Elder Rights and Elder JusticeElder Rights and Elder JusticePanel DiscussionPanel Discussion

Becky A. KurtzBecky A. Kurtz

Georgia State Long-Term Care OmbudsmanGeorgia State Long-Term Care Ombudsman

Older Americans Act Older Americans Act

Reauthorization Listening ForumReauthorization Listening Forum

Dallas, TexasDallas, Texas

February 18, 2010February 18, 2010

Elder Rights and Elder JusticeElder Rights and Elder Justice

How well do we – as an How well do we – as an Aging Network -- Aging Network -- provide justice for provide justice for and protect the and protect the rights of our nation’s rights of our nation’s elders?elders?

How do we prepare for How do we prepare for our own aging and our own aging and the aging of our the aging of our society?society?

What has the OAA and the Aging What has the OAA and the Aging Network done well?Network done well?

Where are the gaps and opportunities for Where are the gaps and opportunities for improved elder rights services to elders?improved elder rights services to elders?

Some suggestions for moving forwardSome suggestions for moving forward

The Older Americans Act:The Older Americans Act:

Sets the objectives and the foundation for Sets the objectives and the foundation for the Aging Networkthe Aging Network

Leverages state and local resources Leverages state and local resources (funding, volunteers, community (funding, volunteers, community partnerships)partnerships)

Anticipates “effective Anticipates “effective and visible” advocacy and visible” advocacy for older individualsfor older individuals

OAA promises protection of elder rights for OAA promises protection of elder rights for vulnerable adults (Title VII):vulnerable adults (Title VII):

““[T]he independence of many elderly is still [T]he independence of many elderly is still threatened by abusive situations . . . . For threatened by abusive situations . . . . For others, independence is hindered by limited others, independence is hindered by limited financial resources, disability, and lack of financial resources, disability, and lack of information on rights and benefits. To help information on rights and benefits. To help address these issues, AoA administers a address these issues, AoA administers a number ofnumber of Vulnerable Elder Rights Programs Vulnerable Elder Rights Programs thatthat provide important protections against provide important protections against threats to the independence, well being, and threats to the independence, well being, and financial security of seniorsfinancial security of seniors.”.” (AoA Website)(AoA Website)

Gaps and Gaps and opportunities for improvementopportunities for improvement

Gaps in elder rights services:Gaps in elder rights services: The most vulnerable elders are unable to access The most vulnerable elders are unable to access

services services Services are not equally available in all settingsServices are not equally available in all settings Person-centered services are not implemented in all Person-centered services are not implemented in all

settingssettings Preventing crisesPreventing crises

How our organizations and structures impact our ability to How our organizations and structures impact our ability to provide elder rights services:provide elder rights services:

Title VII services are not always among the Aging Title VII services are not always among the Aging Network prioritiesNetwork priorities

Our variety of roles can interfere with our servicesOur variety of roles can interfere with our services We must lead elder abuse prevention and response We must lead elder abuse prevention and response

within a fragmented systemwithin a fragmented system

The most vulnerable elders are The most vulnerable elders are often unable to access services often unable to access services

and benefitsand benefitsThe most vulnerable people may be those who The most vulnerable people may be those who

lose their decision-making capacity and have no lose their decision-making capacity and have no authorized decision maker.authorized decision maker.

““Incapacitated and Alone: Health Care Decision-Making for the Incapacitated and Alone: Health Care Decision-Making for the Unbefriended Elderly,” Unbefriended Elderly,”

2003 American Bar Association Commission on Law and Aging2003 American Bar Association Commission on Law and Aging

Limited access to ombudsman and legal Limited access to ombudsman and legal advocacy, as well as public benefits, health care, advocacy, as well as public benefits, health care, financial institutions, and other critical services.financial institutions, and other critical services.

Elder rights services are not equally Elder rights services are not equally available in all settingsavailable in all settings

Examples for ombudsman services:Examples for ombudsman services:

Unavailable for consumers of long-term care in Unavailable for consumers of long-term care in their own home (in most states).their own home (in most states).

Residents of 17% of nursing homes and 53% of Residents of 17% of nursing homes and 53% of board and care/assisted living homes did not board and care/assisted living homes did not receive a regular visit from an ombudsman in receive a regular visit from an ombudsman in Federal Fiscal Year 2008.Federal Fiscal Year 2008.

