1 00:00:05,680 --> 00:00:07,480 2 00:00:07,480 --> 00:00:09,960 SUMMIT ON CARE AND SVRSS AND 3 00:00:09,960 --> 00:00:12,680 SUPPORT FOR PERSONS LIVING WITH 4 00:00:12,680 --> 00:00:15,240 DEMENTIA AND CAREGIVERS BY THE 5 00:00:15,240 --> 00:00:20,120 NATIONAL INSTITUTE ON AGING. 6 00:00:20,120 --> 00:00:22,080 I'M JULIE ZISSIMOPOULOS AND I 7 00:00:22,080 --> 00:00:29,800 SERVE AS SUMMIT CO-CHAIR WITH 8 00:00:29,800 --> 00:00:33,320 ANDREA GILMORE-BYKOVSKYI. 9 00:00:33,320 --> 00:00:35,720 WE HAVE AN EXCELLENT DAY PLANNED 10 00:00:35,720 --> 00:00:37,320 WITH LIVED EXPERIENCE PANEL AND 11 00:00:37,320 --> 00:00:38,960 STAKEHOLDER ENGAGEMENT PANEL AND 12 00:00:38,960 --> 00:00:40,400 FOLLOWING WE HAVE THREE 13 00:00:40,400 --> 00:00:42,000 SESSIONS, DEMENTIA CARE MODELS 14 00:00:42,000 --> 00:00:43,640 AND COORDINATION OF CARE AND 15 00:00:43,640 --> 00:00:45,680 DISPARITY INS HEALTH CARE 16 00:00:45,680 --> 00:00:47,000 ACCESS, UTILIZATION AND QUALITY 17 00:00:47,000 --> 00:00:52,280 AND SUPPORT FOR CARE PARTNERS 18 00:00:52,280 --> 00:00:52,800 AND CAREGIVERS. 19 00:00:52,800 --> 00:00:55,480 AS A REMINDER FOR THOSE JUST 20 00:00:55,480 --> 00:00:57,120 JOINING THERE'S SEVERAL WAYS FOR 21 00:00:57,120 --> 00:00:57,960 PARTICIPANTS TO SUBMIT QUESTION 22 00:00:57,960 --> 00:01:00,080 DURING THE QUESTION AND ANSWER 23 00:01:00,080 --> 00:01:01,160 SESSION. 24 00:01:01,160 --> 00:01:03,120 IF YOU'RE JOINING BY ZOOM, ENTER 25 00:01:03,120 --> 00:01:05,000 YOUR QUESTION IN THE Q&A BOX. 26 00:01:05,000 --> 00:01:13,640 IF YOU'RE JOINING VIA THE NIH 27 00:01:13,640 --> 00:01:15,080 VIDEOCAST USE THE SEND LIVE 28 00:01:15,080 --> 00:01:17,600 FEEDBACK BUTTON AND YOUR 29 00:01:17,600 --> 00:01:18,360 QUESTION WILL BE ADDED TO THE 30 00:01:18,360 --> 00:01:19,880 ZOOM Q&A. 31 00:01:19,880 --> 00:01:21,280 THERE MAY BE A SLIGHT DELAY. 32 00:01:21,280 --> 00:01:23,080 IF YOUR QUESTIONS ARE NOT 33 00:01:23,080 --> 00:01:24,800 ANSWERED LIVE, PRESENTERS AND 34 00:01:24,800 --> 00:01:28,160 PANELISTS WILL TRY TO ANSWER. 35 00:01:28,160 --> 00:01:29,920 IF YOU HAVE QUESTIONS YOU WERE 36 00:01:29,920 --> 00:01:32,120 NOT ABLE TO ASK DURING THE 37 00:01:32,120 --> 00:01:34,960 SUMMIT OR WANTED TO SHARE WITH 38 00:01:34,960 --> 00:01:36,400 PLANNERS AND NIA, YOU HAVE AN 39 00:01:36,400 --> 00:01:38,960 OPPORTUNITY TO JOIN US TOMORROW 40 00:01:38,960 --> 00:01:39,920 AT 4:00 P.M. EASTERN STANDARD 41 00:01:39,920 --> 00:01:42,680 TIME FOR A POST-SUMMIT LISTENING 42 00:01:42,680 --> 00:01:43,040 SESSION. 43 00:01:43,040 --> 00:01:44,600 WE LOOK FORWARD TO HEARING 44 00:01:44,600 --> 00:01:46,080 QUESTIONS AND COMMENTS AND IDEAS 45 00:01:46,080 --> 00:01:48,160 AT THIS SESSION AND ENCOURAGE 46 00:01:48,160 --> 00:01:49,040 THOSE LIVING WITH COGNITIVE 47 00:01:49,040 --> 00:01:49,680 SYMPTOMS AND THEIR CARE PARTNERS 48 00:01:49,680 --> 00:01:57,720 TO JOIN. 49 00:01:57,720 --> 00:02:04,680 I'M PLEASED TO WELCOME HEIDI GIL 50 00:02:04,680 --> 00:02:10,800 AND IAN KREMMER AND ROBERTA 51 00:02:10,800 --> 00:02:11,000 CRUZ. 52 00:02:11,000 --> 00:02:12,480 I TURN IT OVER TO YOU, HEIDI TO 53 00:02:12,480 --> 00:02:19,520 GET US STARTED. 54 00:02:19,520 --> 00:02:20,440 >>CAN YOU HEAR ME? 55 00:02:20,440 --> 00:02:22,440 >>YES, WE CAN. 56 00:02:22,440 --> 00:02:22,880 >>HELLO. 57 00:02:22,880 --> 00:02:27,280 IT WAS AN HONOR TO HAVE 58 00:02:27,280 --> 00:02:27,880 FACILITATED THE STAKEHOLDER 59 00:02:27,880 --> 00:02:29,080 PANEL AND PLEASURE TO BE WITH 60 00:02:29,080 --> 00:02:30,200 YOU TODAY. 61 00:02:30,200 --> 00:02:34,120 WE HAD A PASSIONATE GROUP THAT 62 00:02:34,120 --> 00:02:36,120 MET OVER TWO 90 MINUTE SESSION 63 00:02:36,120 --> 00:02:37,320 TO SHARE PERSPECTIVES ON 64 00:02:37,320 --> 00:02:38,560 RESEARCH GAPS AND OPPORTUNITIES. 65 00:02:38,560 --> 00:02:40,240 WITH BACKGROUNDS IN RESEARCH, 66 00:02:40,240 --> 00:02:47,800 POLICY AND PRACTICE, THE VOICES 67 00:02:47,800 --> 00:02:51,880 OF 11 STAKEHOLDER REPRESENT THE 68 00:02:51,880 --> 00:02:53,840 RESEARCH POLICY AND PRACTICE AND 69 00:02:53,840 --> 00:02:57,240 WERE VOICES OF 11 STAKEHOLDERS 70 00:02:57,240 --> 00:02:59,240 THAT REPRESENT ALSO DIRECT CARE 71 00:02:59,240 --> 00:03:01,080 WORKERS, HEALTH SERVICE 72 00:03:01,080 --> 00:03:04,360 PROVIDERS AND PATIENT ADVOCATES 73 00:03:04,360 --> 00:03:04,800 AND RESEARCHERS. 74 00:03:04,800 --> 00:03:08,440 I REALLY ENJOYED THEIR ENERGY AS 75 00:03:08,440 --> 00:03:10,120 WE TACKLED THE THEMES AND 76 00:03:10,120 --> 00:03:11,280 SESSIONS. 77 00:03:11,280 --> 00:03:12,320 QUESTIONS WERE OPPOSED TO 78 00:03:12,320 --> 00:03:13,800 HIGHLIGHT PROMISING INNOVATIONS 79 00:03:13,800 --> 00:03:15,000 IN RESEARCH, UNDERSTAND WHAT'S 80 00:03:15,000 --> 00:03:17,800 GOING WELL ALONG WITH THE 81 00:03:17,800 --> 00:03:21,200 BARRIERS AND CHALLENGES THAT 82 00:03:21,200 --> 00:03:25,880 EXIST ON AN INDIVIDUAL AND 83 00:03:25,880 --> 00:03:26,800 SYSTEMS LEVEL AND FIRST THE 84 00:03:26,800 --> 00:03:29,040 INDIVIDUAL LEVEL. 85 00:03:29,040 --> 00:03:31,560 WHAT MATTERS WITH LIVING WELL 86 00:03:31,560 --> 00:03:33,640 WITH ALZHEIMER'S DISEASE AND 87 00:03:33,640 --> 00:03:36,720 RELATED DEMENTIAS. 88 00:03:36,720 --> 00:03:38,960 DISEASE-RELATED DEM EN HAS AND 89 00:03:38,960 --> 00:03:41,040 DETECTION AND DIAGNOSIS AND 90 00:03:41,040 --> 00:03:43,560 MANAGING OF WORSENING CONDITIONS 91 00:03:43,560 --> 00:03:48,280 AND COORDINATION OF CARE. 92 00:03:48,280 --> 00:03:51,680 THE SECOND SESSION LOOKED AT THE 93 00:03:51,680 --> 00:03:53,000 WORKFORCE, DISPARITIES AND 94 00:03:53,000 --> 00:03:54,840 HEALTH CARE ACCESS, UTILIZATION 95 00:03:54,840 --> 00:03:56,440 AND QUALITY, ECONOMIC IMPACTS 96 00:03:56,440 --> 00:03:59,880 AND APPROACHES TO PARTICIPATORY 97 00:03:59,880 --> 00:04:01,560 RESEARCH AND DIVERSE RECRUITMENT 98 00:04:01,560 --> 00:04:02,600 AND RETENTION. 99 00:04:02,600 --> 00:04:06,040 AND SO WE'RE SO THANKFUL TO THE 100 00:04:06,040 --> 00:04:08,360 TEAM AT ROSEA LEE ASSOCIATES WHO 101 00:04:08,360 --> 00:04:10,000 CAPTURED THE SUMMARY AND WHAT IS 102 00:04:10,000 --> 00:04:14,480 OUTLINED IS THE CONTENT OF THE 103 00:04:14,480 --> 00:04:17,120 REPORT MY COLLEAGUE AND PANEL 104 00:04:17,120 --> 00:04:19,280 PARTICIPANT IAN KREMMER HELPED 105 00:04:19,280 --> 00:04:20,160 PULL TOGETHER HIGHLIGHTS AND 106 00:04:20,160 --> 00:04:21,480 PLEASE TAKE THE OPPORTUNITY TO 107 00:04:21,480 --> 00:04:24,000 READ THE DEPTH OF PERSPECTIVES 108 00:04:24,000 --> 00:04:25,120 IN THIS REPORT. 109 00:04:25,120 --> 00:04:27,360 WITH LIMITED TIME FOR MY REMARKS 110 00:04:27,360 --> 00:04:29,640 I CAN ONLY HELP BUT EMPHASIZE 111 00:04:29,640 --> 00:04:31,560 THREE THEMES THAT WERE RELEVANT 112 00:04:31,560 --> 00:04:34,640 IN BOTH THE LIVED EXPERIENCE AND 113 00:04:34,640 --> 00:04:38,280 STAKEHOLDER PANELS. 114 00:04:38,280 --> 00:04:41,520 STARTING WITH STIGMA WITH THE 115 00:04:41,520 --> 00:04:42,120 CROSS-CUTTING THEMES. 116 00:04:42,120 --> 00:04:44,120 RESEARCH TO DATE HAS PRIMARILY 117 00:04:44,120 --> 00:04:45,360 FOCUSSED ON IDENTIFYING RESEARCH 118 00:04:45,360 --> 00:04:47,120 RATHER THAN INVENTIONS THAT 119 00:04:47,120 --> 00:04:49,560 REDUCE STIGMA AND THE IMPACT ON 120 00:04:49,560 --> 00:04:53,000 DEMENTIA CARE. 121 00:04:53,000 --> 00:04:55,440 PANELISTED NOTED HOW STIGMA HAS 122 00:04:55,440 --> 00:04:58,000 AN IMPACT ON DIAGNOSIS AND 123 00:04:58,000 --> 00:04:59,280 SCREENING AND WITH TO THE 124 00:04:59,280 --> 00:04:59,960 EXPERIENCE OF COGNITIVE CHANGE 125 00:04:59,960 --> 00:05:01,040 AND DECLINE. 126 00:05:01,040 --> 00:05:03,080 THERE'S A NEED TO ATTEND TO THE 127 00:05:03,080 --> 00:05:05,040 LANGUAGE AND NOMENCLATURE THAT 128 00:05:05,040 --> 00:05:06,200 CAUSES STIGMA AND FEAR. 129 00:05:06,200 --> 00:05:09,080 WE MUST HONOR THE WORK OF THE 130 00:05:09,080 --> 00:05:10,280 DEMENTIA NOMENCLATURE INITIATIVE 131 00:05:10,280 --> 00:05:11,720 AND CONTINUE TO ASK OURSELVES 132 00:05:11,720 --> 00:05:15,240 WHAT IS THE NOMENCLATURE THAT 133 00:05:15,240 --> 00:05:17,480 WILL SUPPORT PRODUCTIVITY AND 134 00:05:17,480 --> 00:05:19,520 ACTION RATHER THAN CAUSE FEAR 135 00:05:19,520 --> 00:05:21,920 AND WHAT WORKS WITH STIGMA AS 136 00:05:21,920 --> 00:05:23,800 ASSOCIATED WITH HIV AND CANCER. 137 00:05:23,800 --> 00:05:26,400 IN ADDRESSING CARE MODELS IN 138 00:05:26,400 --> 00:05:28,280 TRANSITIONS, BOTH PANELS SHARE 139 00:05:28,280 --> 00:05:30,120 PEOPLE WERE UNDER PREPARED FOR 140 00:05:30,120 --> 00:05:32,080 DISEASE PREVENTION, PROACTIVE 141 00:05:32,080 --> 00:05:33,000 CONVERSATIONS AND PLANNING ARE 142 00:05:33,000 --> 00:05:35,880 NEEDED ABOUT THE EVENTS THAT 143 00:05:35,880 --> 00:05:38,400 RESULT IN AVOIDABLE E.R. VISITS 144 00:05:38,400 --> 00:05:39,480 AND NECESSITATE A HIGHER LEVEL 145 00:05:39,480 --> 00:05:41,280 OF CARE. 146 00:05:41,280 --> 00:05:41,880 PANELISTS HIGHLIGHTED 147 00:05:41,880 --> 00:05:43,440 COLLABORATIVE CARE MODELS AND 148 00:05:43,440 --> 00:05:44,040 EMPHASIZED MORE RESEARCH ON 149 00:05:44,040 --> 00:05:45,840 THESE MODELS ARE NEEDED 150 00:05:45,840 --> 00:05:49,440 PARTICULARLY ON THE IMPACT OF 151 00:05:49,440 --> 00:05:50,080 RURAL AREAS AND POPULATION ARE 152 00:05:50,080 --> 00:05:52,320 DIVERSE. 153 00:05:52,320 --> 00:05:54,440 PANELISTS HIGHLIGHTED CARE 154 00:05:54,440 --> 00:05:55,560 NAVIGATION PROGRAMS FALL OUTSIDE 155 00:05:55,560 --> 00:05:58,680 THE DOMINANT CARE MEDICAL MODEL 156 00:05:58,680 --> 00:06:00,960 AND THE DIFFERENT PROGRAMS 157 00:06:00,960 --> 00:06:02,760 RELATED TO WELL BEING AND 158 00:06:02,760 --> 00:06:04,440 HEALTHY LIFE STYLES SUCH AS 159 00:06:04,440 --> 00:06:05,960 STRESS MANAGEMENT, SLEEP, 160 00:06:05,960 --> 00:06:07,920 NUTRITION, PHYSICAL FITNESS, 161 00:06:07,920 --> 00:06:10,320 SOCIAL CONNECTION AND FINDING, 162 00:06:10,320 --> 00:06:11,880 MEANING AND PURPOSE. 163 00:06:11,880 --> 00:06:15,960 AND FROM THE LIVED EXPERIENCE 164 00:06:15,960 --> 00:06:18,720 PANEL ECHOED STAKEHOLDERS WHEN 165 00:06:18,720 --> 00:06:21,200 VOICING HELPING PEOPLE NAVIGATE 166 00:06:21,200 --> 00:06:23,240 DEMENTIA IN THIS COMPREHENSIVE 167 00:06:23,240 --> 00:06:24,400 WAY ARE INSUFFICIENT AND NEED TO 168 00:06:24,400 --> 00:06:27,800 HAPPEN FROM THE BEGINNING OF 169 00:06:27,800 --> 00:06:28,480 DIAGNOSIS. 170 00:06:28,480 --> 00:06:30,160 THERE'S LIMIT TO ACCESS TO THIS 171 00:06:30,160 --> 00:06:31,120 TYPE OF SUPPORT. 172 00:06:31,120 --> 00:06:33,640 RESEARCH IS NEEDED TO EVALUATE 173 00:06:33,640 --> 00:06:35,760 THE POTENTIAL BENEFITS OF CARE 174 00:06:35,760 --> 00:06:37,560 NAVIGATORS TO BRIDGE THE GAP 175 00:06:37,560 --> 00:06:39,360 WITH PLANNING AND INTEGRATING 176 00:06:39,360 --> 00:06:40,600 HEALTH CARE NEEDS WITH GOALS 177 00:06:40,600 --> 00:06:43,000 THAT ALSO ATTEND TO WELL BEING 178 00:06:43,000 --> 00:06:43,800 AND RESILIENCE. 179 00:06:43,800 --> 00:06:45,800 SO IN SCALING HOME-BASED SERVICE 180 00:06:45,800 --> 00:06:47,840 AND SUPPORTS, RESEARCH IS NEEDED 181 00:06:47,840 --> 00:06:50,080 ON WHAT INFORMAL AND FORMAL CARE 182 00:06:50,080 --> 00:06:53,400 IS PROVIDED IN THE HOME AND 183 00:06:53,400 --> 00:06:54,600 ASSET THINGS LIKE TECHNOLOGY, 184 00:06:54,600 --> 00:06:57,880 LOOKING AT QUALITY AND SAFETY 185 00:06:57,880 --> 00:07:00,040 AND WHETHER TRAINING IS 186 00:07:00,040 --> 00:07:00,600 IMPROVING OUTCOMES. 187 00:07:00,600 --> 00:07:04,280 ACROSS BOTH PANELS IT WAS NOTED 188 00:07:04,280 --> 00:07:06,760 TENSIONS ARISE BETWEEN MANAGING 189 00:07:06,760 --> 00:07:09,400 HOME AND MAINTAINING SAFETY. 190 00:07:09,400 --> 00:07:10,760 WITH THE LIVED EXPERIENCE PANEL, 191 00:07:10,760 --> 00:07:13,960 VOICING INDEPENDENCE AS WHAT 192 00:07:13,960 --> 00:07:15,600 MATTERS HOW CAN WE EVALUATE THE 193 00:07:15,600 --> 00:07:17,720 TRADEOFFS OF SUPPORTING QUALITY 194 00:07:17,720 --> 00:07:24,400 OF LIFE DECISIONS, REMAINING 195 00:07:24,400 --> 00:07:24,680 INDEPENDENT. 196 00:07:24,680 --> 00:07:27,240 I LOOK BACK ON MY EXPERIENCE AS 197 00:07:27,240 --> 00:07:28,760 A PINNACLE MOMENT WITH THE 198 00:07:28,760 --> 00:07:31,480 VOICES OF PERSONS IMPACTED BY 199 00:07:31,480 --> 00:07:33,680 DEMENTIA WERE PALPABLE. 200 00:07:33,680 --> 00:07:34,800 THANKS TO THE CONTINUED 201 00:07:34,800 --> 00:07:36,880 INSPIRATION FROM THE SUMMIT 202 00:07:36,880 --> 00:07:40,000 VENUE I VALUE WORKING WITH 203 00:07:40,000 --> 00:07:41,800 PERSONS IMPACTED WITH DEMENTIA 204 00:07:41,800 --> 00:07:44,280 THAT HAVE A DESIRE TO FIND 205 00:07:44,280 --> 00:07:47,400 MEANING, PURPOSE, AND EVEN JOY 206 00:07:47,400 --> 00:07:50,000 WITH RESEARCH AND AS PARTNERS. 207 00:07:50,000 --> 00:07:52,240 I'LL LET MY PARTNER DIVE DEEPER 208 00:07:52,240 --> 00:07:54,640 IN THE NEED FOR DOING RESEARCH 209 00:07:54,640 --> 00:07:56,440 FROM A PARTNERSHIP PERSPECTIVE 210 00:07:56,440 --> 00:07:58,880 AS A STRONG ADVOCATE FOR ROBUST 211 00:07:58,880 --> 00:08:00,920 STAKEHOLDER ENGAGEMENT, THANK 212 00:08:00,920 --> 00:08:02,880 YOU FOR THE OPPORTUNITY AND 213 00:08:02,880 --> 00:08:04,840 LISTENING TO THESE REMARKS TODAY 214 00:08:04,840 --> 00:08:06,280 AND TAKE IT AWAY AND THANK YOU 215 00:08:06,280 --> 00:08:06,680 ALL. 216 00:08:06,680 --> 00:08:07,640 SORRY MY CAMERA WAS NOT WORKING 217 00:08:07,640 --> 00:08:11,520 TODAY. 218 00:08:11,520 --> 00:08:12,480 >>THANK YOU, HEIDI. 219 00:08:12,480 --> 00:08:14,520 I HAVE THE PRIVILEGE OF SERVING 220 00:08:14,520 --> 00:08:15,800 ON THE STEERING COMMITTEES FOR 221 00:08:15,800 --> 00:08:18,160 THE 2017 AND 2020 SUMMITS. 222 00:08:18,160 --> 00:08:21,160 AGAIN AT THIS SUMMIT WE HAVE THE 223 00:08:21,160 --> 00:08:23,360 RESPONSIBILITY TO REFINE 224 00:08:23,360 --> 00:08:24,880 RESEARCH AREAS PRIORITIZED BY 225 00:08:24,880 --> 00:08:28,280 WHAT MATTERS MOST TO THOSE WHOSE 226 00:08:28,280 --> 00:08:29,560 QUALITY OF LIFE WE STRIVE TO 227 00:08:29,560 --> 00:08:29,920 IMPROVE. 228 00:08:29,920 --> 00:08:33,360 LIKE MANY OF YOU I'VE KNOWN 229 00:08:33,360 --> 00:08:35,160 THOUSANDS OF PEOPLE WITH LIVED 230 00:08:35,160 --> 00:08:35,480 EXPERIENCE. 231 00:08:35,480 --> 00:08:38,280 LIKE YOU, MY FAMILY HAS BEEN 232 00:08:38,280 --> 00:08:41,600 REPEATEDLY HIT HARD BY DEMENTIA. 233 00:08:41,600 --> 00:08:43,240 THE RECENT LOST DECEMBER 24 WHEN 234 00:08:43,240 --> 00:08:45,400 MY BRILLIANT FATHER DIED AFTER A 235 00:08:45,400 --> 00:08:46,640 STRUGGLE WITH DEMENTIA. 236 00:08:46,640 --> 00:08:49,000 THE LESSONS HE TAUGHT ME BEFORE 237 00:08:49,000 --> 00:08:51,360 AND AFTER IN DEMENTIA IS GREAT 238 00:08:51,360 --> 00:08:52,720 AND INFORMED THE RESEARCH 239 00:08:52,720 --> 00:08:53,760 PRIORITIES I HIGHLIGHT TODAY 240 00:08:53,760 --> 00:08:55,480 WHICH HAVE THE BENEFIT OF 241 00:08:55,480 --> 00:08:57,680 ALIGNING WITH TALKS THROUGHOUT 242 00:08:57,680 --> 00:08:59,840 THE SUMMIT. 243 00:08:59,840 --> 00:09:03,200 FIRST, DETECTION AND DIAGNOSIS, 244 00:09:03,200 --> 00:09:05,040 SEPARATE BUT RELATED STEPS MUST 245 00:09:05,040 --> 00:09:08,160 BE EQUITABLE, TIMELY, ACCURATE, 246 00:09:08,160 --> 00:09:14,240 COMPASSIONATE AND ACTIONABLE. 247 00:09:14,240 --> 00:09:15,520 ETECA. 248 00:09:15,520 --> 00:09:20,200 WE KNOW GRIEVOUS INEQUITIES 249 00:09:20,200 --> 00:09:23,440 EXIST FOR PEOPLE FACING DEM EN 250 00:09:23,440 --> 00:09:23,880 IS THAT. 251 00:09:23,880 --> 00:09:29,160 MOST ARE DIAGNOSED LATER IN 252 00:09:29,160 --> 00:09:31,720 PROGRESSION THAN TOOLS ALLOW AND 253 00:09:31,720 --> 00:09:37,040 TOO MANY RECEIVE AN INACCURATE 254 00:09:37,040 --> 00:09:40,280 OR VAGUE DIAGNOSIS. 255 00:09:40,280 --> 00:09:42,520 DIAGNOSE AND ADIOS IS COMMON BUT 256 00:09:42,520 --> 00:09:45,640 WE KNOW HOW TO DELIVER BAD NEWS 257 00:09:45,640 --> 00:09:48,520 WELL SO THESE SKILLS CAN BE 258 00:09:48,520 --> 00:09:51,920 TAUGHT, LEARNED AND HOLISTICALLY 259 00:09:51,920 --> 00:09:52,240 IMPLEMENTED. 260 00:09:52,240 --> 00:09:55,080 WE KNOW DIAGNOSIS IS NOT AN END 261 00:09:55,080 --> 00:09:56,560 BUT BEGINNING. 262 00:09:56,560 --> 00:09:57,800 DIAGNOSIS MUST RESULT IN 263 00:09:57,800 --> 00:09:59,080 CLINICIANS CONNECTING PATIENTS 264 00:09:59,080 --> 00:10:01,160 AND FAMILIES WITH 265 00:10:01,160 --> 00:10:02,520 COMMUNITY-BASED RESOURCE AND 266 00:10:02,520 --> 00:10:03,400 STUDY OPPORTUNITIES. 267 00:10:03,400 --> 00:10:09,120 WE NEED RESEARCH HOW TO TEST, 268 00:10:09,120 --> 00:10:11,000 TRANSLATE AND SCALE THE 269 00:10:11,000 --> 00:10:13,200 DIAGNOSIS AND PRINCIPLES. 270 00:10:13,200 --> 00:10:15,000 SECOND, THANKFULLY WE NO LONGER 271 00:10:15,000 --> 00:10:17,280 LABEL STUDY PARTICIPANTS AS 272 00:10:17,280 --> 00:10:20,080 SUBJECTS BUT IT'S INADEQUATE 273 00:10:20,080 --> 00:10:22,000 NEARLY TO TREAT THEM WITH 274 00:10:22,000 --> 00:10:23,080 DIGNITY. 275 00:10:23,080 --> 00:10:24,800 WE MUST SUPPORT PEOPLE FACING 276 00:10:24,800 --> 00:10:26,520 DEMENTIA TO BE FULL STUDY 277 00:10:26,520 --> 00:10:26,800 PARTNERS. 278 00:10:26,800 --> 00:10:28,480 WE NEED PEOPLE FACING DEMENTIA 279 00:10:28,480 --> 00:10:31,160 TO HELP GENERATE PRIORITIES FOR 280 00:10:31,160 --> 00:10:35,000 STUDIES AND DESIGN STUDIES. 281 00:10:35,000 --> 00:10:36,200 RATHER THAN ASK ONLY WHETHER OUR 282 00:10:36,200 --> 00:10:37,800 RESEARCH IDEAS ARE IMPORTANT, WE 283 00:10:37,800 --> 00:10:40,640 MUST ASK WHICH IDEAS ARE MOST 284 00:10:40,640 --> 00:10:41,800 IMPORTANT AND WHY. 285 00:10:41,800 --> 00:10:45,520 WE MUST ASK WHAT IDEAS THEY 286 00:10:45,520 --> 00:10:47,520 WOULD OFFER WE HAVE NOT 287 00:10:47,520 --> 00:10:47,840 IDENTIFIED. 288 00:10:47,840 --> 00:10:50,200 WE NEED RESEARCH ABOUT HOW TO 289 00:10:50,200 --> 00:10:51,320 ENGAGE PEOPLE WITH LIVED 290 00:10:51,320 --> 00:10:53,280 EXPERIENCE AT THE IDEATION STAGE 291 00:10:53,280 --> 00:10:56,320 AND HOW TO CONTINUOUSLY IMPROVE 292 00:10:56,320 --> 00:10:58,600 POORER OUTCOME SETS WITH 293 00:10:58,600 --> 00:10:59,920 PARTICULAR FOCUS ON DRIVING 294 00:10:59,920 --> 00:11:03,560 EQUITY IN THE CONTEXT OF 295 00:11:03,560 --> 00:11:05,040 HETEROGENEITY. 296 00:11:05,040 --> 00:11:06,400 THIRD, WE MUST BETTER UNDERSTAND 297 00:11:06,400 --> 00:11:08,680 HOW INNOVATIONS WORK IN REAL 298 00:11:08,680 --> 00:11:10,960 WORLD SETTINGS USED BY REAL-LIFE 299 00:11:10,960 --> 00:11:13,000 PROVIDERS AND PEOPLE FACING 300 00:11:13,000 --> 00:11:13,640 DEMENTIA. 301 00:11:13,640 --> 00:11:15,840 ALLOW KNOW SHARE ONE ANECDOTE 302 00:11:15,840 --> 00:11:18,240 ABOUT THE POWER OF ELECTRONIC 303 00:11:18,240 --> 00:11:20,560 HEALTH RECORDS IN CARE 304 00:11:20,560 --> 00:11:21,520 TRANSITIONS. 305 00:11:21,520 --> 00:11:23,920 E.H.R.s SHOULD BE INDISPENSABLE 306 00:11:23,920 --> 00:11:25,560 PREVENTING MEDICAL AREAS 307 00:11:25,560 --> 00:11:27,080 ESPECIALLY DURING 308 00:11:27,080 --> 00:11:29,760 HOSPITALIZATIONS BUT WHAT IF THE 309 00:11:29,760 --> 00:11:30,440 E.H.R. IS WRONG? 310 00:11:30,440 --> 00:11:32,800 THE HOSPITAL TRUSTING THE E.H.R. 311 00:11:32,800 --> 00:11:36,160 WHILE IGNORING PROTESTS FROM THE 312 00:11:36,160 --> 00:11:38,760 PATIENT OR PARTNER? 313 00:11:38,760 --> 00:11:40,400 THE HOSPITAL MY FATHER 314 00:11:40,400 --> 00:11:43,560 FREQUENTED CONSISTENTLY OMITTED 315 00:11:43,560 --> 00:11:46,600 INFORMATION FROM HIS SPECIALIST 316 00:11:46,600 --> 00:11:48,040 INCLUDING DIAGNOSED COGNITIVE 317 00:11:48,040 --> 00:11:49,480 IMPAIRMENTS AND MEDICATIONS FOR 318 00:11:49,480 --> 00:11:50,960 OTHER SERIOUS CONDITIONS. 319 00:11:50,960 --> 00:11:53,040 THE E.H.R. ALSO HAD THE DOSING 320 00:11:53,040 --> 00:11:55,520 WRONG FOR HIS GLAUCOMA 321 00:11:55,520 --> 00:11:58,880 MEDICATIONS, INVENTED HIM HAVING 322 00:11:58,880 --> 00:12:01,160 RESPIRATORY DISEASE AND MOST 323 00:12:01,160 --> 00:12:03,920 EGREGIOUSLY LISTED HIM AS FULL 324 00:12:03,920 --> 00:12:05,200 CODE DESPITE THE HOSPITAL HAVE 325 00:12:05,200 --> 00:12:08,440 BOTH HEART AND ELECTRONIC COPIES 326 00:12:08,440 --> 00:12:10,280 OF HIS D.N.R. ORDERS. 327 00:12:10,280 --> 00:12:12,560 DURING AND AFTER EACH 328 00:12:12,560 --> 00:12:14,440 HOSPITALIZATION I SPENT HOURS 329 00:12:14,440 --> 00:12:16,480 GETTING THE E.H.R. CORRECTED 330 00:12:16,480 --> 00:12:19,080 ONLY TO DISCOVER THE SAME ERRORS 331 00:12:19,080 --> 00:12:21,760 WITH EACH SUBSEQUENT 332 00:12:21,760 --> 00:12:22,120 HOSPITALIZATION. 333 00:12:22,120 --> 00:12:23,920 IF SUCH SYSTEM BREAK HAPPEN TO 334 00:12:23,920 --> 00:12:27,120 MY PRIVILEGED FAMILY, HOW WOULD 335 00:12:27,120 --> 00:12:28,680 PEOPLE FAIR IF THEY HAVE NO 336 00:12:28,680 --> 00:12:30,920 PRIVILEGE OR NO FAMILY? 337 00:12:30,920 --> 00:12:32,160 IF E.H.R. DATA ABOUT THE HEALTH 338 00:12:32,160 --> 00:12:34,720 CARE RECEIVED BY PEOPLE WITH 339 00:12:34,720 --> 00:12:36,840 DEMENTIA IS COMPROMISED SO MANY 340 00:12:36,840 --> 00:12:38,760 OF OUR RESEARCH CONCLUSIONS MAY 341 00:12:38,760 --> 00:12:40,160 BE UNDERMINED. 342 00:12:40,160 --> 00:12:42,120 WE NEED RESEARCH ON HOW E.H.R.s 343 00:12:42,120 --> 00:12:45,800 WORK FOR PEOPLE LIVING WITH 344 00:12:45,800 --> 00:12:47,360 DEMENTIA, HOW PROVIDERS UTILIZE 345 00:12:47,360 --> 00:12:51,480 E.H.R.s AND THE EXTENT TO WHICH 346 00:12:51,480 --> 00:12:53,840 INTEROPERABILITY CORRECTS ERRORS 347 00:12:53,840 --> 00:12:56,160 OR CORRECTS AND SUSTAINS ERRORS. 348 00:12:56,160 --> 00:12:58,520 MY PARENTS RAISED TWO SONS TO 349 00:12:58,520 --> 00:13:00,600 RECOGNIZE OUR ETHICAL OBLIGATION 350 00:13:00,600 --> 00:13:01,480 TO REPAIR THE WORLD. 351 00:13:01,480 --> 00:13:06,080 THE OLDER SON IS A NOBEL 352 00:13:06,080 --> 00:13:07,480 LAUREATE WHO'S WORK IMPROVED THE 353 00:13:07,480 --> 00:13:09,800 LIVES OF CHILDREN IN MIDDLE AND 354 00:13:09,800 --> 00:13:11,480 LOWER INCOME COUNTRIES. 355 00:13:11,480 --> 00:13:13,720 THE OTHER SON ASKS YOU TO USE 356 00:13:13,720 --> 00:13:15,960 THIS SUMMIT TO CATALYZE RESEARCH 357 00:13:15,960 --> 00:13:18,520 THAT IS PERSON CENTERED 358 00:13:18,520 --> 00:13:19,320 EMBRACING PEOPLE WITH LIVED 359 00:13:19,320 --> 00:13:21,280 EXPERIENCE AND RESEARCH PARTNERS 360 00:13:21,280 --> 00:13:24,680 SO THIS RESEARCH STRENGTHENS 361 00:13:24,680 --> 00:13:26,360 SYSTEMS ON WHICH THEY DEPEND SO 362 00:13:26,360 --> 00:13:27,560 THIS RESEARCH IMPROVES THE LIVES 363 00:13:27,560 --> 00:13:29,600 OF TENS OF MILLIONS OF PEOPLE 364 00:13:29,600 --> 00:13:30,920 FACING DEMENTIA NO MATTER WHERE 365 00:13:30,920 --> 00:13:32,440 THEY LIVE AROUND THE WORLD. 366 00:13:32,440 --> 00:13:39,160 BACK TO YOU. 367 00:13:39,160 --> 00:13:39,680 >>THANK YOU. 368 00:13:39,680 --> 00:13:41,320 IT'S MY PLEASURE TO INTRODUCE 369 00:13:41,320 --> 00:13:45,600 OUR NEXT , ROBERTA CRUZ, A 370 00:13:45,600 --> 00:13:47,160 CAREGIVER FROM THE LIVED 371 00:13:47,160 --> 00:13:49,760 EXPERIENCE PANEL. 372 00:13:49,760 --> 00:13:52,240 ROBERTA. 373 00:13:52,240 --> 00:13:53,840 >>HI, EVERYONE. 374 00:13:53,840 --> 00:13:59,680 I'M HONORED TO SHARE SOME 375 00:13:59,680 --> 00:14:01,200 EXPERIENCES WITH YOU ALL. 376 00:14:01,200 --> 00:14:04,440 SO IN REFLECTING IN THE ALMOST 377 00:14:04,440 --> 00:14:06,040 EIGHT YEARS OF CAREGIVER FOR MY 378 00:14:06,040 --> 00:14:09,320 MOM I HAVE TO SAY THE MOST 379 00:14:09,320 --> 00:14:11,840 FRUSTRATING ASPECT IS THE 380 00:14:11,840 --> 00:14:14,520 UNCERTAINTY AND NOT KNOWING WHAT 381 00:14:14,520 --> 00:14:17,480 THE RIGHT DECISION MAY BE AT ANY 382 00:14:17,480 --> 00:14:18,920 GIVEN MOMENT. 383 00:14:18,920 --> 00:14:23,240 THIS IDEA OF GOOD CARE GIVING 384 00:14:23,240 --> 00:14:25,280 FOR ONE FAMILY MAY LOOK VERY 385 00:14:25,280 --> 00:14:26,760 DIFFERENT FROM THE NEXT. 386 00:14:26,760 --> 00:14:29,800 AND SO DEPENDENT ON MANY 387 00:14:29,800 --> 00:14:32,040 CONSIDERATIONS INVOLVING ONE'S 388 00:14:32,040 --> 00:14:34,760 OWN LIVED EXPERIENCE, THE 389 00:14:34,760 --> 00:14:36,800 EXISTING SOCIAL SUPPORT NETWORK, 390 00:14:36,800 --> 00:14:37,960 FINANCIAL SITUATION, HOUSING 391 00:14:37,960 --> 00:14:40,680 SITUATION AND SO ON. 392 00:14:40,680 --> 00:14:44,080 FROM MY FAMILY, THE EARLIEST 393 00:14:44,080 --> 00:14:46,800 DECISIONS INVOLVE CONSIDERATIONS 394 00:14:46,800 --> 00:14:47,960 FOR GUARDING MY IMMEDIATE FAMILY 395 00:14:47,960 --> 00:14:50,080 AS MY SON WAS ONE AND A HALF 396 00:14:50,080 --> 00:14:53,120 YEARS OLD AND MY HUSBAND WAS IN 397 00:14:53,120 --> 00:14:55,880 HIS INTERNSHIP YEAR ARGUABLY THE 398 00:14:55,880 --> 00:14:58,280 MOST DIFFICULT YEAR FOR A 399 00:14:58,280 --> 00:15:00,160 PHYSICIAN IN TRAINING AND WE 400 00:15:00,160 --> 00:15:01,760 CONSIDERED EXTENDED FAMILY 401 00:15:01,760 --> 00:15:03,520 OPINIONS AND VALUES DIFFERENT 402 00:15:03,520 --> 00:15:08,320 FROM OURS, FINANCIAL RISK TO 403 00:15:08,320 --> 00:15:10,560 TAKE, HEALTH DIAGNOSES, 404 00:15:10,560 --> 00:15:11,760 BEHAVIORAL, PSYCHOLOGICAL 405 00:15:11,760 --> 00:15:13,880 CONSIDERATIONS AND NOT KNOWING 406 00:15:13,880 --> 00:15:15,600 EXACTLY WHAT MY MOM WANTED 407 00:15:15,600 --> 00:15:16,920 BECAUSE SHE CONSISTENTLY PUT OFF 408 00:15:16,920 --> 00:15:17,840 THE CONVERSATIONS. 409 00:15:17,840 --> 00:15:18,720 SHE DIDN'T WANT TO TALK ABOUT IT 410 00:15:18,720 --> 00:15:22,320 WITH US. 411 00:15:22,320 --> 00:15:25,560 LASTLY MY GAMBLING ADDICT DAD 412 00:15:25,560 --> 00:15:28,160 WHO WAS LEGALLY SEPARATED FROM 413 00:15:28,160 --> 00:15:29,760 MY MOM THOUGH THEY'RE STILL 414 00:15:29,760 --> 00:15:31,240 LIVING TOGETHER IN THE SAME HOME 415 00:15:31,240 --> 00:15:33,040 AND HE WAS ACTIVELY TAKING 416 00:15:33,040 --> 00:15:40,360 ADVANTAGE OF HER MEMORY LOSS. 417 00:15:40,360 --> 00:15:45,640 SO I PAUSE I BRING THE IMAGE OF 418 00:15:45,640 --> 00:15:47,880 A HUGE TIDAL WAVE COMES TO MIND 419 00:15:47,880 --> 00:15:51,160 AND FROM THAT MOMENT YOU SUSPECT 420 00:15:51,160 --> 00:15:56,960 IS NOT RIGHT YOU WONDER WHAT 421 00:15:56,960 --> 00:15:58,600 POSITION YOU'RE IN WHAT CAPACITY 422 00:15:58,600 --> 00:16:00,520 COULD YOU POSSIBLY INTERVENE TO 423 00:16:00,520 --> 00:16:02,360 ASSIST YOUR LOVED ONE. 424 00:16:02,360 --> 00:16:03,440 AND THEN IT BECOMES CLEAR THAT 425 00:16:03,440 --> 00:16:06,920 IT IS THE TIME TO DO SOMETHING. 426 00:16:06,920 --> 00:16:09,760 USUALLY IT'S ONE OF THOSE 427 00:16:09,760 --> 00:16:10,560 EMERGENCY SITUATIONS. 428 00:16:10,560 --> 00:16:14,240 AND IN THAT MOMENT THE NUMBER OF 429 00:16:14,240 --> 00:16:18,160 DECISIONS SEEMS ENDLESS. 430 00:16:18,160 --> 00:16:21,680 AS WE STOOD IN THE FACE OF THE 431 00:16:21,680 --> 00:16:23,120 ONCOMING TIDAL WAVE IT SEEMS ALL 432 00:16:23,120 --> 00:16:26,480 THE FOLKS, THE FAMILY MEMBERS, 433 00:16:26,480 --> 00:16:29,800 WHO WE WOULD CALL ON SUPPORT 434 00:16:29,800 --> 00:16:31,400 WERE CONVENIENTLY NOT AROUND. 435 00:16:31,400 --> 00:16:34,440 THEY DISAPPEARED ALL AT ONCE. 436 00:16:34,440 --> 00:16:35,760 THIS IS ANOTHER CHALLENGE. 437 00:16:35,760 --> 00:16:38,400 THOSE CLOSEST TO MY MOM WERE 438 00:16:38,400 --> 00:16:41,800 JUST NOT AVAILABLE IN HER 439 00:16:41,800 --> 00:16:43,920 GREATEST TIME OF NEED. 440 00:16:43,920 --> 00:16:46,680 SO I HAD TO COME TO ACCEPT THIS 441 00:16:46,680 --> 00:16:48,760 VERY QUICKLY SO AS NOT TO 442 00:16:48,760 --> 00:16:50,640 DETRACT FROM ANY MORE EMOTIONAL 443 00:16:50,640 --> 00:16:55,600 ENERGY I DIDN'T HAVE A LOT OF. 444 00:16:55,600 --> 00:17:01,640 SO BARRIERS AND CHALLENGES TO 445 00:17:01,640 --> 00:17:03,120 HELPING MY MOTHER LIVE WELL. 446 00:17:03,120 --> 00:17:05,440 THE FIRST THOUGHT WAS TO DEFINE 447 00:17:05,440 --> 00:17:08,640 WHAT DOES WELL MEAN AND WELL 448 00:17:08,640 --> 00:17:10,280 ACCORDING TO WHOM BECAUSE IF IT 449 00:17:10,280 --> 00:17:12,920 WERE UP TO MY MOM HE WOULD HAVE 450 00:17:12,920 --> 00:17:15,200 LEFT HER ON HER OWN WITH OR 451 00:17:15,200 --> 00:17:16,000 WITHOUT MY DAD. 452 00:17:16,000 --> 00:17:17,920 SHE WOULDN'T HAVE WANTED US TO 453 00:17:17,920 --> 00:17:19,600 WORRY ABOUT HER BECAUSE WE HAVE 454 00:17:19,600 --> 00:17:21,400 OUR OWN LIFE TO LIVE, THOSE WERE 455 00:17:21,400 --> 00:17:21,960 HER WORDS. 456 00:17:21,960 --> 00:17:24,840 I KNOW THIS IS DIRECTLY 457 00:17:24,840 --> 00:17:26,360 CONNECTED TO HER OWN EXPERIENCE 458 00:17:26,360 --> 00:17:28,680 OF HAVING IMMIGRATED FROM THE 459 00:17:28,680 --> 00:17:31,680 PHILIPPINES AND THAT SHE 460 00:17:31,680 --> 00:17:34,480 PROBABLY HAD TO TELL HERSELF TO 461 00:17:34,480 --> 00:17:36,720 DEAL WITH HER FEELINGS IN HER 462 00:17:36,720 --> 00:17:37,880 OWN PROCESS WITH HER OWN PARENTS 463 00:17:37,880 --> 00:17:38,920 AND THEIR END OF LIFE SO MANY 464 00:17:38,920 --> 00:17:44,200 MILES AWAY. 465 00:17:44,200 --> 00:17:45,960 OUR CHALLENGE WAS TO REDEFINE 466 00:17:45,960 --> 00:17:49,080 WHAT LIVING WELL LOOKED LIKE AND 467 00:17:49,080 --> 00:17:50,680 NEEDED TO BE IN LINE OF 468 00:17:50,680 --> 00:17:52,600 PRIORITIES AND VALUES OF MY 469 00:17:52,600 --> 00:17:54,280 PARTNER AND I AND MY MOM'S 470 00:17:54,280 --> 00:17:55,640 NOTION OF INDEPENDENCE WE HAD TO 471 00:17:55,640 --> 00:17:57,240 PUT ASIDE FOR THE TIME BEING. 472 00:17:57,240 --> 00:18:01,080 THIS IS VERY HARD. 473 00:18:01,080 --> 00:18:03,240 IN OUR FAMILY SITUATION, 474 00:18:03,240 --> 00:18:05,040 FINANCIAL, EMOTIONAL AND TIME 475 00:18:05,040 --> 00:18:05,840 RESOURCES WERE SCARCE. 476 00:18:05,840 --> 00:18:09,160 AS A YOUNG FAMILY NOT YET 477 00:18:09,160 --> 00:18:10,760 ESTABLISHED IN ANY CAREER OR 478 00:18:10,760 --> 00:18:16,760 PROFESSION WITH A ONE AND A 479 00:18:16,760 --> 00:18:18,080 HALF-YEAR-OLD, IF WE WEREN'T 480 00:18:18,080 --> 00:18:19,360 STABLE MY MOM WOULDN'T BE 481 00:18:19,360 --> 00:18:20,360 STABLE. 482 00:18:20,360 --> 00:18:24,440 WHAT IS A GOOD LIFE IS STILL A 483 00:18:24,440 --> 00:18:25,840 QUESTION WE ASK DAILY. 484 00:18:25,840 --> 00:18:29,040 WHAT'S BEEN MOST HELPFUL IN MY 485 00:18:29,040 --> 00:18:31,400 JOURNEY ARE THE EXISTING AND THE 486 00:18:31,400 --> 00:18:33,440 NEW AND SUPPORTIVE 487 00:18:33,440 --> 00:18:35,000 RELATIONSHIPS. 488 00:18:35,000 --> 00:18:36,920 MY PARTNER FIRST AND FOREMOST 489 00:18:36,920 --> 00:18:39,480 AND ALSO SUPPORT GROUPS WITH 490 00:18:39,480 --> 00:18:40,920 OTHER CARE PARTNERS, VARIOUS 491 00:18:40,920 --> 00:18:42,720 FORMS OF ADULT DAY PROGRAMS, 492 00:18:42,720 --> 00:18:43,920 CARVING OUT SPACE AND TIME FOR 493 00:18:43,920 --> 00:18:47,120 MY OWN CONNECTION WITH MY 494 00:18:47,120 --> 00:18:50,360 PARTNER AND CHILDREN AND 495 00:18:50,360 --> 00:18:51,360 CONNECTION WITH PARENTS. 496 00:18:51,360 --> 00:18:54,480 AND TO END, OUR CURRENT SUPPORT 497 00:18:54,480 --> 00:19:00,800 IS A SWEET WOMAN WHO WE MET FROM 498 00:19:00,800 --> 00:19:04,880 CARE.COM AND BLOSSOMED FROM A 499 00:19:04,880 --> 00:19:06,320 DAYCARE SITUATION THROUGH THE 500 00:19:06,320 --> 00:19:08,400 PANDEMIC TO OUR CURRENT 501 00:19:08,400 --> 00:19:13,360 SITUATION AS MY MOM'S END OF 502 00:19:13,360 --> 00:19:14,800 LIFE IN HOSPICE CARE WHERE MY 503 00:19:14,800 --> 00:19:16,480 MOM LIVES FULL TIME WITH HER AND 504 00:19:16,480 --> 00:19:17,240 HER FAMILY. 505 00:19:17,240 --> 00:19:19,000 NO ONE SHOULD DO THIS ALONE AND 506 00:19:19,000 --> 00:19:20,680 I THINK THE MOST IMPORTANT THING 507 00:19:20,680 --> 00:19:23,400 IS THAT WE DO NOT BECOME 508 00:19:23,400 --> 00:19:24,920 ISOLATED IN THIS REALLY 509 00:19:24,920 --> 00:19:29,120 DIFFICULT BUT IMPORTANT WORK. 510 00:19:29,120 --> 00:19:30,200 THANK YOU FOR ALLOWING ME TO 511 00:19:30,200 --> 00:19:40,720 SHARE MY EXPERIENCES WITH YOU. 512 00:19:43,880 --> 00:19:49,520 >>THANK YOU, ROBERTA AND HEIDI 513 00:19:49,520 --> 00:19:50,560 AND YOUR EXPERIENCES AND THE 514 00:19:50,560 --> 00:19:52,880 WORK YOU DID WITH YOUR PANEL. 515 00:19:52,880 --> 00:19:56,880 I AM NOW PLEASED TO WELCOME 516 00:19:56,880 --> 00:19:59,120 DR. KATE POSSIN AND MARCEL 517 00:19:59,120 --> 00:20:02,200 SALIVE CO-CHAIRS OF THE DEMENTIA 518 00:20:02,200 --> 00:20:03,840 CARE MODELS AND COORDINATION OF 519 00:20:03,840 --> 00:20:04,040 CARE. 520 00:20:04,040 --> 00:20:07,160 I TURN IT OVER TO YOU. 521 00:20:07,160 --> 00:20:08,680 >>THANK YOU, YES. 522 00:20:08,680 --> 00:20:12,680 I'M PLEASED TO LAUNCH THIS 523 00:20:12,680 --> 00:20:15,080 SESSION WITH MY COLLEAGUE 524 00:20:15,080 --> 00:20:24,480 DR. SALIVE FROM NIA. 525 00:20:24,480 --> 00:20:26,960 AS WE HEARD THIS MORNING 526 00:20:26,960 --> 00:20:28,680 DEMENTIA CARE IS TOO OFTEN 527 00:20:28,680 --> 00:20:32,240 CRISIS ORIENTED AND FRAGMENTED. 528 00:20:32,240 --> 00:20:33,160 FREQUENCY EMERGENCY DEPARTMENT 529 00:20:33,160 --> 00:20:35,520 VISITS AND HOSPITALIZATIONS ARE 530 00:20:35,520 --> 00:20:37,440 EXPERIENCED WITH PERSONS LIVING 531 00:20:37,440 --> 00:20:40,120 WITH DEM EDGE SHA AS WELL AS 532 00:20:40,120 --> 00:20:41,840 MULTIPLE CARE TRANSITIONS, 533 00:20:41,840 --> 00:20:43,840 PHARMACY AND POTENTIALLY HARMFUL 534 00:20:43,840 --> 00:20:44,800 MEDICATION USE. 535 00:20:44,800 --> 00:20:47,200 PEOPLE WITH DEMENTIA OFTEN 536 00:20:47,200 --> 00:20:49,840 EXPERIENCE AGGRESSIVE END OF 537 00:20:49,840 --> 00:20:51,400 LIFE CARE THAT'S OFTEN 538 00:20:51,400 --> 00:20:53,960 INCONSISTENT WITH THE PATIENT'S 539 00:20:53,960 --> 00:20:54,880 VALUES, EVEN SOMETIMES IF THE 540 00:20:54,880 --> 00:20:57,120 FORMS HAVE BEEN SIGNED AND NOT 541 00:20:57,120 --> 00:20:58,200 UPDATED IN THE ELECTRONIC HEALTH 542 00:20:58,200 --> 00:21:03,560 RECORD AS WE HEARD THIS MORNING. 543 00:21:03,560 --> 00:21:05,840 SPECIALTY CARE IS OFTEN SILOED 544 00:21:05,840 --> 00:21:07,040 WHICH PRESENTS A MAJOR PROBLEM 545 00:21:07,040 --> 00:21:10,200 IN DEMENTIA BECAUSE PATIENTS 546 00:21:10,200 --> 00:21:11,360 OFTEN HAVE MULTIPLE CHRONIC 547 00:21:11,360 --> 00:21:13,800 CONDITIONS THAT COULD BE 548 00:21:13,800 --> 00:21:16,000 DIFFICULT TO COORDINATE. 549 00:21:16,000 --> 00:21:18,800 IN FORMAL CAREGIVERS SHOULDER 550 00:21:18,800 --> 00:21:21,520 SUBSTANTIAL BURDENS WITH MINIMAL 551 00:21:21,520 --> 00:21:24,800 SUPPORT FROM OUR PATIENT-CENTRIC 552 00:21:24,800 --> 00:21:28,400 HEALTH CARE MODELS AND WE KNOW 553 00:21:28,400 --> 00:21:31,520 WHEN CAREGIVERS ARE BURDENED AND 554 00:21:31,520 --> 00:21:33,120 DEPRESSED PEOPLE WITH DEMENTIA 555 00:21:33,120 --> 00:21:34,400 USE THE EMERGENCY ROOM AND 556 00:21:34,400 --> 00:21:38,240 HOSPITAL MORE. 557 00:21:38,240 --> 00:21:43,200 TO ADDRESS THESE GAPS, NAPA 558 00:21:43,200 --> 00:21:45,800 RESEARCH MILESTONE 13.L CALLS 559 00:21:45,800 --> 00:21:48,320 FOR IMPLEMENTATION RESEARCH ON 560 00:21:48,320 --> 00:21:49,480 DEMENTIA CARE. 561 00:21:49,480 --> 00:21:52,840 SPECIFICALLY TO IMPLEMENT AND 562 00:21:52,840 --> 00:21:55,040 EVALUATE OUTCOMES FOR EFFECTIVE 563 00:21:55,040 --> 00:21:55,680 DEMENTIA CARE PROGRAMS THAT 564 00:21:55,680 --> 00:21:57,320 SUPPORT PERSONS LIVING WITH 565 00:21:57,320 --> 00:21:58,640 DEMENTIA AND THEIR CAREGIVERS 566 00:21:58,640 --> 00:22:00,960 INCLUDING THOSE OF SOCIALLY 567 00:22:00,960 --> 00:22:04,440 ETHNICALLY AND RACIALLY DIVERSE 568 00:22:04,440 --> 00:22:05,800 POPULATIONS. 569 00:22:05,800 --> 00:22:08,600 THE FIRST SUCCESS CRITERIA IS TO 570 00:22:08,600 --> 00:22:10,440 WRITE A WHITE PAPER ON PROVEN 571 00:22:10,440 --> 00:22:11,360 PROGRAMS THAT EFFECTIVELY 572 00:22:11,360 --> 00:22:13,720 SUPPORT PERSONS WITH DEMENTIA 573 00:22:13,720 --> 00:22:15,360 AND THEIR CAREGIVERS AS WELL AS 574 00:22:15,360 --> 00:22:16,880 BARRIERS TO NATIONAL 575 00:22:16,880 --> 00:22:20,560 IMPLEMENTATION OF THESE 576 00:22:20,560 --> 00:22:20,800 PROGRAMS. 577 00:22:20,800 --> 00:22:24,440 THIS HAS BEEN ACCOMPLISHED. 578 00:22:24,440 --> 00:22:27,440 NIA COMMISSIONED A NATIONAL 579 00:22:27,440 --> 00:22:32,280 ACADEMIES SUPPORT TO LOOK AT 580 00:22:32,280 --> 00:22:33,520 DEMENTIA AND CAREGIVERS AND 581 00:22:33,520 --> 00:22:35,720 INFORM DECISION MAKING ON WHAT 582 00:22:35,720 --> 00:22:38,320 SHOULD BE DISSEMINATED AND 583 00:22:38,320 --> 00:22:38,920 IMPLEMENTED AND GUIDE FUTURE 584 00:22:38,920 --> 00:22:42,160 ACTIONS AND RESEARCH. 585 00:22:42,160 --> 00:22:46,680 THE MAJOR FINDINGS FROM THIS 586 00:22:46,680 --> 00:22:47,440 SEMINOLE REPORT INCLUDE THAT 587 00:22:47,440 --> 00:22:52,240 THERE ARE INTERVENTIONS READY 588 00:22:52,240 --> 00:22:54,440 FOR IMPLEMENTATION EVIDENCE IS 589 00:22:54,440 --> 00:22:55,480 SUFFICIENT TO JUSTIFY TWO TYPES 590 00:22:55,480 --> 00:22:57,440 OF INTERVENTIONS IN A BROAD 591 00:22:57,440 --> 00:22:58,800 SPECTRUM OF COMMUNITY SETTINGS 592 00:22:58,800 --> 00:23:01,560 WITH EVALUATION CONDUCTED TO 593 00:23:01,560 --> 00:23:03,560 CONTINUE EXPANDING THE EVIDENCE 594 00:23:03,560 --> 00:23:06,600 BASE AND THESE ARE COLLABORATIVE 595 00:23:06,600 --> 00:23:08,320 CARE MODELS WHICH ADDRESS 596 00:23:08,320 --> 00:23:10,880 MEDICAL AND PSYCHOSOCIAL ASPECTS 597 00:23:10,880 --> 00:23:12,880 OF CARE IN A LONGITUDINAL WAY 598 00:23:12,880 --> 00:23:17,440 WITH THE FAMILY. 599 00:23:17,440 --> 00:23:21,800 AND MULTI-COMPONENT CAREGIVER 600 00:23:21,800 --> 00:23:22,480 SUPPORT. 601 00:23:22,480 --> 00:23:24,000 FOR EXAMPLE, REACH 2. 602 00:23:24,000 --> 00:23:25,800 ALSO A MAJOR FINDINGS WAS THAT 603 00:23:25,800 --> 00:23:30,240 GENERATING HIGH STRENGTH 604 00:23:30,240 --> 00:23:30,960 EVIDENCE USING TRADITIONAL 605 00:23:30,960 --> 00:23:32,840 METHODS FOR DEMENTIA CARE 606 00:23:32,840 --> 00:23:34,840 INTERVENTIONS IS CHALLENGING DUE 607 00:23:34,840 --> 00:23:36,680 TO THE COMPLEXITY OF THE 608 00:23:36,680 --> 00:23:37,880 INTERVENTIONS, THE DIVERSITY OF 609 00:23:37,880 --> 00:23:40,360 POPULATIONS AFFECTED AND THE 610 00:23:40,360 --> 00:23:40,880 IMPORTANCE OF CONTEXTUAL 611 00:23:40,880 --> 00:23:47,760 AFFECTS. 612 00:23:47,760 --> 00:23:52,560 TO GET US STARTED WE HAVE THE 613 00:23:52,560 --> 00:23:55,200 PLEASURE OF HEARING FROM ERIC 614 00:23:55,200 --> 00:23:55,560 LARSON. 615 00:23:55,560 --> 00:24:05,760 DR. LARSON. 616 00:24:10,080 --> 00:24:12,600 >>YOU HAVE THE REPORT. 617 00:24:12,600 --> 00:24:15,680 I DID CHAIR CHAIR GROUP AND THIS 618 00:24:15,680 --> 00:24:16,640 IS THE COVER OF THE REPORT. 619 00:24:16,640 --> 00:24:19,240 I WANT TO HIGHLIGHT THE WORDS IN 620 00:24:19,240 --> 00:24:25,640 THE BOTTOM A WAY FORWARD. 621 00:24:25,640 --> 00:24:31,840 THAT'S WHAT WE WANTED TO SAY SAY 622 00:24:31,840 --> 00:24:39,120 IN THE REPORT. 623 00:24:39,120 --> 00:24:40,240 WE WORKED HARD TOGETHER AND WERE 624 00:24:40,240 --> 00:24:41,320 SUPPORTED BY THE NATIONAL 625 00:24:41,320 --> 00:24:44,520 ACADEMY STAFF. 626 00:24:44,520 --> 00:24:46,720 A GROUP OF ADVISORS TO OUR 627 00:24:46,720 --> 00:24:48,360 COMMITTEE AND THERE'S A MIXTURE 628 00:24:48,360 --> 00:24:52,000 OF MOSTLY PEOPLE LIVING WITH 629 00:24:52,000 --> 00:24:55,560 DEMENTIA OR CARE PARTNER AND 630 00:24:55,560 --> 00:24:58,560 ACTION ORIENTED GROUP THAT WORK 631 00:24:58,560 --> 00:25:00,040 CLOSELY WITH US. 632 00:25:00,040 --> 00:25:01,400 AND THE STUDY MODEL WAS AN 633 00:25:01,400 --> 00:25:02,720 INTERESTING ONE. 634 00:25:02,720 --> 00:25:04,840 I PARTICIPATED IN MANY STUDIES 635 00:25:04,840 --> 00:25:07,840 WITH THE ACADEMIES BUT THIS ONE 636 00:25:07,840 --> 00:25:10,280 INVOLVED TWO PHASES. 637 00:25:10,280 --> 00:25:20,040 THE FIRST WAS THE AHRQ 638 00:25:20,040 --> 00:25:22,080 SYSTEMATIC REVIEW AND FOUND 227 639 00:25:22,080 --> 00:25:23,440 STUDIES. 640 00:25:23,440 --> 00:25:24,600 THE KEY POINT IS THAT THOUGH 641 00:25:24,600 --> 00:25:28,440 THERE WERE LOTS OF STUDIES AND 642 00:25:28,440 --> 00:25:33,200 WORK DONE ON THE TOPIC AND THE 643 00:25:33,200 --> 00:25:37,000 QUALITY OF EVIDENCE WAS TO BE 644 00:25:37,000 --> 00:25:37,480 INSUFFICIENT FOR MOST 645 00:25:37,480 --> 00:25:47,160 INTERVENTIONS. 646 00:25:47,160 --> 00:25:49,920 AND THE ABSENCE OF EVIDENCE AND 647 00:25:49,920 --> 00:25:52,400 THE PRESENCE OF INSUFFICIENT 648 00:25:52,400 --> 00:25:53,720 EVIDENCE IS NOT EVIDENCE THAT 649 00:25:53,720 --> 00:26:02,680 THAT BENEFIT IS ABSENT. 650 00:26:02,680 --> 00:26:07,080 AND THE OTHER POINT TO MENTION 651 00:26:07,080 --> 00:26:08,760 HERE IS THAT THE COMMITTEE HAS 652 00:26:08,760 --> 00:26:10,320 IN THE REPORT THE NOTION THAT 653 00:26:10,320 --> 00:26:14,000 ONE OF THE ADVANCES OF OUR 654 00:26:14,000 --> 00:26:15,840 RESEARCH COMMUNITY IN THIS CARE 655 00:26:15,840 --> 00:26:21,800 HAS BEEN AVOIDING HARM. 656 00:26:21,800 --> 00:26:22,920 UNFORTUNATELY WE DON'T DO AS 657 00:26:22,920 --> 00:26:25,080 GOOD A JOB AS WE WANT TO DO SO 658 00:26:25,080 --> 00:26:26,280 THAT CHALLENGE IS STILL THERE 659 00:26:26,280 --> 00:26:28,920 BUT THERE HAS BEEN PROGRESS 660 00:26:28,920 --> 00:26:29,120 THERE. 661 00:26:29,120 --> 00:26:32,440 THE SECOND PHASE OF OUR STUDY 662 00:26:32,440 --> 00:26:35,240 STARTED IN SEPTEMBER AFTER THE 663 00:26:35,240 --> 00:26:37,800 REVIEW AND WHAT YOU'LL NOTE HERE 664 00:26:37,800 --> 00:26:41,160 IS THE START OF OUR WORK BEGAN 665 00:26:41,160 --> 00:26:42,840 BEFORE THE LOCKDOWN. 666 00:26:42,840 --> 00:26:44,240 THE COMMITTEE BASICALLY WORKED 667 00:26:44,240 --> 00:26:54,560 MOSTLY VIRTUALLY. 668 00:26:54,920 --> 00:26:57,480 AND THE POINT OF THIS SLIDE IS 669 00:26:57,480 --> 00:26:58,480 THE COMMITTEE RECOGNIZED EARLY 670 00:26:58,480 --> 00:26:59,960 ON AND THIS IS WHY THE RESEARCH 671 00:26:59,960 --> 00:27:07,520 IN THIS AREA IS SO CHALLENGE CH 672 00:27:07,520 --> 00:27:12,960 THERE'S A COMPLEXITY OF CARE 673 00:27:12,960 --> 00:27:14,360 INTERVENTIONS AND THEY CAN OCCUR 674 00:27:14,360 --> 00:27:15,760 AT THE FOUR LEVELS AND TEND TO 675 00:27:15,760 --> 00:27:19,800 FOCUS ON THE INDIVIDUAL AND 676 00:27:19,800 --> 00:27:21,040 FAMILY LEVELS AND SOCIETAL AND 677 00:27:21,040 --> 00:27:21,840 COMMUNITY LEVELS ARE IMPORTANT 678 00:27:21,840 --> 00:27:26,720 AND THE OTHER POINT IS THAT THE 679 00:27:26,720 --> 00:27:28,360 COMPLEXITY OF THE CONDITION FOR 680 00:27:28,360 --> 00:27:31,480 SO MANY LIVING WITH DEMENTIA IS 681 00:27:31,480 --> 00:27:31,800 HETEROGENOUS. 