Thank you, everybody, for being here. I was being optimistic with a happy spring. It really doesn't feel like that here in Middle Tennessee today.

But hopefully it's coming soon. We're happy that you're here. Like Jen just said, if you wouldn't mind, put your name title, organization, and email into the chat. That's how we keep track of Who's here and Jennifer Rayman, Paula Denslow, and I, Wendy Ellmo will welcome you as your Brain Links hosts.

And please feel free to chat away in the chat. We love activity there.

Especially as it relates to aging health and how that impacts your system of support.

So just to review, we're going to do what we often do.

We're going to do some housekeeping, some updates. I'll do that. And then we'll get into our topic specific talk today, which is on aging health.

Then we'll have any questions? We'll discuss the intersectionality of how aging health impacts your system of support.

We can brainstorm ways that we can integrate anything that they're talking about today into our systems and share news from your system of support.

And then we'll close out with a survey. And so some housekeeping.

So I did share this last time, but please indulge me. We're very excited and we want you all to know that this program that you are a part of has been recognized by Vanderbilt University's Peabody College, and we have been awarded even an award so

We want to thank them very much and also Thank you for being here and for making this program what it is.

I wanted to resurrect this one. This slide goes back to the very beginning When we asked you all, we had you fill out a whiteboard. We all jumped on and we talked about what did we want to get out of this

Collaborative and it was interesting because a lot of the things, so if it's a bigger word it was chosen more often or written down more often, but a lot of them really could be grouped even more. So a lot of them fit the topic of resources. We're looking to get resources from each other.

In different areas. Looking for some strategies, screening information and some networking. And I thought it'd be good to bring back that because that's really what we've what everything's turned into.

So you have received the disability health pages Usually I tell you when they've been emailed out, but I'm going to direct you instead our website to find the most recent version. We had an issue with some links so Just go ahead if you need them, pull them off of there and share them

Broadly so that's from January's meeting And if you'd like to share one thing that you learned from the disability health meeting, please go ahead and share that in the chat.

Or if you've shared These resource pages let us know how you've shared them. We know we're missing some of those shares.

Real quickly, I always like to tell you how to get through the website You go to the Brain Links website, tndisibility.org slash brain go to that Tennessee Brighter Futures, that flower looking logo representing all of our overlapping systems.

And click on the one that you want, like substance use, and then you'll see these the page come up for that. And on the right hand side, you're going to see we have the recorded meeting is there the PowerPoints are there the resource pages

Now the infographics have also been added to the page And you'll see a text document for accessibility purposes.

And I just mentioned the infographics. We do now have infographics for many, many of the groups that have spoken already with more coming out. So this is the one on disability health You can download that information.

Showing really the intersectionality with brain injury in that area and that area We are so excited to tell you that the information from this meeting has been shared and or incorporated into programs over 200,000 times. We have to nail down that number

But we know that it's over 200,000. So that's things like the videos that from these meetings that they've been watched, the emails that have been shared screenings incorporated into systems So thank you, thank you, thank you for sharing that.

And please share them. We're really putting a push on now that there are so many of the resources, get them out to your to your networks share them, especially share the ones that go with your network, but then please also share

The other ones in an email blast and newsletter at conferences on your website on training schedules Please just share and then please, please let us know.

The 2025 schedule. Is next in May.

We'll be talking about gender issues July is suicide.

September is child abuse and then our potentially final is November 6th on veterans issues.

So just real quick, before we dive into the information on aging, I want to give a little preview of how it intersects with brain injury So often traumatic brain injuries are missed or misdiagnosed in older adults.

Because their symptoms often look like other things including dementia. And I really feel like this is more of anecdotal. My mom lives in a in an older, it's independent living but it's a facility for older people and I feel like concussion especially is often

Not treated as the big deal that it can be in older adults.

So I think that's worth watching. For and it's difficult to tease out the symptoms of concussion And so nationally, people age 75 and older have the highest numbers and rates of TBI related hospitalizations.

Over one in 50 Americans age 75 or older experience a TBI related Emergency department visit, hospitalization or death.

And then each year there are about 3 million emergency department visits due to falls in older adults and then this is This is a big number too, that more than half are not even going to tell their doctor about it.

So with that, I want to hand things over to our aging health panel.

Keita Cole. She is the Tennessee Department of Aging and Disability Nutrition Services Director and Dementia Coordinator.

Amanda Boulware, the Tennessee Department of Aging and Disability Director of lifespan respite programs. And then 3D and 3E programs. I'm not sure if I've said that right, Amanda.

Bill Zagorski is the executive director of Centennial Adult Care Centers.

The National Adult Day Services Association, Tennessee Association of Adult Taste Services.

And representing the Tennessee Federation of Aging. And Rochelle Roberts.

Is from the Tennessee Department of Health, the Office of Healthy Aging.

And the state dementia director So very thankful to have them here today and for putting this together they've been just outstanding to work with.

And with that, Amanda, I think I'm handing it over to you. I'm going to stop sharing.

And let you take over.

All right. Sounds good. Yeah, so for those of you who don't know what 3D and 3E programs are, because it's kind of, if you're not in that world, you might not know. So, but 3D is evidence-based disease prevention and health promotion programs.

And then 3E is the National Family Caregiver Support Program. So all kind of related and it relates to the OAA.

Which we will kind of a little bit go over. I'm going to share my screen.

