learned there's nothing like a good case manager. remembering that respite often includes home care. there is another question that i prompted folks for. it is one that marie brought to my attention a couple of years ago. i tried to use it in everything i do. what does it take to have a good life in the context of -- what does it take to have a good life in the context of living with dementia? willard, you began this discussion just a little bit. >> i would answer that by repeating myself by saying take care of yourself. i would say that i am very interested in having you understand what i went through in terms of my personal life with my husband. the one thing is to discourage manipulation.

manipulation, again, by your loved one, either consciously or unconsciously, i can certainly provoke their anger because they are angry they cannot do the things they used to do. my husband -- i did not want to seem frustrated, but by the same token i felt i needed to respect the dignity and also allow him to use the remaining strength he had. he forgot how to tie his tie. that was so frustrating. here is a man who has been tying his tie all his life. he would get so irritated. on the other hand, he would say to me, you want me to take about? give me about. -- take a bath?

give me a bath. i had to set some real limitations. i was honest, patient. i also express my anger. i did get annoyed, but i try to use the word "i" rather than "you." i am angry with you rather than you make me angry. i took the ownership. when i sent you, that got him angry. i had to learn how to really work with him in order to give him some autonomy. here to take care of my insults. he, again, would very often say, what time is it? over and over. i just told you what time. tell me again. he always had some kind of

answer that came back to me. i finally decided i had to set up a schedule. i set up a schedule for breakfast, lunch, dinner, outside and inside activities. i set the schedule. not his schedule. i said take a bath in the morning. he said maybe tomorrow. maybe tonight. i had to learn to be flexible. if he decided to mack then i napped. you cannot sit around trying to decide on what you do for someone else when they are not part of that. >> i had better take the microphone back. the same question to you -- we talked about it in the natrium -- what does it take to have a good life when you are living with this? >> it takes the kind of understanding that i see among the people that are on this

panel. who, out of love, understand that -- for me, i have learned that caregiving is a special relationship. it is a location. it is putting yourself in total responsibility for another human being. you have to get beyond that. also, i have learned that becoming an aggressive advocate for another person gives me a certain sense of well-being. it requires aggressiveness to get the rights of these folks who you love -- the system in

this society cannot deal with this unless you advocate for them. there is a lot of self-respect and saddest -- and satisfaction and strength. >> i have eaten there and it is excellent. put a plug and -- plug in. [laughter] it is harder to arrange for one person than to run a restaurant. those of the difficulties -- to get satisfaction when you overcome this. >> with that, the caregiver's, they have the work to do. we sit there and blahblah.

fix it, please. >> we also spoke about what it takes to have a good life, especially with two young folks in a house. i was struck by something you said regarding your husband still having responsibilities in the house. you talked about the checks. >> yes. he always mentions he will bring deep checks to the house. i am going to bring the checks. he goes to work. he brings the check home. he says, do you want the check? yes, i want the check. i always want the check. in the middle of the night he says, i have to get the checks to you can have money for the children. he was very responsible. he still is responsible. he is the man of the house. that is why i tell him -- if you

tell him he is sick, he gets angry. >> i was struck when i was talking to you and your partner earlier, i told you i was going to be asking this question and you could ignore it, and i was so struck by your response that she made to that question of, what does it take to have a good life? can you speak to that? >> the alzheimer's is a pain in the asked, -- in the --, but it does not changed my mood. i love my partner.

i am happy go -- i have always been that way. it just goes -- again -- i guess because i am irish and from a family with 11 kids. iit bounces off of me. until i tie my shoes. [laughter] >> i was told we are out of time. everyone has been told we are out of time here. i wanted to thank the four view for doing this. there is nothing like stories. is that correct? [applause]

and and i wanted to mention that jim's partner tom will be here at break and lunch and all of them have said that if any of you want to talk to him, they would be more than happy to talk to you. i want to close with something that was commented. they talked earlier about her being with us today. she said -- by " -- i quote -- love, care, patience and respect is what you need to be a good caregiver. thank you. [applause] >> we are going to make a short change in th >> i had not realized when we began the day that a colleague