682 00:27:31,800 --> 00:27:35,440 IT GOES THROUGH PHASES AND 683 00:27:35,440 --> 00:27:37,360 DIFFERENT STAGES, IF YOU WILL. 684 00:27:37,360 --> 00:27:40,720 EQUALLY IMPORTANT IS THE 685 00:27:40,720 --> 00:27:42,080 COMPLEXITY OF WHERE THAT CARE IS 686 00:27:42,080 --> 00:27:43,920 DELIVERED IN THE COURSE OF THE 687 00:27:43,920 --> 00:27:49,760 DISEASE. 688 00:27:49,760 --> 00:27:53,360 THIS IS SOMETHING I HOPE YOU 689 00:27:53,360 --> 00:27:54,840 HEARD THROUGH THE SYMPOSIUM. 690 00:27:54,840 --> 00:27:56,360 THESE ARE THINGS WE THINK ARE 691 00:27:56,360 --> 00:27:57,400 MOST IMPORTANT. 692 00:27:57,400 --> 00:27:58,640 THEY'RE NOT IN ANY ORDER. 693 00:27:58,640 --> 00:28:01,560 THEY'RE ALL IMPORTANT AND THE 694 00:28:01,560 --> 00:28:05,640 GUIDING PRINCIPLES IDENTIFIED AS 695 00:28:05,640 --> 00:28:06,560 PERSON-CENTEREDNESS, PROMOTION 696 00:28:06,560 --> 00:28:11,360 OF WELL BEING, RESPECT AND 697 00:28:11,360 --> 00:28:15,800 DIGNITY, CULTURAL AND LINGUISTIC 698 00:28:15,800 --> 00:28:17,360 INCLUSIVITY AND AFFORDABILITY. 699 00:28:17,360 --> 00:28:18,920 COMPONENTS ARE LISTED HERE AND 700 00:28:18,920 --> 00:28:20,160 THESE ARE THINGS YOU HEARD BUT 701 00:28:20,160 --> 00:28:22,600 I'LL MAKE THE POINT THAT THIS IS 702 00:28:22,600 --> 00:28:28,000 NOT LAST BUT NOT LEAST OF THE 703 00:28:28,000 --> 00:28:29,120 LIST BUT IT'S ALL AREAS WHERE 704 00:28:29,120 --> 00:28:30,400 COMPONENTS OF CARE ARE 705 00:28:30,400 --> 00:28:31,560 IMPORTANT. 706 00:28:31,560 --> 00:28:32,480 DETECTION, DIAGNOSIS, 707 00:28:32,480 --> 00:28:34,160 INFORMATION, MEDICAL MANAGEMENT, 708 00:28:34,160 --> 00:28:37,280 SUPPORT IN ADLs, SUPPORT FOR 709 00:28:37,280 --> 00:28:40,080 CARE PARTNERS AND CAREGIVERS, 710 00:28:40,080 --> 00:28:44,800 COMMUNICATION AND COLLABORATION, 711 00:28:44,800 --> 00:28:45,720 COORDINATION OF LONG-TERM 712 00:28:45,720 --> 00:28:47,640 SERVICES AND SUPPORTIVE AND SAFE 713 00:28:47,640 --> 00:28:48,400 ENVIRONMENTS AND ADVANCED CARE 714 00:28:48,400 --> 00:28:57,560 PLANNING AND END OF LIFE CARE. 715 00:28:57,560 --> 00:29:00,400 THESE ARE STRAIGHTFORWARD AND WE 716 00:29:00,400 --> 00:29:02,200 IDENTIFIED NO INTERVENTIONS THAT 717 00:29:02,200 --> 00:29:07,720 HAD HIGH QUALITY STRENGTH OF 718 00:29:07,720 --> 00:29:17,920 EVIDENCE. 719 00:29:18,520 --> 00:29:23,560 THESE ARE WHERE WE AS A SOCIETY 720 00:29:23,560 --> 00:29:24,320 DECIDE EVERYBODY SHOULD BE 721 00:29:24,320 --> 00:29:25,880 SCREENED AND THE MODELS WERE 722 00:29:25,880 --> 00:29:29,200 COLLABORATIVE CARE AND THE 723 00:29:29,200 --> 00:29:30,600 ADAPTATIONS OF REACH II AND WE 724 00:29:30,600 --> 00:29:31,800 FEEL THOSE ARE READY TO GO 725 00:29:31,800 --> 00:29:41,040 FORWARD AND BE IMPLEMENTED. 726 00:29:41,040 --> 00:29:43,560 THERE'S A TAKE OFF ON THE CARE 727 00:29:43,560 --> 00:29:44,680 MODEL DEVELOPED FOR MANY CHRONIC 728 00:29:44,680 --> 00:29:49,920 DISEASES ESPECIALLY LATE LIFE 729 00:29:49,920 --> 00:29:52,200 CHRONIC DISEASES AND IT INVOLVES 730 00:29:52,200 --> 00:29:53,640 MULTIPLE COMPONENTS AND 731 00:29:53,640 --> 00:29:55,320 DEVELOPMENT OF CARE PLANS AND 732 00:29:55,320 --> 00:29:57,600 TRACKING AND PROVIDER 733 00:29:57,600 --> 00:29:57,960 COLLABORATIONS. 734 00:29:57,960 --> 00:29:59,560 THESE ARE OPERATIONALIZING MANY 735 00:29:59,560 --> 00:30:00,560 OF THE CARE COMPONENTS WE TALKED 736 00:30:00,560 --> 00:30:03,960 ABOUT EARLIER. 737 00:30:03,960 --> 00:30:04,960 AND THE EVIDENCE SHOWS THESE 738 00:30:04,960 --> 00:30:08,240 PROGRAMS DO IMPROVE QUALITY OF 739 00:30:08,240 --> 00:30:09,800 LIFE, QUALITY INDICATORS AND 740 00:30:09,800 --> 00:30:10,360 FREQUENCY OF EMERGENCY ROOM 741 00:30:10,360 --> 00:30:12,920 VISITS. 742 00:30:12,920 --> 00:30:15,800 THE NEXT SLIDE WE CALL THE REACH 743 00:30:15,800 --> 00:30:18,240 II AND ITS ADAPTATION. 744 00:30:18,240 --> 00:30:19,560 THIS IS A MULTI-COMPONENT 745 00:30:19,560 --> 00:30:21,080 INTERVENTION FOR CARE PARTNERS 746 00:30:21,080 --> 00:30:22,800 AND CAREGIVERS. 747 00:30:22,800 --> 00:30:24,840 AND THESE INTERVENTIONS 748 00:30:24,840 --> 00:30:27,480 GENERALLY HAVE SEVEN COMPONENTS, 749 00:30:27,480 --> 00:30:29,560 PROBLEM SOLVING, SKILLS 750 00:30:29,560 --> 00:30:33,360 TRAINING, STRESS MANAGEMENT, 751 00:30:33,360 --> 00:30:35,200 PROVISION OF INFORMATION, 752 00:30:35,200 --> 00:30:38,040 DIDACTIC INSTRUCTION AND ROLE 753 00:30:38,040 --> 00:30:40,680 PLAYING AND REDUCE CAREGIVER 754 00:30:40,680 --> 00:30:41,000 DEPRESSION. 755 00:30:41,000 --> 00:30:42,280 SHE'S ARE OUR RECOMMENDATIONS. 756 00:30:42,280 --> 00:30:43,120 I'LL GO THROUGH THEM QUICKLY 757 00:30:43,120 --> 00:30:45,600 BECAUSE YOU CAN EASILY READ THEM 758 00:30:45,600 --> 00:30:47,400 THE FIRST IS THE IMPLEMENT AND 759 00:30:47,400 --> 00:30:49,560 EVALUATE THE OUTCOMES FOR 760 00:30:49,560 --> 00:30:52,000 COLLABORATIVE CARE MODELS IN 761 00:30:52,000 --> 00:30:53,840 MULTIPLE REAL WORLD SETTINGS. 762 00:30:53,840 --> 00:30:55,920 THE POINT IS WE WANT TO BE A 763 00:30:55,920 --> 00:30:57,200 PRACTICAL WAY FORWARD. 764 00:30:57,200 --> 00:31:01,760 IN THE PROCESS OF IMPLEMENTING 765 00:31:01,760 --> 00:31:04,240 PEOPLE SHOULD BE EXAMINING THE 766 00:31:04,240 --> 00:31:05,800 FACTORS IMPORTANT FOR 767 00:31:05,800 --> 00:31:06,560 DETERMINING HOW TO IMPLEMENT AN 768 00:31:06,560 --> 00:31:08,880 INTERVENTION. 769 00:31:08,880 --> 00:31:11,400 THE SECOND RECOMMENDATION IS A 770 00:31:11,400 --> 00:31:13,160 MIRROR OF THE FIRST. 771 00:31:13,160 --> 00:31:15,840 PRACTICAL WAY FORWARD TO 772 00:31:15,840 --> 00:31:18,480 IMPLEMENT REACH II THE WORLD OF 773 00:31:18,480 --> 00:31:20,600 CAREGIVER SUPPORT AND CARE 774 00:31:20,600 --> 00:31:23,040 PARTNER SUPPORT AND IDENTIFY THE 775 00:31:23,040 --> 00:31:25,360 PRACTICAL ISSUES LIKE WORKFORCE 776 00:31:25,360 --> 00:31:27,120 AND SPACE NEEDS, PAYMENT MODELS, 777 00:31:27,120 --> 00:31:31,080 INTEGRATION AND SO FORTH. 778 00:31:31,080 --> 00:31:32,560 AGAIN, A WAY FORWARD BECAUSE 779 00:31:32,560 --> 00:31:33,440 THERE IS DEFINITELY A WAY 780 00:31:33,440 --> 00:31:36,280 FORWARD. 781 00:31:36,280 --> 00:31:42,800 OUR NEXT SLIDE IS OUR FINAL 782 00:31:42,800 --> 00:31:43,160 THOUGHTS. 783 00:31:43,160 --> 00:31:48,920 AND NEXT SLIDE IS THE OTHER 784 00:31:48,920 --> 00:31:51,720 THREE RECOMMENDATIONS AND USE 785 00:31:51,720 --> 00:31:53,440 INFORMATIVE METHODS AND THIS 786 00:31:53,440 --> 00:31:55,840 ALREADY HAS BEEN IMPLEMENTED TO 787 00:31:55,840 --> 00:31:58,680 SOME EXTENT BY NIA THROUGH THE 788 00:31:58,680 --> 00:32:01,560 IMPACT COLLABORATORY. 789 00:32:01,560 --> 00:32:04,520 PRIORITIZING INCLUSIVE RESEARCH 790 00:32:04,520 --> 00:32:06,800 AND AGAIN THIS TAKES EFFORT 791 00:32:06,800 --> 00:32:09,120 BECAUSE IT DOES NOT HAPPEN 792 00:32:09,120 --> 00:32:09,680 NATURALLY. 793 00:32:09,680 --> 00:32:11,960 ALL RESEARCH IN THIS FIELD IS 794 00:32:11,960 --> 00:32:15,040 INCLUSIVE AND TAKES OUTREACH TO 795 00:32:15,040 --> 00:32:18,600 GET RACIALLY ETHICAL, CULTURALLY 796 00:32:18,600 --> 00:32:19,920 LINGUISTIC DIVERSE PARTICIPANTS 797 00:32:19,920 --> 00:32:21,840 BY THE NATURE OF OUR SOCIETY. 798 00:32:21,840 --> 00:32:24,480 AND LASTLY THIS NOTION OF 799 00:32:24,480 --> 00:32:25,640 ASSESSING REAL-WORLD 800 00:32:25,640 --> 00:32:29,800 EFFECTIVENESS IS VERY IMPORTANT. 801 00:32:29,800 --> 00:32:31,960 AND AGAIN THE PRAGMATIC CLINICAL 802 00:32:31,960 --> 00:32:33,080 TRIALS EMPHASIZE THAT. 803 00:32:33,080 --> 00:32:36,720 AND THE NEXT SLIDE IS MY FINAL 804 00:32:36,720 --> 00:32:36,960 THOUGHTS. 805 00:32:36,960 --> 00:32:38,640 I CAN JUST READ THESE OFF BUT I 806 00:32:38,640 --> 00:32:40,120 THINK YOU'LL SEE THEY FLOW FROM 807 00:32:40,120 --> 00:32:42,840 THE EARLIER PARTS OF THE REPORT. 808 00:32:42,840 --> 00:32:44,040 WE WANT TO PROVIDE COLLABORATIVE 809 00:32:44,040 --> 00:32:46,440 CARE INTERVENTIONS AND REACH II 810 00:32:46,440 --> 00:32:49,000 NOW FOR THOSE WHO WOULD BENEFIT 811 00:32:49,000 --> 00:32:50,200 AND THAT WOULD REPRESENT REAL 812 00:32:50,200 --> 00:32:50,480 PROGRESS. 813 00:32:50,480 --> 00:32:55,680 BUT AT THE SAME TIME THERE'S AN 814 00:32:55,680 --> 00:32:59,320 EVEN MORE A MORE ROBUST EVIDENCE 815 00:32:59,320 --> 00:33:01,840 BASE IS NEEDED TO GUIDE THE 816 00:33:01,840 --> 00:33:03,880 FIELD AND LEARN MORE AND 817 00:33:03,880 --> 00:33:05,400 DISCOVER MORE ABOUT BETTER WAYS 818 00:33:05,400 --> 00:33:09,760 TO IMPROVE CARE AND WELL BEING. 819 00:33:09,760 --> 00:33:11,360 OTHER INTERVENTIONS THAT HAVE 820 00:33:11,360 --> 00:33:13,120 SHOWN SIGNALS TO HAVE BENEFIT 821 00:33:13,120 --> 00:33:14,720 SHOULD BE DEVELOPED AND 822 00:33:14,720 --> 00:33:16,600 EVALUATED AND SOME WOULD BE NEW 823 00:33:16,600 --> 00:33:18,040 AND SOME COULD BE DRAWN FROM THE 824 00:33:18,040 --> 00:33:21,520 RESEARCH BASE. 825 00:33:21,520 --> 00:33:23,320 AND THERE'S AN OPPORTUNITY TO 826 00:33:23,320 --> 00:33:25,280 IMPLEMENT NEW METHODS AND 827 00:33:25,280 --> 00:33:26,120 APPROACHES IN THE FIELD 828 00:33:26,120 --> 00:33:27,480 INCLUDING THROUGH ENGAGING EARLY 829 00:33:27,480 --> 00:33:29,840 CAREER RESEARCHERS AND BUILDING 830 00:33:29,840 --> 00:33:32,200 THE MORE ROBUST USEFUL AND 831 00:33:32,200 --> 00:33:34,680 INCLUSIVE EVIDENCE BASE TO 832 00:33:34,680 --> 00:33:36,760 SUPPORT THE WELL-BEING OF THOSE 833 00:33:36,760 --> 00:33:39,080 LIVING WITH DEMENTIA AND CARE 834 00:33:39,080 --> 00:33:39,360 PARTNERS. 835 00:33:39,360 --> 00:33:41,040 NIA AND OTHERS ARE IN THE FIELD 836 00:33:41,040 --> 00:33:43,320 AND WE THINK IT'S AN IMPORTANT 837 00:33:43,320 --> 00:33:46,200 PART OF THIS WORK. 838 00:33:46,200 --> 00:33:47,600 THE IMPACT COLLABORATIVE, FOR 839 00:33:47,600 --> 00:33:48,800 EXAMPLE, IS FINDING WAYS TO 840 00:33:48,800 --> 00:33:50,560 BRING MORE PEOPLE INTO THE FIELD 841 00:33:50,560 --> 00:33:52,720 BOTH AT ALL LEVELS, JUNIOR AND 842 00:33:52,720 --> 00:33:55,080 MID AND SENIOR CAREER. 843 00:33:55,080 --> 00:33:55,840 SO THANK YOU VERY MUCH. 844 00:33:55,840 --> 00:33:59,400 I WANT TO CLOSE BY THANKING 845 00:33:59,400 --> 00:34:02,080 COMMITTEE WHO PULLED ALL THIS 846 00:34:02,080 --> 00:34:05,120 TOGETHER IN THE FINAL SLIDE. 847 00:34:05,120 --> 00:34:07,200 IT'S A FINAL SLIDE FOR THAT 848 00:34:07,200 --> 00:34:07,600 MATTER. 849 00:34:07,600 --> 00:34:17,760 THANK YOU. 850 00:34:30,600 --> 00:34:32,160 >>I'M DAVE RUBEN AND WOULD LIKE 851 00:34:32,160 --> 00:34:34,000 TO START WITH BACKGROUND. 852 00:34:34,000 --> 00:34:36,360 IN 2017 UCLA HAD AN ACCOUNTABLE 853 00:34:36,360 --> 00:34:36,880 CARE ORGANIZATION. 854 00:34:36,880 --> 00:34:38,240 FOR SOME REASON OR ANOTHER THEY 855 00:34:38,240 --> 00:34:40,800 WERE INTERESTED IN LOOKING AT 856 00:34:40,800 --> 00:34:43,480 THEIR DEMENTIA PATIENTS IN THE 857 00:34:43,480 --> 00:34:43,680 ACO. 858 00:34:43,680 --> 00:34:46,760 THEY PRESENTED THIS MODEL TO ME 859 00:34:46,760 --> 00:34:52,520 WHERE THE 5,000 PATIENTS AT UCLA 860 00:34:52,520 --> 00:34:54,640 WHO HAD DEMENTIA WERE SEPARATED 861 00:34:54,640 --> 00:34:56,320 INTO FIVE TIERS. 862 00:34:56,320 --> 00:34:59,560 THE TOP TIER REPRESENTED THE TOP 863 00:34:59,560 --> 00:35:02,880 1% AND CLASSIFIED THESE ON 864 00:35:02,880 --> 00:35:04,800 UTILIZATION AND THESE WERE VERY 865 00:35:04,800 --> 00:35:06,680 HIGH UTILIZERS. 866 00:35:06,680 --> 00:35:12,280 $186,000 A YEAR OR MORE. 867 00:35:12,280 --> 00:35:14,320 THE NEXT TIER WERE HIGH UTILIZED 868 00:35:14,320 --> 00:35:17,600 $65,000 A YEAR OR MORE. 869 00:35:17,600 --> 00:35:19,760 THE THIRD TIER ALSO HIGH 870 00:35:19,760 --> 00:35:22,320 UTILIZERS, $20,000 A YEAR OR 871 00:35:22,320 --> 00:35:22,520 MORE. 872 00:35:22,520 --> 00:35:23,720 AND INTERESTINGLY ENOUGH THE 873 00:35:23,720 --> 00:35:29,120 FOURTH AND FIFTH TIER THE BOTTOM 874 00:35:29,120 --> 00:35:30,120 80% ACTUALLY USED HEALTH CARE 875 00:35:30,120 --> 00:35:31,040 LESS THAN THE AVERAGE MEDICARE 876 00:35:31,040 --> 00:35:33,200 BENEFICIARY. 877 00:35:33,200 --> 00:35:36,400 SO WE LOOKED BACK UP AT THE TOP 878 00:35:36,400 --> 00:35:40,040 TIER AND ACTUALLY REVIEWED THE 879 00:35:40,040 --> 00:35:42,320 CHARTS AND THEY ARE PEOPLE WHO 880 00:35:42,320 --> 00:35:45,240 HAD BEHAVIORAL PROBLEMS, SEVERE 881 00:35:45,240 --> 00:35:46,880 FUNCTIONAL IMPAIRMENT AND 882 00:35:46,880 --> 00:35:49,920 MINIMAL RESOURCES FOR THEM AND 883 00:35:49,920 --> 00:35:51,680 MANY CO-MORBIDITIES WHICH WERE 884 00:35:51,680 --> 00:35:54,800 THE REASON WHY MANY WERE 885 00:35:54,800 --> 00:35:55,600 HOSPITALIZED. 886 00:35:55,600 --> 00:35:59,040 AND AS YOU SEE IN THE BOTTOM 887 00:35:59,040 --> 00:36:05,000 TIERS THEY TYPICALLY HAD MILD 888 00:36:05,000 --> 00:36:11,400 DEMENTIA AND RECEIVING ROUTINE 889 00:36:11,400 --> 00:36:17,840 A 890 00:36:17,840 --> 00:36:20,960 AND FOCUSES ON PATIENT AND 891 00:36:20,960 --> 00:36:25,080 CAREGIVERS AND INCLUDES EIGHT 892 00:36:25,080 --> 00:36:26,000 ELEMENTS THAT WERE OUTLINED IN 893 00:36:26,000 --> 00:36:28,080 HEALTH AFFAIRS A COUPLE YEARS 894 00:36:28,080 --> 00:36:30,920 AGO AND CONTINUOUS MONITORING 895 00:36:30,920 --> 00:36:34,200 AND ASSESSMENT AND ONGOING CARE 896 00:36:34,200 --> 00:36:35,760 PLANS, PSYCHO, SOCIAL 897 00:36:35,760 --> 00:36:36,480 INTERVENTIONS AIMED AT THE 898 00:36:36,480 --> 00:36:41,400 PERSON LIVING WITH DEMENTIA AND 899 00:36:41,400 --> 00:36:43,840 THEIR CAREGIVERS, 900 00:36:43,840 --> 00:36:44,840 SELF-MANAGEMENT, MEDICATION 901 00:36:44,840 --> 00:36:46,920 MANAGEMENT THOUGH SOME 902 00:36:46,920 --> 00:36:48,400 COMMUNITY-BASED SYSTEMS DON'T. 903 00:36:48,400 --> 00:36:50,400 TREATMENT OF RELATED CONDITIONS 904 00:36:50,400 --> 00:36:51,560 IMPORTANT TO PREVENT 905 00:36:51,560 --> 00:36:52,040 HOSPITALIZATIONS AND 906 00:36:52,040 --> 00:36:58,360 COORDINATION OF CARE. 907 00:36:58,360 --> 00:37:00,880 TO DATE SIX MODELS HAVE EVIDENCE 908 00:37:00,880 --> 00:37:04,240 BASED BASE FOR THEM AND WE 909 00:37:04,240 --> 00:37:07,120 RECLASSIFIED THEM BUT SHOULD BE 910 00:37:07,120 --> 00:37:09,680 NOTED VIRTUALLY ALL ARE 911 00:37:09,680 --> 00:37:12,160 IMPLEMENTED NOW IN HEALTH CARE 912 00:37:12,160 --> 00:37:12,400 SYSTEMS. 913 00:37:12,400 --> 00:37:14,880 THE B.R.I. CONSULTATION MODEL IS 914 00:37:14,880 --> 00:37:19,480 BASED AT A COMMUNITY-BASED 915 00:37:19,480 --> 00:37:21,040 ORGANIZATION AND THE TELEPHONE 916 00:37:21,040 --> 00:37:24,600 DELIVERED GENERALLY BY SOCIAL 917 00:37:24,600 --> 00:37:24,840 WORKERS. 918 00:37:24,840 --> 00:37:26,800 THE MIND AT HOME PROGRAM IS 919 00:37:26,800 --> 00:37:30,760 DELIVERED AT HOME USUALLY BY 920 00:37:30,760 --> 00:37:33,680 NON-CLINICAL COMMUNITY WORKERS 921 00:37:33,680 --> 00:37:37,120 SUPPORTED BY NURSES AND A 922 00:37:37,120 --> 00:37:37,640 GERIATRIC PSYCHIATRIST. 923 00:37:37,640 --> 00:37:41,760 THE CARE ECO SYSTEM IS DELIVERED 924 00:37:41,760 --> 00:37:42,520 BY TELEPHONE. 925 00:37:42,520 --> 00:37:43,240 USUALLY BASED IN A HEALTH CARE 926 00:37:43,240 --> 00:37:46,440 SYSTEM AND THERE'S AN A 927 00:37:46,440 --> 00:37:48,800 NON-LICENSED CARE NAVIGATOR AND 928 00:37:48,800 --> 00:37:54,120 NURSE AND PHYSICIAN BACK UP. 929 00:37:54,120 --> 00:37:56,480 INDIANA UNIVERSITY HEALTHY AGE 930 00:37:56,480 --> 00:38:01,720 BRAIN CENTER ONE OF THE GRAND 931 00:38:01,720 --> 00:38:12,200 DAD WAS AND SOME WORK WITH 932 00:38:19,960 --> 00:38:21,960 PRIMARY CARE PHYSICIANS AND 933 00:38:21,960 --> 00:38:24,840 THESE TEND TO BE NURSE 934 00:38:24,840 --> 00:38:26,880 PRACTITIONERS OR PHYSICIAN 935 00:38:26,880 --> 00:38:29,840 ASSISTANT AND THE INTEGRATED 936 00:38:29,840 --> 00:38:33,000 MEMORY CARE PROGRAM A NURSE 937 00:38:33,000 --> 00:38:34,560 PRACTITIONER PRIMARY CARE PERSON 938 00:38:34,560 --> 00:38:38,960 OF PERSONS LIVING WITH DEMENTIA. 939 00:38:38,960 --> 00:38:41,080 SO THESE MODELS DIFFER. 940 00:38:41,080 --> 00:38:42,320 THEY DIFFER IN THE STAFFING, THE 941 00:38:42,320 --> 00:38:44,320 BASE OF OPERATION, THE SCOPE OF 942 00:38:44,320 --> 00:38:47,520 SERVICES, THE INTENSITY OF THE 943 00:38:47,520 --> 00:38:51,760 SERVICES, COST, EFFICACY AND 944 00:38:51,760 --> 00:38:52,680 EFFECTIVENESS, POTENTIAL RETURN 945 00:38:52,680 --> 00:38:54,160 ON INVESTMENT AND LEVEL OF 946 00:38:54,160 --> 00:38:54,400 EVIDENCE. 947 00:38:54,400 --> 00:39:00,280 ONLY A FEW OF THEM HAVE 948 00:39:00,280 --> 00:39:01,080 RANDOMIZED CLINICAL TRIAL DATA 949 00:39:01,080 --> 00:39:02,520 BUT ALL HAVE DATA SUPPORTING 950 00:39:02,520 --> 00:39:07,160 THEM AND ALL TERRIFIC MODELS. 951 00:39:07,160 --> 00:39:09,600 AND THIS COMPARES THE MODELS 952 00:39:09,600 --> 00:39:12,120 FROM THE LEFT SIDE PROBABLY 953 00:39:12,120 --> 00:39:15,560 CONSIDERED THE LEAST EXPENSIVE 954 00:39:15,560 --> 00:39:17,200 AND INTENSIVE TO THE RIGHT SIDE 955 00:39:17,200 --> 00:39:27,680 WHICH IS THE MOST EXPENSIVE. 956 00:39:29,880 --> 00:39:31,800 BACK TO OUR POPULATION DEMENTIA 957 00:39:31,800 --> 00:39:32,600 CARE MODEL. 958 00:39:32,600 --> 00:39:34,480 SO HERE ON THE RIGHT-HAND SIDE 959 00:39:34,480 --> 00:39:37,640 YOU MIGHT LOOK AT THE TYPES OF 960 00:39:37,640 --> 00:39:40,040 INTERVENTIONS FOR DIFFERENT 961 00:39:40,040 --> 00:39:42,240 TYPES OF PERSONS LIVING WITH 962 00:39:42,240 --> 00:39:42,680 DEMENTIA. 963 00:39:42,680 --> 00:39:45,800 FOR THOSE VERY HIGHEST UTILIZERS 964 00:39:45,800 --> 00:39:49,600 AND SICKEST FOLKS AND MORE 965 00:39:49,600 --> 00:39:51,400 INTENSIVE DEMENTIA CARE PROGRAM 966 00:39:51,400 --> 00:39:57,080 AND CARE PLANNING AND PALLIATIVE 967 00:39:57,080 --> 00:40:02,200 CARE FOR THE 2% TO 20% A MORE 968 00:40:02,200 --> 00:40:04,000 INTENSIVE CARE PROGRAM OR LESS 969 00:40:04,000 --> 00:40:05,000 INTENSIVE CARE PROGRAM WITH 970 00:40:05,000 --> 00:40:07,720 INCREASED SOCIAL SERVICES AND 971 00:40:07,720 --> 00:40:12,880 THEN THE BOTTOM 80% MIGHT BE 972 00:40:12,880 --> 00:40:14,920 MORE INFORMATION AND REFERRAL 973 00:40:14,920 --> 00:40:16,280 SYSTEMS SUCH AS DELIVERED 974 00:40:16,280 --> 00:40:19,560 THROUGH THE ACL PROGRAMS. 975 00:40:19,560 --> 00:40:22,320 AND/OR THEY MAY HAVE LESS 976 00:40:22,320 --> 00:40:23,000 INTENSIVE DEMENTIA CARE 977 00:40:23,000 --> 00:40:28,200 PROGRAMS. 978 00:40:28,200 --> 00:40:37,080 IN OCTOBER 22, JOHN A. HARTFORD 979 00:40:37,080 --> 00:40:38,840 FOUNDATION LOOKED AT MODELS AND 980 00:40:38,840 --> 00:40:41,480 FIVE RECOMMENDATIONS CAME OUT OF 981 00:40:41,480 --> 00:40:41,800 IT. 982 00:40:41,800 --> 00:40:45,440 THE PAYMENT MODEL SHOULD PROVIDE 983 00:40:45,440 --> 00:40:46,640 COMPREHENSIVE DEMENTIA CARE WITH 984 00:40:46,640 --> 00:40:48,680 QUALITY OUTCOME MEASURES. 985 00:40:48,680 --> 00:40:51,480 IT SHOULD ADDRESS BENEFICIARY 986 00:40:51,480 --> 00:40:54,320 AND CAREGIVER NEEDS AS A DIAD. 987 00:40:54,320 --> 00:40:57,160 TO BE ELIGIBLE, BENEFICIARIES 988 00:40:57,160 --> 00:41:00,400 MUST HAVE A DIAGNOSIS OF 989 00:41:00,400 --> 00:41:03,280 DEMENTIA. 990 00:41:03,280 --> 00:41:06,560 IF NOT A DIAGNOSIS OF MCI BUT 991 00:41:06,560 --> 00:41:13,680 PERSONS LIVING WITH DEM SEAN -- 992 00:41:13,680 --> 00:41:15,840 DEMENTIA AND THOSE AVAILABLE TO 993 00:41:15,840 --> 00:41:18,200 THOSE IN RURAL AREAS WHO HAVE 994 00:41:18,200 --> 00:41:19,640 DIFFICULTY ACCESSING CARE AND 995 00:41:19,640 --> 00:41:21,800 THE PAYMENT MODEL SHOULD BE 996 00:41:21,800 --> 00:41:22,760 CAPITATED BASED ON SEVERITY OF 997 00:41:22,760 --> 00:41:23,280 SYMPTOMS AND AVAILABLE 998 00:41:23,280 --> 00:41:25,880 RESOURCES. 999 00:41:25,880 --> 00:41:28,000 THIS IS HOW IT MIGHT WORK. 1000 00:41:28,000 --> 00:41:30,320 THE DIAGNOSIS OF DEMENTIA WOULD 1001 00:41:30,320 --> 00:41:33,120 BE CONFIRMED AND PEOPLE WOULD BE 1002 00:41:33,120 --> 00:41:34,520 CLASSIFIED IN ONE OF THREE 1003 00:41:34,520 --> 00:41:35,160 CATEGORIES. 1004 00:41:35,160 --> 00:41:39,440 PATHWAY ONE, MILD DEMENTIA. 1005 00:41:39,440 --> 00:41:40,960 IN THAT CASE THEY WOULD RECEIVE 1006 00:41:40,960 --> 00:41:43,920 EDUCATION, SUPPORT, REFERRAL TO 1007 00:41:43,920 --> 00:41:44,560 COMMUNITY-BASED SERVICES AND 1008 00:41:44,560 --> 00:41:47,240 CARE NAVIGATORS. 1009 00:41:47,240 --> 00:41:49,920 PATHWAY 2, MODERATE OR SEVERE 1010 00:41:49,920 --> 00:41:52,480 DEMENTIA BUT HAVING SIGNIFICANT 1011 00:41:52,480 --> 00:41:55,600 CAREGIVER RESOURCES AND ALL 1012 00:41:55,600 --> 00:41:57,480 ELEMENTS MUCH COMPREHENSIVE 1013 00:41:57,480 --> 00:41:59,160 DEMENTIA CARE. 1014 00:41:59,160 --> 00:42:02,640 AND PATHWAY 3 INSUFFICIENT 1015 00:42:02,640 --> 00:42:03,920 CAREGIVER RESOURCES THE WAY THE 1016 00:42:03,920 --> 00:42:05,480 RESOURCES DIFFER IS WHAT THE 1017 00:42:05,480 --> 00:42:07,440 CAPITATION RATE WOULD BE. 1018 00:42:07,440 --> 00:42:11,200 THERE WOULD BE AN ANNUAL 1019 00:42:11,200 --> 00:42:13,160 ASSESSMENT OR ASSESSMENT AFTER 1020 00:42:13,160 --> 00:42:16,160 LIKE AN ICU OR PSYCHIATRIC 1021 00:42:16,160 --> 00:42:16,600 HOSPITALIZATION AND 1022 00:42:16,600 --> 00:42:21,440 RECLASSIFIED. 1023 00:42:21,440 --> 00:42:24,240 THE ALZHEIMER'S ASSOCIATION AND 1024 00:42:24,240 --> 00:42:26,440 COLLABORATION DID BUDGET SCORING 1025 00:42:26,440 --> 00:42:31,480 AND OVER 10 YEARS BASED ON 1.8 1026 00:42:31,480 --> 00:42:35,440 MILLION BENEFICIARIES THE GROSS 1027 00:42:35,440 --> 00:42:37,520 SAVING WOULD BE $1.2 BILLION AND 1028 00:42:37,520 --> 00:42:39,120 THE UP FRONT COST TO PAY FOR 1029 00:42:39,120 --> 00:42:43,080 SERVICES WOULD BE $12.9 BILLION 1030 00:42:43,080 --> 00:42:49,800 AND THE NET SAVINGS WOULD BE 9. 1031 00:42:49,800 --> 00:42:53,880 -- $9.2 BILLION AND NURSING 1032 00:42:53,880 --> 00:42:57,040 HOME PLACEMENT REDUCED AND THE 1033 00:42:57,040 --> 00:43:00,000 SAVINGS WOULD BE $20.9 BILLION 1034 00:43:00,000 --> 00:43:01,320 AND ANOTHER $10 BILLION TO THE 1035 00:43:01,320 --> 00:43:03,680 STATE FOR THEIR CONTRIBUTION FOR 1036 00:43:03,680 --> 00:43:09,800 A TOTAL OF ALMOST $31 BILLION. 1037 00:43:09,800 --> 00:43:12,360 DESPITE WHAT THE EXCELLENT 1038 00:43:12,360 --> 00:43:15,960 FOUNDATION THERE'S MUCH MORE TO 1039 00:43:15,960 --> 00:43:16,520 DO. 1040 00:43:16,520 --> 00:43:17,720 CONDUCT TRIALS TO INCREASE THE 1041 00:43:17,720 --> 00:43:19,760 EVIDENCE FOR INCREASING HOLD. 1042 00:43:19,760 --> 00:43:23,440 MOST ARE BASED ON LOW-QUALITY 1043 00:43:23,440 --> 00:43:24,200 EVIDENCE. 1044 00:43:24,200 --> 00:43:26,240 DETERMINE WHICH PROGRAMS BEST 1045 00:43:26,240 --> 00:43:28,280 SERVE THE NEEDS OF VARIOUS 1046 00:43:28,280 --> 00:43:31,600 DIVERSE POPULATIONS IN THE 1047 00:43:31,600 --> 00:43:32,440 SETTINGS WERE CARE ARE 1048 00:43:32,440 --> 00:43:33,200 DELIVERED. 1049 00:43:33,200 --> 00:43:35,440 THE MODELS ARE DIFFERENT AND FIT 1050 00:43:35,440 --> 00:43:37,080 DIFFERENT HEALTH CARE SYSTEMS. 1051 00:43:37,080 --> 00:43:38,480 CONDUCT RESEARCH TO FURTHER 1052 00:43:38,480 --> 00:43:40,880 ADAPT SUCCESSFUL MODEL FOR 1053 00:43:40,880 --> 00:43:41,520 DIFFERENT POPULATIONS AND HEALTH 1054 00:43:41,520 --> 00:43:44,520 SYSTEMS. 1055 00:43:44,520 --> 00:43:46,720 CONDUCT STAGE 5 AND THE NIH 1056 00:43:46,720 --> 00:43:48,360 STAGES OF CHANGING RESEARCH ON 1057 00:43:48,360 --> 00:43:50,560 THE BEST APPROACHES TO 1058 00:43:50,560 --> 00:43:53,760 DISSEMINATE SUCCESSFUL MODELS. 1059 00:43:53,760 --> 00:43:55,720 THEY ARE THERE BUT NOT OUT 1060 00:43:55,720 --> 00:43:55,920 THERE. 1061 00:43:55,920 --> 00:43:59,360 RESEARCH TO CREATE A COMMON SET 1062 00:43:59,360 --> 00:44:01,360 OF OUTCOME MEASURES, ERIC ALSO 1063 00:44:01,360 --> 00:44:02,840 REFERRED TO THIS. 1064 00:44:02,840 --> 00:44:03,680 TO BE ABLE TO COMPARE THE MODELS 1065 00:44:03,680 --> 00:44:05,840 YOU NEED TO HAVE THE SAME 1066 00:44:05,840 --> 00:44:07,320 OUTCOMES. 1067 00:44:07,320 --> 00:44:10,200 AND FINALLY EVALUATE PAYMENT 1068 00:44:10,200 --> 00:44:11,560 MODELS FOR COMPREHENSIVE 1069 00:44:11,560 --> 00:44:12,080 DEMENTIA CARE. 1070 00:44:12,080 --> 00:44:14,760 WHAT'S THE BEST WAY TO PROVIDE 1071 00:44:14,760 --> 00:44:16,280 THIS NEEDED CARE. 1072 00:44:16,280 --> 00:44:18,080 SO I'M GOING TO STOP HERE AND 1073 00:44:18,080 --> 00:44:20,160 THANK YOU FOR ALLOWING ME TO 1074 00:44:20,160 --> 00:44:30,720 SPEAK AND ENJOY THE CONFERENCE. 1075 00:44:32,520 --> 00:44:33,800 >>THANK YOU SO MUCH DR. REUBEN 1076 00:44:33,800 --> 00:44:36,640 AND DR. LARSON. 1077 00:44:36,640 --> 00:44:41,120 I'M ULA HWANG AN EMERGENCY ROOM 1078 00:44:41,120 --> 00:44:43,840 PHYSICIAN AND PROFESSOR AT YALE 1079 00:44:43,840 --> 00:44:45,840 AND I'M HERE TO TALK TO YOU 1080 00:44:45,840 --> 00:44:49,520 ABOUT DEMENTIA IN THE ACUTE CARE 1081 00:44:49,520 --> 00:44:51,120 SETTING AND HOPEFULLY LOOK AT 1082 00:44:51,120 --> 00:44:55,960 THE SETTING TO IMPROVED CARE FOR 1083 00:44:55,960 --> 00:44:58,560 PERSONS WITH DEMENTIA. 1084 00:44:58,560 --> 00:44:59,440 THIS IS MY DISCLOSURE SLIDE. 1085 00:44:59,440 --> 00:45:00,560 IT'S MORE TO HIGHLIGHT THE 1086 00:45:00,560 --> 00:45:03,200 OPPORTUNITIES FOR EVERYONE TO 1087 00:45:03,200 --> 00:45:04,800 SEE THERE ARE EARLY ONGOING 1088 00:45:04,800 --> 00:45:08,680 EFFORTS TO REALLY DIVE INTO 1089 00:45:08,680 --> 00:45:10,120 GERIATRIC AND DEMENTIA CARE 1090 00:45:10,120 --> 00:45:10,840 OPPORTUNITIES FOR THE EMERGENCY 1091 00:45:10,840 --> 00:45:11,680 ROOM DEPARTMENT AND WE HOPE 1092 00:45:11,680 --> 00:45:15,640 THESE CONTINUE TO GROW. 1093 00:45:15,640 --> 00:45:19,040 THE GOAL OF MY SESSION IS TO 1094 00:45:19,040 --> 00:45:22,800 DISCUSS THIS AS A PARTNER FROM 1095 00:45:22,800 --> 00:45:24,160 IMPROVING DEMENTIA CARE. 1096 00:45:24,160 --> 00:45:26,680 DESPITE RESEARCH PARITIES AND 1097 00:45:26,680 --> 00:45:28,000 DESCRIBE THE RESEARCH GAPS, 1098 00:45:28,000 --> 00:45:28,520 OPPORTUNITIES AND FUTURE 1099 00:45:28,520 --> 00:45:31,240 CONSIDERATIONS. 1100 00:45:31,240 --> 00:45:34,240 AS WE KNOW, OLDER ADULTS 1101 00:45:34,240 --> 00:45:36,440 CONTINUE TO INCREASINGLY UTILIZE 1102 00:45:36,440 --> 00:45:37,600 THE HEALTH CARE SYSTEM AND 1103 00:45:37,600 --> 00:45:39,800 NOWHERE MORE DO WE SEE THIS IN 1104 00:45:39,800 --> 00:45:41,640 THE EMERGENCY ROOM DEPARTMENT. 1105 00:45:41,640 --> 00:45:44,560 MOST RECENT DATA INDICATES 1 OF 1106 00:45:44,560 --> 00:45:50,560 2 OLDER ADULTS, $1.85 WILL MAKE 1107 00:45:50,560 --> 00:45:52,880 AN E.D. VISIT ANNUALLY TO AN 1108 00:45:52,880 --> 00:45:55,880 EMERGENCY ROOM DEPARTMENT. 1109 00:45:55,880 --> 00:45:59,040 THAT'S 66 EMERGENCY ROOM VISITS 1110 00:45:59,040 --> 00:46:01,680 FOR EVERY 100 PERSONS 75 AND 1111 00:46:01,680 --> 00:46:01,880 OLDER. 1112 00:46:01,880 --> 00:46:04,600 WHAT WE ALSO KNOW IS IN 2018 1113 00:46:04,600 --> 00:46:10,000 THERE WERE ZERO ACCREDITED 1114 00:46:10,000 --> 00:46:10,720 GERIATRIC EMERGENCY ROOM 1115 00:46:10,720 --> 00:46:14,200 DEPARTMENT BUT AS OF MARCH 2023 1116 00:46:14,200 --> 00:46:19,040 THERE ARE OVER 500 ACCREDITED. 1117 00:46:19,040 --> 00:46:21,280 THIS REPRESENTS 10% JUST DURING 1118 00:46:21,280 --> 00:46:22,120 THE PANDEMIC. 1119 00:46:22,120 --> 00:46:23,680 THE EMERGENCY DEPARTMENT IS NOW 1120 00:46:23,680 --> 00:46:24,720 RECOGNIZING THE IMPORTANCE OF 1121 00:46:24,720 --> 00:46:27,040 ADDRESSING AND PROVIDING THE 1122 00:46:27,040 --> 00:46:28,080 SPECIAL CARE THAT ARE REQUIRED 1123 00:46:28,080 --> 00:46:32,200 BY OLDER ADULTS. 1124 00:46:32,200 --> 00:46:35,160 WHAT WE ALSO KNOW IS OLDER 1125 00:46:35,160 --> 00:46:36,960 ADULTS OR THOSE WITH DEMENTIA 1126 00:46:36,960 --> 00:46:39,200 WHICH MAY INCLUDE YOUNGER 1127 00:46:39,200 --> 00:46:39,840 PATIENTS INCREASINGLY USE THE 1128 00:46:39,840 --> 00:46:41,360 EMERGENCY DEPARTMENTS AT A 1129 00:46:41,360 --> 00:46:43,720 GREATER RATE THAN THOSE WITHOUT 1130 00:46:43,720 --> 00:46:45,440 DEMENTIA OVER DOUBLE. 1131 00:46:45,440 --> 00:46:47,920 WE ALSO KNOW THAT COGNITIVE 1132 00:46:47,920 --> 00:46:49,240 IMPAIRMENT IS MISSED MORE THAN 1133 00:46:49,240 --> 00:46:52,240 HALF THE TIME UP TO 83% OF THE 1134 00:46:52,240 --> 00:46:53,200 TIME IN THE EMERGENCY ROOM 1135 00:46:53,200 --> 00:46:54,440 DEPARTMENT BECAUSE IT'S NOT 1136 00:46:54,440 --> 00:46:56,680 ROUTINE ASSESSED. 1137 00:46:56,680 --> 00:46:59,160 IF THERE'S ONE WAY I WANT YOU TO 1138 00:46:59,160 --> 00:47:00,280 WALK AWAY WITH IS THE GRAPHIC 1139 00:47:00,280 --> 00:47:01,880 FROM MY TALK. 1140 00:47:01,880 --> 00:47:02,920 WHAT WE KNOW FROM PRELIMINARY 1141 00:47:02,920 --> 00:47:05,320 DATA AT THE ACADEMIC EMERGENCY 1142 00:47:05,320 --> 00:47:07,240 ROOM DEPARTMENTS AND WITH 1143 00:47:07,240 --> 00:47:11,120 NATIONAL EMERGENCY ROOM 1144 00:47:11,120 --> 00:47:12,280 DEPARTMENTS, AND WE SHOWED THE 1145 00:47:12,280 --> 00:47:13,320 GRAPH YOU'RE SEEING IN THE 1146 00:47:13,320 --> 00:47:15,760 BOTTOM RIGHT AT THE V.A., THE 1147 00:47:15,760 --> 00:47:16,920 V.A. NATIONAL HEALTH CARE DATA 1148 00:47:16,920 --> 00:47:19,600 WE PRESENTED AT THE MEETING IN 1149 00:47:19,600 --> 00:47:20,760 FEBRUARY. 1150 00:47:20,760 --> 00:47:28,920 THERE'S A SPIKE IN E.D. VISITS 1151 00:47:28,920 --> 00:47:29,840 PRIOR TO THE DIAGNOSIS. 1152 00:47:29,840 --> 00:47:33,280 THIS EMPHASIZES IF HE 1153 00:47:33,280 --> 00:47:34,320 OPPORTUNITY AND SHOT THE 1154 00:47:34,320 --> 00:47:35,280 EMERGENCY DEPARTMENT HAS TO 1155 00:47:35,280 --> 00:47:38,400 BECOME A PARTNER IN ADDRESSING 1156 00:47:38,400 --> 00:47:40,320 AND RECOGNIZING DEMENTIA. 1157 00:47:40,320 --> 00:47:40,880 EARLIER RECOGNITION MEANING 1158 00:47:40,880 --> 00:47:47,440 BETTER CARE COORDINATION. 1159 00:47:47,440 --> 00:47:51,200 THE GERIATRIC RESEARCH NETWORK, 1160 00:47:51,200 --> 00:47:54,920 2.0, ADVANCING DEMENTIA CARE IS 1161 00:47:54,920 --> 00:47:56,480 AN NIA PHASED AWARD THAT TRIES 1162 00:47:56,480 --> 00:47:58,320 TO ADVANCE THE SCIENCE TO 1163 00:47:58,320 --> 00:47:59,680 IMPROVE EMERGENCY CARE FOR 1164 00:47:59,680 --> 00:48:01,680 PERSONS WITH DEMENTIA. 1165 00:48:01,680 --> 00:48:05,040 IN THE EARLIER PHASE DURING THE 1166 00:48:05,040 --> 00:48:08,080 R61 WE HELD A CONSENSUS 1167 00:48:08,080 --> 00:48:09,800 CONFERENCE THAT PULLED TOGETHER 1168 00:48:09,800 --> 00:48:12,160 STAKEHOLDER TO LOOK AT CARE 1169 00:48:12,160 --> 00:48:12,920 TRANSITIONS, COMMUNICATION AND 1170 00:48:12,920 --> 00:48:14,440 SHARED DECISION MAKING, 1171 00:48:14,440 --> 00:48:16,800 DETECTION AND E.D. PRACTICES. 1172 00:48:16,800 --> 00:48:17,560 WHAT HAPPENS WHILE THEY'RE IN 1173 00:48:17,560 --> 00:48:18,760 THE EMERGENCY ROOM DEPARTMENT. 1174 00:48:18,760 --> 00:48:22,600 WE THEN TOOK THE PRIORITIES FROM 1175 00:48:22,600 --> 00:48:27,120 THE STAKEHOLDERS AND EMPHASIZED 1176 00:48:27,120 --> 00:48:28,840 SUPPORT FOR RESEARCH THAT 1177 00:48:28,840 --> 00:48:30,120 TARGETED THESE AREAS. 1178 00:48:30,120 --> 00:48:31,360 SUPPORTS WITH TRAINING AND ALSO 1179 00:48:31,360 --> 00:48:35,360 PILOT FUNDING. 1180 00:48:35,360 --> 00:48:37,440 WHAT I WANT TO SHOW YOU ON THE 1181 00:48:37,440 --> 00:48:40,640 NEXT TWO SLIDES IS WHAT GEAR IS 1182 00:48:40,640 --> 00:48:42,000 AND WHAT THE CONSENSUS 1183 00:48:42,000 --> 00:48:42,560 CONFERENCE IS. 1184 00:48:42,560 --> 00:48:43,760 YESTERDAY AND JUST NOW THIS 1185 00:48:43,760 --> 00:48:46,400 MORNING WITH OUR SESSIONS WITH 1186 00:48:46,400 --> 00:48:47,600 THE LIVED EXPERIENCE PANEL AND 1187 00:48:47,600 --> 00:48:51,000 ALSO WHAT WE HEARD BY DR. LARSON 1188 00:48:51,000 --> 00:48:53,800 AND REUBEN IS THE IMPORTANCE OF 1189 00:48:53,800 --> 00:48:54,760 STAKEHOLDER ENGAGEMENT AND 1190 00:48:54,760 --> 00:48:57,440 HEARING THEIR VOICES AND 1191 00:48:57,440 --> 00:49:01,760 PERSPECTIVES IN THE WORK. 1192 00:49:01,760 --> 00:49:04,680 THERE'S A DIVERSE GROUP OF 1193 00:49:04,680 --> 00:49:05,640 PHYSICIANS, NURSES FROM THE 1194 00:49:05,640 --> 00:49:08,280 EMERGENCY ROOM DEPARTMENT AND 1195 00:49:08,280 --> 00:49:12,560 GERIATRICIANS, PSYCHOLOGISTS AND 1196 00:49:12,560 --> 00:49:14,560 ALLIED HEALTH PROFESSIONS, 1197 00:49:14,560 --> 00:49:16,360 PHARMACISTS, ANYONE WHO WOULD 1198 00:49:16,360 --> 00:49:17,360 TOUCH THE PATIENT IN THE CARE 1199 00:49:17,360 --> 00:49:18,760 CONTINUUM AND WE INCLUDED THE 1200 00:49:18,760 --> 00:49:20,600 VOICE AND PERSPECTIVES OF 1201 00:49:20,600 --> 00:49:22,400 PERSONS LIVING WITH DEMENTIA AND 1202 00:49:22,400 --> 00:49:25,160 HAD FIVE PARTICIPATE IN A 1203 00:49:25,160 --> 00:49:26,160 CONSENSUS CONFERENCE AND CARE 1204 00:49:26,160 --> 00:49:27,800 PARTNERS AT BRINGING THEIR VOICE 1205 00:49:27,800 --> 00:49:29,600 AND PERSPECTIVE TO WHAT MATTERS 1206 00:49:29,600 --> 00:49:30,200 IN THE RESEARCH WE NEED TO 1207 00:49:30,200 --> 00:49:33,000 CONDUCT. 1208 00:49:33,000 --> 00:49:34,920 THIS IS A SCREEN SHOT I WANTED 1209 00:49:34,920 --> 00:49:36,520 TO SHOW YOU. 1210 00:49:36,520 --> 00:49:37,200 WE HAVE THIS CONSENSUS 1211 00:49:37,200 --> 00:49:38,840 CONFERENCE IN OCTOBER OF 2021 1212 00:49:38,840 --> 00:49:39,800 DURING THE PANDEMIC. 1213 00:49:39,800 --> 00:49:41,240 I HAD TO DO THIS VIRTUALLY. 1214 00:49:41,240 --> 00:49:45,440 IT SHOWED THE DEDICATION AND 1215 00:49:45,440 --> 00:49:48,440 COMMITMENT OF A DIVERSE GROUP OF 1216 00:49:48,440 --> 00:49:49,080 STAKEHOLDER WHETHER THEY HEARD 1217 00:49:49,080 --> 00:49:51,400 ABOUT THE TOPIC AREAS AND BROKE 1218 00:49:51,400 --> 00:49:52,320 OUT INTO DISCUSSION ROOMS AND 1219 00:49:52,320 --> 00:49:54,200 RANKED WHAT THEY THOUGHT WERE 1220 00:49:54,200 --> 00:49:55,440 MOST IMPORTANT FROM THEIR 1221 00:49:55,440 --> 00:49:56,040 PERSPECTIVES WITH REGARDS TO 1222 00:49:56,040 --> 00:50:01,320 RESEARCH. 1223 00:50:01,320 --> 00:50:04,080 SOME THEMES THAT CAME ACROSS 1224 00:50:04,080 --> 00:50:05,640 BEFORE TOPIC AREAS YOU ALSO 1225 00:50:05,640 --> 00:50:07,720 HEARD DURING THE LAST DAY AND A 1226 00:50:07,720 --> 00:50:09,640 HALF OF THIS SUMMIT MEETING IS 1227 00:50:09,640 --> 00:50:10,840 THE IMPORTANCE OF REAL WORLD 1228 00:50:10,840 --> 00:50:11,640 CARE. 1229 00:50:11,640 --> 00:50:13,600 ONE POINT I WANT TO EMPHASIZE IS 1230 00:50:13,600 --> 00:50:16,000 DETECTION FOR DEMENTIA AND E.D. 1231 00:50:16,000 --> 00:50:17,080 IS NOT DIAGNOSING. 1232 00:50:17,080 --> 00:50:20,080 WE'RE HERE TO SCREEN BUT NOT 1233 00:50:20,080 --> 00:50:26,720 NECESSARILY DIAGNOSE. 1234 00:50:26,720 --> 00:50:28,520 THE IMPORTANCE IS THE IMPORTANCE 1235 00:50:28,520 --> 00:50:38,120 OF BREVITY IN THE FAST-PACED 1236 00:50:38,120 --> 00:50:39,560 EMERGENCY ROOM DEPARTMENT. 1237 00:50:39,560 --> 00:50:41,000 EQUITY ARE PRIORITIES. 1238 00:50:41,000 --> 00:50:42,280 THE EMERGENCY ROOM DEPARTMENT IS 1239 00:50:42,280 --> 00:50:45,480 ONE OF THE FEW HEALTH CARE 1240 00:50:45,480 --> 00:50:47,040 SETTINGS WHERE WE SEE EVERYONE 1241 00:50:47,040 --> 00:50:48,800 24/7 REGARDLESS OF BACKGROUND. 1242 00:50:48,800 --> 00:50:51,160 PATIENTS WHO ARE VULNERABLE AND 1243 00:50:51,160 --> 00:50:52,040 DISADVANTAGED COME TO THE 1244 00:50:52,040 --> 00:50:52,920 EMERGENCY ROOM DEPARTMENT DOORS 1245 00:50:52,920 --> 00:50:55,560 WHICH IS THE FRONT DOOR TO THE 1246 00:50:55,560 --> 00:50:57,080 HEALTH CARE SYSTEM. 1247 00:50:57,080 --> 00:50:58,760 THIS IS OUR OPPORTUNITY TO 1248 00:50:58,760 --> 00:51:00,920 PROVIDE ACCESS AND MAY OFTEN BE 1249 00:51:00,920 --> 00:51:02,760 THE ONLY TOUCH POINT OF ACCESS 1250 00:51:02,760 --> 00:51:04,640 TO CARE FOR THOSE PATIENTS THAT 1251 00:51:04,640 --> 00:51:05,920 MIGHT BE UNDER RESOURCED. 1252 00:51:05,920 --> 00:51:10,560 THE ABILITY AND OPPORTUNITY TO 1253 00:51:10,560 --> 00:51:13,840 ADDRESS COGNITIVE IMPAIRMENT AND 1254 00:51:13,840 --> 00:51:16,480 SOCIAL DETERMINATES OF HEALTH 1255 00:51:16,480 --> 00:51:18,680 ARE WHAT IT'S ABOUT. 1256 00:51:18,680 --> 00:51:21,680 PATIENT CENTERED PRIORITIES WERE 1257 00:51:21,680 --> 00:51:23,680 ALSO MENTIONED IN THE EMERGENCY 1258 00:51:23,680 --> 00:51:24,800 ROOM DEPARTMENT. 1259 00:51:24,800 --> 00:51:29,800 I MAY INTRODUCE THE CONCEPT OF 1260 00:51:29,800 --> 00:51:32,320 THE QUARTETTE WE HEARD OF THOSE 1261 00:51:32,320 --> 00:51:42,720 LIVING WITH DEM -- DEMENTIA AND 1262 00:51:42,720 --> 00:51:43,960 UNDERSTANDING THE CONSEQUENCES 1263 00:51:43,960 --> 00:51:46,440 OF CARE, HOW WE COMMUNICATE CARE 1264 00:51:46,440 --> 00:51:49,280 AND THE RISK FOR SCREENS AND 1265 00:51:49,280 --> 00:51:50,680 IT'S ALL CRITICAL AND IMPORTANT 1266 00:51:50,680 --> 00:51:52,560 AS WE TRY TO DEVELOP TRUST WITH 1267 00:51:52,560 --> 00:52:03,120 OUR PATIENTS AND THE POPULATION. 1268 00:52:08,560 --> 00:52:12,360 THESE WERE PUBLISHED IN OPEN 1269 00:52:12,360 --> 00:52:12,800 ACC 1270 00:52:12,800 --> 00:52:19,960 ACCESS JOURNALS IN JAMA. 1271 00:52:19,960 --> 00:52:21,280 READ MORE ON THE RESEARCH 1272 00:52:21,280 --> 00:52:23,120 PRIORITIES THAT CAME FROM THE 1273 00:52:23,120 --> 00:52:23,360 MEETING. 1274 00:52:23,360 --> 00:52:26,400 I WANT TO POINT OUT THE EVIDENCE 1275 00:52:26,400 --> 00:52:28,240 AND OPPORTUNITIES WITHIN THE 1276 00:52:28,240 --> 00:52:29,480 SCHEDULE CARE OR EMERGENCY CARE. 1277 00:52:29,480 --> 00:52:30,960 YESTERDAY WE HEARD THE 1278 00:52:30,960 --> 00:52:33,840 IMPORTANCE BY DR. McCREEDY AND 1279 00:52:33,840 --> 00:52:36,280 SHAH ABOUT REFRAMING OUR MIND 1280 00:52:36,280 --> 00:52:38,480 SET FOR PRIMARY CARE AND WANT 1281 00:52:38,480 --> 00:52:40,120 EVERYBODY TO THINK ABOUT THE 1282 00:52:40,120 --> 00:52:43,040 OPPORTUNITIES FOR GERIATRIC 1283 00:52:43,040 --> 00:52:45,280 EMERGENCY CARE. 1284 00:52:45,280 --> 00:52:46,960 IT'S DEMONSTRATED TO IMPACT AND 1285 00:52:46,960 --> 00:52:49,600 SHOW THE ABILITY TO REDUCE RISK 1286 00:52:49,600 --> 00:52:51,040 OF HOSPITALIZATION SO REDUCING 1287 00:52:51,040 --> 00:52:54,400 ADMISSIONS AND READMISSIONS BY 1288 00:52:54,400 --> 00:52:55,400 16% TO 17%. 1289 00:52:55,400 --> 00:52:58,640 WHEN PATIENTS ARE SEEN IN 1290 00:52:58,640 --> 00:53:00,320 GERIATRIC EMERGENCY ROOM DEPENDS 1291 00:53:00,320 --> 00:53:01,640 BY PHYSICAL THERAPY IT'S BEEN 1292 00:53:01,640 --> 00:53:03,120 SHOWN WE CAN REDUCE THEIR RISK 1293 00:53:03,120 --> 00:53:05,800 FOR FALLS AND REDUCE THE RISK 1294 00:53:05,800 --> 00:53:08,760 FOR E.D. REVISITS BY 40%. 1295 00:53:08,760 --> 00:53:12,560 AND WHAT WE ALSO KNOW IS WHEN 1296 00:53:12,560 --> 00:53:17,640 SEEN BY A GERIATRIC E.D. THEME 1297 00:53:17,640 --> 00:53:20,320 THEY HAVE REDUCED MEDICARE COST 1298 00:53:20,320 --> 00:53:21,760 IN SUBSEQUENT MONTHS AFTER THE 1299 00:53:21,760 --> 00:53:23,120 EMERGENCY ROOM VISIT. 1300 00:53:23,120 --> 00:53:26,120 WE'RE SEEING THERE'S EVIDENCE OF 1301 00:53:26,120 --> 00:53:27,200 IMPACT FROM EMERGENCY ROOM 1302 00:53:27,200 --> 00:53:27,680 DEPARTMENTS. 1303 00:53:27,680 --> 00:53:30,480 HOW DO WE TRANSLATE IT NOW FOR 1304 00:53:30,480 --> 00:53:33,040 PATIENTS WHO HAVE DEMENTIA? 1305 00:53:33,040 --> 00:53:37,920 I THINK THERE'S A LOT OF 1306 00:53:37,920 --> 00:53:40,360 OPPORTUNITIES WITH REGARDS TO 1307 00:53:40,360 --> 00:53:41,720 REFRAMING HOW WE CAN DELIVER 1308 00:53:41,720 --> 00:53:44,000 EMERGENCY CARE AND REFRAMING AND 1309 00:53:44,000 --> 00:53:46,480 THINKING OF EMERGENCY CARE AS 1310 00:53:46,480 --> 00:53:47,440 PART OF THE DEMENTIA CARE 1311 00:53:47,440 --> 00:53:48,560 CONTINUUM AND GOING BACK TO THE 1312 00:53:48,560 --> 00:53:51,080 GRAPH I SHOWED EARLIER BECAUSE 1313 00:53:51,080 --> 00:53:54,600 SPIKE IN E.D. VISITS PRIOR TO 1314 00:53:54,600 --> 00:53:56,560 THE DEMENTIA DIAGNOSIS WE HAVE A 1315 00:53:56,560 --> 00:53:58,840 SHOT AT IMPACTING THE PATIENTS 1316 00:53:58,840 --> 00:54:00,040 WITH EARLY DETECTION AND 1317 00:54:00,040 --> 00:54:02,680 CHANGING THE TRAJECTORY OF THEIR 1318 00:54:02,680 --> 00:54:02,880 CARE. 1319 00:54:02,880 --> 00:54:06,520 A VISIT TO AN EMERGENCY ROOM 1320 00:54:06,520 --> 00:54:07,640 DEPARTMENT CAN GET EARLIER 1321 00:54:07,640 --> 00:54:09,520 RECOGNITION AND CONNECT PATIENT 1322 00:54:09,520 --> 00:54:10,760 TO RESOURCES AND CARE TO IMPROVE 1323 00:54:10,760 --> 00:54:12,200 THEIR OUTCOMES. 1324 00:54:12,200 --> 00:54:14,480 WE CAN MAKE THAT DIFFERENCE WITH 1325 00:54:14,480 --> 00:54:16,840 THE EMERGENCY CARE, TO, DURING 1326 00:54:16,840 --> 00:54:19,920 AND FROM THE E.D. 1327 00:54:19,920 --> 00:54:21,840 THE EMERGENCY ROOM CAN 1328 00:54:21,840 --> 00:54:22,720 FACILITATE SHARED DECISION 1329 00:54:22,720 --> 00:54:24,120 MAKING WITH WHAT MATTERS TO THE 1330 00:54:24,120 --> 00:54:25,520 PATIENT AND THEIR FAMILIES. 1331 00:54:25,520 --> 00:54:28,160 MY HOPE IS I'VE BEEN ABLE TO 1332 00:54:28,160 --> 00:54:30,240 SHIFT YOUR MIND SETS IN 1333 00:54:30,240 --> 00:54:30,880 REFRAMING THE EMERGENCY ROOM 1334 00:54:30,880 --> 00:54:32,800 DEPARTMENT AS A PARTNER IN 1335 00:54:32,800 --> 00:54:33,800 DEMENTIA CARE MODELS. 1336 00:54:33,800 --> 00:54:44,000 THANK YOU. 1337 00:54:49,160 --> 00:54:50,880 >>THANK YOU, ULA. 1338 00:54:50,880 --> 00:54:52,200 THE TALK IS TO DEVELOP AND 1339 00:54:52,200 --> 00:54:55,080 EVALUATE CARE MANAGEMENT MODELS 1340 00:54:55,080 --> 00:55:00,240 THAT REALLY PARTNER WITH THE 1341 00:55:00,240 --> 00:55:02,280 EMERGENCY DEPARTMENT. 1342 00:55:02,280 --> 00:55:07,520 HAVING CARE THAT STARTS AT THE 1343 00:55:07,520 --> 00:55:10,240 E.D. AND THEN EXTENDS ACROSS THE 1344 00:55:10,240 --> 00:55:11,840 CARE CONTINUUM. 1345 00:55:11,840 --> 00:55:13,520 THINKING ABOUT THE COLLABORATIVE 1346 00:55:13,520 --> 00:55:15,520 OR COMPREHENSIVE CARE MODELS 1347 00:55:15,520 --> 00:55:17,800 PARTNERING WITH THE E.D. TO 1348 00:55:17,800 --> 00:55:19,440 INTERVENE AT THIS CRITICAL 1349 00:55:19,440 --> 00:55:23,920 MOMENT FOR OUR FAMILIES. 