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From YouTube: 6/28/2022 - Legislative Committee on Senior Citizens, Veterans and Adults With Special Needs
Description
This is the third meeting of the 2021-2022 Interim. Meeting rescheduled from June 7, 2022. Please see agenda for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
Videos of archived meetings are made available as a courtesy of the Nevada Legislature.
The videos are part of an ongoing effort to keep the public informed of and involved in the legislative process.
All videos are intended for personal use and are not intended for use in commercial ventures or political campaigns.
Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
Good
morning,
everyone
and
welcome
to
the
third
meeting
of
the
legislative
committee
on
senior
citizens,
veterans
and
adults
with
special
needs.
First,
we
will
call
the
roll
for
those
members
attending
virtually.
Would
you
please
turn
on
your
cameras
and
respond
when
you
hear
your
name,
madam
secretary,
please
call
the
roll
senator
buck.
B
D
D
A
Gorlo
here,
thank
you,
madam
secretary.
Please
indicate
senator
scheible
and
assemblyman
macarthur
as
excused
and
we
have
a
quorum
for
today.
I
welcome
everyone
who
is
here
in
las
vegas
and
to
those
joining
us
by
video
conference
in
carson
city
and
anyone
listening
over
the
internet,
some
housekeeping
items
so
before
we
begin
I'd
like
to
take
a
moment
to
go
over
some
basic
housekeeping
our
meetings,
our
video
conference
to
carson
city,
while
everyone
is
encouraged
to
participate
from
whichever
location
is
most
convenient.
A
We
are
willing
and
able
to
have
these
meetings
made
available
by
way
of
virtual
participation
as
well.
Everyone
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
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
Please
remember
to
turn
the
microphone
off
when
you
finish
speaking,
each
witness
should
provide
a
business
card
and
a
copy
of
any
written
materials
not
previously
submitted
to
the
secretary.
Since
our
committee
secretary
is
in
carson
city,
please
leave
your
business
card
on
the
witness
table
or
at
the
back
of
the
sign-in
sheet
in
las
vegas.
Our
staff
will
collect
your
cards
at
the
end
of
the
meeting.
A
Anyone
who
would
like
to
receive
electronic
notification
of,
or
access
to
the
committee's
agendas
minutes
and
final
report
can
do
so
by
going
to
the
nevada
legislators
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.
Let's
get
started.
A
Next
item
on
the
agenda
is
public
comment.
Public
comment
is
provided
beginning
and
again
at
the
conclusion
of
the
meeting.
I
would
like
to
call
your
attention
to
the
notation
on
the
agenda.
Limiting
public
comment
to
three
minutes.
Speakers
are
urged
to
avoid
repeating
comments
or
points
made
by
previous
speakers.
Any
person
may
also
submit
written
comments
to
the
committee
secretary
during
or
after
today's
meeting.
A
D
F
G
Good
morning,
madam
chair
members
of
the
committee,
stephen
cohen,
for
the
record
stephen,
with
a
b
cohen,
as
in
the
assemblywoman,
no
known
relation
at
first
glance,
agenda
item
number
five:
the
seed
initiative
sounds
like
a
wonderful
idea.
However,
in
order
to
implement
such
an
initiative,
good
policy
information
is
required
here
in
nevada.
I
don't
believe
that
we
have
such
good
information
from
vocational
rehabilitation.
G
D
D
Yes,
madam
chair
members
of
the
committee
for
the
record,
my
name
is:
barry
gold,
I'm
the
director
of
government
relations
for
aarp
nevada.
I
apologize
as
I
am
unable
to
be
present
either
in
carson
city
or
in
las
vegas.
For
the
meeting
today,
and
I
know
how
important
this
committee
is-
and
I
have
to
admit
I
have
so
many
conflicts-
I'm
actually
actually
multitasking
right
now
and
have
another
webinar
up
on
my
computer,
but
don't
tell
them
that
what
I
wanted
to
talk
about
was
looking
at
your
agenda
item.
D
I've
spoken
to
several
of
the
people
who
will
be
presenting
and
aurp
is
in
strong
support
in
collaboration
with
the
things
they
are
going
to
tell
you
so
on
behalf
of
the
345
000
aarp
members
across
the
state.
Aarp
strongly
supports
the
information
that
jennifer
richards
from
adsd
is
going
to
present
to
you
on
the
vulnerable,
adult
protective
order,
the
access
warrants
and
the
elder
abuse
fatality
review
teams.
D
I
will
not
say
anything:
she
will
tell
you
all
about
those,
but
we
are
a
strong
sport
of
those
happening
here
in
our
state
and
we're
also
strongly
support
the
recommendations
that
marie
coe
is
going
to
talk
to
you
about
the
long-term
care,
ombudsman
and
ways
to
protect
that,
and
I've
also
spoken
to
john
johnson
and
and
agree
with
the
things
for
guardianship.
Thank
you
very
much.
D
Good
morning
and
the
rest
of
the
beautiful
committee
and
handsome
people,
this
is
dora
martinez.
I
represent
the
nevada,
peer
action,
nevada,
disability,
peer
action
coalition,
and
I
would
like
to
echo
people
who
have
spoken
prior
to
me
and
especially
stephen
cohen's
request.
D
I
am
the
one
of
the
recipients
of
vocational
rehabilitation
services
and
what
they
usually
do
to
us.
Disabled
people
is
give
us
the
run
around,
and
I
will
ask
that
you
please
take
a
look
at
the
employment
specifically
pertaining
to
people
with
disability
in
the
state,
it's
very
low
and
it
parks.
We
do
not
want
to
stay
home
and.
D
Government
services,
those
that
can't
can't
work
to
lack
patient
empathy
to
people
with
disabilities.
They
are
oppressed
and
want
to
stay
home
because
we
do
not
like
the
discrimination
that
they
do
give
us,
and
I
please
urge
you
to
do
the
audit,
so
we
can
be
out
there
and
work
and
be
part
of
the
society.
G
Good
morning,
madam
chair,
my
name
is
mikey
kelly
of
north
las
vegas,
nevada,
mikey,
m-I-k-e-y,
last
name
k-e-l-l-y,
and
I'd
like
to
speak
to
something
that
is
not
on
the
agenda
as
we're.
During
this.
During
the
pandemic,
we
were
faced
with
an
increasing
number
of
homeless
persons
and
we
have
a
serious
crisis
in
relation
to
homelessness
and,
in
my
opinion,
and
a
lot
of
others,
we
don't
see
a
strong
addressing
of
the
problem.
G
G
Many
of
them
suffer
from
substance
use
disorder
and,
amidst
that
crowd,
many
are
sex
trafficking
victims
who
have
absolutely
no
place
to
go.
A
large
portion
of
them
are
veterans,
and
many
of
them
are
people
with
such
severe
healthy
issues
that
they
face
crisis
on
a
daily
basis,
but
they
have
no
places
to
go.
Several
years
ago,
the
late
assemblyman
tyrone
thompson
had
a
goal.
It
was
to
strengthen
the
continuum
of
care
for
homelessness.
G
G
That's
oftentimes,
performed
by
one
performed
by
a
municipality,
the
other
performed
by
the
county,
neither
one
of
them
talking
to
each
other.
I
urge
you
once
again
to
achieve
william
thompson's
goal
and
establish
a
unified
and
more
cohesive,
county-wide
continuum
of
care
to
address
the
serious
health
crisis.
Thank
you,
madam
chair.
A
A
I
have
a
motion
from
assemblywoman
consonant
in
a
second
from
senator
spearman,
all
those
in
favor
aye
aye,
any
opposed
hey.
Thank
you.
The
motion
carries
our
next
edge.
Agenda.
Item
is
number
four
presentation
on
achieving
a
better
life
experience
that
able
savings
accounts
to
ease
financial
challenges
for
individuals
with
disabilities
in
nevada,
administered
by
the
office
of
the
state
treasurer.
We
have
presenter
eric,
gimenez
chief
policy,
deputy
from
nevada
state
treasurer.
H
Good
morning,
madam
chair
for
the
record
eric
jimenez
with
the
treasurer's
office,
thank
you
so
much
for
allowing
us
to
to
be
here
today
to
talk
about
one
of
our
favorite
topics,
able
accounts,
which
I
think
are
a
transform
transformational,
financial
tool
for
the
disability
community
here
in
nevada
and
across
the
country,
as
some
of
the
public
commenters
alluded
to.
H
We
know
that
people
with
disabilities
are
one
of
the
largest
minority
groups
in
the
country.
We
know
that
they're
twice
as
likely
to
be
unemployed,
and
we
also
know
that
they
are
twice
as
likely
to
be
twice
as
likely
to
be
living
in
poverty
to
address
a
problem
that
had
occurred
for
decades,
able
accounts
were
were
created
so
that
people
with
disabilities
had
the
ability
to
save
and
to
earn
income
without
threatening
access
to
means-tested
benefits
like
medicaid,
social
security,
food
benefits,
housing
benefits
and
other
benefits.
H
Broadly
people
with
disabilities,
if
they
do
not
have
an
able
account,
can
only
save
about
two
thousand
dollars
per
year
or
twelve
hundred
and
twenty
dollars
per
month
before
losing
access
to
those
means-tested
benefits.
What
that
means
is
that
you
are
destined
to
live
in
a
perpetual
cycle
of
poverty
through
no
fault
of
your
own,
able
accounts
are
a
way
that
you
can
save.
H
Some
money
spend
that
money,
like
everyone
else
in
the
community,
without
threatening
access
to
those
means
tested
benefits,
and
I
think
more
importantly,
there
have
been
other
financial
vehicles
in
the
past
like
special
needs
trusts,
which
are
are
good
for
a
wide
variety
of
purposes,
for
transferring
assets
and
making
sure
someone
is
taken.
Care
of
you
know
when
parents
die
but
able
accounts
have
been
the
first
financial
vehicle
that
a
lot
that
empower
people
with
disabilities
in
making
their
own
choices.
H
The
account
beneficiary
on
enable
account
is
the
person
with
a
disability
unless
there
is
a
guardianship
over
the
person
and
over
the
estate,
and
they
cannot
make
those
financial
decisions
independently.
So
it's
very
important
because
when
the
money
goes
into
the
able
account
for
the
majority
of
the
population,
they
are
making
their
own
spending
decisions,
and
I
know
that
makes
some
people
uncomfortable.
H
H
So
much
like
the
college
savings
assets
that
this
state
administers
tens
of
billions
of
dollars
in
assets
able
accounts
are
managed
at
the
state
level.
So
there
are
state
plans
and
people
can
join
those
state
plans
in
nevada.
We,
we
then
set
up
our
own
plan
in
2015
and
what
we
saw
was
there
was
very
little
engagement
from
numerous
state
agencies
through
the
last
administration.
H
On
making
this
a
priority.
There
was
the
accounts
were
administered
in
the
state,
treasurer's
office,
and
then
marketing
outreach
was
handled
by
the
aging
and
disability
services
division
and,
as
a
result,
nobody
communicated
and
nobody
really
worked
to
set
up
able
accounts.
I
think
when
I
joined
the
treasurer's
office
shortly
after
the
2018
cycle,
there
was
something
like
90
accounts
and
nobody
knew
where
to
go.
No
one
knew
what
to
do
with
it.
H
So
we
worked
with
this
committee
back
in
the
interim
before
the
2019
legislative
session,
and
we
we
drafted
a
bill
assembly
bill
130.
I
think
it
had
like
two
lines
which
moved
the
program
entirely
over
to
the
treasurer's
office
and
since
that
time,
we've
seen
massive
account
growth
with
a
budget
of
zero
dollars
from
your
state
general
fund
broadly,
and
I'm
not
going
to
spend
too
much
time
on
this.
H
All
of
our
able
statutes
are
codified
in
nrs
427a
and
those
specify
that
money
in
enable
account
cannot
be
used
to
calculate
the
personal
assets
for
the
beneficiary
or
owner
of
the
account
for
disability,
medical
or
any
other
health
benefits
for
the
state.
Additionally,
student
loans
and
grants
and
other
federal
aid
programs
do
not
count
as
assets
for
the
person
with
the
disability.
H
Funds
in
enable
account
once
they
are
deposited
in
an
enable
account
they
are
they're
saved
on
a
tax-free
basis.
So
much
like
a
similar
college
savings
529
plan,
it's
a
tax
advantaged
savings
account
and
individuals
can
open
the
account
either
on
their
own
behalf,
or,
like
I
mentioned
before,
if
there
is
an
appropriate
guardianship
with
a
power
of
attorney,
an
authorized
individual,
which
is
usually
a
family
member
or
someone
that
is
declared
by
the
court
to
to
be
that
authorized
individual
can
open
the
account
on
their
behalf.
H
This
is
where
it
gets
a
little
tricky.
There
there's
a
bill
going
through
congress
to
increase
the
age
of
people
who
can
open
able
accounts,
but
right
now,
people
with
disabilities
who,
where
that
disability
occurred
before
the
age
of
26,
are
eligible
to
open
the
account.
That
does
not
mean
they
needed
to
be
diagnosed
before
the
age
of
26,
but
it
need
to
needed
to
have
occurred.
H
So
it's
a
lifelong
disability
and
typically
most
people
with
able
accounts
are
receiving
ssi
or
ssdi,
but
there
have
been
recent
changes
to
federal
regulations
that
now
allow
people
who
are
not
receiving
ssi
and
ssdi
to
also
sign
up
for
able
accounts
as
long
as
they
meet
the
disability
threshold
and
we'll
we'll
talk
about
a
grant
program
that
we're
running
now,
where
that's
been
a
huge
factor
and
you
can
only
have
one
account
per
person,
as
I
mentioned
before,
there
are
you.
H
Pretty
easily
staff
asked
us
to
try
and
contemplate
how
many
people
would
be
able
to
open
an
enable
account
and
it's
kind
of
a
squishy
number,
but
we
know
that
about
42
000
individuals
in
the
state
are
receiving
social
security,
disability
benefits,
but
when
we
open
that
population
up
for
those-
like
I
mentioned
in
the
previous
slide,
who
are
could
be
eligible,
maybe
for
income
of
their
their
family
members
or
other
factors,
are
not
receiving
ssi
and
ssdi.
H
H
Broadly,
you
can
use
these
dollars
to
cover
a
wide
variety
of
qualified
disability
expenses.
Those
can
vary
from
anything
from
education,
health
and
wellness,
housing,
transportation,
legal
and
professional
fees,
employment,
training
and
support
assistive
technology,
which
does
in
fact
include
service
animals.
I've
had
several
folks
get
guide
dogs,
which
I
strongly
support
with
these
money
with
these
dollars,
and
I
get
a
question
a
lot.
H
When
I
talk
to
families-
and
I
talk
to
folks-
and
they
said
well,
can
I
use
the
the
funds
in
this
account
to
take
a
trip
or
or
go
to
disneyland,
and
I
think
if
you
can
make,
if
that
family
can
make
a
reasonable
argument,
that
it
is
a
expense
that
will
increase
the
health
and
wellness
of
that
individual?
Then,
yes,
you
could
use
these
dollars
for
that
broadly.
H
You
can
save
fifteen
thousand
dollars
a
year
if
you
are
not
working
into
an
able
account.
If
you
are
working,
you
can
save
six
thousand
dollars
so
an
additional
twelve
thousand
dollars
a
year.
So
when
you
think
about
someone
that
may
be
working
in
a
sub
minimum
wage,
sheltered
workshop
as
we
have
allowable
under
state
law
here,
this
is
a
huge
tool
in
allowing
them
to
to
get
to
the
minimum
wage
and
earn
a
real
living
without
threatening
access
to
their
means-tested
benefits.
H
If
they
start
to
earn
more
than
26
thousand
dollars
a
year,
that's
great,
and
they
probably
at
a
certain
point,
will
not
need
those
means
tested
benefits
which
is
great,
but
until
such
time
as
they
could
to
get
to
to
that
level
of
income,
we
want
to
make
sure
that
they're
protected
and
that's
why
these
accounts
are
so
important.
Balance
is
under
a
hundred
thousand
dollars
are
execute
excluded
from
the
ssi
resource
limit,
and
we
differentiate
these
from
things
like
special
needs,
trust
which
are
designed
to
be
large
asset.
Bearing
accounts.
H
You
know
hundreds
of
thousands
of
dollars,
transfers
of
properties,
those
sorts
of
things.
These
are
not
that
this
is
really
a
blend
between
a
checking
and
a
savings
account,
and
the
dollars
in
this
account
are
meant
to
be
spent,
which
is
why
I
think
you
see
a
smaller
total
resource
limit
of
a
hundred
thousand
dollars
in
these.
H
We
already
mentioned
this,
so
I
will
move
on
because
I
know
you
have
a
busy
schedule.
We
participate
in
an
alliance
of
state,
a
collaborative
which
I
think
is
a
really
good
model
when
we're
thinking
about
other
things
like
retirement
savings
or
individual
development
accounts
and
other
types
of
financial
vehicles.
We
partner
with
18
states
that
account
for
about
half
of
the
able
accounts
nationally
and
why
we
do.
That
is
because
the
administration
from
a
staff
perspective
in
our
office
is
much
smaller
and
it
reduces
fees
for
participants.
