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From YouTube: 6/22/2022 - Nevada Silver Haired Legislative Forum
Description
This is the third meeting of the 2021-2022 Interim. Please see the agenda for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
F
F
Present
we're
working
on
the
video
that
it's
not.
H
H
C
A
A
A
A
I
am
asking
our
presenters
on
the
zoom
video
to
call
to
leave
your
cameras
off
and
microphones
muted,
until
I
call
up
the
agenda
item
under
which
you
will
present
or
if
I
direct
any
questions
to
you,
the
zoom
video
call
has
a
chat
feature.
However,
this
feature
is
only
to
be
used
for
technical
assistance.
A
Any
links
or
information
that
you
would
like
to
share
during
your
presentation
should
be
stated
verbally
on
the
record.
Members
of
the
public
should
sign
the
sign
in
sheet
at
each
location,
even
if
you
do
not
intend
to
testify
when
testifying.
Please
remember
to
turn
on
your
microphone
and
clearly
state
your
name
and
the
entity
you
re
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.
A
A
Anyone
who
would
like
to
receive
electronic
notification
of
and
access
to
the
forum's
agendas
minutes
and
final
report
can
do
so
by
going
to
the
nevada,
legislature's
website
and
following
the
links.
And
finally
I
would
like
to
remind
everyone
to
please
silence
all
of
your
electronic
devices,
especially
cell
phones
and
laptops,
during
the
meeting
with
that.
A
A
A
A
F
Good
morning
I
am
tony
arcata
payne
and
I
am
a
doctoral
candidate
in
public
policy
at
unlv.
My
area
of
focus
details,
the
impact
of
long-term
care
costs
on
middle
class,
seniors
and
families.
In
addition
to
my
personal
experience,
navigating
long-term
care
in
nevada,
I
have
spent
the
last
two
years
researching
this
topic.
F
There
is
a
crisis
in
america
and
nevada
is
not
immune
from
this
crisis.
This
crisis
impacts
the
forgotten
middle
class
and
how
they
will
pay
for
long-term
care
costs.
Research
shows
that
this
group
gets
ignored
and
underserved
in
today's
long-term
care
market
and
it's
a
problem
that
is
going
to
explode
over
the
next
20
years.
F
There
is
a
natural
tendency
to
believe
that
you
will
always
be
able
to
maintain
your
independence
and
take
care
of
yourself
and
your
family.
However,
at
least
70
percent
of
the
population
will
find
themselves
or
a
family
member
needing
some
type
of
long-term
care
and
facing
the
struggles
of
paying
for
this
care.
F
Unfortunately,
for
some
seniors
living
a
longer
life
comes
with
an
increased
opportunity
to
experience
medical
conditions
that
are
more
prevalent
as
people
age.
Health
challenges
may
range
from
limited
movement
to
more
serious
health
issues
such
as
diabetes,
severe
injury
and
cognitive
issues,
to
name
a
few.
These
conditions
may
result
in
the
need
for
some
form
of
long-term
care,
the
decrease
in
long-term
care
insurance
policies
being
purchased.
F
There
are
some
funding
options
available
to
assist
with
paying
for
long-term
care
costs.
However,
most
have
strict
income
requirements,
making
them
inaccessible
to
the
middle
class
senior
as
of
2021.
There
are
just
over
506
000,
seniors
age
65
and
over
living
in
nevada,
70
or
354
000
may
require
some
type
of
long-term
care
in
their
lifetime.
F
Approximately
90
percent
of
these
seniors
income
is
above
the
poverty
line
and
will
not
qualify
for
financial
assistance
to
help
pay
for
these
costs
presently
in
nevada.
The
monthly
median
cost
of
long-term
care
ranges
from
eighteen
hundred
dollars
a
month
for
adult
day
care
on
the
low
end
to
ten
thousand
three
hundred
dollars
for
nursing
home
care
each
month.
F
Many
seniors
will
have
to
pay
for
these
costs
privately
rely
on
caregiver
support
from
family
and
friends,
which
is
not
always
available,
or
they
will
have
to
spend
down
their
assets
to
qualify
for
net
financial
assistance,
increasing
the
financial
burden
placed
on
the
state's
budget.
There
is
no
easy
fix
to
this
problem,
but
one
fact
stands
out.
The
costs
of
long-term
care
services
continue
to
increase.
F
A
A
A
C
C
D
D
D
We
provide
education
to
residents,
families
facility
staff
and
others
on
a
variety
of
issues
related
to
aging,
long-term
care
and
resident
rights,
and
provide
in-service
training
for
long-term
care
professionals
regarding
trends
and
best
practices
to
improve
the
quality
of
care
for
residents.
In
addition
to
that,
we
also
conduct
regular
unannounced
visits
to
facilities
facility
types.
We
have
three
different
types
of
facilities.
D
We
have
the
home
for
individual
residential
care,
our
herc
homes
we
have
the
residential
facilities
for
groups
also
referred
to
as
assisted
living
facilities,
those
have
alzheimer's
endorsements
for
residential
facilities
for
groups
and
with
those
alzheimer
endorsements.
It's
mandated
that
there's
one
staff
member
for
every
sixth
resident,
and
then
we
have
our
skilled
nursing
facilities.
D
And
in
our
long-term
care
issues,
we'll
start
with
discharges
from
facilities,
our
skilled
nursing
facility
concerns
are
regarding
residents
who
are
sent
to
an
acute
setting,
such
as
the
hospital
or
behavioral
health
are
not
permitted
to
return
to
the
facility.
If
there
is
an
undesirable
behavior,
the
resident
should
be
provided
a
discharge
letter
with
information
to
contact
the
long-term
care
ombudsman
office,
as
well
as
file
an
appeal.
D
Next
are
the
letter
of
agreements.
Group
homes
have
an
increase
of
admissions
for
residents
who
transfer
from
the
hospital
under
a
letter
of
agreement
from
the
hospital.
The
letter
of
agreement
is
a
contract
between
the
hospital
and
the
group
home
provider,
which
indicated
a
higher
monthly
payment
for
resident
care
than
the
resident
can
afford.
D
When
the
contract
ends,
the
resident
is
evicted
for
non-payment
and
then
the
discharge
and
eviction
rights
for
long-term
care
settings
that
do
not
fall
under
the
nursing
home
reform
act.
The
settings
rule
for
residents
on
the
medicaid
waiver
program
have
protections
if
they
are
denied
for
services.
However,
they
do
not
have
an
appeal
process
if
they
receive
an
eviction
letter.
D
D
Workforce
challenges:
there
is
an
ongoing
pandemic
recovery
nurse.
The
nursing
home
industry
has
shed
roughly
235
000
jobs
since
march
2020.
According
to
an
analysis
of
the
u.s
bureau
of
labor
statistics,
data
according
to
an
article
from
aarp,
dangerous
working
conditions,
poor
pay
and
benefits,
limited
advancement
and
burnout
are
all
factors.
D
A
personal
needs
allowance
residents
in
skilled
nursing
facilities
who
receive
financial
support
by
medicaid
are
entitled
to
35
dollars
in
personal
needs,
allowance
to
be
used
for
to
be
used
for
items
such
as
clothing,
personal
items
and
incidentals,
with
inflation
with
inflation,
increasing
costs
of
everyday
items.
35
dollars
must
be
saved
for
many
months
to
be
able
to
replace
basic
clothing
for
residents.
D
The
long-term
care
ombudsman
program
is
recommending
a
change
for
residents
who
receive
a
federal
benefit
rate
such
as
social
security
or
disability
income,
to
receive
15
of
this
income
as
a
personal
needs
allowance,
and
also
allow
in
an
annual
and
annual
assessment
of
the
personal
needs
allowance.
Currently,
many
states
have
increased
the
personal
allowance
as
well
as
implemented
an
annual
assessment.
D
B
B
Each
waiver
is
administered
by
the
division
of
health
care,
financing
and
policy,
also
known
as
medicaid
between
the
two
agencies,
adsd
and
the
division
of
healthcare
financing
and
policy.
We
collaborate
to
develop
the
policy
and
procedure
of
these
waivers
to
ensure
the
most
adequate
opportunity
for
services
is
made
available
to
those
most
vulnerable
within
our
state.
B
Each
waiver
has
the
eligibility
requirements
set
forth
in
the
waiver
application,
which
allows
those
who
meet
a
nursing
facility
level
of
care
access
to
in-home
services.
Each
waiver
requires
that
an
individual
be
at
or
below
300
of
the
social
security
income
threshold
and
require
at
least
one
ongoing
waiver
need.
B
So
cbc
also
administers
and
operates.
Three
state-funded
programs,
including
the
community
service
option
program
for
the
elderly,
referred
to
as
cope
the
personal
assistance
services
program
referred
to
as
pas,
and
the
taxi
assistance
program
referred
to
as
tap
the
cope
and
pass
programs
are
very
similar
to
the
frail
elderly
and
physically
disabled
waivers.
B
A
Excuse
me
miss
wren.
Yes,
could
I
ask
you
to
wait
for
a
few
minutes,
we're
having
a
difficulty
with
our
getting
the
presentation
up.
B
A
B
Yes,
thank
you,
madam
president,
for
the
record
crystal
rand
chief
of
community-based
care
with
aging
and
disability
services
division.
I
will
continue
on
slide
14
for
those
in
the
audience
we're
about
halfway
through
this
slide.
B
So
as
as
stated
previously,
the
cope
and
the
pass
programs
are.
Are
state-funded
programs
intended
to
serve
those
either
waiting
for
a
waiver
slot
to
open,
so
they
can
have
entrance
to
that
medicaid
funded
program?
It's
also
intended
for
those
that
are
above
the
income
threshold,
or
maybe
they
have
too
many
resources
for
them
to
benefit
from
receiving
services
in
the
community.
B
The
tap
program.
The
taxi
assistance
program,
is
a
service
that
allows
individuals
in
clark
county
the
option
to
purchase
discounted
taxi
coupons
to
be
available
for
the
use
within
clark
county
taxi
cab
providers.
This
service
is
available
to
those
over
the
age
of
60
and
also
those
with
a
permanent
disability.
B
B
B
The
orange
color
signifies
those
that
have
waited
less
than
90
days,
and
the
blue
color
are
those
that
have
waited
more
than
90
days.
We
have
seen
seen
an
increase
in
the
waitlist
counts
over
the
past
few
months,
mostly
based
on
staff
shortages
and
a
decline
in
service
provider
options
in
the
community,
and
I
will
get
into
those
later
in
the
presentation.
B
So
this
slide
sorry,
so
this
slide
shows
those
that
are
in
a
pending
status
for
the
frail
elderly
and
physically
disabled
waivers.
So
the
color
again,
the
left
side
is
going
to
be
your
frail
elderly
waiver.
The
right
side
is
going
to
signify
your
physically
disabled
waiver
and
the
the
color
indicates
specific
time
frames
for
each
waiver.
B
It
follows
the
same
format.
It
is
for
fiscal
year
22
to
date,
so
so
this
has
the
same
number
data
range
that
the
other
slides
have.
It
signifies
those
that
are
in
a
pending
status.
What
that
means
are
these
are
individuals
that
have
been
awarded
a
wait
list
slot
and
we
are
ready
to
proceed
further,
so
we
have
submitted
an
application
to
the
division
of
welfare
and
supportive
services
to
perform
a
financial
review
for
eligibility,
and
we
are
also
waiting
for
nevada
medicaid
to
make
a
final
approval
for
these
individuals.
B
So
the
reason
we
have
45
days
called
out
on
this
slide
is
the
nevada
medicaid
office
has
40,
I'm
sorry.
The
division
of
welfare
and
supportive
services
office
has
45
days
to
process
an
application,
so
the
45
days
signifies
how
much
time
has
has
elapsed
since
we
have
received
a
slot
awarded
the
slot
and
we
are
waiting
for
the
next
steps
to
be
taken.
B
B
B
B
The
program
capacity
slide
demonstrates
how
many
slots
are
available
for
each
home
and
community-based
service
waiver
that
cbc
oversees,
as
well
as
the
pas
and
the
cope
program.
I
will
point
out
the
significant
difference
in
caseload
capacity
for
the
fvnpd
waivers,
which
have
medicaid
funded
monies
associated
with
them
versus
the
state
funded,
cope
and
pass
programs.
B
B
B
So,
let's
talk
about
the
challenges
cbc
has
seen
over
the
past
several
years.
We
have
faced
challenges
which
are
no
no
different
than
national
challenges
and
challenges
within
other
agencies
within
the
state.
Currently
cbc
has
a
61
vacancy
rate
within
our
intake
team.
This
causes
delays
in
processing
applicants
to
get
through
the
process
for
waiting
for
a
slot
or
just
to
move
to
the
next
process
prior
to
being
eligible
for
the
program
they
have
applied.
For
our
ongoing
case
management
position
has
a
26
vacancy
rate.
B
B
Our
providers
we
partner
with
are
facing
many
of
the
same
challenges
relating
to
staffing
concerns,
they're
struggling
to
hire
caregivers
and
many
times.
We
find
that
the
administrator
of
the
agency
is
performing
direct
services
him
or
herself
just
to
make
sure
that
the
individuals
that
they
serve
are
getting
what
they
need.
They
they're
on
the
floor
doing
the
job.
B
B
This
presents
challenges
to
our
case
managers,
who
reach
out
to
providers
weekly
to
staff
and
see
where
they
are
at
with
their
availability
of
services
and
many
times
we
we
hear
from
providers
that
they
cannot
take
anymore.
They
don't
have
staff
to
provide
the
services
and
they
don't
have
the
the
capacity.
B
So
our
case
managers
are
are
looking
for
service
providers
weekly
to
see
who
we
can
get
staffed
for
for
various
various
needs
in
the
community.
B
Many
times
we
will
see
that
an
individual
receives
partial
service
delivery,
and
that
is
again
due
to
the
capacity.
So,
for
example,
if
they're
authorized
for
30
hours
per
week,
the
provider
may
only
be
able
to
provide
20
hours
per
week,
so
the
recipient
is
left
just
deciding
which
which
services
are,
are
the
most
need
at
that
time
and
then
a
lot
of
times.
We
do
rely
on
non-paid
caregivers,
such
as
family,
friends,
neighbors
and
other
supports
that
are
available
in
the
community.
