Tag Archives for Senate Aging Committee

Hoarding and seniors: “The Consequences of Clutter” Report 

Published in RINewsToday on July 22, 2024

With the number of seniors afflicted with a hoarding disorder expected to skyrocket to over 14 million, on July 2 U.S. Sen, Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, unveiled a report putting the spotlight on its impact on older hoarders and their communities.  For seniors those consequences include health and safety risks, social isolation, eviction, and homelessness. For communities, those consequences include public health concerns, increased risk of fire, and dangers to emergency responders.

According to the report, citing the Administration for Community Living’s 2020 Profile of Older Americans, the number of seniors in the U.S. is expected to increase from about 54 million in 2019 to over 94 million in 2060. “Because hoarding disorder disproportionately impacts older adults, experts worry that aging could fuel a rise in hoarding in the coming decades,” notes the report, quoting NPR Morning Edition’s Rose Conlon. 

According to the Majority Staff of the Senate Aging Committee who wrote the report (with a whopping 270 citations), it was developed for information purposes only and does not represent the findings or recommendations formally adopted by the Committee.

Hoarding is a chronic and progressive condition

The report notes that this chronic and progressive condition impacts roughly two percent of the general population, while it affects about six percent of those over the age of 70.

“Hoarding disorder is a heartbreaking condition that is posing challenges to older adults, their families, and their communities across the country,” said Chairman Casey (D-PA) in a July 2 statement announcing his report. “The federal government has an obligation to ensure that Americans can age with dignity and this report makes clear that obligation must include doing more to address hoarding disorder,” he says.

According to Casey, the new report, “The Consequences of Clutter: How Hoarding Disorder Affects America’s Older Adults, First Responders, and Their Communities,” demonstrates the scope and severity of the challenges of this complex mental health condition and offers a path forward for how we can help people, communities, and local governments contend with this condition. 

Local communities throughout the United States are already working to address cases of hoarding disorder, including through the formation of hoarding task forces to coordinate response efforts, says

Casey’s report, noting that the local resources  available often do not correspond with the level of challenge communities are facing. 

Casey’s report issued a series of nine recommendations for how the federal government can increase support to communities that are contending with hoarding disorder, including expanding access to treatment for the condition, providing local officials with more extensive guidance and training to support afflicted individuals, and expanding the scope of tracking and research about how hoarding disorder is affecting individuals and communities nationwide.

The report compiles 55 requests for information, responses, and stakeholder statements submitted by non-profits, social services organizations as well as state and local governments to gather information to better understand the impact of hoarding in local communities. 

“Overall, the report does a good job of outlining the importance of the topic and identifies the federal and state agencies that should be involved in assessment and intervention,” says Randy O. Frost, professor emeritus of psychology at Smith College and a leading researcher on hoarding and related topics.

“Hoarding Disorder is a relatively [recognized] new disorder, having just entered the DSM in 2013. Consequently, there are not identified agencies who can claim ownership of the problem and the potential solutions.” This report legitimizes this problem for attention from these agencies, says Frost, noting that this report also highlights the fact that the prevalence of hoarding is extremely high among the elderly.

“Severe cases are sometimes life threatening for the individual and those living nearby or those called in to provide help,” adds Frost.

An Expert’s take…

According to Frost, the report covers the important issues related to hoarding, including education of the general public as well as family, friends, and people suffering with the problem. It highlights the need to train professionals in best practices for intervention. An important assumption underlying the report is that this is a problem which touches many different social service disciplines, from first responders to assisted living facilities, adult protective services, animal control, mental health, public health, child health, elder services, etc. “When a local case is identified, in current practice, it is not unusual for 4 or 5 of these agencies to be involved, often not knowing what each other are doing. Integration among these agency professionals is crucial for dealing with hoarding efficiently,” he says.

“There is a lot more that could be said about this problem, and a lot more detail could have been included regarding specific recommendations,” he said, stressing that this was not the purpose of the report. “The report was to outline the problem and point different agencies in appropriate directions moving forward. It does so and is a welcome effort from a federal agency,” he says.