1350 00:55:23,920 --> 00:55:27,520 THE SECOND GAP OR OPPORTUNITY IS 1351 00:55:27,520 --> 00:55:30,680 TO TAKE THESE EFFECTIVE CARE 1352 00:55:30,680 --> 00:55:34,000 MANAGEMENT MODELS, COMPREHENSIVE 1353 00:55:34,000 --> 00:55:35,360 COLLABORATIVE CARE MODELS AND 1354 00:55:35,360 --> 00:55:37,600 ADAPT THEM AND MAKE SURE THEY 1355 00:55:37,600 --> 00:55:42,840 WORK FOR DIVERSE POPULATIONS AND 1356 00:55:42,840 --> 00:55:43,960 DIVERSE SETTINGS INCLUDING RACE 1357 00:55:43,960 --> 00:55:46,640 AND ETHNIC MINORITY GROUPS, 1358 00:55:46,640 --> 00:55:49,680 RURAL LOCALES, LARGE HEALTH 1359 00:55:49,680 --> 00:55:51,720 SYSTEMS AND SMALL PRACTICES SO 1360 00:55:51,720 --> 00:55:56,840 NO ONE IS LEFT BEHIND. 1361 00:55:56,840 --> 00:56:00,320 AND THIRD, TO CONDUCT STAGE 5 1362 00:56:00,320 --> 00:56:01,320 RESEARCH. 1363 00:56:01,320 --> 00:56:07,320 IF YOU LISTENED TO ELENA FAZIO 1364 00:56:07,320 --> 00:56:10,520 THE TALKED ABOUT IMPLEMENTATION 1365 00:56:10,520 --> 00:56:11,920 AND DISSEMINATION RESEARCH SO WE 1366 00:56:11,920 --> 00:56:13,920 CAN GET THE CARE MODELS OUT 1367 00:56:13,920 --> 00:56:14,320 THERE. 1368 00:56:14,320 --> 00:56:16,440 ALL OF THESE GAPS AND 1369 00:56:16,440 --> 00:56:17,480 OPPORTUNITIES FROM OUR SESSION 1370 00:56:17,480 --> 00:56:20,400 ARE FOCUSSED ON REFEIGNING THE 1371 00:56:20,400 --> 00:56:21,960 EFFECTIVE CARE MODELS AND 1372 00:56:21,960 --> 00:56:25,000 IMPLEMENTING THEM SO THEY CAN 1373 00:56:25,000 --> 00:56:26,680 REACH THE PERSONS LIVING WITH 1374 00:56:26,680 --> 00:56:28,440 DEMENTIA AND CARE PARTNERS WHO 1375 00:56:28,440 --> 00:56:36,560 NEED THE CARE MODELS TODAY. 1376 00:56:36,560 --> 00:56:38,040 WE NOW HAVE THE PLEASURE OF 1377 00:56:38,040 --> 00:56:40,360 HEARING FROM THREE PANELISTS. 1378 00:56:40,360 --> 00:56:43,960 FIRST, ROBERTA CRUZ WHO IS A 1379 00:56:43,960 --> 00:56:47,680 CAREGIVER FOR HER MOM WITH 1380 00:56:47,680 --> 00:56:48,160 DEMENTIA. 1381 00:56:48,160 --> 00:56:50,000 WE HEARD A LITTLE FROM HER THIS 1382 00:56:50,000 --> 00:56:51,200 MORNING. 1383 00:56:51,200 --> 00:56:53,320 MS. CRUZ, WHEN THINKING ABOUT 1384 00:56:53,320 --> 00:56:54,440 HAVING TO COORDINATE CARE FOR 1385 00:56:54,440 --> 00:56:55,920 YOUR MOTHER ACROSS PROVIDERS, 1386 00:56:55,920 --> 00:56:58,080 WHAT POSITIVE OR NEGATIVE 1387 00:56:58,080 --> 00:57:03,280 EXPERIENCES HAVE YOU HAD? 1388 00:57:03,280 --> 00:57:09,280 >>THANK YOU, KATHERINE. 1389 00:57:09,280 --> 00:57:11,160 EXPERIENCES HAVE BEEN ACROSS THE 1390 00:57:11,160 --> 00:57:14,280 BOARD THINKING BACK TO THE 1391 00:57:14,280 --> 00:57:16,200 INITIAL MOMENTS. 1392 00:57:16,200 --> 00:57:18,960 IT'S BEEN EXTREME FROM APATHY OR 1393 00:57:18,960 --> 00:57:24,240 MISUNDERSTANDING TO KINDNESS, 1394 00:57:24,240 --> 00:57:26,840 CONNECTION AND HUMANITY. 1395 00:57:26,840 --> 00:57:28,040 I'LL START WITH THE NEGATIVE 1396 00:57:28,040 --> 00:57:33,320 THAT COMES TO MIND AND THAT 1397 00:57:33,320 --> 00:57:37,400 INITIAL MOMENT WHERE OUR FAMILY 1398 00:57:37,400 --> 00:57:38,840 REALIZED WE NEEDED TO INTERVENE 1399 00:57:38,840 --> 00:57:40,720 AND MOVING MY MOM ACROSS COUNTRY 1400 00:57:40,720 --> 00:57:42,480 AND WE WERE IN COUTH CAROLINA 1401 00:57:42,480 --> 00:57:44,160 AND MY MOM WAS IN THE HOME I 1402 00:57:44,160 --> 00:57:46,520 GREW UP IN IN THE BAY AREA AND 1403 00:57:46,520 --> 00:57:47,360 WE KNEW BEFORE MOVING HER ACROSS 1404 00:57:47,360 --> 00:57:50,960 STATE LINES WE NEEDED TO HAVE A 1405 00:57:50,960 --> 00:57:53,280 DIAGNOSIS FROM HER CURRENT 1406 00:57:53,280 --> 00:57:55,600 PROVIDER AND UNFORTUNATELY THE 1407 00:57:55,600 --> 00:57:58,240 EXPERIENCE WAS MORE OF A BATTLE. 1408 00:57:58,240 --> 00:58:00,240 WE HAD TO FIGHT TO HAVE A 1409 00:58:00,240 --> 00:58:04,760 DIAGNOSIS OR FOR HER TO START 1410 00:58:04,760 --> 00:58:06,320 THE ASSESSMENT FIRST TIME 1411 00:58:06,320 --> 00:58:09,320 MEETING THE PROVIDER WAS A NURSE 1412 00:58:09,320 --> 00:58:11,400 PRACTITIONER WAS HESITANT TO 1413 00:58:11,400 --> 00:58:13,880 ACKNOWLEDGE MY MOM NEEDED TO BE 1414 00:58:13,880 --> 00:58:14,400 SCREENED. 1415 00:58:14,400 --> 00:58:16,680 SHE SAID SHE'S JUST GETTING 1416 00:58:16,680 --> 00:58:16,920 OLDER. 1417 00:58:16,920 --> 00:58:20,840 SHE DIDN'T WANT TO SCREEN HER. 1418 00:58:20,840 --> 00:58:24,640 AND RATHER THAN WORKING AND SHE 1419 00:58:24,640 --> 00:58:35,200 WAS DISMISSIVE AND HESITANT AND 1420 00:58:40,880 --> 00:58:42,080 THEY'RE NOT GOING TO LEAVE 1421 00:58:42,080 --> 00:58:46,520 WITHOUT SOMETHING TAKING PLACE. 1422 00:58:46,520 --> 00:58:49,680 ON THE FLIP SIDE, THE POSITIVE 1423 00:58:49,680 --> 00:58:51,560 NEEDING AND BUILDING 1424 00:58:51,560 --> 00:58:53,040 RELATIONSHIPS WITH PEOPLE WHO 1425 00:58:53,040 --> 00:58:54,680 SINCERELY CARED FOR MY MOM HAS 1426 00:58:54,680 --> 00:58:58,600 BEEN A POSITIVE EXPERIENCE ONCE 1427 00:58:58,600 --> 00:58:59,960 WE WERE IN NORTH CAROLINA AND 1428 00:58:59,960 --> 00:59:02,120 REFLECTING BACK TO THAT I FEEL 1429 00:59:02,120 --> 00:59:07,480 LIKE EACH TIME I, AS A MAIN CARE 1430 00:59:07,480 --> 00:59:09,240 PARTNER MET WITH A PROVIDER AND 1431 00:59:09,240 --> 00:59:10,680 LEARNED IMPORTANT SKILLS ON HOW 1432 00:59:10,680 --> 00:59:13,600 TO CONNECT AND ADVOCATE FOR MY 1433 00:59:13,600 --> 00:59:13,960 MOM. 1434 00:59:13,960 --> 00:59:17,120 IT'S TIRING AND EXHAUSTIVE BUT 1435 00:59:17,120 --> 00:59:21,960 IT TAUGHT ME TO BE PERSISTENT 1436 00:59:21,960 --> 00:59:26,640 AND OPEN TO ANY AND ALL 1437 00:59:26,640 --> 00:59:27,440 INFORMATION FOR EXAMPLE, OUR 1438 00:59:27,440 --> 00:59:28,840 FIRST APPOINTMENT WHEN WE WERE 1439 00:59:28,840 --> 00:59:33,280 ABLE TO SEE A GERIATRIC 1440 00:59:33,280 --> 00:59:34,280 SPECIALIST WE INITIALLY THOUGHT 1441 00:59:34,280 --> 00:59:36,280 THIS WAS WHERE WE NEEDED TO BE 1442 00:59:36,280 --> 00:59:40,600 AND WHERE WE NEEDED TO HAVE MY 1443 00:59:40,600 --> 00:59:41,920 MOM'S CARE AND WANTED A 1444 00:59:41,920 --> 00:59:43,040 DIFFERENCE EXPERIENCE AT THIS 1445 00:59:43,040 --> 00:59:43,600 TIME. 1446 00:59:43,600 --> 00:59:48,040 WE DECIDED TO SWITCH MY MOM'S 1447 00:59:48,040 --> 00:59:50,400 CARE TO DUKE INTEGRATIVE 1448 00:59:50,400 --> 00:59:54,160 MEDICINE AND THOUGH IT WAS MORE 1449 00:59:54,160 --> 00:59:55,360 OF A FINANCIAL COST WE FELT IT 1450 00:59:55,360 --> 00:59:57,440 WAS WHAT WE NEEDED AS A FAMILY 1451 00:59:57,440 --> 00:59:58,680 AND RECOGNIZED SOMETHING WE WERE 1452 00:59:58,680 --> 00:59:59,560 ABLE TO DO BECAUSE OF THE 1453 00:59:59,560 --> 01:00:03,600 RESOURCES WE HAD AT THE TIME FOR 1454 01:00:03,600 --> 01:00:05,280 BUT ALLOWED FOR CONNECTION AND 1455 01:00:05,280 --> 01:00:06,280 ACTION FOR THE CARE WE NEEDED. 1456 01:00:06,280 --> 01:00:13,080 THANK YOU. 1457 01:00:13,080 --> 01:00:20,200 >>THANK YOU, ROBERTA. 1458 01:00:20,200 --> 01:00:22,120 CAROLYN CAN YOU TALK ABOUT YOUR 1459 01:00:22,120 --> 01:00:22,440 EXPERIENCE? 1460 01:00:22,440 --> 01:00:24,000 >>I'D LIKE TO TALK ABOUT THE 1461 01:00:24,000 --> 01:00:25,760 MEMORY CARE. 1462 01:00:25,760 --> 01:00:28,920 AS YOU SAW ON THE MODEL TABLE 1463 01:00:28,920 --> 01:00:31,880 THIS IS A LARGE PRACTICE. 1464 01:00:31,880 --> 01:00:33,160 UNDER 20 STAFF PEOPLE COMPRISED 1465 01:00:33,160 --> 01:00:36,120 OF NURSE PRACTITIONERS WHO 1466 01:00:36,120 --> 01:00:37,600 SPECIALIZE IN GERIATRIC MEDICINE 1467 01:00:37,600 --> 01:00:38,960 AND PSYCHIATRY AND OUR 1468 01:00:38,960 --> 01:00:40,480 SUPPORTING PHYSICIANS, 1469 01:00:40,480 --> 01:00:42,800 REGISTERED NURSES, SOCIAL 1470 01:00:42,800 --> 01:00:48,840 WORKERS, OCCUPATION S, DEMENTIA 1471 01:00:48,840 --> 01:00:49,840 COMPANIONS AND COORDINATORS AND 1472 01:00:49,840 --> 01:00:52,120 THIS IS PREVENTIVE AND SCREENING 1473 01:00:52,120 --> 01:00:58,680 KIND OF CARE, ACUTE ILLNESS FROM 1474 01:00:58,680 --> 01:01:03,800 RASHES TO CHRONIC ILLENCE NESS 1475 01:01:03,800 --> 01:01:08,160 AND -- ILLNESS AND PRESCRIBING 1476 01:01:08,160 --> 01:01:09,440 AND CONCURRENT WITH SPECIALTY 1477 01:01:09,440 --> 01:01:12,080 DEMENTIA CARE AND OFFER IN-HOUSE 1478 01:01:12,080 --> 01:01:15,720 SUPPORT GROUPS DEPEND ON STAGE 1479 01:01:15,720 --> 01:01:18,400 AND CLASSES WITH CAREGIVERS AND 1480 01:01:18,400 --> 01:01:19,160 SINGLE-DAY WORKSHOPS AND DO 1481 01:01:19,160 --> 01:01:20,520 INDIVIDUAL AND FAMILY PSYCHO 1482 01:01:20,520 --> 01:01:22,640 THERAPY FOR OUR FAMILY CARE 1483 01:01:22,640 --> 01:01:22,880 PARTNERS. 1484 01:01:22,880 --> 01:01:24,520 WE ARE ABLE TO FOLLOW OUR 1485 01:01:24,520 --> 01:01:26,080 PATIENTS IN THEIR SENIOR LIVING 1486 01:01:26,080 --> 01:01:27,960 COMMUNITY AS WELL WITH WEEKLY 1487 01:01:27,960 --> 01:01:29,960 AND INTENSIVE COGNITIVE 1488 01:01:29,960 --> 01:01:31,200 ENGAGEMENT ACTIVITIES AND MOST 1489 01:01:31,200 --> 01:01:33,000 IMPORTANT TO US IS TO MAINTAIN 1490 01:01:33,000 --> 01:01:34,920 DIRECT ACCESS TO THIS PRACTICE. 1491 01:01:34,920 --> 01:01:37,560 NO CALL CENTER, NO REFERRAL 1492 01:01:37,560 --> 01:01:39,000 REQUIRED AND AFTER HOURS ACCESS 1493 01:01:39,000 --> 01:01:41,320 TO OUR TEAM VIA DEDICATED PHONE 1494 01:01:41,320 --> 01:01:42,360 LINES FOR OUR ESTABLISHED 1495 01:01:42,360 --> 01:01:42,720 PATIENTS. 1496 01:01:42,720 --> 01:01:46,000 WE BENEFIT FROM THE ADVISORY 1497 01:01:46,000 --> 01:01:47,280 COUNCIL THAT'S COMPRISED OF 1498 01:01:47,280 --> 01:01:48,400 PATIENTS AND FAMILY CAREGIVERS 1499 01:01:48,400 --> 01:01:49,640 IN EVERYTHING WE DO. 1500 01:01:49,640 --> 01:01:51,640 WE CERTAINLY SEE OURSELVES AS 1501 01:01:51,640 --> 01:01:53,840 THE WHAT'S NEXT MODEL. 1502 01:01:53,840 --> 01:01:55,160 THERE'S SO MUCH INVESTMENT TODAY 1503 01:01:55,160 --> 01:01:57,560 AND TIMELY AND ACCURATE 1504 01:01:57,560 --> 01:01:59,520 DIAGNOSIS WHICH IS CRITICAL. 1505 01:01:59,520 --> 01:02:00,480 ROBERTA MENTION THE CHALLENGE 1506 01:02:00,480 --> 01:02:02,160 FOR FAMILIES IS INCREDIBLE BUT 1507 01:02:02,160 --> 01:02:04,320 THEN THE QUESTION IS WHAT 1508 01:02:04,320 --> 01:02:06,600 HAPPENS AFTER THE DIAGNOSIS AND 1509 01:02:06,600 --> 01:02:08,920 SO WE DESIGN THE MODEL WITH 1510 01:02:08,920 --> 01:02:10,720 FAMILY CARE PARTNERS TO WRAP 1511 01:02:10,720 --> 01:02:12,280 SERVICES AROUND THEM IN ONE 1512 01:02:12,280 --> 01:02:14,400 LOCATION RATHER THAN SENDING 1513 01:02:14,400 --> 01:02:16,840 THEM TO MULTIPLE SITES. 1514 01:02:16,840 --> 01:02:19,560 WE'VE BEEN OPEN SINCE 2015 AND 1515 01:02:19,560 --> 01:02:20,920 SERVED OVER 2500 FAMILIES AT 1516 01:02:20,920 --> 01:02:23,200 THIS POINT. 1517 01:02:23,200 --> 01:02:27,720 40% OF WHOM WHO IDENTIFIED AS 1518 01:02:27,720 --> 01:02:28,480 MINORITIZED POPULATION AND 1519 01:02:28,480 --> 01:02:32,080 THEY'RE EXPERIENCES ARE WRITTEN 1520 01:02:32,080 --> 01:02:34,520 ANYWHERE AT THIS POINT AND WE 1521 01:02:34,520 --> 01:02:36,720 TRACK OUR FINANCES QUITE CLOSELY 1522 01:02:36,720 --> 01:02:39,320 SO THIS MODEL ITSELF IS 1523 01:02:39,320 --> 01:02:40,680 FINANCIALLY SUSTAINABLE THROUGH 1524 01:02:40,680 --> 01:02:43,080 BILLING REVENUE AND WE'RE ABLE 1525 01:02:43,080 --> 01:02:45,120 TO OFFER ADDITIONAL SERVICES FOR 1526 01:02:45,120 --> 01:02:46,880 PRIVATE PAY AND BENEFIT FROM 1527 01:02:46,880 --> 01:02:48,920 GRATEFUL PATIENTS OVER THE 1528 01:02:48,920 --> 01:02:49,160 YEARS. 1529 01:02:49,160 --> 01:02:50,960 AS DR. REUBEN MENTIONED IT'S 1530 01:02:50,960 --> 01:02:53,200 IMPORTANT TO CONSIDER MODELS FOR 1531 01:02:53,200 --> 01:02:55,000 WHICH PATIENT POPULATIONS AND 1532 01:02:55,000 --> 01:02:56,360 COMPLEXITIES IS MORE BROADLY 1533 01:02:56,360 --> 01:02:57,760 DEFINED THAN THE MEDICAL 1534 01:02:57,760 --> 01:03:00,240 DEFINITIONS WE OFTEN USE 1535 01:03:00,240 --> 01:03:01,000 INCLUDING GEOGRAPHIC 1536 01:03:01,000 --> 01:03:02,520 DISTRIBUTION AND INCOME LEVELS. 1537 01:03:02,520 --> 01:03:04,600 WE HOPE AS WE'RE CONTINUING TO 1538 01:03:04,600 --> 01:03:05,760 TRACK THESE MODELS THEY'RE 1539 01:03:05,760 --> 01:03:08,200 REQUIRED TO HAVE CO-DESIGN AND 1540 01:03:08,200 --> 01:03:12,320 CO-PRODUCTION OF PATIENTS 1541 01:03:12,320 --> 01:03:12,600 CAREGIVERS. 1542 01:03:12,600 --> 01:03:13,840 NOTHING SHOULD BE DONE TO THEM 1543 01:03:13,840 --> 01:03:16,680 WITHOUT THEIR INPUT AND WE 1544 01:03:16,680 --> 01:03:19,000 INVEST FOR THE WHAT'S NEXT AFTER 1545 01:03:19,000 --> 01:03:21,640 THE DIAGNOSIS AS WE'RE 1546 01:03:21,640 --> 01:03:22,960 CONCURRENTLY ASSESSING AND 1547 01:03:22,960 --> 01:03:23,360 DIAGNOSING FOLKS. 1548 01:03:23,360 --> 01:03:30,400 THANK YOU VERY MUCH. 1549 01:03:30,400 --> 01:03:30,920 >>WONDERFUL. 1550 01:03:30,920 --> 01:03:32,520 IT'S GREAT TO HEAR ABOUT YOUR 1551 01:03:32,520 --> 01:03:34,480 PROGRAM. 1552 01:03:34,480 --> 01:03:37,960 THE LAST PANELIST IS SHARI LING 1553 01:03:37,960 --> 01:03:48,120 FROM CMS. 1554 01:03:51,680 --> 01:03:53,800 >>I'M HONORED TO JOIN YOU AND 1555 01:03:53,800 --> 01:03:55,360 WHAT WE HEARD THROUGHOUT THE 1556 01:03:55,360 --> 01:03:58,120 CONFERENCE THUS FAR HELPS MEET 1557 01:03:58,120 --> 01:04:02,000 THE REQUEST THAT OUR 1558 01:04:02,000 --> 01:04:03,000 ADMINISTRATOR AT CMS REALLY 1559 01:04:03,000 --> 01:04:05,040 OPPOSED DURING A LESSENING 1560 01:04:05,040 --> 01:04:08,760 SESSION HELD IN 2022 WHICH IS 1561 01:04:08,760 --> 01:04:11,280 WHAT ARE SOME OF THE PROMISING 1562 01:04:11,280 --> 01:04:11,720 PRACTICES AVAILABLE. 1563 01:04:11,720 --> 01:04:16,680 WHAT ARE THE RESOURCES NEEDED 1564 01:04:16,680 --> 01:04:19,920 AND FOR WHOM, BY WHOM UNDER WHAT 1565 01:04:19,920 --> 01:04:20,240 CIRCUMSTANCES. 1566 01:04:20,240 --> 01:04:24,800 I'LL CALL OUT OUR THINKING AND 1567 01:04:24,800 --> 01:04:28,320 EFFORT TO MOVE THE HEALTH CARE 1568 01:04:28,320 --> 01:04:31,000 SYSTEM TOWARDS A VALUE-BASED 1569 01:04:31,000 --> 01:04:33,680 CARE SYSTEM RATHER THAN 1570 01:04:33,680 --> 01:04:35,640 VOLUME-DRIVEN ACTUALLY IS TRULY 1571 01:04:35,640 --> 01:04:37,800 AN OPPORTUNITY TO FOCUS ON WHAT 1572 01:04:37,800 --> 01:04:40,000 MATTERS TO THE PEOPLE WE SERVE. 1573 01:04:40,000 --> 01:04:43,440 THAT IS PEOPLE LIVING WITH 1574 01:04:43,440 --> 01:04:43,680 DEMENTIA. 1575 01:04:43,680 --> 01:04:46,520 THOSE WHO ARE AT RISK OF 1576 01:04:46,520 --> 01:04:49,640 DEVELOPING DEMENTIA AND THEIR 1577 01:04:49,640 --> 01:04:51,800 CARE PARTNERS WHO ARE A 1578 01:04:51,800 --> 01:04:54,040 NECESSARY PART OF THE SOLUTION 1579 01:04:54,040 --> 01:04:56,520 SCIENTIFICALLY AND ALSO VERY 1580 01:04:56,520 --> 01:04:56,960 PRACTICALLY. 1581 01:04:56,960 --> 01:04:58,400 I THINK TRUE OPPORTUNITIES EXIST 1582 01:04:58,400 --> 01:05:02,040 THAT REALLY ALIGN WITH THOSE 1583 01:05:02,040 --> 01:05:04,760 PRINCIPLES THAT DR. LARSON LAID 1584 01:05:04,760 --> 01:05:05,280 OUT. 1585 01:05:05,280 --> 01:05:09,600 I WILL SAY THAT OUR EFFORTS MUST 1586 01:05:09,600 --> 01:05:12,680 ADDRESS CARE ACROSS THE HEALTH 1587 01:05:12,680 --> 01:05:17,760 CARE CONTINUUM WITH INTENT IN 1588 01:05:17,760 --> 01:05:18,440 TRANSLATING INFORMATION ACROSS 1589 01:05:18,440 --> 01:05:23,320 CARE SETTINGS AND THEREFORE A 1590 01:05:23,320 --> 01:05:25,280 TRUE OPPORTUNITY IS THROUGH THE 1591 01:05:25,280 --> 01:05:28,520 TECHNOLOGY OF THE ELECTRONIC 1592 01:05:28,520 --> 01:05:31,200 HEALTH RECORDS THAT FRANKLY HAVE 1593 01:05:31,200 --> 01:05:33,760 YET TO BE TRULY REALIZED. 1594 01:05:33,760 --> 01:05:38,120 WHAT HAPPENED TO IAN SHOULD NOT 1595 01:05:38,120 --> 01:05:38,520 HAPPEN. 1596 01:05:38,520 --> 01:05:41,800 THE INFORMATION NEEDED IS THE 1597 01:05:41,800 --> 01:05:44,440 IMPLEMENTABLE IF WE COLLECTIVELY 1598 01:05:44,440 --> 01:05:47,480 FOCUS ON WHAT ARE THE MEANINGFUL 1599 01:05:47,480 --> 01:05:48,440 OUTCOMES THAT MATTER AND FOR 1600 01:05:48,440 --> 01:05:51,000 THAT TO BE ABLE TO TRANSLATE 1601 01:05:51,000 --> 01:05:52,800 ACROSS CARE SETTINGS WITH THE 1602 01:05:52,800 --> 01:05:56,280 CARE THAT IS NEEDED FOR A PERSON 1603 01:05:56,280 --> 01:05:58,960 FOR PEOPLE AS THEY TRAVERSE THE 1604 01:05:58,960 --> 01:06:01,640 HEALTH CARE SYSTEM AND THAT 1605 01:06:01,640 --> 01:06:03,680 ACTUALLY ALSO INCLUDES CARE THAT 1606 01:06:03,680 --> 01:06:05,960 IS UNSCHEDULED AND DELIGHTED 1607 01:06:05,960 --> 01:06:09,960 THAT ULA WAS ABLE TO HELP US 1608 01:06:09,960 --> 01:06:13,640 CONNECT THE DOTS WITH THE 1609 01:06:13,640 --> 01:06:16,400 OPPORTUNITY THAT REALLY CARE IN 1610 01:06:16,400 --> 01:06:18,240 AN EMERGENCY SETTING, BETTER 1611 01:06:18,240 --> 01:06:20,600 CARE IS WHAT SHE DESCRIBES AND 1612 01:06:20,600 --> 01:06:22,720 FRAMES AS GERIATRIC EMERGENCY 1613 01:06:22,720 --> 01:06:25,920 CARE BUT REALLY IT'S GOOD FOR 1614 01:06:25,920 --> 01:06:26,200 ALL. 1615 01:06:26,200 --> 01:06:28,480 SO I THINK WE'RE ON A JOURNEY 1616 01:06:28,480 --> 01:06:31,240 AND DELIGHTED TO HEAR ABOUT SOME 1617 01:06:31,240 --> 01:06:33,440 OF THE BRIGHT SPOTS EMERGING. 1618 01:06:33,440 --> 01:06:36,680 I THINK OUR QUESTION FOR 1619 01:06:36,680 --> 01:06:42,760 OURSELVES IS HOW DO WE TRAVERSE 1620 01:06:42,760 --> 01:06:44,560 DIVIDE BETWEEN EVIDENCE 1621 01:06:44,560 --> 01:06:46,440 GENERATION AND CLINICAL CARE AND 1622 01:06:46,440 --> 01:06:48,000 WHAT BETTER WAY THAN TO FOCUS ON 1623 01:06:48,000 --> 01:06:51,840 THE PEOPLE WHO THE CARE IS 1624 01:06:51,840 --> 01:06:52,360 PROVIDED TO. 1625 01:06:52,360 --> 01:06:54,000 REALLY DELIGHTED TO BE HERE AND 1626 01:06:54,000 --> 01:06:54,240 THANK YOU. 1627 01:06:54,240 --> 01:07:04,360 OVER. 1628 01:07:05,760 --> 01:07:09,760 >>THANK YOU, SHARI LING AND I'M 1629 01:07:09,760 --> 01:07:19,640 MARCEL SALIVE AND I'LL START THE 1630 01:07:19,640 --> 01:07:20,440 DISCUSSION. 1631 01:07:20,440 --> 01:07:23,200 I'LL START WITH OUTCOME 1632 01:07:23,200 --> 01:07:23,480 MEASUREMENT. 1633 01:07:23,480 --> 01:07:26,160 THE NATIONAL CAD MYS SHOWED 1634 01:07:26,160 --> 01:07:26,640 IMPLEMENTED REAL WORLD 1635 01:07:26,640 --> 01:07:28,560 IMPLEMENTATION OF TWO CARE 1636 01:07:28,560 --> 01:07:29,680 MODELS AND THINKING ABOUT 1637 01:07:29,680 --> 01:07:34,920 YESTERDAY'S SESSION ON OUTCOMES 1638 01:07:34,920 --> 01:07:37,800 THAT MATTER MOST AND WHAT 1639 01:07:37,800 --> 01:07:40,600 CAPTURES THE PRIORITIES OF 1640 01:07:40,600 --> 01:07:42,800 PEOPLE LIVING WITH DEMENTIA? 1641 01:07:42,800 --> 01:07:48,400 >>I CAN START WITH THAT. 1642 01:07:48,400 --> 01:07:53,680 SO THE SIX MODELS THAT I 1643 01:07:53,680 --> 01:07:57,000 DESCRIBED ALL HAVE OUTCOMES OF 1644 01:07:57,000 --> 01:07:59,240 EITHER QUALITY OF CARE, CLINICAL 1645 01:07:59,240 --> 01:08:01,320 OUTCOMES INCLUDING FOR BOTH THE 1646 01:08:01,320 --> 01:08:04,440 CAREGIVER AND THE PERSON LIVING 1647 01:08:04,440 --> 01:08:05,840 WITH DEMENTIA AND UTILIZATION 1648 01:08:05,840 --> 01:08:11,080 OUTCOMES. 1649 01:08:11,080 --> 01:08:15,920 THE OTHER OUTCOMES ARE MORE 1650 01:08:15,920 --> 01:08:16,920 EMBRYONIC STAGES FOR EXAMPLE 1651 01:08:16,920 --> 01:08:20,000 GOAL ATTAINMENT SCALING AND 1652 01:08:20,000 --> 01:08:21,440 THEY'RE IN RANDOMIZED CLINICAL 1653 01:08:21,440 --> 01:08:25,960 TRIALS NOW. 1654 01:08:25,960 --> 01:08:31,640 BUT THINKING ABOUT THE QUADRUPLE 1655 01:08:31,640 --> 01:08:33,800 AIM LOOKING AT PROVIDER 1656 01:08:33,800 --> 01:08:34,120 SATISFACTION. 1657 01:08:34,120 --> 01:08:36,240 I THINK THERE'S EVIDENCE FOR ALL 1658 01:08:36,240 --> 01:08:40,000 THOSE AND HOPEFULLY THE EVIDENCE 1659 01:08:40,000 --> 01:08:40,960 WILL BE BETTER BASED ON RESEARCH 1660 01:08:40,960 --> 01:08:43,680 EM MATING FROM THE CONFERENCE. 1661 01:08:43,680 --> 01:08:44,400 -- EMANATING FROM THE 1662 01:08:44,400 --> 01:08:45,800 CONFERENCE. 1663 01:08:45,800 --> 01:08:48,400 >>I CAN AGREE WITH WHAT DAVID 1664 01:08:48,400 --> 01:08:51,160 SAID BUT I WOULD SAY ONE OF THE 1665 01:08:51,160 --> 01:08:52,680 THINGS THAT STRUCK ME AND THE 1666 01:08:52,680 --> 01:08:55,640 MEMBERS OF OUR COMMITTEE WAS THE 1667 01:08:55,640 --> 01:09:01,000 NEED FOR OUTCOME MEASURES THAT 1668 01:09:01,000 --> 01:09:03,520 MEASURE WELL-BEING AND THE IDEA 1669 01:09:03,520 --> 01:09:04,880 OF PEOPLE -- NOT SO MUCH 1670 01:09:04,880 --> 01:09:06,160 UTILIZATION BUT HOW ARE THEY 1671 01:09:06,160 --> 01:09:07,440 FEELING AND WHAT IS THE QUALITY 1672 01:09:07,440 --> 01:09:10,480 OF THEIR LIFE AND THAT INCLUDES 1673 01:09:10,480 --> 01:09:11,800 BOTH THE PERSON LIVING WITH 1674 01:09:11,800 --> 01:09:15,080 DEMENTIA AND THEIR CARE PARTNERS 1675 01:09:15,080 --> 01:09:16,840 AND CAREGIVERS. 1676 01:09:16,840 --> 01:09:20,440 THAT ENCOMPASSED THE QUADRUPLE 1677 01:09:20,440 --> 01:09:22,120 AIM OF THE PROFESSIONAL 1678 01:09:22,120 --> 01:09:23,520 PROVIDERS AS WELL. 1679 01:09:23,520 --> 01:09:24,160 >>THANK YOU. 1680 01:09:24,160 --> 01:09:33,760 WE HAVE A QUESTION FROM MICHAEL 1681 01:09:33,760 --> 01:09:35,400 ELLENBOGEN IF WE CAN UNMUTE AND 1682 01:09:35,400 --> 01:09:36,800 FOR EVERYONE ELSE EP, I 1683 01:09:36,800 --> 01:09:38,040 ENCOURAGE YOU TO TYPE YOUR 1684 01:09:38,040 --> 01:09:39,000 QUESTION IN THE CHAT OR Q&A TO 1685 01:09:39,000 --> 01:09:40,240 SEE THEM. 1686 01:09:40,240 --> 01:09:41,320 >>THANK YOU FOR THE 1687 01:09:41,320 --> 01:09:45,240 OPPORTUNITY. 1688 01:09:45,240 --> 01:09:45,640 CAN YOU HEAR ME? 1689 01:09:45,640 --> 01:09:48,080 >>YES. 1690 01:09:48,080 --> 01:09:48,320 THANK YOU. 1691 01:09:48,320 --> 01:09:51,920 >>THE SUBJECT IS DEAR TO MY 1692 01:09:51,920 --> 01:09:52,120 HEART. 1693 01:09:52,120 --> 01:09:54,120 I'VE BEEN LIVING WITH DEMENTIA 1694 01:09:54,120 --> 01:09:58,360 OVER 10 YEARS SADLY BUT THE GOOD 1695 01:09:58,360 --> 01:10:00,160 NEWS IS IT'S BROUGHT A PASSION 1696 01:10:00,160 --> 01:10:01,960 OUT OF ME TO WANT TO CHANGE THE 1697 01:10:01,960 --> 01:10:03,200 HEALTH SYSTEM AND I BELIEVE 1698 01:10:03,200 --> 01:10:04,320 THERE'S PEOPLE HERE TO HELP ME 1699 01:10:04,320 --> 01:10:05,440 DO THAT. 1700 01:10:05,440 --> 01:10:07,640 I'M WORKING ON A PROJECT THAT IS 1701 01:10:07,640 --> 01:10:10,400 TRYING TO CHANGE THE U.S. HEALTH 1702 01:10:10,400 --> 01:10:13,640 SYSTEM ENTIRELY TO THE POINT WE 1703 01:10:13,640 --> 01:10:19,680 WILL HAVE SOME SORT OF COGNITIVE 1704 01:10:19,680 --> 01:10:22,840 TEST AND HAVE TRAINING TO 1705 01:10:22,840 --> 01:10:24,600 HOSPITAL STAFF TO UNDERSTAND 1706 01:10:24,600 --> 01:10:26,520 WHAT IT'S LIKE TO LIVE WITH THIS 1707 01:10:26,520 --> 01:10:28,040 DISEASE AND MORE IMPORTANTLY TO 1708 01:10:28,040 --> 01:10:29,800 TRAIN THEM HOW TO WORK WITH THE 1709 01:10:29,800 --> 01:10:37,600 PEOPLE WHO COME TO THE HOSPITAL. 1710 01:10:37,600 --> 01:10:40,280 MANY ARE OF THIS AND THOSE ON 1711 01:10:40,280 --> 01:10:43,840 THE COMMITTEE ALREADY ARE AWARE 1712 01:10:43,840 --> 01:10:44,280 OF THIS. 1713 01:10:44,280 --> 01:10:46,800 I ALREADY PUT MY E-MAIL ADDRESS 1714 01:10:46,800 --> 01:10:48,920 OUT THERE TO REACH OUT TO ME. 1715 01:10:48,920 --> 01:10:49,920 I CAN TELL YOU THIS IS GOING TO 1716 01:10:49,920 --> 01:10:53,160 HAPPEN. 1717 01:10:53,160 --> 01:10:58,720 AND THIS IS NOT BECAUSE I HAVE 1718 01:10:58,720 --> 01:11:01,760 THE KNOWLEDGE AND HAVE EXPERTS 1719 01:11:01,760 --> 01:11:03,000 WITH ME HERE TODAY NOT ON MY 1720 01:11:03,000 --> 01:11:04,040 TEAM AND I'D LOVE FOR THEM TO 1721 01:11:04,040 --> 01:11:04,280 JOIN ME. 1722 01:11:04,280 --> 01:11:10,480 THANK YOU. 1723 01:11:10,480 --> 01:11:12,320 >>DOES ANYONE WANT TO COMMENT? 1724 01:11:12,320 --> 01:11:12,680 THANK YOU. 1725 01:11:12,680 --> 01:11:17,520 I HAVE A QUESTION FOR DR. WONG. 1726 01:11:17,520 --> 01:11:20,920 I SAW THE EMERGENCY MEDICINE 1727 01:11:20,920 --> 01:11:26,280 DIDN'T FILL 500 SLOTS IN THE 1728 01:11:26,280 --> 01:11:28,920 MATCH PROGRAM FROM NEXT YEAR AND 1729 01:11:28,920 --> 01:11:31,480 GERIATRICS IS A LONG-STANDING 1730 01:11:31,480 --> 01:11:32,560 SPECIALTY AREA SHORTAGE AND SO 1731 01:11:32,560 --> 01:11:35,720 WHAT ARE THE IMPLICATIONS OF THE 1732 01:11:35,720 --> 01:11:38,400 SHORTAGES IN LIGHT OF YOUR PLANS 1733 01:11:38,400 --> 01:11:43,560 TO JOIN THE FORCES OF GERIATRICS 1734 01:11:43,560 --> 01:11:45,960 AND EMERGENCY MEDICINE TO 1735 01:11:45,960 --> 01:11:47,960 ADDRESS MEDICINE. 1736 01:11:47,960 --> 01:11:50,400 >>IT'S A BIG TOPIC WITH OUR 1737 01:11:50,400 --> 01:11:52,080 NATIONAL MEETINGS IN EMERGENCY 1738 01:11:52,080 --> 01:11:54,240 MEDICINE AND GERIATRICS IN MAY, 1739 01:11:54,240 --> 01:11:56,040 I THINK IT WILL BE A DOMINATING 1740 01:11:56,040 --> 01:11:56,440 DISCUSSION POINT. 1741 01:11:56,440 --> 01:11:59,000 WHEN YOU MENTIONED THE NUMBER OF 1742 01:11:59,000 --> 01:12:00,640 SLOTS THAT INITIALLY WENT 1743 01:12:00,640 --> 01:12:01,880 UNFILLED FOR EMERGENCY MEDICINE, 1744 01:12:01,880 --> 01:12:04,120 THAT REPRESENTS ALMOST 20% OF 1745 01:12:04,120 --> 01:12:05,760 OUR SLOTS. 1746 01:12:05,760 --> 01:12:07,400 I THINK THIS IS A BIG IMPACT. 1747 01:12:07,400 --> 01:12:10,840 IT'S A REFLECTION OF THE COVID 1748 01:12:10,840 --> 01:12:12,200 PANDEMIC AND BURN OUT WELLNESS 1749 01:12:12,200 --> 01:12:14,360 IS CRITICAL AND CROWDING OUR 1750 01:12:14,360 --> 01:12:15,960 EMERGENCY ROOM DEPARTMENTS. 1751 01:12:15,960 --> 01:12:17,800 THE CROWDING OF THE EMERGENCY 1752 01:12:17,800 --> 01:12:19,200 ROOM DEPARTMENTS REPRESENTS THE 1753 01:12:19,200 --> 01:12:22,360 SYSTEM BEING OVERLOADED. 1754 01:12:22,360 --> 01:12:25,040 WE'RE FACING SHORTAGES NOT JUST 1755 01:12:25,040 --> 01:12:26,840 IN EMERGENCY ROOM BUT NURSING 1756 01:12:26,840 --> 01:12:28,360 AND LONG-TERM CARE SERVICES. 1757 01:12:28,360 --> 01:12:31,200 THERE'S NO PLACE FOR PATIENTS TO 1758 01:12:31,200 --> 01:12:31,680 GO. 1759 01:12:31,680 --> 01:12:34,080 I THINK THE WHOLE REASON I WENT 1760 01:12:34,080 --> 01:12:35,760 INTO GERIATRIC EMERGENCY CARE 1761 01:12:35,760 --> 01:12:37,480 AND NOW FOCUSSED ON DEMENTIA 1762 01:12:37,480 --> 01:12:41,320 CARE IS BECAUSE OF THE IMPACT OF 1763 01:12:41,320 --> 01:12:43,680 CROWDING AND IT CAN IMPACT THE 1764 01:12:43,680 --> 01:12:46,360 QUALITY AND WE HAVE TO PROTECT 1765 01:12:46,360 --> 01:12:49,120 THE VULNERABLE POPULATION AND NO 1766 01:12:49,120 --> 01:12:50,360 MORE SO THAN THE EMERGENCY ROOM 1767 01:12:50,360 --> 01:12:52,000 AND WE'RE THE SAFETY NET. 1768 01:12:52,000 --> 01:12:53,280 IF WE CAN'T DO A GOOD JOB WITH 1769 01:12:53,280 --> 01:12:55,240 THE CARE THERE, WHAT WILL HAPPEN 1770 01:12:55,240 --> 01:12:57,000 WITH PATIENTS IN GENERAL? 1771 01:12:57,000 --> 01:12:59,640 TO YOUR QUESTION THERE'S A 1772 01:12:59,640 --> 01:13:00,040 COUPLE SOLUTIONS. 1773 01:13:00,040 --> 01:13:01,400 THEY'RE ALL JUST OPINIONS OF 1774 01:13:01,400 --> 01:13:02,840 MINE BUT AGAIN FOCUSSING ON WHAT 1775 01:13:02,840 --> 01:13:05,120 WE CAN DO RIGHT FOR PATIENTS. 1776 01:13:05,120 --> 01:13:08,280 IF WE CAN REDUCE THE RISK OF AN 1777 01:13:08,280 --> 01:13:10,000 AVOIDABLE HOSPITALIZATION AND 1778 01:13:10,000 --> 01:13:11,640 EMERGENCY ROOM DEPARTMENT WE 1779 01:13:11,640 --> 01:13:13,360 WON'T SEE THE RELIEF IN CROWDING 1780 01:13:13,360 --> 01:13:14,720 BUT WHAT WE'RE DOING IS 1781 01:13:14,720 --> 01:13:16,400 SOMETHING GOOD FOR THE PATIENT, 1782 01:13:16,400 --> 01:13:19,560 FAMILY AND HEALTH CARE SYSTEM. 1783 01:13:19,560 --> 01:13:20,680 I THINK THERE'S AN OPPORTUNITY 1784 01:13:20,680 --> 01:13:22,320 WITH THE SHORTAGES OF 1785 01:13:22,320 --> 01:13:23,720 UNDERSTANDING AND PRESENTING 1786 01:13:23,720 --> 01:13:26,720 REAL-WORLD SOLUTIONS ABOUT HOW 1787 01:13:26,720 --> 01:13:30,840 WE CAN IDENTIFY THE MISSED 1788 01:13:30,840 --> 01:13:32,400 OPPORTUNITIES AND MISALIGNED 1789 01:13:32,400 --> 01:13:33,760 CARE FOR THE PATIENTS AND SHOW 1790 01:13:33,760 --> 01:13:35,880 THE CLINICIANS HOW WE CAN 1791 01:13:35,880 --> 01:13:38,600 POTENTIALLY FACILITATE AND GET 1792 01:13:38,600 --> 01:13:41,440 THEM TO THE PROPER SETTING AND 1793 01:13:41,440 --> 01:13:43,800 GET THEM TO THE BETTER OUTCOMES. 1794 01:13:43,800 --> 01:13:44,760 IT WILL ALSO SHOW THE HEALTH 1795 01:13:44,760 --> 01:13:46,960 CARE CLINICIANS THE VALUE OF 1796 01:13:46,960 --> 01:13:49,400 SOMETHING LIKE A GERIATRIC 1797 01:13:49,400 --> 01:13:52,760 EMERGENCY CARE AND DEMENTIA CARE 1798 01:13:52,760 --> 01:13:52,960 MODELS. 1799 01:13:52,960 --> 01:13:54,040 A LOT OF EMERGENCY ROOM 1800 01:13:54,040 --> 01:14:00,400 PHYSICIANS WILL SAY IT'S NOT AN 1801 01:14:00,400 --> 01:14:02,320 EMERGENCY BUT IT IS IF WE MISS 1802 01:14:02,320 --> 01:14:03,720 IT. 1803 01:14:03,720 --> 01:14:07,600 AND MARRYING THE TWO SPECIALTIES 1804 01:14:07,600 --> 01:14:09,640 FACING A CRISIS POINT AND 1805 01:14:09,640 --> 01:14:10,880 THEY'RE ONLY POTENTIALLY BECOME 1806 01:14:10,880 --> 01:14:13,160 GREATER IF WE DON'T PARTNER AND 1807 01:14:13,160 --> 01:14:13,600 ALIGN. 1808 01:14:13,600 --> 01:14:17,320 I'LL THROW ONE MORE UNSANCTIONED 1809 01:14:17,320 --> 01:14:19,680 SOLUTION IS CAN WE EXPAND THE 1810 01:14:19,680 --> 01:14:22,680 OPPORTUNITY FOR TRAINING WITH 1811 01:14:22,680 --> 01:14:24,400 GERIATRIC AND IF EMERGENCY ROOM 1812 01:14:24,400 --> 01:14:25,680 PHYSICIANS ARE LEAVING THE FIELD 1813 01:14:25,680 --> 01:14:27,560 OR THOSE WHO MAY BE INTERESTED 1814 01:14:27,560 --> 01:14:31,280 IN EMERGENCY CARE CAN THEY 1815 01:14:31,280 --> 01:14:34,200 CONSIDER GERIATRICS. 1816 01:14:34,200 --> 01:14:38,080 FELLOWSHIP SPOTS ARE ALSO NOT 1817 01:14:38,080 --> 01:14:38,320 FILLING. 1818 01:14:38,320 --> 01:14:40,240 COULD THERE BE AN OPPORTUNITY TO 1819 01:14:40,240 --> 01:14:41,400 OPEN UP TO ADDITIONAL 1820 01:14:41,400 --> 01:14:42,000 SPECIALTIES TO GET ADDITIONAL 1821 01:14:42,000 --> 01:14:47,160 TRAINING. 1822 01:14:47,160 --> 01:14:48,560 LONG-WINDED ANSWER BUT A COUPLE 1823 01:14:48,560 --> 01:14:49,880 DIRECTIONS AND EMPHASIZING THE 1824 01:14:49,880 --> 01:14:51,120 OPPORTUNITY FOR PARTNERSHIPS 1825 01:14:51,120 --> 01:14:51,640 WITH THE EMERGENCY ROOM 1826 01:14:51,640 --> 01:14:58,480 DEPARTMENT. 1827 01:14:58,480 --> 01:14:59,000 >>THANK YOU. 1828 01:14:59,000 --> 01:14:59,560 I HAVE A QUESTION FROM THE 1829 01:14:59,560 --> 01:15:02,560 AUDIENCE. 1830 01:15:02,560 --> 01:15:04,960 CAN YOU SPEAK TO THE EXTENT TO 1831 01:15:04,960 --> 01:15:06,560 WHICH CURRENT OR EXISTING 1832 01:15:06,560 --> 01:15:08,600 COMPREHENSIVE CARE MODELS ARE 1833 01:15:08,600 --> 01:15:11,240 REACHING INDIVIDUALS FROM 1834 01:15:11,240 --> 01:15:12,640 DIVERSE GROUPS? 1835 01:15:12,640 --> 01:15:17,800 LIKE RURAL, RACE/ETHNIC 1836 01:15:17,800 --> 01:15:20,360 MINORITIES, FOR EXAMPLE. 1837 01:15:20,360 --> 01:15:22,440 THESE ARE INCOMPLETE DATA. 1838 01:15:22,440 --> 01:15:23,680 EACH OF THE MODEL DEVELOPERS 1839 01:15:23,680 --> 01:15:27,760 COULD PROBABLY SAY MORE ABOUT 1840 01:15:27,760 --> 01:15:30,040 WHAT POPULATIONS THEY'RE 1841 01:15:30,040 --> 01:15:31,600 SERVING. 1842 01:15:31,600 --> 01:15:38,000 I CAN SAY A GOOD BIT ABOUT THE 1843 01:15:38,000 --> 01:15:40,200 STUDY AND CONSULTATION MODEL AND 1844 01:15:40,200 --> 01:15:41,400 UCLA ALZHEIMER'S AND DEMENTIA 1845 01:15:41,400 --> 01:15:41,880 CARE MODEL. 1846 01:15:41,880 --> 01:15:45,040 IN THE TRIAL AND THIS IS PRETTY 1847 01:15:45,040 --> 01:15:48,480 AMAZING BECAUSE IT'S A CLINICAL 1848 01:15:48,480 --> 01:15:52,000 TRIAL, 21% OF THE POPULATION IS 1849 01:15:52,000 --> 01:15:55,680 UNDER REPRESENTED MINORITIES. 1850 01:15:55,680 --> 01:15:59,320 AND THAT'S VERY GOOD. 1851 01:15:59,320 --> 01:16:02,080 ALSO RURAL POPULATIONS 1852 01:16:02,080 --> 01:16:03,360 PARTICULARLY IN NORTH CAROLINA 1853 01:16:03,360 --> 01:16:05,600 AND GEISINGER IN PENNSYLVANIA. 1854 01:16:05,600 --> 01:16:06,760 THERE ARE DATA OUT THERE. 1855 01:16:06,760 --> 01:16:12,520 IT HASN'T BEEN REALLY 1856 01:16:12,520 --> 01:16:13,840 AMALGAMATED INTO A DIGESTIBLE 1857 01:16:13,840 --> 01:16:16,120 DOCUMENT BUT THAT IS A GOAL. 1858 01:16:16,120 --> 01:16:20,160 THAT'S A GOAL TO REACH THESE 1859 01:16:20,160 --> 01:16:20,800 POPULATIONS THAT HAVE BEEN UNDER 1860 01:16:20,800 --> 01:16:28,200 SERVED. 1861 01:16:28,200 --> 01:16:28,720 >>THANKS. 1862 01:16:28,720 --> 01:16:30,040 I HAVE ANOTHER QUESTION FROM THE 1863 01:16:30,040 --> 01:16:31,680 AUDIENCE. 1864 01:16:31,680 --> 01:16:37,800 THIS IS FROM APRIL. 1865 01:16:37,800 --> 01:16:41,800 SO WHAT DOES THE PANEL SEE AS A 1866 01:16:41,800 --> 01:16:43,240 ROLE OF DIG THAT WILL HEALTH 1867 01:16:43,240 --> 01:16:45,120 TECHNOLOGIES IN MEASURING 1868 01:16:45,120 --> 01:16:47,240 QUALITY OF LIFE OUTCOMES FOR 1869 01:16:47,240 --> 01:16:52,720 BOTH PERSONS LIVING WITH 1870 01:16:52,720 --> 01:17:02,200 DEMENTIA AND THE CAREGIVERS? 1871 01:17:02,200 --> 01:17:09,000 HOW CAN YOU SUPPORT 1872 01:17:09,000 --> 01:17:14,720 INTERVENTIONS. 1873 01:17:14,720 --> 01:17:15,640 >>MAY I START? 1874 01:17:15,640 --> 01:17:20,160 >>PLEASE. 1875 01:17:20,160 --> 01:17:23,120 >>WHEN WE THINK OF DIGITAL 1876 01:17:23,120 --> 01:17:23,880 TECHNOLOGIES THEY'RE VEHICLES TO 1877 01:17:23,880 --> 01:17:25,280 MEASURE SOMETHING. 1878 01:17:25,280 --> 01:17:30,760 WHAT'S THE SOMETHING BEING 1879 01:17:30,760 --> 01:17:31,040 MEASURED? 1880 01:17:31,040 --> 01:17:33,040 IF THESE ARE QUALITY OF LIFE 1881 01:17:33,040 --> 01:17:38,280 OUTCOMES OR DATA ELEMENTS I 1882 01:17:38,280 --> 01:17:40,920 WOULD ALSO LOOK TO FINALIZE BY 1883 01:17:40,920 --> 01:17:43,520 WAY OF THE IMPACT ACT. 1884 01:17:43,520 --> 01:17:45,760 AND WHY I MENTION THAT IS 1885 01:17:45,760 --> 01:17:48,320 BECAUSE THERE'S CAREFUL 1886 01:17:48,320 --> 01:17:49,760 STANDARDIZATION OF KEY AREAS, 1887 01:17:49,760 --> 01:17:55,520 KEY BDOMAINS THAT INCLUDE 1888 01:17:55,520 --> 01:17:56,800 MOBILITY FUNCTION AND GOALS OF 1889 01:17:56,800 --> 01:17:57,480 CARE, PAIN AND SO ON AND SO 1890 01:17:57,480 --> 01:18:02,720 FORTH. 1891 01:18:02,720 --> 01:18:03,560 . 1892 01:18:03,560 --> 01:18:05,280 IT'S A SEARCHABLE LIBRARY. 1893 01:18:05,280 --> 01:18:06,720 IT'S CALLED THE DATA ELEMENT 1894 01:18:06,720 --> 01:18:06,960 LIBRARY. 1895 01:18:06,960 --> 01:18:12,920 KEEP IN MIND THAT THOSE ARE THE 1896 01:18:12,920 --> 01:18:15,240 BASIS FOR WHICH MANY OF THE POST 1897 01:18:15,240 --> 01:18:17,120 ACUTE CARE FACILITY BASED 1898 01:18:17,120 --> 01:18:19,560 MEASURES WERE -- IT WAS MEANT TO 1899 01:18:19,560 --> 01:18:21,640 SUPPORT THAT CONSTRUCT. 1900 01:18:21,640 --> 01:18:23,200 THAT CONSTRUCT THOUGH THE 1901 01:18:23,200 --> 01:18:25,360 INFORMATION GATHERED IS ALSO 1902 01:18:25,360 --> 01:18:28,000 USABLE FOR PURPOSES OF THE CARE 1903 01:18:28,000 --> 01:18:28,880 AND KEEPING OF THE INDIVIDUAL 1904 01:18:28,880 --> 01:18:32,120 WHO'S ARE SERVED BY A FACILITY. 1905 01:18:32,120 --> 01:18:36,240 SO IF YOU LOOK AT THOSE TWO, 1906 01:18:36,240 --> 01:18:39,680 THERE'S A CONVERGENCE POINT THAT 1907 01:18:39,680 --> 01:18:44,960 CAN BE AN INDICATOR OF HOW ONE 1908 01:18:44,960 --> 01:18:47,560 TO WHAT MIGHT BE INTEGRATABLE 1909 01:18:47,560 --> 01:18:50,520 AND COVERABLE AND FLAGGING FOR 1910 01:18:50,520 --> 01:18:54,760 YOU THAT THE USCDI, I DON'T KNOW 1911 01:18:54,760 --> 01:18:59,760 WHAT THE ACRONYM IS FOR BUT IT'S 1912 01:18:59,760 --> 01:19:03,600 ABOUT INTEROPERABILITY AND DATA 1913 01:19:03,600 --> 01:19:04,960 AND UNDER ASSESSMENT. 1914 01:19:04,960 --> 01:19:06,120 THIS INCLUDES ASSESSMENT OF WHAT 1915 01:19:06,120 --> 01:19:14,680 YOU MAY BE INTERESTED IN. 1916 01:19:14,680 --> 01:19:16,640 TREMENDOUS OPPORTUNITY TO FOCUS 1917 01:19:16,640 --> 01:19:18,920 ON THIS AND COULD BE LOOKED UPON 1918 01:19:18,920 --> 01:19:21,120 AS INFORMATION INTEGRATABLE IN 1919 01:19:21,120 --> 01:19:22,320 CARE MODELS AND ALIKE. 1920 01:19:22,320 --> 01:19:22,520 OVER. 1921 01:19:22,520 --> 01:19:32,720 THANK YOU. 1922 01:19:36,360 --> 01:19:37,600 >>THERE'S BEEN WORK ON THINKING 1923 01:19:37,600 --> 01:19:40,280 OF MODIFICATIONS TO THE MOMENT 1924 01:19:40,280 --> 01:19:41,640 ENVIRONMENT TO ENABLE AGING IN 1925 01:19:41,640 --> 01:19:42,040 PLACE. 1926 01:19:42,040 --> 01:19:44,400 HOW CRITICAL IS THE QUALITY OF 1927 01:19:44,400 --> 01:19:49,280 THE HOME ENVIRONMENT TO PEOPLE 1928 01:19:49,280 --> 01:19:52,760 WITH THEIR CARE PARTNERS? 1929 01:19:52,760 --> 01:19:58,640 >>THIS IS ONE OF THE MOTIVATION 1930 01:19:58,640 --> 01:20:02,080 OF OUR EXPANSION TO OUR SENIOR 1931 01:20:02,080 --> 01:20:04,800 PERSON'S HOME THERE ASSISTED TO 1932 01:20:04,800 --> 01:20:06,360 INDEPENDENT LIVING AND THE BUILT 1933 01:20:06,360 --> 01:20:07,680 ENVIRONMENT AND THE PEOPLE 1934 01:20:07,680 --> 01:20:11,240 SURROUNDING THEM. 1935 01:20:11,240 --> 01:20:16,160 AND SO HOW CRITICAL IS IT? 1936 01:20:16,160 --> 01:20:17,640 IT'S IMPORTANT TO THE OVER ALL 1937 01:20:17,640 --> 01:20:18,880 WELL BEING OF SOMEONE GETTING 1938 01:20:18,880 --> 01:20:20,400 THROUGH THEIR DAYS IN AN ENGAGED 1939 01:20:20,400 --> 01:20:23,280 AND SAFE MANNER. 1940 01:20:23,280 --> 01:20:26,080 IT ALSO HAS IMPLICATIONS ON 1941 01:20:26,080 --> 01:20:27,640 AFFECTIVE OR EMOTIONAL NEEDS 1942 01:20:27,640 --> 01:20:28,320 BEING MET. 1943 01:20:28,320 --> 01:20:32,160 SO THIS IS WHY WE BOTH VALUE 1944 01:20:32,160 --> 01:20:33,920 CLASSES AND SUPPORT FOR FAMILY 1945 01:20:33,920 --> 01:20:36,200 CARE PARTNERS WHO ARE OUR MOST 1946 01:20:36,200 --> 01:20:38,280 POWERFUL INTERVENTION. 1947 01:20:38,280 --> 01:20:40,520 HAVING THEM TRAINED AND 1948 01:20:40,520 --> 01:20:41,720 EMPOWERED AND EDUCATED AND 1949 01:20:41,720 --> 01:20:43,000 CONNECTED TO A RESOURCE WHEN 1950 01:20:43,000 --> 01:20:45,080 THEY NEED IT ON OUR TEAM HAS 1951 01:20:45,080 --> 01:20:45,840 BEEN IMPORTANT. 1952 01:20:45,840 --> 01:20:48,320 THIS IS WHY ALSO WE'VE ADDED THE 1953 01:20:48,320 --> 01:20:49,480 OCCUPATIONAL THERAPIST TO THE 1954 01:20:49,480 --> 01:20:51,160 TEAM SO THEY ARE ACTUALLY IN THE 1955 01:20:51,160 --> 01:20:53,840 HOME AND SETTING UP THE SPACE SO 1956 01:20:53,840 --> 01:20:56,320 THE PERSON CAN BE AS AUTONOMOUS 1957 01:20:56,320 --> 01:20:59,640 AS INDEPENDENT AS POSSIBLE FOR 1958 01:20:59,640 --> 01:21:01,120 AS LONG AS POSSIBLE WHICH ALSO 1959 01:21:01,120 --> 01:21:02,720 HAS IMPLICATIONS FOR EMOTIONAL 1960 01:21:02,720 --> 01:21:11,480 WELL BEING. 1961 01:21:11,480 --> 01:21:16,160 >>KEEP IN MIND THAT IN THE 1962 01:21:16,160 --> 01:21:17,080 MEDICARE POPULATION MORE THAN 1963 01:21:17,080 --> 01:21:19,640 50% OF INDIVIDUALS ARE GOING TO 1964 01:21:19,640 --> 01:21:24,400 HAVE NOT ONLY COGNITIVE 1965 01:21:24,400 --> 01:21:26,400 IMPAIRMENT OR DIAGNOSIS WITH 1966 01:21:26,400 --> 01:21:27,480 DEMENTIA BUT OTHER COMORBIDITIES 1967 01:21:27,480 --> 01:21:28,480 AND IT'S IMPORTANT TO THINK 1968 01:21:28,480 --> 01:21:32,840 ABOUT THE PERSON AND THE 1969 01:21:32,840 --> 01:21:35,280 PERSON'S NEEDS NOT JUST FOR 1970 01:21:35,280 --> 01:21:36,840 SOLVING THE PROBLEM OF 1971 01:21:36,840 --> 01:21:37,120 COGNITION. 1972 01:21:37,120 --> 01:21:39,440 I'M GLAD TO HEAR ABOUT THAT 1973 01:21:39,440 --> 01:21:41,520 SHIFT AND THAT DEVELOPMENT, 1974 01:21:41,520 --> 01:21:41,760 CAROLYN. 1975 01:21:41,760 --> 01:21:52,040 THANK YOU, OVER. 1976 01:21:57,160 --> 01:21:58,600 THERE WE HAD A QUESTION IN THE 1977 01:21:58,600 --> 01:22:02,160 CHAT ABOUT ADVICE OR SOLUTIONS 1978 01:22:02,160 --> 01:22:07,600 DEALING WITH STAFF SHORTAGES AND 1979 01:22:07,600 --> 01:22:09,320 HIGH TURNOVER THERE. 1980 01:22:09,320 --> 01:22:11,000 THERE'S PEOPLE WHO PROVIDE 1981 01:22:11,000 --> 01:22:13,000 DIRECT CARE FOR PERSONS LIVING 1982 01:22:13,000 --> 01:22:14,400 WITH DEMENTIA AND HOW THAT FITS 1983 01:22:14,400 --> 01:22:24,760 IN THE CARE MODELS. 1984 01:22:39,600 --> 01:22:40,680 >>IT'S A STUMPER. 1985 01:22:40,680 --> 01:22:43,280 >>WE NEED TO TALK ABOUT THE 1986 01:22:43,280 --> 01:22:45,440 CARE PEOPLE RECEIVE AND THERE'S 1987 01:22:45,440 --> 01:22:46,600 OFTEN EMPHASIS ON HOW HARD IT IS 1988 01:22:46,600 --> 01:22:49,920 AND YEAH, IT'S HARD AND YEAH 1989 01:22:49,920 --> 01:22:51,160 THERE ARE SAD ELEMENTS. 1990 01:22:51,160 --> 01:22:54,600 I'VE BEEN AROUND LONG ENOUGH TO 1991 01:22:54,600 --> 01:22:56,120 KNOW OVER THE YEARS CARING FOR 1992 01:22:56,120 --> 01:22:57,840 PERSONS LIVING WITH DEMENTIA AND 1993 01:22:57,840 --> 01:22:59,440 THEIR FAMILIES IS A PRIVILEGE. 1994 01:22:59,440 --> 01:23:00,040 I DON'T THINK WE SPEAK TO THAT 1995 01:23:00,040 --> 01:23:02,880 ENOUGH. 1996 01:23:02,880 --> 01:23:07,080 >>THANK YOU. 1997 01:23:07,080 --> 01:23:14,720 >>I HAVE A QUESTION FOR YOU, 1998 01:23:14,720 --> 01:23:14,960 ROBERTA. 1999 01:23:14,960 --> 01:23:16,880 IT WAS GOOD TO HEAR YOU HAVE A 2000 01:23:16,880 --> 01:23:17,720 CARE PROGRAM THAT WORKED FOR 2001 01:23:17,720 --> 01:23:18,560 YOUR FAMILY. 2002 01:23:18,560 --> 01:23:20,240 THE QUESTION IS WHY DID YOU 2003 01:23:20,240 --> 01:23:22,280 PREFER THE SERVICES THROUGH THE 2004 01:23:22,280 --> 01:23:28,440 DUKE MEDICINE PROGRAM FOR YOUR 2005 01:23:28,440 --> 01:23:29,000 MOTHER'S CARE? 2006 01:23:29,000 --> 01:23:30,400 >>I DID RESPOND IN THE CHAT BUT 2007 01:23:30,400 --> 01:23:31,440 HAPPY TO ANSWER LIVE. 2008 01:23:31,440 --> 01:23:37,800 IT WAS DIFFICULT FOR ME BECAUSE 2009 01:23:37,800 --> 01:23:40,200 MY MOM WAS VERY AS AN IMMIGRANT 2010 01:23:40,200 --> 01:23:42,720 SHE HELD ON TO HER MONEY AND 2011 01:23:42,720 --> 01:23:43,960 ALWAYS DID WHATEVER SHE NEEDED 2012 01:23:43,960 --> 01:23:46,640 TO HOLD ON TO THAT AND FOR US 2013 01:23:46,640 --> 01:23:51,480 DUKE INTEGRATIVE YOU PAY FOR A 2014 01:23:51,480 --> 01:23:56,400 QUALITY OF CARE THAT YOU PAY. 2015 01:23:56,400 --> 01:23:58,360 EASY ACCESS, QUICK RESPONSE, 2016 01:23:58,360 --> 01:24:02,240 COMFORTABLE YOU WALK IN AND IT 2017 01:24:02,240 --> 01:24:03,200 DOES NOT FEEL LIKE A HOSPITAL OR 2018 01:24:03,200 --> 01:24:07,720 CLINIC. 2019 01:24:07,720 --> 01:24:12,280 AS I MENTIONED, I HAD A ONE AND 2020 01:24:12,280 --> 01:24:15,360 A HALF AND 2-YEAR-OLD AT THE 2021 01:24:15,360 --> 01:24:16,800 TIME AND A WAS CARRYING A LOT 2022 01:24:16,800 --> 01:24:19,280 AND IT MADE ALL THE DIFFERENCE 2023 01:24:19,280 --> 01:24:22,920 FOR ME AS HER SOLE CAREGIVER WE 2024 01:24:22,920 --> 01:24:23,680 HAD THAT EXPERIENCE. 2025 01:24:23,680 --> 01:24:27,560 THERE WAS A LOT WE HAD TO FIGURE 2026 01:24:27,560 --> 01:24:27,760 OUT. 2027 01:24:27,760 --> 01:24:30,360 I RECOGNIZE THAT'S A PRIVILEGE. 