State of Nevada ADSD



2266950-58102500RICHARD WHITLEY, MSDirector BRIAN SANDOVALGovernor490537581915DENA SCHMIDTAdministrator00DENA SCHMIDTAdministratorDEPARTMENT OF HEALTH AND HUMAN SERVICESAGING AND DISABILITY SERVICES3416 Goni Road, Suite D-132Carson City, NV, 89706Telephone (775) 687-4210 Fax (775) 687-0574 MINUTESName of Organization:Task Force on Alzheimer’s Disease (TFAD) Date and Time of Meeting:November 17, 201710:00 a.m. Locations:Legislative Counsel Bureau401 South Carson St.Room 2134Carson City, NV 89701Grant Sawyer Building555 E. Washington AvenueRoom 4412Las Vegas, NV 89101To Join the Telephone Call-in Number:877-336-1831ConferenceAccess Number:9186101MinutesCall to Order/Roll CallSenator Valerie Wiener (Ret.), ChairMembers Present: Jill Berntson, Gini Cunningham, Jane fisher, Peter Reed, Valerie Wiener, and Niki RubarthAlternates Present: LeeAnn Mandarino and Jeanne Bishop-ParisseMembers Absent: Senator Joe Hardy and Assemblywoman Lesley CohenStaff Present: Camala Foley, Homa Woodrum, and Sunadda WoodburyPublic 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.)Barry Gold, Director of Government Relations for AARP Nevada, provided comments on the uncertainty of the future of healthcare, not limited to Nevada but nationally as well. He cited concerns regarding the possible ramifications of Medicaid becoming a capitated or a block-grant type formula and what that would do to services. He stated that in the past Nevada has been investigating transitioning all long-term support services to a managed care approach, which could be both beneficial and problematic. Mr. Gold urged TFAD to be cognizant of the need to protect services and funding sources for people who are living with Alzheimer’s disease and other forms of dementia, since they are considered “Duals”, or those who fall under both Medicare and Medicaid. If the managed care system is selected, it is very important to consider who will be doing the care coordination. He shared insights from a study AARP conducted on care coordination methods within a managed care setting and some of the concerns to keep in mind. He emphasized that support services that people with Alzheimer’s disease and other forms of dementia receive are critical in keeping them in the community. Welcoming Remarks Senator Valerie Wiener (Ret.), ChairDue to changes in TFAD support personnel, Sen. Wiener expressed appreciation for assistance received during this transition time to ensure that TFAD can continue to work seamlessly on behalf of those living with Alzheimer’s disease and other forms of dementia and their caregivers.Approval of the Minutes from October 4, 2017 Meeting (For Possible Action)Senator Valerie Wiener (Ret.), ChairJane Fisher moved to approve the minutes from October 4, 2017. Gini Cunningham seconded the motion. Members unanimously approved the minutes.Approval of January 2018 Annual Report (For Possible Action)Senator Valerie Wiener (Ret.), ChairSen. Wiener stated that TFAD members should have all had the chance to review the annual report due to the Governor and the Legislature in January 2018. Jane Fisher moved to adopt the 2018 Annual Report Draft. Peter Reed seconded the motion. Jill Berntson commented that the page numbering on the draft is not accurate and will be corrected on the final draft. Members voted, and the motion passed unanimously, with the correction of the page numbers. A copy of the proposed 2018 Annual Report is on file. See Attachment A.Update on Recruitment for Nevada Consortium on Dementia Research (NCDR) LeeAnn MandarinoProgram Manager IIIThe Cleveland Clinic Lou Ruvo Center for Brain HealthLeeAnn Mandarino, representative for the The Cleveland Clinic Lou Ruvo Center for Brain Health, as well as the alternate for Dr. Charles Bernick, provided an update on the Nevada Consortium on Dementia Research (NCDR). Ms. Mandarino gave an overview of NCDR, outlining the process from the formation to present. She reviewed the mission statement and presented names and credentials of NCDR board members.Additionally, Ms. Mandarino described the inclusion of NCDR website on the Nevada Care Connection portal at , under Nevada Dementia Studies, and highlighted important research information presented on the site. Future meeting dates are also listed on the page.Ms. Mandarino stated that there were 16 people were present at the last meeting, including young researchers from UNLV who were invited to participate to generate more interest in various aspects of neuroscience research in Nevada.The complete Power Point presentation on NCDR is attached to file. See Attachment B. Update and Possible Recommendations New Behavioral Complex Care Program (BCCP) Training Exploration Work Group (For Possible Action)Dr. Peter ReedDirectorSanford Center for AgingDr. Peter Reed stated that there have been ongoing discussions on the BCCP program from the initial implementation stages. The program aims to encourage long-term care providers with incentives to continue supporting people living with Alzheimer’s Disease and