[Senate Hearing 113-908]
[From the U.S. Government Publishing Office]
S. Hrg. 113-908
ALZHEIMER'S DISEASE:
A BIG SKY APPROACH TO
A NATIONAL CHALLENGE
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
BILLINGS, MONTANA
__________
AUGUST 13, 2014
__________
Serial No. 113-29
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
47-032 PDF WASHINGTON : 2023
SPECIAL COMMITTEE ON AGING
BILL NELSON, Florida, Chairman
ROBERT P. CASEY, JR., Pennsylvania SUSAN M. COLLINS, Maine
CLAIRE McCASKILL, Missouri BOB CORKER, Tennessee
SHELDON WHITEHOUSE, Rhode Island ORRIN G. HATCH, Utah
KIRSTEN E. GILLIBRAND, New York MARK KIRK, Illinois
JOE MANCHIN III West Virginia DEAN HELLER, Nevada
RICHARD BLUMENTHAL, Connecticut JEFF FLAKE, Arizona
TAMMY BALDWIN, Wisconsin KELLY AYOTTE, New Hampshire
JOE DONNELLY, Indiana TIM SCOTT, South Carolina
ELIZABETH WARREN, Massachusetts TED CRUZ, Texas
JOHN E. WALSH, Montana
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Kim Lipsky, Majority Staff Director
Priscilla Hanley, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator John E. Walsh, Committee Member..... 1
PANEL OF WITNESSES
Kathleen Burke, Daughter of Alzheimer's Patient, Billings,
Montana........................................................ 3
George Carlson, Ph.D., Director and Professor, Mclaughlin
Research Institute, Great Falls, Montana....................... 5
Patricia Jay Coon, M.D., Billings Clinic, and Co-Chair, Montana
Alzheimer's-Dementia Work Group, Billings, Montana............. 8
Bruce Finke, M.D., Elder Health Consultant, Indian Health
Service, and Representative to the Advisory Council on
Alzheimer's Research, Care, and Services, Billings, Montana.... 11
APPENDIX
Prepared Witness Statements
Kathleen Burke, Daughter of Alzheimer's Patient, Billings,
Montana........................................................ 27
George Carlson, Ph.D., Director and Professor, Mclaughlin
Research Institute, Great Falls, Montana....................... 32
Patricia Jay Coon, M.D., Billings Clinic, and Co-Chair, Montana
Alzheimer's-Dementia Work Group, Billings, Montana............. 35
Bruce Finke, M.D., Elder Health Consultant, Indian Health
Service, and Representative to the Advisory Council on
Alzheimer's Research, Care, and Services, Billings, Montana.... 39
Statements for the Record
Testimony of Max Richtman, President and CEO, National Committee
to Preserve Social Security and Medicare....................... 51
ALZHEIMER'S DISEASE:
A BIG SKY APPROACH TO
A NATIONAL CHALLENGE
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WEDNESDAY, AUGUST 13, 2014
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 10 a.m., in the
South Park Senior Center, 901 South 30th Street, Billings,
Montana, Hon. John E. Walsh, presiding.
Present: Senator Walsh.
OPENING STATEMENT OF SENATOR
JOHN E. WALSH, COMMITTEE MEMBER
Senator Walsh. Good morning. I want to welcome everyone to
this Senate Special Committee on Aging field hearing. I thank
all of you for taking time out of your busy schedule to be here
with us today and to discuss this very important topic.
I would like to start by thanking Dolores Terpstra and the
board of the South Park Senior Center for your generosity in
sharing this space. Thank you very much.
I would also like to thank Bea Ann Melichar, who is the
Executive Director of the Adult Resource Alliance, and her
staff, for all your work. Bea, thank you very much.
I would also like to thank the Alzheimer's Association, and
especially the Montana Director, Heidi Gibson--where is Heidi
at? All right. Heidi, thank you for all the help that you have
done to provide for this field hearing. The Alzheimer's
Association does great work to educate and support families
dealing with this difficult disease. They will be hosting a
number of events across the State the next month to raise
awareness and money to help find a cure, so, if you are able to
participate in a Walk to End Alzheimer's event, I encourage you
to do so.
I will start off with a little bit of housekeeping for this
hearing. I want everyone here to be part of the conversation.
My staff have distributed comment cards that we hope you will
use to ask your questions for our witnesses. Just fill it out
during this hearing and pass it to one of my staff. If my staff
would please raise your hands so you can see who they are. We
may not be able to get to all the questions during this
hearing, but I will make sure your questions for the witnesses
are submitted for the record so they can be answered after the
hearing.
We have a great line-up of witnesses with us today and I am
looking forward to hearing from each one of you. Thank you for
being here with us.
Dealing with Alzheimer's disease is a tremendous challenge.
This is especially true in a rural State like Montana, where
great distances can make it difficult to access community
resources, so, it is crucial that we tackle the challenge head-
on. Perhaps the most important goal of this field hearing is to
raise awareness about the disease and to help reduce the stigma
associated with Alzheimer's.
Alzheimer's disease is not a normal consequence of aging.
It is estimated that half of all Americans with Alzheimer's
disease have not been diagnosed, and, even among those who are
diagnosed, many are not aware of the resources that are
available to them when it is identified. If you or someone you
love has Alzheimer's disease, I encourage you to get in touch
with the Alzheimer's Association or your nearest Area Agency on
Aging or another local support group for more information.
As our population ages, Alzheimer's disease is affecting
more and more families across the State of Montana. Today,
there are about 18,000 Montanans suffering from the disease.
That number is projected to surge to around 27,000 in the next
10 years. This is clearly a growing problem that will only
become more severe as our population ages.
Alzheimer's disease not only affects those with the
disease, but it can cause a tremendous financial, emotional,
and even physical toll for family members and other caregivers.
There are about 48,000 people in Montana who care for someone
with Alzheimer's disease or other dementias. Many of these
unpaid caregivers cut back hours of work or quit their job in
order to take on the responsibility of care. The Alzheimer's
Association estimates that the value of unpaid care in Montana
reached a staggering $677 million in 2013. That number is only
rising, and it does not include the considerable emotional toll
associated with the disease.
Research also shows that this disease particularly affects
women. More than 60 percent of unpaid caregivers for someone
with Alzheimer's disease are women. In addition, roughly two-
thirds of people who develop Alzheimer's disease are women, so,
this disease is equally harmful for both men and women, but
women are disproportionately affected, largely because women
live longer than men. Researchers have shown that older age is
the greatest risk factor for this disease.
There is no doubt that this is a devastating disease.
Symptoms develop slowly at first, but this disease steadily
disrupts neural networks and overtakes a person's ability to
perform basic tasks. This disease can literally cause the brain
to shrink from a healthy three pounds to only one pound. In the
process, people with Alzheimer's lose their ability to take
care of themselves and can even lose the ability and capacity
to recognize members of their own family. It is truly agonizing
for loved ones in this situation.