B
B
B
B
B
Finally,
across
many
programs,
especially
public
programs
such
as
the
waivers
there
is
a
narrow
view
of
what
respite
is
or
who
can
provide
this
service.
One
of
the
largest
providers
of
respite
services
is
personal
care
agencies.
However,
respite
can
be
provided
to
family
caregivers
in
a
number
of
different
ways.
A
F
Do
you
have
any
solutions
for
staff
for
to
to
increase
staffing,
it's
a
huge
issue
everywhere,
and
not
only
for
the
administrative
but
certainly
like
you
pointed
out
this,
the
actual
caregivers.
So
that's
one
of
the
I
thinks
we
need
to
tackle
that
problem.
When
are
there
any
any
good
solutions.
B
B
As
far
as
the
caregiver
agencies,
I
do
know
that
the
the
university
of
nevada
reno
is
working
on
some
studies
to
see
what
kind
of
increases
can
be
made
to
sustain
provider
support
and
then,
within
the
agency,
we
are
working
together
to
to
see
what
kind
of
solutions
we
can
come
up
with,
such
as
training
for
caregivers
respite,
which
was
mentioned
earlier,
really
broadcasting
that
service
to
make
that
available
to
folks.
So
they
don't
receive
that
caregiver
burnout.
B
We
are
also
working
with
nevada,
medicaid
and
other
entities
regarding
a
rate
study
to
see
if,
if
there
are
any
increases
that
can
be
requested
to
see
if
that
would
help
sustain
the
provider
workforce
in
regards
to
the
staffing
shortages
within
cbc,
we
are
working
with
our
human
resources
department
and
with
the
the
department
of
health,
human
resources
and
management
for
outs
advertising
these
jobs
to
to
different
universities
and
different
entities,
to
really
get
the
the
information
out
that
we
are
looking
for
licensed
individuals
for
the
social
worker
positions.
G
G
Yes,
this
is
lucia,
lucille,
we're
speaking
lucille
ayden,
all
right
lucille
go
ahead.
Yes,
I'd
like
to
ask:
how
do
you
handle
the
situation
when
you
have
the
patience
already
and
they're
not
able
to
get
the
care
that
they
need
because
of
the
shortage?
How
do
you
handle
that?
It's
a
it's
a
bad
situation.
B
So
this
is
crystal
wren,
with
aging
and
disability
services
division
for
the
record.
Thank
you
for
the
question.
This
is
a
challenge
that
we
are
facing
daily.
Unfortunately,
so
we
do
have
licensed
individuals
who
do
the
case
management
activities,
so
they
are
able
to
reach
resources
within
the
community
and
within
our
division,
to
see
about
getting
additional
services
in
the
home
many
times
an
individual
who
is
not
receiving
the
the
amount
of
care
that
they
need,
by
example,
of
requiring
30
hours
and
receiving
20..
B
What
we
will
do
is
we
will
increase
our
contact
with
that
individual
to
make
sure
that
their
health
and
safety
is
assured,
while
they're
in
their
home.
So
we
may
reach
out
monthly
instead
of
quarterly,
for
example,
or
they
have
our
phone
number,
they
may
talk
to
them
weekly.
It
really
depends
on
an
individual
basis,
but
that
is
something
that
we
have
been
really
struggling
with
as
an
agency
and
making
those
weekly
contacts
to
our
our
enrolled
provider
community
to
make
sure
that
they
have
that
availability
is
the
first
step.
E
I
went,
can
you
hear
me,
I'm
sorry.
K
E
Sorry,
oh
yes,
there
it
is.
I
have
two
just
points
of
clarification
that
I
wanted
to
ask
about.
When
you
refer
to
providers-
and
you
talk,
I
guess
this
question
would
be
for
miss
ren.
You
talked
about
that.
Some
of
them
are
not
taking
more
cases
in
terms
of
because
of
staff
shortages
and
payments.
E
Are
you
talking
about
providers
in
terms
of
agencies
like
home,
health
care
agencies
and
hospice
support
or
individuals,
or
all
of
the
above
is
one
question
and
then
the
other
point
of
clarification
I
wanted
was
on
the
waivers
that
you
talked
about,
that
the
state
is
providing
and
you're
allowing
people
on
the
waiting
list
to
access
the
services.
E
B
Thank
you
for
the
question
crystal
wren
aging
and
disability
services,
division
for
the
record
I'll
start
with
your
first
question
regarding
what
a
provider
is
identified
as
with
in
my
unit.
B
So
unfortunately
I
I
think
we
do
forget
that
we
have
internal
state
speak
and
then
there
is
some
some
language,
so
a
provider
when
I,
when
I
say
a
provider
that
is
generally
going
to
be
your
personal
care
agency,
it's
going
to
be
any
any
company
that
has
enrolled
with
nevada,
medicaid
or
enrolled
with
aging
and
disability
services,
division
to
provide
a
service
and
be
reimbursed
for
said
service.
So
some
of
our
partner
units
will
say
community
partners,
provider
agencies.
B
So
yes,
so
that
that's
exactly
who
that
is
for
your
second
question
regarding
individuals
on
the
waitlist
for
the
waivers.
So
when
I
say
that
they
can
access
services
while
waiting
that
would
be
accessed
through
the
cope
and
pass
program
which
are
state
funded
programs.
B
For
example,
an
individual
who
is
waiting
for
the
frail
elderly
waiver
will
meet
the
same
requirements
as
the
cope
program
due
to
the
income
and
the
the
the
age
limit,
and
then
the
physical
need.
So
what
we
can
do,
while
they
are
waiting
for
a
waiver
slot
to
become
available,
is
we
can
put
them
on
to
our
cope
program
or
for
the
physically
disabled?
They
can
go
on
the
paths
program
and
they
can
access
services
through
state
general
fund
reimbursed
services
for
the
same
provider,
community.
E
A
Thank
you,
dr
jordan.
You
have
a
question.
I
I
certainly
do
for
the
record
marilyn
jordan,
representing
district
11..
My
question
is
for
miss
cole
in
regards
to
the
personal
needs
allowance
35
a
month
that
hasn't
been
moved
or
changed
since
1991.
Could
you
share
with
us
what
steps
have
been
taken
to
try
and
raise
that
price.
C
C
I
I
So
I
do
sincerely
hope
that
we
address
that
issue
and
that
you
get
back
to
us
on
next
steps
for
what's
going
to
happen,
this
is
not
acceptable
for
the
state
of
nevada
at
all.
Thank
you.
I.
F
F
F
F
A
C
C
C
C
This
income
can
also
provide
for
for
items
like
that
which
could
not
be
a
donated
item.
I
do
agree
with
you
that
there
needs
to
be
more
awareness
about
the
ability
to
donate
to
adults
in
these
settings,
because
there
is
a
need
for
them
to
have
basic
items
that
the
community
would
rally
and
be
able
to
help
provide
for
them.
H
Thank
you
back
to
personal
needs
allowance
on
slide,
eight,
that
thirty
five
dollars.
That's,
who
pays,
that
is
that
medicaid
federal
tax
dollars
that
comes
to
those
programs,
and
then
second
part
of
that
question,
is,
is
that
the
amount
that
nevada
folks
are
receiving
at
this
time.
C
C
We
are
asking
for
similar
to
social
security,
which
is
reviewed
every
year
and
disability
as
well,
for
the
resident
to
be
able
to
keep
a
percentage
instead
of
a
stated
dollar
amount,
a
percentage
of
that
income
which
would
be
reviewed
annually
and
be
a
higher
amount
for
them
to
be
able
to
spend
on
their
needs,
so
their
personal
needs
allowance
would
also
increase
with
that
review
and
similar
with
other
states.
They
have
a
15
percent
allowance
that
they
are
providing
to
the
residents
to
keep,
and
that
amount
is
much
higher.
H
C
H
Okay
and
nevada,
medicaid's
controlled
by
the
state
legislature-
yes,
okay,
just
some
clarification
and-
and
you
may
not
know
this
answer
so
those
other
amounts
the
examples
here
you
got
from
arizona
colorado.
Those
were
changed
through
some
kind
of
legislative
legislature,
action
to
increase
those
amounts
to
the
best
of
your
knowledge.
Yes,
thank
you
very
much.
Thank
you.
Can
I,
madam
sharon,
some
more
questions.
A
One
moment,
let
me
see,
does
anyone
else,
dr
jordan
first
and
then
we'll
go
back
to
you.
Mr
truth,
thank
you.
I
Very
much
as
I
understand
it,
each
state
determines
the
amount
of
money
and
in
terms
of
social
security,
for
example,
social
security
increased
in
2022,
5.3
percent,
and
none
of
this
has
changed
or
helped
or
aided
any
of
our
residents.
And
as
a
representative
for
our
seniors,
we
definitely
need
to
address
this
issue.
I
can't
think
of
a
milli.
I
can
think
of
a
million
things
that
one
item
would
cost
more
than
35
dollars,
and
this
needs
to
be
brought
to
the
state
legislature
as
soon
as
possible.
C
F
A
Peggy
levitt,
I
see
you
have
your
hand
up
go
ahead,
I
mean
so
laura
levitt,
I'm
sorry.
It's
laura
levitt.
You
have
your
hand
up.
E
Yes,
I'm
going
back
to
the
provider
shortage
that
was
mentioned
earlier,
and
this
is
coming
up
in
another
presentation,
but
I
just
wanted
to
mention
that
from
a
few
years
back
isn't
the
staff
shortage
because
of
how
little
the
people,
the
actual
providers,
caregivers,
that
work
for
the
providers
are
getting
paid,
that's
10
to
11
an
hour
and
that
we
were
well.
There
are
several
pushes
to
have
that
increase
to
15
dollars
an
hour.
B
For
the
record
crystal
run
asian
disability
services
division,
so,
for
my
knowledge,
that
is
one
of
the
reasons
that
we
have
heard
throughout
is
the
the
low
reimbursement
wage
for
staff.
B
Crystal
run
for
the
record,
I
I'd
have
to
get
back
to
you
on
that.
I
don't
know
if
there's
a
specific
area
that
controls
the
wage.
I
know
that,
with
the
rates
for
the
services
rendered
through
nevada
medicaid,
that
is
the
reimbursement
rate
that
is
issued
to
the
agency,
and
that
rate
is
to
control
the
administrative
overhead
as
well
as
the
hourly
wage,
but
nevada
medicaid
does
not
control
the
actual
wage
that
is
reimbursed
that
is
dependent
on
each
agency
themselves
as
an
independent
party,
so
any
anything
outside
of
nevada
medicaid.
E
Okay,
thank
you
because
10
to
11
an
hour
is
not
something
that
would
mean
a
long,
lasting
job.
I
would
think
there's
jobs
that
panda
express
currently
for
advertising
19
an
hour,
so
just
want
to
mention
that.
Thank
you.
H
Sorry,
roger
trotham
district
8.
slide
12
on
the
cbc
programs
question
for
those
three
programs.
How
often
is
the
criteria
reviewed
and
adjusted
for
people
looking
to
get
into
those
programs?
Any
idea.
B
Crystal
run
for
the
record
agent
agent
excuse
me
aging
and
disability
services
division.
The
criteria
is
set
within
the
waiver
application,
which
is
a
document
approved
by
the
centers
for
medicare
and
medicaid
services.
This
is
reviewed
and
reapplied
for
every
five
years,
so
it
has
a
kind
of
like
a
five-year
benchmark.
B
There
are
some
standards
that
are
within
the
federal
requirements
for
each
waiver
type
depending
on
the
population
you
serve,
so
that
some
of
that
does
mirror
those
entrances,
such
as
the
level
of
care.
That
is
a
that
is
a
requirement
for
every
waiver
within
the
nation,
every
1915
c
waiver.
I
should
clarify
to
have
a
nursing
facility
level
of
care.
The
income
thresholds
can
be
reviewed
by
each
state.
B
B
Crystal
brennan,
for
the
record,
I
I
I
would
say
it's
a
good
healthy
mix,
so
so
the
federal
government
has
what's
called
a
waiver
application,
it's
kind
of
like
your
your
policy
on
how
to
write
your
waiver
application
and
it
does
have
certain
requirements
within
it,
but
but
the
cms
does
try
to
give
states
leeway
to
to
build
the
program
according
to
the
need
within
the
state,
which
is
what
these
waivers
have
been
built
on.
That's
that's
where
the
300
threshold
comes
in.
B
So
the
administrator
of
the
waiver-
excuse
me
crystal
run
for
the
record.
The
administrator
for
the
home
and
community-based
waivers
is
the
division
of
health
care
financing
and
policy
aka
medicaid
and
then
the
operating
agency
is
us
the
aging
and
disability
services
division.
So
it's
it's
a
partnership.
H
Thank
you
one
more,
madam
chair,
sorry,
19
to
slide
19
area
caregiver
support
services,
I'm
going
to
ramble
just
a
couple
things
here
and
then
I'd
like
what
you
all
have
some
ideas.
A
lot
of
the
support
of
the
services
that
are
provided
are
some
type
of
private
company.
H
What's
the
state
and
you
folks's
opinion,
and-
and
I
know
you
have
to
be
careful
on
some
of
that-
of
where
the
industry
is-
we've
had
some
comments.
I
think
we're
gonna
talk
about
later.
You
know
pay
scales
and
we
are
looking
at
this
a
lot
of
money
involved
in
how
to
do
this,
and
obviously
people
aren't
going
to
do
things
for
minimum
wage
and
whatever
does
private
insurance
does
government
funds
and
the
mixture
of
money
available.
H
It
doesn't
sound
like
there's,
that's
being
either
utilized
or
not
enough
to
provide
level
compensation
for
competent
support
and
help
in
some
of
these
programs.
Do
you
all
look
at
that
struggle
with
that?
I
know
you're.
Looking
at
you
know,
you've
got
workers.
Caseworkers
can't
find
services
for
people.
H
Is
insurance
companies
not
always
available
to
do
that?
There's
a
regulation,
that's
that
keeps
them
from
being
more
profitable
in
doing
some
of
this
and
then
that's
the
last
comment
I'm
going
to
have
on
this
blog.
B
So
thank
you
for
the
question
crystal
ren
aging
and
disability
services.
Division
for
the
record,
so
many
of
the
services
that
are
offered
through
nevada
medicaid
for
the
waiver
populations
and
then
the
state
funded
options
that
we
went
over
today
are
are
not
through
private
insurance.
