Professor Nina Kohn Serves as Reporter for Two Uniform Acts

By Robert Conrad

College of Law Distinguished Professor Nina Kohn is helping to create “gold standard” legislation on some of the most important issues facing older adults and individuals with cognitive disabilities. Based on her legal expertise, including in the area of elder law, Kohn, the David M. Levy L’48 Professor of Law and newly named Distinguished Professor, has worked closely with the Uniform Law Commission (ULC) to create model legislation for the states.

Kohn has been selected not once, but twice, to serve as a reporter for the ULC. The first act she worked on with the ULC was the Uniform Guardianship, Conservatorship and Other Protective Arrangements Act (UGCOPPA), which the ULC describes as a “comprehensive guardianship statute for the 21^st century” that encourages person-centered guardianship reform, including promoting less restrictive alternatives to guardianship. The second act was the Uniform Health-Care Decision Act (UHCDA), a model law governing advance directives and healthcare decision-making for patients without surrogates.

Since joining the College of Law faculty in 2005, Kohn has been an active teacher and prolific scholar. Her research addresses a variety of legal topics associated with elder law, including age discrimination, family caregiving, elder abuse, and supported and surrogate decision making. She is also the author of the leading casebook on elder law. In addition, Kohn has taught on elder law, family law, trusts and estates, torts, and an interdisciplinary gerontology course. She has also served in a variety of public service roles for organizations such as the American Bar Association, the American Law Institute, and the Association of American Law Schools.

However, one of the highlights of her impressive career to date is being selected twice to be a reporter for the ULC, something she calls “the biggest compliment.”

“Being a reporter is part mediator and part editor, as you listen to and try to align the interests of diverse groups and commissioners,” says Kohn, noting that most states do not have the bandwidth to write this type of model law on their own. “Your function as a reporter is to enable a very deliberative, expert-informed, non-partisan approach that integrates various viewpoints and experiences into a model law that is as good as it can be.”

According to Kohn, the ULC model laws give states a solid, consistent starting point, which they may modify to suit their specific needs, budgets, or priorities. The details of the final laws are up to the individual state legislatures.

Kohn finds satisfaction in some recent successes in enacting the acts she has worked on. Consistent with the bipartisan nature of the acts, the UHCDA has been adopted into law in Delaware, a blue state, and Utah, a red state, in partisan efforts that will be beneficial to many. In addition, the UGCOPPA has been adopted in Maine, a blue state; the state of Washington, also a blue state; and Kansas, a red state.

She also believes that her expertise as a reporter has made her a better professor, as she is able to share with her students first-hand knowledge of cutting-edge legal debates and how the law is progressing on a state-by-state basis. Kohn reports that this work has also made her more sensitive about statutory drafting issues, and she has consequently spent more time in the classroom helping her students interpret, critique, and draft statutory language. She also says it has encouraged her to help students appreciate that even when people initially come at an issue from opposite viewpoints, there is often plenty of common ground to be discovered.

The work of a reporter can go on for years, but Kohn is prepared to stick with it in the hopes of seeing the two model laws enacted in as many states as possible.

“It’s hard to say ‘no’ when legislators are saying, ‘We’re interested in making our laws better. Can you help us?” she states. “It’s incredibly satisfying to be able to make a difference and see states improve their laws to make life better for families, patients, and health care providers. This process is an example of how we can work together in a partisan age, and it’s a source of pride to know that my work is helping to bridge differences and improve the law.” 

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Professor Nina Kohn Serves as Reporter for Two Uniform Acts 

New medical task force guidance says ‘no’ to screening older adults for caregiver abuse

by Donna Shryer

The U.S. Preventive Services Task Force has concluded there is insufficient evidence to recommend screening older adults for caregiver abuse and neglect, even as new data reveals the widespread nature of elder mistreatment.

In updated recommendations published in JAMA, the independent panel of medical experts found that more than 1 in 10 adults aged 60 and older experienced at least one type of caregiver abuse or neglect in the past year. Among abused seniors, financial exploitation affects 35%, while neglect impacts 34%, making these the most common forms of elder mistreatment.

Despite this high prevalence, the task force concluded that current evidence is insufficient to assess whether the benefits of elder abuse screening outweigh potential harms. This contrasts sharply with its strong recommendation for screening women of reproductive age for intimate partner violence, where evidence shows moderate benefit.

The evidence gap stems from limited research on screening effectiveness in older populations. Researchers reviewed only two studies examining screening tools for adults 65 and older, with mixed results on accuracy. One tool showed 46% sensitivity and 73% specificity for detecting abuse in dental care settings, while another demonstrated 94% sensitivity and 84% specificity in emergency departments.

The task force emphasized that vulnerable adults, including those requiring care due to physical or mental disabilities, face higher rates of violent victimization regardless of age. However, no studies examined screening tools specifically designed for this population.

Researchers identified critical gaps requiring additional study, including the development of accurate screening instruments for primary care settings and evidence on intervention effectiveness. The task force noted that screening could potentially cause harm through shame, retaliation, or false-positive results, but acknowledged the serious health consequences of undetected abuse. 

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New medical task force guidance says ‘no’ to screening older adults for caregiver abuse 

More than 41,000 retirement-age Americans died of falls in 2023. Here are tips to help prevent it.

By Sara Moniuszko 

More older adults in the United States are dying from unintentional falls, according to new data from the Centers for Disease Control and Prevention.

In the CDC's National Center for Health Statistics data brief out Wednesday, researchers found the death rate for falls in adults 65 and older increased with increasing age for both men and women. From 2003 to 2023, the rate increased more than 70% for adults ages 65 to 74, and more than 75% for those aged 75 to 84. It more than doubled for seniors 85 and older.

In 2023 alone, more than 41,000 retirement-age Americans died of falls — with more than half of those deaths among people 85 and older.

"Falls continue to be a public health problem worth paying attention to," Geoffrey Hoffman, a University of Michigan researcher who was not involved in the new report, told The Associated Press. "It's curious that these rates keep rising."

The data brief did not explore reasons behind the increase, but experts say there are ways to better prevent falls as you age. 

How to help prevent falls

Multiple health organizations, including the National Institute on Aging and the Mayo Clinic, say there are strategies to help prevent falls. 

• Stay physically active: As we age, our muscles lose mass and strength, which can contribute to falls. To counteract this, improving strength, balance, coordination and flexibility can reduce your risk.
• Review your home: Fall-proofing your home by removing unnecessary hazards — like electrical cords in walkways or loose rugs — and adding in helpful tools — like nonslip mats in showers and ample lighting — is another way to make your home safer.
• Use an assistive device: "Using canes and walkers correctly can help prevent falls. If your doctor tells you to use a cane or walker, make sure it's the right size for you," the National Institute on Aging suggests. Other devices like raised toilet seats, handrails or grab bars are other options to consider, the Mayo Clinic adds.
• Wear sensible shoes: Floppy slippers and shoes with slick soles can make you slip and fall, so opt for "properly fitting, sturdy, flat shoes with nonskid soles," the Mayo Clinic suggests.
• Don't ignore your health: Changes in sight and hearing are linked to an increased risk for falls, so it's important to get tested and wear aids as needed. Certain medications can also make you dizzy or sleepy, so be mindful and talk to your healthcare provider if you have questions or concerns. 

