California Elder Justice Coalition (CEJC)
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"Under the Radar"
Developments We're Watching

In today’s tumultuous political environment, many of us are watching and responding to proposed changes to America’s safety net that could have catastrophic impact. Many of our colleagues are spearheading efforts to fight proposed cuts and changes—we encourage you to support the efforts of groups you are aligned with. However, we are also concerned that other proposed or in-process changes with consequential impact for elder justice may be flying under the radar. This chart describes issues we're following and provides links to great sources of additional information. Let us know about issues you're following, updates on those listed, or additional contacts.  To do so, contact us here.


Updated December 2019
Issue
Threat
Status / Additional Info
Elder Abuse / Elder Justice
 


Elder Justice Act Re-authorization
The EJA was enacted in 2010 as part of the Patient Protection and Affordable Care Act, (see below).  It proposed a national structure for elder justice and a Coordinating Council to oversee implementation and develop recommendations. It does not provide funds for direct services and limited funds for research, a national APS data base, and demonstration projects.
For more on the EJA go to Elder Justice Act​​.


​
Most provisions under the EJA were set to expire in 2014. Attempts at reauthorization have failed, and funding for programs and activities has been provided by continuing resolutions. On May 24, 2017, House Republican Pete King introduced H.R. 2639 to extend the EJA through 2021. It was assigned to committees but no action has been taken. 



​


The reauthorization remains stalled. It has not been taken up in committee and congress.gov,  the website for U.S. federal legislative information, has yet to produce a summary. See Congress.gov. 

The Elder Justice Coalition has been in discussions with the Senate Finance Committee and anticipates that a draft of a new bill, which is expected to be called the Elder Justice Reform Act, is likely to be introduced in fall, 2019.  

​For updates, go to Elder Justice Coalition

 Nursing Homes




 
Nursing Home Deregulation   (Updated Aug 2019)
The Centers for Medicare and Medicaid Services (CMS) sets requirements that nursing homes must meet to  to participate in the Medicare and Medicaid programs. They may fine facilities or revoke their licenses for failure to meet the requirements. These punishments have lacked teeth.

​In 2016 CMS issued reforms to promote residents’ health and safety. This included a rule barring nursing homes from requiring residents to sign arbitration agreements (see below). 




​
The current administration has proposed rolling  back the reforms, proposing changes that would:
  • Discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The industry is claiming that the fines focus excessively on catching wrongdoing rather than helping nursing homes improve.
  • Make penalties discretionary in a range of situations.
  • Give wide discretion to states and CMS regional offices.
  • Roll back the ban against arbitration agreements to allow (or even require) nursing homes to require residents to sign the agreements. 
In July, 2019. CMS issued a final rule that reflects the proposed rollbacks, including the repeal of the ban on arbitration agreements (see below). 

​The following organizations  provide frequent updates and action alerts:
  • ​Consumer Voice has produced a side-by-side comparison of the proposed and current nursing  regulations. 
  • Center for Medicare Advocacy
  • California Advocates for Nursing Home Reform (CANHR)
  • Justice in Aging chart, How Nursing Home Protections are Being Rolled Back of industry and congressional requests to remove protections and CMS' responses.

Binding Arbitration: SNFs (Updated Aug 2019)
Skilled nursing facilities prevent residents from pursuing lawsuits against them for neglect, abuse, wrongful eviction, and death by pressuring them into signing arbitration agreements upon admission. Residents typically feel pressured to sign the agreements on admission, essentially waiving their right to  sue the home in the event of abuse or inadequate care.

In fall 2016, the Centers for Medicare and Medicaid (CMS) issued a new rule barring federally funded nursing homes from requiring residents to sign arbitration agreements. Under the Trump administration, CMS issued a proposed rule to roll back the ban and allow (or even require) nursing homes to require residents to sign the agreements. 

​

In July, 2019 CMS issued a final arbitration rule repealing the prohibition against the use of pre-dispute, binding arbitration agreements. ​​








​
Civil Rights
  


Threats to Civil Rights Divisions
​
Many federal departments have civil rights divisions that investigate civil rights violations and discrimination. These include the Department of Justice (DOJ), the Department of Labor (DOL), the Department of Health and Human Services (HHS), the Department of Housing and Urban Development (HUD) the Environmental Protection Agency (EPA), and the Equal Employment Opportunity Commission (EEOC).
The administration has signaled its intent to cut back on civil rights divisions and provisions that impact older adults. For example, the EPA has proposed eliminating an environmental justice program that addresses health threats concentrated in minority communities, and HHS has removed questions about sexual orientation from two surveys of elderly Americans that are used for making funding decisions.​

​
Advocates have been partially successful in getting questions about sexual orientation reinstated.
For more:
SAGE (Services & Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders) is following this and related issues. Contact them at www.sageusa.org.


​

​
Religious Objection Rules
Healthcare personnel are required to provide care or services regardless of their own values.  However, the U.S. Department of Health and Human Services (HHS) rolled out Protecting Statutory Conscience Rights in Health Care, which would allow health care providers to refuse to provide services that conflict with their personal values.

​
Although directed primarily at abortion services, the rule may cover services in Medicaid or Medicare Advantage, the handling of advanced directives, and services for hearing screenings, vaccinations, and mental health treatment. Advocates fear it may open the door for discrimination against members of LGBT and minority communities. For more, see Could Trump’s Religious Objection Guidance Create SNF Turmoil?
Groups following this development:
    ◦    National Consumer Voice
    ◦    SAGE

​






​

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Blog: Elder Justice Viewpoints​

Lisa Nerenberg: COVID, Elder Justice, and Advance Directives
​
​Elizabeth Podnieks: World Elder Abuse Awareness Day: Hope Springs Eternal 


Lisa Nerenberg: Health Justice and Public Health in the Age of Covid-19

​Lisa Nerenberg: An Ecological Model of Elder Justice

Charles Sabatino:  Calling for a U.N. Convention on the Rights of Older People

John Dussich on Restorative Justice and Elder Abuse: A Promising Match? 

​Georgia Anetzberger on How Not to Be a Victim: Remembering Jenny

​More blog posts here. 
​Elder Justice Toolkit Pages by Topic:


Adult Protective Services

Internat'l Elder Justice Policy & Practice

Skilled Nursing Facilities  

Opioids and Older Adults 

Undue Influence

Raising Awareness

Elder Homelessness

Financial Crime 

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  • Home
  • About Us
    • Our Core Values
    • Accomplishments
    • Our Team
    • Our Supporters
    • Contact Us
  • Policy
    • California >
      • Covid 19 Updates
      • CEJC and the Master Plan on Aging
      • Key California Agencies
      • Laws Taking Effect in 2020
      • Innovations and Resources
    • Federal Policy >
      • Key Statutes/ Programs >
        • Elder Justice Act
        • Victims of Crime Act
        • Social Services Block Grant
        • Older Americans Act
      • National Innovations
  • Learn
    • National Advocates Academy
    • Toolkit by Topic (Nat'l) >
      • Adult Protective Services
      • Elder Homelessness
      • Financial Crime
      • International
      • Opioid Crisis
      • Raising Awareness
      • Skilled Nursing Facilities
      • Undue Influence
    • Webinars and Events
    • CEJC Publications
    • News & Updates- Nov/Dec 2020
    • Awareness Snapshots
    • Blog: Elder Justice Viewpoints
  • Join Us
    • Renew
    • Donate