Congress targets senior abuse
When it comes to political, social or health causes, elder abuse has not had the star power of some other movements focusing on the rights of vulnerable people.
Last month, actress Nicole Kidman headlined a congressional hearing on violence against women, and stars of “Law & Order: Special Victims Unit” appeared at a Capitol Hill rally for child-abuse victims. An event sponsored by a coalition of elder abuse groups, meanwhile, featured ordinary senior citizens, recounting in sometimes aching detail how they or their loved ones had been physically and emotionally abused or financially exploited.
The lack of glitter has been reflected over the years in federal support for protecting seniors -- which is to say, support has been limited. That may be about to change. As part of healthcare overhaul legislation, lawmakers are taking steps that would for the first time establish a federal beachhead in fighting elder abuse.
The House healthcare bill would launch a nationwide program of background checks for people who care for the elderly, overhauling a patchwork of state laws that critics say has allowed known offenders to repeatedly end up in positions of trust.
The Senate is considering an even more expansive Elder Justice Act. It would boost federal aid for identifying and investigating elder abuse at the state and local levels, require long-term care providers to report possible crimes to federal authorities and create new oversight within the Department of Health and Human Services for coordinating state and federal anti-abuse efforts. These provisions, already approved by the Senate Finance Committee, are included in the health legislation that is being prepared for floor debate after Thanksgiving.
With broad support in and out of Congress, at least some of the measures appear to have good prospects for being enacted into law. More than 500 advocacy groups have lined up behind the legislation. It still faces opposition on budget grounds, although proponents say the cost of the Elder Justice Act -- about $757 million over four years -- is pocket change in the context of a near $1-trillion healthcare bill.
About 11% of people ages 60 and older suffer from some kind of abuse every year, according to a March study for the National Institute of Justice, an arm of the Justice Department. Other studies have shown that elderly victims of abuse, neglect and exploitation have twice the risk of dying within a year.
Anecdotal evidence of such abuse abounds. A home aide working near Fresno was convicted of involuntary manslaughter last year after giving an 85-year-old woman a lethal overdose of morphine and methadone and ransacking her house. The caregiver had a history of domestic assaults and drug smuggling.
Last month, a postal worker in San Diego pleaded guilty to one count of felony financial elder abuse after taking more than $50,000 from elderly women on her delivery route. “She was using the economy to pour excuses on herself and borrow money,” said Paul Greenwood, an assistant district attorney. “We found out she was spending a lot of the money in the casinos.”
Financial exploitation of the elderly costs as much as $2.6 billion a year. The problem was highlighted with the October conviction of the son of New York philanthropist Brooke Astor for stealing tens of millions of dollars from his mother while she was suffering from Alzheimer’s disease. But advocates for the elderly say such abuse occurs on a lesser scale much more frequently.
Enhancing the rights of the elderly might seem a no-brainer for lawmakers on both sides of the aisle. After all, people older than 55 constitute the fastest-growing population group in the country. Congress is even aging: The average age of a House member is now 56 years, and for a senator, 61.7 years.
But opponents say they are concerned about runaway federal spending and stepping on the toes of state and local governments. The Elder Justice legislation, first introduced in 2002, was opposed by the Bush administration, which felt it would create a new and unnecessary federal bureaucracy.
Others question the expense and efficacy of background checks when even proponents acknowledge that most abuse is perpetrated by people who are already well-known to the victims. Until last year, the background-check bill, first introduced in the Senate in 1997 by Democrat Herb Kohl of Wisconsin, had never made it out of committee.
Still, opposing such measures can be politically tricky. “Why do you want to beat up old people?” Stephen Colbert demanded in an interview with Republican Rep. Cynthia Lummis of Wyoming on his Comedy Central show “The Colbert Report” in March. Lummis voted against legislation earlier this year that would have made federal money available to state and local elder-abuse prosecutors. She told Colbert, “I am opposed to irresponsible spending.”
“So you want us to beat up old people in a fiscally responsible manner?” he shot back.
Now backers of the legislation have maneuvered to link its fate to the debate over healthcare reform, in which it has become an important consideration for some centrist Democrats, such as Sen. Blanche Lincoln of Arkansas, who is considered a crucial swing vote on healthcare legislation. Lincoln, a longtime member of the Senate Special Committee on Aging, is a co-sponsor of the Elder Justice Act. (The median age of her constituents back home is also one of the highest in the nation.)
Supporters say elder abuse should be addressed in healthcare overhaul legislation because it pushes up healthcare costs and because financial exploitation of the elderly leaves many destitute and reliant on public assistance.
“This is prevention, which is a healthcare issue,” says Robert Blancato, who heads the Elder Justice Coalition, an umbrella group for more than 500 groups that support the legislation. They include AARP, the American Bar Assn., and industry groups representing nursing homes and long-term providers, among others.
State and local governments have long been on the front lines of such problems. But many studies have shown a shortage of resources among licensing agencies, long-term-care ombudsmen and adult protective service workers.
“The universal lack of resources, the enormous variation across jurisdictions and the low priority given to elder abuse and neglect make it difficult to see how significant progress can be made without federal standards and financial support,” concluded researchers at Texas A&M University in a report prepared for the Justice Department last month.
The current healthcare bills would require states to conduct comprehensive screening of a wide range of people who are working with the elderly, including those in the burgeoning and unregulated area of home-based care.
More than a dozen states, including California and Florida, currently do not regulate those workers. Most states only check the backgrounds of medical workers, such as nurse aides, and only for crimes they committed in their own states. In 2006, a woman who had been convicted in Kansas of pushing an elderly woman out of a vehicle in a carjacking was discovered to be working in nursing homes in Missouri.
The legislation also would require states to establish clear criteria for prohibiting employment of applicants with a history of violent crime. It also would mandate the development of appeals processes for individuals who are denied employment, plus systems in which workers who have been checked and cleared, but who subsequently commit a disqualifying crime, would be terminated.
Even proponents of the new federal standards say they can go only so far. Studies show that most elder abuse takes place in private homes and that the assailants are family members or trusted advisors, in up to 90% of cases.
The challenges increase as more elderly people spend their time at home or in community and group living arrangements. By comparison, teachers and other professionals outside the home act as a safety net in cases of suspected child abuse because they are required to report evidence of abuse to authorities.
“Adult abuse is a lot harder to get your arms around,” says Marsha Greenfield, a lawyer and senior legislative counsel for the American Assn. of Homes & Services for the Aging, a trade group for nonprofit long-term care providers.
“There are many more elderly people both in community and group living arrangements,” Greenfield says. “But they are also a more invisible population because there are so many people in their own homes.”
Kaiser Health News, an editorially independent news service, is part of the Kaiser Family Foundation, a nonpartisan healthcare policy research organization. Neither KFF nor KHN is affiliated with Kaiser Permanente.