##VIDEO ID:VXBPx76WzCw## e e e e e e e e e [Music] p [Music] everyone welcome to the Board of Health meeting of November 4th 2024 please note this meeting is being recorded and will be available shortly Hereafter for scheduled and On Demand viewing on any smart phone or tablet if anyone else is recording this meeting please notify us pursuant to Governor hey's March 29th 2023 signing of the act of 2023 extending certain covid-19 measures adopted during the state emergency suspending certain measures of the open meeting law until March 31st 2025 this meeting of the chadam board of H is being conducted in person and via remote participation every effort will be made to ensure that the public can adequately access the proceedings as provided for in the order reminded that persons who would like to listen to this meeting will while in progress may do so by calling 1508 945 4410 and the conference ID number is 953 27716 pound or you may join the meeting online via Microsoft team through the link in the posted agenda while this is a live broadcast and simal cast on chadam TV channel 8 and 1072 despite our best efforts we may not be able to provide realtime access we will post a record of this meeting on the town's website as soon as possible and I'll turn the meeting over to our chairman Dr Noble Hansen thank you it shall be the policy of this board to conduct its meetings under the open meetings law so as to encourage public participation whenever time permit and as part of agenda items discussions okay let's first establish a quorum and when I call your name please uh say present Carol Boyce here Ron Broman here and myself noble Hansen here okay so today we have uh something a little different we're having a public forum on community services and we have four people speaking uh Eliza Morrison director of harm reduction Services AIDS support group Cape Cod we'll talk about the community narcon training program Morgan Eldridge uh from the fishing partnership Support Services will talk on services for the fishing Community Lea lacrosse director of chadam community services we'll talk on the town of chadam uh services and Pat Burke uh shine program coordinator will uh talk to us about that program concerning uh Medicare beneficiaries so we'll get started first with u Eliza Morrison director of harm reduction Services AIDS support group Cape Cod Community Narcan training hi everyone thank you so much for having us back today um I will just provide a little brief overview of our services um followed by a um a Naran training some of you in this room have already um experienced one of our trainings I'm going to try to keep it brief because I know we're going to do try and do this in a timely uh manner but just a little bit about the aid support group of Cape Cod um our mission statement as stated here is the aid support group of Cape Cod or referred to sometimes as asgcc um saves lives through prevention education and life sustaining services that address Public Health crises to build Healthy Communities across the cap and Islands um and here we are doing a Narcan training tonight so one of the initiatives of our agency is to reduce the impact of Overdose um on the cape and Islands through public Narcan trainings Naran and distribution to the public um some other services that we provide are medical case management food and nutrition programming short-term Health navigation Behavioral Health Services Housing Services and a prevention and screening program which provides cost-free um screenings for folks to test for things like um HIV um hepatitis C and other STI all of our services are no cost to clients um some of our services that we provide like I said overdose prevention education and free Naran trainings and distribution um linkage to care for STI treatment and also other Supportive Services in the community we partner very closely with lots of supportive um services in the community to link people to um Housing Services uh food stability services medical um services and engagement for treatment um for substance use Services um we provide access to prep and to pep um prep is a daily pill taken to prevent HIV and pep is a pill that can be taken um within 72 hours of potential exposure to HIV to reduce the risk of contraction by about 95% we are also syringe Services Program um we provide um access to sterile syringes uh syringe disposal and syringe retrieval services so we are out in the community frequently doing sweeps um looking for areas that we know might be um might have uh syringes being disposed of improperly we also go out and we pick up syringes um from uh participants homes we make those deliveries and we also do pickups and deliveries of syringes and other um sterile or safer injection supplies to people who do not use illicit substances so people who are um perhaps injecting um hormone replacement therapies um steroid therapy or um diabetic medication we also provide linkage to care for addiction treatment um we have same day referrals and um handoffs to um medications for um opiate use disorder and also to detox um and treatment facilities we also provide post overdose services to people who have either experienced an overdose or at risk for overdose and also their support networks following a a um overdose so our organization um oper Ates using the harm reduction principle um harm reduction I'm sure you're probably familiar with this term but if you're not just briefly meets people exactly where they're at we don't require that anyone be abstinent to um access any of our services we know that there is a lot of gray area in between um total abstinence from substance use and um active substance use and that if we can help to provide people um supports exactly where they are we can help them to navigate to better outcomes so the way we do this is educating people on how to reduce harms that are associated with um specifically opiate use um and other substance use um we don't attempt to minimize the fact that we know that there are very real harms that are associated with substance use but we do attempt to minimize those risks so one of the like I said one of the primary things that our programming focuses on um is Distributing Naran and getting Naran into the community um so who should to carry Naran people who use drugs not just opiates we know through our drug checking um process uh that we can provide onsite to our participants that um not just opiates put people at risk for overdose we have a very contaminated substance Supply here on Cape Cod so really anybody who uses substances is now at risk for experiencing an opiate overdose um anyone who lives with or spends time with somebody who's potentially at risk for overdose shic car Naran and also community members we know um the data shows us that when a community is saturated with people carrying Naran and know who know how to recognize and respond to an overdose um instances of Overdose um are lower in those communities is it legal and is it safe to carry Naran absolutely yes Naran does one thing and one thing only and that is it acts as the anote to an opiate overdose if you use Naran and an individual does not have opiates in their system system it will do absolutely nothing it's safe to have around children it's safe to have around pets it's safe to have around public spaces it is perfectly legal to carry in your car and on your per on your person everybody in Massachusetts has a standing prescription for Narcan you can obtain it at a pharmacy you can obtain it from an organization um that distributes Naran and you can feel confident um carrying it safely and legally on your person there is a law in Massachusetts called the Good Samaritan law that aims to protect the victims of Overdose and those who seek to help during an overdose um so this law is really designed to make bystanders feel more confident and comfortable responding to the best of their ability and comfortability should they recognize what they think is an overdose so what does naram work on works on opioids and only opioids so when we're talking about opioids we have two different classes that we're talking about number one would be prescription opioids so things like oxycodone Percocet vicadin we know now that on Cape Cod we don't see a lot of these actual prescription pills on the market what we're seeing are pills that are pressed to look like their prescription counterparts so people will come to us and maybe they bring us an oxyc conone that they've purchased from somebody when we test the pill using our technology most often it will come back as a um as positive for fentanyl with other um different fillers uh pressed to look like its prescription counterpart um so unfortunately we're not seeing a lot of these prescription medications um but if you do have somebody at home who does have a prescription for opioid um medication then that person might be at risk for overdose um and then we have things like our illicit substances so we have heroin Fentanyl and other opioid analoges we don't see much heroin here on Cape Cod anymore um what we do see is fentanyl and Fentanyl analoges there are over 80 here that we've tested in Massachusetts um and an analog is really anything that's manufactured to mimic the effects of an opiate specifically fentanyl they vary from potency um about 50 times to 100 times stronger than heroin so things that might put somebody at higher risk for overdose anyone who has experienced a period of abstinence and this includes people who have never used an opiate before so if maybe somebody is purchasing a prescription medication that they think think is an oxy an oxycotton um and they take it and it's actually fentanyl that person is much more likely than somebody who has an opiate tolerance to experience an overdose this also includes people who have been through maybe a treatment program or a period of abstinence because of incarceration um they will have a opiate naivity we call it so anyone who has a lowered tolerance because of a period of abstinence is at higher risk for overdose changes in the drug Supply we see this a lot here on Cape Cod because things it kind of acts as a funnel here we see different substances kind of come through in waves because they come from off Cape places like Boston Fall River Brockton Etc um so when we see something that's more potent than what people are accustom to we'll see kind of a um Rising rate of Overdose for a period of time poly substance use um obat are a depressant so what happens when people