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Testimony

Statement by
Kathy Greenlee
Assistant Secretary
Administration on Aging
U.S. Department of Health and Human Services (HHS)

on
Elder Rights and the Older Americans Act 

before
Special Committee on Aging
United States Senate


Tuesday August 23, 2011

Thank you, Senator Blumenthal, for the opportunity to testify at this important hearing on elder justice.  I appreciate the opportunity to share with you the Administration on Aging’s (AoA) commitment to this important issue and the role of the Older Americans Act (OAA) in helping to protect and serve victims of abuse, neglect, and exploitation.   As a Federal advocate for older Americans and their concerns, AoA is dedicated to protecting the rights of older people and preventing their abuse, neglect, and exploitation.

Elder abuse is a substantial global public health and human rights problem.  The World Health Organization has declared that elder abuse is a violation of one the most basic and fundamental human rights: to be safe and free of violence.[1]  In a recent nationally representative study, one in ten older Americans reported being abused or neglected in the past year, and that many of them experienced it in multiple forms.[2]

Unfortunately, elder abuse appears to be on the rise.  Available data from State Adult Protective Services (APS) agencies show an increase in reports of elder abuse between 2000 and 2004.[3]  And despite the accessibility of APS in all 50 States, as well as mandatory reporting laws for elder abuse in most States, an overwhelming number of cases of abuse, neglect, and exploitation go undetected and untreated each year.  While estimates on the incidence and prevalence of abuse vary, the National Academy of Sciences estimated that only one in 14 cases of elder abuse ever comes to the attention of authorities.[4]

These trends are particularly alarming considering what we know about the negative consequences of experiencing abuse.  Older victims of even modest forms of abuse have up to 300 percent higher[5] morbidity and mortality rates than non-abused older people.  Victims of elder abuse have had significantly higher levels of psychological distress and lower perceived self-efficacy than older adults who have not been victimized.[6]  Older adults who are victims of violence have additional health care problems than other older adults, including increased bone or joint problems, digestive problems, depression or anxiety, chronic pain, high blood pressure, and heart problems.[7]  A recent MetLife Mature Market Institute study estimated the direct costs associated with elder financial exploitation were estimated to be $2.9 billion in 2009, a 12 percent increase from 2008.[8]

For nearly forty years, AoA has provided continual Federal leadership in strengthening the elder justice programming designed to prevent and address elder abuse and these consequences through the OAA.

  • The Long-Term Care Ombudsman Program was established in 1972 to represent the rights and advocate on behalf of older residents living in nursing homes, assisted living, and other residential settings.
  • In 1987, a new objective to protect elderly from abuse, neglect, and exploitation was added to Title I of the Act.  A separate authorization of funds for elderly abuse prevention services was also created under Title III Part G.  This had previously been allowed, but appropriation authority not reserved.
  • The National Center on Elder Abuse (NCEA) was created in 1988 as an information clearinghouse on abuse, neglect, and exploitation, including best practices in prevention and treatment, serving as a repository of research, and conducting demonstration projects to promote effective and coordinated responses to elder abuse, neglect, and exploitation.
  • In 1992, the Title VII Elder Abuse, Neglect, and Exploitation Program was established to provide funding to support State and community-based elder justice networks that protect vulnerable seniors and provide them with critical information, and the NCEA received a permanent home in Title II.
  • The 2006 Older Americans Act amendments added provisions in Title II for the assistant secretary on aging to designate a person for elder abuse prevention and services with the responsibility for development of plans for a coordinated, national elder justice system.  In addition, Title VII’s “Elder Abuse, Neglect, and Exploitation Program” was renamed “Vulnerable Elder Rights Protection Services”, and broadened the authority for States to carry out a range of elder justice activities, such as financial literacy and elder shelters, and to initiate multidisciplinary elder justice activities.
  • Most recently, the Elder Justice Act was passed and signed into law in 2010.  The Elder Justice Act provides authority for additional attention in this area, including highlighting critical issues through citizen participatory advisory councils; enhancing APS programs and data; and improving the quality of care in nursing facilities through enhancements to the Long-Term Care Ombudsman Program, establishing a system to report crimes in nursing homes, and assisting States to implement criminal background check programs for employees with direct access to patients.

And over the years, AoA program efforts have taken a more active role in supporting the “first responders” to reports of abuse, neglect, and exploitation: APS.  Over two-thirds of APS programs are located in and administered by State units on aging.  The National Adult Protective Services Association has been a partner in AoA’s NCEA for over 20 years.  This has resulted in a number of projects and activities specifically targeted to enhance APS programs, such as a national training library, core competency training modules, and live web seminars on emerging issues for APS.  And the 2006 amendments to the OAA authorized States to use part of their Title VII allotments for APS, and many States report doing so.

