
role
is
to
assist
the
committee
as
a
whole
and
each
of
you
as
individual
legislators,
while
also
providing
policy
and
research
needs
to
help
you
make
informed
decisions
about
the
issues
reviewed
and
studied
by
this
committee.
C
N
Available
on
the
committee
work
webpage,
the
work
plan
provides
background
information
on
the
powers
and
duties
of
the
committee,
a
glimpse
of
the
work
of
the
committee
during
the
previous
interim,
our
proposed
meeting
schedule
and
committee
staff
contact
information.
I
just
want
to
take
a
few
minutes
to
cover
some
highlights.
N
First,
let's
go
over
the
responsibilities
of
committee,
nevada,
revised
statutes,
chapter
218e,
section
760
establishes
the
general
powers
of
the
legislative
committee
on
senior
citizens,
veterans
and
adults
with
special
needs.
The
committee
is
charged
with
reviewing
studying
and
commenting
on
issues
relating
to
senior
citizens,
veterans
and
adults
with
special
needs.
N
These
divisions
are
required
to
report
to
the
committee
on
the
number
and
dollar
amount
of
purchasing
contracts
and
contracts
awarded
to
local
businesses
that
are
owned
by
service
disabled
veterans.
These
reports
are
required
to
be
submitted
to
the
committee
during
the
interim
period
on
page
two
and
continuing
on
to
page
three.
This
contains
information
about
the
bills
proposed
by
the
committee
during
the
last
interim.
N
Bill
407
would
have
facilitated
a
vulnerable
adult's
ability
to
obtain
a
protective
order
on
their
own
and
also
allow
adult
protective
services
to
petition
the
court
on
their
behalf
assembly
bill
439
would
have
required
state
occupational
licensing
boards
to
streamline
the
process
for
military
spouses
to
attain
professional
licenses
assembly
bill
443
from
the
2021
nevada
legislature
changed
the
number
of
bills
allocated
to
the
committee
from
10
to
six.
You
will
see
that
the
committee
may
submit
up
to
six
bdrs
for
consideration
by
the
2023
legislative
session.
N
N
N
E
Being
none,
then
we'll
go
on
to
our
next
agenda
item,
which
is
a
presentation
regarding
the
programs
and
services
provided
by
the
aging
and
disability
services,
division
of
the
department
of
health
and
human
services.
We
have
miss
jessica
adams,
deputy
administrator
adsd,
dhhs,
ricky,
robb,
deputy
administrator
and
carrie
embry
governor's
consumer
health
advocate.
I
believe
they
will
all
be
participating
via
zoom.
H
H
H
Moving
on
to
advocacy
services,
the
office
for
consumer
health
assistance
has
a
team
of
six
consumer
health
advocates
that
specialize
in
educating
and
advocating
all
nevadans
regarding
their
health
care
needs.
The
most
common
complaints
we
educate
and
provide
advocacy
for
include
billing
issues
and
access
to
health
care,
such
as
assistance,
finding
specialty
providers
and
or
medical
treatments.
H
All
the
logistics
in
place
for
this
individual
to
transfer
out
of
state
and
receive
this
treatment
was
all
set
up
and
arranged.
However,
as
the
day
got
close
for
this
individual
to
travel,
the
mayo
clinic
notified
the
individual
that
their
health
plan
had
not
provided
the
authorization
needed
to
cover
the
treatment.
So
either
this
individual
had
to
cover
the
treatment
himself
or
try
to
get
it
resolved.
H
H
As
a
result,
these
arbitrations
have
saved
consumers
from
getting
a
bill
and
so
far
have
saved
consumers
for
fiscal
year
22
through
september
through
february
212
000
well,
specifically,
212
thousand
dollars
881
dollars.
H
H
In
federal
fiscal
year,
2020
residents
in
skilled
nursing
facilities,
their
top
five
complaints
were
discharge
and
eviction,
dignity
and
respect
physical
abuse,
financial
exploitation
and
care
planning
for
residents
in
group
homes
and
homes
for
ended,
individual
residential
care.
The
five
top
complaints
that
our
long-term
care
ombudsman
advocated
for
individuals
for
were
financial
exploitation,
discharge
and
eviction,
gross
neglect,
dignity
and
respect
and
resident
representative
or
family
conflicts.
H
The
rights
attorney
is
with
aging
and
disability
services
division
and
the
individual,
who
is
our
rights
attorney?
Jennifer
richards,
is
in
this
position
and
you'll
be
hearing
more
from
jennifer
richards
in
future
meetings.
The
rights
attorney
provides
regulatory
policy
and
advocacy
for
the
division.
H
The
rights
attorney
also
provides
technical
assistance
and
education
within
the
divisions
programs,
such
as
adult
protective
services,
the
long-term
care
ombudsman
office
for
consumer
health
assistance,
as
well
as
developmental
services
and
community-based
care
programs.
This
advocacy
often
involves
complex
legal
issues
such
as
evictions,
power
of
attorney
and
guardianships.
H
Adult
protective
services
investigates
reports
of
maltreatment,
of
vulnerable
adults,
age,
18
and
older
investigations
begin
within
three
working
days
of
receipts
of
the
report.
Reports
reports
concerning
high
risk
of
maltreatment
are
responded
to
within
24
hours.
Most
often,
these
high-risk
reports
are
responded
to
the
same
day
as
the
report
is
received.
H
Adult
protective
services
also
provides
ancillary
services
such
as
emergency
homemaker
services,
a
psychiatrist
to
complete
mental
health
evaluations
and
a
forensic
medical
specialist
of
the
allegations
that
adult
protective
services
investigates.
The
most
reports
are
for
self-neglect.
These
are
the
highest
number
of
reports
for
elder
protective
services.
H
H
A
A
Today,
I'm
going
to
be
presenting
information
on
our
developmental
services
and
community-based
care
programs,
so
developmental
services
serves
people
of
any
age
with
a
intellectual
or
developmental
disability.
A
intellectual
disability
is
characterized
by
significant
limitations
in
both
intellectual
functioning
and
adaptive
skills.
It
typically
occurs
before
the
age
of
18
and
is
considered
a
lifelong
condition.
A
Are
severe
chronic
disabilities
attributed
to
neurological
or
genetic
disorders
found
to
be
closely
related
to
a
intellectual
disability,
because
the
condition
results
in
impairment
of
general
intellectual
functioning
and
or
results
in
adaptive?
Behavior
deficits,
similar
to
that
of
a
person
with
a
intellectual
disability
developmental
disabilities,
must
occur
before
the
age
of
22..
A
Once
a
person
is
qualified
for
the
developmental
services,
they
are
served
through.
One
of
three
regional
centers
sierra
regional
center
serves
washoe
county
desert.
Regional
center
serves
urban
clark.
County
and
rural
regional
center
serves
the
rest
of
the
state
through
eight
offices,
with
their
central
office
based
in
carson
city
and
offices
going
up
the
the
northern
part
of
the
state
all
the
way
out
to
elko
and
then
down
in
the
in
the
southern
rural
areas
of
mesquite
and
haram
developmental
services
serves
roughly
7
500.
A
People
of
those
people
about
77
percent
are
adults
over
the
age
of
18,
with
the
other
23
under
18
18,
our
largest
pop
population,
is
with
desert
regional
center.
With
about
69
of
people
residing
in
urban
clark
county
within
the
regional
centers,
we
have
service
coordination,
so
anyone
who
qualifies
for
a
regional
center
is
assigned
a
a
service
creator
that
can
help
that
family
or
the
individual
find
the
services
that
they
may
need.
A
They
can
help
with
things
like
meetings
with
schools,
helping
somebody
connect
with
vocational
rehab,
basically
anything
that
that
person
may
need
as
a
result
of
their
disability
within
the
regional
centers.
We
also
have
a
psychological
services
unit
that
consists
of
licensed
psychologists
as
well
as
mental
health
counselors.
They
can
do
assessments,
counseling
special
training
things
along
along
those
lines,
and
then
we
also
have
nurses.
A
A
They
are
able
to
then
choose
who
they
want
to
spend
money
with
whether
it's
a
program
or
it's
a
individual
person
to
provide
that
that
brief
break
in
care
that
that
family
may
need.
We
also
have
something
called
the
self-directed
family
support
program,
which
is
450
a
month
for
that
family
to
buy
a
specialized
services
that
isn't
going
to
be
covered
by
any
sort
of
other
other
other
program.
Examples
are
things
like
music
therapy,
horseback
riding
therapy
things
along
along
those
lines.
A
These
individuals
often
have
a
higher
level
of
need,
and
so,
therefore,
we
are
able
to
give
that
family
a
small
amount
of
money
to
be
able
to
help
pay
for
their
for
their
care
needs
in
the
actual
home,
and
then
our
biggest
programs
are
our
support
of
living
arrangement,
programs
and
jobs
and
day
training
programs.
A
A
In
a
in
a
home,
setting
jobs
and
day
training
services
can
be
all
sorts
of
different
services
that
just
give
that
person
something
to
do
during
the
day.
A
Behavioral,
consultation
and
nutritional
counseling
are
also
services
that
are
contracted
out
to
provider
agencies.
You
will
be
hearing
more
about
these
services
in
the
next
presentation
on
home
and
community-based
waivers.
A
A
A
One
of
the
reasons
that
we
do
are
not
at
full
capacity
is
well.
We
have
two
different
different
reasons
for
that
one.
We
have
11
separate
homes
on
the
campus.
One
of
these
homes
has
had
to
be
used
as
a
quarantine.
A
Isolation
area
due
to
covid
and
another
home
has
been
in
a
ada
remodel
and
that's
been
a
long
term
project
as
as,
as
we've
worked
through
each
of
those
homes,
so
we
actually
don't
have
enough
beds
to
be
able
to
serve
all
48
people
at
this
point
in
time.
The
other
main
issue
that
we
have
at
the
icf
is
we
are
experiencing
a
major
staffing
shortage.
Our
developmental
support
tech
technicians
are
the
jobs
that
do
the
day-to-day
24-hour
services.
O
A
To
operate
the
actual
campus
within
the
icf,
this
really
provides
24-hour
services.
Again.
This
is
a
facility-based
setting
as
opposed
to
a
home
and
community-based
setting.
There
has
to
be
active
treatments
happening
to
make
sure
that
we
are
promoting
functional
skills
and
it
includes
a
whole
lot
of
different
services.
A
The
two
main
programs
operated
by
cbc
are
our
other
two
1915
c
home
and
community
based
waivers
that
operate
in
the
state,
the
frail
elderly
waiver.
This
is
for
people
who
are
over
the
age
of
65
and
qualify
for
the
qualify
for
medicaid.
You
will
be
hearing
a
lot
more
about
all
of
these
different
services
again
in
the
next
present
presentation:
the
persons
with
physical
disabilities
waiver.
A
There
are
three
more
programs
that
community-based
care
operates.
These
are
all
state-funded
programs,
the
community
services
option
program
for
the
elderly.
This
currently
has
82
people
on
this.
This
program,
they
must
be
65
years
of
age
or
older,
are
typically
a
low-income
person,
but
are
not
qualifying
for
medicaid,
for
whatever
reason
they
are
also
able
to
then
receive
small
small
amounts
of
us
services
such
as
personal
care
services,
homemaker
services,
respite
things
that
are
going
to
again
allow
the
person
to
remain
in
their
home.
A
The
way
that
this
program
is
written
is
it
is
specifically
for
people
who
do
not
qualify
for
medicaid
and
go
up
to
higher
income
limits,
because
this
is
not
a
service
that
is
often
often
covered
by
private
insurance
agencies,
mostly
the
services.
We
all
revolve
around
the
personal
care
that
that
person
needs
to
stay
in
their
fam
or
in
their
home,
and
then
the
taxi
assistance
program
or
tap
for
this
program.
It
is,
it
only
operates
in
urban,
las
vegas.
A
People
are
able
to
buy
discounted,
coupon
books
for
taxi
fares
so
for
they
would
get
a
coupon
worth
twenty
dollars
worth
of
taxi
fare
and
then
they
only
pay
five
or
ten
dollars
for
that
coupon
based
on
their
income,
and
so
now
I'm
going
to
turn
it
over
to
ricky
rob
to
talk
about
the
rest
of
our
programs.
G
Good
morning,
madam
chair
and
members
of
the
committee,
I'm
ricky
rob
I'm
one
of
the
deputy
administrators
for
aging
and
disability
services
and
I'm
going
to
start
on
slide
13
and
we're
going
to
be
talking
about.
Initially
our
planning,
advocacy
and
community-based
service
unit,
also
known
as
pac,
so
you've
just
heard
about
a
variety
of
services
and
programs
offered
by
community-based
care
unit
and
developmental
services
and
as
well
as
ocha.
G
This
this
unit
is
a
unique
unit
and
we
have
the
privilege
of
having
probably
the
smallest
but
most
mighty
group
that
oversees
this
unit.
As
you
can
see
on
the
slide,
we
have
a
variety
of
functions
which
includes
oversight
of
strategic
planning,
various
state
plans,
advocacy
bodies,
as
well
as
contracts
to
support
our
community
provider
network.
G
G
G
And
these
are
federal
pass-through
dollars,
as
well
as
a
state
general
fund.
We
fund
those
out
to
our
community
providers
who
provide
the
actual
direct
service.
The
pac
unit
is
an
indirect
service
program,
but
it
is
basically
our
grants
management
unit
for
aging
and
disability
services,
and
so
that
pass-through
funding
goes
directly
to
those
community
partners
and
non-profits
and
and
the
different
counties
throughout
the
state,
and
they
provide
vital
in-home
and
community-based
services
for
older
adults,
people
with
disabilities
and
family
caregivers.
G
G
During
the
pandemic,
this
unit
also
was
granted
directly
from
the
feds
for
covid
response,
and
it
was
approximately
18
million
dollars
in
emergency
funding
to
support
the
vulnerable
individuals
during
the
pandemic.
As
we
all
know,
our
older
nevadans
were
the
most
vulnerable
population
that
we
needed
to
support.
The
pac
unit
was
able
to
truly
jump
in
create
multiple
programs
on
the
fly
and
and
support
the
entire
system
for
our
most
vulnerable
groups
during
the
coven
pandemic.
G
G
Mills
and
during
the
pandemic
we
were
not
able
to
utilize
those
congregate
settings,
and
so
we
had
to
take
other
opportunities
to
ensure
that
those
older
nevadans
received
their
deliver
their
meals
delivered
to
their
homes,
transportation,
caregiver,
support
the
nevada
care
connection
and
navigation
and
assistance
to
long-term
supports
and
services
services
support
services.
My
apologies
is
also
where
individuals
can
either
call
or
go
into
a
center
and
and
receive
supports
for
their
families,
for
whatever
their
needs
may
or
may
not
be
in
their
homes
or
through
group
settings.
G
G
The
next
program
that
I
will
be
discussing
is
nevada,
early
intervention
services,
which
is
our
most
vulnerable
youngest
nevadans,
which
is
our
birth
to
three
and
those
individual
children
receive
supports
and
services
based
on
a
diagnosis
of
disability
or
developmental
delay.
These
children
could
be
medically
fragile.
G
We
also
support
children
who
are
in
the
child
protective
system,
and
so
we
support
them
in
service
coordination,
special
instruction.
We
have
on-site
audiologists
and
then,
depending
upon
the
needs
of
the
child
and
their
developmental
delays,
they
may
receive
occupational,
physical
or
speech
therapies
to
support
them
to
become
age-appropriate
within
their
development.
G
The
last
program
that
I'll
be
talking
about
is
the
autism
treatment
assistance
program,
and
this
program
is
an
assistance
program
to
support
families
to
obtain
services
and
therapies
for
individuals
under
the
age
of
20,
who
have
been
diagnosed
with
autism
spectrum
disorder.
And
so
this
really
focuses
on
the
supports
and
services
to
support
that
individual
to
have
an
independent
opportunity,
as
as
they
go
into
adulthood.
G
So
the
main
focus
that
we
work
on
is
applied,
behavioral
analysis,
which
is
aba
therapy,
and
so
we
support
the
families
in
obtaining
a
provider
who
is
certified
and
able
to
support
that
family
based
on
the
individual's
needs
and
then,
as
you'll,
see,
there's
additional
types
of
treatments
funded
as
intensive
parent
training,
which
has
really
increased
over
the
last
two
years.
With
the
pandemic.
Since
we
weren't
able
to
go
into
the
individual
homes,
we
were
able
to
do
some
additional
training
to
support
those
families.
G
As
we
move
forward,
we
also
received
a
rate
increase
in
the
last
biennium
to
support
our
registered
behavioral
technicians
to
provide
the
aba
therapies
into
the
in
the
individual's
homes.
So
I'm
excited
to
say
that
we've
been
working
to
reduce
the
wait
list
for
atop
services
and
we
are
being
quite
successful
at
that
at
this
time,
then,
on
slide
17.
G
I
would
just
like
to
take
a
brief
moment.
You'll
hear
more
about
this
as
we
move
forward,
but
we
have
definitely
felt
the
effects
of
covid
and
the
critical
shortage
for
staffing
has
affected
our
vacancy
rate.
So
you
will
be
able
to
see
here
anywhere
from
15
to
50
vacancy
rates
based
on
the
programs
that
we
provide
through
aging
and
disability
services.
G
So
we
truly
have
felt
that
the
impact
to
that-
and
you
know
it
is
our
hope-
that,
through
with
this
next
legislative
session
that
we'll
be
able
to
address
those
concerns
and
those
days
on
slide
18
due
to
the
critical
shortages
and
staffing
and
the
challenges
that
we
have
faced,
we
obviously
can
see
that
we
have
an
impact
to
our
division
case
loads.
G
E
Thank
you
very
much
for
your
presentations.
I
think
I
will
kick
off
the
questions
going
back
to
the
desert
regional
center.
You
mentioned
one
of
the
homes
was
being
remodeled
to
be
ada
compliant.
Do
you
have
an
anticipated
date
on
when
that
would
be
completed.
A
E
Thank
you
for
that.
Let
me
open
up
the
questions
to
other
committee
members
and
then
we'll
circle
back,
because
I
have
a
couple
more
so
are
there
other
committee
members
that
have
questions.
F
Thank
you,
madam
chair.
Just
have
a
couple
questions.
Thank
you.
First
of
all
for
the
very
thorough
report.
One
of
the
things
that
became
quite
noticeable
during
covet
is
the
unevenness
of
the
health
care
delivery
system
with
respect
to
bipolar
communities.
F
I
am
anxious
to
understand
how
that
impacted,
not
just
bipark
communities,
but
also
members
of
the
lgbtq
community,
from
an
emotional
and
psychological
standpoint,
because
it
was
my
experience
here
on
the
ground
that
there
was
a
great
deal
of
suffering,
a
great
deal
of
confusion
as
to
where
they
might
be
able
to
go
for
resources
where
they
might
be
able
to
go
for
help,
and
I
think
what
our
the
basic
response
was
a
big
umbrella
one
over
the
world.
F
You
can
go
to
this
place
and
they
are
addressing
issues
for
the
masses
of
community,
but
many
people
in
bipolar
communities
were
not
able
either
were
not
able
to
get
there
or
because
the
level
of
trust
wasn't
there,
and
sometimes
it's
just
a
matter
of
us
at
the
state
level,
not
really
understanding
where,
when
the
rubber
meets
the
road
where
those
people
are
located
and
how
we
might
be
able
to
do
a
better
job
interacting
with
them.
F
G
Ricky
wrap
for
the
record.
I
I
think
this
is
something
that,
to
be
honest,
it's
it's
an
ongoing
opportunity
for
us,
so
I
I
would
not
be
able
to
answer
to
you
today
on
the
specifics,
but
what
I
will
say
is
that
it
is
something
that
is
that
we're
working
on
and
we'll
continue
to
work
on
and
and
we
are
learning
more
about
those
communities
and
where
we
should
and
can
go
to
support
them.
G
F
Thank
you,
madam
sheriff,
follow
up.
Please.
F
Yeah
and-
and
I
asked
that
question
because,
because
this
is
something
this
is
an
ongoing
concern
for
me
and
every
time
we
have
had
even
during
the
last
interim,
this
committee
and
others
asking
the
question:
what,
if
anything,
have
we
done
to
address
concerns
with
any
degree
of
specificity
for
bipark
and
other
marginalized
communities?
I
know
for
in
fact,
especially
in
senate
district
one.
F
I
was
getting
a
lot
of
calls
from
people
who
just
had
no
idea
where
to
go
for
resources,
and
even
when
they
went
to
the
places
where
it
was
suggested
resources
they
could
receive
information
on
resources.
Sometimes
people
were
unaware
of
the
specific
nuances.
If
you
will
that
affected
people
in
those
communities.
F
Let
me
talking
about
ethnicities,
but
I'm
also
speaking
about
a
large
number
of
people
in
the
lgbtq
community,
particularly
the
t
part
of
that,
and
so
this
this
refrain
has
been
something
that
I've
been
singing
for
the
last
three
years,
and
I
appreciate
the
willingness
to
take
it
back.
I'm
just
hoping
that
when
you
raise
this
issue
again,
if
you
just
point
out
that
this
is
this
is
the
same
question
that
I've
been
asking
since
2020,
and
that
is
how
how
have
we
or
are
we
developing
anything
that
speaks?
F
We
talk
about
things
in
general,
but
there
are.
There
are
some
communities
in
certain
demographic
arenas
that
are
just
not
being
helped
at
all,
because
we've
not
developed
any
significant
outreach
program
to
number
one
identify
what
the
issues
are.