experience an overdose is that their breathing is depressed um when the breathing is depressed and they are also using another substance simultaneously maybe um a benzo or alcohol which are already depressants um as well they have a higher risk for overdose um uh also if people are um using something that is a stimulant with something that is a depressant then we have something that's working on cardiac function as well as something that's working to depress respirations people who have chronic health conditions such as HIV hepatitis see lung disease heart disease Etc anything that would compromise their ability to process um a substance effectively in the body um anyone with a history of past overdose is at higher risk for overdose people with mental health issues like anxiety or depression are at higher risk for overdose the number one risk factor for overdose is people who use substances alone so what is Naran Naran um or nxone is a medication that rapid L reverses an opioid overdose so it is a complete opioid antagonist so that means that it attaches to the opioid receptors and reverses and blocks the effects of other opioids our main concern when we're using Naran is we want to get people breathing again so that's what we're trying to do when we administer Naran is to get people back um breathing so what happens during an opiate overdose so in overdose is the body's response to Too Much substance in the system basically what happens is we all have kind of these receptors that just hang out in our brain they're opiate receptors we all have them so perhaps we experience um a medical issue where um the doctor prescribes us pain medication so perhaps we have a tooth extraction and the doctor prescribes um some percocet or some vicadin you go to the pharmacy you pick up this prescription um you take your first you take your first pill and what's supposed to happen is exactly what happen happens so that medication comes in that prescription opiate sits lightly on top of those receptors tell those receptors hey we're not going to feel pain for x amount of time and then within about four to 6 hours that opiate is flushed from the system it's done exactly what it's supposed to do with fentanyl what happens because it is such a strong opiate is that it comes in and it seeks out those receptors and it binds so firmly and so quickly to those receptors that it um almost instantly stops people from breathing what happens when we administer Narcan is Narcan comes in and it breaks that bond between the opiate and the opiate receptor and it creates a temporary block on those receptors so that for about 60 to 90 minutes that opiate in the system cannot return to those receptors and continue to depress that breathing so respiration um is returned before we respond to an overdose it's important to learn how to recognize one um so some things that you'll see maybe when you come across somebody who is potentially experiencing an opiate overdose and acknowledging that there are other medical issues or medical conditions that can present like an opiate overdose so just knowing that we're always calling 911 and even if you do misdiagnose that this person is experiencing an overdose and you administer Naran there will be absolutely zero adverse effects so better safe than sorry and we always tell people when in doubt go ahead and give that Nar can um but we're looking for things like respiratory depression breathing might be slow shallow sporadic the person may not be breathing at all if they are breathing you may hear a very kind of constricted guttural shallow breathing that kind of comes from the back of the throat um th that will cause those snoring or gurgling sounds you may see bluish or grayish skin tone from lack of oxygen um lips fingernails may change color they might not be able to answer you when you're prompting them they might be disoriented or not able to speak with you at all if you can see their pupils you'll see that they have very smaller pinpoint pupils that's a Hallmark of opiate use so if you can see their eyes and see that they have tiny pupils chances are you are witnessing an overdose um they might not respond at all to stimulus um I also tell people since these overdose happen generally so quickly with fentanyl you want to look for the clues have you walked into a bathroom and there's an individual where you can see that they've used a substance um is there a syringe present is there powder somewhere um so just be looking um and use your use your context clues so when we come upon our victim we're going to assess the level of Consciousness we're going to call out to them and if there's no response we're going to call a little louder and give them a little Shake If there's still no response what we're going to do is we're going to check for their response to pain or agitation by doing something that we call a sternal rub which is where we take the fist just like this we're going to use our Knuckles to kind of graze the uh chest plate here you can also do it under the nose if there's still no response we're going to go ahead and we're going to respond using Naran so always we're calling 911 first if you have access to a cell phone great you be the one to call 911 if there's a bystander and you can call out to someone to call 911 go ahead and do that ideally we're kind of working with other bystanders to respond um so call 911 is the first thing to do and then second we're going to give our first dose of Narcan so Narcan comes in a box just like this there are two 4 milligram single step doses in each of these boxes so giving Narcan is really really simple if you've ever used phon nasal spray you can administer Naran so what we're going to do is we're going to peel the back off we're going to place it into our hand just like this we want to be mindful that this is a singl step um Administration so if you accidentally depress this toggle here then you've discharged your dose and you won't be able to um use this Naran so be careful when you're taking it out of the package we're then going to place the Naran um we're going to take the tip put it into the nostril which whichever nostril is more accessible it doesn't matter we're going to go ahead and place it into the nostril until the nostril touches the fingertips here and then we're going to go ahead and we're going to press and discharge our first dose of Narcan it's as simple as that and then what I always like to tell people is that um if you're waiting for the EMTs to arrive go ahead and put that discharge Jose of Naran down next to the individual just so that when the EMTs get there you can kind of to just step away and they know how many doses that you've given so peel Place press and then we're going to begin our rescue breathing if the individual is not breathing are you raising your hand I'm sorry yeah um so did you say that just there's just one dose in that vile there is just one dose so there are two um single step four milligram doses in each of these kits so this kit contains two doses right and then so it's just one nostril one dose it's one nostril one dose yep and then yeah um so always call 911 always call 911 now what about the consent thing can can a person refuse 911 can a bystander refuse 91 can a friend say I don't want them called how does that work so you always call 911 and then when they arrive they'll make that determination lots of people will opt out of Medical Care especially after they've come back around um using the Naran they actually feel pretty okay aside from what can be some pretty intense withdrawal symptoms um they can refuse medical attention but lots of times um the EMTs who are really like seasoned um at dealing with this at this point can usually convince them to go along and get checked out yeah but they can they can refuse yes okay thanks sure so if the individual is not breathing um we're going to go ahead and begin rescue breathing so like I said responding to an overdose is based on your ability and your comfortability if you are not comfortable providing rescue breathing um then we're just going to skip this step and we're going to monitor the individual for about two to three minutes um if you are comfortable doing rescue breathing it's going to be one breath every 5 seconds for about 2 minutes so rescue breathing we want to take a look and we want to make sure that there's nothing in the mouth we're tilting the head back and lifting the chin and pinching off the nose so we're opening that Airway and we are closing off that nasal passage trying to make sure that all of the um breathing that we're doing is reaching the um individual's lungs so we're breathing for them um we're going to give one breath every five seconds and we're going to continue doing that for about two minutes and then we're going to kind of back off and we're going to assess the situation are we starting to see any changes so is the individual starting to open their eyes are they attempting to breathe on their own are they wiggling fingers are they wiggling toes are they trying to talk um so we're monitoring for any positive change if you do not see a positive change the end of that two minutes you're going to go ahead and you are going to administer a second dose of Narcan and then start that rescue breathing again if they're still not breathing if the person is breathing or starting to try to breathe on their own or they look like they're starting to come around what we're going to do is we're going to get them onto their side into the recovery position it's important to put people onto their side because um Narcan does put people into what we call precipitated withdrawal so what can happen is um people can vomit you don't want anyone to aspirate Narcan can cause a little bit of drainage in the back of the throat again we don't want folks to aspirate it's also a more comfortable way for people to wake up it can be extremely kind of jarring and upsetting and anxiety provoking to wake up and see a whole bunch of bystanders kind of looking down on you and those are the times when you kind of see people maybe get up and run as opposed to staying and waiting for medical attention yeah go ahead yeah so if you come across someone that you presume has an overdose they're not breathing yep do you recommend that people check for a pulse is their heart you can check for a pulse so these Narcan trainings are really designed to make everybody feel as comfortable as possible like you don't have to have any sort of medical experience