1. Improving the Guardianship and Conservatorship System

An OIL priority is to ensure that highly vulnerable older Iowans with diminished decision-making capacity under guardianship and conservatorship receive needed protection.  OIL supports passage of Senate File (SF) 295 by the Iowa House of Representatives in the next legislative session. 

There are nearly 23,000 Iowans for whom the court has appointed a guardian or  a conservator to act as surrogate decision makers for them.  Many are older individuals who lack decision-making capacity because of Alzheimer’s and other dementias.  Guardians are responsible for their living arrangements and  personal care, and conservators are responsible for management of their financial affairs.

SF295 would enable courts to more effectively and efficiently monitor guardianships and conservatorships to prevent and remedy abuse, neglect, and financial exploitation of older Iowans under guardianship and conservatorship.  SF 295 specifically would establish uniform and consistent reporting requirements for both guardians and conservators by requiring them to report the information to the courts  needed  for monitoring, and SF 295 would require that conservators explain the purpose of expenditures of the funds  of older Iowans under conservatorship in annual reports to the court. 

SF 295 also provides that a judge must refer suspected cases of abuse, neglect, and financial exploitation to the county attorney for review and prosecution for violation of the elder abuse law as well as other applicable laws.

OIL has joined with 21 other organizations to support SF 295 including organizations that advocate for older Iowans such as AARP Iowa and the Alzheimer’s Association , Iowa.Chapter.

2. Establishing and Funding Dementia Specialist Program in each of the Area Agencie on Aging

SF2008 has been introduced ion the Senate.  In general it requires the Area Agencies on Aging to provide for dementia friendly initiative and dementia service specialists.

The Older Iowans Legislature is monitoring the progress of this bill and is currently registered in favor.

3. Funding Iowa Return to Community from the Lottery

The State Data Center of Iowa and the Iowa Department on Aging (IDA) estimated the number of people aged 65 and over in Iowa in 2019 was 553,575. This age group accounted for 17.5% of the total Iowa population.

IOWA RETURN TO COMMUNITY PROGRAM INITIATIVE

The long-term living and community support includes the Iowa Return to Community (IRTC) program which is provided by members of the "aging network" hospitals, clinics, long-term care facilities, home- and community-based service providers, Iowa Legal Aid, and other organizations to assist individuals transitioning back home from a skilled nursing facility or hospital. The nursing home diversion program’s objectives are to prevent a skilled stay from becoming a long-term institutional stay, facilitate a successful transition to home, assist with reducing readmission to the hospital or skilled facility, and allow individuals to protect their resources. To participate in the IRTC the individual must be age 60 or older, not Medicaid eligible, residing in a skilled nursing facility or hospital for rehabilitation, with the intent of returning home, and able to safely return home with assistance from a member of the “aging network”, and family members.

From FY 2019 to FY 2022, a total of 2,556 older Iowans (unduplicated) were referred resulting in 3,032 transition episodes. Based on the projected increase in 65-year and older Iowans by 2050, and the considerable increase in IRTC program referrals, it is imperative that a permanent funding source be identified to continue to expand the service throughout Iowa.

This program has proven successful and requires a consistent funding method.  As such, the Older Iowans Legislature urges funding from the Iowa Lottery Appropriation funds thus reducing the risk of General appropriations anomalies that could disrupt this program.

4. Establishing a needed Continuum of Care for Older Iowans including the availabilty of Home Care and Improved Nursing Home Care

Establishing a needed Continuum of Care for Older Iowans including the availability of Home Care and improved Nursing Home Care

The primary focuses of our past efforts concern staffing needs (improving pay and attracting people), the closing of nursing homes in Iowa, improving poor performing facilities, the need for transparency and accountability by nursing homes on how they are spending their money (in particular, the additional $15 million increase in Medicaid reimbursement allocated by the Iowa Legislature this year), and the need for national standards as pointed out by the NASEM report.

Peripheral issues have included, increasing the $50 personal allowance for Medicaid recipients, and keeping people in their homes as long as possible through home modifications, increasing benefits to family caregivers, increasing homecare providers in rural areas, and increased home care reimbursements by Medicaid.

It was further proposed and adopted at the 2023 Session that:

a.     The Older Iowans Legislature work with CMS (Center for Medicaid Services) and enlist the Dept of Inspection and Appeals, the Long-Term Care Ombudsman Office, the Iowa Health Care Association and Telligen to adopt a plan to improve the Special Focus Facility Program.  This should include meeting with the owners and Administrative staff of each of the 10 nursing homes at the beginning of the year to let them know of the state’s desire to help them and to enlist their commitment to examine what they can do to help improve their care.