Co-Chairs and Members of the Older Americans Caucus:
On behalf of the Administration on Aging (AoA), I appreciate the
opportunity to testify about a topic of great concern to older Americans -
elder abuse in nursing homes and other long-term care settings. Your
interest and leadership in this area is important to this Administration and to
the national aging network, and I Recommend you for calling this hearing
today.
I have been asked to address the role of long-term care ombudsmen from
the perspective of the Administration on Aging. We at AoA are proud of
the activities of the long-term care ombudsman program staff and
volunteers across our nation. For more than two decades, they have worked
on the front lines on a daily basis protecting the rights of and advocating for
the approximately 2.5 million vulnerable older Americans living in nursing
homes, board and care facilities, and other long-term care facilities.
ombudsmen are usually the first and sometimes the only people from
outside the facility to see cases related to abuse and are more likely to
intercede immediately to prevent, correct or report these cases than any
other single source.
The Long-Term Care Ombudsman Program under the older Americans Act
was initiated in 1972 by the Nixon Administration in response to the
continuous reports of shocking conditions in America's nursing homes. The
late Dr. Arthur S. Flemming launched the
program in response to numerous recommendations from states and
national associations representing older persons, and since that time states
have worked to develop statewide ombudsman programs to provide a
community presence in long-term care facilities. Today, a total of 565
ombudsman programs, 913 paid ombudsmen and 11,580 volunteers (6,421
of whom were trained and certified to investigate complaints) serve
residents of nursing homes and a growing number of similar adult care
facilities.
Ombudsmen are able to monitor both private and publicly subsidized care
as concerned citizens and officials, rather than as government regulators.
By statute, they are required to identify problems that impact residents and
make recommendations for ways to address those problems. In Fiscal Year
1995, ombudsmen investigated over 218,000 complaints made by over
162,000 individuals. Over 70% of these complaints were resolved or
partially resolved to the residents' or complainants' satisfaction. While
these complaints covered a wide range of concerns, clearly we know that
abuse does occur in long-term care settings. What we do not know is the
full scope of this abuse. In a soon-to-be published article, Dr. Rosalie Wolf
of the Institute on Aging at the Medical Center of Central Massachusetts
states:
"In spite of all the anecdotal information, media exposes,
ethnographic studies, and licensure and certification reports on
nursing homes, little is known about the incidence of abuse in
institutional settings although all agree that it does exist."
We have all heard horrendous stories of the heinous abuse and gross neglect
of nursing home residents, and as Dr. Wolf's statement implies, the media
has helped to spread the word. one example is of a case related in our
annual report that occurred in California. An anonymous caller to the
ombudsman program alleged that a frail elderly female resident of a board
and care home was being ove r medicated with an unprescribed
psychotropic drug with intent to cause her death. The ombudsman went to
the facility and found the resident in a catatonic state. The ombudsman
then contacted the local law enforcement agency, Adult Protective Services,
and an ambulance service which transferred the resident to an acute
emergency center for respiratory failure. Further investigation revealed an
intricate conspiracy between the owner of the facility, an ex-son-in-law, and
a treating physician. The ombudsman played a significant role in pulling
all of the investigatory forces together and collecting information that
ultimately led to a criminal conviction of the guilty parties.
The Senate Special Committee on Aging hearing on October 22, 1997, and
the recent Time magazine article on malnourishment in nursing homes
highlighted one particularly shocking type of abuse'. Other forms of abuse
may be slightly more subtle, but nevertheless, ultimately rob individuals of
their dignity and freedom. I was recently told about a New York State case
of an older gentleman who was admitted to a nursing home after a hospital
discharge. It was questionable whether or not he would recuperate
sufficiently from a stroke to return to his home for which he had "life use".
A heavy amount of therapy was immediately started and he spoke every
day about returning home.
A nursing home ombudsman reassured the man that she would go to his
home and check to see that everything was in order. When she got there,
she found that the home was empty and undergoing renovations. A
neighbor, who possessed the nursing home resident's power of attorney,
told the ombudsman he was renovating the home to prepare it for rental,
and that, in fact, it was to be rented the next month. The ombudsman asked
about the "life use" of the property and the neighbor simply stated he did
not anticipate the elderly man ever coming home again, and reported that
the nursing home resident's personal belongings had been burned and his
hunting dog given away. The ombudsman salvaged half of a grocery bag
of old photographs for the nursing home resident and assisted in
commencing legal action on his behalf. Although valiant efforts were made
by the ombudsman in this situation, the man's health continued to fail so-that he was no longer
able to return home. He eventually gave up pursuing
legal action.
This case is a very sad situation, but indicates the depths that abuse can reach,
whether it be physical, mental or emotional, and the compassionate efforts
made by ombudsmen across the country in similar situations.
These are only two of the many examples where ombudsmen step in to
represent the interests of vulnerable older persons. As ..others here today
will relate in their statements, it is clear that unspeakable tragedies would
occur every day across our country were it not for the vigilance and
devotion of ombudsmen to their duty. That is why this Administration has
continued to advocate for preserving the ombudsman program through the
Older Americans Act, both in the pending reauthorization as well as
through the appropriations process.
In 1992, Congress created the vulnerable elder rights protection programs
in title VII of the Older Americans Act, which brought together all parts of
the Act dedicated to the protection of the rights of vulnerable, at-risk
seniors. This title includes the long-term care ombudsman program, elder
abuse prevention program, legal assistance, and pension and benefits
counseling. In recent years, funding has only been provided for the
ombudsman and elder abuse programs. I think it is important to note that-the elder abuse
provisions of title VII also have a direct relationship with
the work of ombudsmen, particularly as it relates to coordination of services
and training.
