Taking Action Against Elder Mistreatment

as many of them already are required and still are not taking place. For example, the National Consumer Voice for Quality Long-Term Care instead suggests that whenever a nursing home fails to report abuse or neglect, the state sur- vey agency should impose a signifcant monetary penalty (National Consumer Voice for Quality Long-Term Care, 2019). The U.S. Government Accountability Office (GAO), in a June 2019 report, also found that there are signifcant gaps in other CMS pro- cesses that can result in delayed and missed referrals of abuse to law enforcement. For exam- ple, federal law requires nursing home staff to immediately report to law enforcement and the state survey agency responsible for facility over- sight any reasonable suspicions of a crime. How- ever, the state survey agency is not required to In 2016, one in five high-risk hospital emergency room Medicare claims were from potential abuse or neglect in a facility. report complaints of abuse that it discovers to law enforcement in a timely manner and, as the OIG also found, CMS does not conduct oversight on these referrals (U.S. GAO, 2019). The nursing home binding arbitration ban rollback also concerns many advocates. A fnal rule issued in July 2019 reversed the Obama Administration’s ban on having nursing home res- idents sign a contract waiving their rights to sue the facility in cases of neglect and abuse before any incidents have occurred. Instead, CMS is now allowing binding arbitration agreements, but with caveats—the fnal rule prohibits nursing homes from requiring agreements as a condition of admission and from including language prevent- ing residents or anyone else from communicating with any officials (CMS, 2019). Advocates are still concerned that residents and their families may

feel pressured into signing these agreements, or may not knowwhat they are signing. Another area that could be improved is the Special Focus Facility (SFF) program, which is overseen by CMS. It places special scrutiny on selected nursing homes with documented pat- terns of providing poor care. CMS publicly dis- closes the names of the facilities chosen to participate in this program, but the list of hun- dreds of nursing homes that are not selected for the program (but are still eligible because they have a “persistent record of poor care”) has always remained hidden from the public. How- ever, following an inquiry by Sens. Pat Toomey (R-PA) and Bob Casey (D-PA), CMS fnally, for the frst time, released the full list of SFF-eligible facilities. It can be accessed via the U.S. Senate Special Committee on Aging’s website (2019). Conclusion While we are pleased at the progress that has been made in the pursuit of elder justice, no one can really say that we have advanced far enough. We need to ensure that all the entities vested with fghting elder abuse have adequate resources, especially Adult Protective Services and the Long-Term Care Ombudsman program. We must also ensure that laws designed to pro- tect older adults from abuse in nursing homes and long-term-care facilities are fully enforced. We should never have federal funds enable elder abuse and neglect, especially among vulnerable older adults. And, we should ensure that we have processes, such as criminal background checks, to prevent the wrong people from gaining jobs in nursing homes and in long-term-care facilities. Elder justice is a human rights issue for older adults. What the movement lacks is a strong political imperative that helps move issues to the forefront for action. Advocates must take that important next step: They must raise the issue, raise their voices, and make elder justice the high priority it deserves to be in our nation.

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