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 disorders, 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 Alzheimers Disease and Related Disorders Advisory Committee committee from 14 to at least 21, but not more than 25, members. This bill would specify 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 disorders. 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 disorders, 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 expand the number of members serving on the Alzheimers Disease and Related Disorders Advisory Committee from 14 to at least 21, but not more than 25, members. This bill would specify 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 disorders.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 387 (Aguiar-Curry) - Alzheimer’s disease

Bill Summary:

AB 387 would make various changes to the Alzheimer’s Disease and Related Disorders Advisory Committee.

Fiscal Impact:

The California Health and Human Services Agency (CHHS) estimates a range, from low tens of thousands to over $50,000 annually (General Fund), to reimburse for meals, mileage, hotel, flight, and/or ground transportation for advisory committee members. In addition, CHHS anticipates an ongoing cost of approximately $143,000 for staffing resources to meet additional workload.

Background:

Current law requires the CHHS to establish an Alzheimer’s Disease and Related Disorders Advisory Committee, comprised of 14 members as follows:

• • One representing the field of academic medical research.
  • One representing the field of social research.
  • One representing the field of mental health.
  • One representing the Alzheimer’s day care resource centers.
  • One representing the Alzheimer’s disease diagnostic and treatment centers.
  • Two representing families of persons suffering from Alzheimer’s disease or related disorders.
  • Two representing organizations providing services to Alzheimer’s disease patients.
  • One representing a consumer organization representing persons with Alzheimer’s disease.
  • One representing a member of the State Bar who is familiar with the legal issues confronting Alzheimer’s disease victims and their families.
  • Two people who have been diagnosed with Alzheimer’s disease to serve one-year terms.
  • The Secretary of California Health and Human Services or his or her designee.

The advisory committee is required to provide ongoing advice and assistance to the administration and the Legislature as to the program needs and priorities of the target population.

Proposed Law:

AB 387 would rename the advisory committee to the Alzheimer’s Disease and Related Conditions Advisory Committee and change the membership as follows:

• Expand the advisory committee, from 14 to at least 21, but not more than 25, members.
• Add one representing local health jurisdictions, one representing first responders, an additional consumer organization representative, a commissioner from the California Commission on Aging who has expertise regarding Alzheimer’s disease or related conditions, and a representative of primary care physicians.
• Add 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).
• Add up to four additional members selected by the CHHS Secretary.

Related Legislation:

AB 820 (Reyes) would, among other provisions, make changes to the membership of the Alzheimer’s Disease and Related Disorders Advisory Committee. The bill is currently in the Senate Health Committee.

AB 1618 (Aguiar-Curry, 2022) would have made similar changes to the Alzheimer’s Disease and Related Disorders Advisory Committee and would have established the Office of the Healthy Brain Initiative. The bill was held on the suspense file in this committee.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: AB 387

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.
  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 representing local health jurisdictions, one 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, revising the phrase Alzheimer’s disease to Alzheimer’s conditions or related disorders, 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, CHHS reports annual costs from the mid-tens of thousands of dollars to over $50,000 (General Fund), to reimburse members of the Advisory Committee for meals, mileage, hotel, flight, and ground transportation.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, the Advisory Committee was established in 1988 to provide ongoing advice and assistance on program needs and priorities of people impacted by Alzheimer’s disease and related dementia disorders. This work is critical because nearly 700,000 people aged 65 and older are living with Alzheimer's in California today and the number of people impacted increases every year. However, since the creation of the Advisory Committee, the needs of the people affected and our understanding of Alzheimer’s have changed. This bill expands the membership of the Advisory Committee to better reflect the needs of today. This bill also replaces outdated, stigmatizing language and allows committee members who have been diagnosed with Alzheimer’s to serve longer terms consistent with improved outcomes due to modern medicine.
   
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. 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. 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, 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 820 (Reyes), among other provisions, adds to the Advisory Committee one person representing an organization that serves or advocates on behalf of older adults, defined as a person 60 years of age or older. AB 820 is set for hearing in the Senate Human Services Committee on June 19, 2023.
   

SB 639 (Limón) 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 Assembly Health Committee.

1. Prior legislation. AB 1618 (Aguiar-Curry) 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.
   
2. Support. According to the Alzheimer’s Association 690,000 Californians are living with Alzheimer’s and that number is expected to double to nearly 1.5 million in 2040. With an estimated one in five people in the boomer generation expected to develop dementia, California requires a coordinated and purposeful approach to brain health. The Advisory Committee represents all Californians living with dementia, their families, both paid and unpaid caregivers, consumers and provides. Their input has been instrumental in to the work being done in California to care for Alzheimer’s, such as the 2011 State Plan for Alzheimer’s and the 2021 Master Plan for Aging. The Advisory Committee benefits from the collaborative efforts of its members, each bringing unique insights and professional backgrounds, but due to its limited membership, voices that represent key care providers have been disconnected from the work being done by the committee. This bill ensures the Advisory Committee can continue to offer advice on policies and programs with a comprehensive and diverse outlook. This bill modernizes language and practices from code that negatively impact persons living with Alzheimer’s and their caregivers.
   