Person-centered services are not Person-centered services are not implemented in all settingsimplemented in all settings

It is too easy to focus on It is too easy to focus on convenience to the service-convenience to the service-delivery system instead of delivery system instead of promoting what is promoting what is important to the consumer.important to the consumer.

Consumers need “Culture Consumers need “Culture change” in nursing homes change” in nursing homes and every service setting.and every service setting.

We need to help seniors We need to help seniors prevent crisesprevent crises

Too often we are available only when the Too often we are available only when the senior is already in a crisis situation:senior is already in a crisis situation:

After the financial exploitation,After the financial exploitation, After the nursing home placement, After the nursing home placement, After there is no decision-making capacity.After there is no decision-making capacity.

Our attempts are limited in scope or have Our attempts are limited in scope or have lost state funding support in this bare-lost state funding support in this bare-bones economy.bones economy.

Title VII services aren’t always Title VII services aren’t always among Aging Network’s prioritiesamong Aging Network’s priorities

Elder Rights programs and services are not Elder Rights programs and services are not always integrated well into state plans and always integrated well into state plans and area plans area plans

Elder Rights focus can get lost in the Elder Rights focus can get lost in the administrative structure administrative structure

Title VII services aren’t always Title VII services aren’t always among Aging Network’s prioritiesamong Aging Network’s prioritiesFinancial Resources -- examples:Financial Resources -- examples:

Legal Assistance Development -- Title VII mandate and Legal Assistance Development -- Title VII mandate and funding authorization with no appropriationfunding authorization with no appropriation

Expansion of Ombudsman role without proportionate Expansion of Ombudsman role without proportionate funding increasefunding increase

1981 -- Nursing Home Ombudsman became Long-1981 -- Nursing Home Ombudsman became Long-Term Care Ombudsman and mandated to serve board Term Care Ombudsman and mandated to serve board and care residents;and care residents;

2006 -- assisted living added to definition of long-term 2006 -- assisted living added to definition of long-term care facilitycare facility

Our variety of roles can interfere Our variety of roles can interfere with serviceswith services

State Aging Networks must provide:State Aging Networks must provide: Social servicesSocial services Elder rights advocacyElder rights advocacy

And may also provide:And may also provide: Long-term care services (e.g., Long-term care services (e.g.,

Medicaid waiver programs)Medicaid waiver programs) Abuse Investigations (e.g., APS)Abuse Investigations (e.g., APS) Guardianship servicesGuardianship services Licensing and regulating authorityLicensing and regulating authority

Confusion in the “tent”Confusion in the “tent”

Holding these diverse functions Holding these diverse functions

together can cause:together can cause: Confusion for consumersConfusion for consumers Mission creep Mission creep Inability of some programs to fulfill legal Inability of some programs to fulfill legal

mandates and duty to consumersmandates and duty to consumers

Leading in a fragmented, multi-Leading in a fragmented, multi-layered systemlayered system

Leadership that helps focus on protection Leadership that helps focus on protection from and response to elder abuse when from and response to elder abuse when the key players are diverse.the key players are diverse.

Lack of reliable data on elder abuse.Lack of reliable data on elder abuse.

Moving forward . . .Moving forward . . .

Living with the inherent tensions Living with the inherent tensions within our aging tent:within our aging tent:

The interests of elder rights advocates The interests of elder rights advocates will conflict with the interests of service will conflict with the interests of service providersproviders

To succeed, we must be explicit about To succeed, we must be explicit about our roles and clarify our boundariesour roles and clarify our boundaries

It’s not personal, it’s systemic – the OAA It’s not personal, it’s systemic – the OAA creates both service providers and creates both service providers and advocates advocates

Seniors need aging leaders to embrace, Seniors need aging leaders to embrace, not fear, their advocacy mandatenot fear, their advocacy mandate

Federal leadershipFederal leadership

Accountability Accountability Highlighting and sharing state Highlighting and sharing state

and local solutionsand local solutionsResourcesResources

Focus on the elder Focus on the elder

Clearly articulated and Clearly articulated and shared mission, vision, shared mission, vision, and valuesand values

Design all of our services Design all of our services to be “person-centered” to be “person-centered”

Living Longer, Living Safely, Living WellLiving Longer, Living Safely, Living Well