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More than 41,000 retirement-age Americans died of falls in 2023. Here are tips to help prevent it. 

DOJ outlines efforts to combat elder abuse, fraud in annual report to Congress

by Kimberly Bonvissuto 

With “millions” of older adults falling victim to elder abuse and fraud each year, the Department of Justice has released its sixth annual report about its efforts to tackle those crimes and prosecute offenders.

The DOJ’s “Annual Report to Congress on Department of Justice Activities to Combat Elder Fraud and Abuse” report to Congress outlines its efforts from July 1, 2023, to June 30, 2024, to combat elder abuse, neglect, financial exploitation and fraud.

During that period, the department pursued more than 300 enforcement actions against more than 700 defendants charged with stealing almost $700 million from 225,000 victims. The government provided services to more than 230,000 older adult victims and returned more than $31 million to them.

“Because millions of older Americans suffer some form of elder mistreatment each year — and because many more abuses go unreported or unseen — everyone has a role to play in this work,” Attorney General Merrick Garland wrote in a foreword to the report.

Working with partners including the US Postal Inspection Service, state partners and Medicaid Fraud Control Units, as well as law enforcement corpus, the department pursued more than 30 different types of elder fraud schemes. 

The scams with the highest financial losses for older adults — including senior living residents — were investment scams, where older adult lost $1.2 million. Tech support scams led to $590 million in losses, business email compromise scams led to $382 million in losses, romance scams cost victims $357 million and government impersonation cost victims $180 million. 

The department’s National Elder Fraud Hotline received more than 50,000 calls in the past year and helped older victims to report potential crimes and to local available resources and services. The five states with the highest number of calls were California, Florida, New York, Ohio and Texas. The most common types of fraud reported in those calls are romance scams, identity theft and business imposter scams. 

During a September hearing on fighting fraud held by the Senate Special Committee on Aging, US Sen. Bob Casey (D-PA), committee chairman, released the group’s ninth annual fraud book, “Fighting Fraud: Scams to Watch Out For.”

According to that report, FBI data showed that fraud losses among older adults reached $3.4 billion in 2023. According to the FBI’s Internet Crime Complaint Center, or IC3, investment scams were the costliest scams for older adults, with reported losses topping $1.2 billion last year, a 400% increase since 2021. 

The Federal Communications Commission reported that health-related scam calls targeting older adults tend to spike during Medicare’s open enrollment period, October to December. Last year, there were $17 million in confirmed losses due to healthcare scams. Mike Braun (R-IN), ranking member of the Senate Aging Committee, said that Medicare lost $60 billion in 2023 due to fraud, errors and abuse.

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DOJ outlines efforts to combat elder abuse, fraud in annual report to Congress

NH seniors continue to fall prey to scammers as schemes proliferate

Victim of a phone scam? The New Hampshire Department of Justice’s Consumer Protection Hotline is open weekdays from 9 a.m. to 3 p.m. and can be reached by calling 1-888-468-4454 or (603)-271-3641.

By Shawne K. Wickham

They pose as bankers, government agents, IT experts, lottery officials, romantic partners — even relatives — with one goal: Stealing your money.

Despite ongoing news stories and warnings from law enforcement agencies, more than 100,000 Americans fell for scams last year — and two-thirds of them were seniors.

New FBI statistics show more than 400 New Hampshire residents 60 and older fell victim to scams in 2023 at a loss of more than $11 million.

Why is this happening?

Kristen Setera, spokesperson for the FBI’s Boston division, which includes New Hampshire, said seniors are targeted for several reasons. “They’re often more polite and trusting,” she said. “They may be lonely and spend a great deal of time alone.”

But she went on, “We also think they’re a ripe group for targeting because they’re financially stable and own their own homes.”

Bryan Townsend, senior assistant attorney general, said that while not only seniors fall victim to a variety of scams, “They’re targeted first and foremost because they have the most assets.”

“They’re a generation that saved well, that planned well, they have a variety of investment accounts that they can tap into, and scammers know that,” he said.

Townsend, who is the lead prosecutor for the Department of Justice’s elder abuse and financial exploitation unit, said the number of people engaging in this kind of criminal conduct is on the rise, both within the United States and internationally. In some ways, we’re making it easier for them.

“The more that our lives become automated, and we purchase things online, and our lives become online, our personal identifying information gets shared, and ultimately gets stolen and gets compromised,” he said.

As the population ages, scammers are changing how they approach potential victims, the FBI’s Setera said.

“The younger seniors, the Baby Boomers, have more computer skills than the older seniors, which means criminals are modifying their targeting techniques,” she said. “While the traditional scam artists and bad actors will use telephone calls and mass mailings, now there are burgeoning online scams like phishing and email scamming.”

Scammers often insist on confidentiality in their dealings with their targets, and do research online to find out details about their targets to be more convincing, Setera said.

One-fourth are tech scams

According to the FBI’s annual report on elder fraud, tech support fraud was the No. 1 scam perpetrated on seniors last year, while investment scams were the most costly for that group. Nationally, total losses topped $3.4 billion, an 11% increase from those reported in 2022.

In New Hampshire, 97 out of the 408 cases reported last year involved tech support scams. Romance or confidence scams led to the highest loss amounts here, a total of $2.45 million, followed by nearly $1.8 million from tech support scams.

As staggering as those numbers are, experts say these crimes go vastly underreported to state and federal authorities.

“I think a lot of seniors are less likely to report the crime out of shame and fear and embarrassment,” the FBI’s Setera said.

The DOJ’s Townsend has seen that reluctance by victims to report in cases he has prosecuted. But he said, “It’s not about being stupid at all. It’s about individuals preying on some sort of vulnerability that the victim has.”

“Whether that vulnerability is a sense of fear in the case of a grandparent scam, a sense of loneliness in the case of a romance scam, or a sense of desperation in the case of a lottery scam, it’s always feeding off some sense of vulnerability. And once they find it, they target that,” Townsend said.

One ongoing scam involves what the FBI calls “government impersonation,” in which someone poses as a police officer, IRS agent or another official, and insists the individual must pay a fine or risk arrest. “No one’s ever going to call and threaten you with arrest if you don’t send money,” Setera said. “That’s not the way any law enforcement agency operates.”’

In New Hampshire last year, 100 cases of reported fraud involved the use of cryptocurrency or cryptocurrency wallets to steal the victims’ money.

Townsend explained how that works: “What typically happens is the scammers will instruct a victim to go to a nearby convenience store that has a cryptocurrency ATM, to insert cash in the cryptocurrency ATM which then converts it to cryptocurrency, and then send it to a crypto wallet which the scammer controls.”

In some cases, scammers take cash directly from their victims and then use a crypto ATM to send it internationally, Townsend said.

Sting operation

The AG’s office recently announced the arrest of a Massachusetts woman who allegedly acted as a courier in a tech support scam that involved at least three victims.

