State of Nevada ADSD



2266950-58102500RICHARD WHITLEY, MSDirector BRIAN SANDOVALGovernor490537581915EDWARD ABLESER, Ph.D.Administrator00EDWARD ABLESER, Ph.D.AdministratorDEPARTMENT OF HEALTH AND HUMAN SERVICESAGING AND DISABILITY SERVICES3416 Goni Road, Suite D-132Carson City, NV, 89706Telephone (775) 687-4210 Fax (775) 687-0574 of Organization:Task Force on Alzheimer’s Disease (TFAD) Date and Time of Meeting:June 23, 201710:00 a.m. Locations:Sanford Center for AgingUniversity of Nevada Reno/RM 1631644 N. Virginia St.Reno, NV 89557-1234775-784-6375The Cleveland Clinic Lou Ruvo Center for Brain Health Campus, 4th Floor Conference Room888 W. Bonneville AvenueLas Vegas, NV 89106(702) 483-6000To Join the Telephone Call-in Number:877-336-1831ConferenceAccess Number:9186101Draft MinutesCall to Order/Roll CallSenator Valerie Wiener (Ret.), ChairMembers present: Jill Berntson, Jacob Harmon, Dr. Peter Reed, and Sen. Valerie Wiener (Ret.)Members participating by telephone: Gini Cunningham and Wendy SimonsMembers absent: Dr. Charles Bernick, Dr. Jane Fisher, Sen. Joseph Hardy, and Assemblyman OscarsonAlternates present: Lee Ann MandarinoAlternates participating by telephone: Cyndy SotoGuests: Vincent DelGuidice, Cheyenne Pasquale, and Susan HirschStaff present: Jeff Doucet and Sunadda Woodbury A quorum was declared.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.Welcoming Remarks Senator Valerie Wiener (Ret.), ChairSen. 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. Approval of the Minutes from March 10, 2017 Meeting (For Possible Action)Senator Valerie Wiener (Ret.), ChairWendy Simons moved to approve the minutes from March 10, 2017. Dr. Peter Reed seconded the motion. Minutes were approved unanimously.Confirmation of Appointments to TFAD, Beginning July 1, 2017Senator Valerie Wiener (Ret.), ChairSen. 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:Jill Berntson—DHHSSen. Joseph Hardy—SenateAssemblyman James Oscarson—AssemblyDr. Charles Bernick—Medical Professional with Expertise in Cognitive DisordersGini Cunningham—Rural NevadaDr. Jane Fisher—Caregivers for Persons with Cognitive DisordersDr. Peter Reed—Nevada System of Higher Education (NSHE) with Expertise in Cognitive DisordersValerie Wiener—Member-at-LargeWendy Simons—Providers of Service for People with Cognitive DisordersJacob Harmon—Association that Provides Service to Persons with Alzheimer’s DiseaseAppointment 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.Election of Chair and Vice Chair (For Possible Action)Jill BerntsonDeputy AdministratorAging and Disability Services DivisionJill 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. Presentation on Legislative Outcomes from the 2017 Legislative SessionHoma Woodrum, Esq.Chief Advocacy AttorneyAging 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.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. 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.Presentation and Possible Recommendations on Care Transitions Project (For Possible Action)Cheyenne PasqualeNWD CoordinatorAging and Disability Services DivisionCheyanne 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 TransitionsMs. 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.Susan Hirsch, Nevada Senior Services, was invited to present additional information. Ms. Hirsch provided an overview of Care Transitions, noting that the program focuses on the transition from hospital to home. This program operates under the Alzheimer’s Disease Supportive Services Program (ADSSP) Grant II. They have been working with community partners and a national consultant to better understand what the existing evidence-based models are and what could be beneficial to Nevada. Ms. Hirsch reported that their investigations, have revealed that there are no existing interventions specific to people with dementia. After looking at various models, they found the BRIDGE model to be promising. It is a social work-based model that connects to the Aging and Disability Resource Centers statewide. They are also looking to partner with a hospital in southern Nevada to launch the programs. The approach for the first stage of Care Transitions includes:Goal is to serve about 50 people.Referrals will come from hospital partners and will be expanded over time.Work with Rush University to customize the BRIDGE model to Nevada’s needs.Implementation will to begin September 2017. TFAD members discussed the possible connection between the CARE Act and Care Transitions, as well as challenges with getting a proper diagnosis for people who come to the hospital with dementia. Ms. Hirsch emphasized that Care Transitions aligns with the CARE Act, but there will be more intensive involvement. Mr. Harmon would like to form a partnership to address the issues on misdiagnosis, along with ways to improve Alzheimer’s and dementia-related education and awareness for providers. Ms. Woodrum stated that it would be in the scope of her role to assist with outreach efforts as well.Ms. Stutchman expressed concerns that sometimes there is an assumption that the patient already has services/support in place (pre-diagnosis of dementia before hospitalization), but, the person’s condition may have