who has traveled from sacramento to be with us today was here, or would it introduced -- or i would add introduced her. it is my pleasure to introduce lend up. they are the group that supported our efforts to put this on by allowing us to use some dollars that were available this year. we are really pleased about that. in addition, i have to i havelynn -- i have to say lynn has brought a breath of fresh air to the california department of aging. she has good, common sense, something we do not always see in government by that we strive for. she is always looking for ways to get things done. you do see that in the government. she's very collaborative and has been an incredible partner. it is really threw her leadership and one of for

deputies that san francisco has benefited from federal dollars in a year that dollars have been in such short supply. if you would come up and say a couple of words, i will appreciate it and then we will get on with the rest of the panel. [applause] >> thank you. i would like to credit anne hinton and kelly for doing such good work. i am here because we are here to learn just like all of you and i want to take this back. congratulations to everyone. it is cutting edge and important. thank you for including me. [applause] >> ok. we are going to move to the report added the expert panel so

we have the chairs from each of them. i would like to introduce them in turn, going around the table from what i can see. first, the panel for the -- excuse me -- for the finance committee is pat fox on the institute of health and aging. i would like to introduce elisabeth, the chair of prevention committee, the program director for the association and also working nationally on prevention activities, the maintain our brain program. cindi kaufman was chairman of the services subcommittee with the institute for aging, the

vice president for adult day health care and services. finally, the emerging research committee chair and the director pausing at this -- and advocacy. i turn this over to them. >> thank you. thank you. i was the chair of the evidence- based kraft -- evidence-based practices and research committee. we had an amazing task and committee who worked on this together. i am not going to read got the names. they are in your blood. this group came together. -- they are in your book. this group came together. they were tasked with coming together in finding out services

available in your city and do a review of the best practices and emerging research as we know it today for services that provide for people with alzheimer's and dimension. as we were doing this, it raised more questions than it answered. we have a pretty large array of high-quality services. certainly, the breakdown in finding it's affecting all these programs and services. -- in funding is affecting all these programs and services. what might be happening with treatments in the future -- we know that in the next hands years of alzheimer's is going to be very different. tin years ago we would not have had a person with early stage alzheimer's speaking on their own behalf and a panel.

these are new ventures. we also considered, what is the influence of policy? we can talk a lot about services and where we are going, but we also have to legislate about what makes sense that the community level for people. how should diagnosis and care be delivered? how do we consider when and where services are needed. what does early stage services look like? we did not have those 10 years ago. how can people answer and be delivered services at any point in the course of this disease and know that they will be getting what is needed at that time? what do we do for late stage care? what does that look like? we wanted to consider the best practices as they apply to people across the disease sector

and we also want to ensure that we consider programs that might not yet have evidence-based practice. did how do we decide about what should be delivered can years from now when we do not have a model for that? we began research with the help of the contractual agency and the members of our committee to look at the state of california. is anything doing these things well anywhere in california? is anyone doing these things well anywhere in the nation? is anyone doing these things well anywhere in the world, and can we capture that and pull it together and use that information to guide us in that direction? the outcome of this was a coordinated our way of potential services and recommendations for each of the various sub committees. what we did was use those as a

menu for people as they moved forward. did we gave it into four different categories. first, the systems of care. what does a sister of care for -- a system of care for people look like? how is it deliver? is it cost-effective? are there any operating that makes sense for a city like san francisco that is diverse and large? education and prevention -- we talked about best practices and early protection -- and early detection. screening for early symptoms. prevention, or delaying symptoms, including diagnoses, on going cari, managing the disease, -- on going care, managing the disease, and best practices. improving care for people, and what to a corporate services

look like? we wanted services that provide for all stages of the disease. we wanted to make sure that medical care and mental care could both be delivered at the same time for people. we wanted families to have choices about what kinds of things work best for whoever they are working with. as we went through all these recommendations, we can start on this now, but we need policy and legislation to change the way it is delivered in california or the nation. health care, budget cuts, and funding are key elements for any kind of program and service. lastly, we look at financial services. how do we pay for services? what did they cost? savings? how do we best provide for people in difficult economic

times? how do we not pay for these things one day -- when there are no alternatives for folks dealing with these diseases? in all of these cases, our role is to provide a menu of best practices in each category so that those experts at the table who are working on individual projects have the most updated research and available options to choose from from which to make their own recommendations. [applause] >> good morning. my name is cindy kaufman. if i put my glasses on i cannot see you and if i take them off i cannot see my notes. i will go back and forth. i have the honor of being the chair of the subcommittee.