Rachel Chen, 25, of North Andover, Mass., was indicted by a Merrimack County Grand Jury in June for conspiracy to commit theft by deception and attempted theft by deception, both Class A felonies. Authorities allege that Chen went to an Allenstown home on instructions from an “unknown co-conspirator” and obtained a package that she believed contained $22,000 in cash.

Instead it was a sting operation, and Chen was arrested.

The case arose after an Allenstown man became suspicious when a stranger contacted him to proffer technical support.

”This individual had been told that this computer was infected and his bank accounts were compromised, and that he needed to pay money to keep his money safe,” Townsend said. “The instructions were that …a bank employee would be coming to the house to collect the money and ultimately keep it safe.”

The man called Allenstown police who, in coordination with the AG’s office, conducted the sting operation that led to Chen’s arrest, Townsend said. Investigators have since identified two other victims, one in Nashua and another in Vermont, he said.

It’s sometimes difficult to understand how someone could fall for such a scheme. But Townsend said, “Unless you’re involved, unless you’re panicking about this significant loss of assets, you can’t really understand the panic and fear that happens. So I think that tends to cloud the judgment a little bit.”

Setera said families should be having ongoing conversations about the kinds of scams out there, and reminding older relatives not to divulge personal information online or over the phone.

Townsend advises having “a trusted person that you can rely on, whether it’s a family member or a good friend, or even someone at your local police department, who you can connect with and give a quick call to if something just doesn’t seem right.”

If you have been targeted, authorities say, it’s important to contact law enforcement quickly.

Consumers can call the Attorney General’s Consumer Protection Hotline: 603-271-3641. In addition, report scams to the FBI’s Internet Crime Complaint Center (IC3), online at: ic3.gov.

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NH seniors continue to fall prey to scammers as schemes proliferate

Older adults at elevated risk of financial exploitation, AARP report indicates

by Adam Healy

Older adults’ risk of being financially exploited underscores the need for tools to help them and their caregivers keep their money safe, according to a new report published by AARP.

“Over the past decade, criminals have become increasingly sophisticated, posing new risks to the hard-earned savings of American adults,” Jilenne Gunther, the national director of AARP’s BankSafe initiative, said in a statement. “Our data shows that older adults find age-friendly banking services and a highly skilled workforce substantially more appealing than they did ten years ago.”

AARP surveyed 2,014 US adults, of which half were between the ages of 18 and 49 and half were over 50. Among all respondents, 48% reported that they have been a victim or intended victim of financial exploitation, such as scams or fraud. Older adults were more likely to lose a substantial amount of money; 22% of victims over 50 years old indicated that they have lost more than $5,000 as a result of financial exploitation, compared to 13% of victims under 50.

AARP’s report builds on previous research it conducted in 2014. Increasingly many seniors are using online banking tools, highlighting the need for new tools to combat scams and fraud, according to AARP.

For older adults, the need for secure and accessible financial resources is crucial, according to AARP. More than 90% of respondents over 50 indicated that they want highly-trained employees at financial institutions to help prevent exploitation, extra monitoring for unauthorized withdrawals and notifications for unusual account activity. 

Caregivers also play a part in keeping older adults’ finances safe. Among the respondents 50 years and older, three quarters called for special services that allow caregivers to provide better financial assistance. The most popular services, favored by more than 80% of older adults surveyed, included phone calls, emails and text alerts for caregivers when suspicious account activity or large withdrawals are reported by an aging loved one’s financial institution.

This story originally appeared in McKnight’s Home Care. 

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Older adults at elevated risk of financial exploitation, AARP report indicates

Bill promises ‘generational investment’ in senior living and care workforce

by Kimberly Bonvissuto

Proposed federal legislation would make a “generational investment” in the senior living and care workforce at a time when the aging population is growing exponentially and an increasing number of older adults are living with chronic conditions and disabilities, according to its sponsors.

The Long-Term Care Workforce Support Act, introduced by Democrats, was met with mixed reviews from senior living industry advocates on Tuesday, however.

US Sen. Bob Casey (D-PA), chairman of the Senate Special Committee on Aging, called direct care workers the “backbone” for long-term services and supports and said they are “irreplaceable” and “essential” during a Tuesday committee hearing focused on long-term care workforce shortages.

“Here is the bottom line — if we claim that their work as caregivers is essential, we should accord them the status of a professional,” Casey said in introducing the bill, S 4120, co-sponsored by Sens. Tim Kaine (D-VA) and Tammy Baldwin (D-WI). “By professionalizing and supporting the long-term care workforce, we can better recruit and retain professionals in this vital field.”

Casey said the bill would ensure that caregiving can be a sustainable, lifelong career by providing “substantial” new funding to support workers in every part of the long-term care industry, from assisted living communities to nursing homes to home care. Specifically, he said, the bill would provide pathways to enter the care workforce, improve wages and benefits, ensure a respectful and safe working environment, and introduce best practices on recruitment as well as training strategies to promote retention.

Pointing to a PHI report, Casey noted that caregivers earn a median wage of $15.43 per hour, resulting in almost 70% of assisted living communities and 92% of nursing homes reporting significant or severe workforce shortages. 

US Rep. Debbie Dingell (D-MI) introduced companion legislation in the House of Representatives, HR 7994, calling caregiving the “foundation of our economy” that allows for all other work to be possible.

“No care workers should have to live below the poverty line to do this work that millions of Americans depend on,” Dingell said in a statement. “This legislation will make much-needed investments in our care infrastructure and workforce, including family caregivers, to ensure they have the support they need, are paid a living wage, and are able to continue doing their critical jobs.”

‘Time is of the essence’

Provider advocates had varying responses to the bill.

Argentum said it appreciated recognition of the workforce shortages and potential resources to address it but added that “time is of the essence,” with the need to create more than 3 million new jobs in senior living by 2040 to care for a rapidly aging population.

Argentum Senior Vice President of Public Policy Maggie Elehwany said that workforce issues have been one of the few areas of bipartisan agreement in the 118th Congress, with multiple congressional hearings and calls from both sides of the aisle to “stem the exodus of healthcare workers.” 

The association, she added, continues to champion public policy efforts to bolster the senior living workforce, including support for the Safeguarding Elderly Needs for Infrastructure and Occupational Resources (SENIOR) Act, which targets assisted living workforce development, and the Care Across Generations Act, which addresses twin senior and childcare workforce shortages.

The American Seniors Housing Association told McKnight’s Senior LIving that the act prioritizes the need for workforce development programs as the industry and nation face the “real risk of not having enough available and willing workers to keep pace with the growing demand for their services.”

“This important legislation makes a significant investment in workforce development and training grant programs to be offered at the state level, offering a wide range of worker supports, skills training, demonstration projects, technical assistance, as well as worker protections,” ASHA Vice President of Government Affairs Jeanne McGlynn Delgado said. “These are all worthy goals, and if enacted and successful in creating a pipeline of trained long-term care workers, the industry will be well served.”

But Delgado said the legislation is only a partial solution, adding that immigration reform is a necessary component to addressing the sector’s workforce shortage challenges. ASHA said that Congress must take action to advance “one of the many reforms” already proposed, including creating a new visa category for caregivers, accelerating the timeframe an asylee can seek work authorization, and granting green card status to essential workers who worked during the COVID-19 pandemic.