I want to see the slide? Okay, cool.

Right.

All right, so I just wanted to thank everyone for like having us today. We're so excited to have the opportunity to talk about our programs and services that we offer to the older adult population.

Through the Department of Disability and Aging.

So in July of last year, the Tennessee Commission on Aging and Disability, or TCAD, merge with the Department of Intellectual and Developmental Disabilities to form this new Department of Disability and Aging that Keita and I are both part of.

A little history about TCAD. We were created by the Tennessee General Assembly in 1963.

And we're designated as the state union on Aging, which is a federal distinction.

In 2001, we were renamed the Commission on Aging and Disability to include older adults with physical disabilities.

And our funding comes from the federal and state entities. We want our older adults to be able to stay in their homes and community for as long as possible. So that's kind of one of our biggest missions.

As a department and as a department As I mentioned earlier, July of last year, that's kind of when this merge with did happen with TCAD to form our new acronym, DDA.

And it's a place where we can not only just serve those who are over 60, But those who may have physical, mental, or intellectual disabilities as well. Kind of our goal is really to serve everyone from I would say like kind of birth to end of life in a way

So this is our aging network and how we're funded is kind of set up like this in this flow chart here.

So some of the federal allocations from the governor and the state funds flow down to DDA.

And then we distribute the funding to our nine triple ADs who provide services directly or contract with service providers to serve the older adult population. And I'll kind of show you here. This is a map of all of the triple ad so you can look and see where yours is in relation to the county that you live in.

Every county is assigned one of these local AADs. Or area agency on aging disability. We love acronyms here, so we're all about it.

So essentially, if a consumer calls using our INA or information assistance toll free line.

Then they should be routed to a local triple ID. Calls are then routed based on your area code.

And then, um. If the caller is out of state Some people definitely have family members who, you know, their caregiver out of state, but the person that is their loved one lives in Tennessee. We are able to work with that as well.

And all calls are sent to DDA where it's answered and then a consumer is assisted, referred to the correct local agency for those questions and concerns for those specific situations.

In addition to the funding, the AADs receive from us, they may also offer additional services from other sources.

For example, each AAAD contracts with TennCare to provide home and community-based services through choices.

Which is a program I feel like a lot of people are pretty familiar with. Some AAADs receive local grants to cover county specific resources that may include like roofing assistance or minor home repairs, transportation And it can kind of vary by region.

Our AAAD regions are individual agencies and they try to accommodate the needs in their specific community.

As the saying goes, when you visited one triple AD, you visited one triple AD. They all are their own animal and operate very differently So they do not all offer the same exact services, which is why it's important to understand what a consumer is specifically needing so that way.

They can best provide those resources for each individual case. So regardless of if the local agency does not offer a service that's needed by someone.

They have a list of all the resources for their specific area and they can provide that information to a consumer or caregivers.

So we have 10 programs that are funded by the Older Americans Act.

And I'm going to highlight a few of these programs. So I mentioned a little bit earlier our information assistance toll-free line. This program is set up to provide a no wrong door approach.

To consumers. So that way when a consumer calls us We conduct a screening to see which programs will meet all of their needs. And if they need something that we don't provide, then we can work tremendously hard to make sure that

We give them a soft transfer to the correct resource the first time.

I know that we've all experienced receiving an incorrect phone number or given an incorrect contact for an issue and it can definitely be frustrating.

But we want to be able to try to prevent that as much as possible when we're working with anyone that calls in.

So I'm going to break down some of the other programs.

So our long-term care ombudsmen are advocates for Tennessee's roughly 700 long-term care facilities, including nursing homes.

Assisted care living facilities and homes for the aged. The ombudsmen help residents with understanding their rights, who expect excellence in their care.

And resolve complaints for residents as they arise at their direction.

With a resident consent ombudsmen also work in partnership with sister agencies like Health Facilities Commission.

Adult Protective Services and TBI to address resident complaints when necessary.

Common complaints can include like things like abuse or neglect, exploitation, quality care concerns Or even eviction from a facility.

Finally, ombudsmen elevate resident voices, ultimately, and do so through systems of advocacy to influence policymakers and impact long-term care systems in the state for the betterment of the residents.

Our state long-term care ombudsman for Tennessee is Ms. Teresa Teeple.

She is an amazing advocate and they're are many long-term care ombudsman all throughout our triple ADs all across the state so We're trying to meet that need no matter where you are.

So if Keita wants to present on nutrition, I'll let her kind of take it away from here.

Mandy, you caught me on the spot. I was eating my lunch.

No, it's totally fine. It's a salad, so I'm doing nutrition, healthy eating.

So the nutrition program, it is the largest program that is funded through the Department of Disability and Aging.

Aging division. I can't speak for the intellectual and developmental disability division But this is part of the Older Americans Act and the goal of the program is to reduce food insecurity, malnutrition, to encourage socialization. So, you know, that brain health aspect of it, we want to keep our brains healthy, keep our brains active.

So we want to keep our older adults socializing, go into senior centers, eating with friends, eating with others, just to promote that health and well-being.

And hopefully this will then delay the onset of their adverse health conditions again Poor nutrition can lead to more chronic diseases, which can lead to a decrease in brain health which increases falls, and we all know that rabbit hole that you can go down without the proper nutrition. So the nutrition program is made up of congregate meals and home delivered meals. So we do both.