So
many
private
insurance
do
not
reimburse
for
personal
care
related
services.
B
Respite
generally
falls
into
that.
So
a
lot
of
these
are
really
dependent
on
your
your
federally
funded
monies,
as
well
as
your
state
general
fund.
So
so
there
is
a
there
is
a
connection
with
these
services
between
the
federal
funding
and
the
state
funded
programs
to
ensure
that
they
are
doing
what
they
need
to
support
our
vulnerable
populations,
but
the
private
insurance
is
is
not
generally
a
mix
into
that.
A
E
Perfect
this
question
lisa
laughlin
for
the
record.
This
question
is
for
miss
wren.
Just
one
more
point
of
clarification
on
the
waivers
again,
I
had
the
same
question
about
how
often
they're
reviewed,
but
do
you
have
any
statistics
on
how
long
once
people
are
on
the
probe
on
these
programs
and
obviously
they
may
differ,
because
some
are
frail
and
elderly
and
some
have
some
special
needs.
How
long
are
people
generally
on
the
programs?
Do
they
are
they
on
and
off
or
once
they're
on?
Are
they
generally
on?
B
Thank
you
for
that
question
crystal
run,
aging
and
disability
services
division
for
the
record.
We
do
have
data,
I
do
not
have
it
today.
I
can.
I
can
get
that
and
provide
that
to
the
to
the
committee.
I
will
say
that
we
do
see
a
lot
of
individuals
once
they
are
approved
for
a
waiver
and
they
are
on.
They
are
generally
on
until
they're
into
the
next
stage,
either
in
a
nursing
facility
or
unfortunately,
they
they
pass
away.
So
so
it's
usually
a
long
term
assistance
that
we
do
provide.
B
B
B
Most
of
the
frail
elderly
by
nature
is
going
to
be
a
shorter
duration
that
they
are
on
the
services
again
either
they
they
go
into
a
long-term
service
area
or
or
perhaps
they
they
move
out
of
state
or
they're
no
longer
with
us.
So
we
we
do
see
that
that
is
not
as
long,
but
I
will
definitely
get
some
information
back.
A
Thank
you.
I
have
a
question
for
you,
miss
wren
on
page
12,
where
you
talk
about
the
taxi
assistance
program
in
clark
county.
The
rtc
has
a
bus
program
to
help
seniors
and
physically
disabled.
A
B
Thank
you
for
the
question
crystal
run,
aging,
disability
services,
division
for
the
record.
The
the
taxi
assistance
program
is,
is
funds
received
through
the
taxi
cab
authority,
and
it
is
only
for
taxi
cab
services,
so
so
the
rtc
would
be
excluded.
A
C
C
C
A
F
I
have
a
question
for
seniors
that
are
already
in
long-term
care
facilities
or
nursing
homes
and
so
forth
and
they're
paying
they're
paying
they
paying
for
them,
but
on
their
own
funds
and
so
forth.
If
they
run
out
of
money,
what
happens
to
those
people.
C
For
the
record,
marie
co
interim
long-term
care,
ombudsman
people
who
are
in
skilled
nursing
facilities
if
their
income
continues
to
be
spent.
So
if
the
person
had
a
house
that
was
sold
and
that
money
is
now
being
spent
towards
their
care,
if
all
of
that
money
is
spent
down
and
then
their
monthly
income
qualifies
for
institutional
medicaid,
then
the
facility
would
assist
them
to
apply
for
institutional
medicaid
and
they
would
still
be
entitled
to
have
a
personal
needs
allowance
based
on
their
ongoing
income.
C
So,
typically
somebody
who
is
retired
has
social
security,
maybe
a
pension
from
an
employer.
It's
not
a
lot
and
it
doesn't
cover
the
amount
of
cost
for
skilled
nursing
facilities,
and
so
all
of
that
income
goes
to
the
nursing
home
for
their
care,
and
at
the
moment
they
are
only
allowed
to
keep
this
35
dollars
per
month.
A
A
A
We
will
now
have
miss
kayla,
samuels
and
miss
terry
henwood
of
the
division
of
public
and
behavioral
health
present
an
overview
of
senate
bill
340
from
the
2021
legislative
session.
With
information
about
the
home
care
employment
standards
board.
We
will
take
questions
from
members
at
the
end
of
the
presentation.
L
Thank
you
for
the
record.
My
name
is
kayla
samuels,
I'm
a
management
analyst
with
the
division
of
public
and
behavioral
health.
Originally,
my
co-presenter
was
supposed
to
be
cody,
finney,
deputy
administrator
for
the
division
and
chair
of
the
home
care
employment
standards
board.
Unfortunately,
she
was
unable
to
join
us
today,
so
terry
henwood
has
kindly
stepped
in.
L
L
J
J
J
Which
states
upon
receipt
of
an
application
for
a
license?
Healthcare
quality
and
compliance,
may
conduct
an
investigation
into
the
premises,
facilities,
qualifications
of
the
personnel
methods
of
operation,
the
policies
and
purpose
of
any
person
proposing
to
engage
in
the
operation
of
a
personal
care
agency.
J
First
and
foremost,
if
a
personal
care
agency
would
like
to
operate,
they
submit
an
application,
that's
where
nrs
449.0307
kicks
in
and
that
application
comes
through
our
licensing
department
and
our
licensing
department
has
their
own
procedure,
but
basically
it
is
to
review
the
application
and
make
sure
that
the
application
meets
all
of
the
requirements
for
the
licensing
department's
standards.
J
So
once
it
fulfills
those
responsibilities,
our
department,
our
regulatory
department,
gets
a
notification
of
that
application
and
then
it's
ready
and
once
it's
ready,
it
will
be
assigned
to
a
surveyor
who
then
goes
out
to
inspect
the
premises,
facilities,
qualifications
of
personnel,
the
methods
of
operation
policies
which
are
described
in
the
slide
there.
J
So
I
did
want
to
kind
of
go
over
because
sometimes
it
it
just
gives
the
authority
and
it
doesn't
describe
the
actual
process,
and
that
is
our
process,
and
we
try
to
do
that
as
as
quickly
as
we
possibly
can,
because
we
do
know
that
personal
care
agencies
are
ready
to
be
licensed
and
ready
to
provide,
provide
care
to
to
clients
the
second
power
and
duty
of
health
care
quality
and
compliance.
I'd
like
to
review
with
you
today
is
the
complaint
process.
Nrs
449.0307.
J
That
complaint
goes
through
a
variety
of
channels.
First
and
foremost,
it
goes
through
our
complaint
department
channel
who
reviews
the
the
complaint
and
then
assigns
it
to
actually
myself
or
another
supervisor.
At
that
point
we
receive
it.
We
review
it
to
see
that
the
allegations
are
that
are
made
are
categorized
appropriately
for
investigation.
J
I'd
like
to
move
on
to
the
next
slide,
which
states
common
sanctions
applied
by
our
department
to
personal
care
agencies,
and
I'd
like
to
say
before
I
go
over
this-
that
our
department
is
very
invested
in
working
with
the
providers,
the
the
license
ease
and
we
want
to
work
with
them
before
we
get
to
a
sanctioned
type
of
a
place.
J
So
one
of
the
things
that
we
we
do
work
with
the
facilities
on
is
trying
to
come
into
compliance,
but
sometimes
that
isn't
it
doesn't
work
that
way
and
sometimes
the
agencies,
they
they
don't
come
into
compliance,
and
so
therefore
sanctions
are
required.
Sanctions
can
be
imposed
for
a
number
of
reasons.
I
wanted
to
provide
some
examples
of
why
a
sanction
would
be
on
the
table.
J
One
is
if
we
go
out
on
a
complaint
and
we
substantiate
that
complaint
or
some
type
of
egregious
reason,
such
as
abuse
or
neglect
if
there
are
high
severity
levels
of
citations.
J
So
if
our
inspectors
go
out
onto
the
premises
and
find
that
there
is
deficient
practice,
it's
not
just
the
deficient
practice,
but
the
severity
of
that
practice
and
how
many
people
are
affected.
J
J
Before
we
get
into
denial,
suspension
or
revocation
of
a
facility,
we
try
to
go
more
of
a
least
restrictive
route,
and
so
some
of
those
those
options
there,
which
include
the
directed
plan
of
correction,
a
ban
on
admissions,
a
monetary
penalty.
J
Those
may
be
imposed
as
a
lesser
restrictive
option
before
denying
suspending
or
revoking
a
license.
That
is
really
a
last
resort.
Have
we
had
to
do
it?
J
Yes,
we
have,
but
we
do
try
to
bring
the
facility
into
compliance
by
asking
them
to
either
direct,
have
a
directed
plan
of
corrections
that
will
address
the
problem,
pose
a
ban
on
their
admissions
or
or
possibly
dole
out
a
monetary
penalty,
but
even
before
those
sanctions,
we
do
try
to
work
with
the
facility
and
if
we
could
move
on
to
the
next
slide,
this
will
be
the
final
slide.
J
J
We
do
have
a
process
for
this
and
before
we
believe
that
an
agency
is
operating
a
facility
without
a
license,
we
usually
get
a
tip
off
or
a
complaint
if
you
will
and
which
states
that
there's
an
address-
and
they
may
believe
that
an
unlicensed
facility
is
operating,
an
unlicensed
facility
would
be
in
a
facility.
That's
providing
some
kind
of
care,
including
medication
management,
hygiene.
J
J
They
review
and
inspect
the
premises,
and
if
they
find
that
indeed
this
is
an
unlicensed
facility
in
order
to
cease
and
desist
the
operation
of
that
facility
is
provided
at
that
time.
The
order
is
served
by
personal
delivery,
as
the
inspectors
are
on
site
or
a
by
certified
or
registered
mail.
The
order
is
effective
upon
that
service.
J
At
that
point,
the
agency
could
choose
to
cease
operation
and
the
penalty
process
would
end
right
there,
but
the
agency
could
also
apply
for
a
license
within
30
days,
and
the
penalty
process
would
also
end
there,
so
they
do
have
a
couple
of
options
once
provided
that
cease
and
desist
notice.
The
agency.
J
J
If,
unfortunately,
an
action
has
to
be
brought
in
court,
our
department,
healthcare
quality
and
compliance
will
show
the
court
that
the
agency
is
operating
without
a
license.
So
we
would
provide
our
evidence
in
the
form
of
observation
and
interviews
and
record
reviews.
If
there
are
record
reviews,
we
would
present
that
and
then
the
court
may
urge
the
agency
against
operating
the
facility
or
potentially
impose
a
civil
penalty
on
the
operator
to
be
recovered
by
health
care
quality
and
compliance
of
no
more
than
10
000
for
the
first
offense
ten
thousand
dollars.
So
that
is
a.
J
I
just
wanted
to
point
out
that
that
is
potentially
what
could
happen,
of
course,
just
like
sanctions,
and
we,
our
department,
likes
to
work
with
providers
out
there
to
not
get
to
that
point,
but
if
it
does
get
to
that
point,
the
final,
the
final
step
in
the
process
is
that
healthcare
quality
and
compliance
deposits,
the
civil
penalty,
into
a
separate
account
in
the
state
general
fund
to
be
used
to
administer
provisions
of
the
nrs
449.001
through
449.430.
J
That
would
conclude
the
presentation
for
healthcare
quality
and
compliance.
We
do
have
a
question
and
answer
period
on
the
next
slide.
L
F
Thank
you,
madam
sherwood.
Go
please
to
the
last
slide
where,
if
the
agency
applies
for
a
license
within
30
days,
the
penalty
process
ends.
Does
that
mean
at
that
point?
It
goes
back
to
the
investigation
of
the
application
and
the
process
starts
over.
J
Yes,
so
once
I
I
hope,
I'm
answering
your
question
correctly,
but
once
they
decide
and
make
a
determination
that
they
will
go
ahead
and
follow
through
with
the
application
process
and
they
have
the
30
days,
they
will
go
through
the
licensing
unit
of
our
department
and
submit
the
application,
and
we
would
be
monitoring
this
facility.
The
entire
way.
J
Not
to
my
knowledge
again
for
the
record,
terry
henwood,
not
to
my
knowledge,
those
facilities
that
apply
to
be
licensed.
To
make
that
effort.
J
Our
department
sees
that
as
a
show
of
good
faith,
and
we
do
attempt
to
work
with
them
now,
that's
not
to
say
that
it
may
take
a
little
bit
longer
because
they
don't
have
the
they
are
not
qualified
per
se
in
our
regulatory
standards.
But
we
do
attempt
to
work
with
those
facilities
and
not
to
my
knowledge.
Sir.
Have
we
had
someone
apply
for
licensure
and
be
denied.
K
F
E
Thank
you
on
the
creation
of
discord
from
sb
340.
E
And
then
it
indicates
further
down
that
they're,
also
looking
at
the
sufficiency
of
recruitment
and
retention,
and
that
this
may
not
go
to
the
director
richard
whitley
until
december.
E
Or
do
you
know
if
that's
just
that
they
may
come
back
with
something
sooner
and
that's
just
what's
written
in
the
law,
because
it's
at
a
crisis
state
now
with
providers
and
caregivers
from
what
my
understanding
is.
L
L
F
E
Yes,
thank
you
lisa
laflin,
for
the
record.
My
questions
are
also
about
sb
340
I'll
piggyback
a
little
bit
with
the
the
last
question
about
the
recommendation
for
increased
minimum
wage
and
I'm
thinking
back,
which
I
don't
disagree
with,
because
I
it's
a
skill.
E
We
need
to
pay
these
people,
but
I'm
trying
to
figure
out
the
whole
circle
in
terms
of
money,
because
there's
the
also
a
reference
to
low
reimbursement
for
providers,
so
it
seems,
like
you
know,
we
have
a
funding
circle
problem,
so
I
wanted
some
insight
on
that
and
how
we're
trying
to
work
through
that
and
then
also
on
slide
nine
there.
There
were
the
three
points
about
500
supplemental
payments.
E
That
facilities
are,
I
guess,
required
to
or
expected
to
ask
for
the
money
that
money,
but
then
there
was
also
a
reference
to
the
employers
paying
for
the
training.
So
I
guess
my
question
is
for
additional
training
and
education,
which
is
great,
but
does
that
supplemental
funding
pay
for
that
education
or
are
those
two
separate,
I'm
not
sure
how
that
all
goes
together?
I
guess.