Number
two
find
people
who
are
already
in
those
communities
trying
to
help
work
on
those
challenges
and
number
three
making
sure
that
programmatically
from
a
dhhs
perspective
that
information
is
trickling
down.
F
So
it's
a
concern
that
I've
had
since
20,
and
it's
one
that
continues
so
appreciate
your
willingness
to
take
it
back
and
I'm
just
hoping
that
we'll
be
able
to
come
up
with
some
type
of
an
answer
that
addresses
the
addressing
the
challenges
that
are
still
being
felt
by
the
communities.
F
If
we
don't
just
address
the
issues
that
have
been
been
present
since
2020,
the
open
money
that's
coming
in
will
will
be
woefully
short
of
where
the
needs
are
in
those
communities,
because
because
we'll
continue
to
do
a
one
over
one
over
the
world
approach
and
people
in
those
communities,
don't
have
this
same
level
of
trust
in
the
healthcare
system
as
some
in
other
communities.
So
thank
you.
Thank
you
for
your
indulgence,
voucher.
E
Thank
you,
mr
spearman.
Are
we
do
we
have
any
other
questions
from
the
committee.
E
Seeing
none,
I'm
gonna,
quick,
ask
a
question
about
the
autism
treatment
assistance
program.
You'd
mention
that
there
was
a
wait
list
but
that
it
has
been
decreasing.
So
I
wanted
to
find
out
how
many
are
on
the
wait
list,
what
you're
doing
to
decrease
that
wait
list
and
also
what
happens
to
a
person
after
age
20.
G
Thank
you
for
your
question,
madam
chair.
This
is
ricky
rob
for
the
record,
I'm
excited
to
say
when
I
came
into
this
position
about
four
and
a
half
years
ago
we
had
close
to
900
children
on
the
autism
treatment
assistance
program,
wait
list
and
we
just
had
about
25
children
on
that
wait
list
this
week.
So
we're
now
serving
over
900
children
versus
having
900
children
on
a
waitlist
we've
been
doing
multiple
things.
G
We
did
have
an
audit
from
the
19
legislative
session
and
that's
also
helped
us
to
I'm
sorry
from
the
21
legislative
session
and
that's
helped
us
to
really
reach
out.
We
had
a
full
analysis
through
that
audit
and
it's
helped
us
with
working
with
medicaid
and
other
community
providers
to
get
the
word
out.
We
also
received
a
rate
increase
for
registered
behavioral
technicians
from
31
dollars
and
30
cents
to
52.04
cents
per
hour
to
ensure
that
we
are
providing
that
applied.
G
Obviously,
it's
something
we
will
continue
to
work
through,
but
we
have
been
affected
by
the
critical
staffing
shortages
as
well,
so
we're
excited
to
say
that
we
have
approximately
20
children
on
our
current
wait
list,
but
we're
still
working
through
hiring
appropriate
developmental
specialists
to
provide
those
services,
as
well
as
the
providers
to
ensure
that
we
can
remain
having
a
low
wait
list
for
the
autism
treatment
assistance
program.
E
G
Ricky
rob
for
the
record,
so
there's
multiple
pieces
to
that,
and
some
of
those
children
are
duly
eligible
for
an
atap
service,
but
they
also
would
be
eligible
for
developmental
services.
So
we
do
work
closely
as
an
agency
to
ensure
that
we
provide
those
support
so
as
they
age
into
adulthood,
they
have
additional
supports
as
well,
but
I'll
turn
that
over
to
jessica
adams,
to
explain
how
developmental
services
provides
us
supports.
A
Then
they
typically
are
going
to
go
into
one
of
our
programs
that
I
was
talking
about
like
supported,
living
arrangements,
jobs
and
day
training
we're
going
to
keep
providing
services
to
that
person
and
supports
to
that
person
for
the
rest
of
their
of
their
life.
Unfortunately,
though,
for
for
those
in
individuals
who
do
not
reach
the
level
of
care
needs
for
regional
centers.
A
E
Thank
you
very
much
for
that.
Okay,
seeing
no
other
questions,
our
next
order
of
business,
we'll
hear
from
additional
representatives
from
the
aging
and
disability
services,
division
of
the
department
of
health
and
human
services
and
they'll
provide
an
overview
of
the
home
and
community
based
services.
Programs
available
to
individuals
with
functional
limitations
in
nevada,
we'll
take
questions
from
members
at
the
end
of
the
presentation,
so
feel
free
to
start
your
presentation.
Thank
you.
P
Good
morning
for
the
record,
jennifer
frishman
I
serve
as
the
quality
assurance
manager
for
aging
disability
services
and
with
me
today,
on
my
left
on
my
left,
I
have
crystal
ren
the
chief
of
community
based
care,
which
you
just
heard
a
little
bit
about
and
on
my
right
I
have
megan
wicklund.
She
serves
as
the
developmental
services,
qa
manager
and
so
we'll
just
jump
right
into
our
presentation.
If
that's
all
right.
P
P
So
our
agenda
today
is
basically
going
to
be
just
a
brief
overview
of
home
and
community
based
services
and
I'd
like
to
clarify
that
the
home
and
community
based
services
that
we
are
talking
about
are
not
the
same
home
and
community
based
services
that
you
just
heard
in
the
previous
presentation
with
the
pac
unit.
These
are
focusing
on
medicaid,
home
and
community
based
services
and
home
and
community
based
waivers.
P
It
should
be
noted
that
home
and
community-based
services
or
I'll
be
referring
to
it
as
hcbs
are
general
generally
non-medical
services.
So
these
are
services
that
traditional
commercial
insurance
companies
typically
don't
cover
and
then
also
hcbs
are
person-centered
and
tailored
to
the
individual
receiving
the
service.
You
heard
jessica
adams
talk
earlier
that
the
role
of
the
service
coordinator
and
and
the
social
health
assessment.
P
P
You
have
also
comparability
of
services.
So
when
someone
is
on
medicaid,
it
does
not
matter
where
they
reside.
They
could
be
in
elko,
they
could
be
in
pahrump.
They
could
be
in
washout.
Everyone
receiving
state
plan,
medicaid
services
received
the
same
services,
the
waivers,
allow
states
to
target
certain
populations,
so,
for
example,
states
can
use
this
authority
to
target
services
to
the
to
the
elderly
technology,
dependent
children,
people
with
behavioral
conditions
or
people
with
intellectual
disabilities.
P
The
waivers
work
in
conjunction
with
state
planned
medicaid.
A
good
example
of
that
is
personal
care
services,
so
in
nevada,
personal
care
services
are
part
of
the
medicaid
state
plan
and
they
can
be
authorized
up
to
36
hours
a
week.
However,
if
the
service
coordinator
or
the
social
worker
feels
that
the
individual
needs
additional
care,
maybe
they
had
a
recent
hospitalization,
a
surgery
getting
over
an
illness,
something
like
that.
P
The
social
worker
is
authorized
to
provide
attendant
care
services
and
ms
ren
will
get
into
that
in
just
a
little
bit,
and
it's
also
important
to
point
out
that
the
division
of
healthcare,
financing
and
policy
is
the
administrating
administering
agency
and
adsd
is
the
operating
agency
for
these
waivers.
So
the
actual
waiver
is
signed
off
on
by
the
division
of
healthcare,
financing
and
policy.
It's
basically
their
contract
with
the
centers
for
medicare
and
medicaid
services,
and
they
administer
the
program
and
we
operate
it.
P
So
we
provide
the
the
service
coordinators
and
the
social
workers
to
provide
those
services.
Waivers
are
intended
to
give
states
flexibility
to
serve
new
populations
and
provide
services
in
innovative
ways.
As
I
just
said,
the
state
cannot
pay
for
the
same
services
as
state
plan,
but
they
can
help
supplement
medicaid
state
plan
services.
P
Waivers
can't
pay
for
anything
that
would
be
duplicative
from
any
other
federal
funding
source
since
such
as
idea
or
the
4e
programs,
and
we
cannot
pay
for
any
service
to
individuals
residing
in
an
institution,
so
that
could
be
a
nursing
home,
a
hospital,
a
jail
intermediate
care
facility,
etc
and
then
also
waivers
need
to
be
cost
neutral.
So
the
total
annual
cost
of
the
waiver
program
cannot
exceed
the
total
cost
of
those
individuals.
If
they
were
institutionalized.
P
So
the
services,
the
settings
must
be
selected
from
by
the
individual
for
multiple
options,
ensure
the
individuals,
rights
to
privacy,
dignity
and
respect
optimize.
Individual
initiative
and
autonomy
facilitate
individual
choice,
ensure
the
individual
receives
services
in
the
community
to
the
same
degree
of
access
as
individuals
not
receiving
medicaid,
home
and
community
based
services,
and
then
another
big
provision
of
this
rule
is
that
for
folks
that
are
residing
in
congregate
settings.
P
They
need
to
ensure
that
a
lease
residency
agreement
or
other
form
of
written
agreement
will
be
in
place
for
each
participant
and
that
the
document
provides
protections
that
address
eviction,
processes
and
appeals
comparable
to
those
provided
under
the
jurisdiction's
landlord
tenant
laws.
So
anything
that
for
eviction
purposes,
the
person
receiving
waiver
services
has
to
have
the
same
rights
as
an
individual,
not
receiving
hcbs
services
living
in
that
setting.
P
This
next
slide
is
a
very,
very
high
level
overview
of
the
waiver
intake
and
approval
process.
On
your
right
hand,
side
you'll,
see
aging
and
disability
services
adsd.
That's
the
the
first
touch
point
for
someone
who
wants
to
be
become
waiver
eligible
the
social
worker,
the
service
coordinator.
Does
the
intake
process
make
sure
that
the
individual
meets
the
waiver
criteria?
P
That
application
is
then
sent
to
the
division
of
welfare
and
supportive
services,
and
they
actually
do
the
financial
eligibility
to
make
sure
that
the
person
is
eligible
and
then
to
close
that
loop
is
the
division
of
health
care,
financing
and
policy,
so
once
it
gets
through
aging
and
the
welfare
division,
it
goes
to
nevada
medicaid
for
final
approval,
as
they
are
the
administrating
agents
administering
agency
financial
eligibility.
This
again
is
a
very,
very
high
level
overview.
P
Each
case
is
different,
so
when
in
doubt,
have
someone
apply
for
the
waiver
and
the
division
of
welfare
services
will
complete
the
final
financial
eligibility,
but
in
a
nutshell,
individuals
must
be
at
or
below
300
percent
of
the
social
security,
ssi
federal
benefit
rate
for
their
household
size.
They
cannot
have
more
than
two
thousand
dollars
in
resources,
must
be
a
resident
of
the
united
states
and
must
be
a
united
states.
I'm
sorry,
president
of
the
state
of
nevada,
and
must
be
a
united
states,
citizen
or
lawful,
permanent
resident.
P
So
what
waivers
do
we
offer
here
in
nevada?
It's
a
running
joke
and
they've
said
when
you've
seen
one
waiver
program
in
one
state
you've
seen
one
waiver
program
in
one
state,
so
each
state
has
different
waivers.
Some
have
waivers
that
target
brain
injuries,
hiv
aids,
technology,
dependent
children.
Here
in
nevada,
we
have
three
waivers.
We
have
our
frail
elderly
waiver,
as
jessica
mentioned
before,
that
serves
individuals
aged
65
or
older,
that
meet
a
nursing
facility
level
of
care.
I
I
So
the
ongoing
case
manager
will
determine
the
service
need,
based
on
the
assessment
completed
and
based
on
the
needs
of
the
individual
once
approved
for
the
waiver.
They
will
schedule
another
in-person
assessment
to
complete
a
social
health
assessment
which
will
include
an
evaluation
of
the
individual
service
needs
and
goals.
I
The
assessment
includes
an
overview
of
the
activities
of
daily
living,
I'm
going
to
refer
to
that
as
adl
and
instrumental
activities
of
daily
living,
which
is
iadl
so
adls
include
bathing
dressing,
grooming,
toileting
eating
mobility
and
transfers
iadls.
The
instrumental
piece
is
the
meal
preparation,
homemaker
laundry
and
shopping
for
an
individual.
I
I
The
case
manager
will
provide
the
individual
with
a
list
of
medicaid
approved
providers
based
on
the
service
that
they
need.
For
example,
if
they
need
homemaker,
we
will
pull
up
a
list
of
approved
homemaker
providers
and
provide
that
to
the
individual
and
they
can
contact
the
providers
and
do
kind
of
an
interview
to
make
sure
that
that
provider
suits
their
needs
and
their
interests,
and
if
needed,
we
are
there
to
assist
as
well.
I
I
So
the
services
offered
under
the
frail
elderly
and
physically
disabled
waiver
are
are
very
home-based
in
nature.
There's
an
array
of
home
selections
such
as
case
chore,
homemaker
attendant
care,
as
jennifer
mentioned,
and
there's
also
some
community
focused
programs
and
some
residential
settings,
and
I
will
define
these
more
in
the
following:
slides.
I
I
Chore
is
authorized
as
a
one-time
service
intended
to
support
a
task
that
is
outside
the
scope
of
the
personal
care
service,
approved
authorizations.
Examples
of
chore
include
carpet
cleaning
shampooing,
maybe
that
deep,
clean
needed
removal
of
debris
and
clutter
to
keep
individuals
safe
in
their
home,
such
as
a
hoarding
issue,
for
example.
That's
something
that
we
can
authorize
a
company
to
come
in
and
help
remove
that
debris.
So
there
is
no
fall
risk.
I
Respite
is
authorized
as
a
relief
for
the
primary
caregiver,
and
it
does
include
adl
and
iadl
care
and
then
the
personal
emergency
response
system.
We
call
it
pers,
but
it
is
not
the
retirement
system.
This
is
the
the
button
device
that
a
lot
of
folks
will
wear.
They
can
wear
it
as
like
a
lanyard,
a
necklace.
There
are
some
wrist
devices
and
some
devices
that
are
on
their
nightstand.
I
It
is
a
device
that
can
detect
falls,
they
can
be
pushed
in
in
case
of
an
emergency
and
it
alerts
the
company
to
send
emergency
medical
crews
or
police
if
needed,.
I
So
the
following
services
are
available
only
to
those
on
the
physically
disabled
waiver,
and
this
includes
attendant
care
home,
delivered
meals,
specialized
medical
equipment
and
environmental
accessibility.
Adaptations
so
attending
care,
as
jennifer
mentioned
earlier,
is
an
extension
of
our
state
plan,
personal
care
services.
I
She
gave
a
very
good
example
of
when
we
would
authorize
additional
services
if
they
have
exhausted.
What
state
plan
can
offer
the
licensed,
caregiver
or
case
manager
can
go
in
and
authorize
additional
services
as
they
see
fit
to
keep
that
person
safe
in
their
home
home,
delivered
meals
are
authorized
for
those
who
have
a
nutritional
risk
and
are
delivered
to
the
individual's
home.
I
They're
often
delivered
in
bulk,
such
as
a
30
meals
at
a
time,
15
meals
at
a
time
depending
on
what
the
individual
requests
and
it
does
allow
the
individual
to
work
with
that
provider
to
to
ensure
that
their
nutritional
needs
are
met
such
as
a
diabetic
menu.
Maybe
they
need
low
salt,
a
lot
of
different
options
and
they
do
have
like
vegetarian
options
and
different
different
ways
of
supporting
that
person's
preference
specialized
medical
equipment.
I
This
service
isn't
used
as
frequently
as
it
used
to
be,
and
I'm
happy
to
say
that
medicare
has
actually
increased
the
amount
of
devices
that
are
covered
by
medicaid.
So
this
only
comes
in
when
we
have
a
device
that
is
not
covered,
then
specialized
medical
equipment
can
be
used
to
pay
for
something
for
an
individual
to
be
safe
in
their
home
and
environmental
adaptations.
I
This
service
is
for
those
who
are
in
need
of
a
modification
to
their
home,
their
residence
or
perhaps
the
place
they
rent
to
allow
them
to
stay
safe
in
their
home.
Common
adaptations
are
our
ramps
for
for
wheelchairs
or
to
eliminate
the
stairs.
We've
done.
Doorway
widenings
we've
done
roll-in
showers.
Even
thresholds
grab
bars,
you
name
it
they,
they
will
authorize
it.
I
This
last
set
of
services
is
going
to
be
those
that
are
offered
in
the
community
or
a
congregate.
Setting,
so
augmented
personal
care
is
the
name
that
is
associated
with
group
home
coverage,
so
augmented
personal
care
and
assisted
living
are
relatively
the
same
service.
It
just
depends
on
the
provider
and
how
they
enroll
with
medicaid.
I
So
both
services
offer
24-hour
in-home
service
for
individuals
who
are
not
appropriate
to
reside
in
their
private
residence
and
who
still
meet
the
qualifications
for
a
waiver,
so
reimbursement
for
these
services
include
the
iadl
and
adl
care.
However,
room
and
board
is
not
allowed
to
be
reimbursed
through
medicaid,
that
is
a
private
agreement.
That's
arranged
between
the
individual
or
their
representative
and
the
agency.
I
I
They
don't
have
to
transition
to
a
new
setting,
they're
able
to
stay
within
that
location
that
they're
comfortable
with
and
still
retain
that
same
amount
of
care
that
they're
that
they're
needing
so
for
the
waiver
participants
on
the
waitlist.
In
as
of
january
of
2022,
we
had
2648
individuals
on
the
frel
elderly
waiver
and
235
individuals
on
our
wait
list
and
for
the
physically
disabled
waiver.
As
of
january
of
2022,
we
had
1
124
individuals
on
the
waiver
and
84
on
the
wait
list.
Q
Q
Q
We
have
11
waiver
services
that
we
contract
with
community
providers
to
deliver
that
service,
as
jessica
adams
had
previously
mentioned,
and
so
I'm
going
to
go
through
each
one
of
these
for
you
today
we
have
four
types
of
jobs
and
day
training
services.
The
first
one
is
our
day
habilitation,
and
this
service
provides
meaningful
activities
to
people
in
the
community
that
helps
foster
the
acquisition,
retention
or
improvement
of
skills
such
as
daily
living
skills
and
socialization
skills.
Q
This
can
also
include
retirement
activities
for
people
who
no
longer
want
to
work,
and
these
services
are
not
vocational
in
nature.
Our
pre-vocational
services,
on
the
other
hand,
provide
work
experience
including
volunteer
work.
It
teaches
general
employment
related
skills,
such
as
the
ability
to
communicate
with
their
supervisor
co-workers,
customers.
Q
Q
We
also
have
shared
living
services
where
one
or
two
people
live
with
a
family
or
a
couple
in
share
life
experiences
where
natural
supports
are
built
in
and
then
we
have
our
24
hour
supported
living
arrangement
services
that
supports
up
to
four
people
living
in
a
home,
together
with
staff
available,
24
7..
These
services
are
designed
to
ensure
the
health
and
welfare
of
the
person
through
direct
services
and
protective
oversight
that
assists
the
person
to
learn,
improve,
retain
or
maintain
skills
needed
to
be
as
independent
as
possible
in
the
community.
Q
Q
Our
next
waiver
service
is
our
behavioral
consultation,
training
and
intervention,
and
this
is
designed
to
increase
positive,
alternative,
behaviors
and
decrease
and
address
challenging
behaviors
through
behaviorally
based
assessment
and
intervention.
It's
a
well-rounded
approach
to
serving
the
person
and
their
team
through
that
training
and
consultation
component.
Q
Our
next
service
is
our
counseling
services.
This
provides
problem,
identification
and
resolution
in
areas
of
interpersonal
relationships,
independence,
community
participation.
It
can
be
done
via
individual
or
group
counseling
and
is
provided
by
licensed
professionals
in
psychology,
counseling
or
other
related
fields.
Q
Q
They
do
training
to
the
direct
support
staff
or
family
members
to
help
carry
out
treatment
plans,
and
they
also
provide
monitoring
and
assessment
of
the
recipient's
health
condition,
and
then
we
have
nursing
assessment.
That
is
done
by
a
licensed
registered
nurse.
Only
that
identifies
the
person's
needs
and
abilities
that
assessment
information
is
then,
provided
it
provides
recommendations
for
medical
and
mental
health
care
follow-up,
and
the
information
is
then
shared
with
the
person's
team
and
for
review
and
is
included
in
that
person-centered
plan.
Q
And
then
we
have
our
direct
services
that
can
be
performed
by
either
a
licensed,
registered
nurse
or
licensed
practical
nurse.
These
are
direct
skilled,
nursing
services
that
are
intended
to
allow
the
person
to
live
safely
within
the
community,
and
the
services
can
be
provided
at
home
or
in
the
work
setting
as
determined
by
their
person-centered
plan.
Q
We
also
have
non-medical
transportation
that
supports
people
and
accessing
services,
activities
and
resources
in
the
community,
and
these
can
include
bus
passes
and
then
our
last
waiver
service
is
our
nutrition
counseling
service.
I
mean
this
is
provided
by
a
registered
dietitian
to
support
the
health
and
nutritional
needs
of
recipients
through
assessment,
nutritional
plan,
development,
training
and
education
of
the
person
and
those
working
with
them
and
as
of
january
2022.
We
currently
have
2582
individuals
on
the
waiver
and
we
have
412
individuals
who
are
on
our
waiver
waitlist
statewide.
I
P
This
is
jennifer
freshman
for
the
record,
so
there's
two
answers
to
that:
I'll
refer
to
the
elderly
and
physically
disabled
waivers.