H
These
funds,
similar
to
roth,
iras
and
other
retirement
savings
accounts
and
college
savings
assets,
can
be
invested
if
the
individual
or
the
family
wants
to
do
that,
which
I
think
is
an
interesting
opportunity
for
the
disability
community,
because
they've
never
really
had
that
option
before
so.
When
you
go
to
set
up
an
able
account,
you
have
the
option
of
doing
two
paths
you
can
either
say.
H
I
would
like
to
invest
and
I
can
pick
a
strategy-
that's
conservative,
too,
aggressive
or
moderate,
and
I
could
change
that
strategy
if,
for
some
reason,
my
circumstances
change
or
as
I
get
older
or
something,
but
you
can
also
enroll
in
a
fdic
insurer
debit
card
option,
which
I
I
advise
a
lot
of
folks
to
do.
Whereas
you
do
not
earn
interest
on
those
accounts,
you
do
protect
it
and
the
flexibility
of
using
a
debit
card,
I
think,
makes
it
a
lot
easier
for
people
to
spend
money
as
they
need
it.
H
In
the
community
we
have
a
25
minimum
contribution
required
to
open
enable
account,
I'm
working
very,
very
hard
to
try
to
get
rid
of
that
for
nevada
residents
and
we
actually
waived
it
for
the
the
tots
grant
program
which
we'll
talk
about
in
a
minute,
because
it
didn't
make
sense
to
to
have
people
who
needed
money
contributing
money
to
open
an
account.
So
that's
something
that
we're
looking
at
working
towards
getting
it
free
for
nevada
residents
and,
like
I
said,
we
keep
the
maintenance
fees
very,
very
low.
H
If,
if
a
count,
if
an
account
owner
chooses
electronic
statements,
it's
about
11
and
25
cents,
a
quarter
we're
also
trying
to
get
those
low
lower
as
much
as
we
can,
but
someone's
got
to
pay
those
fees.
So
as
we
shift
fees
from
either
nevada
residents
or
one
population
fees
increase
for
other
populations.
So
it's
kind
of
a
balancing
act
and
then
you
can
see
the
the
management
fees
if
you
were
to
to
select
those
risk-based
options
for
the
able
account.
H
This
is
very
exciting.
This
is
probably
the
most
innovative
use
of
able
accounts
in
the
entire
country,
but
on
october
25th
of
last
year,
thanks
to
the
the
votes
and
support
from
the
members
of
this
committee
in
the
entire
legislature,
through
sb
461
or
the
waterfall
bill,
this
office
treasurer
conan
set
up
the
largest
support
program
for
people
with
disabilities.
H
In
the
country
we
started
with
five
million
dollars
the
last
most
one
of
the
most
recent
ifcs
increased,
that
to
12
million
dollars
and
when
we
were
looking
at
arpa
funds
to
to
help
people
with
disabilities
and
families
and
kids
with
learning
loss
recover
from
the
pandemic.
It
was
incredibly
important
to
me
and
the
treasurer
and
the
governor
that
we
do
it
in
a
way
where
people's
benefits
were
protected.
H
We
didn't
want
to
unintentionally,
give
someone
a
five
thousand
dollar
grant
and
then
break
their
medicaid
eligible,
which
is
why
we're
the
only
state
in
the
country
that's
doing
this.
We
have
about
six
or
seven
states
that
are
looking
at
following
us
into
this,
but
it's
first
of
its
kind
program
in
the
country.
It
is
the
largest
program
of
its
kind
in
the
history
of
the
country
and
we're
super
proud
of
that,
and
I
think
you
can
see
our
significant
account
growth
from
last
fiscal
year
to
this
one.
H
We
are
reserving
2
million
of
that
to
support
specifically
children
in
the
foster
care
system
who
are
also
eligible
for
these
accounts
because
they
have
a
disability,
so
we're
incredibly
thankful
to
clark
county
washoe,
county
and
the
division
of
child
and
family
services
for
working
with
us,
and
that's
the
next
population
that
we're
working
through
so
we've
gotten
all
of
the
applications
pretty
much
funded
so
far
and
we're
going
to
work
on
the
foster
kids
going
forward.
H
Let's
talk
about
some
challenges
because
I
know
this
committee
has
bdrs
there's
a
number
of
different
things
and
priorities.
I'd
probably
suggest
housing
if
you
really
wanted
to
focus,
but
one
of
the
biggest
barriers
that
we
have
is
that
these
folks
don't
have
enough
money
to
begin
saving.
So
when
we
have
conversations
talk
to
them
and
say
you
know,
it'd
be
really
good
for
you
to
have
this
vehicle
to
begin
saving
the
biggest
complaint
is
I
don't
have
a
job?
H
I
don't
have
enough
money
or
I've
been
forced
for
20
years
to
spend
down
my
assets
at
the
end
of
each
month.
So
I
don't
lose
my
medicaid,
that's
a
structural
and
systemic
problem,
but
I
think
any
way
that
we,
as
a
state,
government
or
private
philanthropic
dollars,
can
work
to
help
build
the
assets
for
this
underrepresented
class.
I
think,
is
important.
H
We
do
hear
from
folks
that
the
the
enrollment
fees
that
25
fee
is
a
barrier
to
setting
up
the
able
account
and
we
are
working
with
that.
We'd
love
some
support
from
the
legislature
with
that
as
well,
and
you
will
see
budget
enhancement,
requests
from
our
office,
both
from
a
programmatic
side
and
a
staffing
side.
H
H
So
we
will
be
coming
forward
to
the
legislature
with
a
budget
request
with
this,
and
we
think
we
can
reach
a
lot
more
families
if
we
staff
this
program
and
run
it
right
rather
than
continuing
to
to
not
fund
the
program-
and
I
know
that
was
a
lot
all
at
once.
But
you've
got
a
busy
day
ahead
of
you
so
happy
to
take
any
questions
on
one
of
my
favorite
topics.
A
Thank
you,
mr
jimenez.
It's
one
of
my
favorite
topics
too.
I
work
with
a
non-profit
that
provides
healthcare
to
children
and
many
of
them
have
special
healthcare
needs
and
are
disabled.
So
I'm
really
excited
to
hear
about
this
program.
I
will
take
questions
from
community
members
at
the
at
this
time.
So
are
there
any
questions.
A
D
Jimenez,
this
is
a
great
program.
I
just
have
a
couple
of
questions.
One
of
them
is
just
clarifying,
so
if
somebody
wants
to
join
this,
do
they
have
the
option
for
it
to
be
basically
like
a
checking
savings
account
where
that
amount
that
they
have
in
there
is
consistent
as
they
add
to
it
or
debit
from
it,
or
they
have
the
option
for
in
sort
of
an
investment
account,
or
these
one
thing.
H
So
eric
commend
us
for
the
record.
Thank
you
for
the
question.
Broadly.
I
think
they
are
two
separate
things,
but
in
reality
money
is
fungible.
It's
always
getting
invested
right,
but
the
money,
if
you
choose
to
say
like
I,
want
a
specific
think
of
it,
like
a
checking
account
option.
You
can
pick
that
when
you
set
it
up-
and
you
could
say
I
would
like
that
option-
you
click
the
button
and
then
you
get
a
debit
account
and
that
money
is
insured
and
you
don't
take
any
risk
from
the
market
right.
H
D
H
Air
command
is
for
the
record,
there
are
monthly
fees
and
that's
just
how
it
works
with
these
types
of
accounts
on
both
there
are
not
investment
related
fees.
So
when
you
saw
the
there's
a
slide
that
had
something
like
34
to
38
basis
points,
those
fees
are
only
on
the
investment
accounts.
The
quarterly
maintenance
fees
are
on
all
of
the
accounts,
and
that's
just
that's
just
how
we
keep
the
program
solvent.
D
D
H
A
person
selected,
an
investment
option,
remember
they're
getting
interest
on
that,
so
they're,
paying
34
to
38
basis
points
on
that.
That
is
on
top
of
the
the
maintenance
fees.
So
broadly,
you
will
pay
quarterly
maintenance
fees
with
an
able
account,
but
I
think-
and
while
I
struggle
with
that
too,
I
think
it's
important.
You
are
also
keeping
your
medicaid
social
security,
food
assistance
and
housing
assistance
eligibility
through
those
programs.
H
D
I
Thank
you,
madam
chair,
how
you
doing
mr
jimenez
it's
pleasure.
As
always
listening
to
some
of
the
things
you
were
doing
for
some
of
our
most
vulnerable
citizens
couple
questions
here.
I
think
it
was
last
session.
We
got
senate
bill
188,
I
think
that's
the
number,
and
so
I
think
you
answered
part
of
it
because
one
of
the
questions
going
to
be
for
those
children
who
are
in
foster
care.
I
Are
they
able
to
couple
the
ida
with
the
able
accounts,
or
is
that
just
one
thing
and
the
next
thing
would
be
as
we
we
look
at
the
second,
the
other
part
of
188
dealt
with
people
who
are
receiving
some
type
of
social
assistance.
Social
service
assistance
would
any
of
that
spill
over
into
what
you
talked
about
with
respect
to
the
able
accounts,
those
who
are
getting
ssi
sdi?
I
Can
they
couple
that
too,
with
the
provisions
of
senate
bill,
188
and
and
if
so,
what
is
the
best
way
for
us
to
get
the
information
out,
because
I
think
you
said
at
one
point
prior
to
2018
that
there
wasn't
a
whole
lot
of
emphasis
on
for
lack
of
better
term
marketing.
But
what
can
we
do
to
make
sure
that
people
know
that
that's
there,
especially
during
this
time
when
people
there
is
a
housing
shortage
or
a
housing
crisis
here?
I
What
what
can
we
do
to
use
the
information
you
presented
to
us
today
and
188
to
pull
those
together
so
that
more
and
more
people
have
an
opportunity
to
lift
themselves
up
and
out
of
their
current
situation?
That's
part
one
and
I'll
wait.
H
Okay,
that
was
a
long
part
one
senator,
but
I
got
it
eric
commits
for
the
record
senate
bill
188,
which
is
why
we
worked
together
so
diligently.
I
think,
and
it
was
a
very
character.
Building
experience
over
two
sessions
was
so
important
because
it
established
individual
development
accounts
which
are
broadly
able
accounts,
but
for
a
broader
population,
a
broader
spectrum
of
the
population,
while
able
accounts,
are
only
eligible
for
people
with
disabilities
that
occurred
prior
to
the
age
of
26.
H
Idas
are
for
those
receiving
social
services,
regardless
of
disability
status,
those
who
are
in
low
income
housing
units
and
for
children
in
the
foster
care
system.
As
we
we've
learned
a
lot
through
the
the
able
account
experience,
I
think
once
we
get
through
this
foster
care
portion
of
the
tots
grant.
My
intention
is
to
launch
the
council
on
financial
independence
and
set
up
the
the
ida
structure.
So
we
have
a
good
structure
going
into
the
next
legislative
session.
H
They
could
work
interchangeably.
I
don't
see
why
they
couldn't
if
there
was
for
some
reason,
one
pool
of
money.
We
know
they're
separate
federal
grants
that
are
designed
to
go
specifically
into
idas
there.
Someone
could
theoretically
be
eligible
for
both
an
individual
development
account
and
an
able
account.
So
I
think
that's
something
we'll
have
to
to
contemplate
as
we
go
through
the
regulatory
process,
but
I
don't
see
why
they
they
couldn't
work.
H
I
think
the
question
would
be
like:
does
that
benefit
the
person,
or
should
we
have
a
conversation
of
like
which
account
might
be
better
for
the
assets?
In
that?
I
think
when
we
think
about
the
individual
development
accounts,
there
are
they're
a
little
bit
differently
focused
in
the
eligible
expenses
broadly
the
same,
but
they
were
much
more
housing
focused.
They
were
much
more,
you
know.
How
do
we
get
you?
H
A
pathway
out
of
poverty,
while
also
protecting
your
benefits,
so
part
of
your
question
was:
are
those
benefit
thresholds
still
protected
with
the
idas?
We
wrote
that
specifically
so
that
medicaid
benefits
are
protected.
H
We
did
not
write
it
as
social
security
benefits
because
we
were
not
contemplating
largely
disabled
folks,
taking
advantage
of
this
account,
but
the
the
goal
was
to
mirror
them
as
closely
as
possible
to
the
ida
program.
So
I
hope
that
answers
part
one.
I
Part
one
and
part
two
would
be
when
I'm
sorry,
madame
chair
follow-up,.
I
Thank
you
so
part
two
would
be.
You
mentioned
service
fees
that
basically
just
maintenance
fees
for
the
account-
and
I
imagine
that's
a
consequence
of
some
of
the
financial
institutions,
so
the
question
would
be:
would
it
be
plausible
to
perhaps
consider
cdfis
as
some
some
of
the
institutions
that
that
people
might
be
able
to
deposit
or
to
open
up
these
accounts
in
being
that
the
first
name
or
the
first
part
of
that
name
is
community?
I
The
second
middle
name
is
development,
and
so,
if
you
can,
we
can
couple
community
development,
financial
institutions
with
the
idea
of
helping
to
helping
people
to
be
empowered,
financially
and
take
control
of
their
their
own
destiny.
If
you
will
is
there,
is
there
a
way
to
work
with
some
of
the
community
development
financial
institutions
to
either
reduce
or
eliminate
those
fees
just
based
upon
what
their?
What
their
structure
their
bylaws
would
say?
I
Is
there
any
way
that
we
might
be
able
to
create
some
encouragement
if
you
will
from
the
cdfis
to
participate
more
in
the
able
or
the
idea
accounts,
and
I
hope
that
makes
sense
to
you.
H
It
does
senator
eric
commend
us
for
the
record
I'll
start
with
the
able
accounts,
then
we'll
move
into
the
the
ideas
which
I
think
is
a
little
more
interesting
here
with
the
able
accounts
in
the
able
alliance
I
kind
of
walked
in
to
that
contract.
So
we've
been
working
to
to
see
what's
working
and
see.
What's
not
working,
I
think,
as
we
go
up
for
our
next
negotiations,
that
that's
going
to
be
something
that's
important
to
me
is
getting
those
fees
down.
H
I
will
say
if
we
were
to
unenroll
or
do
our
own
plan,
the
fees
would
be
cost
prohibitive
to
administering
the
program
and
that's
just
not
a
risk.
I'm
willing
to
take
right
now
unless
we
have
a
more
developed
option.
I
think
for
something
like
the
ida's
as
we're
contemplating
like
which
fiduciary
organizations
to
to
partner
with
and
assemblywoman
chandra
summers.
Armstrong
was
very
passionate
about
keeping
the
fees
low
within
that
program,
and
I
think
we
put
some
flexibility
language
in
there.
H
I
think
it's
a
really
interesting
conversation
now
that
nevada
has
its
first
real
cdfi.
I
know
the
work
that
ken
evans
has
been
doing
with
the
urban
chamber
is
going
to
be
really
groundbreaking,
particularly
for
folks
in
the
the
african-american
latino
communities
when
we
start
to
contemplate
how
to
set
up
those
ideas.
I
think
thinking
about
a
partnership
with
cdfis
makes
a
ton
of
sense
to
keep
those
fees
low,
but
I
think
broadly,
we
should
set
expectations.
A
Thank
you
senator.
Are
there
any
other
questions
well
seeing
none?
I
do
have
a
couple
of
quick
questions
again.
Working
with
a
non-profit
and
many
of
our
kids
have
special
health
care
needs.
Some
have
been
born
with
conditions.
Some
have
been
involved
in
accidents
or
have
had
chronic
illness.
So
could
you
elaborate
a
little
bit
more
about
the
types
of
conditions
that
would
be
eligible
for
this
program.
H
Thank
you,
madam
chair.
That's
a
great
question
and
I
get
it
every
day
and
we
got
it
a
lot
as
we
launched
the
tots
program.
The
goal
of
these
accounts
is
to
make
sure
that
we're
helping
kids
and
older
individuals
who
need
it,
but
also
not
trying
to
be
overly
restrictive.
H
There
was
a
change
to
to
irs
regulations
over
the
last
year
or
so,
which
lowered
the
threshold
for
disability
standards
in
in
terms
of
what
documentation
might
be
necessary.
Broadly,
if
you
have
a
condition,
that's
that's
categorized
in
what's
called
the
social
security
blue
book
or
are
eligible
for
ssi
or
ssdi
automatically
eligible
right.
So
that's
your
your
developmental
disabilities.
It's
your!
You
know
severe
cognitive
disabilities.
H
It's
severe
autism,
it's
all
sorts
of
other
disabilities
and
physical
impairments
and
those
sorts
of
things
then
there's
this
kind
of
nebulous
of
varying
range
of
disabilities
and
we've
done
a
really
good
job.
Nevada
is
actually
the
national
leader
in
what
I
would
call
settlement
able
accounts
so
through
mass
torts
or
mass
litigation,
where
there
are
a
lot
of
beneficiaries
that
are
either
coming
from
a
medical
malpractice
suit
or
a
prescription
drug
lawsuit,
they're,
often
entitled
to
benefit
checks
and
settlement
checks.
H
So
we
have
worked
with
benefits,
consultants
and
members
from
the
the
trial
or
community
to
make
sure
that
when
those
those
settlements
happen
that
we're
actively
setting
up
able
accounts
for
those
folks
and
what
we've
seen
with
that
population
is,
we've
seen
a
ton
more
in
the
mental
health
space
in
the
severe
emotional
disturbance
space,
which
we
see
a
lot
with
our
foster
youth,
and
we
we've
seen
a
ton
more
in
the
the
autism
spectrum
as
well.