L
Kayla
samuels
for
the
record
and
terry,
please
feel
free
to
jump
in
if
you
have
more
concrete
information,
so
I'll
kind
of
tackle
your
questions
and
the
different
parts,
if
that's
all
right
for
the
increased
minimum
wage
as
well
as
the
rates,
the
board
is
actually
planned
to
address
that
at
the
next
meeting,
which
is
next
tuesday,
the
28th
at
2
pm
over
zoom.
L
L
As
far
as
the
500
supplemental
payments,
that
was
from
the
medicaid
home
and
community-based
services
plan,
and
that
is
and
as
well
as
the
15
supplemental
payment
to
the
providers
is
separate
from
the
retraining
requirement.
The
training
requirement
is
an
nac,
and
so
the
recommendation
was
to
change
that
statute
to
reflect
that
employers
are
expected
to
pay
for
all
required
training.
L
J
Hello,
it's
terry
hanwood
again
for
the
record,
each
cqc
supervisor
kayla.
Yes,
she
said
it
perfectly.
That
is
correct,
and
I
would
also
just
like
to
piggyback
that
she
did
mention
at
the
the
end
there
that
we
are
working
on
on
regulatory
language
to
address
the
the
recommendation
that
the
provider
pay
for
the
training.
So
we
are
in
the
process
of
that
as
well.
H
J
J
H
On
slide
12
again
under
powers
and
duties,
there's
some
discussion
there
about
training
and
the
standards
are
I'm
assuming
that
the
state's
providing
the
standards
and
is
that
in
the
nrs
and
then
what
is
the
training
requirement
who's
directing?
Who
provides?
Who
created
that
curriculum
for
the
training
for
these
type
of
positions
and
workers.
J
Terry
henwood
for
the
record
again,
thank
you
for
your
question.
I'll.
Try
to
answer
that
as
concisely
as
possible:
our
regulatory
requirements.
We
have
a
variety
of
of
nevada,
administrative
code
regulations
that
address
training.
J
There
are
several
trainings
that
our
attendants
undergo
there's
training
at
the
beginning
of
higher
that
is
housed
in
one
nac.
There
are
regulations
for
annual
trainings
tb
testing
physical
examinations
cpr,
so
it
there
are
quite
a
few
regulatory
requirements
regarding
training.
These
trainings
at
the
time
of
higher
include
several
different
personal
care.
J
So
there
are
several
of
those
nacs
and
I
would
like
I
would
like
to
ask
if
it
is
something
that
the
committee
would
like,
maybe
a
list
of
the
different
nevada
administrative
code
sections.
I
could
provide
that
to
the
committee
via
email,
but
there
are
several
and
it's
a
good
question.
H
J
Again,
terry
henwood,
for
the
record
very
good
question
these
trainings
can
be
provided
by
the
provider
themselves.
We
do
not
have
a
regulation
that
states
where
they
need
to
have
these
trainings.
We
just
state
in
the
regulations
what
topic
areas
need
to
be
cover
and
how
to
document
that
there
are
several
avenues
that
providers
take.
They
can
take
these
trainings
online.
J
They
can,
like,
I
said,
have
their
have
it
in
house
or
they
can
go
out
to
other
entities
in
person
to
obtain
the
training
as
long
as
it's
in
the
training
area
that
is
deemed
by
the
regulation.
H
Is
this
a
state
only
for
health
care?
This
type
of
health
care
that
we're
talking
about
is
the
state,
the
only
ones
that
do
this
or
are
there
any
other
to
any
of
the
counties
or
cities
get
involved
and
they're
licensing
you
know
of
these
type
of
facilities
because
they
are
in
a
lot
of
the
you
know:
municipalities
and
counties
and
they're
all
licensing,
all
kinds
of
different.
You
know
businesses,
and
this
is
a
business.
H
What
is
that
relationship
in
the
process
of
this
type
of
health
care
that
we're
talking
about.
J
E
Yes,
thank
you,
I'm
just
curious.
If
any,
if
sb
340
or
these
regulations
do
they
affect
private
people,
who
are
you
know,
perhaps
caring
for
their
parents
in
their
home?
You
know
we're
mostly
talking.
It
sounds
to
me
like
providers
and
agencies,
but
I'm
just
curious
if
they
intentionally
or
unintentionally
get
round
up
in
these
anywhere.
L
Kayla
samuels
for
the
record.
Thank
you
for
your
question.
So
from
my
understanding
of
what
has
happened
within
the
board
private
care
workers
and
private
care
agencies
in
general
as
well,
they
tend
to
have
after
effects
from
any
government
or
medicaid
changes
that
occur,
so
it
tends
to
have
a
trickle-down
effect
with
that.
L
E
So
essentially,
it
ties
to
funding
if
they
are
getting
paid
through
the
state
medicare
medicaid
whatever,
then
they,
the
they're,
required
to
be
compliant
with
everything
we're
talking
about.
If
I
move
down
to
las
vegas
and
take
care
of
my
father
for
three
months
on
my
own
time,
that's
a
different
scenario.
L
A
I
do
have
a
question
for
you
at
the
community
college
here:
it's
not
community
college
anymore.
It's
called
something
else
now,
but
they
have
a
class
there
where
you
can
become
a
cna.
A
L
A
L
Ela
samuels
for
the
record,
so
home
care
and
those
who
work
in
home
care
under
personal
care
agencies.
They
are
required
to
have
a
certain
amount
of
training
specified
in
nrs
and
nac.
L
G
G
Yeah,
thank
you,
I
think
you're
mentioning
that
the
home
health
aide,
and
that
is
something
that
can
be
covered
by
medicare.
If
you
have
a
licensed
person
that
is
in
the
house.
G
My
question
is:
is
the
state
involved
in
helping
different
agencies
or
different
companies
that
they're
contracting
with
that
they're
funding?
Are
they
involved
in
helping
them
to
recruit
the
appropriate
people?
I
do
know
that
it
does
in
many
cases
require
licensed
people,
but
there
are
so
many
other
support
staff
that
can
be
involved.
That
does
not
require
a
license.
G
J
J
The
regulations
just
require,
as
I
had
discussed
earlier,
the
variety
of
different
areas
in
what
non-medical
topic
areas
are
required
for
attendance
who
would
like
to
go
into
this
field
and
again
this?
This
training
can
be
provided
to
to
the
attendant
in-house
or
if
they
have
had
other
training
out
in
the
community
that
can
be
considered
as
acceptable,
but
to
piggyback
again
off
of
your
question.
J
We
don't
currently
have
any
recruitment
programs
per
se,
but
I
do
believe
that
the
the
the
home
care
employment
standards
board
is
in
the
process
of
reviewing
those
issues,
and
I
don't
know
where
that
avenue
will
take
our
board,
but
it
is
definitely
something
we
can
bring
up
in
our
board.
L
Kayla
samuels
for
the
record
just
to
add
on
to
that
in
the
scope
of
investigation
for
the
home
care
employment
standards
board
under
sb
340.
One
of
those
is
the
sufficiency
of
levels
of
recruitment
and
retention
of
home
care
employees,
so
that
definitely
is
on
the
docket
for
the
board
to
address
and
one
of
the
tools
we
are
using
to
address.
That
is
the
survey
that
has
gone
out
to
both
home
care,
employers
and
employees.
G
Next,
I'm
sorry!
Well,
how
does
the
state
determine
that
the
funds
that
they
are
being
given,
that
is
being
given
to
different
agencies
and
different
companies
of
that
nature
is
effective?
That
is
actually
making
the
difference?
How
are
they
monitoring
the
care
that
is
being
given
and
or
lack
of
care
that
is
being
given,
and
how
do
they
correct
that,
if
they
are
not
monitoring
it,
if
they
leave
it
up
to
the
individual
companies
to
make
the
rules.
J
Hi
terry
henwood
for
the
record
supervisor
for
healthcare
quality
and
compliance
we
are
monitoring
in.
I
can
only
speak
to
healthcare
quality
and
compliance
regulatory
division.
We
are
monitoring
those
facilities
right
now
on
a
periodicity
rate
of
every
six
years.
That
has
changed
over
the
over
time
where
there
used
to
be
a
periodicity
rate
of
every
18
months
for
personal
care
agencies
to
ensure
that
everyone
is
trained
and
the
clients
within
the
programs
are
receiving
the
care
that
they
agreed
to
and
that
the
provider
agreed
to
provide.
G
Yes,
I
just
had
a
comment
about
a
health
care
facility.
It's
a
private
health
care
facility
called
little
angels,
it's
run
by
husband
and
wife,
and
I
receive
a
complaint
about
them:
they're,
not
getting
nutritious
meals
and
the
health
the
care
they
need.
So
I
was
wondering
now
when
it's
a
husband
and
wife-run
facility.
J
Again,
terry
henwood,
for
the
record.
Thank
you
for
your
question.
We
are
are
monitoring
at
a
periodicity
of
every
six
years.
If
there
is
a
complaint
that
is
presented,
then
we
go
out
more
frequently
when
that
complaint
comes
in.
J
That
could
happen
not
just
every
six
years.
Every
six
years
is
a
a
full
inspection
of
the
facility.
J
We
could
have
just
been
out
at
a
facility
yesterday
and
a
complaint
may
come
in
today
for
the
exact
same
facility,
and
we
will
go
out
on
that
complaint.
So
it
doesn't
we're
not
bound
on
when
we
have
to
go
out.
We
just
need
to
have
the
information
from
the
community
in
order
to
be
able
to
do
our
jobs.
F
A
question
about
training
I'm
coming
out
of
my
professor
bag.
At
this
point,
when
you
one
of
the
healthcare
workers,
goes
through
the
various
prescribed
training
procedures,
is
there
an
examination
at
the
end
of
it,
or
do
we
just
get
a
piece
of
paper
that
says,
we've
sat
through
the
thing
in
a
classroom,
it's
a
little
difficult
for
me,
for
example,
to
see
that
somebody
could
learn
cpr
by
watching
it
online.
J
Terry
henwood
again
for
the
record.
Thank
you
so
much
for
your
question
doctor.
It's
a
wonderful
question.
I
literally
had
it
up
on
my
computer
today,
but
there
is
a
competency
exam
that
not
only
are
our
attendants
supposed
to
be
trained
in
certain
specific
areas.
It's
not
just
the
certificate
that
we
inspect.
For
once
that
the
training
is
complete.
We
would
want
to
see
that
the
attendant
is
competent
in
that
area
and
the
facilities
have
a
variety
of
different
ways
that
they
can
show
that
an
attendant
is
competent
in
a
specific
area.
J
Some
do
a
post
exam,
some
do
an
in-person
demonstration.
Fortunately,
our
regulations
do
not
designate
what
type
of
competency
has
to
be
completed,
but
just
some
type
of
competency
and
what
we
see
a
lot
of
is
the
post
exam
and
the
in-person
demonstration.
J
So
if,
as
kayla
mentioned,
if
there
is
training
in
preparing
meals,
then
they
would
want
to
demonstrate
that
back
to
show
that
they
can
do
that
task
as
far
as
cpr
cpr
should
be.
J
You
had
mentioned
cpr,
so
I
wanted
to
address
it
for
you.
Cpr
has
to
be
taken
in
person
and
through
the
national
red
cross,
so
first
aid
can
be
online,
but
not
the
in-person
cardiopulmonary
resuscitation
that
has
to
be
done
in
person.
A
I
do
have
one:
are
there
background
checks
done
on
the
facility
and
on
the
workers
and
kind
of
a
second
part
of
that,
because
I
sat
through
many
of
these
hearings
for
that
bill:
protection
for
the
workers,
because
in
the
hearings
for
that
bill,
many
of
the
workers
were
subject
to
abuse
physical
abuse.
J
Terry
henwood
for
the
record
hcqc
supervisor,
I'd
like
to
tackle
your
first
question
and
then
I'll
hand
it
over
to
kayla.
The
first
question,
I
believe,
was
about
background
checks
and,
yes,
madam
president,
they
do
go
through.
There
is
a
nevada,
revised
statute
that
not
just
for
personal
care
agencies,
but
also
for
assisted
living
facilities,
which
we
also
license
for
skilled
nursing
facilities,
which
we
also
license.
J
There
is
a
background
check,
requirement
law
and
a
criminal
history
statement
that
I
think,
not
only
fingerprinting
but
a
criminal
history
statement
that
acknowledges
that
any
employee
has
not
been
convicted
of
a
laundry
list
of
crimes
is
completed
at
the
time
of
hire
before
they
are
providing
services
to
clients
and
then,
therefore,
every
five
years.
A
A
If
they,
you
know,
walk
into
a
room
and
someone
attacks
them.
Is
there
anything
being
thought
about
or
discussed
in
your
board
meetings
to
provide
any
kind
of
protection
you
know
for
the
workers
because,
like
I
said
in
those
hearings,
there
were
some
horror
stories
about
how
some
of
these
workers
had
been
attacked.
L
L
A
E
J
Hi
terry
henwood
for
the
record
hcqc
supervisor.
Yes,
that
is
correct
once
upon
a
time
our
periodicity
was
18
months
and
it
was
put
into
legislation.
Our
periodicity
is
now
six
years
again.
That
was
before
my
time
as
well.
I
apologize
that
I
don't
have
I'm
not
being
much
of
a
historian
here,
but
that
is
the
the
course.
As
I
know
it,
and
currently
we
are.
We
are
inspecting
personal
care
agencies
every
six
years.
E
Can
I
ask
a
follow-up,
so
you
don't
know
the
background
on
that,
because
I
would
wonder
why
it
would
go
from
18
months
to
six
years.
That's
more
than
double!
That's
what
tripled.
J
I
would
be
happy
to
look
into
it
and
provide
clarification
if
that
would
be
acceptable.
A
A
And
foreign
forum
members
before
we
continue
we're
going
to
take
a
short
break.
If
you
could
please
be
back
by
20
after
we'll
proceed,
thank
you.
We're
in
recess.
A
Former
members
recall
back
in
session,
so
we
have
agenda
item
six
presentation
on
alzheimer's
patients
and
services
in
nevada
nevada.
My
goodness
now
we'll
receive
a
presentation
from
mr
charles
duarte,
the
nevada
director
of
public
policy
and
advocacy
from
the
alzheimer's
association.