Spotlight on Rhode Island

“Hoarding is a serious problem that has apparently not been adequately addressed in Rhode Island as well as in the nation as a whole,” charges long-time advocate for vulnerable and marginalized populations Susan Sweet, former associate director of the Department of Elderly Affairs, and founder of the Rhode Island Minority Elder Task Force (RIMETF).  “While it is present in all age groups, adults over 60 years have the highest level of hoarding behavior and the most risk because of diminished physical and often cognitive abilities,” she says.

“This report outlines the difficult life circumstances that elders with the problem of hoarding face.  The Rhode Island network of aging programs and advocates for older adults do not have the resources to create and implement effective remedies,” warns Sweet. “I hope that shining a light on the issue will encourage policy, funding, and attention to what is a mental health issue and a complication in physical illnesses that create obstacles in attempts to help elders afflicted with the disorder,” she says.

According to Sweet, the Ocean State is one of the few areas and the only state that has organized a Hoarding Taskforce to point the way towards effective client management, education and training of eldercare healthcare, mental health programs and social work entities.  The health and well-being of individuals and communities is greatly impacted by the fire hazards, evictions, safety issues, and other self-neglect problems that occur with hoarding behavior.

“Awareness of the prevalence of hoarding and the danger to our communities and citizens should quicken the pace of funding and support to combat this growing threat,” says Sweet.

Like Sweet, Robin Covington, a member of Rhode Island’s Hoarding Task Force, sees the value of the released Senate Aging Committee’s report on hoarding and its recommendations. “As an adult protective services caseworker I saw firsthand the implications of hoarding,” said Covington, who serves as Coalition Director of Saint Elizabeth Haven for Elder Justice. “Hoarding creates health, fire hazard and safety risks, social isolation, eviction and homelessness,” she said. 

“Often times, people who hoard don’t think they have a problem because of their attachment to their possessions, which makes it difficult to deal with”, says Covington.  Because of its behavioral aspects a person with this behavior needs clinical assistance, she notes, not just decluttering of personal items. 

Covington believes that there is a lack of programs and clinical support in place in Rhode Island to address the increasing problem of hoarding. However, the state’s Hoarding Taskforce is working on helping support case managers and providers by developing a workforce initiative to support individuals with clutter or hoarding tendencies. 

Increase funding for Case Manager interventions

But more funding must be given to Community Action Programs who subcontract with OHA to oversee Adult Protective Services. “It’s pricey to cover the costs of visits, intervention and coordination of a clean-up company,” Covington says. 

A lot of times when it is someone over 60, a report to Adult Protective Services is provided and a CAP agency case manager goes out and visits the older adult to put eyes on them and to help with an intervention like the coordination of a clean-up company, but that can be expensive, notes Covington. 

As a Licensed Clinical Social Worker for over 23 years and RIMETF’s president  Lori Brennan-Almeida has seen the negative impact of hoarding up close.  For over 20 years, she has seen RIMETF provide emergency assistance to seniors age 55 and over to pay for services to clean their apartments to avoid eviction.

“Clinical intervention is necessary to stop seniors from hoarding”, says Almeida, stressing the importance of home-based therapy. “Grief counseling may be needed because a person often forms an attachment to compensate for a personal loss,” adds Brennan-Almeida.  

“Without counseling, hoarding may well continue after the debris is gone from their apartment and the senior will just collect more items”, says Brennan-Almeida.  

Keeping tabs on hoarding

“This is our first ever hoarding report,” says Misha Linnehan, Deputy Press Secretary for Sen. Casey.  When asked if there would be a follow-up report next year, she stated: “There are currently no plans for another but it is always a possibility.” 

Kudos to Chairman Casey and the Majority Staff for putting resources, time and effort into crafting this report.  For those people in the trenches, future reports should be written and formal Senate Aging Committee hearings held to keep tabs on this growing problem and to determine if the recommendations from this first report are being implemented. 

Don’t drop the ball on this one.

RI Hoarding Task Force

Janet Spinelli and Kelly McHugh are co-chairs of the RI Hoarding Task Force which is convened through the RI Elder Mental Health and Addiction Coalition co-chaired by Chris Gadbois and Janet Spinelli. 