First,
unfortunately,
as
as
crystal
said,
we
have
two
state-run
programs,
our
pas
program
and
our
co
program
that
can
bridge
the
gap
for
those
waiting
for
services
to
waiting
to
get
on
the
waiver.
P
But
those
are
the
only
two
programs
that
we
have.
They
do
not
have
to
reside
in
an
institution
if
they
are
not
currently
in
an
institution.
So
that's
not
a
requirement
for
our
individuals
with
intellectual
and
developmental
disabilities
waiver.
They
can
be
receiving
state
plan
services,
so
we
have
all
of
the
services
that
ms
wicklund
mentioned,
those
11
waiver
waiver
services.
I
Personal
emergency
response
system-
I
don't
know
if
those
are
attached
to
folks
home
phones
or,
if
they're
on
their
cell
phones,
but
I
know,
there's
been
an
issue
recently
about
3g
and
just
wanted
to
know
if
all
of
these
have
been
confirmed
to
be
above
3g.
So
it's
not
a
situation
where
somebody
presses
the
button.
I
I
E
Our
next
presentation
will
be
from
jeff
duncan
and
cheyenne
pascal
unit
chief
and
planning
chief
respectively,
with
the
aging
and
disability
services,
division
of
the
department
of
health
and
human
services
regarding
senior
citizen
demographics
in
nevada.
Again,
we'll
take
questions
at
the
conclusion
of
the
presentation.
Mr
duncan,
please
proceed
when
you're
ready.
O
O
So
now
that
you've
heard
about
many
of
our
programs.
We
now
want
to
talk
to
you
or
walk
you
through.
Excuse
me
the
who
and
why
we
serve
so.
Our
agenda
today
includes
a
brief
overview
of
our
elders,
count
report
and
then
we'll
highlight
key
sections
of
the
report
listed
there.
We've
also
included
a
resource
slide
and
we'll
answer
any
questions
for
you
all
at
the
end.
O
So
before
I
give
you
the
brief
overview
of
the
2021
report,
we
want
to
thank
many
who
served
on
our
collaboration
team.
So
we
work
closely
with
the
center
for
healthy
aging,
our
office
office
of
statewide
initiatives
at
the
university
of
batorino
school
of
medicine.
Of
course,
individuals
from
our
division
were
part
of
the
team.
O
O
We
did
not
go
into
the
full
detail
of
the
report
today
about
our
older
adult
population
and
we
broke
it
down
for
six
key
sections,
and
this
is
population
economics,
health
status,
health
risk
and
behaviors
health
care
and
then
infrastructure,
but
in
total
there
are
63
charts
in
the
report
and,
of
course,
we're
not
going
to
be
able
to
highlight
all
those
for
you
today,
but
you
will
get
a
link
to
the
report,
so
this
report
not
only
helps
our
agency
with
planning
and
program
development,
but
also
improves
the
awareness
of
the
unique
needs
and
challenges
of
nevada's
older,
adult
population
that
they
face,
and
it
also
should
help
give
our
legislature
state
entities
and
the
community
as
a
whole.
O
A
snapshot
of
nevada,
older
adults,
we'd
like
to
note
that
we
are
currently
planning
for
our
2023
elders,
count
report
it's
currently
underway
and
will
be
published.
This
fall
in
addition
to
the
sections
already
listed
in
the
2021
report.
We
we
will
be
including
new
sections
in
the
2023
report
on
adults
with
disabilities
and
a
section
on
dementia.
O
O
O
O
On
our
migration
or
migration
slide,
we
want
to
point
out
that
nevada
by
older
adults
continues
to
rise,
especially
in
southern
nevada.
O
O
The
last
slide
that
I
will
cover
is
our
living
alone
slide,
so
in
nevada,
14.3
percent
of
the
people
who
live
alone
are
65
and
older
of
that
over
53
are
females
compared
to
30.
For
the
males.
There
are
slight
differences
from
the
national
averages,
with
nevada
mills
trending,
higher
and
nevada
females
trending
lower.
K
Good
afternoon
cheyenne
pasquale
for
the
record,
we
are
going
to
move
into
the
economics
section
on
slide
12.
This
slide
just
shows
the
percentage
of
households
with
people,
age,
65
and
older
living
in
poverty.
Overall,
the
nevada's
population
is
9.6
of
the
people.
Age,
65
and
older
are
living
in
poverty,
and
you
can
see
in
the
rural
areas
that
percentage
jumps
up
to
10.4
percent.
K
Additionally,
we
will
likely
see
our
our
percentage
of
nevada,
popul
population,
age,
65
and
older
increase,
because
not
pictured
on
this
slide
is
the
fact
that
11.8
percent
of
the
population
45
to
64
are
currently
falling
under
the
poverty
threshold.
K
K
K
According
to
the
national
center
for
health
statistics,
heart
disease
has
been
the
leading
cause
of
death
in
the
us
for
decades,
followed
by
cancer.
This
remains
true
in
nevada,
with
the
percentage
of
deaths
related
to
heart,
disease,
disease
and
cancer,
slightly
higher
in
nevada
than
the
us
averages.
K
K
K
This
slide
shows
the
rate
of
falls
increased
dramatically
as
people
age
doubling
between
the
age
group
of
75
to
84
and
the
85
and
older
age
group
falls,
are
particularly
dangerous
after
an
acute
care
hospital
stay
and
contribute
to
increased
30-day
hospital
readmissions
among
nevada's,
older
adults
on
slide
19.
The
nevada
drug
overdose
related
inpatient
admissions,
while
the
overall,
the
rates
of
drug
overdose
related
to
inpatient
admissions
for
nevadans,
age,
55
and
older
is
relatively
small.
There's
a
there's,
an
alarming
increase
in
the
rate
per
100,
000
people,
age,
55
and
older.
K
On
slide
19-
and
this
slide
shows
the
substantiated
cases
and
the
case
types.
It's
interesting
to
note
that
we
reported
the
highest
type.
The
the
most
reported
case
type
is
self
neglect,
but
the
highest
substantiated
case
type
is
abuse.
So.
K
And
on
slide
22,
this
slide
shows
the
age
distribution
of
medicaid
and
chip
enrollees,
you
can
see
age,
65
and
older
is
seven
approximately
seven
percent
of
the
pop
medicaid
population,
but
this
is
the
larger
share
of
dual
eligible
population,
which
accounts
for
approximately
32
percent
of
medicaid
spending.
K
This
next
slide
just
shows
health
care
expenditures
by
type
nevada
is
pretty
comparable
to
the
u.s,
with
hospital
care
being
the
largest
expenditure.
K
The
value
of
on
slide
24,
the
value
of
community-based
services
in
both
terms
of
expenditures
and
quality
of
life,
is
undeniable,
although
long-term
care
facilities
are
still
a
critical
part
of
the
healthcare
infrastructure.
For
many
older
adults,
in-home
services
are
nearly
half
the
average
cost
per
year
than
a
skilled
nursing
facility
in
terms
of
nursing
facilities.
Nursing
homes
in
nevada
have
outpaced
the
us
in
severe
severe
deficiencies
and
substandard
quality
of
care.
Since
2011.
K
K
This
is
a
chart
that
shows
the
comparison
of
rates
per
100,
older
adults.
K
It's
the
workforce,
I'm
sorry.
The
work
first
grew
by
18.5
and
the
population
grew
by
21.8
percent,
so
our
workforce
is
not
growing
at
the
same
rate
as
our
population
is,
which
can
indicate
a
shortage,
and
with
that
we
have
a
few
additional
resources
of
for
your
reading
pleasure
and
we
will
take
any
questions.
F
Hi
yeah.
Thank
you.
Thank
you
so
much
for
the
presentation
and
it
was
a
stark
reminder
of
a
stark
reminder
of
a
briefing
that
we
received.
You
think
it
was
back
in
the
2013
2014-15
interim
regarding
the
graying
of
nevada.
So
here's
my
question.
F
We
know
that
we
don't
have
enough
primary
caregivers
for
the
general
population
and
it
is
exacerbated
when
you
start
looking
breaking
it
down
demographically
for
those
who
are
50
and
over
have
we
looked
at
any
way
that
we
might
be
able
to
mitigate
the
impact
that
the
lack
of
the
number
of
physicians,
necessary
number
of
physicians
is
available
for
our
seniors
and
number.
F
Two
again,
I
have
to
ask
the
question:
have
we
looked
at
what
that
looks
like
as
we
look
at
it
from
the
various
demographic
categories,
not
just
by
poc
but
affectionate
orientation,
differences
in
family
structures
or
lack
thereof,
seniors,
who
are
in
their
60s
or
70s,
did
not
have
the
same
luxury
as
those
who
are
coming
up
with
respect
to
being
able
to
adopt
children,
as
you
have
an
extended
family.
F
So
have
we
looked
at
what
the
needs
may
be
right
now
and
what
they
could
be
because
nevada
is,
is
graying
and
that
grain
will
take
place
across
all
demographic
structures.
What
what
is
it
that
we
need
to
be
doing
now
as
legislators
or
as
policy
makers,
so
that
we
can
reduce
or
mitigate
the
impact
of
some
of
the
negative
impacts
that
come
along
with
the
lack
of
resources.
O
So
this
is
jeff
duncan
for
the
record.
Thank
you
for
your
question,
senator
spearman,
so
I'll
I'll
answer
it
this
way.
I
know
I've
seen
you
on
interim
committees
and
watched
the
legislature
over
the
years.
I've
also
witnessed
our
advisory
bodies
that
really
try
to
advocate
to
bring
additional
physicians
to
the
state.
I
can't
say
that
our
agency
has
a
lead
role
in
that,
but
we
definitely
like
to
be
at
the
table
to
provide
the
information
about
the
populations
we
serve.
F
Follow-Up,
madam
chair,
this
is
probably
more
of
a
comment
than
a
question.
F
I
know
that
for
the
last
several
second
sessions
we've
been
trying
to
look
at
things
with
respect
to
making
sure
that
professional
boards
are
doing
the
right
thing
when
people
apply
for
licensure
and
perhaps
there's
something
that
you
all
might
be
able
to
do
to
help
us
ensure
that
licensing
procedures
are
properly
conducted
and
for
those
who
have
a
right
to
get
a
license
in
the
state
of
nevada
make
sure
that
those
are
done
as
expeditiously
and
safely
as
possible.
F
So
maybe
there
maybe
there
is
some
type
of
intersectionality
in
terms
of
what
you
need
in
order
to
provide
the
services
that
you
need
for
seniors
and
then
some
things
that
we
as
policymakers
might
be
able
to
do
in
the
upcoming
session.
Just
a
thought.
E
Thank
you
vice
chair
spearman.
Does
anyone
else
have
any
questions.
B
Thank
you.
I
don't
know
where
it
was
it's
on
one
of
the
slides
you
referred
to
poverty
threshold.
What
is
that
threshold.
K
Cheyenne
pasquale
for
the
record.
I
do
not
have
that
number
off
the
top
of
my
head,
but
let
me
see
if
I
can
pull
it
up.
E
Being
none,
I
do
have
a
concern.
It's
on
slide,
25,
the
nursing
home
deficiencies,
I
have
to
say
I'm
quite
alarmed
at
the
number
of
severe
deficiencies
and
substandard
quality
of
care
numbers
in
nevada.
Do
you
have
any
specific
information
on
what
those
deficiencies
are
and
what
harm
or
immediate
jeopardy
was
caused
by
those
deficiencies.
O
J
We're
a
team
we
collaborate.
My
name
is
jennifer
williams
with
state
long-term
care,
ombudsman
for
the
record.
The
deficiencies
are
actually
issued
by
the
bureau
of
healthcare
quality
and
compliance,
and
while
the
ombudsman
advocates
for
individuals
in
long-term
care
settings,
we
don't
have
exact
authority
to
regulate
or
enforce
those
deficits.
You
know
impose
those
deficiencies.
However,
as
ms
carrie
embry
mentioned
earlier
in
her
presentation,
we
do
have
trends
that
we
see
in
long-term
care,
and
so
those
would
be
the
types
of
issues
that
we
look
at
as
she
mentioned
previously.
J
Discharge
discharged
issues,
transfers,
exploitation,
physical
and
verbal
abuse
are
some
of
the
top
concerns
that
we
have
and
we
collaborate
with
adult
protective
services
as
well
to
assist
in
those
situations
with
our
residents
in
long-term
care.
So
I
don't
have
specific
information
regarding
those
deficiencies.
E
Thank
you
very
much
for
that.
Yes,
I
think
that
would
be
a
good
idea
to
have
them
come
and
talk
a
little
bit
more
about
that
and
see
what
we
might
be
able
to
look
at
to
decrease
some
of
those
severe
deficiencies
and
substandard
quality
of
care.
E
So
last
call
for
questions
with
our
committee,
any
others
being
none.
Thank
you
again.
I
actually
do
find
data
very
interesting,
so
I
appreciate
your
presentation
so
at
this
point
we
will
have
a
presentation
by
representatives
of
the
aging
and
disability
services,
division
of
the
department
of
health
and
human
services
of
the
state,
long-term
care
ombudsman
regarding
the
status
of
covid19
for
senior
citizens,
adults
with
disabilities
and
those
in
long-term
care
facilities.
Again,
we
will
take
questions
at
the
conclusion
of
the
presentation.
You
may
begin
when
ready.
H
Good
afternoon
and
for
the
record,
my
name
is
tammy
seaver.
I
am
the
social
services
chief
for
adult
protective
services
and
on
behalf
of
myself
and
my
co-presenters
juwan
caver,
who
is
the
clinical
program
manager
with
desert
regional
center
and,
as
you
previously
met,
jennifer
williams,
woods
our
long-term
care
ombudsman.
H
D
D
D
The
individual
impact
increased
isolation,
our
service
providers,
such
as
personal
care
attendants,
a
top
adult
companions,
homemakers
and
chore,
were
limited
or
didn't
support.
People
in
their
own
home
community
congregate
sites
such
as
senior
senior
centers
senior
centers
adult
day
care
jobs
and
day
care
programs
were
initially
unavailable
for
people
to
attend,
family
members
and
or
natural
supports
in
some
cases,
were
afraid
and
or
sick
themselves,
and
didn't
visit
people
who
lived
in
their
own
homes.
D
You
and
I,
the
impact
in
terms
of
those
that
were
in
congregate,
settings
or
long-term
care
environments.
People
residing
in
this
these
environments
experience
isolation
due
to
our
staff
and
family
members
or
other
natural
supports
being
unable
to
visit
them
or
having
less
frequency
of
visits
during
the
initial
stages
of
cold
at
19..
D
In
terms
of
their
the
individual
impact
of
their
health
and
welfare,
people
who
needed
care
beyond
what
they
traditionally
received
in
their
homes
or
congregate,
environment,
experienced
delays
and
admissions
from
carers
from
hospitals,
routine
preventative
care.
Telehealth
was
difficult
for
some
people
who
were
in
facilities
did
not
receive
the
same
protective
oversight.
Measures
such
as
their
rights
weren't
properly
made
not
have
been
properly
assessed,
visitation
from
case
managers.
D
D
With
regards
to
our
program
impact,
our
offices
were
closed
abruptly,
which
didn't
allow
our
staff
the
proper
transition
time
to
move
from
a
working
and
office
environment.
To
many
cases
working
at
home
we
saw
a
staff
who
were
used
to
working
in
face-to-face
environments
with
clients
moved
to
a
virtual
environment,
using
virtual
technology
or
and
or
telephones,
because
staff
began
working
from
home.
D
Coordination
of
services
for
people
became
challenging
for
staff
due
to
the
lack
of
providers,
in
other
words,
providers
that
we
were
used
to
working
with
who
could
support.
People
were
limited
with
their
staffing
issues
themselves,.
D
D
Regarding
the
icf
staff
and
the
programming
there,
the
staff
ex
the
icf
experience
vacancies
and
as
what
was
indicated
earlier
by
ms
jessica
adams,
the
staff
local
staff
of
vacancies
still
continue.
To
this
day,
the
icf
staff
was
considered
essential
workers
and
needed
to
be
at
the
icf.
D
H
For
the
record
again,
my
name
is
tammy
seaver
and
let
me
go
to
the
next
slide.
Thank
you
on
the
first
two
bullets,
these
are
statewide
statistics
for
covid,
so
of
confirmed
cases
of
60
and
over
there
was
16
of
total
confirmed
cases
and
for
those
60
and
over
covet
deaths
accounted
for
79
of
total
deaths.
H
Our
developmental
services,
which
included
desert
regional
center
down
in
the
south,
and
the
rural
and
sierra
regional
centers
up
north
also
had
their
person
serves
and
provider
staff
and
staff
themselves
and
with
our
community-based
care
we
had
451,
confirmed
persons
served,
and
fortunately
126
deaths
from
complications
of
covid.
H
J
Good
afternoon,
jennifer
williams,
woods
for
the
record
state
long-term
care.
Ombudsman,
I'm
going
to
review
our
response
to
to
coped
as
a
division.
So,
first
and
foremost
we
are
able
for
the
federal
funding,
which
many
of
you
may
be
aware
of.
Our
total
number
received
was
was
nearly
25
million
dollars
to
provide
assistance
with
various
programs.
J
So,
with
the
first
rounds
of
the
disbursement,
we
had
the
families
first,
the
cares
act,
which
was
the
corona
virus,
aid
relief
and
economic
security.
We
also
provided
assistance
with
our
from
cares
act
with
the
no
wrong
door
and
our
adrc
system,
with
the
consolidation
consolidated
appropriations
act
we
had,
which
was
by
the
older
americans
act,
and
we
have
the
ssa,
titled
20
dollars
rolling
in
as
well
so,
and
then.
J
Lastly,
we
have
the
american
rescue
plan
act,
which
was
also
part
of
the
older
americans
act,
which
provided
additional
services
and
increase
for
services
that
we
provided,
and
we
also
put
fourth
and
fourth
dollars
for
the
public
welfare
or
public
health
workforce
next
slide.
J
So
this
graph
demonstrates
in
many
different
ways.
Thank
you.
The
ways
that
we
spent
the
money,
the
majority
of
our
dollars,
went
to
food
security,
as
you
heard
earlier,
many
of
our
seniors
especially
had
issues
accessing
food
services.
J
J
So,
as
we
started
our
initial
response
to
the
covid
pandemic,
our
community-based
care
staff
made
sure
that
they
looked
at
all
the
active
recipients
and
look
and
examine
them
by
looking
at
the
risk
level
for
each
individual,
their
support
system
and
availability
of
supplies
and
their
other
health
and
safety
concerns
to
make
sure
that
we're
reaching
those
most
at
risk
and
those
individuals,
240
of
them,
were
identified
and
contacted
the
first
week
of
shutdown,
which
was
again
that
kind
of
the
10th
or
so
of
march
around
that
time
frame.
J
That's
when
that
work
began
through
over
3
400
recipients
were
contacted
between
march
16th
and
march
31st
of
2020
and
throughout
the
pandemic.
Our
adsd
staff
made
maintain
contact
with
all
clients
and
again
the
focus
lean
on
those
with
high
risk
again
not
having
much
of
a
support
system
and
needing
the
most
assistance.
J
Most
importantly,
our
adult
protective
services
made
sure
that
they
continue
their
home
visits
during
the
pandemic.
They
may
have
looked
a
little
differently
taken
place
on
porches
or
outside
to
maintain
the
safety
of
both
the
clients
and
our
adult
protective
services
staff.
Next
slide,
we
had
a
lot
of
innovations.
J
We
came
together
quickly
and
I
would
say,
as
demonstrated
earlier
with
jeff
phoning
a
friend
myself,
that's
what
we
do
we're
flexible
and
we
really
work
well
to
do
things
on
the
fly
come
together
and
work
with
our
community
partners
and
one
of
the
great
great
I
guess,
outcomes
of
that
would
be
our
nevada,
covid,
aging
and
network
and
response
or
nevada
can,
and
so
this
was
a
coordination
of
service
providers
to
provide
a
rapid
response
to
the
immediate
needs
for
food
medication,
telehealth
services
and
social
support
programs,
and
so
many
of
us
in
the
room
were
part
of
these
various
work
groups
to
come
together
and
brainstorm.
J
J
There
were
flexibilities
in
the
older
americans
act
program,
so
we
pivoted
from
home,
delivered
meals
and
home
delivery.
Grocery
programs
simplify
that
application
process
and
we
really
made
other.
There
were
other
flexibilities
to
support
our
older
adults.
J
We
had
additional
legal
service
grant
funding
to
respond
to
civil
needs,
such
as
evictions
for
those
needing
having
difficulty
paying
their
rent
to
keep
them
in
their
in
their
homes.
For
as
long
as
possible,
the
long-term
care
ombudsman
program
we
used
the
cares
act
funding
to
purchase
tablets
for
every
single
long-term
care
facility
in
the
state,
so
that
includes
our
skilled
nursing
facilities,
residential
facilities
for
groups
and
homes
for
individual
residential
care.
J
We
also
purchased
visitation
booths,
which
were
clear,
plexiglas
three-sided
stations
that
could
the
residents
could
sit
behind
and
access
their
family
members
in
person
which
couldn't
be
done
for
quite
some
time,
so
that
helped
alleviate
and
increase
the
access
to
the
residents
from
our
program
and
others
as
well,
and
also
the
family
members,
most
importantly,
to
keep
the
residents
kind
of
entertained.
Even
though,
as
juwan
mentioned,
those
congregate
activities
couldn't
take
place.