or basic life support training in order to administer Naran if you are someone who's comfortable feeling for a pulse that's fine um it is more important that we're checking for respirations so you know are we seeing the chest rise and fall are we feeling breath maybe um are we hearing breath maybe but I imagine you you can get uh confused with an arrest a cardia you know a cardiac arrest you can you can um things like somebody who's just had a seizure maybe somebody who's had a stroke or a diabetic episode so all of those things can also present like an over overdose but like I said no matter what we're calling 911 um and administering Naran is not going to have an adverse effect so if you administer Narin and somebody is maybe post seizure or um has had some sort of a cardiac issue then we're still getting 911 there and we're checking the box with Naran um so yeah okay and then um I imagine that some people don't want to do the rescue breathing is there a risk to rescue breathing if somebody's taking fentanyl can you actually get fentanyl by rescue breathing someone so what I recommend is that people use some sort of a barrier or a shield when they do rescue breathing if you have one available to you um if you don't sometimes people can pull a shirt over um I have before used my hand like this over somebody's mouth in order to provide a little bit of lift um generally people are not inhaling fentanyl um and generally they're they wouldn't have it on their mouth or their nose area um touching fentanyl it cannot be absorbed um through the skin unless it's specially formulated on a transdermal patch um so if you were to come across somebody who maybe had some powder on their clothing or whatever and you accidentally touched it there would be no risk to you for overdose if you do suspect that the person may have inhaled the substance could have it on their face you don't want to put your mucus membrane or any membrane um close to that because you could be affected um so if you're uncomfortable or if you're questioning maybe what their mode of kind of like administration of the substance was you can hold off from doing that rescue breathing so in lie of the rescue breathing we would rescue breathe for two minutes so instead of rescue breathing for the two minutes we would administer the Naran monitor the individual for 2 minutes if there was no change then we would go ahead and we would administer a second dose of Naran and did you say there there's a barrier in the Naran n there's not a barrier in the Naran um lots of people will carry one like on their keychain um in some of the um noock boxes that we've installed there are um there are some mouth Shields but you know obviously those um would just be for use on site and we don't anticipate that you know there would be an elevated risk of overdose on site because you have in the lock box so you know if people carry um a mouth Shield independently that's great I would love if they started putting um facee shields in here I think that would be a great idea but they don't um I have one that I carry on my keychain so yeah if you've got a little basic first aid kit in your car sometimes they have them there too thanks sure um so if the victim doesn't respond to the first dose of Narcan we're going to go ahead and we're going to administer a second dose um and you can go ahead and you can continue administering doses of Naran until help Ares so you can give more than two doses if necessary we do um recognize that people do report that they oftentimes have to give more than two doses so this is the recovery position getting people on their sides again it's a more comfortable and safer way to folks for folks to wake up um I always like to remind people that Narcan is just providing that kind of temporary block on those opioid receptors so um that lasts for about 30 to 90 minutes depending on when the person has used the substance and how strong the substance is so we want to make sure that we're being mindful that that opioid may still be in their system so even after they have um we've you know helped them to return to breathing and it looks like they've started to come around they may still have substance present in their system and they can return to overdose um usually people respond in about 3 to 5 minutes some will require more doses um especially with fentanyl people will be um generally pretty confused when they come back around we want to make sure that we're being reassuring we have them in that recovery position we let them know that they're safe they're probably not feeling good so where can um any Community member get Naran so we can now um everybody can get at the pharmacy like I said we all have a standing prescription for Naran here in Massachusetts so uh your local pharmacy if you just go in and ask um they will be able to provide provide it to you you may have a small co-pay depending on what your insurance is um pretty soon we will be able to get it over the counter I do know that you can actually purchase it on Amazon which is great um this is great for like reducing stigma that's associated with overdose and substance use but maybe cost prohibitive for some people it's going to probably be around $75 per kit um at the um at the store over the counter um you can get it from any of our locations you can either come and grab it or we can we're happy to go out in the community and drop it off um it is also available in noock boxes you may have seen these there are three in chadam so there's one in this building here um there's one at the community center and then there's one at the fish Pier as well so each of these kits um this is to encourage more widespread Community um distribution of Narcan this is a great Anonymous way to get people um who may not have access um readily to Naran um Narin in the community so there's a face shield in here there are about um three to four kits usually that sit in these boxes like I said there are three of these in chatam um yeah so this is just a map of some of the other noock boxes that we've installed on Cape Cod we have about 40 approximately now um and we just got some really great data out of Falmouth which we know has always been a really high-risk Community for overdose um we've installed 13 noock boxes in Falmouth over the past year and for the first time in 10 years the Department of Public Health recognized that the town of chadam had had a marked decrease in um overdose which is really great so that shows us that it's doing exactly what it's supposed to do taking care of your Naran we want to protect it from direct sunlight and exposure to temperatures that are extreme on either end of the spectrum it's important to keep your Naran where you'll use it so if having it in your glove box makes it more accessible to you but it gets hot or it gets cold you just want to replace it more frequently also when in doubt use your Naran even if it's expired even if it's been exposed to somewhat extreme temperatures it will still retain most of its potency so when in doubt go ahead and use that Nar can um and if you keep it um in a place where it's exposed to extreme temps replace it more frequently you don't have to dispose of it any special way um when you get rid of your Naran I like to keep my um expired doses so that I can demonstrate to people how to use it you might like to do that too or you might just want to throw it in the trash that's okay um if you ever use your Naran in the community the report backs that we get from folks um are really really valuable to us they let us know where we need to do a little more distribution in the community where maybe we should do a little more training it also helps us familiarize with some trends that might be happening so if somebody is reporting to us in Brewster that suddenly they're having to use four doses of Naran on someone who's using this substance and that's never happened before and then maybe we'll hear another person in Brewster also report that to us um then we know that maybe we need to be working a little bit more um with Brewster or that there's something in Brewster a substance that we should be aware of and um this also helps us when we work with local police and fire departments so if you okay we just talked about that if you respond or witness an overdose also we have um again we have the post program so our post program works with people who have experienced an overdose or um family members Etc we know it's a really traumatic event to witness um and also to respond to so if anybody needs support after that um we have lots of folks in our organ organization who are trained to do that as well and that wraps that up does anybody have any questions board members other questions Ron did you say that anyone can that's we get that all the time uh can anyone just go into a drugstore and get one themselves they don't have to have a prescription or anything everybody in Massachusetts so there's a doctor um named Dr Alex Wally who works a lot in um substance use medicine um addiction behaviors Etc and he really pushed for this bill in Massachusetts that would enable everybody um to have what they call a standing prescription so it is legal to carry it's legal to purchase and um anyone can walk into a pharmacy and get it yes how expensive is it buy so if you buy it over the counter and it's not yet available in stores here on Cape that I know of um people might have like a $5 copay in their insurance there's some insurances that have a z co-pay um it also depends on how many you get per per month um you know now doctors when they're prescribing pain medication will automatically advise that you also get Naran at the pharmacy um so yeah so it's readily available and people will not be flagged if they um use their insurance to get uh Naran at the pharmacy that's always a concern for people am I going to be flagged as you know an opiate user no you will not so yeah um and then um where did you get your funding from again sure so we have a bunch of different funding sources but our overdose education and Nar and distribution um this particular funding is provided by the Department of Public Health from the state yes correct okay and then how do you sort of navigate the situation where you're treating the overdose but then you're there's concern about getting the patient into treatment yeah rehab I mean how do you you would try to have some of that occur so how how do you navigate that yeah so after you know after someone responds to an overdose um