Nursing Home Care in the Spotlight

Published in the Woonsocket Call on August 4, 2019

Following on the heels of its March 6 hearing, “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes,” the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,” on July 23, in 215 Dirksen, to study proposed reforms to reduce neglect and abuse in the nation’s nursing homes and to put a spotlight on the need to reauthorize key provisions of the Elder Justice Act.

During the two hour and twenty-minute morning hearing, Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Oregon) along 11 members of the Senate committee listened to the testimony of five panel witnesses.

In his opening statement, Grassley acknowledged that the work isn’t done yet to improving the care in the nation’s nursing homes and Congress must protect nursing home and assisted living residents and those in group living arrangements from harm. The Iowa Senator noted in the recently released U.S. Government Accountability Office (GAO) report the federal agency that provides auditing, evaluation, and investigative services for Congress, noted that while one-third of nursing home residents may experience harm while under the care of these facilities, in more than half of these cases, the harm was preventable.

Calls for Bipartisan Efforts to Improve Nursing Home Care

Grassley called on Congress to reauthorize programs, such as the Elder Justice Act, to put the brakes on the growing trend of elder an abuse fueled by social media.

Adds, Wyden, in his opening statement, there is now an opportunity for Congress to come together to hammer out bipartisan legislative reforms to fix the nation’s nursing home oversight efforts. He urged his fellow Senate committee members to work to reduce the instances of physical, sexual, mental and emotion abuse in nursing homes, that appears to be increasing. He also called for a redo to the federal nursing home rating system because it does not reflect the increased prevalence of abuse.

During the first panel, Megan H. Tucker, Senior Advisor for Legal Review, of the HHS Office of Inspector General (OIG), stated that abuse and neglect oftentimes are not properly identified, reported or even addressed. While most providers are delivering good care, Tucker warned that Health and Human Service safeguards are lacking.

Tucker testified that the Centers for Medicare and Medicaid Services (CMS) should use data more effectively and close the gaps in their reporting process to ensure that abuse and neglect are identified and the deficiencies corrected.

Concluding the first panel, John E. Dicken, Director, Health Care, of the U.S. Government Accounting Office (GAO), discussed a newly released GAO report, released at the hearing, that detailed a growing trend of abuse and neglect of residents. According to one GAO report findings, abuse deficiencies more than doubled between 2013 (430) and 2017 (875), with the greatest increase in actual harm and immediate jeopardy deficiencies, and that abuse is still under-reported, he said. The GAO report also expressed concern over “significant gaps” with CMS’s oversight.

Leading the second panel, Robert Blancato, Coordinator of the Elder Justice Coalition, called on Congress to reauthorize, the Elder Justice Act. With elder abuse becoming a “national emergency,” he urged lawmakers to dedicate funding for Adult Protective Services at the local and state levels. Blancato also stressed the importance of strengthening the long-term care ombudsman program, continuing the Elder Justice Coordinating Council, authorizing an Advisory Board on Elder Abuse, Neglect, and Exploitation, and finally funding for elder abuse forensic centers.

President and CEO, Mark Parkinson, of the Washington, DC-based American Health Care Association (AHCA), representing nearly 10,000 of the 15,000 plus nursing homes in the country who provide care to nearly four million individuals each year, stated he was not at the hearing to defend poor care but to provide solutions to Congress to prevent such incidents from happening again.

Fixing the Problem

Parkinson testified that over the past seven years, facilities participating in AHCA’s quality initiative, have shown improvement in 18 of 24 quality measures. Specifically, there are less hospital readmissions, fewer antipsychotic medications being prescribed, staff are spending more time than ever before with residents and today’s nursing homes are more person-centered care today than ever before.

Parkinson called on lawmakers to improve employee background check systems, add patient satisfaction data to CMS’s nursing home rating system, address the severe staffing shortage and to adequate fund Medicaid.

Finally, Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care, ended the second panel discussions, by warning that more must be done to protect nursing home residents from abuse.

