Get the Latest !! Hawaii Dementia Initiatives Christy Nishita, PhD - - PDF document

9/6/2018 1

Get the Latest !! Hawai‘i Dementia Initiatives

Christy Nishita, PhD Debbie Shimizu, LSW Representative Gregg Takayama

Federal Policy Directions & Vision Hawai‘i Efforts to Become “Dementia Capable” Current and upcoming legislation for our kupuna Pur pose of the Pr e se ntation

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www.ha wa ii.e du/ a g ing

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1.Pro mo te c o lla b o ra tive a nd inte rdisc iplina ry re se arc h with a c a de mic a nd c o mmunity pa rtne rs. 2.De ve lo p inno va tive g e ro nto lo g ic a l e duc ation pro g ra ms 3.Pro vide sta te o f the a rt info rma tio n to po lic y ma ke rs, pro g ra m ma na g e rs, c linic ia ns, a nd the g e ne ra l pub lic .

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State of Hawai‘i, De par tme nt of He alth E xe c utive Offic e of Aging

• 1. HRS 349 e stab lishe d the E

xe c utive Offic e o n Ag ing a s the fo c a l po int fo r a ll ma tte rs re la ting to o lde r pe rso ns’ ne e ds a nd the c o o rdina tio n a nd de ve lo pme nt o f c a re g ive r suppo rt se rvic e s within the Sta te o f Ha wa i‘ i

• 2. Pro g ra m & Se rvic e s
• Se nio r Me dic a re Pa tro l Ha wa i‘ i (SMP)
• Ha wa i‘ i Sta te He a lth I

nsura nc e Assista nc e Pro g ra m (SHI P)

• L
• ng T

e rm Ca re Omb udsma n Pro g ra m (L T COP)

• He a lth Ag ing Pa rtne rship
• I

n-Ho me a nd Co mmunity Ba se d Se rvic e s

• F

a mily Ca re g ive r Suppo rt pro g ra m

• 3. Ag ing a nd Disa b ility Re so urc e Ce nte r (ADRC)
• Ope ra te d b y Co untie s
• Assists o lde r pe rso ns, individua ls with disa bilitie s a nd fa mily c a re g ive rs find
• ptio ns fo r lo ng te rm se rvic e s a nd suppo rts

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5

2006 ADRC Gra nt 2009

• ADRC E

xpa nsio n Gra nt

• Co mmunity L

iving Pro g ram Grant

• Ho spital Disc ha rg e

Pla nning Gra nt

2014

• No Wro ng Do o r

Pla nning Gra nt

2015

• No Wro ng Do o r

Imple me nta tio n Gra nt

2017

• HADSSP:

Cr e ating and Sustaining De me ntia- Capable Se r vic e Syste ms for Pe ople with De me ntia and the F amily Car e give r s

De finition of De me ntia De me ntia, the lo ss o f c o g nitive

func tio ning , thinking , re me mb e ring , a nd re a so ning a nd b e ha vio ra l a b ilitie s, to the e xte nt tha t it inte rfe re s with a pe rso n’ s da ily life a nd a c tivitie s

F e de ra l Administra tio n fo r Co mmunity L iving

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T he Why?

Mo st pe o ple with c o g nitive impa irme nt

do no t re po rt it to a nyo ne :

F

e a r

Stig ma Do no t kno w wha t is no rma l L

a c k o f kno wle dg e re : wha t c a n be do ne

Re duc e d insig ht

7

T he Why?

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Diagnosis often delayed by 6+ years after symptom onset Only 19% have discussed their symptoms (e.g., memory loss) with a healthcare provider With no diagnosis, it is very unlikely the individual will receive, connect with, or seek out effective care & support

The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013.

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T he Why?

Whe n a dia g no sis is ma de , it o fte n o c c urs in mid-la te sta g e whe n pe o ple a re fa iling to thrive a t ho me Critic a l to ide ntify the se c o nditio ns e a rly a nd ma ke a ppro pria te re fe rra ls to c o mmunity suppo rts

F e de r al Polic y Dir e c tion De me ntia Capable Syste ms that Pr

• vide Quality Se r

vic e s that ar e Pe r son- Ce nte r e d, Se lf- Dir e c te d, and Cultur ally Compe te nt De me ntia Capable Syste ms that Pr

• vide Quality Se r

vic e s that ar e Pe r son- Ce nte r e d, Se lf- Dir e c te d, and Cultur ally Compe te nt

So urc e : F e de ra l Administra tio n fo r Co mmunity L iving , Alzhe ime r’ s Dise a se I nitia tive g ra nts

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Bac kgr

• und: In Hawai‘i

Hawai‘i is Growing Older at a Faster Pace than the U.S. In 2030, 23% of Hawaii’s Population will be 65+, Compared to 19% in the United States

DBE DT 2040 Se rie s Pro je c tio ns (2012)

Hawai‘i’s Gr

• wing Olde r

Population (% Age 65+)

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#s in U.S. vs. Hawai‘i

2017 •27,000 2020 •29,000 2025 •35,000

Hawai‘i figur e s do not inc lude those who ar e undiagnose d. It’s e stimate d that appr

• ximate ly 60- 80% go undiagnose d.