I am working with my colleagues to strengthen the Federal
commitment to Alzheimer's research and to help ensure that
families have the resources that they need, and, I am proud to
cosponsor the HOPE Act. This bill will ensure that families
will have access under Medicare for not just a diagnosis, but
also information and other services to help navigate the
disease. I have also cosponsored the Alzheimer's Accountability
Act that would require the Director of the National Institutes
of Health to submit an annual budget to meet the goal of
preventing and treating Alzheimer's disease by the year 2025.
If you or a loved one is dealing with Alzheimer's disease,
the message I hope you get from this field hearing is that you
are not alone. There are many talented people in Montana who
are working hard to educate and support caregivers.
One of those people here is here with us today in Billings,
is Kathleen Burke. Both of Kathleen's parents served their
country during World War II. They were decorated for their
service in the European and African Theaters while stationed on
a hospital ship in the Mediterranean Sea. Both, unfortunately,
developed Alzheimer's disease. Kathy knows firsthand the
tremendous challenges of caring for parents with Alzheimer's.
Kathy has drawn from her experience to be an advocate in this
community and she is a member of the Montana Alzheimer's
Association Board of Directors. She is also the Caregiver
Representative for the Montana Alzheimer's Working Group.
Today, I have asked the witnesses to limit their testimony
to approximately five minutes each, and, with that, Kathy, we
would like to hear from you. Thank you, Kathy, for being here.
STATEMENT OF KATHLEEN BURKE, DAUGHTER
OF ALZHEIMER'S PATIENT, BILLINGS, MONTANA
Ms. Burke. Good morning. Senator Walsh, individuals who
recommended my participation, fellow panelists, audience
members, thank you for this vital hearing. It was with a
humbling sense of responsibility that I accepted the invitation
to testify and bring a common face to Alzheimer's. I apologize
ahead of time for speed-reading my testimony, but I am
concerned about the time and do not want to miss points,
especially educational ones.
My name is Kathleen Burke, and unfortunately, I have a
family history of Alzheimer's and related brain disorders on
both sides of my family for at least two generations. I helped
my maternal grandparents when I was the only relative within
900 miles. I resumed caregiving when my mother, Shirley, was
diagnosed with Alzheimer's in 2002, and my father, Jack, in
2010. My mother has been in a nursing home since January 2013
due to her Alzheimer's, now in its final stages. My father, who
was on medication for his mild symptoms of Alzheimer's, died
last September of pancreatic cancer.
I am honored to speak on behalf of the estimated 48,000
caregivers for the 18,000 Montanans currently diagnosed with
Alzheimer's disease. The number of Alzheimer's patients is
projected to increase in Montana by 50 percent by 2025. This is
a startling forecast that we need to derail. When the
government provides to Alzheimer's disease the level of support
that has been given to cancer and heart disease research for
the last 40 years, tremendous strides should also be
accomplished for Alzheimer's.
The Alzheimer's Association provides this list of ten
warning signs that can be used as a checklist to discuss
concerns with medical providers. The signs are: Memory loss
that disrupts daily life; challenges in planning or solving
problems; difficulty completing familiar tasks at home, at
work, or at leisure; confusion with time or place; trouble
understanding visual images and spatial relationships; new
problems with words and speaking or writing; misplacing things
and losing the ability to retrace steps; decreased or poor
judgment; withdrawal from work or social activities; and
changes in mood and personality. According to the 2014
Alzheimer's Disease Facts and Figures report, the personal
difficulties that I will mention now are experienced by many
Alzheimer's families.
Personality changes are common and can cause rifts in
families if one does not remember that the disease adversely
affects the person who used to know and relationships with
them. I had to interrupt a class to deliver a message to a
student about his parents in Great Falls. His Alzheimer's
afflicted father had beaten his mother so severely that she was
taken to the hospital and his father was arrested.
Mom put an appointment on the calendar, but did not know
why. I took off work and found a salesman discussing plots in a
veterans' section of a local cemetery, so my parents thought it
was free for vets. I recognized the salesman, mentioned Mom's
Alzheimer's, and explained that they would not be buying.
Mom was baking a frozen pizza for supper with the plastic
wrap still on it. She said she always did it that way. Since it
was no longer safe for her to cook and Dad did not know how, I
had to solve the problem, which included in-home help costing
$20 to $25 an hour in this area.
Mom was dropped off at a casino to play cards, but Dad
remembered the wrong day, so her friends were not there. Rather
than thinking to phone family members, she accepted a ride from
a complete stranger to take her home. That was pretty shocking.
I would call Mom daily to ask if she had taken the pills
set up for her and if she dressed. I started to find chewed
gelatin pills in the garbage and on the floor. One day, she had
two shoes of different colors, whereas another time she had on
two right loafers. One night when I saw her limping and asked
why, she did not know. I took off her shoe and found a sock
crammed in the toe of her shoe. Dad was angry when I suggested
he had to pay more attention when helping. His typical response
was, ``You do not understand.''
When Dad had a brain abscess in 2007, I had to take Mom to
work with me because I could not safely leave her by herself.
It was difficult to find senior day care in Billings then. It
is still limited, and may require a contract as opposed to
meeting drop-in needs. The client has to be quite independent,
but it is still cheaper than in-home care. My brother was
fearful that my Dad's wanting to save money by taking care of
Mom at home instead of using the nursing home would take a toll
on Dad's failing health, which happens to caregivers.
Driving is a huge issue for Alzheimer's victims and their
families. After twelve years of discussing it at caregiver
meetings, I can remember only three people who gave up driving
on their own, which was not the case for my Dad.
I had four experiences where Mom's increased confusion in
unfamiliar surroundings, coupled with lack of Alzheimer's
knowledge on the part of physicians and nurses, made for
miscommunication and injury. This points out that Alzheimer's
education is needed for everyone, including medical personnel,
to meet the needs of these patients. Employers are another
group for which education would improve understanding as to why
employees need to be gone from work for caregiving for family
members with Alzheimer's.
At the end of their 68th wedding anniversary celebration in
the nursing home on July 4, 2013, Mom pushed Dad away when he
bent over to kiss her goodbye, saying that her husband would
not like that. It was difficult for me to see, but probably
worse for him, since he would not talk about it. He was
diagnosed with pancreatic cancer in August and did not visit
her after that, knowing that she would not understand. It still
hurt not to be able to tell her that her husband died of cancer
and that his funeral was one day before her 91st birthday.
I considered retiring early so I could take care of Mom,
but realized it is a 24/7 job for which there is not enough
support. Her disease does not allow her to speak many words.