So
we
are
trying
to
make
this
as
broad
broad
as
possible.
H
I
think
when
families
or
if
there
are
people
listening
to
this,
if
you
believe
that
your
child
has
a
disability
that
impairs
their
life
and
need
to
access
these
accounts,
you
can
set
one
up
right.
You
you
have
the
ability
to
affirm
under
penalty
of
perjury
when
you
set
those
accounts
up,
we're
not
going
to
ask
for
medical
records
and
and
those
sorts
of
things,
but
there
is
federal
statutes
governing
this.
H
So
we
do
want
to
make
sure
that
whenever
someone
signs
up,
they
are
affirming
that
they
do
in
fact
have
a
disability.
So
I
think
that's
a
long
way
of
answering
your
question
assemblywoman,
but
I
do
think
that
we
are
we're
trying
to
make
this
work
for
a
broad
spectrum
of
the
disability
community.
A
H
Thank
you
for
the
question,
madam
chair,
and
I
think
senator
spearman
alluded
to
this
in
her
earlier
question
like
how
do
we
get
the
word
out?
We
do
that
by
hard
work
right.
We
don't
need
marketing,
budgets
and
other
things.
I
know
a
lot
of
people
will
say
you
need
to
no,
you
need
to
get
into
the
community.
You
need
to
meet
people
where
they
are.
You
need
to
get
in
front
of
folks
that
that
people
trust
in
this
community
and
that's
the
work
that
we've
done.
H
We
have
worked
with
the
department
of
education
in
the
2017
session.
There
was
a
bill
passed
called
the
ab64
which,
which
allowed
an
alternate
pathway
for
a
high
school
diploma
for
a
kid
with
a
disability,
and
what
we've
done
is
so
if
a
if
a
student
or
a
school
is
pursuing
that
option
that
alternate
diploma
does
not
count
against
their
graduation
rates,
so
it
adds
to
the
graduation
rate,
but
in
order
to
get
that
alternate
diploma,
that
student
needs
to
be
educated
about
able
accounts.
H
We've
worked
with
the
department
of
education
to
start
implementing
able
accounts
into
all
iep
meetings
with
families,
so
we're
slowly,
but
sharing
surely
making
sure
that
when
people
are
in
situations
when
they're
talking
about
you
know,
what's
my
child
going
to
do
next
or
how
do
I
care
from
our
child
when
they
graduate
high
school
that
they're
getting
this
information
in
front
of
them,
we
could
always
do
more.
We
could
always
use
more
resources,
but
it's
really
just
getting
in
front
of
the
community
and
meeting
folks
where
they
are.
A
Thank
you
very
much.
I'm
seeing
there
are
no
other
questions.
We'll
close
this
agenda
item
and
move
on
to
the
next
agenda
item,
which
is
agenda,
item
number,
five
presentation
on
united
states
department
of
labor
state
exchange
on
employment
and
disability
initiative.
Presenters
are
john
cunningham
from
project
manager
with
employment,
labor
and
retirement
national
conference
of
state,
legislatures,
bobby
silverstein,
principal
powers,
pyle
slutter
and
for
philly.
Sorry,
legislative
and
policy
council
say
exchange
on
employment,
disability
and
acadia.
A
K
Thank
you,
madam
chair,
and
thank
you
to
the
committee.
Let
me
make
this
big.
K
Again,
thank
you
chair,
thank
you
to
the
committee
for
inviting
us
here
today.
My
name
is
josh
cunham
and
I
am
with
the
national
conference
of
state
legislators
where
I
work
on
various
employment
and
labor
issues,
including
disability
and
inclusive
employment
policies
as
well
as
kind
of
broader
state
government,
employment
policies,
I'll
have
bobby,
introduce
himself
real,
quick
and
then
we'll
dig
in.
J
I'm
the
former
staff
director
and
chief
counsel
to
the
united
states
senate
subcommittee
on
disability
policy,
and
I
was
there
in
congress
when
we
passed
the
americans
with
disabilities
act
and
20
other
pieces
of
disability
related
legislation,
including
multiple
reauthorizations
of
the
rehabilitation
act
and
the
individuals
with
disabilities.
Education.
K
K
We
call
the
state
exchange
on
employment
and
disability
or
seed
this
ongoing
initiative.
This,
as
mentioned,
was
funded
by
the
u.s
department
of
labor's
office
of
disability,
employment
policy.
The
goal
of
seed
is
to
foster
a
workforce
that
is
more
inclusive
of
people
with
disabilities
through
state
and
local
policy.
K
To
do
this,
seed
engages
policymakers
in
various
ways.
These
include
public
testimonies
such
as
we're
doing
today:
individualized
policy,
research
for
state
legislators,
legislative
staff,
state
agencies,
etc.
We
can
provide
gap,
analyses
and
customize
policy
development
pulling
from
experiences
in
other
states
and
connecting
legislatures
and
policymakers
with
subject
matter.
Experts
and
federal
agencies
advocates
business
organizations
etc.
K
From
around
the
country.
We
proactively
build
resources
on
disability,
inclusive
policy
options
as
well
as
developing
those
from
using
examples
from
other
states.
These
resources
are
largely
based
on
a
framework
developed
in
2016
by
a
bipartisan
national
task
force
consisting
of
state
legislators,
state
agency
staff,
as
well
as
private
sector
stakeholders.
K
The
task
force's
working
members
report
identifies
hundreds
of
state
policies
and
examples
falling
into
kind
of
five
key
themes
that
you
see
on
the
screen.
First
of
all,
which
is
laying
the
groundwork
which
includes
establishing
a
state
level,
commitment
to
disability,
inclusive
employment,
we'll
be
digging
into
this
a
little
bit
deeper
in
a
few
minutes.
The
other
themes
include
preparing
for
work
getting
to
and
accessing
work
opportunities,
staying
at
work
and
supporting
self
employment
and
entrepreneurship.
K
Sorry,
real
quick
bobby
sorry
c
does
track
legislative
actions
in
states
related
to
the
work
matters
policy
framework
on
a
monthly
basis
and
bobby
is
going
to
talk
to
you
about
some
of
the
guiding
principles
that
really
does
guide
the
work
that
we
do
so
bobby
I'll
turn
it
over
to
you.
J
Great,
if
I
could
take
30
seconds
to
summarize
what
we
are
not
we
are
not
advocates.
We
provide
policy
assistance,
describe
policy
options,
so
we're
not
here
to
advocate
for
any
particular
position.
What
we
do
is
share
with
your
colleagues
around
the
country
have
been
doing
in
terms
of
enhancing
disability,
inclusive
policy.
J
Now,
when
the
state
and
local
policy
makers
came
together
to
develop
work
matters,
the
first
thing
that
was
decided
on
was
a
set
of
principles
to
guide
the
development
of
the
work
matters
framework
and
the
group
redirect
rejected
what
we
call
the
old
paradigm
of
disability,
which
looks
at
people
with
disabilities,
as
crippled
defective
individuals
who
are
totally
dependent.
J
J
This
was
what
we
call
the
old
paradigm
benevolent
and
benevolent
in
nature,
based
on
pity,
based
on
paternalism
ice
resulting
in
isolation,
segregation
and
denial
of
opportunity.
Instead,
there
is
a
new
paradigm
that
is
recognized
that
says
that
disability
is
a
natural
and
normal
part
of
the
human
experience
that
in
no
way
diminishes
a
person's
right
to
fully
participate
in
all
aspects
of
society,
and
so
the
focus
of
the
policy
should
be
on
fixing
the
physical
and
virtual
environment
and
attitudinal
biases,
and
the
report
is
based
on
four
goals
of
disability
policy.
J
So
some
of
the
themes
of
the
work
matters
is
to
recognize
that
people
with
disabilities
are
underutilized
in
the
workforce
that
they
can
provide
a
valuable
and
unique
contribution,
and
another
key
thing
is
the
simple
sentence
that
is
kind
of
modeled
on
management.
J
So
this
was
another
key
theme
that
we
had
and
the
last
one
is
universal
design,
which
is
basically
the
notion
that
when
you
design
a
building
or
a
website
or
a
new
service
of
support,
a
new
program
that
you
take
into
consideration
the
needs
of
the
greatest
number
of
folks,
so
that
the
initial
stages
address
the
needs
and
you
do
not
have
to
provide
accommodations
next
slide.
Please.
J
So
work
matters
basically
came
up
with
eight
policy
options
based
on
discussions
with
staff.
They
asked
us
to
focus
on
four
state
as
a
model
employer
building
the
capacity
of
the
private
sector,
interagency
coordination
and
collaboration
and
transportation
and
so
josh.
Why
don't
you
start
with
status
model,
employer.
K
I'm
great
thank
you
bobby.
This
is
josh
cunningham.
As
bobby
mentioned,
we
have
been
asked
by
the
committee
to
talk
to
you
about
state
what
we
call
state
as
a
model
employer.
As
with
most
states,
the
state
of
nevada
is
one
of
the
largest
employers
in
the
state
and
because
the
state's
own
employment
practices
are
largely
outlined
in
statutes
and
regulations.
K
The
legislature
has
a
greater
ability
to
modify
those
employment
practices
than
they
do
with
the
private
sector,
and
so
state
legislators
can
adopt
policies
that
emphasize
disability,
inclusive
practices
and
state
government
employ.
This
can
cover
state
government
employee,
recruiting
as
hiring
accommodations
promotions
and
retention.
K
Nevada
nevada
already
has
some
model
policies
in
place
that
we
at
sea
like
to
highlight
when
we're
talking
with
other
states.
This
includes
the
700
hours
program
that
connects
eligible
candidates
with
disabilities
with
temporary
employment
opportunities
within
state
government.
K
Nevada
also
has
an
interview
requirement
and
hiring
preference
for
veterans
with
disabilities
who
are
applying
for
state
job.
Openings.
Nevada
also
has
an
interview
required.
I'm
sorry.
K
There
are
some
additional
policy
options
outlined
in
the
framework
that
you
may
be
interested
in
exploring,
and
those
are
shown
here
on
the
slide.
Just
to
highlight
a
few
of
these.
This,
the
state
can
examine
the
strength
of
its
training,
of
hiring
managers
on
disability
inclusion
and
the
unique
challenges
people
with
disabilities
face
in
the
workplace.
K
K
Seed
has
found
that
a
more
centralized
accommodations
process
is
an
effective
way
of
ensuring
workers
are
receiving
the
accommodations
they
need
to
succeed
in
their
job.
This
approach
can
centralize
accommodations
expertise
that
will
help
identify,
affordable
and
effective
accommodations
and
can
also
centralize
the
financial
cost
of
accommodations,
particularly
for
smaller
budget
strapped
agencies
and
lastly,
with
many
jobs,
relying
more
and
more
on
technology.
K
So
this
is
a
quick
run
over
of
status
as
a
model
employer
and
we'll
take
some
questions
at
the
end
and
can
provide
some
additional
follow-up,
but
I'm
going
to
turn
it
back
over
to
bobby.
Since
we
have
limited
time
and
he's
going
to
talk
about
a
couple
more
policy
areas
that
the
committee
said
they
were
interested
in
so
bobby
I'll
turn
it
back
over
to
you.
J
Right
so
the
next
topic
area
is
building
the
capacity
of
the
private
sector.
J
You
have
a
number
of
programs
and
you're
operated
by
the
vocational
rehabilitation
program,
providing
technical
assistance
to
businesses
developing
a
pipeline,
but
one
of
the
things
that
other
states
are
doing
is
they
have
you
have
a
lot
of
companies
that
contract
with
the
state
they
have
developed
affirmative
action
or
strategic
plans
at
diversity,
equity
inclusion
plans
that
require
workforce
analyses,
goals,
progress
reports
so
again
we
have,
if
you're
interested,
we
can
share
with
you
what
your
colleagues
around
the
country
are
doing
in
terms
of
diversity,
equity,
inclusion,
strategic
plans
that
are
required
of
government
contractors.
J
A
number
of
states
have
developed
work
matters
task
forces
to
look
at
issues
ranging
from
status
to
model
employer
to
engaging
the
private
sector
to
disability
owned
businesses
next
slide,
please
some
states
have
developed
tax
incentives
to
increase
the
hiring
of
of
the
provision
of
accessible
technology
and
accommodations
for
people
and
others.
Tax
credits
for
employing
people
with
disabilities.
So
you've
got
these
incentives
and
tax
credits
that
your
some
of
your
colleagues
have
done
and
again.
J
Part
of
the
issue
is
particularly
small
business
if
they
have
to
provide
an
interpreter
or
reader
or
assistive
technology.
Are
there
some
credits
that
can
be
employed
and
are
there
incentives
for
hiring
people
with
disabilities.
J
J
Your
governor
issued
an
executive
order
create
establishing
the
governor's
task
force
on
integrated
employment.
Again
that
was
2014..
J
This
is
one
of
the
efforts
that
a
lot
of
states
almost
all
states,
except
for
one
called
employment
first,
which
has
the
default
the
presumption
the
priority
is
competitive,
integrated
employment
in
this
executive
order.
There
was
a
provision
for
a
three
and
five
and
ten
year
strategic
plan.
The
one
of
the
questions
is:
have
you
folks,
in
terms
of
oversight?
J
Looked
at
that
plan
those
strategic
plans,
I
I
downloaded
it
and
to
see
which
of
those
policies
hasn't-
have
in
fact
been
implemented.
What
might
require
legislative
action
rather
than
action
by
the
executive
committee
and,
interestingly
enough,
the
topics
that
were
included
in
the
report
pretty
much
parallel.
The
topics
that
were
included
in
work
matters
ranging
from
stays
in
model,
employer
private
sector,
interagency
coordination,
transportation
next
slide.
Please.
J
J
2019
you
passed
ab
456,
which
deletes
the
exemption
for
some
minimum
wage
question
is:
have
you
done
oversight
and
see
implementation
of
that
provision?
There's
a
a
lot
of
states
have
actually
enacted
legislation
creating
employment.
First,
some
states
have
both
an
executive
order
and
legislation.
J
Some
have
only
an
executive
order
like
nevada,
others
have
legislation.
A
we
at
the
seed
project
have
developed
a
comprehensive
policy.
Brief,
called
evolution
of
state
policies,
facilitating
competitive
integrated
employment
for
people
with
disabilities,
which
has
links
to
every
one
of
the
state
policies,
whether
it's
an
executive
order
or
legislation
in
terms
of
employment
first,
as
well
as
a
links
to
every
state
that
has
addressed
the
issue
of
some
minimum
wage
for
people
with
disabilities.
So,
if
you're
interested
in
updating
some
of
your
policies,
this
policy
brief
might
be
helpful
to
you
next
slide.
Please.
J
J
Transportation,
particularly
for
those
matching
transportation
options
for
people
with
disabilities
and
the
other
key
thing
is
measuring
progress.
As
I
said,
what
gets
measured
and
reported
and
has
consequences,
gets
done.
One
of
the
principles.
A
number
of
states
have
extensive
reporting
mechanisms
to
measure
success,
josh.
K
Great
thank
you
bobby
for
the
rest
of
josh
cunningham.
The
final
policy
area
that
we're
going
to
be
discussing
kind
of
in
a
little
bit
of
detail
is
around
accessible
transportation.
K
K
Transportation
systems
can
help
overcome
this
barrier,
convening
a
task
force
or
working
group
that
regularly
regularly
evaluates
transportation.
Accessibility
challenges
can
be
an
effective
way
to
identify
any
necessary
policy
changes.
States
can
also
help
ensure
emerging
transportation
technologies
such
as
autonomous
vehicles
and
ride.
Hailing
services
are
being
designed
and
implemented
with
built-in
accessibility
features
and
processes.
K
This
includes
accessible
software
and
apps
that
allow
writers
with
disabilities
to
participate
in
these
emerging
technologies
in
the
same
manner
that
those
without
disabilities
can't
particularly
when
we're
talking
about
an
economy
that
is
moving
to
a
place
where
it
is
more
reliant
on
these
technologies.
If
they
are
not
made
accessible
by
those
with
disabilities
or
by
a
significant
portion
of
the
people,
then
those
individuals
will
be
even
further
or
even
more
marginalized,
from
participating
in
that
economy.
K
Here
are
a
few
of
the
options
which
I
kind
of
went
over
some
of
these.
If
you're
interested
we
again,
we
can,
we
can
share
more
resources
with
limited
time.
We
aren't
able
to
dig
into
these
too
much,
but
I
just
want
to
re-emphasize
that
these
examples
are
that
we've
all
that
gobby
and
I
have
been
talking
about-
are
all
based
on
existing
policies
in
other
states
and
so
we're
happy
to
follow
up
with
the
committee
with
more
details
about
how
other
states
approach
these
issues.
We
can
also
develop
some
customized
policy
resources.
K
If
you
would
be
interested
that
you
can
share
with
your
colleagues
on
these
issues
as
well,
and
so
with
that.
We
thank
you
for
the
invitation
today
and
we
look
forward
to
working
with
this
committee
going
forward
and
we
are
happy
to
take
any
questions
that
the
committee
might
have.
A
I
Yeah
not
so
much
a
question
as
much
as
maybe
a
comment,
and
I
appreciate
the
overview
and
the
work.