“Congress will have to address the broken immigration system, and the sooner it does, the better for our seniors,” Delgado said. 

The Center for Excellence in Assisted Living, CEAL@UNC, which formally endorsed the legislation, said the act calls out “discriminatory” immigration actions, but “unsurprisingly” doesn’t go so far as to address the “third rail” of immigration.

“CEAL@UNC encourages supportive immigration policies to build the pipeline of new workers into assisted living and other long-term care settings,” Sheryl Zimmerman, MSW, PhD, executive director of CEAL@UNC, told McKnight’s Senior Living.

Zimmerman also said that although the federal government calls for recognizing the importance of the long-term care workforce, CEAL@UNC suggests going one step further and formally recognizing all of those providing direct care.

“The Center for Excellence in Assisted Living appreciates the federal government’s recognition of the essential nature of the direct care workforce, the fact that’s it’s important to virtually every family at some point in their lives, the evidence tying its sufficiency and competency to the well-being of older adults, and that the Long-Term Care Workforce Support Act expressly references the importance of the workforce in assisted living,” Zimmerman said.

Workforce bill ‘misses the mark’

Some senior living and long-term care industry advocacy organizations, however, said the proposed bill “misses the mark” and wouldn’t produce its intended effects.

“The entire long-term care continuum, no matter the type, faces a growing caregiver shortage that impacts access to care for our nation’s seniors and individuals with disabilities,” Clif Porter, senior vice president of government relations for the American Health Care Association / National Center for Assisted Living, told McKnight’s Senior Living. “This legislation ignores a wide swath of the profession and fails to address the elephant in the room — Medicaid frequently doesn’t cover the cost of care, making it difficult for providers to offer higher paying, competitive jobs.”

Porter added in a statement that it’s important for policymakers to recognize that assisted living communities and nursing homes “do everything possible to hire more caregivers.” 

“We must focus on meaningful and comprehensive policies that will actually help long-term care facilities recruit and retain workers, as well as build a strong pipeline of caregivers,” Porter said in a statement. “We hope to continue working with Congress and the administration to find more supportive ways to ensure our nation’s seniors have continued access to care.”

AHCA / NCAL said it supports several bipartisan bills to address workforce challenges facing providers, including the Healthcare Workforce Resilience Act and the Train More Nurses Act as well as three pieces of legislation that apply specifically to nursing homes: the Protecting Rural Seniors’ Access to Care Act, the Building America’s Health Care Workforce Act and the Ensuring Seniors’ Access to Quality Care Act. 

LeadingAge, which also pledged its support to the above-mentioned bills, similarly said that the “devil is truly in the details.”

President and CEO Katie Smith Sloan, in written comments submitted to the committee, urged policymakers to pay attention to “necessary refinements” on funding for the education and training initiatives needed to build and sustain the workforce and investment in coordinated state and federal infrastructures to ensure programs achieve desired goals.

Among LeadingAge’s recommendations was passage of the Expanding Veterans’ Options for Long Term Care Act, the Home and Community-Based Services Relief Act, the Better Care Better Jobs Act and the Expanding Service Coordinators Act to address “inadequate” reimbursement mechanisms. 

In addition, LeadingAge called on Congress to pass legislative proposals addressing gaps in the US immigration system and to develop and streamline federal training requirements for direct care professionals, including exploring how licensed vocational / practical nurses and experienced direct care professionals can assume increased training responsibilities for professional caregivers. 

“This should be done with a focus on developing stackable certifications and opening pathways for aging services staff to engage in a lifetime of career development and learning,” Sloan wrote in her comments. 

Addressing the newly introduced Long-Term Care Workforce Support Act, Sloan suggested dedicating a specific fund to clear HCBS waiting lists, including long-term care providers in both the rate-setting process and the formation of any passthrough threshold for which they would be held accountable by their states, combining grant funds under one roof, and including home health and hospice in the definition of long-term care. 

Senate Aging Committee Ranking Member Sen. Mike Braun (R-IN) cautioned against a federal “one-size-fits-all” approach, suggesting that innovation at the state and local levels is needed to meet the increased demand for direct care professionals. 

“Giving more power to the federal government usually means printing more money and forcing top-down solutions. These solutions are partisan and will not get us anywhere,” Braun said. “To grow the long-term care workforce, the federal government should make it easier for people to enter by removing barriers.”

Elehwany said that Argentum agrees with Braun’s stance on partisan solutions and the need to “work together to pass bipartisan solutions that offer flexibility.”

‘Historic’ legislation addresses job quality

PHI called the bill “historic” and said that it “enthusiastically endorses” the legislation designed to systematically improve direct care job quality and address the sector’s workforce crisis. The organization said the bill enshrines many of PHI’s long-standing policy priorities related to compensation, training, employment conditions and evaluation.

Specifically, the organization noted that the bill authorizes the Department of Health and Human Services to award grants to support workforce recruitment, training, compensation and retention. This authorization includes a $10 million investment in pilot projects on education, training and career advancement across settings, as well as $10 million to support a national technical assistance center to support states’ workforce efforts. 

PHI also supports the bill’s proposal to create a National Direct Care Professional Training Standards Commission to develop national training standards for the direct care workforce, as well as an advisory council to develop a national direct care compensation strategy. 

Issues are ‘multi-dimensional’

Jasmine Travers, PhD, RN, an assistant professor at New York University Rory Meyers College of Nursing, testified during the hearing that the issues affecting the recruitment, retention and morale of the direct care workforce are “multi-dimensional and compounded by an external environment that devalues this work.”

She said the realities that make direct care work unsustainable include low wages and limited benefits, inequities, chronic under evaluation and a demanding work environment, insufficient training and limited growth opportunities.

Travers called for a multi-pronged approach involving federal and state governments, managed care organizations, aging organizations, payers, providers, advocates, care recipients and direct care workers to create solutions for a stronger direct care workforce. 

Financially, she called for competitive wages and benefits, and spending minimums for staffing for Medicaid-funded facilities. She also called for enhanced training programs and opportunities for career advancement, fostering a positive work environment through culture change, focusing on recruitment and retention and sharing best practices. 

“To improve access to and quality of long-term care, we must ensure that all direct care workers receive a living wage, a safe, respectful work environment; opportunities for advancement; adequate training; and accessible benefits to maintain their health and well-being,” Travers testified. “Only when we recognize that these workers are critically important, hardworking professionals, can we begin to improve equity and health outcomes for staff and patients alike.”

Brooke Vogleman, a licensed practice nurse with senior living and care operator TLC Management of Marion, IN, said that staffing should be about training, education and retention.

“We need workforce development programs that help us grow the care force, incentivize caregivers to choose a career in long-term care, and invest in their career development,” Vogleman said. 

Some hearing witnesses testified in favor of access to worker supports and protections. You can read witness testimony on the hearing website.

The Long-Term Care Workforce Support Act is endorsed by 44 organizations, including the Center for Excellence in Assisted Living, or CEAL@UNC; the Gerontological Society of America; the Coalition to End Social Isolation and Loneliness; the American Geriatrics Society; the National Coalition on Aging; and Justice in Aging.

