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Below is the HillCo client report from the October 2 Joint Legislative Committee on Aging hearing.
 
Please see the link below to access DAD’s presentation from today’s meeting and below for a summary.
Legislative Committee on Aging, Oct. 2, 2014
 
 
Debbie Hanna, Chair of the Texas Council on Alzheimer’s Disease and Related Disorders

  • The Committee on Alzheimer’s did great work and the Council has implemented all their recommendations
  • The Council began in 1987 and consists of 12 appointed members
    • Coordinate research programs
    • Created a strategic plan for Texas
    • Help Texans find the infrastructure to face Alzheimer’s disease (AD)
  • DSHS only has one FTE allocated for this disease – she would like to see more people working on it internally at the agency
  • Healthy Brain, Healthy Aging schema
  • Wants to change the message of doom and gloom forever
  • Texas Alzheimer’s Consortium (TARC)
    • Medical schools across Texas are sharing data and have created a valuable repository
    • Have expanded research to the Hispanic community in Texas
      • Previously sorely lacking data on this demographic
    • Has received 28M since its creation and they have positioned themselves in a place of importance for AD research
    • King asked how they could expend the program at DSHS. Through an Exceptional Item in the LAR?                      
      • Probably but we haven’t asked
    • The Harris Study is a longitudinal study of 1800 patients that is very diverse and covers the whole gamut of AD
      • Database with client profiles
      • Scientists us data to publish findings
    • King – is there an opportunity for anyone to participate?
      • No, they would have to be diagnosed at a TARC center for consistency in the cohort
      • In the Hispanic cohort, NP actively go out into the community to recruit to meet enrollment numbers
    • King – can patients already diagnosed with AD be referred to the TARC center to participate in the study?
      • As long as their cognitive functions have not already significantly deteriorated
    • Putting information in dental and optometrist offices could help with education and outreach
  • Dr. Dickerson – can you expand the number of patients in the study? Would encourage a more holistic model with social workers and public health support. “Does not want biology to become our destiny;” UT Arlington is doing a lot of work with Veterans and the Baylor college of medicine has a geriatric assessment unit – there are more resources across the state to help
    • NIH and private funding has increased their 28M to over 80M
    • There is a lot of collaboration across medical disciplines since this is such a complicated disease
    • Dr. Dickerson said he wanted to see the gap in research across the state, for example, is rural Texas represented?
      • There is a rigorous formula for inclusion into the cohort
      • To have national and international recognition they must have diversity across all populations
    • Dr. Dickerson – we need to look at generations within ethnic groups
    • Dr. Dickerson – are Native Americans represented?
      • Will need to check on that

 
Dr. Ron DeVere, Director of the Texas Alzheimer’s Association

  • 330,000 Texans with AD
  • 13,000 unpaid caregivers
  • Association works on global, national and local levels to enhance support
  • Largest non-profit funder of AD research
  • Finalizing their policy priorities
    • Increase education for docs, nurses, and emergency personnel
  • King – seen patients whose family try to shield the patient from knowing their diagnosis
  • A lot of things can be done now to slow the disease – the message people hear is that once you get AD you die
  • Between 1984 and 2011 there were no new guidelines published for AD
    • Believes the glass is full for AD
  • Streckfuss – the increase in unpaid care giver hours has not increase as much as she expected
  • Is there a greater acceleration of disease based on age?
    • Non necessarily – this is something they are studying
  • Dr. Dickerson asked for a vocabulary guide of the different types of dementia

 
Commissioner Weizenbaum, DADS

  • Nursing facilities (NF) are surveyed by DADs for compliance with state licensure rules  AND federal certification requirements
  • Assisted Living Facilities (ALF) are only surveyed for compliance with state licensure rules
    • Both must meet the needs of their residents
    • Have the ability to serve patients with AD without additional certification
  • Discussion of voluntary certification requirements
  • Advertising restrictions on facilities without certification
  • Discussion of the different types of locking devices an AD unit must have to be certified
  • Quality Based Monitoring Program (QMP) passed in SB 1839, 77th Legislative session
    • Registered dieticians, nurses and pharmacists with goals:
      • Develop and share evidence-based best practices and innovations for outcome improvement
      • Regularly visit NFs for collaborative training and education and hands-on assistance for quality improvement
      • Partner with other agencies and organizations
      • Conduct rapid response team interventions for facilities as needed
  • QMP Activities Related to Alzheimer’s and Dementia Care:
    • Culture change:
      • Joint partnership with Texas Culture Change Coalition to present an annual conference
      • Training focuses on dementia care and reducing the use of antipsychotic medications
    • Texas Reducing Antipsychotics in Nursing homes (TRAIN):
      • Joint with TMF Quality Innovation Network
      • Trains on use of antipsychotic medications in the older adult population with dementia without psychosis
    • Alzheimer’s disease tool-kit – evidence-based best practices for assessment and treatment
  • Caregiver support programs
    • National Family Caregiver Support Program
    • Texas Lifespan Respite Care Program:
      • Caregiver training:
        • Resources for Enhancing Alzheimer’s Caregiver Health (REACH) II
        • StressBusting
    • Aging and Disability Resource Center (ADRC) Partnership:
      • Central Texas and Capitol Area Alzheimer’s Association
      • Coastal Bend and Del Mar College
  • Huffman – With the increasing aging population, are their new facilites being built to address the growing needs?
    • Many buildings are very old – there is an increased interest in building small home model communities
    • Passes a new rule that allows for Medicaid bed waivers for these smal home models
    • Huffman – so there is an incentive for industry to grow
  • Huffman – is there sufficient personnel at DADS to oversee all facilities?
    • They have an exceptional item in their LAR for more FTEs to help regulate both nursing home facilities and home health growth
  • Huffman – we must support DADS to get what they need – this will be a recommendation from the committee
  • Streckfuss – Texas is always ranked relatively low for care
    • There is room to improve
    • Do we work well in serving patients with AD?
      • Will research this
  • King – are there any issues with the locking devices?
    • Not all facilities maintain equipment properly or have adequate staffing
      • This keeps regulatory satff at DADS bust investigating complaints
  • King – Is there any data or findings on the use of greenhomes or small homes and quality of care?
    • So new, very little exists
  • King – is respite care always reimbursable?
    • Depends on the program – some programs include it as a benefit
    • 211 has the capacity to relay information on programs
  • King asked the Commisioner if he had heard talk about seperating Aging and Disability into 2 agencies?
    • Will not comment, but has heard the discussion as the HHSC Enterprise goes through Sunset