Amanda, you can go to the next slide. So with congregate nutrition, we have over 200 congregate sites across the state.

The majority of our congregate sites are located within senior centers.

Some of them are within community centers. Maybe in a church or organization, but the majority I would say are within our senior centers so Meals can be available Monday through Friday.

Some of the sinners have alternating schedules. Some do Monday, Wednesday, Friday, some do Monday through Thursday. So I always encourage you to check with your center.

Before you show up. And they are available for those that are 60 plus.

But it can also be available for a spouse or a caregiver if they are assisting that 60 plus individual to the center so they can get that meal for free.

And here's the kicker. If the meal is being paid for by the Older Americans Act.

Then the consumer gets the meal for free. Now, the caveat to that is there are some centers that do not participate in our nutrition program.

We can definitely direct you to ones that do if that's something you're looking for but going into a center and saying, I was told I can get a meal for free. Not always the case.

Essentially, they will probably try to help you get a meal. But there are some that do maybe charge a monetary fee.

It's usually a couple of dollars, nothing astronomical that most older adults can't afford.

And there is an opportunity for anybody who wants to to donate to the program. All the donations that come into the program.

Go back to continue to provide the meals. It is not required. You will not be denied a meal if you do not provide a contribution, but we have found a lot of our older adults like to feel like that they're contributing to what they're receiving. And so they don't want to hand out.

So they want to be able to give a couple of dollars or something like that. Absolutely.

Can happen if they want to. Volunteers who work during meal hours can also receive a mail. So even if they're not 60 plus.

So if you want to volunteer at a senior center to help hand out meals or something like that. That's always an option if that's something that interest you?

You can go to the next one, Amanda. Home delivered meals, sometimes they're referred to as meals on wheels Technically, it's not wrong. The marketer in me.

I like to make the distinction. Meals on Wheels is a brand. You have to pay to use that brand. Some of our centers pay to use that brand. Most of them don't.

So we just call them home delivered meals. Because that's essentially what they are.

So these are for those who are at risk. They're sick, they're homebound, or they do not have transportation to meals.

We can have those meals delivered for them. They are typically delivered by volunteers. So this also provides a friendly visit and a safety check.

So sometimes it may be an older adult that they're, like Amanda said, their family lives out of state. They don't have a network of people that check on them. So a lot of times these meal volunteers are the only person that that older adult may see for the day, for the week, whatever that may be.

Again, these are 60 plus spouses are eligible, even if they're not 60 plus they used to have to be determined to be frail or homebound So maybe I need to update this slide.

That has changed in the Older Americans Act. So that part is coming out. So now it's going to be a little bit easier to receive.

A home delivered meal. The caveat to that, again, there's always a caveat, it's the state. The caveat to that is funding is not changing. So while we're loosening the requirements.

We still have the same amount of funding. So some of our areas have wait lists for home delivered nutrition. Some do not.

So again, like Amanda said, if you talk to one triple AD, you've talked to one triple AD. So there's always Always an option to reach out, always a way to get there. And a lot of times some of our senior centers, if we can't deliver home delivered meals, they have food pantries.

They can do food boxes. They work with others in the community to make sure we can get that nutritious food to our older adults to help with that brain health.

I think I got one more maybe, Amanda. Oh, no, that's it. Okay, back to you.

Just me. Unless you have anything to add.

No, I was just going to say that I believe last year we delivered about 3.4 million meals statewide.

And we served around 60,000 older adults. So it's a huge program. But yeah, we do have a wait list. Unfortunately, something as simple as food.

Should be a right that everybody should get without having to have a barrier to it. But we do what we can. That's why we do those intake screens. We try to prioritize based on needs. So those in greatest need as far as health or access or financial need that we can get them meals as quick as we can. But that is why we work with partners in the community.

To do food boxes or food pantries or different things like that to connect them to those resources. So we don't just want to say, no, sorry, you're on a list.

We want to try to do what we can to make sure these older adults have what they need.

And most of our congregants, I think I only know of one congregate site that has a wait list.

But she serves about 200 meals. That's why a day. So that's why she has a wait list But for the most part, our congregate sites have availability. So that's why we definitely want to encourage it, not only because they can typically get a meal, but also that socialization factor of it and to keep them from being isolated and lonely.

All right, Amanda, I'll let you take it back over.

Sounds good. So now I'm going to kind of touch on our National Family Caregiver Support Program. So chances are in the last 10 years, you or an immediate family member has been a caregiver of an older adult or will be coming up.

We can all understand that challenges that are placed on caregivers. At DDA, we've got a program called the National Family Caregiver Support Program, and it provides counseling support groups for caregivers who qualify.

The program can also provide caregiver training, respite care, personal care, homemaker services, so like housekeeping, and then some areas, adult day services.

So a little bit later, Bill is going to be able to share some more information about adult day services, so I'm not going to share too much about that. But as I mentioned before, each AAD is unique in the services that they provide. So keep in mind that the availability of services kind of depends on the region.

So checking on the local AAD is beneficial to ensure that we are providing the most accurate and up-to-date information as well.

So we currently have five state-funded programs that include options for community living or as we refer to it as simply options. Public guardianship program, the senior center grants.

Respite pilot program and then the Tennessee Unlicensed Facility Registry. This program was created to provide older adults as well as adults with disabilities home and community-based services choices.

This program is available through the local AADs. Our home and community-based services are funded federally through HCBS programs and state funded through options.