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Bill promises ‘generational investment’ in senior living and care workforce

Study finds treating self-neglect among older adults can prevent later abuse

By Rose Lundy

Researchers point to an advocacy program in Maine that works with Adult Protective Services as one solution to preventing exploitation. 

A new study found that almost 40 percent of elder mistreatment cases began with self-neglect. Photo by Jeremy Poland/iStock.

A few years ago, Adult Protective Services put Polly Madson Cox in touch with an older woman who was neglecting herself. She lived alone, struggled to meet her basic needs and was on the verge of eviction.

Madson Cox, who was an advocate with the Elder Abuse Institute of Maine, worked with the woman to try and find a way to stay in her apartment. During that time, the woman invited someone to live with her. Madson Cox soon learned this person was exploiting her, controlling her medications, ability to leave the house and her finances.

A recent study found this is a common problem. An analysis of Maine APS investigations published online last month by the Journal of the American Geriatrics Society found that older adults who neglect themselves often experience other mistreatment at the same time and are at risk of further abuse.

Addressing cases of self-neglect may prevent later abuse, said the study’s lead author, Dr. Stuart Lewis, an associate professor at Dartmouth’s Geisel School of Medicine.

Advocates in Maine said the study findings reinforce the work of a program that was piloted in 2019 under the Elder Abuse Institute of Maine.

“Self-neglect is a huge unmet need in elder mistreatment,” Lewis said. “It has been, historically, a very difficult circumstance to intervene in ways that provide benefit to the person.”

Despite Madson Cox’s efforts, her client was eventually evicted. She worked with the woman as she moved to a hospital, then later into an assisted living facility. She was evicted with only the clothes on her back, so Madson Cox helped her get more clothing and regain access to her finances.

“I think we are incredibly instrumental and a special program,” Madson Cox said. “To meet all those needs, to be able to be involved with her all those months. In that case she was in three different counties across the state of Maine — and I was the sole constant for her.”

Self-neglect, which makes up half of APS investigations nationally, occurs when someone no longer has the capacity for self-care.

Often this means failing to eat appropriately, care for their home, maintain good hygiene or manage their financial affairs, according to the 2021 Adult Maltreatment Report by the U.S. Department of Health and Human Services.

Madson Cox said some indicators of self-neglect could be unsafe housing, such as holes in the roof, rotted floorboards or an infestation; unpaid bills, disabled utilities or banking concerns; concerns about hygiene; and lack of access to medical care or trouble managing their medications.

Patricia Kimball, the study co-author and executive director of the Elder Abuse Institute of Maine, said it’s difficult to address self-neglect because clients often don’t see themselves as victims. Even the term “self-neglect” is stigmatizing, she said, because it blames the person for their situation when there may be factors out of their control.

To examine how self-neglect relates to other forms of mistreatment, researchers analyzed nearly 18,000 Maine APS investigations from July 2017 to October 2021, looking at cases in which the first substantiated allegation was self-neglect. 

The study found that about half of the individuals who were first reported for self-neglect also experienced other mistreatment at the same time. And almost 40 percent of elder mistreatment cases began with self-neglect. 

The study found that the time period between a report of self-neglect and another allegation is often less than a year, ranging from 215 to 388 days, much shorter than what was published in a previous study, Lewis said.

“What’s important about it is (self-neglect) often occurs at the same time as other forms of abuse; that it’s a risk factor for later abuse; and that by treating it, you may potentially prevent other abuse later on,” Lewis said.

Self-neglect shares risk factors with other elder mistreatment, such as physical disability, social isolation, cognitive impairment and lack of social support, according to the study. 

The study was conducted using Maine APS cases collected during a pilot program of the RISE model. This model — “Repair harm; Inspire change; Support connections; Empower choice” — is a new national approach designed to address elder abuse in a way that reduces harm while respecting the individual’s autonomy. Advocates refrain from pressuring clients to make certain decisions about their lifestyle and only provide the support the client seeks, Madson Cox said.

“We respect that clients have the right to make their own decisions and we understand that clients have that right even when their choices might make us or other people uncomfortable, or might make choices that are in opposition to those people around them,” Madson Cox said.

The study found that about half of the individuals who were first reported for self-neglect also experienced other mistreatment at the same time. And almost 40 percent of elder mistreatment cases began with self-neglect. Photo by kitzcorner/iStock

Maine’s RISE pilot project, called Elder Service Connections, started in 2019 by pairing advocates from the Elder Abuse Institute of Maine with APS caseworkers to work on investigations in Aroostook and Cumberland counties.

The advocates were trained in motivational interviewing and supported decision-making, and were able to stay with clients long after APS might be required to close a case. Madson Cox said the time they work with clients can vary greatly, but is usually less than a year.

Data shows the RISE approach works: Clients are significantly less likely to end up back in the APS system after working with a RISE advocate.

To date, the program has received 752 referrals. It expanded in 2021 to include the entire state, and there are currently eight advocates. The budget Gov. Janet Mills signed last year dedicated $800,000 annually to the program. 

Madson Cox, who worked as a RISE advocate for about a year and a half and now oversees the program, said she has seen the findings of the self-neglect study mirrored in her work.

She mentioned the case of a woman in her 70s who was reported for self-neglect because her furnace wasn’t working. The woman had no hot water, struggled to get her snow plowed and was heating her home by using the oven and space heaters. She was paying an exorbitant electric bill, had trouble bathing without hot water and couldn’t get out of her home to access health care.

Advocates spent months working with her, and Madson Cox said as they got to know the client, she disclosed that a community member was financially exploiting her by charging an excessive price for snow removal, and a family member was being verbally abusive and stealing her medication. The advocates were able to fix the furnace, help with the utility bill, secure a new snow removal service and get her medication delivered directly.

“We have the luxury of being able to work with people for a much greater amount of time,” Madson Cox said. “Some of the (conditions) were known as the client became comfortable with us and began trusting us to disclose.”

The RISE system can also work with others in the client’s orbit, including someone who may be exploiting them, Kimball said.

This approach recognizes that often what the older adult wants more than anything is help for a loved one who may be struggling — with addiction, for instance — even if they are the ones exploiting them.

“Often in maltreatment and abuse situations, our clients want the alleged harmer to get help,” Madson Cox said. “They’re not in a place to make choices to sever the relationship or be estranged.”

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and The Silver Century Foundation.

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Study finds treating self-neglect among older adults can prevent later abuse

Older adults eligible to receive free representation in Dauphin County guardianship cases

by: George Stockburger

HARRISBURG, Pa. (WHTM) – Adults 60 and older can now receive free legal representation during guardianship cases in Dauphin County.

The program, which runs through the Pennsylvania Courts’ Office of Elder Justice in the Courts, is paid for by a new, grant-funded pilot project with MidPenn Legal Services and the Dauphin County Orphans’ Court.

The court system says the initiative is focused on increasing the appointment of counsel and frequency of attendance for those in guardianship cases.

