California Elder Abuse Summit Presentation by William F. Benson Health Benefits ABCs April 29, 2010.

California Elder Abuse SummitCalifornia Elder Abuse Summit

Presentation byPresentation by

William F. BensonWilliam F. Benson

Health Benefits ABCsHealth Benefits ABCs

April 29, 2010April 29, 2010

Elder Rights & the OAAElder Rights & the OAAA Rich Long HistoryA Rich Long History

From enactment in 1965 the OAA From enactment in 1965 the OAA established high expectations for its established high expectations for its network of federal, state and local network of federal, state and local agencies – they were given the agencies – they were given the mandate to serve as "effective and mandate to serve as "effective and visible" advocates on behalf of older visible" advocates on behalf of older Americans. Americans.


SUAs to “serve as an effective and SUAs to “serve as an effective and visible advocate for older individuals by visible advocate for older individuals by reviewing and commenting upon all reviewing and commenting upon all State plans, budgets, and policies which State plans, budgets, and policies which affect older individuals and providing affect older individuals and providing technical assistance to any agency, technical assistance to any agency, organization, association, or individual organization, association, or individual representing the needs of older representing the needs of older individuals” (OAA Sec. 305(a)(1)(D))individuals” (OAA Sec. 305(a)(1)(D))


AAAs to “serve as the advocate and focal AAAs to “serve as the advocate and focal point for older individuals within the point for older individuals within the community by (in cooperation with community by (in cooperation with agencies, organizations, and individuals agencies, organizations, and individuals participating in activities under the plan) participating in activities under the plan) monitoring, evaluating, and commenting monitoring, evaluating, and commenting upon all policies, programs, hearings, upon all policies, programs, hearings, levies, and community actions which will levies, and community actions which will affect older individuals” (OAA Sec. 306(a)affect older individuals” (OAA Sec. 306(a)(6)(B)(6)(B)


““serve as an effective and visible serve as an effective and visible advocate” language for AoA:advocate” language for AoA:

-- -- Assistant Secretary shall (1) “serve as the Assistant Secretary shall (1) “serve as the effective and visible advocate for older effective and visible advocate for older individuals within the Department of Health and individuals within the Department of Health and Human Services and with other departments, Human Services and with other departments, agencies, and instrumentalities of the Federal agencies, and instrumentalities of the Federal Government by maintaining active review and Government by maintaining active review and commenting responsibilities over all Federal commenting responsibilities over all Federal policies affecting older individuals”policies affecting older individuals”


““serve as an effective and visible serve as an effective and visible advocate” language for AoA:advocate” language for AoA:

-- Director of Office of LTCOPs will “serve -- Director of Office of LTCOPs will “serve as an effective and visible advocate on as an effective and visible advocate on behalf of …”behalf of …”

-- Director of Office of AIANNH will “serve -- Director of Office of AIANNH will “serve as the effective and visible advocate in as the effective and visible advocate in behalf of older individuals who are behalf of older individuals who are Native Americans…”Native Americans…”


1970s AoA funded:1970s AoA funded:-- Nursing Home Ombudsman Demonstration -- Nursing Home Ombudsman Demonstration

(transferred from PHS to AoA in 1975)(transferred from PHS to AoA in 1975)

-- Number of national legal/law-related -- Number of national legal/law-related demonstration programs (e.g., National demonstration programs (e.g., National Paralegal Institute)Paralegal Institute)

-- SUAs with advocacy assistance grants to -- SUAs with advocacy assistance grants to support state level development in both support state level development in both ombudsman and legal assistance services. ombudsman and legal assistance services.

-- Bi-Regional Advocacy Assistance Centers-- Bi-Regional Advocacy Assistance Centers


Long-Term Care Ombudsman Program added to Long-Term Care Ombudsman Program added to the OAA following demo program (1978 the OAA following demo program (1978 Amendments) Amendments)

-- 1981 amendments add board & care -- 1981 amendments add board & care responsibilityresponsibility

-- 1987 amendments – major for the LTCOP (e.g., -- 1987 amendments – major for the LTCOP (e.g., “analyze & monitor the development & “analyze & monitor the development & implementation of Federal, State, and local laws, implementation of Federal, State, and local laws, regulations…recommend any changes in such regulations…recommend any changes in such laws, regulations, and policies deemed by the laws, regulations, and policies deemed by the Office to be appropriate”)Office to be appropriate”)


