Advocacy

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2023 NCSTHL Priorities

#1 Allocate An Additional $8M In Recurring Funds For Adult Protective Services (APS) To Address Staff Shortages

The NCSTHL recommends that the NC General Assembly allocate these funds to add much-needed staff, in keeping with the growth of the older adult population and the rise in abuse complaints.

• Many people are aware of their county’s Child Protective Services, but they may not be aware that there is a sister-agency dedicated to protect vulnerable older adults from abuse, neglect, and exploitation.
• Currently, the federal government provides 21% of the funding for APS through the Social Services Block Grant (SSBG). The counties pay 79%. Our state allocates no funding for this increasingly important service.
• With the growth in the older adult population, APS units are simply overwhelmed by increased demand.
• In SFY 2005-2006, APS received 14,001 reports, compared to 32,075 reports received in SFY 2020-21, for an increase of 129% in 15 years.
• Added to that, the NYS Elder Abuse Prevalence Study reports that for every 1 case reported, 24 cases go unreported.
• APS incidents are reported from across the spectrum of income and education.
• Unfortunately, the SSBG is a shared bucket of funding across several other county DSS departments, which results in disparities across counties as to availability of APS resources. Counties report on average they need two additional full-time APS staff to address programmatic needs.

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#2 Increase The Senior Center General Purpose Appropriation By $1,265,316 In Recurring Funds.

Senior Center General Purpose (SCGP) funding is currently $1,265,316, which is not meeting the demands of a growing older adult population.

The NCSTHL recommends that the NC General Assembly:

•  Allocate $500,000 evenly amongst all 100 counties to help offset increased administrative costs.
• Allocate the remaining $765,316 for the Division of Aging and Adult Services certification program to increase the allocation each senior center receives. 

There are 169 senior centers in 95 counties that provide programs and services to enhance the health and wellness of older adults.

• Since 2004, funding for senior centers has remained at $1,265,316 per year, with a one-time non-recurring increase in FY 07-08 of $200,000.
• The age 60+ population has nearly doubled from 1.3 million in 2000 to 2.4 million in 2020.
• These services are of significant benefit to help elders remain independent, thus delaying their potential for costlier services or housing options.
• To maintain operation, senior centers must leverage resources from a variety of sources that include federal, state, and local governments, special events, participant contributions, grants, and volunteer hours.

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#3 Allocate An Additional $8M In Recurring Funds For The Home & Community Care Block Grant (HCCBG)

• This grant funds Community-based services such as home-delivered meals, adult day care, transportation, senior centers, in-home aide, and may others, help older adults remain in their homes as long as possible. These supports help to prevent more costly interventions, such as assisted living or nursing home facilities.
• These services are not “means-tested,” meaning they are not based on income, but are based on need determined by objective home assessment conducted by county-based employees.
• These services are NOT provided through Medicaid or Medicare. 
• Many retired North Carolinians worked in the state’s textile and tobacco industries, and other manufacturing that has left the state. They worked hard all their lives. 
• They may have pensions, but many do not. Social Security is NOT enough to live on. They need the supports provided by the HCCBG to live independently for as long as possible.

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#4 Allocate An Additional $1.5M In Recurring Funds For 11 Additional Regional Long-Term Care Ombudsman

“Ombudsman” is a Swedish word meaning “citizen advocate,” and in the LTC setting, they are state-trained individuals whose function is to uphold the rights of residents in long-term care facilities. 

• NC has more than 90,000 LTC beds, with industry standards recommending one ombudsman for every 2,000 beds, resulting in the need for 45 full-time positions operating across the state.
• With 34 filled positions, eleven additional fill-time ombudsmen are needed to meet best practice staffing levels.
• For those who have a loved one in a long-term care (LTC) setting, knowing the regional LTC ombudsman could make a huge difference in their experience with the facility. 
• Their role was heightened by the facility visitation restrictions imposed during the COVID-19 pandemic.   

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#5 Strengthen Long-Term Care Staffing Standards

• In NC, the number of RNs and LPNs in nursing homes is mandated by state licensure, based on the number of residents in their beds. However, there is no requirement on the number of CNAs – the nursing aides who do the direct care tasks such as feeding, bathing, grooming, repositioning, and transport to activities.
• As a result, frail adults suffer unnecessarily because there are not enough direct care workers to care for them, and the aides burn out and quit, so there are constant staff shortages.
• No one would dream of placing their pre-schooler in a day care that was understaffed, would they? We want our state to be as safe as possible for those who are placed in nursing homes, as they near the end of their lives.
• The federal Nursing Home Reform Act (NHRA),as part of the Omnibus Budget Reconciliation Act (OBRA) of 1987, requires minimum staffing levels for registered nurses (RNs) and licensed practical nurses (LPNs), and a minimum educational training for nurse’s aides (NAs), but fails to establish a specific requirement for minimum caregiver/resident ratio or a minimum standard for the number of hours per patient day that a resident should be receiving.