“Guardianship is sometimes necessary for persons with diminished capacity or persons with a disability in managing their affairs,” said the OEJC’s Senior Judge Paula Francisco Ott. “The appointment of counsel through this partnership is a tremendous benefit to all older Pennsylvanians, further ensuring that their concerns, wishes, and rights are respected and protected at every step of the legal process.”

Individuals in guardianship cases can still decline or hire their own representation.

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Older adults eligible to receive free representation in Dauphin County guardianship cases

Signs of Diminished Financial Capacity in Older Adults

by Karen Reimers MD

Significant lapses in financial judgment can raise the suspicion of dementia.

 Key points

• Family members may notice early “red flags” or warning signs of diminished financial capacity.
• Dementia is the most important risk factor for diminished financial capacity.
• In older people, early cognitive impairment can show up as diminished executive functioning.
• If needed, consider having someone help oversee the older person’s financial transactions.

Family members and caregivers can be on the lookout for the following early “red flags” or warning signs of diminished financial capacity, particularly when the changes are clearly different from the older person’s prior baseline financial skills:

• Forgetfulness and memory lapses related to finances, such as mismanagement of accounts, forgetting to open and pay bills, paying bills twice, or forgetting to deposit checks, leading to late payments or other problems
• Poor judgment about finances, such as extreme unwarranted anxiety about money or a new interest in lotteries or get-rich-quick schemes in an individual who would not previously have considered the scheme
• Struggling with simple math calculations and everyday financial tasks, such as figuring out a tip, balancing a checkbook, or interpreting a bank statement, for example
• Disorganization and confusion about money, such as getting overwhelmed with financial decision-making and discussions, deterioration in a person’s ability to understand basic financial concepts
• Significant changes in an older adult’s spending habits, such as uncharacteristic major purchases, gifts, or donations

Normal cognitive changes do occur as we age, often starting around age 50. Most of these changes are not precursors of dementia. Normal cognitive changes due to aging include difficulties with word finding and taking a longer time to process and digest new information. Some aspects of thinking, such as vocabulary, can actually improve as we age. At the same time, in an older person, significant lapses in financial judgment and uncharacteristic poor financial decision-making may raise the suspicion of dementia.

Dementia

Dementia is the most important risk factor for diminished financial capacity. Dementia typically develops gradually over several years. The onset of dementia is usually insidious, with cognitive changes happening gradually over time. Many individuals with early cognitive decline have no awareness there is a problem and don’t appreciate what their deficits are.

Problems with financial decision-making increase the risk of an older adult becoming a victim of financial exploitation. As cognitive abilities decline, older adults are much more susceptible to scams, manipulative tactics, high-pressure sales pitches, fraud, identity theft, abuse of family agreements or power of attorney, exploiting money arrangements, and emotional blackmail.

Elder financial abuse affects millions of families worldwide each year.

Cognitive losses often decline from different causes and at different rates. For some individuals, particularly with Alzheimer’s, memory decline happens first, with language and social skills relatively preserved. In older people, early cognitive impairment can show up as diminished executive functioning, which includes the capacity to plan ahead and meet goals (e.g., making and following a budget and setting financial goals), control impulses (e.g., deciding when to buy and when to save), weigh and analyze multiple factors in financial decision-making (e.g., compare features and costs on big purchases, search for sales and deals), handle unanticipated financial challenges, follow multiple-step directions even when interrupted, and stay focused on financial tasks despite distractions.

Warning Signs

Early warning signs of cognitive problems due to dementia can include getting lost on familiar routes, missing or forgetting appointments, having difficulty cooking, not paying bills, and having trouble with appliances. Early dementia may present as significantly poor judgment in decision-making, such as suddenly gifting the family vehicle to the mail carrier. These are people who may have increased anxiety in unfamiliar situations and be much more easily overwhelmed. They may rely much more on family members for guidance or to answer questions for them.

Distinguishing what might be normal aging from early dementia is sometimes a matter of degree. Spouses often compensate for these early deficits.

What a Family Can Do

To summarize, potential indicators of diminished financial capacity include difficulty in handling routine financial tasks, impulsive decisions, changes in organizational skills, and unusual behavior surrounding money.

In response to these changes, families and caregivers can consider having someone help oversee the older person’s financial transactions, such as a trusted family member or professional fiduciary money manager. It may be helpful to communicate with the bank, which may detect unusual activity and transactions, and to consider online banking and bill payments.

Recognizing and responding to early warning signs of diminished financial capacity can help protect elders from financial exploitation and families from its consequences.

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Signs of Diminished Financial Capacity in Older Adults

So long, senior centers and nursing homes. Older adults don’t want to spend their time in places where they are seen as victims in decline.

by Michael Adams

So long, senior centers and nursing homes. Older adults don’t want to spend their time in places where they are seen as victims in decline. © istock

At 104 years old, Sally has more stories than you can imagine. As a young woman during World War II, she was the embodiment of Rosie the Riveter, working in New York City’s defense factories. She went on to break barriers as one of the first women recognized as a full journeyman in a California shipyard. She has been one of the most dedicated and oldest members of SAGE, the LGBTQ+ older-adult advocacy group.

But the pandemic hit her hard. She moved into a skilled nursing facility, and her vibrant life changed. She missed her friends and wasn’t herself. When SAGE was safely able to reopen in-person services, Sally’s pre-pandemic spirit was rekindled — she could see and talk with her friends and join in the reopening festivities.

Older adults want to connect

Sally’s story is a powerful reminder of an important service offered by older adult centers: connection. As leaders of SAGE and Wallis Annenberg GenSpace, we advocate for our older adults, and when we talk with our members, it’s not the food, housing, or exercise classes that keep people coming back — it’s the connection.

September is National Senior Center Month, but we try not to use that term. Instead, we’re working to redefine the traditional senior center. In our experience, older adults don’t want to spend their time in places built around the notion that they are victims in decline. They want to be in places that empower them to learn, have fun, and grow. Our spaces should reflect this difference and be designed in a way that embraces the idea of new stages in life instead of ages.

That’s why GenSpace was created. Our innovative center in L.A.’s Koreatown offers older adults opportunities to find new hobbies, pursue creativity and health, and meet new people in a welcoming environment.

Creating a community

We held focus groups of older adults to better understand how to create a space that serves the needs of its members. Those focus groups informed the design and programming of GenSpace, so older adults feel supported and seen.

We’ve continually heard from our members that GenSpace is the one place where they feel welcome. So far, we’ve seen a great response from the community, as our classes fill to capacity and we offer more programs to meet demand.

At SAGE, we’ve been advocating and supporting LGBTQ+ older adults for 42 years. When we opened our first SAGE Centers, LGBTQ+ older folks passionately embraced our spaces as the only elder-focused places where they truly felt at home. We’ve seen the power of creating a community and never has it been more important.

And while we are aware of the increasing interest and need for spaces like ours, the country is not prepared to handle the pending age shift.

By 2034, adults aged 65 and older will outnumber children for the first time. This new wave of older people will have longer lifespans and smaller family and support networks while facing more housing, transportation, caregiving, healthcare and technology challenges.

