October 31, 2019 0 By Jose Scott

>>Greg Link: Okay. Well, good morning. It is 8:45 a.m., and we have a lot to cover
today. I realize — so, for those of you who have
not met me before, particularly those in the in the back, I’m Greg Link. I’m the director of the Office of Supportive
and Caregiver Services at the Administration for Community Living. ACL is part of HHS, and we’re the entity that’s
been charged with implementing the requirements of the RAISE Act, as well as the Supporting
Grandparents Act, which that meeting is happening just down the hallway simultaneously. It’s been a crazy but great couple of days. We have a pretty packed agenda for you today,
and I just wanted to run through what we’re going to be doing, but first I wanted to just
throw out a question. Did you all have any quick thoughts or reflections
that you wanted to share with the group on yesterday? I know sometimes we have information overload
and information dump, and then you go back to your room, and, you know, you’re watching
TV, and thoughts come to your mind. Anything that came to mind that you want to
share very quickly, folks on the council? Yes, Alan?>>Alan Stevens: Are we going to get copies
of the slides that were presented yesterday?>>Greg Link: Yes. So, all of the slides that were shown yesterday
as well as today will very soon be up on ACL’s webpage devoted to this, and also the recording. This is all being livestreamed, and recordings
of that livestream will also be posted on the HHS TV website, I believe, our YouTube
channel. So — and we will send — ACL will send out
one of our Gov delivery notices letting folks know that the slides and the notes and everything
are up from this meeting. So, it will be available. So, for today, what we’re going to do — the
first thing out of the box is we’re going to hear from our federal partners around the
table. There’s a lot of really great stuff going
on, either directly or indirectly, for family caregivers, and as part of the development
of that initial report, which requires an inventory of federal programs and initiatives,
we wanted to hear from our federal members on our council about what’s going on. So, we’re going to hear very brief presentations,
and Alan Stevens, our — one of our co-chairs, will be sort of facilitating that. Most of the feds are here; for the couple
three that aren’t, I’ll fill in for them. But we’re anxious to hear about some of the
programs and initiatives, and I think that will help our nonfederal partners understand
sort of the federal landscape that we have currently in place and maybe look for some
opportunities to build some better collaborations. We’re also going to have a couple of working
sessions that will be led by my colleague that’s at NIDILRR here at ACL, Sarah Ruiz,
and you’ll meet her shortly, and then we’ll do some report-outs from those and begin to
develop some prioritization for some recommendations that we want to pursue. We’re hoping that we can — our plan is to
end the day around 2:30 p.m. so that you all can get back home, which would be great, but
before I do that, yesterday, as you may recall, we had a bit of a technical issue. And as you also know, the John A. Hartford
Foundation, through their generous support, has funded the National Academy for State
Health Policy, which will really be an incredible resource for the council initially, but then
for the entire country as we begin to roll out some of the recommendations and look for
ways to begin working with states to improve their caregiver supports. But I did want to give an opportunity for
us to hear the message from the John A. Hartford Foundation, so I’m going to click play and
hope for the best. Okay? [laughter]>>Rani Snyder: Congratulations to the Administration
for Community Living and council members for the beginning of this meeting and for this
journey. I’m Rani Snyder, and I have the privilege
of being vice president of program at the John A. Hartford Foundation. We’re a nonpartisan national philanthropy
based in New York City, and we were established in 1929 by the family owners of the A&P grocery
stores. Our mission is to improve the care of older
adults, and we work in three main areas: creating age-friendly health systems, supporting family
caregivers, and improving serious illness and end-of-life care. You know just by hearing those three that
they’re mutually reinforcing, and even though one of our program areas is focused squarely
on caregivers, the other two, to be quality programs, also need to hold family caregivers
at their core, because caregivers are the linchpin of care, and not just for one, but
at least two people, themselves and those they care for. They need to be identified, supported, trained,
and engaged as core members of care teams. In other words, caregivers really need our
support, and my message today is it is more than a personal family issue. This is a societal issue with societal costs. If we want to ensure that caregivers live
with dignity and receive the care they need, we’ll need everyone to do their part. Our health care systems, our employers, our
community-based organizations, philanthropies, and our policymakers at the federal, state,
and community level. We can all help influence these centers to
build the infrastructure and the workforce needed to develop best care and support our
family caregivers, who too often are left stressed, unprepared in despair, and even
bankrupt. At the John A. Hartford Foundation, we are
making this change. We work in partnership with outstanding organizations
like UCLA Health, the Family Caregiver Alliance, the Benjamin Rose Institute on Aging, AARP,
and now the Administration for Community Living and the National Academy for State Health
Policy, NASHP, to build the RAISE Act Family Caregiver Resource and Dissemination Center. Our aim is for the Center to support the advisory
council of the RAISE Family Caregiver Act to bring together experts and resources that
allow the council to develop policy recommendations. The Center will be a public-facing resource
for stakeholders with an interest in family caregiving policy and also a vehicle to facilitate
uptake, implementation, and dissemination of the council’s recommendations. We are very excited for the work you’re about
to undertake. So, thank you to the Administration for Community
Living and to NASHP, to all of the council members, and to everyone in the audience as
well for participating today. Thank you also to our John A. Hartford Foundation
program officer Scott Bane for being there in person. You are all doing such important work and
ensuring that together we can change the status quo and create a society where older adults
and their families are cared for, valued, and supported.>>Greg Link: So, we really, really appreciate
again the support of the John A. Hartford Foundation, and I’m glad we were able to work
this out, because I think Rani’s message sort of brings together and kind of helps to provide
a really wonderful context and a meaning for our work. Okay, so we’re going to go ahead and jump
into the first section. Does anyone have any questions or any other
thoughts before we move on? We’re running a little early, and it’s intentional
because of that 10:00 fire alarm test, because I want to make sure that all of our federal
partners have a chance to talk about their programs. Just remember that that is a fire alarm test;
they’re not expecting us to vacate the building, but we do want to take that break at 10:00
so that we’re not interrupted by whatever that sounds like. [laughter] So, at this point I’m going to call Alan Stevens
up, and he’s going to take us — the slides that you all — that the federal partners
sent are in no particular order. You all sent them to me over the course of
several days; I dumped them into this deck as they came in, so they’re not in alphabetical
order, they’re not an agency order. So, there’s a divider slide between each set;
Alan will call you out. I’m going to fill in for the Indian Health
Service for CMS and for NIA, so when those slides come up, I’ll just sort of talk to
you about what they’ve got on them, and we can have a discussion after that. So, Alan, I’m going to throw it over to you.>>Alan Stevens: So, just whatever order they
come up?>>Greg Link: Yeah.>>Alan Stevens: It’ll be a surprise. Okay.>>Greg Link: It’ll be a surprise.>>Alan Stevens: Great. Well, we like that this time of the morning. The Department of Veterans Affairs and the