Smetanka urged Congress to take steps to enforce minimum requirements for sufficient staffing, establish standards and oversight for nursing home ownership and operations, prevent rollback of nursing home regulatory standards, increase the transparency of information and to strengthen and adequately fund elder justice provisions.

Now, with the Congress putting poor nursing home care on its policy radar screen, both Democratic and Republic congressional leadership must work closely together to come up with bipartisan solutions. Fix this problem once and for all.

Senate Finance Committee members — Senators Lankford, Stabenow, Daines, Menendez, Carper, Cardin, Warner, Casey, Brown, Cortez Masto, and Hassan – attended the July 23 hearing

To listen to this Senate Finance Committee hearing, go to http://www.c-span.org/video/?462733-1/finance.

For a copy of the GAO report, http://www.gao.gov/assets/710/700418.pdf.

Senate Task Force Calls for Action to Combat State’s Growing Elder Abuse

Published in the Woonsocket Call on June 30, 2019

With the 2019 General Assembly Session ending Friday, June 28, Senator Cynthia Coyne (D-District 32, Barrington, Bristol, East Providence), who led the Senate’s Special Task Force to Study Elderly Abuse and Financial Exploitation, successfully spearheaded an effort to pass legislative proposals to beef up the state’s efforts to combat elder abuse, that is growing and vastly under reported.

“The prevalence and projected growth of elder abuse and exploitation is deeply troubling, particularly in light of our findings that its full extent can’t be known because it is so rarely reported or investigated,” said Coyne in a statement announcing the release of the Senate Task Force’s final report. “As the baby boomers become seniors and our elderly population grows, it’s critical that we do everything we can to protect older Rhode Islanders from this abuse. We are confident we can make significant improvements to prevent elder abuse and exploitation, and I’m grateful for the commitment of my colleagues in the Senate to this issue,” says Coyne.

The Senate Task Force, began studying the prevalence and impact of elder abuse and financial exploitation in Rhode Island last December, releasing its final report June 28, in Room 313 on the third floor of the statehouse, calling for education about elder abuse and monitoring efforts to prevent it.

Rhode Island Elder Abuse Incidents Are Increasing

The 130-page report, citing data supplied by the Rhode Island Division of Elderly Affairs (RIDEA), warns that elder abuse and financial exploitation in the Ocean State is prevalent and incidents are increasing. According to RIDEA, “there were 1,377 confirmed cases of elder abuse in 2017, which is 444 cases more than only five years prior. As the nation’s population of people age 65 and over is expected to double by 2060, the problem is expected to continue growing. Among the recommendations is that the state collaborate with existing community organizations and support outreach and education efforts that specifically focus on seniors and those who interact with them.”

Elder abuse is underreported, too, says the Senate Task Force report, noting that “Only 1 in 23 cases of elder abuse is reported to adult protective services.“ The report recommends strengthening outreach and education efforts for the public, health care workers and others who interact with seniors, and working to dispel stigmas so seniors will be better enabled to report abuse.

The Senate Task Force report also warns that older Rhode Islanders are also extremely vulnerable to financial exploitation, caused by a multitude of factors including a senior’s health, life savings and technology now available to electronically transfer money. With this problem expected to continue growing, it calls for better education for passage of legislation similar to a Connecticut law that requires training for agencies that employ individuals to care for seniors. Another recommendation is to consider a law like one in Delaware to allow financial institutions to place a hold on accounts when they find suspicious transactions.

The Senate Task Force also recommends supporting the Saint Elizabeth Haven for Elder Justice and its enhanced Training and Services to End Abuse in Later Life grant program, and strengthening services available through the POINT, the senior resource service at the Division of Elderly Affairs.