other forms of dementia. The concern is what this means in terms of changes to the care delivery, so the providers can better support this population. TFAD has been exploring what type of trainings are available and what type of trainings are provided. To convene a workgroup to investigate and gather further information on dementia-related training programs across the state, as well as identifying the availability, accessibility, and the quality of the different programs. Once accomplished, the inventory of these training programs may translate into possible new recommendations for TFAD. Dr. Reed extended an invitation to the Task Force member to join the workgroup to meet periodically to make the proposed assessments. Dr. Jane Fisher expressed her desire to join and will follow up with email. Gini Cunningham also asked to be added. Jill Berntson voiced her support and stated a State representative would be willing to participate. Dr. Reed stated he will follow up with details.Jeanne Bishop-Parisse, previously an advisor to the skilled nursing facilities and healthcare consultant, encouraged the workgroup to reach out to the providers, administrators of the facilities, who may be able to share information on special programs relating to BCCP which combine the medical and social aspect of care.Sen. Wiener asked for Dr. Reed to provide an update on the progress of the workgroup in the next TFAD meeting in January 2018.Report on Status of Telehealth and Telemedicine in NevadaDr. Peter ReedDirectorSanford Center for AgingDr. Reed provided an overview of telehealth and telemedicine in Nevada, citing that both are critical in providing opportunities to connect and serve rural communities. He clarified the difference between the two terms. Telehealth is the use of remote technologies to provide health education, primarily to providers and potentially to others, as well caregivers and community members. Telehealth education is an opportunity to build capacity, whereas telemedicine services are the direct delivery of services using remote technology.Dr. Reed highlighted telehealth and telemedicine programs, including:TelehealthProject ECHO, part of the UNR School of Medicine Initiative, provides regular education programs throughout the state on various topics.Surveys to rural providers are conducted to identify the topics of interest and content is developed to meet those needs.Project ECHO is designed as a case-based education.TelemedicineRenown Health has a large telemedicine network, with clinics in many communities and more than 20 specialties that they are able to offer.The Sanford Center also began offering telemedicine services through the Renown Network in Fall 2017.The Cleveland Clinic Lou Ruvo Center for Brain Health also offers several telemedicine programs. The Veterans Administration (VA) may be engaged in telemedicine as well.Update and Possible Recommendations on Nevada 2-1-1 and Care Transitions Project (For Possible Action)Cheyenne PasqualeNWD CoordinatorAging and Disability Services DivisionWebsite update:Tying resources together through common language Developing a roadmap for printed publications Both efforts will be used to reformat and strengthen Nevada Care Connection websiteStill exploring options for domain name to put on printed materials Request the following:The Task Force would like to review content for printed roadmapChange agenda item from 2-1-1 ‘Resource for People with Dementia’ to ‘Nevada Care Connection Updates’.Update and Possible Recommendations on Dementia Friendly Nevada (For Possible Action)Jeff DoucetManagement Analyst IIIAging and Disability Services DivisionUpdate and Possible Recommendations on Dementia Friendly NevadaAdministrative:Work Plan and Evaluation Plan have been accepted and approved by the Administration of Community LivingAccess to the full award funding is no longer limited to 15%. Semi-Annual Report was submitted October 31, 2017 and sent to program partners. The Next Semi-Annual Report is due April 30, 2018. Prevention and Public Health Fund (PPHF) Report due on January 20, 2018.The National Alzheimer’s and Dementia Resource Center Team will be visiting Las Vegas December 7, 2017 (Full Day and Half Day December 8) as a checkup. They did not have time, nor money in their budget to do a full team checkup in Nevada, Las Vegas, Reno, Elko, Winnemucca, etc. Second Year awards have been distributed to partners, ADSD Grant Specialist are collecting budgets and other required paperwork for oversight. Activities: Dementia Friendly Groups. The evaluation team is working with the Dementia Friendly Communities, gathering data for Community Needs Survey (Sanford Center had it translated into Spanish, so a Spanish version will be available). Winnemucca: Align Age Friendly Goals with the Dementia Friendly American Sector Framework. Turley Trot - Passing out surveys with the Shirts. Money raised goes to respite care and education. Elko: Next Meeting is November 28, 2017. Group has closed its survey, over 200 completed with a high