— I’m going to have to go — kind of go through this a little bit to get used to things here. But –>>Greg Link: Dr. Lynda Davis –>>Alan Stevens: — Dr. Lynda Davis.>>Lynda Davis: Yeah, hi.>>Alan Stevens: Hi. You’re up first.>>Lynda Davis: Yes, thank you very much. I have some handouts, if somebody could help
me get these around to everybody. And what isn’t being shared with members of
the audience — I’m going to give you links, and I’m glad to give you my email address,
and you can ask for anything that you don’t see. Can I stay right here or –>>Alan Stevens: Sure.>>Lynda Davis: Okay, thank you very much,
and I’m sorry I have to leave for a little bit during the course of the meeting today. I am so psyched to be here as a caregiver
veteran and somebody at the department with responsibility for supporting our families,
caregivers, and survivors across the continuum of their life’s journey. I want to share with you just very, very quickly
some of the things we are doing that are new. Next slide, please. First of all, and it’s hard to read through
the chandeliers, but — [laughter] — for the first time last year, we created
a federal advisory committee that is for veterans’ families, caregivers, and survivors. It’s chaired by Senator Elizabeth Dole. It has nonprofits, et cetera, et cetera, a
lot of good diversity and representativeness, and it is holding the department accountable
for addressing these populations and their needs. They have a series of recommendations that
have included staff training, readiness, inclusive care, how you engage the caregivers and the
family members in the development of a family-, person-centered, comprehensive care plan. So, we’ll be doing at training. Glad to share the training itself. Also, the implementation; they’re looking
very carefully at the implementation of the MISSION Act, which has in it that section
for the program of comprehensive assistance for family caregivers. That’s the one that has the stipend attached
to it. So, there was a slide the other day about
the amount of money that goes to the VA caregivers, the veteran caregivers, and that smaller number
compared to our whole complete universe of caregivers. We — I’d love to get into talking about that
and the challenges we’re having in the implementation, making sure also that for those who don’t
get that stipend that there’s an awareness of all the programs not just at the federal
level, but at the state and local level and with our nonprofit partners and organizational
partners. Next slide, please. We have a real-time IA-enabled platform that
allows us to do surveys, so for the first time in the department we are doing real-time
surveys of the feedback and the experience of our customer, which includes caregivers
and family members. So, we will have the ability — we have the
ability now to capture compliments, concerns, complaints, and recommendations from our customer
in real time, so within two days the provider, the hospital director, et cetera, gets information,
and when they round in the morning they’re able to talk about outpatient services, distance,
mental health providers, the experience with our patient advocates, et cetera. So, two things they can do: service recovery
and program improvement. And we have a — we have standards across
the department now that we’re implementing so that all of our 150-plus medical centers
and the staff will begin to do the same thing and understand standards, and they can certainly
go beyond those, but there is an expectation to hold ourselves accountable. This is a great tool. Next, just a few other quick things. We have a Center of Excellence. So, we established the first Center of Excellence
for veteran and caregiver research. That is four of our best teams across the
VA, largely research medical center-based, but they are community engaged also, and they’re
going to be looking at different areas related to caregivers, including, as I mentioned yesterday,
the children and youth experience. So, anybody who wants to work with them, I’d
love to make that contact, that connection, and I will make sure that they’re connected
to this group. The other initiative that we’re working on
with several of our colleagues in this room is the Choose Home initiative. It is the commitment to ensure that no veteran
has to be institutionalized if it’s at all possible to enable them and their family and
caregiver to support them at — in their home in their community with the services that
are not only federal, but are state, local, and nonprofit and faith-based, et cetera. So, we’re working on that. We will have a report for you in September
of our 21 pilot sites and what has been found about comprehensive case care management,
the planning, the integration of communities. I think that’ll be a really rich reference,
and, of course, our Center of Excellence that I just mentioned is under there, and how we
not only engage the partners, but create that comprehensive plan. I think that’s the last one. Is that correct? Now, this is just comments on the MISSION
Act and the stipend, and you can see what we’ve done is make sure we’re not just talking
to our customer, as we use, because I’m in charge of customer service for the whole of
government. Go figure. But — [laughter] — the — in your packet you’ll see some — [laughs]
it’s wonderful what you get to do with — you’ll see some handouts that include things like
our journey maps and what we’re doing to map the experience of — we have these for caregivers
using our programs. So, not only the caregivers and our veterans,
but also, we’ve done that mapping for the staff, so we can tell you the moments that
matter to the staff who are doing the case management and their workloads and what happens
when you have 250 people that you have to care for and manage. So, we’re looking at that, because for us
customer service is not just the veteran/family/caregiver/survivor, but it is our own employees. We have to take care of those who are the
providers. I’m glad to share all of that with you. So, there’s a bunch in your packet. I’m glad to talk about it further individually
with you. My email is Lynda, L-Y-N-D-A, .Davis, D-A-V-I-S, Happy to connect you with anybody else who’s
relevant to work we’re all committed to doing that.>>Alan Stevens: Thank you, Dr. Davis. Caregiver Supports? Is that you?>>Greg Link: That’s me. That’ll be me. So, at the Administration for Community Living
we have a number of different programs and initiatives that touch family caregivers either
directly or indirectly. Probably the most well-known set of supports
and the longest running are the Older Americans Act programs. As many of you know, the Older Americans Act
programs are available in every state. The funding flows from ACL AOA to each state
and territory via a formula based on the state’s population. In the case of our caregiver programs, the
formula is based on the state’s population age 70 and older for the National Family Caregiver
Support program. The National Family Caregiver Support program
and its counterpart under the Native American programs under Title VI make available five
core services to every family caregiver who qualifies and is eligible. That’s information, assistance with accessing
services, counseling, support groups and education, respite services, and then a broad category
called supplemental services, which can provide for a variety of goods and services that caregivers
need to remain in place and assisting. The National Family Caregiver Support program
has been operational since 2000. Last year we just completed the first national
evaluation of that program; all of those results are up on our website, some very interesting
results. We were finally able to get at that all-important
question about the importance of respite and perhaps looking at some minimum dosing for
respite, and we were able to show that as respite hours increase the perceived level
of burden can decrease. So, it was — that was — those were some
pretty exciting results. But everything is up on our website. We also have our Alzheimer’s Disease Program
Initiative, or ADPI. We combined — last year we combined our — what
was formerly the Alzheimer’s Disease Supportive Services Programs and then the Alzheimer’s
Disease Initiative Programs into a single program called the Alzheimer’s Disease Program
