beyond physicians, what is really going on on a gut level. so thank you very much. just so you know, we have note takers in the audience, so we will get your comments. >> i would like to speak at the point as well. i went to three doctors before i had a referral to a neurologist. the irony of the whole thing is that it shows the holes in the brain, and is so cost- effective it could have been done three years earlier. >> thank you. maybe i should put my glasses on. ok. >> i have not crystallize to this yet, but as we talk and look at the future, it seems to me that it would be very

helpful in some ways to have this be part of the school system as well, and since families will be relating to people developing alzheimer's disease, dementia, and the behavior could be recognized in the whole society. and i think that to start with you if could be helpful -- with the youth could be helpful. b>> i think for the work you hae done. it is comprehensive and thought out. yet this work seems to be costing a lot of money, which will lead to come through legislation.

sba-10, sba-40, and h.r. 676 as funding sources. >> could you just give the bill? >>kí these are single payer systems that will deliver comprehensive health care to all of the residents of california. 676 on the federal level. >> we want to respond quickly. >> thank you. and the finance committee, we recognize that that is a fundamental problem. the financing -- there is so much does johnson that you cannot have coverage -- so much

destruction -- disjunction that you cannot have accountability. these are exactlyñr the reforms needed to have a financing system to where people can access it. we feel that is necessary from a financing standpoint. >> your point has many big implications, as well,ecbh and california is going forward with a state plan for alzheimer's disease whereby i see as rolling and other pieces of legislation that trend away from skilled -- rolling in legislation in a most cost- effective manner so people get the care they need before ending

up in crisis care, in the emergency room. is an important component. ça>> in terms of recommendation, no. 8 -- improve the quality of home care for people with dementia. you know that they end up in acute care for other kinds of problems, and there are a lot of stories associated with that. the recommendation really speaks to the need. so far, they have not really talked about the issue of

building capacity within what is existence, with dementia, being knowledgeable and recognizing the symptoms at the point of diagnosis or interaction with formal care services, >gñéparticularly health care. and this holds true for the though it might be for a short- term state. -- stay. how can we make things more sufficient? and as far as quality care for persons with dementia, there are all different kinds of programs, and within them, within the crisis care system, there are services and supports for people who do not have families. they advocate for changes in the mental health system.

it is building capacity within our existing system to improve the quality for the point of it, as well. our recommendation is to improve c, taking it as a stepu)'down from nursing homes. there are possibilities of models and programs out there from other places, and we want to make sure. we would like to see a pilot tested. we know we will have to do work at a legislative anend.

when you look across hospice statistics, dementia does not figure prominently, and there are issues around understanding the reimbursement and diagnosis and the understanding of the attending physician of what the end state of the dementia patient looks like, so they cannot get a service referral. objective 12 is to advocate for support for implementation of a strategy. this speaks to the kind of things we have been discussing in terms of health care reform. and a single payer option or whatever you want, however it gets shakeout. i want to make -- however it shapes up. i want to make an editorial point. president obama had a support for the kennedy bill, known as

the class act, which was incorporated into the kennedy health care reform package, looking at funding in some capacity, financing long-term care services for the community. so that is a moving target, and we know we have to continue to be vigilant advocates for those issues. policies create a community sensitive to the needs of individuals with memory loss. i will always associate this with pat fox. how do we build those communities? it really takes a village. e system here, but it is the schools, the arts community, the recreation department. because we are so visible, with representatives across departments today, i got a call from their supervisor and there are four police officers from the tenderloin here.

and boy, are they important. [applause] why are they important? because oftentimes we call the first responders to a family crisis. > capacity so we do not apologize -- mythologize the experience. we normalize, finding a way that the community can respond to most compassionate actions. and finally, putting together some sources of ongoing strategy, facilitating an oath -- an oversight body and advocating for the improvements that we have all talked about is no. 12, a formalized way of saying we want this within the coordinating committee of san francisco as a subcommittee. it is from the department of

+9]"adult services. with that, i will turn this over. now you can comment about anything you want. >> hello. i would like to say thank you for this dementia summit. this is very interesting. i also wanted to ask you if you could address the qualifications for services with those with dementia. you covered the early stages of dementia. bu>> does anyone want to take that? >> are we back? nutrition did come up on some conversations on a variety of levels. getting the right nutrition, getting meals at all, that is

something to look at. we did not have a specific recommendation in that matter, but it was on the radar screen because there are things both in the beginning stages, as long -- along with, as people are progressing through the disease, what are their nutritional needs, and how we get those in the community? that is one of the key things in keeping someone in the community. >> i am a member of long-term care and want to commend the group on its work. there's been a lot of environmental research done on environmental causes of dementia, and i want to recommend that that be included in the recommendation strategies

for management. thank you. >> just to piggyback on that, we have done a great job of looking at the current reality, but when you look at the cause, it would be good to have feedback for what is the right route cause for alzheimer's, and what will help? if we can get to the cause -- and one of the ideas with nutrition is an alternative that would be considered an important concept, advocating a vegan or a rock diet. a book called the time that study -- that china study talks about increasing the idea of getting at diseases such as alzheimer's.