2028 01:24:30,360 --> 01:24:32,600 I RECOGNIZE IT'S NOT A RESOURCE 2029 01:24:32,600 --> 01:24:34,600 AVAILABLE TO THE MAJORITY OF 2030 01:24:34,600 --> 01:24:34,880 PLACES. 2031 01:24:34,880 --> 01:24:38,840 WE HAPPEN TO LAND IN A PLACE 2032 01:24:38,840 --> 01:24:41,120 THAT HAD A LOT OF ACADEMIC 2033 01:24:41,120 --> 01:24:45,720 CLINICAL RESOURCES BUT THAT'S 2034 01:24:45,720 --> 01:24:46,680 MAINLY THE REASON WE PREFERRED 2035 01:24:46,680 --> 01:24:47,680 DUKE INTEGRATIVE CARE. 2036 01:24:47,680 --> 01:24:48,880 >>THANK YOU. 2037 01:24:48,880 --> 01:24:50,680 I WANT TO THANK ALL THE SPEAKERS 2038 01:24:50,680 --> 01:24:53,960 AND PANELISTS AND ESPECIALLY 2039 01:24:53,960 --> 01:24:57,240 WANT TO THANK CASE POSSIN FOR 2040 01:24:57,240 --> 01:25:02,720 HELP AND GREAT LEADERSHIP IN THE 2041 01:25:02,720 --> 01:25:04,880 SESSION. 2042 01:25:04,880 --> 01:25:05,680 DO YOU WANT TO SAY SOME WORDS? 2043 01:25:05,680 --> 01:25:09,320 >>I'M LEFT THINKING ABOUT 2044 01:25:09,320 --> 01:25:10,360 ROBERTA'S CLOSING COMMENT. 2045 01:25:10,360 --> 01:25:15,440 IT IS POSSIBLE TO PROVIDE THE 2046 01:25:15,440 --> 01:25:20,080 CARE THAT FAMILIES NEED AND WE 2047 01:25:20,080 --> 01:25:21,600 HAVE A CHARGE TO DO THE RESEARCH 2048 01:25:21,600 --> 01:25:23,240 REQUIRED AND SO IT'S ACCESSIBLE 2049 01:25:23,240 --> 01:25:24,720 TO ALL FAMILIES STRUGGLING WITH 2050 01:25:24,720 --> 01:25:25,120 DEMENTIA TODAY. 2051 01:25:25,120 --> 01:25:31,000 THANK YOU. 2052 01:25:31,000 --> 01:25:32,280 >>THANK YOU. 2053 01:25:32,280 --> 01:25:34,000 THANK YOU TO EVERYONE FOR THEIR 2054 01:25:34,000 --> 01:25:34,760 EXCELLENT CONTRIBUTION TO THE 2055 01:25:34,760 --> 01:25:35,200 MORNING SESSION. 2056 01:25:35,200 --> 01:25:36,920 WE NOW HAVE A SCHEDULED 2057 01:25:36,920 --> 01:25:38,640 35-MINUTE BREAK. 2058 01:25:38,640 --> 01:25:40,280 WE'LL BE RECONVENING AT 1:00 2059 01:25:40,280 --> 01:25:44,120 P.M. EASTERN STANDARD TIME. 2060 01:25:44,120 --> 01:25:47,720 >>WELCOME BACK FROM 2061 01:25:47,720 --> 01:25:50,800 THE BREAK. 2062 01:25:50,800 --> 01:25:54,120 I'M ANDREA GILMORE-BYKOVSKYI IS 2063 01:25:54,120 --> 01:25:56,480 MY NAME JOINED WITH JULIE 2064 01:25:56,480 --> 01:26:06,760 GILMORE-BYKOVSKYI AND YOU MAY 2065 01:26:06,760 --> 01:26:12,280 ENTER QUESTIONS INTO Q&A AS WE 2066 01:26:12,280 --> 01:26:15,560 PROCEED TO OUR NEXT SCIENTIFIC 2067 01:26:15,560 --> 01:26:17,480 SESSION AND ON THE NIH VIDEOCAST 2068 01:26:17,480 --> 01:26:19,800 YOU CAN ENTER QUESTIONS THERE 2069 01:26:19,800 --> 01:26:21,160 AND WE'LL ROUTE THEM TO SPEAKERS 2070 01:26:21,160 --> 01:26:22,480 AND CO-CHAIRS OF THE SESSION. 2071 01:26:22,480 --> 01:26:25,520 UP NEXT WE'RE GOING HEAR FROM 2072 01:26:25,520 --> 01:26:27,560 OUR FOURTH SCIENTIFIC SESSION 2073 01:26:27,560 --> 01:26:28,840 DISPARITIES IN HEALTH CARE 2074 01:26:28,840 --> 01:26:30,480 ACCESS, UTILIZATION AND QUALITY. 2075 01:26:30,480 --> 01:26:35,760 THIS SESSION IS CO-CHAIRED BY 2076 01:26:35,760 --> 01:26:40,640 DOCTORS CHANEE FABIUS AND 2077 01:26:40,640 --> 01:26:43,600 EMERALD NGUYEN. 2078 01:26:43,600 --> 01:26:46,640 I'LL HAND IT OVER TO YOU, 2079 01:26:46,640 --> 01:26:46,880 CHANEE. 2080 01:26:46,880 --> 01:26:47,320 >>WONDERFUL. 2081 01:26:47,320 --> 01:26:49,080 THANK YOU AND THANK YOU ALL FOR 2082 01:26:49,080 --> 01:26:54,040 JOINING US THIS AFTERNOON TO 2083 01:26:54,040 --> 01:26:56,000 DISCUSS DISPARITIES AND HEALTH 2084 01:26:56,000 --> 01:26:56,600 CARE ACCESS, UTILIZATION AND 2085 01:26:56,600 --> 01:27:06,760 QUALITY. 2086 01:27:12,160 --> 01:27:15,640 IN THE SUMMIT IN 2020 IT WAS A 2087 01:27:15,640 --> 01:27:16,320 CROSS-CUTTING THEME. 2088 01:27:16,320 --> 01:27:17,800 THIS UNDER SCORES THE IMPORTANCE 2089 01:27:17,800 --> 01:27:20,480 OF THE TOPIC AND THIS YEAR WE 2090 01:27:20,480 --> 01:27:24,880 WILL SPECIFICALLY FOCUS ON 2091 01:27:24,880 --> 01:27:25,760 DISPARITIES IN HEALTH CARE 2092 01:27:25,760 --> 01:27:36,320 ACCESS, OUT LIECHGS AND QUALITY. 2093 01:27:36,640 --> 01:27:39,280 THE NATIONAL ACADEMIES OF 2094 01:27:39,280 --> 01:27:39,880 SCIENCE AND MEDICINE REPORT 2095 01:27:39,880 --> 01:27:42,200 RELEASED A 2021 CALLS FOR 2096 01:27:42,200 --> 01:27:45,040 RESEARCH TO ADDRESS DISPARITIES 2097 01:27:45,040 --> 01:27:47,400 IN HEALTH CARE ACCESS AND HEALTH 2098 01:27:47,400 --> 01:27:51,400 RELATED OUTCOMES. 2099 01:27:51,400 --> 01:27:54,360 SIMILAR WORK LED IN 2021 2100 01:27:54,360 --> 01:27:55,160 SUMMARIZED THE INFORMATION 2101 01:27:55,160 --> 01:28:02,040 PRESENTED AT THE 2020 SUMMIT. 2102 01:28:02,040 --> 01:28:04,320 PART OF THEME ONE WAS THE IMPACT 2103 01:28:04,320 --> 01:28:05,400 OF DEMENTIA AND HIGHLIGHTED 2104 01:28:05,400 --> 01:28:07,640 CHALLENGES IN THE ACCESS TO 2105 01:28:07,640 --> 01:28:09,960 SERVICES AND HOW THE DISPARITIES 2106 01:28:09,960 --> 01:28:11,760 MAY BE PARTICULARLY HARMFUL FOR 2107 01:28:11,760 --> 01:28:14,360 PEOPLE FROM UNDER REPRESENTED 2108 01:28:14,360 --> 01:28:14,840 GROUPS. 2109 01:28:14,840 --> 01:28:16,360 THAT PAPER ALSO HIGHLIGHTED 2110 01:28:16,360 --> 01:28:19,240 DISPARITIES IN HEALTH CARE COSTS 2111 01:28:19,240 --> 01:28:21,840 AND INSURANCE POLICIES RELATED 2112 01:28:21,840 --> 01:28:24,440 TO DEMENTIA. 2113 01:28:24,440 --> 01:28:26,960 TODAY'S PRESENTATION ARE GOING 2114 01:28:26,960 --> 01:28:28,560 TO FOCUS ON THOSE PARTICULAR 2115 01:28:28,560 --> 01:28:30,040 ISSUES AND HIGHLIGHT SOME OF THE 2116 01:28:30,040 --> 01:28:31,320 ONGOING WORK THAT NEEDS TO BE 2117 01:28:31,320 --> 01:28:31,680 DONE. 2118 01:28:31,680 --> 01:28:34,840 SO I'M GOING TO GO AHEAD AND 2119 01:28:34,840 --> 01:28:36,520 INVITE EMERALD TO COME ON AND 2120 01:28:36,520 --> 01:28:42,960 TELL US A BIT ABOUT OUR 2121 01:28:42,960 --> 01:28:48,720 PRESENTATION. 2122 01:28:48,720 --> 01:28:50,000 >>THE PRESENTATION IN TODAY'S 2123 01:28:50,000 --> 01:28:52,280 SESSION WILL HIGHLIGHT THREE 2124 01:28:52,280 --> 01:28:52,720 IMPORTANT TOPICS. 2125 01:28:52,720 --> 01:28:54,120 THE FIRST PRESENTATION SETS THE 2126 01:28:54,120 --> 01:28:55,680 STAGE FOR US AND FOR THE SESSION 2127 01:28:55,680 --> 01:28:59,240 BY PROVIDING AN OVERVIEW OF 2128 01:28:59,240 --> 01:29:01,440 PLACE-BASED AND OTHER CONTEXTUAL 2129 01:29:01,440 --> 01:29:02,560 FACTORS RESEARCHERS HAVE 2130 01:29:02,560 --> 01:29:04,280 EXAMINED TO UNDERSTAND 2131 01:29:04,280 --> 01:29:06,240 DISPARITIES IN HEALTH CARE CACK 2132 01:29:06,240 --> 01:29:07,960 ACCESS AND QUALITY. 2133 01:29:07,960 --> 01:29:09,520 THE SKNT PRESENTATION WILL COVER 2134 01:29:09,520 --> 01:29:11,080 THE ROLE OF HEALTH INFORMATION 2135 01:29:11,080 --> 01:29:16,520 TECHNOLOGY OR H.I.T. IN 2136 01:29:16,520 --> 01:29:17,680 ADDRESSING ACCESS AND QUALITY 2137 01:29:17,680 --> 01:29:19,240 AND THE STATE OF THE RESEARCH ON 2138 01:29:19,240 --> 01:29:22,440 INSURANCE POLICIES AND HOW THOSE 2139 01:29:22,440 --> 01:29:23,440 IMPACT DISPARITIES AND IMPACTING 2140 01:29:23,440 --> 01:29:25,760 QUALITY. 2141 01:29:25,760 --> 01:29:28,040 NOW I'M VERY PLEASED TO WELCOME 2142 01:29:28,040 --> 01:29:28,960 OUR THREE PRESENTERS. 2143 01:29:28,960 --> 01:29:34,960 OUR FIRST PRESENTER IS DR 2144 01:29:34,960 --> 01:29:45,520 DR. SHEKINAH FASHAW-WALTERS AND 2145 01:29:48,240 --> 01:29:52,520 THEN JIE CHEN AND THEN NORMIA 2146 01:29:52,520 --> 01:29:52,720 COE. 2147 01:29:52,720 --> 01:29:55,800 >>I'M LOOKING FORWARD TO 2148 01:29:55,800 --> 01:29:57,040 SPEAKING WITH ALL ABOUT THE 2149 01:29:57,040 --> 01:29:58,160 ROLFE PERSON AND PLACE AND THE 2150 01:29:58,160 --> 01:29:59,680 QUALITY OF DEMENTIA CARE. 2151 01:29:59,680 --> 01:30:01,440 YESTERDAY WE GOT TO HEAR QUITE A 2152 01:30:01,440 --> 01:30:05,880 BIT FROM DR. DRABO ON 2153 01:30:05,880 --> 01:30:07,480 DIFFERENCES THAT WE SEE ACROSS 2154 01:30:07,480 --> 01:30:10,000 DEMOGRAPHIC GROUPS OR I REFER TO 2155 01:30:10,000 --> 01:30:10,880 IN THE PRESENTATION AS PERSON. 2156 01:30:10,880 --> 01:30:15,120 IN MY SHORT TIME I WILL BRIEFLY 2157 01:30:15,120 --> 01:30:16,320 COVER DIFFERENCES IN DEMENTIA 2158 01:30:16,320 --> 01:30:17,480 DIAGNOSES BY RACE AND ETHNICITY 2159 01:30:17,480 --> 01:30:21,240 AND WE'LL START TALKING ABOUT 2160 01:30:21,240 --> 01:30:21,960 SOCIAL DETERMINATES OF HEALTH AS 2161 01:30:21,960 --> 01:30:23,720 A ROOT CAUSE OF THE DIFFERENCES 2162 01:30:23,720 --> 01:30:27,040 WE SEE AND WE'LL START TO DIG 2163 01:30:27,040 --> 01:30:27,840 INTO PLACE AS A SOCIAL 2164 01:30:27,840 --> 01:30:29,000 DETERMINATE OF HEALTH. 2165 01:30:29,000 --> 01:30:32,040 THEN I'LL SHARE DATA FROM MAYBE 2166 01:30:32,040 --> 01:30:32,720 FOUR DIFFERENT HEALTH CARE 2167 01:30:32,720 --> 01:30:36,160 SERVICES TO ILLUSTRATE THE ROLE 2168 01:30:36,160 --> 01:30:36,800 OF PLACE AND WE'LL WRAP UP NEXT 2169 01:30:36,800 --> 01:30:41,160 STEPS. 2170 01:30:41,160 --> 01:30:44,160 AS MANY KNOW, BLACK AMERICANS AS 2171 01:30:44,160 --> 01:30:45,640 WELL AS LATINO AMERICANS ARE TWO 2172 01:30:45,640 --> 01:30:47,600 TO ONE AND A HALF TIMES MORE 2173 01:30:47,600 --> 01:30:51,160 LIKELY THAN WHITE AMERICANS TO 2174 01:30:51,160 --> 01:30:53,760 HAVE ALZHEIMER'S DISEASE AND 2175 01:30:53,760 --> 01:30:55,760 OTHER DEMENTIAS BUT LESS LIKELY 2176 01:30:55,760 --> 01:30:57,240 TO HAVE A DIAGNOSIS OF THE 2177 01:30:57,240 --> 01:30:59,360 CONDITION AND OFTEN DIAGNOSED AT 2178 01:30:59,360 --> 01:31:01,040 LATER STAGES OF THE DISEASE 2179 01:31:01,040 --> 01:31:02,120 WHICH PUTS THEM IN GREATER NEED 2180 01:31:02,120 --> 01:31:04,600 FOR MORE MEDICAL CARE. 2181 01:31:04,600 --> 01:31:06,520 I WANT YOU TO KEEP THAT IN MIND 2182 01:31:06,520 --> 01:31:08,440 AS WE TALK ABOUT THE SERVICES 2183 01:31:08,440 --> 01:31:09,200 AND CARE THAT ARE AVAILABLE TO 2184 01:31:09,200 --> 01:31:12,120 FOLKS. 2185 01:31:12,120 --> 01:31:16,880 SOME STUDIES SHOW AFTER 2186 01:31:16,880 --> 01:31:19,680 ADDRESSING FOR HEALTH RISK SUCH 2187 01:31:19,680 --> 01:31:26,320 AS BLOOD PRESSURE AND EVEN 2188 01:31:26,320 --> 01:31:29,960 DIABETES THE DISEASE NO LONGER 2189 01:31:29,960 --> 01:31:40,520 EXISTS WITH DEMENTIA AND THESE 2190 01:31:41,760 --> 01:31:44,080 ARE IMPORTANT WITH RISK. 2191 01:31:44,080 --> 01:31:45,200 THERE'S A NUMBER OF SOCIAL 2192 01:31:45,200 --> 01:31:46,080 DETERMINATES OF HEALTH THAT LEAD 2193 01:31:46,080 --> 01:31:46,600 TO DISEASE. 2194 01:31:46,600 --> 01:31:48,920 MANY ELEMENTS YOU SEE ON THE 2195 01:31:48,920 --> 01:31:51,400 SLIDE FROM ECONOMIC STABILITY TO 2196 01:31:51,400 --> 01:31:52,400 FOOD, HEALTH CARE, NEIGHBORHOOD 2197 01:31:52,400 --> 01:31:54,480 AND ENVIRONMENT CAN ALL BE 2198 01:31:54,480 --> 01:31:56,480 LINKED TO DIABETES IN DIFFERENT 2199 01:31:56,480 --> 01:31:58,480 WAYS. 2200 01:31:58,480 --> 01:32:00,480 IF WE ADDRESS THESE SOCIAL 2201 01:32:00,480 --> 01:32:02,360 DETERMINATES OF HEALTH IN FRONT 2202 01:32:02,360 --> 01:32:05,280 OF YOU, WE CAN ELIMINATE UNOF 2203 01:32:05,280 --> 01:32:08,000 THE MANY DRIVERS WE SEE IN BLACK 2204 01:32:08,000 --> 01:32:11,280 AND LATINO POPULATION. 2205 01:32:11,280 --> 01:32:12,320 FOLLOW ME HERE. 2206 01:32:12,320 --> 01:32:15,200 WHAT I WANT TO DO IS PUSH US 2207 01:32:15,200 --> 01:32:16,280 BEYOND SEEING THESE DIFFERENCES 2208 01:32:16,280 --> 01:32:20,400 IN DEMENTIA AS DISPARITIES TO A 2209 01:32:20,400 --> 01:32:24,080 PLACE TO SEE THE DIFFERENCES AS 2210 01:32:24,080 --> 01:32:25,160 INEQUITIES. 2211 01:32:25,160 --> 01:32:26,560 WHY? 2212 01:32:26,560 --> 01:32:28,160 DISPARITIES ARE DIFFERENCES 2213 01:32:28,160 --> 01:32:30,120 WHERE HISTORICALLY DISADVANTAGED 2214 01:32:30,120 --> 01:32:33,000 OR MARGINALIZED GROUP IS FURTHER 2215 01:32:33,000 --> 01:32:34,640 DISADVANTAGED OR MARGINALIZED 2216 01:32:34,640 --> 01:32:36,800 BUT INEQUITIES ARE DISPARITIES 2217 01:32:36,800 --> 01:32:38,360 UNFAIR, UNJUST AND AVOIDABLE. 2218 01:32:38,360 --> 01:32:42,560 SO IF THE DATA SHOWS US THAT IF 2219 01:32:42,560 --> 01:32:46,280 WE CAN CONTROL FOR RISK LIKE 2220 01:32:46,280 --> 01:32:47,720 DIABETES IN SOCIO ECONOMIC 2221 01:32:47,720 --> 01:32:49,240 STATUS THAT THEN WE CAN 2222 01:32:49,240 --> 01:32:52,280 ELIMINATE THE DIFFERENCES THAT 2223 01:32:52,280 --> 01:32:54,000 WE SEE IN DEMENTIA AND WHAT THE 2224 01:32:54,000 --> 01:32:54,960 DATA IS TELLING US IS THAT WE 2225 01:32:54,960 --> 01:32:58,280 ARE LOOKING AT A DISPARITY THAT 2226 01:32:58,280 --> 01:33:00,120 IS ACTUALLY AN INEQUITY WHICH 2227 01:33:00,120 --> 01:33:01,000 MEANS IT CAN BE FIXED. 2228 01:33:01,000 --> 01:33:03,840 SO LET'S TAKE A LOOK AT THE 2229 01:33:03,840 --> 01:33:05,680 CARTOON HERE ON THE SLIDE OF 2230 01:33:05,680 --> 01:33:07,360 THREE INDIVIDUALS WATCHING A 2231 01:33:07,360 --> 01:33:09,440 BASEBALL GAME FROM BEYOND THE 2232 01:33:09,440 --> 01:33:09,640 FENCE. 2233 01:33:09,640 --> 01:33:14,000 THE REALITY IS DISPARITIES HIT 2234 01:33:14,000 --> 01:33:16,680 AND EQUITIES EXIST. 2235 01:33:16,680 --> 01:33:17,840 EQUALITY ASSUMES EVERYONE WILL 2236 01:33:17,840 --> 01:33:19,640 BENEFIT FROM THE SAME SUPPORT 2237 01:33:19,640 --> 01:33:21,600 BUT EQUALITY CAN EXACERBATE 2238 01:33:21,600 --> 01:33:21,880 DISPARITIES. 2239 01:33:21,880 --> 01:33:26,400 I'LL TALK MORE ABOUT THAT LATER. 2240 01:33:26,400 --> 01:33:27,040 EQUITY SAYS EVERYBODY GIVES THE 2241 01:33:27,040 --> 01:33:28,200 SUPPORT THEY NEED. 2242 01:33:28,200 --> 01:33:30,080 YOU SEE ONE INDIVIDUAL STANDING 2243 01:33:30,080 --> 01:33:30,800 ON TWO BOX AND ANOTHER 2244 01:33:30,800 --> 01:33:32,480 INDIVIDUAL NOT STANDING ON ANY 2245 01:33:32,480 --> 01:33:33,840 BOX BECAUSE THAT IS WHAT THEY 2246 01:33:33,840 --> 01:33:36,040 NEEDED TO SEE OVER THE FENCE. 2247 01:33:36,040 --> 01:33:38,200 BUT THEN JUSTICE PUSHES US EVEN 2248 01:33:38,200 --> 01:33:41,280 FURTHER TO SAY THE CAUSES OF THE 2249 01:33:41,280 --> 01:33:42,560 INEQUITY SHOULD BE ADDRESSED AND 2250 01:33:42,560 --> 01:33:45,400 SYSTEMIC BARRIERS SHOULD BE 2251 01:33:45,400 --> 01:33:45,640 REMOVED. 2252 01:33:45,640 --> 01:33:49,800 SO SAY THE FENCE REPRESENTS THE 2253 01:33:49,800 --> 01:33:50,960 DISPARATE IMPACT OF SOCIAL 2254 01:33:50,960 --> 01:33:52,400 DETERMINATES OF HEALTH. 2255 01:33:52,400 --> 01:33:55,840 WHAT IF WE REMOVED THAT FENCE 2256 01:33:55,840 --> 01:34:00,400 AND REMOVED THE DISPARATES 2257 01:34:00,400 --> 01:34:00,920 IMPACTS OF THE SOCIAL 2258 01:34:00,920 --> 01:34:02,280 DETERMINATES OF HEALTH. 2259 01:34:02,280 --> 01:34:05,400 WE'D PROBABLY BE LEFT WITH NO 2260 01:34:05,400 --> 01:34:08,200 MORE DIFFERENCES IN THE DEMENTIA 2261 01:34:08,200 --> 01:34:10,040 PREVALENCE SO WE'RE TALKING 2262 01:34:10,040 --> 01:34:10,600 ABOUT AN INEQUITY THAT'S 2263 01:34:10,600 --> 01:34:12,920 AVOIDABLE AND FIXABLE. 2264 01:34:12,920 --> 01:34:15,080 ONE OF THE SOCIAL DETERMINATES 2265 01:34:15,080 --> 01:34:19,520 OF HEALTH THAT ACT AS A FENCE 2266 01:34:19,520 --> 01:34:23,160 CREATING INJUSTICE IS PLACE. 2267 01:34:23,160 --> 01:34:25,000 RESEARCHERS SAY ZIP CODES ARE 2268 01:34:25,000 --> 01:34:26,320 BETTER PREDICT OF HEALTH THAN 2269 01:34:26,320 --> 01:34:27,520 THE HEALTH CARE RECEIVED BECAUSE 2270 01:34:27,520 --> 01:34:29,320 THE ZIP CODE PREDICTS THE HEALTH 2271 01:34:29,320 --> 01:34:30,720 CARE YOU CAN RECEIVE. 2272 01:34:30,720 --> 01:34:32,240 WE KNOW FROM DIFFERENT PARTS OF 2273 01:34:32,240 --> 01:34:33,800 THE LITERATURE HIGH-QUALITY 2274 01:34:33,800 --> 01:34:35,640 PROVIDERS WHETHER THEY BE 2275 01:34:35,640 --> 01:34:38,600 HIGH-QUALITY PHYSICIANS, 2276 01:34:38,600 --> 01:34:40,160 HOSPITALS, HOME HEALTH AGENCIES, 2277 01:34:40,160 --> 01:34:43,760 THEY'RE LESS LIKELY TO SERVE IN 2278 01:34:43,760 --> 01:34:44,720 DISADVANTAGED OR MINORITIZED 2279 01:34:44,720 --> 01:34:45,080 COMMUNITIES. 2280 01:34:45,080 --> 01:34:49,000 YOU MAY BE ASKING WHY THIS IS 2281 01:34:49,000 --> 01:34:51,240 AND WHERE THIS STARTED IT 2282 01:34:51,240 --> 01:34:52,880 STARTED WITH RESIDENTIAL 2283 01:34:52,880 --> 01:34:53,160 SEGREGATION. 2284 01:34:53,160 --> 01:34:54,720 LET'S GO TO THE NEXT SLIDE FOR A 2285 01:34:54,720 --> 01:34:56,920 QUICK HISTORY LESSON. 2286 01:34:56,920 --> 01:34:59,520 IN 1935 IN AN ATTEMPT TO HELP 2287 01:34:59,520 --> 01:35:02,440 LOWER INCOME FOLKS AFFORD HOMES 2288 01:35:02,440 --> 01:35:04,320 SECURITY MAPS WERE CREATED ALONG 2289 01:35:04,320 --> 01:35:06,240 WITH THE PRACTICE OF RED LINING. 2290 01:35:06,240 --> 01:35:08,720 YOU SEE GREEN AREAS THE BEST 2291 01:35:08,720 --> 01:35:11,600 AREAS AND BLUE AREAS WHICH WERE 2292 01:35:11,600 --> 01:35:14,280 GOOD AREAS AND YELLOW AREAS 2293 01:35:14,280 --> 01:35:16,680 WHICH HAD DECLINING VALUE AND 2294 01:35:16,680 --> 01:35:20,360 RED AREAS WERE KNOWN AS 2295 01:35:20,360 --> 01:35:24,560 HAZARDOUS BECAUSE THAT'S WHERE 2296 01:35:24,560 --> 01:35:25,880 FOREIGN BORN PEOPLE LIVED AND 2297 01:35:25,880 --> 01:35:27,600 IMMIGRANT LIVED AND BLACK PEOPLE 2298 01:35:27,600 --> 01:35:27,800 LIVED. 2299 01:35:27,800 --> 01:35:30,320 THIS IS STILL MIRRORED IN OUR 2300 01:35:30,320 --> 01:35:31,720 HEALTH CARE SERVICES. 2301 01:35:31,720 --> 01:35:32,640 IN STUDIES HAVE SHOWN PLACE 2302 01:35:32,640 --> 01:35:35,240 MATTERS FOR ACCESS TO HIGH 2303 01:35:35,240 --> 01:35:36,040 QUALITY HEALTH SERVICES. 2304 01:35:36,040 --> 01:35:38,760 I WANT TO SHOW YOU THIS IN FOUR 2305 01:35:38,760 --> 01:35:40,040 DIFFERENT SERVICES TODAY. 2306 01:35:40,040 --> 01:35:41,880 LET'S GO TO THE NEXT SLIDE. 2307 01:35:41,880 --> 01:35:45,000 THIS FIRST SERVICE WE'LL TALK 2308 01:35:45,000 --> 01:35:47,480 ABOUT IS ACCESS TO DEMENTIA 2309 01:35:47,480 --> 01:35:49,120 SPECIFIC CARE WITHIN ASSISTED 2310 01:35:49,120 --> 01:35:49,480 LIVING. 2311 01:35:49,480 --> 01:35:51,080 WITH OTHER COLLEAGUES BACK IN 2312 01:35:51,080 --> 01:35:54,120 2020 WE PUBLISHED A STUDY IN 2313 01:35:54,120 --> 01:35:56,560 JAMDA THAT COMPARES DIFFERENCES 2314 01:35:56,560 --> 01:35:58,600 IN COUNTY SOCIO ECONOMIC 2315 01:35:58,600 --> 01:35:59,960 CHARACTERISTICS BETWEEN COUNTIES 2316 01:35:59,960 --> 01:36:02,880 THAT HAVE AT LEAST ONE ASSISTED 2317 01:36:02,880 --> 01:36:04,240 LIVING WITH CARE BEDS AND 2318 01:36:04,240 --> 01:36:06,520 COUNTIES THAT DO NOT HAVE ANY 2319 01:36:06,520 --> 01:36:07,800 DEMENTIA SPECIFIC CARE. 2320 01:36:07,800 --> 01:36:10,120 WE FOUND COMPARED TO COUNTIES 2321 01:36:10,120 --> 01:36:12,240 WITH ASSISTED LIVINGS BUT NO 2322 01:36:12,240 --> 01:36:14,360 DEMENTIA SPECIFIC CARE, COUNTIES 2323 01:36:14,360 --> 01:36:17,680 THAT HAD DEMENTIA SPECIFIC CARE 2324 01:36:17,680 --> 01:36:19,600 HAD SUBSTANTIALLY HIGHER COLLEGE 2325 01:36:19,600 --> 01:36:21,160 ATTAINMENT, WERE MORE LIKELY TO 2326 01:36:21,160 --> 01:36:26,960 BE IN URBAN AREAS, HAD A HIGHER 2327 01:36:26,960 --> 01:36:28,800 MEDIAN HOUSEHOLD INCOME VALUE 2328 01:36:28,800 --> 01:36:30,360 AND MORE PRIVILEGED AREAS. 2329 01:36:30,360 --> 01:36:34,280 FROM AN ANALYSIS OF 2016, HOME 2330 01:36:34,280 --> 01:36:34,960 HEALTH ASSESSMENT DATA I 2331 01:36:34,960 --> 01:36:38,520 DOCUMENT THE USE OF HIGH-QUALITY 2332 01:36:38,520 --> 01:36:40,040 HOME HEALTH AGENCIES FOR THOSE 2333 01:36:40,040 --> 01:36:48,560 LIVING WITH DEM EN -- DEMENTIA 2334 01:36:48,560 --> 01:36:52,080 WERE LOSEST AMONG BLACK AND 2335 01:36:52,080 --> 01:36:53,720 LATINOS AND PEOPLE LIVING IN 2336 01:36:53,720 --> 01:36:55,680 DEMENTIA IN NEIGHBORHOODS WITH A 2337 01:36:55,680 --> 01:36:56,720 GREATER SHARE OF WHITE RESIDENTS 2338 01:36:56,720 --> 01:36:59,520 WERE MORE LIKELY TO USE HIGH 2339 01:36:59,520 --> 01:37:01,000 QUALITY HOME HEALTH AGENCIES 2340 01:37:01,000 --> 01:37:02,600 COMPARED TO THOSE LIVING IN 2341 01:37:02,600 --> 01:37:03,240 NEIGHBORHOODS WITH FEWER WHITE 2342 01:37:03,240 --> 01:37:05,560 PEOPLE. 2343 01:37:05,560 --> 01:37:06,960 THE OTHER GRAPHS GO IN THE 2344 01:37:06,960 --> 01:37:07,800 OPPOSITE DIRECTION. 2345 01:37:07,800 --> 01:37:10,800 YOU SEE THIS DOWNWARD SLOPE. 2346 01:37:10,800 --> 01:37:11,800 THIS GRAPHS REPRESENT 2347 01:37:11,800 --> 01:37:17,680 NEIGHBORHOODS THAT HAVE A HIGHER 2348 01:37:17,680 --> 01:37:21,880 SHARE OF LATINO RESIDENTS. 2349 01:37:21,880 --> 01:37:23,480 WE SEE WITH THE INCREASING SHARE 2350 01:37:23,480 --> 01:37:25,160 OF LOWER-INCOME RESIDENTS, 2351 01:37:25,160 --> 01:37:27,400 PEOPLE LIVING WITH DEMENTIA 2352 01:37:27,400 --> 01:37:28,280 ACCESS FEWER HIGH-QUALITY HOME 2353 01:37:28,280 --> 01:37:33,440 HEALTH AGENCIES. 2354 01:37:33,440 --> 01:37:34,960 THE NEXT TWO EXAMPLES SHOW AN 2355 01:37:34,960 --> 01:37:36,400 INTERESTING INTERACTION BETWEEN 2356 01:37:36,400 --> 01:37:37,760 PERSON AND PLACE. 2357 01:37:37,760 --> 01:37:41,000 WE WILL LOOK AT WHITE AND BLACK 2358 01:37:41,000 --> 01:37:43,480 PEOPLE LIVING WITH AND WITHOUT 2359 01:37:43,480 --> 01:37:46,280 DEMENTIA WHO RESIDE IN 2360 01:37:46,280 --> 01:37:47,600 NEIGHBORHOODS WITH A VARYING 2361 01:37:47,600 --> 01:37:50,320 AMOUNT OF SOCIAL DEPRIVATION. 2362 01:37:50,320 --> 01:37:51,960 THE HIGHER NUMBER ALONG THE 2363 01:37:51,960 --> 01:37:54,320 BOTTOM OF THE CHART, THE MORE 2364 01:37:54,320 --> 01:37:55,560 SOCIO ECONOMICALLY DEPRIVED THE 2365 01:37:55,560 --> 01:38:01,600 NEIGHBORHOOD IS OR LOWER INCOME. 2366 01:38:01,600 --> 01:38:06,000 WHAT WE FIND FOR END OF LIFE IN 2367 01:38:06,000 --> 01:38:08,360 THE LAST 30 DAYS OF LIFE THE 2368 01:38:08,360 --> 01:38:10,440 PROPORTION HOSPITALIZED 2369 01:38:10,440 --> 01:38:12,520 INCREASED AS THE NEIGHBORHOOD 2370 01:38:12,520 --> 01:38:14,240 SOCIAL DEPRIVATION INCREASED. 2371 01:38:14,240 --> 01:38:16,200 WE DON'T SEE THE SAME SLOPING 2372 01:38:16,200 --> 01:38:18,080 GRADIENT FOR FOLKS AT THE END OF 2373 01:38:18,080 --> 01:38:20,600 THEIR LIFE LIVING WITHOUT 2374 01:38:20,600 --> 01:38:21,240 DEMENTIA. 2375 01:38:21,240 --> 01:38:22,360 LET'S MOVE TO THE NEXT SLIDE. 2376 01:38:22,360 --> 01:38:24,200 HERE I SHOW THE PROPORTION OF 2377 01:38:24,200 --> 01:38:26,720 PEOPLE IN THEIR LAST 30 DAYS OF 2378 01:38:26,720 --> 01:38:28,080 LIFE WITH THE FEEDING TUBE 2379 01:38:28,080 --> 01:38:29,800 INSERTION AND THE SIMILAR 2380 01:38:29,800 --> 01:38:32,240 PATTERN EXISTS WHERE AMONG THOSE 2381 01:38:32,240 --> 01:38:37,760 WITHOUT DEMENTIA THERE'S A 2382 01:38:37,760 --> 01:38:40,960 MINIMAL OBSERVABLE DISPARITY BUT 2383 01:38:40,960 --> 01:38:42,680 WITH DEMENTIA THERE'S A LARGE 2384 01:38:42,680 --> 01:38:44,280 AND GROWING DISPARITY 2385 01:38:44,280 --> 01:38:47,120 EXACERBATED BY AN INCREASING 2386 01:38:47,120 --> 01:38:49,240 SOCIAL DEPRIVATION INDEX. 2387 01:38:49,240 --> 01:38:50,800 THE LAST TWO EXAMPLES SHOW 2388 01:38:50,800 --> 01:38:52,840 PEOPLE WITH DEMENTIA AND BLACK 2389 01:38:52,840 --> 01:38:55,000 PATIENTS OFTEN FACE BURDENSOME 2390 01:38:55,000 --> 01:38:56,320 INTERVENTIONS AT THE END OF LIFE 2391 01:38:56,320 --> 01:38:59,120 THAT CAN BE EXACERBATED BY PLACE 2392 01:38:59,120 --> 01:39:02,640 ESPECIALLY FOR THOSE LIVING WITH 2393 01:39:02,640 --> 01:39:03,640 DEMENTIA. 2394 01:39:03,640 --> 01:39:06,320 SO DEMENTIA, RACE, NEIGHBORHOOD, 2395 01:39:06,320 --> 01:39:09,120 SOCIO ECONOMIC STATUS HAVE AN 2396 01:39:09,120 --> 01:39:10,880 AFFECT ON THE OBSERVED OUTCOMES 2397 01:39:10,880 --> 01:39:13,600 THAT WE'RE STUDYING HERE. 2398 01:39:13,600 --> 01:39:15,760 IT MEANS THAT INTERVENTIONS 2399 01:39:15,760 --> 01:39:18,520 SHOULD CONSIDER STRUCTURAL 2400 01:39:18,520 --> 01:39:19,760 APPROACHES TO IMPROVING CARE NOT 2401 01:39:19,760 --> 01:39:22,200 JUST FOR END OF LIFE CARE IN 2402 01:39:22,200 --> 01:39:25,320 THIS EXAMPLE I SHOW HERE BUT FOR 2403 01:39:25,320 --> 01:39:26,600 HOME HEALTH AGENCIES AND 2404 01:39:26,600 --> 01:39:27,800 ASSISTED LIVING AND NURSING 2405 01:39:27,800 --> 01:39:29,720 HOMES AS WELL. 2406 01:39:29,720 --> 01:39:31,080 WE CAN MOVE ON TO THE LAST 2407 01:39:31,080 --> 01:39:31,280 SLIDE. 2408 01:39:31,280 --> 01:39:33,800 THE LAST PIECE I WANTED TO 2409 01:39:33,800 --> 01:39:34,960 SUMMARIZE WERE NEXT STEPS. 2410 01:39:34,960 --> 01:39:36,480 I KNOW WE'LL HAVE A BIT MORE 2411 01:39:36,480 --> 01:39:38,640 TIME TO TALK THROUGH THESE IN 2412 01:39:38,640 --> 01:39:40,880 DETAIL COMING UP BUT ONE OF THE 2413 01:39:40,880 --> 01:39:43,320 BIG TAKEAWAYS THEY THINK WE NEED 2414 01:39:43,320 --> 01:39:45,160 TO REALLY FOCUS ON IS THAT 2415 01:39:45,160 --> 01:39:46,000 THERE'S A LOT MORE WORK THAT 2416 01:39:46,000 --> 01:39:48,360 NEEDS TO BE DONE IN THIS AREA TO 2417 01:39:48,360 --> 01:39:51,360 UNDERSTAND THE ROLE OF PLACE IN 2418 01:39:51,360 --> 01:39:54,040 DEMENTIA CARE AND THE FOCUS ON 2419 01:39:54,040 --> 01:39:55,240 THE INTERACTION BETWEEN PLACE, 2420 01:39:55,240 --> 01:39:58,200 POLICIES AND PEOPLE. 2421 01:39:58,200 --> 01:40:00,480 THAT'S IT FOR NOW. 2422 01:40:00,480 --> 01:40:07,520 THANK YOU SO MUCH. 2423 01:40:07,520 --> 01:40:08,080 >>GOOD AFTERNOON. 2424 01:40:08,080 --> 01:40:09,360 I'M JIE CHEN. 2425 01:40:09,360 --> 01:40:11,680 THE TITLE IS EVIDENCE OF HEALTH 2426 01:40:11,680 --> 01:40:13,480 INFORMATION TECHNOLOGY AND 2427 01:40:13,480 --> 01:40:14,280 REDUCED HEALTH DISPARITIES IN 2428 01:40:14,280 --> 01:40:17,800 DEMENTIA CARE. 2429 01:40:17,800 --> 01:40:21,120 I WOULD LIKE TO THANK THE 2430 01:40:21,120 --> 01:40:24,240 SUPPORT FROM THE NIH. 2431 01:40:24,240 --> 01:40:26,720 THE COVID-19 PANDEMIC HAS 2432 01:40:26,720 --> 01:40:32,880 ANNOUNCED THE WAY THE INDUSTRY 2433 01:40:32,880 --> 01:40:34,280 UTILIZES TECHNOLOGY. 2434 01:40:34,280 --> 01:40:40,880 AND THERE'S MANY EXPERIENCING A 2435 01:40:40,880 --> 01:40:42,520 SUBSTANTIAL INCREASE FROM .84 2436 01:40:42,520 --> 01:40:47,040 MILLION IN TO 52.7 MILLION IN 2437 01:40:47,040 --> 01:40:47,240 2020. 2438 01:40:47,240 --> 01:40:49,040 IT'S PERCEIVED AS BENEFICIAL AND 2439 01:40:49,040 --> 01:40:50,360 COST EFFECTIVE. 2440 01:40:50,360 --> 01:40:54,040 PATIENTS WITH ADRD AND THEIR 2441 01:40:54,040 --> 01:40:54,680 CAREGIVERS GENERALLY RESPONDED 2442 01:40:54,680 --> 01:40:57,720 WELL TO THE USE. 2443 01:40:57,720 --> 01:41:00,240 THEY SHOWED SATISFACTION LEVELS 2444 01:41:00,240 --> 01:41:02,960 AMONG PATIENTS AND THE 2445 01:41:02,960 --> 01:41:06,440 CAREGIVERS WERE COMPARABLE FOR 2446 01:41:06,440 --> 01:41:11,080 VIRTUAL AND IN-PERSON CARE. 2447 01:41:11,080 --> 01:41:13,800 EVIDENCE SUGGESTED THAT THEY 2448 01:41:13,800 --> 01:41:16,280 UTILIZE REMOTE PROVIDERS TREME 2449 01:41:16,280 --> 01:41:19,920 LINING TREATMENT AND EASING 2450 01:41:19,920 --> 01:41:21,720 BURNOUT AMONG HEALTH CARE 2451 01:41:21,720 --> 01:41:24,520 PROVIDERS AND IT'S BEEN SEEN AS 2452 01:41:24,520 --> 01:41:27,720 A FEASIBLE ALTERNATIVE FOR 2453 01:41:27,720 --> 01:41:31,880 DIAGNOSING ADRD ALLOWING FOR 2454 01:41:31,880 --> 01:41:34,280 EARLIER INTERVENTION AND 2455 01:41:34,280 --> 01:41:35,800 MANAGEMENT. 2456 01:41:35,800 --> 01:41:41,640 MEANWHILE THE USE OF HIT WAS OF 2457 01:41:41,640 --> 01:41:43,640 INTEREST AND PROVIDES A SET OF 2458 01:41:43,640 --> 01:41:46,320 CHALLENGES THAT MUST BE 2459 01:41:46,320 --> 01:41:46,880 CONSIDERED. 2460 01:41:46,880 --> 01:41:49,680 AND THEY'RE GENERALLY LESS 2461 01:41:49,680 --> 01:41:54,680 COMFORTABLE AND MAY LACK ACCESS 2462 01:41:54,680 --> 01:41:56,760 TO INTERNET OR AFFECT THE 2463 01:41:56,760 --> 01:41:58,360 ABILITY TO UTILIZE TECHNOLOGY. 2464 01:41:58,360 --> 01:41:59,800 MORE RESEARCH IS NEEDED TO 2465 01:41:59,800 --> 01:42:02,040 UNDERSTAND THE UNIQUE CHALLENGES 2466 01:42:02,040 --> 01:42:08,400 FOR PATIENTS WITH ADRD AMONG 2467 01:42:08,400 --> 01:42:09,720 MINORITIZED POPULATIONS. 2468 01:42:09,720 --> 01:42:12,160 I WOULD LIKE TO EMPHASIZE THE 2469 01:42:12,160 --> 01:42:14,760 ISSUE OF THE DIGITAL DIVIDE. 2470 01:42:14,760 --> 01:42:16,280 LIMITED ACCESS TO BROADBAND 2471 01:42:16,280 --> 01:42:18,840 INTERNET AND THE TECHNOLOGIES 2472 01:42:18,840 --> 01:42:21,000 POSES CONSIDERABLE CHALLENGES 2473 01:42:21,000 --> 01:42:23,680 FOR THE UTILIZATION OF HIT IN 2474 01:42:23,680 --> 01:42:24,480 DEMENTIA CARE. 2475 01:42:24,480 --> 01:42:27,280 AND WHILE IT CAN IMPROVE 2476 01:42:27,280 --> 01:42:29,840 EFFICIENCY, STUDIES SHOW AFRICAN 2477 01:42:29,840 --> 01:42:32,880 AMERICAN AND HISPANIC PATIENTS 2478 01:42:32,880 --> 01:42:34,400 ADRD HAVE LESS ACCESS TO THE 2479 01:42:34,400 --> 01:42:37,040 HEALTH CARE SYSTEM COMPARED TO 2480 01:42:37,040 --> 01:42:39,960 NON-HISPANIC WHITE COUNTERPARTS. 2481 01:42:39,960 --> 01:42:42,640 COMPARED TO URBAN AND SUBURBAN 2482 01:42:42,640 --> 01:42:43,600 AREAS THEY HAVE A HIGHER PERCENT 2483 01:42:43,600 --> 01:42:47,520 OF OLDER ADULTS, HIGHER 2484 01:42:47,520 --> 01:42:52,280 INCIDENTS OF HEALTH DISPARITIES 2485 01:42:52,280 --> 01:42:54,520 AND POOR HEALTH CARE 2486 01:42:54,520 --> 01:42:56,200 INFRASTRUCTURE INCLUDING HIT 2487 01:42:56,200 --> 01:42:58,000 ADOPTION AND TELEHEALTH 2488 01:42:58,000 --> 01:42:58,880 CAPABILITIES. 2489 01:42:58,880 --> 01:43:01,720 AND HENCE EVIDENCE OF THE HIT 2490 01:43:01,720 --> 01:43:03,120 HEALTH CARE QUALITY AND EQUITY 2491 01:43:03,120 --> 01:43:05,400 IS HIGHLY NEEDED. 2492 01:43:05,400 --> 01:43:07,400 I'LL FIRST PRESENT PROMISING 2493 01:43:07,400 --> 01:43:09,960 EVIDENCE OF HIT AT THE HOSPITAL 2494 01:43:09,960 --> 01:43:11,840 SETTING AND EXPAND UPON THE 2495 01:43:11,840 --> 01:43:13,560 EVIDENCE OF HIT IN THE CONTEXT 2496 01:43:13,560 --> 01:43:16,000 OF PARTNERSHIPS BETWEEN 2497 01:43:16,000 --> 01:43:16,960 HOSPITALS, COMMUNITIES AND 2498 01:43:16,960 --> 01:43:22,920 PUBLIC HEALTH SYSTEMS. 2499 01:43:22,920 --> 01:43:28,280 HOSPITALS DELIVER VIT AL HEALTH 2500 01:43:28,280 --> 01:43:32,680 CARE SERVICES. 2501 01:43:32,680 --> 01:43:34,640 HOSPITAL-BASED HIT IMPROVES 2502 01:43:34,640 --> 01:43:35,920 COORDINATION AND ENCOURAGES 2503 01:43:35,920 --> 01:43:37,960 PATIENT ENGAGEMENT AND ENABLES 2504 01:43:37,960 --> 01:43:44,360 HEALTH INFORMATION EXCHANGE. 2505 01:43:44,360 --> 01:43:46,160 WE FIRST PRESENTED EVIDENCE OF 2506 01:43:46,160 --> 01:43:48,800 THE ETHNIC DISPARITIES. 2507 01:43:48,800 --> 01:43:53,760 USING MEDICARE DATA OUR STUDY 2508 01:43:53,760 --> 01:43:55,880 EXAMINED THE QUALITY OF THE POST 2509 01:43:55,880 --> 01:44:00,800 DISCHARGE SUCH AS REMOTE PATIENT 2510 01:44:00,800 --> 01:44:03,880 MONITORING AND THE TREATMENT AND 2511 01:44:03,880 --> 01:44:05,880 EXPLORE THE ASSOCIATION WITH 2512 01:44:05,880 --> 01:44:09,480 MEDICARE PATIENT AND IN-PATIENT 2513 01:44:09,480 --> 01:44:11,960 PAYMENT AND MEDICARE FEE FOR 2514 01:44:11,960 --> 01:44:15,680 SERVICE PAYMENT AND HOSPITAL HIT 2515 01:44:15,680 --> 01:44:17,680 WAS HIGHER IN PAYMENT ON AVERAGE 2516 01:44:17,680 --> 01:44:20,480 BUT HIT WAS ASSOCIATED WITH MORE 2517 01:44:20,480 --> 01:44:22,800 SUBSTANTIAL COST SAVINGS FOR 2518 01:44:22,800 --> 01:44:23,600 AFRICAN AMERICAN AND HISPANIC 2519 01:44:23,600 --> 01:44:25,720 PATIENTS WITH ADRD. 2520 01:44:25,720 --> 01:44:28,480 THE COST SAVED FROM $2100 TO 2521 01:44:28,480 --> 01:44:30,760 $2,000 PER PERSON PER YEAR. 2522 01:44:30,760 --> 01:44:34,240 THIS SUGGEST THE POTENTIAL TO 2523 01:44:34,240 --> 01:44:36,760 DESIGN AND USE HIT TO MEET 2524 01:44:36,760 --> 01:44:37,960 PREFERENCES AND NEEDS BY A 2525 01:44:37,960 --> 01:44:40,680 PATIENT'S RACE AND ETHNICITY. 2526 01:44:40,680 --> 01:44:42,160 CONSISTENTLY ANOTHER STUDY 2527 01:44:42,160 --> 01:44:44,240 DEMONSTRATED A PROMISING ASPECT 2528 01:44:44,240 --> 01:44:46,200 OF HOSPITAL HIT, PATIENT 2529 01:44:46,200 --> 01:44:48,960 ENGAGEMENT AND FUNCTIONALITY. 2530 01:44:48,960 --> 01:44:52,040 FOR INSTANCE, ACTIVE PATIENT 2531 01:44:52,040 --> 01:44:55,160 INVOLVEMENT IN THEIR OWN HEALTH 2532 01:44:55,160 --> 01:44:57,840 RECORDS TO SHARE IN DECISION 2533 01:44:57,840 --> 01:45:02,520 MAKING AND PREVENTED E.D. 2534 01:45:02,520 --> 01:45:02,920 VISITS. 2535 01:45:02,920 --> 01:45:05,600 EVIDENCE OF HIT IN URBAN AND 2536 01:45:05,600 --> 01:45:06,240 RURAL DISPARITIES FOR PATIENTS 2537 01:45:06,240 --> 01:45:12,680 IS PROMISING. 2538 01:45:12,680 --> 01:45:14,680 POST DISCHARGE COMBINED WITH 2539 01:45:14,680 --> 01:45:16,560 SERVICES SIGNIFICANTLY DECREASED 2540 01:45:16,560 --> 01:45:19,560 THE ODDS OF HAVING PREVENTIBLE 2541 01:45:19,560 --> 01:45:20,320 HOSPITALIZATION AMONG PATIENTS 2542 01:45:20,320 --> 01:45:27,240 WITH ADRD IN RURAL AND IN 2543 01:45:27,240 --> 01:45:28,280 METROPOLITAN AREAS AND HOUSING 2544 01:45:28,280 --> 01:45:32,840 IS ESSENTIAL FOR CARE MANAGEMENT 2545 01:45:32,840 --> 01:45:36,160 AND COMMUNITY FOR PATIENTS WITH 2546 01:45:36,160 --> 01:45:38,680 ADRD AND THE SYSTEM REQUIRE A 2547 01:45:38,680 --> 01:45:40,240 ROBUST PARTNERSHIP AMONG HEALTH 2548 01:45:40,240 --> 01:45:41,720 CARE AND SOCIAL SECTORS TO 2549 01:45:41,720 --> 01:45:48,400 PROVIDE WHOLE PERSON CARE. 2550 01:45:48,400 --> 01:45:51,400 AGENCIES INCLUDING THE CDC AND 2551 01:45:51,400 --> 01:45:53,480 AMONG OTHERS HAVE ADVOCATED 2552 01:45:53,480 --> 01:45:55,000 REINFORCING THE ROLE OF PUBLIC 2553 01:45:55,000 --> 01:45:56,080 HEALTH SYSTEMS AND ACROSS-SECTOR 2554 01:45:56,080 --> 01:46:03,200 COLLABORATIONS. 2555 01:46:03,200 --> 01:46:05,600 AFRICAN AMERICAN AND HISPANIC 2556 01:46:05,600 --> 01:46:07,800 BENEFICIARIES WERE MORE LIKELY 2557 01:46:07,800 --> 01:46:10,280 TO BE TREATED WITHOUT SYSTEM 2558 01:46:10,280 --> 01:46:14,440 SUPPORT OR INFRASTRUCTURE. 2559 01:46:14,440 --> 01:46:15,480 AND ADJUSTING FOR THE 2560 01:46:15,480 --> 01:46:18,040 DEMOGRAPHIC CHARACTERISTICS AND 2561 01:46:18,040 --> 01:46:21,920 HEALTH NEEDS AND RESULTS SHOW 2562 01:46:21,920 --> 01:46:23,520 IT'S TREATED IN HOSPITAL WITH 2563 01:46:23,520 --> 01:46:25,120 SUPPORT OF HIT AND THE PUBLIC 2564 01:46:25,120 --> 01:46:28,280 HEALTH SYSTEM ENCOUNTERED A 2565 01:46:28,280 --> 01:46:30,600 LOWER MEDICARE PATIENT WITH 2566 01:46:30,600 --> 01:46:31,560 ADMISSIONS ESPECIALLY FOR 2567 01:46:31,560 --> 01:46:35,800 AFRICAN AMERICAN PATIENTS. 2568 01:46:35,800 --> 01:46:38,680 FINALLY I WANT TO REVIEW HEALTH 2569 01:46:38,680 --> 01:46:40,080 INFORMATION EXCHANGE QUICKLY AND 2570 01:46:40,080 --> 01:46:42,240 THE FIGURE TABULATES ASSOCIATION 2571 01:46:42,240 --> 01:46:44,040 BETWEEN THE PAYMENT MODEL AND 2572 01:46:44,040 --> 01:46:46,280 THE PUBLIC HEALTH COLLABORATION 2573 01:46:46,280 --> 01:46:49,440 USING THE 2020 AMERICAN HOSPITAL 2574 01:46:49,440 --> 01:46:49,680 SURVEY. 2575 01:46:49,680 --> 01:46:52,040 RESULTS SHOW THE HOSPITALS WITH 2576 01:46:52,040 --> 01:46:54,480 THE PUBLIC COLLABORATION WERE 2577 01:46:54,480 --> 01:46:56,400 MORE LIKELY TO RECEIVE 2578 01:46:56,400 --> 01:47:00,240 INFORMATION NEEDED TO TREAT 2579 01:47:00,240 --> 01:47:01,240 COVID-19 AND HOSPITAL 2580 01:47:01,240 --> 01:47:03,120 COLLABORATING WITH PUBLIC HEALTH 2581 01:47:03,120 --> 01:47:06,760 SYSTEMS WERE MORE LIKELY TO 2582 01:47:06,760 --> 01:47:07,720 RECEIVE INFORMATION FROM OUTSIDE 2583 01:47:07,720 --> 01:47:11,480 PROVIDERS. 2584 01:47:11,480 --> 01:47:13,800 AND THE ASSOCIATION WAS ROBUST 2585 01:47:13,800 --> 01:47:14,920 AFTER CONTROLLING FOR 2586 01:47:14,920 --> 01:47:16,280 CHARACTERISTICS AND GEOGRAPHIC 2587 01:47:16,280 --> 01:47:19,520 LOCATIONS AND THE SOCIAL 2588 01:47:19,520 --> 01:47:22,280 DETERMINATES OF HEALTH AND 2589 01:47:22,280 --> 01:47:23,160 ROBUST PARTNERSHIP BETWEEN 2590 01:47:23,160 --> 01:47:27,400 HEALTH CARE SYSTEM AND PUBLIC 2591 01:47:27,400 --> 01:47:29,880 HEALTH MAY REFLECT COMMUNITY 2592 01:47:29,880 --> 01:47:30,960 RESOURCES AND WITH SOCIAL 2593 01:47:30,960 --> 01:47:32,600 SERVICE AND THROUGH THE TRUST 2594 01:47:32,600 --> 01:47:34,760 AND SOCIAL NETWORKS THAT HAVE 2595 01:47:34,760 --> 01:47:35,840 BEEN EMBEDDED IN COMMUNITIES FOR 2596 01:47:35,840 --> 01:47:40,120 DECADES. 2597 01:47:40,120 --> 01:47:43,200 HIT SUPPORTED SYSTEM-LEVEL 2598 01:47:43,200 --> 01:47:46,360 MULTI-DISCIPLINARY INTEGRASE FOR 2599 01:47:46,360 --> 01:47:48,360 POPULATION HEALTH AND EQUITY 2600 01:47:48,360 --> 01:47:51,960 CALLED SMILE HAS POSITIVE 2601 01:47:51,960 --> 01:47:52,280 FRAMING. 2602 01:47:52,280 --> 01:47:55,080 THE E SMILE MODEL IS HOW HIT CAN 2603 01:47:55,080 --> 01:47:57,840 WORK WITH PATIENTS AND 2604 01:47:57,840 --> 01:47:58,880 CAREGIVERS AND PROVIDERS AND 2605 01:47:58,880 --> 01:48:00,600 SYSTEMS AND COMMUNITY AND PUBLIC 2606 01:48:00,600 --> 01:48:03,240 ASSISTANCE AND THE POLICY MAKERS 2607 01:48:03,240 --> 01:48:04,880 TO IMPROVE HEALTH EQUITY AND 2608 01:48:04,880 --> 01:48:08,400 ACCESS AND QUALITY WHILE 2609 01:48:08,400 --> 01:48:14,360 REDUCING HEALTH CARE COST. 2610 01:48:14,360 --> 01:48:16,120 THE EXCITING NEWS IS FEDERAL 2611 01:48:16,120 --> 01:48:17,920 POLICY SUCH AS 21 CENTURY CURES 2612 01:48:17,920 --> 01:48:20,400 ACT ARE BEING IMPLEMENTED TO 2613 01:48:20,400 --> 01:48:22,640 IMPROVE DATA COMPLETENESS AND 2614 01:48:22,640 --> 01:48:25,040 THE DATA QUALITY OF E.H.R. 2615 01:48:25,040 --> 01:48:28,400 DATA INTEROPERABILITY ACROSS 2616 01:48:28,400 --> 01:48:29,680 SYSTEMS AND CROSS-SECTOR 2617 01:48:29,680 --> 01:48:30,880 COLLABORATION AND PAYMENT TO 2618 01:48:30,880 --> 01:48:33,360 UNITE THE SUPPORT AND IMPROVE 2619 01:48:33,360 --> 01:48:36,120 THE TELEHEALTH SYSTEM FOR ALL. 2620 01:48:36,120 --> 01:48:39,640 AS MORE INVESTMENT ARE DIRECTED 2621 01:48:39,640 --> 01:48:41,640 TOWARDS DEVELOPING AND 2622 01:48:41,640 --> 01:48:42,960 STRETCHING CAPACITY IT'S 2623 01:48:42,960 --> 01:48:45,520 CRITICAL TO ASSESS HIT 2624 01:48:45,520 --> 01:48:46,800 INFRASTRUCTURE AND COMMUNITY 2625 01:48:46,800 --> 01:48:49,000 INTEGRATION TO ENGAGE AND SERVE 2626 01:48:49,000 --> 01:48:51,360 PATIENTS WITH ADRD FROM 2627 01:48:51,360 --> 01:48:53,000 DIFFERENT RACIAL AND ETHNIC 2628 01:48:53,000 --> 01:48:54,360 GROUPS, PATIENTS WITH VARIOUS 2629 01:48:54,360 --> 01:48:57,760 NEEDS AND PATIENTS LIVING IN 2630 01:48:57,760 --> 01:48:58,800 COMMUNITIES WITH LACK OF HEALTH 2631 01:48:58,800 --> 01:48:59,880 CARE RESOURCES AND OTHER 2632 01:48:59,880 --> 01:49:02,200 STRUCTURAL BARRIERS. 2633 01:49:02,200 --> 01:49:07,400 RESEARCH IS ALSO NEEDED TO 2634 01:49:07,400 --> 01:49:08,640 UNDERSTAND EARLY DISEASE 2635 01:49:08,640 --> 01:49:11,120 TRAJECTORY TO UNDERSTAND THE 2636 01:49:11,120 --> 01:49:13,920 IMPACT OF HEALTH ON PREVENTION 2637 01:49:13,920 --> 01:49:17,560 AND DELAYING THE OUTSET OF ADRD. 2638 01:49:17,560 --> 01:49:17,760 NEXT. 2639 01:49:17,760 --> 01:49:22,160 I WOULD LIKE TO CONCLUDE MY TALK 2640 01:49:22,160 --> 01:49:23,000 WITH OUR SLOGAN, FEARLESS 2641 01:49:23,000 --> 01:49:23,200 FORWARD. 2642 01:49:23,200 --> 01:49:33,400 THANK YOU. 2643 01:49:35,680 --> 01:49:37,800 >>HI, THANKS. 2644 01:49:37,800 --> 01:49:40,480 IT'S AN HONOR TO TALK ABOUT FOUR 2645 01:49:40,480 --> 01:49:43,920 POLICIES IN PLACE AFFECTING 2646 01:49:43,920 --> 01:49:46,280 HEALTH CARE AND INSURANCE AND 2647 01:49:46,280 --> 01:49:49,800 THE ONSET OF EFFECTIVE CHANGING 2648 01:49:49,800 --> 01:49:52,680 QUALITY OF CARE AVAILABLE FOR 2649 01:49:52,680 --> 01:49:54,960 PEOPLE LIVING WITH DEMENTIA. 2650 01:49:54,960 --> 01:49:57,320 FIRST MY WORK IS FUNDED BY THE 2651 01:49:57,320 --> 01:49:58,000 NIA BUT MY THOUGHTS TODAY ARE MY 2652 01:49:58,000 --> 01:50:03,400 OWN. 2653 01:50:03,400 --> 01:50:04,840 THE ELEPHANT IN THE ROOM HAS 2654 01:50:04,840 --> 01:50:08,000 BEEN THE TRANSITION TO MEDICARE 2655 01:50:08,000 --> 01:50:08,280 ADVANTAGE. 2656 01:50:08,280 --> 01:50:09,040 IT'S THE PRIVATE HEALTH 2657 01:50:09,040 --> 01:50:10,280 INSURANCE OPTION AVAILABLE FOR 2658 01:50:10,280 --> 01:50:12,440 OLDER ADULTS IN THE UNITED 2659 01:50:12,440 --> 01:50:14,920 STATES AS OPPOSED TO THE MORE 2660 01:50:14,920 --> 01:50:15,640 TRADITIONAL OR FEE FOR SERVICE 2661 01:50:15,640 --> 01:50:18,800 MEDICARE PROGRAM. 2662 01:50:18,800 --> 01:50:20,480 WE ARE RANDOMLY APPROACHING 50% 2663 01:50:20,480 --> 01:50:22,840 OF THE OLDER POPULATION NOW 2664 01:50:22,840 --> 01:50:24,440 BEING INSURED BY MEDICARE 2665 01:50:24,440 --> 01:50:24,720 ADVANTAGE. 2666 01:50:24,720 --> 01:50:29,000 THE SWISH IS NOT UNIVERSAL. 2667 01:50:29,000 --> 01:50:32,400 THE GROWTH IN MEDICARE ADVANTAGE 2668 01:50:32,400 --> 01:50:34,480 ENROLLMENT HAS BEEN GREATEST 2669 01:50:34,480 --> 01:50:37,440 AMONG BLACK AND HISPANIC 2670 01:50:37,440 --> 01:50:37,720 ENROLLEES. 2671 01:50:37,720 --> 01:50:39,320 THERE'S AN UPTICK AMONG THE 2672 01:50:39,320 --> 01:50:42,080 INDIVIDUALS WHO ARE ENROLLED IN 2673 01:50:42,080 --> 01:50:46,280 MEDICARE AND MEDICAID INSURANCE. 2674 01:50:46,280 --> 01:50:47,760 UNTIL RECENTLY DATA FOR MEDICARE 2675 01:50:47,760 --> 01:50:49,760 ADVANTAGE WAS HARD TO COME BY. 2676 01:50:49,760 --> 01:50:51,040 IT WAS IN THE LAST 10 YEARS 2677 01:50:51,040 --> 01:50:52,600 ADMINISTRATIVE AND COUNTER DATA 2678 01:50:52,600 --> 01:50:54,840 HAS BEEN AVAILABLE AND THERE HAS 2679 01:50:54,840 --> 01:50:56,600 BEEN A VAST IMPROVEMENT IN THE 2680 01:50:56,600 --> 01:50:58,200 DATA NOT JUST AVAILABILITY AND 2681 01:50:58,200 --> 01:50:59,880 IN QUALITY OVER THE LAST FIVE 2682 01:50:59,880 --> 01:51:03,800 YEARS BUT CRITICAL GAPS REMAIN. 2683 01:51:03,800 --> 01:51:04,960 A RECENT REPORT DOES STATE THEY 2684 01:51:04,960 --> 01:51:06,840 CAN NO LONGER PROVIDE AN 2685 01:51:06,840 --> 01:51:07,640 ACCURATE DESCRIPTION OF THE 2686 01:51:07,640 --> 01:51:11,600 QUALITY OF CARE IN MEDICARE 2687 01:51:11,600 --> 01:51:13,520 ADVANTAGE AND THAT IS AN IRISH 2688 01:51:13,520 --> 01:51:15,080 GOING FORWARD FOR ALL DISEASES 2689 01:51:15,080 --> 01:51:16,600 BUT ESPECIALLY AMONG THOSE WITH 2690 01:51:16,600 --> 01:51:21,320 DEMENTIA. 