That's
being
done,
one
of
the
things
that
happens
to
us
all
too
often,
I
think,
when
we're
doing
policy
is
we
make
policy
based
upon
the
people
who
already
can
do
and
not
think
about
the
people
who
want
to
do
but
need
just
a
little
bridge
to
make
sure
that
that
happens.
I
So,
thank
you
so
much
and
I
I
appreciate
working
with
this
committee
and
now
that
I
know
I
remember
that
seed
is
around
I'll,
be
calling
on
the
services
a
lot
more.
I
guess
in
my
way
of
maybe
a
question,
and
that
would
be
so
within
the
military.
It
seems
like
it's
a
real
close
system
in
terms
of
support,
family
support,
etc,
but
often
that's
not
translated
for
the
people.
I
The
families
who
live
off
base
off
post,
who
live
out
in
in
the
economy
so
is
there
anything
that's
happening
with
respect
to
making
sure
that
there
is
some
type
of
informational
connectivity
between
those
persons
in
the
military
who
would
need
these
types
of
services,
understand
those
types
of
services
and
for
those
who
for
the
that
are
off
base,
but
also
connected
to
the
military,
but
also
working
in
and
around
the
various
communities
which
the
service
member
might
be
stationed.
I
hope
that
hasn't
been
too
convoluted.
K
And
I'll
be
honest
with
you,
I
I'm
not
familiar
enough.
I
think
with
those
processes
and
I'm.
K
Oh,
yes,
I'm
sorry.
This
is
josh
cunningham
with
the
ncsl
and
bobby
feel
free.
If
you
have
more
information,
but
we're
happy
to
look
into
that,
and
I
can
connect
you
with
some.
I
have
some
colleagues
that
work
more
closely
on
military
issues,
but
unfortunately
that's
a
little
bit
outside
of
the
realm
of
what
some
of
the
work
that
we've
been
doing.
But
yes
happy
to
follow
up
with
you
and
connect
you
with
some
some
folks
who
can
give
you
a
better
answer
to
that.
I
You
know,
thank
you.
Yes,
one
thing
that
I've
noticed
is
a
lot
of
the
information
that
we
have
available
to
the
civilian
population
is
stove
piped
and
it
doesn't
get
out
to
the
the
military
and
because
we
don't
have
on-base
housing
for
all
military
families,
then
that
information
gets
lost
and
people
in
living
in
communities
are
kind
of
go.
Here's
a
theater
and
young
line
trying
to
find
it,
so
it
would
be.
I
A
Okay,
seeing
there
are
no
further
questions.
We
will
close
this
item
of
business
and
move
on
to
our
next
item.
We
are
going
to
skip
a
couple
agenda
items
and
move
on
to
agenda
item.
10.
Do
some
some
timing
issues
so
apologize
for
not
letting
everyone
know
in
advance
on
that,
so
we'll
be
moving
again
to
agenda
item
10.
A
It's
the
presentation
on
the
heroes
to
education
program,
to
support
teaching
licenses
for
veterans
and
military
spouses
in
nevada,
so
we'll
now
have
dr
george,
anne
rice,
chief
operating
officer
of
the
heroes
to
education
program
to
present
to
the
heroes,
education
partner,
to
support
teaching
licenses
for
veterans
and
military
spouses
in
nevada.
Dr
rice,
please
proceed
with
your
presentation
when
you
are
ready.
F
Thank
you
very
much,
and
I'm
very
grateful
to
this
committee
for
letting
me
come
and
present
heroes
to
education.
F
Let's
see,
first
of
all,
as
we
all
know,
there's
a
crisis
in
public
education,
not
only
in
nevada,
but
in
all
states
we
have
positions
that
are
unfilled:
teachers,
I.t,
custodians
bus
drivers,
you
know
early
retirements
and
job
abandonment,
the
colleges
of
education,
declining
enrollment.
F
F
F
Our
member,
our
leadership,
is
under
general
lieutenant
general
david
oley.
We
have
eight
retired
military
officers,
we
have
one
retired
college
president
human
resources-
and
me
I
am
the
k-12
representative.
F
F
F
What
we
will
be
doing
is
recruiting
of
these
heroes,
conducted
by
district
representatives
to
identify
jobs
that
go
along
either
with
their
aspirations
or
with
their
current
school
set
sets
skill
sets
rather
the
gaps
between
their
knowledge
and
their
requirements
for
the
jobs.
We
will
help
make
arrangements
for
them
to
fill
in
those
gaps
and
to
have
mentors
one
of
the
things.
That's
very
big
is
transition
mentoring.
When
we
brought
together
a
group
of
current
ccsd
and
la
uni,
unified
teachers
who
are
veterans,
we
ask
them
what
kind
of
support
do
you
wish?
F
You
would
have
that
you
did
not
have,
as
you
made
the
transition
from
military
into
the
school
districts
and
they
said
transitioning
helping
us
navigate
the
system.
That's
what
we
need
before.
We
need
job
training
help
in
transition.
So
we
built
that
into
the
program.
We
are
also
working
with
the
interstate
compact
for
military
licenses.
F
We
are
heading
heroes
to
education,
heading
the
passage
the
strategy
passage,
because
we
cannot
wait
two
to
three
years
to
have
a
majority
of
the
states
passed
this
legislation,
and
so
we
are
heading
that
group
in
order
to
look
out.
How
can
we
get
the
information
to
the
influencers
so
that
state
legislatures
around
the
country
legislators
around
the
country
will
know
why
this
is
so
important?
F
On
the
national
front,
we
have
presented
to
the
white
house
domestic
policy
council,
a
presentation
of
who
we
are
basically
it's,
this
presentation,
but
it's
video
as
well
as
this,
and
we
are
looking
for
a
presidential
executive
order
and
the
reason
for
that
is.
We
need
to
get
started
and
be
funded
right
away
and
then
step
two
is
congressional
legislation.
F
This
is
what
I
just
said.
We
have
presented
to
the
white
house
domestic
policy
council
to
joining
forces.
We
have
total
support,
senator
spearman
from
the
va.
We
have
the
secretary,
the
deputy
secretary
and
now
the
under
secretary
for
benefits,
and
they
have
designated
people
within
that
head
departments
to
work
with
us
in
a
memorandum
of
agreement
that
they
support
us
and
that
this
is
what
they
will
do
for
us,
and
so
that's
very
important.
Senators
mansion
scott
duckworth
ernst,
tester
danes
and
representatives,
turner
and
alluria
have
been
briefed
along
with
many
others.
F
F
California,
los
angeles,
san
diego
miami-dade,
stood
up
and
said
if
we
don't
go
along
and
support
this
effort,
we
are
missing
a
great
opportunity
and
they
have
been
with
us
this
entire
five
and
a
half
years,
and
so
those
are
the
states
in
which
we
are
building
prototypes
so
that
when
we
get
the
green
light,
we
know
what
to
do.
First,
what
to
do
second,
and
so
on
and
just
quickly
these
are
the
districts
within
the
states
that
are
helping
us
build
the
models.
F
You
all
have
a
copy
of
this
presentation.
We
also
have
advisory
groups
because
you
cannot
come
up
with
a
plan
and
hand
it
down.
What
you
must
do
is
involve
those
who
will
be
the
benefactors
of
the
work,
as
well
as
those
who
will
administer
the
work.
So
we
have
a
advisory
group
of
military
spouses
for
school
safety,
for
transition,
mentoring
for
induction
and
teacher
leadership
and
alternative
route.
F
F
Those
are
the
ones
that
we
can
reach
out
to
people
who
are
leaving
the
service.
Moving
to
your
particular
state.
We
can
make
them
aware
of
jobs
that
are
available
in
public
education,
the
state
departments
of
employment,
the
workforce
development
boards.
I
had
no
idea,
california
has
48
of
these
workforce
development
boards.
Of
course,
we
have
being
much
smaller
too.
Florida
has
30-something
of
these
boards
state
departments
of
education,
every
city
and
county
government
las
vegas,
henderson,
boulder
city,
north
las
vegas.
F
The
county
of
clark
are
willing
to
put
openings
on
their
websites
and
to
include,
in
their
representatives
newsletters
information
about
jobs
that
are
available.
The
state
national
guards
work
for
warriors
esgr,
I'm
working
with
a
a
person
in
esgr
in
california
who,
by
the
way,
is
living
now
in
las
vegas,
and
he
has
made
an
agreement
and
is
trying
out
where,
if
a
school
district
will
say,
we
have
this
very
unique
position
and
we
can't
seem
to
locate
anyone
for
it.
F
He
will
take
the
job
description,
convert
it
into
dd214
language
and
take
it
to
all
the
reserve
and
guard
units
to
see
if
there
are
people
that
fit
that
that
are
looking
for
jobs.
We're
also
working
with
the
state
and
the
commissioner
for
the
interstate
compact
for
military
children
and
soldier
for
life
has
become
a
very,
very
important
part
of
this
work.
We're
working
also
to
have
access
to
that
nellis
and
it
creates
access
to
the
military
and
family
readiness
center
to
local
military
spouse,
professional
networks.
F
Last
week
I
talked
to
the
ceo
or
the
president
of
the
board
of
directors
for
the
army's
tab
program
in
order
to
get
them
involved.
This
is
all
reach
out
to
make
these
jobs
available,
then
to
help
them
secure
the
jobs
within
the
school
districts.
What
we
want
to
do,
for
example,
if
someone
is
stationed
at
tinker
air
force
base
in
oklahoma,
they
plan
to
get
out
of
the
service
within
six
months.
F
We
want
to
connect
them
with
the
nevada
representative,
because
what
if
they
want
to
go
home
to
winnemucca
who's,
going
to
help
them
in
order
to
make
that
transition
unless,
while
they're
a
tinker,
we
connect
them
with
the
nevada
assets
that
we
have.
Chambers
of
commerce
have
been
very
important
with
their
mac
committees,
blue
star
families
and
student
vets
of
america,
and
then
we
have
you
know
different
locations.
F
I've
told
you
about
soldier
for
life,
the
the
army's
partnership
for
youth
success
pays
program
as
well
as
the
army
reserve
units
we're
working
very
closely
with
them
in
each
of
our
states,
and
then
we
have
the
national
associations
that
are
working
with
us,
and
so
what
will
happen
as
soon
we
will
have
in
each
state
a
state
director
and
on
military
installations,
a
recruiter,
a
place,
a
counselor
and
a
placement
assistance
person
in
states
like
california
or
florida
or
virginia
or
texas,
that
have
multiple
installations.
F
They
will
have
more
than
one
of
these
teams
that
will
become
partners
for
the
school
districts
within
those
teams.
That's
why
the
models
are
so
important.
How
do
you
go
about
that?
What
are
those
departments?
What
are
those
groups
that
can
help
you
and
then
there
will
be,
as
I
explained
before,
the
on
the
military
installations
and
we
will
give
personalized
service
and
then
the
transition.
F
We
don't
want
to
just
say:
okay,
here's
the
job
we're
done
with
you
move
on.
We
want
to
make
sure
that
we
have
training
available
so
that
they
can
grow
within
that
job.
If
you
have
someone
who
wants
to
be
a
teacher,
but
does
not
have
a
degree
yet
they
can
become
a
paraprofessional
or
their
current
skill
set
area,
and
then
what
they
can
do
is
work
in
that
job,
build
seniority
and,
at
the
same
time,
being
prepared
for
the
ultimate
career
goal
that
they
have.
F
Okay,
let
me
wait
a
few
minutes.
I
was
warned
if
I
put
it
up
too
quickly,
it
wouldn't
show
yeah
we.
I
can.
I
See
it
on
the
internet,
let.
F
Of
it's
a
little
small
okay,
let's
see,
how
do
I
do
that?
Well,
you
have
this
available
to
you.
They
can
make
copies
for
you,
but
you
can
see
within
nevada.
I
have
state
government
and
the
entities
within
nevada
that
are,
you
know,
state
government
and
then
every
single
entity,
community
groups
that
we've
identified
so
far.
What
I'd
like
to
ask
of
you
is
number
one.
If
you
look
at
this
and
you
say
oh
they've
forgotten
or
here's
a
whole
group,
that's
just
concerned
with
veterans
or
national
guard
or
spouses.
F
A
Thank
you
very
much
for
this
presentation.
Do
we
have
any
questions
from
the
committee
members.
F
I
have
one
more
thing:
if
I
might,
the
department
of
education
has
announced
on
the
reciprocity
interstate
compact
for
milita
reciprocity
agreement
for
teacher
licensure,
the
interstate
compact.
They
want
to
be
the
first
in
the
nation
to
approve
it,
and
so
that
will
go
through.
F
They
are
looking
for
a
sponsor
in
the
intra,
a
senator
for
education
that
would
sponsor
to
go
through
that
interim
that
committee,
because
it
has
to
do
with
certification,
licensure
and
so
on,
but
nevada
has
announced
during
a
nationwide
webinar
that
they
plan
to
be
the
very
first,
and
I
was
very
proud
of
of
that
announcement.
I
can
tell
you
every
one
of
those
advisory
committees
that
we
have.
I
always
make
sure
there
is
nevada
representation.
F
I
want
us
to
have
credit
for
the
things
that
that
we
are
doing
and
recognize
nationally
for
these
things,
and
so
that's
the
extra
thing
I
wanted
to
throw
in.
A
I
Thank
you
ma'am,
madam
chair,
so
I
just
have
one
well
just
a
couple
2019.
I
think
it
was.
We
passed
the
national
guard,
youth
challenge,
I
want
to
say
it
was
sent
bill
295
or
something
like
that
for
the
school
it's
going
to
open
up
in
helco.
I
So
the
question
then,
would
be
because
of
the
the
nature
of
the
schools
it's
for
for
students,
for
whom
education
is
a
priority.
Just
the
way
it's
delivered
is
not
if
that
makes
sense,
so
they're,
not
they
don't
get
in
trouble.
It's
just.
They
need
a
different
way
of
learning.
So
have
you
given
any
type
of
consideration
in
terms
of
staffing
that
school?
That
would
be
number
one?
I
And
then
I
think
you
might
have
answered
the
other
one,
but
when
we
talk
about
nellis
and
creech
and
up
in
fallon
one
of
the
things
that
I
don't
know
that
we
do
a
lot.
I
You
mentioned
it,
but
but
also
the
national
guard,
and
this
is
full-time
guard
because
you
do
have
those
that
you
know
do
the
drills
once
a
month
or
whatever,
but
but
those
who
are
full-time
guard
and
those
who
are
members
of
the
individual
ready
reserves
because
they're
not
a
part
of
a
unit
per
se,
but
they
are
attached
to
units
as
units
personnel,
strength
fall
below
what
it
should
be,
and
these
are
the
people
that
kind
of
fill
in
to
fill
up.
I
If
you,
if
you
will
so
all
of
the
branches
of
the
military
and
all
aspects
thereof,
national
guard,
usa,
irr
making
sure
that
they're
all
a
part
of
it.
The
second
thing
that
I
would
ask
would
be-
and
I've
been
talking
about
this-
I
don't
know
forever-
and
that
is
military
spouses.
I
We
get
the
recognition
at
retirement
and
they
get
a
thank
you
card
and
some
roses,
but
for
the
most
part
it
doesn't
do
anything
for
what
they
have
to
show
our
appreciation
for
what
they
put
in
their
sacrifice.
So
I'm
I'm
thinking
about.
How
can
we
use
this?
I
The
issues
about
reciprocity,
to
begin
to
move
congress
towards
establishing
a
federal
retirement
system?
Yes,
because
it's
not
just
when
they
go
someplace,
they
have
to
learn
or
they
have
to
take
additional
courses
or
whatever
you
know
for
certification,
but
it's
they're,
never
there
long
enough
to
to
establish
any
type
of
retirement.
I
I
I
know
she
has
a
great
concern
for
military
families
and
for
education,
but
at
some
point
in
time
we
have
to
do
this
because
we
have
military
spouses.
Who
are
you
know
flipping
from
one
place
here
tinker
you
know
they
go
to
fort
hood
and
then
from
fort
hood.
They
go
to
fort.
You
know
joint
base,
washington
or
or
wherever
and
and
they
never
get
a
chance
to
retire.
So
can
we
integrate
this
with
that
and
and
I'll
stop
there,
I'm
on
a
soapbox
now.
Thank
you.
F
Thank
you
in
response
to
this
is
dr
rice
in
response
to
senator
spearman's
question
we're
working
with
the
school
that
the
military
in-
and
it's
called,
oh,
my
gosh,
it's
slipped
my
mind,
but
the
military
institute
in
oakland,
and
they
they
have
this
very
same
thing:
private.
We
modeled.
I
F
After
that,
okay,
well,
we
are
working
with
them.
We
are
working
just
in
southern
california,
because
I'm
the
one
man
staff,
that's
working
in
the
field,
and
so
I
thought
I'm
gonna
get
the
low
hanging
fruit
and
they
contacted
me
and
said:
can
we
be
part
of
this
and
I
said:
well,
we
weren't
looking
at
charter
schools
right
now,
public
charters
in
the
future.
Definitely
but
we're
not
doing
charters
right
now
and
then
they
said.
F
Well,
let
us
tell
you
who's
on
our
board,
the
head
of
the
national
guard,
the
person
who's,
the
chair
of
the
governor's
military
advisory
council
and
also
former
governor
jerry
brown.