declined and that person’s needs increase post-hospitalization. Then the services are not available to them when they transition back home or to an assisted- living facility. Ms. Hirsch explained that Care Transitions is a bridge program that can address these concerns with the help of a social worker who would act as an interventionist to assist with ensuring that the individuals can have the care they need at home or to wherever they are transferred.Dr. Reed suggested that Ms. Hirsch return to update TFAD at the next meeting to provide additional details prior to the launch of this program. Ms. Hirsch accepted the invitation and asked that Dr. Reed also present information on the evaluation component of the program as well.A copy of Ms. Pasquale’s Power Point presentation on NWD and Care Transitions is attached to file. See Attachment A.Update and Possible Recommendations on Dementia Friendly Nevada (For Possible Action)Jeff DoucetManagement Analyst IIIAging and Disability Services DivisionJeff Doucet presented an update on Dementia Friendly Nevada, which is under the Alzheimer’s Disease Initiative (ADI)-Specialized Supportive Services Program (SSS), also referred to as Grant III. Highlights from the update include:Northern Nevada Project Coordinator Contract Position will start July 1st, 2017.Southern Nevada position anticipated to start the end of July 2017.First-year funding distributed to all partners. Second-year funding to be distributed in August 2017. (Pending transition from Planning Stage to Transition Stage, ensuring that funding amounts to each community are being expended appropriately.)Second meeting with Administration for Community Living (ACL) will be July 5, 2017, to review work plans.Technical Assistance partner (N4A) will only need $25,000 for the life of the project, not per year, which allows more funding to be redistributed to meet other needs.Mr. Doucet reported on outcomes from the Request for Proposals (RFPs) grant funding process, which was initiated in May 2017. Four communities were selected in the first year as pilot communities for Dementia Friendly Nevada activities: Las Vegas, Reno, Elko, and Winnemucca.White Pine was not selected, but they can reapply another munities vary in level of progress with their Dementia Friendly activities.The next grant cycle will be in January 2018, with three or four additional communities to be selected.Mr. Doucet also clarified the difference between Planning Stage vs. Implementation Stage. They are continuing discussions of project work plan and time lines with ACL. The budget has been revised three times, with minor adjustments in details. Federal partners have made additional requests on Nevada’s work plan activities, including:Evaluation measures tied to projected outcomes.Nevada tool box of services tied to Dementia Friendly activities—must present new and different activities in each grant cycle. Working with community partners to establish specific plans to expand direct services tailored to their unique needs.Dr. Reed reiterated the importance of the focus on direct services in the evaluation rather than just the implementation of the program. The aim should be for each community to come together and set their own priorities and track the extent to wish they are able to carry out their plans and achieve those priorities. A copy of the Nevada Alzheimer’s Grants Project Update is attached to file. See Attachment B.Update and Possible Recommendations on Nevada Consortium on Dementia Research (NCDR) and On-Line Continuing Education Opportunity for First Responders (For Possible Action)LeeAnn MandarinoProgram Manager IIIThe Cleveland Clinic Lou Ruvo Center for Brain HealthNCDRLeeAnn Mandarino provided an update on the progress of the Nevada Consortium on Dementia Research (NCDR), which was a recommendation in the 2015 TFAD State Plan. Dr. Charles Bernick and the Cleveland Clinic are leading this effort. The group has been meeting quarterly for a year and a half. Progress has included the creation of by-laws and formation of an executive committee that consists of Dr. Bernick, research scientists from Roseman University of Health Sciences, and an educator from the College of Southern Nevada. The purpose for creating this committee was to create a network throughout the state on what research activities are taking place. The information was to be distributed through a research website, but NCDR has not created this yet. Discussion ensued regarding possible ways to expedite the development of this research website to move the work of NCDR forward so that both researchers and patient recruits can utilize this resource. Ms. Pasquale commented that she has the draft of the website already formulated and asked to meet with Ms. Mandarino to discuss the matter in detail. Sen. Wiener requested that Ms. Mandarino return and report on the decision and progress of the website at the next TFAD meeting. Healthcare Provider and First Responder Dementia EducationTo best meet the needs for community education on dementia, the Cleveland Clinic is developing an online training video for first responders and other healthcare providers in the community. Ms. Mandarino reported that Las