2691 01:51:21,320 --> 01:51:23,200 WHAT WE KNOW IS BLACK AMERICANS 2692 01:51:23,200 --> 01:51:26,240 DO NOT ENROLL IN AS HIGH QUALITY 2693 01:51:26,240 --> 01:51:27,320 MEDICARE ADVANTAGE PLANS AS 2694 01:51:27,320 --> 01:51:29,880 THEIR WHITE COUNTERPARTS IF YOU 2695 01:51:29,880 --> 01:51:32,680 TAKE THE STAR RATING AS A 2696 01:51:32,680 --> 01:51:34,760 MEASURE THE HIGH QUALITY PLAN. 2697 01:51:34,760 --> 01:51:37,800 AND RECENT WORK HIGHLIGHTS THAT 2698 01:51:37,800 --> 01:51:40,440 THIS IS PART TO WHERE BLACK 2699 01:51:40,440 --> 01:51:42,440 AMERICANS LIVE COMPARED TO WHERE 2700 01:51:42,440 --> 01:51:43,960 HIGH QUALITY MEDICARE ADVANTAGE 2701 01:51:43,960 --> 01:51:46,160 PLANS ARE OFFERED AS HIGHLIGHTED 2702 01:51:46,160 --> 01:51:51,280 IN THE PRESENTATION EARLIER. 2703 01:51:51,280 --> 01:51:54,000 WE ALSO KNOW THAT HISPANIC AND 2704 01:51:54,000 --> 01:51:54,880 AFRICAN AMERICAN PATIENTS WITH 2705 01:51:54,880 --> 01:51:56,920 DEMENTIA ARE MORE LIKELY TO 2706 01:51:56,920 --> 01:51:59,040 ENROLL IN M.A. PLANS LEADING TO 2707 01:51:59,040 --> 01:52:00,640 DOWN STREAM AFFECTS IN WHERE 2708 01:52:00,640 --> 01:52:02,960 THEY RECEIVE CARE AND MORE 2709 01:52:02,960 --> 01:52:06,480 LIKELY TO BE ADMITTED TO 2710 01:52:06,480 --> 01:52:07,560 SEGREGATED NURSING HOMES WITH 2711 01:52:07,560 --> 01:52:10,560 LOWER QUALITY OF CARE OVER ALL. 2712 01:52:10,560 --> 01:52:12,160 IF YOU BELIEVE THAT PEOPLE SHOW 2713 01:52:12,160 --> 01:52:14,600 THE QUALITY OF CARE THEY'RE 2714 01:52:14,600 --> 01:52:18,440 RECEIVING WITH THEIR FEET, WE DO 2715 01:52:18,440 --> 01:52:20,440 SEE CONCERNING TRENDS ABOUT 2716 01:52:20,440 --> 01:52:23,120 ENROLLMENT AND DISENROLLMENT IN 2717 01:52:23,120 --> 01:52:25,480 MEDICARE ADVANTAGE. 2718 01:52:25,480 --> 01:52:27,000 DISENROLLMENT MEANING LEAVING 2719 01:52:27,000 --> 01:52:28,280 THE MEDICARE ADVANTAGE PROGRAM 2720 01:52:28,280 --> 01:52:29,600 ALTOGETHER AND MOVING TO 2721 01:52:29,600 --> 01:52:33,000 TRADITIONAL MEDICARE. 2722 01:52:33,000 --> 01:52:35,600 WE 2723 01:52:35,600 --> 01:52:38,360 WE SEE DISENROLLMENT RATES ARE 2724 01:52:38,360 --> 01:52:39,960 HIGHER FOR THOSE LIVING WITH 2725 01:52:39,960 --> 01:52:41,800 DEMENTIA COMPARED TO THOSE WHO 2726 01:52:41,800 --> 01:52:42,520 DO NOT HAVE A DIAGNOSED DEMENTIA 2727 01:52:42,520 --> 01:52:44,800 CASE. 2728 01:52:44,800 --> 01:52:46,200 ALL THIS WILL CONTINUE TO PLAY 2729 01:52:46,200 --> 01:52:49,320 OUT AS WE CHANGE THE BENEFIT 2730 01:52:49,320 --> 01:52:50,560 STRUCTURES IN THE TWO DIFFERENT 2731 01:52:50,560 --> 01:52:52,000 INSURANCE POLICIES. 2732 01:52:52,000 --> 01:52:54,400 ONE EXAMPLE IS THE SWITCH FROM 2733 01:52:54,400 --> 01:52:56,120 HOSPICE TO BEING ALWAYS COVERED 2734 01:52:56,120 --> 01:52:58,280 BY TRADITIONAL MEDICARE TO BEING 2735 01:52:58,280 --> 01:53:04,280 A CARVE-IN POLICY WHERE MEDICARE 2736 01:53:04,280 --> 01:53:07,080 ADVANTAGE MAY NOW BE COVERING 2737 01:53:07,080 --> 01:53:10,640 PLANS A HOSPICE CARE ITSELF. 2738 01:53:10,640 --> 01:53:13,520 WE KNOW PEOPLE ON HOSPICE HAVE 2739 01:53:13,520 --> 01:53:15,800 DIFFERENT PATHWAYS OR PEOPLE ON 2740 01:53:15,800 --> 01:53:16,480 MEDICARE ADVANTAGE HAVE 2741 01:53:16,480 --> 01:53:17,840 DIFFERENT PATHWAYS TO HOSPICE 2742 01:53:17,840 --> 01:53:19,280 AND WHERE THEY COME FROM AND 2743 01:53:19,280 --> 01:53:20,240 WHETHER THEY COME FROM THE 2744 01:53:20,240 --> 01:53:25,920 COMMUNITY OR NOT OR FROM 2745 01:53:25,920 --> 01:53:27,920 HOSPITAL. 2746 01:53:27,920 --> 01:53:29,920 WE KNOW HOSPITALS CAN REDUCE 2747 01:53:29,920 --> 01:53:31,000 RATES OF PEOPLE WITH DEMENTIA 2748 01:53:31,000 --> 01:53:32,600 AND NEED TO BE CAREFUL AS WE 2749 01:53:32,600 --> 01:53:34,880 CHANGE THE REIMBURSEMENT POLICY 2750 01:53:34,880 --> 01:53:35,760 AMONG THE DIFFERENT INSURANCE 2751 01:53:35,760 --> 01:53:38,720 PLANS AND HOW THIS IS GOING TO 2752 01:53:38,720 --> 01:53:39,320 CHANGE FOR PEOPLE LIVING WITH 2753 01:53:39,320 --> 01:53:44,240 DEMENTIA. 2754 01:53:44,240 --> 01:53:46,240 THE NEXT TYPE OF CHANGE THAT'S 2755 01:53:46,240 --> 01:53:47,560 HAPPENING IS INCREASED EMPHASIS 2756 01:53:47,560 --> 01:53:48,400 ON CARE COORDINATION. 2757 01:53:48,400 --> 01:53:54,000 THIS IS DONE AT THE INSURANCE 2758 01:53:54,000 --> 01:53:58,280 LEVEL THROUGH WHAT THEY CALL 2759 01:53:58,280 --> 01:54:04,280 ISNPs OR DSNPs AND THERE'S THE 2760 01:54:04,280 --> 01:54:05,680 CAREGIVER ACT AND RECORD AND 2761 01:54:05,680 --> 01:54:07,960 ENABLE ACT A STATE-LEVEL POLICY 2762 01:54:07,960 --> 01:54:10,200 THAT REQUIRES HEALTH CARE 2763 01:54:10,200 --> 01:54:13,080 PROVIDERS TO IDENTIFY A 2764 01:54:13,080 --> 01:54:13,760 CAREGIVER IN AN ACUTE CARE 2765 01:54:13,760 --> 01:54:17,520 SETTING. 2766 01:54:17,520 --> 01:54:19,360 WHILE THEY'VE BEEN AROUND A 2767 01:54:19,360 --> 01:54:20,960 WHILE WE HAVE FAIRLY LIMITED 2768 01:54:20,960 --> 01:54:23,160 EVIDENCE ABOUT THEIR 2769 01:54:23,160 --> 01:54:24,440 EFFECTIVENESS NAMELY BECAUSE 2770 01:54:24,440 --> 01:54:31,080 IT'S HARD TO IDENTIFY AND ONE 2771 01:54:31,080 --> 01:54:34,040 WHO USED A NURSE CARE MANAGER 2772 01:54:34,040 --> 01:54:36,400 MODEL IMPROVED THE QUALITY OF 2773 01:54:36,400 --> 01:54:38,000 CARE WITH PERSONS LIVING WITH 2774 01:54:38,000 --> 01:54:38,280 DEMENTIA. 2775 01:54:38,280 --> 01:54:41,320 THERE'S PROMISE WE SHOULD LOOK 2776 01:54:41,320 --> 01:54:44,320 FURTHER IN THE INCREASE TO 2777 01:54:44,320 --> 01:54:46,640 COMMUNICATION AND INCREASED CARE 2778 01:54:46,640 --> 01:54:46,920 MANAGEMENT. 2779 01:54:46,920 --> 01:54:53,160 WE ALSO KNOW ENROLLMENT IN ISNPs 2780 01:54:53,160 --> 01:54:54,360 IS ASSOCIATED WITH RESIDENTS IN 2781 01:54:54,360 --> 01:54:56,080 A NURSING HOME AND THAT DEPENDS 2782 01:54:56,080 --> 01:54:57,840 ON THE LEVEL OF CARE AND ACCESS 2783 01:54:57,840 --> 01:54:59,960 TO CARE THEY WERE GETTING WHEN 2784 01:54:59,960 --> 01:55:06,640 LIVING IN THE COMMUNITY. 2785 01:55:06,640 --> 01:55:08,120 THE CARE ACT PAPER JUST RECENTLY 2786 01:55:08,120 --> 01:55:09,760 ACCEPTED THIS WEEK. 2787 01:55:09,760 --> 01:55:11,360 IT'S NOT EVEN HOT OFF THE 2788 01:55:11,360 --> 01:55:14,480 PRESSES YET LOOKING AT THE CARE 2789 01:55:14,480 --> 01:55:16,800 ACT ON COMMUNICATION. 2790 01:55:16,800 --> 01:55:19,680 WE DO SEE THAT AS STATES ACCEPT 2791 01:55:19,680 --> 01:55:21,880 OR PASS THE POLICY FOR THE CARE 2792 01:55:21,880 --> 01:55:24,160 ACT TO INCREASE COMMUNICATION TO 2793 01:55:24,160 --> 01:55:28,480 CAREGIVERS IN ACUTE CARE 2794 01:55:28,480 --> 01:55:29,560 SETTINGS LEADS TO IMPROVED 2795 01:55:29,560 --> 01:55:30,720 PHYSICIAN COMMUNICATION AND 2796 01:55:30,720 --> 01:55:32,960 WHILE THE PAPER DOESN'T LOOK 2797 01:55:32,960 --> 01:55:35,200 SPECIFICALLY AT PATIENTS WITH 2798 01:55:35,200 --> 01:55:36,640 DEMENTIA YOU CAN IMAGINE THEY 2799 01:55:36,640 --> 01:55:37,680 MAY BENEFIT FROM SUCH 2800 01:55:37,680 --> 01:55:40,000 COMMUNICATION AND IDENTIFICATION 2801 01:55:40,000 --> 01:55:41,880 OF CAREGIVERS DISPROPORTIONATELY 2802 01:55:41,880 --> 01:55:46,760 MORE THAN OTHERS. 2803 01:55:46,760 --> 01:55:49,600 A THIRD AREA WHERE THERE'S BEEN 2804 01:55:49,600 --> 01:55:50,920 A LOT OF GROWTH AND CHANGES 2805 01:55:50,920 --> 01:55:55,200 HAPPENING HAS BEEN IN THE 2806 01:55:55,200 --> 01:55:58,680 MEDICARE/MEDICAID HOME AND 2807 01:55:58,680 --> 01:56:04,920 COMMUNITY BASED SERVICES. 2808 01:56:04,920 --> 01:56:07,840 WE HAVE BEEN SEEING THIS AND 2809 01:56:07,840 --> 01:56:11,120 KNOW IT SAVES MONEY OVER ALL BY 2810 01:56:11,120 --> 01:56:12,440 INCREASING INSTITUTIONALIZATION 2811 01:56:12,440 --> 01:56:14,440 AND BENEFITS CAREGIVERS. 2812 01:56:14,440 --> 01:56:17,880 IT'S NOT A PANACEA. 2813 01:56:17,880 --> 01:56:19,400 WE KNOW IT LEADS TO MORE 2814 01:56:19,400 --> 01:56:20,680 HOSPITAL COMPARED TO THOSE IN 2815 01:56:20,680 --> 01:56:22,120 NURSING HOMES AND LOWER LEVELS 2816 01:56:22,120 --> 01:56:24,120 OF SOCIAL ENGAGEMENT AMONG THE 2817 01:56:24,120 --> 01:56:26,120 PERSON LIVING WITH DEMENTIA. 2818 01:56:26,120 --> 01:56:28,560 WE NEED TO THINK ABOUT BOTH 2819 01:56:28,560 --> 01:56:34,640 EXPANDING PERHAPS HOME AND 2820 01:56:34,640 --> 01:56:35,600 COMMUNITY SERVICES AND LOOK AT 2821 01:56:35,600 --> 01:56:38,240 THE DOWN SIDE AS WELL. 2822 01:56:38,240 --> 01:56:40,120 IT'S IMPORTANT TO NOTE TOO 2823 01:56:40,120 --> 01:56:41,400 THERE'S VARIATION IN HOME 2824 01:56:41,400 --> 01:56:43,880 COMMUNITY-BASED SERVICES ACROSS 2825 01:56:43,880 --> 01:56:45,840 STATES. 2826 01:56:45,840 --> 01:56:47,280 SO ONE MEDICAID PROGRAM MEANS 2827 01:56:47,280 --> 01:56:48,240 SOMETHING ABOUT ONE MEDICAID 2828 01:56:48,240 --> 01:56:49,560 PROGRAM BUT THERE'S ROOM FOR 2829 01:56:49,560 --> 01:56:53,360 GROWTH HERE IN THINKING WHAT IS 2830 01:56:53,360 --> 01:56:54,920 IT ABOUT ONE PARTICULAR 2831 01:56:54,920 --> 01:56:56,080 COMMUNITY-BASED SERVICES PROGRAM 2832 01:56:56,080 --> 01:56:56,720 AND HOW'S THAT WORK COMPARED TO 2833 01:56:56,720 --> 01:56:59,840 ANOTHER. 2834 01:56:59,840 --> 01:57:01,880 WE ALSO NEED TO BE MINDFUL OF 2835 01:57:01,880 --> 01:57:02,600 RACIAL DIFFERENCES WITHIN THE 2836 01:57:02,600 --> 01:57:04,920 HOME AND COMMUNITY-BASED 2837 01:57:04,920 --> 01:57:06,120 SERVICES PROGRAMS BETWEEN 2838 01:57:06,120 --> 01:57:07,800 STATES. 2839 01:57:07,800 --> 01:57:09,880 WE KNOW THEY SERVE DIFFERENT 2840 01:57:09,880 --> 01:57:10,480 PATIENTS AND DIFFERENT 2841 01:57:10,480 --> 01:57:12,240 POPULATION CHARACTERISTICS AND 2842 01:57:12,240 --> 01:57:13,440 HAVE DIFFERENT UTILIZATION 2843 01:57:13,440 --> 01:57:16,640 PATTERNS AND DIFFERENT TIMING OF 2844 01:57:16,640 --> 01:57:18,440 SERVICES AND WE NEED TO HONE IN 2845 01:57:18,440 --> 01:57:21,560 ON WHY ALL THE DIFFERENCES 2846 01:57:21,560 --> 01:57:21,960 HAPPEN. 2847 01:57:21,960 --> 01:57:24,080 IS IT PREFERENCES OR ACCESS OR 2848 01:57:24,080 --> 01:57:28,280 DIFFERENCES IN THE FAMILIAL 2849 01:57:28,280 --> 01:57:29,160 SUPPORT. 2850 01:57:29,160 --> 01:57:31,400 HOW DO WE SEE THE DIFFERENCES TO 2851 01:57:31,400 --> 01:57:33,480 ADDRESS THE GOAL OF PROVIDING 2852 01:57:33,480 --> 01:57:36,040 THE BEST SUPPORT TO EVERYONE 2853 01:57:36,040 --> 01:57:38,440 LIVING WITH DEMENTIA. 2854 01:57:38,440 --> 01:57:39,960 LASTLY I WANT TO TALK A LITTLE 2855 01:57:39,960 --> 01:57:41,600 BIT ABOUT PHARMACOLOGIC 2856 01:57:41,600 --> 01:57:42,920 DEVELOPMENT AND COVERAGE. 2857 01:57:42,920 --> 01:57:45,160 WE HEAR ABOUT IT IN THE NEWS AND 2858 01:57:45,160 --> 01:57:48,200 LOTS OF DEBATES ON PHARMACOLOGIC 2859 01:57:48,200 --> 01:57:48,520 INTERVENTIONS. 2860 01:57:48,520 --> 01:57:49,440 WE'RE NOT QUITE THERE YET WHERE 2861 01:57:49,440 --> 01:57:52,920 WE HAVE A PILL THAT WILL SOLVE 2862 01:57:52,920 --> 01:57:54,040 ANY MAJOR PROBLEMS BUT WE DO 2863 01:57:54,040 --> 01:57:58,080 WANT TO BE AWARE OF WHAT OUR 2864 01:57:58,080 --> 01:57:59,720 COVERAGE DECISIONS AND THE 2865 01:57:59,720 --> 01:58:01,720 DIFFERENT PHARMACOLOGIC 2866 01:58:01,720 --> 01:58:02,760 DEVELOPMENTS MEAN FOR 2867 01:58:02,760 --> 01:58:03,440 DISPARITIES WITHIN DEMENTIA AND 2868 01:58:03,440 --> 01:58:06,480 CARE. 2869 01:58:06,480 --> 01:58:09,240 WE DO ALREADY KNOW THAT THERE 2870 01:58:09,240 --> 01:58:13,400 ARE DISPARITIES IN ANTIDEMENTIA 2871 01:58:13,400 --> 01:58:14,960 DRUGS ALREADY BETWEEN WHITE 2872 01:58:14,960 --> 01:58:16,600 VERSUS NON-WHITE PATIENTS, 2873 01:58:16,600 --> 01:58:18,800 FEMALE VERSUS MALE PATIENTS AND 2874 01:58:18,800 --> 01:58:24,000 RURAL VERSUS URBAN PATIENTS. 2875 01:58:24,000 --> 01:58:25,520 WE KNOW THERE'S DISPARITIES AND 2876 01:58:25,520 --> 01:58:27,240 WE NEED TO KEEP THEM IN MIND 2877 01:58:27,240 --> 01:58:28,680 WHEN WE MAKE COVERAGE DECISIONS 2878 01:58:28,680 --> 01:58:29,600 AS THE MEDICINES IMPROVE GOING 2879 01:58:29,600 --> 01:58:33,080 FORWARD. 2880 01:58:33,080 --> 01:58:38,320 THE PANDEMIC ACCELERATED A LOT 2881 01:58:38,320 --> 01:58:42,160 OF FUNDING IN HOME AND 2882 01:58:42,160 --> 01:58:46,000 COMMUNITY-BASED SERVICES AND 2883 01:58:46,000 --> 01:58:47,560 WIDESPREAD GROWTH OF 2884 01:58:47,560 --> 01:58:48,720 TELEMEDICINE AS IN THE PREVIOUS 2885 01:58:48,720 --> 01:58:49,400 TALK. 2886 01:58:49,400 --> 01:58:51,400 WE NEED TO THINK ABOUT WHERE DID 2887 01:58:51,400 --> 01:58:53,000 THIS BENEFIT AND WHAT CAN WE 2888 01:58:53,000 --> 01:58:54,920 LEARN FROM IT AND WHO DID IT 2889 01:58:54,920 --> 01:58:56,680 BENEFIT AND WHAT LESSONS CAN WE 2890 01:58:56,680 --> 01:59:00,400 TAKE FROM THESE TYPES OF 2891 01:59:00,400 --> 01:59:06,680 PANDEMIC CHANGES IN POLICY. 2892 01:59:06,680 --> 01:59:08,080 I WOULD LIKE TO ADVOCATE WE 2893 01:59:08,080 --> 01:59:09,320 CONTINUE FOCUSSING ON 2894 01:59:09,320 --> 01:59:10,880 DOCUMENTING DISPARITIES AND 2895 01:59:10,880 --> 01:59:12,480 DIFFERENCES BUT WE NEED TO 2896 01:59:12,480 --> 01:59:14,600 UNDERSTAND WHY THE DIFFERENCES 2897 01:59:14,600 --> 01:59:16,160 HAPPEN IN ORDER TO DEVELOP 2898 01:59:16,160 --> 01:59:19,960 POLICIES THAT BEST SERVE ALL 2899 01:59:19,960 --> 01:59:21,320 COMMUNITIES AND IN ALL 2900 01:59:21,320 --> 01:59:23,000 SITUATIONS THEY FACE. 2901 01:59:23,000 --> 01:59:26,000 AND I THINK WE NEED TO THINK 2902 01:59:26,000 --> 01:59:27,200 CREATIVELY HOW TO EXAMINE THE 2903 01:59:27,200 --> 01:59:28,760 PANDEMIC PERIOD. 2904 01:59:28,760 --> 01:59:29,880 YES, THERE WAS A GLOBAL PANDEMIC 2905 01:59:29,880 --> 01:59:31,440 THAT CHANGED EVERYTHING AND 2906 01:59:31,440 --> 01:59:32,680 CHANGED A LOT OF POLICIES AND WE 2907 01:59:32,680 --> 01:59:34,440 WANT TO THINK ABOUT WHAT CAN WE 2908 01:59:34,440 --> 01:59:35,640 LEARN FROM THAT TIME PERIOD THAT 2909 01:59:35,640 --> 01:59:39,720 WE CAN TAKE FORWARD AND MOVE 2910 01:59:39,720 --> 01:59:41,080 FORWARD SO WE CAN ADDRESS CARE 2911 01:59:41,080 --> 01:59:44,400 AND POLICIES GOING FORWARD. 2912 01:59:44,400 --> 01:59:50,040 THANK YOU. 2913 01:59:50,040 --> 01:59:51,920 >>THANK YOU. 2914 01:59:51,920 --> 01:59:52,760 THANK YOU ALL FOR THOSE 2915 01:59:52,760 --> 01:59:54,600 TREMENDOUS AND EXCITING 2916 01:59:54,600 --> 01:59:54,960 PRESENTATIONS. 2917 01:59:54,960 --> 02:00:03,280 I AM JUST GOING TO TAKE A MINUTE 2918 02:00:03,280 --> 02:00:04,640 TO REVIEW THE GAP RESEARCH 2919 02:00:04,640 --> 02:00:06,480 OPPORTUNITIES SESSION 4 2920 02:00:06,480 --> 02:00:09,720 PARTICIPANTS HAVE SORT OF BEEN 2921 02:00:09,720 --> 02:00:12,200 BRAIN STORMING OVER THE PAST FEW 2922 02:00:12,200 --> 02:00:14,280 WEEKS AS WE PREPARE FOR TODAY. 2923 02:00:14,280 --> 02:00:15,120 THE FIRST INCLUDES IDENTIFYING 2924 02:00:15,120 --> 02:00:17,320 AND IMPLEMENTING STRATEGIES TO 2925 02:00:17,320 --> 02:00:19,400 EXPAND -- EXCUSE ME, DATA 2926 02:00:19,400 --> 02:00:20,920 AVAILABILITY AND LINKAGES 2927 02:00:20,920 --> 02:00:25,680 BETWEEN DATA SOURCES AT LOCAL, 2928 02:00:25,680 --> 02:00:27,320 STATE AND FEDERAL LEVELS AS WELL 2929 02:00:27,320 --> 02:00:29,120 AS ACROSS HEALTH CARE SETTINGS 2930 02:00:29,120 --> 02:00:31,520 IN AND OUT OF TRADITIONAL HEALTH 2931 02:00:31,520 --> 02:00:33,920 SYSTEMS THAT FACILITATE THE 2932 02:00:33,920 --> 02:00:35,200 EXAMINATION OF SOCIAL 2933 02:00:35,200 --> 02:00:38,440 DETERMINATES OF HEALTH, INCREASE 2934 02:00:38,440 --> 02:00:40,680 REPRESENTATION OF POPULATION 2935 02:00:40,680 --> 02:00:43,560 VULNERABLE TO EXCLUSION AND 2936 02:00:43,560 --> 02:00:46,680 EXAMINE EXAMINATION OF DEMENTIA 2937 02:00:46,680 --> 02:00:51,040 CARE AND QUALITY AND HIGHLIGHT 2938 02:00:51,040 --> 02:00:52,320 DEVELOPING STRATEGIES THAT 2939 02:00:52,320 --> 02:00:53,880 CONSIDER HEALTH INFORMATION 2940 02:00:53,880 --> 02:00:55,960 EXCHANGES ACROSS SILOS OF HEALTH 2941 02:00:55,960 --> 02:01:01,680 CARE SETTINGS SUCH AS ADULT 2942 02:01:01,680 --> 02:01:03,920 DAYCARE CENTERS. 2943 02:01:03,920 --> 02:01:05,840 EXAMINE HOW HEALTH INFORMATION 2944 02:01:05,840 --> 02:01:07,000 TECHNOLOGY AFFECTS CARE ACCESS 2945 02:01:07,000 --> 02:01:11,320 AND QUALITY OF COST FOR THOSE 2946 02:01:11,320 --> 02:01:12,680 LIVING WITH DEMENTIA FOR 2947 02:01:12,680 --> 02:01:14,520 POPULATIONS UNDER INCLUDE IN 2948 02:01:14,520 --> 02:01:17,880 RESEARCH AND THE SUBBULLETS 2949 02:01:17,880 --> 02:01:20,080 FOLLOWING NUMBER 2 INCLUDE 2950 02:01:20,080 --> 02:01:20,880 DESCRIBING AND IDENTIFYING 2951 02:01:20,880 --> 02:01:23,040 DRIVING FACTORS FOR DISPARITIES 2952 02:01:23,040 --> 02:01:24,520 OF HEALTH INFORMATION TECHNOLOGY 2953 02:01:24,520 --> 02:01:28,280 AND ACCESSIBILITY, AVAILABILITY 2954 02:01:28,280 --> 02:01:29,720 AND UTILIZATION INCLUDING USER 2955 02:01:29,720 --> 02:01:31,120 FRIENDLY DESIGNS AND PATIENT 2956 02:01:31,120 --> 02:01:34,280 PORTALS TO ENGAGE PATIENTS AND 2957 02:01:34,280 --> 02:01:38,280 CAREGIVERS AND TELEMEDICINE TO 2958 02:01:38,280 --> 02:01:39,480 LOOK AT COORDINATION AS IT 2959 02:01:39,480 --> 02:01:42,120 RELATE TO DISEASE AND PREVENTION 2960 02:01:42,120 --> 02:01:44,320 AND TO EXAMINE THE SECOND SUB 2961 02:01:44,320 --> 02:01:46,960 BULLET LOOK AT TECHNOLOGY ACCESS 2962 02:01:46,960 --> 02:01:48,880 AND DEVELOPING STRATEGIES TO 2963 02:01:48,880 --> 02:01:51,720 ADDRESS DISPARITIES AND 2964 02:01:51,720 --> 02:01:53,200 ACCESSIBILITY IN USERS FOR ALL 2965 02:01:53,200 --> 02:01:56,600 SETTINGS AND THE FINAL BULLET 2966 02:01:56,600 --> 02:01:58,960 THE THIRD GAP IN OPPORTUNITY 2967 02:01:58,960 --> 02:02:02,560 CONDUCT RESEARCH TO DETERMINE 2968 02:02:02,560 --> 02:02:04,400 HOW HEALTH CARE POLICY AND 2969 02:02:04,400 --> 02:02:05,960 PAYMENT MODELS AFFECT ACCESS AND 2970 02:02:05,960 --> 02:02:07,760 QUALITY OF CARE RECEIVED BY 2971 02:02:07,760 --> 02:02:09,840 PEOPLE LIVING WITH DEMENTIA IN 2972 02:02:09,840 --> 02:02:12,160 COMMUNITY AND RESIDENTIAL 2973 02:02:12,160 --> 02:02:14,360 SETTINGS TO GUIDE INTERVENTION. 2974 02:02:14,360 --> 02:02:17,520 CONDUCT ANALYSES EXAMINING HOW 2975 02:02:17,520 --> 02:02:20,680 TO USE MEDICAL CARE AND ASSESS 2976 02:02:20,680 --> 02:02:23,720 AND HOW CARE IS IMPACTED BY 2977 02:02:23,720 --> 02:02:25,640 MEDICARE, MEDICAID AND OTHER 2978 02:02:25,640 --> 02:02:29,880 HEALTH INSURANCE MODELS SUCH AS 2979 02:02:29,880 --> 02:02:32,600 PRIVATE LONG INSURANCE MODEL AND 2980 02:02:32,600 --> 02:02:35,960 PROVIDE CARE AND CONCORDANCE. 2981 02:02:35,960 --> 02:02:37,640 SO FOLLOWING OUR PRESENTATIONS 2982 02:02:37,640 --> 02:02:39,640 AND THE REVUKE OF OUR GAPS AND 2983 02:02:39,640 --> 02:02:40,800 OPPORTUNITIES I'M EXCITED TO 2984 02:02:40,800 --> 02:02:45,400 HEAR FROM OUR THREE PRESENTERS 2985 02:02:45,400 --> 02:02:45,600 TODAY. 2986 02:02:45,600 --> 02:02:56,080 FIRST WE'LL HAVE MARICRUZ 2987 02:02:56,680 --> 02:03:00,840 RIVERA-HERNANDEZ AND HEAR FROM 2988 02:03:00,840 --> 02:03:02,760 TINA SADARANGANI FROM NEW YORK 2989 02:03:02,760 --> 02:03:08,120 UNIVERSITY AND WE'LL HEAR FROM 2990 02:03:08,120 --> 02:03:09,640 EMMANUEL DRABO AN ASSISTANT 2991 02:03:09,640 --> 02:03:10,200 PROFESSOR AT JOHNS HOPKINS 2992 02:03:10,200 --> 02:03:12,240 UNIVERSITY. 2993 02:03:12,240 --> 02:03:16,240 FIRST WE'LL GIVE THE FLOOR TO 2994 02:03:16,240 --> 02:03:18,760 DR. RIVERA-HERNANDEZ. 2995 02:03:18,760 --> 02:03:20,880 >>THANK YOU FOR INVITING ME TO 2996 02:03:20,880 --> 02:03:22,280 BE PART OF THE SESSION 2997 02:03:22,280 --> 02:03:23,360 INCORPORATING THE PRESENTATIONS. 2998 02:03:23,360 --> 02:03:26,000 THE PRESENTATIONS DESCRIBE 2999 02:03:26,000 --> 02:03:27,200 DISPARITIES AMONG MEDICARE 3000 02:03:27,200 --> 02:03:29,520 ENROLLEES AND ONE TALKED ABOUT 3001 02:03:29,520 --> 02:03:31,640 THE GAP IN THE DISPARITIES IN 3002 02:03:31,640 --> 02:03:32,920 DEMENTIA CARE AND OUTCOMES WHICH 3003 02:03:32,920 --> 02:03:36,120 IS EXTREMELY IMPORTANT GIVEN THE 3004 02:03:36,120 --> 02:03:38,080 RACIAL AND ETHNIC DISPARITIES IN 3005 02:03:38,080 --> 02:03:41,480 THE INCIDENTS OF DEMENTIA AND 3006 02:03:41,480 --> 02:03:43,160 ENROLLMENT OF ETHNIC AND RACIAL 3007 02:03:43,160 --> 02:03:45,280 MINORITY POPULATIONS IN THE 3008 02:03:45,280 --> 02:03:46,320 MEDICARE ADVANTAGE PROGRAM. 3009 02:03:46,320 --> 02:03:50,000 ONE OF THE KEY MESSAGES OF THE 3010 02:03:50,000 --> 02:03:52,000 WORK IS THAT INSURANCE IMPACTS 3011 02:03:52,000 --> 02:03:53,040 ACCESS TO CARE. 3012 02:03:53,040 --> 02:03:55,000 THE VAST MAJORITY OF PEOPLE 3013 02:03:55,000 --> 02:04:00,640 LIVING WITH DEMENTIA ARE 3014 02:04:00,640 --> 02:04:06,320 ENROLLED IN MEDICARE. 3015 02:04:06,320 --> 02:04:08,920 MORE EVIDENCE ARE NEEDED FOR 3016 02:04:08,920 --> 02:04:12,120 DISPARITIES AND THE USE OF 3017 02:04:12,120 --> 02:04:14,560 TELEHEALTH AS DEMONSTRATED. 3018 02:04:14,560 --> 02:04:19,760 MEDICARE ENROLLEES CAN DECIDE 3019 02:04:19,760 --> 02:04:22,440 BETWEEN TRADITIONAL MEDICARE OR 3020 02:04:22,440 --> 02:04:25,360 MEDICARE ADVANTAGE. 3021 02:04:25,360 --> 02:04:26,640 ENROLLEES WITH DEMENTIA MAY FACE 3022 02:04:26,640 --> 02:04:27,840 CHALLENGING IN SELECTING THE 3023 02:04:27,840 --> 02:04:30,040 RIGHT PLAN FOR THEM WITH THE 3024 02:04:30,040 --> 02:04:31,560 APPROPRIATE BENEFITS WHICH MAY 3025 02:04:31,560 --> 02:04:37,280 LEAD TO LOWER RATE OF CARE 3026 02:04:37,280 --> 02:04:38,480 EXPERIENCES. 3027 02:04:38,480 --> 02:04:41,000 EVEN OTHER WORK SHOWS GEOGRAPHIC 3028 02:04:41,000 --> 02:04:43,240 HAS THE IMPACT OF THE TYPE OF 3029 02:04:43,240 --> 02:04:52,160 CARE OFFERED TO ADULTS LIVING 3030 02:04:52,160 --> 02:04:56,240 WITH DEMENTIA AND TELEHEALTH 3031 02:04:56,240 --> 02:04:58,120 PROVIDERS MUST ADDRESS DIGITAL 3032 02:04:58,120 --> 02:05:02,120 GAPS AND ENROLLING IN MEDICARE 3033 02:05:02,120 --> 02:05:02,400 ADVANTAGE. 3034 02:05:02,400 --> 02:05:05,600 AND CURRENTS TRENDS SHOW THAT 3035 02:05:05,600 --> 02:05:08,160 MEDICARE ADVANTAGE ENROLLMENT IS 3036 02:05:08,160 --> 02:05:10,280 EXPECTED TO GROW OUTPACING 3037 02:05:10,280 --> 02:05:12,240 TRADITIONAL MEDICARE. 3038 02:05:12,240 --> 02:05:15,960 GIVEN THIS AMONG MEDICARE 3039 02:05:15,960 --> 02:05:17,320 ADVANTAGE THEY SPECIALIZE IN 3040 02:05:17,320 --> 02:05:21,160 CARING FOR PEOPLE WITH MORE 3041 02:05:21,160 --> 02:05:23,360 COMPLEX HEALTH NEEDS WITH 3042 02:05:23,360 --> 02:05:25,360 OUTCOMES AND THERE'S RESEARCH ON 3043 02:05:25,360 --> 02:05:25,560 THIS. 3044 02:05:25,560 --> 02:05:28,280 IN TERMS OF GEOGRAPHYING 3045 02:05:28,280 --> 02:05:28,840 DISPARITIES IN THE USE OF 3046 02:05:28,840 --> 02:05:31,400 TELEHEALTH PATIENT-REPORTED 3047 02:05:31,400 --> 02:05:32,240 MEASURES COULD PROVED ADDITIONAL 3048 02:05:32,240 --> 02:05:33,320 INFORMATION ON THE ISSUES. 3049 02:05:33,320 --> 02:05:35,920 HOWEVER, ONE THING WE HAVE 3050 02:05:35,920 --> 02:05:36,840 LEARNED FROM RESEARCH AT OUR 3051 02:05:36,840 --> 02:05:39,320 CENTER FOR GERONTOLOGY IS 3052 02:05:39,320 --> 02:05:41,040 MEDICARE BENEFICIARIES WITH 3053 02:05:41,040 --> 02:05:42,880 DEMENTIA WERE LESS LIKELY TO BE 3054 02:05:42,880 --> 02:05:44,000 INCLUDED IN PERFORMANCE MEASURES 3055 02:05:44,000 --> 02:05:47,720 THAN ENROLLEES WITHOUT AND THOSE 3056 02:05:47,720 --> 02:05:49,560 INCLUDED IN THE PATIENT-REPORTED 3057 02:05:49,560 --> 02:05:52,040 MEASURES ENROLLEES WITH DEMENTIA 3058 02:05:52,040 --> 02:05:54,560 REPORTED SIGNIFICANTLY WORSE 3059 02:05:54,560 --> 02:05:55,800 CARE EXPERIENCE ACROSS DIFFERENT 3060 02:05:55,800 --> 02:05:59,120 MEASURES COMPARED TO THOSE 3061 02:05:59,120 --> 02:06:00,480 WITHOUT DEMENTIA. 3062 02:06:00,480 --> 02:06:02,280 MORE EVIDENCE ARE NEEDED TO 3063 02:06:02,280 --> 02:06:03,000 ADDRESS THE POPULATION. 3064 02:06:03,000 --> 02:06:05,920 WE NEED TO CONTINUE TO USE THE 3065 02:06:05,920 --> 02:06:08,520 TOOLS PRESENTED HERE SUCH AS ZIP 3066 02:06:08,520 --> 02:06:10,160 CODE LEVEL INFORMATION TO 3067 02:06:10,160 --> 02:06:11,480 ADDRESS SOCIAL DETERMINATES OF 3068 02:06:11,480 --> 02:06:15,040 HEALTH AND TO IMPROVE RESOURCES 3069 02:06:15,040 --> 02:06:16,480 IN SPECIFIC AREAS AS WELL AS 3070 02:06:16,480 --> 02:06:19,280 EXAMINING WHETHER MEDICARE PLANS 3071 02:06:19,280 --> 02:06:20,960 ACROSS GEOGRAPHIC MARKETS IMPACT 3072 02:06:20,960 --> 02:06:25,680 THE NEEDS OF THOSE ENROLLED. 3073 02:06:25,680 --> 02:06:29,400 AND THIS HIGHLIGHTS SOME AREAS 3074 02:06:29,400 --> 02:06:30,040 WE MUST FOCUS. 3075 02:06:30,040 --> 02:06:30,960 THANK YOU VERY MUCH AND I LOOK 3076 02:06:30,960 --> 02:06:41,440 FORWARD TO THE CONVERSATION. 3077 02:06:42,400 --> 02:06:42,840 >>NEW. 3078 02:06:42,840 --> 02:06:43,600 DR. SADARANGANI. 3079 02:06:43,600 --> 02:06:45,040 >>THE QUALITY OF CARE THAT 3080 02:06:45,040 --> 02:06:46,560 PERSONS WITH DEMENTIA RECEIVE 3081 02:06:46,560 --> 02:06:48,440 SHOULD NOT BE AFFECTED BY WHERE 3082 02:06:48,440 --> 02:06:50,320 THEY LIVE OR THE COLOR OF THEIR 3083 02:06:50,320 --> 02:06:52,240 SKIN BUT THE RESEARCH TODAY 3084 02:06:52,240 --> 02:06:58,280 PRESENTED SUGGESTS IT DOES. 3085 02:06:58,280 --> 02:07:00,520 DR. WALTERS NOTE THE PREVALENCE 3086 02:07:00,520 --> 02:07:01,960 AMONG BLACK AND ACCESS TO CARE 3087 02:07:01,960 --> 02:07:04,560 CORRELATES TO WHERE YOU LIVE. 3088 02:07:04,560 --> 02:07:07,520 DR. COE NOTED AFRICAN AMERICAN 3089 02:07:07,520 --> 02:07:10,240 AND HISPANIC PATIENTS WERE MORE 3090 02:07:10,240 --> 02:07:12,320 LIKELY TO BE ADMITTED TO 3091 02:07:12,320 --> 02:07:13,600 SEGREGATED NURSING HOMES WITH 3092 02:07:13,600 --> 02:07:14,800 FEWER RESOURCES AND LOWER 3093 02:07:14,800 --> 02:07:17,120 QUALITY OF CARE AND DR. CHEN 3094 02:07:17,120 --> 02:07:18,840 NOTED GAPS IN HEALTH INFORMATION 3095 02:07:18,840 --> 02:07:20,440 TECHNOLOGIES AMONG THE 3096 02:07:20,440 --> 02:07:22,360 POPULATIONS THAT NEED THEM MOST 3097 02:07:22,360 --> 02:07:23,360 INCLUDING MINORITIZED PERSONS 3098 02:07:23,360 --> 02:07:25,120 AND THOSE WHO LIVE IN RURAL 3099 02:07:25,120 --> 02:07:25,440 COMMUNITIES. 3100 02:07:25,440 --> 02:07:27,080 HOWEVER, OUR PRESENTERS HAVE 3101 02:07:27,080 --> 02:07:29,000 ALSO DEMONSTRATED WHEN 3102 02:07:29,000 --> 02:07:30,320 PARTNERSHIPS ARE FORMED WITHIN 3103 02:07:30,320 --> 02:07:31,960 COMMUNITIES AND POLICIES AND 3104 02:07:31,960 --> 02:07:36,880 PROGRAMS EXIST THAT EQUITABLY 3105 02:07:36,880 --> 02:07:37,760 RESOURCE HOSPITALS WE CAN 3106 02:07:37,760 --> 02:07:40,280 DELIVER A HIGHER STANDARD OF 3107 02:07:40,280 --> 02:07:42,000 DEMENTIA CARE THAT IMPROVES 3108 02:07:42,000 --> 02:07:44,800 OUTCOMES IN DIVERSE POPULATIONS. 3109 02:07:44,800 --> 02:07:46,280 NOTABLY, DR. CHEN FOUND AFRICAN 3110 02:07:46,280 --> 02:07:47,400 AMERICAN PATIENTS WITHIN HER 3111 02:07:47,400 --> 02:07:50,400 PUBLIC HEALTH SYSTEM PARTNERSHIP 3112 02:07:50,400 --> 02:07:52,040 EXPERIENCED SIGNIFICANTLY LOWER 3113 02:07:52,040 --> 02:07:54,960 COST, IN-PATIENT VISITS AND 3114 02:07:54,960 --> 02:07:58,280 RE-ADMISSION RATES WHEN TREATED 3115 02:07:58,280 --> 02:08:00,400 AT HOSPITALS WITH A PUBLIC 3116 02:08:00,400 --> 02:08:02,000 HEALTH SYSTEM PARTNERSHIP. 3117 02:08:02,000 --> 02:08:04,560 IN MY OWN WORK FOCUSSED ON HOME 3118 02:08:04,560 --> 02:08:07,880 AND COMMUNITY BASED SERVICES 3119 02:08:07,880 --> 02:08:11,360 ADULT DAY CENTERS WHERE HALF OF 3120 02:08:11,360 --> 02:08:13,680 PERSONS WITH DEMENTIA THE 3121 02:08:13,680 --> 02:08:16,280 OBSERVATIONS AND FINDINGS FROM 3122 02:08:16,280 --> 02:08:18,400 STAFF ARE RARELY LEVERAGED OR 3123 02:08:18,400 --> 02:08:19,760 SHARED WITH PROVIDERS. 3124 02:08:19,760 --> 02:08:20,960 DAY PROGRAMS ARE FREQUENTLY 3125 02:08:20,960 --> 02:08:23,600 UNDER RESOURCED LIKE MANY 3126 02:08:23,600 --> 02:08:25,720 LONG-TERM CARE SETTINGS THAT 3127 02:08:25,720 --> 02:08:26,480 DISPROPORTIONATELY SERVE 3128 02:08:26,480 --> 02:08:27,640 MINORITY POPULATIONS. 3129 02:08:27,640 --> 02:08:30,360 AND THESE LACK THE TECHNOLOGY TO 3130 02:08:30,360 --> 02:08:31,800 FACILITATE COLLABORATIVE CARE. 3131 02:08:31,800 --> 02:08:34,240 THIS CONTRIBUTES TO FRAGMENTED 3132 02:08:34,240 --> 02:08:35,640 CARE OF PEOPLE WITH COMPLEX AND 3133 02:08:35,640 --> 02:08:39,040 SOCIAL NEEDS AND COSTLY AND 3134 02:08:39,040 --> 02:08:40,360 TRAUMATIC OUTCOMES. 3135 02:08:40,360 --> 02:08:43,200 TWO KEY FINDS ARE WE MUST AIM TO 3136 02:08:43,200 --> 02:08:45,320 DELIVER HIGHER STANDARDS OF 3137 02:08:45,320 --> 02:08:47,000 DEMENTIA CARE ACROSS TRADITIONAL 3138 02:08:47,000 --> 02:08:48,400 AND NON-TRADITIONAL HEALTH CARE 3139 02:08:48,400 --> 02:08:49,360 SETTINGS FOR MINORITIZED 3140 02:08:49,360 --> 02:08:51,040 POPULATIONS AND WHEN WE 3141 02:08:51,040 --> 02:08:51,920 INTEGRATE CARE ACROSS 3142 02:08:51,920 --> 02:08:52,840 NEIGHBORHOODS WHETHER AT HOME OR 3143 02:08:52,840 --> 02:08:54,600 IN THE HOSPITAL OR IN MY CASE 3144 02:08:54,600 --> 02:08:57,440 THE DAY CENTER WE CAN PROVIDE A 3145 02:08:57,440 --> 02:08:59,920 MORE COHESIVE AND HOLISTIC CARE 3146 02:08:59,920 --> 02:09:02,360 WHILE MEETING PEOPLE WHERE THEY 3147 02:09:02,360 --> 02:09:04,200 ARE. 3148 02:09:04,200 --> 02:09:05,480 TO ACHIEVE HIGH QUALITY DEMENTIA 3149 02:09:05,480 --> 02:09:07,600 CARE FOR ALL WE MUST LEVERAGE 3150 02:09:07,600 --> 02:09:08,280 TECHNOLOGY AND TAKE GREAT CARE 3151 02:09:08,280 --> 02:09:10,080 IN DESIGNING OUR INTERVENTIONS 3152 02:09:10,080 --> 02:09:13,680 TO ENSURE THE PEOPLE WHO WOULD 3153 02:09:13,680 --> 02:09:15,480 BENEFIT THE MOST CAN ACCESS THE 3154 02:09:15,480 --> 02:09:17,400 TECHNOLOGIES THAT MAKE THAT CARE 3155 02:09:17,400 --> 02:09:18,120 POSSIBLE. 3156 02:09:18,120 --> 02:09:20,920 AGENCIES PROVIDING HOME AND 3157 02:09:20,920 --> 02:09:21,880 COMMUNITY-BASED SERVICES CAN 3158 02:09:21,880 --> 02:09:23,640 FACILITATE ACCESS TO CULTURALLY 3159 02:09:23,640 --> 02:09:25,880 APPROPRIATE INTEGRATED HEALTH 3160 02:09:25,880 --> 02:09:27,400 AND SOCIAL CARE THAT LEVERAGES 3161 02:09:27,400 --> 02:09:28,400 TECHNOLOGY BUT NEED THE 3162 02:09:28,400 --> 02:09:29,440 RESOURCES TO DO SO. 3163 02:09:29,440 --> 02:09:32,360 GOING FORWARD WE NEED TO EXAMINE 3164 02:09:32,360 --> 02:09:34,560 CLOSELY HOW WE WORK WITH 3165 02:09:34,560 --> 02:09:35,240 MINORITIZED PERSONS AND 3166 02:09:35,240 --> 02:09:37,080 COMMUNITY PARTNERS TO CO-CREATE 3167 02:09:37,080 --> 02:09:38,560 DEMENTIA FRIENDLY POLICIES AND 3168 02:09:38,560 --> 02:09:40,000 PROGRAMS AND INTERVENTIONS THAT 3169 02:09:40,000 --> 02:09:41,280 SUPPORT INTEGRATIVE CARE IN THE 3170 02:09:41,280 --> 02:09:43,600 COMMUNITY AND NOT SIMPLY ASSUME 3171 02:09:43,600 --> 02:09:46,280 IF WE BUILD IT THEY WILL COME. 3172 02:09:46,280 --> 02:09:51,840 THANK YOU SO MUCH. 3173 02:09:51,840 --> 02:09:52,160 >>THANK YOU. 3174 02:09:52,160 --> 02:09:56,360 DR. DRABO. 3175 02:09:56,360 --> 02:09:57,840 >>THANK YOU FOR HAVING ME HERE. 3176 02:09:57,840 --> 02:10:01,320 I WANTED TO START BY SAYING THE 3177 02:10:01,320 --> 02:10:02,400 SPEAKERS AND PANELISTS HAVE 3178 02:10:02,400 --> 02:10:03,680 HIGHLIGHT THE PROFOUND 3179 02:10:03,680 --> 02:10:05,600 DISPARITIES IN DEMENTIA CARE AND 3180 02:10:05,600 --> 02:10:08,040 THERE'S GREATER OPPORTUNITY FOR 3181 02:10:08,040 --> 02:10:10,840 LEVERAGING PROGRAMS IN CARE 3182 02:10:10,840 --> 02:10:13,480 DELIVERY MODELS TO HELP IN THE 3183 02:10:13,480 --> 02:10:14,160 HEALTH EQUITY OF PERSONS LIVING 3184 02:10:14,160 --> 02:10:16,280 WITH DEMENTIA AND THEIR CARE 3185 02:10:16,280 --> 02:10:18,000 PARTNERS AND FOR EFFECTIVE 3186 02:10:18,000 --> 02:10:19,080 IMPLEMENTATION WILL NEED TO 3187 02:10:19,080 --> 02:10:20,400 UNDERSTAND HOW THE PROGRAMS AND 3188 02:10:20,400 --> 02:10:22,320 POLICIES ARE WORKING FOR 3189 02:10:22,320 --> 02:10:24,480 DIFFERENT POPULATIONS IN ORDER 3190 02:10:24,480 --> 02:10:26,440 TO TARGET THEM FOR THE SUB 3191 02:10:26,440 --> 02:10:26,760 POPULATION. 3192 02:10:26,760 --> 02:10:31,880 AND OFFERING TARGETED PROGRAMS 3193 02:10:31,880 --> 02:10:34,080 IT WILL BENEFIT AND ALLOW US TO 3194 02:10:34,080 --> 02:10:35,080 MAKE BETTER USE OF THE HEALTH 3195 02:10:35,080 --> 02:10:40,280 CARE RESOURCES WE HAVE. 3196 02:10:40,280 --> 02:10:43,200 AND FURTHERMORE BY DOING SO 3197 02:10:43,200 --> 02:10:45,280 USING THE DATA HEALTH 3198 02:10:45,280 --> 02:10:46,800 ORGANIZATIONS ARE REQUIRED AND 3199 02:10:46,800 --> 02:10:48,080 DEMONSTRATE THE VIABILITY OF 3200 02:10:48,080 --> 02:10:48,640 PROGRAMS AND JUSTIFY THEIR 3201 02:10:48,640 --> 02:10:51,480 EXPANSION. 3202 02:10:51,480 --> 02:10:53,440 AND MUCH INTERVENTION TO THE 3203 02:10:53,440 --> 02:10:54,760 MOST APPROPRIATE AT RISK 3204 02:10:54,760 --> 02:10:59,200 POPULATION WILL ALSO INVOLVE 3205 02:10:59,200 --> 02:11:02,360 SCREENING AND DEVELOP RIGOROUS 3206 02:11:02,360 --> 02:11:04,880 EFFECT AND THE EVIDENCE OUR 3207 02:11:04,880 --> 02:11:06,640 PRESENTERS SHARED WITH US ANSWER 3208 02:11:06,640 --> 02:11:07,800 IMPORTANT QUESTIONS AND RAISE 3209 02:11:07,800 --> 02:11:11,840 NEW ONES. 3210 02:11:11,840 --> 02:11:12,480 NOTABLY WHILE OFFERS TO 3211 02:11:12,480 --> 02:11:15,360 INTEGRATE DEMENTIA CARE THE HIGH 3212 02:11:15,360 --> 02:11:17,080 RATE OF THE ENROLLMENT AMONG 3213 02:11:17,080 --> 02:11:19,680 PEOPLE WITH DEMENTIA AS 3214 02:11:19,680 --> 02:11:21,680 HIGHLIGHTED BY DR. COE IS CAUSE 3215 02:11:21,680 --> 02:11:22,160 OF CONCERN. 3216 02:11:22,160 --> 02:11:26,360 AND WE'LL NEED TO UNDERSTAND HOW 3217 02:11:26,360 --> 02:11:28,320 PLANS ARE ALIGN WITH CARE AND 3218 02:11:28,320 --> 02:11:31,120 SUPPORT NEEDS WITH PERSONS 3219 02:11:31,120 --> 02:11:33,640 LIVING WITH DEMENTIA AND 3220 02:11:33,640 --> 02:11:35,440 CAREGIVERS AND LOOK AT TO WHICH 3221 02:11:35,440 --> 02:11:38,680 ANY PLANS ARE OFFERED TO BLACK 3222 02:11:38,680 --> 02:11:39,720 PERSONS ARE WORSE THAN OTHERS 3223 02:11:39,720 --> 02:11:43,000 OFFERED TO OTHER POPULATIONS. 3224 02:11:43,000 --> 02:11:45,600 THERE'S BEEN A HISTORY OF 3225 02:11:45,600 --> 02:11:50,960 DISPARITY BY OFFERING INCENTIVE 3226 02:11:50,960 --> 02:11:53,640 WHICH CERTAIN POPULATIONS. 3227 02:11:53,640 --> 02:11:55,880 ARE SIMILAR MECHANISMS AT PLAY 3228 02:11:55,880 --> 02:11:57,360 OR IS THERE RESTRICTIVE NETWORK? 3229 02:11:57,360 --> 02:11:58,960 MORE RESEARCH IS NEEDED TO FULLY 3230 02:11:58,960 --> 02:12:01,360 UNDERSTAND THE IMPLICATIONS OF 3231 02:12:01,360 --> 02:12:03,760 MANAGE CARE AND EVOLVING POLICY 3232 02:12:03,760 --> 02:12:04,920 CHANGES IN THE PROGRAM FOR 3233 02:12:04,920 --> 02:12:07,440 PERSONS LIVING WITH DEMENTIA AND 3234 02:12:07,440 --> 02:12:10,120 THEIR CAREGIVERS. 3235 02:12:10,120 --> 02:12:11,840 IN LIGHT THE EVIDENCE DR. CHEN 3236 02:12:11,840 --> 02:12:14,800 PROVIDED THERE'S OPPORTUNITY TO 3237 02:12:14,800 --> 02:12:16,800 INTEGRATE TELEHEALTH TO IMPROVE 3238 02:12:16,800 --> 02:12:19,440 ACCESS TO CARE BUT THE DIGITAL 3239 02:12:19,440 --> 02:12:22,680 DIVIDE REMAINS A BARRIER. 3240 02:12:22,680 --> 02:12:24,240 WITH THE INFRASTRUCTURE BILL 3241 02:12:24,240 --> 02:12:27,160 SIGNED INTO LAW WE SHOULD 3242 02:12:27,160 --> 02:12:30,120 INCLUDE $65 BILLION, THERE'S A 3243 02:12:30,120 --> 02:12:31,720 UNIQUE OPPORTUNITY TO EXPAND 3244 02:12:31,720 --> 02:12:33,440 ACCESS TO AMERICANS AND HELP 3245 02:12:33,440 --> 02:12:36,000 CLOSE THE DIGITAL DIVIDE. 3246 02:12:36,000 --> 02:12:38,480 CLOSING IT WILL NOT BE ENOUGH. 3247 02:12:38,480 --> 02:12:41,160 WE NEED TO ADDRESS 3248 02:12:41,160 --> 02:12:41,960 INTEROPERABILITY FOR SYSTEMS FOR 3249 02:12:41,960 --> 02:12:43,680 HEALTH INFORMATION EXCHANGE BUT 3250 02:12:43,680 --> 02:12:47,320 WE HAVE THE INCENTIVES IN PLACE. 3251 02:12:47,320 --> 02:12:49,200 DO WE NEED MORE ASSERTIVE 3252 02:12:49,200 --> 02:12:51,000 NATIONAL APPROACH TO ENSURE 3253 02:12:51,000 --> 02:12:52,960 PROVIDERS AND PAYERS WILL MAKE 3254 02:12:52,960 --> 02:12:53,880 THE NECESSARY INVESTMENTS. 3255 02:12:53,880 --> 02:13:04,080 THANK YOU? 3256 02:13:04,800 --> 02:13:07,440 >>THE FOR THE WONDERFUL 3257 02:13:07,440 --> 02:13:09,840 PRESENTERS AND PANELISTS. 3258 02:13:09,840 --> 02:13:11,360 WE'LL TRANSITION BACK TO OUR 3259 02:13:11,360 --> 02:13:12,000 QUESTION AND ANSWER PORTION OF 3260 02:13:12,000 --> 02:13:20,440 THE SESSION. 3261 02:13:20,440 --> 02:13:25,040 NOW A QUESTION FOR DR. FA 3262 02:13:25,040 --> 02:13:26,600 DR. FASHAW-WALTERS. 3263 02:13:26,600 --> 02:13:27,880 WHAT ARE THE NEXT STEPS FOR 3264 02:13:27,880 --> 02:13:29,440 INTERACTION BETWEEN PLACE AND 3265 02:13:29,440 --> 02:13:29,680 POLICY? 3266 02:13:29,680 --> 02:13:31,320 >>THAT'S A GREAT QUESTION. 3267 02:13:31,320 --> 02:13:35,480 I HAVE DONE SOME OF THIS WORK IN 3268 02:13:35,480 --> 02:13:37,840 THE GENERAL MEDICARE POPULATION. 3269 02:13:37,840 --> 02:13:40,640 A PAPER THAT SHOULD BE OUT 3270 02:13:40,640 --> 02:13:43,880 SOONER RATHER THAN LATER REALLY 3271 02:13:43,880 --> 02:13:46,120 LOOKING AT THE ROLE OF PUBLIC 3272 02:13:46,120 --> 02:13:48,080 REPORTING AND HOME HEALTH AND 3273 02:13:48,080 --> 02:13:52,920 HOW THAT VARIES BY NEIGHBORHOOD 3274 02:13:52,920 --> 02:13:53,320 TYPE. 3275 02:13:53,320 --> 02:13:54,880 THAT'S AN EXAMPLE HOW IT COULD 3276 02:13:54,880 --> 02:13:55,560 BE DONE. 3277 02:13:55,560 --> 02:13:58,440 SOME OF THE FIRST STEPS AND WHAT 3278 02:13:58,440 --> 02:14:00,760 DR. COE PRESENTED IS 3279 02:14:00,760 --> 02:14:02,040 UNDERSTANDING WHAT POLICIES ARE 3280 02:14:02,040 --> 02:14:04,120 AT PLAY AND TAKING THEM AND 3281 02:14:04,120 --> 02:14:05,280 INTERACTING THEM BY PLACE. 3282 02:14:05,280 --> 02:14:07,240 IT'S IMPORTANT TO TAKE NOTE OF 3283 02:14:07,240 --> 02:14:09,480 HOW FEDERALISM WORKS AND THAT 3284 02:14:09,480 --> 02:14:11,320 POLICIES WILL HAVE DIFFERENT 3285 02:14:11,320 --> 02:14:13,120 IMPACTS AT DIFFERENT LEVELS 3286 02:14:13,120 --> 02:14:14,880 NATIONALLY, STATEWIDE, LOCALLY 3287 02:14:14,880 --> 02:14:16,560 AND REALLY JUST LOOKING AT THE 3288 02:14:16,560 --> 02:14:17,040 INTERACTIONS I THINK IS 3289 02:14:17,040 --> 02:14:22,160 IMPORTANT. 3290 02:14:22,160 --> 02:14:23,000 >>THANK YOU. 3291 02:14:23,000 --> 02:14:25,480 WE HAVE A QUESTION THAT'S COME 3292 02:14:25,480 --> 02:14:27,160 IN FROM OUR AUDIENCE. 3293 02:14:27,160 --> 02:14:33,160 IT STARTS OUT BY SAYING THAT 3294 02:14:33,160 --> 02:14:37,560 SHEKINAH YOUR WORK HAS BEEN A 3295 02:14:37,560 --> 02:14:38,880 POSITIVE INFLUENCE FOR THE 3296 02:14:38,880 --> 02:14:40,040 INDIVIDUAL AND THIS IS A 3297 02:14:40,040 --> 02:14:41,880 QUESTION FOR THE PRESENTERS AND 3298 02:14:41,880 --> 02:14:42,880 PANELISTS AS WELL, WHAT ARE 3299 02:14:42,880 --> 02:14:44,920 FOLKS THINKING IN TERMS OF 3300 02:14:44,920 --> 02:14:46,680 AUGMENTING THE FOCUS ON ASSETS 3301 02:14:46,680 --> 02:14:47,400 IN THE GAPS AND OPPORTUNITIES 3302 02:14:47,400 --> 02:14:57,440 FROM THE SESSION THEME? 3303 02:14:57,440 --> 02:14:59,600 >>I CAN START BY A QUICK 3304 02:14:59,600 --> 02:15:00,680 OVERVIEW BY THE PREFERENCE. 3305 02:15:00,680 --> 02:15:03,000 SOME OF MY WORK HAS THOUGHT 3306 02:15:03,000 --> 02:15:04,360 ABOUT HOW WE MIGHT CHARACTERIZE 3307 02:15:04,360 --> 02:15:06,040 HOME HEALTH AGENCIES OR NURSING 3308 02:15:06,040 --> 02:15:08,840 HOMES OR OTHER PROVIDERS AS 3309 02:15:08,840 --> 02:15:10,600 LOWER-QUALITY PROVIDERS WHEN WE 3310 02:15:10,600 --> 02:15:13,000 SEE A HIGHER PROPORTION OF 3311 02:15:13,000 --> 02:15:15,880 MARGINALIZED PATIENTS USING THAT 3312 02:15:15,880 --> 02:15:16,680 PARTICULAR SERVICE. 3313 02:15:16,680 --> 02:15:18,000 A NUMBER OF MY PROJECTS HAVE 3314 02:15:18,000 --> 02:15:19,720 STARTED TO FOCUS IN ON THE 3315 02:15:19,720 --> 02:15:21,200 SERVICES IN NURSING HOMES AND 3316 02:15:21,200 --> 02:15:23,200 HOME HEALTH WHERE WE SEE THE 3317 02:15:23,200 --> 02:15:24,240 OPPOSITE HAPPENING. 3318 02:15:24,240 --> 02:15:25,880 SO THEY MIGHT HAVE A HIGH 3319 02:15:25,880 --> 02:15:27,880 PROPORTION OF BLACK PATIENTS BUT 3320 02:15:27,880 --> 02:15:29,440 THEY ARE ALSO HIGH QUALITY AND 3321 02:15:29,440 --> 02:15:32,800 SO JUST THINKING ABOUT FOCUSSING 3322 02:15:32,800 --> 02:15:35,720 ON DARE I SAY THE POSITIVE SIDE 3323 02:15:35,720 --> 02:15:46,160 OF THIS NARRATIVE AS WELL. 3324 02:15:47,200 --> 02:15:49,360 >>THANK YOU, DO OTHERS HAVE 3325 02:15:49,360 --> 02:15:49,640 THOUGHTS? 3326 02:15:49,640 --> 02:15:52,120 IF NOT WE CAN MOVE ON TO THE 3327 02:15:52,120 --> 02:15:53,120 NEXT QUESTION. 3328 02:15:53,120 --> 02:15:56,040 >>I WANT TO ADD THAT IT 3329 02:15:56,040 --> 02:15:58,680 REQUIRES A WHOLE VILLAGE TO WORK 3330 02:15:58,680 --> 02:15:59,960 TOGETHER ESPECIALLY FOR A 3331 02:15:59,960 --> 02:16:04,000 PATIENT WITH DEMENTIA AND PEOPLE 3332 02:16:04,000 --> 02:16:07,600 WITH DIFFERENT BACKGROUND AND 3333 02:16:07,600 --> 02:16:08,400 LANGUAGE. 3334 02:16:08,400 --> 02:16:12,000 THE POLICY MAKERS NEED TO 3335 02:16:12,000 --> 02:16:14,120 MOTIVATE ALL THE STAKEHOLDERS TO 3336 02:16:14,120 --> 02:16:15,360 WORK TOGETHER TOWARDS THAT 3337 02:16:15,360 --> 02:16:17,040 DIRECTION AS WELL AS THE 3338 02:16:17,040 --> 02:16:18,880 COMMUNITIES AND HEALTH CARE 3339 02:16:18,880 --> 02:16:20,840 PROVIDERS AND CAREGIVERS, 3340 02:16:20,840 --> 02:16:21,680 EVERYONE TOGETHER UNITED. 3341 02:16:21,680 --> 02:16:27,720 THAT'S WHAT I WANT TO ADD. 3342 02:16:27,720 --> 02:16:30,760 >>WE HAVE ANOTHER QUESTION FROM 3343 02:16:30,760 --> 02:16:31,920 AN ATTENDEE. 3344 02:16:31,920 --> 02:16:33,840 WITH THE PUBLIC AND THIS IS 3345 02:16:33,840 --> 02:16:35,920 PROBABLY DIRECTED TO A FEW OF 3346 02:16:35,920 --> 02:16:38,280 OUR PRESENTERS. 3347 02:16:38,280 --> 02:16:39,760 WITH THE PUBLIC HEALTH CARE 3348 02:16:39,760 --> 02:16:42,160 PANDEMIC ENDING THE MIDNIGHT 3349 02:16:42,160 --> 02:16:43,080 RULE FOR CONTROVERSY TO POST 3350 02:16:43,080 --> 02:16:44,600 ACUTE CARE IS COMING BACK. 3351 02:16:44,600 --> 02:16:48,360 DO WE KNOW WHAT AFFECT THIS 3352 02:16:48,360 --> 02:16:49,600 POLICY CHANGE WILL HAVE ON 3353 02:16:49,600 --> 02:16:55,120 PATIENTS ONE ADRD OR PESHZ 3354 02:16:55,120 --> 02:16:57,520 LIVING WITH DEMENTIA AND 3355 02:16:57,520 --> 02:16:59,720 CESSATION OF PAYMENT FOR 3356 02:16:59,720 --> 02:17:01,840 TELEHEALTH AND AUDIO POLICIES 3357 02:17:01,840 --> 02:17:03,760 MAY CONTRIBUTE TO THE 3358 02:17:03,760 --> 02:17:06,400 DISPARITIES SINCE RURAL AND 3359 02:17:06,400 --> 02:17:10,000 MINORITIZED COMMUNITIES FACE 3360 02:17:10,000 --> 02:17:16,760 VIDEO-BASED MODALITIES. 