How Congress Is Addressing Elder Justice in America

What recent hearings and upcoming legislation could do to help

By Bob Blancato

Credit: Adobe Stock

(Editor’s note: This story is part of Next Avenue’s month-long focus on elder justice, with support from The John A. Hartford Foundation.)

As the national coordinator of the national and grassroots advocacy group, the Elder Justice Coalition, I believe the need to address elder justice has become even more urgent recently. Congress appears to think so, too.

Elder justice is the holistic approach of preventing and handling elder abuse, neglect, financial exploitation and maltreatment for older adults. Lately, there has been a new and disturbing dimension of elder mistreatment: the disproportionate number of nursing home and assisted living residents dying from COVID-19 and the extent to which neglect and poor care is contributing to these deaths.

What’s more, social isolation and heightened financial stresses of the pandemic have likely increased elder abuse and decreased family and community members’ ability to spot and report it.

What Congress Has Been Doing and May Do About Elder Justice

Important Congressional committees have been looking into this and the entire Congress is likely to soon approve legislation to help.

The critical missing piece in Congress addressing elder justice is the need to reauthorize the landmark Elder Justice Act of 2010.

On June 25, the House Ways and Means Committee’s Health Subcommittee held a powerful hearing examining the COVID-19 crisis in nursing homes.  Prior to that, the House Select Committee on the Coronavirus held its own hearing discussing the root of the virus’ spread into nursing homes and possible courses of action.

In addition, last month, Sen. Chuck Grassley (R-Iowa), chair of the Senate Finance Committee, sent an important letter to the federal Center for Medicare and Medicaid Services (CMS) which led CMS within days to mandate the reporting of COVID-19 cases by nursing homes to the Centers for Disease Control and Prevention (CDC).

Two pieces of important elder justice legislation have been introduced in the Senate in recent weeks as well. The Promoting Alzheimer’s Awareness to Prevent Elder Abuse Act and the Protecting Seniors from Emergency Scams Act take important steps to limit targeted scams through training, educational materials or data collection.

Similarly, the Stop Senior Scams Act would establish an advisory group charged with educating retail and financial employees on elder financial exploitation. This bipartisan bill passed the Senate via unanimous consent this month and is being considered by the House.

Another bill, the Senior abuse Training and Offense Prevention (STOP) Act, would create a grant program awarded by the Department of Justice to support activities preventing, identifying and eliminating elder abuse. It’s pending in the House.

Additionally, the House’s Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act would authorize $500 million for states to set up “strike teams” assisting nursing homes. It would also create incentives for high quality nursing homes to create COVID-19 units and require CMS to provide guidance to nursing homes and data on case numbers.

And What’s Missing

However, the critical missing piece in Congress addressing elder justice is the need to reauthorize the landmark Elder Justice Act of 2010, the first comprehensive legislation to address the abuse, neglect and exploitation of older adults at the federal level.

There’s ongoing activity to move a comprehensive reauthorization bill forward, but it seems to lack the urgency the situation demands.

Congressional analysts expect that the bill, once introduced, will call for dedicated and increased funding for Adult Protective Services, a vital front-line essential service in the fight against elder abuse.

The bill will also likely strengthen the act’s Long-Term Care Ombudsman Program. It initiates investigations into abuse in nursing homes but has been essentially halted by the Trump administration during the pandemic. And the bill would continue the important work of the Elder Justice Coordinating Council, whose 15 federal agencies work together for a coordinated federal approach to fighting elder abuse and fraud.

The reauthorization might well also provide federal support for coronavirus testing of older Americans and PPE (personal protective equipment) for nursing home staff, visitors and residents as well as for ombudsmen and Adult Protective Services workers.

Finally, the bill will probably lead to improvements in Nursing Home Compare, a website from Medicare designed to help people make wise choices when selecting a nursing home. It has fallen woefully short lately. One example: the nursing home in Kirkland, Wash. with the first widespread outbreak of the coronavirus virus had the highest 5-star rating from Nursing Home Compare.

The best chance for Congress to meaningfully address elder justice will come with the next emergency package to deal with the pandemic. That package may well include the Elder Justice Reauthorization Act and nursing home reforms.

Doing so will not only note the need for elder justice funding but provide the money for it, too.

Elliot Kelly, an intern at the Elder Justice Coalition, assisted in contributing to this article.

Full Article & Source:
How Congress Is Addressing Elder Justice in America

‘Replace denial with proposal’ on long-term care, House committee told

“All viable proposals deserve to be vetted, studied and moved forward,”
Robert Blancato, national coordinator of the Elder Justice Coalition,
told the House Ways and Means Committee. (YouTube)

Congress must “replace denial with a detailed, bipartisan legislative proposal on long-term care” to address the needs of a growing older population facing high costs for healthcare and housing, Robert Blancato, national coordinator of the Elder Justice Coalition, told the House Ways and Means Committee at a hearing Thursday.

