and i figure they must know each other. >> actually, residential facilities became a huge topic of conversation around education and training, and there is the dementia waver around facilities that insures across the board not only residential facilities, but where it came back to training and where it is needed for the different behaviors and needs. but also, looking at the residential facility a step- down way to get people out of a higher skill level of care when they do not need the skill level. when they need the social model more than anything else as a wonderful opportunity to a acknowledge that there does need to be some of those holes that need to be patched.

>> i will add to that. i think that is a challenge right now and the community- based service arena, getting people in. getting people to spend the night changes cost complications hugely and implies a high level of care. that is one of those challenges where i think if we got better at the earlier treatment options, that would be more comprehensive and we would get better at that. that came up with us in some discussions. >> and i will point out that the school of nursing at the university is one of the authorities on non- pharmacological management of day-night problems in alzheimer's and dementia. i hope there is further progress and research so that

people will not wake up in the middle of the natnight and that could obviate the need for some of the services mentioned. >> one thing that i did not see in all of your comprehensive lists was anything about spiritual care. it comes to mind in three ways. clergy would be an important group to educate to be able to identify the issue. they are gatekeepers. second, there is a body of knowledge for care providers about how to provide appropriate, relevant care for people with dementia and their families. third, it is important to identify spiritual needs in people with dementia and their families. [applause] >> that is exactly why we wanted to do this. we wanted to find things that we left out. >> i want to know how close we are to include preventive

detention in our health plan. i will have an mri for my needs and they are setting up a test to determine problems in the future regarding arthritis. i am wondering -- how close are we to it, and how expensive is it, to include early detection for those who want to take charge of their health? >> some techniques that the doctor mentioned, including the pittsburgh compound, are not yet part of general medical practice. they are in the experimental realm, although they are promising. and once things to fall into availability -- to -- do fall into practicality, you have to ask yourself what the big health-care agencies are doing,

and so forth. so one of the hopes of a more logical health care system is that decisions for the availability of screening tests like the ones we're talking about will be made in a thoughtful, logical manner, rather than just randomly, as is often the case. >> education and prevention workers certainly talked about that. not the imagery, necessarily,[xñ but getting it tested now. there are a lot of controversies about whether or not you could have cognitive screening.

let's talk about genetic testing for a moment. should we all get tested? i would say no. but if there were a treatment that could prevent me from getting alzheimer's, i have a different view on that. so we recognize that there may be a role in the future. but we decided not to recommend broadbased screening if the available treatments change. >> i have a question. most here are caregivers, and you have shared what an impact it has to do with the daily needs of going shopping, attending a party, or whatever,

without having the patient with you. i question is, has a thought process occurred where you have a network of care givers who can create a community and french ships where maybe i have a person i am taking care of, maybe you do, we live in the same neighborhood, and there could be an opportunity for relief. that is like mothers and saying, "hey, could to car pool today, i aóm3will do it next week." may be a network could be farmed -- maybe a network could be formed. >> i would say that the care giver alliance already has a rich network of caregivers support groups where you meet others and they are often local and also givers for people with special needs, like early dementia.

you can find people through that network, and similarly, they have web-based caregiver support groups where if you do not have the opportunity to attend a meeting, you still can meet people. it is not a perfect solution, but it is a wonderful one, and i do not >> good afternoon. i am an uncompensated care giver. there are over $1 billion in that industry. i have been doing that for the last three years for my mother. as i like to say, i work 36 hours a day, eight days a week. and when it comes to an ira, it just gets under my craw that i am not not able to contribute to an ira because

i do not have earned income i could take money out of savings or take unearned income and avert that to end ira -- to an ira and take advantage of tax shelter benefits that everyone else enjoys, but it is just another slap in the face. maybe this form can go to the federal or state government and allowed at least a nominal compensation for that. thank you. [applause] >> thank you so much, everybody, for this. my dad has dementia -- different from alzheimer's. he is fortunately in a great assisted living facility in san

francisco. this was addressed earlier by one of the earlier panelists about treating the group versus treating the individual, and how when you focus on one you take away from the other. i wanted to comment on that. even in this facility which he is fortunate to be in, i find that the caregiver's, blast the, they are amazing, do not attend to him as an -- bless them, they are amazing, do not attend to him as an individual. his symptoms are different from other peoples. years ago, i worked for united cerebral palsy. active in my training to be a caregiver for that disease was the fact that most of us were