Initiative, which makes discretionary grants available at the state level as well as to
communities to begin building dementia-capable systems in states and communities for persons
with Alzheimer’s disease or related dementias, as well as other types of supports and services
for family caregivers. Again, we have full information on our website
about that program and also a very robust technical assistance support center, the National
Alzheimer’s Disease Resource Center, out of — that’s operated by RTI International. They’ve been our TA support contractor for
a number of years on this program. We also, back in 2009, began implementing
the Lifespan Respite Care Program — that was one of the programs I had the good fortune
to begin implementing — where we’re actually helping states think about respite in a very
concrete and very deliberative way about, how do we build respite systems, respite programs,
and services that are accessible, affordable, of high quality, that have an adequate workforce. We’ve so far funded — I believe it’s 37 states
with a number of — up from one up to three or four grants to build respite care — lifespan
respite care programs that look across the age and disability spectrum. A couple of other programs and initiatives
that we have that touch the lives of family caregivers. We fund the National Alzheimer’s Disease Call
Center. It’s a 24/7/365 call center for caregivers
of persons with Alzheimer’s and dementia to really help them get connected to specialized
resources in their communities. Many of you are probably familiar with the
Elder Care Locator, which we’ve been operating for years. It’s a wonderful resource that connects folks
to their area agencies on aging and aging and disability resource centers to help not
only caregivers, but also older adults and persons with disabilities connect to resources
in the community. Last year we funded a small discretionary
grant because we know the financial — oftentimes the financial impact of caregiving, and the
caregivers need tools and resources to better be able to plan for and manage their caregiving
experience. We funded the Strengthening Financial Literacy
and Preparedness for Family Caregivers; we are working with the Alzheimer’s Association
to begin to build tools and resources that can help educate family caregivers on how
to be prepared for and navigate some of the financial hurdles that can come along with
family caregiving. Our Research and Rehabilitation Training Center
on Family Supports at NIDILRR, which one of our council members, Joe Caldwell, has been
intimately involved with, has also done a tremendous amount of research information-gathering
on a wide array of supports and initiatives going on. And then we have our ADRC No Wrong Door Program,
which does connect family caregivers to resources as well in the community. So, I’m going to just jump to CMS because
Melissa Harris is our CMS rep, and she is at the HCBS conference, so asked that I just
talk through the couple of slides that she has. In the Medicaid program, she provided a snapshot
that talks about some of the direct supports that are available under Medicaid. Of course, respite under the 1915(c) home
and community-based waivers and 1915(i) state plan options. Certain Medicaid benefits can allow for care
coordination, which can be of assistance to family caregivers; the PACE Program also providing
an interdisciplinary approach in multiple locations around the country that include
adult day health care programs and facilitating caregivers retaining employment. There are some number of indirect supports
that are available to the Medicaid beneficiaries themselves that could impact and also provide
supports to family caregivers, and we’ve laid them out here: some home modifications, personal
care assistance, and hospice care, and then, of course, the website has some
information on this. There are a number of direct supports under
Medicare. The hospice benefit; caregivers of beneficiaries
who receive dialysis can receive dialysis training; and then there are some indirect
supports that we have laid out here. Keep in mind that all of the information we
have on these slides will be of use to you as the council as you begin thinking about
how we begin to flesh out the report that is going to be developed as part of this work. So, I’m going to turn it back over to Alan,
and we’ll continue on through the folks here around the table.>>Alan Stevens: So I think this is going
to be Mark? Oh, it’s a duet.>>Greg Link: Do we have anybody from ACF?>>Heidi Stirrup: Yes, I’m here.>>Greg Link: Oh, perfect.>>Heidi Stirrup: Thank you. Good morning, everyone, and thank you for
the opportunity to speak here on behalf of the Administration for Children and Families. My name is Heidi Stirrup, and I’m the deputy
assistant secretary for policy at ACF. ACF is the second-largest operating division
within the Department of Health and Human Services, and while we’re mostly responsible
for promoting the economic and social wellbeing of children, families, individuals, and communities
we do have some grant programs and funding opportunities that address the needs of grandparents
and other relatives caring for family members, so-called kinship caregivers. Kinship care refers to situations in which
grandparents and other relatives care for children whose own parents are unable to care
for them. Sometimes this is an informal private arrangement
between the parents and the relative caregivers; in other cases, guardianship is given to relative
caregivers, and Child Welfare is not involved; and in other situations, the local child welfare
agency is involved. Child welfare systems vary from state to state,
but they generally include public agencies such as Departments of Social Services or
Family and Children Services. Caseworkers at these agencies are required
by law to ensure the safety, wellbeing, and permanent living arrangements of children. Their responsibilities include investigating
reports of child abuse and neglect and arranging for services for children and families. Child welfare agencies strive to provide services
and resources to keep children in their homes with their families whenever safe and possible. When children cannot safely remain with their
parents, placement with relatives is preferred over placement in foster care with non-relatives. Caseworkers try to identify and locate a relative
or relatives who can safely care for the children while parents receive services to help them
address the issues that brought the children to the attention of Child Welfare, be it disability
or health conditions of some sort. Placement with relatives or kinship care provides
permanency for children and helps them maintain family connections. ACF’s Children’s Bureau funds kinship navigator
programs to support kinship caregiver families to ensure they are served appropriately. In addition to the Children’s Bureau, ACF
also includes the Office of Family Assistance, or OFA, which manages the Temporary Assistance
to Needy Families Program, or TANF. TANF is a block grant to the states and is
designed to provide financial assistance to help low-income families become self-sufficient. Caregivers do not have to have legal custody
to apply for TANF benefits, but they do have to meet their state’s TANF definition of a
kin caregiver. Even if a relative or caregiver does not qualify
for TANF benefits, it is possible to apply for and receive benefits for the children
living in the home. And finally, the Administration for Native
Americans, another program office at ACF, is a source for developing local solutions
and improving services to tribal and Native American communities. Thank you.>>Alan Stevens: Thanks. So, as you saw a preview, Mark, I think you’re
up next, and if I can do a bit of an editorial, as Dr. Schultz was just discussing yesterday
in the aging — the IOM report, this issue of privacy issues and transfer of information
was clearly one that was important, and we didn’t have the expertise to really dig into
it and come up with really good answers. So, I’m particularly proud to see you here
and know that’ll add a lot to what we did not have before.>>Mark Vafiades: Thank you. The national coordinator — the ONC is the
Office of the National Coordinator for health IT, and it was established in 2004, and principally