Alzhe ime r’ s Asso c iatio n F a c ts and F ig ure s (2017)

Dementia Caregivers in Hawai‘i

Abo ut 70% o f Alzhe ime r’ s c a re is pro vide d in the ho me b y unpa id c a re g ive rs 66,000 de me ntia c a re g ive rs in Ha wa i‘ i, de live ring 75 millio n ho urs o f unpa id c a re , a t a to ta l va lue o f $944 millio n USD

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Alzhe ime r’ s Asso c ia tio n F a c ts a nd F ig ure s (2017)

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Living Alone with Dementia in Hawai‘i

Major

ity with ADRD live in the c ommunity – about 70% in the home

15- 33% live alone 30% or

mor e have no c ar e give r suppor t

15

Alzhe ime r’ s Asso c ia tio n F a c ts a nd F ig ure s (2017)

F unde d by the Administr ation for Community L iving, In Collabor ation with the De par tme nt of Ge r iatr ic Me dic ine , Ge r iatr ic Wor kfor c e E nhanc e me nt Pr

• gr

am

Building a Better System in Haw ai‘i

Cre a ting a De me ntia Ca pa b le No Wro ng Do o r Ne two rk

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Our Hawai‘i De me ntia Goal: Syste ms Change

Pe r

sons with me mor y loss or de me ntia and the ir c ar e give r s r e c e ive pe rso n-

c e nte re d, c o o rdinate d c are , and e ngage d in the large r c o mmunity

Syste ms Change : 3 Str ate gie s

De me ntia Capable State Age nc ie s or “Doors”

Me mor y Car e Re sour c e s in the Community De me ntia- F r ie ndly Community

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Str ate gy #1 Ha wa i‘ i’ s “No Wro ng Do o r” Syste m

Pe rso n- C e nte re d Appro a c h Stre a m line d Ac c e ss to Public L T SS Pro g ra m s

Syste m Func tio ns

DDD AMHD DVR AAAs CSHNB MQD VHA/ OVS CI L s

E nsur ing “Door s” ar e De me ntia Capable

De me ntia Capability

T r aining- T ar ge ting F r

• ntline ,

Infor mation and Re fe r r al Staff, Case Manage r s, at all “Door s”

De ve lope d base d on

National Be st Pr ac tic e s

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Cor e Compe te nc ie s- De me ntia Capability

Part 1. U nde rstanding the Basic s

 De fine de me ntia , Alzhe ime r’ s dise a se a nd re la te d de me ntia s.  De sc rib e a t le a st 3 sig ns a nd sympto ms

• f de me ntia a nd the impo rta nc e o f

e a rly de te c tio n  Unde rsta nd the wa y in whic h de me ntia pro g re sse s a nd its impa c t o n individua ls’ e ve ryda y living skills.

Part 2. T aking Ac tio n

 I de ntify ho w de te c tio n o f me mo ry lo ss fits into e xisting inta ke a nd a sse ssme nt pro to c o ls.  Utilize two va lida te d to o ls, the AD8 a nd Mini-Co g , to e ffe c tive ly ide ntify c lie nts with me mo ry lo ss a nd po ssib le de me ntia .  Unde rsta nd stra te g ie s to ta ke a c tio n o nc e a c lie nt with me mo ry lo ss is ide ntifie d.

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Part 3. S uppo rting Clie nts and F amilie s

 De sc rib e the type s o f se rvic e s a nd suppo rts pe o ple with de me ntia a nd the ir fa milie s

• fte n re q uire .

 I de ntify lo c a l re so urc e s tha t ma y he lp to suppo rt pe o ple with de me ntia a nd the ir c a re pa rtne rs.  Re c o g nize the wa ys in whic h a de me ntia c a pa b le syste m b e ne fits c lie nts a nd the g re a te r c o mmunity.

Standar dize d Asse ssme nt T

• ols at “Door

s”

• AD8
• Mini- Cog

24

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AD8 Sc r e e ning T

• ol

Mini- Cog

26

9/6/2018 14

Summar y of Pr

• c e ss

Pe r son/ Clie nt c ome s thr

• ugh “Door

” AD8 and/ or Mini- Cog Online Re fe r r al T

• ol to

Re fe r to ADRCs or

• the r

Door s for L T SS

Re fe r r al to PCP

Conne c t to Community Re sour c e s

Str ate gy #2- Build Me mor y Car e Suppor ts and Se rvic e s in the Community

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Suppor ts in the Community

 Me mor

y Clinic s

 Me mor

y Car e Navigation Memory Clinic

• Kokua Kalihi

Valle y

• Molokai

Community He alth Ce nte r

• Kalihi Palama

He alth Ce nte r

• We st Hawaii

Community He alth Ce nte r

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Why A Memory Clinic?