>> the way to provide polio care was developing a vaccine. and i know that the bucks center in marin and a lot of scientific centers are desperately trying to figure out how to deal with they> thank you for taking my statement. in my court needing care for alzheimer's early on, both as a geriatric facilitator and in long-term care facilities, one thing that emerges for me as a low hanging fruit, an area where we can terrific a leak improve quality of life for people with dementia, caregivers, and the

cost of a needed hospitalization. that is in accurate diagnosis and treatment. and once that diagnosis and treatment is in place, encouraging a mechanism for communicating behavior and responding to medication so it can be continually adjusted for the benefit of the person. i see that as a quick way to gain a lot of ground. >> i think the education and prevention committee -- i want to say a couple of things. educating consumers so we can be advocates and the way that was described earlier -- in the way

described earlier. >> this summit is a good step forward. i would like to recommend to the panel that they consider in their final report expanding objective 8-1 to expand the meaning of the acute care hospital to also include facilities. facilities with dementia units should be invited to help identify best practices in skilled nursing facilities. the second thing i would like the panel to consider is objective 9-tobe, -- nine-b,

cabout the likelihood that adult slots will be cut back. given the moratorium on licensing, i think charles rivera and his staff believed they could piled the tests to " show that their program could be cost-neutral to the city and low-income san francisco residents and people on medical. thank you. [applause] >> good afternoon. thank you very much for this summit. i am very appreciative to all of the ones in here who have given

me help throughout my journey with my husband, who was diagnosed with alzheimer's in 2004. i am looking at!ózd your objecte 13, and i was in all of -- in awe -- let's look at it. our panelists mentioned that she has children. on a number 13, it says memory loss policies and practices create a sensitive community. i would also like to say that if we could consider children more -- as people get alzheimer's younger and younger, i have a child who was involved from middle school who is now just finishing his freshman year in college. is very difficult for those

children. -- get -- it is very difficult for those children, particularly if it is your father and you are a i have been married for 20 years, and i became a single parent again. i think it is important that that aspect is look at -- looked at. and we should say, how do we approach that? how do we get those children to seek help? my son went on his own this year after being in college for a year. i think it is really important, because it impacts all9v&n fami, not just the main care providers. my oldest son brought me this morning, and he really did not want to come. i have been under a lot of stress and in the hospital.

my husband is 17 years older than i am. i think it is important that we do not forget those children involved in this family situation. we should not forget the impact that it has on them. [applause] >> i want to also thank you for putting on this conference and allowing us the opportunity. i have two comments. the first is relating to the workforce and the existing system. i do not know if you are aware that the health department used to have a chronic care section that has 14 trained public health nurses to help them to

connect to services were there are respites, where there are services. that team of 14 nurses has a trained case manager who could provide a single point of contact to these elderly patients, but they were all wiped out this year. now there are no free home visits by nursing case managers. so that is -- in terms of building capacity, that is not building capacity. it is decreasing capabilityz helping these clients who need services to access services. so i would hope that the panel

in your recommendation was looking to build capacity by regaining funding for these trained case managers to help the clients stay in the community. that is what the focus is, to help them stay in the community instead of institutionalizing these guys. that is my first comment. the second comment is about se. we really do need cultural providers, especially in mental health. all of these services -- i would hope the panel would consider, other than educating the

providers -- i came from the university of california, san francisco. i know that they emphasize a lot of help diversity and culture of competency works. i want to use a panel to make a recommendation for any kind of provider to have bilingual providers, along with putting the curriculum in their education about sensitivity. [applause] >> towards the back? >> this is for the finance and education committee. i am a speech pathologist, and i think one thing to consider is putting up feeding tubes in patients, because it is costly.

if more people could be better educated on tradition as well as strategy, to help these elders. aspiration pneumonia is probably one of the major causes of death, so i want to say that there are lots of specialists. thank -blu>> someone who was a shy abt speaking in public passed a note and mentioned that their mother was hospitalized. she had a wristband for imitation allergy -- a medication allergy.

>> i think this would fall someplace and 7.1 with education -- in 7.1, with education. if any behavior changes dramatically, it would be a good idea to contact an attorney early on, rather than at a point of crisis. does a mother know what is going on? no, not really. i would like to help you create powers of attorney while the folks still have capacity of signing documents. this would divert a lot of expensive and unnecessary procedures.

an early visit, just for the patient. the forms are available on the internet and you do not actually need a lawyer. [applause] >> i have two questions as well. my first one is kind of long, sort of. i am wondering about hipa practice is as far as people diagnosed with dementia that may be long-distance. we had a caregiver for a father, a mother. as it turned out, a tornado went through the town and that was when we first discovered a problem with her memory, even though we called frequently. so i wonder how that relates, for doctors to be able to

divulge that information. my second comment is about objective 6 and objectives 7. after diagnosis, the point of contact and service -- most of what we learned and likewise for other people in the room was by accident. so having the resources and the step-by-step process is very important. >> it tends to be in conflict. when people are diagnosed early, they retain capacity to choose. so it is not really a decision that dr. made. obviously,, the family will influence that, but they have

the right to decide who gets told. >> hello. i have a couple points. one is to piggyback on what people have said about the need to have some kind of intergenerational setting. there is such a separation in our culture. and somebody mentioned that we are apologizing. we need to demythologize the shame around to dementia and alzheimer's. -- around dementia. there is a lot of stigma around it, and the care giver -- they

are not wanting to come forth and say they have it, because there is such-imagery, and they feel really isolated. i want to say both as a social worker and a long distance caregiver for elderly parents, it is really important to note -- maybe i am plugging -- that the services are available. it is our intention to keep people living safely and independently in their homes. if you do have any inclination or suspicion that somebody is having a hard time, losing capacity, might need assistance with setting up services -- adult services and social workers are available to go out

and work with those individuals and families to really connect people to services in the community with the intention, if at all possible, to keep them living in their homes. and there's a 24-hour hot line for adult protective services. [applause] >> working in a long term public facility has a social worker, one of the holes i see is caregiving at night. people have sleeping difficulties, and i'm wondering if that has been thought of, and what the answers might be? i have a number of residents i work with who are