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SOCIAL WELFARE POLICY

Instructor: Michael Dover

University of Akron

POLICY/TOPIC: ELDER ABUSE

BRIEF #1

Elder Abuse

“There are nearly 17,000 nursing homes in the United States that currently care for 1.6 million residents-a figure expected to quadruple to 6.6 million residents by 2050”

-U.S. House of Representatives, Committee on Government Reform-Minority Office.

SCOPE OF THE PROBLEM

According to the National Center on Elder Abuse (NCEA), in 2005, between 1 and 2 million Americans, age 65 or older, have been injured, exploited, or otherwise mistreated by someone on whom they depended on for care or protection. Although there are state mandated agencies such as Long Term Care Ombudsman and State Surveyors, there are still alarmingly high rates of psychological, verbal, and often sexual abuse committed to elderly in long-term care facilities (Fisher, 2003).

Medicaid/Medicare provides approximately 55-60 percent of health coverage (NCEA, 2005) and has mandated policies to ensure that long-term care facilities are obligated to provide medical, social, medication, dietary, and most importantly a safe, secure, nurturing environment that residents can call home. The Ohio Attorney General’s Medicaid Fraud Control Unit has the authority to investigate and prosecute abuse and neglect in long-term care facilities, to mandate compliance and continue to be monitored by Ombudsmen and state surveyors (Ohio Task Force Final Report, 2005).

The NCEA, says studies have estimated that between 3 and 5 percent of the elderly population have been abused, that may be as many as 5 million victims every year. In a 2004 Survey of State Adult Protective Services, findings show a 19.7 percent increase in the combined total of reports of elderly and vulnerable adult abuse and neglect and a 15.6 percent increase in the last four years since the last survey was conducted in 2000 (Oconto Commission on Aging, Inc., 2007).

The existing problem is that elder abuse is still rising at an alarming rate. The rights of our elderly have been and are still being violated without any successful intervention from the government.

Reports from Residents: In the most recent study of abuse in nursing homes, funded by a grant from the National Ombudsman Resource Center, the ombudsmen interviewed 80 residents in 23 nursing homes in Atlanta. This survey found that 44 percent reported they had been abused, while 48 percent reported they had been treated roughly (Hawes, 2002).

Recently, the Minority Staff of the Special Investigations Division of the House Committee on Government Reform issued a report asserting that the abuse of residents “is a major problem in U.S. nursing homes (US House, 2001). This report analyzed data from the Online Survey Certification and Reporting (OSCAR) System and the nursing home complaint investigations during a two year period (i.e., January 2000-January 2002) and included three deficiency codes related to abuse (F223, 224, 225). The report concluded:

• During the two-year period, nearly one-third of all certified facilities had been cited for some type of abuse violation that had potential to harm or had actually caused harm to a nursing home resident.

• Ten percent of the nursing homes in the U.S. were sited for abuse violations that caused actual harm to residents or placed them in immediate jeopardy of death or serious injury.

• The percentage of nursing homes with abuse violations has been increasing, probably as a result of mote stringent reporting requirements and increased vulnerability among residents.

• The cases involving abuse included physical and sexual abuse as well as verbal abuse involving threats and humiliation. (Brown, 2004)

Past Policies

Older American Act of 1965: This act created the Administration on Aging, it authorized grants for aging related community planning, services programs, demonstration and training projects.

In the late 1960’s and early 1970”s there were growing issues of elder abuse in the nursing homes being viewed publicly through the news and other media sources. The Long Term Care Ombudsman, created in 1972 as a demonstration program, was established as advocates for residents of nursing homes under the Older Americans Act (Ombudsman Philosophy, 1991).