Services are seriously lagging

Our ecosystem of services, resources, and facilities that support older adults is seriously lagging. Not only do we not have the necessary resources, but we aren’t prepared to offer older adults what they need to thrive.

Furthermore, centers today often aren’t designed to serve the disparate needs of our increasingly diverse population. LGBTQ+ elders, for example, experience acute levels of social isolation, while Black and brown elders struggle with serious health disparities, as illustrated during the COVID pandemic.

These are some reasons why LGBTQ+ elders and older adults of color, who are more likely to age in poverty and with serious health problems, need community centers more than anybody.

Investments to support older adults are growing, which is encouraging. California is one of five states implementing a Master Plan for Aging (MPA), which provides a road map to transform the infrastructure and services available to each state’s rapidly aging population. New York state and Vermont are drafting MPAs now. But more is needed as demand grows for spaces that help older adults stay active and connected.

By revolutionizing spaces and services for older adults, we can breathe new life into these traditional community institutions and turn them into destinations that older people want and need. We can and must give older adults a vibrant next phase of their lives — so other people like Sally can party and connect with their community until they’re 104 and beyond.

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So long, senior centers and nursing homes. Older adults don’t want to spend their time in places where they are seen as victims in decline.

Caretaker ‘preyed’ on home care residents left begging for food, Georgia officials say

By Tanasia Kenney

An Atlanta woman gets a 20-year sentence after she’s accused of neglecting disabled and older adults living in her unlicensed personal care home in Georgia, state authorities said. Getty Images/iStockphoto

Residents of a home care facility were promised “housing, meals and other services,” but were instead left without cash and begging for food, according to the Georgia Attorney General’s Office. 

Now, an Atlanta woman is headed to prison. 

Michelle Oliver was given a 20-year sentence, with the first seven years to be served in prison, after she was convicted Sept. 8 on charges related to the neglect of older, disabled adults living in an unlicensed personal care home she owned, state authorities said.

A Dougherty County jury found her guilty on multiple charges including willful deprivation of an elder person and 51 counts of financial exploitation of a disabled adult, according to a news release.

 Investigators said Oliver, who owned the Miracle One Care Center, also pocketed more than $32,000 from residents between December 2016 and September 2017, all while still depriving them of basic needs. An investigation found residents were often left alone in filthy homes with no furniture, air conditioning or access to clean clothes.

“Michelle Oliver preyed upon some of our state’s most vulnerable and in-need citizens,” Attorney General Chris Carr said in a statement. “She systematically neglected those she had promised to help, all while taking their money but leaving them with nothing in return.” 

In December 2016, Oliver moved several residents from the Atlanta area into “a series of duplexes” nearly 200 miles away in Albany, according to authorities. The Georgia Department of Human Services, along with the Georgia Bureau of Investigation and other state agencies, launched an investigation after a complaint from a concerned citizen about the Albany facility. 

In addition to the dirty conditions, investigators said residents were deprived of food despite Oliver hiring a “cook” who prepared meals in the morning “but left before the lunch hour.”

“Due to the residents’ disabilities, they did not have access to their own money and were left to beg neighbors and nearby stores for food on a near daily basis,” state authorities said. 

A financial payee who took residents’ monthly payments pleaded guilty to charges in the case last year, according to the attorney general’s office. 

The residents were eventually moved out of the duplexes, many of which the Albany Code Enforcement deemed “unfit for human occupation,” authorities said.

Albany is about 90 miles southeast of Columbus.

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Caretaker ‘preyed’ on home care residents left begging for food, Georgia officials say

Sizing Up the Decisions of Older Adults

A new training tool helps to assess whether some seniors can make informed choices about their own care and well-being.

The Interview for Decisional Abilities, or IDA, was developed by two geriatricians to help train Adult Protective Services workers in how to gather information about a client’s decision-making ability.Credit...Lindsey Wasson/Reuters

By Paula Span

During a recent Zoom conference call, four Adult Protective Services workers from California, using a tool called the Interview for Decisional Abilities, or IDA, were trying to figure out whether something fishy was going on with an 82-year-old woman they knew as Ms. K.

Adult Protective Services agencies in every state receive reports of possible neglect, self-neglect, abuse or exploitation of older people and other vulnerable adults. But agency workers consistently face a bedeviling question: Does the adult in question have the capacity to make a decision about their medical care, living conditions or finances — even if it’s not the decision that the family, doctor or financial adviser thinks should be made?

IDA was developed by two geriatricians to help train Adult Protective Services workers in how to handle that issue. The program helps them learn to use a structured interview procedure to gather information about a client’s decision-making ability. The two dozen California staff members taking the course had already completed 10 hours of individual online instruction; now they were practicing their new interviewing skills in small groups, role-playing with facilitators.

Ms. K, a fictional character, was being played by Bess White, a special projects administrator at Weill Cornell Medicine. In the scenario, a bank manager had reported certain suspicions: Ms. K had $60,000 in a savings account but her withdrawals had increased sharply, from $600 a month to $600 a week. A younger man — her nephew, she said — had begun accompanying her to the bank, where a teller thought the man had seemed controlling and intimidating. An investigator who visited Ms. K at home learned that her only credit card had expired and that she had little cash.

But Ms. K denied being financially exploited; her nephew lived with her, she said, and helped with chores and rides to doctor’s appointments. He used the bank withdrawals to buy their groceries.

In the exercise, one of the A.P.S. trainees had ascertained that Ms. K grasped the basic concept of financial exploitation. Ms. K had heard about scams from the news, she said. And yes, she understood that a friend or relative might similarly take advantage.

So the interviewer continued: “What do you think could happen if someone took another person’s money without their permission?”

Ms. White, in the role of Ms. K, replied: “I guess the person could take it and take it until there’s nothing left.” But when the interviewer probed further to see if Ms. K understood that she herself might be facing this risk, she balked. She relied on her nephew, Ms. K said; she didn’t want to upset him.  (Click to continue reading)

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Sizing Up the Decisions of Older Adults

Common Questions and Answers About COVID-19 for Older Adults and People with Chronic Health Conditions

According to the United States Centers for Disease Control and Prevention (CDC), coronaviruses are a large family of viruses that are common in humans and can cause illnesses ranging from mild respiratory infections like the common cold to serious illnesses, such as pneumonia or Severe Acute Respiratory Syndrome (SARS). COVID-19 has been detected in more than 200 countries, including the US.

 

Why are older adults and those with chronic health conditions at higher risk?

Older adults and individuals with chronic health conditions including heart disease, lung disease, diabetes, cancer, and hypertension are at higher risk for more serious COVID-19 illness and death. This is because our immune systems grow weaker as we age, which makes it more challenging for older adults to fight off infectious diseases. Chronic diseases are also more common with age, and can compromise the immune system, making older adults more vulnerable to serious complications. Because of the rapid spread of COVID-19, the Centers for Disease Control and Prevention (CDC) has issued guidance for people who are at the highest risk for severe illness from the virus. It is imperative that older adults and others who are at high risk follow the advice of CDC.

What are the symptoms of COVID-19 and how is it different from flu and allergies?

