Q&A: World Elder Abuse Awareness Day

With U.S. Senator Chuck Grassley


Q: What’s your greatest concern in 2020 regarding elder abuse?

A: The global pandemic has exposed grave concerns our society must confront to protect the nation’s most vulnerable citizens. Approximately 1.4 million Americans live in about 15,000 nursing homes across the country. Many Iowans have a loved one who lives in a long-term care facility. Every American ought to be concerned about quality standards and compliance in long-term care facilities for two good reasons. Taxpayers pay the lion’s share of nursing home funding and someday any one of us may need long-term care services for rehabilitation, memory care, assisted living or 24-hour skilled nursing care. The highly contagious infectious disease known as COVID-19 has disproportionately impacted seniors living in nursing homes and long term care facilities. The Centers for Medicare and Medicaid Services (CMS) released findings in June that estimated nearly 32,000 residents have died so far from the virus. That’s more than one-fourth of all COVID-19 fatalities in the United States. The startling death toll from COVID-19 among this population is yet another call to action that I have long championed to bring about.

As former chairman of the Senate Aging Committee and current chairman of the Senate Finance Committee, which has jurisdiction over CMS, I keep a tight leash on the federal oversight agency that administers public laws written to protect senior care and ensure effective use of tax dollars in U.S. nursing homes. CMS defines the standards nursing homes must meet to participate in the Medicare and Medicaid programs.

Last year, the Senate Finance Committee conducted a series of hearings to examine gaps in enforcement of nursing home abuse. A U.S. Government Accountability Office (GAO) investigation found a 103 percent increase in abuse deficiencies between 2013 and 2017. The GAO noted abuse in nursing homes is often underreported; its audit found abuse citations had more than doubled in that four-year period from 430 in 2013 to 875 in 2017. Specifically, the GAO found delayed or missed referrals and inadequate information collected on facility-reported incidents. The report documented physical, mental, verbal and sexual abuse perpetrated against residents.

The number of nursing home deaths attributed to COVID-19 delivers a wake-up call we can’t afford to ignore. The federal government needs to do a better job enforcing compliance with standards of care. When a loved one requires a long-term care facility to deliver around-the-clock services, every family deserves peace of mind that every nursing home resident will receive high-quality, compassionate care and be treated with dignity and respect.  

Q: What are you doing to improve care, compliance and outcomes in U.S. nursing homes and curb elder abuse?

A: From my leadership positions in the U.S. Senate, I have led constant efforts to raise awareness and stop elder abuse, including my efforts to crack down on exploitation of nursing home residents on social media and elder financial exploitation that costs seniors an estimated $2.9 billion each year. In 2017, I won passage of the Elder Abuse Prevention and Prosecution Act to strengthen the federal government’s ability to identify and prosecute mistreatment of older Americans. Since our nursing home oversight hearings last year, I’ve been building a broad coalition of policymakers, regulators, patient advocates and elder abuse experts to develop meaningful reforms to improve standards of care in nursing homes. My legislation will be introduced very soon. The lessons learned from COVID-19 also have informed these conversations for reform, such as providing personal protective equipment and testing for nursing home workers and residents and improving reporting requirements for COVID-19 deaths, staffing levels and suspected abuse and neglect. In addition, the pandemic has affirmed the demand for telehealth services, as well as televisits for nursing home residents isolated from loved ones during the lockdown.

More than 20 years ago, the federal government launched an online tool called Nursing Home Compare. It was designed to give Americans a convenient tool to comparison shop when they were in the market for a long-term care facility and to incentivize the industry to earn good ratings. Transparency brings accountability. Since then, it’s become increasingly clear the information must be timely, accurate, comprehensive and user-friendly to be effective. It’s time to upgrade the Five-Star Rating System on Nursing Home Compare.

Finally, the CARES Act approved hundreds of billions of dollars to respond to the public health emergency. More resources may be on the way. I’m working to ensure emergency relief spending doesn’t leave nursing home residents behind and to improve adult protection services for the most vulnerable elderly in our communities.

World Elder Abuse Day is June 15, 2020. Call 9-1-1 if a situation is serious, life-threatening or dangerous. To report elder abuse, neglect or exploitation in Iowa, contact the state long-term care ombudsman at (866) 236-1430. Report complaints about nursing home or home health services to the Iowa Department of Inspections and Appeals (877) 686-0027. To report elder abuse of individuals living in the community, call the Iowa Department of Human Service hotline at (800) 362-2178.