RICHARD WHITLEY, MS
Director
BRIAN SANDOVAL
Governor
DEPARTMENT OF HEALTH AND HUMAN SERVICES
AGING AND DISABILITY SERVICES
3416 Goni Road, Suite D-132
Carson City, NV, 89706
Telephone (775) 687-4210 · Fax (775) 687-0574
http://adsd.nv.gov
Name of Organization: Task Force on Alzheimer’s Disease (TFAD)
Date and Time of Meeting: June 23, 2017
10:00 a.m.
Locations: Sanford Center for Aging
University of Nevada Reno/RM 163
1644 N. Virginia St.
Reno, NV 89557-1234
775-784-6375
The Cleveland Clinic Lou Ruvo Center for Brain Health Campus, 4th Floor Conference Room
888 W. Bonneville Avenue
Las Vegas, NV 89106
(702) 483-6000
To Join the Telephone Call-in Number: 877-336-1831
Conference Access Number: 9186101
Draft Minutes
I. Call to Order/Roll Call
Senator Valerie Wiener (Ret.), Chair
Members present: Jill Berntson, Jacob Harmon, Dr. Peter Reed, and Sen. Valerie Wiener (Ret.)
Members participating by telephone: Gini Cunningham and Wendy Simons
Members absent: Dr. Charles Bernick, Dr. Jane Fisher, Sen. Joseph Hardy, and Assemblyman Oscarson
Alternates present: Lee Ann Mandarino
Alternates participating by telephone: Cyndy Soto
Guests: Vincent DelGuidice, Cheyenne Pasquale, and Susan Hirsch
Staff present: Jeff Doucet and Sunadda Woodbury
A quorum was declared.
II. Public Comment (This item is to receive comments, limited to three (3) minutes, on any issue and any discussion of those items. However, no action may be taken upon a matter raised under public comment period unless the matter itself has been specifically included on an agenda as an action item.)
Gina Stutchman, representing Arbors Memory Care and the Nevada Assisted Living Association, provided comments. She requested a clarification of the by-laws, how the members fulfill the Nevada Revised Statutes requirements, and who might be representing the care providers in Nevada.
Sen. Wiener stated that she will respond to this inquiry in agenda item V., which pertains to confirmation of appointments to TFAD.
III. Welcoming Remarks
Senator Valerie Wiener (Ret.), Chair
Sen. Wiener thanked everyone for their contributions during the legislative session, she particularly noted efforts for the passage of SB92, the bill sponsored by Sen. Joseph Hardy to remove the sunset on TFAD, which allows the task force to become permanent in the Department of Health and Human Services (DHHS).
Sen. Wiener explained that when the bill was first drafted and introduced in the 2013 legislative session, the task force was given a four-year timeframe to determine whether there would be value to the work. After that period, TFAD has proven its value to and for Nevadans and has been given permanent status.
IV. Approval of the Minutes from March 10, 2017 Meeting (For Possible Action)
Senator Valerie Wiener (Ret.), Chair
Wendy Simons moved to approve the minutes from March 10, 2017. Dr. Peter Reed seconded the motion. Minutes were approved unanimously.
V. Confirmation of Appointments to TFAD, Beginning July 1, 2017
Senator Valerie Wiener (Ret.), Chair
Sen. Wiener provided clarification regarding membership appointments. She explained that the members’ terms were all set to expire on June 30, 2017, which was the sunset date in statute under the original legislation. At the time of passage of SB92, removal of TFAD sunset, DHHS Director Richard Whitley was charged with making the categorized appointments specified in the statute and the by-laws. She noted that, TFAD membership comprises representatives from various categories, including two legislators who will continue to participate until new appointments are made by the Legislative Commission, who will be meeting in August 2017.
Sen. Wiener reviewed the Current Members List, which includes a grid, displaying the members’ names and categories they represent. Director Whitley determined that these individuals satisfy the requirements to represent the different categories needed and approved their appointments.
TFAD membership presently constitutes:
1. Jill Berntson—DHHS
2. Sen. Joseph Hardy—Senate
3. Assemblyman James Oscarson—Assembly
4. Dr. Charles Bernick—Medical Professional with Expertise in Cognitive Disorders
5. Gini Cunningham—Rural Nevada
6. Dr. Jane Fisher—Caregivers for Persons with Cognitive Disorders
7. Dr. Peter Reed—Nevada System of Higher Education (NSHE) with Expertise in Cognitive Disorders
8. Valerie Wiener—Member-at-Large
9. Wendy Simons—Providers of Service for People with Cognitive Disorders
10. Jacob Harmon—Association that Provides Service to Persons with Alzheimer’s Disease
Appointment terms were also staggered, with three members serving one-year terms, and the others serving two year terms.