So
this
provided
some
activities
for
them
to
do
and
provided
contact
information
to
the
ombudsman
program.
J
So
we
still
have
that
lifeline
to
them.
Our
staff
again,
as
we
mentioned
previously,
switched
to
making
phone
calls
using
those
tablets
to
make
video
calls
with
the
to
the
residents
and
staff
in
lieu
of
facility
visits.
Since
we
were
shut
out
for
quite
some
time
and
then,
whether
permitting
we
were
able
to
conduct
window
and
outdoor
visits
to
speak
with
residents,
when
we
could.
J
With
our
cbc
waivers
our
community-based
care,
there
was
a
lot
of
flexibility
with
our
appendix
k,
which
allowed
us
to
have
some
alternative
methods
for
service
delivery.
So
our
adult
day
care
and
jobs
and
day
programs
providers
were
able
to
services
were
provided
in
their
in
the
clients,
homes,
using
telephone
zoom
teams
and
any
other
video
communication
or
audio
communication
available.
J
As
we
mentioned
previously,
those
face-to-face
interactions
were
modified
to
to
do
use
those
various
other
instruments
to
maintain
that
communication
and
continuing
with
our
person-centered
plan
and
lastly
allowed
it
was
a
retainer
payments
were
made
to
job
and
day
program
providers
when
an
individual
was
hospitalized
or
absent,
due
to
closure
for
cobin
19
for
up
to
30
consecutive
service
or
billing
days.
J
E
E
E
One
welcome
back
to
the
legislative
committee
on
senior
citizens,
veterans
and
adults
with
special
needs
for
the
next
item
of
business.
We
have
mr
barry
gold,
director
of
government
relations
with
aarp
nevada
here,
to
give
us
an
overview
of
federal
and
state
initiatives
pertaining
to
senior
citizens.
C
Thank
you
so
much,
madam
chair
members
of
the
committee.
Again
for
the
record,
my
name
is:
barry
gold,
I'm
the
director
of
government
relations
for
aarp.
Before
I
forget
I'd
like
to
thank
you
for
inviting
aarp
to
participate
on
behalf
of
the
345
000
aarp
members
I
like
to
mention
whenever
I
testify.
C
I
wanted
to
mention
just
very
briefly
the
history
of
this
committee.
I
remember
when
kathy
mclean
was
running
around
the
legislative
building
the
last
week
trying
to
get
this
through
and
she
actually
did-
and
we've
been
working
with
this
committee
ever
since
then
getting
some
important
issues
that
are
heard
on
seniors,
vets
and
adults
with
special
needs
which
often
don't
find
themselves
in
front
of
the
other
committee.
C
So
this
is
a
great
committee
and
I'm
so
glad
to
be
able
to
be
here
and
to
continue
to
participate
and
I'll
talk
about
the
piece
of
legislation
that
really
kind
of
saved
this
committee.
A
little
bit
later,
I
wanted
to
first
of
all
say
that
the
the
information
you
heard
this
morning
was
fabulous
and
there
was
a
lot
of
great
information.
C
There
was
a
lot
of
interesting
things
that
were
said
a
lot
of
things
that
I
would
have
liked
to
have
commented
on,
but
that's
not
why
you
invited
me
so
there's
other
things.
I'd
like
to
also
mention
that
aarp
I
serve
on
the
commission
on
aging
and
we
look
at
a
lot
of
those
issues
and
a
lot
of
those
things.
You've
heard
in
ongoing
oversight
and
evaluation,
a
lot
of
things
that
adsd
and
medicaid
are
doing
so.
C
There's
people
out
there
keeping
their
eyes
on
this
and
making
sure
that
our
older
adults,
people
with
disabilities
and
adults
with
special
needs
and
veterans
are
being
looked
at.
So
I
just
wanted
to
assure
you
of
that
and
with
that-
and
I
looked
at
the
responsibilities
of
the
committee,
and
some
of
it
sounds
like
my
job
too
that's
kind
of
interesting,
but
I
wanted
to
first
talk
about
a
lot
of
the
things
that
were
done.
This
is
by
no
means
a
comprehensive
list
of
all
the
legislation
that
affected
older
adults.
C
There
was
a
lot
of
things
and
a
lot
of
things
and
trust
me.
A
lot
of
lobbyists
came
up
to
me
during
the
session
or
actually
called
me
since
we
weren't
there
and
said
barry.
I
got
a
bill
you
want
to
look
at
and
yes,
there
was
an
effect
on
older
adults
at
some
things,
but
it
may
have
been
outside
our
public
policy
or
it
might
have
a
minor
effect.
C
So
there's
a
lot
of
things,
so
I'm
going
to
focus
on
a
lot
of
the
things
that
aarp
looked
at
and
some
of
the
other
things
so
I'll
start
off
with
ab35
and
ab35
was
a
bill
that
kind
of
changed
the
eligibility
requirements
for
some
of
the
services
from
a
fund
for
fund
for
a
healthy
nevada,
which
is
a
funding
source
and
it
lowered
the
eligibility
from
the
age
of
62
to
60,
and
it
was
a
bill
that
was
brought
forth
by
adsd
and
it
was
a
great
bill
and
it
also
combined
some
programs
and
now
it's
for
seniors
and
disabilities,
so
that
was
ab35.
C
Ab-76
was
an
enabling
piece
of
legislation
that
allowed
the
veterans
administration
to
investigate
and
operate
an
independent
adult
day
care
center.
You
heard
about
adult
care
center,
so
the
veterans
could
open
their
own,
which
is
really
great
because
they
have
a
separate
funding
source
and
it
wouldn't
cost
the
state
money
and
if
indeed
they
do
go
down
that
road
and
they
open
it
up.
Sometimes
there's
these
waiting
lists.
C
You
heard
about
so
veterans
who
needed
adult
daycare
could
possibly
get
those
services
without
going
on
a
waiting
list
and
it
would
actually
save
the
state
money
in
the
state
program.
So
it's
a
win-win
for
everybody,
so
that
was
a
great
bill
and
that
one
passed
ab177
is
what
I
call
the
rx
labeling
bill
and
it
allowed
for
you
to
put
a
language
on
your
prescription
pill
bottle
on
how
to
take
your
prescription
drug.
So
it's
not
the
name
of
the
drug.
C
It's
how
to
take
it
so
take
one
three
times
a
day
and
that's
really
important,
because
you've
heard
me
say
before
about
life-saving
prescription:
drugs,
don't
work!
If
you
can't
afford
them
life-saving
prescription,
drugs,
don't
work
if
you
don't
know
how
to
take
them.
So
that
was
a
great
piece
of
legislation.
Teresa
benitez
thompson
was
behind
that
one,
and
it's
really
going
to
be
helping.
C
I
don't
know
how
it's
being
used,
but
what
a
great
idea,
so
people
can
pick
up
their
pill
bottle
and
they
say
do
I
take
one
of
these
once
a
day
or
two
of
these
three
times
a
day.
They
can
read
it
in
their
own
language
and
that's
fabulous
ab190.
I
could
talk
about
all
day.
That
was
the
caregiver
sick
leave
bill.
Third
time
was
a
charm
we
got
it
passed,
I'm
so
pleased
about
that.
C
So
caregivers
who
are
who
are
still
employed,
and
if
you
remember
I
said,
60
percent
of
them
are
if
they
already
earn
and
receive
sick
leave,
sick
leave,
sick
pay
paid
or
on
page
they
can
use
a
portion
of
that
to
care
for
someone
else,
and
we
learned
just
how
important
that
was
during
the
pandemic,
that
people
were
taking
care
of
each
other,
so
ab190
passed
ab216
allowed
for
cognitive
assessments
and
care
planning
for
younger
people.
It
allowed
them
to
be
added
to
the
state
plan
services.
C
Before
you
had
to
wait
until
you
were
like
65
and
by
then
it
may
have
been
too
late.
So
if
we
could
do
these
cognitive
assessments
on
people
who
had
different
forms
of
cognitive
impairment,
it
would
really
help
them
get
the
assessment
they
needed
in
some
of
the
care
planning
which
could
really
help
improve
the
quality
of
their
lives.
As
they've
aged
ab217,
I
like
to
call
the
unlicensed
caregiver
training
bill
that
took
a
few
sessions
to
get
done
and
what
it
is
it
really.
C
We
finally
found
a
way
to
get
everybody
to
agree
on
it.
It
allows
the
board
of
health
to
establish
regulations
that
say
what
type
of
facilities,
because
we
all
know
that,
like
people
in
nursing
homes,
okay,
nursing
homes
that
get
medicare
funding
places
like
that
or
medicaid
funding,
there's
certain
training.
That's
required
it's
in
statute.
They
know
what
it
is,
but
a
lot
of
the
smaller
facilities,
whether
it
be
you
know,
I'm
not
I'm
going
to
say
the
group
homes
and
I
may
be
wrong
or
some
of
these
smaller
facilities.
C
There's
nothing
in
statute
on
what
kind
of
training
they
need
and
how
often
they
need
it.
I
always
used
to
like
to
say
we're
really
good
at
having
fingerprinting
and
background
checks,
but
not
a
lot
else.
So
you
want
to
know
if
you're
going
to
go
in
one
of
these
places
or
you're
going
to
put
your
mom
or
your
dad
there,
that
the
people
that
are
inside
those
doors
know
what
they
are
doing.
C
So
we
finally
got
this
one
done
and
the
board
of
health
will
make
regulations
on
the
type
of
facilities
so
who
it
applies
to
and
what
topics
and
what
training
they're
going
to
receive,
as
well
as
finding
internet
sources
for
free
or
low-cost
training.
So
it's
not
going
to
be
very,
very
expensive
to
make
sure
that
these
people
get
the
training
that
they
need
also
with
what
was
going
on
with
pandemic.
C
It's
also
about
infectious
infectious
disease
programs
that
these
facilities
needed
to
have
one,
because
a
lot
of
them
didn't
always
have
something
like
that
they
might
have
had
tb
control
stuff,
but
infectious
disease
things
like
cleaning
wiping
down
services.
All
of
a
sudden.
We
all
learned
a
lot
about
that,
and
then
there
was
some
oversight
with
that
as
well.
In
terms
of
how
they're
going
to
oversight
this
training
ab344
was
what
I
call
the
hospital
transition
bill
and
that's,
they
were
going
to
look
for
funding
and
I
think
adsd
is
moving
forward
with
this.
C
Ab430
is
why
we
are
all
here
today.
That
was
the
bill
that
changed
the
interim
structure
and
it
eliminated
a
lot
of
committees.
I
will
not
say
they
were
unnecessary
people
who
follow
those
committees.
Their
hearts
were
broken,
perhaps
because
they
didn't
they
didn't
stay.
But
this
committee,
since
we've
been
involved
with
that-
and
I
mentioned
that
these
issues
are
so
important.
C
A
lot
of
different
people
spoke
up
and
they
said
we
need
to
save
the
senior
committee
because
it
is
so
important
for
the
seniors,
the
vets
and
adults
with
special
needs,
and
this
one
was
saved.
This
one
was
was
one
of
the
at
the
very
end
it
got
pulled
out
of
the
fire
so
to
speak,
and
that's
why
we're
here
today
and
I'm
so
pleased
that
that
happened.
C
So
let's
go
on
these
are
the
health
one.
So,
let's
go
on
to
the
next
one,
which
is
sb5
and
sb5
was
the
telehealth
bill
and
what
it
really
basically
allowed
it
said.
Insurance
would
pay
for
audio
only
telehealth,
that's
really
important,
because
not
everybody
has
a
computer
with
a
camera
or
a
smartphone
with
a
camera.
C
They
also
had
something
in
there
to
create
a
dashboard
on
the
access
on
who
was
using,
who
was
using
telehealth,
and
we
urged
the
people
were
the
I
think
it
was
somewhere
in
hhs
and
and
that
dashboard
to
include
you
know
it
was
gender.
It
was,
it
was
gender,
it
was
race,
it
was.
Income
was
all
that
we
urge
them
to
also
collect
data
on
caregivers,
who
are
accessing
it
and
age.
Is
it
younger
people
who
are
looking
at
this
is
that
older
people
are
looking
at
it's
kind
of
nice
to
know.
C
C
C
C
It
allowed
the
state
to
get
for
to
look
for
grants
that
were
going
to
look
for
health
care
and
behavioral
health
outcomes.
They
send
reports
to
the
legislatures
on
the
efforts
to
reduce
disparities
in
health
care.
It
specifically
mentioned
kidney
disease
and
what
was
happening
in
kidney
disease
and
disparities
in
that,
and
it
also
looked
at
other
state
programs
and
looking
at
reducing
disparities
in
that
and
also
talks
about
training
for
state
employees
on
dealing
with
disparities
and
trying
to
get
equitable
health
care
outcomes.
Sb
380
is
the
rx
transparency
bill.
C
We
were
the
first
state
in
the
country
to
have
transparency
bill,
saying
that
I
believe
it
was
diabetes.
Drugs
had
to
it
was
diabetes,
drugs
or
it
was
asthma
drugs.
I
can't
remember
now
if
they
rose
over
a
certain
a
certain
threshold,
the
companies
had
to
report.
Why?
What
was
behind
the
cost
of
that?
Two
years
later
we
added
diabetes
or
asthma,
whichever
was
the
other
one,
but
you
know
that
just
wasn't
good
enough.
C
So
last
session
we
did
all
drugs
all
prescription
drugs
that
are
over
40
dollars
in
what
they
called
a
single
course
of
therapy.
So
they
really
looked
at
one
month
of
treatment,
so
that
was
a
controversial
exactly
what
that
is
over
forty
dollars
for
a
single
course
of
therapy
that
went
up
over
ten
percent
in
one
year
or
twenty
percent
in
two
years
they
had
to
provide
to
the
state
information
on
why
the
info
is
going
to
be
presented
at
a
public
hearing.
It
includes
now
manufacturers
hold
sales,
wholesalers
and
pbms.
C
Okay,
if
you
know
anything
about
the
prescription
drug
process
in
the
chain,
it
is
a
complex
one,
so
it
kind
of
includes
everybody
to
know
what's
happening
in
that
it
talks
a
little
bit
about
penalties
and
what
they're
used
for
before
the
penalties.
If
they
didn't
do,
it
were
only
used
for
education
about
diabetes
and
asthma.
Well,
now
we're
collecting
information
about
all
prescription
drugs,
so
they
can
use
that
information
for
more
sb
396
is
the
rx
purchasing
bill
that
allows
the
state
and
public
entities
to
enter
into
group
purchasing
things.
C
That
is
why
the
governor
announced
that
nevada
was
joining
the
northwest
drug
consortium,
which
is
this
fabulous
thing
which
oregon
and
washington
started,
and
we
are
joining
the
good
description
by
it.
It's
by
states
four
states,
it's
kind
of
changed
name.
It's
now
called
array,
health
care
and
every
prescription
drug
that
is
fda,
approved.
There's
no
formularies
if
you
enroll
once
the
state
enrolls
us
in
this
northwest
drug
consortium
array.
Health
is
anybody,
regardless
of
whether
you
have
insurance
or
not.
Can
enroll
in
that.
C
Well,
as
I
said,
all
fda
approved
drugs
are
there
and
there's
discounts
on
generic
drugs
and
non-generic
drugs,
and
if
you
have
insurance,
you
can
decide
if
your
insurance
is
cheaper
use
your
insurance.
If
your
insurance
is
more
money,
you
can
use
them
as
well
as
we've
all
seen.
Sometimes
sometimes
your
insurance
company-
they
make
you
pay
a
little
more
for
generics
and
they
make
you
pay
a
little
something
because
it
may
be
there.
So
that's
a
wake
great
way
to
get
some
lower-cost,
prescription
drugs
into
the
hands
of
people
and
that's
so
important.
C
Prescription
drugs
are
the
largest
driver
of
the
cost
of
healthcare
and
then
there's
sb,
420
and
sb.
420
was
certainly
talked
about
a
lot.
That's
the
public
option
bill
and
what
it
does
is
it
asks
the
state
to
design,
establish
and
operate
a
public
health
insurance
option
that
people
can
buy.
It
also
says
that
they
may
offer
it
to
small
businesses
and
that's
a
decision
they're
looking
at
and
so
they're
looking
to
reduce
costs
and
how
that's
going
to
happen.
C
It
has
to
reduce
costs
over
a
certain
threshold
of
five
percent
over
certain
things
and
then
15
percent
over
the
cost
of
the
first
four
years
that
it's
going
to
be
in
operation
right
now.
There's
requires
an
analysis
to
be
done.
There's
a
lot
of
input.
I've
been
following
those
meetings
and
learning
all
about
that
doesn't
start
for
several
years.
I
want
to
say
it's
2026,
something
like
that
before
it
would
be
operating
so
we'll
see
how
that
goes.
We
have
to
do
something
to
lower
the
cost
of
prescription
drugs.
C
Let's
see
420
also
talked
about
pregnant
women
and
doulas,
not
something
aarp
paid
a
lot
of
attention
to
that
part
of
the
bill,
even
though
we
are
50
plus.
So
there
are
probably
some
50
year
old
women
out
there
that
are
getting
pregnant
or
there
are
some
doulas
out
there
that
need
to
get
paid.
So
we
looked
at
that
and
the
other
thing
was
all
medicaid
managed
care
organizations.
C
The
contract
with
the
state
had
to
submit
a
good
faith
rfp
to
participate
in
that,
so
it
kind
of
guaranteed
people
would
at
least
want
to
play
that
we
were
contracted
with
then.
The
other
thing
in
terms
of
health
that
I'm
going
to
mention
that
passed
was
hcbs.
You
heard
a
lot
about
home
and
community
based
services
for
those
of
you
who
have.
I
didn't
list
that
on
the
thing
I
see
assembly,
macarthur,
you're,
looking
what
is
budget?
That's
not
on
there,
but
that's
really
important.
C
Those
of
you
who
have
heard
me
testify
before
you've
heard
me
talk
about
home
and
community
based
services,
and
I
heard
I
was
so
glad
to
hear
they
say
they
said
it's
half
the
price.
It's
actually
about
four
to
one
between
four
to
one
and
five
to
one.
People
can
be
taken
care
of
at
home,
as
opposed
to
being
in
a
nursing
home.
I
will
never
say
nursing
homes
are
not
necessary.
C
There
will
always
be
some
people
who
require
24-hour
skilled
care,
and
that
may
be
the
best
place
for
them,
but
it
is
better
easier
and
cheaper
for
a
lot
of
people.
I
love
to
talk
about.
When
I
talk
to
groups,
I
say
who
wants
to
go
in
a
nursing
home,
raise
your
hand
and
not
a
hand,
goes
up,
because
people
understand
they'd
much
rather
be
taken
care
of
at
home
with
the
independence
and
dignity,
which
is
where
they
want
to
be
so
this
past
session.
C
C
A
dream
come
true:
I
can
retire
now
you
did
it
okay,
that
was
so
great.
I
was
so
glad
to
hear
that,
and
they
also
funded
the
staff
to
implement
it,
so
the
waiver
slots
are
funded
by
slots,
they're
called
slots.
Okay,
that's
like
a
position,
but
I
always
like
to
say
slots
are
people,
so
you
understand
it's
a
person
to
do
that.
Well,
if
you
give
the
state
150
more
slots
and
they
don't
have
the
staff
to
actually
implement
it,
it
doesn't
work.
So,
thank
you
so
much
teresa
benitez-thompson.
C
C
C
It
talked
about
a
lot
of
those
things
and
it
talked
a
little
bit
about
signature
verification,
I'm
not
going
to
talk
about
that
controversial
subject,
but
it
did
discuss
that
a
little
bit.
So
that
was
the
election
bill
and
that
affects
older
adults
because,
as
we
all
know
who
votes
who
is
who
who
were
the
itinerant
voters,
older
adults
and
we
need
to
make
sure
they
have
the
opportunity
to
make
their
voice
heard
in
whatever
way,
they're
most
comfortable
doing
ab388
making
sure
is
the
broadband
bill,
and
what
this
one
did.
C
Is
it
created
a
voluntary
fund
to
make
grants
to
help
people
look
at
what
was
going
on
with
broadband?
It
also
required
a
report
to
be
done
on
where
underserved
areas
were
done.
So
that's
really
important,
but
I
have
better
news
to
talk
about
when
I
talk
about
some
federal
initiatives.
Sb
150
is
is
a,
I
want
to
say
a
cute
little
bill.
It's
the
tiny
house
bill.
C
If
you
remember
the
tiny
house
bill,
it
allowed
different
people
with
populations
in
cities
and
counties
to
change
their
zoning
to
allow
tiny
home
parks,
so
that
was
kind
of
a
nice
little
thing
that
happened.
We
all
know
about
affordable
housing.
Affordable
housing
is
a
big
issue
in
our
state.
So
this
is
a
new,
unique
form
of
affordable
housing,
so
that
was
kind
of
an
interesting
idea.
So
that's
the
tiny
house
bill.
Sb
284
is
affordable,
housing,
tax
credits,
how
you
obtain
them
and
how
to
use
them.
C
F
C
One
of
those
subjects
that
I
listened
to
her
in
the
hearing
and
she
talked
about
the
housing
tax
credits,
and
I
said,
oh,
I
understand
how
those
works
when
I
walked
out
of
the
room
it's
like.
Well,
what
did
she
talk
about?
It's
a
very
complex
thing:
we
need
people
who
understand
the
tax
credits
in
affordable
housing
because
something
has
to
be
done,
but
that
was
a
nice
bill.
