By Alzheimer’s/Dementia Expert Panel For Health Commission Community and Public Health Committee November 16,2010 1
5.3 million people in the USA 6 th leading cause of death 10.9 million caregivers http://www.alz.org/alzheimers_disease_facts_figures.asp 2
50 Deaths by: 40 Stroke – declined 18.2% 30 HI V – 20 declined 16.3% Heart Disease – 10 declined 11.1% 0 Prostate Cancer – -10 declined 8.7% Breast Cancer – -20 declined 2.6 % 3
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 4
One out of every two persons 85+ has dementia. Between now and 2020, San Francisco will experience a dramatic increase. 5
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. 6
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. 7
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. 8
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 9
Determine strengths & weaknesses of current dementia services Make program & Identify policy principles & recommendations concepts for to improve how to address dementia services & the crisis in develop new services dementia care 10
Absence of Silos Inconsistent practice integrated care Lack of understanding State and federal of the needs of Stigma & regulatory & individuals with early discrimination financing barriers memory loss. Informal care relies on The absence of loved uncompensated ones nearby care from loved ones 11
To improve the quality of life for people with dementia and for their caregivers 12
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. 13
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. 14
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. 15
Disease Management for Mild, Risk Reduction Moderate, & Advanced Dementia, & End-of-Life Issues Early Identification of Alzheimer’s & Dementia Advanced Care Planning What To Expect as the Disease Progresses Ethical Issues Services & Resources Emergency Preparedness and Caregiver Wellness and Support Safety 16
Expand dementia training to facilitate the use of 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. 17
Diagnosis of mild cognitive impairment (MCI) should be encouraged and facilitated with clearly established diagnostic criteria. Best treatment options and care should be determined 18
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. 19
Promotion & dissemination of Expanded community education & standards & guidelines for care training Education & training for service Improved service coordination providers Improved access to resources & Shared client information services in the early stages Delayed need for more intensive Team-based care services in later stages 20
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 21
Implementation requires a unified, Sustained effort from proactive, long term 2010 to 2020. response. Visible leadership across city Shared responsibility. departments coming from the Mayor’s Office. 22
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 23
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 24
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 25
In September 2010, $320,700 was awarded (for 1 st 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 26
Assistance with facilitation of workgroups : DAAS will be working with DPH concerning staff support for some workgroups 27
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 28
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