Sen. Wiener also reminded members that statute requires them to submit names for their first and second alternates within 30 days of appointment. Alternates should represent the same category so they can contribute the same expertise to the group in the absence of the members.
VI. Election of Chair and Vice Chair (For Possible Action)
Jill Berntson
Deputy Administrator
Aging and Disability Services Division
Jill Berntson conducted the election of the new Chair and Vice Chair. She expressed appreciation for the service Sen. Wiener and Dr. Reed have provided in those capacities. She also thanked the members for their dedication, commitment, passion, and efforts to improve care for persons living with Alzheimer’s disease and their caregivers in Nevada.
Ms. Berntson explained that the Chair and Vice Chair serve from July 1st to June 30th of every year. Therefore, it is necessary now to appoint a new Chair and Vice Chair.
Ms. Simons moved to retain the present leadership, with Sen. Wiener as Chair and Dr. Reed as Vice Chair, for an additional year. Jacob Harmon seconded the motion. The motion was approved unanimously.
TFAD Members offered expressions of support and appreciation to both Sen. Wiener and Dr. Reed for their leadership.
VII. Presentation on Legislative Outcomes from the 2017 Legislative Session
Homa Woodrum, Esq.
Chief Advocacy Attorney
Aging and Disability Services Division
Homa Woodrum stated that she joined ADSD in January 2017 and shared her background and experiences working with the aging population in various capacities, including in private practice as a guardianship attorney.
Ms. Woodrum addressed an inquiry from TFAD regarding 2015 State Plan, retired recommendation #17, pertaining to issues related to summary guardianships and how they should be treated when the protected person is living with Alzheimer’s disease and other forms of dementia. After looking over this prior recommendation, Ms. Woodrum stated that there have been multiple changes in guardianship legislations, and suggested that it might be more appropriate to form a new recommendation if TFAD chooses to pursue further guardianship issues.
Ms. Woodrum provided a comprehensive definition of guardianship and explained the process and related challenges. She shared findings from the work of the Commission to Study Guardianship in Nevada’s Courts, citing that the participation of Senator Becky Harris and Assemblyman Michael Sprinkle on that committee resulted in several legislative outcomes. She explained that previous guardianship rules were not “bad,” but were not closely monitored. Therefore, there have been various changes in the reporting requirements.
Some of the major changes in guardianship laws in the 2017 legislative session include:
· Change from the term “ward” to “protected person,” focusing on guardianship as a protective measure.
· Splitting adult guardianships from minor guardianships, with NRS 159 being used for adults and NRS 159A for minors.
· A “Protected Persons Bill of Rights,” which aligns with the recommendations in the 2017 TFAD State Plan, was included in several pieces of legislation.
· A law passed, which gives people a private right of action, associated with the violation of the actions in the Bill of Rights, allowing people to seek legal recourse when they feel these rights are violated.
· For those persons with diminished capacities, a law was also passed, in concert with the others, that allows for mandatory counsel for these protected persons under guardianship. Funding will come from the $1 increase in real property recording fees.
· The “Protected Persons Bill of Rights” also includes significant restrictions on the guardians’ ability to decide on visitations.
Ms. Woodrum shared other legislative outcomes of interest to TFAD, including:
· Passage of AB31, which allows for change in the attorney’s title to an attorney for older persons and persons with disabilities, and it expands services for those under 60 (younger-onset individuals).
· Multiple elder abuse bills, which affect increase in penalties for elder abuse.
· Increased notice provisions for guardians.
· Personal Service Requirement—a process server will now be used.
· Guardianship Nomination Lock Box to be established in the Secretary of State’s Office.
· Physicians Assistants (PAs) and Advanced Practice Registered Nurses (APRNs) are now allowed to sign Physician Order for Life-Sustaining Treatment (POLST).
· SB121 was passed, appointing a committee to conduct an interim study concerning issues regarding the behavioral and cognitive care of older persons.
· AB394, a bill pertaining the allowance for people to use leave time for caregiving time, did not pass. Perhaps TFAD could revisit again in the future.
· Small expansion of Long-Term Care Ombudsman program, which adds three new positions in Reno, Elko, and Las Vegas.
· Various bills pertaining to provider rate reviews passed, including review of certain Medicaid reimbursement rates.
· ADSD received increased funding for home-delivered meals, which could allow for early exposure to people with potential health concerns, including Alzheimer’s disease and other forms of dementia.