Passed Elder Abuse Legislation Heads to Governor’s Desk for Signature

As the result of this Senate Task Force, in the final days of the General Assembly, Coyne and Rep. David A. Bennett (D-District 20, Warwick, Cranston) introduced legislation (S 0603A, H 5573) to combat tackle the issue of elder abuse in the Ocean State. The legislation, expanding an existing law that requires people who have reasonable cause to believe a person age 60 and over is being abused, neglected or mistreated to report it to the Division of Elderly Affairs, which will report the incident to law enforcement if appropriate and intervene, was passed an now heads for the Governor’s desk for signature. .

Currently, health care providers and others who come into contact with elderly or disabled people in health care facilities are required to report suspected abuse or neglect within 24 hours. The enacted law adds a section of law requiring reporting of suspected abuse, exploitation, neglect or self-neglect of people over age 60, regardless of whether they live in a health care facility. It also expands the list of those required to report suspected abuse to include physician assistants and probation officers and protects employees who report abuse from liability (unless they are found to be a perpetrator) or negative consequences at work for reporting abuse or neglect.

The Rhode Island General Assembly also passed legislation (S 0845A, H 6114) sponsored by Coyne and Rep. Patricia A. Serpa (D-District 27, West Warwick, Coventry, Warwick). The legislation requires the collecting municipal probate data to access the guardianship program, as well as to seek federal grants to support education, monitoring and resources for guardians. It also recommends a nationwide criminal background check for anyone seeking guardianship or limited guardianship of another adult, even temporarily. Under the bill, anyone who is found to have been convicted or plead nolo contendere to charges for a variety of crimes, including violent crimes or crimes involving abuse or neglect of elders, would be disqualified.

Members of the task force include Senator Coyne; Senator Sandra Cano (D-District8, Pawtucket); State Long-Term Care Ombudsman Kathleen Heren; Special Assistant Attorney General Molly Kapstein Cote; Mary Ladd, chief of program development at the Rhode Island Division of Elderly Affairs; AARP- Rhode Island Associate State Director John DiTomasso; State Police Detective Kyle Shibley; Warwick attorney Mark Heffner; and Saint Elizabeth Haven for Elder Justice Director Jeanne Gattegno.
With the release of its report this month, Coyne’s Special Task Force to Study Elderly Abuse and Financial Exploitation, is off to a good start by giving the Rhode Island General Assembly a legislative road map needed to protect vulnerable Rhode Island seniors from physical, emotional and financial abuse. It’s a first step, but hopefully not the last. Senate leadership might consider making the Senate’s Special Task Force to Study Elderly Abuse and Financial Exploitation, permanent, charged with recommending legislative proposals each session, mirroring best practices, gathered from other states, to combat elder abuse.

To get a copy of the Senate Task Force’s elder abuse report, to http://www.rilin.state.ri.us/commissions/eafe/commdocs/Special%20Task%20Force%20to%20Study%20Elderly%20Abuse%20and%20Financial%20Exploitation%20REP.pdf.

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

The Best of…Nationally Elder Abuse and Neglect on the Increase

           Published June 25, 2001, Pawtucket Times

           Although numerous federal studies and Congressional hearings have put the public spotlight on elder abuse and neglect over the years, a Special Senate on Aging panel calls for the nation to get serious to tackle this all-to-common tragedy, called by some “the dark side” of aging. 

           “With the senior population skyrocketing, incidents of elder abuse will only continue to rise,” warned Democratic Chairman John Breaux of Louisianato his panel colleagues at the June 14th hearing.   At the hearing Senator Breaux took over the reins of the Aging  Committee from the former Chairman Republican Larry Craig ofIdaho, with the Senate majority tipping to the Democrats.  Initially it was Senator Senator Craig who had planned and put the hearing on the Senate schedule.      

           At the  hearing, Chairman Breaux estimated that more than 820,000 older and developmentally disabled individuals are subjected to abuse, neglect and exploitation.  Meanwhile, throughout  the hearing “Elder Abuse, Neglect, and Exploitation: A Hidden National Tragedy,” several witnesses testified that this number is too low because of underreporting and there are no universal definitions of what is elder abuse and neglect.  To combat abuse, Chairman Breaux and the witnesses called for more funding to be provided to adult protective services, better training for medical personnel to identify the problem early and more resources for caregivers to help them with their caregiving responsibilities.