The RI Hoarding Task Force has two committees including the HD Task Force Toolkit Development Committee lead by Christopher Liu, an undergraduate at Brown University and the HD Task Force Website and Outreach Committee.  

Anyone interested in joining the Task Force can email RIEMHAC@gmail.com  More information and resources can be found at RIHoardingtf.ri.gov which is supported through the EOHHS Money Follows the Person Program.

For download a copy of the Senate Aging Committee’s hoarding report, go to chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.aging.senate.gov/imo/media/doc/the_consequences_of_clutter.pdf

Shortage of direct care professionals a local and national concern

Published in RINewsTdoay on April 22, 2024

Last week, at  the Senate Dirksen Building, Room SD-562,  Chairman Bob Casey, of the U.S. Special Committee on Aging, (D-PA), showcased S. 4120, legislation that he introduced with U.S. Senators Tim Kaine (D-VA), and Tammy Baldwin (D-WI). The Long-Term Care Workforce Support Act, introduced during the 118thCongress, would ensure that direct care professionals have a sustainable, lifelong career by providing substantial new funding to support these workers in every part of the long-term care industry, from nursing homes to home care, to assisted living facilities.

The Senate Aging Committee details a number of statistical findings showing the need for Congress to address the nation’s severe ongoing direct care professional workforce shortage. “A recent survey revealed 92% of nursing facility respondents and nearly 70% of assisted living facilities reported significant or severe workforce shortages.

In 2022, a survey of nursing facilities showed more than 50% of the facilities were limiting the number of new admissions due to staffing vacancies or shortages.  Another recent survey of Home and Community Based Service providers showed that all 50 states were experiencing home care worker shortages, and 43 states reported that some HCBS provider groups have closed due to worker shortages,” says the fact sheet.

Addressing the cause

By improving compensation, benefits, and support systems, S.4120  would ensure the United States has a “strong, qualified pipeline of workers to provide desperately needed care for older adults and people with disabilities.” notes a statement announcing the introduction of Casey’s legislative proposal.  

Specifically, S. 4120 would increase the number of direct care professionals, especially in rural communities.  It also would provide pathways to enter and be supported in the workforce for women, people of color, and people with disabilities.

S. 4120 would also improve wage compensation for direct care professionals to reduce vacancies and turnover.  It ensures that direct care professionals are treated with respect, provided with a safe working environment, protected from exploitation, and provided fair compensation.

The legislative proposal also documents the need for long-term care, identify effective recruitment and training strategies, and promote practices that help retain direct care professionals. It also would strengthen the direct care professional workforce in order to support the 53,000,000 unpaid family caregivers who are providing complex services to their loved ones in the home and across long-term care settings.

At press time, S. 4120 is endorsed by 50 organizations, including Domestic Workers Alliance, SEIU, AFSCME, Caring Across Generations, National Coalition on Aging (NCOA), Justice in Aging, National Partnership for Women & Families, National Council on Independent Living (NCIL), and the National Disability Rights Network (NDRN).

And a companion legislative proposal was introduced in the House by Congresswoman Debbie Dingell (D-MI).

Senate Aging Committee puts spotlight on Direct Care Staffing Shortage 

The April 16th hearing entitled, “The Long-Term Care Workforce: Addressing Shortages and Improving the Profession,” examined the challenges currently facing long-term care workers who are often underpaid and overworked, leading to widespread worker shortages that threaten the availability of care for those who need it.  

“It’s a crisis that stems largely from a lack of support for and investment in our caregiving workforce,” warns Casey in his opening statement. “Between 50 to over 90 percent of long-term care settings and providers report significant staffing shortages, affecting their ability to provide services, accept new clients, or even to remain open,” he says.

Casey noted that many direct care professionals have to work multiple jobs or overtime just to be able to support themselves and their families.  In 2022, their medium wage was just above $15 dollars an hour, well below what is paid for warehouse and convenience store jobs, per Casey.

“The direct care workforce, the majority of whom are women of color, are more likely to live in poverty compared to the general public,” notes Casey.

“Cumbersome federal regulations, requirements, and protections” and a “one-size fits all approach” won’t fix the direct care staffing shortage, responds Ranking Member Mike Braun (R-IN).