completion rate for those who start survey. These dyads of people living with dementia and their care partners served as a panel to share about their experiences living with Alzheimer’s and other forms of dementia. Washoe County: They reshaped questions for people living with dementia and created a discussion group format for people living with dementia. This provided great opportunities for the group to hear things directly from those affected by Alzheimer’s. Washoe county want to reach out to Spanish Speaking communities and hear about best practices from other communities. Las Vegas: North Carolina Model of Train the Trainer includes 5 Master Trainers, train 20 communities’ volunteers, who will go into the community (Faith based and Financial businesses) make them aware of Dementia. Plan to reach 500 organizations per year. Webpage: The structure will help other communities to connect with Dementia Friendly Nevada.Resource Notebook: macro view for this will provide a going through the disease process (beginning or middle of disease process). It will provide an overview to help understanding and awareness of resources available for consideration (applicable to full state). Guide will work in connection with existing resources: Nevada211, ADSD Brochure, Roadman, etc. They are working with Nevada211 on common language. Second Round Funding.Plan to release after the first of the year through February 5th. Funding announcements are anticipated from mid-March to April 2018 for an additional three community action groups.We have interest from several communities have indicated an interest.Challenges: Recruitment for Direct Service Programs. Increase Service Deliver for EPIC, RCI Care ConsultationsDetermine how to align service delivery so that programs do not compete against themselves for clients based on funding source. Turning the second year, at least 40% of expenditures must be on direct service. During the third year, at least 50% of expenditures must be used for direct services. XI.Update and Possible Recommendations on Veterans in Care (VIC) Initiative (For Possible Action)Wendy SimonsDeputy Director of WellnessDepartment of Veteran ServicesThe primary purpose of the VIC Program is to provide education about benefits on programs for veterans. The statistics are now higher at 1500 veterans and 90 facilities. The launch of the program was department driven to make sure that our veterans have access to supports. Dr. Fisher‘s group is addressing the cultural awareness of working with the Latino and other populations. Aging veterans are also a special population that benefits. We have completed 10 workshops, 8 of those were in titled Bravo Zulu. And those were provided through the Perry Foundation, with the great skill set of Dr. Jennifer Carson crafting a template for achieving excellent through Relationship-Centered Care. In 2009, Boston University was doing a study on the dementing veteran and the aging veteran, what was called LOSSD which is Late Onset Stress, like PTSD but a geriatric form. Any emotional strain for shell shock and whatever else they experienced in combat never claimed as PTSD. The late onset stress symptomology of changes for that population was starting to bubble up but nothing ever happened with that study from 2009. Now we’re starting to see this introduced. Workshops in the south and the north were beyond expectation. Dr. Carson and her ability to do the research to capture the military experience are essential. 2018 is still under review as to how it will be delivered. We had to up our participants in southern and northern Nevada who attended all four workshops in the series. Each received certificate of commendation for their attendance and participation on behalf of learning how to better care for their aging veteran. Wendy Simmons shared a caregiver story, these tools help veterans be more successful in navigating their cognitive changes. A veteran did not want to take a bath or a shower. Sometimes care can be a challenge, so she her to advise the veteran that the general is going to be visiting him in two hours and it would be appropriate for him to be properly turned out to meet the general. The veteran jumped in the shower and came back out and was tidy and then the caregiver explained that the general would have to miss the meeting with the veteran.XII.Discuss and Consider Possible New Recommendations on Guardianship (For Possible Action)Homa WoodrumElder and Disability Rights AttorneyAging and Disability Services Division Guardianship in Nevada [ADULT GUARDIANSHIP RESIDENCY AND JURISDICTION V. 0.5] The meaning of the word “jurisdiction” essentially involves the right to speak (and make orders) on a legal matter. In law schools across the country, there are numerous flavors of this sphere of authority such as “subject matter jurisdiction” and “personal jurisdiction.” Thinking just of individuals for a moment, it would make sense that if someone lives in Nevada, a New York court wouldn’t be issuing orders about their life. But what if someone