you know generally like if we we get lots of referrals through our post program and that can come to us through um police departments it can come to us through individuals who are self-referred um folks kind of sometimes are referred from their doctor or their practitioner who are saying you know this person could use some extra support a lot of people after they experience an overdose are not ready to go to treatment so harm reduction after an overdose especially is really really important making sure that people have um have Naran they have access to Supportive Services perhaps they're not ready to go to treatment but they would try something like Suboxone or methadone or maybe some outpatient services so if they do end up going to the hospital the hospital will you know um contact their primary care provider provide you know the reasoning why they were um you know brought to the emergency department and then usually we'll get referrals from there right so you get referrals from somebody that hasn't had an overdose they just want your services sometimes from sometimes okay great um questions from the people in the room or online we just no okay all right well thank you very much that's great you're welcome go ahead uh can someone just buy it and have it oh yeah in other words if a parent or grandparent knows one of their children are on that they could have it yeah absolutely we work a lot with um grandparents who are raising children of parents who experience substance use issues sometimes those parents have supervised visitation in their homes and they want to make sure that you know everybody is safe so they um they'll access Narcan yeah the aim of um putting Narcan in the noock boxes and doing these Community trainings Etc is to make them available to anybody who wants to know how to to use it and is interested in carrying it yeah it's funny i' never heard of that for you know until we started but I questioned a couple of kids that I know in the neighborhood there and they all know what it is what it's used for it's amazing yeah yeah I mean we're seeing here in Massachusetts one of the highest Rising rates of accidental overdose is in the 15 to 25y old age demographic so that really tells us that these kids are buying pills that are laced with fentanyl um and that they're trying substances maybe for the first time and AR opiate naive and experiencing overdose um so it's scary it's important for parents to know it's important for grandparents to know um and it's important for I guess young people to know as well yeah so so you interact with the schools as well directly we do yep all of the school nurses on Cape Cod um have Naran that we have provided them um Distributing actively Distributing Naran in school is a much bigger higher level issue um the school resource officers most schools also carry um you know also carry Naran you can't really have a noock box in schools at this time um but um like a private entity like fouth Academy has a noock box um because they are a private entity it's different working with the public schools but yeah all the nurses all the nurses have it yep we get referrals from them as well so all right yeah well great that's uh terrific information um and um this will all be archived so actually people can access this talk later on through the town website so wonderful move on we have we got a big schedule yeah thank you so much for having us thank you okay um next we have Morgan Eldridge from the fishing partnership Support Services good right okay thank you all for letting me present to you about our um organization uh we are fishing partnership and our mission is to improve the health health safety and economic security of commercial fishermen their families and their communities we have three program areas community health safety at Sea and economic security all of these program areas aim to improve the overall health of fishing families so we have four port offices in Massachusetts all in the major uh fishing ports New Bedford Gloucester Plymouth and in chadam this is our chadam office uh we have four Navigators or community health workers in this office here in chatam three full-time and one part-time which we just hired this year uh the need for our services has increased uh significantly Over The Last 5 Years um and in case you were wondering community health workers are they are basically public health workers that are embedded in the community sometimes in community health centers sometimes hospitals and they are using um their experiences and their cultural competencies to help people connect to services and referrals within their Community um when they need them one of our major programs is health insurance navigation we are Navigators with the health connector and Mass health um which means that we're trained at the highest level to be in the community to help people um navigate enrollment apply for coverage um troubleshoot their their Co their enrollments or applications access Primary Care Behavioral Health Services and Specialists we are the only Navigator organization from Yarmouth to Provincetown and although we work with fishing families this specific Grant requires us to work work with the entire community so we help anyone under the age of 65 access health insurance and just to show you what some of those numbers look like in the last year our fiscal year um we assisted 261 consumers with accessing um assistance of the uh with their health insurance 200 of the um of the or 204 of those were um health Connector enrollments which means that they were not um they had either no subsidies or they had some subsidies I'm not sure if you're aware of the programming and how that works but I can explain it to you and um of those 204 health Connector uh assisted is connector care which means that this is a population of people that have a income under 500% of the feder federal poverty level they're receiving subsidies in two ways federal tax credits and a state subsidy which means they have a z deductible we also assisted 57 Mass health consumers and did over 202 200 enrollments 120 of those were uh connector care plans that's a big population to have in the on Cape Cod to have received that many um that much of a of help we also provide yes do you know what the what the federal poverty level is now for a family for for a single person yeah yes it's $75,500 so half of that yeah so F that's up to the 500% yeah y thanks the maximum amount so that's that's for 2025 um so our we officer we also offer mental health and trauma support so our fishing communities have and in chadam recently have experienced a couple of losses that can tend to be extremely difficult to navigate especially a population that is challenging to admit when they need some help um we offer uh counseling for fishermen and their families um and in response to any tragedy we can uh mobilize to be in that area to help the community um or the family with Services we partner with Riverside Trauma Center in out of dam um we've educated their providers on the fishing industry um what it's like to live in a fishing family be a fisherman being independent resilient hard-headed um and uh we've been able to offer um 64 people with direct support to that counseling our organization um has has also been able to secure three free counseling sessions for anyone in the fishing industry um and that's a 24hour response we also offer opioid education and Narcan distribution uh in years past uh we have partnered with AIDS support group uh they offered trainings at our trainings um since 2023 we have received funding to train all of our Navigators or all of our community health workers to administer that training we have um adopted a way of doing this by training fishermen as First Responders uh non-traditional First Responders so as a as fishermen are they're out on the water they're working um and if there is a overdose or they they know there's a vessel that is nearby that has had an overdose they are typically the first to respond the Coast Guard can take a couple of hours to get to that that vessel um so they're there and able to help and save a life here we offered this training in um in inside of our CPR and first aid training so we we all we bring the oen training to all of our safety and survival trainings as well as our CPR in first a so we've always Incorporated it into something else to to normalize it um there is a stigma around fishermen and uh for as being substance users um and we have worked very hard to break that stigma um we have made them understand that they are actually able to save a life or why they are at a higher risk of developing a substance use disorder um which is the work that they do is not something that is a typical 9 to-5 it's not something that you can leave and go to the doctor if you're in pain um and fishermen are more likely to be prescribed opioids because of the work that they do and they're 11 times more likely to die of an opioid overdose so we also worked with the commercial I mean I'm sorry we we worked with the United States Coast Guard in southeast sector New England um and we helped they developed a marine safety information bulletin and encouraged all man Mariners to carry Naran so that fishermen felt more comfortable carrying Narcan on their vessel they didn't feel like they would be boarded and scrutinized and possibly charged with something that um that they that could you know get them into trouble um so here are some of the numbers that we have for our training events and these were all cape and Islands Focus trainings yes so uh most do do most of the fishing boats out of chadam carry Naran if they're on overnight um if they have come to our training um they have most likely received Naran so you think how many you think half of them carry it or a few or um so I'm these are the let's see through our trainings if you add these up this is all of the cape I mean that's a range of people from all over the cape so people from chadam may be going to a training in Falmouth and people from you know like well Fleet are coming here to a training so it's hard to determine exactly what the number is for chadam fishermen that are carrying um but it is likely that most of them are are carrying the the Naran on their vessel um we in our uh first aid and CPR class we give all vessels a first aid kit with $250 or $300 worth of supplies and in that is four doses of Naran so if they've done if they've gotten that kit then they've gotten the Naran and whether they're