“To grow the long-term care workforce, the federal government should make it easier for people to enter by removing barriers,” says Braun, in his opening statement, calling for “productive approaches to build and grow the care professions.”

Overworked and not enough money

Nicholas Smith, a direct support professional at SPIN, a Pennsylvania-based organization that provides lifespan services for over 3,000 people with intellectual disabilities and autism, came to testify. “I work nearly 65-70 hours a week… due to my work, I have missed family events, nieces’ and nephews’ recitals, and school functions… a lot of people are leaving this field to make more money,” said the Philadelphia resident who has worked in the long-term care industry for over 25 years.

According to Smith, the national average for direct service professional wages is only $15.43 in long-term care. “We spend time training new hires only to lose them because they cannot make a living wage,” he says, noting that other industries are offering more money.

“While people want to stay in this field, they cannot make ends meet. Pennsylvania has a long waitlist for home and community-based services, and this is due to the workforce crisis,” he says.

In her testimony, Brooke Vogleman, a licensed Practical Nurse with Huntington, Indiana based TLC Management, stated:  “I’ve seen what happens when long-term care facilities lack workers, resources and government support, like during the pandemic. Many of my colleagues got burned out and left the profession, forcing facilities to rely on costly temporary staffing agencies.”

Vogleman called on federal policy makers, including members of the Senate Aging Committee, to address the challenge through “targeted investments, not blanket mandates.”  

For instance, she told the Senators that LPNs are integral to the facility’s interdisciplinary team. “Staffing mandates that do not include our contributions to patient care or recognize us as nurses are very concerning to me and will have unintended consequences on residents,” she says.

Staffing mandates will force facilities to depend more on expensive staffing agencies, warns Vogleman. “Personally, I’m concerned they will actually increase staff burnout, as current caregivers will be stretched thin and working longer hours in order to comply with these impossible standards,” she says.

Matthew Connell, Ed.D., of Ivy Tech Community College of Indiana, came to share the work and achievements of his community college in addressing the shortage of healthcare and long-term care workers in Indiana.

According to Connell, serving more than 190,000 students at 19 campuses and 26 satellite locations as well as on-line, graduates more associate level nurses in Indiana.  Nearly half of these students are pursuing college credit while in high school. Ivy Tech is the nation’s single largest provider of dual credit.

Ivy Tech’s programs are especially designed to help graduates enter the workforce quickly and provide critical services for the state’s long-term care population at a tuition rate that is the lowest in the state, he notes. “One in three Registered Nurses [in Indiana] is an alum. More than 90% of its nursing graduates choose to remain in Indiana, working in hospitals and care settings,” he adds.

The last witness, Jasmine L. Travers, assistant professor at New York University’s College of Nursing,  concisely summed up how to fix the nursing shortage.  She suggested: “To improve access to and quality of long-term are, we must ensure that all direct care workers receive a living wage, a safe, respectful work environment, opportunities for advancement, adequate training, and accessible benefits to maintain their health and well-being.  Only when we recognize that these workers are critically important, hardworking processionals, can we begin to improve equity and health outcomes for staff and patients alike.”

Putting the spotlight on Rhode Island’s Direct Care Staffing Shortage

According to John E. Gage, MBA, NHA, President & CEO, of the Rhode Island Health Care Association (RIHCA), the Covid-19 pandemic had a dramatic impact on the healthcare sector across the country and especially in Rhode Island, and a disproportionate impact on nursing facilities. On a national level, in February 2020 nursing facilities workforce totaled 1,587,000. Today, it is 1,462,800, down by 124,200 or 7.8%. In Rhode Island, it is more dramatic. Pre-pandemic RI nursing facility workforce was 9,797 (2/2020). Current BLS data shows the most recent number of workers in RI nursing facilities is 8,300 – down 1,497 workers or 15.3%.  This is just about double the rate of loss of workers post-pandemic in RI compared to the national statistics.

“There are some local efforts to attract workers back to RI nursing homes,” says Gage, noting that there is a need to be laser-focused on workforce development efforts. 