She has eating challenges and is confined to a wheelchair. I
visit her daily, but she usually does not realize who I am. I
miss both my parents, the one who died physically and one who
has almost died mentally.
In closing, thank you for letting me testify. With proper
funding, I am looking forward to what can be done with
Alzheimer's funding to prevent the terrible Montana forecast
from becoming a reality.
Senator Walsh. Thank you, Kathy, very much.
Again, if you have questions for the panel, please pass
them to my staff, and so what we will ask you to do is pass
them over to the outside of the aisle, and my staff will
collect the questions and we will make sure that they get
asked, based on our timing.
Next, we will hear from George Carlson. George is the
Director of the McLaughlin Research Institute, a nonprofit
organization in Great Falls, Montana. George joined the
McLaughlin Institute in 1988 and has overseen an expansion of
the facility. Dr. Carlson is the 2014 inductee of the Montana
Bioscience Hall of Fame. I am proud to have supported the
McLaughlin Institute as Lieutenant Governor, and I will
continue to support the Institute as a U.S. Senator for the
State of Montana.
Dr. Carlson, you may begin. Thank you.
STATEMENT OF GEORGE CARLSON, PH.D., DIRECTOR
AND PROFESSOR, McLAUGHLIN RESEARCH
INSTITUTE, GREAT FALLS, MONTANA
Dr. Carlson. Thank you, Senator Walsh, for providing me
this opportunity to testify today on behalf of the McLaughlin
Research Institute, and more importantly, on behalf of the
people of Montana who are or will be afflicted by Alzheimer's
and related dementing illnesses.
As you know, MRI is an independent, nonprofit research
organization in Great Falls, and we conduct basic biomedical
research to try to understand and, ultimately, prevent
neurodegenerative diseases like Alzheimer's, Parkinson's, and
related disorders. I thank you, Senator Walsh, for recognizing
the looming national crisis that will be caused by Alzheimer's
and other dementias as our population ages.
The personal tragedy of dementia, that you just heard one
example, cannot be fully comprehended by those whose family
members have been spared. The suffering caused by Alzheimer's
is reason enough to expand our efforts to prevent this illness.
Unfortunately, the economic impact of dementing diseases also
is immense.
Currently, according to the Alzheimer's Association, five
million Americans and as many as 25,000 Montanans, if you
include all dementias, are currently afflicted, with an annual
financial cost to the country approaching $100 billion. By
2050, if nothing changes, as many as 16 million Americans could
be affected, costing the economy $1.2 trillion. However,
investment in research can bend this cost curve.
The effectiveness of biomedical research, which is funded
largely by the National Institutes of Health, is unquestioned.
Progress against cancer and heart disease over the past 50
years, to name only two examples, has been remarkable. For
example, the impact of statins, which were developed based on
fundamental basic research, on lowering the risk of coronary
artery disease and heart attacks is well known.
In contrast, Alzheimer's was identified as a disease over
100 years ago and there are still absolutely no therapies
capable of even slowing its inexorable course. It is telling
that for every $28,000 the Federal Government spends on caring
for patients with dementias, only $100 in Federal funds goes to
support research on these disorders.
National Institutes of Health funding for Alzheimer's
disease in 2013 was approximately $412 million, in comparison
to $3 billion for AIDS research, $2 billion for cardiovascular
disease, and $5 billion for cancer research. Support for
research into all these diseases certainly is important, but
the financial impacts of dementia is now greater than those of
either heart disease or cancer.
On the positive side, the Obama administration has
developed and is implementing a National Plan to Address
Alzheimer's Disease. Unfortunately, funding is below the levels
needed to accelerate progress toward the worthy goal of
developing treatments that would prevent, halt, or reverse the
course of Alzheimer's disease.
New approaches developed using mice, by MRI scientists and
our collaborators, are being used to identify the earliest
molecular changes in neurodegenerative diseases with the goal
of finding markers in the blood that can indicate the presence
of disease processes decades before clinical signs or symptoms
appear. Although there is no treatment now, future therapeutic
interventions are much more likely to be successful in the
early stages of disease.
We also are beginning to understand the mechanisms for the
prion-like spread of Alzheimer's disease pathology within the
brain, potentially offering a new way to intervene in the
disease process. The way disease spreads from one region of the
brain to another is similar for Alzheimer's and Parkinson's
disease as well as for chronic traumatic encephalopathy, which
arises from traumatic brain injury and has been found in our
troops returning from Iraq and Afghanistan, so, this is a
separate health crisis. The cost of the war does not end when
the troops withdraw.
We understand more about Alzheimer's and other dementive
disease than ever before, and our research is at a pivotal
point. It is largely a matter of our elected representatives
deciding that a cure is worth funding. At the same time that
science is close to making a difference for people who will
suffer dementing disorders, Federal funding for medical
research is drying up.
We at McLaughlin are starting an exciting new initiative to
speed up the translation of basic research findings into
medical practice. We are collaborating with Benefis Health
System in Great Falls to develop a Center for Aging Research
and Memory Care, a unique partnership between an excellent
community hospital and an internationally recognized research
institution. This ``center without walls'' is not a place, but
an exciting new initiative aimed at improving patient care now
and in developing new avenues to search for ways to prevent
disease.
As only one example, we will transplant stem cells from
Alzheimer's patients into mice to watch the progression of
disease in a living brain, providing a new tool to test
potential therapies and giving us real hope for a cure.
With Federal support shrinking, the State of Montana
stepped up with a grant of nearly $1 million in 2014 as seed
money for this Center for Aging Research and Memory Care, and,
I would like to thank you, Senator Walsh, for your support of
this appropriation when you were Lieutenant Governor.
Americans also recognize that our Nation's global
leadership in science is tenuous. Our leadership position will
evaporate if policymakers shortchange government support for
basic research. Unlike the U.S., countries like China and India
are rapidly increasing their investments in science. MRI
scientists are now receiving funding from India's National
Center for Biological Sciences to help establish a mouse
genetics facility and lab in Bangalore. While this
international collaboration is exciting, I had never imagined
that our research in Montana would be supported by funds from a
developing country.
To maintain America's leadership in biomedical research, as
well as find ways to prevent dementia and other devastating
diseases, it is essential that talented young people pursue
scientific careers. We at MRI have observed first-hand
decisions by talented post-doctoral trainees discouraged by the
downturn in grant application success rates to abandon basic
research for careers that offer more security.
If Congress and the administration let funding for
Alzheimer's and related disorders stagnate as inflation further
eats away at its value, we will compromise progress at a time
our health care system and the Nation can least afford it.
Discoveries made at MRI and research organizations across the
country have set us on the road to finding a way to prevent or
cure dementing illness. It is essential to enhance Federal
support for Alzheimer's disease research.