it was initially put in place to really encourage and assist in the implementation of electronic
medical records, which now basically is referred to as electronic health records. And although — let me switch this over — although
since 2004, when I got involved with implementing health records, since then, 97 percent of
hospitals and approximately 80 percent of outpatient medical offices are on electronic
health records. However, they’re not necessarily connected
to one another, so if you’re not in a system like a Kaiser where everything’s under one
roof, you’re getting care in different places, and they’re not necessarily sharing information
with one another. And that’s what we’re working to now do with
the implementation of the 21st Century Cures Act, so that all health care deliverers are
basically sharing information and know what’s going on in the person’s life. Now, allowing — obviously, access for caregivers
is very, very important, because allowing family members and caregivers to access patient
health information through a portal is becoming much more common. In 2017, 86 percent of non-acute care hospitals
reported offering this access to patients and their loved ones, but despite this, clinicians
and practice administrators often struggle to navigate federal and state laws regarding
proxy access and privacy and so forth, and it can be different from state to state. So, HIPAA does allow for patient access and
access for their caregivers. Sometimes you go places, and people use the
excuse of HIPAA as why they can’t share access, but it’s maybe because they don’t quite understand
it, and that’s what we’re also trying to help clear up. So, again, currently, one in four accessed
their care recipients’ online medical record at least once in 2017. So, again, very, very, very important that
we can so that we can coordinate care and have access to the electronic health record. Again, under HIPAA a patient’s personal representative,
someone authorized under state and other applicable laws to act on behalf of the patient, has
the right to access the patient’s health information. The patient also has the right to allow the
personal representative to share this information with someone else like a doctor or a hospital. Again, this is something that a lot of people
don’t realize. Other opportunities created by caregiver access
to patient portals include enabling providers to differentiate with whom they are exchanging
secure messaging; the patients or someone else involved in care; the ability to respect
patient preferences for including others in their care — and, again, this is along separate
access for the patient and the caregiver — improve transitional care by providing family caregivers
with timely, accurate, and comprehensive information after patients have been discharged from the
hospital; create a collaboration between clinicians and family caregivers; more impactful involvement
of caregivers in patient self-management plans; and greater information transparency, which
enables family caregivers to alert clinicians to missing or inaccurate information in patients’
health records. So, again, one thing we’re also working for;
so many caregivers are accessing a patient portal just using the login and password information
of the patient, and again, more and more, we’re trying to have a differentiation between
a caregiver accessing and/or the patient. So, now, next thing, and this is very important. Once again, using portals allows you to sign
in to, say, a hospital portal, but if you’re getting care at many different locations,
as mentioned, you’ve got to sign in to different portals, even to see lab tests and, again,
different types of care, post-acute care facilities also, and so forth. But one of the provisions of the 21st Century
Cures Act that we are implementing is patient access to their health records on their smartphone
at no charge, and this will consolidate all your records from different facilities into
one app. And, again, that should be at no charge; we’re
in the process of writing — we have proposed rules out there now. When they are finalized and implemented, hopefully
in the not-too-distant future, then patients and their caregivers will be able to access
that information and carry it with them on their smartphone. This will greatly increase the ability to
care for your loved ones. So, I think that is it. This is my information. There’s so much information, by the way, at, which is which is ONC’s website,, and chapter four is specific to allowing
portal access for caregivers. So, if you go to the ONC website and look
for ONC Patient Engagement Playbook, chapter four, you can read a little bit more about
what we’re doing in the world of giving access to caregivers. Thank you very much.>>Alan Stevens: Okay, next will be CDC and
Lisa McGuire.>>Lisa McGuire: Thank you so much. So, CDC is a public health agency and — would
it be easier if I came there? Because I think I might have an animation
in my slides. Or can you click fast, Alan?>>Alan Stevens: I can click fast if you’d
like –>>Lisa McGuire: Okay.>>Alan Stevens: — or you’re welcome to [inaudible].>>Lisa McGuire: Okay [laughs]. We’ll let Alan click fast. This will be a test of his chair skill. [laughter] I’ve known Alan for a few years, so — so,
CDC is a public health agency, and so what actually is a public health agency? So, what public health does is we really bridge
the gaps between biomedical sciences and community supports, so we take those — that information
that comes out of those clinical studies or the NIA-funded research, and we package it
and make it usable so it can go into existing systems and structures that exist within public
health. So, for example, we may develop continuing
education curriculum or materials for providers, but we do it in conjunction with an accrediting
body, and that material then goes within their existing CE structures, or we work with our
partners to get our materials out to state and local public health officials. So, at CDC, we are, as I said, a public health
agency, and that’s where the congressionally funded Healthy Brain Initiative is housed. The purpose of the Healthy Brain Initiative
is really to take public health strategies to promote brain health, address dementia,
and support the needs of caregivers. So, we are — we have a very wide mission
and wide charge, and we do this consistent with the wheel that you see up there on the
right-hand side, which represents four of the essential services of public health. So, public health at the state/local levels
typically does follow those essential services of public health. This is something that they structure their
programs with, so, as a public health agency, a national public health agency, we make sure
that our materials fit into those existing structures of the way that public health already
operates to increase the uptake and utilization of those materials. One of the big things that we do every five
years is we develop a road map, and you’re seeing our road map for state and local public
health. That’s the first three items there on the
left. So, what we do is we get panels together like
the folks in this room; our most recent road map that we released in November, we had about
150 different individuals from a variety of different walks of life: federal people, scientists,
community leaders, people who were living with Alzheimer’s disease and related dementias. We had caregivers; we had public health officials. So, we had a variety of different people. We scoured the literature; we looked at our
previous road maps to see which of the actions had been completed, which ones still needed
work on. We looked — got our crystal balls out and
made projections of where we thought the field was and where the field was going for the
next five years. So, the third picture there with a nice woman
looking at us, that was on the road map we released in November, and that has 25 actions
for state and local public health, so it’s a little bit fewer than the number of actions
that we had previously, but those actions were more targeted. There are also an increased number of actions
in there for caregiving that I’ll talk about in a minute. As we were developing that road map, we realized
where we were not getting uptake in our actions, and that was within Indian country. So, you heard Larry Curley speak yesterday