Vegas PBS station will record a video session, which will comprise a panel of physicians and first responders, including but not limited, to legal representation, social workers, Emergency Room (ER) personnel, and others. This course will help frontline responders recognize behaviors that may be associated with the most common forms of dementia that affect behavioral issues. The video training will focus on Alzheimer’s disease (AD), diffuse Lewy body dementia (DLB), and frontotemporal degeneration (FTD). Various situations/scenarios will be presented, and panelists will discuss the best ways to respond, perform proper and more expedited screening, and determine an appropriate plan for care. Once completed, the video will be posted on the Vegas PBS website, where first responders and other providers can have easy access to view it. Also, Continuing Education Credits (CEUs) may be offered.Sen. Wiener commented that this educational offering aligns directly with 2015 TFAD State Plan recommendations on education and awareness for which Sen. Hardy oversaw and pursued legislation. She advised Ms. Mandarino to contact various licensing boards to ensure that they will endorse CEU credits for this training video.Ms. Mandarino stated the videotaping is scheduled for July 27, 2017, with the website release planned for September 2017.Ms. Woodrum inquired who would be invited/involved on the panel and recommended that Assemblyman Sprinkle be invited because he is a paramedic and also has a vested legislative interest in this population. An outline of the Health Care Provider First Responder Dementia Education Program is attached to file. See Attachment C.Discussion and Possible Recommendations on Guidelines for Behaviorally Complex Care Program (BCCP) Training (For Possible Action)Dr. Peter ReedDirectorSanford Center for AgingDr. Reed stated that this discussion is a follow up of prior discussions regarding BCCP. He explained that BCCP has provided financial incentives to skilled nursing facilities to support people living with dementia, who are potentially experiencing responsive behaviors. His concern is whether there is training and support to ensure the level of care that is needed. What can be done to develop proper training? Dr. Reed expounded that many training programs are available, and offered by various organizations. However, the challenge is finding ways for providers to access these programs and determine which ones would best meet the needs of their clients. He proposed that a work group could be formed to conduct an environmental scan of the existing programs and identify the core content within those. In addition, the work groups should determine how to develop awareness of existing training programs that would be applicable and beneficial, as well as finding ways to promote better access to those offerings. Additionally, the group could explore other new training programs and possibly compile a portfolio of courses that could support training for the providers utilizing BCCP. This would require resource allocation, so there would need to be careful consideration.Ms. Simons commented that she understands this, the facilities participating in BCCP are bringing consultants-clinicians, on board to assist, but there does not seem to be any formal type of training program enforced to help the staff—the direct care workers. She supported Dr. Reed’s recommendations and proposed the formation of a subcommittee or work group, which ever would be most feasible.Jill Berntson said she can consult with Linda Anderson, at the Attorney General’s Office to advise how best to assemble those who can conduct this study. She also suggested involving Medicaid to make sure that what TFAD wants to suggest in the future align with what the requirements are for BCCP. Dr. Reed concurred that it would be good to form a collaboration with Medicaid in this process as well.Ms. Simons moved to create a work group to as discussed. Mr. Harmon seconded the motion. The motion passed unanimously. Related to a timeframe, Dr. Reed would like to solicit participation of other TFAD members and /or colleagues in this work group. He will determine a name for the group and outline its purpose. Then this information can be distributed out to people to consider getting involved. Mr. Harmon suggested inviting providers to participate as well, because there could be other systemic challenges that should be considered. Ms. Stutchman shared there needs to be differentiation between public funding (Medicaid) to SNFs vs. no funding to assisted-living facilities. However, she agreed that additional training would be beneficial to staff to provide helpful tools for performing their jobs effectively. Discussion and Possible Recommendations on How to Strengthen Elder Protective Services (EPS) (For Possible Action)Jacob HarmonExecutive DirectorNorthern Nevada Alzheimer’s AssociationMr. Harmon related that last year, he observed that EPS was overworked and understaffed, so he thought that TFAD could look at some ways that they might be able to help. He reported that, since then, ADSD has made some changes that have improved their ability to recruit and retain EPS workers. Therefore, his