Sb
311
is
rural
housing,
affordable
housing
and
it
allows
rural
housing
authorities
to
create
non-profits
to
own
and
operate
affordable
housing
for
low
and
moderate
income.
C
People
again
ask
julia
ratty.
She
can
tell
you
more
about
that
one.
So
what
are
some
of
the
things
that
didn't
happen?
What
are
some
of
the
no-gos
that
didn't
happen
in
terms
of
looking
at
older
adults?
One
of
them
you
heard
about
before
was
ab407
was
the
order
protection
for
vulnerable
adults.
Now
I
will
tell
you
that
was
this
committee's
bdr.
This
committee
submitted
that
bdr
and
it
didn't
make
it
well.
Why
didn't
it
make
it
because
it
got
released
very,
very
late.
C
It
got
released
very
late
kind
of
like
the
middle
of
may.
There
were
some
language
things
that
had
to
happen
with
it,
and
it
was
one
of
those
bills
that
involves
attorneys
and
lawyers.
Okay-
and
I
there's
some
some
attorneys
that
I'm
looking
at
right
now,
and
sometimes
it
takes
them
just
a
little
while
to
get
all
the
language
agreed
upon.
Okay
and
the
bill
came
out
so
late
that
there
wasn't
time
to
do
that.
I
know
they're
still
working
about
that.
C
I
will
tell
you:
there
are
28
states
that
have
something
very
similar
in
place
and
it's
really
important
to
have
something
like
that.
It's
specific
to
vulnerable
adults.
I
could
go
into
it
more,
but
I
don't
think
I
need
to.
I
can
tell
you
jennifer
richards,
who
I
believe
you
heard
from
earlier
today
is
still
working
on
this
bill.
C
I
spoke
to
her
yesterday
and
if
you
want
to
know
more
about
that
and
do
another
bdr
and
get
this
across
the
finish
line,
they
would
really
like
that
they
would
like
to
have
that
a
national
expert
from
justice
in
aging
said
this
type
of
order
is
a
critical
tool
for
restorative
justice.
So,
just
a
thought
just
a
thought
that
I'll
throw
out
there,
sb
56,
didn't
make
it.
That
was
a
telehealth
bill
for
audio
only
for
behavioral
health
saying
they
had
to
do
behavioral
health.
C
C
Sb
218
was
tenants
rights
and
it
had
a
whole
lot
of
stuff
in
it.
It
was
very
comprehensive
bill
and
sometimes
the
more
things
you
throw
in
it.
It
didn't
make
it
across
the
finish
line.
An
sb
200
is
one
of
my
favorites.
It's
work
and
save
work
and
save
is
a
plug-and-play
system.
It
is
for
employees
who
have
no
way
to
save
through
their
employer
and
what
it
is.
It's
an
auto
401
k
auto
for
auto
ira
program
that
costs
the
employer,
nothing,
they
don't
contribute,
they
just
offer
it
to
their
employees.
C
Who
can
say?
Yes,
I
want
to
do
it
or
no.
I
don't
want
to
do
it.
A
little
bit
of
money
comes
out
of
their
check.
It
is
not
matched
by
the
employer.
There
is
a
fiscal
agent
that
does
it
like.
I
say
it's
a
public-private
partnership
and
that
way
people
can
start
saving
for
retirement
so
when
they
retire,
they
have
means
instead
of
needs.
Several
states
have
passed
it
before
the
before
the
pandemic.
A
few
states
have
even
passed
it
during
the
pandemic.
C
There's
very
interesting
progre
in
oregon
who's,
the
first
one
who
said
that
you
can
join
their
program,
sometimes
there's
a
startup
cost
of
like
a
million
bucks
or
more,
and
that
can
states
go
oh
wait
a
minute,
but
if
you
can
join
another
program,
that's
another
way
to
look
at
that.
Just
another
thought
I'm
throwing
out
there,
so
those
are
some
of
the
things
that
didn't
make
it.
The
next
thing
I
want
to
talk
about
is
state
initiatives.
C
You
know
what
I
have
a
different
thing
here.
Let's
see
state
initiatives,
state
initiatives
are
things
that
are
happening
around
the
state
and
I
think
that
could
be
the
very
last
one
depending
on
which
one
I
sent
to
you.
I
had
two
versions
of
this,
but
there
is
one
that
says:
state
initiatives
could
be
one
of
the
last
ones.
C
Aarp
sent
letters
to
the
governor
talking
about
medicaid
redeterminations,
and
I
mentioned
that
to
a
couple
people
during
the
break
and
during
the
public
health
emergency
states
were
not
allowed
to
disenroll
people
for
medicaid,
and
that
was
important
because
there
was
so
much
going
on
people
needed
health
care.
So
after
the
public
health
emergency
is
over
they're
going
to
start
doing,
the
redeterminations
and
people
might
get
disenrolled,
their
income
might
be
too
high.
There's
a
lot
of
different
things.
There
were
some
exceptions
made
to
allow
people
to
enter
medicaid.
C
So
we
sent
a
letter
saying
we
need
to
make
sure
we
don't
disenroll
people
inappropriately.
Let's
say
they
move
during
the
and
we
don't
have
their
address.
Things
have
gone
on.
We
need
to
make
sure
that
not
everybody
who's
on
medicaid
is
that
good
at
answering
mail
and
looking
at
things
and
following,
I
don't
want
to
say
following
directions
but
doing
the
complex
steps
that
it
requires.
C
So
we
sent
a
letter
to
that
and
we've
been
working
with
medicaid
and
with
welfare
and
they're
doing
some
things
to
make
sure
that
they're
doing
outreach
to
make
sure
everyone's
addresses
how
they
can
do
automatic
referrals
using
information
from
other
programs.
Maybe
income
levels
things
like
that,
so
it's
not
such
an
onerous
process
to
get
involved
and
the
other
thing
that's
really
important.
If
people
are
being
disenrolled
because
their
income
is
too
high,
they
lost
their
job
during
the
pandemic,
so
they
were
eligible
for
medicaid
and
now
they
got
a
job
again.
C
So
they
don't
el
they're,
not
eligible
anymore,
but
they
may
not
have
insurance.
They
will
be
auto
referred
to
nevada
health
link
that
the
health
insurance
exchange.
So
then
they
can
buy
insurance
through
to
health
links.
So
that's
really
important.
So
I
was
really
glad
about
that.
We
sent
another
letter
to
the
governor
into
director
whitley
about
booster
shots
and
nursing
homes.
You
heard
about
covert
response
in
nursing
homes.
C
We
actually
did
better
than
most
states
in
terms
of
the
number
of
deaths,
some
states,
30
and
40
percent
of
the
deaths
in
the
state
were
in
nursing
homes.
Imagine
that
we
were
much
lower.
We
were
somewhere
between
different
times
during
the
pandemic.
Eight
percent
12
percent-
so
you
think
about
that.
That's
really
good
part
of
that
is.
We
have
so
few
nursing
homes
are
here
because
we
do
home
and
community
based
services.
So
that's
really
great.
C
So
we
sent
letters
because
the
booster
shots
we
did
kind
of
okay
in
terms
of
the
first
initial
vaccines,
but
in
terms
of
getting
booster
shots,
it's
pretty
appalling.
The
last
that
I
looked,
I
think
we
were
third
from
the
bottom
in
residents
that
had
regular
shots
and
booster
shots,
and
the
staff
was
doing
just
a
little
better.
So
we
really
need
to
find
a
way
to
reach
out
and
aarp
is
working
with
the
nevada,
vac
in
nevada,
vax,
equity
coalition
and
immunized
nevada
on
developing
some
messaging
to
reach
out
to
the
nursing
homes.
C
In
terms
of
how
do
we,
how
do
we
message?
How
do
we
get
boots
on
the
ground
to
give
these
people
shots
and
to
make
sure
that
the
booster
shots
get
done
as
well?
The
initial
shots
were
really
good,
but
we
need
to.
We
know
these
are
the
most
vulnerable,
these,
the
people,
if
they
get
it,
are
liable
to
have
the
worst
outcomes.
So
what
can
we
do,
and
how
can
we
do
that
and
who
do
we
reach?
So
the
nursing
home
residents
is
an
interesting
question.
C
Are
there
if
they
have
guardians,
then
the
guardians
or
the
decision
makers,
whether
they
get
a
shot?
Perhaps
if
the
staff
has
to
go
in
and
say
hey,
you
want
to
get
a
booster
shot
and
the
person
goes.
What
I
don't
know,
I
don't
like
shots,
that's
that
that
doesn't
work.
So
we
need
to
figure
out
a
way
to
do
that
and
they're
going
to
help
us.
Do
that
because
they've
done
messaging
that
works
and
they
also
know
how
to
get
boots
on
the
grounds
in
the
facility,
so
we're
really
pleased
about
that.
C
Some
of
the
state
initiatives
that
we
are
working
on
is
that
work
and
save
like
I
said
it's
going
on
in
several
states
both
last
year
and
this
year,
we'll
see
if
there's
sponsors
in
the
state
that
are
still
looking
to
look
at
that.
I
know
it's
taken
a
couple
of
sessions.
This
bill
usually
takes
a
few
sessions
to
get
it
across.
I
know
the
treasurer
is
very
interested
in
this.
Like
I
said
this
saves
the
state's
money
it'll.
It
enables
stable
retirements
for
people
in
the
future
hcbs.
C
I
already
talked
about
that
across
the
country,
we're
looking
at
protecting
funding,
doing
all
things,
some
rebalancing
making
sure
there's
more
people
at
home
than
in
nursing
homes,
where
it's
cheaper.
Looking
at
the
waiting
lists,
prescription
drugs
people
are
looking
at
prescription
drugs
rate
setting
boards,
whether
it
be
price
boards,
co-pays
price,
gouging,
there's
a
lot
of
different
things:
transportation,
importation,
there's
a
lot
of
things
states
are
doing
at
a
state
level.
Did
you
know
that
there
is
an
importation
bill
on
the
books
in
nevada?
C
I
don't
see
a
lot
of
head
shaking.
There
is
an
importation
bill
that
was
done
a
dozen
years
ago
or
more,
and
it
was
very
simple.
It
said
that
the
board
of
pharmacy
could
license
online
canadian
pharmacies
and
then
people
could
go
there
to
do
that.
What
a
unique
way
to
do
that
they,
I
think,
I
believe
they
three
pharmacies
applied,
but
they
never
advertised
it.
They
never
really
pushed
it,
and
so,
as
far
as
I
know,
it's
still
on
the
book,
but
other
states
are
doing
some
other
things
for
importation.
C
C
What
I'll
say
is
we
sent
a
letter
to
the
governor
about
broadband
and
the
arpa
funding,
and
I
mentioned
this
in
another
place
as
well,
but
the
governor
announced
he's
going
to
spend
500
million
dollars
in
our
funding
on
making
sure
broadband
is
accessible
to
people
all
over
the
state
and
that's
really
a
big
deal,
because
there
really
is
a
digital
divide
in
our
state
access
to
quality,
affordable
health
care.
You
have
heard
me
use
that
phrase
over
and
over
and
over
again
consumer
protection
things
payday
lending,
renters
fraud
utilities,
affordable
housing.
C
We
talked
about
including
accessory
dwelling
units.
I
know
there's
a
lot
of
talk
about
what
I'll
call
rent
stabilization
or
price
controls
on
rents.
That
is
something
that
typically,
is
not
a
statewide
idea.
There
are
some
people
that
have
talked
to
me
about
having
making
sure
there's
no
state
presumption
that
they're
going
to
stop
that
they're,
going
to
allow
municipalities
to
do
that.
So
I've
been
talking
to
people
about
that
and
that's
something
to
consider,
because
we
have
to
figure
out
something.
The
last
thing
somebody
had
their
rent
raised,
like
6
000,
something
just
outstanding.
C
That's
that's
an
indication;
they
want
you
to
move,
but
you
know
people
shouldn't
have
that
happen
to
them.
So
all
those
things
on
here,
a
lot
of
things
here
are
basically
what
you
see
me
come
to
the
table
for
a
lot
of
the
things
we
do
so
that's
what's
happening.
I
will
also
mention
one
other
things
and
that
has
to
do
with
nursing
homes
and
that's
the
nurse's
compact.
As
we
have
trouble,
we
didn't
even
get
hearing
last
time.
Several
of
us
at
the
bordering
states
have
the
nurses
compact.
C
We
talked
about
the
doctor
shortage.
We
also
have
a
terrible
nursing
shortage.
You've
heard
about
how
umc
nurses
had
forced
mandatory
overtime
and
they
weren't
happy
about
that.
So
what
we
can
do
about
that,
at
least
to
give
it
a
hearing
and
people
talk
about
the
nurses,
compact
nurses,
who
may
want
to
work
here,
and
these
aren't
licensed
trained
nurses
and
what
we
could
do
about
that
federal.
Let's
talk
about
federal
stuff
right
now,.
C
There's
a
lot
of
state
and
local
funding
that
went
from
the
american
rescue
plan
act.
There's
a
lot
of
different
things:
the
aca
marketplace,
exchanges
like
hemp
like
like,
like
nevada
health
link,
they
had
expanded
eligibilities
to
get
subsidies.
The
the
premiums
were
limited
to
eight
point
five
percent
of
income,
so
they
really
helped
people
to
provide
insurance,
and
that
was
important.
C
Medicaid
was
really
important
because
they
they
increased
the
f
map,
which
is
the
federal
matching
program
for
the
states
they
increased
it
for
if
people
would
do
certain
things
for
hcbs,
so
they
submitted
a
spending
plan
and
everything
in
the
spending
plan
got
approved
by
the
state.
Okay,
but
they're,
taking
it
to
ifc
a
little
bit
slowly
so
they're,
taking
it
to
ifc
a
little
slowly.
C
And
there's
and
there's
things
that
are
coming
that
are
going
to
take
some
time
they
already
had.
The
provider
cuts
were
restored
where
you
have
to
cut
the
provider
rates
during
the
special
session.
They
restored
those
provider
rates,
so
they
were
made
whole,
so
they
can
stay
in
business.
They
did
things
on
workforce
where
they
did
a
one-time,
500
payment
and
we
were
not
clearly
the
only
state
that
did
that,
so
people
would
stay
in
their
jobs.
Those
personal
care
workers
would
stay
in
their
wars.
More
of
those
are
going
to
come.
C
C
Like
I
said,
I
had
two
versions
of
that,
so
there's
a
stout
state
state
and
local
funding
the
marketplace
exchanging
the
medicaid,
the
increase
f
map,
medicaid
expansion,
the
american
rescue
plan
had
expansion
involved.
We
are
a
medicaid
expansion
state,
so
that
didn't
apply
to
us,
but
it
really
encouraged
states
to
do
that.
To
get
me
poor
insurance.
C
In
that
american
rescue
plan,
there
was
pension
plan
relief
which
really
helped
multi-employer
pension
plans,
something
called
the
butch
lewis
emergency
pension
plan
relief
act
has
provided
94
billion
dollars
and
save
pensions
for
about
three
billion
people.
Again,
don't
ask
me
questions
about
that.
If
you
want
no
more
information,
I'd
be
glad
to
talk
to
my
national
office
they're,
the
ones
who
sent
me
some
of
this
national
information
because
they
track
a
lot
of
that.
The
other
thing
that
came
from
the
arpa
funds
were
the
emergency
rental
and
homeowner
assistance.
C
C
C
The
governor
announced
he's
going
to
spend
500
million
dollars
on
infrastructure
and
more
to
make
sure
people
did
that
when
digital
equity
and
training,
so
that's
really
important
and
then
there's
a
permanent
subsidy
program
that
was
created
called
the
affordable
connectivity
program.
It
used
to
be
the
bbb
and
I
don't
remember
what
the
bbb
stands
for,
but
now
it's
the
acp,
it's
the
affordable
connectivity
program
gives
you
a
thirty
dollar
a
month
discount.
Seventy
five
dollars
tribal.
There's
a
hundred
dollar
discount
on
a
device.
There
is
criteria
for
that
income
and
others.
C
So
a
lot
of
the
things
that
happened
federally
were
were
funding
things
during
the
pandemic.
The
buildback
better
act,
which
is
so
far
stalled
right
now
isn't
going
anywhere,
and
we
don't
know
when
it's
going
to
come
up
had
some
great
things
for
prescription
drugs,
so
prescription
drug
costs
included
things
like
medicare
negotiation,
thirty,
five
dollar
insulin
copay,
which
is
a
life
changer
for
people
on
insulin
and
two
thousand
dollar
out
of
pocket
for
part
d
drugs
out
of
pocket
cap.
C
There
also
was
a
hearing
benefit
for
the
first.
That's
another
dream
come
true
for
barry
you're,
going
to
have
a
hearing
benefit
in
medicare
wow.
What
a
deal
that
is
well,
the
buildback
better
act
is
is
stalled
right
now
we
don't
know
what's
going
to
happen
to
it.
Sick
leave
was
originally
also
in
there
and
that's
that
we're
going
to
have
some
paid
sick
leave
for
people
that
was
very
controversial.
There's
a
few
people
who
I
will
not
mention
who
said
that
was
a
sticking
point.
C
No,
no,
no
we'll
see
what
happens
whether
that
stays
or
not
nursing,
home
staffing
was
in
there
and
that's
something
else.
I
wanted
to
mention
in
terms
of
federal
or
state
initiatives
to
look
at
besides
the
nursing
compact.
One
of
them
was
something
as
simple
as
the
staffing
and
making
sure
there
was
a
registered
nurse
on
staff
at
all
times.
Sometimes
they
have
rn.
C
Sometimes
they
have
lpns,
so
that
makes
sure
that
there's
an
rn
on
staff
at
all
times
and
perhaps
looking
at
staffing
ratios,
because
we
had
some
trouble
with
nursing
homes
being
short
staffed.
You
have
to
be
very
careful
with
staffing
ratios,
because
when
you
have
a
staffing
ratio,
sometimes
that
becomes
the
ceiling
and
not
the
floor.
So
that's
just
always
something
to
look
at
and
that's
something
why
you
need
to
make
sure
that
it's
sufficient
and
housing
is
something
that
was
also
included
in
the
buildback
better
act.
But
right
now
that's
stalled.
C
I
did
the
state
initiatives
early,
so
the
other
things
that
happened.
Federally
were
stimulus.
Payments
aarp
was
very
involved
in
the
last
round
of
stimulus
patients
for
fourteen
hundred
dollars
and
we
wanted
to
make
sure
that
dependents
also
got
the
fourteen
hundred
dollars,
including
adult
dependents.
They
were
not
included
more
also
to
make
sure
the
people
on
social
security,
ssi
and
ssdi
and
veterans
were
eligible
for
that.
C
Another
bill
that
we
wanted
in
the
build
back
better
act,
but
it's
also
moving
separately
is
something
called
credit
for
caring
caregivers
spend
an
average
of
24
of
their
income.
Take
caring
for
other
people.
They
know
this
is
a
five
thousand
dollar
federal
tax
credit
for
caregiving
there's
eligibility
requirements,
and
you
have
to
do
certain
things,
but
it's
a
way
for
caregivers
who
are
like,
I
said,
spend
24
percent
of
their
income.
People
of
color
spend
more
than
that
they
spend
up
to
30
35
percent
of
their
income.
C
Aarp
is
still
working
on
that
we're
still
seeing
if
we
can
get
that
across
the
finish
line.
There
are
many
states
that
are
working
on
that
state
by
state
by
state.
We
do
not
have
state
income
tax,
so
we
are
not
going
to
work
on
that
here.
So
we're
glad
about
that.
The
other
thing
that
happened
federally
was
the
fraud
and
scam
reduction
act
that
allows
the
ftc
to
do
more
for
response
and
prevention
that
also
passed
recently,
and
that's
a
great
great
thing
right.
There
that's
going
to
help
people.
C
And
that's
it
and
all
that
I'll
say.
If
I
have
any
questions,
please
ask
me
questions
and
again
thank
you
for
inviting
aarp
to
participate
in
this
process.
We
look
forward
to
working
with
the
committee
I'd
like
to
thank
lcb
for
everything
that
they
do.
They
make
this
process
so
much
easier
for
everyone
and
what
I
forgot
to
mention
in
the
beginning
is
you
heard
a
presentation
from
adsd
about
their
covert
response?
C
I
would
like
to
thank
them
and
I'd
like
to
thank
dina
schmidt
individually
as
the
director
of
adsd,
for
what
they
did
to
make
sure
services
were
there.
They
put
together
that
program
called
nevada
care.
Nevada
can
can,
and
it
was
this
fabulous
program
that
put
providers
and
community
providers
and
advocates
and
people
together
to
make
sure
we
were
getting
out
there
to
make
sure
the
people
that
needed
help
got
help.
So
thank
you
very
much
on
behalf
of
the
345
000.
E
Thank
you
so
much
for
the
presentation
I
almost
feel
like.
I
should
stand
up
and
clap
don't
do
that.
Well.
Thank
you.
I
really
appreciate
this
presentation.
It
was
a
really
great
overview
committee.
Any
questions.
C
C
F
Thank
you
and
thank
you,
mr
gold.
I
really
appreciate
your
thoroughness
and
I
echo
your
your
gratitude
regarding
how
adsd
has
has
helped
out
during
the
pandemic
couple
of
things.
Just
a
couple
comments.
I
know
there
there
was
a
little
bit
of
consternation
and,
for
some
reason,
some
controversy
about
the
maryland
voting.