and talk about some of the challenges in Indian country, and we recognize that Indian country
has some of — has the same needs, sometimes more of those needs and deficits than we see
in non-Indian country, and so we realized that we needed to take a different approach. So, we spent two years developing that road
map that you see on the right-hand side. We worked with tribal organizations; we worked
with Larry; we worked with ACL’s Title VI group; we worked with Indian Health Service,
a variety of different partners, and so we have eight actions that are developed and
targeted specifically for Indian country. So, with our state and local road map — and
everybody has at their seat a copy of our issue map for caregiving. So, what we recognize is there’s 25 actions. That’s a lot. As a public health program, you might be only
interested in a couple of those items, or you might be interested in a specific topic. So, what we did is we took those action items,
and we organized them topically — next — and so you can see down here at the bottom, here
are the different issue maps that we have. So, the one you have at your table today is
focused exclusively on caregiving. The layout of all these issue maps are identical. They first talk about what is the issue, why
it’s important, basically why you should care and why this is important for your constituents. The middle piece shows the actions, and you
can see the colored icons there. Those correspond to those essential services
of public health, and then we have a few success stories or examples that we share with you. So, these are on our website, For those of you who are in the audience,
we do have some copies of these out in the hallway, and if you need more, or you need
quantities of them, please let me know. The other thing that we do a lot of at CDC
is data collection because we need to know where we stand on a specific issue, and we
need to see if we’re making progress. So, we have a series of products, and I gave
you an example of one on your table. It’s double- sided, so one side is caregiving
and the other side is our cognitive variable. But what this data comes from is — comes
from CDC’s behavioral risk factor surveillance system. What the BRFSS — B-R-F-S-S is — and try
that quickly — is it is a state-based surveillance system. So, in many states it is the only data that
is available at the state level or county level for health behaviors, health conditions,
and a variety of risk factors. So, there’s about 450,000 people annually
complete the BRFSS survey, and it is state-based, which also means state-owned and -operated. So, each state controls the content that is
on their BRFSS, the optional module portion of it. They make decisions of what are the most important
issues for their state and which questions to include. So, you’ll see as I’m talking about what we
have done with that data, we, for caregiving, have 44 states, D.C., and Puerto Rico, and
most of you are thinking, “Well, they’re missing a few states.” Yes, we are missing a few states, but keep
in mind it is a negotiation with each and every state to — and they have to recognize
that it’s important for them, plus every other topic matter related to health is talking
to the states and saying, “Oh, please, my questions are really, really important.” But — so there is a negotiation and a working
process. So, we’re very proud that in three years we
were able to get 44 states, D.C., and Puerto Rico to administer this caregiving module. So, Alan is giving you the examples here. So, on the left-hand side you can see the
national for the for 44 states, D.C., and Puerto Rico. The second is we’ve translated the — this
infographic into Spanish, which will be available on our website in the next couple weeks, and
then for each of those states and territories and D.C. that participate in the module, we
have state-specific data available for you which is on our website as well. So, this module asked people — asked them
if they’re providing care or assistance to a friend or family member who has a health
condition or a disability, so we don’t just say, “Are you a caregiver?” because we know
that people tend to under-report. So, we ask — we give them a situation, and
then they self-identify as fitting into that situation. If they indicate that they are a caregiver,
we ask them about the intensity and duration of the caregiving experience; we ask the relationship. So, is it a child? Is it Grandma? Is it the mother-in-law? Who are they providing care for, and what
is the main reason they believe they’re providing care for that person? Many people will say old age and frailty,
but, you know, they can indicate if it’s cancer, if it’s a cognitive disability, if it’s an
intellectual disability. So, there’s a variety of different response
options for you. So, I’m telling you all this because the data
is there. It is free; it’s publicly available. Download it; use it. We are doing a lot of the analysis around
Alzheimer’s disease because that’s what one of the emphasis of my program; my colleagues
in cancer analyzing that data. But check it out. The right-hand side here Alan is showing us
— we did some stratifications by race and ethnicity. So, we have infographics for American Indian,
Alaskan natives, African-Americans, Hispanic adults. As well as the Hispanic adults, we’ve also
translated that into Spanish, and with the new year of the data, we’re exploring other
options for our infographic series. Next slide, or next portion. So –>>Alan Stevens: Oh, sorry.>>Lisa McGuire: So, the top middle one. We have developed — we’ve developed a series
of data briefs. My program historically did a document called
the State of Aging and Health in America, which was a really, really thick book with
lots of numbers that made your eyes cross, so what we decided to do is to develop five
smaller documents. So, here is the issue brief that we have on
caregiving. It is on our website. It’s about 12 pages. It has state data; it has different stratifications
such as race, ethnicity, other risk factors. So, please check it out. We also have one on subjective cognitive decline;
we want to have one on cardiovascular disease. We have another one on cognitive decline and
chronic health conditions, and then the fifth one in the series that is in development will
be looking at racial and ethnic disparities. Then at the bottom, if you don’t like the
data that we have available for you on our infographics or on our data briefs, we do
have an interactive data portal where you can go in and click on your state, select
the variables that you’re interested in, and develop your own infographics, or you can,
you know — or you can make an infographic for the nation, or you can download the data
and analyze it yourself. So, we truly, truly believe in data for action
and not just developing data at CDC and putting it out there. So, the last thing I’ll say is that for caregiving
month, my program has a big launch planned, so we have our — we typically do a
feature talking about some aspect of caregiving, but we have a new communications person who
is very creative, and we’re developing an interactive infographic that has five survival
tips for caregivers, animated graphic, and then there will also be a social media campaign. So, I encourage you to please check out our
website, There is a little box on there, an icon, to
sign up for our newsletter. Sign up for our newsletter; I promise we will
not send you a newsletter every day. We will send it to you maybe one, two, three
times a month at most. So, thank you very much.>>Alan Stevens: Okay. All right. Oh, sorry, I thought you were coming up. So, next is the Office of the Assistant Secretary
for Planning and Evaluation, and it’s Helen Lamont.>>Helen Lamont: [inaudible]>>Alan Stevens: Sure.>>Helen Lamont: All right. Hi, everyone. It’s nice to see you again. I’ll do a little bit longer introduction,
although I won’t go through our acronym again. I’m Helen Lamont, I’m from ASPE, and as I
mentioned yesterday, we are the secretary’s key policy shop, so we’re charged with making
sure there’s good information and data available for policymakers when they’re making decisions. We cover all of the work that the department
does, so there’s a person in ASPE who knows what’s going on in every agency in HHS, and
then we work across the department and across departments in the federal government on topics