3. Policy comment. This bill and AB 820 should be reconciled, as both bills each add a member representing older adults to the Advisory Committee. One adds a Commission on Aging member and the other adds an organization that serves and advocates on behalf of older adults. Additionally, if double jointing amendments are adopted, both bills if enacted, will take effect adding two (instead of one) new members representing older adults to the Advisory Committee, leaving only three members to be appointed at the discretion of the CHHS Secretary.

SUPPORT AND OPPOSITION:

Support: Alzheimer’s Association (sponsor)

Alzheimer’s Greater Los Angeles

Alzheimer’s Orange County

Alzheimer’s San Diego

California Assisted Living Association

California Commission on Aging

California Senior Legislature

County Health Executives Association of California

Oppose: None received

-- END --

Date of Hearing: March 29, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 387

Author:(Aguiar-Curry) – As Introduced Ver:February 2, 2023

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

SUMMARY:

This bill increases the membership of the Alzheimer’s Disease (AD) and Related Disorders Advisory Committee (Advisory Committee) within the California Health and Human Services Agency (CHHSA) from 14 to at least 21, but no more than 25, members, as specified.

FISCAL EFFECT:

CHHSA reports annual costs from the mid-tens of thousands of dollars to over $50,000 (General Fund), to reimburse members of the Advisory Committee for meals, mileage, hotel, flight, and ground transportation.

COMMENTS:

1. Purpose. According to the author:

Nearly 700,000 people aged 65 and older are living with Alzheimer's in California…The [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 Alzheimer’s is increasing, and the needs of the people affected along with our understanding of Alzheimer’s has changed… [T]his bill expands the membership of the [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.

1. Background. According to the Department of Public Health (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. According to the Alzheimer’s Association (AA), AD and other dementias disproportionately affect Black Americans, Hispanic Americans, Asian Americans, American Indian/Alaska Natives, members of the LGBTQ+ community, and women. Almost two-thirds of those living with AD are women.
2. Advisory Committee. The Advisory Committee provides advice and assistance to the administration and the Legislature regarding the program needs and priorities of people diagnosed with AD or related disorder, and consists of 14 members representing researchers, service providers, people living with AD or a related disorder and families of persons living with AD or related disorders, among others. Advisory Committee members are not compensated, except for reimbursement for travel and other necessary expenses incurred in the performance of their official duties.
   
3. Related Legislation.
   
   1. AB 385 (Ta) requires DPH to implement a public awareness campaign and include education for unpaid caregivers. AB 385 is pending in this committee.
      
   2. AB 786 (Bains) requires the California Department of Aging to establish the Alzheimer’s and Dementia Caregiver Education and Support Grant Program, a five-year grant program to expand access to evidence-supported dementia caregiver education training and support, including respite, support groups, and care counseling, for caregivers of persons with dementia, including AD. AB 786 is pending in the Assembly Committee on Aging and Long-Term Care.
      
4. Prior Legislation.
   
   1. AB 1618 (Aguiar-Curry) of the 2021-22 Legislative Session would have expanded the membership of the Advisory Committee and established the Office of the Healthy Brain Initiative. AB 1618 was held on the Senate Appropriations Committee suspense file.
      
   2. AB 1684 (Voepel) of the 2021-22 Legislative Session 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 on the Senate Appropriations Committee suspense file.
      

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

Date of Hearing: March 14, 2023

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 387

Author:(Aguiar-Curry) – As Introduced Ver:February 2, 2023

SUBJECT: Alzheimer’s disease.

SUMMARY: Increases the membership of the Alzheimer’s Disease (AD) and Related Disorders Advisory Committee (Advisory Committee) within the California Health and Human Services Agency (CHHSA) from 14 to at least 21, but no more than 25, members. Specifically, this bill:

1. Increases the membership of the Advisory Committee from 14 to at least 21, but no more than 25 members. Adds the following members to the Advisory Committee:
   1. One representing local health jurisdictions;
   2. Additional one member representing a consumer organization representing persons living with AD or related disorders;
   3. One representing first responders;
   4. One commissioner from the California Commission on Aging who has expertise regarding AD or related disorders;
   5. One representing primary care physicians;
   6. 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. Requires these members to participate in the activities of the Advisory Committee to the extent that their participation is not incompatible with their respective positions as Members of the Legislature; and,
      
   7. Up to four additional members selected by the Secretary of CHHSA.
      
2. Specifies that members described in 1) a) through e) and 1) g) above serve at the pleasure of their appointing authority. Specifies that the legislative members described in 1) f) serve at the pleasure of their appointing authority.
3. Clarifies that the Advisory Committee is to also consult with family members or informal caregivers. Makes other technical and clarifying changes.
   

