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
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