Can
we
be
part
of
this,
and
so
I
said:
welcome
so
we're
we're
having
to
expand
to
northern
california
just
to
accommodate
them,
so
we
are
working
with
them
and
whatever
lessons
we
learn
with
them
will
be
able
to
transfer
over
to
elko
number
two
with
the
national
guard.
F
I
can
tell
you
that
the
national
guard
has
been
so
far
our
go-to
agency
in
all
three
states.
I
can
tell
you
that
the
national
guard,
they
call
it
the
outreach
here.
We
call
it
work
for
warriors
in
california.
They
call
it
work
for
warriors
florida.
They
call
it
careers
or
something
else,
but
they
will
publish
every
single
week.
F
Openings
in
school
districts
I
mean
and
get
it
out
to
their
people,
and
the
agencies
in
california
and
florida
also
have
on
their
databases,
not
only
national
guard
and
reserve,
but
also
have
just
the
veterans
veterans
separately.
As
far
as
the
readiness
we
have
been
in
contact
with
the
63rd
readiness
division
out
of
california,
that
covers
nevada,
and
so
we've
made
them
part
of
this
and
aware
of
what
what
we
are
trying
to
do
with
military
spouses.
F
That's
one
of
the
things
that,
as
soon
as
we
are
recognized
nationally,
because
we're
still
out
here
in
never
never
land,
but
as
soon
as
we
are
recognized
nationally.
That
is
one
of
our
top
priorities
and
I
believe
that
it
can
be
fixed
with
the
military
spouse
retirement.
F
F
His
wife
has
six
or
seven
state
certificates
every
time
he
move,
you
know
received
orders
to
that.
The
family
was
to
go.
She
had
to
start
all
over
with
her
career.
That's
why
the
the
law
that
was
passed
by
our
legislature
in
2019
was
so
important
to
say
that
if
you
come
number
one
you're
going
to
get
top
priority
and
not
go
at
the
bottom
of
a
pile
and
number
two.
F
If
you're
in
the
middle
of
an
arl
program,
getting
that
professional
experience
you
need,
we
will
pick
up
where
the
other
state
left
off.
So
you
don't
have
to
start
all
over
again.
So
those
are
the
things
and,
yes,
I
think
retirement
has
to
be
a
top
priority.
Once
we
get
this
outreach
established
and
it
seems
to
be
a
no-brainer
because
you
already
have
the
federal
system
set
up
and
you
just
have
to
put
spouses
of
active
duty
personnel
within
that
system
and
by
the
way,
general
ollie's
wife
has
no
retirement
after
30-something
years.
F
A
A
A
B
B
I
really
appreciate
the
opportunity
to
share
a
little
bit
of
our
work
and
kind
of
the
direction
I'd
like
to
go
in
the
brief
amount
of
time
this
morning
is
to
quickly
highlight
some
of
what
I
believe
will
be
driving
demand
for
health
care
in
nevada
over
the
last
the
next
decade,
as
well
as
some
unique
features
of
supply
of
health
workers
in
nevada,
including
some
pretty
enduring
shortages
in
some
critical
fields.
But
I'm
going
to
conclude
with
some
discussion
of
some
policy
measures.
B
We
have
plenty
of
well-vetted
policy
measures
and
strategies
that
we
can
undertake
as
a
state
to
piggyback.
On
that
last
presentation
we
heard
one
thing
I
hope
the
legislature
takes
a
closer
look
at
in
2023
than
they
did
in.
2021
is
a
nursing
licensure
compact,
just
as
there
are
compacts
for
military
spouses
and
others
to
take
advantage
of
employment
opportunities
in
education.
There
are
also
in
nursing
and
a
number
of
other
fields.
We
are
a
party
to
four
of
nine
health
related
compacts
in
nevada.
B
Nursing
is
not
one
of
them
next
slide.
Please.
B
I'm
going
to
share
a
little
bit
of
information
from
some
resources
that
are
contained
on
my
office's
website
and
just
highlighting
a
couple
here.
The
document
on
the
far
right
is
also
available
in
hard
copy
to
any
individual
who's
interested
in
receiving
them,
and
I
believe
my
contact
information
will
be
at
the
conclusion
of
this
slide,
but
a
lot
of
the
workforce,
data
and
information,
I'm
sharing
with
you
today
can
readily
be
found
on
these
web
locations.
B
But
to
begin
with,
I
just
want
to
quickly
point
out
what
is
driving
current
and
projected
demand
for
health
care
in
nevada.
I
think
that
we
had
the
mother
of
all
disruptions
with
the
pandemic,
but
I
think
we
are
slowly
returning
back
to
some
of
what
has
been
driving
unprecedented
workforce
demand
in
our
state
at
the
top
of
the
list
are
demographic
trends,
most
notably
population
growth
and
aging.
B
I'd
also
point
out
that
we
are
becoming
a
more
diverse
state,
and
so,
when
I
look
to
and
think
of
policy
solutions
to
increase
the
overall
supply
of
health
workers
and
nevada,
I'd
also
want
to
point
out.
We
need
to
double
down
on
efforts
to
make
sure
that
that
workforce
is
diverse
and
reflects
the
communities
they
serve.
B
Additional
drivers
are
insurance
related,
particularly
those
associated
with
the
affordable
care
act
and
the
medicaid
expansion
in
our
state,
and
I've
listed
a
couple
of
others
there
and
can
go
into
additional
detail.
If
the
committee
would
like
that
next
slide,
I
mentioned
the
pandemic
and
I
think
one
of
the
big
issues
that
we'll
need
to
keep
our
eye
on
as
a
state
or
a
couple
of
things.
B
Do
we
embrace
some
of
the
changes
to
health
care
and
other
areas
of
our
economy
like
keeping
a
reimbursement
for
telehealth
that
was
permitted
during
the
public
health
emergency?
Are?
Are
people
leaving
professions,
as
you
read,
anecdotally,
about
in
the
newspapers
and
so
forth?
I'm
I'm
I'm
optimistic
that
there
is
a
lot
of
shuffling
between
jobs
and
that
nurses,
for
example,
aren't
bailing
out
of
nursing
as
to
what
you
might
read
in
the
papers:
they're
just
changing
jobs,
they're
taking
opportunities
to
become
traveling,
nurses
and
increase,
pay
and
so
forth.
B
But
again
where
we
are
now
is
slowly.
Turning
our
back
on
the
pandemic,
the
pandemic
is
still
with
us,
but
I
think
that
there
will
be
impacts
that
we
will
be
dealing
with
from
a
workforce
perspective
for
a
long
time.
Next
slide.
B
And-
and
here
just
for
your
information
is
kind
of
what
I've
argued
in
the
past-
that
green
line
is
employment
in
nevada
in
healthcare.
It's
been
relatively
steady.
I
would
argue:
it's
been
recession
resistant,
if
not
recession,
proof
for
most
of
the
time
I've
been
looking
at
this
data
next
slide,
and
that
includes
the
the
great
pandemic
that
top
line
in
the
graph.
B
There
is
employment
and
hospitality
and
casino
world,
and
I
don't
know
that
that
is
those
employment
levels
they
they
cratered,
of
course
in
march
and
april
of
2020
slowly
returning
to
that
figure
of
about
280
000
at
the
close
of
last
year,
but
I
don't
know
that
we
will
see
sectors
such
as
hospitality,
return
to
that
pre
pandemic
level.
B
The
the
two
pictures
on
the
left
side
of
the
slide
recently
completed
a
new
hospital
construction
up
here
in
rena,
the
northern
nevada
sierra
center,
as
well
as
an
outpatient
orthopedic
clinic
as
well
as
I've
got
some
sketches
of
hospitals
in
construction
in
southern
nevada.
So,
while
we,
we
may
have
some
concern
about
whether
demand
will
return
to
pre-pandemic
levels.
B
B
When
I
look
at
health
workforce
supply,
of
course,
shortages
leap
out
at
the
the
top
of
my
list,
I
point
going
to
share
a
little
bit
of
data
on
that
in
the
following.
Slides
I'd
also
want
to
point
out
kind
of
a
good
news,
bad
news
story,
and
that
is,
we
continue
to
see
a
steady
growth
in
licensed
health
professionals
in
medicine,
nursing
other
fields
and
so
forth.
B
But
when
you
adjust
that
data,
particularly
for
southern
nevada,
what
we
see
is
is
kind
of
a
treading
water
in
terms
of
per
capita
growth
of
licensees.
B
Other
trends
that
we
need
to
keep
our
eye
on
is
that
we
have
an
aging
health
workforce,
that's
serving
an
aging
population,
so
just
as
we
are
a
a
state
that
attracts
retirees
or
those
approaching
retirement
are
slowly
aging,
statewide
demographically.
B
We
also
have
an
aging
workforce
that
will
be
retiring
out
in
greater
numbers
over
the
next
five
to
ten
years.
I'll
also
just
point
out:
geographic
and
diversity,
mismatches
or
amount
distribution
of
health
professionals,
particularly
when
we
look
at
numbers
in
urban
versus
rural
parts
of
the
state.
Next
slide.
B
Just
a
real
quick
note
in
this
presentation
when
I
speak
of
shortages,
I'm
typically
talking
about
a
situation
which
the
demand
for
a
professional
is
greater
than
the
supply.
Psychiatrists
and
pediatricians
are
good
examples,
but
I'd
also
want
to
point
out
that,
even
if
we're
not
sure
whether
demand
exceeds
supply
in
most
cases,
there
is
certainly
plenty
of
need.
B
Whether
there
is
enough
workers
or
not
and
demand
is
more
of
an
economist
or
an
econometric,
a
type
of
concept
that
simply
says
what
the
market
is
willing
to
pay.
It's
exceeds
the
supply
of
available
workers,
and
so
just
that
little
footnote
before
I
get
into
some
of
those
shortages
next
slide
in
the
next
six
slides,
I'm
going
to
quickly
walk
you
through
kind
of
what
primary
care
oral
health
and
mental
health
shortages
look
like
in
nevada.
B
This
is
a
map
that
we
update
a
pretty
continuously
that
looks
at
shortage
areas
that
are
federally
designated
by
the
health
resources
and
services
administration,
and
so,
when
I
talk
about
a
primary
care
hipsa,
these
are
again
federal
designations
that
illuminate
shortages,
they're,
also
very
critical
for
our
state
in
terms
of
programs
that
are
tied
to
shortage
designations,
such
as
reimbursement
for
rural
health,
clinics
and
critical
access
hospitals
or
loan
repayment
programs.
B
What
this
figure
highlights
is
that
about
two-thirds,
actually,
a
little
over
two-thirds
of
the
state
reside
in
one
of
those
light,
blue
or
dark
blue
health
shortage
areas,
the
darker,
the
shading,
the
the
worst
the
shortage
area.
Importantly,
when
we
look
at
geographic
disparities
in
workforce
10
of
our
state's
14
rural
counties,
the
entire
county
or
single
county
hipsas
next
slide
related
data
from
a
recent
release
of
data
from
the
national
2022
county
health
rankings
and
roadmaps.
B
I
include
this
slide
to
just
highlight
kind
of
county
level:
differences
in
some
cases,
they're
quite
striking.
If
you
look
at
pershing
county,
for
example,
they
have
approximately
6
700
residents
for
every
single
primary
care,
doc,
a
little
bit
better.
In
urban
areas,
by
contrast-
but
I
would
point
out
in
this
and
other
slides,
that
most
counties
in
this
state
exceed
our
u.s
average
of
population
to
primary
care
docs
in
this
case,
1300
nationally
1700
residents
in
nevada
and
then
again
a
lot
well
above
that
line
next
slide.
B
Similar
story
with
respect
to
dental
versus
workforce
shortages,
roughly
three
and
five
nevadans
live
in
a
dental
shortage
area.
More
importantly,
11
of
14
rural
and
frontier
counties
or
single
dental
hipsas
next
slide,
as
was
the
case
with
primary
care.
Docs
again
we
see
a
lot
of
geographic
variation
in
these
population.
To
dentist
ratios,
I
would
argue
that
they're
they're,
even
more
striking
in
rural
areas
than
was
the
case
with
primary
care.
B
B
B
Where
we
don't
see
those
shortages,
but
essentially
95
of
the
state,
resides
in
a
mental
hipsa.
This
is
one
that
focuses
exclusively
on
psychiatrists.
B
There
are,
for
all
intents
and
purposes,
no
psychiatrist
practicing
in
rural
areas
I'll
get
to
that
in
a
minute,
but
if
we
look
at
this
16
of
our
state's
counties,
including
clark
county
or
an
entire
county,
mental
health
professional
shortage
areas,
I'll
conclude
with
the
next
slide
on
the
topic
of
shortages
next
slide.
Please
thank
you.
This
one,
I
think,
is
important
again
part
of
that
county
health
rankings.
Release
that
I
wanted
to
share
with
you
is
that
this
doesn't
focus
exclusively
on
psychiatrists.
B
It
looks
at
psychiatrists,
clinical
psychologists,
marriage
and
family
therapists,
as
well
as
counselors
and
licensed
clinical
social
workers
who
provide
mental
health
services.
I
think
this
provides
a
more
nuanced
view
in
that,
if
we
were
just
looking
at
psychiatrists,
there
would
not
be
any
bars
in
those
rural
areas
is
the
case
with
eureka
county,
but
what
we
do
see
are
other
mental
and
behavioral
health
providers,
filling
those
those
gaps
and
playing
those
roles
in
very
important
ways
in
our
rural
counties.
Next
slide.
B
I
will
conclude
my
discussion
of
averages
in
in
presentations
past
I've.
I've
talked
about
our
state's
poor
rankings,
whether
it's
physicians,
46th
in
the
country
and
positions
per
capita
or
48th
or
49th
for
registered
nurses.
I'd
like
to
just
kind
of
leave
you
with
a
couple
of
factoids
here
and
I
I
think
we
should
strive
to
be
more
than
above
average.
But
if
we
look
at
what
it
would
take
right
now
in
nevada
to
meet
national
averages
or
national
metrics
and
population
providers,
we
would
need
an
additional
2100.
Physicians.
B
We'd
need
an
additional
it's
a
staggering
number,
but
we
would
need
close
to
4
400
additional
registered
nurses
just
to
meet
that
average
we're
doing
better
in
some
fields,
such
as
dentistry
and
pharmacists,
that
pharmacist
number
that
it's
still
a
a
staggering
number
that
we
need
to
at
least
fall
in
the
middle
of
the
pack.
But
we've
made
improvements.
It
matters
if
you
have
a
pharmacy
school
in
the
state
which
we
now
do
in
southern
nevada.
Next
slide.
B
Now
this
and
the
subsequent
three
slides
or
what
I
hope
that
you
take
away
from
this,
and
that
is,
we
have
shortages.
We
have
wealth,
workforce
deficits
that
touch
upon
a
lot
of
the
work
of
this
particular
committee
and
the
work
of
the
legislature,
but
we
have
some
again
well
vetted
strategies,
and
I
would
want
you
to
be
thinking
about
this
in
the
following
slides
in
in
the
following
terms,
and
that
is
there's
not
a
single
solution
to
addressing
workforce
shortages.
B
However,
I
I
feel
optimism
and
that
we
have
a
variety
of
tools
in
the
toolkit
to
address
those
at
the
top
of
my
list,
and
I
think
there's
no
substitute
for
this
are
is
the
need
to
increase
both
the
number
and
diversity
of
health
care
education,
graduates.
This
means
health
care
and,
I
would
argue,
public
health
care
programs
is
the
best
strategy
to
attract
students
and
residents
from
nevada,
train
them
in
nevada
and
prepare
them
for
licensure
in
our
state.
B
We
see
this
in
medicine.
We
see
this
in
public
nursing
programs.
The
public,
nursing
programs
in
nevada
keep
upwards
of
90
of
their
grants,
they're
they're
doing
exactly
what
they
need
to
do.
Those
programs
need
to
be
increased.
There
are
also
strategies
that
I'm
going
to
point
to
that
include
stretching
the
existing
healthcare
workforce
through
a
variety
of
means.
Telehealth
is
a
good
example
of
something
that
we
can
do
as
a
state.
I've
spoken
with
providers,
particularly
in
behavioral
health,
outside
of
nevada.
B
That
would
like
to
continue
what
they
started
during
the
pandemic
and
that
is
provide
services
to
nevada
residents.
Those
those
agreements,
however,
are
temporary
and
will
expire
with
the
the
public
health
emergency,
so
stretching
the
workforce
is
again
something
we
need
to
pay
attention
to
the
final
category
I
stole
this
line
from
hamilton
is
to
beg,
still
borrow
and
barter
workers
from
other
states
what
we
had
to
do
out
of
necessity
in
nevada.
B
Like
a
lot
of
other
states,
which
you
know
use,
traveling
nurses
provide
expedited
licensure
for
individuals
who
wanted
to
come
to
nevada
or
provide
services
through
telehealth.
I
think
they
complement
other
efforts,
but
again
at
the
top
of
my
list
will
be
our
need
to
grow
our
own
and,
in
some
cases,
start
new
programs.
There's
a
there's,
a
chinese
proverb
that
the
best
time
to
plant
a
tree
was
20
years
ago.
The
second
best
time
is
right
now
or
today,
and-
and
I
think
we
can
still
build
on
what
we've
already
accomplished
next
slide.