 
Patty Ducayet, Texas State LTC Ombudsman

  • Described virtual tours that are privately operated that simulate AD for someone without the disease
    • King said they should set one up at the capitol during session to raise awareness, if someone else would pay for it
  • Ombudsman protects resident’s rightfederal and State mandated program
  • Ombudsman +6 FTEs at DADS, but are not a part of the agency directly
  • Work with the 28 centers for aging across the state that house local ombudsmen
  • Espouse an informal problem solving process
  • The keep frequent direct contact with residents and help to resolve problems
  • Under a federal requirement to comment and make recommendations on laws
  • There are 52 certified nursing facilities in Texas
    • 200 others with locked units that care for dementia patients that are not certified
    • Believes certification demonstrates a higher quality of care
  • The restriction on advertising is narro – non-certified facilities can still advertised as a locked facility for AD patients
  • Funding for the program is through DADS
  • They have 10 major initiatives planned to educate on overmedication of antipsychotics
  • There is a list of the certified facilities on the web
  • Huffman – we need a practical approach to encourage certification – what is the cost for a facility to get to certification standards?
    • Real cost would be in increased training
    • If the facility has a locked unit already, there wouldn’t really be other construction costs
  • Huffman supports certification but she needs to look at the reality of a facility’s ability to get certification
  • Streckfuss – how do you publicize yourself?
    • All patients when they enter a facility get their information
    • Streckfuss doesn’t believe that many people understand what an ombudsman is

 
Maurice Pitts – Texas Association of Regional Councils

  • 28 Area Agencies on Aging (AAA)
    • Provide support for over 200,000 patients a year
    • Work closely with COGs
    • Promote dignity and quality of life for the elderly
    • Some examples of services they provide:
      • Preventative health
      • Rights
      • Benefits
      • Counseling
      • Transportation

 
Deborah Moore, Director of the Harris Co. AAA

  • Help plan, provide and contract for services for seniors 60+
  • Promote wellness, wellbeing and dignity
  • Provide nutrition services, both home delivered meals and congregate meals
  • Provide benefits counseling, caregiver training, respite services, in-home repairs
  • Provide Demand Response Transportation for individuals in the 12 counties surrounding Harris
    • Provided almost 300,000 trips in FY ‘13
    • Provides consitent and reliable transportation for seniors in their community
  • Huffman – This is from federal funding and then dispensed through DADS
  • Huffman – How do you find your drivers and are they background checked?
    • The Harris County Rides is a program that conducts background checks and they use vans and taxis
    • Curtis Cooper – contract with local providers that also do meal delieveries
    • Huffman – do you have enough services to meet the need?
      • Underserved with waiting lists
    • Huffman – do they have to make an appointment in advance
      • 2 days in advanced to congregate sites
    • Huffman – is this being replicated in other areas of the state?
      • Transportation is offered at all AAAs in some form
  • King – Is there an emergency provision that would bypass the 2 day window?
    • Yes
    • Age is the only requirement for the nutrition services transportation
    • An individual younger than 65 living with a disability can also access Houston Rides

 
Yvette Lugo, President Rio Grande Agency on Aging

  • Provided an overview of their services and the programs they support
  • AAA provides seniors the ability to live well in their community, avoiding institutionalization
  • Help seniors choose benefit plans
  • Focus on educating family care givers and giving them supports
  • Take Time Texas website to access information on respite care
  • Dr. Dickerson wishes there was a way to make AAA’s more visible
    • Is there another White House Conference to discuss aging?
    • Texas needs to be present and vocal
      • Dr. Dickerson – Is it true that any senior can attend any class at a Texas University for free for non-credit?
      • Will have to find out
      • If true, best unkept secret – older people could find a real purpose there
  • King – How would you recommend changing the word “respite” to help others understand?
    • There is no translation of the word in Spanish
    • It just will take a lot of education