lived in New York and just moved to Nevada? At what point does the authority of a court change or the ability of someone to ask a court for relief shift? All areas of law are unique, and circumstances are unique as well. This informational sheet is meant to generally address some of the issues in guardianship and how jurisdiction between states, between counties, and the like come into play. Warning: guardians can be removed for failing to perform their obligations appropriately and according to the law and can also face other possible penalties. A guardianship where jurisdiction is lost could result in emergencies without an appropriate outlet to approach for help from the courts. Be certain to obtain independent legal advice. This document is meant to be informational. Guardianship Jurisdiction in Nevada Law Part of Nevada Revised Statutes 159, where adult guardianship “lives” (NRS 159A is the chapter for minor guardianships, or guardianships over individuals before the age of majority) includes the “Adult Guardianship and Protective Proceedings Jurisdiction (Uniform Act).” A Uniform Act is something that has been drafted for states to potentially adopt, or adopt with adjustments unique to their state, to encourage best practices and similarities across the country. Adopted in 2009, this uniform act deals with inter court communication, cooperation with other courts, and taking testimony in another state.Teasing out some hypotheticals, if Jane Doe moved to Nevada 5 months ago and someone is seeking now to be her guardian in Nevada, Nevada could not take jurisdiction through issuing orders or granting a guardianship, because Nevada has not yet become Jane’s home state. If Jane Doe moved to Nevada 5 months ago and someone, seeing that, files in Jane’s prior home state and that state states it will not take jurisdiction, then that would meet an exception to jurisdiction listed previously and the filing might be made successfully. Chances are that by the time jurisdiction was declined in the other state, Jane would have hit the 6-month mark anyway. There are unique exceptions in emergencies. There are also unique considerations beyond the state – such as in which county a guardianship may be filed successfully. Nevada Law: County Venue in Guardianship The idea of “venue” is different from jurisdiction because jurisdiction must do with the power of the court to issue rulings about a case while venue must do with the actual location where the case is going to be heard. NRS 159.037 provides that in a home state, the right place to be for the guardianship case as ffiled would be “the county where the proposed [protected person] resides.”There are complications beyond that where someone might have, say, resided in one county but fallen ill and have been moved to another county. Did that person chose to relocate and now, then, be residing in that new county? If there are competing counties, the first place where the case is filed in the state considers whether they are the right venue and the other case in the other county is “stayed” until that decision is made. NRS 159.039. Additionally, if there’s a case in one county in the state, the court can transfer that case to another county if it is in the interest of the protected person, or, if it isn’t against the interests of the protected person, to somewhere convenient for the guardian. This must be done through a petition to transfer so that the new venue has all the information a judge would need to make decisions in the case.Adult Guardianship and Protective Proceedings Jurisdiction Act The Uniform Law Commission deals with guardianship specifically through the Adult Guardianship and Protective Proceedings Jurisdiction Act. It means to “provide [e [ a mechanism for resolving multi-state jurisdictional disputes. The goal is that only one state will have jurisdiction at any one time.” See The website referenced above includes an “Enactment Status Map” which, as of November 2017, reflected that the 45 states as well as Puerto Rico and the US Virgin Islands, have enacted the uniform legislation in some form. The exceptions Kansas, Texas, Wisconsin, Michigan, and Florida This is helpful when looking at someone who has made a recent move or is going to make a move in the future but is under guardianship, facing guardianship, or the like. Organizations including the National Academy of Elder Law Attorneys and the Alzheimer’s Association support the Act. Much like the specific adopted Nevada law already referenced, the UAGPPJA looks at the six-month window of time for a “home state.” Transfers to another state are covered in Article 3 of the Uniform Act and indicate that the original court can’t dismiss the local proceeding until there is an order from the new state accepting the guardianship.What is interesting is that even if the laws regarding jurisdiction are similar, comparing state rules about incapacity could mean that what qualifies as incapacity in Nevada may not qualify elsewhere. The Uniform Act contemplates this and