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Elder abuse is a growing and largely unnoticed problem in the U.S., according to a report (pdf) by the Government Accountability Office (GAO).

The report was the focus of a March 2 hearing by the Senate Special Committee on Aging.

Elder abuse can take many forms, including physical, sexual, or psychological abuse; neglect; and financial exploitation. It has been linked to shorter life spans, depression, and other health problems.

An Under-the-Radar Problem

The most recent study on the subject found that 14.1 percent of elders had been abused in the last year. The GAO’s report, however, determined that this figure almost certainly underestimates the problem, since the vast majority of elder abuse cases go unreported.

The GAO report further states that “as the American population ages, the extent of abuse will likely grow.”

The March 2 hearing included testimony (pdf) from actor Mickey Rooney, who said that his “daily life became unbearable” due to abuse he experienced at the hand of his wife and stepson.

Rooney said that they took control of his finances without his consent, leaving him feeling “trapped, scared, used, and frustrated.”

Elder Protection Programs Face Challenges

While there are state and federal programs in place to prevent elder abuse, they “may not be able to meet the needs of the increasing number of older Americans,” the GAO report suggests.

The report identifies numerous problems with the current elder protection programs. One major issue is a lack of funding. In FY 2009, only $11.9 million in federal funding was allotted to elder justice activities; state Adult Protective Services (APS) programs received a small fraction of that money.

The report also points out that the Administration on Aging has been lax in establishing federal guidelines for collecting data on elder abuse. “Without these data, states cannot benefit from their collective experience in this area,” the report’s authors write.

Training Materials in Development

National health reform is likely to have a positive impact on the issue of elder abuse, however.

Included in the legislative package signed into law by President Obama in March 2010 is the Elder Justice Act — which, among other things, will fund the design and development of training resources addressing elder abuse.

These resources will eventually be distributed to all Medicare- and Medicaid-certified nursing homes in the U.S.

Abuse Prevention Curriculum Already Available

A free curriculum on preventing elder abuse and neglect, geared toward employees in all long-term care settings, is already available at the PHI Training and Organizational Development Services website.

“Proper education is essential to eradicating elder abuse from long-term care settings,” said Peggy Powell, PHI National Director of Curriculum and Workforce and Development. “This curriculum provides trainees with the tools necessary to recognize, report, and ultimately prevent elder abuse.”

This training was developed through a grant from the Centers for Medicare & Medicaid Services (CMS) to the Michigan Department of Community Health. Partners in its development included Michigan State University, the Michigan Office of Services to the Aging, BEAM (a wholly owned subsidiary of MPRO, Michigan’s federally designated quality improvement organization), and PHI.

– by Matthew Ozga

Approximately $4.3 billion in federal funds have been made available to help states establish and expand home- and community-based long-term services and supports for older adults and people with disabilities.

The new funds will support the Money Follows the Person (MFP) demonstration program, which the Affordable Care Act (ACA) extended for an additional five years through 2016, and the Community First Choice Option, which the ACA created.

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the availability of the funds on February 22.

Money Follows the Person

The MFP program helps individuals transition from living in a nursing home or other institution to living in the community with the services and supports they need.

The new funding will enable 13 additional states [scroll down to see chart] to help an estimated 13,000 people move into the community. Twenty-nine states and the District of Columbia already operate MFP programs. Together, these states will receive more than $45 million in the first year of the program.

Since 2008, PHI and its colleagues at the Direct Service Workforce Resource Center have provided technical assistance to states participating in MFP, supporting their efforts to ensure the workforce necessary to meet the service and support needs of the people transitioning into the community.

A recent study (pdf) by the Kaiser Commission on Medicaid and the Uninsured found that inadequate community workforce supply, along with lack of affordable housing, were the key obstacles to the success of this program.

Community First Choice Option

Sebelius also announced funding and the posting of a proposed rule (pdf) for the Community First Choice Option (CFC) program. This proposed rule describes details of CFC and solicits public comment for 60 days.

CFC, which will take effect in October 2011, gives participating states a 6 percent increase in federal Medicaid matching funds to provide community-based attendant services and supports to older adults and people with disabilities with Medicaid.

Between 2011 and 2014, the federal government is prepared to provide $3.7 billion in new funds to participating states to support the provision of these services.

Some state-level advocates for older adults and people with disabilities see CFC as crucial in providing new federal matching funds for states considering drastic cuts to home- and community-based services.

Advocates in California hope CFC funding can help offset costs to the In-Home Supportive Services (IHSS) program and avoid the need for implementing cuts to this and other Medicaid programs.

New PHI Fact Sheet

To learn more about CFC and other ACA provisions for home- and community-based services, see PHI’s new Health Care for Health Care Workers Health Reform Facts 5: Home- and Community-Based Services Expansion Offers Opportunity to Improve Direct-Care Jobs.

