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

9/6/2018 Get the Latest !! Hawai‘i Dementia Initiatives Christy Nishita, PhD Debbie Shimizu, LSW Representative Gregg Takayama Pur pose of the Pr e se ntation Federal Policy Directions & Vision Hawai‘i Efforts to Become “Dementia Capable” Current and upcoming legislation for our kupuna 1

9/6/2018 www.ha wa ii.e du/ a g ing _________________________________________ 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 . State of Hawai‘i, De par tme nt of He alth 4 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 o 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 o ptio ns fo r lo ng te rm se rvic e s a nd suppo rts 2

9/6/2018 5 2017 • HADSSP: Cr e ating and 2015 Sustaining De me ntia- • No Wro ng Do o r Capable Se r vic e Imple me nta tio n 2014 Syste ms for Gra nt Pe ople with • No Wro ng Do o r De me ntia and Pla nning Gra nt 2009 the F amily Car e give r s • ADRC E xpa nsio n Gra nt 2006 ADRC • Co mmunity L iving Gra nt Pro g ram Grant • Ho spital Disc ha rg e Pla nning Gra nt 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 3

9/6/2018 7 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 8 T he Why? With no diagnosis, it is Only 19% have very unlikely the Diagnosis often discussed their individual will delayed by 6+ receive, connect symptoms (e.g., years after with, or seek out memory loss) symptom onset effective care & with a healthcare support provider The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013 . 4

9/6/2018 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 De me ntia Capable Syste ms that Pr Pr ovide Quality Se r ovide Quality Se r vic e s that ar vic e s that ar e e Pe r Pe r son- Ce nte r son- Ce nte r e d, Se lf- Dir e d, Se lf- Dir e c te d, and e c te d, and Cultur Cultur ally Compe te nt 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 5

9/6/2018 Bac kgr ound: 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 owing Olde r Population (% Age 65+) 6

9/6/2018 #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 oximate 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 14  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 Alzhe ime r’ s Asso c ia tio n F a c ts a nd F ig ure s (2017) 7

9/6/2018 Living Alone with Dementia in Hawai‘i 15  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 Alzhe ime r’ s Asso c ia tio n F a c ts a nd F ig ure s (2017) 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 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 ogr am 8

9/6/2018 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 e c e ive pe rso n- r 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- F r ie ndly Community Me mor y Car e Re sour c e s in the Community De me ntia Capable State Age nc ie s or “Doors” 9

9/6/2018 ate gy #1 Ha wa i‘ i’ s “No Wro ng Do o r” Str Syste m DDD AMHD DVR AAAs MQD VHA/ OVS CSHNB CI L s Stre a m line d Syste m Pe rso n- Ac c e ss to Func tio ns C e nte re d Public L T SS Appro a c h Pro g ra m 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 ontline , 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 10

9/6/2018 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 o 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. 11

9/6/2018 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 o 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 ools at “Door s” • AD8 24 • Mini- Cog 12

9/6/2018 AD8 Sc r e e ning T ool Mini- Cog 26 13

9/6/2018 Pe r son/ Clie nt c ome s thr ough “Door ” Summar y of AD8 and/ or Pr oc e ss Mini- Cog Online Re fe r r al T ool to Re fe r to ADRCs or othe r Door s for L T SS Conne c t to Re fe r r al to Community PCP 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 14

9/6/2018 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 15

9/6/2018 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 Held Once a Month Ca re g ive r Coordinated Care Psyc hia trist E duc a tio n Rotate Through Different Stations Die tic ia n L e g a l 16

9/6/2018 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 E - Pe rso n-c e nte re d, DUCAT 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 - to c o mmunity CT se rvic e s 17

9/6/2018 Navigation Clie nts- By the Numbe r s 35 T o ta l 58% a re 80+ 55% F e ma le Se rve d: 276 Hrs Spe nt 21% L ive Pe r Clie nt Alo ne M=6.9 Most F r e que nt Suppor ts Pr ovide d by Me mor y Car e Navigator s 78.4% 77.5% 36 80.0% 70.0% 51.0% 60.0% 49.0% 42.2% 50.0% 36.3% 40.0% 27.5% 30.0% 20.0% 8.8% 4.9% 10.0% 0.0% 18