former concerns have been alleviated, and EPS is in much better shape than the previous year. To elaborate, Ms. Berntson explained that EPS experienced very difficult challenges in staff shortages, but two things have been accomplished:ADSD could hire EPS social workers at a higher step, which has helped with recruitment.Increasing the pay rate of EPS workers, which aligns with Child Protective Services workers, has improved recruitments.Presentation on Speech Therapy and DementiaVincent DelGiudice, MS, CYF-SLPVegas Voice InstituteSen. Wiener invited Vincent DelGiudice from the Vegas Voice Institute to give a presentation on speech therapy and dementia, noting that the information will address unique needs of people living with dementia. Mr. DelGiudice explained that dementia affects a person’s communication abilities--both the ability to understand and the ability to effectively communicate through speech. Difficulty with swallowing may also lead to aspiration pneumonia, which may affect the likelihood of the 30-day hospital readmission and perpetuate other health concerns. Mr. DelGiudice shared, in print, a comprehensive Power Point presentation, in which he described challenges associated with dementia and speech, swallowing, the process of diagnosis, the effects of these health issues on both the patient and the caregiver, and possible treatments and rehabilitative measures. Areas addressed in the Power Point include:Speech and SwallowingDysphagiaHallmarks Symptoms Associated with Types of DementiaCompensatory Strategies vs. Rehabilitative ExercisesPostural Changes and Compensatory StrategiesDiet Modifications (Last possible course of action)Rehabilitative ExercisesCaregiver Education (Encourage practice exercises at home)Strategies for Supporting Feeding, Hydration and Enjoying MealsFeeding TubeImpacts on CommunicationCommunication Options for Speech TherapyFocused (Ideas for engagement)Speech TherapyChallengesA copy of the Power Point on Dementia and Speech Therapy presented by Mr. DelGiudice is attached to file. Please see Attachment D.Discussion ensued about effective and ineffective therapy methods and how to access the services offered by Mr. DelGiudice. He explained that physicians often send a prescription for treatment to him and he evaluates the patient. Mr. DelGiudice described that not only does he work with the patient, but he also involves the caregiver in the session, as appropriate, and provides education to the caregiver as well.Review of Retired Recommendations in 2017 State Plan Appendix and Possible Recommendations (For Possible Action)#10 Reducing Out-of-State Placement—Dr. Jane FisherCyndy Soto, Dr. Jane Fisher’s alternate, commented that this recommendation be maintained on the retired list on the State Plan’s Appendix. Presently, it is not clear whether there is a trend in the number of out-of-state placements that would warrant returning it to the State Plan. She reported that Dr. Fisher recommends that TFAD revisit the status of out-of-state placements in 6 to 12 months when more data is available.#11-14 Promoting Awareness and Education—Sen. Joseph HardyDue to Sen. Hardy’s absence, review of these retired recommendations will be deferred until the next meeting.#17 Guardianship—Sen. Valerie Wiener (Ret.)Sen. Wiener commented that, based on what Ms. Woodrum reported earlier regarding the developments and changes in guardianship laws, including new reporting requirements, it is appropriate to retain this recommendation in the Appendix.Consideration of Agenda Items for Next Meeting (For Possible Action)Senator Valerie Wiener (Ret.), ChairPossible agenda items for next meeting may include:Update on Care Transitions (Susan Hirsch and Peter Reed)Update on NCDR and On-line Dementia Training (Ms. Mandarino)Update on Nevada 2-1-1 Current Numbers (Ms. Pasquale)Review of Retired Recommendations #11-14 (Dr. Hardy)New BCCP Training Exploration Work Group (Dr. Reed)Progress Report on Guardianship Legislation (Ms. Woodrum)Status of Telehealth/Telemedicine in Nevada (Mr. Harmon, Ms. Cunningham, Dr. Reed (UNR), and Ms. Mandarino (Cleveland Clinic)Approval of Possible Meeting Dates for 2017 (For Possible Action)Senator Valerie Wiener (Ret.), ChairSen. Wiener explained that, previously, meeting dates had been scheduled up to the sunset date of June 30, 2017. Since TFAD has now received permanent status, meeting dates for the rest of 2017 are proposed as follows:Friday, August 25, 2017Wednesday, October 4, 2017Friday, November 17, 2017Dr. Reed moved to accept the dates as suggested. Mr. Harmon seconded the motion. The motion was approved unanimously.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.)No public comment.AdjournmentThe meeting was adjourned at 1:16 p.m.NOTE: Items may be considered out of order. The public body may combine two or more agenda items for consideration. The public body may remove an item from the agenda or delay discussion relating to an item on the agenda at any time. The public body may place reasonable restrictions on the time, place, and manner of public comments but may not restrict comments based upon viewpoint. ................
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