– by Gail MacInnes, PHI National Policy Analyst

This winter the Small Business Majority (SBM) sponsored a webinar in three regions on what the Affordable Care Act means for small business.

The educational program, “Your Bottom Line: What Healthcare Reform Means for Your Small Business,” focused on both federal and state provisions to help local small business owners understand how the law will affect them. The topics discussed included:

• Small business tax credits — who’s eligible for them and how to claim them
• State insurance exchanges
• High-risk pools
• Shared responsibility
• Cost containment

The webinar covered many of the broad outlines of the new law regarding cost containment. For example, the law will reduce the deficit by over $100 billion by 2020 and by $1.3 trillion by 2030. The webinar also explained where consumers will be able to get coverage (employer, Medicaid, Medicare, and the exchanges), as well as new insurance reforms.

SBM provided tools and resources for small businesses interested in learning more about the law, including health care statistics for small business.

Tax Credits for Small Business

The webinar further detailed the new and forthcoming tax credits for small businesses.

More than 4 million businesses are eligible for tax credits (83.7 percent of all businesses) with 1.2 million businesses eligible for the maximum credit.

Tax credits will be available on a sliding scale with up to 35 percent of premium expenses for 2010 to 2013, and up to 50 percent of premium expenses for any two years beginning in 2014.

– by Carol Regan, Director of PHI Government Affairs Office

Guest Commentary: Health Care Reform and Small Business

As a home care services provider who purchases health care coverage for my 150 employees, I was eager to participate in “Your Bottom Line: What Healthcare Reform Means for Your Small Business.” Like other long-term care providers, I am seeking information on how obtaining health care coverage for my employees will change.

While I am a supporter of “health care for health care workers,” I also worry about the cost of reform because we continue to face reimbursement cuts. Yet, with our insurance premiums out of control and unsustainable, something has to change.

Tax credits, exchanges, mandates, grandfathering…the list of new terminology goes on and on. The requirements and the unanswered questions of the new Affordable Care Act (ACA) are daunting.

The timeline for implementation begins now and stretches into 2018. With all of the talk of repealing the law — and a good deal of misinformation being disseminated about what the law is really all about — some may be inclined to just ignore it. But long-term care providers really need to prepare for what is coming and understand the opportunities and the challenges.

The Take Aways

For me, the major take aways from the webinar were a) the reminder of how extremely complex this act is, and b) that each and every one of us is affected by it.

We will need help understanding the language, making decisions for our businesses, and explaining our decisions to our employees. We will also need to understand the tax implications for our businesses and our employees. I was struck by how even with a specific timeline spanning from 2010 to 2018, many areas of the ACA are moving targets — subject to change.

I am concerned about the benefits that will be provided in the exchanges and the insurance choices offered under the exchanges. A major issue for long-term care providers like me is the affordability of health coverage for our employees over the next couple of years, until these exchanges are operational in 2014.

We have a lot of learning ahead and it remains to be seen what it all translates into. The devil is in the details.

I encourage other employers of long-term care services and supports to join me in learning about the new law and how it can benefit employers and our workers. I found the printed materials available on the SBM website helpful and encourage you to take a look.

Editor’s Note

More information about health care reform and how it impacts long-term care — including the fact sheet Small Business Benefits Available to Eldercare/Disability Services Employers (pdf) — is available on the PHI Health Care for Health Care Workers website.

Read the PHI’s case study on the Visiting Nurse Association of Indiana to learn how Linda invested considerable resources to strengthen her company’s leadership and communication, and created a supportive and respectable work environment.

President Obama‘s budget proposal for FY 2012, released on February 14, plans for a five-year freeze on non-security federal discretionary spending, as well as cuts to a number of programs for low-income older adults and families.

Also this week, the House of Representatives began debating a continuing resolution to fund the federal government until the end of FY 2011, which includes $100 billion in cuts to many programs. The House leadership has pledged to make even more drastic cuts in the FY 2012 appropriations process.

Despite the prevailing focus on the nation’s debt and tough fiscal choices, many programs for providing long-term services and supports and improving the health care workforce fared well in Obama’s budget proposal.

The Health Resources and Services Administration budget justification narrative (4.7 MB pdf) highlights the importance of the Personal and Home Care Aide State Training Program. It also includes $51 million for State Health Care Workforce Development Grants and $59.8 million for the Nurse Education, Practice, Quality and Retention Program, which includes second year funding for the Nursing Assistant and Home Health Aide Program.

The Administration on Aging budget justification narrative (pdf) also includes funding for long-term services and supports, such as $120 million for administration of the CLASS program and $416.5 million for home and community-based supportive services. The budget proposal also includes $16.5 million for Adult Protective Services and an increase of $5 million over FY 2010 levels for the Long-Term Care Ombudsman Program.

The Affordable Care Act provisions (pdf) for training opportunities for direct-care workers (Sec. 5302) and for career ladders and wage benefit increases to improve long-term care staffing (Sec. 6703) — both of which PHI advocated for — do not appear to be included in the budget proposal.