3361 02:17:16,760 --> 02:17:19,160 >>THERE WAS A WORKING PAPER 3362 02:17:19,160 --> 02:17:21,360 PRESENTED LAST WEEK ABOUT THE 3363 02:17:21,360 --> 02:17:23,680 AFFECT OF ESSENTIALLY NOT USING 3364 02:17:23,680 --> 02:17:26,920 NURSING HOMES FOR POST ACUTE 3365 02:17:26,920 --> 02:17:29,400 CARE DURING THE PANDEMIC. 3366 02:17:29,400 --> 02:17:31,680 IT WASN'T SPECIFICALLY AMONG 3367 02:17:31,680 --> 02:17:37,720 ADRD PATIENTS BUT ABOUT THE 3368 02:17:37,720 --> 02:17:37,960 SWITCH. 3369 02:17:37,960 --> 02:17:45,200 AND THEY DID FIND WHITE 3370 02:17:45,200 --> 02:17:47,040 INDIVIDUALS HAD A HIGHER 3371 02:17:47,040 --> 02:17:48,480 PROBABILITY OF GOING HOME FROM 3372 02:17:48,480 --> 02:17:50,200 THE SWITCH FROM POST ACUTE CARE. 3373 02:17:50,200 --> 02:17:52,240 AS WE THINK OF WHAT'S GOING ON 3374 02:17:52,240 --> 02:17:57,400 NOW WITH THE END OF THE OFFICIAL 3375 02:17:57,400 --> 02:17:59,600 PANDEMIC PERIOD IS WHO IS GOING 3376 02:17:59,600 --> 02:18:01,960 TO INSTITUTIONALIZE CARE AND WHO 3377 02:18:01,960 --> 02:18:02,640 WILL BE GOING HOME BECAUSE 3378 02:18:02,640 --> 02:18:03,600 THERE'S RACIAL DIFFERENCES IN 3379 02:18:03,600 --> 02:18:07,160 WHERE PEOPLE ARE GOING AND HOW 3380 02:18:07,160 --> 02:18:10,600 PEOPLE RESPONDED TO THE PANDEMIC 3381 02:18:10,600 --> 02:18:11,560 ITSELF IN THAT DECISION. 3382 02:18:11,560 --> 02:18:13,160 SO I DON'T THINK WE HAVE A 3383 02:18:13,160 --> 02:18:15,360 PERFECT ANSWER AS TO HOW IT'S 3384 02:18:15,360 --> 02:18:18,200 GOING TO IMPACT PEOPLE WITH 3385 02:18:18,200 --> 02:18:20,000 DEMENTIA SPECIFICALLY BUT THERE 3386 02:18:20,000 --> 02:18:21,200 DEFINITELY ARE DISPARITIES IN 3387 02:18:21,200 --> 02:18:24,000 WHO IS ABLE TO GO HOME AND WHO 3388 02:18:24,000 --> 02:18:27,000 WILL STILL BE USING TRADITIONAL 3389 02:18:27,000 --> 02:18:32,400 NURSING HOME SETTINGS FOR 3390 02:18:32,400 --> 02:18:33,280 POST-ACUTE CARE. 3391 02:18:33,280 --> 02:18:35,160 >>THANK YOU. 3392 02:18:35,160 --> 02:18:39,320 AND THEN I WONDER GIA OR TINA 3393 02:18:39,320 --> 02:18:42,560 YOU IF HAVE ANY FEEDBACK ON THE 3394 02:18:42,560 --> 02:18:46,160 COMMENT ABOUT TELEHEALTH AND 3395 02:18:46,160 --> 02:18:48,560 RURAL COMMUNITIES AND THE GROUPS 3396 02:18:48,560 --> 02:18:50,520 LACKING VIDEO-BASED 3397 02:18:50,520 --> 02:19:00,800 TELEMODALITIES. 3398 02:19:41,720 --> 02:19:45,720 -- I SHOWED IN MY SLIDES IT CAN 3399 02:19:45,720 --> 02:19:48,320 BE THE RESULT OF ADRD PATIENTS 3400 02:19:48,320 --> 02:19:50,160 INCLUDING THE CAREGIVERS OF THE 3401 02:19:50,160 --> 02:19:51,200 PATIENTS WHO ARE AFRICAN 3402 02:19:51,200 --> 02:19:51,760 AMERICAN OR HISPANICS IN 3403 02:19:51,760 --> 02:19:55,080 GENERAL. 3404 02:19:55,080 --> 02:19:59,520 ALL REPORTED SATISFACTION OF 3405 02:19:59,520 --> 02:20:06,160 USING IT IN PIPPEN -- OPINION 3406 02:20:06,160 --> 02:20:09,240 IT'S THE PATIENTS NOT IN THE 3407 02:20:09,240 --> 02:20:11,040 STUDY WE NEED TO LOOK AT MORE 3408 02:20:11,040 --> 02:20:14,160 AND MORE EMPIRICAL EVIDENCE IS 3409 02:20:14,160 --> 02:20:16,120 NEED TO LOOK AT THE IMPACT OF 3410 02:20:16,120 --> 02:20:19,240 HEALTH DISPARITIES WHICH 3411 02:20:19,240 --> 02:20:24,160 EVIDENCE HAS BEEN INCONCLUSIVE. 3412 02:20:24,160 --> 02:20:28,320 AND CAN EVEN EXACERBATE THE 3413 02:20:28,320 --> 02:20:28,600 DISPARITIES. 3414 02:20:28,600 --> 02:20:29,480 AND THERE'S POLICY THAT'S 3415 02:20:29,480 --> 02:20:31,400 SUPPORTIVE IF WE CAN DO MORE AND 3416 02:20:31,400 --> 02:20:32,960 ADVOCATE MORE. 3417 02:20:32,960 --> 02:20:37,200 IT'S THE RIGHT MOMENT TO ADDRESS 3418 02:20:37,200 --> 02:20:39,120 AND REDUCE THE DISPARITIES. 3419 02:20:39,120 --> 02:20:44,560 >>I WOULD ADD IF I MAY I THINK 3420 02:20:44,560 --> 02:20:45,760 CONCEPTUALLY THE TECHNOLOGY 3421 02:20:45,760 --> 02:20:46,720 POLICIES HELP MEET PEOPLE WHERE 3422 02:20:46,720 --> 02:20:48,600 THEY ARE WHICH IS CRITICAL 3423 02:20:48,600 --> 02:20:50,920 HOWEVER, TO DR. CHEN'S POINT 3424 02:20:50,920 --> 02:20:52,760 INTO THE PERSON WHO OPPOSED THE 3425 02:20:52,760 --> 02:20:53,920 QUESTION WHICH IS AN EXCELLENT 3426 02:20:53,920 --> 02:20:56,240 ONE IF YOU DON'T HAVE HIGH SPEED 3427 02:20:56,240 --> 02:20:58,600 BROADBAND AND CAN'T TAKE A VIDEO 3428 02:20:58,600 --> 02:21:01,920 CALL WE'RE JUST EXACERBATING 3429 02:21:01,920 --> 02:21:02,720 DISPARITIES AND THE COMPONENT OF 3430 02:21:02,720 --> 02:21:06,560 VOICE ONLY IS CRITICAL AND IT'S 3431 02:21:06,560 --> 02:21:08,440 IMPORTANT IN THE CAUTIONARY TALE 3432 02:21:08,440 --> 02:21:10,880 TO THOSE OF US BEING CHALLENGED 3433 02:21:10,880 --> 02:21:13,280 TO COME UP WITH INNOVATIONS AND 3434 02:21:13,280 --> 02:21:15,440 DO THIS IN A WAY THAT MAKES IT 3435 02:21:15,440 --> 02:21:16,880 ACCESSIBLE TO THE POPULATIONS 3436 02:21:16,880 --> 02:21:21,480 WHO NEED IT MOST AND PERHAPS 3437 02:21:21,480 --> 02:21:22,080 INVOLVING LEVERAGING THE 3438 02:21:22,080 --> 02:21:23,040 COMMUNITY-BASED ORGANIZATIONS TO 3439 02:21:23,040 --> 02:21:24,720 HELP THE INDIVIDUALS AND HELP 3440 02:21:24,720 --> 02:21:26,120 ACCESS AND REACH THEM AND MAKE 3441 02:21:26,120 --> 02:21:27,440 SURE THEY HAVE THE TOOLS 3442 02:21:27,440 --> 02:21:34,760 NECESSARY TO BENEFIT FROM THEM. 3443 02:21:34,760 --> 02:21:37,320 >>THANK YOU FOR YOUR RESPONSES. 3444 02:21:37,320 --> 02:21:42,600 WE HAVE A QUESTION FROM THE 3445 02:21:42,600 --> 02:21:49,120 AUDIENCE FROM MICHAEL 3446 02:21:49,120 --> 02:21:50,560 ELLENBOGGEN. 3447 02:21:50,560 --> 02:21:51,800 CAN YOU TAKE THEM OFF MUTE TO 3448 02:21:51,800 --> 02:22:02,120 ASK THEIR QUESTION. 3449 02:22:08,280 --> 02:22:08,800 GO AHEAD. 3450 02:22:08,800 --> 02:22:10,360 >>WERE YOU ABLE TO HEAR ME 3451 02:22:10,360 --> 02:22:12,360 UNTIL NOW? 3452 02:22:12,360 --> 02:22:13,520 >>WE DID NOT IF YOU WOULDN'T 3453 02:22:13,520 --> 02:22:16,080 MIND STARTING OVER. 3454 02:22:16,080 --> 02:22:18,280 >>MY NAME IS MICHAEL EL 3455 02:22:18,280 --> 02:22:20,360 ENBOGGEN AND I'M LIVING WITH 3456 02:22:20,360 --> 02:22:20,880 DEMENTIA. 3457 02:22:20,880 --> 02:22:22,760 I HAVE TO TELL YOU YOU'RE ALL 3458 02:22:22,760 --> 02:22:26,280 TALKING ABOUT IS GREAT AND IT'S 3459 02:22:26,280 --> 02:22:27,680 VERY IMPORTANT BUT ONE OF THE 3460 02:22:27,680 --> 02:22:29,560 PROBLEMS WE HAVE IS AS YOU KNOW 3461 02:22:29,560 --> 02:22:30,560 THE MEDICAL SYSTEM IS VERY 3462 02:22:30,560 --> 02:22:34,040 COMPLICATED. 3463 02:22:34,040 --> 02:22:36,080 NOT ONLY IS IT COMPLICATED IT'S 3464 02:22:36,080 --> 02:22:38,720 A REAL MESS SADLY TO SAY. 3465 02:22:38,720 --> 02:22:41,760 MY WIFE, WHO HAPPENS TO BE A 3466 02:22:41,760 --> 02:22:43,000 MEDICAL PERSON FOR 35 YEARS HAS 3467 02:22:43,000 --> 02:22:46,120 TRIED TO MANAGE MY PART OF THE 3468 02:22:46,120 --> 02:22:47,160 DIAGNOSIS AND TO GET HELP 3469 02:22:47,160 --> 02:22:48,560 STRUGGLES TO GET THAT AND SHE 3470 02:22:48,560 --> 02:22:51,400 UNDERSTANDS HOW IT ALL WORKS. 3471 02:22:51,400 --> 02:22:54,720 SO WHAT I THINK IS CRITICAL TO 3472 02:22:54,720 --> 02:22:56,680 ALL THE PEOPLE ESPECIALLY TO 3473 02:22:56,680 --> 02:22:58,760 STOP DISCRIMINATION AND 3474 02:22:58,760 --> 02:23:00,760 DISPARITIES IS WE NEED HEALTH 3475 02:23:00,760 --> 02:23:03,440 NAVIGATORS THAT ARE PAID BY THE 3476 02:23:03,440 --> 02:23:05,560 GOVERNMENT THAT CAN WALK PEOPLE 3477 02:23:05,560 --> 02:23:06,440 THROUGH THE WHOLE PROCESS FROM 3478 02:23:06,440 --> 02:23:09,120 THE BEGINNING TO THE END OF 3479 02:23:09,120 --> 02:23:10,160 WHAT'S NEEDED. 3480 02:23:10,160 --> 02:23:12,760 YOU HAVE MANY PEOPLE OUT THERE 3481 02:23:12,760 --> 02:23:15,640 WHO ARE LIVING ALONE WITH THIS 3482 02:23:15,640 --> 02:23:17,120 DISEASE AND SURE YOU CAN CALL 3483 02:23:17,120 --> 02:23:18,400 THEM UP AND TELL THEM DO THIS 3484 02:23:18,400 --> 02:23:20,240 AND DO THAT, DO YOU THINK 3485 02:23:20,240 --> 02:23:23,000 THEY'LL BE ABLE TO REMEMBER WHEN 3486 02:23:23,000 --> 02:23:24,040 THEY HAVE DEMENTIA? 3487 02:23:24,040 --> 02:23:26,640 ABSOLUTELY NOT. 3488 02:23:26,640 --> 02:23:30,160 WE HAVE TO FIGURE OUT GETTING A 3489 02:23:30,160 --> 02:23:31,520 PERSON FROM POINT A TO POINT B 3490 02:23:31,520 --> 02:23:32,760 AND THEN THE NEXT LEVEL. 3491 02:23:32,760 --> 02:23:35,280 WE NEED TO BE ABLE TO WALK THE 3492 02:23:35,280 --> 02:23:36,480 PEOPLE THROUGH THE SYSTEM 3493 02:23:36,480 --> 02:23:38,320 BECAUSE THE SYSTEM IS TOO 3494 02:23:38,320 --> 02:23:39,520 COMPLICATED AND PEOPLE DON'T 3495 02:23:39,520 --> 02:23:41,080 KNOW WHERE TO TURN FOR WHAT TYPE 3496 02:23:41,080 --> 02:23:43,920 OF DOCTOR AND EVERYTHING. 3497 02:23:43,920 --> 02:23:44,880 I TALKED TO PEOPLE WITH DEMENTIA 3498 02:23:44,880 --> 02:23:46,800 EVERY DAY AND PEOPLE ARE AT A 3499 02:23:46,800 --> 02:23:47,160 LOSS. 3500 02:23:47,160 --> 02:23:52,280 THE CAREGIVERS ARE AT A LOSS AND 3501 02:23:52,280 --> 02:23:53,200 WE NEED YOUR HELP. 3502 02:23:53,200 --> 02:23:54,920 >>THANK YOU, MICHAEL FOR YOUR 3503 02:23:54,920 --> 02:23:55,400 COMMENTS. 3504 02:23:55,400 --> 02:23:58,000 I'LL NOTE THERE WERE SEVERAL 3505 02:23:58,000 --> 02:23:59,840 REACTIONS THUMBS-UPS AND HEARTS 3506 02:23:59,840 --> 02:24:02,000 AND CLAPS FROM THE AUDIENCE. 3507 02:24:02,000 --> 02:24:03,520 I THINK YOUR COMMENT VERY MUCH 3508 02:24:03,520 --> 02:24:04,040 RESONATES WITH EVERYONE 3509 02:24:04,040 --> 02:24:12,920 ATTENDING. 3510 02:24:12,920 --> 02:24:15,760 >>PERHAPS WE CAN TAKE ANOTHER 3511 02:24:15,760 --> 02:24:17,320 QUESTION REGARDING VIRTUAL 3512 02:24:17,320 --> 02:24:19,360 SUPPORT AUDIENCE CAN YOU TALK 3513 02:24:19,360 --> 02:24:23,800 ABOUT WHETHER THERE'S RELUCTANCE 3514 02:24:23,800 --> 02:24:27,760 FOR BIPOC POPULATIONS AND OTHERS 3515 02:24:27,760 --> 02:24:30,000 TO GO BACK TO THOSE SETTINGS 3516 02:24:30,000 --> 02:24:35,600 VERSUS WHITE POPULATIONS. 3517 02:24:35,600 --> 02:24:37,600 PERHAPS SHEKINAH CAN START US 3518 02:24:37,600 --> 02:24:47,920 OFF OR GIA AS WELL. 3519 02:24:57,960 --> 02:25:04,280 >>IT'S AN EXCELLENT QUESTION. 3520 02:25:04,280 --> 02:25:06,840 FIRST THE EVIDENCE FOR DIFFERENT 3521 02:25:06,840 --> 02:25:09,600 ETHNIC GROUPS AND ASIANS AND 3522 02:25:09,600 --> 02:25:12,400 OTHERS WERE LITTLE VERY FEW 3523 02:25:12,400 --> 02:25:12,680 EVIDENCE. 3524 02:25:12,680 --> 02:25:17,920 SECOND, AMONG THE EVIDENCE WE 3525 02:25:17,920 --> 02:25:19,480 OBSERVED WE FIND THE CAREGIVERS 3526 02:25:19,480 --> 02:25:22,720 OF THE ADRD PATIENT FOR HISPANIC 3527 02:25:22,720 --> 02:25:32,560 REPORTED THE LANGUAGE BARRIERS 3528 02:25:32,560 --> 02:25:34,800 AND CAREGIVERS REPORTED THE 3529 02:25:34,800 --> 02:25:39,560 SOCIAL ISOLATION AND IN THE 3530 02:25:39,560 --> 02:25:39,800 SUPPORT. 3531 02:25:39,800 --> 02:25:43,520 I DON'T HAVE EMPIRICAL EVIDENCE 3532 02:25:43,520 --> 02:25:50,520 TO SUPPORT THE NEEDS FROM OTHERS 3533 02:25:50,520 --> 02:25:52,520 AND GENERALLY SPEAKING THERE'S 3534 02:25:52,520 --> 02:25:56,480 EVIDENCE AND AMONG THOSE WHO 3535 02:25:56,480 --> 02:26:01,640 ACTUALLY USE THE TELEHEALTH AND 3536 02:26:01,640 --> 02:26:04,200 PEOPLE REPORT GOOD FEEDBACK 3537 02:26:04,200 --> 02:26:06,360 INCLUDING CAREGIVER SUPPORT FROM 3538 02:26:06,360 --> 02:26:10,640 DIFFERENT RACE AND ETHNICITIES 3539 02:26:10,640 --> 02:26:16,400 BUT BARRIERS WERE INDICATED FOR 3540 02:26:16,400 --> 02:26:19,680 DEMENTIA CARE WE NEED TO LOOK AT 3541 02:26:19,680 --> 02:26:22,680 THE ABILITY TO ATTEND TO 3542 02:26:22,680 --> 02:26:25,320 KNOWLEDGE AND THE EDUCATION AND 3543 02:26:25,320 --> 02:26:27,720 RESOURCES SHOULD BE GIVEN TO 3544 02:26:27,720 --> 02:26:28,040 CAREGIVERS. 3545 02:26:28,040 --> 02:26:29,600 MORE EVIDENCE IS NEEDED FOR 3546 02:26:29,600 --> 02:26:34,760 PEOPLE WITH DIFFERENT CULTURAL 3547 02:26:34,760 --> 02:26:45,080 BACKGROUND AND YES 3548 02:27:14,480 --> 02:27:17,440 >>THERE'S GREATER RELUCTANCE 3549 02:27:17,440 --> 02:27:19,720 BECAUSE OF COVID AND TELEHEALTH 3550 02:27:19,720 --> 02:27:20,720 MAY BE THE PREFERRED OPTION AND 3551 02:27:20,720 --> 02:27:21,880 SHOULD STILL BE AVAILABLE. 3552 02:27:21,880 --> 02:27:23,880 DO YOU HAVE A SENSE WHETHER 3553 02:27:23,880 --> 02:27:25,000 THERE'S HESITANCY TO GO BACK IN 3554 02:27:25,000 --> 02:27:31,080 PERSON. 3555 02:27:31,080 --> 02:27:34,720 >>I DON'T HAVE KNOWLEDGE TO 3556 02:27:34,720 --> 02:27:45,080 ANSWER THAT QUESTION. 3557 02:27:45,480 --> 02:27:53,920 I THINK MOST BUT TELEHEALTH IS 3558 02:27:53,920 --> 02:27:55,760 HELPFUL. 3559 02:27:55,760 --> 02:27:56,520 THAT'S MY SENSE. 3560 02:27:56,520 --> 02:27:59,280 TINA YOU HAVE SOMETHING TO SAY. 3561 02:27:59,280 --> 02:28:00,960 >>I SPEAK FROM THE PERSPECTIVE 3562 02:28:00,960 --> 02:28:03,720 OF ADULT DAY SERVICES WHICH 3563 02:28:03,720 --> 02:28:06,320 SERVES A DIVERSE POPULATION AND 3564 02:28:06,320 --> 02:28:08,960 IN IN THE EARLY QUALITATIVE 3565 02:28:08,960 --> 02:28:11,560 RESEARCH THERE'S OVERWHELMING 3566 02:28:11,560 --> 02:28:12,840 ENTHUSIASM TO RETURN TO 3567 02:28:12,840 --> 02:28:14,640 IN-PERSON AS FAR ASS NOT ONLY 3568 02:28:14,640 --> 02:28:16,560 WITH THE PERSONS WITH DEMENTIA 3569 02:28:16,560 --> 02:28:19,160 AND OTHER CHRONIC CONDITIONS BUT 3570 02:28:19,160 --> 02:28:19,760 BY CAREGIVERS BECAUSE THESE 3571 02:28:19,760 --> 02:28:21,920 COMMUNITY RESOURCES AND 3572 02:28:21,920 --> 02:28:26,800 IN-PERSON SERVICES COULD NOT BE 3573 02:28:26,800 --> 02:28:28,000 REPLACED BUT THERE WAS EVIDENCE 3574 02:28:28,000 --> 02:28:30,400 TO SUPPORT THEY APPRECIATED THE 3575 02:28:30,400 --> 02:28:33,440 ADDED VIRTUAL COMMUNICATIONS AND 3576 02:28:33,440 --> 02:28:34,640 CONNECTIONS AND COLLABORATION 3577 02:28:34,640 --> 02:28:35,960 REMOTE SERVICES ENABLE. 3578 02:28:35,960 --> 02:28:40,360 I FEEL IT'S A STRONG COMBINATION 3579 02:28:40,360 --> 02:28:42,800 OF BOTH BUT THERE'S SIGNIFICANT 3580 02:28:42,800 --> 02:28:46,480 VALUE TO IN-PERSON ENGAGEMENT IN 3581 02:28:46,480 --> 02:28:51,440 DIVERSE POPULATIONS. 3582 02:28:51,440 --> 02:28:52,520 >>THANK YOU BOTH. 3583 02:28:52,520 --> 02:28:54,600 I WANT TO POSE THE QUESTION FROM 3584 02:28:54,600 --> 02:28:59,360 AN ATTENDEE AND LIFT UP 3585 02:28:59,360 --> 02:29:01,080 MICHAEL'S COMMENTS ABOUT CARE 3586 02:29:01,080 --> 02:29:03,280 PARTNERS AND CARE COORDINATION. 3587 02:29:03,280 --> 02:29:05,000 THIS QUESTION SAYS THE PANEL 3588 02:29:05,000 --> 02:29:06,320 DIDN'T SPEAK DIRECTLY TO THE 3589 02:29:06,320 --> 02:29:10,000 CARE PARTNER ROLE IN HOW THEY 3590 02:29:10,000 --> 02:29:12,760 ARE OR ARE NOT SUPPORTED IN 3591 02:29:12,760 --> 02:29:15,840 DIVERSE SETTINGS AND HAS THAT 3592 02:29:15,840 --> 02:29:20,640 BEEN STUDIED AND COULD IT BE 3593 02:29:20,640 --> 02:29:25,280 UNRECOGNIZED IN WHO GOES HOME 3594 02:29:25,280 --> 02:29:26,080 AND WHO DOESN'T. 3595 02:29:26,080 --> 02:29:27,040 IF YOU HAVE INSIGHT I INVITE YOU 3596 02:29:27,040 --> 02:29:37,280 TO COME ON. 3597 02:29:46,320 --> 02:29:51,920 >>DOES YOUR WORK COVER 3598 02:29:51,920 --> 02:29:55,960 CAREGIVERS? 3599 02:29:55,960 --> 02:29:57,760 >>AND THE NEED FOR CAREGIVERS 3600 02:29:57,760 --> 02:29:59,080 TO NAVIGATE THE SYSTEMS. 3601 02:29:59,080 --> 02:30:00,320 WE EXPECT SO MUCH AND THERE'S 3602 02:30:00,320 --> 02:30:02,160 BEEN A PLETHORA OF RESEARCH TO 3603 02:30:02,160 --> 02:30:05,720 SHOW WE EXPECT SO MUCH FROM 3604 02:30:05,720 --> 02:30:06,040 CAREGIVERS. 3605 02:30:06,040 --> 02:30:10,600 THEY'RE DOING COMPLEX TASKS AND 3606 02:30:10,600 --> 02:30:13,360 NAVIGATING A HIGHLY BUREAUCRATIC 3607 02:30:13,360 --> 02:30:15,720 SYSTEM AND WITH LIMITED LANGUAGE 3608 02:30:15,720 --> 02:30:16,640 AND HEALTH CARE DELIVERY 3609 02:30:16,640 --> 02:30:17,720 KNOWLEDGE AND TO THE FOLLOW-UP 3610 02:30:17,720 --> 02:30:19,240 ABOUT THE PERSON WHO ASKED ABOUT 3611 02:30:19,240 --> 02:30:22,040 POST PANDEMIC, I DO THINK THE 3612 02:30:22,040 --> 02:30:22,880 NEED TO SUPPORT CAREGIVERS HAS 3613 02:30:22,880 --> 02:30:24,080 NEVER BEEN CLEARER. 3614 02:30:24,080 --> 02:30:25,800 THE BURDEN ON THEM HAS NEVER 3615 02:30:25,800 --> 02:30:27,760 BEEN GREATER AND I THINK THERE'S 3616 02:30:27,760 --> 02:30:29,960 POTENTIAL FOR ALL OF US TO 3617 02:30:29,960 --> 02:30:39,240 REFRAME DEMENTIA CARE GIVING AND 3618 02:30:39,240 --> 02:30:45,040 SELFLESS AND WONDERFUL WE CAN'T 3619 02:30:45,040 --> 02:30:50,160 DO THAT WITHOUT THE RESOURCES 3620 02:30:50,160 --> 02:31:00,600 AND AND IT CAN AFFECT OUR 3621 02:31:00,920 --> 02:31:07,240 CAREGIVERS. 3622 02:31:07,240 --> 02:31:09,280 >>I'LL HIGHLIGHT TINA'S 3623 02:31:09,280 --> 02:31:11,280 COMMENTS TO RECOGNIZE THE 3624 02:31:11,280 --> 02:31:13,680 IMPORTANCE OF CAREGIVERS AND 3625 02:31:13,680 --> 02:31:15,960 UNDERSTAND CULTURE AND 3626 02:31:15,960 --> 02:31:17,000 EVERYTHING THAT MAKES US WHO WE 3627 02:31:17,000 --> 02:31:20,800 ARE CONTRIBUTES TO HOW WE VIEW 3628 02:31:20,800 --> 02:31:22,160 CARE GIVING AND THE WAY WE GIVE 3629 02:31:22,160 --> 02:31:26,080 CARE TO OLDER FAMILY MEMBERS AND 3630 02:31:26,080 --> 02:31:27,040 THERE NEEDS TO BE BETTER 3631 02:31:27,040 --> 02:31:30,600 SUPPORTS FOCUSSED ON CAREGIVERS. 3632 02:31:30,600 --> 02:31:32,200 WE'RE AT TIME. 3633 02:31:32,200 --> 02:31:34,360 I DO WANT TO JUST THANK EVERYONE 3634 02:31:34,360 --> 02:31:36,200 FOR ATTENDING AND THEIR 3635 02:31:36,200 --> 02:31:36,560 PARTICIPATION. 3636 02:31:36,560 --> 02:31:38,680 VERY THOUGHTFUL PRESENTATIONS AS 3637 02:31:38,680 --> 02:31:41,000 WELL AS QUESTIONS AND I TURN THE 3638 02:31:41,000 --> 02:31:41,840 SESSION BACK OVER TO OUR SUMMIT 3639 02:31:41,840 --> 02:31:42,040 CHAIR. 3640 02:31:42,040 --> 02:31:42,120 3641 02:31:44,560 --> 02:31:45,840 >>WONDERFUL. 3642 02:31:45,840 --> 02:31:47,160 THANK YOU SO MUCH. 3643 02:31:47,160 --> 02:31:49,160 THANK YOU EVERYONE FOR THESE 3644 02:31:49,160 --> 02:31:49,680 EXCELLENT REMARKS. 3645 02:31:49,680 --> 02:31:53,040 QUESTIONS FROM THE AUDIENCE AND 3646 02:31:53,040 --> 02:31:53,600 TREMENDOUS DISCUSSION ALL 3647 02:31:53,600 --> 02:31:53,840 AROUND. 3648 02:31:53,840 --> 02:31:57,200 WE'RE NOW GOING TO HAVE A BRIEF 3649 02:31:57,200 --> 02:31:57,840 10-MINUTE BREAK. 3650 02:31:57,840 --> 02:32:00,120 WE CAN ALL STRETCH IF WE NEED 3651 02:32:00,120 --> 02:32:00,680 TO. 3652 02:32:00,680 --> 02:32:04,240 WE'LL RECONVENE AT 2:15 EASTERN 3653 02:32:04,240 --> 02:32:05,760 STANDARD TIME FOR OUR LAST 3654 02:32:05,760 --> 02:32:06,840 SCIENTIFIC SESSION OF DAY TWO. 3655 02:32:06,840 --> 02:32:26,480 SEE YOU ALL SHORTLY. 3656 02:32:26,480 --> 02:32:34,720 >>SESSION IS CO-CHAIRED BY KEN 3657 02:32:34,720 --> 02:32:42,000 HEPBURN AND LIZ NECKA. 3658 02:32:42,000 --> 02:32:42,800 >>LET ME MAKE SOME FRAMING 3659 02:32:42,800 --> 02:32:46,520 COMMENTS. 3660 02:32:46,520 --> 02:32:50,680 THE SESSION IS FOCUSSED ON 3661 02:32:50,680 --> 02:32:53,400 FAMILY CAREGIVERS AND OF PERSONS 3662 02:32:53,400 --> 02:32:58,040 LIVING WITH DEMENTIA ILLNESSES. 3663 02:32:58,040 --> 02:33:02,240 WE KNOW THERE ARE OVER 11 3664 02:33:02,240 --> 02:33:03,280 MILLION CAREGIVERS OF PERSONS 3665 02:33:03,280 --> 02:33:04,960 LIVING WITH DEMENTIA AND PROVIDE 3666 02:33:04,960 --> 02:33:09,360 ENORMOUS VALUE IN THE HELP THEY 3667 02:33:09,360 --> 02:33:11,080 GIVE IN GUIDING PEOPLE THROUGH 3668 02:33:11,080 --> 02:33:12,360 DAYS THAT ARE SAFE AND AS CALM 3669 02:33:12,360 --> 02:33:15,080 AS POSSIBLE. 3670 02:33:15,080 --> 02:33:17,560 WE GIVE MONETARY VALUE TO THAT 3671 02:33:17,560 --> 02:33:18,880 WORK ALMOST $300 BILLION. 3672 02:33:18,880 --> 02:33:25,240 THE REAL VALUE IS INCALCULABLE. 3673 02:33:25,240 --> 02:33:27,320 NOT ONLY DO THEY PROVIDE DAY TO 3674 02:33:27,320 --> 02:33:28,640 DAYCARE THEY ORGANIZE CARE. 3675 02:33:28,640 --> 02:33:32,440 THEY'RE THE CENTRAL SOURCE OF 3676 02:33:32,440 --> 02:33:34,440 CARE FOR PEOPLE LIVING WITH 3677 02:33:34,440 --> 02:33:35,360 DEMENTIA AND PROVIDE THAT SOURCE 3678 02:33:35,360 --> 02:33:41,440 OF CARE OVER EXTENDED PERIOD OF 3679 02:33:41,440 --> 02:33:42,280 TIME. 3680 02:33:42,280 --> 02:33:43,840 THEY CREATE SYSTEMS WHERE THERE 3681 02:33:43,840 --> 02:33:44,520 ARE NO SYSTEMS. 3682 02:33:44,520 --> 02:33:47,320 WE HEARD ABOUT THE MODEL CARE 3683 02:33:47,320 --> 02:33:50,880 SYSTEMS GIVES GREAT HOPE FOR THE 3684 02:33:50,880 --> 02:33:55,760 POSSIBILITY OF COORDINATED CARE 3685 02:33:55,760 --> 02:33:58,200 WHO RIGHT NOW WE HAVE FAMILY 3686 02:33:58,200 --> 02:33:59,920 CAREGIVERS WHO COORDINATE CARE 3687 02:33:59,920 --> 02:34:11,400 AND DO IT IDIOS SS SS SSIN -- 3688 02:34:12,000 --> 02:34:13,000 IDIOSYNCRATICALLY AND VERY FEW 3689 02:34:13,000 --> 02:34:14,400 REPORT GETTING ANY KIND OF 3690 02:34:14,400 --> 02:34:16,160 TRAINING TO DO WHAT THEY NEED. 3691 02:34:16,160 --> 02:34:18,600 THIS COULD VARY FROM GETTING A 3692 02:34:18,600 --> 02:34:20,200 PAMPHLET WHICH IS WHAT WE'RE 3693 02:34:20,200 --> 02:34:24,920 TOLD YESTERDAY IS ONE KIND OF 3694 02:34:24,920 --> 02:34:26,960 EDUCATION PROVIDED TO GOING 3695 02:34:26,960 --> 02:34:28,080 THROUGH PSYCHO EDUCATIONAL 3696 02:34:28,080 --> 02:34:29,360 PROGRAMS OR BEING INVOLVED IN A 3697 02:34:29,360 --> 02:34:34,600 SUITE OF PROGRAMS. 3698 02:34:34,600 --> 02:34:36,840 ONLY 30% GET SUPPORTIVE 3699 02:34:36,840 --> 02:34:37,120 SERVICES. 3700 02:34:37,120 --> 02:34:38,240 THEY'RE OUT ON AN ISLAND DOING 3701 02:34:38,240 --> 02:34:42,520 ALL THE WORK AND ORGANIZING ALL 3702 02:34:42,520 --> 02:34:44,200 THE CARE. 3703 02:34:44,200 --> 02:34:49,400 WHAT WE KNOW ABOUT AND 3704 02:34:49,400 --> 02:34:53,960 ACKNOWLEDGE ABOUT CAREGIVERS ARE 3705 02:34:53,960 --> 02:34:58,360 GOING TO GROW BECAUSE THE 3706 02:34:58,360 --> 02:35:01,160 NUMBERS OF PERSONS IN NEED GROW 3707 02:35:01,160 --> 02:35:09,240 OVER THE NEXT 30, 40 YEARS. 3708 02:35:09,240 --> 02:35:12,160 THIS IS THE CENTRAL POINT OF THE 3709 02:35:12,160 --> 02:35:15,160 SESSION AND CONFERENCE AS A 3710 02:35:15,160 --> 02:35:16,520 WHOLE. 3711 02:35:16,520 --> 02:35:19,840 CAREGIVERS ARE INCREASINGLY 3712 02:35:19,840 --> 02:35:21,560 HETEROGENOUSLY ADVANTAGED OR 3713 02:35:21,560 --> 02:35:21,880 DISADVANTAGED. 3714 02:35:21,880 --> 02:35:27,920 I WANT TO DWELL FOR A SECOND ON 3715 02:35:27,920 --> 02:35:28,200 THIS. 3716 02:35:28,200 --> 02:35:32,120 WE HAD WONDERFUL EXAMPLES OF 3717 02:35:32,120 --> 02:35:37,320 CAREGIVERS AND CARE PARTNERS 3718 02:35:37,320 --> 02:35:38,640 PROVIDING LOVING AND THOUGHTFUL 3719 02:35:38,640 --> 02:35:40,160 CARE AND FEELING REWARDED IN 3720 02:35:40,160 --> 02:35:44,760 THAT CARE. 3721 02:35:44,760 --> 02:35:48,360 I THINK WE HAVE REASON TO THINK 3722 02:35:48,360 --> 02:35:50,720 ABOUT THEM IN THESE TERMS AND 3723 02:35:50,720 --> 02:35:51,680 REWARDED FOR THEIR WORK. 3724 02:35:51,680 --> 02:35:59,320 WE'VE BEEN TOLD AND IMPORTANTLY 3725 02:35:59,320 --> 02:36:01,720 HOW MUCH DISPARITY THERE SIN 3726 02:36:01,720 --> 02:36:03,720 TERMS OF CAREGIVER SUPPORT. 3727 02:36:03,720 --> 02:36:04,960 THERE'S OTHER INTERSECTIONS WE 3728 02:36:04,960 --> 02:36:07,240 SHOULD THINK ABOUT. 3729 02:36:07,240 --> 02:36:10,400 I'M AWARE OF A COUPLE 3730 02:36:10,400 --> 02:36:11,880 DISSERTATIONS GOING ON. 3731 02:36:11,880 --> 02:36:13,800 ONE IN WHICH CHILDREN WHO ARE 3732 02:36:13,800 --> 02:36:19,640 TAKING CARE OF PARENTS WHO ARE 3733 02:36:19,640 --> 02:36:21,000 ABUSIVE DURING THEIR CHILDHOOD 3734 02:36:21,000 --> 02:36:26,040 AND THE OTHER LOOKING AT 3735 02:36:26,040 --> 02:36:28,280 ADOLESCENT CHILDREN OF EARLY ON 3736 02:36:28,280 --> 02:36:29,200 SET PERSONS LIVING WITH DEMENTIA 3737 02:36:29,200 --> 02:36:39,720 AND WHAT'S HAPPENING TO THEM. 3738 02:36:45,200 --> 02:36:51,880 AND DEAL WITH ADULTS WHO HAD 3739 02:36:51,880 --> 02:36:52,320 REJECTION. 3740 02:36:52,320 --> 02:36:55,800 SO NOT ALL CARE GIVING IS 3741 02:36:55,800 --> 02:37:03,280 REWARDED AND COMFORTABLE. 3742 02:37:03,280 --> 02:37:05,760 THERE'S LOOK AT WHAT A NIMBLE 3743 02:37:05,760 --> 02:37:14,400 SENSE OF WHAT CARE GIVING IS. 3744 02:37:14,400 --> 02:37:19,400 CAREGIVERS ARE NOT NECESSARILY 3745 02:37:19,400 --> 02:37:21,800 WELL AND CAREGIVERS INTERACT AND 3746 02:37:21,800 --> 02:37:32,360 WE HEARD -- ARE THEY ACCORDED A 3747 02:37:37,560 --> 02:37:38,720 ROLE OR GIVEN RESPONSIBILITIES. 3748 02:37:38,720 --> 02:37:38,760 3749 02:37:40,280 --> 02:37:45,800 DO THEY EXIST IN TERMS OF THOSE 3750 02:37:45,800 --> 02:37:46,400 AND IN THE ORGANIZATIONS EVEN 3751 02:37:46,400 --> 02:37:56,640 IDENTIFY THEM. 3752 02:38:02,040 --> 02:38:03,280 WE'LL HAVE LIZ SHED LIGHT ON 3753 02:38:03,280 --> 02:38:03,480 THIS. 3754 02:38:03,480 --> 02:38:07,720 >>I'LL TURN IT OVER TO OUR 3755 02:38:07,720 --> 02:38:11,400 PRESENTERS AND DR. ROBERTO AND 3756 02:38:11,400 --> 02:38:16,760 DR. GAUGLER AND DR. VAN HOUTVEN 3757 02:38:16,760 --> 02:38:18,200 AND LOOKING TOWARDS 3758 02:38:18,200 --> 02:38:19,760 INTERVENTIONS AND BROADER 3759 02:38:19,760 --> 02:38:21,320 IMPLEMENTATION CONSIDERATIONS 3760 02:38:21,320 --> 02:38:26,800 AND FINISHING THINKING ABOUT 3761 02:38:26,800 --> 02:38:30,520 POLICY AND SYSTEMS. 3762 02:38:30,520 --> 02:38:37,760 WE'LL HAVE RITA CHOULA AND JASON 3763 02:38:37,760 --> 02:38:39,720 RESENDEZ AND CASSANDRA THOMAS TO 3764 02:38:39,720 --> 02:38:44,000 SHOWED MORE LIGHT ON THIS. 3765 02:38:44,000 --> 02:38:46,400 >>I'M KAREN ROBERTO FROM 3766 02:38:46,400 --> 02:38:48,440 VIRGINIA TECH AND HERE TO SPEAK 3767 02:38:48,440 --> 02:38:53,560 TO YOU ABOUT THE IMPORTANCE OF 3768 02:38:53,560 --> 02:39:01,840 CONTEXT FOR UNDERSTANDING THIS 3769 02:39:01,840 --> 02:39:03,640 AND THERE'S FACTORS THAT LEAD TO 3770 02:39:03,640 --> 02:39:06,440 OUTCOMES ACROSS THE LIFE SPAN. 3771 02:39:06,440 --> 02:39:08,440 SPECIFICALLY THEY REFER TO 3772 02:39:08,440 --> 02:39:11,760 EDUCATION ACCESS AND QUALITY, 3773 02:39:11,760 --> 02:39:13,200 HEALTH CARE EQUALITY, 3774 02:39:13,200 --> 02:39:14,440 NEIGHBORHOOD AND BUILT 3775 02:39:14,440 --> 02:39:16,240 ENVIRONMENTS, SOCIAL AND 3776 02:39:16,240 --> 02:39:19,360 COMMUNITY CONTEXT AND ECONOMIC 3777 02:39:19,360 --> 02:39:19,720 STABILITY. 3778 02:39:19,720 --> 02:39:22,000 STRUCTURAL AND SOCIAL VARIABLES 3779 02:39:22,000 --> 02:39:25,800 SUCH AS RACE, ETHNICITY, GENDER 3780 02:39:25,800 --> 02:39:29,080 AND CULTURE BOTH TRANSCEND AND 3781 02:39:29,080 --> 02:39:32,720 INFLUENCE THE SOCIAL 3782 02:39:32,720 --> 02:39:34,880 DETERMINATES OF HEALTH. 3783 02:39:34,880 --> 02:39:36,720 I'LL TALK ABOUT LOCATION, FAMILY 3784 02:39:36,720 --> 02:39:40,040 STRUCTURE AND COMMUNITY CULTURES 3785 02:39:40,040 --> 02:39:44,440 INFLUENCING UNPAID DEMENTIA 3786 02:39:44,440 --> 02:39:45,560 CARRIL STRAIGHTING THE 3787 02:39:45,560 --> 02:39:46,120 IMPORTANCE OF CONTEXT PLUS 3788 02:39:46,120 --> 02:39:56,280 CULTURE. 3789 02:40:00,240 --> 02:40:01,080 THE REALITIES MAKE IT EXTREMELY 3790 02:40:01,080 --> 02:40:06,040 DIFFICULT TO SETTLE ON A SINGLE 3791 02:40:06,040 --> 02:40:08,760 SET OF CHARACTERISTICS THAT 3792 02:40:08,760 --> 02:40:09,720 ENCAPSULATE COMMUNITIES AND THE 3793 02:40:09,720 --> 02:40:16,720 FEDERAL DEFINITIONS OF RURAL THE 3794 02:40:16,720 --> 02:40:17,360 METROPOLITAN DEFINITION OFFER 3795 02:40:17,360 --> 02:40:19,080 DIFFERENT CONCLUSIONS ABOUT THE 3796 02:40:19,080 --> 02:40:20,200 DEMOGRAPHICS OF THE POPULATION. 3797 02:40:20,200 --> 02:40:22,480 THE SOCIAL LANDSCAPES AND THE 3798 02:40:22,480 --> 02:40:27,880 ECONOMIC STATE OF RURAL AMERICA. 3799 02:40:27,880 --> 02:40:36,200 THE CENSUS MEASURES ACROSS 3800 02:40:36,200 --> 02:40:37,160 CITIES AND SUBURBS. 3801 02:40:37,160 --> 02:40:41,720 SO WHY DO DEFINITIONS MATTER? 3802 02:40:41,720 --> 02:40:45,640 WE KNOW CARE GIVING IN RURAL 3803 02:40:45,640 --> 02:40:48,040 AREAS OCCURS ACROSS ALL GROUPS 3804 02:40:48,040 --> 02:40:49,400 AND INCOME AND EDUCATION LEVELS, 3805 02:40:49,400 --> 02:40:53,080 FAMILY TYPES AND GENDER TYPE AND 3806 02:40:53,080 --> 02:40:55,080 SEXUAL ORIENTATION YET RURAL 3807 02:40:55,080 --> 02:40:56,560 COMMUNITIES ARE CHARACTERIZED 3808 02:40:56,560 --> 02:40:58,400 DIFFERENTLY DEPENDING ON THE 3809 02:40:58,400 --> 02:40:59,760 DEFINITION USED. 3810 02:40:59,760 --> 02:41:02,320 FOR EXAMPLE, USUALLY WE SEE 3811 02:41:02,320 --> 02:41:05,080 LITTLE RACE DIVERSITY AMONG 3812 02:41:05,080 --> 02:41:06,520 OLDER FAMILIES IN RURAL AREAS 3813 02:41:06,520 --> 02:41:09,640 WHEREAS WHEN USING THE NON-METRO 3814 02:41:09,640 --> 02:41:11,280 DEFINITION WE FIND WITHIN PLACE 3815 02:41:11,280 --> 02:41:13,600 VARIATIONS WITH DIVERSITY FOR 3816 02:41:13,600 --> 02:41:15,840 THE SMALLER TOWN AREAS BEING 50% 3817 02:41:15,840 --> 02:41:19,400 HIGHER THAN THOSE OF METRO AND 3818 02:41:19,400 --> 02:41:29,680 OPEN-LAND AREAS. 3819 02:41:32,520 --> 02:41:34,560 COMPARED TO THE URBAN 3820 02:41:34,560 --> 02:41:36,240 COUNTERPARTS, RURAL INFORMAL 3821 02:41:36,240 --> 02:41:37,560 CAREGIVERS REPORT HAVING NO 3822 02:41:37,560 --> 02:41:38,160 CHOICE BUT TAKING ON CARE 3823 02:41:38,160 --> 02:41:48,440 RESPONSIBILITIES. 3824 02:41:49,760 --> 02:41:50,880 HAVING GREATER DIFFICULTIES 3825 02:41:50,880 --> 02:41:52,480 FINDING AFFORDABLE SERVICES AND 3826 02:41:52,480 --> 02:41:56,440 HAVING FEW IF ANY CONVERSATIONS 3827 02:41:56,440 --> 02:41:57,880 WITH PROFESSIONAL CARE PROVIDERS 3828 02:41:57,880 --> 02:42:01,440 ABOUT THEIR OWN HEALTH NEEDS. 3829 02:42:01,440 --> 02:42:06,520 IT'S UNCLEAR FROM THE RESEARCH 3830 02:42:06,520 --> 02:42:10,880 WHETHER RURAL FAMILY CAREGIVERS 3831 02:42:10,880 --> 02:42:12,680 ASSUME CARE RESPONSE ACTS 3832 02:42:12,680 --> 02:42:16,440 BECAUSE OF CHOICE, ENGRAINED OR 3833 02:42:16,440 --> 02:42:19,120 FAMILY NORMS AND VALUES, STRONG 3834 02:42:19,120 --> 02:42:20,240 INFORMAL NETWORKS THAT SUPPORT 3835 02:42:20,240 --> 02:42:22,800 THEM AND THEIR CARE GIVING 3836 02:42:22,800 --> 02:42:23,000 ROLES. 3837 02:42:23,000 --> 02:42:28,160 INADEQUATE SERVICES AND 3838 02:42:28,160 --> 02:42:28,840 FAITH-BASED CULTURAL RELUCTANCE 3839 02:42:28,840 --> 02:42:30,640 AND HELP FROM ORGANIZATIONS OR 3840 02:42:30,640 --> 02:42:32,440 LIKELY A COMBINATION OF THESE 3841 02:42:32,440 --> 02:42:38,560 AND OTHER INFLUENCES. 3842 02:42:38,560 --> 02:42:40,760 UNDERSTANDING DIFFERENCES IS 3843 02:42:40,760 --> 02:42:41,960 IMPORTANT FOR POLICY MAKERS AND 3844 02:42:41,960 --> 02:42:43,760 SERVICE PROVIDERS WHO ARE 3845 02:42:43,760 --> 02:42:46,200 SEEKING TO RECRUIT HOW THEY 3846 02:42:46,200 --> 02:42:47,360 SERVE RURAL FAMILIES PROVIDING 3847 02:42:47,360 --> 02:42:57,640 DEMENTIA CARE. 3848 02:42:58,320 --> 02:43:00,200 GREATER RECOGNITION HAS BEEN TO 3849 02:43:00,200 --> 02:43:03,960 STRUCTURES THAT DIVERGE FROM WHO 3850 02:43:03,960 --> 02:43:04,520 CONSTITUTES CAREGIVERS AND 3851 02:43:04,520 --> 02:43:10,120 PATTERNS OF CARE. 3852 02:43:10,120 --> 02:43:14,400 A HOST OF COMPLEX TRENDS AND 3853 02:43:14,400 --> 02:43:18,080 SERIAL MARRIAGES, UBIQUITY WOMEN 3854 02:43:18,080 --> 02:43:21,160 IN THE LABOR FORCE AND THE 3855 02:43:21,160 --> 02:43:22,840 GROWING ETHNIC POPULATION AND 3856 02:43:22,840 --> 02:43:24,200 SEXUAL MINORITY POPULATIONS HAVE 3857 02:43:24,200 --> 02:43:26,400 ADDED COMPLEXITY TO AMERICAN 3858 02:43:26,400 --> 02:43:36,520 LIFE. 3859 02:43:36,760 --> 02:43:41,000 THE PRESENT CHALLENGE AND 3860 02:43:41,000 --> 02:43:43,200 LOOKING AT THOSE WHO DO A 3861 02:43:43,200 --> 02:43:45,080 YAOMAN'S JOB AND LOOK AT THE 3862 02:43:45,080 --> 02:43:47,600 NEEDS OF EXTENDED CAREGIVERS, 3863 02:43:47,600 --> 02:43:49,440 GRANDCHILDREN, NIECES AND 3864 02:43:49,440 --> 02:43:52,680 NEPHEWS AND STEP KIN WHO ASSUME 3865 02:43:52,680 --> 02:43:55,400 THE ROLE OF DEMENTIA CAREGIVER. 3866 02:43:55,400 --> 02:43:58,160 WITH FEW EXCEPTIONS MOST STUDIES 3867 02:43:58,160 --> 02:43:59,880 REGARDLESS OF SAMPLE SIZE OR 3868 02:43:59,880 --> 02:44:01,120 DESIGN INCLUDE A RELATIVELY 3869 02:44:01,120 --> 02:44:02,320 SMALL NUMBER OF EXTENDED FAMILY 3870 02:44:02,320 --> 02:44:12,520 CAREGIVERS. 3871 02:44:21,720 --> 02:44:25,840 THEY REPORT PARTICIPATING IN 3872 02:44:25,840 --> 02:44:27,640 FEWER EVENTS AND SOME REPORT 3873 02:44:27,640 --> 02:44:29,840 DEPRESSIVE SYMPTOMS OTHER 3874 02:44:29,840 --> 02:44:31,800 EXTENDED FAMILY CAREGIVERS AND A 3875 02:44:31,800 --> 02:44:33,640 SMALL PERCENTAGE OF FAMILY 3876 02:44:33,640 --> 02:44:36,080 MEMBERS USE SUPPORTIVE SERVICES. 3877 02:44:36,080 --> 02:44:38,480 IN COMPARISON OUR QUALITATIVE 3878 02:44:38,480 --> 02:44:40,840 RESEARCH ON RURAL DEMENTIA 3879 02:44:40,840 --> 02:44:45,920 CAREGIVERS IN VIRGINIA FOUND 3880 02:44:45,920 --> 02:44:48,920 THAT EXTENDED FAMILY MEMBERS 3881 02:44:48,920 --> 02:44:50,920 REPORTED SMALL CARE GIVING 3882 02:44:50,920 --> 02:44:52,160 NETWORKS, UNSPOKEN EXPECTATIONS 3883 02:44:52,160 --> 02:44:53,440 WITHIN THEIR FAMILY THEY WOULD 3884 02:44:53,440 --> 02:44:59,760 BE THE CAREGIVER. 3885 02:44:59,760 --> 02:45:02,280 HEALTH PROBLEMS AND EXHAUSTION 3886 02:45:02,280 --> 02:45:05,760 AND LACK OF PERSONAL TIME 3887 02:45:05,760 --> 02:45:08,400 ASSOCIATED WITH CAREGIVER AND 3888 02:45:08,400 --> 02:45:10,520 NOT ATTENDING SPORT GROUPS OR 3889 02:45:10,520 --> 02:45:13,160 INFORMATION. 3890 02:45:13,160 --> 02:45:16,600 THESE ILLUMINATE THE EXPERIENCE 3891 02:45:16,600 --> 02:45:18,440 AND UNDER SCORE THE NEED FOR 3892 02:45:18,440 --> 02:45:20,480 STUDY OF THEIR SITUATIONS AND 3893 02:45:20,480 --> 02:45:22,240 CHALLENGE TO INFORM POLICIES AND 3894 02:45:22,240 --> 02:45:27,320 GUIDE SERVICES AND 3895 02:45:27,320 --> 02:45:28,600 INTERVENTIONS. 3896 02:45:28,600 --> 02:45:30,600 THE RESEARCH LITERATURE CONFIRMS 3897 02:45:30,600 --> 02:45:32,400 BELIEFS ABOUT SERVICE USE ABOUT 3898 02:45:32,400 --> 02:45:35,000 IN FORMAL AFAMILY CAREGIVERS AND 3899 02:45:35,000 --> 02:45:40,880 IN RURAL AREAS IN PARTICULAR. 3900 02:45:40,880 --> 02:45:42,800 SUPPORT SERVICE IS LOW AND GAPS 3901 02:45:42,800 --> 02:45:44,240 IN SERVICE PROVISION AND 3902 02:45:44,240 --> 02:45:46,240 AVAILABLE SERVICES DO NOT ALWAYS 3903 02:45:46,240 --> 02:45:51,960 MEET FAMILY NEEDS. 3904 02:45:51,960 --> 02:46:01,480 NEXT IDIOCRASS IS -- 3905 02:46:01,480 --> 02:46:05,680 IDIOSYNCRASIES SHOW THEY DON'T 3906 02:46:05,680 --> 02:46:08,480 WANT OUTSIDERS TO GIVE CARE OR 3907 02:46:08,480 --> 02:46:10,600 RELATIVES REFUSE CARE FROM 3908 02:46:10,600 --> 02:46:12,400 OUTSIDE PROVIDERS. 3909 02:46:12,400 --> 02:46:14,400 THEY OFTEN DON'T KNOW HOW TO 3910 02:46:14,400 --> 02:46:17,200 NAVIGATE SERVICES. 3911 02:46:17,200 --> 02:46:18,200 FORMAL SERVICES IN 3912 02:46:18,200 --> 02:46:20,440 GEOGRAPHICALLY ISOLATED 3913 02:46:20,440 --> 02:46:24,520 COMMUNITIES OFTEN ARE TOO FAR 3914 02:46:24,520 --> 02:46:28,280 FROM CAREGIVERS' HOMES OR NOT 3915 02:46:28,280 --> 02:46:32,480 AVAILABLE AT THE RIGHT TIME OF 3916 02:46:32,480 --> 02:46:34,520 DAY AND VARYING ELIGIBILITY 3917 02:46:34,520 --> 02:46:38,040 REQUIREMENTS AND LOWER RATIOS OF 3918 02:46:38,040 --> 02:46:40,400 PROFESSIONALS IN OTHER AREAS CAN 3919 02:46:40,400 --> 02:46:47,160 INFLUENCE THE QUANTITY AND 3920 02:46:47,160 --> 02:46:49,240 QUALITY OF SUPPORT AND THEY FACE 3921 02:46:49,240 --> 02:46:52,440 THE TRIPLE JEOPARDY OF BEING 3922 02:46:52,440 --> 02:46:54,080 PART OF VULNERABLE FAMILIES IN 3923 02:46:54,080 --> 02:46:57,360 UNDER SERVED PLACES AND HOLDING 3924 02:46:57,360 --> 02:46:58,680 CULTURAL BELIEFS TO NEG GAIT THE 3925 02:46:58,680 --> 02:47:04,680 USING OF FORMAL SERVICES. 3926 02:47:04,680 --> 02:47:08,400 MANY RURAL CAREGIVERS HAVE 3927 02:47:08,400 --> 02:47:10,160 LIMITED ACCESS TO HEALTH CARE 3928 02:47:10,160 --> 02:47:12,800 AND FACE NUMEROUS CARE RELATED 3929 02:47:12,800 --> 02:47:14,760 CHALLENGES INCLUDING A DEARTH OF 3930 02:47:14,760 --> 02:47:17,000 WORKERS AND IN FORMAL SERVICES. 3931 02:47:17,000 --> 02:47:18,960 HOWEVER, WE NEED TO SITUATION 3932 02:47:18,960 --> 02:47:20,880 CAREGIVERS WITHIN BROADER FAMILY 3933 02:47:20,880 --> 02:47:23,560 AND COMMUNITY CONTEXT. 3934 02:47:23,560 --> 02:47:25,800 STUDIES OFTEN CAPTURE INFLUENCES 3935 02:47:25,800 --> 02:47:28,120 ON INFORMAL AND ON INDIVIDUALS 3936 02:47:28,120 --> 02:47:30,880 AND FAMILIES BUT OVERLOOK THE 3937 02:47:30,880 --> 02:47:32,880 ACTUAL CAPACITY OF COMMUNITIES 3938 02:47:32,880 --> 02:47:35,840 TO SUPPORT THE EFFORTS OF UNPAID 3939 02:47:35,840 --> 02:47:36,120 CAREGIVERS. 3940 02:47:36,120 --> 02:47:39,160 THOUGH THE ALLOCATIONS OF 3941 02:47:39,160 --> 02:47:41,520 CAREGIVER RESOURCES MOSTLY 3942 02:47:41,520 --> 02:47:43,120 DETERMINE FEDERAL AND STATE 3943 02:47:43,120 --> 02:47:45,920 LEAVES, COUNTY BUDGETS ARE MORE 3944 02:47:45,920 --> 02:47:46,680 LIKELY TO INFLUENCE ALLOCATION 3945 02:47:46,680 --> 02:47:49,200 OF LOCAL SERVICES SUCH AS 3946 02:47:49,200 --> 02:47:50,400 TRANSPORTATION AND MEAL PROGRAMS 3947 02:47:50,400 --> 02:47:53,000 AND THEREFORE HAVE A MORE 3948 02:47:53,000 --> 02:47:54,720 IMMEDIATE AND DIRECT INFLUENCE 3949 02:47:54,720 --> 02:47:56,760 ON SOURCES OF SUPPORT AVAILABLE 3950 02:47:56,760 --> 02:48:00,120 TO CAREGIVERS. 3951 02:48:00,120 --> 02:48:05,080 NEXT, IN CONCLUSION, INFORMAL 3952 02:48:05,080 --> 02:48:08,200 DEMENTIA CARE REFLECTS 3953 02:48:08,200 --> 02:48:09,120 CONTEMPORARY, SOCIAL AND 3954 02:48:09,120 --> 02:48:11,080 POLITICAL REALITIES. 3955 02:48:11,080 --> 02:48:13,360 WHEN A STUDY IN PLACE-BASED 3956 02:48:13,360 --> 02:48:15,280 DIFFERENCES IN DEMENTIA CARE BE 3957 02:48:15,280 --> 02:48:17,920 THEY RURAL, URBAN OR SOMEWHERE 3958 02:48:17,920 --> 02:48:20,760 IN BETWEEN IS CRITICAL TO 3959 02:48:20,760 --> 02:48:22,600 UNDERSTAND PLACES ARE DYNAMIC 3960 02:48:22,600 --> 02:48:24,240 RESULTING IN A SHIFT IN THE 3961 02:48:24,240 --> 02:48:28,000 URBAN RURAL TAXONOMIES. 3962 02:48:28,000 --> 02:48:29,760 INCLUDING DIVERSE FAMILY 3963 02:48:29,760 --> 02:48:31,080 STRUCTURES IN OUR RESEARCH 3964 02:48:31,080 --> 02:48:32,440 PROVIDES INSIGHT IN THE COMPLEX 3965 02:48:32,440 --> 02:48:33,960 MEANING OF FAMILY DEMENTIA CARE 3966 02:48:33,960 --> 02:48:36,200 AND POINTS TO THE LIMITS OF 3967 02:48:36,200 --> 02:48:36,760 VIEWING CAREGIVERS AS A 3968 02:48:36,760 --> 02:48:41,120 MONOLITHIC GROUP. 3969 02:48:41,120 --> 02:48:46,000 GREATER INTENTIONALITY AND 3970 02:48:46,000 --> 02:48:47,720 SPECIFICITY IS NEEDED IN CULTURE 3971 02:48:47,720 --> 02:48:49,920 AND HOW FAMILIES RELY ON 3972 02:48:49,920 --> 02:48:52,920 INFORMAL SERVICES AND USE FORMAL 3973 02:48:52,920 --> 02:48:55,600 SERVICES TO SUPPORT THEIR CARE 3974 02:48:55,600 --> 02:48:58,040 GIVING EFFORTS AND THERE'S 3975 02:48:58,040 --> 02:48:58,640 INTERVENTIONS AND SERVICE 3976 02:48:58,640 --> 02:49:01,320 DELIVERY MODELS THAT CAN BE 3977 02:49:01,320 --> 02:49:02,280 REPLICATED, SUCH PROGRAMS MAY 3978 02:49:02,280 --> 02:49:07,440 NEED TO BE TAILORED TO THE 3979 02:49:07,440 --> 02:49:08,720 DISTINCTIVE FEATURES OF PLACES 3980 02:49:08,720 --> 02:49:12,480 AND COMMUNITIES FOR DEMENTIA 3981 02:49:12,480 --> 02:49:13,480 CAREGIVERS AND RELATIVES RESIDE. 3982 02:49:13,480 --> 02:49:22,080 THANK YOU VERY MUCH. 3983 02:49:22,080 --> 02:49:25,120 >>HELLO, EVERYBODY. 3984 02:49:25,120 --> 02:49:26,200 THANK YOU SO MUCH FOR HAVING ME 3985 02:49:26,200 --> 02:49:27,760 I'M JOE GAUGLER FROM THE 3986 02:49:27,760 --> 02:49:30,320 UNIVERSITY OF MINNESOTA. 3987 02:49:30,320 --> 02:49:34,520 IT'S AN HONOR TO PRESENT WITH 3988 02:49:34,520 --> 02:49:38,240 DR. ROBERTO AND NECKA AND PEOPLE 3989 02:49:38,240 --> 02:49:40,960 WHOSE WORK I'VE ADMIRED MANY 3990 02:49:40,960 --> 02:49:41,160 YEAR. 3991 02:49:41,160 --> 02:49:43,880 TODAY I'LL TALK ABOUT SOONER 3992 02:49:43,880 --> 02:49:49,880 THAN BETTER. 3993 02:49:49,880 --> 02:49:53,360 HOW DO WE IDENTIFY CAREGIVERS AT 3994 02:49:53,360 --> 02:49:59,760 THE EARLY STAGE TO FACILITATE 3995 02:49:59,760 --> 02:50:00,120 IMPLEMENTATION? 3996 02:50:00,120 --> 02:50:05,320 MANY CONTRIBUTED TO TO THE 3997 02:50:05,320 --> 02:50:08,040 HEALTH CARE SYSTEM SUCH AS THE 3998 02:50:08,040 --> 02:50:08,680 ELECTRONIC HEALTH RECORDS AND 3999 02:50:08,680 --> 02:50:13,640 WHILE THAT'S CLEARLY IMPORTANT 4000 02:50:13,640 --> 02:50:24,120 TO TARGET CAN HELP US HOW WE 4001 02:50:27,320 --> 02:50:28,800 CAN SUSTAIN INNOVATIONS. 4002 02:50:28,800 --> 02:50:31,520 WITH THAT IN MIND, WHAT DOES 4003 02:50:31,520 --> 02:50:32,560 IMPLEMENTATION SCIENCE GIVE US 4004 02:50:32,560 --> 02:50:34,720 THAT CAN HELP US BETTER DESIGN 4005 02:50:34,720 --> 02:50:36,800 INTERVENTIONS AT THE EARLIEST 4006 02:50:36,800 --> 02:50:39,200 STAGES OF THE NIH STAGE MODEL, 4007 02:50:39,200 --> 02:50:44,800 FOR EXAMPLE STAGES 1 AND 2? 4008 02:50:44,800 --> 02:50:48,840 IL ELEVATES THE NEED TO DEFINE 4009 02:50:48,840 --> 02:50:58,120 MECHANISMS OF AN INTERVENTION. 4010 02:50:58,120 --> 02:51:00,520 I THINK MANY OF US WOULD AR GREW 4011 02:51:00,520 --> 02:51:02,480 IF WE DON'T UNDERSTAND WHY AND 4012 02:51:02,480 --> 02:51:06,480 HOW AN INTERVENTION WORKS IT 4013 02:51:06,480 --> 02:51:12,560 IMPEDES OUR ABILITY TO IMPLEMENT 4014 02:51:12,560 --> 02:51:14,320 INTERVENTIONS IN LATER STAGES. 4015 02:51:14,320 --> 02:51:16,000 NEXT, IT GIVES US A SERIES OF 4016 02:51:16,000 --> 02:51:18,800 MEASURES TO CONSIDER EVEN IN THE 4017 02:51:18,800 --> 02:51:19,440 EARLIER STAGES OF INTERVENTION 4018 02:51:19,440 --> 02:51:29,640 DEVELOPMENT. 4019 02:51:31,360 --> 02:51:34,520 IT GIVES A FRAME WORK TO LOOK AT 4020 02:51:34,520 --> 02:51:35,880 SUCCESSFUL IMPLEMENTATION EVEN 4021 02:51:35,880 --> 02:51:37,600 AT THE EARLIEST STAGES TO INFORM 4022 02:51:37,600 --> 02:51:42,680 HOW WE SCALE AN INTERVENTION AND 4023 02:51:42,680 --> 02:51:45,280 HOW WE ADAPT AND WHAT 4024 02:51:45,280 --> 02:51:48,640 IMPLEMENTATION SCIENCES GIVES US 4025 02:51:48,640 --> 02:51:50,040 ARE STRONG FRAME WORKS AND 4026 02:51:50,040 --> 02:51:51,440 IMPLEMENTATION SCIENCE HAS BEEN 4027 02:51:51,440 --> 02:52:02,200 AT THE FOREFRONT OF ADVANCE IIN 4028 02:52:04,600 --> 02:52:07,040 METHODOLOGIES TO LOOK AT 4029 02:52:07,040 --> 02:52:07,920 EFFECTIVENESS CONSIDERATION. 