Thank you, Senator Walsh, for this opportunity to testify
on behalf of the research community, and more importantly, on
behalf of families affected by dementing illness.
Senator Walsh. Thank you, Dr. Carlson. Thanks for the work
that you and MRI are doing. We really appreciate it.
Next, we have Dr. Patricia Coon. Dr. Coon is a geriatrician
at the Billings Clinic and will serve as the Co-Chair of the
Montana Alzheimer's/Dementia Work Group that will develop a
State plan for dealing with this disease. She is also on the
Board of Directors of the Billings Clinic Foundation.
Dr. Coon, the floor is yours.
STATEMENT OF PATRICIA JAY COON, M.D., BILLINGS
CLINIC, AND CO-CHAIR, MONTANA ALZHEIMER'S-
DEMENTIA WORK GROUP, BILLINGS, MONTANA
Dr. Coon. Thank you. Good morning, Senator Walsh, fellow
speakers, and members of the audience. As you have heard, I am
Patricia Coon, a physician who has practiced geriatric medicine
for nearly 30 years, the majority at the Billings Clinic in the
frontier State of Montana. I also serve as the Co-Chair of the
Montana Alzheimer's/Dementia Work Group, a statewide work group
established this year with the goal of improving the lives of
individuals in Montana with Alzheimer's and other dementias and
to provide better support for the families and caregivers. It
is an honor to be here to speak for that group today to discuss
our efforts and the challenges we face caring for individuals
with this devastating disease.
I think we have to--I always have to frame the dialog.
Alzheimer's disease is likely one of the most significant
public health crises of our generation. It is a progressive and
ultimately fatal neurologic disorder and is the sixth leading
cause of death in the United States, but, unlike the other top
ten leading causes of death in our country, for example, heart
disease and cancer, it is the one without a way to prevent it
or cure it. There is no effective treatment. Yet, at present,
Federal funding for Alzheimer's disease research is
substantially less than for cancer and cardiovascular research.
As a health care provider and a resident of the U.S., this is
very concerning to me for the following reasons.
Alzheimer's disease is already a common disorder.
Currently, more than five million Americans are living with
this incurable disorder. The disease is estimated to--the
number is estimated to triple by 2050. In Montana, as you
mentioned, Senator, 11 percent of our seniors are living with
this disease. Given the slow, insidious nature of the disease,
on average, individuals with Alzheimer's survive four to eight
years after diagnosis. Some live as long as 20 years. Much of
this time is spent with significant mental and physical
disability and dependence.
Not surprisingly, Alzheimer's disease takes a significant
toll on caregivers and families, physically, emotionally, and
financially. Patty Davis described losing her father, President
Reagan, to Alzheimer's disease as ``the long goodbye.''
Families and friends say goodbye to an individual slowly over
time as the disease gradually steals away his or her memory and
other cognitive functioning. In the most severe stage of the
disease, nursing home placement is almost inevitable, and I
think Kathy has shared that with us.
The financial burden of Alzheimer's disease and other
dementias is high at an individual, family, State, and national
level. It is the costliest chronic disease in our society. It
is estimated that the national cost of caring for people with
Alzheimer's and other dementias will reach $214 billion in
2014, this year. Of those costs, 70 percent of it is absorbed
by Medicare and Medicaid. The out-of-pocket spending for
individuals with dementia and their families is estimated to be
$36 billion this year.
The national annual cost for caring for these individuals
is projected to reach $1.2 trillion, with a ``T'', by 2050.
Unless we change the trajectory or course of this disease, the
economic burden stands to overwhelm us all. I applaud the steps
the Federal Government has taken in recent years to address
this, including Congress passing the National Alzheimer's
Project Act, which led to the creation of the National Plan to
Address Alzheimer's Disease in 2012. The plan is designed to
help those with the disease, their families, and caregivers
today and work toward changing the trajectory of the disease in
the future, but, more is needed if, as a Nation, we want to
prevent and effectively treat the disease by 2025.
Now, our efforts in Montana. While working toward changing
the course of the disease in the future, we need at a
community, State, and national level to deliver better care and
support to individuals suffering with this disease and their
families and caregivers today. I continue to see the
devastating effects of Alzheimer's disease and dementia on my
patients and their families. I have watched the health care
industry and patient advocacy groups struggle to provide the
comprehensive quality care and services these individuals and
families require and deserve.
Given the slow progressive nature of the disease with its
associated cognitive and physical disability and its associated
psycho-social issues--that is the behavioral issues--it will
take a village to accomplish this. We need to develop effective
dementia-capable systems at the health care organization level
and the community and State levels and find new strategies to
provide high-quality coordinated care, services, and programs
to these individuals and their families and caregivers.
To help achieve this here in Montana, a number of concerned
and motivated individuals--Dr. Carlson and Kathy are part of
that--have formed the Montana Alzheimer's/Dementia Work Group.
This statewide grassroots effort consists of a diverse group of
individuals from across the State representing multiple
industries or stakeholder groups, including the Alzheimer's
Association, the Montana Office on Aging, and other government
agencies, patient advocacy groups, caregivers, senior services
groups, et cetera.
The Work Group has established itself with identifying the
challenges and gaps--has tasked itself with identifying the
challenges and gaps Montanans face when dealing with this
disease and estimating its economic impact on our State. Using
this information, over the next 12 to 18 months, we plan to
develop a comprehensive Montana Alzheimer's Disease Plan,
similar to what we see from the Alzheimer's Association. This
plan will serve as a roadmap specific for Montana to help
inform our State government on critical dementia issues. It
will also provide a set of recommendations on how to implement
and support Alzheimer's disease care and services and will
outline what steps our State should take over a given timeframe
to achieve key recommendations.
Given the current and future impact of Alzheimer's disease
on our State's budget, particularly Medicaid, we feel that
developing and implementing a well-formulated State plan now
will move Montana toward becoming a dementia-capable State and
prepare us for the sweeping economic and social impact
Alzheimer's disease will have on us going forward.
To be prepared for the Alzheimer's disease public health
crisis, Montanans face the same challenges as other States.
Alzheimer's can no longer be the silent or hidden disease.
Statewide, we need to increase public awareness about it and
encourage early detection and diagnosis. We need to deliver
community-based and residential care services in an equitable,
cost effective manner. There needs to be better support for
family caregivers to help alleviate their burden. Training
programs for all caregivers, for example, physicians, nurses,
emergency room personnel, with a standardized curriculum needs
to be developed to ensure providers have the skills necessary
to deliver coordinated, quality dementia care. In partnership
with our Federal and State governments and key stakeholders, we
need to create dementia-friendly communities that locally
provide high-quality coordinated care, services, and programs
to individuals with Alzheimer's and their families.'
