Legislature(2023 - 2024)BELTZ 105 (TSBldg)
04/15/2024 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB235 | |
| SB237 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 235 | TELECONFERENCED | |
| += | SB 237 | TELECONFERENCED | |
SB 235-CNA TRAINING
1:32:25 PM
CHAIR BJORKMAN announced the consideration of SENATE BILL NO.
235 "An Act relating to certified nurse aide training; and
providing for an effective date."
1:32:45 PM
SENATOR CATHY GIESSEL, District E, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 235, introduced SB 235 by saying
her mother has dementia and lives in the Anchorage Pioneer Home.
The Pioneer Homes serve as a safety net for many Alaskans who
suffer from dementia. She noted the percentage of the population
of seniors in the Pioneer Homes is growing exponentially with
dementia and Alzheimer's patients. These are high-level care
[patients] and this places high demand on the Pioneer Homes, and
she also noted home and community-based clinicians or service-
providers, many of whom go into homes to serve people with
Alzheimer's or dementia. She said SB 235 would increase the
training required for the Certified Nurse Aides (CNAs), the
front-line, hands-on care providers in the Pioneer Homes and in
home and community-based services. She shared some facts and
statistics:
• Alaska has the highest growth in senior population of any
state for the last ten years in a row.
• 34 percent of Alaska's residential care patients have at
least some form of dementia.
• 49 percent of nursing home residents have at least some
form of dementia.
• 36 percent of patients using home health services have at
least some form of dementia.
SENATOR GIESSEL noted the federal government had increased
regulations for training for CNA's relating to treating dementia
and presented a document, "Care of Cognitively Impaired
Residents" with defined criteria for regulations. She
acknowledged the language suggested regulation that should be
passed by the board of nursing, as the body that regulates CNAs.
Unfortunately, she said this isn't happening and [SB 235 would
meet] a critical need of a growing population.
[Original punctuation provided.]
ADOPTED FEDERAL REGULATION LANGUAGE
Care of cognitively impaired residents:
(i) Techniques for addressing the unique needs
and behaviors of individual with dementia
(Alzheimer's and others);
(iii) Understanding the behavior of cognitively
impaired residents;
(iv) Appropriate responses to the behavior of
cognitively impaired residents; and
(v) Methods of reducing the effects of cognitive
impairments.
1:36:06 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, noted letters of support for SB 235
in the committee's information packet from the following
organizations:
• Resources of Alaska
• Alzheimer's Association
• The Aleutian-Pribilof Islands
• UAA National Resource Center for Alaska Native Elders
• The Alaska Commission on Aging
• State of Alaska Long-term Ombudsman's Program
• Alaska Pioneer Homes
• Hope Community Resources
• Fairbanks Resource Agency
• Bigelow Community Consulting
1:37:28 PM
MAUREEN TOWNSEND, representing self, Kenai, Alaska, gave invited
testimony on SB 235. She paraphrased the following letter to the
committee:
[Original punctuation provided.]
To whom it may concern,
I am writing to you in response to bill NO.235. This
is a subject that is important to me due to my own
experience training as a CNA, followed by my clinical
experience within the dementia wing. Despite my
training at the college (and my prior years serving as
a PCA) I was not prepared for working with dementia
patients. You see, I have always had a fear of losing
my memory and losing my sense of self. This was
something that I had shared with my class, which
prompted my instructor to place me in the dementia
wing for my clinicals. Though some of the residents
were docile, there were also frequent times of
hysterical or often violent behavior. It is my opinion
that the CNAs that I worked with and myself could have
benefited from additional training in which to give us
tools for the situations we faced.
After working in the dementia wing, and seeing what I
witnessed, I changed my path and went into Dermatology
as a surgical assistant instead. I imagine I am not
the first that this has happened to. We have a real
need for CNAs in my area, so being discouraged due to
a lack of training in the field is a real shame. It is
my hope that in the future we can offer more programs
to those who need it the most.
All the best,
Maureen Townsend
1:39:49 PM
MICHELLE CASSANO, representing self, Anchorage, Alaska, gave
invited testimony in support of SB 235. She said she was a
retired nurse, currently living in Anchorage and that she began
her nursing career in Nome. She said she cared deeply about the
quality of dementia care education and person-centered training
for CNAs. She said her husband, Lawrence Williams, a veteran,
deserved better care and to be safe and that without the
knowledge there could be injury to the CNAs and to the patient.
She continued by paraphrasing the following letter:
[Original punctuation included.}
March 5, 2024
To: Alaska Legislature
Fm: Michelle Cassano, Alzheimer's advocate
Re: SB 235
Thank you for taking my testimony on this pivotal
issue, upon my husband's passing recently, we
concluded a 13-year battle with Alzheimer's and
related dementias.