F
But
I
want
to
say
thank
you
for
working
with
some
of
the
veteran
veterans
organizations
to
make
sure
that
we
were
able
to
get
that
done,
because
I've
heard
from
veterans
and
veterans
who
are
in
that
category
of
seniors
as
well,
for
whom,
knowing
that
they
will
have
that
as
a
a
permanent
option.
At
least
right
now
has
been
very
gratifying
to
them.
So
veterans
and
I've
also
heard
from
had
an
opportunity
to
talk
to
a
gold
star
widow.
F
Last
saturday,
talking
about
the
melon
voting
option,
so
thank
you.
The
hearing
aids.
I,
ironically
enough,
I
just
got
a
text
the
other
day
from
someone
trying
to
figure
out
how
they
might
be
able
to
pay
for
hearing
aids.
So
my
challenge
is
going
to
be.
Will
you
please
ask
the
national
aarp
office
to
stay
on
top
of
that
build
better
plan?
F
I
have
no
idea
why
hearing
aids
is
controversial
to
people,
especially
when
we
have
medical
evidence
that
shows
that
hearing
loss
when
not
dealt
with
also
advances
dementia
and
alzheimer's
and
some
other
cognitive
issues
in
older
people.
F
Last
but
not
least
I'll
I'll
say
this,
we
have
in
2019
we
passed
pay
equity
here
in
nevada,
and
I'm
just
going
to
ask
if
you
all
can
get
with
nerc
nevada,
equal
rights
commission
and
see
how
that
might
be
faring,
because
one
of
the
things
that
was
a
motivator
for
me
in
carrying
the
bill
is
the
fact
that
you
have
more
women
who
retire
in
poverty
than
you
do
men
and
most
of
the
time
at
least
more
than
70
of
the
time
it's
because
they've
not
been
paid
equitably.
F
So
I
think
that
that
pay
equity,
especially
where
we
are
now
with
respect
to
housing,
insecurity,
food
insecurity
and,
and
that
sort
of
thing
I
just
want
to
make
sure
that
we're
doing
everything
that
we
can
do
to
monitor,
to
make
sure
that
the
good
actors
are
are
being
thanked
and
the
bad
act,
bad
actors,
if
you
will
are
being
put
on
notice,
that
about
the
pay
equity.
So
thanks
a
lot.
F
The
voting
piece
helped
a
lot
of
seniors
and
also
and
helped
veterans
who
were
in
that
position
and
helped
some
of
our
gold
star
widows.
That's
women,
who've
lost
spouses
who
have
lost
their
partner
while
on
active
duty
or
as
an
act
of
war.
So
thank
you
hearing
aids.
We
got
to
get
this
done,
though,
because
there
are
too
many
people
who
need
the
hearing.
F
Aids
and
a
cheap
pair,
as
I
understand,
or
any
inexpensive
period
costs
something
like
three
thousand
dollars
and
talked
to
someone
yesterday,
who
was
quoted
a
price
for
about
eight
thousand
dollars
and
that's
probably
more
than
eight
months
of
social
security,
payment
or
income
that
most
people
who
rely
on
social
security
for
their
financial
livelihood.
So
thank
you
continue,
madam
chair.
C
Madam
chair
to
you
and
through
you
to
senator
spearman,
thank
you
for
bringing
up
hearing
aids,
something
I
forgot
to
mention,
which
I
do
more
than
often
than
I
want
to
admit,
is
aarp
also
worked
with
the
fda
who's
coming
up
with
a
regulation
for
over
the
counter
hearing
aids.
I
don't
know
exactly
how
much
they're
going
to
be,
but
they
will
be
much
much
less
pricey,
because
you're
right,
they're,
very,
very
pricey.
C
I
don't
want
to
admit-
and
I
don't
want
to
pull
my
hair
back
and
let
you
see
what's
sitting
behind
my
ear
right
now,
but,
yes,
they
are
very
expensive.
So
having
the
over-the-counter
kind,
which
I
don't
know
how
they
compare,
but
it's
something
that
people
can
can
access
that
would
be
cheaper.
We
were
instrumental
in
pushing
that
because
something
needs
to
be
done
and
we're
not
giving
up
on
the
buildback
better
act.
C
E
L
L
I've
been
listening
in
all
day
to
your
hearing,
and
so
I
want
to
thank
you
all
for
your
continued
attention.
I
know
you
have
been
inundated
with
all
kinds
of
information,
a
lot
of
really
good
presentations
throughout
the
day,
with
lots
of
facts
and
figures
and
information
on
bills
and
all
kinds
of
different
things.
So
what
what
I
want
to
do
today
is
talk
a
little
bit
more
conceptually
and
first,
I'm
going
to
share
my
views
on
different
dimensions
of
quality
of
life
and
well-being.
L
So
we're
all
kind
of
on
the
same
page
with
what
that
means.
I
also
want
to
talk
about
some
of
the
key
resource
needs
for
supporting
quality
of
life
and
well-being
and
how
we
can
do
that
really
through
the
aging
services
and
healthcare
continuum,
and
then
also
I'm
going
to
describe
some
of
the
key
initiatives
at
the
sanford
center
for
supporting
quality
of
life
to
get
started.
I
think
I
probably
don't
need
to
go
into
a
lot
of
details
on
population
need.
There
were
wonderful
presentations
earlier
from
our
colleagues
at
the
state
agencies.
L
Talking
about
the
demographics
within
our
state,
particularly
the
elders
count
outlining
kind
of
what
a
lot
of
the
different
health
needs
are.
I
would
just
say
that
we
do
live
in
a
very
rapidly
aging
state.
Our
population
is
getting
older
and,
along
with
the
aging
process,
comes
some
key
health
concerns
and
those
include
comorbid,
chronic
diseases,
dementia
and
alzheimer's
disease.
L
L
But
what
I
will
say
is
that
when
I
think
of
quality
of
life
as
a
professor
of
public
health
and
someone
who
works
in
a
school
of
medicine,
I'm
thinking
about
health-related
quality
of
life
and
really
for
me,
that's
about
the
outcome
of
health
conditions
and
our
ability
to
live
one's
life
as
they
choose
and
to
live
where
they
choose.
So
do
you
have
the
ability?
L
So
when
I
think
about
quality
of
life
and
health
related
quality
life,
I'm
thinking
about
physical
health
or
the
different
diseases,
disease
states
that
may
compromise
our
physical
abilities
and
activities
of
daily
living.
I'm
thinking
about
emotional
and
mental
health,
which,
certainly,
when
you
think
about
mental
behavioral
health,
there's
a
big
concern
there
for
elders.
L
I'm
thinking
about
cognitive
health
and
I
draw
a
distinction
between
cognitive
health
or
the
functioning
of
the
brain,
such
as
which
can
be
compromised
by
conditions
such
as
alzheimer's
disease
or
dementia,
and
then
emotional
or
mental
health,
which
are
different
psychiatric
conditions
that
can
compromise
that
I'm
also
looking
at
social
health.
Do
we
have
a
network
of
people
to
whom
we
can
seek
support
and
receive
that
support?
Of
course,
financial
health
is
an
important
element
of
our
overall
quality
of
life,
as
is
environmental
health
and
the
conditions
in
which
we
live.
L
Many
people
also
talk
about
spiritual
health
and
having
a
sense
of
connectedness
and
meaning
and
purpose.
So
for
me,
when
I
think
of
quality
of
life,
it's
really
those
dimensions.
Physical,
health,
immense
emotional,
health,
cognitive,
health,
social,
health,
financial,
health,
environmental,
health
and
spiritual
health,
and
all
of
those
dimensions
need
to
be
present
to
a
certain
degree
to
enable
people
to
be
able
to
choose
how
they're
going
to
live
and
where
they're
going
to
live.
L
Those
dimensions
really
are
the
elements
that
get
compromised
when
someone
develops
a
chronic
disease
or
develops
dementia
develops,
frailty
and-
and
so
those
are,
the
kinds
of
things
that
you
were
implementing
supports
and
services
to
enable
people
to
maintain
their
independence
and
their
quality
of
life
across
those
different
dimensions.
L
However,
I
draw
a
distinction
between
quality
of
life
and
well-being,
and
I
do
this
for
a
very
specific
reason.
When
I
think
of
well-being,
I
think
about
the
dimensions
of
ourselves
or
the
dimensions
of
a
person
that
really
transcend
those
health
related
conditions
that
can
compromise
our
well-being.
L
And
what
I
mean
by
that
is
I'm
talking
about
well-being,
and
this
is
a
model
that
was
developed
by
a
group
called
the
eden
alternative
international,
but
they
describe
well-being
as
being
identity
or
having
a
sense
of
personhood
and
being
known
to
others,
an
opportunity
for
growth
and
continued
learning
and
development,
autonomy
or
self-determination,
the
ability
to
make
decisions
for
yourself,
security
feeling
safe
and
that
you
have
an
environment
in
which
you're
comfortable
connectedness,
with
others
having
opportunities
to
connect
with
other
people
who
bring
meaning
into
your
life,
meaning
and
purpose,
and
also
joy,
and
I
contend-
and
I
believe
that
these
domains
of
well-being
can
be
supported
at
a
high
level.
L
Despite
the
aging
related
changes
that
come
along
with
chronic
diseases
and
dementia.
Despite
physical
and
cognitive
limitations,
we
can
still
support
well-being
such
that
people
have
a
sense
of
identity,
growth,
autonomy,
security,
connectedness,
meaning
and
joy,
and
so
when
I
think
about
how
we
develop
programs
and
deliver
services
to
older
adults.
I
certainly
am
thinking
about
those
elements
of
quality
of
life
and
health
related
quality
of
life
that
I
mentioned
before,
supporting
physical
health,
supporting
cognitive
health.
L
But
I'm
also
thinking
about
how
we
can
transcend
the
challenges
that
come
along
with
physical
and
cognitive
limitations
and
help
to
support
overall
well-being,
and
so
the
question
I
ask
then,
is:
how
can
we
support
nevada's
elders?
How
can
we
meet
these
basic
human
needs
by
creating
conditions
that
really
do
support
quality
of
life
and
well-being?
And
the
answer
I
keep
coming
back
to
is
that
we
need
a
well-integrated,
well-resourced,
continuum
of
supports
and
services
that
are
built
around
the
needs
of
the
person.
L
So
what
do
those
needs?
Look
like.
I
think
that,
ultimately,
at
in
the
current
time
in
my
interpretation,
a
lot
of
this
comes
down
to
workforce
right
and
there's
the
first
element
of
the
workforce
in
terms
of
ensuring
that
all
of
the
elements
of
the
continuum
of
services
that
are
needed
to
provide
support
are
present.
Without
those
services
present,
people
are
not
able
to
access
the
support
that
they
need,
but
it's
not
just
having
the
services
accessible.
L
It's
also
ensuring
that
the
workforce
has
the
knowledge
and
the
skills
that
they
need
to
deliver
these
services
effectively
and
that
they
have
an
understanding
of
all
of
the
other
services
that
exist
so
that
there's
integration
across
all
of
these
different
elements.
So
we
need
to
train
our
existing
and
our
future
workforce
to
understand
the
needs
of
elders
and
to
understand
the
service
delivery
strategies
that
are
going
to
use
person-centered
approaches
to
enable
people
to
have
high
quality
life
and
well-being.
L
We
not
only
need
the
people
or
the
professionals
the
workforce
that
works
there,
but
we
need
people
with
the
right
knowledge
and
the
right
skills,
and
that
can
only
come
not
only
through
offering
programs
and
services,
but
by
training.
The
people
who
deliver
those
programs
and
services
to
be
effective
aging
is
a
whole
life
experience.
L
You
all
know
that
each
one
of
you
is
aging
I'm
delighted
to
share
that
tomorrow.
If
you
are
fortunate
enough
to
make
it
through
the
night,
you
will
wake
up
a
day
older
and
you
will
continue
aging
for
the
rest
of
your
natural
life,
and
so
our
goal
here
is
not
to
extend
life
indefinitely,
but
to
promote
quality
of
life
and
well-being
in
a
way
that
enables
people
to
live
well
and
aging
is
a
whole
life
experience.
L
So
there
are
both
needs
and
resources
that
are
needed
to
meet
those
needs
across
the
entire
lifespan
and
in
all
of
the
dimensions
of
the
human
experience.
So
there
are
lots.
I've
talked
a
couple
times
about
the
continuum
of
services.
There
are
lots
of
different
elements
to
this.
You
heard
a
lot
about
these
earlier
from
the
presentations
from
adsd,
but
I
just
want
to
briefly
touch
on
a
couple
of
the
ones
that
I
see
as
the
key
elements
of
this
continuum
of
services.
L
L
The
other
bucket
that
I
moved
to
that's
still
in
those
home
and
community-based
services
are
home-based
care
options
and
opportunities.
This
includes
home
health,
home
care,
homemaker
services,
and
I
just
want
to
draw
a
distinction
because
there
is
often
confusion
between
home
care
and
home
health.
So
when
I
refer
to
home
care,
I'm
talking
about
in-home
personal
aids
that
support
people
in
their
activities
of
daily
living
right,
so
in-home
care
that
support
people
with
their
everyday
life.
L
So
that
includes
independent
living
group
homes,
assisted
living
skilled
nursing
homes.
These
are
places
where
people
live
and
hopefully
are
living
in
the
least
restrictive
environment
possible
for
them
to
receive
the
support
that
they
need
to
live
well
and
the
services
they
need
to
engage
in
their
activities
of
daily
living.
L
That
is
aligned
with
their
own
individualized
needs,
and
that's
where
this
idea
of
person-centered
or
patient-centered
approaches
to
care
really
come
into
play
is
that
we
want
to
get
to
know
everything
there
is
to
know
about
a
person
and
match
the
level
of
support
that
they're
receiving
to
their
level
of
need,
as
well
as
their
strengths
and
what
they're
capable
of
doing
so.
We
can
maximize
their
independence.
L
You
know
people
become
very
myopic.
Professionals
become
very
myopic
and
very
specialized
in
the
work
that
they
do
and
they
sometimes
aren't
as
familiar
with
the
other
resources
and
opportunities
that
are
being
provided
by
others.
That
could
benefit
the
work
that
they're
doing
themselves.
So
you
know
you
think
about
just
as
an
example,
a
diabetes
self-management
program,
which
would
be
a
hell
of
community-based
health
and
wellness
program
to
give
people
living
with
diabetes
training
they
need
to
manage
their
own
conditions.
So
it's
education,
it's
self-efficacy
and
skills
and
knowledge.
L
Well,
if
there's
a
physician
who's
working
with
a
patient
who
has
diabetes
and
they're
only
looking
at
the
medical
management
side
of
that
and
aren't
aware
of
the
opportunity
for
their
patient
to
enroll
in
a
self-management
program
to
learn
skills
for
themselves,
then
that's
a
missed
opportunity.
So
it's
really
about
connecting
those
dots
so
we're
taking
advantage
of
all
of
the
resources
really
from
a
person-centered
perspective.
L
And
that
goes
across
that
entire
continuum
of
services
and
supports.
So
now
I'm
going
to
shift
gears.
I've
talked
about
what
I
see
as
the
critical
needs
for
elders
and
that
larger
system
of
support,
but
I
was
also
asked
to
share
a
bit
about
the
initiatives
at
the
stanford
center
for
aging
and
the
kinds
of
things
that
we
contribute
to
this
system
of
support.
So
I
want
to
share
a
bit
about
that.
L
First,
though,
I
want
to
talk
about
coke
you've
heard
several
times
about
an
initiative
here
in
nevada,
called
nevada
can,
or
the
nevada
kind
of
19
aging
network,
rapid
response
that
was
led
by
the
nevada,
aging
disability
services
division
under
the
leadership
of
dina
schmidt,
and
I
was
privileged
to
have
the
opportunity
to
work
with
administrator
schmidt
in
developing
and
delivering
nevada
can
ultimately,
over
that
year
and
a
half
I
mean
this
was
a
program
it
was
so
rapidly
developed.
L
I
just
want
to
say
I
think
it's
been
mentioned
before,
but
it
was
really
understated
what
it
was
described
before
this
was
a
rapidly
developed
innovation
here
in
nevada
that
gained
national
attention
and
was
launched.
So
I
know
for
me:
I
I
got
my
stay-at-home
order
from
the
university
on
march
17th.
L
What
was
that
st
patrick's
day?
I
guess
2020.
we
were
told,
go
home,
don't
come
back
and
within
two
weeks
a
planning
period
had
taken
place
and
the
state
of
nevada
launched
nevada
can
its
website
went,
live
on
april,
1st
2020
after
a
two-week
planning
period,
and
it
created
a
triage
system
for
mobilizing
community-based
aging
services.
L
Organizations
in
ensuring
that
elders
across
the
state
could
stay
home
and
stay
connected
to
the
food
that
they
needed,
the
health
care
they
needed
and
the
social
support
that
they
needed
and
from
april
1st
2020
to
the
end
of
2021.
During
that
roughly
18
to
20
month
period,
there
was
a
tremendous
amount
of
support
provided
to
older
adults.
There
were
pop-up
food
delivery
groups
that
came
together.
The
primary
one
was
called
delivering
with
dignity,
but
the
food
and
medication
delivery
arm
of
nevada
can
delivered
close
to
600
000
meals
to
older
adults.
L
During
that
18-month
period
I
was
privileged
to
lead
the
telehealth
action
team.
As
part
of
that,
we
delivered
over
20
000
telehealth
visits
to
older
nevadans
through
the
partners
that
were
a
part
of
that
telehealth
group.
There
was
an
innovation
called
the
nest,
collaborative
or
nevada
ensures
support
together,
which
offered
virtual
social
support.
They
delivered
over
5
000
hours
of
virtual
social
support
to
elder
nevadans,
and
this
initiative
was
developed
so
quickly.
L
Nevada
can
and
was
so
innovative
that
we
were
invited
to
present
on
it
or
to
testify,
rather
about
this
initiative
to
the
u.s
senate
special
committee
on
aging
and
that
took
place
in
june
of
2020,
and
I
had
the
honor
of
offering
that
testimony
to
the
u.s
senate
special
committee
on
aging
about
nevada
can-
and
I
feel
like
it's
something
that
you
need
to
be
aware
of,
and
really
should
be
very
proud
of.
L
That
nevada
through
its
work
in
supporting
elders
during
kobud,
was
nationally
recognized
as
a
leader
in
innovation
and
in
rapid
action,
and
that's
because
of
nevada
can
so.
I
just
want
to
mention
that
now
in
terms
of
the
sanford
center
for
aging
and
by
the
way,
I'm
not
taking
credit
for
nevada
can
at
the
sanford
center.
L
For
aging,
it
was
very
much
a
statewide
collaborative
activity
led
by
adsd
and
and
including
dozens
and
dozens
of
organizations
and
partners,
but
in
the
nevada
or
excuse
me
in
the
sanford
center
for
aging,
we
have
a
wide
range
of
direct
services
that
we
offer.
We
have
the
sanford
geriatric
specialty
care
center.
This
is
a
clinic
where
we
have
a
interdisciplinary,
comprehensive
geriatrics
assessment
for
older
adults
is
part
of
university
health,
which
is
now
part
of
renowned
health.
L
As
of
this
last
october,
and
so
we
see
patients
really
with
multiple
chronic
conditions,
dementia
and
frailty.
We
get
to
know
everything
there
is
to
know
about
them
and
we
provide
a
care
plan
that
goes
back
to
their
primary
care
provider,
for
them
to
implement
in
recommendations
and
supporting
people.
L
L
These
are
supported
by
u.s
administration
for
community
living,
as
well
as
the
nevada
division
of
public
and
behavioral
health,
and
through
these
we
offer
health
education
for
older
adults,
on
specific
conditions
and
for
specific
opportunities
that
includes
diabetes,
self-management,
diabetes,
prevention,
fall
prevention,
chronic
pain,
self-management,
strength
and
conditioning
programs.
So
a
wide
range
of
different
health
education
opportunities
to
support
quality
of
life
for
elders.
L
We
also
offer
direct
in-home
support
through
a
program
called
senior
outreach
services
that
is
funded
again
by
the
nevada,
aging
disability
services
division.
This
offers
one
on
one
in-home,
companionship
and
social
support
for
low-income
homebound
elders
in
washoe
county.
We
also
offer
transportation
services
with
support
from
adsd
and
also
medication
therapy
management
services
with
support
both
from
adsd
as
well
as
dpbh
our
medication
therapy
management
is
worth
calling
out
because
it's
a
really
innovative
program
through
which
we
have
a
certified
geriatrics
pharmacist.
L
That
does
comprehensive
reviews
of
the
medications
that
someone
is
taking
and
looks
for
negative
interactions
between
those
I
mentioned
earlier,
the
importance
of
understanding
polypharmacy
among
older
adults.
You
know
lots
of
times.
People
will
have
multiple
healthcare
providers
who
are
prescribing
different
prescriptions
or
different
medications
without
coordinating
with
each
other,
and
these
can
cascade
and
they
interact
and
create
all
kinds
of
problems.
I
there's
one
story
that
I
always
share.
L
Those
are
the
direct
services
that
I
want
to
mention
at
this
time.
I
also
want
to
mention
the
training
that
we
do,
and
this
is
really
important.
I
said
that
the
way
we're
going
to
ensure
that
we
have
a
well-integrated
well-connected
system
of
support,
that,
inter
intersects
between
the
aging
services
world
and
the
clinical
world,
is
through
training,
and
we
have
a
variety
of
different
training
initiatives
that
we
offer.