actively trained regarding each individual's set of symptoms. it is exhausting? where is the money and the time? it was possible to be educated for each individual. i would suggest, if it is possible, to believe that day -- that they, there is active effort to find out about the individual and their particular needs. to make that an important component of training for care givers, if that makes any sense. >> it makes total sense. pertinent and appropriate

comments. i have just been told that it is time for something. [laughter] there is one crucial element of the information -- and sounds like we have time for another comment or two. >> i am from the program in san francisco. [applause] a number of commons -- comments triggered some phrases. individuals who are caring for loved ones and have dementia live quiet lives of desperation. there is a whole privacy issue where they might not be referred to that one door and the recommendation -- we need to look at privacy as a barrier. someone mentioned hippa. it goes to the utility's per

cent all the way down -- i would hope that it would be kind of a tax on alert system would be created so that the person is referred. nighttime is the right time. what i mean by that is that after the expert cat -- after the expert panel had a session, there was a remarkable article about elderly jewish people in manhattan who are taken to an all -- to a day program at night said they can jimenez and be involved -- reminisce and be involved. we know that sundowning occurs. we need to have an alternative to staffing patterns that are basically loaded towards daytime shifts and away from my time shifts so we have a quality of life standard where individuals who see the night time is the

right time and can have adequate staffing and social stimulation rather than worrying about their not sleeping. when people do not sleep, it becomes a problem. when people have behaviors', it becomes a problem. let's have the individual not seen as a problem but as the center of a plan in terms of needs and preferences. the night time is the right time even though it is not convenient in terms of staffing. [applause] >> i just wanted to make another comment about -- thanks, that was good. i wanted to come back to the question about training. one of the things that i think is difficult is to separate out a task-oriented caregiver from a person who approaches somebody as an individual.

that is definitely a trading piece that we talked about. -- training piece that we talked about. we have to define, the death of paramount, whether dementia or alzheimer's -- when people have -- we have to define cognitive impairment whether it is dementia or alzheimer's. when somebody has the cognitive impairment, i can tell you that this never came up and our discussion. we look dead blood pressure, heart rate, medication, but never talked about what that might mean when that person goes home. that is one of the things that i think when we talk about a culture of training physicians and families and the community, we have to talk about cognitive impairment in a different way so that we see people as individuals. so we take into account what it

means when it -- when they walked out of a conversation. >> i have been told the american building is ready. we will stop. we have time for another comment or two. >> laurel ethridge. professional caregiver and a recent caregiver myself. my father has dementia and lives with me as his primary care giver. my concern is for early dementia care. i know we are aware that the needs of people with early dementia are very different from those with moderate or advanced dementia. yet most of the programs and services and care services tend for economic reasons to lump everyone together, which excludes people with early

dementia who do not want to be left to get there. it -- to be lumped together. one of the things i advocate for as resources are limited is that it is not just the squeaky wheel that gets the grease in terms of more moderate people with dementia. we have more and more early die -- early detection and diagnosis. the need for services for people with early dementia and really gets a strong -- with the early dementia should really get strong focus. [applause] >> hello. i would like to add one comment to the lexicon that was used. we use the terminology "no wrong door." i would like us to keep in mind also that nobody falls through the cracks. part of that was mentioned by

one man from adult protective services. i think part of the problem is that we have certain mechanisms today. it was mentioned earlier that about 40% of adults in san francisco are loaned -- are long without a relative nearby. i think we have such a fragmented system that nobody talks to one another. when we have public health services says -- services, they are not communicating with other parties. we are able to develop, and i hope we will be able to develop something whether it involves all volunteers -- and obviously privacy is critical. i have been thinking about that, too. we must recognize that we cannot rely solely on an informal

system so that people do not fall through the cracks. we do need some formal system, otherwise, as the population ages, we are going to have a lot more tragedy, and i do not want to see in it. [applause] >> i hear that we have some pretty hungry people in the room. one last comment? >> hello? over here. >> two last comments. >> my name is diane out. -- diana. i and the director of an asian center. i want to thank the panel for the dedication for putting this together because it is truly a lot of work. i also want to thank my colleagues who are here. especially the ones on the

panel. you have done tremendous work. i want to -- one of the things that i am leary about is that we spend so much time -- if the goal is to raise awareness, you have done that. if the goal is to solve problems, we are barely touching on solutions and suggestions. you have done a great job putting in recommendations and actions together. what really would be important is follow-up work after the summit. what we are going to do after the summit. what are the plans for meeting and following up with recommendations? if you do not follow what, the summit has gone to waste. after we walked out of here, most of us forget about what we have heard today here. unless you keep up the effort,

