ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  February 15, 2022 3:03 p.m. MEMBERS PRESENT Representative Liz Snyder, Co-Chair Representative Tiffany Zulkosky, Co-Chair Representative Ivy Spohnholz Representative Zack Fields Representative Ken McCarty Representative Christopher Kurka Representative Mike Prax MEMBERS ABSENT  All members present COMMITTEE CALENDAR  HOUSE BILL NO. 308 "An Act relating to dementia awareness." - HEARD & HELD PREVIOUS COMMITTEE ACTION  BILL: HB 308 SHORT TITLE: DEMENTIA AWARENESS SPONSOR(s): REPRESENTATIVE(s) STUTES 02/07/22 (H) READ THE FIRST TIME - REFERRALS 02/07/22 (H) HSS, FIN 02/15/22 (H) HSS AT 3:00 PM DAVIS 106 WITNESS REGISTER FATE PUTNAM, Staff Representative Louise Stutes Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented HB 308 on behalf of Representative Stutes, prime sponsor. JORDAN LEWIS, PhD, Professor of Medical Education University of Alaska Anchorage Anchorage, Alaska POSITION STATEMENT: Gave invited testimony during the hearing on HB 308. PAM KELLEY, Executive Director Alzheimer's Disease Resource Agency of Alaska Inc.; Chair Alaska Dementia Action Collaborative Anchorage, Alaska POSITION STATEMENT: Testified in support of HB 308. JOSH LONN, Chair Community Board Alzheimer's Association Alaska Chapter Anchorage, Alaska POSITION STATEMENT: Offered statistics related to Alzheimer's disease during the hearing on HB 308. NONA SAFRA, Member Alaska Commission on Aging Homer, Alaska POSITION STATEMENT: Provided invited testimony in support of HB 308. KAROL FINK, Chief Chronic Disease Prevention and Health Promotion Division of Public Health Department of Health and Social Services Anchorage, Alaska POSITION STATEMENT: Responded to questions during the hearing on HB 308. PAMELA SAMASH, on behalf of self Nenana, Alaska POSITION STATEMENT: Testified in support of HB 308. ACTION NARRATIVE 3:03:52 PM CO-CHAIR LIZ SNYDER called the House Health and Social Services Standing Committee meeting to order at 3:03 p.m. Representatives Kurka, McCarty, Zulkosky, and Snyder were present at the call to order. Representatives Fields, Spohnholz, and Prax arrived as the meeting was in progress. HB 308-DEMENTIA AWARENESS  3:04:39 PM CO-CHAIR SNYDER announced that the only order of business would be HOUSE BILL NO. 308, "An Act relating to dementia awareness." 3:06:30 PM FATE PUTNAM, Staff, Representative Louise Stutes, Alaska State Legislature, presented HB 308 on behalf of Representative Stutes, prime sponsor. He said the proposed legislation would adopt a dementia awareness program within the Department of Health and Social Services (DHSS). The program would be designed to qualify for funding from the Building Our Largest Dementia Infrastructure for Alzheimer's Act (BOLD). Designed in 2018, he said, the Act is a federal program to raise national awareness of dementia, as early detection would reduce the risk of cognitive decline. He said that the Act directs the Centers for Disease Control and Prevention (CDC) to provide funds to public health departments for the development of educational programs on dementia, and HB 308 would help obtain these federal funds. The funds would also support caregivers to improve management of dementia-related diseases. He said to be eligible for the federal funds DHSS would need to submit the application to the CDC for a core competency award. The application would need to identify how the plan would educate the public. He noted that the core competency awards range from $350,000 to $500,000, annually. 3:09:14 PM MR. PUTNAM explained that HB 308 would establish a dementia awareness program tasked with the following basic functions: create educational materials for healthcare professionals to aid in the recognition of the symptoms of dementia; create a statewide list of dementia service providers in Alaska; consult with national organizations concerning the most appropriate materials needed for a public-awareness campaign; coordinate program implementation and activities for public education; campaign statewide to publicize the scope of the issue and promote early detection through screening; educate the public about the risk of developing dementia and ways to avoid the onset; and increase the awareness of wellness visits to patients. MR. PUTNAM voiced the opinion that the proposed legislation is needed because Alaska has "a large and growing" senior population, with approximately 12,500 Alaskans suffering from Alzheimer's and other related diseases. He stated that it is the fifth leading cause of death for people over the age of 65. Mr. Putnam emphasized the importance of getting "in front of this issue before it becomes an insurmountable problem." He stated that the proposed legislation would create a centralized agency tasked with protecting public health by organizing the best programs available for all Alaskans. He noted that currently there are many groups in the private sector whose work addresses Alzheimer's disease and other dementia only after they have been diagnosed. He pointed out that unfortunately once these diseases have been diagnosed, the treatment to reduce the impacts is very limited. He said HB 308 is designed "to get out in front of the diagnosis with early detection" and look for ways to delay cognitive decline so people can lead healthier lives. He noted that DHSS has submitted a fiscal note reflecting the cost of running the program, and the bill sponsor's office is working with the administration to find ways to reduce the cost. He acknowledged that there is a need for experts to work on the program. He said the sponsor encourages DHSS to seek funds from BOLD to pay for the public education program. 3:14:02 PM JORDAN LEWIS, PhD, Professor of Medical Education, University of Alaska Anchorage, testified in support of HB 308 and shared that his research focuses on dementia. He stated that the stigma surrounding dementia prevents families from seeking medical care, and this results in distress and burnout. He stated that increasing education about dementia will decrease stigma, normalize conversations with healthcare providers, and help with the understanding that dementia is not a normal part of the aging process. He advised that receiving an early diagnosis could relieve anxiety over symptoms and help providers work with patients concerning treatment options. An early diagnosis would also give families the opportunity to maximize time together, find resources and support programs, and save on medical and long-term care costs for families and state government. He reported that the early diagnosis of Alzheimer's disease and dementia would collectively save the country approximately $7 trillion in health and long-term care costs. He encouraged support for HB 308. 