4030 02:52:07,920 --> 02:52:10,760 FOR EXAMPLE THE NEED TO 4031 02:52:10,760 --> 02:52:11,560 INCORPORATE MULTI-LEVEL 4032 02:52:11,560 --> 02:52:14,400 STAKEHOLDER ENGAGEMENT AT ALL 4033 02:52:14,400 --> 02:52:16,320 STEPS AND UTILIZING MIXED 4034 02:52:16,320 --> 02:52:16,560 METHODS. 4035 02:52:16,560 --> 02:52:18,920 I'M AN ADVOCATE BUT HOW TO 4036 02:52:18,920 --> 02:52:21,240 EFFECTIVELY INTEGRATE 4037 02:52:21,240 --> 02:52:22,480 QUALITATIVE AND QUANTITATIVE 4038 02:52:22,480 --> 02:52:27,760 DATA COLLECTION STRANDS TO GIVE 4039 02:52:27,760 --> 02:52:34,240 A STRONGER INFERENCE TO THE 4040 02:52:34,240 --> 02:52:37,600 LATER STAGES AND HYBRID TESTING 4041 02:52:37,600 --> 02:52:40,080 TO GIVE METHODOLOGIES TO COLLECT 4042 02:52:40,080 --> 02:52:45,200 IMPLEMENTATION DATA AND 4043 02:52:45,200 --> 02:52:53,600 EFFECTIVE 4044 02:52:53,600 --> 02:52:55,800 EFFECTIVENESS AND THE 4045 02:52:55,800 --> 02:52:57,280 OPTIMIZATION STRATEGY AND I'M 4046 02:52:57,280 --> 02:53:00,080 INCLUDING THE REFERENCE OF A 4047 02:53:00,080 --> 02:53:01,040 WONDERFUL TEXTBOOK. 4048 02:53:01,040 --> 02:53:03,480 THERE'S TOOLS WE CAN APPLY AT 4049 02:53:03,480 --> 02:53:04,080 THE EARLIEST STAGES OF 4050 02:53:04,080 --> 02:53:14,520 IMPLEMENTATION TESTING. 4051 02:53:18,920 --> 02:53:25,080 I WANTED TO SHOW THIS STUDY HOME 4052 02:53:25,080 --> 02:53:27,920 ALONE AGE NIH STAGE 1 4053 02:53:27,920 --> 02:53:29,360 INTERVENTION FOR THOSE WHO LIVE 4054 02:53:29,360 --> 02:53:34,520 ALONE AND HAVE COGNITIVE 4055 02:53:34,520 --> 02:53:34,840 IMPAIRMENT. 4056 02:53:34,840 --> 02:53:39,280 IT'S ESSENTIAL LY DESIGN TO 4057 02:53:39,280 --> 02:53:42,200 PREPARE FOR PILOT TESTING. 4058 02:53:42,200 --> 02:53:44,480 WE WERE DELIBERATE IN COLLECTION 4059 02:53:44,480 --> 02:53:47,160 OF IMPLEMENTATION DATA ALONGSIDE 4060 02:53:47,160 --> 02:53:49,200 MORE STANDARD FEASIBILITY 4061 02:53:49,200 --> 02:53:50,720 TESTING PROCESSES FOR EXAMPLE. 4062 02:53:50,720 --> 02:53:53,160 WE'RE GOING TO IDENTIFY 4063 02:53:53,160 --> 02:53:54,720 TREATMENT COMPONENTS AND EXAMINE 4064 02:53:54,720 --> 02:53:56,320 THE USEFULNESS AND DETERMINE 4065 02:53:56,320 --> 02:53:57,400 WHETHER THE INTERVENTION 4066 02:53:57,400 --> 02:54:01,120 ELEMENTS OF HOME ALONE AS 4067 02:54:01,120 --> 02:54:02,360 ORIGINALLY CONCEIVED REQUIRE 4068 02:54:02,360 --> 02:54:04,640 ADAPTATION AND USE THE FRAMEWORK 4069 02:54:04,640 --> 02:54:06,440 TAKEN FROM IMPLEMENTATION 4070 02:54:06,440 --> 02:54:08,000 SCIENCE TO GUIDE THAT ADAPTATION 4071 02:54:08,000 --> 02:54:10,240 WORK PRIOR TO OUR PHASE 2 PILOT 4072 02:54:10,240 --> 02:54:10,440 TEST. 4073 02:54:10,440 --> 02:54:12,760 AND AS I ALLUDED TO EARLIER 4074 02:54:12,760 --> 02:54:16,440 WE'RE UTILIZING WHAT'S CALLED A 4075 02:54:16,440 --> 02:54:18,920 CONVERGENCE PARALLEL MIXED 4076 02:54:18,920 --> 02:54:21,360 METHODS DESIGN FOR QUALITATIVE 4077 02:54:21,360 --> 02:54:22,240 DESCRIPTIVE INFORMATION. 4078 02:54:22,240 --> 02:54:24,680 THE FORMER USED TO UNDERSTAND 4079 02:54:24,680 --> 02:54:25,360 IMPLEMENTATION CONSIDERATIONS 4080 02:54:25,360 --> 02:54:27,640 AND ASPECTS OF THIS PARTICULAR 4081 02:54:27,640 --> 02:54:30,080 INTERVENTION. 4082 02:54:30,080 --> 02:54:33,080 THEN YOU SEE HERE THE PHASE 2 4083 02:54:33,080 --> 02:54:34,800 ASPECT OF THE STAGE 1 4084 02:54:34,800 --> 02:54:35,160 INTERVENTION. 4085 02:54:35,160 --> 02:54:37,000 WE'LL PILOT TEST HOME ALONE. 4086 02:54:37,000 --> 02:54:39,200 ONE OF OUR MAIN AIMS IS TO 4087 02:54:39,200 --> 02:54:40,120 DETERMINE THE IMPLEMENTATION 4088 02:54:40,120 --> 02:54:41,840 POTENTIAL OF HOME ALONE. 4089 02:54:41,840 --> 02:54:43,080 DETERMINE WHETHER HOME ALONE IS 4090 02:54:43,080 --> 02:54:46,080 CARRIED OUT AS INTENDED. 4091 02:54:46,080 --> 02:54:48,680 STANDARD FIDELITY EVALUATION AND 4092 02:54:48,680 --> 02:54:51,040 IS IT DEEMED FEASIBLE AND 4093 02:54:51,040 --> 02:54:53,400 ACCEPTABLE AND APPROPRIATE BY 4094 02:54:53,400 --> 02:54:54,920 THE PEOPLE DELIVERING THE 4095 02:54:54,920 --> 02:54:57,360 INTERVENTION TO AS WELL AS THE 4096 02:54:57,360 --> 02:54:57,720 INTERVENTIONS. 4097 02:54:57,720 --> 02:54:59,080 AND THE REASON WHY THIS IS 4098 02:54:59,080 --> 02:55:00,880 IMPORTANT IS IT WILL GIVE US KEY 4099 02:55:00,880 --> 02:55:02,000 INFORMATION FOR WHEN WE THINK 4100 02:55:02,000 --> 02:55:04,880 DOWN THE LINE NOT JUST DOING THE 4101 02:55:04,880 --> 02:55:07,440 BIG RANDOMIZED CONTROL TRIAL IN 4102 02:55:07,440 --> 02:55:10,040 HOPEFULLY A SUBMITTED RO1 4103 02:55:10,040 --> 02:55:11,760 PROPOSAL AND ALSO ARE WE GETTING 4104 02:55:11,760 --> 02:55:12,960 GOOD INFORMATION TO SUGGEST THIS 4105 02:55:12,960 --> 02:55:14,520 IS AN INTERVENTION THAT NOT ONLY 4106 02:55:14,520 --> 02:55:17,240 IS GOING TO BE EFFICACIOUS BUT 4107 02:55:17,240 --> 02:55:19,480 LIKELY WILL BE PICKED UP AND 4108 02:55:19,480 --> 02:55:20,280 ADOPTED AND USED IN THE 4109 02:55:20,280 --> 02:55:21,640 COMMUNITY WHICH IN THE END I 4110 02:55:21,640 --> 02:55:24,320 THINK IS ALL OF OUR GOALS. 4111 02:55:24,320 --> 02:55:29,080 I'VE ALWAYS HEARD IMPLEMENTATION 4112 02:55:29,080 --> 02:55:31,920 SCIENCE AS AN ETHICAL ENDEAVOR. 4113 02:55:31,920 --> 02:55:33,960 AND WE HEARD DURING THE SUMMIT 4114 02:55:33,960 --> 02:55:43,000 AND I'M SURE YOU'RE AWARE THE 4115 02:55:43,000 --> 02:55:46,640 IMPLEMENT 4116 02:55:46,640 --> 02:55:49,840 IMPLEMENTATION -- RESEARCH TO 4117 02:55:49,840 --> 02:55:53,160 IMPLEMENTATION IS LEAKY AND LOOK 4118 02:55:53,160 --> 02:55:54,120 AT POSSIBLE WAYS. 4119 02:55:54,120 --> 02:55:56,440 WE'LL BE USING A MIXED METHODS 4120 02:55:56,440 --> 02:55:58,760 DESIGN AND EXPLANATORY MIXED 4121 02:55:58,760 --> 02:56:00,200 METHODS DESIGN WHERE THE 4122 02:56:00,200 --> 02:56:01,120 QUALITATIVE DATA WILL HELP 4123 02:56:01,120 --> 02:56:03,440 UNDERSTAND THE INTERVENTIONS AND 4124 02:56:03,440 --> 02:56:04,560 MECHANISM OF BENEFIT MORE SO 4125 02:56:04,560 --> 02:56:06,400 THAN IN WE RELIED ON 4126 02:56:06,400 --> 02:56:07,360 QUANTITATIVE DATA. 4127 02:56:07,360 --> 02:56:10,680 YOU SAW THIS AS A KEY POINT I 4128 02:56:10,680 --> 02:56:12,160 BROUGHT UP EARLIER AND OTHERS 4129 02:56:12,160 --> 02:56:20,200 HAVE AS WELL AND IN SOME OF OUR 4130 02:56:20,200 --> 02:56:22,360 INTERVENTION STUDIES AND A MORE 4131 02:56:22,360 --> 02:56:24,760 STANDARD AIM IS DETERMINED 4132 02:56:24,760 --> 02:56:27,120 WHETHER KEY EMPIRICAL OUTCOMES 4133 02:56:27,120 --> 02:56:30,120 CHANGE OVER THE SIX MONTH PERIOD 4134 02:56:30,120 --> 02:56:31,600 TO INFORM SUBSEQUENT TESTING. 4135 02:56:31,600 --> 02:56:35,960 I WANTED TO LEAVE YOU WITH THE 4136 02:56:35,960 --> 02:56:37,320 CONCEPTUAL MODEL AT THIS POINT. 4137 02:56:37,320 --> 02:56:39,400 THIS IS IMPORTANT NOT JUST 4138 02:56:39,400 --> 02:56:41,320 BECAUSE IT HELPS INFORM OUR 4139 02:56:41,320 --> 02:56:43,320 ANALYSES OF EFFICACY AND 4140 02:56:43,320 --> 02:56:44,720 EFFECTIVENESS BUT WILL HELP US 4141 02:56:44,720 --> 02:56:46,320 LEARN AND UNDERSTAND ARE THESE 4142 02:56:46,320 --> 02:56:47,800 THE ACTUAL MECHANISMS LEADING TO 4143 02:56:47,800 --> 02:56:51,600 THE OUTCOMES WE ANTICIPATE AND 4144 02:56:51,600 --> 02:56:53,520 IF NOT WHAT DOES LEAD TO 4145 02:56:53,520 --> 02:56:54,960 POSITIVE OUTCOMES IN THIS 4146 02:56:54,960 --> 02:56:56,960 PARTICULAR INTERVENTION AND MORE 4147 02:56:56,960 --> 02:56:58,320 IMPORTANTLY HOLDING ON TO THE 4148 02:56:58,320 --> 02:57:00,560 CORE MECHANISMS AS CENTRAL TO 4149 02:57:00,560 --> 02:57:02,520 FUTURE TESTING NOT JUST EFFICACY 4150 02:57:02,520 --> 02:57:04,920 BUT HOPEFULLY DOWN THE LINE AND 4151 02:57:04,920 --> 02:57:05,960 EFFECTIVENESS EVALUATION IF NOT 4152 02:57:05,960 --> 02:57:07,320 DISSEMINATION AND 4153 02:57:07,320 --> 02:57:07,920 IMPLEMENTATION. 4154 02:57:07,920 --> 02:57:10,280 AND AGAIN WHY THIS IS SO 4155 02:57:10,280 --> 02:57:10,520 IMPORTANT? 4156 02:57:10,520 --> 02:57:11,880 MANY IMPLEMENTATION SCIENTISTS 4157 02:57:11,880 --> 02:57:14,800 BELIEVE ADAPTATION IS 4158 02:57:14,800 --> 02:57:15,160 UNAVOIDABLE. 4159 02:57:15,160 --> 02:57:17,360 IN ORDER TO FIT IT TO CONTEXT 4160 02:57:17,360 --> 02:57:18,480 AND PLACE AND PEOPLE ADAPTATION 4161 02:57:18,480 --> 02:57:19,720 IS NEEDED. 4162 02:57:19,720 --> 02:57:20,600 IF YOU'RE GOING TO BE DOING 4163 02:57:20,600 --> 02:57:22,040 ADAPTATION THE RIGHT WAY YOU 4164 02:57:22,040 --> 02:57:23,240 WANT TO MAKE SURE YOU'RE 4165 02:57:23,240 --> 02:57:27,440 CHANGING THE MODE, DELIVERY 4166 02:57:27,440 --> 02:57:32,480 INTERVENTION AND THE BENEFITS 4167 02:57:32,480 --> 02:57:35,760 ARE MAINTAINED AND 4168 02:57:35,760 --> 02:57:37,600 CONCEPTUALIZATION IS IMPORTANT 4169 02:57:37,600 --> 02:57:39,800 TO LEAD TO APPROPRIATE 4170 02:57:39,800 --> 02:57:40,560 IMPLEMENTATION. 4171 02:57:40,560 --> 02:57:43,720 I ENCOURAGE YOU ALL TO CONNECT 4172 02:57:43,720 --> 02:57:45,480 WITH US ON TWITTER, OUR CENTER 4173 02:57:45,480 --> 02:57:47,440 FOR HEALTHY AGING AND 4174 02:57:47,440 --> 02:57:47,760 INNOVATION. 4175 02:57:47,760 --> 02:57:49,200 FEEL FREE TO CALL AND E-MAIL ME 4176 02:57:49,200 --> 02:57:50,040 AT ANY TIME. 4177 02:57:50,040 --> 02:57:51,400 I LOVE TO TALK ABOUT THIS AND 4178 02:57:51,400 --> 02:57:52,800 MAYBE WE'LL HAVE TIME TO DO SO 4179 02:57:52,800 --> 02:57:55,360 IN THE PANEL AND IF YOU GO THE 4180 02:57:55,360 --> 02:57:57,160 TO THE NEXT SLIDE AND ACCESS THE 4181 02:57:57,160 --> 02:58:00,440 SLIDES I TRIED TO COMPILE WHAT I 4182 02:58:00,440 --> 02:58:01,040 FELT WERE THE KEY RESOURCE TO 4183 02:58:01,040 --> 02:58:01,960 HELP GUIDE NOT MY THINKING BUT I 4184 02:58:01,960 --> 02:58:03,000 HOPE YOURS AS WELL. 4185 02:58:03,000 --> 02:58:06,600 THANKS FOR YOUR TIME AND I 4186 02:58:06,600 --> 02:58:12,320 APPRECIATE IT AGAIN. 4187 02:58:12,320 --> 02:58:14,200 >>THANKS SO MUCH. 4188 02:58:14,200 --> 02:58:16,840 MY NAME IS COURTNEY VAN HOUTEN A 4189 02:58:16,840 --> 02:58:17,960 UNIVERSITY IN DUKE UNIVERSITY IN 4190 02:58:17,960 --> 02:58:19,760 POPULATION HEALTH SCIENCES AND 4191 02:58:19,760 --> 02:58:20,760 AN INVESTIGATOR IN THE V.A. 4192 02:58:20,760 --> 02:58:24,120 SYSTEM OF CARE IN DURHAM IN OUR 4193 02:58:24,120 --> 02:58:25,680 CENTER CALLED ADAPT. 4194 02:58:25,680 --> 02:58:29,600 I'M AN NIH-FUNDED RESEARCHER AND 4195 02:58:29,600 --> 02:58:31,240 DISTANCE CAREGIVER AT THE MOMENT 4196 02:58:31,240 --> 02:58:34,800 AND HAVE SOME EXPERIENCE OF MY 4197 02:58:34,800 --> 02:58:36,680 BELOVED DAD LIVING WITH 4198 02:58:36,680 --> 02:58:36,960 DEMENTIA. 4199 02:58:36,960 --> 02:58:40,720 HE JUST ENTERED HOSPICE TWO 4200 02:58:40,720 --> 02:58:42,040 WEEKS AGO AND DEALING WITH 4201 02:58:42,040 --> 02:58:43,280 UNPRECEDENTED TIMES FROM MY 4202 02:58:43,280 --> 02:58:44,040 EXPERIENCE. 4203 02:58:44,040 --> 02:58:47,120 I'LL TALK ABOUT EXPANDING POLICY 4204 02:58:47,120 --> 02:58:50,240 SUPPORT TO PROMOTE CAREGIVER 4205 02:58:50,240 --> 02:58:51,520 RESILIENCE AND WELL-BEING AND 4206 02:58:51,520 --> 02:58:53,120 FOCUS ON ECONOMIC COSTS. 4207 02:58:53,120 --> 02:58:54,480 THE REASON I'M FOCUSSING ON THIS 4208 02:58:54,480 --> 02:59:00,080 IS BECAUSE I DO STUDY ECONOMICS 4209 02:59:00,080 --> 02:59:02,400 BUT AND LOOKING AT HOW 4210 02:59:02,400 --> 02:59:03,080 INTERTWINED OUR ECONOMIC 4211 02:59:03,080 --> 02:59:04,640 SECURITY AND MENTAL AND PHYSICAL 4212 02:59:04,640 --> 02:59:05,880 HEALTH ARE. 4213 02:59:05,880 --> 02:59:07,840 THESE ARE CRITICAL. 4214 02:59:07,840 --> 02:59:09,240 WITHOUT ECONOMIC SECURITY IT'S 4215 02:59:09,240 --> 02:59:11,200 HARD TO THRIVE AND HAVE 4216 02:59:11,200 --> 02:59:12,840 RESILIENCE AS A CAREGIVER OR 4217 02:59:12,840 --> 02:59:13,880 HUMAN BEING. 4218 02:59:13,880 --> 02:59:15,240 WE HAVE A LOT OF EVIDENCE AND 4219 02:59:15,240 --> 02:59:17,720 OTHERS HAVE SPOKEN ABOUT THE 4220 02:59:17,720 --> 02:59:20,240 REWARDS TO CARE GIVING. 4221 02:59:20,240 --> 02:59:21,720 HOWEVER, THERE'S STRONG EVIDENCE 4222 02:59:21,720 --> 02:59:24,320 AS WELL THAT IN THE CAUSAL 4223 02:59:24,320 --> 02:59:26,360 INFERENCE LITERATURE THAT SHOWS 4224 02:59:26,360 --> 02:59:27,320 THERE'S NEGATIVE AFFECT TO 4225 02:59:27,320 --> 02:59:29,200 ECONOMIC COSTS IF YOU'RE A 4226 02:59:29,200 --> 02:59:29,880 CAREGIVER. 4227 02:59:29,880 --> 02:59:31,280 THIS COMES THROUGH LEAVING THE 4228 02:59:31,280 --> 02:59:34,280 LABOR FORCE TOO EARLY, HAVING 4229 02:59:34,280 --> 02:59:36,400 DECREASED WAGES AND REDUCED 4230 02:59:36,400 --> 02:59:37,480 PROMOTIONS AND EARLY RETIREMENT 4231 02:59:37,480 --> 02:59:38,840 AND EARLY RETIREMENT FOR WOMEN 4232 02:59:38,840 --> 02:59:41,200 ESPECIALLY IS A NEGATIVE IMPACT 4233 02:59:41,200 --> 02:59:42,760 FOR THEIR ECONOMIC SECURITY IN 4234 02:59:42,760 --> 02:59:44,680 OLD AGE. 4235 02:59:44,680 --> 02:59:46,120 AND WOMEN ARE CARE GIVING SO 4236 02:59:46,120 --> 02:59:51,920 IT'S A HUGE GENDER ISSUE FOR 4237 02:59:51,920 --> 02:59:53,640 SURE. 4238 02:59:53,640 --> 02:59:55,320 KEN MENTIONED THIS IN THE 4239 02:59:55,320 --> 02:59:58,200 INTRODUCTION BUT WE HAVE SO MUCH 4240 02:59:58,200 --> 03:00:01,800 HETEROGENEITY IN THE TYPES OF 4241 03:00:01,800 --> 03:00:07,800 CAREGIVERS AND IT'S A FANCY WORD 4242 03:00:07,800 --> 03:00:09,360 FOR THE HIGHEST RISK GROUPS AND 4243 03:00:09,360 --> 03:00:10,640 THERE'S ECONOMIC COSTS AND WHO 4244 03:00:10,640 --> 03:00:12,040 THE PEOPLE WHO FARE THE WORSE 4245 03:00:12,040 --> 03:00:14,240 BECAUSE THEN WE CAN TARGET 4246 03:00:14,240 --> 03:00:15,640 INTERVENTIONS AND POLICY 4247 03:00:15,640 --> 03:00:16,920 REMEDIES TO SUPPORT THEM. 4248 03:00:16,920 --> 03:00:18,400 WE HAVE LESS EVIDENCE ON WHAT 4249 03:00:18,400 --> 03:00:20,520 ARE THE HIGHEST RISK GROUPS FROM 4250 03:00:20,520 --> 03:00:21,800 THE CAUSAL INFERENCE LITERATURE 4251 03:00:21,800 --> 03:00:24,520 BUT WHAT WE DO KNOW IS THAT 4252 03:00:24,520 --> 03:00:27,720 PEOPLE WHO ARE FEMALE CAREGIVERS 4253 03:00:27,720 --> 03:00:29,520 HAVE REDUCED WAGES AND THOSE ARE 4254 03:00:29,520 --> 03:00:35,040 NOT SEEN IN MALE CAREGIVERS WE 4255 03:00:35,040 --> 03:00:38,600 HAVE KNOWLEDGE FROM ERIC LARSON 4256 03:00:38,600 --> 03:00:42,520 AND MEGAN IF YOU'RE A CAREGIVER 4257 03:00:42,520 --> 03:00:44,600 TAKING CARE OF SOMEONE WITH 4258 03:00:44,600 --> 03:00:47,800 MEMORY IMPAIRMENT YOU FACE 4259 03:00:47,800 --> 03:00:49,920 HIGHER COSTS AND IF THERE'S 4260 03:00:49,920 --> 03:00:50,840 FUNCTIONAL LIMITATIONS ALONE OR 4261 03:00:50,840 --> 03:00:52,720 ON TOP OF A MEMORY IMPAIRMENT 4262 03:00:52,720 --> 03:00:54,680 YOU'LL FACE HIGHER COSTS. 4263 03:00:54,680 --> 03:00:58,200 IF YOU'RE AN INTENSIVE CAREGIVER 4264 03:00:58,200 --> 03:01:01,400 YOU'RE MORE LIKELY TO QUIT WORK 4265 03:01:01,400 --> 03:01:04,480 THAN PEOPLE WHO ARE 4266 03:01:04,480 --> 03:01:05,880 NON-INTENSIVE CAREGIVERS AND IN 4267 03:01:05,880 --> 03:01:08,760 TERMS OF THE LITERATURE ON WORK 4268 03:01:08,760 --> 03:01:11,000 OUTCOMES AND HETEROGENEITY 4269 03:01:11,000 --> 03:01:11,920 PEOPLE DEPRESSED AS CAREGIVERS 4270 03:01:11,920 --> 03:01:14,000 ARE MORE LIKELY TO MISS WORK 4271 03:01:14,000 --> 03:01:16,440 COMPARED TO PEOPLE NOT 4272 03:01:16,440 --> 03:01:16,800 DEPRESSED. 4273 03:01:16,800 --> 03:01:17,960 THESE ARE COMMON SENSE AND 4274 03:01:17,960 --> 03:01:19,280 PROBABLY NOT A HUGE SURPRISE TO 4275 03:01:19,280 --> 03:01:20,920 PEOPLE BUT THESE ARE SOME OF KEY 4276 03:01:20,920 --> 03:01:22,640 GROUPS AND IT'S IMPORTANT TO 4277 03:01:22,640 --> 03:01:24,760 KNOW THESE HIGH RISK GROUPS TO 4278 03:01:24,760 --> 03:01:25,800 TARGET POLICY REMEDIES. 4279 03:01:25,800 --> 03:01:29,160 WE NEED TO HAVE GAPS FILLED 4280 03:01:29,160 --> 03:01:30,320 HOWEVER, IN TERMS OF STRUCTURAL 4281 03:01:30,320 --> 03:01:33,080 RISK FACTORS AND THAT'S BEGIN TO 4282 03:01:33,080 --> 03:01:35,000 HAPPEN SHOWING IF YOU EXPERIENCE 4283 03:01:35,000 --> 03:01:38,480 BIAS AS A CAREGIVER YOU HAVE 4284 03:01:38,480 --> 03:01:40,120 WORSE MENTAL HEALTH AND THERE'S 4285 03:01:40,120 --> 03:01:43,400 A PAPER LOOKING AT THAT. 4286 03:01:43,400 --> 03:01:45,400 AND JUST A REAL PLUG IS THAT WE 4287 03:01:45,400 --> 03:01:46,880 NEED TO THINK ABOUT CAUSAL 4288 03:01:46,880 --> 03:01:50,480 INFERENCE SO WE CAN MAKE SURE 4289 03:01:50,480 --> 03:01:52,320 THE CARE GIVING IS CAUSING THE 4290 03:01:52,320 --> 03:01:54,160 NEGATIVE OUTCOMES AND NOT 4291 03:01:54,160 --> 03:01:58,280 ANOTHER FACTOR TO GUIDE FLS. 4292 03:01:58,280 --> 03:01:59,440 -- POLICY. 4293 03:01:59,440 --> 03:02:01,640 POLICY EVIDENCE ON WHAT WORKS ON 4294 03:02:01,640 --> 03:02:02,600 RESISTANCE BECAUSE THE MAJORITY 4295 03:02:02,600 --> 03:02:05,120 OF SUPPORT POLICIES ARE AT THE 4296 03:02:05,120 --> 03:02:07,840 LOCAL OR STATE LEVEL AND UNDER 4297 03:02:07,840 --> 03:02:09,720 FUNDED OR INACCESSIBLE. 4298 03:02:09,720 --> 03:02:12,200 WE DO HAVE AN EXAMPLE HOWEVER, 4299 03:02:12,200 --> 03:02:13,160 FROM ONE LARGE NATIONAL POLICY 4300 03:02:13,160 --> 03:02:14,680 THAT COMES FROM THE VETERANS 4301 03:02:14,680 --> 03:02:14,920 AFFAIRS. 4302 03:02:14,920 --> 03:02:17,960 I'VE HAD THE HONOR TO EVALUATE 4303 03:02:17,960 --> 03:02:21,000 THE PROGRAM IN THE LAST 11 4304 03:02:21,000 --> 03:02:21,200 YEARS. 4305 03:02:21,200 --> 03:02:22,960 THE V.A. SPREAD A PROGRAM THAT 4306 03:02:22,960 --> 03:02:24,840 WAS PASSED BY LAW THEY HAD TO 4307 03:02:24,840 --> 03:02:27,720 OFFER COMPREHENSIVE CAREGIVER 4308 03:02:27,720 --> 03:02:28,800 SUPPORTS TO CAREGIVERS OF 4309 03:02:28,800 --> 03:02:33,280 VETERANS IN THE SYSTEM. 4310 03:02:33,280 --> 03:02:34,920 THIS SUPPORT IS QUITE MANY 4311 03:02:34,920 --> 03:02:36,400 FEATURES BUT THE KEY FEATURES 4312 03:02:36,400 --> 03:02:38,920 ARE LISTED AND INCLUDES A 4313 03:02:38,920 --> 03:02:41,320 MONTHLY STIPEND AND TRAINING TO 4314 03:02:41,320 --> 03:02:42,760 CAREGIVERS, HEALTH INSURANCE IF 4315 03:02:42,760 --> 03:02:45,520 YOU DON'T ALREADY HAVE IT AS A 4316 03:02:45,520 --> 03:02:49,760 CAREGIVER OF A VETERAN AND PEER 4317 03:02:49,760 --> 03:02:50,000 SUPPORT. 4318 03:02:50,000 --> 03:02:52,440 THE MAIN POINTS OF CONTACT FOR 4319 03:02:52,440 --> 03:02:53,920 GETTING SERVICES THROUGH THE 4320 03:02:53,920 --> 03:02:55,600 HEALTH SYSTEM IS THROUGH A 4321 03:02:55,600 --> 03:02:56,840 SOCIAL WORKER OR PSYCHOLOGIST 4322 03:02:56,840 --> 03:02:58,200 WHO WILL MEET WITH THE 4323 03:02:58,200 --> 03:03:02,360 CAREGIVERS AND TELL THEM ABOUT 4324 03:03:02,360 --> 03:03:05,080 AND DEVICE A TREATMENT PLAN THAT 4325 03:03:05,080 --> 03:03:06,840 MEETS THE NEEDS OF THE 4326 03:03:06,840 --> 03:03:07,120 CAREGIVERS. 4327 03:03:07,120 --> 03:03:09,680 AND TO HIGHLIGHT THE IMPACT ON 4328 03:03:09,680 --> 03:03:12,920 ECONOMIC COSTS AGAIN WE FOUND IN 4329 03:03:12,920 --> 03:03:16,200 A CAUSAL ANALYSIS THAT THIS 4330 03:03:16,200 --> 03:03:16,840 NATIONAL COMPREHENSIVE PROGRAM 4331 03:03:16,840 --> 03:03:19,880 ABOUT 40,000 CAREGIVERS HAVE 4332 03:03:19,880 --> 03:03:22,680 PARTICIPATED IN DOES REDUCE 4333 03:03:22,680 --> 03:03:23,400 PERCEIVED FINANCIAL STRAIN AMONG 4334 03:03:23,400 --> 03:03:25,040 THE CAREGIVERS WHO PARTICIPATE. 4335 03:03:25,040 --> 03:03:26,560 THIS IS IMPORTANT BECAUSE THE 4336 03:03:26,560 --> 03:03:28,560 WAY YOU FEEL ABOUT THE FINANCES 4337 03:03:28,560 --> 03:03:30,080 IS ALSO REALLY TIED TO YOUR 4338 03:03:30,080 --> 03:03:31,400 MENTAL HEALTH AND NOT JUST THE 4339 03:03:31,400 --> 03:03:32,640 AMOUNT OF MONEY YOU HAVE WHICH 4340 03:03:32,640 --> 03:03:37,200 IS ALSO IMPORTANT OF COURSE. 4341 03:03:37,200 --> 03:03:38,440 THAT'S ONE NATIONAL POLICY WE 4342 03:03:38,440 --> 03:03:40,880 CAN DRAW FROM. 4343 03:03:40,880 --> 03:03:42,280 WE HAVE TO MOVE TO INDIRECT 4344 03:03:42,280 --> 03:03:44,640 POLICIES AT THE STATE LEVEL. 4345 03:03:44,640 --> 03:03:46,520 OF COURSE THERE'S CAREGIVER TAX 4346 03:03:46,520 --> 03:03:48,400 CREDITS PEOPLE HAVE EVALUATED 4347 03:03:48,400 --> 03:03:52,120 BUT IN A RECENT WORKING PAPER WE 4348 03:03:52,120 --> 03:03:55,520 HAVE ESTIMATED HOW NEW STATE 4349 03:03:55,520 --> 03:03:58,520 FAMILY LEAVE POLICIES HAVE 4350 03:03:58,520 --> 03:03:59,720 AFFECTED CAREGIVERS. 4351 03:03:59,720 --> 03:04:01,640 WE FIND EVIDENCE OF INCREASE 4352 03:04:01,640 --> 03:04:03,000 WILL RESILIENCE IN THE PEOPLE 4353 03:04:03,000 --> 03:04:05,240 LIVING IN STATES WITH PAID 4354 03:04:05,240 --> 03:04:07,360 FAMILY LEAVE POLICIES HAVE AN 4355 03:04:07,360 --> 03:04:08,320 INCREASE OF PROVIDING CARE 4356 03:04:08,320 --> 03:04:12,600 GIVING AND HAVE INCREASED LABOR 4357 03:04:12,600 --> 03:04:13,480 ATTACHMENT AMONG THOSE 4358 03:04:13,480 --> 03:04:14,440 CAREGIVERS THOSE LIKELY TO 4359 03:04:14,440 --> 03:04:20,760 BECOME CAREGIVERS. 4360 03:04:20,760 --> 03:04:23,440 THESE ARE AVERAGE AFFECTS BUT WE 4361 03:04:23,440 --> 03:04:26,520 LOOKED AT TRYING TO IMPACT THE 4362 03:04:26,520 --> 03:04:27,800 HETEROGENEITY AND THERE'S A NO 4363 03:04:27,800 --> 03:04:30,440 DIFFERENCES BY RACE OR MARITAL 4364 03:04:30,440 --> 03:04:32,680 STATUS FOR FEMALES IN WHO 4365 03:04:32,680 --> 03:04:34,520 BENEFITS BUT DID FIND FEMALES 4366 03:04:34,520 --> 03:04:36,960 AND LOW-EDUCATION FEMALES IN 4367 03:04:36,960 --> 03:04:37,760 PARTICULAR BENEFIT IN TERMS OF 4368 03:04:37,760 --> 03:04:48,160 LABOR FORCE ATTACHMENT. 4369 03:05:00,720 --> 03:05:01,840 SELF-NOMINATING TO SERVICES IS 4370 03:05:01,840 --> 03:05:03,640 NOT AN EQUITABLE APPROACH AND 4371 03:05:03,640 --> 03:05:06,520 THIS CAME UP IN AN EARLIER TALK 4372 03:05:06,520 --> 03:05:08,600 AND TALKING ABOUT BUILDING THE 4373 03:05:08,600 --> 03:05:09,240 RESEARCH AND POLICY REMEDIES IN 4374 03:05:09,240 --> 03:05:13,840 THE AREA. 4375 03:05:13,840 --> 03:05:16,480 THIS IS A BUSY SLIDE BUT I WANT 4376 03:05:16,480 --> 03:05:19,320 TO HIGHLIGHT USING THE MISSION 4377 03:05:19,320 --> 03:05:22,480 OF PUBLIC HEALTH AND 4378 03:05:22,480 --> 03:05:23,360 MULTI-SECTORIAL APPROACH WILL BE 4379 03:05:23,360 --> 03:05:25,080 AN EQUITABLE POLICY TO SUPPORT 4380 03:05:25,080 --> 03:05:25,360 CAREGIVERS. 4381 03:05:25,360 --> 03:05:29,040 WHY DO WE NEED A PUBLIC HEALTH 4382 03:05:29,040 --> 03:05:30,160 FRAME? 4383 03:05:30,160 --> 03:05:32,440 WE KNOW CAREGIVERS FACE 4384 03:05:32,440 --> 03:05:35,040 HEIGHTENED RISK OF BAD OUTCOMES 4385 03:05:35,040 --> 03:05:37,000 COMPARED TO NON CAREGIVERS. 4386 03:05:37,000 --> 03:05:38,440 THERE'S THE DEFINITION OF PUBLIC 4387 03:05:38,440 --> 03:05:42,120 HEALTH PROBLEM WE NEED TO 4388 03:05:42,120 --> 03:05:42,360 REMEDY. 4389 03:05:42,360 --> 03:05:43,920 EQUITY IS THE CENTER OF THE 4390 03:05:43,920 --> 03:05:44,920 PUBLIC HEALTH FRAME. 4391 03:05:44,920 --> 03:05:47,480 THIS IS WHAT SHOULD GUIDE THE 4392 03:05:47,480 --> 03:05:48,840 MULTI-SECTORIAL APPROACH LOOKING 4393 03:05:48,840 --> 03:05:52,120 AT ASSESSMENT AND POLICY 4394 03:05:52,120 --> 03:05:52,760 DEVELOPMENT. 4395 03:05:52,760 --> 03:05:56,040 IT'S NOT JUST MULTI-SECTORS 4396 03:05:56,040 --> 03:05:56,920 THERE'S SYSTEMS AND EMPLOYERS 4397 03:05:56,920 --> 03:05:57,800 AND RESEARCHERS THAT NEED TO 4398 03:05:57,800 --> 03:06:00,920 WORK IN SILOS AND NEED 4399 03:06:00,920 --> 03:06:01,720 CROSS-COLLABORATION AS SOME 4400 03:06:01,720 --> 03:06:02,320 COLLEAGUES MENTIONED EARLIER 4401 03:06:02,320 --> 03:06:07,520 WHICH I AGREE WITH. 4402 03:06:07,520 --> 03:06:09,440 WITH DR. CHEN'S TALK OF HEALTH 4403 03:06:09,440 --> 03:06:10,360 INFORMATION TECHNOLOGY AND 4404 03:06:10,360 --> 03:06:12,400 PUBLIC HEALTH SYSTEMS WORKING 4405 03:06:12,400 --> 03:06:15,360 TOGETHER WOULD BE AN AMAZING 4406 03:06:15,360 --> 03:06:16,200 COLLABORATION FOR SUPPORTING 4407 03:06:16,200 --> 03:06:21,880 CAREGIVERS MORE BROADLY. 4408 03:06:21,880 --> 03:06:27,360 I'M GOING TO TALK ABOUT A COUPLE 4409 03:06:27,360 --> 03:06:32,720 DIFFERENT SECTORIAL SOLUTIONS 4410 03:06:32,720 --> 03:06:37,560 AND ONE THING WE NEED TO HAVE IS 4411 03:06:37,560 --> 03:06:38,360 INCREASED FUNDING FOR THE 4412 03:06:38,360 --> 03:06:40,920 NATIONAL CAREGIVER STRATEGY 4413 03:06:40,920 --> 03:06:41,280 IMPLEMENTATION. 4414 03:06:41,280 --> 03:06:43,280 PUBLIC HEALTH IS A KEY SECTOR 4415 03:06:43,280 --> 03:06:45,480 THAT COULD HELP WITH SCREENING, 4416 03:06:45,480 --> 03:06:47,040 CREATING REGISTRIES, MONITORING 4417 03:06:47,040 --> 03:06:48,440 RISK THROUGH LOCAL AGENCIES 4418 03:06:48,440 --> 03:06:50,400 PEOPLE TRUST AND USING LIKE AREA 4419 03:06:50,400 --> 03:06:51,800 AGENCIES ON AGING. 4420 03:06:51,800 --> 03:06:53,720 PUBLIC HEALTH CAN USE THE 4421 03:06:53,720 --> 03:06:57,800 LIMITED RESOURCE TO TARGET 4422 03:06:57,800 --> 03:06:58,440 PRESENT AND FUTURE CAREGIVERS 4423 03:06:58,440 --> 03:07:00,960 MOST AT RISK AND LOOKING AT 4424 03:07:00,960 --> 03:07:08,320 WEALTH GAP AMONG BLACK FAMILIES 4425 03:07:08,320 --> 03:07:10,120 IN TERMS OF HISTORICAL WEALTH 4426 03:07:10,120 --> 03:07:13,800 AND FOR EVERY ONE DOLLAR OF 4427 03:07:13,800 --> 03:07:16,000 WHITE WEALTH BLACK FAMILIES HAVE 4428 03:07:16,000 --> 03:07:20,000 12 CENTS AND PUBLIC HEALTH CAN 4429 03:07:20,000 --> 03:07:22,600 LINK TO SERVICES AND TAX CREDITS 4430 03:07:22,600 --> 03:07:24,960 AND EXISTING SERVICES AND 4431 03:07:24,960 --> 03:07:26,520 PROGRAMS THEY ALREADY QUALIFY 4432 03:07:26,520 --> 03:07:29,440 FOR LIKE THE EARNED INCOME TAX 4433 03:07:29,440 --> 03:07:29,800 CREDIT. 4434 03:07:29,800 --> 03:07:30,840 HEALTH SYSTEM SOLUTION 4435 03:07:30,840 --> 03:07:31,280 MULTI-FOLD. 4436 03:07:31,280 --> 03:07:34,680 WE HEARD ABOUT SOME TODAY BUT WE 4437 03:07:34,680 --> 03:07:36,920 NEED TO IDENTIFY CAREGIVERS FOR 4438 03:07:36,920 --> 03:07:37,200 OUTREACH. 4439 03:07:37,200 --> 03:07:38,840 IT'S A NO-BRAINER BUT THERE'S NO 4440 03:07:38,840 --> 03:07:40,640 WAY TO DO IT IN BOTH HEALTH 4441 03:07:40,640 --> 03:07:41,240 SYSTEMS. 4442 03:07:41,240 --> 03:07:44,520 BECAUSE OF THAT WE CAN'T LOOK AT 4443 03:07:44,520 --> 03:07:46,760 THE ABILITY TO PROVIDE CARE OR 4444 03:07:46,760 --> 03:07:49,360 MONITOR HOW THEY'RE DOING. 4445 03:07:49,360 --> 03:07:52,320 WE NEED TO SCREEN PATIENTS. 4446 03:07:52,320 --> 03:07:53,400 PATIENTS ARE CAREGIVERS AND WE 4447 03:07:53,400 --> 03:07:57,200 KNOW THEY FACE HEIGHTENED RISK 4448 03:07:57,200 --> 03:07:59,240 AND USE THE PATIENT VISIT TO 4449 03:07:59,240 --> 03:08:01,680 IDENTIFY CAREGIVERS STATUS AND 4450 03:08:01,680 --> 03:08:04,720 NEED TO INCENTIVIZE CAREGIVERS 4451 03:08:04,720 --> 03:08:09,520 TO IMPROVE QUALITY OF CARE AND 4452 03:08:09,520 --> 03:08:10,280 BEYOND SPREADING EVIDENCE-BASED 4453 03:08:10,280 --> 03:08:12,200 SCREENING WE NEED TO EXPAND 4454 03:08:12,200 --> 03:08:12,800 JOYFUL SUPPORTS BECAUSE NOT 4455 03:08:12,800 --> 03:08:17,800 EVERYONE WANTS TRAINING. 4456 03:08:17,800 --> 03:08:19,560 EMPLOYER SOLUTIONS INCLUDE BASIC 4457 03:08:19,560 --> 03:08:22,400 BENEFITS TO HELP THOSE REMAINING 4458 03:08:22,400 --> 03:08:28,360 WORKING LIKE FLEXIBLE WORK AND 4459 03:08:28,360 --> 03:08:30,400 GERIATRIC AND LONG-TERM CARE 4460 03:08:30,400 --> 03:08:32,520 INSURANCE BENEFITS FOR 4461 03:08:32,520 --> 03:08:33,960 EMPLOYEES. 4462 03:08:33,960 --> 03:08:34,560 RESEARCH SOLUTIONS HAVE BEEN 4463 03:08:34,560 --> 03:08:36,160 TALKED ABOUT ELSEWHERE. 4464 03:08:36,160 --> 03:08:38,280 I'LL FINISH ONE ONE MORE SLIDE. 4465 03:08:38,280 --> 03:08:39,280 THINKING ABOUT THE NATIONAL 4466 03:08:39,280 --> 03:08:42,840 POLICY SOLUTIONS WE NEED TO 4467 03:08:42,840 --> 03:08:47,320 INCREASE FUNDING. 4468 03:08:47,320 --> 03:08:48,720 FROM PAID LEVEL WOULD BE VERY 4469 03:08:48,720 --> 03:08:49,720 BENEFICIAL TO CAREGIVERS AND 4470 03:08:49,720 --> 03:08:52,120 THAT NEEDS TO BE ENACTED. 4471 03:08:52,120 --> 03:08:54,760 CONSIDERING CARE GIVING AS WORK 4472 03:08:54,760 --> 03:08:56,600 WOULD HELP INCREASE CAREGIVER 4473 03:08:56,600 --> 03:09:01,480 RESILIENCE IN THE ECONOMIC FRAME 4474 03:09:01,480 --> 03:09:06,520 AND THINGS LIKE SOCIAL SECURITY 4475 03:09:06,520 --> 03:09:08,440 CREDIT AND ADOPTING SUPPORT AND 4476 03:09:08,440 --> 03:09:11,880 SUPPORTING UNIVERSAL COVERAGE TO 4477 03:09:11,880 --> 03:09:13,600 ENABLE CHOICE WHEN YOU DON'T 4478 03:09:13,600 --> 03:09:14,840 HAVE CHOICE IS WHERE WE HAVE 4479 03:09:14,840 --> 03:09:17,440 WORSE OUTCOMES AND DIDN'T MEET 4480 03:09:17,440 --> 03:09:20,200 THE DEFERENCES OF OLDER ADULTS 4481 03:09:20,200 --> 03:09:21,680 AND THOSE LIVING WITH DEMENTIA 4482 03:09:21,680 --> 03:09:22,800 IN SOME CASES. 4483 03:09:22,800 --> 03:09:25,360 USING THIS FRAME WE WOULD HAVE A 4484 03:09:25,360 --> 03:09:26,840 WORLD WHERE CAREGIVERS HAVE 4485 03:09:26,840 --> 03:09:28,680 EQUITABLE POLICY SUPPORT AND 4486 03:09:28,680 --> 03:09:30,400 THESE ARE SOME OF THE BENEFITS 4487 03:09:30,400 --> 03:09:32,200 WE'D SEE. 4488 03:09:32,200 --> 03:09:33,040 I'LL STOP THERE. 4489 03:09:33,040 --> 03:09:34,160 THIS COULD BE A GUIDELINE 4490 03:09:34,160 --> 03:09:36,160 BECAUSE THEY'VE BEEN 4491 03:09:36,160 --> 03:09:36,880 IMPLEMENTING A NATIONAL PROGRAM 4492 03:09:36,880 --> 03:09:43,360 IN THE LAST 11 YEARS. 4493 03:09:43,360 --> 03:09:46,280 >>THANK YOU TO ALL THE SPEAKERS 4494 03:09:46,280 --> 03:09:49,520 AND I WANT TO JUST SAY TO 4495 03:09:49,520 --> 03:09:51,280 EVERYONE PARTICIPATING AS I GO 4496 03:09:51,280 --> 03:09:53,320 OVER THE RESEARCH GAPS AND 4497 03:09:53,320 --> 03:09:57,320 OPPORTUNITIES WE REALLY ARE 4498 03:09:57,320 --> 03:09:59,760 DEPENDING ON YOUR COMMENTS AND 4499 03:09:59,760 --> 03:10:00,560 THOUGHTS ABOUT THEM. 4500 03:10:00,560 --> 03:10:02,360 ONE OF THE BIG OUTCOMES OF THE 4501 03:10:02,360 --> 03:10:06,720 SUMMIT IS GOING TO BE A SET OF 4502 03:10:06,720 --> 03:10:08,440 GAPS AND OPPORTUNITIES AND THEY 4503 03:10:08,440 --> 03:10:10,320 BENEFIT FROM FEEDBACK AND 4504 03:10:10,320 --> 03:10:10,640 SUGGESTIONS. 4505 03:10:10,640 --> 03:10:15,880 THE GAPS AND OPPORTUNITIES WE'VE 4506 03:10:15,880 --> 03:10:18,640 IDENTIFIED WE WANT TO RECOMMEND 4507 03:10:18,640 --> 03:10:19,600 CONDUCTING RESEARCH TO EVALUATE 4508 03:10:19,600 --> 03:10:22,160 NEW AND EXISTING METHODS TO 4509 03:10:22,160 --> 03:10:23,680 ENABLE HEALTH SYSTEMS TO IMPROVE 4510 03:10:23,680 --> 03:10:24,280 EQUITABLE IDENTIFICATION OF 4511 03:10:24,280 --> 03:10:31,160 CAREGIVERS. 4512 03:10:31,160 --> 03:10:34,880 WE JUST HEARD IT'S HARD TO FIND 4513 03:10:34,880 --> 03:10:36,360 CAREGIVERS WE NEED EQUITABLE 4514 03:10:36,360 --> 03:10:36,960 IDENTIFICATION TO PROVIDE 4515 03:10:36,960 --> 03:10:38,640 SUPPORT AND SERVICES AND INVOLVE 4516 03:10:38,640 --> 03:10:42,480 THEM IN THE DEVELOPMENT AS WELL 4517 03:10:42,480 --> 03:10:43,720 AS TESTING OF CAREGIVER FOCUSSED 4518 03:10:43,720 --> 03:10:50,240 INTERVENTIONS. 4519 03:10:50,240 --> 03:10:52,240 AND HERE WE'RE ECHOING ONE OF 4520 03:10:52,240 --> 03:10:56,520 THE MAJOR THEMES LOOKING AT 4521 03:10:56,520 --> 03:10:57,600 CULTURALLY INFORMED RESEARCH ON 4522 03:10:57,600 --> 03:10:59,720 CAREGIVER AND THE SUPPORT FOR 4523 03:10:59,720 --> 03:11:07,640 CARE AND CAREGIVING THAT 4524 03:11:07,640 --> 03:11:09,880 INCORPORATES CAREGIVING AS A 4525 03:11:09,880 --> 03:11:12,640 CONDITION AND BUILD ROBUST 4526 03:11:12,640 --> 03:11:14,040 RESEARCH EVIDENCE ABOUT 4527 03:11:14,040 --> 03:11:17,120 SYSTEMS-LEVELS POLICIES AND 4528 03:11:17,120 --> 03:11:19,320 POLICIES ACROSS THE SECTORS JUST 4529 03:11:19,320 --> 03:11:21,240 DISCUSSED REGARDING THE 4530 03:11:21,240 --> 03:11:26,080 POSITIVE, NEGATIVE OR NEUTRAL 4531 03:11:26,080 --> 03:11:26,880 AFFECTS ON CAREGIVER RESILIENCE 4532 03:11:26,880 --> 03:11:29,960 AND INEQUITIES AND ACCESS TO 4533 03:11:29,960 --> 03:11:31,200 SUPPORTS AND SERVICE. 4534 03:11:31,200 --> 03:11:32,600 THEY INCLUDE BUT ARE NOT LIMITED 4535 03:11:32,600 --> 03:11:37,520 TO PUBLIC HEALTH, HEALTH 4536 03:11:37,520 --> 03:11:38,480 SYSTEMS, COMMERCIAL AND 4537 03:11:38,480 --> 03:11:43,160 CORPORATE ENTITIES. 4538 03:11:43,160 --> 03:11:45,440 AND LOOK AT CAREGIVER RACE, 4539 03:11:45,440 --> 03:11:48,480 SOCIO ECONOMIC STATUS, PLACE AND 4540 03:11:48,480 --> 03:11:50,520 HEALTH LITERACY. 4541 03:11:50,520 --> 03:11:51,560 THOSE ARE GAPS IN OUR 4542 03:11:51,560 --> 03:11:51,880 OPPORTUNITIES. 4543 03:11:51,880 --> 03:11:55,840 I WANT TO TURN IT OVER TO OUR 4544 03:11:55,840 --> 03:11:56,160 DISCUSSANTS. 4545 03:11:56,160 --> 03:12:01,080 >>I'LL TURN IT OVER TO RITA 4546 03:12:01,080 --> 03:12:05,320 CHOULA AND CASSANDRA THOMAS AND 4547 03:12:05,320 --> 03:12:08,000 JASON RESENDEZ TALK ABOUT THEIR 4548 03:12:08,000 --> 03:12:09,080 EXPERIENCE IN THE ADVOCACY AND 4549 03:12:09,080 --> 03:12:09,520 PUBLIC POLICY SPACE. 4550 03:12:09,520 --> 03:12:12,680 RITA. 4551 03:12:12,680 --> 03:12:13,360 >>GOOD AFTERNOON. 4552 03:12:13,360 --> 03:12:15,960 I'M RITA CHOULA SENIOR DIRECTOR 4553 03:12:15,960 --> 03:12:18,240 AARP PUBLIC POLICY INSTITUTE. 4554 03:12:18,240 --> 03:12:21,200 I'D LIKE TO START BY SAYING 4555 03:12:21,200 --> 03:12:22,320 THANK YOU TO THE FAMILY 4556 03:12:22,320 --> 03:12:23,840 CAREGIVERS WHO HAVE SPOKEN TODAY 4557 03:12:23,840 --> 03:12:24,600 AND YESTERDAY. 4558 03:12:24,600 --> 03:12:28,320 AS A FORMER FAMILY CAREGIVER TO 4559 03:12:28,320 --> 03:12:33,760 MY MOTHER WHO LIVED WITH FRONTAL 4560 03:12:33,760 --> 03:12:38,480 TEMPORO DEMENTIA AND THEY OPEN A 4561 03:12:38,480 --> 03:12:43,280 WEN -- WINDOW TO THE REALITIES 4562 03:12:43,280 --> 03:12:46,000 FACED ON A DAILY BASIS FROM CARE 4563 03:12:46,000 --> 03:12:50,440 PARTNERS AND KNOWS THEY CARE FOR 4564 03:12:50,440 --> 03:12:51,760 WITH DEMENTIA. 4565 03:12:51,760 --> 03:12:53,360 THIS SHOULD INFORM RESEARCH 4566 03:12:53,360 --> 03:12:56,280 POLICY AND PRACTICE AND WHILE 4567 03:12:56,280 --> 03:12:58,800 OFTEN SILOED IT'S A CRITICAL 4568 03:12:58,800 --> 03:13:01,160 TRIAD THAT SHOULD WORK IN 4569 03:13:01,160 --> 03:13:02,440 CONCERT TO DEVELOP SOLUTION 4570 03:13:02,440 --> 03:13:04,560 SHOULD IMPACT FAMILY CAREGIVERS 4571 03:13:04,560 --> 03:13:06,080 AND THOSE LIVING WITH DEMENTIA. 4572 03:13:06,080 --> 03:13:10,520 I OFTEN HEAR THE TERM INFORMAL 4573 03:13:10,520 --> 03:13:11,400 CAREGIVERS WHETHER YOU USE THE 4574 03:13:11,400 --> 03:13:13,120 TERMS CAREGIVER OR CARE PARTNER 4575 03:13:13,120 --> 03:13:14,080 OR SOMETHING ELSE, I 4576 03:13:14,080 --> 03:13:14,920 RESPECTFULLY WOULD LIKE TO 4577 03:13:14,920 --> 03:13:18,760 ADDRESS THE USE OF THE TERM 4578 03:13:18,760 --> 03:13:19,120 INFORMAL. 4579 03:13:19,120 --> 03:13:20,600 AS THE STORY SHARED IN THE LAST 4580 03:13:20,600 --> 03:13:23,280 TWO DAYS AND MILLIONS OF OTHERS 4581 03:13:23,280 --> 03:13:24,400 LIVE THERE'S NOTHING INFORMAL 4582 03:13:24,400 --> 03:13:26,160 ABOUT THE MILLIONS OF HOURS OF 4583 03:13:26,160 --> 03:13:27,280 UNPAID CARE FAMILY AND FRIENDS 4584 03:13:27,280 --> 03:13:31,560 PROVIDE. 4585 03:13:31,560 --> 03:13:33,760 I APPRECIATED DR. ROBERTO'S 4586 03:13:33,760 --> 03:13:34,920 FOCUS ON THE RECOGNITION FAMILY 4587 03:13:34,920 --> 03:13:36,840 IS A BROAD TERM. 4588 03:13:36,840 --> 03:13:37,840 IT'S CRITICAL RESEARCH 4589 03:13:37,840 --> 03:13:39,320 DEFINITIONS ARE INCLUSIVE AND 4590 03:13:39,320 --> 03:13:43,720 RECOGNIZE HOW FAMILY IS DEFINED 4591 03:13:43,720 --> 03:13:46,520 ACROSS CULTURES, GEOGRAPHY, RACE 4592 03:13:46,520 --> 03:13:48,720 AND GENDER AND SEXUAL IDENTITIES 4593 03:13:48,720 --> 03:13:50,400 AND RECOGNIZING FAMILY IS OFTEN 4594 03:13:50,400 --> 03:13:58,200 ONE PERSON, A SOLE CAREGIVER. 4595 03:13:58,200 --> 03:14:04,080 DR. GAUGLER AND VAN HOUTVEN 4596 03:14:04,080 --> 03:14:06,200 SPEAK TO THIS WHETHER WE TALK 4597 03:14:06,200 --> 03:14:10,040 RESEARCH OR POLICY SO OFTEN WE 4598 03:14:10,040 --> 03:14:11,440 HEAR FROM CAREGIVERS THEY FEEL 4599 03:14:11,440 --> 03:14:13,840 INVISIBLE WHETHER AT THE BEDSIDE 4600 03:14:13,840 --> 03:14:15,480 NAVIGATING COMPLEX SYSTEMS OR IN 4601 03:14:15,480 --> 03:14:16,920 THEIR EVERYDAY RESPONSIBILITY. 4602 03:14:16,920 --> 03:14:19,520 THERE'S RESEARCH AND RELATED 4603 03:14:19,520 --> 03:14:21,040 INTERVENTIONS DEVELOPED THAT 4604 03:14:21,040 --> 03:14:25,160 SPEAKS TO THE MANY OF THE NEEDS 4605 03:14:25,160 --> 03:14:27,400 THESE CAREGIVERS FACE. 4606 03:14:27,400 --> 03:14:30,320 HOWEVER, IT OFTEN STOPS AT THE 4607 03:14:30,320 --> 03:14:31,200 PROVERBIAL DOOR. 4608 03:14:31,200 --> 03:14:33,000 THE INTERVENTIONS IS WHAT 4609 03:14:33,000 --> 03:14:34,520 IMPACTS THOSE WE'RE TRYING TO 4610 03:14:34,520 --> 03:14:38,440 SUPPORT. 4611 03:14:38,440 --> 03:14:40,320 DR. VAN HOUTVEN SPEAKS TO THE 4612 03:14:40,320 --> 03:14:41,760 NEAT FOR POLICY SOLUTIONS 4613 03:14:41,760 --> 03:14:43,160 FEDERALLY AND IN STATES. 4614 03:14:43,160 --> 03:14:45,560 THERE IS HEIGHTENED FOCUS 4615 03:14:45,560 --> 03:14:48,680 RIGHTFULLY SO ON THE NED FOR -- 4616 03:14:48,680 --> 03:14:51,800 NEED FOR THE SOLUTIONS TO 4617 03:14:51,800 --> 03:14:52,640 SUPPORT CAREGIVERS. 4618 03:14:52,640 --> 03:14:55,560 WE HAVE A UNIQUE AND OVERDUE 4619 03:14:55,560 --> 03:14:58,880 OPPORTUNITY TO MAKE A DIFFERENCE 4620 03:14:58,880 --> 03:15:01,560 IN THE LIVES OF CAREGIVERS BY 4621 03:15:01,560 --> 03:15:04,520 PUTTING INTO ACTION THE SUPPORT 4622 03:15:04,520 --> 03:15:05,280 TO CAREGIVERS DELIVERED TO 4623 03:15:05,280 --> 03:15:07,640 CONSIDERATION LAST SEPTEMBER. 4624 03:15:07,640 --> 03:15:10,080 I WANT TO QUOTE DR. VAN HOUTVEN 4625 03:15:10,080 --> 03:15:14,800 AND ENCOURAGE US TO LOOK BEYOND 4626 03:15:14,800 --> 03:15:17,440 THE AVERAGE. 4627 03:15:17,440 --> 03:15:19,200 IN ORDER TO LOOK AT INEQUITIES 4628 03:15:19,200 --> 03:15:21,280 AND BIAS AND LACK OF ACCESS TO 4629 03:15:21,280 --> 03:15:23,160 QUALITY SERVICE AND SUPPORT AND 4630 03:15:23,160 --> 03:15:27,120 THE OVER ALL COST OF CAREGIVING 4631 03:15:27,120 --> 03:15:28,480 PARTICULARLY IN MINORITIZED 4632 03:15:28,480 --> 03:15:29,640 COMMUNITIES WE MUST MAKE CHANGES 4633 03:15:29,640 --> 03:15:31,960 IN HOW WE DEVELOP AND IMPLEMENT 4634 03:15:31,960 --> 03:15:34,520 RESEARCH AND POLICY FOR FAMILY 4635 03:15:34,520 --> 03:15:34,960 CAREGIVERS. 4636 03:15:34,960 --> 03:15:36,680 THIS WORK IS INTENTIONAL AND 4637 03:15:36,680 --> 03:15:39,720 NEEDS TO BE DONE TO BRING ABOUT 4638 03:15:39,720 --> 03:15:41,200 INTEGRATED SYSTEMS AND SUPPORTS 4639 03:15:41,200 --> 03:15:42,720 THAT ADDRESS THE COST OF THOSE 4640 03:15:42,720 --> 03:15:45,080 LIVING WITH DEMENTIAS AND THEIR 4641 03:15:45,080 --> 03:15:46,080 FAMILIES. 4642 03:15:46,080 --> 03:15:46,680 IT MAY NOT BE EASY BUT IT IS 4643 03:15:46,680 --> 03:15:48,600 CRITICAL. 4644 03:15:48,600 --> 03:15:50,440 THANK YOU FOR THE OPPORTUNITY TO 4645 03:15:50,440 --> 03:15:51,000 SPEAK TODAY. 4646 03:15:51,000 --> 03:15:51,720 I LOOK FORWARD TO FURTHER 4647 03:15:51,720 --> 03:15:59,040 DISCUSSION. 4648 03:15:59,040 --> 03:16:02,080 >>THANK YOU, RITA AND FOR 4649 03:16:02,080 --> 03:16:03,040 INCLUDING ME. 4650 03:16:03,040 --> 03:16:10,360 I'M JASON RESENDEZ AND CEO OF AN 4651 03:16:10,360 --> 03:16:13,000 ORGANIZATION FOCUSSED ON 4652 03:16:13,000 --> 03:16:14,600 BUILDING HEALTH AND WEALTH 4653 03:16:14,600 --> 03:16:15,760 EQUITY THROUGH RESEARCH POLICY 4654 03:16:15,760 --> 03:16:17,520 AND INNOVATION. 4655 03:16:17,520 --> 03:16:18,720 A RIGOROUS FOCUS ON 4656 03:16:18,720 --> 03:16:19,640 UNDERSTANDING AND ADDRESSING THE 4657 03:16:19,640 --> 03:16:21,840 IMPACT OF DEMENTIA CARE AND 4658 03:16:21,840 --> 03:16:25,000 FAMILY CAREGIVERS IS CRITICAL 4659 03:16:25,000 --> 03:16:27,680 GIVEN THE VITAL ROLE PLAYED IN 4660 03:16:27,680 --> 03:16:29,880 HELPING CARE PARTNERS NAVIGATE 4661 03:16:29,880 --> 03:16:31,000 COMPLEX HEALTH CARE AND ECONOMIC 4662 03:16:31,000 --> 03:16:34,280 REALITIES ASSOCIATED WITH 4663 03:16:34,280 --> 03:16:34,520 DEMENTIA. 4664 03:16:34,520 --> 03:16:36,720 AS DR. HEPBURN HIGHLIGHTED THEY 4665 03:16:36,720 --> 03:16:37,920 CREATE SYSTEMS WHERE DON'T EXIST 4666 03:16:37,920 --> 03:16:41,160 AND TAKE IT A STEP FURTHER. 4667 03:16:41,160 --> 03:16:44,640 FAMILY CAREGIVERS ARE THE HUMAN 4668 03:16:44,640 --> 03:16:45,200 INFRASTRUCTURE THAT MAKE 4669 03:16:45,200 --> 03:16:46,360 DEMENTIA CARE POSSIBLE IN THIS 4670 03:16:46,360 --> 03:16:47,560 COUNTRY AND ANY COUNTRY. 4671 03:16:47,560 --> 03:16:48,840 ACCORDING TO THE NATIONAL 4672 03:16:48,840 --> 03:16:50,440 ALLIANCE FOR CARE GIVING AND 4673 03:16:50,440 --> 03:16:57,040 PARTNERS AT AARP, THEY ARE 53 4674 03:16:57,040 --> 03:16:58,400 MILLION AMERICANS PROVIDING 4675 03:16:58,400 --> 03:16:58,600 CARE. 4676 03:16:58,600 --> 03:17:02,440 IT COMES WITH SOME REWARDING AND 4677 03:17:02,440 --> 03:17:04,040 SOME HARMFUL CONSEQUENCES. 4678 03:17:04,040 --> 03:17:05,400 CAREGIVERS OF COLOR EXPERIENCE 4679 03:17:05,400 --> 03:17:07,360 NEGATIVE HEALTH AND ECONOMIC 4680 03:17:07,360 --> 03:17:08,920 CONSEQUENCES DUE TO FAMILY 4681 03:17:08,920 --> 03:17:09,160 CAREGIVER. 4682 03:17:09,160 --> 03:17:13,120 WHEN RESUMING DEMENTIA 4683 03:17:13,120 --> 03:17:14,240 SPECIFICALLY NEARLY HALF 4684 03:17:14,240 --> 03:17:17,600 CAREGIVERS SAY PROVIDING CARE IS 4685 03:17:17,600 --> 03:17:20,800 EMOTIONALLY STRESSFUL AND OFTEN 4686 03:17:20,800 --> 03:17:21,920 INVOLVES PHYSICAL STRAIN. 