While conditions for older Americans have improved markedly since the passage of the Older Americans Act of 1965 (OAA), many older persons are denied their basic rights and benefits and suffer abusive situations, ranging from financial exploitation to severe neglect. They may need advocacy on their behalf because physical or mental disabilities, social isolation, limited educational attainment, or limited financial resources prevent them from being able to protect, or advocate for, themselves.
The OAA established a nationwide network of 57 State and Territorial Units on Aging (SUAs), 655 Area Agencies on Aging (AAAs), 221 Tribal Organizations representing approximately 300 tribes, and over 27,000 service providers. This network assists older people who are the most socially and economically vulnerable, providing consumer assistance on matters concerning elder rights and benefits.
Aging network agencies provide a range of consumer assistance services. When a state or area agency cannot provide service themselves, they can link older people to other organizations which provide the service. The telephone number of the appropriate agency can be obtained by calling AoA's Eldercare Locator at 1-800-677-1116. (It is helpful to have the zip code of the older person in need of assistance.) Consumer assistance programs available through the aging network include:
- The Long-Term Care Ombudsman Program
- Elder Abuse Prevention Programs
- Prevention of Health Care Fraud, Waste and Abuse
- Legal Assistance Services
- Benefits, Pension, and Insurance Counseling
The Ombudsman Program: Investigating Complaints about Nursing Home Care
An ombudsman is a public official appointed to investigate citizen's complaints against organizations, entities, or persons which may be infringing upon the rights of individuals in nursing homes and board and care facilities. Professional ombudsmen, working with citizen volunteers, have made a dramatic difference in the lives of nursing home residents since the Long-Term Care Ombudsman Program was initiated 25 years ago.
Through periodic visits to nursing homes and response to telephone complaint lines, ombudsmen have exposed problems hidden from public view, resolved specific complaints, protected residents' rights, and given emotional support to lonely and vulnerable older people. Ombudsmen often detect mood or health changes in residents that are overlooked by busy staff.
According to the latest data from states (1995), more than 6,400 certified volunteer ombudsmen, backed by 900 paid staff, investigated 218,455 complaints from residents of long-term care facilities, family members, and professionals. Seventy percent of these were fully or partially resolved. One-third of these complaints were about poor resident care ranging from cold food and enforced early bedtimes to verbal abuse, medical neglect, and even wrongful death.
Prevention of Elder Abuse
The four common kinds of elder abuse are: Physical abuse--the infliction of physical pain or injury (e.g., slapping, bruising, sexually molesting, restraining); Psychological abuse--the infliction of mental anguish (e.g., humiliating, intimidating, threatening); Financial abuse--the improper or illegal use of the resources of an older person, without his/her consent, for someone else's benefit; and Neglect--failure to fulfill a caretaking obligation to provide goods or services (e.g., abandonment, denial of food or health-related services).
All 50 states have passed laws (e.g., elder abuse, adult protective services, domestic violence laws, mental health commitment laws) that authorize the state to protect and provide services to vulnerable, incapacitated, or disabled adults.
The state-designated agencies, usually called adult protective service agencies (APS), receive and screen calls for potential seriousness. The agency keeps information received concerning reports of suspected abuse confidential. If mistreatment is suspected, an investigation is conducted (in cases of an emergency, usually within 24 hours).On the basis of a comprehensive assessment, a care plan is developed which might involve: obtaining a medical assessment of the victim; admitting the victim to the hospital; assisting the victim in obtaining needed food, heat, or medication; arranging for home health care or housekeeping services; calling the police; or referring the case to the prosecuting attorney.
Once the immediate situation has been addressed, the APS continues to monitor the victim's situation and works with other community agencies, serving the elderly, to provide ongoing case management and service delivery. The older person has the right to refuse services offered by APS, unless he or she has been declared incapacitated by the court and a guardian has been appointed.
Prevention of Health Care Fraud, Waste and Abuse
The General Accounting Office estimates that billions of Medicare dollars are lost each year to waste, fraud and abuse. The AoA has become a partner in a government-led effort to combat this problem, focusing on two main strategies.
1) In May 1997, AoA awarded funds to twelve agencies and organizations to utilize public and private providers at the state and local level to train retired professionals to identify and report waste, fraud and abuse.
2) Working in partnership with the Office of the Inspector General and the Health Care Financing Administration, AoA provided funding to fifteen State Offices on Aging to train state and local personnel to recognize and report suspected cases of fraud and abuse. A 1996 demonstration program utilizing these types of efforts in five targeted states resulted in the recovery of $187 million in fines, settlements, and audit disallowances.
Legal Assistance
The aging network provides legal assistance to older people in all states. Legal assistance is required by older people in a variety of fundamental areas including: income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.
In 17 States, special Statewide Legal Hotlines are available to help with a range of legal and related problems. This innovative delivery system provides both quality assistance for simple issues and referrals when more extensive help is needed.
Pension Counseling Programs
Many people are confused by the technical language and numerous qualifications associated with their pension plans and are intimidated by the procedures in pursuing claims. The AoA funds a Technical Assistance Project at the Pension Rights Center in Washington, D.C., as well as six demonstration projects around the country to: conduct outreach to workers confused about pensions; provide people with information and expert advice on pursuing claims; establish a system for referral of workers with complex claims to lawyers willing to help free of charge or at a reduced rate; and encourage workers to take responsibility for their own income security in old age by understanding their pension plans.