the work is not as productive as it could be. one of the things, as a nurse myself, that i always think about is when we go and see doctors, we get our blood pressure checked and our heart rate. one of the things that i always thought about is -- what about a mental check up? so many of immigrants especially have a depression that is undetected. many elderly have early cognitive dementia that his son diagnosed. -- is undiagnosed. i think that would be useful. that calls for some change. a big change. you definitely would meet with a lot of resistance for acting on anything at all. with budget cuts now -- i was watching television the

aggregate. -- i was watching television the other day. there were telling us that the day care program would be tight. one of the big problems with dementia is socialization. those day care programs are by far much lower. unless the recommendations are carried out, then the discussions here -- >> thank you. [applause] for this recognition of what we do next. the panel meets in december. they put this together in short order. i do not know that it could have been any other way, but that is the question. are we going to discuss that later, or do you want me to address that now?

we have addressed that with leaders of the committee and those that we think are significant. i introduced those folks earlier on. they are tenacious. there is no way that they are going to let this go. but this effort is shared by everyone. the community, the social service community, the caregivers. once the report is released, we will be making contact to ask you if there is some way that you want to participate as we go forward. we will be having more groups and have already put a work plan to gather that strategizes this -- together that strategizing is this. we are now working on who will chair those work groups.

you are right. although i have to say not only has good work been put on paper, but there has been much learning. it continues. that is the plan. if you are interested in working on that -- i know it does not -- i know i do not look like america, do i? [inaudible] all right. but the mayor is trying to get to us. i do not think we want to put the marriage between you and lunch any longer. >> one quick comment? i take care of my 96-year-old father. i am fortunate enough that he attends an adult program. when i brought him to san francisco in 2005, his heart was

functioning at 38% capacity. he attends st. mary's and is bored. he walks and his snout is at 60% function. -- and his heart is now at 60% function. he sees a cardiologist. i have a question about exercise. on the weekends when he does not go, he starts having the sundowning the fact. the other thing i want to say -- i am told he has dementia, but he has never really been diagnosed by a neurologist and i would like to talk to somebody. do i need to have that done? i do not think he has alzheimer's, but i do not know. watching my dad -- he was always -- she was a boxer who tried out for the 1936 olympics. exercise is wonderful for him.

i cannot say enough good things about st. mary's. i would like to have him have more space so they can be out in the sunshine. i have taken my preschool there for years. that is a beautiful facility. i wish everyone could go to something like that. >> thank you. >> to make a lot of important points. by that also finds exercise to be helpful in the beginning. -- my father also finds exercise to be helpful, in the beginning. i know that one day a police car followed him halfway out of town. it was not a high crime day, thank you very much, so they were able to do that. thank you. >> we are going to break for lunch. i want to tell you we have --

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. >> forgot no. 2. silver is nothing. there is no having made it and so we beat foreman. i love the competition. . >> american made has really taken it on themselves to green american cities. >> we have a new organizer for the city and county of san francisco. oh, mayor as well. yeah, that's part of the job description. yeah, mayor of san francisco. >> the city is extremely concerned about the emission of green house gasses and making san francisco a sustainable city. >> we need to find other ways to create energy without harm to the environment and this is one source. >> we have over 2 megawatts of

solar on various city buildings. we are looking at tidal power and we're beginning to look at geothermal power. >> we're on the roof of the moscone center of san francisco and we have 2500 panels that power the center. >> here we are using real energy, energy from the sun, free energy from the sun coming in right here. this converts directly into electricity. >> all these technologies cost money. they don't make economic sense. solar never made economic sense. bio fuels never made economic sense. it's when it was adopted that it started making sense. >> some of them have challenges, that take a long time to prove out, but there's no reason that the challenge of where we will get tomorrow's energy in the united states should not produce a very, very large. >> san francisco is unique in

the united states because we serve our own power needs. >> the city of san francisco is well positioned in that we are perfectly located to take advantage of any renewable category. >> we tend to be the last one to figure it all out. it's real people that are saying, enough's enough. . >> the answer is going to be in renewable. the sooner we do something about it, the easier it will be it resolve. >> we're not just talking about what a city can do, we're doing it. >> san francisco has set very aggressive goals for greening the city. >> i'm not just naively optimistic, i am pragmatically optimistic that we