Montana also faces unique challenges. Given its large land
mass and small population, it is not only a rural State, but a
frontier State. Rural and frontier communities struggle to
recruit and retain primary care providers, who do the lion's
share of the work with these individuals. They lack the
community-based and residential dementia care services found in
larger communities. For decades, one of our State's biggest
exports has been its youth. This affects the availability of
local family support to help somebody afflicted with the
disease. To ensure their care needs are met, many will need to
be admitted to a local nursing home, a high-cost place, or
leave the community to be closer to family. There is also a
shortage of geriatric specialists across the State. Our Work
Group and State will need to consider these unique challenges
as we develop and implement an Alzheimer's Disease State Plan.
In conclusion, I would like to thank you and the Committee
again for the opportunity to testify today and talk about the
Montana Alzheimer's/Dementia Work Group initiative. I
appreciate your interest and efforts to address Alzheimer's
disease going forward. It is clearly a prevalent, costly,
devastating condition with high morbidity and mortality. If the
course of the disease is not altered, by mid-century, the
economic and societal impact of this disease on all of us will
be overwhelming. Likely, all of us and our children will be
impacted by it.
Working in partnership, we all need to do what is necessary
to achieve the goal of the National Plan to Address Alzheimer's
Disease, to prevent and effectively treat Alzheimer's disease
by 2025. As a physician who provides medical care for these
individuals, I look forward to the day when I can offer truly
effective preventive treatment options to my patients and
family, such as I wish I could for Kathy's mother, and I would
like to do going forward for Kathy, for example.
Thank you again for your time on this.
Senator Walsh. Thank you, Dr. Coon.
Again, this is a very difficult disease to deal with, and
we are seeing a lot of discussion here, but, again, we want
participation from the audience, so if you have questions,
please pass them over to your left or right, to the end of the
aisle, and my staff will pick them up and we will make sure
that we get those questions asked.
Next, we have Dr. Finke. Dr. Finke is a family physician
and geriatrician and serves as a national leader in elder care
and palliative care for the Indian Health Service. He is the
Indian Health Service Representative to the National Advisory
Council on Alzheimer's Research, Care, and Services. He now
works with Tribes in the Nashville area and nationally in the
develop of health care services for elders.
Dr. Finke, please.
STATEMENT OF BRUCE FINKE, M.D., ELDER HEALTH
CONSULTANT, INDIAN HEALTH SERVICE,
AND REPRESENTATIVE TO THE ADVISORY
COUNCIL ON ALZHEIMER'S RESEARCH,
CARE, AND SERVICES, BILLINGS, MONTANA
Dr. Finke. Good morning, Senator Walsh. As you said, I am
Dr. Bruce Finke, Elder Health Consultant for the Indian Health
Service, and I am very pleased to be able to be with you today.
On a personal note, I very much grew up as a caregiver for
my beloved grandfather, who had dementia, as well.
In every Tribal community, there are individuals with
dementia and caregivers struggling to support them. IHS
population health data and workload statistics confirm this,
and, the high rates of diabetes, cardiovascular disease, and
traumatic brain injury suggest additional population risk for
dementia. It is likely that dementia is under-recognized and
diagnosed at later stages in Tribal communities, even relative
to the low rates of diagnosis in the Nation as a whole.
Clinical care for persons with dementia and support to
their families requires significant care management and
coordination, resources often beyond the capacity of tribal IHS
and urban health programs. Caregiving challenges for families
in Indian Country are amplified by the relative lack of formal
long-term care services.
Over the years, Tribes have been the lead in the
development and provision of these services. The Indian Health
Care Improvement Act Reauthorization in 2010 provided IHS and
Tribes with new authorities for the services, but so far, these
authorities have not received funding, and the capacity of
local Tribal and Federal care systems to expand access to long-
term services and supports remains a significant challenge.
As others have mentioned, in January 2011, President Obama
signed into law the National Alzheimer's Project Act, NAPA,
requiring the HHS Secretary to establish the National
Alzheimer's Project, including a national plan to overcome
Alzheimer's disease and an advisory council to inform that
plan. This plan includes a detailed listing of current Federal
activities and recommendations for priority actions. The April
2014 plan update describes the progress made to date in the
areas of research, care and support, and interagency
collaboration.
Through the National Plan, the IHS is working with the
Administration for Community Living and the Administration on
Aging around four person-centered goals for improving the care
for and the lives of American Indians and Alaska Natives with
dementia and their families. These goals are expressed as
statements that every individual with dementia should be able
to make. I was diagnosed in a timely way. I know what I can do
to help myself and who can help me. Those helping to look after
me feel well supported, and, my wishes for care are understood
and honored.
Our work on these four goals builds on Indian Country
strengths: Strong families and a tradition of family
caregiving; community-oriented primary care; committed and
active public health nursing and community health
representatives; and the Tribally operated aging network.
To improve the lives of those with dementia, we are
partnering with Tribes and across Federal agencies and bridging
the usual boundaries of clinical and community-based services.
Some examples: The IHS and Administration for Community Living
are working with the VA to adapt and implement the evidence-
based REACH VA model of caregiver support, using both public
health nursing on the clinical side and the Tribal aging
network through the senior centers. The VA is a terrific
resource for programmatic expertise in dementia and,
importantly, also provides clinical expertise in diagnosis and
management of dementia for many of the Native veterans who
receive primary care in the IHS and Tribal sites.
Most care for persons with dementia can and should take
place in primary care. IHS Tribal and urban clinics are
improving access and continuity and enhancing care management
coordination for our Improving Patient Care program, a primary
care medical home initiative. In recent years, increased
funding for purchased and referred care, formerly contract
health services, has increased access to the specialty services
that support this primary care.
Tribes continue to take the lead in the development and
provision of long-term services and supports, and under a
Memorandum of Understanding signed in 2011, the IHS,
Administration for Community Living, and CMS, the Centers for
Medicare and Medicaid Services, regularly coordinate and have
developed meetings, webinars, and web-based technical
assistance resources to support these Tribal efforts.
Increasing awareness and recognition of dementia in Indian
Country starts with access to quality care and meaningful
support for individuals with dementia and their caregivers in
Indian Country. The IHS is committed to working in partnership
with Tribes, Federal agencies, and community organizations to
provide individuals with dementia and their families with the
best possible care.
Thank you, and I am looking forward to questions and
conversation.
Senator Walsh. Thank you, Dr. Finke.
Finally, our last guest was not able to make it today due
to weather. It was Mr. Max Richtman, who is the President and
CEO of the National Committee to Preserve Social Security and
Medicare. He had flight troubles due to weather yesterday
coming out of the D.C. area, but, his prepared testimony will
also be entered into the record.
The hearing record for this meeting will remain open for
five business days for additional statements and post-hearing
questions submitted in writing for our witnesses to answer.