L
We
have
one
at
unr
at
the
sanford
center
for
aging,
but
there
is
also
a
wep
or
geriatrics
workforce
enhancement
program
grant
at
the
geriatrics
group,
at
unlb
school
of
medicine
and
between
these
two.
These
are
five-year
awards
that
we
both
received
between
these
two
hersa
is
funding
about
1.5
million
in
geriatrics
training
each
year
for
five
years
in
the
state
of
nevada,
and
it's
highly
unusual
that
any
state
will
receive
two
of
these
awards.
L
In
fact,
when
we
applied
the
rfp
from
this
federal
agency
said
they
would
only
fund
one
in
each
state,
but
somehow
the
the
good
proposal
writing
out
of
unlv
and
unr.
We
were
able
to
bring
two
of
these
into
the
state
of
nevada,
and
so
I
encourage
you
to
check
out
the
good
work
that's
happening
at
unlv,
as
well
as
what
we're
doing
at
unr.
L
What
these
programs
do
is
that
they're,
providing
training
to
primary
care
providers
on
how
to
offer
what
they
call
age-friendly
health
systems
or
using
a
framework
called
the
four
m's
in
their
clinical
work.
The
four
m's
stand
for
what
matters
to
the
patient:
mobility,
mentation
or
dementia,
and
depression
and
medications.
So,
as
I
said
earlier,
these
are
the
critical
things
that
we
need
to
be
thinking
about,
frailty
medications,
dementia
and
then
really
making
sure
that
it's
being
driven
by
the
patient.
It's
what
matters
to
the
patient
that
is
front
and
center
within
this.
L
So
we're
teaching
primary
care
providers
about
these
four
m's
of
providing
good
elder
care.
I
want
to
make
an
interesting
point,
which
is
that
hersa
used
to
fund
and
they
still
do
to
a
certain
degree,
but
their
their
funding,
used
to
exclusively
support
specialists
in
geriatrics,
so
training
geriatricians
were
physicians
specializing
in
geriatrics,
geriatric
social
workers.
L
Therefore,
they
shifted
their
focus
and
these
geriatrics
workforce
enhancement
grants
are
intended
to
train
primary
care
providers
to
increase
their
basic
level
of
competence
in
serving
their
older
adults
to
recognize.
You
know
also
when
they
need
to
refer
people
to
specialists,
but
to
really
use
the
specialist
just
for
the
most
highly
complicated
situations
and
to
enable
basic
geriatrics
competence
among
primary
care
teams.
So
that's
the
goal
of
icecap
nevada.
It
includes
a
certificate
program
for
primary
care
providers
as
well
as
health
professions.
L
We
also
deliver
this
training
through
a
series
of
what's
what's
called
project
echo
project.
Echo
is
a
telehealth
education
initiative
at
the
school
of
medicine,
so
we're
training
rural
providers.
Our
series
is
focused
on
dementia.
We
offer
it
twice
a
year.
We
also
through
this
initiative
at
unr,
have
a
program
called
bravo
zulu
and
bravo.
Zulu
is
really
innovative.
L
It
was
actually
a
program
developed
by
the
nevada
department
of
veterans,
services
who's,
one
of
our
partners
on
this
award,
and
it
is
a
training
program
for
professional
and
family
caregivers
of
veterans
who
are
living
with
dementia.
So
this
is
a
highly.
L
12-Hour
training
program
to
give
care
providers
the
skills
and
knowledge
they
need
to
support
people
living
with
dementia,
but
layered
with
veteran
culture.
So
they
understand
the
unique
needs
of
veterans
who
may
be
experiencing
dementia
at
the
sanford
center.
We
also
have
our
nevada
geriatrics
education
center,
supported
by
adsd.
L
They
provide
trainings
for
rural
health
care
professionals,
as
well
as
a
geriatrics
lecture
series,
and
also
training
to
adsd
staff
through
various
contracts.
We're
also
teaching
students
at
unr
about
gerontology
through
our
gerontology
academic
program,
and
we
have
the
ali
program
or
the
osher
lifelong
learning
institute,
which
provides
adult
education
for
elders
living
in
the
community.
L
So
what
do
I
see
is
the
biggest
gaps
I
think
statewide
right
now
and
of
course,
we've
just
talked
about
a
whole
host
of
different
things,
right
that
full
continuum
of
services,
the
need
for
integrating
community-based
and
clinical
services
to
support
older
adults,
but
one
of
the
biggest
gaps
that
I
see
right
now
is
a
lack
of
clinical
services
for
people
living
with
dementia.
L
Now
we
do
have
some
resources.
Certainly
the
cleveland
clinic
down
in
las
vegas
has
a
very
thorough,
comprehensive
approach
to
supporting
people
living
with
dementia,
but
statewide
and
in
general
I
do
think
there's
a
tremendous
need
to
increase
the
emphasis
on
early
detection
of
dementia,
on
accurate
diagnosis
of
dementia
and
ongoing
care
management,
community
education
and
support.
L
Now
there
are
a
lot
of
resources.
There's
an
initiative
called
dementia
friendly
nevada
initiative
that
exists
through
a
program
called
the
dementia
engagement,
education
and
research
program
at
the
school
of
public
health
at
unr,
that's
supported
by
adsd
as
well
they're,
building
community
strength
for
enabling
people
living
with
dementia
to
live
well.
There
certainly
are
a
variety
of
community
supports
the
alzheimer's
association
you'll
be
hearing
from
charles
duarte.
L
I
mentioned
I
serve
as
the
chair
of
that
task
force
and
chair
gorlo
has
has
just
joined
us
as
a
representative
of
the
legislature
on
our
our
task
force.
So
we're
really
excited
to
have
you
join
that
work.
We
are
currently
working
on
developing
our
new
state
plan
for
alzheimer's
disease
that
will
be
released
in
january
2023.
L
It
will
have
many
different
recommendations,
both
programmatic
and
policy
recommendations,
that
I
commend
you
to
as
you're
looking
for
information
about
what
needs
to
be
done
here
in
nevada
related
to
dementia.
L
L
Across
the
aging
services
network
in
nevada,
we
know
this
is
not
sufficient,
it
doesn't
cover
everything.
Aging
is
a
complex
human
experience
and
we
need
a
complex
but
well-integrated
effective
system
of
support
to
meet
the
needs
of
that
human
experience,
and
I
believe
that
to
support
quality
life
and
well-being.
L
As
I
describe
them,
we
need
a
robust
well-integrated
system
that
brings
together
community
supports
with
clinical
services
and
that
these
must
work
in
concert
across
these
sectors
to
support
a
person-centered
or
better,
yet
a
person-directed
experience
in
which
they
can
access
the
services
they
need
when
they
need
them.
So
they
can
live
the
life
that
they
choose
in
the
manner
they
choose
in
a
location
they
choose.
E
Thank
you
so
much
dr
reed
for
your
presentation
committee
members.
Do
we
have
any
questions.
E
Vice
chair
spearman,
please
go
forward
with
your
question.
F
Thank
you.
I
I
didn't
want
to
disappoint
you,
madam
chair.
First,
dr
peters,
thank
you
so
much
for
for
this
presentation.
I
just
have
a
couple
of
questions.
I
guess
and
one
of
them
I
I
I
asked
to
ask
mr
gold
when
we
were
talking
with
aarp.
F
We
know
that
the
population
is
aging.
What
we
don't
know-
or
I
don't
know
that
we
have
addressed
it-
is
how
do
we
make
sure
that
we
are
recruiting
the
kinds
of
medical
services
and
doctors,
technicians,
nurses,
the
whole
medical
team?
How
is
there
anything
that
we
can
do
to
make
sure
that
we're
recruiting.
F
Experts
in
these
various
areas
that
will
already
be
here
as
our
population
ages-
that's
number
one
and
number
two
it
struck
me.
I
like
what
you
said.
You
know
the
good
news.
Is
they
come
this
time
tomorrow,
you'll
be
a
day
older
and
I
think
one
of
the
things
that
we
don't
do
well
in
our
society
is
to
honor
aging
and
honor.
Our
elders-
and
I
have
a-
I-
have
a
theory
that
if
you
don't
die
young
you're
going
to
get
old
and
it's
surprising
how
quickly
that
happens.
F
20
today
and
before
you
know
it
you're
53
weeks
from
now.
So
how?
How
can
we
make
sure
that
we
are
recruiting
the
kinds
of
medical
experts
or
experts
in
the
medical
field
dealing
with
geriatric
medicine
so
that
we've
got
the
skill
sets
and
the
numbers
of
people
that
we
need
here
in
nevada
and
number
two?
How
can
we?
F
What
can
we
do
now
to
begin
to
create
a
to
create
an
environment
of
cultural
competency
that
respects
aging
the
aging
process
and
the
wisdom
many
times
it
goes
with
it,
because,
right
now,
where
we're
going
the
road
that
it
looks
like
we're
going
down
now,
is
anybody
out
anybody
over
the
age
of
40-
and
you
know
get
out
of
here,
and
maybe
you
don't
matter
so
and
that's
that's
being
a
little
facetious,
but
that's
the
direction
I'm
going
in
right
now.
F
L
Sure,
thank
you
very
much
for
those
questions.
Vice
chair
spearman,
those
are
complicated
topics.
I
I
want
to
start
with
your
second,
which
is
about
what
I
call
ageism
and
what
the
field
calls
ageism
and
if
you
invite
me
back
I'll,
give
you
a
whole
another
talk
just
about
that.
L
But
ageism
is
a
form
of
discrimination,
just
like
any
other
in
which,
in
our
culture
and
in
our
society,
we
really
have
a
penchant
for
embracing
youth
and
beauty
as
the
the
standard
for
all
people
and
therefore
denying
elders
the
opportunity
to
truly
thrive,
as
active
citizens,
they're
often
have
their
views
and
perspectives
diminished,
they're
discriminated
against
in
a
variety
of
different
settings
and,
as
you
said,
there's
sort
of
these
thresholds
like
anyone
over
40.
L
Well
goodness,
but
I
look
around
the
room,
I
see
many
people
over
40
who
are
here
with
us,
and
I
think
many
of
you
would
agree
with
me
that
there
is
no
age
at
which
you
lose
your
productivity.
L
There
is
no
age
at
which
you
lose
your
interest
in
normal
everyday
activities,
and
I
think
it's
about
helping
to
educate
the
public
as
much
as
it
is
the
professional
workforce
in
the
aging
service
and
healthcare
realms
about
the
need
to
be
person-centered,
that
each
person
is
unique
and
different
and
age
is
just
another
one
of
those
characteristics
that
needs
to
be
respected
from
a
culturally
competent
perspective.
L
Now,
the
one
thing
that
I
do
argue
in
my
discussions
about
ageism
is
that
what's
interesting
about
age
is,
that
is
the
one
characteristic
that
gets
discriminated
against,
that
we
all
share
and
that
it
also
is
the
one
characteristic
in
which,
if
you
don't
see
yourself
in
that
form
of
discrimination
today
than
discriminated
against,
those
people
is
in
essence
discriminating
against
your
own
future
self.
L
L
This
was
not
what
he
was
here
to
talk
about
today,
but
I
know
aarp
actually
has
a
wonderful
program
called
disrupt
aging
and
disrupt
ageism,
which
is
a
training
program
and
also
a
national
campaign
to
help
younger
generations
recognize
the
value
of
elders
in
our
society,
and
I
think
that
is
something
that
needs
to
be
a
part
of
any
training
programs
that
we
offer
for
folks,
but
also
just
our
general
messaging
to
the
public
in
terms
of
recruiting
health
care
professionals
to
support
older
adults
again,
I
I
think
that
it's
as
much
about
recruiting
people
into
the
health
disciplines
as
it
is
into
the
geriatrics
specialties.
L
I
have
embraced
that
philosophy
that
hersa
has
put
forward
that
I
mentioned
in
in
my
remarks
that
we
will
not
be
able
to
train
enough
specialists
to
support
the
aging
of
the
population,
that
what
we
need
is
all
health
care
professionals
to
understand
their
role
in
supporting
older
adults
and
to
understand
what
they
can
do
in
treating
and
caring
for
older
persons
and-
and
so
I
think
that
the
workforce
issue
really
for
me
as
much
as
it's
about
recruitment.
It's
about
training.
L
You
know
we
need
to
increase
our
recruitment
of
health
professionals
overall
right.
We
need
to
get
a
stronger
pipeline
of
people
coming
into
all
the
healthcare
disciplines,
and
then
we
need
to
be
sure
that
all
of
those
healthcare
disciplines
at
every
level
are
receiving
education
and
training
about
geriatrics
and
about
aging,
because
we
can't
count
on
specialists
to
be
the
sole
providers
for
what
a
fifth
of
our
population.
F
And
so
I'm
sure,
with
your
indulgence
that
goes
along
with
the
the
the
next
thing
I
was
going
to
say
is
a
couple
of
years
ago,
a
couple
of
sessions
ago.
F
We
had
a
bill
that
required
cultural
competency,
training
for
everyone,
who's
in
the
medical
profession
or
in
medical
facilities,
and
perhaps
that's
something
that
we
need
to
look
at,
including
in
the
cultural
competency
requirements
you
mentioned
something
about
will
covet
and
long
haulers
and
I'm
seeing
more
and
more
people
who
survive
covet,
but
the
long
hauler
vicissitudes,
if
you
will,
are
exacerbating
some
illnesses
that
naturally
come
with
aging.
F
Is
there
anything
from
a
policy
perspective
that
we
probably
need
to
look
at
with
respect
from
to
to
health
care
both
now
and
in
the
future?
Is
there
something
that
this
committee
should
look
at
with
respect
to
bringing
forward
some
type
of
br
legislative.
L
Once
they
have
them.
I
think
from
a
healthcare
perspective
that
could
be
really
beneficial,
but
then
not
only
being
reactive,
being
proactive
and
moving
upstream
and
putting
more
investment
into
health,
education
and
community-based
wellness
programs-
and
I
recognize
this
is
a
lifelong
accumulation
of
risk.
But
really
I'm
thinking
about
people
in
their
40s
50s
and
60s,
who
need
the
knowledge
and
the
skills
and
the
tools
to
engage
in
physical
activity,
better
diets,
healthier
foods,
etc
to
help
to
reduce
the
development
of
those
conditions.
I
think
that
could
be
really
beneficial.
F
Yeah
and
last
last
question:
we,
we
talked
a
lot
about
the
aging
in
general,
there's
a
a
part
of
the
whole
discussion
that
is
left
out
either
by
design
or
default,
and
that
is
what
does
that
look
like
for
bipod
communities
and
specifically
for
lgbtq.
F
When
you
look
at
quality
of
life
issues,
you're
still
talking
about
the
same
ratio,
three
to
four
times
more
likely
not
to
have
those
sorts
of
things
and
what
are
we
doing
with
respect
to
making
sure
that
we
recognize?
I
know
a
certain
woman,
benitez
thomas
thompson
had
a
bill,
I
want
to
say
it
was
2015
and
2017
that
required
some
additional
training
ceus
with
respect
to
recognizing
suicide
ideation,
but
it
was
across
the
population.
F
But
what
we've
seen
in
covet
is
that
that
isolation
has
exacerbated
those
statistics,
and
so
people
who
are
isolated
now,
whether
they're
in
the
general
population
and
even
the
lgbtq
population,
are
more
likely
to
have
the
suicide
ideation.
I
want
to
say
it's
like
four
times
as
much
three
times
as
likely
to
have
a
plan
and
then
carry
out
that
plan
so
to
complete
suicide
ideation.
F
So
again,
what
is
it
that
we
need
to
know
and
be
looking
at
with
respect
as
policy
makers,
and
can
any
of
this
be
addressed
when
we
start
talking
about
curriculum
at
the
schools
of
medicine
here
in
nevada,
both
public
and
private.
L
Yeah
absolutely
again,
thank
you
very
much
for
that
question
and
there
were
a
lot
of
different
elements
loaded
into
that
question.
So
I'm
going
to
do
my
best.
I
I
want
to
start
with
where
you
started,
which
is
the
bipod
communities
and
aging
services.
L
I
I
can
tell
you
just
in
my
career
working
with
aging
services
professionals,
both
in
healthcare
as
well
as
in
the
community,
supports
that
I
I
have
never
come
across
a
person
who
does
not
embrace
and
recognize
the
need
for
promoting
diversity
and
inclusion
among
the
people
that
we
are
serving
and
to
ensure
that
all
the
programs
that
we're
developing
are
accessible
to
all,
irrespective
of
race,
sexual
orientation,
etc,
and
particularly
economic
need,
I
think,
is
one
of
the
greatest
aspects
of
diversity
that
we
deal
with
in
aging
services.
L
I
think
that
we
have
is
not
our
intention
or
our
our
good
hopes
for
doing
so,
but
really
building
the
necessary
long-term,
trusting
relationships
with
communities
of
color
and
other
diverse
communities
such
that
they
see
the
programs
that
we're
offering
as
appropriate
and
beneficial
to
them,
and
I
think
that
can
only
come
through
fostering
more
discussion,
more
robust
engagement
and
really
thinking
together
about
what's
going
to
best
meet
the
needs
of
communities.
I
will
say
from
the
task
force
on
alzheimer's
disease
side.
L
Our
vice
chair
for
the
tfad
is
tina
dortch
who's
with
the
office
of
minority
health,
as
she
has
led
the
development
of
our
recommendations
related
to
cultural
competence
and
ensuring
that
alzheimer's
disease
and
dementia
related
supports
and
services
are
appropriate
for
a
variety
of
different,
diverse
communities.
So
we
have
a
very
particular
emphasis
on
that,
but
I
think
it's
something
that
needs
to
go
deeper
than
just
a
recommendation
and
estate
plan
right.
L
It's
about
the
relationships
at
the
community
level
that
need
to
be
fostered
to
help
communities,
understand
the
relevance
of
the
programs
that
are
available
to
them
and
to
help
the
professionals
offering
those
programs
understand
how
to
best
engage
with
communities
who
are
traditionally
underserved
and
then
that
knowledge,
as
you
pointed
out,
if
I
can
just
take
it
a
little
further
to
your
next
elements,
that
knowledge
does
need
to
be
disseminated
within
the
curricula
of
all
of
the
health
professions.
L
I
I
know
we
have
a
very
strong
office
of
diversity
at
the
school
of
medicine
at
unr,
it's
led
by
dr
nicole
jacobs,
and
she
develops
all
manner
of
different
diversity
initiatives
for
engaging
our
students
and
helping
them
recognize
the
need
for
learning
about
how
to
serve
diverse
communities,
but
also
our
faculty
and
faculty
development
programs
that
help
us
build
our
capacity
to
extend
that
knowledge
out
into
the
community,
both
through
clinical
services
and
through
the
relationships
with
a
whole
host
of
different
partners.
L
So
again,
I
think
there's
a
high
level
of
commitment
to
supporting
these
things
and
that
it
is
a
journey
of
learning
that
that
is
still
underway.
In
terms
of
how
we
do
that
most
effectively,
but
it
is
something
that's
infused
both
in
the
curricula
as
well
as
for
the
professional
work
of
both
current
and
future
professionals
in
healthcare.
E
Thank
you
vice
chair
and
a
quick
question
I
mean:
does
anybody
else
have
questions
on
our
community.
E
Again,
thank
you
vice
chair
spearman,
those
were
some
really
great
questions
and
dr
reed.
Thank
you
very
much
for
your
presentation.
It
was
very
thought
provoking.
So
thank
you
very
much.
Okay
for
our
next
jenna
item.
We
have
mr
charles
rort
direct
nevada,
director
of
public
policy.
E
Sorry
there's
an
echo
oh
they're.
Okay,
thank
you,
as
I
was
saying,
mr
charles
dwarf
nevada,
director
of
public
policy
and
advocacy
for
the
alzheimer's
association
to
present
on
the
current
status
of
alzheimer
patients
and
services
in
nevada.
We'd
also
like
to
welcome,
is
kathy
maupin.
I
hope
I
pronounced
that
correctly.
My
apologies,
if
I
didn't
a
caregiver
and
volunteer
for
the
alzheimer's
association
again
we'll
take
questions
at
the
conclusion
of
the
presentation.
You
may
begin
when
you're
ready.
R
R
It's
a
pleasure
being
here
today,
dr
reed's,
always
a
tough
act
to
follow,
as
is
barry
gold,
but
I'll
do
my
best
to
be
brief
and
and
provide
information.
That's
helpful
to
the
committee.
You've
already
heard
a
lot
of
good
testimony
and
I'd
say
that
you're
saving
the
best
for
last,
but
some
of
the
the
testimony
you've
already
heard,
has
been
excellent.
R
You
know
a
lot
of
us
come
to
our
work
here
at
the
alzheimer's
association
because
of
connections
we
have
through
family
and
friends,
and
for
me
it
was
my
father
who
passed
away
in
2003
with
from
alzheimer's,
and
it's
currently
a
very
good
friend
of
mine
who's,
my
age
who
had
younger
onset
dementia
and
is
still
living
with
that
and
for
my
guest
here,
kathy
maupin.
R
She
has
a
similar
journey
that
she
wants
to
share
with
you.
Folks
kathy
is
a
an
advocate,
an
educator.
She
is
a
support
group
facilitator
and
a
volunteer
extraordinaire
for
the
alzheimer's
association.
R
She
also
advocates
on
federal
policy
for
us
with
members
of
congress,
and
so
we're
very
grateful
to
have
kathy
here,
to
tell
you
a
little
bit
about
her
story
and
at
the
conclusion
of
her
comments.
