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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

PHI and about 50 other national organizations voiced their opposition to the proposed $3.8 billion cuts to employment and training funding in H.R. 1, the House-passed FY 2011 Continuing Resolution (CR).

On March 2, the groups sent a letter (pdf) to the chairmen and ranking members of the Senate Appropriations Committee and the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, stating, “we urge you in the strongest possible terms to reject the proposed cuts to WIA and other critical job training programs under H.R. 1.”

The budget cuts in the CR would completely eliminate funding for the Adult, Dislocated Worker, and Youth programs under the Workforce Investment Act (WIA) in Program Year 2011. The proposal would also slash or completely eliminate funding for programs such as Job Corps, YouthBuild, and Community Service Employment for Older Americans.

WIA funding supports programs that help to develop and train the direct-care workforce. Programs such as Pennsylvania’s Health Care Industry Partnerships, a sectoral strategy that was made possible in part by the state’s use of the discretionary Title 1 WIA funds, for example, would be hard hit.

The organizations wrote that “the cuts included in the House CR impact current and future workers at all ages, incomes, and skill levels, and will be felt across the entire country.”

They call the proposed cuts “draconian” and explain that both workers and employers would suffer if the employment and training funding was slashed.

The National Skills Coalition, National Law Center on Homelessness & Poverty, American Association of Community Colleges, United States Conference of Mayors, and Wider Opportunities for Women were among the many organizations that signed onto the letter.

– by Deane Beebe

The number of Ohio’s nursing home residents age 60 and below has grown significantly as young people with mental illness have increasingly been placed in this setting.

According to an article published in the Dayton Daily News on January 10, the shift to nursing home placements is the result of state budget cuts in recent years to the behavioral health support system.

As many as 16 percent of Ohio’s nursing home residents were age 60 and below in 2009, up from 4 percent in 1994. Three-fourths of these residents have been diagnosed with a severe mental illness.

Staff Lack Behavioral Health Training

Despite the increase in the number of nursing home residents with severe mental illness, “staff often don’t have the expertise or time to meet the needs of those with behavioral issues,” Bob Applebaum, Ph.D., director of the Ohio Long-Term Care Research Project at Miami University’s Scripps Gerontology Center, told the Daily News.

While some direct-care workers are trained in behavioral health (pdf page 6), these workers are typically employed in substance abuse or mental health settings. Training for these workers (pdf) is usually limited and declining.

“Training has eroded dramatically over the past decade for the behavioral health direct-care workforce,” said Michael Hoge, Ph.D., Yale University School of Medicine, and the senior science and policy advisor for the Annapolis Coalition. “Funding has been reduced and there are few mandates for training other than accreditation standards that require basics in fire safety and similar topics.”

Huge and Growing Problem

There has been a national trend toward placing younger, physically able people with mental illness in nursing homes, which poses a risk to older, frailer residents, the Associated Press reported in March 2009.

Younger people with mental illness comprised 9 percent of the nation’s nearly 1.4 million nursing home residents in 2009, up from 6 percent in 2002.

“The issue of mentally ill persons in nursing homes is a huge and growing problem because the direct-care workers on the frontlines are not trained in behavioral health,” Hoge said.

– by Deane Beebe

The deaths of six residents over six months at an assisted living facility in North Carolina have intensified the state’s debate on the adequacy of training and supervision of unlicensed medication aides.

Medication aides are direct-care workers who are permitted to administer medications in assisted living facilities in North Carolina.

Thomas Goldsmith of the News & Observer reports that state public health officials concluded in December that poorly trained staff and unsafe diabetic care resulted in the transmission of a hepatitis B infection amongst diabetic residents, who were on average age 70.

An investigation by the North Carolina Division of Public Health found that the infection was spread between residents by unlicensed “med techs” who reused glucose monitors and other devices. The agency also found that no staff member was designated to coordinate infection control.

Med techs who work at North Carolina assisted living facilities, formerly known as adult care homes, are not required to be licensed or have state-approved infection control training. Goldsmith reports that they “may get only one-on-one training from a nurse on diabetic care.”

In the 1990s, the North Carolina Board of Nursing had proposed a uniform set of standards for medication aides working in all long-term care settings, but such standards have only been required in nursing homes.

Scope of Practice

The tragedies also fueled the discussion on whether med techs employed at North Carolina assisted living facilities should be permitted to administer glucose tests and insulin injections.

John Buse, M.D , Ph.D., former president of medicine and science at the American Diabetes Association, advised that many people manage their own diabetes but cautioned that facility owners and managers should “understand that insulin is a drug where the margin for error is very small.”

PHI commented on the case for this article, noting that quality long-term care depends on “not only training but decent wages and benefits and career advancement opportunities.”

North Carolina is one of six states to receive a Personal and Home Care Aide State Training Program demonstration award to develop and pilot test curricula for personal care aides working in homes and facilities.

– by Deane Beebe

State and area agencies that assist elders must work harder to meet the needs of the aging LGBT community, according to a report (pdf) by the University of Minnesota and the PFund Foundation, an organization that advocates for LGBT rights.

The study surveyed 15 aging agency directors from Iowa, Minnesota, Wisconsin, and North Dakota. It found that eight of those 15 agencies offered LGBT-specific training for their workers. However, only one of the agencies offer targeted services for LGBT elders.

Nationally, roughly one-third of aging agencies have funded, or have offered to fund, LGBT training for their workers, the report found.

The authors of the report present numerous recommendations on how policymakers and service providers can better address the needs of LGBT elders.

In October, the organization Services & Advocacy for GLBT Elders (SAGE) inaugurated the nation’s first National Resource Center on LGBT Aging to address these same issues. SAGE’s resource center was launched with assistance from PHI.

– by Matthew Ozga

The Alliance for Health Reform hosted a briefing on December 2 entitled “The Health Workforce Dream Team,” which included a review of the direct-care workforce and the role that direct-care workers can play in a team approach.

Bob Konrad, Ph.D, an investigator at the Cecil G. Sheps Center for Health Services Research, spoke about the variability — or, more frequently, absence — of training requirements for groups of direct-care workers among states. He also discussed the enormous growth of demand for direct-care worker services (pdf), both in the past several years and in the decade to come.

As Konrad noted, the importance of the direct-care workforce received some attention in the Affordable Care Act with the establishment of the Personal Care Workforce Advisory Panel, a component of the CLASS Act. His comments encompassed community health workers and behavioral health paraprofessionals as well as certified nursing assistants, home health aides, and personal care assistants.

Following the presentations, several participants commented on the need for nurse practitioners and nurses to work up to the limits of their scopes of practice. Konrad noted that direct-care workers, too, can play an elevated role, and that there is a need to identify and recognize needed competencies for direct-care workers to realize this potential.

The briefing was held in Washington, D.C. and attended by Congressional staff, members of the media, and stakeholders in aging issues and health care. A webcast of the “Health Workforce Dream Team” briefing, as well as source materials (pdf), including PHI publications, are available online.

– by Gail MacInnes, PHI National Policy Analyst