This will conclude the official part of our hearing. I am
going to now gavel out, and I will move to questions that we
have received from the audience.
The first question that we have is from Nita to Dr. Coon.
What are State legislators doing to improve financial
commitment to assisted living and nursing home placement for
seniors?
Dr. Coon. It is a very good question, and unfortunately, I
do not have an answer to it, because as not being a State
legislator, I am not involved in that process. I do not have
any answer. I do not know if, Dr. Carlson----
Dr. Carlson. No, I do not.
Dr. Coon. One of the things that we do as we do our--the
Work Group moves forward and makes our State plan, it will be
vetted and then it will actually be presented to the State
legislature, so, if people do have some questions or concerns,
or if they also have some potential solutions for what they
perceive, it would be great to get it to us so we can
incorporate it into our State plan, or they can join us,
because we still have an open membership at this point on our
State Plan Work Group.
Senator Walsh. Okay. Great.
Next, this question is for anyone on the panel who feels
they have an answer. What is being done in other countries, for
example, the rate of Alzheimer's in the USA versus China,
versus Europe, and does exercise help or other alternative
methods help with this disease?
Dr. Carlson. That is an interesting question, and it is
something that I think our Task Force should look into. The
cultural differences are immense. Also, an immense difference
is single-payer health care, so, the cost--it takes away one
concern for a family member, which we hope will change in this
country, as well, is am I insured? I do not know. That is a
very interesting question. What does France do? Many countries,
as was alluded to with Tribal Governments, have a tradition of
in-home caregiving, like India and so on. Even some people in
India seem to look at dementia as a stage of life and it is
caring for the family members, but, it is those caregivers are
removed from society just as much there as anywhere else, so,
the incidence in the U.S., I do not believe, is any greater,
other than the increase in incidence of diabetes, which is a
risk factor.
Senator Walsh. Dr. Finke.
Dr. Finke. I would just comment that the National
Alzheimer's Project Act requires, among other things, that HHS
look--or, coordinate with international bodies to fight
Alzheimer's globally, and there is a significant effort through
that work to coordinate with other nations. On the research
side, through the National Institutes of Aging, there is quite
a bit of activity to develop--and the Alzheimer's Association
actually is a part of that work--to develop a common basis for
research efforts and a sharing of information across national
boundaries to facilitate research.
There has also been quite a bit of sharing. There was a G-
7, G-8 meeting in London over the past couple of years--I am
not sure of the exact date--at which nations shared their
approach to addressing Alzheimer's.
The language that we have--that the Administration for
Community Living and the Indian Health Service adopted around
patient-centered goals, in part, comes from language that Great
Britain has adopted as a way of framing their efforts to
improve care for persons with Alzheimer's.
Dr. Coon. I have an answer more on a clinical level than--I
think it is a great idea for us to look at what other countries
are doing, in particular, England is doing with regards to this
disease. I know that as a health care provider, I often go to
their NICE site, which is the National Institute for Clinical
Excellence, and they are much more robust in the information
they provide than we get anywhere else in this country, and I
think that does need to be something that needs to be
addressed.
I want to answer the second question, because I think there
was something about exercise. You know, we do not have any
effective treatments. I do want to say, I am one of probably
the few people that keep referring to it as a chronic disease.
We do know there are three phases, pre-clinical into mild
cognitive impairment, and, when people start having problems
with mental functioning, we actually call it Alzheimer's
disease, but, it is a continuous disorder, similar to what we
see for heart disease. Plaque gets laid down. You finally have
your heart attack. This means plaque and tangles get laid down
and you finally get the disease.
Anywhere along that spectrum, we encourage exercise. We
want to control other risk factors, such as diabetes,
hypertension, elevated cholesterol, work and do those vascular
risk factors so that that is not a double-whammy to the brain,
leading to cognitive impairment, so, I think, exercise is very
important.
Also, what I often counsel my patients to do is mental
gymnastics, and that there are actually three apps available
for Smartphones. There are also programs available that have
people go through, and set up by neuropsychologists and
neurologists have set up these programs that allow people to
really work on the different domains, whether it is memory,
visual-spatial, or other areas of the brain that are affected
by this disease, for them to try to improve it. I know that
there has been some thought that these programs may actually
help with working memory in people who have mild cognitive
impairment.
Mental gymnastics, physical gymnastics, and controlling
vascular risk factors are very important, which means lifestyle
change, which, I think, we hear all the time from our doctors,
but all of that is very important, so, I hope that answered
that question that the person was asking.
Senator Walsh. Any other input on that question?
Okay. This next question is from Lisa, and it is, again, to
the panel. What do we believe can be done to help caregivers?
Ms. Burke. Well, I think we need two things, as a
caregiver. One, a sense of humor, and I do not think that
should be underestimated, and patience, and, we need education,
as I stated before, so many times, the diagnosis comes, and it
is kind of like when people hear the word ``cancer.'' It is
like it is a shock and you do not know what to do, where to go
for help, and, there are all kinds of resources, whether they
be local ones, whether they be websites, but, I think education
is primary, not only for the person who has been diagnosed, but
for their caregivers and for the community as a whole, as I
mentioned before, because there is a lot of misunderstanding.
We have--fortunate, in a big city like this, we have
different caregiver groups. I mean, there are ones through the
Billings Clinic, ones through the Alliance, ones through
different nursing homes, and they provide speakers and sharing
of experiences, like I mentioned, so that caregivers are maybe
not surprised by the progress or certain situations that come
past because they know that other people have had them and
potential ways to help work with them.
Senator Walsh. Dr. Finke. I am sorry. Go ahead, Dr. Coon,
first.
Dr. Coon. You know, I think that there are probably several
things that we need to do for caregivers. One is education, but
not only for the caregivers, especially when they are dealing
with individuals with the significant behavioral issues we see
with this disease, but we need to have better education of
health care providers that are working with these individuals,
nursing home staff, assisted living staff, so that, together,
they can really address the situation that--the behavioral
issues and the problems we see taking care of this individual.
I think we need to do a better job of coordinating care. I
think there is a woman in the audience, now, and she is part of
our group, as well, and I always remember, her husband was
diagnosed with the disease. She would walk out of the
provider's office and say, what do I do now? I often refer to
it as opening Pandora's box, and, there was not the coordinated
care she needed for her to figure out how do you go along and
make sure that she manages the disease successfully. She
actually stumbled around for several months before she went to
the Alzheimer's Association.
Finally, I think that we need to monitor the caregivers'
health. We need to make sure that we provide them respite and
resources for that, because it takes a heavy toll on them
physically and mentally. We need to monitor them for
depression, and, we need to relieve some of the financial
burden on the family, as well.
Senator Walsh. Dr. Finke.
