Support for Arkansas Week provided by the Arkansas Democrat-Gazette, the Arkansas Times, and Little Rock Public Radio.

Hello, and welcome to Arkansas Week.

I'm Chris Cain.

Alzheimer's disease is affecting more Arkansas families than ever, and a new state report shows the updated numbers.

We'll share that with you in just a little bit.

But first, the federal government is once again staring down a possible shutdown as lawmakers in Washington, D.C., remain at odds over spending legislation.

Joining us to discuss what's at stake is the Arkansas Democrat-Gazette.

Washington correspondent Alex Thomas joining the show, and we appreciate you taking some time, Alex, to talk about this on our program.

Set the stage for us.

How did we get to this point and where in the shutdown is once again looming right now?

Where are we at the stages of shutdown looming?

Because I feel like there's different stages that we go through every time this happens.

Yeah.

Chris, first of all, thank you for having me on this week.

When it comes to how we got here, Congress traditionally has to approve 12 spending bills for their fiscal year by September 30th.

This is something Congress knows when they start.

This is something Congress knows when they end the year.

They know that September 30th is the due date to get all 12 bills done.

The problem?

The House and Senate are very far from getting those 12 bills done.

They've passed three.

But at the same time, three is closer to zero than it is to 12.

And on top of that, they haven't passed the same three bills, the same three topics, but not the same three bills.

So what is what?

What are we going to do from here?

Well, the House has passed a short term continuing resolution which keeps funding at the same levels.

No increases, no ten decreases from where we are right now.

And that CR will fund the government through November 21st.

The problem?

It needs 60 votes in the Senate.

That is how most legislation is addressed in the Senate.

And when the Senate voted on that House resolution last Friday, not only did they reject that, but they rejected a Democratic alternative that would have also boosted health care funding, including Obamacare tax credits.

So where are we now?

Well, the Senate will be back in town on Monday.

They could reconsider that House resolution.

But at the same time, if they consider something else that can meet that 60 vote threshold, the House isn't going to be in town until the start of October.

Both chambers took off this week for Rosh Hashanah, and the Democratic members have been alerted that they don't expect any votes until October 1st at the earliest.

This is a situation that seems to come about every year.

What would the average Arkansan notice if the government does shut down next week?

Well, the good news is, if there is some good news in a situation like this, is that we expect mandatory non-discretionary programs to continue.

Things like Medicare, Medicaid, Social Security, national parks would most likely be closed for those Arkansans who are coming up to DC.

The Smithsonian Museum would be closed, most likely.

But here's the interesting wrinkle in all of this.

The Office of Management and Budget has not put out any sort of plan regarding what to do if a shutdown happens.

And so a lot of people were confused up until Wednesday night when we learned that the Office of Management budget, which is part of the white House, has told agencies to prepare reduction in forces if a shutdown does in fact go into place.

So what reduction force is essentially is reducing the workforce in an agency.

We saw this at the start of the administration with Doge and Trump 2.0, what they wanted to do to reshape the government.

So this they are seeing this as an opportunity amid this game of chicken, to further implement their goals and how they see the scope of the federal government touched on how it could affect federal employees in Arkansas and even some services.

What about veterans benefits and veterans services here in the state?

Now those should continue, thankfully.

But at the same time, how is that going to affect the workforce?

That's something that we've seen in past shutdowns, where maybe services take longer to process.

Maybe they're not.

They don't have the right kind of people to be in certain kind of offices.

That's something that a shutdown really affects for people day in, day out.

Yeah.

You're still going to get your mail.

Yes.

You're still going to get the services that are needed for those who need those services.

But it may take longer just to process certain things because the workforce simply isn't there.

Let's talk about Congressman Womack.

He was on this program last week, voiced some frustrations with these continuing resolutions.

Is this sentiment by him shared by members of Arkansas's other delegation as well?

I think so.

I was talking to Representative Crawford enroute off the House floor, leaving to go back to his district last Friday, and I asked him, you know, everyone's labeling this as the Schumer shutdown, blaming minority leader in the Senate, Chuck Schumer, that this shutdown could happen and he said, look, the House did what it was supposed to do.

We passed things by simple majority.

And if they can't pass in the Senate, they need to come up with something.

So there is some frustration among the delegation.

Senator Bozeman, who is a senior Senate appropriator.

He knows that people are frustrated by this process.

He wants the process to improve.