4687 03:17:21,920 --> 03:17:23,600 AND THEY'RE TWICE AS LIKELY TO 4688 03:17:23,600 --> 03:17:25,320 SAY THEY'RE HEALTH HAS GOTTEN 4689 03:17:25,320 --> 03:17:29,600 WORSE AS A RESULT OF THEIR 4690 03:17:29,600 --> 03:17:31,160 CAREGIVING RESPONSIBILITIES 4691 03:17:31,160 --> 03:17:34,480 COMPARED TO OTHER CAREGIVERS AND 4692 03:17:34,480 --> 03:17:37,200 6 IN 10 PROVIDER CARE WHILE 4693 03:17:37,200 --> 03:17:38,800 WORKING LEADING TO CONSEQUENCES 4694 03:17:38,800 --> 03:17:40,000 AS THAT CARE BECOMES MORE 4695 03:17:40,000 --> 03:17:44,920 DIFFICULT TO BALANCE WITH WORK. 4696 03:17:44,920 --> 03:17:47,520 THESE ISSUES BECOME MORE 4697 03:17:47,520 --> 03:17:53,200 CHALLENGING WHEN WE CONSIDER 4698 03:17:53,200 --> 03:17:57,840 OTHER BARRIERS AND ACCESS TO 4699 03:17:57,840 --> 03:18:00,440 HEALTH CARE AND AMPLIFIED WITH 4700 03:18:00,440 --> 03:18:01,600 THOSE WHO REQUIRE SPECIALIZED 4701 03:18:01,600 --> 03:18:02,920 HEALTH CARE SERVICES HARDER AND 4702 03:18:02,920 --> 03:18:04,360 HARDER TO COME BY IN 4703 03:18:04,360 --> 03:18:06,720 LOW-RESOURCED COMMUNITIES. 4704 03:18:06,720 --> 03:18:07,720 THE REALITY UNDER SCORES THE 4705 03:18:07,720 --> 03:18:09,560 IMPORTANCE OF THE DEVELOPMENT OF 4706 03:18:09,560 --> 03:18:11,200 INTERVENTIONS ESPECIALLY 4707 03:18:11,200 --> 03:18:12,600 HOME-BASED INTERVENTIONS ROOTED 4708 03:18:12,600 --> 03:18:13,640 IN THE LIVED EXPERIENCE OF 4709 03:18:13,640 --> 03:18:15,840 PEOPLE LIVING WITH DEMENTIA AND 4710 03:18:15,840 --> 03:18:17,280 THEIR CAREGIVERS. 4711 03:18:17,280 --> 03:18:22,640 AND THE CONSEQUENCES OF DEMENTIA 4712 03:18:22,640 --> 03:18:23,560 CAREGIVING UNDER SCORE POLICY 4713 03:18:23,560 --> 03:18:27,600 AND POLICIES THAT CATALYZE 4714 03:18:27,600 --> 03:18:32,480 CAREGIVER EDUCATION AND ADVANCED 4715 03:18:32,480 --> 03:18:35,240 SECURITIES AND MANAGING RISK. 4716 03:18:35,240 --> 03:18:38,840 THE NATIONAL STRATEGY FOR FAMILY 4717 03:18:38,840 --> 03:18:40,040 CAREGIVING IS UNDER RESOURCED 4718 03:18:40,040 --> 03:18:42,080 AND NECESSITATES SUPPORT AND 4719 03:18:42,080 --> 03:18:44,720 FURTHER INVESTMENT AND FOCUS. 4720 03:18:44,720 --> 03:18:45,440 THANK YOU ALL FOR THIS 4721 03:18:45,440 --> 03:18:47,320 OPPORTUNITY TO SPEAK AND I LOOK 4722 03:18:47,320 --> 03:18:53,680 FORWARD TO CONTINUED DISCUSSION. 4723 03:18:53,680 --> 03:18:57,160 >>HELLO. 4724 03:18:57,160 --> 03:19:00,160 THANK YOU FOR INVITING ME. 4725 03:19:00,160 --> 03:19:08,960 MY NAME IS CAS AN DRA AND -- 4726 03:19:08,960 --> 03:19:17,600 CAS -- CASSANDRA AND I CARED FOR 4727 03:19:17,600 --> 03:19:19,720 MY GRANDMOTHER WITH DEMENTIA AND 4728 03:19:19,720 --> 03:19:21,120 BEFORE THAT I WAS FIRST AND 4729 03:19:21,120 --> 03:19:24,400 FOREMOST A GRANDDAUGHTER. 4730 03:19:24,400 --> 03:19:26,160 THERE IS A LOT OF LOVE AND 4731 03:19:26,160 --> 03:19:30,520 SUPPORT BUT ALSO THERE'S A NEED 4732 03:19:30,520 --> 03:19:33,400 FOR MORE SOCIAL SUPPORT AND 4733 03:19:33,400 --> 03:19:35,280 DIAGNOSIS OF THESE SYMPTOMS. 4734 03:19:35,280 --> 03:19:38,640 I ACCEPTED TO LIVE WITH MY 4735 03:19:38,640 --> 03:19:40,120 GRANDMOTHER IN HER APARTMENT 4736 03:19:40,120 --> 03:19:43,680 AFTER THE PASSING OF MY 4737 03:19:43,680 --> 03:19:45,920 GRANDFATHER AND THE DIAGNOSIS OF 4738 03:19:45,920 --> 03:19:47,280 HER SYMPTOMS AND NEED WAS FILLED 4739 03:19:47,280 --> 03:19:49,040 WITH ANXIETY AND SHAME DUE TO 4740 03:19:49,040 --> 03:19:50,600 POOR CULTURAL SENSITIVITY AND 4741 03:19:50,600 --> 03:19:53,840 LACK OF AFFIRMATION OF THE 4742 03:19:53,840 --> 03:19:55,600 FRUSTRATIONS MY GRANDMOTHER 4743 03:19:55,600 --> 03:20:00,480 ENCOUNTERED ON A DAILY BASIS. 4744 03:20:00,480 --> 03:20:01,840 THAT'S A SPECIFIC CONCERN IS 4745 03:20:01,840 --> 03:20:03,800 IT'S A DAILY BASE FOR THE 4746 03:20:03,800 --> 03:20:05,760 DISEASE AND THE CONCERNS AND 4747 03:20:05,760 --> 03:20:07,720 SYMPTOMS ARE AFFECTING MOBILITY, 4748 03:20:07,720 --> 03:20:09,200 VERBAL CUES, COMMUNICATION. 4749 03:20:09,200 --> 03:20:11,360 I WOULD OFTEN INSIGHT OTHER 4750 03:20:11,360 --> 03:20:12,440 FAMILIES TO TREAT HER TO LUNCH 4751 03:20:12,440 --> 03:20:14,840 SO I WOULD HAVE A MENTAL HEALTH 4752 03:20:14,840 --> 03:20:16,720 BREAK AND PEER SUPPORT BUT ALSO 4753 03:20:16,720 --> 03:20:17,400 SHE WOULD GET WEEKLY SOCIAL 4754 03:20:17,400 --> 03:20:20,400 INTERACTIONS. 4755 03:20:20,400 --> 03:20:22,280 A LOT OF THE TIMES IT DID FEEL 4756 03:20:22,280 --> 03:20:25,080 LIKE MY GRANDMOTHER AND I WERE 4757 03:20:25,080 --> 03:20:26,400 ALONE IN DEALING WITH DAILY 4758 03:20:26,400 --> 03:20:26,720 CHALLENGES. 4759 03:20:26,720 --> 03:20:29,560 I LEARNED TO ASSERT MY NEEDS 4760 03:20:29,560 --> 03:20:31,640 WITH RESPITE CARE AND CHECKLIST 4761 03:20:31,640 --> 03:20:34,920 OF NEEDS AND LIMITED PART-TIME 4762 03:20:34,920 --> 03:20:37,440 JOBS AND EDUCATION FROM 4763 03:20:37,440 --> 03:20:39,440 HANDBOOKS FROM THE COUNTY AND 4764 03:20:39,440 --> 03:20:40,560 AGING DISABILITY RESOURCE 4765 03:20:40,560 --> 03:20:41,400 CENTERS. 4766 03:20:41,400 --> 03:20:43,840 WE HAVE THE ASSET OF A COMMUNITY 4767 03:20:43,840 --> 03:20:46,160 NURSE TO FILLED HER MEDICATIONS 4768 03:20:46,160 --> 03:20:47,440 HOWEVER, THE MORE 4769 03:20:47,440 --> 03:20:48,840 DISEASE-SPECIFIC QUESTIONS WERE 4770 03:20:48,840 --> 03:20:52,080 UNANSWERED IN THOSE 4771 03:20:52,080 --> 03:20:53,000 INTERACTIONS. 4772 03:20:53,000 --> 03:20:55,800 AS THE DISEASE PROGRESSED 4773 03:20:55,800 --> 03:20:56,760 ASSERTING WHAT MY GRANDMOTHER 4774 03:20:56,760 --> 03:21:01,720 HAD TO SHARE WAS IMPORTANT AND I 4775 03:21:01,720 --> 03:21:03,560 HAD AN OPPORTUNITY TO BE MORE 4776 03:21:03,560 --> 03:21:04,920 PATIENT AND ENCOURAGE HER TO 4777 03:21:04,920 --> 03:21:06,120 FIND THE WORDS WITHOUT HELPING 4778 03:21:06,120 --> 03:21:08,800 AND RESOURCES ON THE RESERVATION 4779 03:21:08,800 --> 03:21:10,160 IMPACTED OUR QUALITY OF CARE. 4780 03:21:10,160 --> 03:21:12,680 THE LACK OF MEDICAL SUPPLIES AND 4781 03:21:12,680 --> 03:21:15,600 LOAN CLOSETS AND SEEKING MORE 4782 03:21:15,600 --> 03:21:19,000 TRAINING AND TIME MANAGEMENT WAS 4783 03:21:19,000 --> 03:21:19,320 CHALLENGING. 4784 03:21:19,320 --> 03:21:20,480 HOWEVER, THE HEALTH EDUCATION 4785 03:21:20,480 --> 03:21:23,440 AND CULTURAL SENSITIVE OF 4786 03:21:23,440 --> 03:21:25,040 IDENTIFYING SOCIAL SUPPORT AND 4787 03:21:25,040 --> 03:21:26,280 RESPONSIBILITIES WITH THE 4788 03:21:26,280 --> 03:21:27,920 ISOLATION AND LOCKDOWN AND 4789 03:21:27,920 --> 03:21:30,320 HOLDING THE SPACES FOR 4790 03:21:30,320 --> 03:21:32,720 COMMUNICATION TO ADAPT AND MEET 4791 03:21:32,720 --> 03:21:35,520 THE FRUSTRATION IS A STEP IN 4792 03:21:35,520 --> 03:21:37,840 EMPOWERING OUR CAREGIVERS AND 4793 03:21:37,840 --> 03:21:38,080 FAMILY. 4794 03:21:38,080 --> 03:21:39,200 THANK YOU FOR THE OPPORTUNITY TO 4795 03:21:39,200 --> 03:21:40,800 SPEAK AND I LOOK FORWARD TO 4796 03:21:40,800 --> 03:21:47,360 FUTURE DISCUSSION. 4797 03:21:47,360 --> 03:21:49,600 >>HOW TO ALL OF OUR PANELISTS 4798 03:21:49,600 --> 03:21:50,200 AND DISCUSSANTS. 4799 03:21:50,200 --> 03:21:52,360 WE'LL HAVE ABOUT A 15-QUESTION 4800 03:21:52,360 --> 03:21:54,480 QUESTION AND ANSWER PERIOD AND I 4801 03:21:54,480 --> 03:21:55,360 HAVE A QUESTION TO START THINGS 4802 03:21:55,360 --> 03:21:57,200 OFF. 4803 03:21:57,200 --> 03:22:03,000 I WOULD LIKE ADVICE AS A 4804 03:22:03,000 --> 03:22:05,920 RESEARCHER ABOUT WHAT IT IS -- 4805 03:22:05,920 --> 03:22:12,560 WHAT TERM IS THIS USED TO ENGAGE 4806 03:22:12,560 --> 03:22:14,600 FAMILY CAREGIVERS IN RESEARCH. 4807 03:22:14,600 --> 03:22:19,400 IS IT FAMILY CAREGIVER, CARE 4808 03:22:19,400 --> 03:22:21,800 ASSISTANT WHICH CASSANDRA JUST 4809 03:22:21,800 --> 03:22:22,800 USED? 4810 03:22:22,800 --> 03:22:26,440 THAT'S ONE PART OF THE QUESTION. 4811 03:22:26,440 --> 03:22:27,920 THE SECOND IS MAYBE MORE TO THE 4812 03:22:27,920 --> 03:22:29,600 CARE PARTNERS AND CAREGIVERS. 4813 03:22:29,600 --> 03:22:33,320 I'M STRUCK BY ROBERTA'S 4814 03:22:33,320 --> 03:22:35,360 EXPERIENCE BASICALLY HAVING TO 4815 03:22:35,360 --> 03:22:40,920 GRAB THE PROVIDER BY THE THROAT 4816 03:22:40,920 --> 03:22:43,080 IN ORDER TO GET A DIAGNOSIS. 4817 03:22:43,080 --> 03:22:44,720 WHAT SHOULD A CAREGIVER CALL 4818 03:22:44,720 --> 03:22:46,400 HERSELF OR HIMSELF? 4819 03:22:46,400 --> 03:22:51,240 HOW SHOULD THAT PERSON IDENTIFY 4820 03:22:51,240 --> 03:22:53,000 SO AS TO GAIN AGENCY IN AN 4821 03:22:53,000 --> 03:22:55,480 ENVIRONMENT WHERE CARE IS BEING 4822 03:22:55,480 --> 03:22:57,800 PROVIDED AND NOT BE DISREGARDED? 4823 03:22:57,800 --> 03:23:02,680 SO TWO QUESTIONS. 4824 03:23:02,680 --> 03:23:05,040 >>I'LL START WITH THE FIRST 4825 03:23:05,040 --> 03:23:08,280 ABOUT WHAT DO WE CALL OR HOW WE 4826 03:23:08,280 --> 03:23:09,280 IDENTIFY THE CAREGIVERS. 4827 03:23:09,280 --> 03:23:11,480 WE FIND THAT CHALLENGING 4828 03:23:11,480 --> 03:23:12,520 PARTICULARLY IN RURAL AREAS THAT 4829 03:23:12,520 --> 03:23:16,600 THE FAMILY MEMBERS DO NOT SEE 4830 03:23:16,600 --> 03:23:17,720 THEMSELVES AS CAREGIVERS. 4831 03:23:17,720 --> 03:23:18,320 THEY'RE DOING WHAT THEY'RE 4832 03:23:18,320 --> 03:23:20,560 SUPPOSED TO BE DOING. 4833 03:23:20,560 --> 03:23:24,640 WE HAVE TRIED HELPERS, AFTERING 4834 03:23:24,640 --> 03:23:26,040 PERSONS WITH MEMORY PROBLEMS AND 4835 03:23:26,040 --> 03:23:26,920 THOSE TERMS. 4836 03:23:26,920 --> 03:23:31,280 ONCE WE START TALKING TO THEM 4837 03:23:31,280 --> 03:23:35,640 THEY SAY, OH, YEAH, I AM A 4838 03:23:35,640 --> 03:23:41,800 CAREGIVER AND THEN IT'S MORE 4839 03:23:41,800 --> 03:23:44,480 COMMON BUT PEOPLE DON'T PERCEIVE 4840 03:23:44,480 --> 03:23:45,480 THEMSELVES AS CAREGIVERS. 4841 03:23:45,480 --> 03:23:47,520 >>I THINK AT LEAST IN OUR 4842 03:23:47,520 --> 03:23:48,480 RESEARCH WE DON'T LABEL PEOPLE 4843 03:23:48,480 --> 03:23:50,840 BUT WE TRY TO IDENTIFY PEOPLE BY 4844 03:23:50,840 --> 03:23:52,520 WHAT ACTIVITIES THEY PERFORM 4845 03:23:52,520 --> 03:23:55,680 WHEN WE TRY TO ASK THEM DO YOU 4846 03:23:55,680 --> 03:23:57,680 REGULARLY HELP A FAMILY MEMBER 4847 03:23:57,680 --> 03:24:00,280 OR FRIEND DUE TO THEIR ONGOING 4848 03:24:00,280 --> 03:24:00,840 HEALTH PROBLEMS? 4849 03:24:00,840 --> 03:24:03,120 IT'S PROBABLY NOT EXACTLY THE 4850 03:24:03,120 --> 03:24:05,200 QUESTION AND LET THEM COME TO 4851 03:24:05,200 --> 03:24:07,520 THEIR OWN ROLE. 4852 03:24:07,520 --> 03:24:09,200 I THINK LIKE IN HEALTH ECONOMICS 4853 03:24:09,200 --> 03:24:11,600 WE USE THE TERM INFORMAL CARE TO 4854 03:24:11,600 --> 03:24:12,640 INDICATE THERE'S NO PRICE FOR IT 4855 03:24:12,640 --> 03:24:16,080 BUT WE MOVED AWAY FROM THAT TERM 4856 03:24:16,080 --> 03:24:17,880 AND LOTS WE WOULD NEVER SAY 4857 03:24:17,880 --> 03:24:21,640 YOU'RE AN INFORMAL CAREGIVER. 4858 03:24:21,640 --> 03:24:22,720 IT DOESN'T RECOGNIZE THE 4859 03:24:22,720 --> 03:24:26,480 RICHNESS AND COMPLEXITY OF THE 4860 03:24:26,480 --> 03:24:27,760 ROLE. 4861 03:24:27,760 --> 03:24:30,200 >>I'D ADD TO THAT AND BE 4862 03:24:30,200 --> 03:24:33,000 CURIOUS TO RITA'S THOUGHTS. 4863 03:24:33,000 --> 03:24:34,560 IT COMES DOWN TO RECOGNIZING 4864 03:24:34,560 --> 03:24:37,800 THAT COMPLEXITY AND THE ROLE AND 4865 03:24:37,800 --> 03:24:39,440 PROVIDING A DESCRIPTION OF WHAT 4866 03:24:39,440 --> 03:24:41,080 CARE GIVING MEANS AND THE OF HOW 4867 03:24:41,080 --> 03:24:43,440 TO APPROACH IT. 4868 03:24:43,440 --> 03:24:47,520 AND GIVING FOLKS THAT VOCABULARY 4869 03:24:47,520 --> 03:24:53,920 AND FRAMEWORK TO SELF-IDENTIFY 4870 03:24:53,920 --> 03:24:54,240 CAREGIVERS. 4871 03:24:54,240 --> 03:24:57,240 WE AS ASOCIETY UNDER VALUED THIS 4872 03:24:57,240 --> 03:24:58,920 AND NOT DESCRIBED THE ACTS AND 4873 03:24:58,920 --> 03:25:01,160 LABOR OF CARE AS SOMETHING 4874 03:25:01,160 --> 03:25:02,120 MEANINGFUL THAT WE LOOK PAST. 4875 03:25:02,120 --> 03:25:04,400 WE DON'T SEE IT IN OUR DAILY 4876 03:25:04,400 --> 03:25:05,880 LIVES IN A WAY THAT MAKES SENSE 4877 03:25:05,880 --> 03:25:08,520 TO BE INTEGRATED INTO A HEALTH 4878 03:25:08,520 --> 03:25:10,960 SYSTEM OR TO BE VALUED WITH AN 4879 03:25:10,960 --> 03:25:12,360 EMPLOYER SETTING. 4880 03:25:12,360 --> 03:25:14,600 IT'S UP TO US AS GATE KEEPERS IN 4881 03:25:14,600 --> 03:25:18,200 WAYS TO DESCRIBE AND CREATE THAT 4882 03:25:18,200 --> 03:25:20,080 VALUE VOCABULARY TO ENABLE THAT 4883 03:25:20,080 --> 03:25:30,320 IDENTIFICATION. 4884 03:25:30,560 --> 03:25:34,520 >>I THINK IT'S CRITICAL. 4885 03:25:34,520 --> 03:25:37,640 AS WE DO WORK TO EDUCATE HEALTH 4886 03:25:37,640 --> 03:25:40,080 CARE PROVIDERS AROUND WHO THE 4887 03:25:40,080 --> 03:25:41,520 INDIVIDUALS, PARTNERS, 4888 03:25:41,520 --> 03:25:42,600 DAUGHTERS, ETCETERA, WE'RE 4889 03:25:42,600 --> 03:25:53,040 CALLING THEM CAREGIVERS. 4890 03:25:55,040 --> 03:25:57,560 THERE'S HOPEFULLY SOME IMPACT IN 4891 03:25:57,560 --> 03:25:58,520 GREATER COMMUNICATION THERE 4892 03:25:58,520 --> 03:25:59,880 BECAUSE OFTEN TIMES WHEN YOU GO 4893 03:25:59,880 --> 03:26:02,640 IN AND SAY I'M THE DAUGHTER, I'M 4894 03:26:02,640 --> 03:26:05,560 THE WIFE, I'M THE PARTNER, 4895 03:26:05,560 --> 03:26:06,560 THERE'S AN ASSUMPTION THIS IS 4896 03:26:06,560 --> 03:26:09,360 YOUR DUTY AND RESPONSIBILITY AND 4897 03:26:09,360 --> 03:26:12,760 IT'S NOT TAKEN AS SERIOUSLY. 4898 03:26:12,760 --> 03:26:14,480 MANY OF THE ISSUES AND CONCERNS 4899 03:26:14,480 --> 03:26:19,640 YOU HAVE. 4900 03:26:19,640 --> 03:26:21,440 >>LIZ HAS BEEN MONITORING THE 4901 03:26:21,440 --> 03:26:24,120 QUESTIONS FLOATING FROM 4902 03:26:24,120 --> 03:26:25,480 PARTICIPANTS AND I WONDER IF YOU 4903 03:26:25,480 --> 03:26:27,480 HAVE SOMETHING TO THROW OUT TO 4904 03:26:27,480 --> 03:26:27,680 US? 4905 03:26:27,680 --> 03:26:28,680 >>DO I. 4906 03:26:28,680 --> 03:26:29,760 ALONG THE SAME NOTES THERE'S A 4907 03:26:29,760 --> 03:26:31,720 QUESTION IN THE CHAT ABOUT THE 4908 03:26:31,720 --> 03:26:33,760 CHOICE AN INDIVIDUAL MAKES TO 4909 03:26:33,760 --> 03:26:35,600 BECOME A CAREGIVER OR CARE 4910 03:26:35,600 --> 03:26:37,200 PARTNER RATHER THAN AS YOU WERE 4911 03:26:37,200 --> 03:26:39,280 TALKING ABOUT FEELING LIKE THIS 4912 03:26:39,280 --> 03:26:43,520 MIGHT BE A DUTY OR FEELING LIKE 4913 03:26:43,520 --> 03:26:45,040 THIS IS THE ONLY POSSIBLE OPTION 4914 03:26:45,040 --> 03:26:51,280 IN OUR HEALTH CARE SYSTEM. 4915 03:26:51,280 --> 03:26:52,920 AND WONDERING IF THERE'S 4916 03:26:52,920 --> 03:26:53,840 DIFFERENCES BETWEEN YOU MAY 4917 03:26:53,840 --> 03:26:56,880 CHOOSE AND WHAT ENCOURAGES 4918 03:26:56,880 --> 03:26:57,800 ACTIVE CHOICE VERSUS SOMEONE 4919 03:26:57,800 --> 03:27:02,480 FEELING LIKE THEY CAN PLUG A 4920 03:27:02,480 --> 03:27:07,160 HOLE. 4921 03:27:07,160 --> 03:27:09,720 >>A CHALLENGING QUESTION. 4922 03:27:09,720 --> 03:27:12,040 SO OFTEN WE HAVE THIS IDEA -- I 4923 03:27:12,040 --> 03:27:13,680 THINK EVEN KEN SPOKE TO THAT 4924 03:27:13,680 --> 03:27:17,440 WHEN HE FIRST OPENED UP THIS 4925 03:27:17,440 --> 03:27:18,480 DIFFICULTY OF WHAT CAREGIVING 4926 03:27:18,480 --> 03:27:19,640 LOOK LIKES AND WHO THAT IS AND 4927 03:27:19,640 --> 03:27:22,800 HOW THEY ARRIVE AT THE ROLE IN 4928 03:27:22,800 --> 03:27:23,080 CAREGIVING. 4929 03:27:23,080 --> 03:27:26,720 AS WE'RE TALKING ABOUT THE TERM, 4930 03:27:26,720 --> 03:27:28,240 IF ANYTHING IT HEIGHTENS THE 4931 03:27:28,240 --> 03:27:30,440 NEED TO HAVE SOME SORT OF TERM 4932 03:27:30,440 --> 03:27:34,600 TO REALLY DEFINE WHAT THAT ROLE 4933 03:27:34,600 --> 03:27:36,560 IS BECAUSE IT IS VERY DIFFICULT 4934 03:27:36,560 --> 03:27:38,320 AGAIN WHEN YOU'RE TALKING ABOUT 4935 03:27:38,320 --> 03:27:41,480 IT WHETHER YOU'VE HAD CHOICE OR 4936 03:27:41,480 --> 03:27:45,360 WHETHER YOU'VE ASSUMED IT. 4937 03:27:45,360 --> 03:27:47,960 TO REALLY LOOK AT WHAT THE ROLE 4938 03:27:47,960 --> 03:27:53,200 IS TO YOU AND DESCRIBE THAT. 4939 03:27:53,200 --> 03:27:55,000 AND LOOKING AT SOME FORMAL TERM 4940 03:27:55,000 --> 03:27:57,680 AND COUPLING THAT WITH WHAT 4941 03:27:57,680 --> 03:27:58,920 YOU'RE NEEDS ARE, WITH WHAT 4942 03:27:58,920 --> 03:28:00,680 YOU'RE DOING FOR THAT PERSON AND 4943 03:28:00,680 --> 03:28:03,560 WITH THE CHALLENGES YOU'RE 4944 03:28:03,560 --> 03:28:07,560 FACING ARE VERY CRITICAL IN 4945 03:28:07,560 --> 03:28:09,280 HELPING REALLY SPEAK TO WHAT 4946 03:28:09,280 --> 03:28:14,120 YOU'RE NEEDS ARE AND ALLOW A 4947 03:28:14,120 --> 03:28:16,400 PROVIDER OR OTHER PROFESSIONAL 4948 03:28:16,400 --> 03:28:17,280 TO REALLY SUPPORT YOU AND DEMAND 4949 03:28:17,280 --> 03:28:23,000 THAT SUPPORT. 4950 03:28:23,000 --> 03:28:28,840 >>AND THE HISTORY OF THAT 4951 03:28:28,840 --> 03:28:29,520 RELATIONSHIP. 4952 03:28:29,520 --> 03:28:31,400 HOW THEY BECAME THE CAREGIVER 4953 03:28:31,400 --> 03:28:34,800 AND ALLUDING TO THE CHALLENGING 4954 03:28:34,800 --> 03:28:38,440 SITUATIONS WE SEE CAREGIVERS IN. 4955 03:28:38,440 --> 03:28:40,080 I THINK CARE AS PERSONS 4956 03:28:40,080 --> 03:28:42,960 PROVIDING CARE WHETHER HEALTH 4957 03:28:42,960 --> 03:28:44,440 CARE OR OTHER SERVICE PROVIDERS 4958 03:28:44,440 --> 03:28:47,520 NEED TO STEP BACK AND RECOGNIZE 4959 03:28:47,520 --> 03:28:49,040 PEOPLE COME INTO THE CARE GIVING 4960 03:28:49,040 --> 03:28:50,720 ROLE FROM MULTIPLE POINTS IN 4961 03:28:50,720 --> 03:28:53,760 THEIR LIVES AND FOR MULTIPLE 4962 03:28:53,760 --> 03:28:54,000 REASONS. 4963 03:28:54,000 --> 03:28:56,720 >>CAN I INVERT A LITTLE. 4964 03:28:56,720 --> 03:28:59,640 I'M VERY CAREFUL NOT TO REFER TO 4965 03:28:59,640 --> 03:29:01,880 THE PERSON WITH DEMENTIA AS A 4966 03:29:01,880 --> 03:29:02,440 LOVED ONE FOR EXACTLY THAT 4967 03:29:02,440 --> 03:29:09,440 REASON. 4968 03:29:09,440 --> 03:29:10,840 >>SO THAT POINT THERE'S EIGHT 4969 03:29:10,840 --> 03:29:12,800 OF COMMENTS IN THE CHAT HOW 4970 03:29:12,800 --> 03:29:13,800 THERE'S GROWING AMOUNTS OF 4971 03:29:13,800 --> 03:29:19,720 KINLESSNESS. 4972 03:29:19,720 --> 03:29:23,520 AND THEY DON'T HAVE FAMILY TO 4973 03:29:23,520 --> 03:29:26,080 PROVIDE THAT CARE AND THERE'S A 4974 03:29:26,080 --> 03:29:27,560 SECONDARY OR TERTIARY CARE 4975 03:29:27,560 --> 03:29:30,920 PARTNER WHO MAY HAVE MORE OF AN 4976 03:29:30,920 --> 03:29:32,160 EPISODIC ROLE RATHER THAN 4977 03:29:32,160 --> 03:29:32,800 CONTINUED ROLE. 4978 03:29:32,800 --> 03:29:35,120 WHAT DOES THE PANEL THINK ABOUT 4979 03:29:35,120 --> 03:29:37,400 HOW TO INCLUDE AND IDENTIFY THE 4980 03:29:37,400 --> 03:29:38,200 INDIVIDUALS AND MAKE SURE 4981 03:29:38,200 --> 03:29:38,800 THEY'RE GETTING THE SERVICES 4982 03:29:38,800 --> 03:29:42,960 THEY NEED? 4983 03:29:42,960 --> 03:29:45,040 >>I THINK I CAN SPEAK TO THAT 4984 03:29:45,040 --> 03:29:45,520 BRIEFLY. 4985 03:29:45,520 --> 03:29:47,480 QUICKLY IN TERMS OF THE PRIOR 4986 03:29:47,480 --> 03:29:48,520 QUESTION ABOUT THE CHOICE, 4987 03:29:48,520 --> 03:29:49,880 WHETHER PEOPLE FEEL LIKE THEY 4988 03:29:49,880 --> 03:29:52,440 HAVE A CLOSING TO BE A 4989 03:29:52,440 --> 03:29:53,920 CAREGIVER, WE DO KNOW AND THIS 4990 03:29:53,920 --> 03:29:56,720 IS IN THE FACTS AND FIGURES 4991 03:29:56,720 --> 03:29:58,560 REPORT FOR THE ALZHEIMER'S 4992 03:29:58,560 --> 03:29:59,360 ASSOCIATION WHICH IS MOST PEOPLE 4993 03:29:59,360 --> 03:30:01,920 DON'T FEEL LIKE THEY HAVE A 4994 03:30:01,920 --> 03:30:03,960 CHOICE TO BE CAREGIVER FOR A 4995 03:30:03,960 --> 03:30:05,400 VARIETY OF REASONS PROBABLY 4996 03:30:05,400 --> 03:30:07,800 COMPLEX ONES AS SOME OF US 4997 03:30:07,800 --> 03:30:08,320 ALLUDED TO. 4998 03:30:08,320 --> 03:30:09,800 NUMBER ONE THAT'S IMPORTANT. 4999 03:30:09,800 --> 03:30:13,960 NUMBER TWO, THE ISSUE OF 5000 03:30:13,960 --> 03:30:15,080 KINLESSNESS YOU HEARD ME TALK 5001 03:30:15,080 --> 03:30:16,680 ABOUT THE STUDY WE'RE LAUNCHING 5002 03:30:16,680 --> 03:30:21,040 CALLED HOME ALONE WHICH IS 5003 03:30:21,040 --> 03:30:22,280 PRECISELY DESIGN TO ADDRESS AND 5004 03:30:22,280 --> 03:30:24,920 IDENTIFY SOME OF THE NEEDS OF 5005 03:30:24,920 --> 03:30:26,600 THE INDIVIDUALS WHO DON'T HAVE 5006 03:30:26,600 --> 03:30:29,680 AN AVAILABLE CAREGIVER. 5007 03:30:29,680 --> 03:30:32,320 THE TARGET IN OUR PROGRAM ARE 5008 03:30:32,320 --> 03:30:35,360 THOSE WHO LIVE ALONE AND MAY 5009 03:30:35,360 --> 03:30:39,080 HAVE A CAREGIVER AND WE'LL START 5010 03:30:39,080 --> 03:30:42,200 RECRUITING BUT LIKE MANY ARE 5011 03:30:42,200 --> 03:30:43,160 SAYING IN THE CHAT IT WILL 5012 03:30:43,160 --> 03:30:44,440 PROBABLY BE PEOPLE WHO DON'T 5013 03:30:44,440 --> 03:30:48,680 HAVE AVAILABLE SUPPORT FROM 5014 03:30:48,680 --> 03:30:49,840 FAMILY, FRIENDS OR OTHERS. 5015 03:30:49,840 --> 03:30:51,200 ONE OF THE THINGS WE'LL LOOK AT 5016 03:30:51,200 --> 03:30:53,320 IS WHAT CAN BE DONE 5017 03:30:53,320 --> 03:30:54,000 ENVIRONMENTALLY AS WELL AS IN 5018 03:30:54,000 --> 03:30:57,840 TERMS OF HOW THEY IDENTIFY 5019 03:30:57,840 --> 03:31:00,720 ENGAGING IN ACTIVITIES AND WITH 5020 03:31:00,720 --> 03:31:03,120 THE ENVIRONMENT TO HELP THEM 5021 03:31:03,120 --> 03:31:04,840 BETTER LIVE WITH THEIR COGNITIVE 5022 03:31:04,840 --> 03:31:05,200 IMPAIRMENT. 5023 03:31:05,200 --> 03:31:06,800 IT'S A KEY GAP AND THERE'S NO 5024 03:31:06,800 --> 03:31:07,720 DOUBT ABOUT IT. 5025 03:31:07,720 --> 03:31:10,280 FOR THOSE OF US IN CARE GIVING 5026 03:31:10,280 --> 03:31:12,880 WE CAN'T CONTINUE TO IGNORE 5027 03:31:12,880 --> 03:31:14,000 PEOPLE WHO DON'T HAVE CAREGIVERS 5028 03:31:14,000 --> 03:31:15,200 BECAUSE IT'S CRITICAL. 5029 03:31:15,200 --> 03:31:19,560 WE KNOW LIVING ALONE -- NOT 5030 03:31:19,560 --> 03:31:22,440 SAYING IT'S A COROLLARY BUT WE 5031 03:31:22,440 --> 03:31:24,440 DON'T KNOW RISKS OF LIVING ALONE 5032 03:31:24,440 --> 03:31:25,240 FOR MANY HEALTH CONDITIONS 5033 03:31:25,240 --> 03:31:27,240 INCLUDING DEMENTIA. 5034 03:31:27,240 --> 03:31:28,440 THAT'S A KEY GROUP OF PEOPLE WE 5035 03:31:28,440 --> 03:31:29,840 NEED TO TARGET AND IDENTIFY MORE 5036 03:31:29,840 --> 03:31:35,120 EFFECTIVELY. 5037 03:31:35,120 --> 03:31:38,080 >>I WILL ADD THAT NEEDS TO BE 5038 03:31:38,080 --> 03:31:40,360 FOLLOWED BY POLICY. 5039 03:31:40,360 --> 03:31:44,360 FOR EXAMPLE, ONE OF THE POINTS I 5040 03:31:44,360 --> 03:31:45,960 COMPLETELY AGREE WITH WAS ABOUT 5041 03:31:45,960 --> 03:31:46,840 THE IMPORTANCE AND OPPORTUNITY 5042 03:31:46,840 --> 03:31:49,400 OF POLICY LIKE PAID FAMILY AND 5043 03:31:49,400 --> 03:31:53,040 MEDICAL LEAVE TO SUPPORT FAMILY 5044 03:31:53,040 --> 03:31:54,520 CAREGIVERS AND NARROW INEQUITIES 5045 03:31:54,520 --> 03:31:56,760 OVER TIME BUT WHEN YOU LOOK AT 5046 03:31:56,760 --> 03:31:58,520 HOW WE DEFINE QUALIFICATION FOR 5047 03:31:58,520 --> 03:32:00,720 PAID FAMILY LEAVE BENEFITS AT 5048 03:32:00,720 --> 03:32:02,480 THE FEDERAL LEVEL IT'S VERY 5049 03:32:02,480 --> 03:32:05,360 NARROW IN HOW WE DEFINE A FAMILY 5050 03:32:05,360 --> 03:32:08,640 CAREGIVER IN THAT RELATIONSHIP. 5051 03:32:08,640 --> 03:32:11,080 THERE'S EFFORTS UNDERWAY TO HOW 5052 03:32:11,080 --> 03:32:12,920 WE DEFINE FAMILY FOR POLICY AND 5053 03:32:12,920 --> 03:32:16,000 HAVE TO ENSURE WE'RE LOOKING AT 5054 03:32:16,000 --> 03:32:17,160 WHERE WE'RE FINDING CONSENSUS 5055 03:32:17,160 --> 03:32:18,320 AROUND THE NEEDS OF THE 5056 03:32:18,320 --> 03:32:21,920 DEFINITION AND HOW WE TRANSLATE 5057 03:32:21,920 --> 03:32:23,400 THAT INTO POLICY SO THAT THOSE 5058 03:32:23,400 --> 03:32:25,280 FOLKS WHO ARE PROVIDING THAT 5059 03:32:25,280 --> 03:32:31,240 CARE EPISODICCALLY OR MAYBE IT'S 5060 03:32:31,240 --> 03:32:34,080 PROVIDING CARE FOR CHOSEN FAMILY 5061 03:32:34,080 --> 03:32:35,480 I'M COVERED BY POLICY IN THE 5062 03:32:35,480 --> 03:32:37,760 SAME WAY I WOULD IF I WAS 5063 03:32:37,760 --> 03:32:38,480 PROVIDING CARE FOR A GRAND 5064 03:32:38,480 --> 03:32:41,480 MOTHER OR FATHER. 5065 03:32:41,480 --> 03:32:43,960 >>THERE WAS ALSO A SECOND 5066 03:32:43,960 --> 03:32:46,120 QUESTION AND TOTALLY BUILDING 5067 03:32:46,120 --> 03:32:47,880 OFF WHAT JASON WAS SAYING AROUND 5068 03:32:47,880 --> 03:32:49,280 THE BROADER SENSE OF FAMILY AND 5069 03:32:49,280 --> 03:32:51,800 THERE MAY BE MORE THAN ONE 5070 03:32:51,800 --> 03:32:53,120 CAREGIVER, I THINK IT SPEAKS TO 5071 03:32:53,120 --> 03:32:55,440 THE NEED ESPECIALLY IN A HEALTH 5072 03:32:55,440 --> 03:32:59,880 SYSTEM SETTING WHERE YOU HAVE TO 5073 03:32:59,880 --> 03:33:02,720 THROW AWAY THE ASSUMPTIONS. 5074 03:33:02,720 --> 03:33:04,840 BECAUSE SOMEBODY'S SITTING AT 5075 03:33:04,840 --> 03:33:06,240 SOMEBODY'S SIDE IT MAY INTO THE 5076 03:33:06,240 --> 03:33:08,440 BE THE INDIVIDUAL PROVIDING THAT 5077 03:33:08,440 --> 03:33:11,480 FULL CARE. 5078 03:33:11,480 --> 03:33:12,480 HOW DO HEALTH SYSTEMS OR HEALTH 5079 03:33:12,480 --> 03:33:15,960 PROVIDERS DO A BETTER JOB OF 5080 03:33:15,960 --> 03:33:18,160 COMMUNICATING AND ENGAGING WITH 5081 03:33:18,160 --> 03:33:19,680 THE PERSON, THE PATIENT NEEDING 5082 03:33:19,680 --> 03:33:22,840 THE CARE AND THOSE CAREGIVERS 5083 03:33:22,840 --> 03:33:29,800 AND NAMELY FAMILY MEMBERS AND 5084 03:33:29,800 --> 03:33:32,080 FRIENDS AROUND AND IT'S NOT EASY 5085 03:33:32,080 --> 03:33:33,480 YOU HAVE TO ENGAGE WITH PEOPLE 5086 03:33:33,480 --> 03:33:34,520 TO UNDERSTAND WHAT'S GOING ON AS 5087 03:33:34,520 --> 03:33:44,880 THEY TRANSITION HOME. 5088 03:33:58,160 --> 03:34:02,920 >>HOW DO WE ENCOURAGE SUPPORT 5089 03:34:02,920 --> 03:34:06,520 AND AGENCY BEFORE THE CRISIS 5090 03:34:06,520 --> 03:34:10,440 ACTUALLY SETS IN? 5091 03:34:10,440 --> 03:34:12,000 >>WE HOSTED A LOT OF TALKING 5092 03:34:12,000 --> 03:34:13,880 CIRCLES WITHIN THE FAMILY TO 5093 03:34:13,880 --> 03:34:15,280 IDENTIFY WHO WAS THE BEST 5094 03:34:15,280 --> 03:34:18,040 QUALIFIED AND I THINK THAT GOES 5095 03:34:18,040 --> 03:34:19,920 INTO THE POLICIES THAT COULD BE 5096 03:34:19,920 --> 03:34:23,120 PUT IN PLACE AS TO WHAT 5097 03:34:23,120 --> 03:34:27,400 QUALIFIES YOU AS A CAREGIVER. 5098 03:34:27,400 --> 03:34:29,600 I FORTUNATELY HAD SOME 5099 03:34:29,600 --> 03:34:31,960 CAREGIVING EXPERIENCE IN THE 5100 03:34:31,960 --> 03:34:35,200 EDUCATIONAL SECTOR CARING FOR 5101 03:34:35,200 --> 03:34:37,080 PERSONS WITH CEREBRAL PALSY 5102 03:34:37,080 --> 03:34:39,000 WHILE IN HIGH SCHOOL AND NOT 5103 03:34:39,000 --> 03:34:39,800 EVERYBODY HAS THE OPPORTUNITIES 5104 03:34:39,800 --> 03:34:43,040 TO LEARN FROM THAT ASPECT AND BE 5105 03:34:43,040 --> 03:34:46,040 ABLE TO PROVIDE THE MOBILITY 5106 03:34:46,040 --> 03:34:51,320 CARE OR THE VERBAL CUES AND THE 5107 03:34:51,320 --> 03:34:52,440 COMMUNICATION NEEDS. 5108 03:34:52,440 --> 03:34:54,520 WHEN IT CAME TO THE FAMILY 5109 03:34:54,520 --> 03:34:58,120 DYNAMIC IT WAS -- I WAS THE BEST 5110 03:34:58,120 --> 03:35:00,000 SUITED FOR IN TERMS OF TIME 5111 03:35:00,000 --> 03:35:00,320 MANAGEMENT. 5112 03:35:00,320 --> 03:35:04,120 I HAD JUST GRADUATED COLLEGE. 5113 03:35:04,120 --> 03:35:06,480 I DIDN'T HAVE ANY OTHER JOB 5114 03:35:06,480 --> 03:35:08,480 OPPORTUNITIES AVAILABLE AND IT 5115 03:35:08,480 --> 03:35:12,880 JUST KIND OF FELT LIKE IT WAS 5116 03:35:12,880 --> 03:35:14,000 THE PERFECT COMBINATION OF JUST 5117 03:35:14,000 --> 03:35:18,520 KIND OF GOING FORWARD WITH BEING 5118 03:35:18,520 --> 03:35:19,120 THE CAREGIVER. 5119 03:35:19,120 --> 03:35:20,440 LIZ, REMIND ME WHAT THE LAST 5120 03:35:20,440 --> 03:35:21,880 PART OF THE QUESTION WAS? 5121 03:35:21,880 --> 03:35:25,320 >>ENCOURAGING PEOPLE TO BE OPEN 5122 03:35:25,320 --> 03:35:26,920 TO PREEMPTIVE SUPPORT MAYBE 5123 03:35:26,920 --> 03:35:27,920 BEFORE THE CRISIS SETS IN. 5124 03:35:27,920 --> 03:35:28,120 >>TRUE. 5125 03:35:28,120 --> 03:35:33,120 THANK YOU. 5126 03:35:33,120 --> 03:35:35,560 WE DID A LOT OF TALKING 5127 03:35:35,560 --> 03:35:40,160 INDIVIDUALLY WITH THE FAMILY OF 5128 03:35:40,160 --> 03:35:41,720 WHAT NEXT STEPS WOULD BE AND 5129 03:35:41,720 --> 03:35:46,960 WHAT THOSE NEXT STEPS WOULD LOOK 5130 03:35:46,960 --> 03:35:54,440 LIKE I REALLY CAN'T SAY MUCH. 5131 03:35:54,440 --> 03:35:57,200 IT JUST SORT OF HAPPENED AND 5132 03:35:57,200 --> 03:35:59,360 SOMETIMES THERE'S NO SOCIAL 5133 03:35:59,360 --> 03:36:00,640 SUPPORT OR STRATEGIC PLANNING. 5134 03:36:00,640 --> 03:36:01,720 IT'S JUST WHAT NEEDS TO BE DONE 5135 03:36:01,720 --> 03:36:10,160 AND WHO IS GOING TO VOLUNTEER. 5136 03:36:10,160 --> 03:36:12,080 I THINK THE QUESTION NEEDS TO BE 5137 03:36:12,080 --> 03:36:12,360 ADDRESSED. 5138 03:36:12,360 --> 03:36:12,960 I'M NOT THE PERSON TO DO IT 5139 03:36:12,960 --> 03:36:23,120 THOUGH. 5140 03:36:41,480 --> 03:36:44,280 >>THIS HAS BEEN A FABULOUS 5141 03:36:44,280 --> 03:36:46,360 PANEL AND EVERYBODY WAS SO 5142 03:36:46,360 --> 03:36:48,440 DISCIPLINED AND ON TIME AND 5143 03:36:48,440 --> 03:36:50,760 TIMELY IN THEIR REMARKS. 5144 03:36:50,760 --> 03:36:53,280 I'M VERY GRATEFUL AND THANKFUL 5145 03:36:53,280 --> 03:36:56,640 TO ALL OF YOU AND TO THE 5146 03:36:56,640 --> 03:36:56,880 AUDIENCE. 5147 03:36:56,880 --> 03:37:00,320 PLEASE SEND IN COMMENTS ON OUR 5148 03:37:00,320 --> 03:37:02,440 GAPS AND OPPORTUNITIES AND I'LL 5149 03:37:02,440 --> 03:37:05,200 TURN IT BACK OVER TO ANDREA AND 5150 03:37:05,200 --> 03:37:06,800 JULIE AND THEY'LL CLOSE OUT THE 5151 03:37:06,800 --> 03:37:07,120 DAY. 5152 03:37:07,120 --> 03:37:08,720 THANK YOU TO THE PANELISTS AND 5153 03:37:08,720 --> 03:37:18,520 DISCUSSANTS. 5154 03:37:18,520 --> 03:37:20,000 >> 5155 03:37:20,000 --> 03:37:22,080 >>THANK YOU TO THE PRESENTERS 5156 03:37:22,080 --> 03:37:23,440 AND PANELISTS AND PARTICIPANTS. 5157 03:37:23,440 --> 03:37:26,120 WE'RE GRATEFUL FOR ALL OF YOUR 5158 03:37:26,120 --> 03:37:28,800 SESSIONS AND YOUR INSIGHTS. 5159 03:37:28,800 --> 03:37:30,040 IT'S MY PRIVILEGE TO CLOSE OUT 5160 03:37:30,040 --> 03:37:31,960 THE DAY WITH A FEW SUMMARY 5161 03:37:31,960 --> 03:37:36,400 COMMENTS ON TODAY'S SUMMIT. 5162 03:37:36,400 --> 03:37:39,000 WE BEGAN THE DAY WITH THE LIVED 5163 03:37:39,000 --> 03:37:41,880 EXPERIENCE ENGAGEMENT PANEL. 5164 03:37:41,880 --> 03:37:45,320 HEIDI GIL DESCRIBED THE 5165 03:37:45,320 --> 03:37:47,160 CROSS-CUTTING THEME AND 5166 03:37:47,160 --> 03:37:48,080 SCREENING OR COGNITIVE 5167 03:37:48,080 --> 03:37:50,480 IMPAIRMENT AND DECISION MAKING 5168 03:37:50,480 --> 03:37:52,520 AND SUGGESTED APPROACHES FROM 5169 03:37:52,520 --> 03:37:53,480 OTHER HEALTH APPROACHES SUCH AS 5170 03:37:53,480 --> 03:37:57,480 HIV AS A WAY FORWARD. 5171 03:37:57,480 --> 03:38:01,880 AND WE HEARD WITH THE CHALLENGES 5172 03:38:01,880 --> 03:38:05,520 OF HELPING THOSE WITH DEMENTIA 5173 03:38:05,520 --> 03:38:09,680 LIVE WELL AND WHAT IT MEANS FOR 5174 03:38:09,680 --> 03:38:09,920 FAMILIES. 5175 03:38:09,920 --> 03:38:13,960 AND THERE WAS A CALL FOR 5176 03:38:13,960 --> 03:38:15,200 DETECTION AND DIAGNOSIS AND 5177 03:38:15,200 --> 03:38:18,240 CONNECTIONS TO THE RESOURCES AND 5178 03:38:18,240 --> 03:38:19,400 STUDY OPPORTUNITIES. 5179 03:38:19,400 --> 03:38:21,280 AND WE LOOKED AT HOW E.H.R. 5180 03:38:21,280 --> 03:38:24,440 COULD BE A TOOL BUT COULD ALSO 5181 03:38:24,440 --> 03:38:27,320 BE COMPROMISED AND CALLED FOR 5182 03:38:27,320 --> 03:38:28,360 RESEARCH. 5183 03:38:28,360 --> 03:38:30,520 DR. POSSIN AND SALIVE LOOKED AT 5184 03:38:30,520 --> 03:38:32,200 CARE MODELS AND COORDINATED 5185 03:38:32,200 --> 03:38:33,560 CARE. 5186 03:38:33,560 --> 03:38:39,160 DR. LARSON AND DR. REUBEN LOOKED 5187 03:38:39,160 --> 03:38:42,040 AT ABSENCE FOR CARE MODELS DUE 5188 03:38:42,040 --> 03:38:43,600 TO THE INTERVENTIONS AND THE 5189 03:38:43,600 --> 03:38:45,480 VARIATION IN CARE IN MODELS TO 5190 03:38:45,480 --> 03:38:48,480 CREATE CHALLENGES IN GENERATING 5191 03:38:48,480 --> 03:38:49,840 THEM AND IMPORTANT WAY FORWARD 5192 03:38:49,840 --> 03:38:51,680 IS GENERATING EVIDENCE ON 5193 03:38:51,680 --> 03:38:53,280 COLLABORATIVE CARE MODELS AND 5194 03:38:53,280 --> 03:38:56,280 PAYMENT MODELS IN THE REAL WORLD 5195 03:38:56,280 --> 03:38:56,600 SETTING. 5196 03:38:56,600 --> 03:38:58,400 AND AMONG SEVERAL AREAS ONE 5197 03:38:58,400 --> 03:39:00,440 CALLED FOR NEW RESEARCH THAT 5198 03:39:00,440 --> 03:39:02,880 CARE MODELS THAT INTEGRATE ACUTE 5199 03:39:02,880 --> 03:39:06,600 AND POST-ACUTE CARE SETTINGS IN 5200 03:39:06,600 --> 03:39:08,360 THE CARE CONTINUUM. 5201 03:39:08,360 --> 03:39:09,440 THIS IS IMPORTANT FOR ADDRESSING 5202 03:39:09,440 --> 03:39:14,480 EQUITY AND INCLUSION ISSUES. 5203 03:39:14,480 --> 03:39:20,520 OUR PANELISTS, CRUZ AND OTHERS 5204 03:39:20,520 --> 03:39:25,520 LOOKED AT THE INSIGHT OF CARE 5205 03:39:25,520 --> 03:39:28,440 FROM EXPERIENCING HESITATION AND 5206 03:39:28,440 --> 03:39:33,280 APATHY TO KINDNESS AND 5207 03:39:33,280 --> 03:39:36,720 CONNECTION AND EMPHASIZED WRAP 5208 03:39:36,720 --> 03:39:39,600 SERVICES IN ONE LOCATION AND 5209 03:39:39,600 --> 03:39:43,560 OPPORTUNITIES BY HISTORY TO 5210 03:39:43,560 --> 03:39:45,240 VALUE-BASED SYSTEMS AND DESIRED 5211 03:39:45,240 --> 03:39:47,240 OUTCOMES OF THOSE LIVING WITH 5212 03:39:47,240 --> 03:39:48,080 DEMENTIA ACROSS THE DIFFERENT 5213 03:39:48,080 --> 03:39:54,320 CARE SETTINGS. 5214 03:39:54,320 --> 03:39:58,760 DR. NGUYEN LOOKED AT ACCESS 5215 03:39:58,760 --> 03:40:00,600 UTILIZATION AND QUALITY AND 5216 03:40:00,600 --> 03:40:04,960 DR. WALTERS AND COE LOOKED AT 5217 03:40:04,960 --> 03:40:06,400 SOCIAL DETERMINATES OF HEALTH 5218 03:40:06,400 --> 03:40:08,280 AND PARTICULARLY PLACE AND 5219 03:40:08,280 --> 03:40:12,000 BARRIERS TO ACCESSING HEALTH 5220 03:40:12,000 --> 03:40:13,040 INFORMATION, TECHNOLOGY AND 5221 03:40:13,040 --> 03:40:15,360 POLICY AND DESIGN AS DRIVING 5222 03:40:15,360 --> 03:40:16,720 MECHAN 5223 03:40:16,720 --> 03:40:18,480 MECHANISMS OF DISPARITIES IN 5224 03:40:18,480 --> 03:40:19,480 ACCESS OF QUALITY. 5225 03:40:19,480 --> 03:40:22,080 WHERE ONE LIVES AFFECTS ACCESS 5226 03:40:22,080 --> 03:40:23,200 AND USE OF HEALTH INFORMATION 5227 03:40:23,200 --> 03:40:24,560 TECHNOLOGY AND WHAT INSURANCE 5228 03:40:24,560 --> 03:40:26,280 PLANS ARE AVAILABLE AND SERVICES 5229 03:40:26,280 --> 03:40:30,600 THEY HAVE ACCESS TO. 5230 03:40:30,600 --> 03:40:33,440 THEY CALLED OUT THE GAP AND DATA 5231 03:40:33,440 --> 03:40:36,160 LINKAGES ACROSS LOCAL STATE AND 5232 03:40:36,160 --> 03:40:37,920 FEDERAL LEVELS AS WELL AS ACROSS 5233 03:40:37,920 --> 03:40:38,960 HEALTH CARE SETTINGS THAT IF 5234 03:40:38,960 --> 03:40:41,280 ADDRESSED WILL SUPPORT NEW 5235 03:40:41,280 --> 03:40:44,080 RESEARCH ON SOCIAL DETERMINATES 5236 03:40:44,080 --> 03:40:45,000 OF HEALTH ON HEALTH INFORMATION 5237 03:40:45,000 --> 03:40:46,440 TECHNOLOGY AND THE ROLE OF 5238 03:40:46,440 --> 03:40:47,800 POLICY INCLUSIVE OF POPULATIONS 5239 03:40:47,800 --> 03:40:52,400 OFTEN EXCLUDED. 5240 03:40:52,400 --> 03:40:56,280 OUR PANELISTS ADDED INSIGHT BY 5241 03:40:56,280 --> 03:40:58,680 SUGGESTING RIGOROUS RESEARCH ON 5242 03:40:58,680 --> 03:41:00,920 PLACE CAN HELP TARGET SCARCE 5243 03:41:00,920 --> 03:41:03,960 HEALTH RESOURCES TO PERSONS 5244 03:41:03,960 --> 03:41:06,320 LIVING WITH DEMENTIA AND 5245 03:41:06,320 --> 03:41:07,480 PARTNERS AND HEALTH CARE AND 5246 03:41:07,480 --> 03:41:09,080 SERVICE SETTINGS INCLUDING ADULT 5247 03:41:09,080 --> 03:41:10,080 CARE CENTERS MORE LIKELY TO 5248 03:41:10,080 --> 03:41:14,840 BENEFIT FROM THEM. 5249 03:41:14,840 --> 03:41:18,800 DR. HEPBURN AND NECKA CO-CHAIRED 5250 03:41:18,800 --> 03:41:20,800 SESSION FIVE AND FRAMED THE 5251 03:41:20,800 --> 03:41:22,240 SESSION NOTING THE CURRENT STATE 5252 03:41:22,240 --> 03:41:23,840 IS THERE IS NO COORDINATED CARE 5253 03:41:23,840 --> 03:41:28,200 MODEL ACCESSIBLE TO MOST. 5254 03:41:28,200 --> 03:41:29,840 FAMILY CARE COORDINATE WITHOUT 5255 03:41:29,840 --> 03:41:31,360 SUFFICIENT SUPPORT. 5256 03:41:31,360 --> 03:41:33,720 CARE GIVING NETWORKS ARE COMPLEX 5257 03:41:33,720 --> 03:41:35,080 AND REFLECT THE COMPLEXITY IN 5258 03:41:35,080 --> 03:41:37,320 FAMILY STRUCTURES AND 5259 03:41:37,320 --> 03:41:37,640 RELATIONSHIP. 5260 03:41:37,640 --> 03:41:39,480 THEY'RE HETEROGENOUS IN MANY 5261 03:41:39,480 --> 03:41:42,320 CHARACTERISTICS AND IN THEIR 5262 03:41:42,320 --> 03:41:44,280 ADVANTAGE AND DISADVANTAGE. 5263 03:41:44,280 --> 03:41:49,000 DR. ROBERTO AND GAUGLER AND VAN 5264 03:41:49,000 --> 03:41:53,400 HOUTVEN POINTED TO FAMILY 5265 03:41:53,400 --> 03:41:54,120 INFLUENCING FAMILY CARE AND 5266 03:41:54,120 --> 03:41:57,240 CALLED OUT A GAP IN RESEARCH ON 5267 03:41:57,240 --> 03:41:57,720 RURAL CAREGIVERS. 5268 03:41:57,720 --> 03:41:59,840 THEY POINTED TO A KEY ISSUE FOR 5269 03:41:59,840 --> 03:42:02,000 RESEARCH STUDIES, HOW TO 5270 03:42:02,000 --> 03:42:03,920 IDENTIFY EARLY STAGE OF 5271 03:42:03,920 --> 03:42:05,480 INTERVENTION DESIGN TO 5272 03:42:05,480 --> 03:42:09,440 FACILITATE LATER IMPLEMENTATION. 5273 03:42:09,440 --> 03:42:11,680 THEY POINTED OUT THE COST OF 5274 03:42:11,680 --> 03:42:15,320 CARE ANYTHING GIVING -- 5275 03:42:15,320 --> 03:42:17,440 CAREGIVING AND LOOKING AT WHO IS 5276 03:42:17,440 --> 03:42:18,320 MOST IMPACTED AND WHY USING 5277 03:42:18,320 --> 03:42:22,280 METHODS TO IDENTIFY THE PATHWAYS 5278 03:42:22,280 --> 03:42:24,920 WE NEED TO INFORM POSITION 5279 03:42:24,920 --> 03:42:25,840 CHANGE OF CHANGE. 5280 03:42:25,840 --> 03:42:27,880 SEVERAL HIGH PRIORITY RESEARCH 5281 03:42:27,880 --> 03:42:28,960 AREAS WERE CALLED FOR INCLUDING 5282 03:42:28,960 --> 03:42:31,200 NEW RESEARCH ON THE POLICIES AND 5283 03:42:31,200 --> 03:42:33,200 PRACTICE IN THE PUBLIC HEALTH 5284 03:42:33,200 --> 03:42:34,240 AND HEALTH CARE SYSTEMS AS WELL 5285 03:42:34,240 --> 03:42:35,680 AS IN THE COMMERCIAL AND 5286 03:42:35,680 --> 03:42:37,520 CORPORATE SECTORS EMPHASIZING 5287 03:42:37,520 --> 03:42:39,120 THE RESEARCH SHOULD IDENTIFY THE 5288 03:42:39,120 --> 03:42:42,320 POLICIES AND PRACTICES THAT 5289 03:42:42,320 --> 03:42:46,080 SUPPORT CAREGIVER RESILIENCE AND 5290 03:42:46,080 --> 03:42:47,280 SHOULD IDENTIFY THOSE THAT 5291 03:42:47,280 --> 03:42:48,800 SUSTAIN INEQUITIES IN ACCESS TO 5292 03:42:48,800 --> 03:42:50,480 SERVICES AND SUPPORT FOR 5293 03:42:50,480 --> 03:42:51,840 OPPORTUNITIES FOR CHANGE. 5294 03:42:51,840 --> 03:42:56,600 OUR PANELISTS RITA CHOULA AND 5295 03:42:56,600 --> 03:43:07,120 CASSANDRA THOMAS AND JASON R 5296 03:43:11,400 --> 03:43:13,520 RESENDEZ SPOKE ABOUT HOW 5297 03:43:13,520 --> 03:43:14,800 FAMILIES ARE HIGHLY IMPACTED. 5298 03:43:14,800 --> 03:43:20,960 THE CHALLENGES ARE DAILY AND 5299 03:43:20,960 --> 03:43:23,800 HELP IDENTIFY RESOURCES AND 5300 03:43:23,800 --> 03:43:26,080 EMPOWER CAREGIVERS. 5301 03:43:26,080 --> 03:43:31,040 THE DISCUSSION CALLED ON MORE 5302 03:43:31,040 --> 03:43:33,240 PERSONS WITHOUT CAREGIVERS AND 5303 03:43:33,240 --> 03:43:36,880 PARTNERS AND WHO PROVIDES CARE 5304 03:43:36,880 --> 03:43:37,760 FOR NEEDS AND SUPPORT. 5305 03:43:37,760 --> 03:43:40,000 THANK YOU FOR YOUR ATTENTION TO 5306 03:43:40,000 --> 03:43:42,880 MY CLOSING COMMENTS AND OVER TO 5307 03:43:42,880 --> 03:43:44,720 ANDREA TO PREVIEW OUR FINAL DAY 5308 03:43:44,720 --> 03:43:45,120 TOMORROW. 5309 03:43:45,120 --> 03:43:47,200 >>WONDERFUL, THANK YOU, JULIE. 5310 03:43:47,200 --> 03:43:48,080 THANK YOU EVERYONE FOR JOINING 5311 03:43:48,080 --> 03:43:51,880 US TODAY AGAIN AND FOR YOUR 5312 03:43:51,880 --> 03:43:52,480 PARTICIPATION. 5313 03:43:52,480 --> 03:43:54,520 WE WILL RESUME TOMORROW AT 11:00 5314 03:43:54,520 --> 03:43:56,280 A.M. EASTERN STANDARD TIME AND 5315 03:43:56,280 --> 03:43:58,360 BEGIN OUR DAY AGAIN FIRST WITH 5316 03:43:58,360 --> 03:44:00,400 REMARKS FROM THE LIVED 5317 03:44:00,400 --> 03:44:02,120 EXPERIENCE AND STAKEHOLDER 5318 03:44:02,120 --> 03:44:02,520 ENGAGEMENT PANEL. 5319 03:44:02,520 --> 03:44:04,200 WE'LL THEN HEAR FROM THE THREE 5320 03:44:04,200 --> 03:44:07,160 SCIENTIFIC SESSIONS YOU SEE 5321 03:44:07,160 --> 03:44:08,360 LISTED HERE, SESSION SIX 5322 03:44:08,360 --> 03:44:11,320 FOCUSSED ON THE DEMENTIA CARE 5323 03:44:11,320 --> 03:44:13,400 WORKFORCE, SESSION SEVEN WILL 5324 03:44:13,400 --> 03:44:18,440 DISCUSS ECONOMIC IMPACTS AND 5325 03:44:18,440 --> 03:44:20,520 IMPLICATIONS AND SECTION EIGHT 5326 03:44:20,520 --> 03:44:21,920 LOOKING AT PARTICIPATORY 5327 03:44:21,920 --> 03:44:23,720 RESEARCH AND DIVERSE RECRUITMENT 5328 03:44:23,720 --> 03:44:25,880 AND RETENTION IN DEMENTIA CARE 5329 03:44:25,880 --> 03:44:27,040 RESEARCH. 5330 03:44:27,040 --> 03:44:28,480 LASTLY, I WANT TO HIGHLIGHT IF 5331 03:44:28,480 --> 03:44:30,240 YOU HAVE QUESTIONS YOU WERE NOT 5332 03:44:30,240 --> 03:44:31,000 ABLE TO ASK THROUGHOUT THE 5333 03:44:31,000 --> 03:44:33,440 COURSE OF THE SUMMIT AND/OR HAVE 5334 03:44:33,440 --> 03:44:35,520 INPUT YOU WOULD LIKE TO SHARE 5335 03:44:35,520 --> 03:44:37,120 WITH SUMMIT PLANNERS AND THE 5336 03:44:37,120 --> 03:44:38,880 NATIONAL INSTITUTE ON AGING, 5337 03:44:38,880 --> 03:44:41,840 PLEASE JOIN US TOMORROW AT 4:00 5338 03:44:41,840 --> 03:44:43,120 P.M. EASTERN TIME. 5339 03:44:43,120 --> 03:44:45,880 THIS WILL BE A POST-SUMMIT 5340 03:44:45,880 --> 03:44:47,080 LISTENING SESSION AND WE WOULD 5341 03:44:47,080 --> 03:44:48,640 VERY MUCH LOOK FORWARD TO 5342 03:44:48,640 --> 03:44:49,960 HEARING YOUR QUESTIONS, COMMENTS 5343 03:44:49,960 --> 03:44:52,080 AND IDEAS AND WE IN PARTICULAR 5344 03:44:52,080 --> 03:44:54,320 WOULD LIKE TO ENCOURAGE THOSE 5345 03:44:54,320 --> 03:44:56,200 WHO ARE LIVING WITH COGNITIVE 5346 03:44:56,200 --> 03:44:57,960 SYMPTOMS AND OR FIND THEMSELVES 5347 03:44:57,960 --> 03:45:02,160 AS CARE PARTNERS, CAREGIVERS, 5348 03:45:02,160 --> 03:45:06,000 CARE ASSISTANTS TO THOSE WITH 5349 03:45:06,000 --> 03:45:07,080 INDIVIDUALS WITH COGNITIVE 5350 03:45:07,080 --> 03:45:07,360 SYMPTOMS. 5351 03:45:07,360 --> 03:45:09,960 THAT IS POSTED IN THE CHAT WITH 5352 03:45:09,960 --> 03:45:11,520 THE ZOOM INFORMATION SO YOU'LL 5353 03:45:11,520 --> 03:45:12,680 BE ABLE TO JOIN US. 5354 03:45:12,680 --> 03:45:14,360 THANK YOU AGAIN SO MUCH AND WE 5355 03:45:14,360 --> 03:45:15,280 LOOK FORWARD TO SEEING EVERYBODY 5356 03:45:15,280 --> 00:00:00,000 TOMORROW FOR DAY THREE.