Existing law requires the Secretary of California Health and Human Services to be responsible for oversight and coordination of programs serving people living with Alzheimers disease and related conditions, and their families. Existing law establishes the Alzheimers Disease and Related Disorders Advisory Committee in the California Health and Human Services agency, and specifies the committees duties, including requirements for making policy and plan recommendations.

This bill would rename the advisory committee to the Alzheimers Disease and Related Conditions Advisory Committee, and expand the number of members serving on the committee from 14 to at least 16, but not more than 20, members. The bill would prescribe the qualifications of certain members on the committee, and revise the duties of the committee. The bill would, in the provisions governing the committee, revise references to Alzheimers disease to also refer to related conditions.

This bill would incorporate additional changes to Section 1568.17 of the Health and Safety Code proposed by AB 2207 to be operative only if this bill and AB 2207 are enacted and this bill is enacted last.

Existing law requires the Secretary of California Health and Human Services to be responsible for oversight and coordination of programs serving people living with Alzheimers disease and related conditions, and their families. Existing law establishes the Alzheimers Disease and Related Disorders Advisory Committee in the California Health and Human Services agency, and specifies the committees duties, including requirements for making policy and plan recommendations.

This bill would rename the advisory committee to the Alzheimers Disease and Related Conditions Advisory Committee, and expand the number of members serving on the committee from 14 to at least 16, but not more than 20, members. The bill would prescribe the qualifications of certain members on the committee, and revise the duties of the committee. The bill would, in the provisions governing the committee, revise references to Alzheimers disease to also refer to related conditions.

This bill would incorporate additional changes to Section 1568.17 of the Health and Safety Code proposed by AB 2207 to be operative only if this bill and AB 2207 are enacted and this bill is enacted last.

Existing law requires the Secretary of California Health and Human Services to be responsible for oversight and coordination of programs serving people living with Alzheimers disease and related conditions, and their families. Existing law establishes the Alzheimers Disease and Related Disorders Advisory Committee in the California Health and Human Services agency, and specifies the committees duties, including requirements for making policy and plan recommendations.

This bill would rename the advisory committee to the Alzheimers Disease and Related Conditions Advisory Committee, and expand the number of members serving on the committee from 14 to at least 16, but not more than 20, members. The bill would prescribe the qualifications of certain members on the committee, and revise the duties of the committee. The bill would, in the provisions governing the committee, revise references to Alzheimers disease to also refer to related conditions.

Existing law requires the Secretary of California Health and Human Services to be responsible for oversight and coordination of programs serving people living with Alzheimers disease and related conditions, and their families. Existing law establishes the Alzheimers Disease and Related Disorders Advisory Committee in the California Health and Human Services agency, and specifies the committees duties, including requirements for making policy and plan recommendations.

This bill would rename the advisory committee to the Alzheimers Disease and Related Conditions Advisory Committee, and expand the number of members serving on the committee from 14 to at least 21, 16, but not more than 25, 20, members. The bill would prescribe the qualifications of certain members on the committee. committee, and revise the duties of the committee. The bill would, in the provisions governing the committee, revise references to Alzheimers disease to also refer to related conditions.

Existing law requires the Secretary of California Health and Human Services to be responsible for oversight and coordination of programs serving people living with Alzheimers disease and related conditions, and their families. Existing law establishes the Alzheimers Disease and Related Disorders Advisory Committee in the California Health and Human Services agency, and specifies the committees duties, including requirements for making policy and plan recommendations.

This bill would rename the advisory committee to the Alzheimers Disease and Related Conditions Advisory Committee, and expand the number of members serving on the committee from 14 to at least 21, but not more than 25, members. The bill would prescribe the qualifications of certain members on the committee. The bill would, in the provisions governing the committee, revise references to Alzheimers disease to also refer to related conditions.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2680

Author:(Aguiar-Curry)

As Amended Ver:August 23, 2024

Majority vote

SUMMARY

Makes several changes to the Alzheimer's Disease and Related Disorders (ADRD) Advisory Committee in the California Health and Human Services Agency, including renaming the advisory committee to the Alzheimer's Disease and Related Conditions (ADRC) Advisory Committee, and expanding the number of members serving on the Committee from 14 to at least 16, but not more than 20, members, as specified, and revising references to Alzheimer's disease (AD) to also reference related conditions, among other clarifying changes to the law governing the Committee.

Senate Amendments

1. Revise reference from mental health to behavioral health.
2. Update reference from AD or related condition daycare resource centers to organizations providing adult day care services focused on persons living with AD or related conditions.
3. Update reference from AD diagnostic and treatment centers to California Alzheimer's Disease Centers.
4. Update the reference from "formal caregivers" to "direct care workforce".
5. Delete the proposed addition of the the representatives from local health jurisdictions, first responder, primary care physician representative, commissioner from the California Commission on Aging, and one of two representatives of a consumer organization representing persons with AD or related conditions.
6. Require the Committee to provide planning support and the legislature by tracking, monitoring, and considering recommendations made in the final report of the Governor's Task Force on Alzheimer's (Disease) Prevention and Preparedness, and the California Master Plan for Aging, in addition to other state plans and reports, including the California State Plan for Alzheimer's Disease, rather than updating the recommendations of the 1987 California Alzheimer's Disease Task Force Report.
7. Expands the duties of the Committee to review current state policies not only concerning care and treatment of AD and related conditions but also risk reduction.
8. Expands the duties of the Committee to develop recommendations for risk reduction through increasing public awareness of AD and related conditions as well as brain health.
9. This bill and AB 2207 (Reyes) both amend the same code sections. This bill is being amended to avoid chaptering out the other, should both bills be enacted."

COMMENTS

1. Background. According to the Department of Public Health, AD is a type of dementia that impacts a person's memory, thinking, and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Dementia is a general term for memory loss and other cognitive problems that are serious enough to interfere with daily life. According to a 2021 report "Related Dementias Facts and Figures in California: Current Status and Future Projections" by DPH in conjunction with the Alzheimer's Association (AA), AD and the number of Californians 65 and older living with AD is projected to more than double by the year 2040. Additionally, while California's population is expected to grow by just 16% by 2040, the number of people living with Alzheimer's disease will grow by 127%. According to the AA, AD and other dementias disproportionately affect Black Americans, Hispanic Americans, Asian Americans, American Indian/Alaska Natives, members of the LGBTQ community and women.
2. ADRD Advisory Committee. The ADRD Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by AD and related dementia disorders. Since its creation, the population of people living with AD continues to increase and the needs of the people affected along with our understanding of AD has evolved. Currently composed of 14 members, the ADRD Advisory Committee has been instrumental in strategic planning projects like the 2011 California State Plan for Alzheimer's Disease. This bill renames the advisory committee to the ADRC Advisory Committee. Further, this bill expands the Committee from 14 members to at least 16, but not more than 20 members. The additional members include two ex officio, nonvoting members, consisting of one Senator appointed by the Senate Committee on Rules and one Member of the Assembly appointed by the Speaker of the Assembly. These members shall participate in the activities of the committee to the extent that their participation is not incompatible with their respective positions as Members of the Legislature. Up to four additional members selected by the Secretary of California Health and Human Services.

According to the Author

Nearly 700,000 people aged 65 and older are living with AD in California now. Of people aged 45 and older, nearly 12% have subjective cognitive decline. The ADRD Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by AD and related dementia disorders. Since its creation, the population of people living with AD is increasing, and the needs of the people affected along with our understanding of AD has changed. The expansion of membership and terms of the members of the ADRD Advisory Committee will better reflect the needs of today. This bill also replaces outdated, stigmatizing language and allows committee members who have AD to serve longer terms consistent with improved outcomes thanks to modern medicine. The author concludes that law and representation of this community has to grow with our understanding of this devastating group of diseases and the increasingly specialized needs of their caregivers, who are disproportionately women.