Ms. Woodrum added that there may other “alternatives” to addressing guardianship issues with two new developments that might be of interest to TFAD.
1. Judge Francis Doherty, Second Judicial District Court of Nevada, received a “Supportive Decision Making,” grant to study the retention of a person’s right to decide, but allowing for provisions to select a trusted person to assist in various situations. This focuses particularly on adults with intellectual and developmental disabilities, but may also be applicable to persons living with Alzheimer’s disease and other forms of dementia.
2. The Nevada Attorney General’s Office received an “Abuse in Later Life” grant to do a statewide study and coordination of law enforcement efforts with community providers regarding prevention of and reporting abuse of persons in later life.
Ms. Stutchman raised concerns with inspections of assisted living facilities by the Bureau of Health Care Quality and Compliance (HCQC), DHHS, suggesting that Ms. Woodrum work with them to improve the process. Sen. Wiener asked that Ms. Stutchman discuss these matters with Ms. Woodrum later to allow TFAD to proceed with other agenda items.
VIII. Presentation and Possible Recommendations on Care Transitions Project
(For Possible Action)
Cheyenne Pasquale
NWD Coordinator
Aging and Disability Services Division
Cheyanne Pasquale provided updates on the No Wrong Door (NWD) developments during the last few months. She reviewed the objectives of NWD, along with the person-centered counseling process, which help people to explore care options and provide a formal entry point into services.
The Person-Centered Work Group changed the name from Person-Centered Counseling Program to Resource and Service Navigation Program. There will be two levels of certifications offered including:
· Level 1: Intake Staff, Support Staff and Partners—Introduction to person-centeredness, who the NWD partners are, and how people can connect with resource navigators, etc.
· Level 2: Resource Navigators—More in-depth look at services and processes.
Enhancement Training, developed specifically for people with dementia, will also be offered. Two modules were developed for the resource centers many years ago, including: 1) Memory & Dementia and 2) Managing Difficult Behaviors.
Other training modules are also being developed which will center around starting conversations about dementia and how to keep loved ones involved in decision-making.
Update on Nevada 2-1-1
Ms. Pasquale reported that Nevada 2-1-1 has been engaged in a marketing campaign that emphasizes the Nevada 2-1-1 URL (web address). They have also worked with a vendor to ensure that the Nevada 2-1-1 URL is more search-engine friendly. Additionally, Nevada 2-1-1 has two outreach network staff who have been engaging in outreach and working with community partners, not only to inform them about Nevada 2-1-1, but also to encourage various organizations to add their services to the database to expand the base of resources. Nevada 2-1-1 is also creating an Ambassador Group that will assist with growing the outreach efforts and involve individuals in the community who can tell others about Nevada 2-1-1.
Sen. Wiener inquired whether the challenges to getting organizations to commit to being included in the resource list have been alleviated, as that concern was discussed in a previous TFAD meeting. Ms. Pasquale responded that the resource directory has grown, so the follow up is likely happening.
Seeking more information about call volume to Nevada 2-1-1, Sen. Wiener asked Ms. Pasquale to return at the next TFAD meeting and report on the numbers post-marketing campaign (current numbers). In addition, she requested information on vendors that have been added.
Dr. Reed asked if the certification training is available to others in organizations outside the resource centers. Can other representatives from organizations representing that type of service also obtain those certifications? Ms. Pasquale explained that she envisions the certification program will be opened to other types of providers. The providers that obtain this certification would subsequently become part of the NWD network.
Regarding the enhancement training, Jacob Harmon added that the Alzheimer’s Association, both north and south, is contracted by the State to provide the same services (dementia training/awareness for caregivers). Mr. Harmon inquired whether there would be duplication of services. He questioned if the plan is to transition these services to the Resource Centers (RCs), or will the Resource Centers refer “out” to organizations who specialize in this area? Ms. Pasquale said that the aim is to train the Resource Navigators to connect with other entities who can provide the expertise in the various areas of need.
Dr. Reed suggested that NWD consult with outside expert entities to make sure that the training provided to care navigators will align, context-wise, with the training that is already being approved in the community. Ms. Pasquale said that she will be sending outlines of the training to community partners for input as well.
Care Transitions
Ms. Pasquale stated that the primary goal of Care Transitions, which is a big part of NWD, is to improve health outcomes and quality of life for people with dementia, as well as promoting better connections with health care providers. The secondary goal would be to reduce the 30-day hospital readmission rate. In partnership with Nevada Senior Services, the objective is to release an evidence-based model that can be sustained and replicated throughout Nevada.