Blancato, one of six hearing witnesses, and Rep. Richard Neal (D-MA), chairman of the committee, both noted that assisted living costs more than $40,000 per year, on average.

“Navigating a fragmented and insufficient long-term care system can be not only confusing and emotionally taxing, but also enormously expensive – even unaffordable. …These high price tags weigh heavily on aging Americans and their families as they try to plan for future long-term care needs,” Neal said in prepared remarks, noting costs associated with nursing homes and home healthcare as well.

Long-term care-related costs are the biggest unfunded liability facing baby boomers, Blancato said in his prepared remarks. “Many older adults rely on Medicaid to fund their long-term care needs. However, states are increasingly considering waivers that would block-grant Medicaid, which could lead to individual caps on care funding,” he said.

Approximately 16.5% of assisted living residents rely on Medicaid to cover their assisted living services, according to the National Center for Assisted Living.

The National Investment Center on Seniors Housing & Care-funded study that found that 54% of the 14.4 million middle-income older adults in 2029 in the United States will lack the financial resources to pay for senior living and care, Blancato said, indicates that “future ability to privately pay [for long-term care needs] may be in jeopardy.”

The witness said “all viable proposals deserve to be vetted, studied and moved forward,” including those involving Medicare and Medicaid reform, to address long-term care costs. “I believe we can all agree that something needs to be done,” he said.

A “real national solution,” Blancato said, should include:

• A strong Medicaid program that continues to support home- and community-based services over institutional care.
• Possibly a long-term care benefit in Medicare.
• Use of the tax code to provide a “meaningful” tax credit for family caregivers and a tax deduction for the purchase of private long-term care insurance.

 

‘Disturbing pattern of abdication’

In addition to cost issues, Blancato noted in his prepared remarks, “We see a disturbing pattern of abdication by certain federal agencies vested by law with the responsibility to ensure quality care in nursing homes, assisted living and long-term care facilities.” He in part called for additional funding and training for long-term care ombudsmen “so they can expand their important work into assisted living.”

Hearing witness Richard Mollot, executive director of the Long Term Care Community Coalition, told committee members that alternatives to nursing home must be affordable, accessible and safe.

“Seniors and families want and deserve options to nursing homes that provide safety in a more home-like setting,” he said. “While most states are rightfully opening up assisted living to Medicaid beneficiaries, the utter lack of federal standards in this sector has, unsurprisingly, led to increasing reports of rampant abuse and neglect. Our seniors and their families deserve better.”

Mollot also cited “inadequate access to humane dementia care” as an issue involving assisted living and nursing home operators.

“Far too many facilities fail to anticipate the needs of individuals with dementia or equip their staff with the knowledge and skills necessary to provide comfort and care to residents who are experiencing common behavioral and psychological symptoms of the disease,” he said. “In what other industry would it be acceptable to be unable to meet the needs of the majority of one’s customers?”

Care planning benefit eludes most

Hearing witness Robert Egge, chief public policy officer of the Alzheimer’s Association, shared the findings of a recent study that found that in 2017, less than 1% of Medicare beneficiaries living with dementia received comprehensive dementia-specific care planning that could improve care, quality of life and medication management as well as reduce hospitalizations and emergency department visits. This is despite the fact that since 2017, physicians and other healthcare professionals have been able to obtain reimbursement for providing such care planning.

“For the benefits of care planning to reach more Americans affected by Alzheimer’s, more clinicians must use the care planning benefit,” he said. The bipartisan Improving Hope for Alzheimer’s Act (H.R. 1873 / S. 880), Egge added, would help achieve this goal by requiring the Department of Health and Human Services to educate clinicians and report to Congress on ways to increase the benefit’s use and on related barriers.

“This bill has already garnered significant bipartisan support in both chambers, and we urge the Committee on Ways and Means to hold a markup,” he said. “We look forward to working with the bill’s sponsors and committee leadership to ensure its movement in the full House and Senate.”

Watch the hearing here. Read witness testimony here. Read Neal’s opening statement here.

Full Article & Source:
‘Replace denial with proposal’ on long-term care, House committee told

It's Time To Make The Elder Justice Act More Effective

By Bob Blancato

Ageism can creep into public policy and negatively affect millions of older Americans. A prime example: the nation’s failure to prevent elder abuse despite the upcoming 10^th anniversary of the bipartisan Elder Justice Act in March 2020.

Passing that law took seven years. Back then, the struggle to get the legislation enacted was convincing lawmakers that elder abuse, neglect and financial exploitation were real issues. Yet there had been more than 45 years of laws defining the federal response to child abuse and domestic violence.

Unfortunately, the struggle continues today.

The Underfunding of the Elder Justice Act

The Elder Justice Act has received less than 10% of the funding that was authorized, especially with respect to achieving its main goal of dedicated funding for Adult Protective Services. What’s more, major provisions of the legislation — including the creation of forensic centers to help in elder abuse detection — have never been funded.

Why is that?