Dr. Finke. I will answer that, that there is a small but
important body that is around specific interventions that
improve caregiver health. Some of this work comes out of the
REACH research from the--funded by the National Institutes of
Aging. REACH stands for Resources for Enhancing Alzheimer's
Caregiver Health, and, this work demonstrated an intervention
that actually did improve outcomes for both caregivers and
persons with dementia. The VA has taken that work, adapted it
for the VA, evaluated it, and is now spreading it across the
system as the REACH VA program, a highly successful program
within the VA.
As I mentioned briefly earlier, the IHS is working with the
Administration on Aging within the Administration for Community
Living with the VA to take that model and bring it into Indian
County. I think there has also been work through the
Administration on Aging outside of Indian Country to adapt that
model, but that is--I think we are really excited about this as
a structured way to support caregivers as part of the
caregiver--as part of caring for the individual with dementia.
Dr. Carlson. One thing, I think, that cannot be
overemphasized is the importance of diagnosis, early diagnosis
as soon as practical, allowing the patient to plan and the
caregivers, before they actually are caregivers, to know what
resources are available. That is what we are trying to
implement with Benefis Health System.
A telling study was done by Riley McCarten in Minneapolis.
He took 8,000 veterans 70 years of age and older who had no
record of any cognitive impairment in their records. They were
seeing the physicians for other reasons. He implemented, or
tested each one of these, and with a very simple cognitive
test--it takes two or three minutes--27 percent of those
failed, and on followup, 95 percent of those who failed were
shown to have clinical dementia, so, if those people were
identified earlier on, there would be less people not bringing
their parents or their wife or husband in a moment of crisis,
but having time to find the resources and to get help when they
most need it.
Senator Walsh. Dr. Carlson, are these tests available from
your local physician, or how would you----
Dr. Carlson. What we are trying to do now with Benefis, and
this has been implemented in Minneapolis, is the test is
actually--it is called a mini-cog. You are just asked to
remember three words over a, it is, like, a two-or three-minute
period and draw a clock with a particular time on it, so, it
would be like the vital sign. When the nurse takes your
temperature and height and weight and your blood pressure, they
would administer this simple test before you go and see the
physician, and then the physician would be the one responsible
to followup, if necessary.
Senator Walsh. Okay. Great. Thank you.
The next question is from Janice. It is for Dr. Carlson.
Has the McLaughlin Institute applied for funding from the
National Active and Retired Federal Employees through the
National Alzheimer's Association? And, then, where else have
you applied for and received funding?
Dr. Carlson. The bulk of our funding has come from the
National Institutes of Health, and I was not aware of this
funding source, so thank you very much, if funding is available
through that, but, most of it is through the Federal
Government, both National Institute on Aging and National
Institute for Neurologic Disorders and Stroke. We also have
applied for--the Alzheimer's Association gives grants, as well.
One thing I would like to emphasize is the success rate now
is terrible. As recently as seven or eight years ago--the way
the grant applications work at the National Institutes of
Health is it goes to a panel of scientists for peer review. The
applications are ranked and given a percentile score, so, it
has always been competitive, which is a good thing, but they
would fund between 15 and 20 percent of these basic research
applications. The top 15 or 20 percent were very likely to
receive funding.
With the National Institute of Aging now, the cutoff has
been as low as six or seven percent, and I do not think the
peer review system has the resolution to tell--to say that an
application that scores in the top six percent is significantly
different from that which scores in the top ten percent or
fifteen percent, and that is where increased funding could
really make a difference, in getting realistic--going back to a
realistic competition rather than this hyper-competitive
situation we are in now.
Senator Walsh. What country would you say has taken the
lead role on research, as far as investment and moving forward?
Dr. Carlson. Well, as a percent of GDP, places like Israel,
Great Britain, but, still, and this is why it is worrying, the
U.S. still has the best research in the world, but, other
countries, the rate of increase in China and India is
frightening, but, we are still--you know, with our university
system and our funding for the National Institutes of Health,
even though it is going down, we are still at the top, but, it
is not a God-given right to be at the top and I think we have
to work on it and have increased funding for research.
Senator Walsh. Okay. Ms. Burke, this question is for you.
What would your advice be for someone who has recently been
diagnosed with Alzheimer's as their first stop to find
information or support services, especially for someone from a
rural part of our State?
Ms. Burke. I think the Alzheimer's Association. We have a
fantastic Montana branch. We also have a national one. The
glitch that we have discovered in our Work Group is that access
to information is difficult in our rural area. They have
fantastic websites, but if the Internet is not working well,
that is a problem, but, I think, they could contact the office
here in Billings. There are also additional websites, and, like
I said, I wrote down some of the ones that I have used, and the
government now has one, Alzheimers.gov.
I think the education is important. If we can help each
other figure that out via the website, you can take that
information and talk to your local care provider. You could
probably make arrangements to make a long trip to Billings,
depending on where you live in the State, to come here, but,
education is so important, and the support of people who have
been dedicating their organizations and lives to this disease
to help for education is something that needs to be tapped
into.
Sometimes, knowing about resources is a difficult thing,
and I think the Alliance does a really good job of that. They
have a book called, Whom Do I Ask?, and it is not just about
Alzheimer's, but it is all kinds of resources that are
available in the Billings community. Again, that might not be
as helpful for the geographically isolated parts in our State,
but it is a place to start, because they are always willing to
share the knowledge, and that is what needs to be done, in my
mind.
Senator Walsh. Okay, great. This question is from Marcia
and it is for me, and the question is, what will the Ryan
budget do to Alzheimer's?
My answer there is that the House passed Congressman Ryan's
budget in April. It does not specifically cut Alzheimer's
research at the National Institutes of Health, but it proposes
an almost $800 billion to be cut over the next decade from the
non-defense/discretionary budget, so, realistically, that would
cut NIH funding by as much as one-third by 2024, so, that is
something I am not supportive of. I think that, you know, based
on what we have heard here today, we need to continue to invest
and put additional resources into research.
With the McLaughlin Institute, and when I was serving as
the Lieutenant Governor, along with Governor Bullock, we
visited the McLaughlin Institute to see what they were doing,
and we looked at it like the--you know, not only from the
United States perspective, but Montana, having this resource
right here in the State of Montana, we could become a leader in
the United States with the resource that we have right here in
our backyard in Great Falls, Montana.
I know that--and, that is one of the reasons Governor
Bullock initially invested in, or put some money into research.
I am confident that he will continue to invest in this area,
because with Montana's--you know, our population is aging and
we need to invest in this area, but not only from the State of
Montana, but we could become a leader nationwide where other
States are coming to Montana to find out what we can do--what
they can do to better prepare for this terrible disease.
The next question, again, is from Elaine for Dr. Carlson.
