Elder Abuse, OAA & Prevention

1. Elder Abuse, OAA & Prevention Bill Benson, National Policy Advisor National Adult Protective Services Association Chair, NCSSS CGA Advisory Board

2. Today’s Purposes Overview of Federal Efforts to Address Elder/Adult Abuse Introduction to the Older Americans Act Introduction to Federal Efforts re Health Promotion/Disease Prevention

3. “to retain respect for sausages and laws, one must not watch them in the making.” (attributed to Bismarck)

4. Elder & Adult Abuse Congressional history re elder abuse Elder Justice Act SSBG Older Americans Act (& elder abuse provisions)

5. A few words about NAPSA • Represents interests of states’ APS programs • Membership includes: former & current APS administrators and staff, state & local APS agencies • Mission to improve quality & availability of protective services for disabled adults & elders who are abused, neglected or exploited

6. Source: Congressional Research Service

7. EJA Background Lengthy Congressional History • “Protective Services for the Elderly” – Senate Special Committee on Aging, July 1977 • “Protective services probably have a more profound effect upon older Americans than any other age group…This need is likely to intensify in the years ahead as our population becomes older”

8. EJA Background Lengthy Congressional History • Hearings dating back to 1978 – 30 years ago • Mary Rose Oakar’s 1980 “The Prevention, Identification and Treatment of Elder Abuse” Legislation • 1981 -- "Elder Abuse: An Examination of a Hidden Problem“ -- states were spending only 6.6% of protective services monies on senior citizens -- this a "serious and unjustified imbalance."

9. EJA Background Lengthy Congressional History • 1985 -- "Elder Abuse: A National Disgrace" • Echoed 1981 study and called for Federal government assistance to the states to combat elder abuse using 1974 federal child abuse law as model • Found that states spent $22.14 per child resident for child protective services versus $2.91 per older person for elderly protective services

10. EJA Background Lengthy Congressional History • 1991 Government Accounting Office Study on Elder Abuse Reporting Systems • 1992 OAA Amendments • Title VII – Elder Abuse Chapter • National Incidence Study • Hearings by Senate Special Committee on Aging 2001 - 2003

11. Elder Justice Act – It’s Been Tricky But We’re Still Upright & Going Strong!!

12. EJA – History Close only counts in horseshoes and hand grenades

13. EJA – close but no cigar…so far Came close in Senate in 2004 (introduced in 2003) Came close in Senate in 2006 (introduced in 2005) Came close in Senate in 2008 (introduced in 2007) But could be a very different story in 2009-2010

14. Elder Justice Act – 111th Congress • Bi-Partisan • S. 795 – Hatch (R), Lincoln (D), Kohl (D), Snowe(R) • Amends the Social Security Act by adding Elder Justice to an amended Title XX, entitled Block Grants to States for Social Services and Elder Justice and adding a new Subtitle 2 - Elder Justice • H.R. 2006 – King (R), Schakowsky (D), Baldwin(D)

15. EJA - S. 795 & H.R. 2006 • Collection of Uniform National Data on Elder Abuse, Neglect and Exploitation • Establishes an Elder Justice Coordinating Council (& an Advisory Board on EAN&E) in the Office of the Secretary of HHS. • Grants for stationary and mobile forensic centers

16. EJA - S. 795 & H.R. 2006 • Grants & Incentives for LTC staffing • LTC Ombudsman capacity improvement grants and training • National Training Institute for Surveyors

17. EJA in the House – H.R. 2006 • DoJ Provisions: • Provide resources to states for improved prosecution. • Require prompt reporting of crimes in nursing homes. • Make the Department of Justice responsible for a coordinated federal response to elder justice. • DOJ would provide grants to support state prosecutors, including employees of State Attorneys General and Medicaid Fraud Control Units handling elder justice-related matters.

18. What the EJA means for Adult Protective Services (APS) • First dedicated federal funding for APS • $100 million in new money to states for APS • $25 million in new money for APS demo grants • $3-4 million for HHS for a federal “home” for APS

19. What the EJA means for APS: State Funding Adult Protective Service Grant Program (State Formula Grants) -- Use of Funds • Authorizes $100 million • Funds may be used only by states and local governments to provide adult protective services & may only be used for APS. • State receiving funds would be required to provide these funds to the agency or unit of state government having legal responsibility for providing adult protective services in the state. • Each state would be required to use these funds to supplement and not supplant other federal, state, and local public funds expended to provide adult protective services.

20. What the EJA means for APS: National Demonstration Grants State Adult Protective Service Grants (Demonstration Program) – Authorizes $25 million “Would require the Secretary to establish grants to states for adult protective service demonstration programs. Funds may be used by state and local units of government to conduct demonstration programs that test: training modules developed for the purpose of detecting or preventing elder abuse; methods to detect or prevent financial exploitation and elder abuse; whether training on elder abuse forensics enhances the detection of abuse by employees of state or local government; and other related matters. States would be required to submit applications to the Secretary.”