But at the same time, here we are less than a week until shutdown day.

And that shutdown threat is getting larger and larger by the second.

Yeah.

Senator Bozeman, who you just mentioned, and Senator Cotton both supporting the House bill.

What did they say their reasoning was for that?

No one likes the shutdown.

Shutdowns are bad.

People do not like shutdowns.

As I mentioned, services get delayed.

But also you want to have faith and trust in the federal government.

And when you have shutdowns, that further erodes that trust.

And yet people still have faith in the federal government and Congress, believe it or not.

So they don't like this idea of a shutdown.

They want to continue funding services.

And the thing that Representative Womack has mentioned to me is that that seven week continuing resolution would give lawmakers enough time to finish the appropriations process or put a bigger dent in the approaching appropriations process, maybe not pass the remaining nine bills, but maybe pass those three bills I mentioned earlier and then work on the other nine, hopefully trying to make a big dent, trying to get the appropriations done by the end of the calendar year before lawmakers leave for the holidays.

Yeah.

Let's stay on appropriations for just a minute.

And you were talking about where each chamber stands.

Can you kind of give us an update on where those are going to get finalized, or if they're going to get finalized by the end of the year?

And also, can you highlight the process for our viewers a little bit, how those maybe differ from some of the other talking points and sticking points of this bill?

Yeah.

So the appropriations bills, they get considered in the appropriations committees, both the Senate and House have appropriations committees, and they consider those measures.

Then they get put on the full floor, and most of the time the House will pass something that the Senate doesn't like, or the Senate will pass something the House doesn't like.

The Senate appropriators are more bipartisan in their work, and the House appropriators are more well, in this Congress, conservative Republican leaning in their work, not likely to get Democratic support for a lot of their bills.

So what that means is they have to come to a compromise, go to a conference and work out the details to get, again that 60 votes in the Senate and also get that simple majority in the House.

The issue right now is they've passed three bills with funding for the legislative branch agriculture, military, construction and veterans Affairs.

But they haven't passed the same three bills in the chamber.

So they need to come to a conference, work out their differences on those three bills, and then they could pass them as a full body, send those to the white House for the president's signature.

The big thing I want to emphasize here, Chris, is with these appropriations bills, there is these things called earmarks.

And earmarks used to be a dirty word around these parts and D.C., but earmarks are projects in your states and districts that lawmakers request federal dollars for.

Because if you're a small community in Arkansas, you can't build a new highway, you can't build a new sewer system, you can't do anything like that because the projects are just too expensive.

So you have your lawmakers request money and you get federal support.

Things like the Springdale Northern Bypass work on the A harbor in East Arkansas, remediation work at the former Army Navy Hospital in Hot Springs.

Those are things that the Arkansas delegation has requested and secured funding for in these appropriation bills.

But the problem is, unless they have the final bill that has that language, it's never going to get that kind of funding.

You need the appropriation bills to pass and get the White House's approval.

Otherwise, those projects don't get those funds.

You mentioned a moment ago the Democrats had their own resolution that they were trying to bring forward as well.

What's been the sentiment for both sides, as they're trying to find a compromise here somewhere to make it all work.

And get this spending bill passed.

Is anything that the Democrats are trying to do likely to make it through, or is it going to be a fully Republican led resolution that ends up getting passed?

Right.

So that Democratic Alternative had health care funding in it, not just to address some of the cuts in the one big Beautiful Bill act, but also the Obamacare tax credits that are set to expire at year's end.

That's another thing that Congress has to get done this calendar year.

Otherwise those tax credits are just going to go away.

They're not going to get the federal support that they need to exist.

This just adds to a very long list of things for Congress to do this year.

Avoid a government shutdown.

Pass the appropriations bills, help fund the Obamacare tax cuts or tax credits, rather.

And oh yeah, by the way, if you're someone like Senator Bozeman or your representative from a very agriculture heavy district, you want to make sure you can find some way to direct some economic relief to farmers have been struggling over the last 4 or 5 years.

This is a laundry list of items that Congress needs to get done.

And they're struggling just to do the basic things like funding the government.

Let's talk about political impact for Arkansas lawmakers.

If for any reason this doesn't go through and the government is shut down.

Election year coming up next year, what are you seeing as far as any type of potential political impact that this could have?

Well, I think the big thing is figuring out how to frame this to make it look less bad than it's going to be.

Because, again, no one likes shutdowns.

There's no net positive from a shutdown.