Legal Services/AssistanceLegal Services/Assistance

-- Legal Services Developers (initially had to be -- Legal Services Developers (initially had to be attorneys)attorneys)

-- 1970s-1980s – expansion of legal assistance -- 1970s-1980s – expansion of legal assistance under Title III & tensions with aging network & under Title III & tensions with aging network & with LSCwith LSC

- 1987 Amendments: Neither a state, nor a state - 1987 Amendments: Neither a state, nor a state agency nor an AAA “may require any provider of agency nor an AAA “may require any provider of legal assistance under this title to reveal any legal assistance under this title to reveal any information that is protected by the attorney-information that is protected by the attorney-client privilege.” client privilege.”


““Prevention of Abuse, Neglect, & Exploita-Prevention of Abuse, Neglect, & Exploita-tion of Older Individuals” program added tion of Older Individuals” program added to OAA as new Part G of Title III by ‘87 to OAA as new Part G of Title III by ‘87 amendments (Rep. Mary Rose Oakar)amendments (Rep. Mary Rose Oakar)

-- Grants to states-- Grants to states

-- Prevention activities & referrals to others -- Prevention activities & referrals to others (e.g., law enforcement, APS, LTCOP)(e.g., law enforcement, APS, LTCOP)

-- “Trigger” language re appropriations-- “Trigger” language re appropriations

Elder Rights & the OAAElder Rights & the OAATitle VIITitle VII

““Vulnerable Elder Rights Protection” – 1992 Vulnerable Elder Rights Protection” – 1992 Amendments -- AoA described Title VII as,"...a Amendments -- AoA described Title VII as,"...a powerful new tool to assist vulnerable older powerful new tool to assist vulnerable older people to exercise their rights and secure the people to exercise their rights and secure the benefits to which they are entitled. It provides benefits to which they are entitled. It provides a framework upon which States can build a a framework upon which States can build a coordinated, integrated, statewide system of coordinated, integrated, statewide system of advocacy and assistance for such older advocacy and assistance for such older people. Based on Title VII, states will be able people. Based on Title VII, states will be able to establish a single focal point for OAA to establish a single focal point for OAA programs and activities which are primarily programs and activities which are primarily advocacy oriented..."advocacy oriented..."


Subtitle A Initially consisted of 5 chapters:Subtitle A Initially consisted of 5 chapters:

-- Ch 1 – General State Provisions (State Plan -- Ch 1 – General State Provisions (State Plan Requirements)Requirements)

-- Ch 2 – Ombudsman Programs-- Ch 2 – Ombudsman Programs

-- Ch 3 – Prevention of Elder Abuse, Neglect & -- Ch 3 – Prevention of Elder Abuse, Neglect & ExploitationExploitation

-- Ch 4 – State Elder Rights & Legal Assistance -- Ch 4 – State Elder Rights & Legal Assistance Development Development

-- Ch 5 – State Outreach, Counseling, and -- Ch 5 – State Outreach, Counseling, and Assistance Program for Insurance & Public Assistance Program for Insurance & Public BenefitsBenefits


Why create Title VII?Why create Title VII?

-- Emphasis on state-level -- Emphasis on state-level

-- Emphasis on protecting rights of older -- Emphasis on protecting rights of older individualsindividuals

-- Strengthening of individual programs-- Strengthening of individual programs

-- Emphasizing coordination among -- Emphasizing coordination among programs/servicesprograms/services

Why not direct legal assistance services?Why not direct legal assistance services?

Elder Rights & the OAAElder Rights & the OAAOther ProvisionsOther Provisions

Title IITitle II

-- NORC-- NORC

-- NCEA-- NCEA

-- Various Demonstration Programs -- Various Demonstration Programs (e.g., P & A, Housing Ombudsman)(e.g., P & A, Housing Ombudsman)

Elder Rights & the OAAElder Rights & the OAAAppropriations HistoryAppropriations History

OAA appropriations: Title IIIOAA appropriations: Title III(in thousands)(in thousands)

FY 1993 FY 2000

FY 2003

FY 2010

93-10 $

93-10 %

Supp. Serv.