A
K
K
I
spent
12
years
as
the
administrator
for
nevada
medicaid
in
three
years,
as
the
administrator
for
hawaii
medicaid
so
may
be
able
to
address
some
of
the
questions
you
previously
asked
of
some
of
the
presenters,
and
I
think
that
those
presentations
were
really
good
setup
for
what
I'm
about
to
tell
you
today,
but
my
current
in
my
current
capacity,
I
also
serve
as
the
vice
chair
of
the
nevada
task
force
on
alzheimer's
disease
and
as
the
chair
of
the
legislative
subcommittee
of
the
commission
on
aging,
and
so
it's
a
pleasure
being
here
today,
I'm
gonna.
K
If,
madam
president,
with
your
permission,
can
I
address
a
couple
of
issues
that
came
up
in
the
prior
presentations
may
help
your
your
members.
K
So,
thank
you,
madam
president.
So
there
was
a
question
regarding
the
personal
needs
allowance
and
who
pays
that
actually
that
is
paid
by
medicaid.
So
if
there
is
going
to
be
an
increase
in
the
personal
needs
allowance,
it
will
be
a
cost
to
the
state
and
to
the
counties.
Now
being
that,
that
being
said,
it
doesn't
mean
it
shouldn't
go
up,
it
should
go
up.
It
just
means
that
there
will
have
to
be
an
investment.
K
The
commission
on
aging
heard
from
experts
in
the
division
of
welfare
and
supportive
services,
as
well
as
nevada
medicaid
about
the
increase
in
personal
needs
allowance
for
nursing
facility
residents,
and
so
there
is
a
cost.
They
did
present
an
estimate
of
that
cost,
and
so
hopefully
this
will
move
forward.
It
is
one
of
the
recommendations
by
the
legislative
subcommittee
to
increase
the
personal
needs
allowance
to
something
around
fifteen
fifty
dollars
to
sixty
dollars
a
month
with
regard
to
personal
care
services.
K
I
might
point
the
forum
to
a
terrific
study
that
was
done
by
the
gwen
center
in
las
vegas
they're,
a
think
tank
in
las
vegas,
a
nonpartisan
think
tank,
and
they
produced
a
report
in
2020
called
helping
hands
an
assessment
of
personal
care
services
in
nevada
and
essentially
what
they
pointed
to
are
the
problems
that
you
folks
have
touched
on,
and
that
is
low
wages.
K
And
so
they
would
have
to
increase
their
payments
to
these
agencies
so
that
it
could
hopefully
filter
down
to
those
employees
increased
wages.
There
was
a
reference
to
a
500
supplemental
payment
that
the
state
was
making.
That
is
a
part
of
the
american
recovery
act
and
it's
a
one-time
payment.
It's
not
going
to
be
any
future
payment,
and
so,
if
rates
are
going
to
be
going
up
from
on
the
medicaid
side,
it
has
to
be
a
part
of
the
governor's
budget
in
the
legislative
budget
and
it
could
be
a
significant
cost.
K
But
again
it's
one
of
those
investments
that
we're
going
to
have
to
make.
And
you
know
one
of
the
things
I'll
touch
on
today
is
this
care
gap
that
you
folks
have
been
talking
about.
There
are
13
000
personal
care
attendants
in
nevada
by
2050,
we're
going
to
need
10
000
more,
but
experts
are
saying
that
that
number
of
13
000
is
not
going
to
increase,
and
so
there's
a
significant
care
gap.
There
is
going
to
have
to
be
addressed
and
those
will
have
to
be
addressed
through
working
conditions
and
wages.
K
So
again,
it's
a
serious
concern.
Training
is
also
a
concern
for
the
alzheimer's
association.
We
really
want
a
dementia
capable
workforce
and
right
now
there
is
really
no
training
requirement
for
in-home
care
providers
around
dementia
services
and
how
to
communicate
with
somebody
with
dementia
and
how
to
deal
with
someone
with
dementia.
K
Very
good,
thank
you
very
much
so
again.
My
name
is
charles
duarte,
chuck
duarte,
the
nevada,
public
policy
and
advocacy
director
for
the
alzheimer's
association
in
nevada.
K
There
we
go
okay,
so
a
few
things
I
want
to
talk
about
today.
I
want
to
talk
about
some
facts
and
figures
on
a
national
level,
and
then
I
want
to
get
granular
and
talk
about
some
facts
and
figures
around
alzheimer's
disease
and
other
dementias
in
nevada.
Specifically,
I'd
like
to
touch
on
some
of
our
state
policy
priorities
and
also
about
the
alzheimer's
association
and
some
of
the
services
we
provide.
K
K
There's
vascular,
dementia,
lewy
body,
dementia,
other
forms
of
dementia,
but
by
far
and
away
alzheimer's
disease
is
the
most
prevalent
accounting
for
60
to
80
of
all
dementias.
And
so,
if
somebody
has
a
diagnosis
of
alzheimer's
disease,
it
is
a
form
of
dementia,
but
there
are
other
forms.
K
K
Many
individuals
who
are
diagnosed,
who
meet
the
diagnostic
criteria
for
alzheimer's
disease
are
not
diagnosed
by
a
physician,
and
so
quite
often
somebody
you
know,
may
have
the
disease
but
has
never
sought.
A
diagnosis,
never
talked
to
a
provider
nor
have
their
family
members
and
so
often
they're
not
diagnosed
fewer
than
half
of
medicare
beneficiaries.
K
Who
may
actually
have
a
diagnosis
of
alzheimer's
disease
are
aware
of
it
and
that's
because
their
provider
has
never
told
them,
nor
have
they
told
a
family
member
about
that
diagnosis,
and
so
for
some
reason.
You
know
that
diagnosis
is
sometimes
held
away
from
the
person
living
with
dementia
or
alzheimer's
disease,
as
well
as
their
family
and
caregivers.
K
Alzheimer's
disease
has
seen
an
increase
of
145
percent
between
2000
and
2019,
and
so
the
you
know,
the
death
rates
are
going
up
as
opposed
to
the
death
rates
for
other
chronic
diseases
which
are
going
down,
including
cancer,
and
so
one
in
three
seniors
dies
with
alzheimer's
disease
or
another
form
of
dementia.
Now
that
may
not
show
up
in
their
death
certificate.
K
Quite
often
what
happens
is
they'll
die
of
another
condition,
for
example,
pneumonia
aspiration
pneumonia
they'll
choke
on
something,
and
so
you
know
it
may
be
another
direct
cause
of
death,
but
that
is
certainly
not
the
reason
for
the
death.
It's
because
of
alzheimer's
disease.
K
So
about
the
burden
of
alzheimer's
disease
isn't
shared
equally
amongst
the
different
demographics
across
our
nation
and
and
so
the
the
burden
to
families
is
not
shared
equally
as
well.
About
two-thirds
of
americans
with
alzheimer's
are
women.
K
Blacks
are
two
times
more
likely
than
whites
to
have
alzheimer's
disease
or
another
dementia
hispanics
one
and
a
half
times
more
likely.
However,
despite
that
disparity,
two-thirds
of
blacks,
40
percent
of
native
americans
and
39
of
hispanics
believe
it's
harder
for
them
to
get
care
for
alzheimer's
disease
or
good
care
for
alzheimer's
disease.
K
In
2021,
alzheimer's
disease
and
other
dementias
cost
the
nation
355
billion
dollars
by
2050,
that
will
rate
go
up
to
more
than
a
trillion
dollars,
and
this
is
an
important
slide,
because
this
is
how
the
cost
of
alzheimer's
disease
is
shared
amongst
payers.
So
medicare
pays
for
a
lot
of
the
costs
associated
with
with
the
care
of
somebody
with
dementia.
K
However,
medicaid
has
a
huge
share
of
that
as
well.
Medicaid
pays
for
all
the
long-term
care
services
keep
in
mind.
Medicare
does
not
pay
for
long-term
nursing,
home
care
or
group
homes
or
other
kinds
of
of
long-term
services
and
supports,
but
medicaid
does
and
then
the
second
largest
share
is
actually
out-of-pocket
expense,
so
families
that
have
somebody
living
with
them
or
they're
caring
for
somebody,
a
loved
one
or
a
spouse
with
alzheimer's
disease
or
another
form
of
dementia.
K
So
if
you
look
on
the
left
and
that
purple
block
65
years
and
older
for
people
that
old
with
alzheimer's
disease,
there's
about
forty
nine
thousand
of
them
living
in
nevada
right
now
in
the
next
three
years,
that
number
is
going
to
go
up.
Thirty,
one
percent
to
sixty
four
thousand
and
it's
the
third
fastest
rate
of
growth
of
alzheimer's
disease
in
the
nation,
followed
by
we're
arizona
and
rhode
island.
K
The
part
of
the
slide
on
the
left
on
the
right,
which
is
orange,
that
talks
about
the
deaths
that
occurred
associated
with
alzheimer's
disease
disease
in
covid.
A
lot
of
these
deaths
occurred
in
nursing
homes
in
2019,
and
a
lot
of
those
patients
had
alzheimer's
disease.
K
In
nevada,
there
are
2167
people
in
hospice
programs
with
the
primary
diagnosis
of
of
alzheimer's
disease
in
terms
of
hospitalizations,
it's
one
of
the
highest
in
terms
of
the
rates
of
hospitalization
hospitals
use
the
term
bed
days,
and
so
there's
one
thousand
seven
hundred
eleven
bed
days
per
thousand
people
with
dementia
and
that's
extremely
high
rate.
K
The
cost
to
the
state
medicaid
program
is
very
high
as
well,
and
there
is
a
question
about
who
pays
for
this
well
about
63
of
every
dollar
spent
is
federal
on
medicaid,
however,
state
government,
the
nevada
legislature,
has
to
come
up
with
that
other
37
cents
on
the
dollar,
and
so
a
huge
piece
of
this
cost.
203
million
dollars
in
the
cost
of
care
for
people
with
dementia
is
paid
for
by
state
government
and
state
tax
dollars,
not
just
federal
tax
dollars.
K
K
I
think
I'll
skip
over
the
rest
of
those
numbers
and
talk
a
little
bit
about
caregiving,
and
we've
talked
a
lot
about
that
today
about
professional
or
paid
caregiving,
but
there's
a
lot
of
unpaid
caregiving.
So
here
in
nevada
about
48
000
individuals
provide
unpaid
care
to
someone
living
with
dementia.
K
K
The
other
problem
we
have
is
that
80
percent
of
those
who
are
providing
care
have
problems
themselves.
They
have
chronic
conditions
or
multiple
chronic
conditions
and
a
lot
of
them
because
of
the
burden
of
of
care
of
caregiving
to
somebody
with
dementia
who
may
have
that
disease
for
a
long
period
of
time,
the
caregivers
themselves
often
suffer
suffer
from
depression.
K
Sometimes
it
could
be
due
to
other
forms
of
dementia
or
medical
conditions,
and
sometimes
it
could
be
often
it's
alzheimer's
disease,
but
about
10
to
15
percent
of
people
who
say
they
have
mild
mild
cognitive
problems
go
on
to
develop
dementia.
K
I
mentioned
some
of
these
already,
but
a
couple
of
numbers
I
want
to
point
out,
and
so
in
terms
of
the
burden
of
care,
that's
growing
or
the
gap
in
care.
That's
growing!
It's
not
only
the
personal
care,
attendance
or
in-home
attendance
that,
where
we're
seeing
a
care
gap
develop,
but
it's
also
around
trained
professionals.
K
So
it's
estimated
you
know,
given
the
fact
that
nevada's
rate
of
growth
of
65
plus
is
the
fastest
in
the
nation,
we're
going
to
need
an
additional
267
percent
increase
in
geriatricians
to
take
care
of
those
seniors
in
in
the
next
25
years.
K
In
addition,
people
that
diagnose
dementia-
generally,
you
know
a
primary
care
provider-
can
provide
an
initial
screening
and
make
recommendations
for
a
differential
diagnosis,
but
that
differential
diagnosis
of
dementia
is
usually
done
by
a
neurologist
and
or
a
neuropsychologist
can
be
done
by
trained
geriatrician,
but
nevada
amongst
20.
Other
states
is
considered
a
neurology
desert,
meaning
that
we
don't
have
enough
neurologists
to
do
the
job.
K
So
there's
a
survey
that's
conducted
every
year
by
the
department
of
health
and
human
services
here
in
nevada,
it's
called
the
behavioral
risk
factor
surveillance
system
and
there
are
two
modules
in
that
survey
that
are
pertinent
to
the
work
that
we
do
at
the
alzheimer's
association
and
one
is
called
the
subjective,
cognitive
decline
survey
and
this
cognitive
decline
survey
asks
people
45
years
and
older
if
they're,
having
increasing
problems,
self-reported
problems
with
with
memory,
cognition
or
or
that
type
of
thing,
and
one
in
seven
people,
age,
45
and
older,
say
they're
having
problems
with
cognition.
K
Now,
when
you
look
at
the
age
cohorts
of
these,
it's
interesting
because
one
in
seven
or
sixteen
percent
of
people,
age,
45
to
55
age,
55
to
65,
say
that
they're
having
problems
so
even
at
a
young
age,
people
are
starting
to
recognize
that
they
may
have
problems
and
that's
not
to
say
that
someone
self-reporting
cognitive
decline
is
going
to
go
on
to
dementia.
K
The
most
important
thing,
I
think
with
this
statistic,
is
that
of
those
people
that
say
they
are:
they
have
problems
with
cognition.
Less
than
half
have
ever
talked
to
a
provider
about
that
or
a
medical
provider
about
that
problem,
and
so
that's
why
this
disease
goes
undiagnosed.
For
so
often,
nearly
a
quarter
of
those
with
subjective
cognitive
decline
in
these
surveys
say
that
they
that
it
interferes
with
social
activities,
work,
volunteering,
other
types
of
things
and
28
say
they
need
help
with
household
tasks
and
that's
a
growing
number.
K
So,
given
all
of
that,
the
alzheimer's
association
has
a
number
of
state
policy
priorities
and
I
like
to
touch
on
them,
and
we
have
three
that
we're
highlighting,
although
we
don't
limit
ourselves
to
three
here
in
the
state
of
nevada,
we
can
do
more,
but
these
are
the
three
that
we're
looking
at
we're
looking
to
expand
access
to
an
early
and
accurate
diagnosis,
and
that
means
augmenting
the
services
that
a
neurologist
neuropsychologist
would
provide
for
diagnosis,
but
also
training,
our
primary
care
workforce
to
help
with
screening
and
initial
diagnosis
of
dementia,
and
so
we're
proposing
something
called
the
nevada
memory
network.