Despite these efforts and the critical role of APS as “first responders,” programs across the country report many unmet needs.  In the last two annual All State Directors Calls on the impact of the economy on aging programs, we heard that in these hard, economic times, States have had to make hard choices and many APS programs have experienced budget cuts.  As a result, APS programs have had to cope with limited staffing to carry out even the most basic program functions of receiving and investigating reports of abuse, and training budgets for those remaining staff has been significantly reduced, and in some cases eliminated altogether.  Exacerbating the problem is a widespread lack of consistent national and State data on case statistics or program outcomes, making it difficult to demonstrate how effective this program is in serving vulnerable adults and seniors.

In response, this administration continues to try to increase the effectiveness of elder justice and APS programs across the country.  On July 1, 2011, AoA published a program announcement to fund the first Federal APS resource center.  This center will be dedicated exclusively to supporting APS programs with the purpose of enhancing and improving the consistency and quality of APS programs and services across the country.  The center will be funded at $200,000 per year for up to three years, and will begin operation by September 30, 2011.  In addition, the President’s FY 2012 budget includes a request for $15 million for APS demonstration grants under Section 2042 of the Social Security Act (as added by the Elder Justice Act of 2009).  In addition, the FY 2012 President’s budget includes an additional $5 million request for the Long-Term Care Ombudsman Program and $1.5 million to begin addressing elder abuse in Indian Country through demonstration programs. 

AoA’s elder rights programs are but one component of a larger system to keep older adults independent and in their own homes.   Taken as a whole, AoA’s performance measures and indicators form an interconnected system of performance measurement akin to the three legs of a stool (efficiency, outcomes and targeting) holding up AoA’s mission and strategic goals that include:

  1. Empowering older people, their families, and other consumers to make informed decisions about, and to be able to easily access, existing health and long-term care options;
  1. Enabling seniors to remain in their own homes with a high quality of life for as long as possible through the provision of home and community-based services, including supports for family caregivers;
  2. Empowering older people to stay active and healthy through Older Americans Act services and the preventative care benefits under Medicare;
  3. Ensuring the rights of older people and prevent their abuse, neglect and exploitation; and
  4. Maintaining effective and responsive management.

As the former secretary of aging for the State of Kansas, and now having the honor to serve as the U.S. assistant secretary for aging and listening to individuals and families in a variety of settings, I have seen firsthand how the OAA reflects the American values we all share:

  • Supporting freedom and independence;
  • Helping people maintain their health and well-being so they are better able to live with dignity;
  • Protecting the most vulnerable among us; and
  • Providing basic respite care and other supports for families so that they are better able to take care of loved ones in their homes and communities for as long as possible, which is what Americans of all ages overwhelmingly tell us they prefer. 

For more than a year, we have received reports from more than 60 listening sessions held throughout the country, and received online input from interested individuals and organizations, as well as from seniors and their caregivers, about the reauthorization of the OAA.  This input represented the interests of thousands of consumers of the OAA’s services.  We continue to encourage ongoing input and discussions.

During our input process we were consistently told that, as it is currently structured, the OAA is very helpful, flexible and responsive to people’s needs.  We also heard a few themes, I will mention two today:

FIRST:            Improve program outcomes by:

  • Embedding evidence-based interventions in disease prevention programs;
  • Creating incentives to enhance performance;
  • Encouraging comprehensive, person-centered approaches;
  • Providing flexibility to respond to local nutrition needs; and
  • Continuing a strong commitment to efforts to fight fraud and abuse.

SECOND:       Remove barriers and enhancing access by:

  • Extending caregiver supports to senior parents who are caring for their adult children with disabilities;
  • Providing ombudsman services to all nursing facility residents, not just older residents; and
  • Using Aging and Disability Resource Centers as single access points for long-term care information to public and private services.

Let me give three brief examples of areas we would like to discuss as you consider legislation:

  • Ensuring that the best evidence-based interventions for helping older individuals manage chronic diseases are utilized.  These have been effective in helping people adopt healthy behaviors, improve their health status, and reduce their use of hospital services and emergency room visits. 
  • Improving the Senior Community Service Employment Program (SCSEP) by integrating it with other seniors programs.  The President’s 2012 budget proposes to move this program from the Department of Labor to the Administration on Aging at HHS.  We would like to discuss adopting new models of community service for this program, ranging from intergenerational service that assists children, assistance with helping seniors remain independent in their homes, and continuing to support community organizations that rely on SCSEP participants for their valuable work contributions.
  • Combating fraud and abuse in Medicare and Medicaid by making permanent the authority for the Senior Medicare Patrol Program (SMP) as an ongoing consumer-based fraud prevention and detection program -- and by using the skills of retired professionals as volunteers to conduct community outreach and education so that seniors and families are better able to recognize and report fraud and abuse.