$313,708 $310,082

$355,673

$368,348

+$54,640 +17%

Home meals

$89,659 $146,970

$180,985

$217,676

+$128,017

+143%

Cong. meals

$363,236 $374,336

$384,592

$440,783

+$77,547 +21%

OAA Total

$1,372,700 $1,513,048

$1,784,469

$2,341,722

+$969,022 +70%

Source: CRS Report for Congress: Older Americans Act: History of Appropriations, FY1966-FY2004FY 2011 Administration on Aging Justification of Estimate for Appropriations CommitteesFY 2010 appropriations conference report, H.Rept. 111-366

OAA appropriations: Title OAA appropriations: Title VIIVII

(in thousands)(in thousands)

FY 1993 FY 2000

FY 2003

FY 2010

93-10 $

93-10 %

Ombudsman

$3,870 n/s n/s $16,827 +$12,957 +335%

Prev. abuse

$4,348 n/s n/s $5,056 $708 +16%

Title VII

$8,218 $13,181

$18,559

$21,883

+$13,665

+166%

OAA Total

$1,372,700 $1,513,048

$1,784,469

$2,341,722

+$969,022

+70%

n/s= not specifiedSource: CRS Report for Congress: Older Americans Act: History of Appropriations, FY1966-FY2004FY 2011 Administration on Aging Justification of Estimate for Appropriations CommitteesFY 2010 appropriations conference report, H.Rept. 111-366

Elder Justice Act Elder Justice Act “Lovers of Sausage and the Law Should Watch “Lovers of Sausage and the Law Should Watch

Neither Made”Neither Made”

FEDERAL DOLLARS SPENT ON ABUSE AND NEGLECT

7%($520 Million)

2%($153.5 Million)

91%($6.7 Billion)

Child Abuse

Domestic Abuse

Elder Abuse

Source: Congressional Research Service

Number of Components in the Number of Components in the Elder Justice ActElder Justice Act

H.R. 3490, Subtitle H, Sec. 6701H.R. 3490, Subtitle H, Sec. 6701

Authorized for FY 2011-2014Authorized for FY 2011-2014

Amends Title XX of the SSA (Sec. 2011 & Amends Title XX of the SSA (Sec. 2011 & following) – Finance Committee & Ways & following) – Finance Committee & Ways & MeansMeans

Only portion of original version of EJA (note Only portion of original version of EJA (note Sestak’s Elder Abuse Victims Act of 2009)Sestak’s Elder Abuse Victims Act of 2009)

9 Major Distinct Components (& Definitions)9 Major Distinct Components (& Definitions)

Number of Components in the Number of Components in the Elder Justice Act (2)Elder Justice Act (2)

13 Distinct Authorizations of Funding – Need 13 Distinct Authorizations of Funding – Need Annual Appropriations – Otherwise, “Close but Annual Appropriations – Otherwise, “Close but no cigar”no cigar” ““Such Sums”Such Sums” Varying amounts per FYVarying amounts per FY Fixed authorizations for some provisions – e.g., APS Fixed authorizations for some provisions – e.g., APS

grants to statesgrants to states

Heavily LTC-focused XXXHeavily LTC-focused XXX Who Will Administer/Implement?Who Will Administer/Implement?

AoA?AoA? CMS?CMS? Secretary?Secretary? Other?Other?

EJA Component Parts EJA Component Parts

Elder Justice Coordinating Council – all fedsElder Justice Coordinating Council – all feds Authorization – such sumsAuthorization – such sums

Advisory Board on EAN & E – 27 public membersAdvisory Board on EAN & E – 27 public members Authorization – such sumsAuthorization – such sums

Research Guidelines re human subject Research Guidelines re human subject protectionsprotections Authorization -- $6.5 M then $7.0 MAuthorization -- $6.5 M then $7.0 M

Forensics Centers (4 Stationary Centers, 6 Forensics Centers (4 Stationary Centers, 6 Mobile Centers)Mobile Centers) Authorization -- $4M FY 11 (to $8 M)Authorization -- $4M FY 11 (to $8 M)


Enhancement of Long-Term CareEnhancement of Long-Term Care Grants & Incentives for LTC Staffing (Career Grants & Incentives for LTC Staffing (Career

Ladders, Wage & Benefit Increases, Technology, Ladders, Wage & Benefit Increases, Technology, Adoption of Standards for Transactions re Clinical Adoption of Standards for Transactions re Clinical Data)Data)

Authorization -- $20M FY 11 (drops to $15 M in FY 13-14)Authorization -- $20M FY 11 (drops to $15 M in FY 13-14)