As the national coordinator of the bipartisan Elder Justice Coalition, I believe there are three factors.

The first, and biggest one: denial.

Many policymakers and their staffs still don’t acknowledge elder abuse and neglect as a problem. So, it is nearly impossible to persuade them that it warrants new federal money. Yet the Justice Department has clearly acknowledged the issue, noting that one in 10 people over 60 are victims and that victims of elder financial abuse can lose up to $3 billion a year.

A second factor for the failure of the Elder Justice Act to be fully implemented is a lack of reliable data showing the extent of this problem. In our world today, data drives dollars. Here’s one statistic worth noting: The Government Accountability Office says the recorded number of instances of abuse in nursing homes more than doubled from 2013 to 2017.

A third factor is what I call the “friendly fire” problem. Advocates against domestic violence have done a very effective job getting federal attention, but they haven’t extended their effectiveness to help advance elder justice. The irony is that the predominant victim in domestic violence and elder abuse is a woman.

Ageism at Work

It isn’t hard to see that ageism is at work here.

Any victim of abuse, neglect or exploitation — no matter her or his age — should be helped. Programs need to be in place that would prevent and detect abuse and provide needed support systems. This is not today’s reality. Elder abuse is the last element of our nation’s inter-generational cycle of abuse and lagging the furthest behind in terms of a response from policymakers.

Compounding the problem is lax enforcement of laws already in place for elder abuse prevention and prosecution, especially for victims of abuse in nursing homes. Earlier this year, in her Senate Finance Committee testimony, one daughter spoke about the death of her mother from dehydration caused by neglect at a nursing home which had previously received the highest 5-star rating from the federal government.

Champions in Congress and in the Trump Administration

Thankfully, there are a few strong elder justice champions in Congress in both parties.

Sen. Charles Grassley, the Republican chairman of the Senate Finance Committee, and Sen. Ron Wyden, the committee’s top Democrat, are working on a new Elder Justice Act. They’ve held two major hearings over the past few months.

Rep. Peter King (R-N.Y.) and Rep. Suzanne Bonamici (D-Ore.) have advanced important elder justice legislation in the House. Rep. Rosa DeLauro (D-Conn.), as chair of the Labor Health and Human Services Appropriations Subcommittee, has secured the funding that elder justice has today.

Sen. Susan Collins (R-Maine) and Sen. Bob Casey (D-Pa.) have ensured the Senate Special Committee on Aging addresses this issue as well.

There are strong Trump administration advocates working on elder justice, too, including Lance Robertson, assistant secretary of aging at the Administration for Community Living and Toni Bacon, who runs the Elder Justice Initiative at the Department of Justice.

And there are others in Washington. But not enough of them. How long will it be before the topic of elder justice is raised on the 2020 election campaign trail?

In testimony I delivered before the Senate Finance Committee last month I said: “…failure to improve the federal response to elder abuse may be one of the worst examples of ageism in public policy.”

Opportunities for Change

There are real opportunities to change things in Congress, though.

The first is the passage of the two-year budget agreement which will allow elder justice programs to get needed increases. The House passed its funding bill and the Senate is expected to in September. (You can follow my group’s website, ElderJusticeCoalition.com, for details.)

The second opportunity is passage of the bipartisan Elder Justice Reform Act, a bill that’s expected to be introduced in September. It will address elder justice issues including: more funding for Adult Protective Services and the Long-Term Care Ombudsman Program as well as strengthened criminal background checks of employees at long-term care facilities.

Anyone who has an older relative, friend or neighbor should demand the federal government do more to prevent elder abuse. Whether it’s stopping robocalls and scams or protecting older adults from opioid misuse and abuse, our voices need to be raised.

The solutions are there. We just need to muster the political will and the outrage to force action.

Full Article & Source:
It's Time To Make The Elder Justice Act More Effective

Statement from the Elder Justice Coalition on Report of Nursing Home Staff Shortages

The bipartisan Elder Justice Coalition today called for immediate Congressional hearings into a disturbing report issued this weekend pointing to chronic staff shortages in nursing homes.

The Coalition specifically asked the hearings to focus on the response by Centers for Medicare and Medicaid Services (CMS) to the report, specifically on how staffing shortages went unnoticed and on changes to the nursing home star rating system to prevent this problem in the future.

Bob Blancato, National Coordinator of the Elder Justice Coalition, said, “Although there may not be consensus on optimal staffing levels in nursing homes, this new data from CMS again reveals that many facilities do not have adequate staffing to protect the health and safety of their residents. Staff shortages can contribute to elder abuse—most especially neglect—and we must do everything possible to prevent this. The decision to place an individual in a nursing home is difficult enough without having concerns about the quantity and quality of the staff at a given facility, and grading facilities ‘on a curve’ is no way to ensure the safety of vulnerable older adults in nursing homes.”

Full Article & Source:

Statement from the Elder Justice Coalition on Report of Nursing Home Staff Shortages