Eligibility is similar for the federal program, but you have to be 60 and older.

And for the state program, you have to be 18 or older.

So we do this so that way we can serve more people and still spend the dollars required by the law.

To be eligible for options, an individual must be, number one, a resident of Tennessee 18 years of age or older, and they also must meet the activities of daily living or ADLs or the instrumental activities for daily living, IADLs, limitation requirements.

For federally funded program requirements, those are kind of the same.

But just that the age requirement changes from the 18 plus to 60 plus.

And as with all of our programs at the state on aging, there's no income eligibility requirement for this program.

However, there is a sliding fee scale based on income. So some services available might include like the homemaker services, like I kind of said earlier, like the house cleaning.

Personal care, bathing, dressing, et cetera, and home delivered meals.

So for the public guardianship program, it should be utilized kind of as a last resort for individuals. Ideally, if someone's unable to care for their basic needs, including financial and physical, we really want a trusted family member or friend to step in and assist. However, we know that

Not every individual has someone like that or even is willing to assist in that way. So that's kind of where the court can appoint a public guardian to assume the responsibility of that individual.

There are different types of public guardianship services, including person only so that's when A person is appointed as the guardian over an individual and that guardian or conservator is permitted to make decisions related to health care.

Property only, that's when someone's appointed as the guardian over the property.

The Guardian conservator is permitted to make decisions related to estate and financial matters.

Person and property. So that's when someone is appointed a guardian over the person and the property.

Or the plenary guardianship. The guardian or conservator in that case is permitted to make all healthcare and financial decisions.

And then there's a durable power of attorney as well. When a serving, when someone serving as a client as attorney is in fact under a durable power of attorney, so a DPOA, And the district public guardian is permitted to make decisions regarding finances and or health care as designated by the client.

And set forth in the signed power of attorney document. And that document is durable, allowing it to kind of remain in effect in case of disability.

All right. And then the Lifespan Respite Grant is a collaboration with the Tennessee Respite Coalition, which recently changed their name to the Tennessee Caregiver Coalition. So if you've heard of one.

They're still around. They've just changed a name and they're still doing their stuff just new branding in a way. And they are really great. Their goal is to really promote current respite services to caregivers and the public.

They utilize vouchers for family caregivers of children and adults of all ages with disabilities and or chronic conditions.

The main purpose of the program is to really reduce caregiver burnout by offering an option to receive assistance.

This grant also works with states to develop sustainable high quality respite program across the lifespan.

All right. And then for all of you Medicare fans out there, I feel like that's kind of one of our highlights of our programs that we offer. The Tennessee State Health Insurance Assistance program. So SHIP, that's kind of our acronym for that

It's a federally funded program that provides free, unbiased counseling and assistance to Tennessee's Medicare Sorry, Medicare eligible individuals, their families as well, and caregivers.

We don't promote any insurance agency And we maintain the confidentiality with all of our clients.

So whether someone is new to Medicare or a seasoned beneficiary, our trained counselors can assist with all Medicare questions, no matter what it is.

And according to our recent data, which was shared for the ACL, so the Administration for Community Living.

Tennessee ship was able to provide the following services savings between July 2023 and December.

23. ACL hasn't released any of the 2024 data yet. So this is the latest that we can share.

But I think it's really great in terms of the people that we were able to impact.

So all of the money that was saved by these beneficiaries is life changing.

And it means that they can pay for their groceries, utilities, and other necessities that is vital for a good quality of life.

So if anyone has any questions or wants to make a referral to this program.

You can call the number 1-877 801-0044.

And then, Keita, do you want to share about a dementia capable of Tennessee?

Yeah, Amanda, right off that ship number again, I'm putting it in the chat.

Oh, yeah, yeah. It is.

1-877. 801-0044.

Okay.

Okay, sorry. I was trying to do it as you were reading it. I just didn't do it fast enough.

Okay. Yeah.

So the Dementia Capable Tennessee is our new initiative that we are doing with the Department of Disability and Aging.

It is a grant that we received through the federal government through ACL or Administration for Community Living.

And it is the Alzheimer's Disease Program Initiative Grant. Again, Amanda said we like our acronym, so ADPI.

So the purpose of this grant is to make Tennessee more dementia friendly and dementia capable state.

We have partnered with the Tennessee Department of Health And we are… them and us are implementing what we are calling dimension navigators So they are individuals who will work within the community to guide a family along after they potentially receive a diagnosis of dementia. Maybe they have a loved one that

Has a suspicion of dementia. They do not have to have an actual diagnosis, but our navigators will Do an intake, find out kind of what they're struggling with, what they need, and then we'll be able to provide them with resources and then kind of be that point of contact for them.

So a lot of times when a family receives that news, they don't know where to turn. They don't know what to do. They don't know what's out there.

So are these navigators again with us and with the Department of Health are there to be that connection in the community. Most of the time, physician's offices don't have the staff to work with an individual. They don't have a social worker that can help them with resources. So we want to be there to help them with that.

Along with the dimension navigators, we are doing training So we have a dementia 101, brain health, and then dementia and the IDD population.

That we can do training within the community or within a staff. So if you've got staff that you want to have trained.

Let us know. We can definitely come out and do those trainings or we can do it virtually.

We will also be implementing what we're calling the STAR Caregiver Program. It's an evidence-based program for caregivers to help them identify behavioral issues.