EXISTING LAW:

1. Establishes the Advisory Committee within CHHSA to provide advice and assistance to the Administration and the Legislature as to the program needs and priorities of people diagnosed with AD or related disorder, and consisting 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 AD or related disorders day care resource centers;
   5. One representing the AD or related disorders diagnostic and treatment centers.
   6. Two representing families of persons living with AD or related disorders;
   7. Two representing organizations providing services to AD or related disorders patients;
   8. One representing a consumer organization representing persons with AD or related disorders;
   9. One representing a member of the State Bar who is familiar with the legal issues confronting those living with AD or related disorders and their families; and,
   10. Two people who have been diagnosed with AD or a related disorder to serve one-year terms. [Health & Safety Code (HSC) §1568.17(a)]
       
2. Specifies that members of the Advisory Committee serve without compensation but are to receive reimbursement for travel and other necessary expenses actually incurred in the performance of their duties. [HSC§1568.17(c)]
   
3. Requires the Advisory Committee to do all of the following:
   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), the California Commission on Aging, 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 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. [HSC §1568.17(d)-(e)]

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 currently living with AD in California. Of people aged 45 and older, nearly 12% have subjective cognitive decline. The Alzheimer’s Disease and Related Disorders (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. As the population of people living with AD continues to grow, it is important that the ADRD Advisory Committee is updated to best represent them in their role of providing feedback as the state of California continues to do its best to investing in equity solutions and maximizing benefits for underserved and marginalized communities. Therefore, this bill expands the membership 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 AD to serve longer terms consistent with improved outcomes thanks to modern medicine.
   
   The author also points out 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 the removal of other harmful terminology. These changes allow the committee to represent and serve persons living with AD and their caregivers in the most respect as possible while uplifting them and giving them the equitable representation that they deserve. Additionally, low-income people are more likely to have informal caregivers and will be better represented in the committee members updates.
   
2. BACKGROUND. According to the Department of Public Health (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.
   
   1. 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. Public health 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. Public health should collaborate with or lead initiatives to ensure that government agencies that serve these populations are trained in appropriate and effective strategies.
   2. AD and Dementia in California. According to the January 2021 Related Dementia Facts and Figures in California: Current Status and Future Projections (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 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.
         
   3. 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 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 ADRDs.
         
         Key Partners include: California Department of Aging, California Department of Health Care Services, California Health and Human Services (CalHHS) ADRD Advisory Committee, AA, Caregiver Resources Centers, Area Agencies on Aging, and the Centers for Disease Control and Prevention.
         
   4. 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.
         
   5. Taskforce on Alzheimer’s Disease Prevention and Preparedness: In 2019, Governor Gavin Newsom formed the Task Force on Alzheimer’s Disease Prevention, Preparedness and the Path Forward (Alzheimer’s Taskforce). The purpose of the Alzheimer’s 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 Alzheimer’s Taskforce were incorporated into the MPA.
      
      Specifically, the Alzheimer’s 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, Alzheimer’s disease 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.”
      
3. SUPPORT. Supporters such as AA and the County Health Executives Association of California state in support of this bill that increasing the membership would expand partnerships, can support collective efforts to reduce the risk of cognitive decline amongst our residents, and ensure that the Advisory Committee can continue to advise on policies and programs with a comprehensive and diverse outlook.
   
   The California Commission on Aging supports this bill and recommends amending the current language to read, “One commissioner from the California Commission on Aging who has expertise, background and/or lived experience regarding Alzheimer’s disease or related disorders.” Expanding membership to a commissioner to serve on this critically important advisory committee will tap the diverse backgrounds and lived experiences of devoted individuals who serve on the Commission on Aging.
   
4. RELATED LEGISLATION.
   
   1. AB 385 (Ta) would require DPH to implement a public awareness campaign and include education for unpaid caregivers. AB 385 is pending a hearing in Assembly Health Committee.
      
   2. AB 786 (Bains) would require, subject to an appropriation by the Legislature, the California Department of Aging to establish the Alzheimer’s and Dementia Caregiver Education and Support Grant Program, a five-year grant program to expand access to evidence-supported dementia caregiver education training and support, including, but not limited to, respite, support groups, and care counseling, for caregivers of persons with dementia, including AD, as prescribed. AB 786 is pending a hearing in Assembly Aging and Long-Term Care Committee.
      
5. PREVIOUS LEGISLATION.
   
   1. 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.
      
   2. 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.
      
   3. SB 861 (Limon) of 2022 would have established, upon appropriation by the Legislature, the Dementia Care Navigator Grant Pilot Program under the California Department of Aging for the purpose of incentivizing local organizations to provide dementia care navigation training services. SB 861 was vetoed by Governor Newsom who indicated:
      
      “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.”
      

REGISTERED SUPPORT / OPPOSITION:

Support

Alzheimer's Association (sponsor)

Alzheimer's Greater Los Angeles

Alzheimer's Orange County

Alzheimer's San Diego

California Commission on Aging

County Health Executives Association of California

Opposition

None on file.

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097