1. Elder Rights and Elder Justice Panel Discussion Becky A. Kurtz Georgia State Long-Term Care Ombudsman Older Americans Act Reauthorization Listening Forum Dallas, Texas February 18, 2010

2. Elder Rights and Elder Justice How well do we – as an Aging Network -- provide justice for and protect the rights of our nation’s elders? How do we prepare for our own aging and the aging of our society?

3. What has the OAA and the Aging Network done well? Where are the gaps and opportunities for improved elder rights services to elders? Some suggestions for moving forward

4. The Older Americans Act: Sets the objectives and the foundation for the Aging Network Leverages state and local resources (funding, volunteers, community partnerships) Anticipates “effective and visible” advocacy and visible” advocacy for older individuals for older individuals

5. OAA promises protection of elder rights for vulnerable adults (Title VII): “[T]he independence of many elderly is still threatened by abusive situations.... For others, independence is hindered by limited financial resources, disability, and lack of information on rights and benefits. To help address these issues, AoA administers a number of Vulnerable Elder Rights Programs that provide important protections against threats to the independence, well being, and financial security of seniors.” (AoA Website)

6. Gaps and opportunities for improvement

7. Gaps in elder rights services:  The most vulnerable elders are unable to access services  Services are not equally available in all settings  Person-centered services are not implemented in all settings  Preventing crises How our organizations and structures impact our ability to provide elder rights services:  Title VII services are not always among the Aging Network priorities  Our variety of roles can interfere with our services  We must lead elder abuse prevention and response within a fragmented system

8. The most vulnerable elders are often unable to access services and benefits The most vulnerable people may be those who lose their decision-making capacity and have no authorized decision maker. “Incapacitated and Alone: Health Care Decision-Making for the Unbefriended Elderly,” 2003 American Bar Association Commission on Law and Aging Limited access to ombudsman and legal advocacy, as well as public benefits, health care, financial institutions, and other critical services.

9. Elder rights services are not equally available in all settings Examples for ombudsman services: Unavailable for consumers of long-term care in their own home (in most states). Residents of 17% of nursing homes and 53% of board and care/assisted living homes did not receive a regular visit from an ombudsman in Federal Fiscal Year 2008.

10. Person-centered services are not implemented in all settings It is too easy to focus on convenience to the service- delivery system instead of promoting what is important to the consumer. Consumers need “Culture change” in nursing homes and every service setting.

11. We need to help seniors prevent crises Too often we are available only when the senior is already in a crisis situation:  After the financial exploitation,  After the nursing home placement,  After there is no decision-making capacity. Our attempts are limited in scope or have lost state funding support in this bare- bones economy.

12. Title VII services aren’t always among Aging Network’s priorities  Elder Rights programs and services are not always integrated well into state plans and area plans  Elder Rights focus can get lost in the administrative structure

13. Title VII services aren’t always among Aging Network’s priorities Title VII services aren’t always among Aging Network’s priorities Financial Resources -- examples:  Legal Assistance Development -- Title VII mandate and funding authorization with no appropriation  Expansion of Ombudsman role without proportionate funding increase 1981 -- Nursing Home Ombudsman became Long-Term Care Ombudsman and mandated to serve board and care residents; 2006 -- assisted living added to definition of long-term care facility

14. Our variety of roles can interfere with services State Aging Networks must provide:  Social services  Elder rights advocacy And may also provide:  Long-term care services (e.g., Medicaid waiver programs)  Abuse Investigations (e.g., APS)  Guardianship services  Licensing and regulating authority

15. Confusion in the “tent” Holding these diverse functions together can cause:  Confusion for consumers  Mission creep  Inability of some programs to fulfill legal mandates and duty to consumers

16. Leading in a fragmented, multi- layered system Leadership that helps focus on protection from and response to elder abuse when the key players are diverse. Lack of reliable data on elder abuse.

17. Moving forward...

18. Living with the inherent tensions within our aging tent:  The interests of elder rights advocates will conflict with the interests of service providers  To succeed, we must be explicit about our roles and clarify our boundaries  It’s not personal, it’s systemic – the OAA creates both service providers and advocates  Seniors need aging leaders to embrace, not fear, their advocacy mandate

19. Federal leadership  Accountability  Highlighting and sharing state and local solutions  Resources

20. Focus on the elder  Clearly articulated and shared mission, vision, and values  Design all of our services to be “person-centered”

21. Living Longer, Living Safely, Living Well