Arguments in Support

AA, the sponsor this bill, states that this bill updates the ADRD Advisory Committee membership to include critical partners for systems change, including primary care providers, local public health officials and first responders. This bill expands the ADRD Advisory Committee from 14 to at least 21, but not more than 25, members, adding one representing local health jurisdictions, one representing first responders, an additional consumer organization representative, a commissioner from the CCA who has expertise regarding Alzheimer's conditions or related disorders, and a representative of primary care physicians. This bill also adds non-voting members (one Senator appointed by the Senate Committee on Rules and one member of the Assembly appointed by the Speaker of the Assembly), and up to four additional members selected by the CHHSA Secretary. AA continues that this bill also removes stigmatizing language and practices from code that negatively impact persons living with AD and their caregivers. AA concludes that this bill overcomes stigma by removing unfair term limits for committee members living with AD or related dementias, broadens caregiver terminology to reflect the realities of informal caregiving, and removes other harmful terminology.

Arguments in Opposition

There is no known opposition to this bill.

FISCAL COMMENTS

According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

VOTES:

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

ASSEMBLY FLOOR: 71-0-9

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

ABS, ABST OR NV: Calderon, Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Papan, Luz Rivas

SENATE FLOOR: 40-0-0

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

UPDATED

VERSION: August 23, 2024

CONSULTANT: Eliza Brooks / HEALTH / (916) 319-2097 FN: 0004668

 THIRD READING  

Bill No: AB 2680

Author: Aguiar-Curry (D)

Amended: 8/23/24 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 6/12/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Wiener

NO VOTE RECORDED: Smallwood-Cuevas

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 71-0, 5/21/24 (Consent) - See last page for vote

SUBJECT: Alzheimer’s disease

SOURCE: Alzheimer’s Association California

DIGEST:

This bill expands the Alzheimer’s Disease and Related Disorders Advisory Committee (ADRD), from 14 members to not more than 21 members, as specified, and makes other clarifying changes to the law that governs the Advisory Committee.

Senate Floor Amendments of 8/23/24 delete the requirement that increases the membership of the Alzheimer’s Disease and Related Disorders Advisory Committee from 14 to at least 16, but not more than 20 members, and instead increases the member from 14 to at least 17, but not more than 21 members. Add the Executive Director of the California Commission on Aging, or the Director’s Designee, two ex officio, nonvoting members appointed by the legislature, and up to four additional members selected by the Secretary of the California Health and Human Services Agency.

ANALYSIS:

Existing law:

1. Requires the California Health and Human Services Agency (CHHS) to establish an Advisory Committee, comprised of 14 members as follows:
   1. One representing the field of academic medical research;
   2. One representing the field of social research;
   3. One representing the field of mental health;
   4. One representing the Alzheimer’s day care resource centers;
   5. One representing the Alzheimer’s disease diagnostic and treatment centers;
   6. Two representing families of persons suffering from Alzheimer’s disease or related disorders;
   7. Two representing organizations providing services to Alzheimer’s disease patients.
   8. One representing a consumer organization representing persons with Alzheimer’s disease;
   9. One representing a member of the State Bar who is familiar with the legal issues confronting Alzheimer’s disease victims and their families;
   10. Two people who have been diagnosed with Alzheimer’s disease to serve one-year terms; and,
   11. The Secretary of CHHS or his or her designee. [Health and Safety Code §1568.17]

This bill:

1. Expands the Advisory Committee, from 14 to at least 17, but not more than 21, members, adding: the Executive Director of the California Commission on Aging, or the Director’s designee; two ex officio, nonvoting members (one Senator appointed by the Senate Rules Committee and one member of the Assembly appointed by the Speaker of the Assembly); and up to four additional members selected by the CHHS Secretary.
   
2. Makes other clarifying changes such as revising the Advisory Committee name to the Alzheimer’s Disease and Related Conditions Advisory Committee, including adding Alzheimer’s disease “or related conditions” throughout this bill, adding informal caregivers as a stakeholder, and indicating certain members serve at the pleasure of their appointing authority.

Comments

1. Author’s statement. According to the author, nearly 700,000 people aged 65 and older are living with Alzheimer's in California today. The Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by Alzheimer’s disease and related dementia disorders. Since its creation, the population of people living with Alzheimer’s is increasing, and the needs of the people affected along with our understanding of Alzheimer’s has changed. This bill expands the membership and terms of the members of the ADRD Advisory Committee to better reflect the needs of today. This bill also replaces outdated, stigmatizing language and allows committee members who have Alzheimer’s to serve longer terms consistent with improved outcomes thanks to modern medicine. This bill will help representation of this community grow to meet today’s understanding of this devastating group of diseases and the increasingly specialized needs of their caregivers, who are disproportionately women.
2. Alzheimer’s disease background. According to the U.S. Centers for Disease Control and Prevention, in 2020 as many as 5.8 million Americans were living with Alzheimer’s disease. Younger people may get Alzheimer’s disease, but it is less common. The number of people living with the disease doubles every five years beyond age 65. This number is projected to nearly triple to 14 million people by 2060. Furthermore, a 2024 Summary Report by CDPH indicates that Alzheimer’s disease was the leading cause of death for adults 85 years and older, and the second leading cause of death overall for Californians in 2022. Alzheimer’s disease is the most common type of dementia. It is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment. Alzheimer’s disease involves parts of the brain that control thought, memory, and language. It can seriously affect a person’s ability to carry out daily activities. Scientists do not yet fully understand what causes Alzheimer’s disease. There likely is not a single cause but rather several factors that can affect each person differently. Age is the best known risk factor for Alzheimer’s disease. Researchers believe that genetics may play a role in developing Alzheimer’s disease. According to the CDPH report, lower education level, poverty, lived trauma, and discrimination, which are prevalent in underserved populations, are all factors that are associated with an increased risk of Alzheimer’s disease and related dementia. However, a healthy lifestyle may help reduce risk of developing Alzheimer’s disease. Two large, long term studies indicate that adequate physical activity, a nutritious diet, limited alcohol consumption, and not smoking may help.
3. Advisory Committee. The Advisory Committee members represent consumers, family members, providers, people diagnosed with Alzheimer’s disease, and advocates, who serve on a volunteer basis without compensation. The Advisory Committee holds quarterly meetings that are open to the public. The Advisory Committee has finalized two fact sheets on dementia and mental health: the Provider Guidance fact sheet and the Consumer Guidance fact sheet. In June of 2019, Governor Newsom called for the development of a comprehensive new framework for supporting Californians as they age. In early 2020, the Governor’s Task Force on Alzheimer’s Prevention, Preparedness & Path Forward (Task Force on Alzheimer’s) aligned its efforts with the Master Plan for Aging to build mutually beneficial plans for California, including a dementia-friendly workforce, culturally responsive diagnoses and treatments, affordable care, and targeted research. The Task Force submitted a report, Our Path Forward, with recommendations to the Governor in November 2020.

Related/Prior Legislation

AB 2207 (Reyes, 2024) expands the membership of the Alzheimer’s Disease and Related Disorders Advisory Committee, among other advisory groups and bodies, to include the Executive Director of the California Commission on Aging, the Director of the California Department of Aging, or both, or other persons that serve or advocate for older adults. The bill is pending on the Senate Floor.

SB 639 (Limón, 2023) renames Alzheimer’s diagnostic and treatment centers as “diagnostic hubs” and revises and expands the functions of these entities. Revises legislative intent to specify that satellite locations that will serve regions without a postsecondary higher educational institution with a medical center, which will serve as diagnostic hubs for their regions, are also encouraged to be established. The bill is pending on the Assembly Floor.

AB 387 (Aguiar-Curry, 2023) would have been substantially similar to this bill. The bill was held on the Senate Appropriations Committee suspense file.

AB 820 (Reyes, 2023) would have add, among other provisions, one person representing an organization that serves or advocates on behalf of older adults, defined as a person 60 years of age or older, to the Advisory Committee. The bill was held on the Senate Appropriations Committee suspense file.

AB 1618 (Aguiar-Curry, 2022) would have expand the membership of the Advisory Committee and established the Office of the Healthy Brain Initiative at the California Department of Public Health. The bill was held in the Senate Appropriations Committee.

AB 1684 (Voepel, 2022) would require CDPH to implement a public awareness campaign on Alzheimer’s disease and include education for unpaid caregivers. The bill was held in the Senate Appropriations Committee.

SB 861 (Limon, 2022) would have established the Dementia Care Navigator Grant Pilot Program, to be administered by the California Department of Aging, to incentivize organizations that provide services to local communities to provide dementia care navigation training services. The bill was vetoed by Governor Newsom.