that are cross-cutting. We do a lot of convening and collaborating,
evaluation, and strategic planning. My office, as I mentioned yesterday, covers
aging, disability, long-term services and supports, and behavioral health, and so we’re
well suited for this work and for looking at caregiving for these populations. So, as I mentioned, ASPE has a — both a substantive
role and also a convening role, so I’m going to talk about the work that we do in caregiving
that relates to both of these. So, our main role is policy research, and
we do a variety of policy research on innovative health and long-term services and supports
models for older adults and people with disabilities. The one you might be most familiar with is
consumer-directed care, which started as a demonstration project in our office and has
been rolled out through Medicaid waivers. And then, specifically in the informal caregiving
space, we’re proud to say that we supported the first and second rounds of the national
study on caregiving. As a result of that, NIH has taken on the
funding of that. We also previously funded the caregiver supplement
to the national long-term care survey starting in the ’80s, and so we have a long history
of supporting data collection on informal caregiving. We’ve put out two reports using that data,
one specifically on informal caregiving in the U.S., caregivers of older adults, and
then another profile of people with dementia and their caregivers, and those are available
on our website as well. We also do a little bit more detailed work
on where we can make progress in the caregiving front, and so as a result of actually the
national long-term care survey data collection and some analyses that were done, we found
that, controlling for all other factors, the physical burden of caring for someone was
a predictor of nursing home placement. And so, we did some work to look at how assistive
technology can reduce the caregiver burden. We had a project a couple years ago to look
at the economic impact of programs to support caregivers, and through that project we looked
specifically at the — I hate to say it — categories of caregivers, but different age demographic,
working/non-working characteristics, and used a microsimulation model to see how some of
the different policy options to support caregivers would impact the overall caregiving population. So, we found that there are some caregivers
that were not working before they became caregivers, and that’s why they were chosen to be caregivers,
and there are some caregivers who are over 85. So, if you looked at the whole broad swath
of caregivers and applied, for example, a tax credit, the impact would be minimal and
wouldn’t cover the cost of providing that care, but we learned some important things. If somebody has chosen to be a caregiver because
they have a less full work history you would implement different policies and supports
for them than you would for somebody who had been working fulltime and chose to leave the
workforce to be a caregiver. So, that’s the type of detailed information
that we’re trying to make available for policymakers. We have a project right now to look at the
supply of informal caregivers and demographic changes, so, as you know, the baby boomers
had fewer children than previous generations and so through this project, we’re looking
at how childless people now get informal support, who they use, what networks they use, if they’re
going to extended family or other family and friends, how that changes over the course
of their disability, and then we’re using our microsimulation model to project what
caregiving will look like and who will be the caregivers in the future years. More broadly, we have a long-term care model
that we’ve used for everything from modeling the — what’s it called — the Long-Term Care
Financing legislation to some of these informal caregiving pieces, and we update that with
new data as it becomes available. And then we have a project right now looking
at the role of informal caregivers and integrated health care systems. The thought there is that the family physician
will say, “Oh, yes, of course, I talk to the caregiver if I have a patient who has dementia;
that’s who I get a lot of information from. I’m going to work with them on medication
management.” As we move to these more formal integrated
systems, a higher reliance on health IT, how are these informal processes being formally
implemented, and how are the caregivers being formally recognized? Do they have access to the patient’s health
information? Do they get assessed for their needs? So, we’re looking at a couple of high-performing
programs to see what they’re doing to support informal caregivers. And then the other part of my job and the
other area that we work on, and this is the convening aspect of ASPE, is implementing
the National Alzheimer’s Project Act. The National Alzheimer’s Project Act is similar
both structurally and in terms of substance to the RAISE Family Caregivers Act. It requires us to have an advisory council,
to assess federal programs, to write a national strategy, and to update it annually. It was implemented in — excuse me, it was
enacted in 2011, and we’ve been carrying it out since them. So, we have a federal advisory council that
meets quarterly; it’s set up similar to this one, which, actually, you all might not know
this, but this is a unique structure to have the feds and the non-feds on a council, and
it’s been very successful in the NAPA space to make sure that the things that the non-feds
are recommending can be implemented and create a really, really nice partnership between
the feds and the non-feds. So, I hope we can replicate that here. The group makes recommendations both to HHS
and to Congress on an annual basis, and you saw yesterday the increase in funding that
resulted from some of the recommendations to Congress, and the work of our advocates,
I should say. And then annually we write and update the
national plan to address Alzheimer’s disease. The 2019 update will be coming out in October,
and I counted, that’s our eighth iteration — I can hardly believe it — since it was
first released in 2012. It’s a little bit different than this activity
because we’re not seeking to cure family caregiving, and much of the Alzheimer’s plan is looking
towards a cure for dementia or a way to prevent it, but quite a bit of the information in
the national plan is similar. For example, one of our key goals is to support
people with dementia and their families, and we specifically call out family caregivers
and the need to maintain their own health and wellbeing while they do that work, and
many of the action steps that we’re implementing through the plan are similar to the work that
this group is going to be looking at. So, I would say there’s a strong focus on
supporting family caregivers through the NAPA work both in the presence of caregivers on
our advisory council and in the substance of what we’re doing. You’ve heard a lot of it from my federal colleagues,
and you will continue to do it. And I would like for us to be able to continue
to collaborate with that work. Grace asked yesterday how these things will
work together, and certainly my presence and the presence of Joan and Lisa, who are also
on the NAPA advisory council, will make sure there is some coordination. So, I would encourage you to get involved
in some of the NAPA stuff, if nothing else, to learn from what we were able to do there
and what the advocacy community was able to do there, and then specifically to invite
you to the 2020 National Dementia Care and Services Research Summit that NIH is convening
in mid-March. The purpose of this is to lay out a research
agenda for NIH and other federal partners to address the care and service needs of people
with dementia and their caregivers. So, it’ll align very closely with this work,
and it’s a nice showcase of what has happened and where things have gone since 2017, and
also an opportunity to have input into the future of research on caregiving.>>Alan Stevens: Thank you so much. Okay, and next we’ll have an overview from
SAMHSA from Rosemary Payne. Rosemary?>>Rosemary Payne: It actually came on. Great, thank you. I want to bring you greetings from our Assistant
Secretary of the Substance Abuse and Mental Health Services Administration, as well as