In spite of these disappointments and worrisome cuts to programs for low-income families, the budget proposal’s emphasis on investing in the direct-care workforce and maintaining long-term services and supports for older adults and people with disabilities is encouraging.

– by Gail MacInnes, PHI National Policy Analyst

News that Brian Lee, the director of the Florida Long-Term Care Ombudsman Program, was forced to resign from his position on February 14 brought an outcry from ombudsmen throughout the state and from the Consumer Voice.

Several news outlets have reported that Lee was pushed out of his job shortly after he began asking nursing homes for the names of companies and individuals with ownership and operational interests in their facilities — a transparency provision in the new federal health care reform law.

Under the law, ombudsmen now have the authority to request this ownership information from Medicare- and Medicaid-funded nursing homes.

Ownership and Quality

A statement released by the Consumer Voice on February 15 explains, “The law was the subject of congressional hearings in which witnesses testified that it is often impossible to hold nursing homes accountable for quality because of complex ownership and operating structures.”

A recent Government Accountability Office report (pdf) said, “To determine the effect of ownership on nursing home quality of care, it is necessary to have complete and accurate ownership information that provides a clear understanding of the relationship of each owner to the nursing home and any other owners.”

Beginning in 2012, the Nursing Home Compare website will include a summary of nursing homes’ ownership data, according to the Consumer Voice.

“We are very concerned that the governor of Florida has yielded to industry demands to dismiss an effective advocate for residents in a state that so many elderly Americans choose as their retirement home,” said Consumer Voice Executive Director Sarah Wells. “As a national voice for long-term care residents, we strongly urge the governor to follow the law and allow the ombudsman program to operate without interference.”

Lee served as the director of Florida’s Long-Term Care Ombudsman Program for over seven years, overseeing 300 volunteers who advocated for the residents of the state’s 677 nursing homes.

Lee reportedly had a “tense” relationship with the Florida Assisted Living Association and the Florida Health Care Association, which claimed that the “ombudsman office overstepped its authority.”

“Brian was recognized by his colleagues in Florida and nationally for his commitment to protecting the rights of long-term care residents and working with residents, families, and providers to improve care,” Wells said. “The office must be independent and free of political interference to perform its statutory functions.”

– by Deane Beebe

Health Action 2011 logo

Consumer advocates’ interest in long-term services and supports is growing, as evidenced by several workshops at Health Action 2011, Families USA‘s annual consumer action conference.

Workshops ranged from “New Options for Home and Community-Based Services” to “Dual Eligibles: New Opportunities, New Challenges.” The latter is about people enrolled in both Medicare and Medicaid (pdf).

I was asked to co-present a workshop entitled “The CLASS Program and Building the Workforce to Deliver Services” (pdf) to help advocates better understand the new CLASS (Community Living Assistance Services and Support) program.

Critical Connection Between CLASS and the Workforce

This workshop stressed the critical connection between the need to invest in and support a quality direct-care workforce, on the one hand, and the new CLASS program, which will offer participating consumers who pay into the program the ability to purchase in-home services and supports.

Carol Regan, PHI Government Affairs Director

It is surprising to many that there are more direct-care workers in this country than nurses, and that it is the direct-care worker that will be relied on to meet the needs of CLASS beneficiaries — not nurses.

More than 3.2 million workers are employed in the eldercare disability services field today, and another 1.2 million are anticipated by 2018 (pdf).

Because of concern regarding the additional workers that will be required to provide long-term services and supports when the CLASS program begins in five years, the Affordable Care Act (ACA) included the creation of the Personal Care Attendant (PCA) Workforce Advisory Panel.

Its members are charged with advising the Health and Human Services (HHS) Secretary and Congress on the adequacy of the size of the workforce, wages and benefits, and access to PCA services.

CLASS Details in Development

Connie Garner, the lead staff person on long-term care from the late Senator Ted Kennedy‘s office, provided the workshop participants with information on what this program will do for millions of Americans. Garner now leads Advance CLASS, a new organization established to ensure the successful implementation of the CLASS program.

The CLASS program is a voluntary, federally administered, consumer-financed long-term care insurance plan. It, too, became law when President Obama signed the ACA. The CLASS plan will provide a cash benefit to participating consumers to help them pay for needed assistance, including home care, nursing home care, and assisted living, if they become functionally limited.

Before people can enroll, the HHS Secretary must design and implement the program. The law requires the Secretary to release the details of the plan no later than October 1, 2012, with sign up beginning later in 2012 or 2013.

PHI is looking forward to the announcement of the appointees to the PCA Panel so that the panel can get started on developing recommendations on what is needed to improve direct care jobs in order to provide quality services. PHI is a member of Advance CLASS.

– by Carol Regan, Director of PHI Government Affairs Office