carrying it on their vessel or if they're leaving it in their truck either way they they have it okay thanks um I think that's it I was keeping it brief because I know there was four of us that were here so um I'm happy to answer any questions if you have any questions from all the board members no you're Community Health um workers you said you had four are they employed by your the alliance or these people that volunteer their time and have other jobs so we are fishing partnership we're not the alliance um fishing partnership Support Services yes all of our Navigators are employed by fishing partnership um it's a full-time job for them full-time we only have one part-time Navigator who will um hopefully be full-time after the budget is uh completed um but in the state we have nine community health workers so nine Navigators wow and then where does your funding come from so we have funding from multiple sources we are um lucky enough to have funding through the eohhs money um in the state our um other funding is through CDC and ni um for the safety trainings um so some of that money comes from Homeland Security money um in the naos and um we then we also have smaller grants uh we recently got a Blue Cross Blue Shield grant for um developing some mental health uh curriculum and um and uh uh work there and then I'm trying to think I think we have it there's funding sources from all but those are are our two biggest ones great thanks um any questions from uh in the room or online okay yes to the mic please right what up at the table here the mic can you go over to the mic otherwise that's okay is the green light on you said push the button you said that you supply um first aid in Nar cam to the when they take the course are they responsible for replacing that you give them a list when the items expire so yes they get a so the first aid kits are very well organized they have inside the big kit they have um individual bags based on um the type of response there's consumables there's um um you know splints there's all the and there is a list a a laminated list of everything that is in there so once they do use it they they do have to replace it on their own right now we are hopefully um as we saturate the industry with these first aid kits hopefully we'll be able to use some of that funding to um refill the kits uh but right now we're just focused on getting those out there and encouraging them to refill them when need to okay yeah thank you you're welcome and there are other sources like the aid support group that could help re you know resupply them um yes with the with the Nar so in addition to the trainings anyone can come into our office and get a Naran kit if um they need to all of our Navigators are trained to do one-on-one trainings are one-on-one handoffs like a warm handoff um so we we can we can do that in the office as well in all of them yeah that's great okay great great information and like I said this will all be archived and available through the website so people can hopefully look at it later on as well absolutely um thank you thank youg thank you and our next uh uh speaker is Leah lacrosse director of chatim community services we'll talk about services from the town of chadam okay good evening everybody um um my presentation is a little bit smaller than the rest so um I figured that I would just first give I thought it was important um to give an overview of the community services department because it is a new Department in the town of chadam so um the department came about it was founded in 2022 um first director hired in July of 2022 sorry what am I doing oh thank you I'll wait till it says it is he's doing it for you there we go thank you Mark um so we were founded in 2022 the first director was hired in July of 2022 that's me um and then in January of 23 we hired our deputy director of commity Community Services um for the recreation and beaches division Amy Howell um so this the way it's structured is um Amy is overseas the recreation in beaches division while I oversee all of it I also serve as the Director of the Council on Aging or as it's known now the center for active living um and also um recently added in May was our adult social worker Diane Nash um if you haven't met her I I encourage you to she's fantastic we're still in search of a youth social worker right now um but Amy oversees all the recreation and beaches staff including um all of the the staff that comes about in the summertime the lifeguards the seasonal staff and I oversee directly the sefl staff as well as the social workers worker right now um we have a lot of services that are offered at the seal and we're adding more every day um we have a very dedicated team of staff that we we try to brainstorm new services that were needed and new Services as we see the changing needs of the people who come um to get services at the seel right now pretty soon you're going to hear about shine I don't know where Pat oh there's Pat you'll hear about shine um which is serving the health insurance needs of everyone uh you'll hear about that next um but we have a a rather large durable equipment um durable medical equipment lending library so if you're having surgery if you're having a knee replacement or or you're in need of a wheelchair or a walker Something's Happened you've taken a fall um we have a lot of that equipment right on site and you can sign it out there's no do due date you bring it back whenever you're done with it um now we are so proud to offer Clinical Services as I said our clinical Department right now is a department of one uh she's very very busy but she has um she works very closely with the police department as well even though she's part of the community services department her office is located at the police department we did that we kind of planned that strategically um because most most of the time we're alerted to a Behavioral Health crisis through the police department and so this way she's in the office she can go right to that call and be there right at the time that she's needed most um so she will see people wherever there are she makes home visits she sees people at the um Council on Aging we have a lot of older adult adults that are in need of her services um she makes a lot of referrals out she does not do counseling like individual counseling she will not be somebody's direct therapist long-term therapist but she'll make sure you get the resources you need um our Outreach Services are extensive I just put in fuel assistant applications that's one of the things we do this type of year um right now we have one full-time Outreach coordinator but she will um help with fuel ass assistance applications if somebody is experiencing um financial difficulties and needs help with rent she will refer them to the correct Services make those phone calls um she'll help with with any really to provide any resources that are needed especially um we're seeing a lot of of food insecurity right now as you can imagine with grocery prices and rent prices um so we have one of our bigger programs is healthy meals in motion and that's run in conjunction with the Family Pantry of Cape Cod basically even though it's run out of the cell anybody you don't have to be an older adult to qualify you just come in and see our Outreach specialist you fill out an application which is basically just your name address and phone number no income requirements and then you're given um a it it looks almost like a um grocery list order form and you check off what you want once a month I send those into the Family Pantry and then on the third Wednesday of the month a great big giant 18wheeler appears with all the groceries in the back and the people who are part of the program line up at the seaal in front and we load the groceries in your car and you go it's uh a very popular program when I started I think we only had 14 people enrolled and now we have 42 um um so and and actually we're filling out more and more enrollment forms every day again as you can imagine uh food insecurity is huge right now um also once they're signed up for healthy meals in motion they can also visit the food pantry every 10 days if they um they don't have to wait just once a month for that our newest program this past year um is sorry the now serving for to families should have been on the healthy meals em motion so I apologize yes question just to back up so do you deliver meals to to uh homes of people so we are um the answer to that is yes we are the only um COA on the cape that actually most every um COA on the cape participates in healthy meals and motion but we're the only COA on the cape that will if somebody is unable to pick up their groceries we will deliver them to their homes we have several that we deliver to is that done by volunteers to the COA it's done by our drivers our paid we have four um paid drivers that work intermittent hours and and Leah you also have Meals on Wheels which runs out of that's Elder Services correct yes so that's a a great Point Judy thank you um H um Meals on Wheels is actually a program even though we have the the the person the staff person located in the um Center for active living it is run it's a program run and managed by Elder Services of Cape cot we just lend them their space and then they do deliveries to people at home every day so you have four full-time paid drivers not full-time they're they're more when needed as needed per DM and then they will drive where else will they take people to doctor's appointments and therapy and to Boston for an appointment or how does it work great question so we we have drivers we're doing right now an average about the answer to that with the exception of Boston is yes um we do Ride Transportation rides Monday through Friday right now we're averaging between 22 and 32 rides per day believe it or not um and they are to and from medical appointments we do only because we don't charge for these services we only go as far as hyenas um but where we leave off the ccrta picks up um they do have a bus that goes to Boston for medical appointments several days a week um so we do that we have some people will call in orders to the grocery store and charge them and we'll go pick them up and bring them we do prescription deliveries to people at home um if there's availability we will bring them um um to hair appointments or to the bank but we prioritize medical appointments first and foremost so thank you yep um one other thing we also bring them to the Orleans Day program