Gage calls for RI Medicaid to increase reimbursements to nursing facilities to cover today’s actual cost of care, not on facility costs from 2011 (13 years ago!) with minimal average inflationary increases in the 11 years since the price-based reimbursement methodology began in 2013.  According to Gage, RI nursing facilities need an adequate, sustainable reimbursement system to foster continued high-quality care and services and provide nursing home with rates that enable them to retain current workers and recruit more caregivers.

RIHCA, a non-profit trade association representing more than 80 percent of the nursing homes in the state, and its parent organization, the American Health Care Association (AHCA) support the legislative efforts of Senator Casey’s Long-Term Care Support Act. “We support all efforts to increase Medicaid rates to enable facilities to regain and grow their workforce – both direct care and ancillary staff, to enhance the quality of care and quality of life for our nation’s and RI’s most frail elder citizens today and for the years ahead,” he says. 

“It is heartening to see the Senate Committee on Aging and leading members of Congress addressing the care worker crisis in long term care including supporting our many thousands of unpaid caregivers who provide a significant portion of long term supports and services,” says Maureen Maigret, policy advisory of the Senior Agenda of RI (SACRI). Multifaceted solutions are needed, adds Maigret that include supporting training programs for nurses and paraprofessionals, career ladders and providing adequate Medicaid provider payments as Medicaid is the primary payer for long term care.

According to Maigret, in homecare alone, 75% of persons referred for subsidized home and community care through the state Medicaid or the Office of Healthy Aging Home Cost Share program are waiting two months, and often longer, to get services. “Our nursing homes are challenged to recruit the nursing staff needed to provide resident-centered quality care. Federal funding during the pandemic brought some funding in to support worker wages but that funding has ended,” she says.

“The state Healthcare Workforce Initiative led by the Executive Office of Health and Human Services and the Department of Labor has been looking at needs across the healthcare system and addressing some of the training and education issues,” says Maigret, noting that advocacy groups, such as the SACRI, support the Medicaid reimbursement rate increases as recommended by the Office of the Health Insurance Commissioner. “These rate increases are necessary to reduce service wait lists and provide livable wages for direct care staff many of whom are women and women of color,” she says. 

Over 23 years ago, in his weekly commentaries in the Pawtucket Times, this writer reported on the crisis of a direct care staffing shortage and inadequate reimbursement being paid to  nursing facilities to care for Rhode Island’s fail seniors. Isn’t it finally time for the Rhode Island General Assembly to come up with the necessary funds and strategy to fix these problem once and for all?

To watch the Senate Aging Committee hearing held on April 16, 2024, go to https://www.aging.senate.gov/hearings/the-long-term-care-workforce-addressing-shortages-and-improving-the-profession

Senate Aging Committee tackles AI generated scams

Published in RINewsToday on January 8, 2024

Over two months ago, U.S. Senate Special Committee on Aging Chairman, Bob Casey (D-PA), put the spotlight on Artificial Intelligence (AI) driven fraud and scams. During the Nov. 16 hearing held in SD-106, “Modern Scams: How Scammers Are Using Artificial Intelligence & How We Can Fight Back,” the Senate panel highlighted the most common scams targeting seniors in 2023 with a focus on how scammers are using AI to create voice-clones and deep fakes to deploy scams and convince targets of their veracity. The hearing also explored how AI is being used to enhance fraud detection technology.

During the Senate panel hearing, lasting one hour and a half, Chairman Casey announced the Senate Aging Committee’s release of its annual Fraud Book, and brochure on AI-powered  scams and a bookmark featuring tips to avoid scams. Chairman Casey also noted he would approach the Federal Trade Commission (FTC) to request information about the agency’s work to track the use of AI scams targeted to older Americans.  On Dec. 5, Casey sent a letter to the FTC urging the agency to track AI scams.

Senate Panel Takes a Look at AI’s Good and Bad

“Today, we heard disturbing testimony about scammers using artificial intelligence to make their ploys more life-like and convincing,” said Chairman Casey in his opening remarks. “Any consumer, no matter their age, gender, or background, can fall victim  to these ultra-convincing scams, and the stories we heard today from individuals across the country are heartbreaking. As a parent and grandparent, I relate to the fear and concern these victims must feel. Federal action is needed to put up guardrails to protect consumers from AI—while also empowering those that can use it for good,” he said.