We remain concerned about efforts to eliminate this title because we
believe that doing so will eliminate critical consumer protection services for
especially vulnerable elders. This year, as part of our reauthorization
proposal, we have recommended a consolidation within title VII,
combining the four separate authorizations into one. This proposal would
provide the states with greater flexibility to address their elder protection
activities consistent with their needs, while maintaining a base funding level
for the long-term care ombudsman program. In other words, in addition to
the ombudsman program, states would have the complete flexibility in
choosing the level of support for consumer protection services, which could
include elder abuse prevention programs and activities.
The ombudsman program also makes significant contributions toward
combatting fraud and abuse in Medicare and Medicaid. At the 1995 White
House Conference on Aging, President Clinton announced "Operation
Restore Trust" (ORT), a major initiative to fight Medicare and Medicaid
fraud. The state ombudsmen in California, New York, Illinois, Florida and
Texas were designated as part of a core team for ORT, a two-year
demonstration project of the U.S. Department of Health and Human
Services involving the coordinated efforts of the Health Care Financing
Administration, the office of the Inspector General and the Administration
on Aging. Under ORT, ombudsmen in the five states launched ambitious
statewide training programs to educate ombudsmen and other professionals
about fraud, waste and abuse, and strategies for handling it. These
activities have been very successful in returning funds to the Medicare
Trust Funds. For example, in Florida, a relative questioned charges to
Medicare of over $1,000 for an "anticontracture" device for his family
member who lived in a nursing home. The ombudsman went to the facility
and found that an individual had visited the facility and ordered the brace
devices for almost all of the 90 patients. The contraptions were stored in
the residents' closets; they were not used to help any of the frail, sick people
to whom they were given; and in many cases, they caused pain and skin
abrasions. The ombudsman reported her suspicion of Medicare fraud to the
appropriate authorities, providing documentation for what she had observed
at the facility. The individual was ultimately convicted of organized fraud
in several facilities, sentenced to jail, and ordered to pay restitution and
fines.
One topic of today's hearing, which focuses on background checks of those
who work in long-term care facilities and settings, is an important one.
According to the Administration on Aging's Long-Term Care Ombudsman
Annual Report for FY 1995, the two most frequent nursing home
complaints involved accidents and improper handling, and issues related to
dignity and respect. -The FY 1995 report analyzed data from 29 states. The
FY 1996 data, which is currently being compiled and analyzed, will be
from all 50 states, Washington, DC and Puerto Rico. This data was
collected under the newly implemented National Ombudsman Reporting
System
(NORS).
In FY 1995, the 29 states reported over 80,000 complaints. Around 5
percent of these complaints (4,500) were reported for complaint categories
which are specifically defined as abuse. For example, physical abuse
complaints number about 1,800. other complaint categories such as
"dignity, respect, staffattitudes" or "personal funds mismanaged" include
complaints which often involve abuse, neglect and exploitation. If these
cases are added to the specific abuse complaints, there are over 17,000
complaints, more than 20% of the total which are received. The line
between neglect and abuse is very hard to draw. The complaints reported
under many categories such as "personal hygiene" and "accidents, improper
handling" can also involve abuse issues. Adding these categories will result
in 30,000 complaints or more than 1/3 of the total for nursing facilities.
The 29 states were responsible for less than half of the complaints reported.
The data received from the ombudsmen is not specifically aimed at
measuring abuse but does give an indication of a significant incidence of
abuse in nursing facilities.
Why does such abuse occur so frequently? We knowthat some of these acts
are carried out by individuals who should not be working in caregiving
environments. They have histories of inappropriate behavior and,
unfortunately, some of these types of individuals find jobs in some long-term care facilities. We
also know that many caring and committed
individuals work in nursing homes and other long-term care settings around
the country as well. But for those who commit crimes, who abuse or
neglect, clearly, solutions must be found to prevent this type of problem
from continuing, and ombudsmen play key roles in identifying the problem
in many areas. Many ombudsmen across the country have indicated a need
for a nationwide system of background checks on applicants.
Unquestionably, some form of advance screening is necessary for those
individuals who work on a daily and hourly basis with our loved ones.
Also of equal importance is training, particularly for those in the criminal
justice system who work with frail and often uncommunicative victims and
witnesses of criminal abuse, as well as training staff in residents, needs and
rights and how to work with residents under trying conditions. ombudsmen
and others in the aging network throughout the nation carry out such staff
training programs on a regular basis. In addition, I cannot say enough
about how important it is to fully implement the training and certification
requirements of the historic Nursing Home Reform law. Finally, and
equally important, is the expansion of a community presence in facilities
through the Older Americans Act ombudsman program to provide
additional eyes and ears in long-term care facilities..
In conclusion, the Administration on Aging is proud of the many
contributions which the Long-Term Care Ombudsman Program has played
in helping to empower residents and potential residents of nursing homes
and long-term care facilities to resolve problems and receive quality care as
well as providing timely and accurate consumer information. This is a
program that has a proven track record. We also believe that this successful
program, in conjunction with legal assistance personnel, benefits
counselors, information and referral representatives, and other state and
area agency staff, provide a valuable model for expanding the ombudsman
concept into other arenas, in particular when older persons face a
bewildering array of decisions regarding their health care. The
Administration on Aging has proposed this type of program as part of our
reauthorization efforts for the 105th Congress, and it has been met with
interest and enthusiasm.
I appreciate the opportunity to testify before you today, and look forward to
any questions that you might have.