back and forth because we haven't had an adult supportive Day program here in our town Orleans um does so we have been bringing residents to that program um a few times a week is the Orleans Program full or um I don't know if they're full right now but we're going to be that's actually on the next slide so I'll tell you more about that um chat and better together is one of our newest it's on the next next slide sorry chat and better together is um one of our newest programs and as I said we try to build programming when we see the the different needs we were seeing a lot of um individuals coming into the seaal and saying that they were um really kind of feeling this desperation um this loneliness that was bordering on a desperation they were isolated Alone um their kids lived in different states and their grandchildren they didn't have anybody so we applied for a grant um and through the Massachusetts Council on Aging we got a grant to start a pilot program chat them better together um and what it does every month it brings together right now there's about 35 individuals that come together and we do field trips um we do things like I I think this in the past two months we've gone to um done a chadam seal tour they're going to the Glass Museum uh this week and then they have a a lunch they've also done tours of the police department and the DPW and the fish Pier all sorts of things this group has bonded tremendously um and we were fortunate to have um some Anonymous donations and a donation from Bill bogdanovich in broadreach healthcare to continue the program this year so that's that's been wonderful um we do blood pressure a free blood pressure clinics through the VNA foot care clinics um and thanks to the great staff here um they do we do Flash TV which it started out as our program person reading our newsletter on the air for chadam TV for those who had difficulty reading and now it's expanded to all of our community services and we offer classes on proper exercise and nutrition coming up in January we're very excited to report that we're starting our own adult supportive Day program the Riders Cove respit program we received a $274,000 grant to fund the first to start it up and fund the first year um it'll take place on Tuesdays and Thursdays at the sefel it'll offer respit care um respit services to caregivers who have been caring for their loved one with cognitive um with dementia dementia related illnesses uh it's going to be a very person centered offer person centered programs what that means is we're going to meet with you as a caregiver and say what's most important to you and the person that we're caring for what are the goals and we're going to build that programming around that um they'll have a l healthy lunch and a daily snack they'll go on field trips there's going to be a lot of Art and music because that um we've learned through research contributes to to um a healthy mind so we're very excited about that uh We've hired a director and we're putting things together and hoping to open that in January and other than that I think I know there are more services we have um but if you have if anyone has any more questions uh questions from the board um okay I think uh yeah I think uh I asked some as you went along but uh that's great so this like I said this will be archived so people can refer back to it and um great uh any questions from the public or online I don't see any um all right great thank you very much thank you and then we have um Pat Burke for the shine program coordinator which is also a Council of Aging um service Le and I work closely together yeah she got my slides right up there thank you very much I've been here a few times as you all know my name is Pat Burke um I'm a shine counselor in chadam I'm also on working with Le on the COA board of directors and I would like to say one thing before I start I think your the information that people learn from your meetings is invaluable and I talk you up all the time and I can't understand why more people aren't here well you can go to the website and you can get into this meeting the the actual meeting and Sol video and I think a lot of people hopefully a lot of people look at it later in the evening or whatever um but I was talking up to the finance director today I sent him the community needs assessment thank you so Medicare open enrollment that's really what we're going to talk about happens every year let's see oh almost talk about shine serving the health and insurance needs of everyone on Medicare except we also help anyone who comes in we um have worked with uh Morgan on people who um need Mass health applications and she's been a lifesaver to us our program is federally funded through the administration of Community Living which is a part of the Department of HHS we provide free unbiased health insurance information counseling assistance to Massachusetts Medicare beneficiaries of all ages and their caregivers we also do screening for public benefit programs there are 13 regional office covering in the state and the Greater Boston Chinese Golden Age center there you go 600 plus shine coun 60% of the shine counselors are volunteers always a question I get when I'm doing my shine counseling how can we help you what we do is help Medicare beneficiaries understand Medicare and Mass health rights and benefits we educate people on about all of their health insurance options what happens most of the time not in open enrollment but during the rest of the year people come in and say I'm going to be 65 and I have no idea what to do and unfortunately the the system is rather complex and when people are trying to decide oh my God what am I going to do I thought this was free it's always they're always all of us are always able to give them and try to alleviate some of the feas that they have and say you know you're going to be all right we're going to get you signed up and you'll be all set we try to educate consumers with limited resources on the programs um uh I know about Morgan's program and other lowincome programs that are available there are big new Medicare Savings programs that H have come into effect um over the last um year I think and for those programs there's no asset tests so they're just looking at monthly income and those programs are are are valuable and helping people pay if they have high cost drugs if they're on an inhalers or eloquest or zerto or any of those drugs that cost a gazillion dollars and they'll they might pay their Part B premium they sometimes can get um SNAP benefits so it's it's a a program that they're really trying to push because they've lowered they've taken away the asset test so you can have they don't ask about your house or your 401k or anything they ask how much money do you get a month so I think we've seen a a a relatively uh large increase in people being able to utilize these programs see what else so 101 F everyone knows what medic I think everyone here knows what Medicare is yes no one um so if someone comes in for for an appointment with you you can actually sign them up for their Medicare benefits right at that time go on the website and do the whole thing yes I can I have great power with permission Medicare is as everyone knows the federal health insurance program that helps with the cost of health care it's not comprehensive it does not cover all medic medical expenses um or the cost of long-term care there are three different parts Part A which is Hospital insurance that is free 80% covers 80% Part B is medical insurance covers 80% but you have to pay for that part D is Pres prescription drug coverage and part C is what is now called Medicare Advantage Programs which include ab and usually poy and I will talk about those later because there's some big changes with those um who's eligible if you're 65 or older if you have flatty work credits through payroll tax you're entitled to premium free part a if you're under 65 and you receive 24 months of ss uh Social Security disability payments you're eligible you get automatically get signed up um you enroll and find out if you're eligible through the Social Security Administration www.ssa.gov and it's really important to have a my Social Security account because that's the only way you can enroll what did I do here okay so quickly there are many enrollments periods there are seven months around your 65th birthday which is called your initial en rollment enrollment period any time during that time excuse me you can enroll in U Medicare A and B or just Medicare A if you're still working and have insurance um January 1st to March 31st is poy enr if you miss your poy enrollment that's what when you can enroll General enrollment Massachusetts has um the Medicare Advantage has an open enrollment plan January 1st to March 31st only if you are already enrolled in Medicare Advantage plan anytime between then you can change to another Medicare Advantage plan or opt out back to traditional Medicare October 15th through December 7th is open enrollment happens every year the dates are exactly the same we are very fortunate here in chadam that we were able to serve people 5 days a week um all day right and um we are one of we do have a couple left I got a couple of people from howich coming tomorrow because they're they're mostly booked you also can get a qualifying event if you move or retire or if you're incarcerated anything like that you have what's called called the special enrollment period so Medicare is not going to tell you to enroll when you're 65 unless you already get the social security so you must call Social Security or go online and enroll Medicare and Social Security are two entirely separate programs but to get Medicare you have to go on to Social Security now it's very easy to enroll online you if you have a my social Security account you click Medicare and it walks you right through it it it it's not a difficult thing to do but um we are able to help people with that I've set people up with my Social Security account so they can get through the programs delaying Medicare Parts B and D so this is interesting um you need to decide if you want to take Medicare part A if you delay Medicare part A there's no penalty if you are still working uh you're still getting health insurance through your spouse you don't have to sign up you can sign up when you're 65 it's free but if you're contributing to a health savings account you have to delay your Medicare part A because you need to have about six months not contributing to that