K
K
K
The
other
thing
that
we'd
like
to
do
is
to
put
a
dementia
crisis
program
in
place.
I
had
the
privilege
of
sitting
in
on
meetings
between
adult
protective
service
workers,
mobile
outreach,
safety
team
members
who
are
lawful
represented
by
law
enforcement
and
social
workers,
county
social
workers.
So
over
the
last
year,
we've
had
this
discussion
through
an
ongoing
meeting
of
a
coalition
to
talk
about
what
some
of
the
issues
are.
K
So
somebody
with
dementia,
who's,
eloped
from
a
nursing,
home
or
or
family
home
is
wandering
on
the
street
is
certainly
upset
and
when
some,
when
a
law
enforcement
officer,
sometimes
encounters
it
and
you've
heard
about
this
in
the
news,
including
in
las
vegas
recently
that
person
with
dementia
might
act
out
acting
out
for
somebody
with
dementia
is
just
a
form
of
communication,
meaning
I'm
scared,
I'm
nervous,
I'm
in
pain,
I'm
hungry,
but
they
act
out
in
certain
ways
and
not
recognizing
that
they
often
end
up
in
an
encounter
with
law
enforcement
that
ends
up
in
them
being
put
in
handcuffs
taken
to
either
a
jail,
a
hospital
or
a
psychiatric
facility,
all
of
which
are
the
wrong
places
for
somebody
with
dementia
and
so
we're
talking
about,
and
we
have
to
have
some
support
for
a
program
called
dementia
care.
K
Specialists
is
based.
It
was
a
program,
that's
tested
out
of
wisconsin
and
has
been
implemented
in
four
or
five
other
states,
and
this
provides
a
point
of
contact
for
law
enforcement,
county
social
workers
and
others
when
they
have
an
encounter
with
somebody
with
dementia.
So
they,
this
person
can
is
trained
to
help
with
the
escalation
of
that
encounter
to
help
with
crisis
stabilization
and
to
provide
ongoing
community
support
to
them
if
they
have
a
family
caregiver
to
them
and
their
family,
and
so
we
would
really
like
to
support
dementia
care
program.
K
There
are
some
programs
across
the
state
that
are
both
our
public
schools
of
medicine
that
do
that,
but
we
want
to
further
enhance
that.
We
also
want
to
establish
clinics
or
hubs
where
diagnoses
of
dementia
can
occur.
We've
got
two
terrific
hubs.
We
need
more
of
them.
That's
the
problem.
One
is
up
in
in
reno
at
the
renowned
neurology
institute
and
the
other
is
in
las
vegas
at
the
cleveland
clinic
lurubo
center
for
brain
health,
and
so
we
want
to
expand
on
their
capacity
to
see
more
patients
and
provide
more
diagnostic
care.
K
We
want
to
have
a
warm
handoff
to
the
primary
care
providers
with
the
care
plan,
and
we
want
to
help
that
caregiver
who
may
be
involved,
understand
that
care
plan
and
then
finally,
we
want
a
care
navigator
to
help
that
that
patient
caregiver
dyad
those
partners
to
get
access
to
community-based,
supports
and
ongoing
services,
and
this
is
kind
of
a
model
of
what
we're
talking
about.
So
you
can
see
the
pcp
here,
the
primary
care
provider.
Does
an
initial
screening
sends
it
to
the
memory
assessment
clinic
where
they
do
a
diagnosis.
K
We
also
want
to
make
sure
that
that
family
caregiver
has
communication
with
the
state
case
manager
in
these
programs,
so
that
they
can
put
notes
into
a
case
management
system
and
that
case
manager
can
know
on
an
ongoing
basis.
What's
going
on
with
that
patient
and
can
provide
specialized
training
to
that
caregiver.
K
And
so
we
really
want
to
make
sure
that
they're
getting
the
caregiver
is
getting
as
much
support
as
possible.
A
couple
other
ways.
We
want
to
make
sure
that
that's
that's
encouraged
is
we
want
to
make
it
easier
for
that
caregiver
that
family
member
to
get
paid
currently
nevada
medicaid
pays
for
that,
but
they
won't
pay
for
a
spouse,
and
I
can
tell
you
a
lot
of
caregivers,
most
of
whom
their
their
spouses
and
they
often
give
up
their
own
careers
in
order
to
become
a
full-time
caregiver
to
somebody
living
with
dementia.
K
And
so
we
want
to
be
able
to
pay
them
to
be
a
caregiver.
We
also
want
to
pay
other
family
members
or
friends
to
be
caregivers
and
make
it
simpler
to
do
that
and
then.
Finally,
what
we
want
to
do
is
we
want
to
provide
respite
care
to
family
caregivers,
and
we
want
to
make
sure
that
we're
staying
on
top
of
their
mental
health
and
even
providing
a
health
coach
to
them
so
that
they
know
how
to
deal
with
their
with
their
stress
as
a
caregiver,
but
also
have
access
to
respite
services.
K
I
mentioned
the
dementia
specialist
program.
This
is
based
out
of
work
in
wisconsin
and
it
all.
I
already
discussed
the
fact
that
it
provides
crisis,
intervention,
crisis,
stabilization
and
long-term
support
to
people.
We
also
see
this
this
position
as
providing
screenings
and
referrals
out
in
the
community.
There
are
some
excellent
tools
and
new
technologies
that
are
being
developed
to
do
a
very
accurate
screening,
at
least
at
the
level
of
dementia,
not
necessarily
a
specific
type
of
dementia,
and
so
screening
would
become
an
important
role
for
these
positions
as
well.
K
A
little
bit
about
the
alzheimer's
association,
our
vision
is
a
world
without
alzheimer's
disease
and
all
other
dementias,
and
this
is
probably
the
most
important
slide.
So
we
maintain
a
24
7
help
line
1
800,
272
3900
and
at
any
time,
time
of
day
seven
days
a
week,
you
can
call
and
speak
to
a
licensed
clinical
professional
about
your
needs
and
and
and
so
they'll
help
you
with
information
as
well
as
educational
resources
for
caregivers.
K
K
We
maintain
partnerships
with
a
number
of
clinical
research
firms
and
agencies,
including
nih,
and
so
we
have
a
program
called
trial
match
and
this
allows
people
who
are
living
with
disease,
but
people
who
may
not
have
any
dementias
to
be
participants
in
dementia
drug
treatment
trials.
K
And
we
host
the
largest
international
scientific
conference
on
alzheimer's
disease
at
the
aaic,
the
alzheimer's
association
international
conference.
The
alzheimer's
association
is
the
largest
individual
organization
in
terms
of
research
funding
only
behind
nih
in
the
united
states,
the
national
institutes
of
health
in
terms
of
funding
research
activities
and
then,
of
course,
we
have
our
walk
to
end
alzheimer's,
our
fundraising
event,
it's
going
to
be
in
october,
in
las
vegas
and
also
in
october,
in
the
reno
sparks
area,
and
that
is
it
for
me.
A
Thank
you
so
much
for
that
presentation,
forum
members.
Any
questions.
G
I
I
have
well,
I
have
like
a
number
of
questions.
Jim
that
might
all
might
be
related,
and
my
first
question
is
why
it
is:
why
is
it
such
a
growing
pandemic
now
alzheimer's,
and
what
caused
it.
K
Well,
thank
you,
lucille.
That's
a
wonderful
question
for
the
record.
My
name
is
charles
duarte.
I
think
there's
a
there's,
a
combination
of
factors.
One
is
our
aging
population.
You
know
for
a
long
time.
You
know
we've
seen
this
increase,
you
know
the
baby,
boomer
population
and,
and
so
one
of
the
major
factors
that
contributes
to
alzheimer's
disease.
K
It's
not
necessarily
just
genetics,
but
it's
actually
age,
and
so,
when
you
break
down
some
of
the
factors
associated
with
the
risk
of
alzheimer's
disease,
number
one
is
age.
There
are
other
factors
like
education
and
social
engagement,
physical
activity
and
then,
of
course,
genetics.
But
age
is
a
part
of
it.
So,
with
our
growing
population
there's
more
frequent
issues
with
with
dementia.
The
second
is,
you
know.
Historically,
this
is
something
that's
never
not
been
diagnosed
or
people
have
resisted
getting
a
diagnosis.
K
I
think
more
and
more,
and
thank
goodness
for
this
through
awareness
campaigns,
people
are
asking
their
doctors
about
it,
and
doctors
are
more
willing
to
provide
the
screening,
that's
necessary
and
refer
them
for
a
diagnosis,
and
so
I
think
that's
another
reason
why
we're
seeing
an
increase.
K
The
third
reason
I
think
has
to
do
with
lifestyle:
there
are
risk
factors
associated
with
diet
or
lack
of
diet,
a
poor
diet,
lack
of
exercise,
other
types
of
risk
factors
like
drinking
injury
to
your
brain,
other
types
of
factors
that
contribute
to
the
risk
of
alzheimer's
disease,
and
so
now
we're
just
recognizing
it.
One
of
my
colleagues
says:
alzheimer's
disease
is
a
disease
of
middle
age,.
G
K
A
F
Thank
you,
mr
mark.
That
was
an
excellent
presentation.
I
I
have
one
question
and
one
comment.
First,
the
question
is
that
there
you
mentioned
that
so
many
people
were
hospitalized
with
alzheimer's
disease.
So
I
understand
that
you,
obviously
you
can
have
physical
disease
all
kinds
of
problems
that
alzheimer's
manifests,
but
there
are
some
people
that
just
have
alzheimer's
disease
and
they
don't
necessarily
need
to
be
hospitalized.
F
My
other
comments,
I
think
you
made
an
excellent
point
on
on
the
factors
of
about,
because
we,
we
really
don't
know
the
cause
of
alzheimer's
disease.
There
are
ongoing
studies
high
in
research
using
mri
and
physio
and
physiological
imaging
of
of
the
brain,
but
we
really
don't
know
the
cause
of
alzheimer's
disease,
but
one
of
the
huge
factors
is
really
is
lifestyle
too,
and
you
pointed
it
out,
it's
exercised,
it's
it's
it's
actually.
F
You
know
it's
hard
to
really
show
the
proof
of
it,
but
it's
pretty
well
shown
that
if
you
exercise
on
on
a
regular
basis,
you
decrease
your
your
chances
of
developing
dementia
out
with
alzheimer's
anyway,
and
so
that's
that
is
really
an
important
issue
that
the
lifestyle
issue
could
be
it's
one
of
the
one
of
the
worst
things
you
can
do
for
your
health.
F
Everybody
knows
how
bad
smoking
is,
but
being
a
couch
potato
is
maybe
just
as
deadly
and
not
exercising
is
not
only
terrible
for
your
physical
health,
but
it's
really
bad
for
your
mental
health.
So
we
have
a
community
that
engages
on
a
regular
walking
basis,
and
I
think
it
really.
It
really
shows
that
it
really
helps
the
whole
community
and
the
society
if
you
just
stay
healthy.
K
Well,
doctor,
thank
you
for
that
question
and
so
to
maybe
piggyback
on
your
comment
and
then
answer
your
question.
Yes,
you
know,
and
in
fact
social
engagement
is
one
of
the
factors
that
really
contributes
to
a
lessening
of
the
risk
of
alzheimer's
disease.
So
the
fact
that
you
mentioned
you
know
a
group
walking
club.
K
Essentially
that
does
two
things
right,
that
creates
social
engagement
opportunities
for
people
to
talk
and
maintain
that
kind
of
those
personal
relationships
as
well
as
exercise
and
both
of
those
contribute
to
the
lowering
the
risk
of
alzheimer's
disease
with
respect
to
hospitalizations.
K
I'm
not
an
expert
in
those
statistics,
but
I
can
tell
you
from
some
of
the
data
that
I've
seen
a
lot
of
those
hospitalizations
are
secondary,
so
they're
secondary
to
things
like
behaviors,
and
so
you
know
somebody
is
demonstrating
a
risky
behavior
in
a
nursing
facility.
They
may
get
admitted
to
a
hospital
to
treat
them
for
behavioral
issues
and
often
times
they
end
up
getting
over-medicated
or
other
chronic
conditions.
K
But
you
know:
alzheimer's
disease,
particularly
in
late
stages,
will
result
in
individuals
who
may
have
problems
with
falls.
Another
increased
cause
of
of
hospitalization
as
well
as
pneumonia,
and
so
all
of
those
are
they
may
be
secondary,
but
they're
really
not
secondary,
because
it's
really
alzheimer's
disease.
I
Yes,
thank
you
for
your
presentation.
For
the
record,
my
name
is
marilyn
jordan.
My
question
comes
from
some
of
your
data
that
says
that
we
are
a
neurology
desert.
I
I
looked
this
information
up
and
it's
projected
that
by
19
or
2025
we're
going
to
have
128
000
people
suffering
from
this
serious
disease,
but
only
97
possible
neurologists
throughout
the
state.
What's
your
organization
or
what
is
the
state
of
nevada,
doing
to
recruit
people
to
help
us
attack
and
work
with
the
members
of
our
senior
citizens
in
nevada
to
to
reduce
this
problem.
K
So
in
terms
of
what
the
alzheimer's
is,
thank
you
thank
you
again
doctor,
but
charles
dewart,
for
the
record.
In
terms
of
the
alzheimer's
association,
we
work
on
policies
that
help
support
the
increase
in
access
to
an
early
diagnosis,
and
so
I
mentioned
the
fact
that
one
of
our
policy
priorities-
and
I
hope
to
have
some
legislation
around
this
in
the
next
session-
is
to
get
some
funding
to
support
an
increase
in
the
number
of
neurologists
and
neuropsychologists
in
in
nevada.
Now,
neurologists
and
neuropsychologists
are
not
dying
a
dozen.
K
K
A
medical
director
at
the
cleveland
clinic
lurubo
center
told
me
that
he
firmly
believes
that
50
of
the
diagnoses
that
he
makes
for
alzheimer's
disease
can
be
done
by
a
trained
primary
care.
Physician
a
family
doctor
and-
and
so
I
think,
if
we're
going
to
be
looking
at
bringing
in
resources,
it
really
has
to
focus
on
that
primary
care
home
for
people
again
we're
trying
to
bring
in
resources
through
legislation
that
I
mentioned
the
nevada
memory
network.