Please discuss family DNA and Alzheimer's. I am sorry. That
one, we already had.
This is the next question. Again, it is for me. What can be
done to invest in research, and how can we prioritize help for
families?
My answer is that there is clearly more that we can do. I
think we have heard from all of our panelists that education is
very important. Early identification is important, and,
communication is extremely important, but, two things that we
can do. You know, there are two bills that we should pass
immediately. The first one is the Alzheimer's Accountability
Act, which would require an annual budget for the NIH for
Alzheimer's research to meet the goal of preventing and
treating Alzheimer's by 2025, and, then, we should also pass
the HOPE Act, which will open more Medicare services for
Alzheimer's treatment, so, those are two things that I think
that we can do immediately to take on--to take steps forward.
This next question is for Dr. Carlson. Again, Dr. Carlson,
I want to thank you for the great work that you do at the
McLaughlin Institute. Your testimony did a great job of showing
that Federal funding for Alzheimer's research may not be
enough, given the tremendous challenges that this disease
presents for our country, but, the question is, what are some
of the opportunities for further scientific research that are
not being taken advantage of now, but would be taken if
Congress increased investment in Alzheimer's research?
Dr. Carlson. That is a very good question, and what happens
when the funding gets tight--this is not unique to the National
Institutes of Health, but just in general, if there is a
limited amount of funds, people become more conservative in
distributing those funds, so, the more innovative ideas are the
ones that suffer, so, the grants that are funded are ones that
are on paths that seem to be promising, even though those paths
have not proven to be successful, so, someone who proposes
something entirely new and entirely different and does not have
preliminary results to support it, they are not going to get
funding.
Basically, it is trying to identify the more innovative,
new approaches to research that have not been tried before, and
if there is enough money, you can fund those things rather than
the same stuff that has yielded good results, but it has not
yielded any preventative treatments or cures just yet.
Senator Walsh. Okay. Thank you.
Finally, the last question that I have is for Dr. Coon. You
know, we are looking forward to seeing the ultimate work of the
Montana Alzheimer's/Dementia Work Group. Please do not hesitate
to reach out to my office if there is anything we can do to
help. We want to be helpful. Although you still have work to
do, what are your initial thoughts about unique approaches that
would be particularly effective in a rural State like Montana?
Dr. Coon. You know, I think that what--as we, as a Work
Group, speak, what we really are talking about, how do we
improve coordinated care within not only the State, but in the
community, in general, so, it is really looking at community
efforts to coordinate care, bring like resources available to
those individuals in the community, and that is, I think, the
main challenge we are going to have.
There are models of care out there that currently could be
implemented, but we are talking about a community at a State
level. Some of that--and I am going to make a plea for another
research bucket--so, there also needs to be dollars put toward
health services research that allows us to take these models,
implement them in communities to see if we can improve the
outcomes of these individuals by truly providing coordinated
services throughout those facilities. Higher education, better
education with these individuals, having those resources
available to the families, that all needs to take place at a
community level and not necessarily at a State, at a Federal
level, so, I think, that is the direction where we are really
going for the Work Group at this time.
Senator Walsh. Okay, great.
I do have one more question, and that is for Dr. Finke.
Again, I want to thank you for coming to Montana to share your
experience. Alzheimer's is a disease that affects everyone, no
matter who you are or where you live. Can you go into a little
further detail about the Indian Health Service outreach to
Reservations about Alzheimer's, and what should Montana Tribes
expect to see from IHS in the coming years?
Dr. Finke. Thank you. The Indian Health Service is a
primary care-based health system, as you know, and so our work
around the Alzheimer's and dementia on the clinical basis
really is going to be about building the structures and the
platform of care in the primary care level to be able to
provide the kind of coordinated managed care that individuals
with Alzheimer's and their families need.
I mentioned in my initial comments the Improving Patient
Care Program, which is the medical home model, and I think what
we see out of the medical home model is a more robust platform
of primary care. We see this already at Northern Cheyenne, for
example, where they have been working on this model longer than
others and they have begun--they have care teams building
continuity of care with panels of patients, and those teams are
actually doing outreach and care management for elders, for
frail elders and elders with dementia, out of their care teams,
and, I think, building a more robust, capable platform of
primary care will help us to manage--support and manage care
for folks with Alzheimer's and their families.
I also think we should expect to see, as we work with the
VA, with the Administration on Aging around the REACH
intervention, more structured support for family caregivers
and, really, an approach that says, care for a person with
Alzheimer's involves care for those who care for them, as well.
Senator Walsh. Okay, thank you.
Just a real quick survey. Just a show of hands of how many
in our audience today have been impacted in one way or another
by Alzheimer's.
[Show of hands.] Wow. When you look at just our audience
here today and our State, sooner or later, we probably will
all, in some way or another, be affected, so, whatever we can
do to provide additional resources for research to combat this
problem, it is something that we should do, and, I can promise
you that I will work very hard in the U.S. Senate for the time
that I will be there to fight for additional resources, because
this is a very debilitating disease that affects so many of us
in the State of Montana and around the country.
Again, I want to thank all of the panelists who came today
with your testimony. We will make sure that--as a member of the
Aging Committee, I will take this information back to
Washington, D.C., and share it with my colleagues on the Aging
Committee, so, thank you very much for being here.
I want to thank all of the--everybody who attended today
for showing up just because of your interest in this. I am
confident that we will move forward and progress in fighting
this terrible disease.
Then, finally, I would like to--you know, when we put
committee hearings and meetings like this together, I get to
sit up here in front and take a lot of the credit for doing
this, but I can tell you that it does not happen without a lot
of work from a lot of people behind the scenes, and,
especially, I would like to have Jim Corson and Matt Peterson
to please stand up and take a round of applause.
These gentlemen are members of my staff here in Billings
and they do a tremendous amount of work, and so if there are
other issues or input that you want to have for our staff that
you want us to receive in Washington, D.C., please do not
hesitate to reach out to them.
Again, thank all of you for being here. I think that we
have some refreshments and cookies in the back, and, again,
thank you so much to our host facility--yes.
Ms. Gibson. Senator, I am Heidi Gibson from the Alzheimer's
Association, the Montana Chapter. I would just like to
cordially invite you to the Walk to End Alzheimer's in Billings
September 21st at the zoo. There is information on the back
table, not only about the walk, but just about connections,
caregiving, and we are really better together, but also bills
that the Senator mentioned, the HOPE Act and also the
Alzheimer's Accountability Act.
Senator Walsh. Thank you, Heidi.
Any other comments?
[No response.] Okay. Again, thank you all, and enjoy the
rest of your day.
[Whereupon, at 11:06 a.m., the Committee was adjourned.]
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APPENDIX
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Prepared Witness Statements
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Statements for the Record
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[all]