To try to combat those issues without medical or medicine pharmaceutical intervention. That's the word I was looking for.

My brain's not working today. So the STAR Caregiver program is really good to help identify those trouble behaviors so then we can kind of reverse those behaviors and make life for the caregivers a little easier. We also have a dementia gatekeepers program or education program. So that's just out educating people that

Retail stores, banks, grocery stores that might Need… some education on what to look for. Maybe somebody comes in the bank and they're like, I want to withdraw all my money.

That's probably not typical behavior, especially if it's an older adult. So these gatekeepers kind of know Okay, this is something that I need to be concerned about. But then it's like, well, what do I do? We train them on what to look for those red flags and then give them the resources to refer somebody or their family on to us.

As a navigator, and then we can reach out to them, try to help them with resources, try to provide them with information.

So lots of things going on. This is a three-year grant. So we have it until September of 2027.

Fingers crossed the state legislation, they didn't give us money for next fiscal year, but Fingers crossed it's coming that we can continue this because this is definitely something. And again, the collaboration with the Department of Health.

Is great because they have health departments and Rochelle, I don't want to say it wrong, but I don't think you have all 95 counties, but you have regional and local. So with their help, at this point in time, the way I've looked at it is

People in Tennessee don't care where they get their information, if it's from us or from health, they just want the information. So the fact that we can collaborate with other state departments and provide this invaluable dementia education and information is important.

Okay, I'm done.

All right. So here are some amazing quotes from some of our volunteers.

I'm not going to read through all of them. I'm just going to pick out one.

So I feel that I received much more from the residents than the time that I give.

It's an honor to be their advocate. It's been able to do so many things for so many people.

Volunteering is able to reduce depression increase social connection, decrease risk of disease.

Improve longevity. Provide less stress and helps with cognition

All right, so here is some of our stats from our 2023 impact report, volunteer impact report.

We're going to have a new one coming out really soon so We don't have these stats for 2024 just yet.

But in 2023, we were able to serve so many people. If you look at that, that's just incredible throughout the state.

Some of the opportunities, if you're interested in volunteering with us are delivering meals to a neighbor, preparing or serving meals. You could also teach a class or lead an activity at a senior center.

Providing rides around the town through like our My Ride program becoming a friendly visitor.

Serving as a board member even assisting people with health insurance options, taking a booth at a local event, advocating for a long-term care residents.

So many different ways to get involved. With us.

So again, here is many of our programs. Use volunteers as a way to reach older adults.

And so in 2020, we actually began tracking all of our volunteer efforts through a volunteer impact report.

Of all of our programs, due to the increase of volunteers during the pandemic, actually.

So you can see from this slide that our volunteer impact has continued to grow year after year.

And people of all ages are seeing the need in their communities.

To help older adults stay active. The steady increase in numbers from year to year shows that more programs are continuing to improve their tracking of volunteer data.

And new and innovative ways to recruit and retain volunteers have been used to apply not only for funding, but also matching funds for grants.

Each year during the National Volunteer Week, the independent sector releases their value of volunteer time report.

And they collect data from all over the country to determine this value and it's released not only in a national amount, but the value for each state.

So with over, let's see, I think it's 532,000 hours of service in 2023 volunteers contributed to over I think it's 17 million in-kind contributions to our state programs across the state, which is just incredible.

So and here is our contact information for Keita and myself.

Our stuff is also going to be at the very end, so don't feel like you have to catch this right now.

And I know that I just was able to give you a whole bunch of information. It could be overwhelming.

If anyone has any questions about these programs or anything with aging related in Tennessee, feel free to reach out to Keita or myself.

And we'll do our best to provide you with that information.

Let us know and I will kick it over to Bill.

Thanks, Amanda. And thanks, Keita as well. So I love the fact that I have to come behind you guys because you just make it so easy to meet that bar. So anyway, thanks everyone for being here today. And I want to just talk a few minutes just about kind of this continuum of adult services, Adult Healthcare.

And how it looks in Tennessee, as well as some comparison to the United States as well, too. We can go to the next slide. My information will be later too. So for those just like going to 1AAA, you've been to one triple a if you've been to one adult day service provider, you've been to one adult day service provider. There are at least 42 licensed programs across the state of Tennessee right now.

There are at least a dozen or so respite programs. There's a probably quite a bit more. There are some challenges with understanding where these respite programs operate because they don't all need to be licensed. So there's a definition in Tennessee, there's a definition in Kentucky. There's about 30 different definitions in other states too. And our work with the National Association really wanted to come up with a common definition for adult day services and it's long, it's wordy, but it's extremely intentional.

Better about four years come up with this definition. And this is being adopted at both federal level and multiple states as well. But the multi-service is a system of professionally delivered integrated home community-based therapeutic social and health related services provided to individuals to sustain living within the community. And that's the biggest point.

The adult day services are an alternative community-based long-term care option to promote wellness and maintain the quality of life for participants and caregivers alike. There's a big disconnect that most people think it is just for the participant that's attending the program. It is just as much for the caregiver, probably more beneficial for the caregiver than it is for the person participating.

But like I said, there's a huge spectrum of what adult day services are. Go to the next slide too.

And that continuum is continuing to grow. You'll also see very quickly in here, I do refer to everything as adult day services. Technically in Tennessee, at least through June 30th this year, it is licensed as adult daycare. The Tennessee Association did have some legislation that is through the House and is exposed on the consent calendar in the Senate next week to finally change that term.