 Typical PCP

appointments are short, no time to evaluate memory loss.

 Long wait to obtain

appointments with Specialists

 Brain health rarely

addressed in medical model

Schedule of the Memory Clinic (Group Visit Model)

Ge ria tric ian Psyc hia trist L e g a l Die tic ia n Ca re g ive r E duc a tio n

Held Once a Month Coordinated Care Rotate Through Different Stations

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Me mor y Car e Navigation

Ho me visits pro vide d b y Public

He a lth Nurse s a nd so c ia l wo rke rs

E

DUCAT E- Pe rso n-c e nte re d,

c ultura lly a ppro pria te e duc a tio n fo r fa milie s SUPPORT

• Ca ring pre se nc e ,

e mpo we r pa tie nts a nd fa milie s to ma ke g o o d de c isio ns CONNE

CT

• to c o mmunity

se rvic e s

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Navigation Clie nts- By the Numbe r s

T

• ta l

Se rve d: 276 58% a re 80+ 55% F e ma le 21% L ive Alo ne Hrs Spe nt Pe r Clie nt M=6.9

35 36

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

78.4% 77.5% 51.0% 49.0% 42.2% 36.3% 27.5% 8.8% 4.9%

Most F r e que nt Suppor ts Pr

• vide d by Me mor

y Car e Navigator s

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De me ntia F rie nds he lp to c re ate an inc lusive c o mmunity whe re pe o ple living with de me ntia are suppo rte d to live a go o d quality life .

Str ate gy #3- De me ntia- F r ie ndly Community Building

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De me ntia F r ie nds he lp to c r e ate an inc lusive c ommunity whe r e pe ople living with de me ntia ar e suppor te d to live a good quality life .

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Cur r ic ulum Compone nts

• De me ntia Basic s to

Build Awar e ne ss

• Quic k E

xe r c ise s to Build E mpathy

• Ple dge to Be c ome

a De me ntia F r ie nd and T ake Ac tion

9/6/2018 21

Why be a De me ntia F r ie nd? Join the Move me nt

12 Million De me ntia F r ie nds- Busine ss owne r

s, fir st r e sponde r s, c hur c h me mbe r s, stude nts, boy sc outs, r e tir e e s…

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De me ntia F r ie nds “Champions”

 Champions

T r aining- Jan 2018

 T

r ain- the - T r aine r Mode l

127 “F

r ie nds” to Date

Collaborative Effort

9/6/2018 23

De me ntia F r ie nds in Sc hools Ne xt Ste ps

T

ailor ing to se c tor and

• r

ganization ne e ds

T

rac k c hange s made by busine sse s and

• r

ganizations, towar d de ve loping a “de me ntia- fr ie ndly” c ommunity

Vision- a mor

e inc lusive c ommunity for pe r sons with de me ntia

Inte r e ste d in a De me ntia F r ie nds Se ssion? Chr isty Nishita c nishita@hawaii.e du

9/6/2018 24

Summar y of 3 Ar e as

De me ntia Capable State Age nc ie s or “Door s”

Me mor y Ca r e Re sour c e s in the Community De me ntia- F rie ndly Community

ADRCs Executive Office on Aging Project Dana Catholic Charities Public Health Nursing Branch, DOH Developmental Disabilities Division, DOH Gerontology Program – Child & Family Services

• Dept. of Geriatric Medicine Geriatric Workforce Enhancement

Program Kokua Kalihi Valley Molokai Community Health Ctr Alzheimer’s Association Adult Mental Health Division Centers for Independent Living

• Dept. of Human Services Med-QUEST

AARP Hawaii Mediation Center of the Pacific Project Dana Kalihi Palama West Hawaii Community Health Center

9/6/2018 25

Cur r e nt and Upc oming L e gislation

Bills that passe d in 2018 Pr

• pose d le gislation for

2019 Kupuna Cauc us

E

ve r y 1st F r iday of the month at 1:30 pm – 2:30 pm at the State Capitol

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THANK YOU

Chr isty Nishita, Ph.D. Unive r sity of Hawaii c nishita@hawaii.e du De bbie Shimizu, L SW E xe c utive Offic e on Aging de br a.shimizu@doh.hawaii.gov Re p. Gr e gg T akayama Hawai‘i State L e gislatur e r e ptakayama@c apitol.hawaii.gov