K
What
the
state
is
doing
is
you
know
honestly
they're
trying
they
have
loan
repayment
programs
and,
if
you're
a
geriatrician
or
want
to
be
a
geriatrician,
you
can
apply
for
loan
repayment
programs
and
then
the
board
of
medical
examiners
does
encourage
physicians
to
get
training
in
dementia
and
alzheimer's
disease.
K
They
have
a
program
that
that
the
nevada
legislature
passed
in
2003
that
allows
for
every
two
hours
of
continuing
continuing
medical
education
to
count
for
four
hours:
oh
continuing
medical
education
in
alzheimer's
disease
or
dementia
to
count
as
four
hours
of
continuing
medical
education
credits.
So
it's
not
much,
but
that's
what
the
state
is
doing.
As
far
as
I
know,.
K
Oh,
if
I
can't
mention
a
couple
other
things,
our
two
schools
of
public
health
have
done
a
really
good
job
of
trying
to
increase
the
number
of
of
residents
that
go
into
the
fields
of
geriatrics
and
they've
got
grants
from
the
health,
the
united
states,
health,
human
excuse
me,
health
resources,
services,
administration
and
to
support
this
activity
of
increasing
the
number
of
geriatrically
trained
physicians
and
then
up
in
reno.
K
We've
got
something
called
project
echo,
which
is
an
online,
a
webinar
based
training
program
for
primary
care
providers
around
dementia
care,
and
so
that
happens
two
to
three
times
a
year.
I
believe
it's
a
six
week
course
for
primary
care
providers,
and-
and
so
there
there's
other
activities
going
on,
particularly
through
our
public
schools
of
medicine,
to
train
primary
care
practices.
I
Yeah,
I
feel
that
that's
something
that
we
should
pay
attention
to.
Yes,
we
have
an
increase
in
the
number
of
folks
experiencing
that
and
all
aspects
of
the
different
kinds
of
dementia,
but
we
need
to
have
some
people
that
are
able
to
diagnose
it
and,
as
you
said
earlier,
we
don't
have
people
getting
diagnosed.
So
a
lot
of
people
are
walking
around
with
the
possibilities,
but
nobody
to
help
them.
K
Right
exactly-
and
I
think
that
becomes
an
important
issue
that
becomes
a
really
important
issue
when
we
start
looking
at
drug
treatments
that
are
coming
down
the
pipeline
through
the
fda.
So
there
are
a
number
of
clinical
trials
of
new
drugs.
You
know
one
was
recently
approved
by
the
fda,
although
I
think
in
you
know
some
fields,
some
folks
feel
that
it
had
a
minimal
impact
and
only
an
impact
on
delaying
alzheimer's
disease
for
those
in
the
mild
cognitive
stage.
K
But
there
are
other
drugs
in
the
pipeline
and
to
get
the
drug.
You
have
to
have
a
diagnosis
and
to
get
a
diagnosis,
you
have
to
have
a
specialist
look
at
you,
and
so
I
think
that
pressure
is
going
to
be
increasing
to
have
those
types
of
fields,
specialties
and
training
expanded.
But
again
I
think
we
cannot
discount
the
the
the
use
the
importance
of
our
primary
care,
physicians
and
other
practitioners
in
helping
with
that
diagnostic
work.
H
Thanks,
madam
chair,
charles
excellent
presentation,
I
got
a
series
of
questions
here
so
sure
bear
with
me
on
your
I'm.
H
Yeah,
all
right
I'll
make
sure
it
goes
yeah,
roger
trotham,
district
8
here
in
clark
county
on
your
nevada
priorities
on
the
num
on
the
third
one
fun,
dementia
care
specialists.
H
Let
me
first
of
all
any
idea
what
that
would
cost
is
your
first
comment:
question
yeah.
K
You
know,
based
on
the
thank
you
very
much
for
the
question
so
again,
charles
dewart,
for
the
record,
based
on
the
work
in
wisconsin
that
I've
been
able
to
look
into
it's
about
a
hundred
thousand
dollars
a
year
for
each
position.
It
includes
things
like
you
know:
access
to
equipment,
benefits,
etc.
What
we're
talking
about
here
are
master's
level,
social
workers,
not
clinical
social
workers,
but
masters
level.
K
Individuals
on
in
in
a
health
field
most
likely
social
work,
and
so
each
position
would
probably
cost
about
a
hundred
thousand
dollars
a
year.
But
again
if
they
can
delay
the
onset
of
our
placement
in
a
nursing
home
by
18
months,
they
would
send
save
tens
of
thousand
dollars
a
year
per
person
if
they
can
delay
that
placement
and
keep
people
living
a
good
life
in
their
communities.
K
So
very
good
question:
you
know:
oftentimes
people
look
at
a
piece
of
legislation
and
if
it
has
a
dollar
a
pound
attached
to
it
or
a
cost,
they
shy
away
from
it.
But
again
I
think
they
have
to
look
at
the
alternatives,
and
what
I
presented
before
was
that
the
nevada
medicaid
program,
which
is
partly
funded,
not
not
an
insignificant
amount
funded
by
legislative
state
dollars.
You
know
they
paid
233
million
dollars
a
year
for
dementia
care
and
one-third
of
that
is
state
dollars.
K
Now
imagine
if
we
could
avoid
even
a
small
percentage
of
that
by
investing
in
these
types
of
positions,
I
think
it
could
create
tremendous
cost
savings,
which
is
why
a
very
conservative
state
like
wisconsin
and
georgia
have
invested
heavily
in
these
positions
because
they
do
recognize
that
it
saves
money
in
the
long
run.
Its
state
saves
the
state
money
in
terms
of
inappropriate
hospitalizations,
medicaid
costs,
and
so
it's
an
investment,
but
it
does
have
cost
savings
and
it
avoids
car
future
costs.
H
H
K
K
As
a
lobbyist
during
the
legislative
session,
but
the
answer
is
yes,
we
are
going
to
be
asking
for
this.
I'm
currently
talking
with
the
nevada,
aging
and
disability
services
division
to
see
if
they
can
include
the
dementia
care
specialist
program
as
a
part
of
their
budget.
K
I
have
a
meeting
with
the
director
of
health
and
human
services,
richard
whitley
on
july
5th,
to
talk
about
this,
but
the
commission
on
aging.
The
nevada
commission
on
aging,
has
also
recommended
these
positions
as
a
part
of
their
legislative
priorities
in
the
next
next
session.
So
hopefully
we'll
have
a
legislative
sponsor
or
a
committee
sponsor
to
move
this
forward.
H
Thank
you
appreciate
that
couple
more
going
to
the
family,
caregiver
waiver
discussion.
K
Absolutely
so
so
again,
chuck
dewater
for
the
record.
Under
current
medicaid
regulations,
spouses
and
guardians
are
considered
legally
responsible
individuals
are
precluded
from
being
paid.
However,
many
other
states
have
passed
waiver
programs.
These
are
medicaid
waiver
programs
and
what
a
waiver
is
is
actually
the
state
going
to
the
secretary
of
the
u.s
department
of
health
and
human
services
and
say
secretary.
We
want
to
waive
certain
federal
regulations
to
make
sure
we
can
provide
a
program,
that's
appropriate
for
the
people
in
nevada.
K
That's
what
a
waiver
is,
and
so
other
states
have
requested
the
the
secretary
to
waive
those
requirements
and
allow
legally
responsible
individuals,
I.e,
spouses
and
and
guardians
to
be
paid
caregivers
paid,
family
caregivers.
So
at
the
federal
level,
there's
one
recognition
that
has
to
occur
and
that
can
be
done
in
a
process
that
medicaid
does
call
the
state
plan
change.
The
legislature
can
choose
to
recognize
that
through
legislation,
and
so
what
we're
asking
is
for
the
nevada
legislature
in
the
next
session
to
sponsor
a
bill
to
move
a
bill
forward.
K
That
would
create
the
opportunities
for
these
structured
family,
caregiver
programs
to
be
developed
and
to
allow
spouses
and
guardians
to
be
paid
caregivers,
and
so
we,
the
commission
on
aging,
is
moving
this
forward.
As
a
recommendation,
we
have
a
possible
bill
sponsor
who
wants
to
carry
this
bill
into
the
next
session.
We
believe
that
it
will
have
either
a
cost
savings
or
a
minimal
cost,
and,
and
so
we're
hopeful
that
this
will
move
forward
in
the
next
session.
H
Thank
you.
I
appreciate
that
good
answers.
One
last
question:
this
is
about
your
organization.
You
know
the
alzheimer's
association.
I
think
we
need
more
of
these
types
of
groups
that
do
different
things.
Can
you
give
us
a
little
bit
of
an
idea
of
how
your
organization
is
funded,
where
you
get
your
money
to
continue?
I
know
you,
you
know
you
you
fundraise.
K
So,
thank
you
for
the
question
again
for
the
record
check
whoa,
the
vast
majority
of
our
dollars
come
from
donations,
and
so
we
raise
a
lot
of
money
through
through
our
activities,
including
our
walk
to
end
alzheimer's.
We
had
an
event
yesterday
called
the
longest
day,
and
so
a
lot
of
our
operational
costs
are
funded
by
those
types
of
activities
across
the
nation.
K
We
do
apply
for
state
grants
and
some
of
those
grants
do
support
some
of
our
services.
For
example,
here
in
nevada,
we
have
the
privilege
of
getting
grant
funding
from
the
aging
and
disability
services
division
to
provide
vouchers
to
family
caregivers,
so
they
can
pay
for
respite
and
take
a
break
from
caregiving.
So
that's
an
example
of
the
type
of
grants
that
we
do.
K
K
Less
than
one
percent
of
our
money
comes
from
like
big
pharma,
big
pharmacy
companies,
and
so
we
really
try
not
to
be
obliged
to
organizations
that
may
be
seeking
some
sort
of
quid
pro
quo
from
the
association,
some
sort
of
endorsement
for
the
work
that
they're
doing,
and
so
we
really
try
to
keep
those
those
requests
to
a
minimum.
So
most
of
our
dollars
come
from
donations
as
well
as
grants
that
we
get
from
states
across
the
nation.
A
E
Yes,
thank
you
for
that.
Informative
presentation.
Mr
duarte,
one
question
one
comment:
I'm
thinking
about
the
neurology
shortage
and
glad
to
see
some
creative
problem
solving
here,
because
I
suspect
that
it's
not
even
just
a
matter
of
recruiting,
I
suspect,
there's
a
shortage
of
residency
programs
in
the
nation.
So
I
don't.
I
don't
see
how
we'll
even
be
able
to
as
a
nation
get
the
number
of
neurologists
through
our
you
know,
get
the
number
of
neurologists
we
need
without
more
residency
programs.
E
So
I'm
glad
you're
looking
at
new
ways
to
diagnose
this
and
then
my
other
was
just
a
point
of
clarification,
because
I
was
really
struck
by
the
increase
in
alzheimer's
deaths.
Disease
deaths
and
I
you
may
have
started
to
touch
on
this,
so
explain
to
me
how
you
die
from
alzheimer's
as
a
primary
condition,
or
is
it
that
alzheimer's
is
not
being
diagnosed
as
the
primary
condition
and
it's
something
else
secondary
is
what's
killing
them,
that's
associated
with
the
alzheimer's.
So
the
statistic
was
so
huge.
I
I
was
like
trying
to
understand
it.
K
So
again,
charles
the
work
for
the
record-
and
you
know
I'm
not
an
expert
in
this
data,
but
I
can
tell
you
what
you
know:
I've
read
and
what
the
association
has
published
around
the
increase
in
death
rates,
association
associated
with
alzheimer's
disease,
and
so
the
both
both
of
the
points
you
made
are
correct.
K
There's
an
increased
number
of
individuals
who
are
getting
diagnosed,
who
go
into
the
hospital
with
alzheimer's
disease
or
a
nursing
home,
most
likely
with
a
primary
diagnosis
of
alzheimer's
disease
and
and
die
as
a
result
of
the
disease
itself.
The
disease
is
fatal
and
it
is
progressive,
and
so
the
disease
will
result
in
the
inability
to
eat
the
inability
to
do
a
lot
of
different
functions
and
so
that
in
and
of
itself
will
result
in
death.
K
The
fact
that
they
can't
take
in
water
properly
can't
eat
will
result
in
starvation
and
death.
The
other
very
common
problem
is
something
called
aspiration:
pneumonia,
which
is
the
result
of
the
inability
to
control
your
swallowing
and
control
your
drinking
and
that's
a
brain
function,
and
so
it
results
in
food
and
under
water
and
bacteria
getting
into
your
respiratory
system.
And
so
that's
that's
a
really
major
large
cause
of
death
rates
associated
with
with
alzheimer's
disease.
And
again,
you
know
so.
K
We've
got
increasing
diagnosing
of
alzheimer's
disease,
albeit
it's
still
not
at
the
point
where
we'd
like
to
see
it,
but
also
the
fact
that
alzheimer's
disease
greatly
contributes
to
these
kind
of
secondary
factors
such
as
failure
to
thrive,
inability
to
eat
and
aspiration.
Pneumonia.
E
G
K
Well,
thank
you
for
that
question
actually
is
a
very
important
question,
an
extremely
common
one.
The
alzheimer's
association,
puts
out
a
presentation
for
lay
people.
It's
called
the
10
warning
signs,
and
in
that
presentation
we
really
make
a
distinction
between
what's
normal
aging
and
what
could
be
problems
caused
by
or
the
early
onset
of
dementia,
and
so
the
fact
that
you
know
you
forgot
your
keys
twice
this
week.
Someplace
doesn't
mean
that
you
have
dementia.
K
The
fact
that
you
know
I
can't
remember
somebody's
name
that
I
just
met
two
minutes
ago
doesn't
mean
I
have
dementia,
but
increasingly,
if
you
have
problems
with
cognition
with
memory
thinking
executive
functions
like
reasoning
that
become
more
and
more
frequent,
it's
important
you
talk
to
a
family
member
to
a
spouse
and,
ultimately
to
a
provider.
K
So
it's
it's
really
something
that
is
cumulative
and
again
the
association
puts
out
an
excellent
educational
program
for
lay
people
called
the
10
warning
signs,
and
that
really
can
help
an
individual
make.