account before you can sign up if you do not sign up for hot be when you are initially eligible and you do not have credible health insurance there is a lifetime penalty for not signing up for Medicare Part B and that is 10% for every 12 months that you haven't had Medicare Part be I can tell you that I had someone come in to see me recently and theen y was 100% because they had not signed up for 10 years so it was a bit shocking and I hate to tell give people such bad news if you enroll late in a party which is a drug plan you have two months after you sign up for Medicare to oll in a party plan there was also a lifetime penalty for that and that is um they figure that out they gather the aggregate of what the um Medicare drug plans were and what they were paid and then they tell you what the penalty is it depends on how long it hasn't been I've had people that have come in that had a $40 a month penalty and people that have come in that have had a $4 a month penalty but that penalty is Lifetime as well and it's unfortunate yes so if you're signing up and say you're not on any any drugs any medications the numbers work out so you should still sign up for Part D and pay for it it doesn't matter whether you're taking drugs if you don't sign up for it right but they may feel they don't need it they don't ask they just say do you have a plan they should still sign up anyway so you would sign up for the um the most in inexpensive one right um as a I said there are two parts two choices original Medicare part A and B well with original Medicare you add a Part D which is a prescription drug coverage and you can also add what's called a Medicap they're a Medicare supplement insurance we are fortunate here in the state of Massachusetts we have seven providers that offer Medigap insurance they there are there are two types of Med Medigap Insurance you can get regard they are regulated through the Massachusetts insurance industry and regardless of what the provider charges you they are all required to give you exactly the same thing so people that are paying more money aren't getting better benefits there are two types of those plans and they do tend to be you know they're a bit more pricey they can go anywhere from a $115 up a month for the lower plant up to 20 $85 a month which you know it can be quite costly you have to have some funds to be able to do that the Medicare Advantage plans Medicare po C I'm sure you've all Seen Those ads on TV you know put your uh ZIP code in and we'll give you a free ride to somewhere I don't know where my husband keeps wanting to put that zip code in and I told him he's going nowhere Medicare Advantage plans include everything they include part A Part B and Drug coverage almost all of them have drug coverage there are a few that don't but they usually include all three so your pot B payment goes right to whoever your Medicare Advantage provider is and it's one one bulk payment these these plant have multi a multitude of types of costs they can cost anywhere from $0 a month to $240 a month they can be they they are um because we live in Massachusetts they are very good plans the plans that we have here are very good plans the challenges we have here as we live on cape card there are only three providers that provide Medicare Advantage PL on Cape Cod they are Blue Cross Blue Shield toughs and Fallon one and those are the only ones and I'm going to get more to that so we talked a little bit about your Medicap there are two types supplement 1A available to all who are eligible it covers pretty much everything the only thing it doesn't cover is uh once a year um $240 $240 poy payment um these can be costly though you know a supplement 1A plan is is is 200 at least $230 a month supplement one is what people often refer to as medx bronze and those plans are available to people as as you can see who turned 65 before January 1st 2020 and those are the most expensive plans and they cover everything the the the positive with these plans are you can go anywhere you don't need a primary care doctor you don't need a referral you can go any place within the continguous United States Hawaii and Alaska and parts of Canada and you will be covered you will not get a bill everything will be covered and that's why people choose these plans they have they have discounts you know if you enroll early if you don't get everybody the paper list billing they have a few they've added a few pluses some of them have some dental coverage some of them have for a couple of bucks you can get um I and ear coverage which is helpful now we're back this well okay we Medicare open enrollment once a year October 15th through December 7th uh January 1st is when if you change your plan when your new plan will take place the only reason it's important is well the one reason is because there are changes every year every single year this year we saw dramatic changes with the inflation reduction act we saw changes in the number of of uh providers for uh Part D plans we saw prices go up significantly in many of those plans and we also saw some changes that were positive for people on um expensive medications because they can only charge you $2,000 in a year there's no more donut Hall like Gap coverage they can charge you $2,000 within a 12-month period for drugs if you go over that they won't you don't get charged for that but we look at those every single year and it's a good idea to come back in and just you know get a look at them make sure you have the best coverage for whatever you have it I can't tell you the number of people that have said oh I haven't been in I never came in and and then you say to them well you know you you're taking two things you could be paying 35 or $40 less a month so it is important wait a minute no oh you can do it yourself you can go on medicare.gov and log in and create account an account and it will get you to find your own Health and Drug plans if your medications are bought through um a drug plan they'll all be on there you won't even have to add them and you can look at the drug plans and see what um what's available what plan you have what's a better plan see how much money you're going to save it's it's not easy to navigate this website I will tell you that it's uh pretty busy right now but if you are going to go in you need to sign up for a medicare.gov account it's very easy all you need is your Medicare card your last name your date of birth and your current address with zip codo City and when your part A or Part B coverage starts they ask you to pick a username pick a password and pick a secret question and once you get that information you can get in and see everything you can see all um explanation of benefits any procedure you've ever had done that through Medicare will be on this website so it it's it it is helpful uh Medicare Advantage as I said those plans are um J January 1st you can change those plans if the the example here is is a bit appropo because I did um send to Judy something that had come out about the Medicare Advantage plans and I didn't have a slide Parton and it was a little wory but what I would like to tell you is this we have three providers as I've said Blue Cross Blue Shield has seven Med Medicare Advantage plans available to Cape to bille County one two three of them are hmos four of them are ppos Fon Health Plan has four and toughs has eight and all of toughs are hmos the the issue this year is Blue Cross Blue Shield when they were doing their contracts decided they were no longer going to contract with Community Care Centers the Community Care Centers on Cape Cod that are utilized for many of the people who have these plans are out of cave health services and two places in mashy and Falmouth so it's been a huge deal Blue Cross has not notified their um clients yet they plan to do that on November 15th but out of Cape Health Services has sent a letter to their um their clients letting them know that if their primary care provider is an outou of Cape Health provider they will no longer be covered by the advantage plan that they're on the that Blue Cross plan that they're on and they will um either have to pick a different Medicare Advantage plan or go somewhere else to get their care so this has been um we brought this to you know ran it up the flag to everybody and Julian siia got involved and I was on a call with him and he's you know trying to do what he can do the problem is you're notifying people November 15th open enrollment ends December 7th nobody has any openings and what people are having to do was called 1 1800 Medicare and it's a it's really challenging I dealt with this myself last week when with a client who had this and we were able to change our um primary care physician to someone at Fontaine but she was going to get a visit sometime in July of 25 and you know we don't even know if that will happen but we hopefully got her a primary care provider it is it is a very big issue here because a lot of people have these Blue Cross ma plans and um uh it was very concerning when we heard about it and listened on the call and listened to aave health talk the the CEO of out Cape Health was there uh the people from Blue Cross and it it seemed like it boiled down to what um where Outer Cape health and the other two uh Mash p and Falmouth fell in the heus um what's the word I'm looking for the quality metrics and that they didn't say what quality metric wasn't what they want it to be but when I was doing a little more research on this today I saw that almost all of their plans are almost all of their metrics are five stars but a few of them are like four and four stars so Blue Cross would like to be a five-star plan because that's a huge plus to be a five-star plan we have not had a five-star plan in Massachusetts in a long time so I'm sure they are looking to do that yes so if you sign up for a Medicare Advantage plan yes is the company obligated to find you a PCP locally no you have to search for it yourself call officers and find out if they accept it or not I mean what list was we went on the um Blue Cross website and looked for pcps in 02633 and they pulled up one one fellow at Fontaine and other people at at out of cap but we couldn't use them so we were able to um sign up for that person but you have to do it yourself right so the the big problem on the cape is is is getting a PCP so signing up for Medicare Advantage doesn't necessarily help you there over you have to traditional if you sign up for a Medicare Advantage plan you