when i was first asked to sit, i thought, this is great. as we came together and i looked around the table at the people i was working with, i was struck by the expertise that sat around the table. that came together to work on what to services and systems look like in san francisco. i need to start off by thanking the committee i worked with for their diligence and the fact that day -- that they were in there even when it felt like herding cats. one of the challenges that we face in looking at the services is trying to get too far into details when you are planning for the future. we started trying to pick, where does this start in the process

when it almost felt ill -- a little overwhelming at times. i felt fortunate to work in a city like san francisco that has some of the opportunities and has some of these services and the dedication and the foresight that i do not think other communities have. in coming together, one of the things that we looked at and where we started was looking at the services that are available, which started going down a very narrow path. if you start looking at the services right now, what does that look like for the future? how do we make recommendations? where do we need to come to to go forward? no one is going to monitor what is going to happen month by month. one of the members of the

committee came up with the idea of a road map, because part of who we are surveying is a huge array of people. we are trying with services to serve people with alzheimer's and other dementias. we are trying to serve the caregiver's. we are trying to serve people who have very little money. people with moderate income. people who have some money at their disposal. we are looking at people in the beginning stages of dementia, and the middle stages, in the end stages. part of what we wanted to try and capture was how anybody can come into the system at any point. how do we make sure that we get them where they need to go? in your handout, you have a listing of things that i will not go through in detail of the

vast areas of things that we really try to look at. we tried to look at care management. taking a look at not necessarily what we have this moment in time, but putting a framework on at our round, are we meeting the need currently? if we do not, where do we need to go? where are we right now? if we can have a community where people can maneuver through with them come in at various places, what does that look like? if we came together with an overall umbrella of looking at the individual areas and looking at what we have, do we have people throughout the stages of dementia? do we have the services available? what do we have for the services of people of various income?

the end result was, i believe, something like a 12-page document that had something -- that had some detail and some policy and a lot of information that we wanted to hold on to, even though it had come down to too much detail. it gave us that foundation of a place to go. we took the recommendation, working with the panel and bringing things back, and then putting it together with the best practices and the education and the financial piece, looking at where we want to go for the future. it was truly an honor working with this group. i think we came up with some very concrete, very forward- thinking things both in policy and then the services that we

need. i was also struck by -- and a couple of comments that happened this morning -- coming together at this time in the economy and not knowing where we would be at this moment in time, looking at services even as we went through watching some services go away in the actual planning of what we were trying to do. there was an advocacy peace that we look that -- piece that we looked at. if these things go away, they cannot come back. we are heading towards a place where we are going to need things more than ever and tried to get those things back off the ground. i am agreeing that cuts are better than dropping services,

but everybody has a vested interest in maintaining the services that we have going forward. that phone number that was put up earlier, calling the governor, we absolutely -- in order for this whole project to come to the conclusion that it needs to come to, i think this is a time for us all to work together. [applause] >> good morning. i would like to thank those on the subcommittee and who helped

me to think through some of the complicated aspects of the financial aspects that we face now and continue to face. san francisco is projected to grow in the future. this is primarily due to the boom generation. as such, the cost for caring for people will increase. these costs will include both out of pocket expenses and also costs from the standpoint of family and friends who contribute to unpaid labor to care for people with alzheimer's disease and associated dementias. a major problem -- when considering how to pay for the care for the future san franciscans who will develop the disease is that the services are paid by a wide variety of

sources including federal, state, and local funds. raise from medicaid, a private health insurance, medical, and many other sources in between. these are each with their own set of eligibility criteria and related rules and regulations resulting in a fragmented system of health and long-term care services. these financing methods and are responsible for the patchwork of services we have today. by patchwork, i mean care systems that can, for example, only serve people of certain income levels or with certain medical conditions or of a certain age or certain psychiatric condition or who have a job with a particular employer. these, among other regulations, a governor who we serve and who may not be served by a variety

of funding sources. as a result, there is a less than optimal integration of finances and medical and long- term care services that are necessary to meet the interchanging needs of people with alzheimer's disease and associated conditions. recognizing that these very medical long-term streams presented by my colleagues, the finance subcommittee has focused its recommendations on two basic issues. i am making the simpler than they are, but i wanted to give you the gist of them. first of all, it is important that the existing funding streams are repaid so that whatever funds are available from whatever source continued to be available. there are