SB 491 (Alquist, Chapter 339, Statutes of 2008) increased the Advisory Committee’s membership from 12 to 14 members.

SB 139 (Mello, Chapter 303, Statutes of 1988) established the Advisory Committee.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/19/24)

Alzheimer’s Association California (source)

Alzheimer’s Greater Los Angeles

Alzheimer’s Orange County

Alzheimer’s San Diego

California Assisted Living Association

California Commission on Aging

California Life Sciences

County Health Executives Association of California

County of Alameda

Elderly Care Everywhere

LeadingAge California

OPPOSITION: (Verified 8/19/24)

None received

ARGUMENTS IN SUPPORT: The Alzheimer’s Association California, the sponsor of this bill, writes that Alzheimer’s disease is now the second leading cause of death among Californians in 2022, according to CDPH’s 2024 Summary Report, with approximately 690,000 Californians now living with Alzheimer’s. The Advisory Committee provides ongoing advice and assistance on program needs and priorities for those impacted by Alzheimer’s disease and related conditions. The sponsor writes that the Advisory Committee benefits from the collaborative efforts of its members, but due to its limited membership, several key stakeholders and care providers have been disconnected from the committee’s work. Alzheimer’s Los Angeles, Alzheimer’s Orange County, and Alzheimer’s San Diego write that the bill will ensure that the committee better reflects the voices of consumers, advocates, and the providers who serve those living with Alzheimer’s and related conditions.

The California Commission on Aging asserts that Alzheimer’s is the most common type of dementia, accounting for approximately seventy percent of dementia cases. Women, African-Americans, and Latinx individuals are at increased risk for developing Alzheimer’s or a related condition. This bill will permit informal caregivers to be represented by broadening caregiver terminology, remove stigmatizing language in the code, and ensuring members of the Advisory Committee who are impacted by Alzheimer’s disease and related conditions can fully participate.

ASSEMBLY FLOOR: 71-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Calderon, Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Papan, Luz Rivas

Prepared by: Margarita Niemann / HEALTH / (916) 651-4111

8/25/24 13:35:41

**** END ****

 THIRD READING  

Bill No: AB 2680

Author: Aguiar-Curry (D)

Amended: 8/19/24 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 6/12/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Wiener

NO VOTE RECORDED: Smallwood-Cuevas

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 71-0, 5/21/24 (Consent) - See last page for vote

SUBJECT: Alzheimer’s disease

SOURCE: Alzheimer’s Association California

DIGEST:

This bill expands the Alzheimer’s Disease and Related Disorders Advisory Committee (ADRD), from 14 members to not more than 20 members, as specified, and makes other clarifying changes to the law that governs the Advisory Committee.

Senate Floor Amendment of 8/19/24 change the requirement that expands the Alzheimer’s Disease and Related Disorders Advisory Committee from 14 members to at least 21, but not more than 25, members, and instead expands the Committee from 14 members to at least 16, but not more than 20, members, as specified.

ANALYSIS:

Existing law:

1. Requires the California Health and Human Services Agency (CHHS) to establish an Advisory Committee, comprised of 14 members as follows:
   1. One representing the field of academic medical research;
   2. One representing the field of social research;
   3. One representing the field of mental health;
   4. One representing the Alzheimer’s day care resource centers;
   5. One representing the Alzheimer’s disease diagnostic and treatment centers;
   6. Two representing families of persons suffering from Alzheimer’s disease or related disorders;
   7. Two representing organizations providing services to Alzheimer’s disease patients.
   8. One representing a consumer organization representing persons with Alzheimer’s disease;
   9. One representing a member of the State Bar who is familiar with the legal issues confronting Alzheimer’s disease victims and their families;
   10. Two people who have been diagnosed with Alzheimer’s disease to serve one-year terms; and,
   11. The Secretary of CHHS or his or her designee. [Health and Safety Code §1568.17]

This bill:

1. Expands the Advisory Committee, from 14 to at least 16, but not more than 20, members, adding two ex officio, nonvoting members (one Senator appointed by the Senate Committee on Rules and one member of the Assembly appointed by the Speaker of the Assembly), and up to four additional members selected by the CHHS Secretary.
   
2. Makes other clarifying changes such as revising the Advisory Committee name to the Alzheimer’s Disease and Related Conditions Advisory Committee, including adding Alzheimer’s disease “or related conditions” throughout this bill, adding informal caregivers as a stakeholder, and indicating certain members serve at the pleasure of their appointing authority.

Comments

1. Author’s statement. According to the author, nearly 700,000 people aged 65 and older are living with Alzheimer's in California today. The Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by Alzheimer’s disease and related dementia disorders. Since its creation, the population of people living with Alzheimer’s is increasing, and the needs of the people affected along with our understanding of Alzheimer’s has changed. This bill expands the membership and terms of the members of the ADRD Advisory Committee to better reflect the needs of today. This bill also replaces outdated, stigmatizing language and allows committee members who have Alzheimer’s to serve longer terms consistent with improved outcomes thanks to modern medicine. This bill will help representation of this community grow to meet today’s understanding of this devastating group of diseases and the increasingly specialized needs of their caregivers, who are disproportionately women.
2. Alzheimer’s disease background. According to the U.S. Centers for Disease Control and Prevention, in 2020 as many as 5.8 million Americans were living with Alzheimer’s disease. Younger people may get Alzheimer’s disease, but it is less common. The number of people living with the disease doubles every five years beyond age 65. This number is projected to nearly triple to 14 million people by 2060. Furthermore, a 2024 Summary Report by CDPH indicates that Alzheimer’s disease was the leading cause of death for adults 85 years and older, and the second leading cause of death overall for Californians in 2022. Alzheimer’s disease is the most common type of dementia. It is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment. Alzheimer’s disease involves parts of the brain that control thought, memory, and language. It can seriously affect a person’s ability to carry out daily activities. Scientists do not yet fully understand what causes Alzheimer’s disease. There likely is not a single cause but rather several factors that can affect each person differently. Age is the best known risk factor for Alzheimer’s disease. Researchers believe that genetics may play a role in developing Alzheimer’s disease. According to the CDPH report, lower education level, poverty, lived trauma, and discrimination, which are prevalent in underserved populations, are all factors that are associated with an increased risk of Alzheimer’s disease and related dementia. However, a healthy lifestyle may help reduce risk of developing Alzheimer’s disease. Two large, long term studies indicate that adequate physical activity, a nutritious diet, limited alcohol consumption, and not smoking may help.
3. Advisory Committee. The Advisory Committee members represent consumers, family members, providers, people diagnosed with Alzheimer’s disease, and advocates, who serve on a volunteer basis without compensation. The Advisory Committee holds quarterly meetings that are open to the public. The Advisory Committee has finalized two fact sheets on dementia and mental health: the Provider Guidance fact sheet and the Consumer Guidance fact sheet. In June of 2019, Governor Newsom called for the development of a comprehensive new framework for supporting Californians as they age. In early 2020, the Governor’s Task Force on Alzheimer’s Prevention, Preparedness & Path Forward (Task Force on Alzheimer’s) aligned its efforts with the Master Plan for Aging to build mutually beneficial plans for California, including a dementia-friendly workforce, culturally responsive diagnoses and treatments, affordable care, and targeted research. The Task Force submitted a report, Our Path Forward, with recommendations to the Governor in November 2020.

Related/Prior Legislation

AB 2207 (Reyes, 2024) would expand the membership of the Alzheimer’s Disease and Related Disorders Advisory Committee, among other advisory groups and bodies, to include the Executive Director of the California Commission on Aging, the Director of the California Department of Aging, or both, or other persons that serve or advocate for older adults. The bill is pending on the Senate Floor.

SB 639 (Limón, 2023) would rename Alzheimer’s diagnostic and treatment centers as “diagnostic hubs” and revises and expands the functions of these entities. Revises legislative intent to specify that satellite locations that will serve regions without a postsecondary higher educational institution with a medical center, which will serve as diagnostic hubs for their regions, are also encouraged to be established. The bill is pending on the Assembly Floor.

AB 387 (Aguiar-Curry, 2023) was substantially similar to this bill. The bill was held on the Senate Appropriations Committee suspense file.