B
I
promise
I'm
not
going
to
go
through
every
bullet
on
this,
but
when
I
talk
about
grow
your
own
strategies
here
are
some
examples.
I
I
couple
that
with
strategies
such
as
loan
repayment
programs
or
scholarship
programs
that
can
be
used,
but
at
the
top
of
my
list
is
the
need
to
expand
publicly
supported
healthcare
programs
and
and
that's
above
and
beyond
medicine,
where
I
call
my
home,
nursing,
allied
health
and
other
areas
next
slide.
B
Here
are
some
examples
of
how
we
can
stretch
the
workforce.
I
mentioned
earlier
telehealth
applications
and
so
forth.
I
would
also
add
some
of
the
other
items
on
this
list.
One
of
the
things
that
happened
in
nursing
and
inpatient
hospital
care
in
nevada
during
the
pandemic
is
hospitals,
went
back
to
team-based
models
where
we
didn't
have
the
luxury
of
providing
the
right
number
of
nurses
or
we
didn't
have
the
you
know,
allied
health
in
those
inpatient
settings.
B
So
we
went
back
to
team
based
models
which
again
stretched
what
was
available
at
a
time
of
severe
shortages
in
most
corners
of
the
state
final
slide.
B
Here's
some
examples
of
the
bag,
still
borrowing
barter
bucket,
if
you
will,
what
we
did
during
the
pandemic,
is
the
governor's
directive.
11
help
create
the
battleborn
medical
corps.
We
also
have
reserve
medical
corps
in
our
big
urban
counties
and
kind
of
a
statewide,
but
a
lot
of
the
measures
here
and
it's
not
to
be
dismissive
of
them-
are
typically
efforts
to
lure
or
get
individuals
licensed
in
other
states
to
practice
and
resettle
here.
B
But
I
again
these
are
important
and
necessary
parts
of
complementing
what
I
mentioned
in
the
preceding
slides
on
one
last
flood
for
licensure
compacts,
because
again
that
discussion
in
the
previous
presentation
about
a
heroes
to
education
program,
we
need
to
do
a
heroes
to
health
care
as
well.
I
suspect
there
are
a
lot
of
active
duty,
military
and
those
approaching
retirement
that
have
a
spouse
with
a
nursing
license
or
another
type
of
health
care
license,
and
we
we
need
to
have
all
hands
on
deck.
In
approaching
this.
B
In
conclusion,
next
slide
promise
to
leave
you
with
a
couple
of
good
news
stories.
The
first
is
gme
the
red
arrow.
There
is
the
first
installment
of
then
governor
sandoval's,
gme
task
force
and
the
funds
that
have
been
distributed
to
teaching
hospitals
and
schools
of
medicine
across
the
state
for
the
past
six
or
seven
years,
and
those
grants
delivered
on
what
they
were
promised
to
do,
and
that
is
increase.
B
B
Another
really
important
measure
of
success
in
nevada
has
been
our
ability
to
attract
and
keep
both
nurse
practitioners
and
physician
assistants.
It's
hard
to
imagine
in
nevada
right
now
what
our
primary
care
shortages
and
needs
would
be
like
if
we
did
not
have
this
pretty
substantial
influx
of
nurse
practitioners
in
tomato
we've
also
had
a
existing
pa
program
in
southern
nevada
and
a
relatively
new
one
in
northern
nevada.
B
But
if
you
look
at
that
blue
line
there,
we
have
about
tripled
the
number
of
nurse
practitioners
now
licensed
and
practicing
in
nevada
versus
a
decade
ago
and
we've
more
than
doubled
of
the
per
capita
number.
So
this
is
a
a
great
story
that
I
think
we
can
model
and
apply
to
other
areas
that
had
nothing
more
to
do
than
a
change
in
licensure
final
slide:
full
disclosure.
B
This
is
a
program
that
my
office
oversees,
but
this
small
and
but
mighty
program
has
done
a
great
job
of
providing
loan
repayment
or
loan
forgiveness
to
not
only
physicians
and
nurses,
but
a
wide
range
of
health
professionals
who,
in
exchange
for
that
loan
repayment,
agreed
to
practice
in
medically
underserved
areas.
So
it's
kind
of
a
a
win-win
strategy.
B
They
went
from
zero
to
one
behavioral
health
provider
in
that
community,
and
I
point
this
out
as
really
important
in
that
they
still
have
plenty
of
unmet
behavioral
health
needs,
but
a
strategy
for
small
communities
that
will
never
attract
a
clinical
psychologist
or
psychiatrist
is
again
a
use
of
what
we
have
now
and
that
is
psych
mental
health
and
nurse
practitioner
programs
in
both
north
and
south
and
individuals
interested
in
serving
in
those
communities
final
slide.
B
I
promise
just
want
to
leave
you
with
a
link
to
some
of
the
recent
work
of
my
office,
that
about
a
health
workforce,
research,
center
and
reports
that,
I
think,
will
help
inform
your
work
in
the
work
of
the
legislature
as
we
approach
the
2023
session.
I
would
also
add
not
on
this
list
is
a
really
recent
project.
B
At
my
office
we
are
coordinating
with
nursing
education
programs,
a
northern
nevada,
nursing
summit
on
july
13th
I'd
be
happy
to
provide
the
committee
and
anybody
taking
part
in
today's
committee
meeting
just
reach
out
to
me.
If
you
need
additional
information
and
with
that
happy
to
take
any
questions,
you
have.
A
I
Questions
other
than
thank
you,
dr
peckham,
and
one
of
the
things
that
I
think
we
probably
need
to
do
better
as
a
state,
and
that
is
look
at
the
licensing
time
frame
for
many
of
the
positions,
because
so
often
what
I
hear
from
people
who
are
trying
to
come
into
the
state
is
that
either
the
the
timing
is
protracted
or
some
of
the
things
that
are
required,
that
some
of
the
boards
require
for
health
care
professionals
in
me,
that
sort
of
thing
are
so
cumbersome
that
they
decide
just
to
go
someplace
else,
and
I
don't
think
it's
a
it's
a
matter
of
of
protecting
the
public
safety
as
much
as
it
probably
is
just
antiquated
processes.
A
I'm
dr
peckham,
I
actually
have
a
quick
question.
I'm
sorry
did
you
have
okay,
I
was
going
back
to
the
slides
and
specifically
the
ratio
of
population
to
primary
care.
Physicians,
where
the
u.s
average
is
a
little
over
1300
and
nevada
average
a
little
over
1700,
but
even
looking
at
that
u.s
average.
Is
that
where
we
should
be
as
a
country
on
that
range
seems
like
a
lot
of
times
when
I
hear
from
professional
organizations
that
their
staff
to
patient
or
staff
to
student
ratios
they're
always
less
than
what
the
averages
are.
B
Yeah-
and
I
I'm
happy
to
provide
that
again,
john
pakka,
for
the
record-
I
want
to
be
real
careful
because
I
think
without
dodging
your
question,
there's
a
more
nuanced
answer,
and
that
is
that's
only
looking
at
primary
care
physicians.
It's
often
the
case
if
you
go,
for
example,
into
a
federally
qualified
health
center
or
a
rural
health
care
clinic
in
rural
nevada,
you're,
probably
going
to
see
a
nurse
practitioner
or
a
pa
most,
if
not
all,
of
the
time.
B
So
with
that
said,
though
I
what
what
I
like
to
think
of
with
that,
putting
that
u.s
average
is
that
would
be
a
nice
aspirational
target
for
our
state,
and
that
is
if
currently,
as
a
state,
we
are
now
just
eyeballing
this
about
twice
that
that
rate.
If
we
we
set
the
goal
to
have
1400
nevadans
per
primary
care,
doc
by
say,
2025
or
2030.,
that
at
least
gives
us
something
to
to
move
toward.
B
I
would
also
argue
and
point
that-
and
I
want
to
be
really
careful-
is
that
in
many
instances
we
have
health
care
and
behavioral
health
needs
that
exceed
any
reasonable
definition
of
what
the
need
is
compared
to
the
us.
So
we
probably
need
more
than
that
average
number,
but
I
think
it
gives
policymakers
such
as
yourself
a
means
of
setting
a
target
and
then
thinking
about
how
do
we
get
to
that
target
or
how
do
we
approach
or
improve
on
that
number?.
A
Thank
you
and
continue
with
that
conversation
just
a
little
bit,
I
realize
beg
borrowing
and
stealing
from
other
states.
They're
also
short,
in
many
cases,
these
healthcare
professionals
as
well.
So
I
like
the
idea
of
growing
our
own,
but
what
are
your
thoughts
or
any
recommendations
on
growing
someone,
that's
already
in
the
profession,
so
taking
someone
who
might
have
just
their
rn
or
bsn
and
making
them
an
aprn
or
a
physician
assistant,
making
them
a
doctor?
B
Yeah
thanks
for
the
question
again
john
pakken,
for
the
record.
We
already
have
some
of
those
in
progress
and
I
would
point
out
the
work
both
in
southern
nevada,
reno
and
elk.
We
have
an
area,
health,
education,
centers
program
that
strives
to
do
a
couple
of
things,
and
that
is
strategies
to
get
kids
interested
in
talking
about
healthcare
career
careers.
B
I
would
say
as
early
as
middle
and
high
school,
but
more
importantly,
the
work
of
the
ahax
has
shifted
to
what
they
refer
to
as
inter-professional
education,
so
working
in
team-based
care,
but
also
thinking
about
career
ladders
that
young
woman,
I
showed
on
the
slide
who's
a
loan
recipient
now
practicing
in
lovelock
nevada,
started
out
as
a
nursing
assistant
in
that
hospital.
B
She
quickly
moved
up
and
decided
she
would
pursue
her
rn
degree,
which
led
to
her
pursuing
an
online
master's
degree
and
then
getting
her
certificate
to
practice
in
the
psychiatric
behavioral
health
from
a
nurse
practice
practitioners
perspective,
but
I
think
it's
important
that
in
that
journey
or
that
career
ladder
as
it
was
in
her
case
she
always
had
one
foot
in
healthcare
from
a
very
you
know.
B
As
a
young
adult
and
that
having
that
foot
in
healthcare
and
an
organization
such
as
the
hospital
and
others
that
were
attentive
to
the
fact
that
they
have
other
needs
requiring
much
more
advanced
education
and
so
forth,
that
that's
that's
one
of
one
strategy
that
I
think
is
a
dynamite
for
rural
areas,
and
that
is,
you
have
students.
You
have
residents
that
would
like
careers
in
health
care,
but
they
want
to
make
more
than
12
an
hour
or
13.
B
Whatever
a
nursing
assistant
makes
and
and
stay
in
the
community,
I
would
say:
there's
short
answers.
There's
some
of
that
work
already
in
place.
B
Well-
and
I
one
other
thing,
one
other
thing-
that
I
is
getting
a
lot
of
attention
right
now-
are
partnerships
between
higher
education
institutions
and
largely
hospitals
right
now
to
foster
apprenticeship
programs.
I
I
think
one
thing
I'd
personally
like
to
see
disappear
are
unpaid
internships.
So,
with
the
idea
of
apprenticeship
models,
are
you
get
paid
while
you're
learning
how
to
become
a
nurse
or
a
medical
assistant
and
so
forth?
A
Thank
you
very
much
seeing
that
there
are
no
additional
questions.
We'll
close
this
item
of
business.
Oh
I'm,
sorry,
senator
smith,
do
you.
I
Have
a
question
I'm
so
sorry
yeah.
I
just
had
a
brief
comment.
West
last
session,
I
think
it
was
assimilate.
Ellison
had
a
bill
that
would
allow
students
in
high
school
to
take
various
courses
and
then
at
the
completion
move
into
some
type
of
a
an
apprenticeship
program,
and
I'm
wondering
if
that
model
could
is
something
that
could
be
that
could
accommodate
the.
I
guess,
a
question
that
the
chairwoman
just
asked
in
terms
of
growing
someone
who's
already
there.
I
If
that,
if
that's
a
possibility-
and
I'm
sorry-
I
don't
remember
the
exact
real
number-
I
know
it
came
before
commerce
and
labor,
but
students
in
high
school,
I
think
starting
off
their
sophomore
year.
They
could
start
taking
it
and
maybe
even
looking
at
some
type
of
combination
between
that
and
students
who
are
in
high
school
and
who
are
taking
college
courses
concurrently.
B
A
A
He
got
away.
That's
okay,
appreciate
you
trying
to
get
him.
We
have
our
presenters
jonathan
norman,
with
the
nevada
coalition
of
legal
service
providers
and
deborah
brookout,
who
attempted
to
kill
our
little
friend
with
legal
aid
service
center
of
southern
nevada.
L
Thank
you,
chair
members
of
the
committee.
I
want
to
thank
you
for
the
opportunity
to
present
today.
My
name
is
jonathan
norman,
I'm
the
statewide
statewide
advocacy,
outreach
and
policy
director
for
the
nevada
coalition
of
legal
service
providers,
I'm
joined
by
deborah
bookout,
who
is
the
directing
attorney
for
the
adult
guardianship
program
at
the
legal
aid
center
of
southern
nevada.
L
So
the
coalition
is
made
up
of
northern
nevada
legal
services,
which
is
washoe
legal
services.
I
think
they're
going
through
a
name
change,
legal
aid,
center
of
southern
nevada,
the
senior
law
program
in
clark
county
and
then
the
volunteer
attorneys
of
rural
nevada
and
between
those
organizations.
We
have
20
attorney
around
20
attorneys,
who
are
doing
full-time
direct
representation
of
protected
persons
and
proposed
protected
persons.
L
This
amounts
to
the
representation
of
thousands
of
nevada's
most
vulnerable
citizens.
Every
year
in
2017,
there
was
a
major
shift
in
guardianship
and
the
adoption
of
a
protected
person's
bill
of
rights
and
those
the
protected
persons
bill
of
rights.
I
like
to
think
of
it
as
protecting
the
freedom
of
of
people
who
need
a
guardianship
as
much
as
is
possible,
given
their
situation.
L
It
provided
those
proposed
protected
person's
counsel
and
the
ability
to
get
accurate
information
in
looking
at
the
guardianship
statute.
You
know
we,
there
was
a
lot
of
change
in
2017.
L
That
was
all
positive
and
now
there's
just
some
tweaks
that
I
think
could
make
this
the
the
statute
even
better
for
for
our
people
who
need
guardianships
in
our
state,
and
so
we
we've
identified
nine
things
and
I
like
to
lump
them
into
three
categories:
one
maximizes,
the
freedom
of
the
protected
person
and
proposed
protected
persons
before
guardianship
during
guardianship
and
and
those
seeking
to
end
the
guardianship
and
then
the
other
big
category
is
protecting
the
life
savings
of
the
protected
person
and
creating
accountability
when
it
does
need
to
be
spent.
L
M
My
name
is
deborah
bookout
and,
as
jonathan
mentioned,
I
am
the
directing
attorney
for
the
guardianship
advocacy
program
at
legal
aid
center
of
southern
nevada.
I've
been
representing
adults
in
guardianship
since
2014
when
our
office
accepted
our
first
referral
from
the
long-term
care
ombudsman's
office.
M
M
But
we
have
also
learned
where
the
changes
still
need
to
be
made,
and
so
this
presentation
we
will
address
several
provisions
in
guardianship
that
we
think
are
not
quite
living
up
to
the
protections
outlined
in
the
bill
of
rights
and
with
the
revisions.
We
think
that
they
can
do
so.
M
The
commission
has
philosophy
the
commission's
report
recommended
moving
away
from
viewing
guardianship
as
paternalistic
and
focusing
on
person-centered
guardianship.
M
The
principles
outlined
in
the
protected
person's
bill
of
rights
that
the
stat
that
the
2017
legislature
enacted
detail
the
rights
that
a
vulnerable
person
in
guardianship
retains
throughout
the
life
of
a
guardianship,
the
right
to
be
independent,
the
right
to
certain
freedoms,
the
right
to
be
treated
with
dignity,
the
right
to
autonomy
and
decision
making
regarding
how
their
money
is
spent
where
they
live,
who
they
interact
with
the
right
to
have
their
wishes
and
preferences
considered
when
decisions
about
those
things
are
made.
M
M
Currently,
a
person
seeking
a
temporary
guardianship
does
not
have
to
specify
the
the
risk
or
medical
treatment
that
the
proposed
protected
person
faces.
Nor
do
they
have
to
adhere
to
the
notice
requirements,
the
general
notice
requirements.
We
think
that
the
guardianship
should
have
to
specify
exactly
what
risk
the
protected
person
is
facing
or
what
medical
treatment
is
required
and
that
the
court
should
limit
any
order,
granting
a
temporary
guardianship
to
the
authority
to
address
those
specific
needs.
M
When
those
protections
aren't
there,
a
temporary
guardian's
actions
can
can
can
cause
irrevocable
harm
to
protect
a
person
and
we've
seen
those
harms.
For
example,
we
have
had
a
case
we
had
a
case
in
which
the
petitioner
alleged
only
that
the
proposed
protected
person
needed
medical
treatment.
The
court
granted
the
the
the
temporary
guardianship
and
the
order
gave
the
temporary
guardian
broad
authority
to
act
before
we
could
speak
to
our
new
client
before
we
could
talk
to
family
or
medical
providers
or
friends.