Protecting Residents of LTC FacilitiesProtecting Residents of LTC Facilities National Training Institute for Surveyors (with National Training Institute for Surveyors (with

National Complaint Intake System)National Complaint Intake System) Authorization -- $12 M FY 11-14Authorization -- $12 M FY 11-14

Grants to State Survey Agencies re complaint Grants to State Survey Agencies re complaint investigations systemsinvestigations systems

Authorization -- $5M FY 11-14Authorization -- $5M FY 11-14


Reporting to Law Enforcement of Crimes Reporting to Law Enforcement of Crimes Occurring in Federally Funded LTC Facilities (to Occurring in Federally Funded LTC Facilities (to Secretary & Law Enforcement)Secretary & Law Enforcement)

Includes owners, operators, employees, Includes owners, operators, employees, managers, agents, contractors of LTC managers, agents, contractors of LTC facilitiesfacilities

CMPs for failure to do soCMPs for failure to do so

Additional Penalties for RetaliationAdditional Penalties for Retaliation

No AppropriationNo Appropriation


National Nurse Aide RegistryNational Nurse Aide Registry Study & report to Coordinating Council & Congress – Study & report to Coordinating Council & Congress –

18 mos.18 mos. Congress (Finance, W&Ms, E&C) “shall, as they Congress (Finance, W&Ms, E&C) “shall, as they

deem appropriate, take action on the deem appropriate, take action on the recommendationsrecommendations

Authorization – such sumsAuthorization – such sums

• Evaluation Evaluation • No AppropriationNo Appropriation• ““Tap” – not less than 2% appropriated for each Tap” – not less than 2% appropriated for each

programprogram

EJA Component Parts – LTC Ombudsman EJA Component Parts – LTC Ombudsman Grants & TrainingGrants & Training

• Grants to StatesGrants to States• Improve capacity of LTCOPs to respond to/resolve Improve capacity of LTCOPs to respond to/resolve

complaints about abuse & neglectcomplaints about abuse & neglect• Pilot programs with state & local ombudsman Pilot programs with state & local ombudsman

entitiesentities• National support (e.g., Nat’l LTCO Resource Center)National support (e.g., Nat’l LTCO Resource Center)• Authorizes $5 million in FY 08, $7.5 million in FY 09 Authorizes $5 million in FY 08, $7.5 million in FY 09

& $10 million in FY 10 & FY 11& $10 million in FY 10 & FY 11

• Ombudsman Training Programs re elder abuse, Ombudsman Training Programs re elder abuse, neglect & exploitation – authorized at $10 million neglect & exploitation – authorized at $10 million for FY 2008-2011for FY 2008-2011

What the EJA means for Adult Protective What the EJA means for Adult Protective Services (APS)Services (APS)

• First dedicated federal funding for APSFirst dedicated federal funding for APS

• $100 million in new money to states for $100 million in new money to states for APSAPS

• $25 million in new money for APS demo $25 million in new money for APS demo grantsgrants

• $3-4 million for HHS for a federal “home” $3-4 million for HHS for a federal “home” for APSfor APS

What the EJA means for APS: What the EJA means for APS: A “Federal Home”A “Federal Home”

► Establish functions with respect to Establish functions with respect to Adult Adult Protective Services (APS)Protective Services (APS) to be administered by to be administered by the Secretary to provide leadership to the the Secretary to provide leadership to the states’ programs. states’ programs. Authorizes $3m FY 11 & $4m Authorizes $3m FY 11 & $4m FY 12-14FY 12-14

► Functions include providing funding and support Functions include providing funding and support to state and local adult protective services to state and local adult protective services offices that investigate reports of abuse, neglect offices that investigate reports of abuse, neglect and exploitation of elders and vulnerable adults; and exploitation of elders and vulnerable adults; collecting and disseminating information on collecting and disseminating information on abuse in coordination with the Department of abuse in coordination with the Department of Justice; developing and disseminating Justice; developing and disseminating information on best practices; conducting information on best practices; conducting research and providing technical assistance to research and providing technical assistance to states that provide or fund protective services.states that provide or fund protective services.

What the EJA means for APS: State What the EJA means for APS: State FundingFunding

Adult Protective Service Grant Program (State Formula Adult Protective Service Grant Program (State Formula Grants)Grants) -- Use of Funds -- Use of Funds

► Authorizes $100 millionAuthorizes $100 million

► Funds may be used only by states and local governments to Funds may be used only by states and local governments to provide adult protective services & may only be used for APS.provide adult protective services & may only be used for APS.