The Nursing Home Reform Act of 1987: In response to reports of widespread neglect and abuse in nursing homes in the 1980’s, Congress enacted legislation in 1987 to require nursing home’s participation in the Medicare/Medicaid programs to comply with requirements for quality of care. This law included the Omnibus Reconciliation Act of 1987 (OBRA 1987), also known as the Nursing Home Reform Act. It specifies that a nursing home “must provide social activities in order to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. This act specifies freedom from abuse, neglect and misappropriation of funds (Williamson & Lavecchia , 2007)

The 1987 Nursing Home Reform Act focused on the quality of life and care, the importance of the individual resident, and the need to help the resident reach the “highest practicable level” of functioning. Enforcement policies were established that gave the Health Care Financing Administration. the license to impose a variety of corrective measures when a facility is not in compliance with the requirements for participation in the Medicare/Medicaid programs (Brown, 2004). As a result of the Nursing Home Reform Act, a new survey and certification process was implemented in 1995.

In 2001, the first National Summit on Elder Abuse was held with the purpose of recommending a national policy agenda to protect the vulnerable population (Elder Abuse and Neglect, 2003). In 2005, Joan Lawrence, Director of the Ohio Department of Aging, sent a follow up letter to Governor Taft about the Summit in 2003 and meeting with Ohio Elder Task Force. Their recommendations were to study and make recommendations regarding elder abuse, neglect, and exploitations occurring in Ohio and to address the sufficiency of existing programs (Ohio Elder Abuse Task Force Report, 2005). One existing program to address was the survey and certification process.

Current Policies

While many studies indicate that changes in law and regulations may have had a positive effect on improving the environment and overall health care of nursing home residents, recent reports by the Health Care Financing Administration and the General Accounting Office have raised serious concerns about residents’ care and well-being. The Senate Special Committee on Aging held hearings in the summer of 1998 on these reports. At the same time, the Office of Inspector General undertook additional studies aimed at assessing the quality of care in nursing homes.

The report examined the capacity of the State nursing home survey and certification program to monitor quality of care. A companion report analyzed trends in the Online Survey Certification and Reporting System (OSCAR) which revealed data that indicated quality of care problems in nursing homes. Other Office of General reports addressed the trends in reported abuse in nursing home (Brown, 2004).

All States reported implementing the Health Care Financing Administration’s guidelines in the same way, including an entrance conference, resident interviews, reviewing medical records, and the review with an exit conference to provide the nursing home with information about their potentially deficient areas. Based on the OSCAR data over the four standard surveys, all sample States completed 97 percent of standard surveys for all nursing homes in the mandated 9-15 month time frame (Brown, 2004).

Although all States reported that nursing home standard surveys are unannounced, almost all directors and surveyors believed that facilities roughly predicted the survey start date. Since the administrators know that they are in the 9-15 months window, they usually have fewer deficiencies and quality of care issues when approaching time of inspection.

Proposed Policy

States report nursing homes anticipate their annual standard survey and often modify their normal activities to reduce potential deficiencies. There have been instances where the facility administrator will tell faculty exactly when the surveyors are to arrive. Yearly rituals are done to prepare for the inspections. The facility becomes overly staffed with administration taking a part in the cleaning, serving of meals to residents, and answering call lights that are normally ignored. Directors and surveyors are concerned about whether or not standard surveys represent an accurate reflection of quality of life in nursing homes. The answer is no. What occurs during the state survey is usually done annually when the facility anticipates upcoming inspections.

Fact: From June 1, 2005-June 30, 2006, a total of 14,797 reports of abuse, neglect, exploitation were received by the County Departments of Jobs and Family Services. These reports were investigated and classified as either substantiated or un substantiated (Ohio Dept of Jobs and Family Services, 2006). In order to substantiate a case a surveyor must establish the action occurred. Abuse is almost difficult to cite due to constraints placed on the surveyors. Abuse must be observed by the surveyors rather than recounted by the resident or family member.

Under current laws, the elderly are not fully protected. Many abuse complaints go without action taken against the nursing home. These unresolved issues of abuse contribute largely to the statistics of elder abuse in the long-term facility. This proposed policy would allow state surveyors to become more effective by changing the survey schedule to make surveys more unpredictable and random. There should not be a 9-15 month window for inspections. This newly proposed bill would ensure the safety of our elderly and allow surveyors to see “the true picture” of the facility at random. These surveys should not be restricted to the traditional, daytime 9-5 inspections, but should include inspections during the evening and night shifts.