And if agencies start reducing their workforce, there will definitely be fewer and fewer positives to mention.

And a shutdown that could happen next week.

So if you're a Republican who's running for office, how do you frame this to spin it?

So you go, hey, you know what?

I did my part.

I did what I was supposed to do, but the other guys, they took out the process.

Senator Cotton's running for reelection.

Allie Schaffner is the main Democrat in that race right now.

But if you're a Schaffner or any other Democrat in that race, you're sitting here shrugging your shoulders, going, well, wait a minute.

Like, you guys can't fund the government and we expect you to continue helping us out.

We expect you to continue representing Arkansas.

That's going to be the argument that you can make if you're on the opposing side.

But like I said, Republicans have been framing this as the Schumer shutdown.

That's Senate Minority Leader Chuck Schumer has not been willing to work with Republicans in the Senate to meet that 60 vote threshold.

Reminder that he did work with Republicans, or at least approved of what Republicans did back in March to avoid a shutdown.

But same time, they are not willing to do that this time around, a shutdown.

Nothing new, not unprecedented.

Of course.

We talk about it every year.

It's happened historically, and they vary.

If they do end up happening in terms of length.

Is this a shutdown?

If it does happen, you could see a drawn out.

Or is this one they could get resolved quickly based on some of the headway that's been made in negotiations over the last several days.

Yeah, it seems like the sides in this haven't been talking as much as they should.

If they want to avoid a shutdown on September 30th, how long the shutdown could last?

No one really knows.

There were, you know, shutdown threats in the Biden administration, shutdowns in the Trump administration, including a lengthy one at that over immigration before everyone just relented and said, hey, you know what?

We need to fund the government.

We need to end this stalemate.

We're in here.

But this is a completely different Congress and a completely different white House than what we saw in Trump.

1.0.

How do we reach that compromise, Chris?

It's just an unknown at this point.

Will there be adults in the room to put their hands up and say, hey, you know what, we need to get this done.

Let's work together.

That's just something we're going to have to see next week.

But right now, as we're leading in to next week, it's not looking great.

A lot of things to keep an eye on and we appreciate you doing that for everyone here in Arkansas.

Up in Washington, he is the Arkansas Democrat-Gazette Washington correspondent Alex Thomas.

Alex, thanks again for joining us.

We appreciate your time, and we'll talk with you again soon.

Yes, sir.

Chris, thank you so much.

All right.

Stay with us.

Come back after this.

We'll continue our program.

And welcome back to Arkansas Week.

Alzheimer's disease is affecting more Arkansas families than ever.

A new state report shows over 60,000 Arkansans living with the disease, and 173,000 providing unpaid care worth more than $5 billion a year.

This report highlights progress, but also the challenges that lay ahead.

And joining us to break it all down is David Cook, public policy director with the Alzheimer's Association Arkansas chapter.

And David, thanks for taking some time to join us on the program.

Chris, it's a pleasure to be here.

Thank you for having me.

This report that came out a week ago did have some signs of progress, which is encouraging.

I know that's what we want to highlight, certainly, but also the challenges that lay ahead.

I mentioned the numbers just now.

You know, 60,000 with Alzheimer's, 173,000 caregivers, 11% or over 11% of Arkansans over 65 have been diagnosed.

I know that these are pretty stark.

What stood out to you about that latest report?

What's that to me?

Is this the number of caregivers?

When someone receives a diagnosis, those caregiving duties typically fall to family and friends.

And just the amount of caregivers who are providing that care, often unpaid.

It is so essential for us to support family caregivers in this this work.

It's certainly less expensive, to provide care in home.

So the more we can do to protect our and, and care for our caregivers.

I think that's essential to the state.

What's also concerning is the increase in prevalence we've seen over the last few years.

And those numbers are only going to go up because, it is 60,000 Arkansans over the age of 65.

But that number does not include those individuals who may be living with a younger onset diagnosis, or those who may be living with another form of dementia.

A stark number or statistic is 1 in 3 seniors will actually die of some form of dementia or dementia diagnosis.

That is a sobering statistic.

Let's go back to unpaid care for just a moment, because you highlighted that 5 billion a year, what the estimate is, what kind of impact does that have on a family when there's a diagnosis and steps are needed to take to care for that family member?

Well, I, I speak from personal experience.

My dad is living with dementia.

Caregiver burden and stress is huge throughout the continuum.