AB 820 (Reyes, 2023) would add, among other provisions, one person representing an organization that serves or advocates on behalf of older adults, defined as a person 60 years of age or older, to the Advisory Committee. The bill was held on the Senate Appropriations Committee suspense file.

AB 1618 (Aguiar-Curry, 2022) would expand the membership of the Advisory Committee and established the Office of the Healthy Brain Initiative at the California Department of Public Health. The bill was held in the Senate Appropriations Committee.

AB 1684 (Voepel, 2022) would require CDPH to implement a public awareness campaign on Alzheimer’s disease and include education for unpaid caregivers. The bill was held in the Senate Appropriations Committee.

SB 861 (Limon, 2022) would have established the Dementia Care Navigator Grant Pilot Program, to be administered by the California Department of Aging, to incentivize organizations that provide services to local communities to provide dementia care navigation training services. The bill was vetoed by Governor Newsom.

SB 491 (Alquist, Chapter 339, Statutes of 2008) increased the Advisory Committee’s membership from 12 to 14 members.

SB 139 (Mello, Chapter 303, Statutes of 1988) established the Advisory Committee.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/19/24)

Alzheimer’s Association California (source)

Alzheimer’s Greater Los Angeles

Alzheimer’s Orange County

Alzheimer’s San Diego

California Assisted Living Association

California Commission on Aging

California Life Sciences

County Health Executives Association of California

County of Alameda

Elderly Care Everywhere

LeadingAge California

OPPOSITION: (Verified 8/19/24)

None received

ARGUMENTS IN SUPPORT: The Alzheimer’s Association California, the sponsor of this bill, writes that Alzheimer’s disease is now the second leading cause of death among Californians in 2022, according to CDPH’s 2024 Summary Report, with approximately 690,000 Californians now living with Alzheimer’s. The Advisory Committee provides ongoing advice and assistance on program needs and priorities for those impacted by Alzheimer’s disease and related conditions. The sponsor writes that the Advisory Committee benefits from the collaborative efforts of its members, but due to its limited membership, several key stakeholders and care providers have been disconnected from the committee’s work. Alzheimer’s Los Angeles, Alzheimer’s Orange County, and Alzheimer’s San Diego write that the bill will ensure that the committee better reflects the voices of consumers, advocates, and the providers who serve those living with Alzheimer’s and related conditions.

The California Commission on Aging asserts that Alzheimer’s is the most common type of dementia, accounting for approximately seventy percent of dementia cases. Women, African-Americans, and Latinx individuals are at increased risk for developing Alzheimer’s or a related condition. This bill will permit informal caregivers to be represented by broadening caregiver terminology, remove stigmatizing language in the code, and ensuring members of the Advisory Committee who are impacted by Alzheimer’s disease and related conditions can fully participate.

ASSEMBLY FLOOR: 71-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Calderon, Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Papan, Luz Rivas

Prepared by: Margarita Niemann / HEALTH / (916) 651-4111

8/20/24 16:01:49

**** END ****

 THIRD READING  

Bill No: AB 2680

Author: Aguiar-Curry (D)

Introduced: 2/14/24

Vote: 21

SENATE HEALTH COMMITTEE: 10-0, 6/12/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Wiener

NO VOTE RECORDED: Smallwood-Cuevas

ASSEMBLY FLOOR: 71-0, 5/21/24 (Consent) - See last page for vote

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SUBJECT: Alzheimer’s disease

SOURCE: Alzheimer’s Association California

DIGEST:

This bill expands the Alzheimer’s Disease and Related Disorders Advisory Committee (ADRD), from 14 members to not more than 25 members, as specified, and makes other clarifying changes to the law that governs the Advisory Committee.

ANALYSIS:

Existing law:

1. Requires the California Health and Human Services Agency (CHHS) to establish an Advisory Committee, comprised of 14 members as follows:
   1. One representing the field of academic medical research;
   2. One representing the field of social research;
   3. One representing the field of mental health;
   4. One representing the Alzheimer’s day care resource centers;
   5. One representing the Alzheimer’s disease diagnostic and treatment centers;
   6. Two representing families of persons suffering from Alzheimer’s disease or related disorders;
   7. Two representing organizations providing services to Alzheimer’s disease patients.
   8. One representing a consumer organization representing persons with Alzheimer’s disease;
   9. One representing a member of the State Bar who is familiar with the legal issues confronting Alzheimer’s disease victims and their families;
   10. Two people who have been diagnosed with Alzheimer’s disease to serve one-year terms; and,
   11. The Secretary of California Health and Human Services or his or her designee. [Health and Safety Code §1568.17]

This bill:

1. Expands the Advisory Committee, from 14 to at least 21, but not more than 25, members, adding one member representing local health jurisdictions, one member representing first responders, an additional consumer organization representative, a commissioner from the California Commission on Aging who has expertise regarding Alzheimer’s conditions or related disorders, and a representative of primary care physicians. Adds two ex officio, nonvoting members (one Senator appointed by the Senate Committee on Rules and one member of the Assembly appointed by the Speaker of the Assembly), and up to four additional members selected by the CHHS Secretary.
   
2. Makes other clarifying changes such as revising the Advisory Committee name to the Alzheimer’s Disease and Related Conditions Advisory Committee, including adding Alzheimer’s disease “or related conditions” throughout this bill, adding informal caregivers as a stakeholder, and indicating certain members serve at the pleasure of their appointing authority.

Comments

1. Author’s statement. According to the author, nearly 700,000 people aged 65 and older are living with Alzheimer's in California today. The Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by Alzheimer’s disease and related dementia disorders. Since its creation, the population of people living with Alzheimer’s is increasing, and the needs of the people affected along with our understanding of Alzheimer’s has changed. This bill expands the membership and terms of the members of the ADRD Advisory Committee to better reflect the needs of today. This bill also replaces outdated, stigmatizing language and allows committee members who have Alzheimer’s to serve longer terms consistent with improved outcomes thanks to modern medicine. This bill will help representation of this community grow to meet today’s understanding of this devastating group of diseases and the increasingly specialized needs of their caregivers, who are disproportionately women.
2. Alzheimer’s disease background. According to the U.S. Centers for Disease Control and Prevention, in 2020 as many as 5.8 million Americans were living with Alzheimer’s disease. Younger people may get Alzheimer’s disease, but it is less common. The number of people living with the disease doubles every five years beyond age 65. This number is projected to nearly triple to 14 million people by 2060. Furthermore, a 2024 Summary Report by CDPH indicates that Alzheimer’s disease was the leading cause of death for adults 85 years and older, and the second leading cause of death overall for Californians in 2022. Alzheimer’s disease is the most common type of dementia. It is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment. Alzheimer’s disease involves parts of the brain that control thought, memory, and language. It can seriously affect a person’s ability to carry out daily activities. Scientists do not yet fully understand what causes Alzheimer’s disease. There likely is not a single cause but rather several factors that can affect each person differently. Age is the best known risk factor for Alzheimer’s disease. Researchers believe that genetics may play a role in developing Alzheimer’s disease. According to the CDPH report, lower education level, poverty, lived trauma, and discrimination, which are prevalent in underserved populations, are all factors that are associated with an increased risk of Alzheimer’s disease and related dementia. However, a healthy lifestyle may help reduce risk of developing Alzheimer’s disease. Two large, long term studies indicate that adequate physical activity, a nutritious diet, limited alcohol consumption, and not smoking may help.
3. Advisory Committee. The Advisory Committee members represent consumers, family members, providers, people diagnosed with Alzheimer’s disease, and advocates, who serve on a volunteer basis without compensation. The Advisory Committee holds quarterly meetings that are open to the public. The Advisory Committee has finalized two fact sheets on dementia and mental health: the Provider Guidance fact sheet and the Consumer Guidance fact sheet. In June of 2019, Governor Newsom called for the development of a comprehensive new framework for supporting Californians as they age. In early 2020, the Governor’s Task Force on Alzheimer’s Prevention, Preparedness & Path Forward (Task Force on Alzheimer’s) aligned its efforts with the Master Plan for Aging to build mutually beneficial plans for California, including a dementia-friendly workforce, culturally responsive diagnoses and treatments, affordable care, and targeted research. The Task Force submitted a report, Our Path Forward, with recommendations to the Governor in November 2020.