our director from the Center for Substance Abuse Treatment. I’m glad to be here to represent SAMHSA as
an agency on this workgroup. As you can see, the mission for SAMHSA is
to reduce the impact of substance abuse and mental illness on Americans’ communities. At SAMHSA, we provide a wide variety of grant
programs that are aimed at prevention, treatment, and recovery services for individuals at risk
for mental illness and substance use disorders or those living with these disorders. Many of our grants include supporting family
or family caregivers who have loved ones or are custodial responsibility for someone at
risk and living with mental illness or substance use disorders. In addition, SAMHSA supports the development
of mental health and substance use workforce policy implementation and supporting building
healthy communities. Excuse me, my allergies are bothering me a
little bit today.>>Alan Stevens: And excuse us, but we’re
having a little bit of trouble getting the recording. Could you get closer to your mic?>>Rosemary Payne: Sure. I’ll actually sit. Currently, within two of the centers for SAMHSA,
the Center for Mental Health Services — next slide — you’ll find that we have four programs
or grant programs that are specifically aimed at children and families, consumer and family
network grants, Project LAUNCH, which specifically targets our Native American and Alaskan native
populations, and children’s mental health services. All four of these grants have within them
support systems for family or family caregivers for individuals whose children suffer with
serious emotional disturbances. Within the Center for Substance Abuse Treatment,
we specifically target support for families with pregnant and postpartum women, and then
our children and families, that covers our transitional age adults as well as our adolescents
and pediatric populations around services for individuals that have mental illness or
a substance use disorder. We also have grants that we support families
that are involved in the criminal justice system as a result of their substance use
disorder with supportive housing, recovery services, trying to keep the family system
together as they transition through the juvenile justice systems. Next slide. Here I have listed specifically the grants
that are currently available in 2019 and the grants that are still pending awards in 2019. Again, I spoke about Project LAUNCH, which
specifically is targeting for our Native American/Alaskan native patient population, as well as the
criminal justice grants. Within our grant systems, we have both block
grants and discretionary grants, so under the consumer and family networks, those are
state block grants that go directly to the states based on a formula, and then the states
issue the grant funding within the communities with the highest need. We are looking forward to participating in
the Family Caregiver Council, and I will be taking back information that’s discussed here
to see how that we can help continue to expand and support family caregivers. Thank you.>>Alan Stevens: Great. And next, we will have the FDA. Did you say you were doing that one?>>Greg Link: No, I think it’s Katie O’Callaghan.>>Alan Stevens: I’m sorry.>>Katie O’Callaghan: Good morning, everyone. I’m Katie O’Callaghan. I’m a representative from the Food and Drug
Administration in the Center for Devices and Radiological Health. For those that don’t know, the FDA is an agency
that’s maybe a little more behind the scenes for this particular group, but we do have
responsibility for regulating $2.5 trillion dollars of — worth of products that consumers
spend money on, including food, drugs, medical devices, vaccines, and tobacco, so that’s
about 20 percent. If you think about the things that you buy
for yourself and your family, about 20 percent of those, the quality really relies on the
many folks at FDA who proudly come to work to protect and promote the public health. But what does that really mean? I think regulation can be a little bit of
a mysterious concept to the average American consumer. We really focus on — particularly for the
medical product areas, we focus on the twin areas of safety and innovation. So, at the Center for Devices and Radiological
Health, where I work, these medical devices include things like assistive technologies,
wheelchairs, prosthetic limbs, knee replacements, joint replacements, heart valves, stimulators
for Parkinson’s disease. And then if you think about the home health
care environment, many of those devices are things that our Center regulates. And you think about some of the more innovative
technologies that are supporting, you know, the sort of modern health care with telehealth
and mobile health technologies that can help us better monitor patients in the home environment
outside of the clinic, all of that falls under our scope. So, there are a handful activities at the
Center for Devices that I wanted to highlight for you all here. While the patient and consumer have been at
the center of our mission from the get-go, a number of years ago we began to place a
greater emphasis on patient engagement so that the work that we’re doing is not simply
on behalf of the patient, but more and more in partnership with patients and with caregivers
in recognition that the role of the patient and caregiver in the health care delivery
system has changed; that with more and more information being available, that we, you
know, are seeing this shift towards more of a partnership and a shared model of decision
making and care planning; and that we needed to bring that into our work and our decision
making as well. And so, I had the privilege of leading a two-year
organization-wide effort to better understand the needs, the experiences, the preferences
of patients and caregivers, and then find a way to bring that into the work that we
do every day at the agency. So, we have a couple of other initiatives
that I think are relevant to the discussions of this group at the center. We have health of women as well as pediatric
and special populations’ efforts, which take a particular lens to look at, what are some
of the challenges and opportunities facing those groups that are affected by our decisions
or by the technologies that we regulate. The digital health program is really a burgeoning
area of innovation. I touched on some of the, you know, mobile
health technology opportunities that we have in technologies. If you think about, you know, your smart watches
and some of the sensors and the application capabilities that they’re developing, you
may have seen in the news that, you know, people can monitor their heart rhythms. Increasingly, opportunities to look at glucose
monitoring, and these technologies really enable us to take that peephole view of the
clinic visit and zoom out and see what’s really happening with patients over the long term. So, really exciting opportunities to improve
and support the work that caregivers are doing taking care of family members in the home
health care environment. And then we also work a lot with sponsors,
which refers to the manufacturers of these technologies, to make them essentially more
user-friendly. Next slide, please. In terms of the patient engagement work, there
are two programs that I wanted to highlight for you all here. The first is our patient engagement advisory
committee. This is — for the FDA, given the very scientific
and technical review work that we do to regulate products, most of our advisory committees
are comprised of clinical and scientific experts. We decided that we needed a committee solely
comprised of patients and caregivers, and, of course, these folks all have their own
professional expertise that they also bring to the table. And so, we comprise this group to help advise
the FDA commissioner and our agency in terms of things that we could do to better incorporate
the patient and caregiver perspectives into our work. We have had two meetings; our third meeting
is coming up very soon, September 10th, focused on cybersecurity and how do you communicate
risks of cybersecurity to patients and consumers. Think about things like pacemakers or insulin
pumps that are very important in the care and monitoring of conditions for patients
that are essentially computers, and so they have all of the same kinds of cybersecurity
risks that you might have with any other sort of connected technology. So, a very challenging area. We want to make sure to get the patient and