That
distinction
between
what
is
normal
aging
and
what
could
be
not
necessarily
is
but
could
be
on
the
early
signs
of
dementia.
A
K
So
to
answer
your
question
again,
charles
the
work
of
the
brexit,
it
would
not
be
based
on
the
in
so
let
me
back
up
a
little
bit.
Medicaid
eligibility
would
be
for
that
patient,
the
person
receiving
care,
and
so
that's
based
on
income.
K
However,
if
a
spouse
or
guardian
is
providing
care,
the
medicaid
program
can
set
up
criteria
by
which
to
pay
them
and
that
could
vetting
that
could
include
income.
However,
in
other
states,
what
they
found
is
that
most
often
somebody
a
spouse
or
guardian
or
even
you
know,
a
daughter-in-law,
a
daughter
whatever
it
might
be.
K
They
have
to
give
up
their
careers
their
time
in
the
workforce
to
be
a
caregiver
because
of
the
disease.
The
disease
progresses
to
the
point
where
it
goes
from.
You
know
mild
to
moderate
to
extreme
and
as
that
disease
progression
occurs,
the
individual
is
going
to
need
ultimately
need
almost
24
hour
care,
and
so
the
ability
of
that
person
to
provide
in-home
support
and
get
paid
for
it
is
the
fact
that
they
probably
happen
to
give
up
their
job.
K
Now
some
states
like
missouri
what
they've
done
is
they
say
you
can't
be
working
outside
the
home
in
another
role
if
you're
a
paid
family
caregiver,
so
some
states
have
set
up
that
criteria
that
you
know
this
is
going
to
be
your
job,
we'll
pay
you,
but
you
can't
be
doing
you
know
three
other
jobs
on
the
side,
so
this
criteria
that
could
be
developed.
A
A
A
I
don't
know
if
you've
considered
anything
like
that
in
your
in
your
legislative
priorities,.
K
K
An
important
aspect
of
this
is
that
the
caregiver
him
or
herself
is
in
contact
with
the
state
social
worker,
who's
monitoring,
the
condition
or
the
needs
of
that
person,
including
respite,
and
so
what
we
recommend
and
what
some
states
have
done
is
to
say
at
least
one
day
a
week,
they're
getting
someone
to
come
into
the
home
or
they're
paying
for
that
person
to
be
taken
outside
the
home
to
something
like
an
adult
daycare
facility,
so
that
that
person
that
caregiver
can
have
respite
can
you
know,
maintain
some
sort
of
social
connection
can
do
the
work
that
they
need
to
do
to
you
know
for
household
to
maintain
their
households,
whatever
that
case
might
be.
K
So
the
answer
is
yes
on
the
medicaid
program.
Currently
the
state
of
nevada,
aging
and
disability
services.
Division
pays
for
respite
for
people
who
may
not
be
taking
care
of
someone
on
medicaid,
but
they
have
voucher
programs
and
again,
the
alzheimer's
association
in
nevada
is
a
recipient
of
those
grants
and
what
we
do
is
we
administer
them
and
we
provide
vouchers
to
people
who
are
caregivers
and
the
caregiver
can
then
pay
for
somebody
to
come
into
the
home
and
give
them
some
respite
or
relief,
or
they
can
pay
for
that.
K
The
patient
to
go
to
an
adult
daycare
facility
for
that
day,
so
they
could
still
have
respite.
So
the
answer
is
yes,
that's
an
important
aspect
of
helping
caregivers
do
their
job,
because,
if
not
their
mental
health
and
their
physical
health
will
suffer
and
and
they
will
diminish
in
their
ability
to
be
a
caregiver.
H
Madam
chair,
sorry,
one
more
question:
you
know,
charles
you
sat
through
some
of
the
previous
presentations
we
had
and
you
sounds
like
you've
been
doing
this
for
a
long
time.
What's
the
private
sector
business
type
things
going
on
out,
there
is
this.
You
know
we
know
that
in
health
care
itself
with
aging
populations,
there
are
some
expansions
and
a
lot
of
things
are
going
on.
What
are
some
of
the
things
that
are
keeping
you
know
private
industry
and
obviously
they're
they're?
They
want
to
make
a
buck
and
they
need
to
be
profitable.
H
You
know,
progression
and
growing
and
making
some
of
that
available
through
insurances,
whatever
we
do
as
an
american
as
a
citizen
or
a
person
to
try
and
find
health
care
for
some
of
these
things,
because
we
talk
about
all
the
time
government
funding-
and
I
I
just
have
a
concern
about
that-
becoming
the
only
answer.
What
are
some
thoughts
or
that
you
have
on
some
of
that.
K
So
you
know
in
a
prior
life,
I
actually
was
a
marketing
director
for
a
blue
cross
blue
shield
plan
and
sold
long-term
care
plans
to
people
that
blue
cross
and
blue
shield
had
developed,
and
I
can
tell
you-
and
I
think
tony
archipelan,
who
testified
in
public
comment
earlier
today.
She
hit
the
nail
on
the
head,
and
that
is
that
the
private
sector,
particularly
the
insurance
market,
has
not
been
able
to
really
provide
a
sustainable
solution
to
long-term
care
needs
of
families,
a
private,
sustainable
solution
for
long-term
care
needs
of
families.
K
You
know
oftentimes.
If
you
have
to
buy
long-term
care
policy,
you
have
to
buy
it
when
you're
very
young,
you
get
medically
underwritten
and
and
then,
if
you
buy
it,
when
you
need
it
of
course,
then
it's
unaffordable.
K
K
Neither
does
medicare
pay
for
long-term
care
services,
and
so
when
you
look
at
the
fact
that
these
services
are
really
not
part
of
the
employer-sponsored
healthcare
pro
model,
the
insurance
model,
it
really
leaves
just
one
significant
or
two
significant
pairs.
K
One
is
medicaid
because
that's
medicaid's
job
medicaid's
job
is
to
provide
long-term
services
and
support,
so
people
can't
afford
it
and
that's
their
their
mandate
by
congress
since
1965.,
and
so
you
know,
fortunately
or
not,
private
sector
insurance
model
has
not
been
able
to
address
long-term
care.
K
Congress
did
in
1965
with
the
establishment
of
medicaid,
so
again,
you're
really
talking
about
a
sector
of
the
health
care
market
that
is
going
to
be
predominantly
funded
by
government-sponsored
programs
for
now
into
the
future,
unless
there
can
be
some
solution
on
the
private
sector
side
and
I've
not
seen
any
in
the
40
years
that
I've
been
working
in
this
business.
K
So
the
answer
is
yes
now
to
make
it
so
private
entities
can
provide.
We
were
talking
about
a
lot
about
personal
care,
attendance
services
and
again
to
be
clear.
A
personal
care
attendant
is
somebody
who
has
some
training
goes
into
a
home
and
helps
people
with
activities
of
daily
living,
bathing
toileting
dressing,
grooming,
ambulating,
but
also
other
types
of
activities,
activities
like
chores
in
the
house,
cooking
shopping,
et
cetera
and
again,
when
you
look
at
the
payer
for
that,
there's
two
pairs
out
pocket
costs
and
medicaid
private
insurance.
K
Long-Term
care
insurance
pays
for
some
of
that.
But
it's
a
very
small
percentage
and
again
people
can
only
a
few.
A
percentage
of
the
population
can
afford
long-term
care
insurance,
and
so
it
really
ends
up
being
medicaid
and
out-of-pocket
costs
to
families,
and
I
can
tell
you
from
the
caregivers
who
are
part
of
our
programs
who,
former
caregivers,
whose
loved
ones
have
passed
away
from
alzheimer's
disease.
K
They
tell
me
that
it's
bankrupted
them,
it's
it's
interfered
with
their
ability
to
earn
a
living,
it's
disrupted
their
careers
and,
and
so
our
ability
to
support
them
is
extremely
important
as
a
way
of
reducing
state
costs
and
federal
costs.
By
investing
in
those
programs
and
again
it
is
going
to
be
an
investment
of
state
and
federal
dollars.
But
if
we
invest
a
dollar
up
front
in
some
of
these
measures,
we're
going
to
we're
going
to
save
tens
of
thousands
of
dollars
from
the
back
end.
So
again
it's
it's
a
cost-effective
strategy.
K
But
again
you
know.
I
I,
like
I
said
in
the
years
that
I've
been
involved
with
this
I've,
not
seen
substantial
private
sector
solutions.
I
mean
there's
solutions
in
other
other
nations.
K
Most
of
them
involve
some
sort
of
taxing
authority
to
fund
a
long-term
care
program
for
seniors,
but
but
again
you're
talking
about
you
know
a
a
nationalized
program.
Japan
is
one
one
country.
It
comes
out
as
an
example,
but
there
are
many
others.
A
K
A
So
forum
members
we're
going
to
move
on
to
agenda
item
seven.
The
facilitator
reports
concerning
issues
of
importance
to
seniors
before
we
have
miss
aidan
and
miss
tyler
do
their
presentations.
I'm
going
to
ask
miss
jordan.
If,
if
she
has
anything.
I
Thank
you
so
much.
Madam
president,
during
the
course
of
this
past
month,
we've
spent
a
great
deal
of
time
both
miss
tyler
and
miss
aidan
in
chatting
about
what
we
could
do.
We
looked
into
a
number
of
the
agencies
throughout
nevada
and
we
came
up
with
a
very
interesting
list
that
we
have
85
independent
living
facilities.
I
We
have
more
than
160
assisted
living
facilities
in
our
state.
We
have
memory
care
facilities,
73,
we
have
nursing
home
adult
care
11.
We
have
35
centers
for
hospices
and
68
respite
care
facilities
and,
surprisingly
enough,
many
of
these
facilities
are
unavailable
for
visitation
or
discussion
due
to
staffing
issues,
but
mostly
due
to
covert
restrictions.
I
So
many
of
the
facilities
are
on
lockdown
and
it's
really
difficult
to
be
able
to
go
and
visit.
I
was
able
to
talk
to
maybe
10
different
facilities
and
ask
what
they
consider
to
be
their
major
challenges
for
long-term
care
and
the
following
were
examples:
an
increasing
aging
population.
I
An
issue
that
I
thought
was
most
interesting
was
the
overall
quality
of
care.
If
you
have
five
people
with
one
staff
person
and
you
elevate
to
15
or
20,
that's
not
going
to
be
quality
of
care.
I
The
integration
of
services
was
also
an
issue
when
somebody
moves
from
one
place
to
another
or
they
move
from
independent
living
into
skilled
nursing,
there's
a
lack
of
coordination,
so
that
seems
to
be
very,
very
an
issue
that
needs
to
be
addressed,
and
the
financing
cost,
of
course,
is
always
a
care
cost.
I
A
Thank
you
we'll
hear
from
miss
aiden.
Our
northern
facilitator.
First,
miss
aidan.
Do
you
have
anything
for
us.
G
G
A
Thank
you.
Thank
you
very
much.
Mercedes
miss
tyler,
our
facilitator
in
the
south.
Do
you
have
anything
for
us
today.
G
I
visited
my
senior
city
quite
frequently
because
I
go
there
to
exercise,
but
one
of
the
main
points
of
that
they
pointed
out
to
me
is
the
long-term
care
costs
and
insurance,
and
things
of
that
nature.
G
Also,
it
was
brought
to
my
attention
that
medicaid,
even
though
they
do
pay
say
a
certain
amount
that
they
actually
can
put
a
lien
on
the
senior's
home
and
the
question
came
up
with
what
happened
with
the
spouse,
that
you
know
that's
still
there,
but
those
are
really
troubling
issues
when
it
comes
to
long-term
care,
long-term
care
insurance.
Apparently
it's
just
not
an
available
option
that
you're
able
to
say
keep
your
property
or
things
of
that
nature.
Another
thing,
too,
is
the
definition
say
of
long-term
care.
G
How
long
is
long-term
care
per
se?
It
is
short
intermittent
or
really
long
say
for
years,
for
example,
and
if
the
senior
plan
to
return
to
their
home.
At
some
point
I
mean
you
can
be
in
a
skilled
nursing
facility
for
a
year
and
go
back
home,
but
if
your
home
is
already
taken
the
and
I
use
the
word
taken,
but
they
say
no,
it's
not
taken.
It's
actually,
they
put
a
lien
on
it
and
they,
whatever
money
they
have
actually
spent
out,
they
actually
take
it
back.
Well.
What
does
that?
G
The
other
is,
I
got
a
email
from
mercedes-benz,
I
don't
know,
is
she
there
or
not,
but
she
says
she
did
visit
a
few
facilities
in
her
area
and
one
senior
citizen
excuse
me
center
actually
closed
because
of
the
lack
of
participation,
and
she
said
it
was
actually
changing
the
centers
to
active
adult
centers,
and
she
also
mentioned
several
other
concerns
which
we
are
already
working
on
or
talking
about,
I
should
say
the
rising
cost
of
health
care
and
that
basically
includes
long-term
care
facility
utility
costs,
food
costs
rising
gasoline,
that's
rising,
everything
is
rising,
but
the
benefits
say
for
your
social
security,
also
senior
precipitation,
apparently
there's
a
problem
with
senior
transportation,
getting
seniors
backwards
and
forth
to
the
community
centers
in
other
places,
uber
and
lyft
drivers
and
things
of
that
nature
prefer.
G
A
Yes,
go
ahead,
please.
E
F
Will
happen
when
people
can't
ambulate
anymore,
and
I
don't
have
the
answer
to
that-
they
do
have
a
hundred
people
a
day
plus
minus
at
the
one
center
in
my
district
senate
district
three,
and
I
think
that
a
concern
is
that
this
may
eventually
close
down
itself
and
I
hope
not.
A
A
F
A
Seeing
none,
I
do
have
a
couple
of
comments
we
have
seen
and
heard
during
our
meetings
a
lot
of
information
about
seniors
senior
living.
A
I
think
some
of
these
programs
presentations
have
resonated
with
some
of
us,
so
what
I
would
like
is
for
the
forum
members
to
possibly
go
back
through
the
presentations
pick
out,
something
that
you
feel
we
would
be
able
to
have
the
legislature
enact
something
that
would
enrich
the
lives
of
seniors
and
bring
that
knit
to
the
next
meeting
so
that
we
can
begin
to
discuss
what
we
are
going
to
ask
for
our
bdr
next
session.