By Alzheimers/Dementia Expert Panel For Health Commission Community - - PowerPoint PPT Presentation

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By Alzheimer’s/Dementia Expert Panel

For Health Commission Community and Public Health Committee

November 16,2010

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 5.3 million people in the USA  6th leading cause of death  10.9 million caregivers

http://www.alz.org/alzheimers_disease_facts_figures.asp

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• 20
• 10

10 20 30 40 50

Deaths by:

Stroke –

declined 18.2%

HI V –

declined 16.3%

Heart Disease –

declined 11.1%

Prostate Cancer –

declined 8.7%

Breast Cancer –

declined 2.6 %

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 A diabetic who is developing dementia or

Alzheimer’s – increases cost of care in Medicare by 60% because they are unable to manage their care

 Poor diabetes control increases risk for Alzheimer’s

disease

 Dementia/cognitive loss prevents people with heart

disease from managing their illness

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 One out of every two

persons 85+ has dementia.

 Between now and 2020,

San Francisco will experience a dramatic increase.

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San Francisco’s response to the crisis in dementia care should be comparable to the City’s comprehensive and effective response to the AIDS epidemic back in the 1980s.

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A better-coordinated, more integrated network of services and supports that enables people with mild cognitive impairment (MCI), Alzheimer’s and other dementias, and their loved ones, to get the care they need.

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In 2007 - the Long Term Care Coordinating Council identified need to focus on people with dementia and their caregivers. In 2008 - the Mayor provided $100,000 to DAAS and appointed an Alzheimer’s/ Dementia Expert Panel: Alzheimer’s experts, aging experts, medical providers, community service providers, advocates, researchers, economic experts, public agencies, and family caregivers. In 2009 - Strategy for Excellence in Dementia Care completed.

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 Evaluate current dementia care services, assess the

need for additional services, investigate national and international research and best practice models

 Develop recommendations to address the need for

services from 2010 to 2020, including projected costs

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Determine strengths & weaknesses of current dementia services Identify principles & concepts for how to address the crisis in dementia care

Make program & policy recommendations to improve dementia services & develop new services

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Silos Inconsistent practice Absence of integrated care State and federal regulatory & financing barriers Lack of understanding

• f the needs of

individuals with early memory loss. Stigma & discrimination Informal care relies on uncompensated care from loved ones The absence of loved

• nes nearby

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To improve the quality of life for people with dementia and for their caregivers

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35 recommendations for implementation over a 10 year period (2010 to 2020)

 Some recommendations are not expensive.  Others may require policy changes, changes in funding

regulations, and/or investments.

 For the long-term recommendations, there is groundwork

to be done in the next few years.

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Dementia care should be integrated into San Francisco’s existing home and community based service delivery network, which emphasizes ongoing chronic care management. This will enable the needs of the whole person to be considered and addressed.

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 Public education should target:

• Persons with memory loss
• Persons with Alzheimer’s and related dementias
• Caregivers
• Service providers, care managers, and health care

professionals.

 Funding should be obtained to enable the

provision of this expanded public education.

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Risk Reduction Early Identification of Alzheimer’s & Dementia What To Expect as the Disease Progresses Services & Resources Caregiver Wellness and Support

Disease Management for Mild, Moderate, & Advanced Dementia, & End-of-Life Issues Advanced Care Planning Ethical Issues Emergency Preparedness and Safety

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 Expand dementia training to facilitate the use

• f the most current guidelines and standards

for dementia care.

 Target training for primary care physicians,

hospitalists, and the medical staff of primary care health centers and clinics.

 Focus of training should cover medications,

diagnosis, end-of-life care, and managing difficult behaviors and critical crisis care issues.

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 Diagnosis of mild cognitive impairment (MCI)

should be encouraged and facilitated with clearly established diagnostic criteria.

 Best treatment options and care should be

determined

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Employ care managers with dementia expertise operating as the “single-point-of- contact” for people with dementia using primary care health centers and clinics in SF.

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Expanded community education & training Improved service coordination Shared client information Team-based care

Promotion & dissemination of standards & guidelines for care Education & training for service providers Improved access to resources & services in the early stages Delayed need for more intensive services in later stages

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Alzheimer’s/ Dementia Expert Panel Members from DPH - appointed by Mayor - included: Gail Cobe, RN, Clinical Nurse Specialist, Dementia

Program, LHH

Edgar Pierluissi, MD, Medical Director, ACE Unit, SFGH Robert Cabaj, MD, Director, Community Behavioral

Health Services, DPH

Gay Kaplan, RN, Director of Services, Curry Senior

Center

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Implementation requires a unified, proactive, long term response. Sustained effort from 2010 to 2020. Shared responsibility. Visible leadership across city departments coming from the Mayor’s Office.

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 Four new Implementation Workgroups are

being formed to explore the details to explore and implement the 35 recommendations:

(1) Training, Education & Standards (already formed) (2) Medical Resources (3) Additional Services & Settings (4) Waivers, Pilot Projects, Demonstration Projects & Advocacy

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 Dementia Care Excellence Oversight Committee

• Gail Cobe, RN, has accepted

 Membership in 3 implementation workgroups-

Medical Resources

• Edgar Pierluissi, MD, has accepted

Additional Services & Settings

• Kelly Hiramoto has accepted

Waivers, Demonstration Projects & Advocacy

• Jim Soos, has accepted

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Contract with Alzheimer’s Association for Education, Training and Promotion of Standards

 $115,000 contract with the Department of Aging

and Adult Services (DAAS) to implement all recommendations in Strategy re education and training - between April 2010 and January 2011

 This contract being considered by DAAS for

continuation in 2011

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In September 2010, $320,700 was awarded (for 1st year of a two-year project) to UCSF - with DAAS, Alzheimer’s Association, & Kaiser San Francisco, by U.S. Administration on Aging (AoA) to create The San Francisco Dementia Care Network. Goals:

• Improve ability of medical systems to diagnose

Alzheimer’s and other dementias

• Connect caregivers of high risk individuals to needed

educational and support services

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 Assistance with facilitation of workgroups:

• DAAS will be working with DPH concerning staff

support for some workgroups

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 You also can become a part of San Francisco’s Strategy for

Excellence in Dementia Care.

• We welcome your participation in the implementation activities now

beginning.

• You can consider how the recommendations in this Strategy might be

addressed by DPH Programs and Services.

 For additional information, please contact:

• Anne Hinton at Anne.Hinton@sfgov.org
• Bill Haskell at Bill.Haskell@sfgov.org