Aging Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-179

Title:

AN ACT CONCERNING THE ALZHEIMER'S DISEASE AND DEMENTIA TASK FORCE'S RECOMMENDATIONS ON TRAINING.

Vote Date:

3/11/2014

Vote Action:

Joint Favorable Substitute

PH Date:

2/25/2014

File No.:

SPONSORS OF BILL:

Aging Committee

REASONS FOR BILL:

To connect the growing number of Connecticut state residents with Alzheimer's disease and dementia to critically needed services.

***Substitute language, as contained in LCO 2293, modifies the underlying bill as follows: section 1(b) was changed to remove requirement that homes create a dementia care committee and instead designate one person to make recommendations concerning care of those with dementia.***

RESPONSE FROM ADMINISTRATION/AGENCY:

Edith Prague, Commissioner, State Department on Aging

“…The Task Force has provided an excellent pathway for us to be able to begin to address the needs of this population and their caregivers. The guidance provided to our Department will assist in moving forward with our State Plan to address programming and to educate others about these needs. This bill proposes a first step to address concerns related to the many of these vulnerable elders who reside in some type of institutional or supportive living environment.

The Alzheimer's Association has documented that over 60% of individuals who reside in institutional care settings are living with a diagnosis of dementia. It is imperative that the employees of the facilities that care for those with dementia are trained and sensitive to the unique needs of this special population. This bill expands the training requirements and ensures the consistency with which not only institutional facilities educate their employees, but also law enforcement and the Probate Court as well.”

Deb Migneault, Senior Policy Analyst, Connecticut Legislative Commission on Aging “…The recommendations put forward in the Task Force report focus on strategies to increase public awareness, encourage and promote early detection and diagnosis of the disease and address gaps in quality of care. A key recommendation to address quality of care is work to build a capable and prepared workforce through dementia specific training.

…There are few Alzheimer's and dementia care training requirements for health care professionals and facilities serving individuals with Alzheimer's disease or dementia in Connecticut. It is estimated that sixty eight percent of nursing home residents in Connecticut have some form of dementia. Yet, Connecticut only requires Alzheimer's special care units or programs to provide dementia-specific training to their staff.

Of course, individuals with Alzheimer's or other dementias are served throughout the health care system and community. Many health care professionals and others are not trained to deal with the unique needs of individuals with Alzheimer's or related dementias. Enhanced specialist training is needed to prepare the direct care workforce for the unique challenges faced by people with Alzheimer's disease. Dementia specific capabilities need to be expanded and enhanced to ensure a dementia competent workforce with the skills to provide high quality care.

Currently, there are no dementia specific training requirements for home and community-based providers. Yet, Connecticut's aging population and re-balancing initiatives toward home and community-based services will increase demand for direct care workers employed in community-based settings, such as home health aides, homemakers and companions and personal care assistants. Seventy percent of individuals with Alzheimer's or related dementias reside in the community, and this is likely to increase the demand for home care services and supports.

Additionally, emergency responders often lack knowledge or training on how to respond to situations that involve a person with dementia…Therefore, the Task Force recommends the inclusion of training on dementia and Alzheimer's in the annual missing persons police training as well as dementia specific training for Emergency Medical Technicians.”

Jewel Mullen, Commissioner, Department of Public Health

“…The Department is supportive of the concept raised in this bill and agrees that more widespread training in dementia care would not only benefit patients and their families, but also the various health care providers noted in the proposal. However we respectfully request the Committee consider the following proposed technical changes:

● Lines 34 and 35 contains outdated references to Section 19a-36 and the Public Health Code. The Department respectfully requests changing the language to the following: '(d) In accordance with section 19a-495, the Commissioner of Public Health may amend the Regulations of Connecticut State Agencies to implement the provisions of this section.' Section 19a-495 is the enabling statute that allows DPH to create regulations pertaining to facility licensing.

● Sections 1, 2, 3, 8, and 14 mandate the Commissioner to create or update regulations to implement the provisions of this bill. DPH respectfully requests changing the 'shall' to a 'may' as DPH believes that regulations related to these provisions are unnecessary.”