Related/Prior Legislation

AB 2207 (Reyes, 2024) expands the membership of the Alzheimer’s Disease and Related Disorders Advisory Committee, among other advisory groups and bodies, to include the Executive Director of the California Commission on Aging, the Director of the California Department of Aging, or both, or other persons that serve or advocate for older adults. The bill is set for hearing on July 3, 2024 in the Senate Human Services Committee.

SB 639 (Limón, 2023) renamed Alzheimer’s diagnostic and treatment centers as “diagnostic hubs” and revises and expands the functions of these entities. Revises legislative intent to specify that satellite locations that will serve regions without a postsecondary higher educational institution with a medical center, which will serve as diagnostic hubs for their regions, are also encouraged to be established. The bill is pending in the Senate.

AB 387 (Aguiar-Curry, 2023) was substantially similar to this bill. The bill was held on the Senate Appropriations Committee suspense file.

AB 820 (Reyes, 2023) added, among other provisions, one person representing an organization that serves or advocates on behalf of older adults, defined as a person 60 years of age or older, to the Advisory Committee. The bill was held on the Senate Appropriations Committee suspense file.

AB 1618 (Aguiar-Curry, 2022) expanded the membership of the Advisory Committee and established the Office of the Healthy Brain Initiative at the California Department of Public Health. The bill was held in the Senate Appropriations Committee.

AB 1684 (Voepel, 2022) required CDPH to implement a public awareness campaign on Alzheimer’s disease and include education for unpaid caregivers. The bill was held in the Senate Appropriations Committee.

SB 861 (Limon, 2022) would have established the Dementia Care Navigator Grant Pilot Program, to be administered by the California Department of Aging, to incentivize organizations that provide services to local communities to provide dementia care navigation training services. The bill was vetoed by Governor Newsom.

SB 491 (Alquist, Chapter 339, Statues of 2008) increased the Advisory Committee’s membership from 12 to 14 members.

SB 139 (Mello, Chapter 303, Statutes of 1988) established the Advisory Committee.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 6/24/24)

Alzheimer’s Association California (source)

Alzheimer’s Greater Los Angeles

Alzheimer’s Orange County

Alzheimer’s San Diego

California Assisted Living Association

California Commission on Aging

California Life Sciences

County Health Executives Association of California

Elderly Care Everywhere

LeadingAge California

OPPOSITION: (Verified 6/24/24)

None received

ARGUMENTS IN SUPPORT: The Alzheimer’s Association California, the sponsor of this bill, writes that Alzheimer’s disease is now the second leading cause of death among Californians in 2022, according to CDPH’s 2024 Summary Report, with approximately 690,000 Californians now living with Alzheimer’s. The Advisory Committee provides ongoing advice and assistance on program needs and priorities for those impacted by Alzheimer’s disease and related conditions. The sponsor writes that the Advisory Committee benefits from the collaborative efforts of its members, but due to its limited membership, several key stakeholders and care providers have been disconnected from the committee’s work. Alzheimer’s Los Angeles, Alzheimer’s Orange County, and Alzheimer’s San Diego write that the bill will ensure that the committee better reflects the voices of consumers, advocates, and the providers who serve those living with Alzheimer’s and related conditions.

The California Commission on Aging asserts that Alzheimer’s is the most common type of dementia, accounting for approximately seventy percent of dementia cases. Women, African-Americans, and Latinx individuals are at increased risk for developing Alzheimer’s or a related condition. This bill will permit informal caregivers to be represented by broadening caregiver terminology, remove stigmatizing language in the code, and ensuring members of the Advisory Committee who are impacted by Alzheimer’s disease and related conditions can fully participate.

ASSEMBLY FLOOR: 71-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Calderon, Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Papan, Luz Rivas

Prepared by: Margarita Niemann / HEALTH / (916) 651-4111

6/27/24 15:38:55

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: AB 2680

SUBJECT: Alzheimer’s disease

SUMMARY:

Expands the Alzheimer’s Disease and Related Disorders Advisory Committee (Advisory Committee), from 14 members to not more than 25 members, as specified, and makes other clarifying changes to the law that governs the Advisory Committee.

Existing law: Requires the California Health and Human Services Agency (CHHS) to establish an Advisory Committee, comprised of 14 members as follows:

• 1. One representing the field of academic medical research;
  2. One representing the field of social research;
  3. One representing the field of mental health;
  4. One representing the Alzheimer’s day care resource centers;
  5. One representing the Alzheimer’s disease diagnostic and treatment centers;
  6. Two representing families of persons suffering from Alzheimer’s disease or related disorders;
  7. Two representing organizations providing services to Alzheimer’s disease patients.
  8. One representing a consumer organization representing persons with Alzheimer’s disease;
  9. One representing a member of the State Bar who is familiar with the legal issues confronting Alzheimer’s disease victims and their families;
  10. Two people who have been diagnosed with Alzheimer’s disease to serve one-year terms; and,
  11. The Secretary of California Health and Human Services or his or her designee. [HSC §1568.17]

This bill:

1. Expands the Advisory Committee, from 14 to at least 21, but not more than 25, members, adding one member representing local health jurisdictions, one member representing first responders, an additional consumer organization representative, a commissioner from the California Commission on Aging who has expertise regarding Alzheimer’s conditions or related disorders, and a representative of primary care physicians. Adds two ex officio, nonvoting members (one Senator appointed by the Senate Committee on Rules and one member of the Assembly appointed by the Speaker of the Assembly), and up to four additional members selected by the CHHS Secretary.
   
2. Makes other clarifying changes such as revising the Advisory Committee name to the Alzheimer’s Disease and Related Conditions Advisory Committee, including adding Alzheimer’s disease “or related conditions” throughout the bill, adding informal caregivers as a stakeholder, and indicating certain members serve at the pleasure of their appointing authority.

FISCAL EFFECT:

According to the Assembly Committee on Appropriations, minor and absorbable costs to the California Department of Public Health (CDPH).

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, nearly 700,000 people aged 65 and older are living with Alzheimer's in California today. The Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by Alzheimer’s disease and related dementia disorders. Since its creation, the population of people living with Alzheimer’s is increasing, and the needs of the people affected along with our understanding of Alzheimer’s has changed. This bill expands the membership and terms of the members of the ADRD Advisory Committee to better reflect the needs of today. This bill also replaces outdated, stigmatizing language and allows committee members who have Alzheimer’s to serve longer terms consistent with improved outcomes thanks to modern medicine. This bill will help representation of this community grow to meet today’s understanding of this devastating group of diseases and the increasingly specialized needs of their caregivers, who are disproportionately women.
2. Alzheimer’s disease background. According to the U.S. Centers for Disease Control and Prevention, in 2020 as many as 5.8 million Americans were living with Alzheimer’s disease. Younger people may get Alzheimer’s disease, but it is less common. The number of people living with the disease doubles every five years beyond age 65. This number is projected to nearly triple to 14 million people by 2060. Furthermore, a 2024 Summary Report by CDPH indicates that Alzheimer’s disease was the leading cause of death for adults 85 years and older, and the second leading cause of death overall for Californians in 2022. Alzheimer’s disease is the most common type of dementia. It is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment. Alzheimer’s disease involves parts of the brain that control thought, memory, and language. It can seriously affect a person’s ability to carry out daily activities. Scientists do not yet fully understand what causes Alzheimer’s disease. There likely is not a single cause but rather several factors that can affect each person differently. Age is the best known risk factor for Alzheimer’s disease. Researchers believe that genetics may play a role in developing Alzheimer’s disease. According to the CDPH report, lower education level, poverty, lived trauma, and discrimination, which are prevalent in underserved populations, are all factors that are associated with an increased risk of Alzheimer’s disease and related dementia. However, a healthy lifestyle may help reduce risk of developing Alzheimer’s disease. Two large, long term studies indicate that adequate physical activity, a nutritious diet, limited alcohol consumption, and not smoking may help.
3. Advisory Committee. The Advisory Committee members represent consumers, family members, providers, people diagnosed with Alzheimer’s disease, and advocates, who serve on a volunteer basis without compensation. The Advisory Committee holds quarterly meetings that are open to the public. The Advisory Committee has finalized two fact sheets on dementia and mental health: the Provider Guidance fact sheet and the Consumer Guidance fact sheet. In June of 2019, Governor Newsom called for the development of a comprehensive new framework for supporting Californians as they age. In early 2020, the Governor’s Task Force on Alzheimer’s Prevention, Preparedness & Path Forward (Task Force on Alzheimer’s) aligned its efforts with the Master Plan for Aging to build mutually beneficial plans for California, including a dementia-friendly workforce, culturally responsive diagnoses and treatments, affordable care, and targeted research. The Task Force submitted a report, Our Path Forward, with recommendations to the Governor in November 2020.
4. Related legislation. AB 2207 (Reyes) expands the membership of the Alzheimer’s Disease and Related Disorders Advisory Committee, among other advisory groups and bodies, to include the Executive Director of the California Commission on Aging, the Director of the California Department of Aging, or both, or other persons that serve or advocate for older adults. AB 2207 is set for hearing on June 17, 2024 in the Senate Human Services Committee.