Indeed, the government is making an effort in reducing the abuse of our elderly, but the numbers of abuse cases are still increasing at an alarming rate. These reasons alone calls for changes in current policies.

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KEY ORGANIZATIONS/INDIVIDUALS

Office of Public Affairs

Department of Health and Human Services

Room 5541 Cohen Building

330 Independence Avenue, S.W.

Washington, D.C. 20201

Ohio Attorney General Marc Dann

Colleen Brown, Executive Assistant

614-466-4320

State Office Tower

30 E. Broad Street, 17th Floor

Columbus, Ohio 43215-3428

State Surveyors

The Ohio Department of Health

1-800-342-0553

Bureau of Information and Operational Support, Public Information

245 North High Street, 3rd Floor

Columbus, Ohio 43266-0588

Department of Aging Director Joan Lawrence

1-800-266-4346

50 W. Broad Street, 9th Floor

Columbus, Ohio 44325-3365

Administration on Aging

202-245-0641

330 Independence Avenue, SW

Washington, DC 29201

National Center on Elder Abuse

202-682-0100

810 First Street, NE

Suite 500

Washington, DC 20002

Long Term Care Ombudsman

800-282-1206

50 W. Broad Street, 9th Floor

Columbus, Ohio 44325-3365

Glossary

Elder Abuse- A single or repeated act or lack of appropriate actions, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.

F0223- Resident has a right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.

F0224- Facility must have written policies and procedures that prohibit abuse and neglect.

F0225- Facility may not employ persons who have been found guilty of abuse.

General Accounting Office-A Congressional Investigative Agency that examines the use of public funds, evaluates federal programs and activities, and provides analysis, opinions and recommendations.

Health care Financing Administration-created as a principal operating component of the Dept of the Secretary on March 8, 1977, to combine under one administration the oversight of the Medicare program, the Federal portion of the Medicaid program and related quality assurance activities.

Long Term Care Facility- A establishment that offers a range of medical and/or social services designed to help people who have disabilities or chronic care needs.

Nursing Homes- see long term care facility.

Ombudsmen- Advocates for quality of care and quality of life in nursing homes and assisted living facilities. They identify, investigate, and resolve complaints by or on behalf of residents.

Physical Abuse-Any violence-including hitting, striking with objects, slapping, grabbing, or otherwise causing bodily harm.

Psychological Abuse- The infliction of anguish or distress through threats, verbal aggression, intimidation, humiliation, harsh orders, or other forms of verbal harassment.

The Senate Special Committee- Initially established in 1961 as a temporary committee, it became permanent in 1977. Has no Legislative authority but it studies issues related to older Americans, particularly, Medicaid and Social Security.

Sexual Abuse-Nonconsensual sexual contact of any kind.

State Surveyors- State agency that ensures that nursing homes comply with federal quality standards and that inadequate resident care is identified and corrected.

BIBLIOGRAPHY

Brown, J. (2004). Nursing Home Survey and Certification: Overall Capacity. Retrieved from the Dept of Health and Human Services website: .

Elder Abuse and Neglect. (2003). Retrieved October 8, 2007, from



Elder Abuse, Neglect, and Exploitation in Ohio (2006). Retrieved October 30, 2007, from

Fischer. C. (2003). Elder Abuse in Nursing Homes. Retrieved September 22, 2007, from

Hawes, C. (2002). Elder Abuse in Residential Long-Term Care Facilities: What is Known About Prevalence, Causes, and Prevention. Retrieved October 22, 2007, from .

National Center on Elder Abuse. (2005). Retrieved September 22, 2007, from

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The Elder Justice Act Update (2007). Retrieved October 23, 2007 from the Oconto County Commission on Aging website:

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Ohio Task Force Final Report. (2005). Retrieved October 8, 2007, from

htttp://infocenter/publications/eatffinal.html.

Ombudsman Philosophy. (1991). What is the Long Term Care Ombudsman Program (Online). Available: .

Williamson & Lavecchia , (2007). Federal Laws for Nursing Homes. Retrieved October 22, 2007 from

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Wilson, C. (2003). Selection and Investigation of Nursing Homes. Retrieved October 22, 2007 from .

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