But once you get that diagnosis, there is like this panic.

What do we do?

Where do we go next?

And that's a very real feeling.

And so navigating the health care system for a regular healthy adult is challenging.

But if you add the layer of Alzheimer's and dementia and possible comorbidities, navigating that system from diagnosis to care to end of life support to now treatments, we have treatments available for people in the early stages.

Can be very challenging for families.

But of course, the impact to the state is, these, these family caregivers are caring for their families at home.

And what we're learning is more and more, more and more people want to age in place at home.

And so we need to make sure that we are, we have adequate, home community based services in place for these caregivers.

But also we can delay placement in long term care.

How will some of this data help move policy forward?

How will it help state leaders understand the needs and and what we can do to provide that support at home?

Well, the Alzheimer's Dementia Advisory Council was established in 2021.

It has been essential, in terms of having that government infrastructure to make lawmakers aware of the Alzheimer's crisis.

We can't wait for it to show up.

It's already here.

And so that's created a level of awareness inside the state House that's been encouraging.

But what we're learning, many of our lawmakers, they feel this personally, either they have a family member who's lived with it or passed from it, or they at least know someone who has.

So that that level of awareness has continued to grow.

And so over the last few years, we've continually put, put this data out there and we're hoping that, when you take a look at the cliff, Arkansas is going to invest money in this disease.

You're either going to pay for higher Long-Term care cost or you're going to pay for risk reduction, early detection, diagnosis.

And we're hoping that we can form a public health strategy to help us drive some of that risk reduction, because we know from the science is clear, is that up to 40 to 45% of dementia cases worldwide could be prevented by just inserting some regular, modifiable risk factors.

Healthy, healthy living, healthy eating, diet, exercise.

What's good for the heart is good for the brain.

We know that from science, and so we're hoping we take this data that we learned from our latest research project and that does translate into policy.

It's been successful in other states.

And we're seeing the lawmakers begin to respond.

When you talk about education, right.

Where the more you educate, the more you're able to get information out there to folks to maybe mitigate some of those risks, right.

But also trying to educate families on that moment that they may have panic.

Right.

Like you mentioned, where there's that moment of a diagnosis and there's a panic.

What kind of support is being given to caregiver education right now to help those families not have that moment where they realize their, you know, their world is falling apart.

And that's that's been another encouraging trend we've seen in the state.

Nonprofits have collaborated together to increase access to, dementia education awareness, risk reduction.

Also how to age healthy and some of the warning signs of Alzheimer's disease.

Some of those are the programs that we offer at the Alzheimer's Association.

But other nonprofits have also stepped up.

And because of the advisory council, we're seeing more collaboration, where at one time we were all working in silos.

But we're coming together to help increase access to this critical information, where the health department has been slow.

They've been good partners, but we need to see more from them.

Is it tough in a rural state to to be able to branch out and serve the entire community is role as Arkansas is.

It's very tough, especially getting to parts of the Delta in the more remote parts of, the state, northeast Arkansas, southwest Arkansas, all that that delta region is still largely underserved.

And so for a nonprofit like ours, who is a six staff team, we cover all 75 counties.

And so that can stretch us.

But also, being in a rural state like Arkansas, you know, the state revenue is is is limited.

We have other priorities.

We're funding.

And so, you know, getting access to state GSR to help drive some of this work has been challenging for us.

What could more funding do for the association?

I think, what's critical is, is the state needs to develop and invest in a public health robust strategy to help us, again, increase access to risk reduction, but also make the public aware that early detection and diagnosis is critical.

While it's always been a priority of the association now, with treatments being only viable for people in the very early stages, early detection diagnosis is again, so critical and access to that is critical.

With an investment in public health, we can again create more levels of awareness.

We can expand access to education and make sure we're reaching those, rural families who are navigating the seas, basically on an island.

What can you share with us about some of the breakthroughs in treatment options that you've seen in the last decade or sooner?

Well, I am this is my seventh year at the Alzheimer's Association.

And, in that time we've seen a lot of research developments, in terms of being able to diagnose the disease early.

There was a time where you could only confirm a diagnosis through autopsy.

That's not the case anymore.

Now we can catch it early or, through amyloid Pet and, biomarkers like blood.

Blood tests are now hitting the market.

But more important than that, for the first time in human history, we actually have treatments out in the market.

Horby that is being prescribed here in Arkansas that can slow the progression of the disease.