caregiver perspectives early on. Another program we have is the Patient and
Caregiver Connection. The National Alliance for Caregiving, Grace
spoke yesterday, is one of our inaugural members, and that program essentially creates a network
connecting our scientific experts with patient and caregiver organizations so that we can
tap in very early on and throughout any of the processes that we have to look at different
information to understand what the impacts might be on patients and caregivers. We’re very excited about that program. Next slide, please. Who knows what human factors is? [laughs]
That’s what I thought. So, forgive me for getting a little technical
here, but I think it’s really important when you think about these kinds of technologies. It essentially refers to, how does the user
and that interface with the technology affect how it works, whether or not it’s safe, whether
or not it does what it’s supposed to do? And so, you know, we’ve all had technology
that sounded great but was not user-friendly, and that really can impede — when you’re
thinking about medical technologies, that can impede safe use. That can make it less effective, and so it’s
really critical that we understand human factors. This is work that we have always done, but
we’re trying to do with this increased focus on patient and caregiver perspectives is to
do that more holistically. We understand that diversity affects just
about anything that we do; it certainly has an impact on things like design and use of
technologies. So, we’re taking that information and trying
to help connect what we learn from patients and caregivers with the manufacturers who
actually design and improve these products over time. And with that, I’ll close.>>Alan Stevens: Okay. Next will be the Consumer Financial Protection
Bureau.>>Stacy Canan: Hi, I’m — can you hear me? Yes? Is that better? Excellent. Great. Hello, everyone. I’m Stacy Canan. I’m here representing the Consumer Financial
Protection Bureau. First, I just want to say that I’m very sorry
I was unable to be here yesterday at the, you know, the beginning session. I had work travel and was out of town, but
I want to thank Hector Ortiz, who stood in for me. So — and could we change slides, please? Thank you. I’m going to highlight two of our resources
that I think will be relevant to family caregivers and for those who are being cared for. First, a little bit about the CFPB, the Consumer
Financial Protection Bureau. And hopefully Hector had a chance yesterday
to say this, but we are a financial regulator. We regulate banks and non-banks, and to that
end, we enforce the federal consumer protection laws; we supervise and examine banks and non-banks;
we write rules and regulations; we study the marketplace; and, importantly, we also engage
in educating consumers and empowering them to make sound financial decisions. When Congress established the CFPB back in
2011, they set up an Office of Financial Protection for Older Americans. I lead that office, and we do a mix of policy,
research, and educational initiatives that are designed to help protect older adults
from financial harm, and within that we include elder financial exploitation, and we also
help older adults make sound financial decisions as they age. Two of our sort of premier products I’m going
to focus on and then just sort of generally mention a bunch of other products and resources
that we have, which, as I said earlier, I think you’ll find relevant because, as we
all know, there is often a very serious financial toll, you know, after becoming a financial
caregiver. So, our materials and resources, I think,
would be relevant definitely for the caregiver him or herself as well as the person that’s
being cared for. So, the first is Money Smart for Older Adults. It’s a “train the trainer” curriculum that
we created with the FDIC. Many of you may be aware of money — the money
smart program that the FDIC developed. This one is very particularized and focuses
on how to identify frauds and scams and how to protect yourself and your loved ones. It has been extremely popular, used by caregivers,
service providers, federal/local government agencies, AAAs, faith-based groups, and it
is a great organization –organizing tool as well. It is several — many, many hours of content. We highly recommend you do not do all at once,
but it’s very malleable, and it can be broken out into, like, a 30-minute session, a 40-minute
session, and is very easy to use, offered in both English and in Spanish. Next slide, please. The one that I think you may find the most
relevant is our Managing Someone Else’s Money set of guides. And we released these back in 2013, and we
periodically update them depending on changes in laws and things of that sort. And what it is, is really a very plain-language
guide for nonprofessional fiduciaries, for the family financial caregiver who may not
necessarily be even managing their own finances all that well, let alone knowing how the — sort
of the, you know, the rules of the road for what they have to do to manage the finances
for a friend or a loved one. And we have separate guides for the four most
common types of lay fiduciaries — that agents under power of attorney, guardians and conservators,
trustees, and Social Security and VA representatives. And for my colleague from the VA, we did work
with the VA on that and with Social Security Administration on the Social Security guides. So, we have this one also available in English
and Spanish. Among the tips and recommendations that are
included in there are also tips on how to protect the assets of the person that is being
cared for. So, those are the two main slides that I have,
but I do want to quickly mention some of our other resources, which, again, I think will
be of interest to you. We have a guide, protecting residents from
elder financial exploitation in congregate care facilities, and this is a guide that’s
designed for maybe a nursing facility, assisted living facility, that provides tips and recommendations
on how to conduct training, how to set up protocols, how to be looking out for the residents
for their safety and how to prevent elder financial exploitation of the residents. We have a guide that we created with the SEC,
Planning for Incapacity. It’s very short; it’s about three and a half
pages. Again, plain language, easy to understand,
with the most important tips and recommendations on how to plan for the future. We have something we call “Ask CFPB.” It’s an interactive set of thousands of questions
and answers on our website,, which helps people essentially navigate their
financial lives. Whether you may be in — you know, having
questions about a mortgage, a credit card, a student loan, a Social security claiming,
debt collection, there is a question and answer, and many of them probably there for you. Again, I — you know, we are always constantly
updating them. If you feel like that there’s a certain amount
of content that might be relevant that we don’t include, contact me, and, you know,
we will look to do that. We do have a fair amount of content that is
specifically designed for financial caregivers as well. We have a lot of guides and resources for
people who are contemplating taking out a reverse mortgage, and, you know, explaining
what a reverse mortgage is, whether it might be the right product for you or for the person
that you’re caring for. We also have a complaint portal, and I’ll
end on that one. So, if you or the person you’re caring for
is having difficulty with a credit card company, mortgage company, you know, any financial
product service provider, you can submit a complaint, and we route that to the company
and then get a response. So, again, you know, we have devised products
and services to help people navigate their financial lives, whether, again, you’re a
caregiver or for the person that you might be caring for. Thank you.>>Greg Link: Thanks. So, it is 10:00 a.m., and we’re expecting
that fire alarm test. We still have a few more federal agencies
to go through, so as soon as that test is over, we’ll come back, and we will go through
those very quickly, and then we’ll move into the next portion of our agenda. So, let’s take a quick break now. Don’t go too far. Please plan to be back here right at 10:15
a.m., and we will get underway again.