SB 639 (Limón of 2023) renames Alzheimer’s diagnostic and treatment centers as “diagnostic hubs” and revises and expands the functions of these entities. Revises legislative intent to specify that satellite locations that will serve regions without a postsecondary higher educational institution with a medical center, which will serve as diagnostic hubs for their regions, are also encouraged to be established. SB 639 is pending in the Senate.

1. Prior legislation. AB 387 (Aguiar-Curry of 2023) was substantially similar to this bill. AB 387 was held on the Senate Appropriations Committee suspense file.

AB 820 (Reyes of 2023), among other provisions, would have added one person representing an organization that serves or advocates on behalf of older adults, defined as a person 60 years of age or older, to the Advisory Committee. AB 820 was held on the Senate Appropriations Committee suspense file.

AB 1618 (Aguiar-Curry of 2022) would have expanded the membership of the Advisory Committee and established the Office of the Healthy Brain Initiative at the California Department of Public Health. AB 1618 was held in the Senate Appropriations Committee.

AB 1684 (Voepel of 2022) would have required CDPH to implement a public awareness campaign on Alzheimer’s disease and include education for unpaid caregivers. AB 1684 was held in the Senate Appropriations Committee.

SB 861 (Limon of 2022) would have established the Dementia Care Navigator Grant Pilot Program, to be administered by the California Department of Aging, to incentivize organizations that provide services to local communities to provide dementia care navigation training services. SB 861 was vetoed by Governor Newson, who stated:
The need for quality, culturally competent care is a priority of my administration. As an example of this commitment, the 2022 Budget Act included $281.4 million over three years to recruit, train, and certify community health workers who can provide dementia care navigation, among other services. This bill creates more than $6 million in General Fund cost pressures that were not accounted for in the budget.
With our state facing lower-than-expected revenues over the first few months of this fiscal year, it is important to remain disciplined when it comes to spending, particularly spending that is ongoing. We must prioritize existing obligations and priorities, including education, health care, public safety and safety-net programs.
The Legislature sent measures with potential costs of well over $20 billion in one-time spending commitments and more than $10 billion in ongoing commitments not accounted for in the state budget. Bills with significant fiscal impact, such as this measure, should be considered and accounted for as part of the annual budget process.
While I am unable to sign this bill, I am directing the Department of Health Care Access and Information to work with stakeholders including those that work on dementia care as they begin to develop and implement the Community Health Worker program established by SB 184 (Committee on Budget and Fiscal Review, Chapter 47, Statutes of 2022), and funded by the Budget Act of 2022.

SB 491 (Alquist, Chapter 339, Statues of 2008) increased the Advisory Committee’s membership from 12 to 14 members.

SB 139 (Mello, Chapter 303, Statutes of 1988) established the Advisory Committee.

1. Support. Alzheimer’s Association California, the sponsor of this bill, writes that Alzheimer’s disease is now the second leading cause of death among Californians in 2022, according to CDPH’s 2024 Summary Report, with approximately 690,000 Californians now living with Alzheimer’s. The Advisory Committee provides ongoing advice and assistance on program needs and priorities for those impacted by Alzheimer’s disease and related conditions. The sponsor writes that the Advisory Committee benefits from the collaborative efforts of its members, but due to its limited membership, several key stakeholders and care providers have been disconnected from the committee’s work. Alzheimer’s Los Angeles, Alzheimer’s Orange County, and Alzheimer’s San Diego write that the bill will ensure that the committee better reflects the voices of consumers, advocates, and the providers who serve those living with Alzheimer’s and related conditions. The California Commission on Aging asserts that Alzheimer’s is the most common type of dementia, accounting for approximately seventy percent of dementia cases. Women, African-Americans, and Latinx individuals are at increased risk for developing Alzheimer’s or a related condition. This bill will permit informal caregivers to be represented by broadening caregiver terminology, remove stigmatizing language in the code, and ensuring members of the Advisory Committee who are impacted by Alzheimer’s disease and related conditions can fully participate.
2. Support if amended. The California Society of Health System Pharmacists will support the bill if amended to include a Geriatric Clinical Pharmacist as one of the members on the Alzheimer’s Disease and Related Conditions Advisory Committee. They write that Geriatric Clinical Pharmacists play an important role in the treatment of Alzheimer’s disease by providing tailored support to the unique healthcare needs of older adults.

SUPPORT AND OPPOSITION:

Support: Alzheimer’s Association California (sponsor)

Alzheimer’s Greater Los Angeles

Alzheimer’s Orange County

Alzheimer’s San Diego

California Assisted Living Association

California Commission on Aging

California Life Sciences

County Health Executives Association of California

Elderly Care Everywhere

LeadingAge California

Oppose: None received.

-- END --

Date of Hearing: May 15, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2680

Author:(Aguiar-Curry) – As Introduced Ver:February 14, 2024

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill renames the Alzheimer’s Disease (AD) and Related Disorders (ADRD) Advisory Committee in the California Health and Human Services agency to the Alzheimer’s Disease and Related Conditions Advisory Committee, and expands the number of members serving on the committee from 14 to at least 21, but not more than 25, members, and prescribes the qualifications of certain members on the committee.

FISCAL EFFECT:

Minor and absorbable costs to the California Department of Public Health (CDPH).

COMMENTS:

1. Purpose. This bill is sponsored by the Alzheimers Association (AA). According to the author:

Nearly 700,000 people aged 65 and older are living with AD in California now. Of people aged 45 and older, nearly 12% have subjective cognitive decline. The ADRD Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by AD and related dementia disorders. Since its creation, the population of people living with AD is increasing, and the needs of the people affected along with our understanding of AD has changed. The expansion of membership and terms of the members of the ADRD Advisory Committee will better reflect the needs of today. This bill also replaces outdated, stigmatizing language and allows committee members who have AD to serve longer terms consistent with improved outcomes thanks to modern medicine. That law and representation of this community has to grow with our understanding of this devastating group of diseases and the increasingly specialized needs of their caregivers, who are disproportionately women.

1. Background.

AD. According to CDPH, AD is a type of dementia that causes problems with memory, thinking, and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Dementia is a general term for memory loss and other cognitive problems that are serious enough to interfere with daily life. AD is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out simple tasks. While the specific causes of AD are not fully known, it is characterized by changes in the brain that result in loss of neurons and their connections, which affect a person’s ability to remember and think.

Nearly 700,000 people 65 years and older are living with AD in California now. Longer life expectancies and the aging of the large baby boom cohort will lead to an increase in the number and percentage of Californians who will be 65 years of age and older. According to a 2021 CDPH report, “Alzheimer’s Disease and Related Dementias Facts and Figures in California: Current Status and Future Projections,” while California’s population is expected to grow by just 16% by 2040, the number of people living with AD will grow by 127%.

ADRD Advisory Committee. SB 139 (Mello), Chapter 303, Statutes of 1988, established the ADRD Advisory Committee to provide ongoing advice and assistance on program needs and priorities of persons living with AD and related dementia disorders. Composed of 14 members, the ADRD Advisory Committee has been instrumental in strategic planning projects, such as the 2011 California State Plan for AD.