Nancy Shaffer, Connecticut State Long Term Care Ombudsman

“…Most skilled nursing facilities periodically provide in-house dementia training to their staff. The recommendations in this legislative proposal will provide a framework and schedule for the facility administrator to ensure this training is provided. It provides a universal template for all facilities. Especially significant in this proposal is the requirement for each nursing facility to establish a dementia care committee 'to review and make recommendations to the administrator concerning residents with dementia, including, but not limited to: (1) Factors which affect person-centered care, (2) wellness indicators, and (3) staff training programs for dementia care capability' (SB No. 179 Raised, lines 23-27). This adds the aspect of resident-centered and facility-specific detail to the home's plan that is extremely important and beneficial. Not all homes, nor all staff, and certainly not all residents with dementia are the same. An individualized plan for the skilled nursing home is an excellent idea.”

NATURE AND SOURCES OF SUPPORT:

Kelly Smith-Papa, Masonicare

“…As you are aware, Special Act 13-11, which established the Task Force, required as part of the membership composition, the appointment of representatives from the provider community, and in particular several from long-term care facilities and community-based health care.

…The Workforce Training and Development Subcommittee held numerous meetings, discussions and deliberations before we presented our recommendations to the full task force for adoption. The subcommittee found that individuals with Alzheimer's or other dementias are served throughout the health care system as well as throughout the community. It is in our opinion that many health care professionals and other professionals in the community are neither informed nor equipped to deal with the unique needs of individuals with Alzheimer's or related dementias. In particular, there was overwhelming consensus that enhanced training in dementia care is necessary to prepare the direct care workforce for the unique challenges in caring for these individuals. Dementia training will lead to the delivery of quality care, and ensures a dementia competent workforce.”

Kathy Null, AARP CT Volunteer

“…Recent findings suggest that there are over 70,000 individuals age 65 and older living with Alzheimer's or a related dementia. Yet, despite the growing need, there are few Alzheimer's and dementia training requirements for health care professionals serving those individuals in our state.

The competency-based training outlined in S.B. 179 would help build a high-quality workforce and improve care for individuals with Alzheimer's and dementia.

…The proposal would also ensure that nursing facility employees receive training upon employment, and annually thereafter, on the symptoms and appropriate care for individuals living with Alzheimer's or dementia”

Laurie Julian, Director of Public Policy, Alzheimer's Association, CT Chapter

“…The training requirements set forth in S.B. 179 are not burdensome when balanced against patient safety. As noted, the task force comprised of provider experts in the field which overwhelmingly agreed dementia specific training would be an asset and investment. Wandering occurs in sixty percent of patients with Alzheimer's. Learning basic dementia skills in understanding aggressive behaviors, interacting and communicating with aggressive behaviors, and pain management has made a significant difference in the quality of life for both patient and staff.”

Mag Morelli, President, LeadingAge Connecticut

“…The bill before you today is very well intended and we support the underlying concept that enhanced training throughout the field of aging services would be beneficial to those we serve who are suffering from Alzheimer's Disease and other dementia related conditions. We do, however, have some specific comments regarding the proposal as it is written which we have outlined below. We submit these comments and offer our assistance with this proposal in an effort to bring forth workable and appropriate training recommendations.

● In Section 1, the bill recommends that each nursing home establish a dementia care committee and appoint a designated staff person to oversee the implementation of dementia related care and training in the facility. While a committee may be appropriate for some nursing homes, it seems to be an excessive requirement. We would support the appointment of the designated staff person, but would not be inclined to support the mandating of a full committee for every nursing home.

The phrase 'training and education on Alzheimer's disease and dementia symptoms and care' is used throughout the statute. This phrase is somewhat vague as to what type of training is intended and what will be viewed as acceptable.”

● …There are different requirements for newly licensed administrators and those who are licensed by endorsement. We would recommend that those who are newly licensed be afforded the same opportunity to receive training within the prescribed time limit as those who are licensed through endorsement, until such time as the training programs are able to ensure their curriculum is in compliance with the mandate.

● It is our understanding that the dementia training could be incorporated into currently mandated units of training which we believe would be an extremely beneficial method of training.