            Despite the fact that many believe that elder abuse and neglect take place in nursing facilities and assisted living facilities, most often times it occurs in a person’s home where nearly 95 percent of all domestic long-term care is being informally provided by family members and community-based caregivers, noted Chairman Breaux.

            Summing up testimony from hearing witnesses, a Senate Aging Committee staffer told The Times that elder abuse can be caused by social, medical and legal factors.

             “We are expecting families to provide a large amount of long-term care and we give only minimal assistance and support to them,” the Senate staffer said.  To deal with social factors causing elder abuse and neglect, “we need more respite care and training in care giving skills.” he added.   

             As to medical factors, the Senate staffer added, “it is crucial that better training be made available to physicians and nurses to recognize the early signs of elder abuse itself.”  If this occurred there could be much quicker interventions, he said.  

             Finally, legal factors, specifically the lack of funding for elder protective services, reduce the effectiveness of prosecuting persons who financially exploit elderly.

                 So what’s happening inRhode Island?

             According to Wayne Farrington, Chief of Facilities Regulation,Rhode Island’s Department of Health, elder abuse is on the increase in nursing facilities and assisted living facilities across the state.  “This year we have had about a 15 percent increase in reports of abuse, neglect or mistreatment,” he says.  Farrington speculates that the rise in reporting is a result of a better informed public who know where to register complaints combined with increased publicity over the staffing shortage in nursing facilities and community-based provider agencies.  The shortage of nursing assistants, who provide most of the direct patient care, along with nurses oftentimes results in the facility not being able to provide the needed care.

            “Because neglect abuse and mistreatment are criminal matters they are turned over to the Rhode Island Office of the Attorney General for further investigation and prosecution, Farrington says.  “If we find that facilities have violated regulations that have resulted in the abuse or neglect we will cite the facility with deficiencies that may be tied to civil monetary penalties.

           According to Medicaid Fraud Unit Chief Bruce Todesco, of the state’s Office of the Attorney General, there are really no accurate statistics or numbers that tell the incidence of elder abuse and neglect inRhode Island.  “A lot of information comes from different sources,” he said, stressing that it would take a lot of work to pull together meaningful statistics.

           Adds, Genevieve  Allair-Johnson, Special Assistant Attorney General who serves as Elderly Affairs Liaison for Criminal Division, in the Attorney General’s Office, elder abuse and neglect cases may be under reported because the elderly person does not want to proceed against the child and competency issues often times come into play.

           “We work closely with the Department of Elderly Affairs and local police departments and provide them with legal assistance in their investigations, Allair-Johnson says.  “When discussing a case sometimes it comes up that additional inquiries will have to be made to bring about charges.”   

            Allair-Johnson states “Many times criminal charges will not be filed in cases because high standards must be met.”   Rather than filing criminal charges for elder abuse or neglect other options are in place like removing the elderly person from a home, or seeking a court ordered guardianship.

          Over the last few years the Office of the Attorney General has developed effective partnerships with the local police departments, Department of Elderly Affairs, and the Alliancefor Better Long-Term Care,” Allair-Johnson says.  “There are a host of state agencies and resources that are beginning to pull together to resolve this elder abuse issue. We’re going in the right direction.”

          To obtain materials on elder abuse, including the pamphlet “The Elder Victims Guide to the Criminal Justice System,” or to seek information about consumer issues or to report elder abuse, neglect and financial exploitation, call the Attorney General’s Senior Line at 888-621-1112. 

          If one has a reasonable knowledge and suspects an elderly person has been abused neglected or mistreated in a nursing facility call the Division of Facility Regulation at 222-2566.

          Herbert P. Weiss is a Pawtucket, Rhode Island-based  free lance writer covering aging, health and medical care issues,  This article appeared in the June 25, 2001 in the Pawtucket Times.   He can be reached at hweissri@aol.com.