have to have a primary care provider you can't it's not like a Medicap plan have but do they does the company make sure you they provide you with one or is it up to you to find one it's up to you to find one so if you are on Blue Cross Blue Shield Medicare Advantage yes and you are a member of a Comm if your primary care is um either at Outer Cape health or one of the other two Community Health um centers in Falmouth um then you you're being dropped is basically what you're saying by Blue Cross Bo Shield Medicare Advantage so the choices then are to find another provider which we just said is very difficult could could another could they switch to a different Medicare Advantage plan the the challenge is this um the other two Fallon health is Fallon's a Central Mass provider um they're picking up more contracts on cape card um I am not 100 could not say with 100% that um they have a contract without a cape Health yet they were at they were working on the contract with Fallon health so that they would have a contract without a cape Health okay so that's and the all the the difference is of the Blue Cross plans three of them are hmos and the other four are ppos so the network is broader and often times people who are looking for somebody that may be outside of the Cape Cod healthc care system will look at one of these ppos because it'll give them a little more a little larger provider group all of the tough plans are all hmos so when you sign up for a toughs plan you're signing up for all of your providers are here on kcard so it's a it's a big change it really is a big change for people and um uh I would say more to come but there's not that much time left before people I did S suggest that um maybe they extend their final day to the end of January to give people more time to make the change but um they've changed who's on the call so I don't know the answer to that question is there um I mean contact your State Rep I mean I know Julian already knows yeah he knows uh I mean he was very um you know he was up he he was upset about it it affects a lot of people you know if we read the community based assessment you did 20 chadam is the second oldest population in in the state and Orleans is second and these are his constituents so he's trying to do the best he can the challenge becomes trying to understand what the process is and and because it's Medicare and because it the process is is is so complex it's difficult you know when you just come in at all of a sudden and say oh my God this is a nightmare but what can we do about it you know many many there were many ideas that were floated but unfortunately I do not think there is any Council on Aging or the county office that has any open appointments for open enrollment for people I mean we try to squeeze them in we we work hard in chadam to make sure we can squeeze in as many people as we can in the day you mean shine appointments yeah so we can help them you know but um Leah can you go up to the mic I can't do anymore no I just wanted to add to it that now they are to confirm with you because you may not know they are all full now including the county so everybody's full so I don't know the answer to that problem but I think it's important information to have I think it's important that that you know in case anyone ever ask you asks a question and you can always refer them down to um Alexis at the seal and she'll reach out to who's ever there that day or send an email to one of us and and we do the best we can to help people to call them back and see what we can do yeah so if you um early in the enrollment period if you went in and signed up for a plan and and then you get more information and you want to change the plan before the enrollment period ends can you go back in and change what you yes yes yeah so you can it's I mean I've been here more than once when we've had the primary care physician talk and that's the challenge I mean that this the woman who came in wanted to choose um a a physician who's listed on the Blue Cross website as taking patience and when you call she is not yeah so you know and and we've let them know that so that that maybe they can update their website but you know it is what it is but I think it's important information for everyone to know in in just in case they're in this uh dilemma the inflation reduction act this is the impact 35 maximum monthly co-pays for diabetes medications 5% Co insurance for po catastrophic phase coverage yeah that's all last year so that's done what happened in 25 was they eliminated the coverage Gap they put um out of pocket spending as I said at 2000s and now what they've done is they've developed What's called the Medicare prescription payment plan so let's say you're taking you sign up for a plan the deductibles the new deductibles are $590 on most drug plans and you are taking a lot of EX a lot of drugs and some expensive ones your cost in January could be $1,100 you can call the prescription the drug plan and you can say I'd like to sign up for this Medicare prescription payment plan and what they will do is divide the money over the 12 months so you will pay your premium and then you will pay for the drugs through the drug plan and then oh a little close to the mic there and then you will um not have to pay CVS or Stop and Shop wherever you get the drugs it it's a little um it's new this is the first year so um I haven't noticed anyone signing up for it yet but you would we can't sign you up for it you have to call a drug plan to sign up for that but it's a good step uh there are drugs in um uh coming up in this is what I just said you know so uh Mass health can help with drug cost the Medicare Savings Program as I said is extremely helpful to people who have high high cost Drugs High cost inhalers high cost um uh zerto uh elois all of these drugs that right through the roof OIC um people who are taking it for um you know type 2 diabetes prescription Advantage it used to be bigger than it was it's a little less now with the Medicare Savings programs um and there are manufacturers plans there are there is a place called meds.org so if you really can't afford it and you go on those uh that website you can often times get um get some help from people um Morgan talked about the health Connector we don't uh do too much of this we can for people um you know that are going to lose their health Connector coverage we can help them with that we can sign them up for Medicare if they're eligible but it's it's it's not not really a big part of our jobs um just some you know there are you can there ra strict guidelines uh people the people this is good information for people who you know stop watching TV after tomorrow and then once they'll be you know Joe namoth will be back and you know whoever else telling you that you can have all of these things and what what happened was a few years ago me Medicare received 161,000 complaints regarding those advertisements and so they've put some very strict guidelines into place that if you call one of those people they have to identify themselves as a broker or an agent for the insurance plan so that people not misled and don't get get get off at things that quite frankly they they're probably not eligible for and won't get in this state um so those are the things you can uh that are a positive that have come out of that because many of those advert advertisements were um you know people would come into to me and a 95y old guy came in and said what do you think should I switch to what Joe namoth has I said no you're good stay where you are so don't miss your deadlines disim roll from the health Connector if you're on it be sure your doctors are in the network of the Medicare health plan you're choosing that kind of a key point today uh make sure your meds are all on the plans formulary because sometimes they're not consider setting up your own medicare.com account and remember review your plans every year between 10:15 and 127 there a couple of little Social Security Medicare the mass College of Pharmacy they do some good Outreach prescription Advantage shine um unfortunately everybody's kind of booked up so there we go thank you very much great that's good information I didn't know I would be lost no that was great questions from the board for Pat or any from uh online or in the room no you guys but I'm going to keep talking you up you are excuse me I think you you need people really need to know what you're doing I think you're doing important work here and I I I don't think enough people know it so let me ask one other question one of the big things you hear is uh like chemotherapy drugs experimental drugs very expensive they're not in your drug plan uh chemotherapy drugs most chemotherapy is Poppy because their infusions administered in a hospital the the newer drugs like OIC I utilized uh that that's um so new you know they don't divide out who's taking it for weight loss versus who's taking it for type 2 diabetes you know it's very effective on type 2 diabetes I can tell you my husband's hemoglobin A1 he was nine he took OIC it's it's 5.9 I mean so it's a huge it's a very valuable drug you know we did lose a few pounds but you know it's good okay great well thank you very much it's good information I I agree and like I said it's it's archived so hopefully we can get the word out and uh get more of the knowledge around but I thank all the speakers um I think it was really helpful and worked up can I just put one more um service that we do have available I've mentioned before we have a recovery code in town who's here once a week um she is being supported by our opioid settlement funds um we have a three-year contract we're about one year into it and she's been very effective and been working great with our team here so anybody who um has any uh questions or concerns about families or their friends or has any type of substance Ed to order not just opioids um I urge them to reach out to Kelly um at the police department on Wednesdays or they can call us and we can help them get in touch as well so okay great thank you very much thank you um any other uh old business new business we have the minutes to approve from October 21st motion I'll make a motion to approve the minutes a second second um all in favor say I I motion are that the minutes of October 21st are approved and then I guess I can take a um motion to close the meeting I'll make that motion to close the meeting and all in favor say I I okay good we are adjourned thank you [Music] pap [Music]