► State receiving funds would be required to provide these funds to State receiving funds would be required to provide these funds to the agency or unit of state government having legal responsibility the agency or unit of state government having legal responsibility for providing adult protective services in the state. for providing adult protective services in the state.

► Each state would be required to use these funds to supplement Each state would be required to use these funds to supplement and not supplant other federal, state, and local public funds and not supplant other federal, state, and local public funds expended to provide adult protective services. expended to provide adult protective services.

► California: $9.958 milllion =170 FTEs (at $60,000 California: $9.958 milllion =170 FTEs (at $60,000 each)each)

What the EJA means for APS: What the EJA means for APS: National Demonstration GrantsNational Demonstration Grants

State Adult Protective Service Grants State Adult Protective Service Grants (Demonstration Program(Demonstration Program) – ) – Authorizes $25 millionAuthorizes $25 million

““Would require the Secretary to establish grants to states Would require the Secretary to establish grants to states for adult protective service demonstration programs. for adult protective service demonstration programs. Funds may be used by state and local units of Funds may be used by state and local units of government to conduct demonstration programs that government to conduct demonstration programs that test: training modules developed for the purpose of test: training modules developed for the purpose of detecting or preventing elder abuse; methods to detect detecting or preventing elder abuse; methods to detect or prevent financial exploitation and elder abuse; or prevent financial exploitation and elder abuse; whether training on elder abuse forensics enhances the whether training on elder abuse forensics enhances the detection of abuse by employees of state or local detection of abuse by employees of state or local government; and other related matters. States would government; and other related matters. States would be required to submit applications to the Secretary.”be required to submit applications to the Secretary.”

Implementation of the EJAImplementation of the EJA

►““Show me the money” Show me the money” (“Jerry Maguire) – (“Jerry Maguire) – the battle & challenges for appropriationsthe battle & challenges for appropriations Significance for APSSignificance for APS

►Who will be responsible for what at HHS?Who will be responsible for what at HHS?►What is the timetable especially sans What is the timetable especially sans

appropriations – e.g., no action taken appropriations – e.g., no action taken until appropriations?until appropriations?

►Those items not requiring appropriations Those items not requiring appropriations – e.g., reporting of crimes in LTC facilities– e.g., reporting of crimes in LTC facilities

AppropriationsAppropriations

► Advocacy needed by all of you: Advocacy needed by all of you: ► California has a lot of members on the California has a lot of members on the

Appropriations Committees (full & Labor, Appropriations Committees (full & Labor, HHS Subs) – but all members needed – see HHS Subs) – but all members needed – see www.elderjusticecoalition.com

► Importance of APS funds – new money to Importance of APS funds – new money to statesstates

► Your Governor’s Office (& national orgs)Your Governor’s Office (& national orgs)► California Legislature (& national orgs)California Legislature (& national orgs)► State orgs – e.g., C4A & CWDA (Nat’l reps)State orgs – e.g., C4A & CWDA (Nat’l reps)

Appropriations – Past as Appropriations – Past as Prologue?Prologue?

►The Track RecordThe Track Record►Congress (and States)Congress (and States)►Aging NetworkAging Network►Elder Abuse Victims – just another client Elder Abuse Victims – just another client

group?group?►OAA ReauthorizationOAA Reauthorization

““Be bold” notionBe bold” notion Pick right vehicles (e.g. APS & OAA)Pick right vehicles (e.g. APS & OAA) Pyrrhic victories – little sustained joyPyrrhic victories – little sustained joy

CongratulationsCongratulations

National Adult Protective National Adult Protective Services AssociationServices Association

Elder Justice CoalitionElder Justice Coalition

Health Benefits ABCsHealth Benefits ABCs11101 Georgia Ave., #32011101 Georgia Ave., #320

Silver Spring, MD 20912Silver Spring, MD 20912

301-933-6492301-933-6492

[email protected]@starpower.net

This Affects All GenerationsThis Affects All Generations

California Elder Abuse Summit Presentation by William F. Benson Health Benefits ABCs April 29, 2010.

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Transcript of California Elder Abuse Summit Presentation by William F. Benson Health Benefits ABCs April 29, 2010.