What
I'll
do
is
start
the
formal
part
of
my
presentation,
so
I'm
going
to
turn
it
over
to
kathy
right
now.
S
S
S
I
despaired
as
I
watched
my
mother,
lose
her
ability
to
walk
and
to
talk
to
dress
herself
and
to
brush
her
teeth.
She
became
incontinent.
She
forgot
how
to
read
and
write,
and
she
depended
upon
me
to
help
her
with
all
of
the
activities
of
daily
living.
I
dressed
her.
I
fed
her
pureed
foods
with
a
spoon
because
it
was
hard
for
her
to
swallow.
S
S
S
Some
attend
aa
meetings
because
they
use
alcohol
to
deaden
their
fears
or
to
seek
sleep
or
an
escape
from
the
daily
demands
of
caregiving.
Some
have
substance,
abuse
issues
and
have
gone
into
rehab
physically.
Some
of
my
members
have
suffered
from
heart
and
vascular
problems
due
to
stress
and
lack
of
sleep.
Some
have
hip
knee
and
back
issues
from
lifting
wheelchairs
and
their
loved
ones.
S
S
S
S
S
While
a
doctor
took
a
phone
call,
we
could
have
planned
so
much
better.
If
I
had
known
what
her
diagnosis
was.
Medical
personnel
need
education
about
this
disease,
especially
how
to
manage
hospitalized
alzheimer's
patients.
I
had
a
support
group
member
recently
be
asked
to
stay
24
hours
a
day
to
take
care
of
her
her
father.
While
he
was
hospitalized
for
pneumonia,
they
just
said
they
were
short
staffed.
They
couldn't
handle
his
getting
out
of
bed,
he's
ripping
out
ivs
his
oxygen.
S
R
In
terms
of
my
presentation,
I
have
up
here
a
list
of
some
of
the
areas
I'd
like
to
touch
on
before
I
go
any
further.
I
want
to
mention
that
I
will
address,
or
hopefully
we'll
make
some
suggestions
related
to
geriatric
workforce
training
from
senator
spearman,
as
well
as
some
of
her
questions
around
outreach
and
education
to
communities
of
color
and
the
lgbtq
communities.
R
So
I'll
talk
a
little
bit
about
that
at
the
end
of
my
presentation
before
I
go
on
and
talk
about
national
facts
and
figures.
One
of
the
things
I
think
that's
important
is
to
define
terms,
and
one
of
the
terms
we
have
to
understand
is
the
difference
between
alzheimer's
disease
and
dementia.
R
R
You
can
also
see
dementia-like,
behaviors
and
other
diseases,
some
of
which
are
treatable,
like
depression,
stroke
thyroid
disease,
even
urinary
tract
infections.
That's
why
it's
so
important
that
when
you
experience
problems
with
cognition
thinking,
reasoning,
memory
or
your
loved
one
has
problems
like
that
to
see
a
doctor
and
get
a
diagnosis,
because
some
of
these
things
can
be
treated
for
the
alzheimer's
association.
R
The
other
thing
that's
important
for
people
living
with
dementia
or
alzheimer's
disease
is
the
importance
of
caregivers,
in
particular,
family,
caregivers
and
friends.
The
alzheimer's
association
estimates
that
there
are
over
11
11
million
americans
who
are
providing
unpaid
care
to
individuals
living
with
dementia.
R
The
other
important
aspect
here
and
kathy
spoke
to
this
earlier,
is
that
research
shows
that
half
of
medicare
beneficiaries
with
a
diagnosis
of
alzheimer's
disease
or
another
dementia
in
their
charts,
half
of
them
are
even
told
that
they
have
dementia,
and
so
quite
often,
they're,
never
told.
Nor
is
a
caregiver,
ever
told
that
this
person
has
dementia
and
so
again
having
an
early
and
accurate
diagnosis
provided
to
the
patient,
and
the
caregiver
is
extremely
important
and
one
of
the
reasons
we
advocate
for
it.
R
So
you
know
one
of
the
things
that
and
I'll
be
frank
about
this.
We
were
a
little
disappointed
in
elders,
count
2021,
because
there
was
zero
mention
of
alzheimer's
disease
or
dementia
in
that
report,
as
it
is
such
an
important
part
of
aging
and
more
prevalent
as
as
our
senior
population,
particularly
here
in
nevada
ages.
But
one
of
the
things
that
I
know
that
jeff
duncan
mentioned
is
that
they're
going
to
add
it
to
the
2023
report
and
we're
grateful
for
that
addition.
R
But
it's
important
to
know
that,
while
other
diseases
like
heart
disease,
for
example,
we've
seen
deaths
from
heart
disease
decrease
in
the
last
20
years,
there's
actually
been
an
increase
of
almost
145
percent
in
deaths
from
alzheimer's
disease,
and
likewise,
we've
seen
deaths
from
different
types
of
cancers.
Go
down.
Why
why?
While
deaths
from
alzheimer's
disease
increase-
and
that's
probably
an
underestimate,
because
again,
it's
often
difficult
to
get
a
diagnosis.
R
And
in
fact,
one
in
three
seniors
dies
with
alzheimer's
or
another
dementia,
and
I
specifically
use
the
words
here:
dies
with
alzheimer's
disease,
because
if
you
talk
to
a
physician
or
clinician
or
even
family
members,
who've
gone
through
that
journey
with
a
loved
one
oftentimes.
Somebody
who
has
alzheimer's
disease
doesn't
die
from
the
disease
itself.
R
R
Skip
this
slide
here,
you
know,
I
know.
Senator
spearman
has
asked
these
questions
repeatedly
today
and-
and
I
want
to
make
sure
that
we
put
this
out
there
last
year,
the
alzheimer's
association
as
a
part
of
its
2021
facts
and
figures
report
put
out
a
special
report
and,
and
they
called
it
specifically,
they
called
out
discrimination
in
care,
and
one
of
the
things
that
they
put
out
in
this
report
is
the
the
unequal
burden
of
of
alzheimer's
disease
amongst
different
communities
or
populations.
R
R
The
cost
burden
of
alzheimer's
disease
is
extremely
high
for
the
united
states.
It
is
considered
the
most
expensive
disease
and
in
2021
the
the
u.s
spent
a
combined
355
billion
dollars
on
alzheimer's
disease.
A
lot
of
that
in
the
long-term
care
arena
by
2050.
That
number
is
expected
to
increase
to
more
than
one
trillion
dollars
a
year.
R
R
And
so
every
year,
as
a
part
of
their
facts
and
figures
report,
the
alzheimer's
association
puts
out
state-specific
information,
and
so
this
is
information
from
the
2021
facts
and
figures
report.
There's
some
updated
information
information,
I'll
mention
from
the
2022
report,
which
was
issued
on
march
15th,
but
I'll
get
into
that
in
a
bit.
R
We
are
expected
to
see
a
31
increase
in
the
growth
of
individuals
with
living
with
dementia
or
alzheimer's
disease
by
2025,
not
2050,
2025.,
and
so
that
number
right
now
we
are
estimated
that
individuals,
65
and
older,
with
alzheimer's,
is
around
49
000
nevadans.
That
number
will
increase
to
64
000..
R
A
special
study
was
also
done
of
individuals
with
dementia
in
nursing
homes
and
the
excess
number
of
deaths
that
occurred
with
individuals
who
had
a
diagnosis
of
alzheimer's
disease
or
another
dementia
who
were
in
nursing
facilities
in
nevada,
and
there
were
678,
basically
covid
related
nursing
home
deaths
for
individuals
with
alzheimer's
disease
in
nursing
facilities,
and
I've
mentioned
this
before
in
nevada.
R
R
R
R
One
of
the
things
that
I
mentioned
was
that
there
was
some
more
recent
data
released
in
the
2022
facts
and
figures
report.
I
apologize.
I
couldn't
incorporate
it
into
the
slides
because
I
had
to
hand
them
in
a
little
bit
before
the
report
was
released,
but
just
to
sort
of
update
some
of
these
facts
and
figures
for
nevada.
R
Again
I
mentioned
that
80
percent
of
of
nevada
caregivers
have
one
or
more
chronic
conditions
in
terms
of
the
need
of
geriatricians.
These
are
specially
trained
physicians
in
geriatrics,
we're
anticipating
that
by
2050,
we'll
need
to
see
an
increase
of
about
267
percent
in
the
number
of
geriatricians
serving
nevadans
who
may
have
dementia
in
the
2022
report.
There
is
also
a
reference
to
a
a
study
that
was
done
on
neurology
deserts.
R
I
believe
it
was
dr
reed
who
mentioned
that
geriatricians
and
neurologists
are
really
the
individual
specialists
that
are
involved
in
differential,
diagnosing
of
different
types
of
dementias
and
are
critical
to
that
type
of
diagnostic
work.
Nevada
is
considered
one
of
20
states,
that's
a
neurology
desert,
and
so
it's
going
to
become
more
and
more
important
for
us
to
train
physicians,
particularly
family
physicians
and
other
primary
care
providers,
including
nurse
practitioners
and
physician
assistants,
to
be
more
competent
in
the
care
of
their
aging
patients.
R
Apologize
for
that,
so
one
of
the
things
that
the
department,
health
and
human
services
here
does
is
every
other
year.
They
conduct
a
survey
on
what's
called
subjective,
cognitive
decline
and
what
that
basically
means
is
it's
self-reported
memory
problems
that
have
been
getting
worse
over
the
past
year,
and
so
this
is
part
of
a
survey.
That's
done.
R
A
very
broad
survey
called
the
behavioral
risk
factor,
surveillance
system
and
one
of
the
areas
they
look
at
is
cognitive
decline
for
individuals,
45
years
of
age
or
older
and
in
those
individuals,
one
in
seven
report,
subjective
cognitive
decline.
So
again,
that's
a
problem
with
memory
or
reasoning
that
is
getting
worse.
R
What's
also
interesting
and
somewhat
disturbing,
is
that
less
than
half
of
those
people
who
experience
subjective
and
report
subjective
cognitive
decline
actually
talk
to
anybody
or
including
a
family
member
about
their
concerns
and
fifty
percent.
Don't
talk
to
a
health
care
provider
about
it.
So
this
leads
to
a
gross
under
under
diagnosing
of
alzheimer's
disease
and
dementia
or
late
diagnostic
work,
which
occurs
in
individuals
in
the
middle
stages
of
the
disease,
where
it's
much
more
obvious
and
again
at
a
point
where
they
really
can't
be
fully
involved
in
their
own
care
planning
and
financial
affairs.
R
The
association
has
four
public
policy
platforms.
These
are
consistent.
A
consistent
state
of
excuse
me
a
consistent
set
of
state
policy
priorities
that
we
implement
across
chapters
and
across
states,
and
so
those
include
in
increasing
public
awareness
for
the
importance
of
an
early
diagnosis,
building
a
dementia
capable
workforce,
increasing
home
and
community-based
services
and
enhancing
the
quality
of
care
in
residential
savings.
R
What
we
do
as
public
policy
folks
at
the
state
level
is
we
try
to
translate
this
into
actions
that
can
be
taken
either
legislative
or
appropriation,
actions
that,
because
that
can
be
taken
by
state
legislatures
or
by
the
governor
in
in
the
development
of
their
budget
work,
and
I'm
going
to
talk
about
three
policy
priorities.
I
can
say
up
front
that
we're
grateful
that
the
cleveland
clinic
lou
rouevo
center
for
brain
health
supports
these
three
initiatives
as
well
as
aerp,
nevada
and
I'll
talk
in
more
detail
about
each
of
these.
R
But
number
one
is
better
access
to
early
and
accurate
diagnosis
and
I'll
talk
about
a
proposal
for
establishing
a
nevada
memory.
Network
number
two
better
medicaid
supports
for
family,
caregivers
and
I'll
talk
about
different
programs
across
the
nation
which
can
serve
as
models
for
modifying
our
existing
home,
existing
home
and
community
base
waiver
for
the
frail
elderly
and
then
third
helping
individuals
and
families
who
are
dealing
with
the
dementia
crisis
and
we'll
talk
about
the
experience
in
other
states
and
and
programs
that
have
been
borne
out
to
be
very
successful
in
other
states.
R
My
first
proposal
here
is
the
nevada
memory
network
and
these
are
not
in
any
order
of
importance,
but
I've
been
privileged
to
work
with
dr
peter
reed
and
the
sanford
center
on
aging,
as
well
as
renowned
neurology
department,
and
have
had
initial
talks
with
the
cleveland
clinic
luruvo
center
about
establishing
a
more
robust
network
of
memory
clinics.
These
are
memory,
assessment,
clinics
or
macs.
That
really
would
serve
multiple
purposes,
and
this
is
based
off
a
proven
work.
R
That's
been
done
at
emory
university
and
the
university
of
california
san
francisco,
as
well
as
the
university
of
wisconsin.
I
can
also
say
that
we
have
good
bones
here
in
nevada.
We
have,
as
dr
reid
mentioned,
very
good
schools,
medicine
that
include
geriatric
workforce
enhancement
program
grants.
We
have
partners
like
the
ruvo
center
for
brain
health
and
down
at
unlv.
We
have
the
unlv
brain
health
department,
that's
doing
excellent
research
and
also
the
sanford
center
for
aging.
So
we
have
good
bones
to
build
on
and
that's
what
we
want
to
propose
here.
R
So
I'm
going
to
go
to
a
graphic
that
kind
of
explains
what
we're
talking
about
and
we're.
Having
very
serious
conversations
right
now
between
the
sanford
center
on
aging
and
renowned
neurology
department
about
establishing
this
las
vegas
is
fortunate
to
have
the
lou
rouveaux
center,
which
provides
these
memory
assessment
services.
We
need
to
develop
a
more
complete
capability
up
in
northern
and
rural
nevada
through
this
initiative.
R
We
hope
to
do
that,
but
we
know
that
primary
care
providers
would
form
the
basis
of
any
network
for
doing
cognitive
assessments,
and
so
one
of
the
things
that
we
know
is
essential
and
dr
reed
talked
to
about
this
is
primary
care
education,
and
so
this
would
be
using
experts
at
the
max
or
memory
assessment
clinics,
which
would
include
neurologists,
neuropsychologists
and
other
clinical
clinicians
to
really
help
primary
care
practices
effectively
screen
patients
so
that
when
they
make
a
referral
to
a
memory
assessment
clinic,
it's
a
quality
referral
with
good
information,
backing
up
that
that
service,
and
so
it's
it's
a
two-way
street
between
the
mac
and
the
pcp.
R
When
the
patient
and
the
caregiver.
Now
this
dyad
of
individuals,
a
patient
in
the
caregiver,
is
extremely
important
to
be
included
in
any
kind
of
cognitive
assessment
work
when
they
go
to
the
mac.
They
are
both
assessed
in
terms
of
their
capabilities
and
needs,
and
then
a
full,
comprehensive
diagnostic
workup
is
done
by
the
mac
and
when
that's
done,
the
caregiver
is
given
that
information
as
well
as
the
patient,
and
then
that
care
plan
is
handed
off
back
to
the
pcp
to
take
care
of
that
patient
in
the
communities
where
they
live.
R
And
so
the
pcp
can
provide
ongoing
medical
support
with
help
from
the
neurologist
or
neuropsychologist
at
the
mac.
But
what's
also
very,
very
important,
and
this
is
played
out
through
the
work
at
emory
university
as
well
as
ucsf
has
been
care.
Navigators
care
navigators
are
basically
social
workers
who
really
support
people
with
a
diagnosis
as
well
as
their
caregivers
in
the
community
to
make
sure
they're
getting
the
social
services
and
supports
they
need
and
monitoring
the
the
care
and
well-being
of
the
caregivers
themselves.
R
R
The
other
program
I
want
to
mention
is
a
family
caregiver
waiver.
Again,
we
heard
really
good
presentations
this
morning
from
the
department
of
health
and
human
services
staff,
particularly
those
in
the
aging
and
disability
services,
division
about
the
work
that
they're
doing
keeping
people
out
of
nursing
homes
and
providing
in-home
supports
for
individuals,
including
those
who
are
on
the
nevada,
medicaid,
home
and
community-based
waiver
for
the
frail
elderly.
R
R
They
put
a
report
on
excellent
programs
across
across
the
nation
and
again,
georgia
stands
out
as
one
of
those
areas
where
they're
doing
excellent
work
and
what
they
really
are
doing
is
keeping
in
touch
with
the
caregivers.
So
the
state
social
worker
or
case
manager
is
staying
in
close
contact
through
a
case
management
system
with
the
caregiver
who
puts
in
their
notes
about
what
what
the
patient
needs
the
beneficiary.
R
In
this
case
needs
in
terms
of
ongoing
care,
but
also
what
the
caregiver
needs
and
the
state
social
worker
or
case
manager
puts
together
a
training
program,
not
just
a
service
program,
but
a
training
program
for
the
caregiver
to
help
them
do
the
job.
They
need
to
do.
That's
patient-centered
person-centered,
for
not
only
the
patient,
receiving
the
services,
but
also
for
the
caregiver,
and
so
this
structured
process
of
training
and
caregiver
support
is
what
states
are
doing
to
more
effectively
take
care
of
individuals
and
keep
them
in
their
home
they're.
R
Also
making
it
easier
to
pay
family
caregivers
to
to
do
this
work
in
nevada.
We
do
that
same
thing.
It's
not
as
easy,
as
in
other
states
to
get
paid
as
a
family
caregiver,
and
sometimes
it's
not
allowed
to
have
a
spouse
or
a
guardian,
provide
that
care,
but
in
in
some
states
that
are
doing
a
good
job
of
this.
R
They
are
allowing
spouses
and
and
guardians
to
serve
as
paid
caregivers,
and
so
we
would
look
to
the
division
of
aging
and
disability
services
to
basically
augment
the
waiver
that
they
already
have
in
place,
and
hopefully
this
wouldn't
be
extremely
expensive
to
do,
but
it
really
would
provide
the
kind
of
supports
and
training
that
people
need
to
be
more
effective
caregivers.
R
Behaviors
that
are
at
risk,
putting
them
at
risk
or
putting
others
at
risk
and,
as
with
mental
health
crises,
this
often
results
in
somebody
with
potential
dementia
diagnosis,
getting
handcuffed
thrown
in
the
back
of
a
patrol
car
taken
to
a
hospital
emergency
room
where
they
may
not
be
able
to
make
a
diagnosis,
providing
them.
Who
then
provides
them
with
psychiatric
medication
management
which
is
inappropriate,
or
they
may
end
up
in
a
in
a
mental
health
hospital
ward,
and
all
of
these
are
inappropriate
interventions
and
law
enforcement
recognizes
this
county.
R
Social
workers
recognize
this,
but
they
don't
have
somebody
in
the
field,
who's,
helping
them
with
these
crisis
situations
who
can
serve
as
a
resource
for
ongoing
support,
and
so
we
looked
to
the
state
of
wisconsin
which
developed
this
and
back
in
2016.
R
The
legislature
heard
about
this
from
these
kinds
of
crises
from
law
enforcement
from
social
work
staff
and
they
funded
a
small
number
of
positions.
I
believe
they
funded
six
positions
which
were
called
dementia
care
specialists,
and
these
were
a
master's
level
trained
people
who
really
served
as
the
front
line
on
in
dementia
crisis
interventions
and
post-crisis
stabilization
work.
R
But
they
were
also
involved
in
training
communities
to
be
more
dementia
friendly
and
dementia,
capable,
including
some
of
these
community
organizations
like
mobile
outreach
safety
teams,
and
these
have
been
very,
very
effective
so
much
so
that
the
wisconsin
legislature
in
their
2020
session,
I
believe,
approved
64
positions,
dementia
crises,
specialists
and
these
are
one
specialists
per
county,
and
so
they
felt
it
was
such
an
important
aspect
of
the
work.
R
That's
not
that's
needed
for
people
experiencing
these
types
of
crises,
whether
it's
in
in
the
home
in
the
community
or
even
in
a
nursing
home
that
they
they
funded
position
in
each
county.
R
The
states
of
georgia
and
maryland
are
looking
at
this
program
as
we
are,
and
the
alzheimer's
association
here
in
nevada
is,
is
working
very
closely
with
the
unr
deer
program
or
dementia
education,
engagement
and
research
program,
as
well
as
adsd,
and
we're
working
with
talking
with
law
enforcement
and
also
county
social
workers
about
moving
a
similar
program
forward,
certainly
not
as
ambitious
as
64
positions,
but
we
want
to
start
someplace.
R
We
are
looking
at
grant
funding
with
the
help
of
adsd,
but
that
grant
support
would
need
to
be
continued
with
appropriations
on
ongoing
financial
support
from
the
legislature.
So
again,
this
is
based
off
a
proven
model
out
of
wisconsin
that
other
states
are
looking
to
emulate
because
of
the
growing
incidences
of
dementia
crises
that
are
occurring
across
their
states
and
we're
hearing
across
nevada.
R
So
the
work
that
we
do
at
the
association
is
not
only
state
level
work.
We
do
federal
work.
One
of
the
things
that
we
really
focus
on
on
at
the
federal
level
and
kathy
is
one
of
our
ambassadors,
which
means
she
works
very
closely
with
one
of
our
members
of
congress.
Congressman
amodei
who's
been
very,
very
supportive
of
the
association's
policy
positions
and
funding,
but
one
of
the
things
that
we
really
work
hard
on
is
looking
at
increasing
research
funding
at
the
federal
and
at
the
national
institutes
of
health
around
alzheimer's
disease.