The main symptoms of COVID-19, which may appear between 2 to 14 days after exposure, can include: fever or chills, coughing, difficulty breathing or shortness of breath, fatigue, muscle or body aches, headache, sore throat, congestion or runny nose, new loss of taste or smell, nausea or vomiting, and diarrhea. There are other symptoms that are not as common—like a rash or discoloration of the hands or feet—that may be a sign of COVID-19 so contact your healthcare professional if you are concerned. Not everyone with COVID-19 will experience symptoms, or symptoms may be mild enough that they are dismissed, but individuals may still be contagious without symptoms.

When should I call a healthcare professional?

Call 911 and seek emergency care if you or a loved one have trouble breathing, feel pain or pressure in the chest, experience new confusion, are unable to wake or stay awake, have bluish lips or face, or think you may need immediate care.

If you think you may have COVID-19 or have been exposed to someone who had COVID-19, contact a healthcare professional or the public health department to see if you are eligible for a COVID test and where to go if you are.

How do they test for COVID-19?

To diagnose a potential case, healthcare professionals may run tests to rule out influenza and other common infections. Not all healthcare facilities are able to test for COVID-19. There are a number of different tests, some involving swabbing the nose and throat, while others required taking samples of saliva. Others may require a blood draw. Note that COVID-19 tests that detect active infection will not detect previous infection or antibodies.

Will I have to pay for testing?

The Centers for Medicare and Medicaid Services (CMS) is taking important steps to waive cost-sharing for COVID-19-related testing and treatment to ensure all patients who need it have access to care. Medicare and Medicare Advantage Plans will cover lab tests for COVID-19 with no out-of-pocket costs, any necessary hospital care, and telehealth services including virtual check-ins and full visits for those living in rural areas.

How can I best protect myself?

COVID-19 is thought to spread mainly between people in close contact with one another through respiratory droplets from coughs or sneezes. It may also be transmitted when you touch a surface or object with the virus on it, then touch your mouth, nose, or eyes.

It is important to avoid people who may be infected. Older adults and those with underlying health conditions that can put them at increased risk should stay home to avoid being around others. Nursing homes and retirement and long-term care facilities should continue to limit all visitors, including social visits.

The best way to prevent illness is to avoid being exposed to the virus. Restrictions and recommendations vary by state and city but generally, it is best to avoid

• Gatherings where social distancing (staying at least 6 feet apart) is not possible,
• Any indoor gatherings where masks are not required/used,
• Non-essential air travel, and
• Cruise ships (Note that major cruise lines have suspended trips and others are restricting passengers over the age of 70)

For older adults and adults with underlying health conditions, CDC advises taking extra measures to put distance between yourself and others including:

• Staying home whenever possible
• Wearing a mask whenever you go out—especially in settings where social distancing is not possible. Cloth masks can keep people from spreading the virus through talking, coughing, or sneezing, even among those who may not realize they are carrying the disease. Studies show that people can spread the virus before they have symptoms, or even if they are infected but never develop symptoms.
• Take hand sanitizer when you go out and use when soap and water are not available
• Use proper handwashing techniques—using soap and water for at least 20 seconds, especially after blowing your nose, coughing, sneezing, or using the bathroom
• Avoid handshakes and touching high-traffic surfaces in public places—for example, elevator buttons, door handles, handrails, or counters. Use a tissue or your sleeve to cover your hand or fingers if you must touch shared surfaces.
• Avoid touching your face, nose, eyes, and mouth as much as possible

Until there are licensed vaccines widely available in the US to prevent COVID-19, you should still ensure that you and your family are up to date on all recommended vaccines, including influenza (flu) and pneumococcal (pneumonia) vaccines. Experts are concerned that individuals who get sick with flu or pneumonia, while sick with COVID-19, will have worse outcomes and will be at higher risk of death. In addition, simultaneous outbreaks of flu and COVID-19 would overwhelm the already stressed US healthcare system. Learn more about the benefits of influenza and pneumonia vaccination.

How can I prepare to be at home for an extended period of time?

Here are some important but simple steps you can take in preparing to remain at home for an extended period:

Getting Medicines and Medical Supplies

Ask your physician or local pharmacy if ordering your medicines online is an option. Many online pharmacies (including national chains) will fill valid prescriptions and ship them directly to your door allowing you to avoid going to the pharmacy in person. CMS is also working with private plans to waive prescription drug refill limits and to relax restrictions on home or mail delivery of prescription drugs. However, only order from a reputable online pharmacy. The United States Food and Drug Administration (FDA) warns consumers about rogue online pharmacies that claim to sell prescription medicines at deeply discounted prices. Read the FDA warning. If you have questions, call a healthcare professional. Also, be sure you have over-the-counter medicines and medical supplies (fever reducers, tissues, hydrating beverages, etc.) to treat fever and other symptoms.

Ordering Groceries

Have enough basic household items and groceries on hand so you are prepared to stay at home for an extended period of time. Most major grocery chains have made it possible to order groceries online and have them delivered to your door. Check the websites of local or national grocery stores that may allow you to select your items online and then arrange for shipping. Keep in mind, however, that many of these services are experiencing delays due to the high volume of people choosing the safety of online ordering rather than in-person shopping. This means you will need to plan ahead. If you have questions or concerns about the delivery timeline, speak to a customer service representative.

If you must go out for groceries, try to find a local grocery store that offers hours just for older adults. Most of these hours are earlier in the day and offer a chance for older adults to shop without as much exposure. Remember to cover your nose and mouth with a face covering, stay vigilant with handwashing, and avoid touching your eyes, mouth, and nose since COVID-19 can remain on certain surfaces for hours and in some cases, days.

How can I help loved ones at risk?

Everyone has a role to play in reducing community spread. The same recommendations for people at risk should be adhered to by everyone to help protect the more vulnerable in our communities. Businesses, schools, and local and federal government should all work together to mitigate community spread of COVID-19 and help protect older adults and those with pre-existing medical conditions.

If you are a caregiver for someone in a long-term care facility, respect their rules on who can come and go, ask about the health of the other residents frequently, and know the plan if there is an outbreak.

If your loved ones live alone, check on them frequently and find out what services your local Area Agency on Aging offers.

What should I do if I get sick?

If you do get sick, first call a healthcare professional. Unless you need immediate medical care, you should stay at home to avoid spreading your illness. Stay in touch with others by phone or email. You may need to ask for help from friends, family, neighbors, community health workers, and others if you become sick. Determine who can provide you with care if your caregiver gets sick. If you or a loved one needs help, contact your local public health department to connect with caregiving services.

If you develop emergency warning signs for COVID-19, call 911 and get medical attention immediately. In adults, emergency warning signs include:

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse and/or
• Bluish lips or face

What are other reliable resources for the most up-to-date information?

• Administration for Community Living: acl.gov/COVID-19
• United States Centers for Disease Control and Prevention: coronavirus.gov
• World Health Organization: who.int

 

Note: This resource is based on content developed jointly by NFID and the Alliance for Aging Research, reflecting the latest  information about COVID-19.

Reviewed: December 2020

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Common Questions and Answers About COVID-19 for Older Adults and People with Chronic Health Conditions