M
M
M
Another
example
is
a
case
in
which
a
granddaughter
filed
a
temporary
petition
over
her
grandfather,
alleging
that
he
was
being
financially
exploited.
The
court
granted
the
temporary
guardianship
and
again
granted
broad
authority
for
the
temporary
guardian
to
act.
The
granddaughter
went
to
the
bank
drained
her
grandfather's
accounts
and
we
never
heard
from
her
again
had
the
court
been
required.
Had
the
court
limited
the
order,
in
that
case,
to
blocking
the
accounts
to
protect
the
the
her
grandfather.
M
M
M
So
there
are
many
all
life
altering
decisions
that
are
made
throughout
the
life
of
a
guardianship
case,
for
example,
where
a
protected
person
lives
their
community
and
the
connections
they
have
within
that
community
are
extraordinarily
important
to
the
health
and
well-being
of
a
protected
person.
M
Yet
when
a
court
allows
a
guardian
to
move
a
protected
person
to
another
state
or
city
where
there
are
no
community
or
connections
for
the
protected
person,
the
protected
person
currently
doesn't
have
the
right
to
appeal
that
decision.
M
M
These
these
decisions
have
a
an
effect
on
a
protected
person's
mental
health
and
well-being.
We
have
many
senior
clients
who
do
not
have
very
many
years
and
any
decision
affecting
their
quality
of
life.
They
should
have
a
remedy
and
we
strongly
recommend
that
these
decisions
should
be
appealable
and
they
currently
are
not.
M
The
the
protected
person
faces
an
uphill
battle
to
terminate
a
guardianship,
and
we
suggest
that
the
person
anyone
objecting
to
a
guardianship
carries
the
burden.
If
a
protected
person
has
provided
evidence
to
the
court
that
the
guardianship
is
no
longer
needed,
then
they
have
met
their
burden
and
anyone
objecting
to
that
would
then
have
the
burden
to
prove
that
the
guardianship
should
not
be
terminated.
That
is
more
in
line
with
the
bill
of
rights
than
we
currently
have
right
now,.
M
M
M
After
awarding
fees
at
the
attorney's
senior
rate,
when
the
work
performed
should
have
been
performed
by
that
of
a
paralegal
or
associate
at
a
much
lower
rate,
the
court
failed
to
make
to
determine,
in
that
case
whether
that
rate
was
reasonable
for
the
work
performed
or
whether
the
estate
could
actually
sustain
the
award
of
fees.
M
In
another
case,
the
court
awarded
a
hundred
and
fifty
thousand
dollars
in
fees
in
a
guardianship
case
where
there
was
no
objection
to
the
guardianship
again.
In
that
case,
the
court
made
no
findings
regarding
whether
those
fees
were
reasonable,
and
in
that
case
the
attorneys
had
failed
to
file
the
proper
notice
of
intent
to
seek
fees.
M
In
another
case,
our
our
client
objected
to
the
guardianship
the
court
granted
it.
Our
client
objected
to
the
guardian.
The
court
appointed
him
anyway,
then
the
court
granted
40
000
in
fees
from
the
protected
person,
making
no
findings
as
to
whether
those
fees
were
reasonable,
and
in
that
case
also,
the
the
attorney
failed
to
file
the
notice
of
intent.
M
So
when
the
courts
have
awarded
fees
in
those
cases
that
I
just
described
or
there's
been
no
notice,
the
they
have
done
so
under
the
provision
that
allows
compensation
and
expenses
for
the
guardian,
this
practice
should
be
prohibited.
The
2017
legislature
enacted
a
specific
provision
to
guide
the
court
in
granting
fees
for
attorneys
in
guardianship.
M
M
M
As
you
can
imagine,
an
attorney
rate
is
much
higher.
An
hourly
rate
for
an
attorney
is
much
higher
than
that
of
a
non-attorney
gal
or
guardian
adult
item,
and
this
practice
must
also
be
prohibited.
Our
recommendation
would
require
the
court
to
award
fees
to
a
guardian
adult
item
at
a
non-attorney
guardian
ad
litem
rate,
which
is
significantly
lower
than
that
of
an
ease
rate.
M
So
for
for
judicial
expediency,
we
are
recommending
a
couple
of
other
changes.
We
are
recommending
that
the
petition
for
guardianship
provide
an
email
contact,
address
or
information
for
both
the
proposed
guardian
and
for
the
proposed
protected
person.
We
are
also
recommending
that
the
needs
assessment
be
attached.
M
M
This
has
led
to
a
lot
of
confusion
and
delay
in
the
in
the
conclusion
of
the
guardianship
petition
and
then,
finally,
the
guardianship
commission's
report
made
it
clear
that
a
guardianship
should
only
be
granted
as
a
last
resort
and
that
there
should
be
consideration
as
to
whether
there
are
less
restrictive
alternatives
available,
so
we're
recommending
that
any
order
granting
guardianship
should
contain
the
court
should
include
whether
less
restrictive
alternatives
were
available
considered
not
available,
and
then
that's
the
the
reason
the
guardianship
was
granted.
M
This
is
in
line
with
the
commission
and
also
the
bill
of
rights
in
granting
independence
to
the
protected
person,
and
that's
those
are
that
those
are
the
recommendations
that
we
think
would
bring
the
current
statutes
more
in
line
with
the
bill
of
rights
and
what
the
commission
intended
we've
come
a
long
way
since
the
commission
was
first
created,
I
think,
just
with
a
few
more
little
tweaks.
M
We
can
get
that
much
further
and
provide
the
productions
that
vulnerable
adults
in
in
clark,
county
and
nevada
require,
but
also
the
the
the
159
overall
would
be
more
in
line
with
the
19
enumerated
rights
outlined
in
the
in
the
protected
person's
bill
of
rights.
L
Jonathan
norman
for
the
record
before
the
question,
so
nine
things
that
we
think
should
be
changed,
and
you
know
the
temporary
guardianship
should
identify
why
the
temporary
guardianship
is
needed
and
be
limited
to
that
need
to
clarify
the
protected
person
gets
to
decide
on
communication.
L
L
When
the
court
awards
attorneys
fees
from
the
protected
person's
life
savings,
there
should
be
more
accountability,
and
you
know
when
I
think
of
we're
allowing
the
government,
through
the
court
to
take
someone's
life
savings
in
a
lot
of
instances,
and
I
think,
if
we're
going
to
do
that
and
in
a
lot
of
instances,
it
might
be
necessary,
we
should
show
our
work
and
that's
where
the
judge
should
make
findings
on
the
reasonable
factors.
It
shouldn't
just
be
an
order
that
this
is
reasonable.
L
L
I
think
that
that
that
that
shouldn't
be
happening
to
someone's
life
savings
and
then
the
final
thing
is
just
shutting
that
loophole
so
that
attorneys,
who
don't
file
that
notice
that
you're
required
to
serve
on
all
the
parties
that
you
intend
to
seek
fees.
L
If
you
don't
go
through
the
right
door,
then
you
should
be
barred
and
shouldn't
be
allowed
back
in
you
know
you
don't
get
a
second
bite
at
the
apple
to
come
in
as
a
professional.
That's
for
accountants
and
other
professionals
that
the
guardianship
commission
thought
the
guardian
might
need,
and
then
finally,
is
just
just
tweaking
the
the
petition
so
that
it
has
information
that
can
just
make
you
know
the
attorney
getting
to
the
protected
person
talking
with
them
easier
understanding
with
the
attachment.
What
is
needed.
L
So
those
are
the
changes
that
I
think
would
like,
as
ms
bookout
said,
would
would
make
our
guardianship
statute
really
embody
the
protected
person's
bill
of
rights,
and
I
don't
want
to
say
that
our
guardianship
statute's
not
doing
a
good
job.
I
think
we've
come
so
far
and
the
changes
that
the
legislature
you
know
enacted
in
2017
were
really
incredible,
and
I
just
think
you
know
it's
like
we're
95
there
and
we
can
just
get
you
know
we
can
get
that
a
plus-
and
I
guess
we're
open
to
questions.
Thank
you.
A
Thank
you
both
that
very
insightful
presentation.
Are
there
any
questions
from
our
community
members?
A
I'm
not
hearing
anything
from
senator
spearman,
but
I
have
questions
because
this
is
not
my
wheelhouse.
So
tell
me
a
little
bit
more
about
a
guardianship.
What
conditions
would
someone
need
to
be
under
a
guardianship?
In
my
mind,
it'd
be
someone
who
might
be
like
have
alzheimer's
or
dementia
and
need
a
guardianship.
M
So
our
clients
present
with
all
kinds
of
disabilities
which
make
decision
making
difficult
for
them.
We
have
clients
who
have
intellectual
disabilities
and
can't
manage
their
money
clients
with
alzheimer's
clients,
with
dementia
adults
who
have
been
in
car
accidents
and
suffered
from
traumatic,
brain
injury.
M
It
just
the
range
is
pretty
broad
and
so
because
it's
so
broad
right,
no
one,
no
one!
What
am
I
trying
to
say?
There's
nothing,
there's
not
one
thing
that
works
to
provide
the
support
for
everyone
right.
M
There
should
be
a
range
of
options
for
folks
who
need
assistance
with
decision
making,
whether
it's
managing
their
medical
care
or
paying
their
bills,
which
is
why
I
think
that
the
original
commission
focused
on
the
person
that
you
know
shifted
the
the
view
of
guardianship
from
a
sort
of
a
paternalistic
view
to
the
person
and
the
person's
needs,
and
so
it
could
be.
It's
pretty
broad.
M
A
Thank
you
for
that
clarification.
So
can
you
walk
me
through
the
process
just
so
I
have
a
better
understanding
of
a
court
case
kind
of
like
what
you're
talking
about
with
the
granddaughter
and
she
ended
up
draining
the
grandfather's
savings.
So
was
a
grandfather,
a
part
of
this
process
or
were
other
family
members
brought
into
it?
How
would
something
like
that?
Look.
M
So,
in
a
general
case,
the
petitioner,
the
person
seeking
to
either
be
the
guardian
or
have
someone
else
appointed
to
be
the
guardian
for
the
protected
person.
We
used
to
call
the
protected
person's
wards
that
changed
after
the
the
2017
legislature.
M
The
petitioner
would
file
a
petition
explaining
why
the
proposed
protected
person
needed
needs
a
guardian
and
then
would
be
required
to
serve
notice
on.
You
know
a
list
of
folks
entitled
to
notice
generally
folks
within
the
second
degree
of
consequinity
like
siblings
parents,
children.
So
that's
in
a
general
case,
once
the
petition
is
filed
and
there's
service
on
those
entitled
to
notice,
there's
a
citation
hearing.
Now
we
get
appointed
the
legal
aid
gets
appointed
from
as
soon
as
the
petition
is
filed.
M
So
we
get
notice
of
a
case
immediately,
so
we
can
get
involved
at
the
outset
and
so
at
the
citation
hearing.
All
of
those
entitled
to
notice
can
come
to
the
citation
and
object
or
not
to
the
request
for
guardianship
in
the
temporary
guardianship
situation,
where
the
granddaughter
drained
her
grandfather's
account.
That
was
a
temporary
and
so
those
notice
requirements
aren't
required
under
certain
certain
circumstances.
M
For
those
temporaries,
so
in
that
case
no
other
family
member
was
notified,
we
were
notified
and
the
client
was
notified,
but
the
guardianship
the
temporary
was
granted
before
there
was
a
hearing
which
is
what
the
currently
the
provision
allows.
That's
how
that
was
able
to
happen.
So
that's
why
the
suggestion
would
be
if,
if
is
a
need
for
a
temporary
guardianship,
the
very
specific
need
should
be
identified
and
the
order
should
only
grant
authority
to
address
that
specific
need,
so
that
would
have
prohibited
what
happened
in
the
temporaries.
A
M
There
is
no
list,
and
that
would
be
great,
but
there
isn't.
However,
in
the
in
the
provision
that
addresses
fees,
it
actually
outlines
what
would
be
reasonable
for
services
that
would
be
provided
sort
of
outside
of
guardianship
like
what
would
it
cost
for
you
to
hire
a
bookkeeper
to
to
keep
your
books?
Those
are
usually
guardian
expenses,
though.
So,
if
a
guardian
is
hiring,
you
know
an
accountant
at
600,
but
a
bookkeeper
could
do
it
for
60.
Then
that's
where
the
court.
A
A
We
were
originally
going
to
do
lunch
at
this
time,
but
I
think
we're
going
to
try
and
power
through
because
I
don't
think
our
lunch
has
come
yet
yeah.
Oh
then
we're
going
to
take
a
brief
recess
about
30
minute
recess.
Then
we'll
move
on
to
agenda
item
number
eight.
So
it
is
11
58,
according
to
my
clock,
we'll
just
round
to
12..
So
let's
return
at
12
o'clock,
12
30.!
Thank
you.
A
A
N
I
hold
the
office
of
the
attorney
for
the
rights
of
older
persons
and
persons
with
a
physical
disability,
intellectual
disability
or
a
related
condition.
We
shorten
that
to
the
rights
attorney.
The
position
was
established
in
1989
under
nrs
427a
and
as
a
governor
appointed
position
for
the
over
700
000
adults
in
nevada
living
with
a
disability.
The
rights
attorney
works
to
advance
systemic
improvement
in
the
aging
and
disability
services
network
through
legal
and
policy
advocacy
to
ensure
that
nevadans
can
live,
independent,
meaningful
and
dignified
lives.
N
E
Self-Neglect,
obviously,
is
not
a
crime
I
mean
is
the
failure
of
a
person
to
provide
for
themselves
if
they're
unable
to,
and
so
we
do,
investigate
those
and
get
resources
and
services.
If
the
some
the
person
is
acceptable,
there
is
no
single
pattern
of
abuse.
Sometimes,
abuse
is
the
continuous
of
long-standing
patterns
of
a
physical,
emotional
or
financial
abuse
within
the
family.
E
E
A
person
over
80
years
of
age
is
two
to
three
times
more
likely
to
be
abused
and
may
be
a
person
of
with
cognitive
impairment.
Two-Thirds
of
the
reports
examines
identified
women's
victims.
However,
it's
worth
noting
that
victimization
does
not
discriminate
by
race,
sex
income
level,
cultural,
ethnic
groups,
sexual
orientation,
religion
or
marital
status.
E
It
has
been
estimated
that
abuse
of
elderly
women
by
their
spouses
is
increasing
among
the
growing
over
60
age
category
and
that
women
do
suffer
a
higher
percentage
of
abuse
than
men.
Often,
the
client
resides
with
the
alleged
abuser
and
has
developed
a
dependency
on
the
abuser
to
meet
some
or
all
of
their
daily
care
needs.
The
vulnerable
senior
often
is
living
with
an
adult
child,
significant
other
or
spouse.
E
E
E
E
E
If
we
do
receive
a
case,
we
have
a
centralized
intake
that
takes
our
reports.
It's
reviewed
by
our
intake
supervisor
and
the
case
initiation
has
to
be
done
within
three
business
days.
We
do
triage
with
a
level
one
or
a
level.
Two,
a
level
two
case
would
be
the
the
72
hours
business
days.
However,
a
level
one
would
mean
that
the
worker
would
have
to
initiate
the
case
within
24
hours.
E
There
is
the
investigation
and
then,
most
importantly,
our
intervention.
We
want
to
stop
the
abuse
we
want
to
get
services
in
the
home
for
those
who
need
it
and
who
are
wanting
it
after
every.
You
know
that
the
cases
allegations
are
ruminated
there's
the
case
closure
and
after
the
worker
closes
the
case
before
it
is
put
in
case
closure.
The
supervisor
must
review
the
case
to
make
sure
that
the
appropriate
investigation
was
done.
E
E
And
2021
was
8236.
E
E
And
we
still
have
this
whole
week
to
go,
so
I
think
we
will
definitely
make
that
that
number
and
with
our
our
outreach
campaigns,
we
know
that
our
numbers
are
definitely
going
to
be
moving
up.
E
Here's
our
person
of
interest
data
person
of
interest
is
the
person
that
is
alleged,
who
do
the
abuse?
Here's
the
highest
number
is
the
no
family
relationship
exists,
that's
38
percent
of
our
cases,
the
child,
30
percent,
other
relatives,
20
percent
and
12
percent.
The
person
of
interest
in
our
cases
is
marked
as
the
spouse
or
domestic
partner.
E
E
What
are
we
facing
in
adult
protective
services
as
far
as
our
workforce?
There
is
definitely
a
lack
of
licensed
social
workers
in
the
state.
We,
you
know
we
recruit,
we
will
get
a
list
of
eligible
social
workers
to
do
an
interview
and
we
may
possibly
get
two
or
three
people
on
the
list
to
to
interview.
E
E
E
E
So
that
means
you
know
we're
that
the
higher
caseload
per
worker
we've
got
an
increasing
caseload
statewide.
We
believe,
because
of
out
the
outreach
we're
doing,
and
just
of
course,
because
of
our
population
growth
so
kind
of
to
give
you
a
point
is
our
I
wouldn't
say
our
standard
that
we
look
at
is
usually
40.
Cases
per
social
worker
and
our
social
workers
are
currently
carrying
one
one.
Social
worker
has
70
cases,
so
50,
plus
vacancy
rate
means
aps.
N
N
Some
of
you
may
be
familiar
with
this.