● …In Section 7 we would object to the expanding the authority to grant Connecticut nursing home administrator CEUs to a national organization, the National Council of Certified Dementia Practitioners. National organizations are specifically not included in this statute and should instead be working through the National Association of Long Term Care Administrator Boards (NAB) which provides accreditation for nursing home administrator courses on a national level.

The Committee should recognize that increased training will require additional resources on the part of the organizations and workers who are mandated to meet them. Every effort should be made to make the training affordable and accessible.”

Matthew Barrett, Executive Vice President, Connecticut Association of Health Care Facilities CAHCF)

“…CAHCF asks the Aging Committee to continue to be mindful that additional requirements on the skilled nursing facility community are too often unaccompanied by no commensurate reimbursement under our state's Medicaid reimbursement system. It is increasingly important to provide fair and adequate reimbursement as our nursing facility providers serve an ever-increasing population of higher acuity residents with more complex care needs, such as those diagnosed with Alzheimer's disease and dementia.”

Pam Atwood, Director of Dementia Care Services, Hebrew Health Care

“…More than 60% of all people in long term care have some form of dementia. Yet most nursing programs only cover the 3-D's, depression, delirium and dementia, in one evening of a 'normal health and aging' course. Nurses need to know better. Licensed nursing home administrators get even less education. Administrators need to know better.

More than 50% of all people over age 85 have some form of dementia. That means a statistical probability that the majority of very old citizens have dementia. Law enforcement can receive specialty training through the Alzheimer's Association, but it isn't required. Law enforcement, probate appointees, and emergency medical technicians need to know better.

This bill is easily enacted through established training programs which range in cost from $75 to $1000. Dementia-specific education is available through higher education institutions, non-profit non-governmental organizations such as the National Council of Certified Dementia Practitioners, the Alzheimer's Foundation of American and the Alzheimer's Association.”

Bette Marafino, President, CT Alliance for Retired Americans

“…Training of all personnel who care for these patients is crucial. A couple of physicians I have spoken to say that all too often patients are heavily medicated so they will be easier to handle by nursing home personnel. And this is not always the right approach. An increase in respite care support for the growing population of caregivers is also much needed.”

Christine Donovan

“…I became employed as a caregiver and began to work with dementia and Alzheimer's clients. I did not receive any formal training and feel it would have been beneficial despite my personal experiences.”

Katherine Swenson

“…I submit this testimony to speak about the importance of expanding dementia (neurocognitive) training so many more individuals…can live safely in their homes. I also want to express how unique Alzheimer patients' needs are and the extra care that is required. The reward of caring for these individuals is enormous.”

Kripa Sreepada

“…For long-term care facilities to contribute to the goal of reduced hospitalizations, staff development and training on how to care for behaviors of residents with dementia is key. With appropriate training, nursing home and assisted living staff would not have to send a resident with dementia to the hospital for behavioral outbursts and could rather use behavioral interventions to calm them down and ease their aggression.”

Sandra Pniewski

“…This small investment in training will reveal great returns in patient care and safety as well as overall quality of life for the individuals we live with and serve daily. Facilities that provide care to the growing number of individuals with the disease must keep up with the needs of its clients. Minimum training in dementia care for all staff in skilled facilities, residential care homes, assisted living facilities, adult congregate living facilities, adult day care centers, hospice, home health agencies and homemaker/companion agencies upon hire and annually thereafter is not burdensome and is minimal when considering patient safety and quality of care.”

Toni Marie Dumaine

“…My experience working with people that have Alzheimer's disease or dementia has opened my eyes to how delicate they are. It is extremely important to know a person's personal history, likes and dislikes in order to defuse, redirect and calm a person who could potentially escalate in to a frenzy. It is important to maintain their dignity and make them feel safe in their environment. There are basic steps someone could take to help a person with Alzheimer's disease or dementia stay calm. It will benefit everyone involved in their care.

These steps could be a breakthrough for a better understanding and a natural way of defusing, redirecting or calming our delicate population of Alzheimer's and dementia patients. The passing of SB179 will be a beginning to educate the front line care professionals.”

NATURE AND SOURCES OF OPPOSITION:

None expressed.

Reported by: Amy Linskey/Art Mongillo

Date: 3/13/14