Of adult day care to adult day services. And it's part of a longitudinal expansion to have more sophistication in the adult day health care and adult day respite space too. But it truly is a continuum.

As a consumer of services that allows individuals of any cognitive and physical level to remain living in the community for the rest of their lives and allow caregivers to get a break.

So you have respite programs and social programs and medical programs and specific diagnosis programs as well. And we'll get into a little bit of those details too, but truly presented as a program.

Next slide, please. So adult day services and adult day respite. Here in Tennessee, there is no licensure difference between any of the types of programs yet.

However, you can really think of it as looking at the start of the continuum. Respite, short-term braking. Adult day respite would be a formal version of respite. There are many, many informal versions of respite too. Short breaks, friends.

Church, you know, faith-based organizations, adult day respite in Tennessee. There is a license exemption from the Tennessee Department of Human Services for respite organizations that are faith-based organizations and provide four hours to six hours of care per person per day, up to 12 hours per week.

Or sorry, up to 12 hours per person, 12 people per day and up to 16 hours per week. So there's a respite exemption.

Not a lot of providers really follow that exemption yet. It is fairly new.

But there are a few license exempt providers and we're working to try to really expand that exemption so that more individuals that are not just faith-based organizations can really enter in that and we'll be working more with TCAD and the legislature next year with it too. But looking at some individuals that are more self-initiating

There are senior centers that have respite organizations. There are senior centers that have adult day services, social model organizations.

But more self-initiating individuals that need a slight higher level of care, a lower acuity, but have the therapeutic physical cognitive activities really need no medical supervision or medication support and usually incontinence care is not part of the provision of services and the respite and social model programs.

I've seen program size vary across the United States. I've seen it anywhere from five people to 500 in the 10 in Tennessee, it is really kind of in that that five to 40 or so programs. There are some respite organizations that have really grown in faith-based organizations, but they're very short term.

Programs too. Next slide, please. As you move into adult day services and adult day health care. And again, you'll see why I kind of blend these lines. They're not clear that this social model programs and the medical model programs really have a little bit more involvement of cognitive therapeutic cognitive activities of therapeutic physical activities. Everything is socialization.

But then as a nutrition management and wellness programs and disease prevention and true medical model programs will usually have RNs, LPNs on staff full time to be able to provide incontinence care, medication. They utilize CNAs for other therapeutic activities. And there are a number of programs across the state of Tennessee that do get into the provision of physical and occupational therapy or other services as well that really kind of push that line into more true health care.

But it is a daytime program too. So you see this progression from early disease state to late disease states and then everywhere in between. And as you move through this continuum, the higher levels of care also provide the same benefits. It's just they provided a few additional services for individuals that progress in that disease state too. Next slide, please.

This is why I want to say that those lines are blurred. So the National Assault Adult Day Services Association works with the CDC, and this is from the NPAL survey. This is the National Post-Acute and Long-Term Care Survey.

Just like Keita said, we all love our acronyms, but adult day services is truly a continuum because this is a national count of more than 4,000 programs across the United States that there is very few programs that are only medical or only social. The overwhelming majority are somewhere in between. Almost half are equally socially and medical. And similar in Tennessee, since there is no licensure difference right now.

There is no program that is essentially only medical or only social, but there is a blend depending on the level of services provided. And it's just being mindful of what your needs are to be able to visit your local program and see what they can do to help your specific loved one.

The clients you're serving. Next slide, please. Again, this is kind of the evolution of adult day services and adult day health care. And part of the reason that the adult day services is the terms used now. Adults don't need care, but it's not just for individuals that are 65 with dementia. It's individuals over the age of 18 who can't safely remain at home.

So, you know, you'll have individuals of every age and diagnosis. There's programs across the state of Tennessee. There is a program specific to brain injury in East Tennessee. There's a number of provoked programs that are dementia specific. Here in Tennessee, I haven't seen them, but there are some programs that are specific to fairly rare disease like Pick's disease or You know, NPC type 2, but you have individual programs that are specific, but the majority of programs in the expansion across both the state and the nation have been in the agent diagnosis agnostic space.

So the ability to serve individuals across the board who need additional oversight, but really at the same time, really just need the socialization and the person-centered care. So it is for everybody that can't stay at home by themselves.

Next slide, please. Cost payers, everything else as Amanda and Keita had mentioned earlier, there is a number of funding opportunities in the adult day space. They do generate blend with virtually all home and community-based services. So home care, some home delivered meals, transportation services.

By and large, Medicaid is the largest provider or the largest payer of adult day services across the United States and roughly the larger, I guess the largest in Tennessee as well too.

Previous to 2010, Medicaid was about the 80% to 90% of revenues across the United States in the adult day space. That's down to about 40 to 60, depending on the state.

Not that Medicaid is paying less. It's that other programs are paying more.

In Middle Tennessee, as well as a number of other triple A's are able to use those family caregiver support programs for adult day respite.

Or the Alzheimer's support funds for Alzheimer's Alzheimer's disease respite. And there are some other triple A's that are able to replicate that too So family caregiver support programs, there's Title III-E funds from the Older Americans Act and can get into advocacy later, but as we get into Older Americans Act authorization, contact your

Your elected representatives and advocate for expansion. Long-term care insurance pays for you know for adult day services and almost all licensed home and community-based services. The VA is now the largest is the second largest provider of or payer of the adult day services space because it's much, much less expensive to the VA.