The Older Americans Act has historically enjoyed widespread, bipartisan support.  One of its great strengths is that it does not matter if an individual lives in a very rural or frontier area, or in an urban center – the programs and community-based supports it provides are flexible enough to meet the needs of individuals in diverse communities and settings.  Based in part upon the extensive public input we received, we believe that the reauthorization can strengthen the OAA and put it on a solid footing to meet the challenges of a growing population of seniors, while continuing to carry out its critical mission of helping elderly individuals maintain their health and independence in their homes and communities. We look forward to working with this Committee as the reauthorization process moves forward.

Thank you again, Senator Blumenthal, for your leadership on these important issues and for your invitation to testify today. I would be happy to answer any questions.



[1] World Health Organization. World Report on Violence and Health. http://www.who.int/violence_injury_prevention/violence/world_report/en/summary_en.pdf . 2002.

[2] Beach SR, Schulz R, Castle NG, Rosen J. Financial Exploitation and Psychological Mistreatment Among Older Adults: Differences Between African Americans and Non-African Americans in a Population-Based Survey. Gerontologist 2010.

  Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W et al. Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study. American Journal of Public Health 2010; 100(2):292-297.

[3] Teaster PB, Dugar T, Mendiondo M, Abner EL, Cecil KA, Otto JM. The 2004 Survey of Adult Protective Services: Abuse of Adults 60 Years of Age and Older. National Center on Elder Abuse: Washington, DC. Retrieved August 8, 2011 from: http://www.ncea.aoa.gov/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf

 

[4] National Research Council. Elder Mistreatment: Abuse, neglect and exploitation in an Aging America. Washington, D.C.: The National Academies Press, 2003.

 

[5] Dong X. Medical implications of elder abuse and neglect. Clin Geriatr Med 2005; 21(2):293-313.

  Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L et al. Elder Self-neglect and Abuse and Mortality Risk in a Community-Dwelling Population. JAMA 2009; 302(5):517-526.

  Dong X, Simon MA, Beck T, McCann J, Farran C, Laumann EO et al. Elder abuse and mortality: The role of psychological and social wellbeing. Gerontology 2011; In press.

  Lachs MS, Williams CS, O'Brien S, Pillemer KA, Charlson ME. The mortality of elder mistreatment. JAMA 1998; 280(5):428-432.

  Dong X, Simon MA, Evans DA. Prospective Study of the Elder Self-Neglect and Emergency Department Use in a Community Population. American Journal of Emergency Medicine 2011; In-press.

  Dong X, Simon MA, Fulmer T, Mendes de Leon CF, Hebert LE, Beck T et al. A Prospective Population-Based Study of Differences in Elder Self-Neglect and Mortality Between Black and White Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2011; 66A(6):695-704.

  Lachs MS, Williams CS, O'Brien S, Hurst L, Kossack A, Siegal A et al. ED use by older victims of family violence. Ann Emerg Med 1997; 30(4):448-454.

  Lachs MS, Williams CS, O'Brien S, Pillemer KA. Adult protective service use and nursing home placement. Gerontologist 2002; 42(6):734-739.

 

[6] See full article discussing the negative behavioral health consequences at: http://www.ncea.aoa.gov/NCEAroot/Main_Site/Library/Statistics_Research/Research_Reviews/emotional_distress.aspx.

  Comijs, H.C., Penninx, B.W.J.H., Knipscheer, K.P.M., & van Tilburg, W. (1999). Psychological distress in victims of elder mistreatment: The effects of social support and coping. Journal of Gerontology, 54B (4), P240-P245.

 

[7] Bitondo Dyer C., Pavlik V. N., Murphy K. P., and Hyman D. J. (2000). “The high prevalence of depression and dementia in elder abuse or neglect.” Journal of the American Geriatrics Society. 48:205-208.

  Burt,M. and Katz, B. “Rape, Robbery, and Burglary: Responses to Actual and Feared Criminal Victimization, with Special Focus on Women and the Elderly,” Victimology: An International Journal 10 (1985): 325-358.

  Mouton C. P., Espino D. V. (1999). “Problem-orientated diagnosis: Health screening in older women.” American Family Physician. 59: 1835.

  Fisher, B.S., and Regan, S.L. (2006). “The Extent and Frequency of Abuse in the Lives of Older Women and Their Relationship With Health Outcomes.”  The Gerontologist, 46: 200-209.

  Coker, A., Davis, K., Arias, I. et al. (November 2002).  “Physical and Mental Health Effects of Intimate Partner Violence for Men and Women.”  American Journal of Preventive Medicine.  Vol. 23 No. 4: 260-268.

  Stein, M. & Barrett-Connor, E. (2000). “Sexual Assault and Physical Health: Findings from a Population-Based Study of Older Adults.”  Psychosomatic Medicine.  Vol. 62: 838-843.

 

[8] Metlife Study. Elder Financial Abuse: Crimes of Occasion, Desperation and Predation against American's Elders. http://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf  Accessed July 1st 2011. 2011.

Last revised: June 18, 2013