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