1. Related Legislation. AB 387 (Aguiar-Curry), of the current legislative session, is substantially similar to this bill, but was held on this committee’s suspense file.
2. Prior Legislation. AB 1618 (Aguiar-Curry), of the 2021-22 Legislative Session, would have expanded the membership of the ADRD Advisory Committee and would have established the Office of the Healthy Brain Initiative at CDPH. AB 1618 was held on the Senate Appropriations Committee suspense file.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 16, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2680

Author:(Aguiar-Curry) – As Introduced Ver:February 14, 2024

SUBJECT: Alzheimer’s disease.

SUMMARY: Makes several changes to the Alzheimer’s Disease and Related Disorders (ADRD) Advisory Committee in the California Health and Human Services Agency (CHHSA).

1. Renames the ADRD Advisory Committee to the Alzheimer’s Disease and Related Conditions (ADRC) Advisory Committee.
2. Expands the number of members serving on the ADRC Advisory Committee from 14 to at least 21, but not more than 25, members. Adds the following members to the ADRC Advisory Committee:
   1. One member representing local health jurisdictions;
   2. One member representing first responders;
   3. One member who is a Commissioner on the California Commission on Aging (CCA) who has expertise regarding Alzheimer’s disease (AD) and related conditions;
   4. One member representing primary care physicians;
   5. Two ex officio, nonvoting members, consisting of one Senator appointed by the Senate Committee on Rules and one Member of the Assembly appointed by the Speaker of the Assembly. Requires these members to participate in the activities of the ADRC Advisory Committee to the extent that their participation is not incompatible with their respective positions as Members of the Legislature; and,
   6. Up to four additional members selected by the CHHSA Secretary.
3. Specifies that members described in 2) a) through d) and 2) f) above serve at the pleasure of the CHHSA Secretary and members described in 2) e) above serve at the pleasure of their appointing authority.
4. Removes the one-year term limit for the two people who have been diagnosed with AD or a related condition.
5. Revises references to AD to also refer to related conditions.

EXISTING LAW:

1. Requires the CHHSA Secretary to be responsible for the oversight and coordination of programs serving people living with AD and related disorders and their families, including, but not limited to:
   1. State level support and assistance to all programs within CHHSA and member departments developed for this target population;
   2. Establishment of the ADRD Advisory Committee; and,
   3. Review of the recommendations contained in the 1987 California Alzheimer’s Disease Task Force Report and subsequent state plans, in consultation with appropriate state departments and the ADRD Advisory Committee. [Health & Safety Code (HSC) § 1568.15]
2. Requires CHHSA to establish an ADRD Advisory Committee consisting of 14 members selected as follows:
   1. One representing the field of academic medical research;
   2. One representing the field of social research;
   3. One representing the field of mental health;
   4. One representing the AD day care resource centers;
   5. One representing the AD diagnostic and treatment centers;
   6. Two representing families of persons suffering from AD or related disorders;
   7. Two representing organizations providing services to AD patients;
   8. One representing a consumer organization representing persons with AD;
   9. One representing a member of the State Bar who is familiar with the legal issues confronting AD victims and their families;
   10. Two people who have been diagnosed with AD to serve one-year terms; and
   11. The CHHSA Secretary or their designee. [HSC § 1568.17]
       
3. Provides that members of the ADRD Advisory Committee serve at the pleasure of the CHHSA Secretary. [Ibid]
   
4. Authorizes the CHHSA Secretary to establish fixed terms for ADRD Advisory Committee membership and requires those terms to be staggered. [Ibid]
   
5. Requires members of the ADRD Advisory Committee to serve without compensation, but to receive reimbursement for travel and other necessary expenses actually incurred in the performance of their official duties. [Ibid]
   
6. Requires the ADRD Advisory Committee to do all of the following:
   1. Provide ongoing advice and assistance to the Administration and the Legislature as to the program needs and priorities of the target population;
   2. Provide planning support to the Administration and the Legislature by updating recommendations of the 1987 California Alzheimer’s Disease Task Force Report and regularly review and update recommendations as needed;
   3. Appoint a chairperson and vice chairperson; and,
   4. Meet quarterly. [Ibid]
7. Requires the ADRD Advisory Committee to do all of the following when making policy and plan recommendations:
   1. Consult with a broad range of stakeholders, including, but not limited to, people diagnosed with AD, family caregivers, community-based and institutional providers, AD researchers and academicians, formal caregivers, the Alzheimer’s Association (AA), CCA, and other state entities;
   2. Consider the recommendations of other state plans, including, but not limited to, the Olmstead Plan, the Long-Range Strategic Plan on Aging, and the California Department of Aging’s (CDA’s) State Plan on Aging;
   3. Consider cultural and linguistic factors that impact persons with AD and their families who are from diverse populations; and,
   4. Review current state policies and practices concerning care and treatment related to AD and other dementia disorders, and develop recommendations concerning all of the following issues:
      1. Community-based support for California’s diverse people with AD and their family members;
      2. Choices for care and residence for persons with AD and their families;
      3. An integrated public health care management approach to AD in health care settings that makes full use of dementia care practices;
      4. The dementia competence of health care professionals; and,
      5. Early identification and intervention through increasing public awareness of AD. [Ibid]
         
8. Requires all meetings of the ADRD Advisory Committee, and any subcommittees thereof, to be open to the public and adequate notice be provided in accordance with the Bagley-Keene Open Meeting Act. [HSC § 1568.17]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, nearly 700,000 people aged 65 and older are living with AD in California now. Of people aged 45 and older, nearly 12% have subjective cognitive decline. The ADRD Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by AD and related dementia disorders. Since its creation, the population of people living with AD is increasing, and the needs of the people affected along with our understanding of AD has changed. The expansion of membership and terms of the members of the ADRD Advisory Committee will better reflect the needs of today. This bill also replaces outdated, stigmatizing language and allows committee members who have AD to serve longer terms consistent with improved outcomes thanks to modern medicine. The author concludes that law and representation of this community has to grow with our understanding of this devastating group of diseases and the increasingly specialized needs of their caregivers, who are disproportionately women.
2. BACKGROUND.
   1. AD. According to a 2021 report “Related Dementias Facts and Figures in California: Current Status and Future Projections” by the California Department of Public Health (DPH) in conjunction with the AA, AD and the number of Californians 65 and older living with AD is projected to more than double by the year 2040. Additionally, while California’s population is expected to grow by just 16% by 2040, the number of people living with AD will grow by 127%. Nearly 700,000 people aged 65 and older are living with AD in California now. Of people aged 45 and older, nearly 12% have subjective cognitive decline. Over the next 20 years, the impact of AD on the State of California will increase dramatically. Longer life expectancies and the aging of the large baby boom cohort will lead to an increase in the number and percentage of Californians who will be 65 years of age and older. Since the primary risk factor for AD is older age, substantial increase is anticipated in the numbers of people who will be living with the disease.
      
   2. ADRD Advisory Committee. The ADRD Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of persons impacted by AD and related dementia disorders. Since its creation, the population of people living with AD continues to increase and the needs of the people affected along with our understanding of AD has evolved. Currently composed of 14 members, the ADRD Advisory Committee has been instrumental in strategic planning projects like the 2011 California State Plan for AD.
      
      According to DPH, AD is a type of dementia that causes problems with memory, thinking, and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Dementia is a general term for memory loss and other cognitive problems that are serious enough to interfere with daily life. AD is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out simple tasks. While the specific causes of AD are not fully known, it is characterized by changes in the brain that result in loss of neurons and their connections. These changes affect a person’s ability to remember and think. In June 2021, the U.S. Food and Drug Administration granted conditional approval to Aduhelm (aducanumab) for the treatment of AD even though an advisory panel had recommended against allowing the drug on the market. Aduhelm is the first drug on the market able to remove amyloid, the sticky substance that builds up in the brains of AD patients. According to news reports, Aduhelm is not reaching many patients and the reasons include its high cost, insurers' reluctance to cover it, and lingering questions about whether it actually slows memory loss.
      