To allow to provide individuals home and community-based services than institutionalization. So the Mission Act really expanded that in 2016, 2017, and then it continues to grow across the United States. And there's a number of other funding opportunities.

Go ahead and the next slide. I think I list a few of them as well.

Okay, I don't. There are a number of other funding opportunities. And as Amanda mentioned, the Tennessee Caregiver Coalition does have a caregiver grant system that uses respite vouchers that can be used for adult day or for other respite sources. Guide is a new program that's the Centers for Medicare and Medicaid Services Guiding to improve dementia experience.

The adult day services are a direct names type of respite in the guide program.

I believe we're going to talk a little bit more about that later. But overall, adult day services still remains in this the 2024 numbers were just released. Average cost of adult day services as of 2024 was $26,000 a year, where home care has gone up to $77,000.

Assisted living is up to 75,000. And then a private nursing facility is actually 111 to $117,000 per year.

As you can see, the cost saving and that's an on-private basis. So the cost to this system can be slightly more, slightly less.

I'm a little bit biased. I think it's the best kept thing or the best kept secret or the best thing since sliced bread.

Look, it does allow individuals to live in place at a fraction of the cost of institutional care.

Next slide, please. So I guess I did not include, I wanted to save some time for Rochelle and some time for questions as well, too. I'm happy to revisit the guide model program as well. But I think Rochelle has a

A few things that she can present and I'll take a drink of water. Sorry, I'm talking so fast trying to get away with that without coughing as I do a little bit of a head cold.

Thanks, everybody.

Yeah, and thank you for having me on board with the conversation. All of this great information needs to be shared far and wide.

I think the collaboration across all of the members that are here is just is beautiful and we always say that there's a piece of pie for everybody and us working together make this stronger, more resilient Tennessee Which is the ultimate goal.

So I work in the Office of Healthy Aging as the state dementia director, which is a very new position for Tennessee, but we're very excited to see this take place.

There are 31 states total with state dementia directors, and it adds that value and importance to these aging conversations and focusing on building our infrastructure for dementia across Tennessee.

So our office was rebranded in November, so you might know us as the Office of Patient Care Advocacy.

But over time, it has shifted and we are we pride ourselves in really operating as an approach to healthy aging across that life course.

So we operate in two different buckets. And one is the healthy aging. And then the other one is developing out the dementia infrastructure.

So we're strengthening these supports for Tennesseans and ensuring that public health initiatives address the unique needs of the older adults And then bold really facilitates our efforts when it comes to dementia.

And building that statewide capacity to really support the individuals living with dementia and their caregivers.

So these coincide with all of our mission and vision of TDH.

And so we also take this public health lens approach So a proactive and population-based approach to aging So ensuring that individuals of all age have the resources and support needed to maintain health and well-being.

But we're also strengthening, again, that the dementia related services and systems across the state.

We know that a strong public health response can really mitigate future impact of chronic diseases, including dementia.

And the common public health approaches that we use, the early detection and diagnosis, reduction of risky behaviors.

Collection and use of surveillance data and workforce development really create great impact.

In this area. Next slide.

So again, you know, our work is about building a Tennessee where every person, regardless of their age, can live that healthy, supportive life.

So raising awareness, expanding services, training our workforce. Fostering the dementia friendly communities and advancing policies is really the area that we like to sit.

So without going into too much detail on every one of the activities that that's taking place in the Office of Healthy Aging. This kind of provides a high level snapshot. If you guys receive the PowerPoint slides, there's more detail

Within that in the notes section. But really driving that change here in Tennessee. So through engaging communities, which is our faith-based partnership.

With UTC, we've been able to engage with leaders and members of congregations faith-based and religious communities to empower them with education and then train them and provide education to their members.

We've launched the In the Dark campaign, so increasing that public awareness and understanding how to integrate brain health into public health efforts.

The Dementia Navigator Program, which was mentioned earlier, and our resource repository that's being developed out by the Tennessee Dementia Action Collaborative, or RTAC Another acronym to add to your bucket And then the Tennessee ADRD Advisory Council, so Alzheimer's Disease and Related Dementia Council.

So they're building out this resource. Our intent is to make this a public facing dashboard of resources that are trusted across Tennessee.

But in that process of building that out right now. Also, our national collaborations really strengthen our impact. So we sit on a few different boards, committees, councils across the span.

And so that helps provide influence here in Tennessee and guides our next steps.

When it comes to workforce training, we've been able to offer the Tennessee Dementia ECHO, which is a partnership with Vanderbilt University who serves as our central Tennessee hub.

And they're providing education to primary care providers And they are working with University of Tennessee Memphis to build out the West Hub.

To offer that more specific focus in that area. And then also working with Erlanger and UT Chattanooga in the East.

We were able to also offer a local health department echo pilot, which trained over 100 public health staff, which we really we were shocked. We were given a pilot opportunity to train 20 to 40 and then ultimately trained over 100 individuals.

And we really feel like that education launched their efforts in the age-friendly approach. So our West Tennessee friends out there actually received their recognition first. So every county in the grand division and West became recognized as age-friendly and it has since spread. So we have 50 local health departments that are actively

Recognized or in pursuit of age-friendly recognition And it's just another way to integrate our messaging and our prevention brain prevention praying that safe messaging into the work that we're doing already We've also partnered with others like TPI Fine. They recently

Released a TBI find app which supports caregivers. It encourages them to collect the information on the person that they're caring for.