3:15:56 PM PAM KELLEY, Executive Director, Alzheimer's Disease Resource Agency of Alaska Inc. and Chair, Alaska Dementia Action Collaborative, stated that, once symptoms have begun, individuals with dementia and family members come to the Alzheimer's Resource of Alaska, and at this point it is too late for prevention. She stated that over the last 38 years the agency has helped thousands of Alaskans to slow the rate of cognitive decline and adapt to future changes. She described the current public awareness efforts as "on the retail level," while HB 308 would be a "wholesale campaign." She questioned, "Don't we owe it to ourselves to try?" 3:18:18 PM JOSH LONN, Chair, Community Board, Alzheimer's Association Alaska Chapter, stated that Alaska can soon expect to be impacted by dementia at a higher rate per capita than any other state in the country. He reported that the population of Alaskans with Alzheimer's disease accounts for approximately 8,500 of Alaska's 12,500 dementia cases, and it is expected to impact 3,000 more Alaskans by 2025. He noted that there are 10 types of dementia, with Alzheimer's disease being the most common. He surmised that the overall dementia population will surpass 17,000 Alaskans. He stated that a dementia public- awareness campaign would be instrumental in preparing Alaska for the approaching "dementia tsunami." He talked about the benefits of early detection and commented on caregiver burnout in Alaska's workforce. He stated that the disease's progression leads to public safety issues, behavioral changes, wandering, and the inability to perform basic tasks. He urged the committee to support HB 308 in recognition of families who have been impacted by dementia and wished they had known the signs sooner. 3:21:00 PM NONA SAFRA, Member, Alaska Commission on Aging, stated that the Alaska Commission on Aging supports HB 308. She said the workforce and state budget will be affected by the number of people who will be diagnosed with dementia in the next decade. She advised that the state needs a better approach in preparing for this public health crisis, and HB 308 would mitigate the onset of dementia by educating the public. She shared that she has a brain injury, which increases the odds of getting dementia, and she is a caregiver for someone with Alzheimer's disease. She stated, "It's too late for him, but it's not too late for others." She called HB 308 a "game changer." 3:23:20 PM REPRESENTATIVE MCCARTY referred to the language on page 2, line 2 and line 26 of the proposed legislation. Regarding a list of state providers, he asked whether providers would need to have certain qualifications to be acknowledged. MR. PUTNAM answered that most people who provide services for dementia would be part of this program. In response to a follow-up question, he stated that he is not aware of past requirements or accreditations for this program. 3:25:20 PM REPRESENTATIVE KURKA drew attention to the fiscal note, which reflected over $16,000 for the fiscal year 2023 (FY 23) and over $750,000 for FY 24. He observed that a new staff person would be added, and the services category would total $521,000. He asked whether these expenses would be covered by the state. MR. PUTNAM answered that the sponsor's office is working with DHSS concerning the amount of the fiscal note. He reiterated that BOLD would provide funding between $350,000 and $500,000 annually. In order to fund the program, he said, DHSS would need to hire a subject-matter expert, as materials need to be produced early for program development. He deferred to the department to offer further explanation. REPRESENTATIVE KURKA noted that no additional staff would be hired in the first year; however, there would be a 50-percent increase in funding for services in FY 24. He questioned the reason for the funding increase. MR. PUTNAM pointed to the back of the fiscal note where it is explained that 90 days after the passage of HB 308 the department would be recruiting well into FY 23; therefore, the department would need the funds only for a portion of the year. However, beginning in FY 24, DHSS will need an Alzheimer's disease specialist. 3:28:10 PM CO-CHAIR SNYDER requested that DHSS speak to the fiscal note, comparing this program with similar-sized programs. 3:29:03 PM KAROL FINK, Chief, Chronic Disease Prevention and Health Promotion, Division of Public Health, Department of Health and Social Services, explained that most of the fiscal note is built by looking at the budgets in place for other programs; however, she said an economy of scale does not exist because the work of each program differs. In response to a follow-up question, she confirmed that DHSS took into consideration the tobacco prevention program, nutrition program, and marijuana education program. She explained that each program would have different funding streams and sources. 3:31:08 PM CO-CHAIR SNYDER opened public testimony on HB 308. 3:31:35 PM PAMELA SAMASH, on behalf of self, noted that she is a member of the Alaska Commission on Aging, which supports HB 308. She stated that she is testifying on her own behalf in support of the proposed legislation. She emphasized that because the senior population of Alaska is growing substantially there is a need for the awareness of dementia and Alzheimer's disease, and the proposed legislation could help people become more prepared. She said Interior Alaska needs more housing and skilled nurses to handle this population and the chronic health issues that come with dementia. She highlighted the importance of learning prevention measures, such as diet and exercise, which could drastically reduce the number of individuals who will have to face dementia. She urged the committee to support HB 308 and Alaska's seniors. 3:33:13 PM CO-CHAIR SNYDER, after ascertaining that there was no one else who wished to testify, closed public testimony on HB 308. CO-CHAIR SNYDER announced that HB 308 was held over. 3:34:48 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 3:35 p.m.