It
was
ab407
last
session
and
this
bill
was
sponsored
by
the
seniors
veterans
and
adults
with
special
needs.
As
a
committee
bill,
we
still
believe
from
the
agency
that
this
is
something
nevada
should
look
at
and
consider
for
this
session
again,
I
have
submitted
an
outline
of
protection
orders
in
nevada.
N
Existing
nevada
law
does
have
several
types
of
protection
orders,
but
typically
there
must
be
a
specific
relationship,
especially
for
the
domestic
violence
protection
order.
As
you
heard
earlier
in
the
presentation,
the
majority
of
persons
of
interest
in
adult
protective
services
cases
do
not
have
a
family
relationship.
N
N
N
Another
common
element
is
empowering
the
individual
to
seek
the
order
for
themselves,
but
also
allowing
adult
protective
services
to
act
as
the
petitioner,
when
there
is
a
a
circumstance
that
presents
as
such
and
they've
outlined,
that
in
statute,
some
states,
such
as
washington,
have
brought
in
their
criteria
to
allow
any
interested
person
to
file
for
the
protective
order.
That
seems
to
be
the
minority
and
what
I
would
caution
against
that
practice.
N
What
we
would
like
to
see
in
nevada
is
empowering
the
individual
to
have
this
remedy
and
also
adult
protective
services
to
be
able
to
act
as
partici
as
petitioner,.
N
Some
of
the
judicial
relief-
that's
common
to
the
orders
across
the
jurisdictional
survey,
include
restraining
conduct,
restraining
physical
access
or
prohibiting
physical
access
to
a
particular
location,
restraining
certain
contact
requiring
an
accounting,
restraining,
the
transfer
of
property
and
other
judicial
relief.
I
know
oregon
specifically
includes
a
custody
of
a
pet,
for
example,
in
their
statute.
N
So
not
only
is
this
a
national
recommendation,
it
will
also
help
us
collect
and
track
data-
that's
historically
very
difficult
to
obtain
for
this
population,
allowing
aps
to
act
as
a
petitioner,
we'll
also
build
upon
existing
relationships
and
partnerships
with
our
legal
aid.
Servicers
service
providers
throughout
the
state-
and
this
is
a
tool
that
we
can
use
for
early
intervention
and
early
case
initiation,
to
prevent
some
of
these
cases
that
we
see
in
the
headlines
when
it's
too
late.
N
And
in
a
moment,
I'm
going
to
invite
one
of
our
colleagues
from
law
enforcement
as
well.
He
graciously
agreed
to
be
here
to
give
the
law
enforcement
perspective,
but
let
me
give
you
a
brief
background
on
access
warrants
in
nevada.
There
is
no
current
statute
authorizing
adult
protective
services
to
petition
for
or
obtain
access,
af
an
access
warrant
following
a
denial
of
entry
to
a
private
property
premises.
E
So,
thank
you,
I'm
tammy
seaver
for
the
record,
so
I'm
just
going
to
give
you
a
case.
Example.
This
is
just
one
of
of
many.
We
would
have
been
here
all
day
long
if
we
could
have
picked
out
the
cases
that
we've
had,
but
our
aps
received
a
report
of
abuse
from
an
apartment,
complex
manager,
who
was
concerned
about
an
elderly
woman
that
was
living
with
her
adult
child.
E
There
were
reports
that
the
daughter
was
yelling
and
screaming
and
intimidating
the
adult,
the
parent,
when
the
apartment
staff
would
try
to
speak
with
the
parent
regarding
the
adult
living
in
the
apartment
and
not
on
the
lease
which
was
not
legal.
They
would
the
adult
child
would
not
let
the
parent
come
to
the
door.
E
Our
aps
social
worker
attempted
to
contact
knocked
on
that
was
knocked
on
the
door,
but,
however,
the
adult
child
would
not
let
her
come
in
and
speak
to
her
her
parents,
the
adult
child,
responded
to
the
social
worker.
She
knew
her
rights
and
she
didn't
have
to
let
anybody
have
access
to
the
apartment
or
to
her
parent.
E
She
stated
that
her
attorney
informed
her
of
this.
After
several
welfare
checks
were
called
in
by
her
family,
the
social
worker
could
see
the
client
sitting
in
care
in
the
kitchen.
However,
the
adult
child
would
not
allow
her
to
the
social
worker
to
go
in
and
speak
to
her.
The
social
worker
contacted
law,
enforcement's
law
law,
non-emergency
line
and
a
patrol
officer
arrived
at
the
scene.
E
However,
the
adult
child
refused
to
let
the
police
in
the
in
the
home
and
the
police
officer
informed
the
social
worker
that,
without
a
warrant
they
could
not
force
access
as
that
they
could
see.
The
client
was
sitting
at
the
table
and
it
was
no
one.
There
was
no
apparent
distress
this
being.
This
was
a
southern
nevada
case,
as
we
made
a
referral
to
the
local
law.
Enforcement's
detective
bureau
that
specializes
in
abuse
neglect
regarding
the
isolation.
N
N
While
that's
the
case
in
nevada,
most
jurisdictions
do
have
a
mechanism
for
applying
for
and
executing
a
warrant
that
allows
aps
to
access
and
conduct
their
investigation
concerning
the
reports
of
a
vulnerable
or
older
adult,
and
we
can
get
into
a
bit
more
about
the
law.
But
I'd
like
to
welcome
sergeant
mendoza
to
the
table,
and
he
has
a
few
words
on
the
law
enforcement
perspective.
O
Good
afternoon
my
name
is
detective
sergeant
john
michael
mendoza,
with
story
county
sheriff's
office.
I
am
here
to
provide
the
perspective
of
law
enforcement
on
these
proposals.
I
have
over
22
years
of
experience
working
with
law
enforcement,
and
many
of
my
cases
have
involved
seniors
or
adults
with
disabilities.
O
My
partnership
with
aps
or
other
mdt
groups
is
critical
to
investigate
prosecute
cases
for
an
adult
model
treatment
in
our
jurisdiction,
especially
in
rural
nevada.
The
cases
for
adults
have
used
neglect.
Isolation.
Exploitation
are
often
very
difficult
and
require
additional
resources
that
our
agency
simply
cannot
provide,
in
other
words
like
transportation.
O
Our
agency
supports
this
initiative
because
it
will
improve
early
case
intervention,
thus
improving
the
quality
of
life
of
our
elderly.
Often
we
are
called
to
do
multiple
welfare
checks
and
have
no
legal
authority
to
access
the
property.
The
access
warrant
will
help
maximize
law
enforcement
response
and
use
of
our
limited
resources,
especially
in
rural
areas.
O
The
access
warrant
will
help
strengthen
coordinated
response
between
law
enforcement
aps
and
mdt
groups.
Regarding
the
protective
order
and
fatality
review
teams,
our
agency
supports
any
initiatives
that
improve
coordinated
efforts
to
help
protect
nevada's.
Most
vulnerable
adult
population.
Thank
you.
N
N
N
Additionally,
the
national
practices
outline
not
only
to
allow
access
for
aps,
but
also
for
those
not
to
interfere
with
the
investigation,
and
so
what
that
entails
is
oftentimes
the
adult
protective
services,
social
worker
who's
trying
to
access
the
individual
will
be
denied
interviewing
them
alone,
that
the
person
insists
on
staying
in
the
room
and
there's
continued
concerns
of
undue
influence
exploitation,
because
we
can't
speak
to
the
person
alone
to
assess.
What's
going
on.
In
that
situation,
I've
listed
some
other
states
and
some
other
practices
that
were
unique
to
those
minority
states.
N
Aps
has
the
independent
authority
to
apply
for
the
warrant.
A
probable
cost
standard
is
used
by
a
majority
of
states.
That
would
be
consistent
with
the
nevada
law
in
this
area
and,
of
course,
the
national
survey
revealed
that
there
must
be
a
denial
or
refusal
of
access
in
order
to
prove
up
the
affidavit.
N
So
now
we've
talked
about
improvements
in
the
adult
maltreatment
system
response
for
prevention,
improvements
that
can
be
made
in
the
ongoing
investigation
stage
of
the
case.
So,
finally,
I'd
like
to
look
at
the
end
of
the
life
cycle
of
the
case
and
improvements
that
can
be
made
in
system
response,
your
case,
evaluation
and
retrospection,
and
that
is
the
use
of
elder
abuse,
fatality
review
teams.
N
N
Includes
a
list
of
all
the
states
deploying
these
tactics
and
and
how
they
utilize
these
teams,
but
essentially
it's
a
multi-disciplinary
group
with
the
goal
of
identifying
system
gaps
and
improving
victim
services
across
the
state.
N
N
N
The
elder
abuse
fatality
review
teams
have
been
demonstrated
to
be
effective
again.
According
to
the
american
bar
association
study,
participants
reported
that
it
enhanced
their
knowledge
their
ability
to
do
their
jobs
effectively
to
collaborate
with
their
colleagues.
It
facilitated
large
level
policy
changes
and
practices
and
that
led
to
systemic
changes,
statewide
and
also
in
their
local
communities.
N
A
A
A
I
will
take
that
as
a
no
all
right
well,
seeing
that
there
are
no
questions.
Thank
you
again
for
your
presentation
and
we
will
close
this
item
of
business
and
move
forward
to
the
next
agenda.
Item
agenda.
Item
number:
nine:
we
have
ms
marie
coe
with
the
long-term
care
budmen
program
with
aging
and
disability
services
division
here
to
present
on
issues
related
to
residents,
rights
in
group
homes
and
assisted
living
facilities
in
nevada,
miss
coe.
You
may
begin
when
you're
ready.
C
C
The
ombudsman
program
we
are
authorized
under
the
older
americans
act,
which
is
the
federal
law
requiring
each
state
to
have
an
ombudsman
program,
and
specifically,
if
you're
unaware
of
what
an
ombudsman
is,
we
are
advocates
for
residents
in
long-term
care,
the
long-term
care
ombudsman
program.
We
receive
complaints
from
anywhere
and
based
on
the
complaints
that
we
receive.
If
it
is
within
our
role,
we
would
open
up
an
investigation
and
proceed
some
of
the
items
that
we
can
look
into
are
assisting
residents
with
day-to-day
concerns,
such
as
health,
safety
and
personal
preferences.
C
C
C
In
addition
to
our
investigations,
we
also
conduct
regular
unannounced
visits
into
facilities
in
this
particular
setting.
We
go
a
minimum
of
once
every
quarter
into
every
single
facility
licensed
in
the
state
skilled
nursing
facilities,
which
are
a
higher
level
of
care.
We
visit
those
settings
once
a
month,
so
talking
about
the
facility
types,
the
home
for
individual
residential
care
are
homes
in
the
community
in
a
regular
neighborhood.
It
could
be
the
house
right
next
door
to
yours
that
are
licensed
to
provide
care
for
two
residents.
C
C
Currently
in
nevada,
we
have
16
613
licensed
residential
beds
to
provide
care
for
residents
in
nevada
who
need
care
in
these
settings.
Specifically
what
we're
going
to
be
talking
about
today,
the
residential
facilities
for
groups.
There
are
7
610
licensed
beds,
so
these
residents
can
be
affected
by
this
presentation.
C
The
concern
is
that
there
is
no
protections
right
now
for
residents
in
these
settings
if
they
are
facing
an
eviction,
so
they
should
receive
a
30-day
notice
when
transferring
or
discharging,
and
that
notice
should
also
be
sent
to
our
office.
The
ombudsman's
office,
however,
that
doesn't
always
happen
and
there's
no
mechanism
to
enforce
or
penalize
the
provider
for
not
following
that
part
of
the
law,
and
then,
if
it
does
happen,
that's
where
the
10
calendar
days
comes
into
play.
C
The
resident
has
10
days
to
meet
with
the
owner
or
the
administrator
of
this
facility
to
try
to
compromise
and
come
to
a
resolution.
In
order
to
stay
and
oftentimes,
there
may
be
a
behavioral
aspect
or
a
financial
issue
that
has
brought
about
the
eviction
in
the
first
place
and
there's
no
forum
to
adjudicate
any
of
these
eviction
disputes
and
allow
the
resident
to
have
due
process.
C
So
I've
provided
a
chart
on
the
left
is
skilled,
nursing
facility
information
and
on
the
right
is
the
non-skilled
facility
information
and
that
would
apply
to
the
residential
facilities
for
groups.
So
you
can
see
the
similarities
and
differences
between
skilled
nursing
and
non-skilled
nursing
facilities.
C
C
There
are
not
these
protections
and
residents
are
being
evicted
to
homeless,
shelters
where
their
needs
cannot
be
met,
so
if
they
have
care
needs
that
were
currently
being
provided
in
the
facility.
Those
are
not
met
at
a
homeless,
shelter
or
they
may
be
sent
to
a
hospital
where
their
bed
is,
and
this
just
happened
yesterday.
Actually,
a
resident
was
sent
to
a
hospital
and
was
there
and
ready
to
return
back
to
their
bed,
and
their
bed
was
filled
by
someone
else,
and
they
are
not
permitted
to
return
back
to
their
home.
C
C
This
is
the
copy
of
the
federal
language
regarding
the
settings
rule
and,
as
you
can
see
it
states,
the
state
must
ensure
a
lease
residency
agreement
or
other
form
of
written
agreement
be
in
place
for
each
res.
Each
participant
that
provides
protections
that
address
eviction,
processes
and
appeals
comparable
to
the
landlord
tenant
law.
Nevada
is
currently
not
in
compliance
with
this
rule.
A
change
to
nrs-449a
would
bring
the
state
into
compliance
as
well
as
provide
increased
protections
for
all
residents
in
non-skilled
nursing
settings.
C
C
We
have
seen
residents
who
go
to
the
hospital
and
are
transferred
to
a
facility,
a
residential
facility
for
group,
where
the
hospital
signs
a
contract
for
several
thousand
dollars
for
several
months,
maybe
three
or
four
months,
and
when
that
contract
ends
the
resin
the
resident
doesn't
have
the
means
to
provide
the
current
payment
that
the
hospital
has
been
paying
and
the
resident
then
receives
an
eviction
notice,
and
so
the
resident's
care
needs
are
being
compromised.
Because
of
this
practice
and
again,
there's
no
protections
in
place
for
the
residents.
C
C
We
would
like
to
see
and
establish
a
universal
appeal
process
to
match
protections
currently
in
place
for
skilled
nursing
facilities,
to
require
a
process
for
eviction,
letters
that
are
sent
to
the
ombudsman's
office
within
30
days
of
the
proposed
eviction.
So
that
way,
an
advocate
can
go
out
and
meet
with
the
resident
and
the
providers
to
provide
advocacy
and
to
impose
penalties
for
facilities
who
do
not
follow
this
current
process.
C
C
We
would
screen
the
letters
and
open
up
case
investigations
as
necessary.
Currently
we
receive
all
discharge
notices
from
skilled
nursing
facilities
and
if
we
see
that
a
resident
is
being
discharged
to
a
homeless,
shelter
or
somewhere
that
may
be
an
unsafe
location,
we
open
up
a
case
for
investigation
and
go
meet
with
that
resident
and
make
sure
that
their
needs
can
be
met
in
that
setting
and
that
they
are
consenting
to
that
transfer.
C
Our
advocacy
role
would
be
to
obtain
consent
first
from
the
resident,
and
then
we
would
assist
the
resident
to
file
an
appeal
and
regarding
that
eviction,
if
needed,
we
could
refer
to
legal
services
and
we
would
continue
our
ongoing
advocacy.
This
is
a
similar
process
that
happens
right
now,
with
skilled
nursing
facility
discharges.
A
A
A
As
a
reminder,
we
ask
the
public
comments,
be
kept
to
three
minutes,
so
everyone
interested
in
speaking,
can
be
accommodated.
In
addition,
public
comment
may
be
provided
in
four
different
ways,
all
of
which
are
listed
on
the
agenda.
A
person
may
also
submit
public
comments
in
writing
either.
In
addition
to
testifying
or
in
lieu
thereof,
written
public
comments
may
be
submitted
before
during
or
after
the
meeting
adjournment,
and
we
will
start
with
public
comment
in
las
vegas
and
then
take
comments
in
carson
city.
A
No,
I
don't
see
anyone
coming
up
to
the
table.
Bps
is
there
anyone
waiting
to
make
public
comment
on
the
phone.
D
Good
morning
or
good
afternoon,
madam
chair
advisor
and
the
committee,
my
name
is
dora
martinez
and
I
do
represent
the
nevada
disability
peer
action
coalition.
Sorry
for
that
delay,
I
had
to
mute
my
alexa.
I
just
want
to
say
thank
you
so
much
I
was,
we
were
informed.
D
The
disability
community
were
informed
that,
due
to
the
power
it
be,
they
did
not
eliminate
this
committee
and
we
appreciate
that
you
know
we
are
usually
the
disability
commit
community
are
usually
you
know
when
we're
out
of
sight
we're
sort
of
out
of
mind
for
some
people,
and
we
just
appreciate
that
we
that
you
all
know
that
we
are
here
and
we
are
listening
to
you
all,
and
I
must
say
you
guys,
are
doing
a
fantastic
job
and
and
thank
you
so
much
for
the
able,
the
able
guy,
the
famous
pretzel
bad
eric,
jimenez
and
jennifer
richards
for
doing
a
great
job.