21. What the EJA means for Adult Protective Services (APS): A Federal “Home” Focal Point for APS Within HHS • Would establish functions with respect to Adult Protective Services (APS) to be administered by the Secretary to provide leadership to the states’ programs. • Functions include providing funding and support to state and local adult protective services offices that investigate reports of abuse, neglect and exploitation of elders and vulnerable adults; collecting and disseminating information on abuse in coordination with the Department of Justice; developing and disseminating information on best practices; conducting research and providing technical assistance to states that provide or fund protective services. • Authorizes $3-4 million per year

22. Elder Justice Act – Status • House – EJA Pending • Senate – EJA legislation part of the Senate Leadership’s Health Care Reform Legislation – the “meld” bill • If passes the Senate (as part of HCR) goes to “Conference Committee” • No opposition from the Administration (or any known source) • What you can do!

23. Social Services Block Grant (SSBG)

24. Social Services Block Grant Recent History • Who has heard of it? • Former Title XX of SSA -- HUGE importance to states for human services • 1996 Welfare Reform: Congress & Governors reduced SSBG from $2.8 B to $2.38 B, promising restoration to $2.8 B in FY 2003 • Agreement broken; SSBG further reduced to $1.7 B – its current level (over $1 B less than in 1996 - in 1996 dollars) • Repeated efforts to restore funding have been unsuccessful – BUT NOW NOT FIGHTING OFF FURTHER CUTS!

25. SSBG & APS • Nationally – 37 States, $169 million (includes $18.6 million TANF transfer (11%)) = 7% of SSBG • 42.44% of combined total expenditures for APS • NY SSBG APS $ = $60.84 million (36% of national total) • 412,000 adults received APS services Source: SSBG Annual Report on Expenditures & Recipients 2005 – US DHHS, ACF, Office of Community Services

26. Older Americans Act

27. 1965 – A Remarkable Year for Older Americans • Medicare (SSA, Title XVIII) • Medicaid (SSA, Title XIX) • Older Americans Act (OAA)

28. Older Americans Act • Dual Mission • Service System Development • Advocacy • National Infrastructure • Federal • State • Local

29. Older Americans Act 7 Titles – Approx. $1.8 Billion Annually • I Statement of Objectives • II Administration on Aging – DHHS • III “Aging Network” – SUAs, AAAs & Community Services • IV Activities for Health, Independence & Longevity (R & D Discretionary Funds) • V Senior Employment Program (DoL) • VI Programs for American Indians, Alaska Natives & Native Hawaiians (Grants to Tribes) • VII Elder Rights

30. Older Americans ActTitle III • State Units on Aging – GA Division of Aging Services; MD Department of Aging; FL Department of Elder Affairs • Departments (several cabinet level) • Agencies in Umbrella Departments • Commissions • AAAs – GA -- Atlanta Regional Commission; MD – Baltimore City, Baltimore County, Upper Peninsula • County/City Government • Regional Councils • Non-Profits • Several states with small 60+ population – SUA serves as AAA (AK, DE, ND, NH, SD, RI, WY, DC & territories)

31. Older Americans Act & Other Aging Network Services Local Community Services (est. 27,000+ providers): e.g., • Home-delivered & congregate meals • I & A (I & R) • Adult day care • Transportation • Case management • Medicaid waiver services • Home repair • Senior centers • Family caregiver support • Disease prevention/health promotion • Evidence-based Prevention Grants

32. Older Americans Act – Title VII • Title VII – Elder Rights Title created in 1992 • Chapter 3 – Programs for Prevention of Elder Abuse, Neglect & Exploitation • Funding has remained largely static – ≈ $5.1 million/year • Very little, if any, goes to APS • For public ed and outreach, training & TA • Promoting the development of an elder A, N, & E System

33. OAA – 2006 Amendments: Elder Justice Provisions • Assistant Secretary to designate within AoA an individual responsible for administering activities related to elder abuse prevention programs. Among this person’s responsibilities are “to develop objectives, priorities, policy and a long-term plan for facilitating the development, implementation, and improvement of a coordinated, multidisciplinary elder justice system.” • Requires the conduct of a national incidence and prevalence study of elder abuse, neglect and exploitation in all settings where older persons live.

34. …Shifting Gears…. Health Promotion & Disease Prevention

35. Is Prevention Key to Preventingan Aging Tsunami?

36. Health Care Expenditures for Chronic Conditions • 83% of all Health Care Spending Involved People with Chronic Conditions in 2001 • Medicare – 98% • Medicaid – 83% • Privately Insured – 74% • Uninsured – 72% Source: Medical Expenditure Panel Survey, 2001, and Partnership for Solutions

37. What’s the health picture for Boomers? By 2030 • More than 6 of every 10 will be managing more than one chronic condition • 14 million (1 out of 4) will be living with diabetes • >21 million (1 out of 3) will be considered obese • Their health care will cost Medicare 34% more than others • 26 million (1 out of 2) will have arthritis • Knee replacement surgeries will increase 800% by 2030 “When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007

38. Exercise Prevention

39. Federal Policy & Prevention • Medicare covers good prevention services, but there’s little promotion • Federal agencies (CDC, AHRQ, AoA) promote evidence-based interventions (note ARC) • Older Americans Act – only dedicated funding for HP/DP for elderly • CDC’s Healthy Aging Program • Economic Stimulus legislation provides $1 billion for new Prevention & Wellness fund

40. Prevention & Health Care Reform Both Senate and House Health Care Reform bills contain numerous provisions related to prevention • House – Affordable Health Care for America Act – passed House • Senate – Patient Protection & Affordable Care Act – full debate to begin post-Thanksgiving