And so what they do, they it has to be given early.

It's an infusion based drug.

Of course, Arkansas being a rural state, access to those treatments is limited.

Access to diagnostics is limited.

So that's another issue as well.

But I guess back to your question most profoundly, again, is the availability of treatments, because these treatments are actually treating the underlying biology of the disease and not just the symptoms.

And so with these tools in the hands of physicians, prescribers are wanting to get these to their patients early.

And we've seen patients in Arkansas have great success on the treatments.

A second treatment is about to hit the pipeline here in the next month or so.

We know you and this is about to come online.

And so that's that's huge.

And just like we saw in cancer and other chronic disease spaces, once you have those first generation treatments the treatments get gets gets better.

It accelerates research in certain areas and we get better at treating diseases.

And again it's going to be a combination of therapies going forward I believe.

Speaking of early, you highlighted that there is another statistic that wasn't even mentioned, the ones that I was talking about with the ages of 65 and older being diagnosed.

You mentioned earlier, what are some of the trends we're seeing there that trouble you?

And you mentioned just now how vital it is that if those early trends are caught and the treatment options are available, what kind of outcomes could be expected or at least hopeful, for moving forward?

Traditionally, Alzheimer's and dementia has been reserved for like an aging space.

Now, age is your greatest risk factor.

1 in 3 seniors again, is going to pass from this.

But cases are getting diagnosed early and earlier, which is which is really alarming.

And so I'm in my mid 40s and I've had cognitive testing and we have to do it earlier so physicians can track the baseline.

And but there's still such a stigma attached to it.

Right.

And it's not a front room conversation.

Similar to where mental health was like ten years ago.

And if we could normalize the conversation around brain health in the same way we've done in mental health, that would change the game in terms of people being more comfortable and having this conversation with their physician.

Right.

Yeah.

And mentioning stigma there too, and going towards more of a traditional, what people mostly associate the disease affecting with older people.

There seems to be at times there could be reluctance to go through that testing because you may just say, oh, mom's just getting older, or dad or whoever it may be, whatever family member or friend, close friend you have, there may be that reluctance because you think, well, that's just part of aging.

What are some of the signs that maybe those out there could be watching right now that have seen a few signs here or there, but have kind of been reluctant to move forward with any type of formal testing.

What would you tell them to to really make sure that they get that help that they need when they need it?

Yeah, that's a great point.

There are some things that happen in our brain as we age that are just a normal part of aging.

I think all of us have faced those times in our life where we are panic searching for our phone or keys, something we misplaced.

But typically we have the ability to retrace our steps and eventually find where we left it last.

And what we see in Alzheimer's and particularly dementia, dementia is really a collection of symptoms that interfere with your daily routine of life.

And so if you're starting to see that you are maybe forgetting there some behaviors, you're not always going to recognize it in yourself.

Family members will see this first.

If if mom is doing something she's never done before that are out of character for her, or if she loses the ability to, you know, you know, do things like following processes, like maybe completing a recipe, those kind of things when when there's some memory loss or cognitive decline that starts interfering with your routine of daily living, then it's time to have that conversation with the physician.

But we also encourage folks to be proactive and not wait for those moments.

Right.

For the 65 plus population, there is Medicare coverage available.

And every time you go in for an annual wellness visit, you can ask your physician to perform a cognitive assessment.

As part of that visit.

Most often.

More often than not, patients have to self-advocate for that.

But we do encourage people to be proactive so that your physician or your clinician can establish that baseline and begin to track you as you age as well.

Don't have much time left, but can you just tell everybody where the resources are available to find online today?

Sure.

With so many people in Arkansas being affected by this, this disease, no one should have to travel this journey alone.

So the Alzheimer's Association is here for you 24 hours a day, seven days a week.

You can reach us at 1-800-272-3900.

Or there's a plethora of resources available on our resources on our website at Alcorn, Arkansas.

Okay.

Fantastic.

David, thank you so much.

He is David Cook, the public policy director with Alzheimer's Arkansas Association of the Arkansas chapter.

We appreciate your time on the program.

We look forward to seeing you again here soon.

Thanks, Chris.

All right.

That is all for us here on Arkansas Week this week.

Thank you so much for joining us.

I'm Chris Cain.

We look forward to seeing you right back here.

Same time same place next week.

Support for Arkansas Week provided by the Arkansas Democrat-Gazette, the Arkansas Times, and Little Rock Public Radio.