indicates that if there is no objection, “deference” (or respect of the other court’s decision), should be given about the need for a guardianship. Within 90 days of the transfer, however, the new state court needs to evaluate the case to get it into compliance with their state laws. This means it is possible the guardianship may ultimately end or be substantially be modified in the new state. Getting Legal Help The Nevada Lawyer Referral Service is a resource where you can obtain contact information for attorneys in the state to assist in guardianship court: 1-800-789-5747Pro Bono Legal Services in the state include: There are guardianship forms online for Clark County that can provide guidance for the rest of the state at: Many areas of the state have “Lawyer in the Library” or “Ask a Lawyer” programs designed to assist with access to justice.Aging and Disability Services Division houses entities such as Elder Protective Services, the Long-term Care Ombudsman, and more at: adsd. There are guardianship compliance officers in Washoe County and Clark County at this time who can be contacted regarding cases. The Attorney for the Rights of Older Persons, Persons with a Physical Disability, an Intellectual Disability, or a Related Condition is also the state’s Legal Assistance Developer and can provide connections for counsel for persons who are over 60 or persons at any age with disabilities or related conditions. They are based in the Carson City office of Aging and Disability Services Division and have the short title of “Advocacy Attorney”: 775-687-4210. XIII. Discuss and Consider Possible New Recommendations for the 2019 State Plan (For Possible Action)Senator Valerie Wiener (Ret.), ChairConsider possible recommendations for the 2019 State Plan. The Task Force needs to consider recommendations and language based on the current State Plan and our 2017 work.Following are subjects we covered in 2017:Emergency Medical Services in Rural and Frontier NevadaBehaviorally Complex Care ProgramCultural Competency/AccommodationCare Transitions ProjectGuardianship LegislationSpeech Therapy and DementiaWe could take a closer look at Nevada 211 and see how we can make it stronger. And determine where the resources are throughout the entire state of Nevada. Awareness of resources in the state and maybe if it were a recommendation. The Task Force discussed Public Safety recommendation in the state plan. This should involve a collaborative connection; an approach being used in the community.XIV.Consideration of Agenda Items for Next Meeting (For Possible Action)Senator Valerie Wiener (Ret.), ChairMembers to update status of 2017 State Plan recommendations or consider moving them to Appendix as appropriate.Members determine which recommendations in Appendix should be returned to 2019 State Plan.XV.Approval of Possible Meeting Dates for 2018 (For Possible Action)Senator Valerie Wiener (Ret.), ChairWednesday, January 10, 2018Friday, March 9, 2018Wednesday, May 9, 2018Friday, July 6, 2018Wednesday, September 5, 2018Friday, November 2, 2018Wendy Simons made a motion to accept the meeting dates. Peter Reed seconded the motion. 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 commentAdjournmentThe meeting was adjournedNOTE: 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.NOTE: We are pleased to make reasonable accommodations for members of the public who have disabilities and wish to attend the meeting. If special arrangements for the meeting are necessary, please notify Sunadda Woodbury at 775-687-2495 as soon as possible and at least two days in advance of the meeting. If you wish, you may e-mail her at swoodbury@adsd.. Supporting materials for this meeting are available at 3416 Goni Road, D-132, Carson City, NV 89706 or by contacting Sunadda Woodbury at 775-687-2495 or by e-mail at swoodbury@adsd..Agenda Posted at the Following Locations:Aging and Disability Services Division, Carson City Office, 3416 Goni Road, Suite D-132, Carson City, NV 89706Aging and Disability Services Division, Las Vegas Office, 1860 East Sahara Avenue, Las Vegas, NV 89104Aging and Disability Services Division, Reno Office, 445 Apple Street, Suite 104, Reno, NV 89502Aging and Disability Services Division, Elko Office, 1010 Ruby Vista Drive, Suite 104, Elko, NV 89801State Legislative Building, 401 S. Carson Street, Suite 3138, Carson City, NV 89701Grant Sawyer State Office Building, 555 E. Washington Ave., Suite 4401, Las Vegas, NV 89119Department of Health and Human Services, 4126 Technology Way, Suite 100, Carson City, NV 89706Carson City Senior Center, 911 Beverly Drive, Carson City, NV 89706Washoe County Senior Center, 1155 East 9th Street, Reno, NV 89512Las Vegas Senior Center, 451 East Bonanza Road, Las Vegas NV 89101Sanford Center for Aging, University of Nevada Reno, 1644 N. Virginia St., Reno, NV 89557Humboldt General Hospital,118 E Haskell St, Winnemucca, NV 89445Notice of this meeting was posted on the Internet: http//adsd. and ................
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