In the last 4 years of his life our family had to rely
on memory care, assisted living and finally hospice to
keep my husband safe and in the best health possible.
There are so many medical, social and economic issues
surrounding Alzheimer's I would like to focus on the
caregivers who care for these fragile individuals.
As a nurse I never thought I would not be able to care
for my husband, but when his safety was at risk due to
wandering and agitation, we made a difficult decision.
The facility during COVID had difficulty maintaining
staff, many young individuals with little experience
with seniors and/or Alzheimer's. Subsequently he was
frequently transported to Emergency Services, each
visit averaged $14,000 at least once a month, when a
warm drink and being put back to bed would have
sufficed. This is a burden to emergency rooms, poor
use of resources and terribly upsetting to patient and
family.
CNAs trained in dementia care can effectively manage
challenging behaviors and ensure the safety and
security of our loved ones. This gives us peace of
mind, knowing that our family member is in capable
hands, even in difficult situations.
CNAs trained in dementia care can recognize early
signs and symptoms of cognitive decline. This enables
timely interventions and support services, potentially
slowing the progression of dementia.
When our resources mandated, we move my husband to a
Medicaid waiver facility, we found a staff who were so
well trained and connected with my loved one and
anticipated quirks, like lying on the floor when
tired?avoiding falls?getting him comfortable and
helping with processes that would allow rest, two
years not one hospital visit.
I cannot explain how reassuring it is to know your
loved one has proper care, backed by education, CNA's
are an important part of the healthcare team, they
attend continuing education, adding dementia training
is critical as our population ages, and more are
diagnosed with early onset dementias. Classes and
training is offered by agencies such as the
Alzheimer's Association and often are at little to no
cost, should not be a burden in terms of a fiscal
note.
Again, my appreciation of your attention to this
matter.
Michelle Cassano
MS. CASSANO concluded her testimony with gratitude and said her
thoughts are with those who have family members living with
dementia.
1:44:27 PM
LAURA MCENTIRE, Senior Director of Health Systems, Alzheimer's
Association, Dallas, Texas gave invited testimony on SB 235. She
said she was a Licensed Clinical Social Worker (LSCW) and that
she cares for her father who is experiencing middle-stage
Alzheimer's. She said she could provide background for the
importance of person-centered care for dementia patients and the
need for CNAs to be trained in this type of care.
MS. MCENTIRE outlined recommendations for quality care practices
based on comprehensive review of current evidence, best
practices and expert opinions. She said the recommendations
offered a wholistic approach to training and care to support
persons at risk for cognitive decline and support for persons
living with dementia throughout the disease. She said person-
centered care for dementia is widely accepted as a value-based
approach to caring for people with dementia and is a guiding
principle in care services. She said person-centered care is a
philosophy built around understanding the unique needs, values
and beliefs of individuals receiving care. This approach assists
in creating a more interpersonal relationship between the person
living with dementia and their care-providers, such as CNAs. A
person-centered approach enables care assistance to emphasize a
social model focused on relationships of care rather than a
medical model which tends to focus on processes, schedules,
staffing and organizational needs. She said comprehensive
training on this topic is necessary because the philosophy of
person-centered care needs to be interwoven into all aspects of
care. She said if a CNA is offered training around effective
communications or managing behaviors, it would be important for
the CNA to really understand how knowing the specific
preferences of that person would affect the type of
communication they would have. For example, she suggested that
if the person being cared for is a veteran and prefers to be
called "Colonel" rather than their first name, that might help
with effective communication. She also said CNAs may receive
training to help manage behavioral expressions. Understanding
what has been meaningful to a patient in their lives prior to
their dementia can help make meaningful connections. She related
that cooking alongside her father facilitated a connection with
him due to his past work in restaurants; however, her mother did
not enjoy cooking, so cooking with her likely would not create a
meaningful, enjoyable connection if she were experiencing
dementia. She said it's very important that CNAs learn specific
techniques for effective care and that they also understand the
importance of a person-centered approach. She emphasized that
training for this type of disease can not be covered in a brief
overview and that dementia is complex and progressive and often
is experienced in different phases. One aspect of a person-
centered approach was knowing where the person was in their
disease and knowing that what was effective at one point may not
be effective at a later stage and would require revisiting what
had been important in the patient's life before dementia. She
said comprehensive training would allow better recruitment of
effective CNAs, and it would improve retention of people working
as CNAs in various settings.
1:48:48 PM
SENATOR MERRICK joined the meeting.
1:48:49 PM
MS. MCENTIRE concluded her testimony, saying the training would
prevent surprises [for new CNAs] as CNAs would be prepared for
the behaviors that may be "normal" for certain patients. This
[comprehensive training] would help CNAs embrace the necessary
care, think outside the box and work with a team-based approach.
1:50:06 PM
CHAIR BJORKMAN held SB 235 in committee.