Updating that information regularly, including pictures. So when silver alerts happen, they are prepared to share this information immediately within the most recent picture versus the driver's license that might not have been updated for the last two decades.

So great opportunities across many agencies here in Tennessee And then finally, we've also proposed a couple legislative budget requests and unfortunately ours have not been approved either. So we are not stopping. So looking to to promote these to more and that includes

The development of a hub and spoke memory network So we increase that we were doing the provider training when it comes to the Tennessee Dementia echo and then supporting that through that hub and spoke network, increasing the access to

That specialize information to be able to better manage those living with dementia.

And then we also want to expand our dimension navigator program to every single county here in Tennessee.

We know these resources, these warm handoffs, instead of just handing them a packet of information is the way to go.

And creates that continuity of care. Next slide.

And then finally, our Tennessee Dementia Action Collaborative briefly mentioned that But it was formed in 2022 and it is a group of strong and passionate leaders in ADRD, so Alzheimer's disease and related dementia We offer networking education opportunities, best practice sharing, and collaborating among individuals and organizations.

Some of our successes over the last year, we've increased both our membership and the numbers of counties that we are serving in.

Along with the statewide. So the members that are offering statewide services This group really, although they work independently of the ADRD Advisory Council, they're in alignment with our state plan that's developed by the council.

So again. Feel free to reach out. We can provide some more information. We'd love to have you as members of our action collaborative to help push these changes across.

And I think my next slide is all of our contact information. So feel free to reach out to us and ways we can collaborate, issues that we can support, please let us know.

So here's just all of our contact information if anyone needs to needs to see it.

And I will stop sharing.

Thank you so much, everybody. Amanda, Keita, Bill, and Rochelle, thank you so much. We're going to give people an opportunity to ask you some questions in a minute.

I'm gonna I'm gonna go back to sharing.

And go on to the next. The next one and just come back to brain injury for a second to remind you of that intersection.

So a lot of brain injuries in older adults are missed or misdiagnosed. I think that's a really important thing.

I often wonder too if it's If it's taken as seriously.

Because they have other things going on. When I think about someone with a concussion.

And there's kind of this thought of, well, it's not a big deal First of all, it is. But second of all, I think of like having vestibular changes after a concussion, if I were an older adult or adult ocular motor, you know, I'm looking at things and getting dizzy

That would be so debilitating or it could be and they're deserving of the chance to have treatment as well. And there is treatment for concussions and like we said, nationally people age 75 and older case numbers and rates of TBI.

Related hospitalizations, one in 50 age 75 or older experience a traumatic brain injury.

Related hospital visit or death And then each year about 3 million emergency departments there are visits due to falls in older adults. And that's really the big thing is falls and then a lot are not going to tell their doctor.

Not going to tell anybody some of them. In Tennessee, almost 30% of Tennesseans, 65%, An older reported falling in the last 12 months, about 30%, that's high.

Older women are at the highest risk of falling. And then two great prevention resources, because we really want to not have them happen in the first place is the steady brochures that hold steady fall prevention program of the CDC.

Has some great brochures. Like how to like how it has a list of things that you can do one of them a quiz that you can take to see if you are at risk of falling.

And then there's a great prevention rack card as well that the CDC has so So those are available and then available when dealing with people who are older.

This is from our infographics. And you'll see that all of our infographics all contain this part because it's all important for anybody, whatever group you're working with, to screen for a prior history of brain injury assess their cognitive and functional impairment

Educate the staff on brain injury, educate the person about their brain injury.

Provide and teach accommodations and connect people with community resources.

For brain injury and these are just some common problems, and I'll refer you to the infographic. I think the important thing for an older adult I might say, well, you know, their memory wasn't always that great or their balance wasn't that great, but it's really important to look at

A change in that thing? Is there a change well then it might be a change from the fall or from the concussion that happened. So again, we have to just look a little more carefully with someone who is older.

And then these are some things that you might see someone looking interested now.

In a group because they can't pay attention they appear like they're breaking the rules all the time. Could be that they don't remember the rules.

They may be processing more slowly than they did before. They may look more argumentative.

Because they're irritable or they're angry, they're impulsive. The lights are too bright now because of their concussion. The noises are too loud.

So again, just I'll refer you to that infographic. I wanted to remind you of the brain links signs and symptoms.

Where there is a This is good for kind of showing to somebody if they don't have it at the time of the injury Which would be awesome but to show it to them afterwards and then kind of just look at it and go oh yeah there probably was a concussion here.

And I did maybe have even more symptoms that I reported to the doctor because I didn't realize that was a symptom.

And then there is an area on older adults. We've got to watch them more carefully for a longer time because there's more space within they're uh the brain and the skull where blood might take a longer time to accumulate.

Before we really see problems. So that's really important and then I think for this population, it's really important for them to understand that concussions are treatable now there is a lot of evidence-based research that shows that there are ways to treat every type of

Concussion and that message has to get out to I think this age group especially everyone, but this age group especially. So we're going to, before we get into questions and answers so everybody can feel free to ask your questions, we're going to

Let the people who are watching this as a video afterwards do their certificate and a reminder for them to join us next time.

We will stop recording. There.