At the Senate Panel hearing, Ranking Member Mike Braun of Indiana warned that an increasing number of sophisticated fraudsters are carrying out AI attacks on seniors by utilizing voice-cloning and deepfakes to create images nearly identical to a real-live  person to dupe consumers into giving away valuable information and money.

“In context of frauds and scams, AI can be leverage negatively – but it can also be part of the solution,” says Braun.

According to Braun, the private sector has used AI and machine learning since the 1990s to combat fraud.  He called on the federal government to embrace similar technology by testing promising solutions to systems that suffer the most fraud, like Medicare.

Gary Schildhorn, a Philadelphia attorney told the Senate panel about his story of an attempted scam against him where his son’s voice was cloned by AI.  When he received a call that sounded like his son Brett, saying he had been in a car accident and needed $9,000 to post bail, he almost fell for the scam.

“There was no doubt in my mind that it was his voice on the phone—it was the exact cadence with which he speaks.  I sat motionless in my car just trying to process these events. How did they get my son’s voice? The only conclusion I can come up with is that they used artificial intelligence, or AI, to clone his voice…it is manifestly apparent that this technology… provide a risk-less avenue for fraudsters to prey on us,” says Schildhorn.

In his testimony, Steve Weisman, an Amherst attorney with Margolis, Bloom & D’Agostino who teaches white-collar crime at Bentley College in Waltham, pointed to the Federal Trade Commission’s Consumer Sentinel report for 2022, revealing that seniors reported more than $1.6 billion in losses to frauds and scams. But the actual amount could be as high as $48.4 billion, he says, because many were afraid to report losing money due to embarrassment or sham.

Seniors Tempting Target to AI Scammers

Seniors are the target of scammers because “that is where the money is,” notes Weisman, because they may have a “life time of accumulated savings that make them a tempting target for scammers.”

According to Weisman, AI has created additional opportunities for phone call scams,  because it can be used to remove foreign accents from scammers voices, making them appear more reliable.  AI created Robocall scripts can enable conversations with the scammer’s targeted victims, too.  Finally, AI cloning technology can make the targeted victim below they are talking to a loved one.

Weisman says that AI can be used by scammers to set up social media bots that appear to come from “real” people.  This allows them to create large numbers of believable bots to promote numerous scams, particularly involving cryptocurrency.

Scammers are now using AI technology more effectively in romance and family emergency scams, too, warns Weisman. 

AI can create fake profiles on multiple dating platforms, writing a grammatically correct biography, making it easier for scammers in foreign countries who are not familiar with speaking English. AI can also create photos or deepfakes for the profile, he says.

Weisman told the panel that AI generating software can create an audio voice that sounds exactly like that of the grandchild, using as little as 30 seconds worth of the grandchild’s voice.

Seeking a Balanced Approach

“The interplay of AI and scams brings forth both challenges and opportunities. Striking a careful balance between fostering AI innovations and protecting vulnerable populations is paramount,” says Dr. Tahir Ekin, of the San Marcus, Texas -based McCoy College of Business.

“In the fight against AI driven scams, awareness and AI literacy are crucial weapons,” says Ekin. “Existing efforts that educate seniors on safe digital practices, such as the work FTC Federal Advisory Council and the “Pass It On” campaign, can be enhanced to include AI related scams,” he says.

Tom Romanoff, Director, Technology at the Washington, DC-based Bipartisan Policy Center, stated, “As the good of this technology is being explored, we must acknowledge AI’s risks and seek a balanced approach, focusing on curtailing abuse while promoting positive uses and innovations.”

“As I stated in the beginning, we must tackle the abuse while driving toward positive application to safeguard its adoption,” says Romanoff.

To view the Senate Aging hearing, held on Nov. 16, go to: https://www.youtube.com/watch?v=7CMhzgQdz_I.

For a copy of Fighting Fraud: Top Scams in 2022,  go to https://www.aging.senate.gov/imo/media/doc/fraud_book_2023__english.pdf