   3. Health Equity. According to the AA, AD and other dementias disproportionately affect Black Americans, Hispanic Americans, Asian Americans, American Indian/Alaska Natives, members of the LGBTQ and women. Black Americans are about two times more likely than white Americans to have AD and other dementias. Hispanic Americans are about one and one-half times more likely than white Americans to have AD and other dementias. By 2050, Asian Americans are projected to comprise nearly 8% of those aged 65 and older. Native Americans have high rates of chronic conditions, including conditions that are suspected risk factors for AD, such as obesity, diabetes and hypertension. Almost two-thirds of those living with AD are women. Below are recommendations from the AA on what the public health community can do:
      1. In addressing dementia, public health should identify underserved populations and those who experience a disproportionate burden of disease;
      2. Public health officials must learn about the impact of AD and other forms of dementia on these populations;
      3. The public health community must identify the local causes of these disparities and collaborate with community partners and stakeholders to develop initiatives to address them;
      4. Public health practitioners should be sure to identify culturally, linguistically, and age appropriate strategies for people living with AD and their caregivers; and,
      5. The public health community should collaborate with or lead initiatives to ensure that government agencies that serve these populations are trained in appropriate and effective strategies.
   4. AD and Dementia in California. According to the January 2021 “Related Dementia Facts and Figures in California: Current Status and Future Projections” (2021 Report), in 2019, approximately 660,000 Californians over 65 years of age lived with AD, which accounted for approximately 11% of the nation’s AD prevalence (5.8 million people). The 2021 Report points out that between 2019 and 2040:
      1. The population of California will expand by 16%, whereas the population of people living with AD will expand by 127%;
      2. The number of Californians over 75 years of age living with AD will more than double, growing to over 1.3 million;
      3. The number of Californians between 55 and 74 years of age living with AD will increase 26%, growing to 194,975 people;
      4. The number of people living with AD in California’s 15 most populous counties (those with a population of 700,000 or more) will at least double;
      5. The number of Californians living with AD will increase 11% for women, growing to 917,482 people; and increase 8% for men, growing to 609,197 people;
      6. The number of people living with AD will more than triple for Californians who identify as Latino/Latina/Latinx (Latino/a/x) American, growing to 431,982 people; nearly triple for Californians who identify as Black/African American, growing to 91,071 people; and more than double for Californians who identify as Asian American/Pacific Islander, growing to 241,106 people;
      7. The number of people living with AD will more than double for Californians who identify as lesbian, gay, or bisexual, growing to 74,522 people; and,
      8. People with Down syndrome have an increased risk of developing AD. Estimates show that AD affects about 30% of people living with Down syndrome who are between 50 and 59 years of age and closer to 50% of people living with Down syndrome who are 60 years of age and older.
         

The 2021 Report also included discussions on living arrangements for people living with AD; caregiving for people with AD and the costs of caring for people with AD.

• 1. AD Program. In 1984, legislation was enacted that established the AD Program. To meet the legislative mandates of relieving the human burden and economic cost of AD and related disorders, and to assist in ultimately discovering the cause and treatment of these diseases, the AD Program:
     
     1. Established and administers a statewide network of 10 California Alzheimer's Disease Centers (CADCs) at university medical centers. The CADCs are dedicated to improving the quality of life of persons affected with AD and their families by providing diagnostic and treatment services; professional training for medical residents, postdoctoral fellows, nurses, interns, and medical students; and community education, such as caregiver training and support; and,
        
     2. Established and administers the Alzheimer's Disease Research Fund, which awards grants through a competitive process to scientists in California engaged in the study of AD.
        

Key Partners include: CDA, California Department of Health Care Services, ADRD Advisory Committee, AA, Caregiver Resources Centers, Area Agencies on Aging, and the federal Centers for Disease Control and Prevention.

• 1. Master Plan for Aging (MPA): In January of 2021, the Governor released his MPA. The MPA prioritizes the health and well-being of older Californians and the need for policies that promote healthy aging. The MPA serves as a blueprint for state government, local government, the private sector, and philanthropy to prepare the state for the coming demographic changes and continue California’s leadership in aging, disability, and equity. The work plan laid out in the MPA two years after its release continues to highlight the urgent needs facing California’s older adults, people with disabilities, their families, advocates and the workforce supporting these populations. The MPA outlines five bold goals and 23 strategies to build a California for All Ages by 2030. It also includes a Data Dashboard on Aging to measure progress. The Goals of the MPA are as follows:
     1. Goal One: Housing for All Ages and Stages;
     2. Goal Two: Health Reimagined;
     3. Goal Three: Inclusion and Equity, Not Isolation;
     4. Goal Four: Caregiving That Works; and,
     5. Goal Five: Affording Aging.
        
  2. Taskforce on Alzheimer’s Disease Prevention and Preparedness (Taskforce). In 2019, Governor Gavin Newsom formed the Taskforce. The purpose of the Taskforce was to present recommendations to the Governor on how local communities, private organizations, businesses, government, and families can prevent and prepare for the rise in the number of cases of AD and all its consequences. Recommendations from the Taskforce were incorporated into the MPA.
     
     Specifically, the Taskforce states: “While California is known for its ‘youth culture,’ the state has the second-longest life span in the nation: 80.8 years. With age comes greater risk for AD and all dementias. It is also true that no other state has the media-savvy or industry our state has, meaning California is uniquely positioned to dispel myths about aging and de-stigmatize AD. Widespread misinformation, lack of understanding and negative perceptions in the population about dementia, AD and other age-related diseases present a major barrier to policy change and health system transformation. Designing an ‘Alzheimer’s Public Awareness Campaign’ that educates the public about the different neurodegenerative diseases, their prevention, symptoms, diagnosis and treatments is essential.”
     

1. SUPPORT. AA, the sponsor this bill, states that this bill updates the ADRD Advisory Committee membership to include critical partners for systems change, including primary care providers, local public health officials and first responders. This bill expands the ADRD Advisory Committee from 14 to at least 21, but not more than 25, members, adding one representing local health jurisdictions, one representing first responders, an additional consumer organization representative, a commissioner from the CCA who has expertise regarding Alzheimer’s conditions or related disorders, and a representative of primary care physicians. This bill also adds non-voting members (one Senator appointed by the Senate Committee on Rules and one member of the Assembly appointed by the Speaker of the Assembly), and up to four additional members selected by the CHHSA Secretary. AA continues that this bill also removes stigmatizing language and practices from code that negatively impact persons living with AD and their caregivers. AA concludes that this bill overcomes stigma by removing unfair term limits for committee members living with AD or related dementias, broadens caregiver terminology to reflect the realities of informal caregiving, and removes other harmful terminology.
   
2. RELATED LEGISLATION. AB 2613 (Zbur) of 2024 establishes within CHHSA, until January 1, 2029, the Jacqueline Marie Zbur Rare Disease Advisory Council (Council), composed of a minimum of 17 members, appointed as specified. The Council would generally act as the advisory body on rare diseases to the Legislature and state and private entities that provide services to, or that are charged with the care of, persons with rare diseases. AB 2613 is pending a hearing in the Assembly Committee on Health.
3. PREVIOUS LEGISLATION.
   1. AB 387 (Aguiar-Curry) of 2023 was substantially similar to this bill but was held on the Assembly Appropriations Committee suspense file.
   2. AB 1618 (Aguiar-Curry) of 2022 would have expanded the membership of the Advisory Committee and would have established the Office of the Healthy Brain Initiative at DPH. AB 1618 was held in Senate Appropriations Committee suspense file.
      
   3. AB 1684 (Voepel) of 2022 would have required DPH to implement a public awareness campaign on AD that includes education for unpaid caregivers, including family and friends who provide care to someone with AD or dementia. AB 1684 was held in Senate Appropriations Committee suspense file.
      
   4. SB 861 (Limón) of 2022 would have established, upon appropriation by the Legislature, the Dementia Care Navigator Grant Pilot Program under the CDA for the purpose of incentivizing local organizations to provide dementia care navigation training services. SB 861 was vetoed by the Governor.
   5. SB 491 (Alquist), Chapter 339, Statutes of 2008, expands the membership of the ADRD Advisory Committee, and requires the ADRD Advisory Committee to update the 1987 Task Force Report on Alzheimer’s and make recommendations to the CHHSA Secretary and the Legislature.
   6. SB 139 (Mello), Chapter 303, Statutes of 1988, required the establishment of the ADRD Advisory Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

Alzheimer's Association
Alzheimer's Greater Los Angeles
Alzheimer's Orange County
Alzheimer's San Diego
California Assisted Living Association
California Life Sciences
County Health Executives Association of California (CHEAC)
LeadingAge California

Opposition

None on file.

Analysis Prepared by: Eliza Brooks / HEALTH / (916) 319-2097