Transition is coming to the Traumatic Brain Injury (TBI) program, which is moving from the Health Resources and Services Administration (HRSA) to the Administration for Community Living (ACL).

For nearly 20 years, HRSA has administered this program to providing services to thousands of individuals affected by traumatic brain injuries. However, with the passage of the TBI Reauthorization Act of 2014, the Department of Health and Human Services (HHS) Secretary Sylvia Burwell was given the authority to review the program’s aims and goals and determine its best fit within HHS. ACL was formed in 2012 to advance policy and implement programs that support the rights of older Americans and people with disabilities to live in their communities throughout their lifespan. Thus, it was determined that ACL would be best positioned to support the TBI program into the future.

Program experts at HRSA and ACL are working closely together to ensure a smooth transition. For now, HRSA will continue to administer all current operations for the TBI program, including:

• The State Implementation Program, which provides funding to states, territories, and federally recognized Indian Tribes and Native American organizations to develop or enhance community-based services to those at risk for or impacted by TBI, and
• The Protection and Advocacy Grants Program, which provides training, advocacy, legal consultation and representation to individuals with TBI.

HRSA and ACL staffers are working closely to ensure a smooth transition of the program. After October 1, 2015, ACL will assume responsibility for grant oversight and administration and issue new grant awards as existing projects come to conclusion. As this process unfolds, our agencies will distribute additional information. For now, grantees who have questions should contact their current HRSA project officer or grants management specialist.

This change in administration will not change HHS’ enduring commitment to a community-based approach to prevention, early identification, screening, and referral to effective treatment for TBI. Staff in both of our agencies look forward to working with grantees and other interested parties to make this transition a success.

Learn more about the TBI Program

Assistant Secretary for Aging Kathy Greenlee spoke about opportunities to improve the well-being of older persons to the United Nations Open-Ended Working Group on Ageing this week.

The Open-Ended Working Group on Ageing was established by the General Assembly in December, 2010 “to consider the existing international framework of the human rights of older persons and identify possible gaps and how best to address them, including by considering, as appropriate, the feasibility of further instruments and measures.”

U.S. Statement, delivered by Kathy Greenlee

Agenda Item 4, "Existing international framework on the human rights of older persons and identification of existing gaps at the international level"

Wednesday, July 30, 2014

Thank you. I’m Kathy Greenlee, Assistant Secretary for Aging, and the Administrator for the Administration for Community Living in the Department of Health and Human Services. I’m pleased to offer the U.S. government’s thoughts on how to improve the well-being of older persons. In this regard, we recommend the following positive strategy to advance ageing issues at the UN.

First, member states can insert language calling for practical actions to improve the situation of older persons into relevant resolutions and outcome documents. These would include documents of the UNGA Plenary, Second Committee, Third Committee, ECOSOC subsidiary bodies, ILO, WHO, and UN HABITAT. The actions suggested should be consistent with the Madrid International Plan of Action on Ageing. The Madrid Plan enjoys widespread, cross-regional support and provides an agenda for including older persons in the benefits of development; advancing health and well-being into old age; and ensuring enabling and supportive environments for older persons.

Second, member states can use side events and panel discussions to highlight topics of particular importance, with a view to arriving at solutions for specific concerns. At the August 2013 OEWG session, the United States was pleased to be represented by an attorney with the U.S. Equal Employment Opportunity Commission at an event about employment discrimination against older persons.

Third, language outlining broad objectives and indicators related to older persons can be included in the strategic plans of the UN funds and programmes and other UN organizations, including ILO, UNDP, UNFPA, UN Women, UNAIDS, and WHO. These additions to the Strategic Plans will inform efforts to develop and assess policies and programs.

Fourth, human rights treaty bodies can engage on ageing issues within their respective mandates by encouraging member states to address older persons in their reports and presentations to the treaty bodies, and by addressing such issues in their concluding observations, as appropriate. The treaty bodies that most pertain to older persons are the Human Rights Committee; the Committee on Economic, Social, and Cultural Rights; the Committee on the Elimination of Discrimination Against Women; and the Committee on the Rights of Persons with Disabilities.

Fifth, existing Special Rapporteurs—including those on adequate housing, extreme poverty, health, and violence against women—can examine issues involving older persons within their mandates and underscore the relevance of these issues across the lifespan.

Sixth, the HRC Independent Expert on the Enjoyment of All Human Rights by Older Persons can report on implementation of the Madrid Plan. This can be done in her annual oral presentations to the HRC and in her written report due in three years. As the Independent Expert and Open-Ended Working Group on Ageing have related mandates, their efforts should be complementary rather than duplicative. The Independent Expert can provide added value by suggesting ways in which member states can implement existing laws and formulate improved policies on behalf of older persons.

Lastly, member states can use the HRC’s Universal Periodic Review process to produce country-specific observations concerning older persons.

Since the outset of the Open-Ended Working Group, some member states have supported negotiating a new international legal instrument on the rights of older persons. The United States continues to have serious concerns about this proposal. We question what a new convention would add to the protections already present in existing human rights treaties, which apply to persons of all ages, including older persons. The situations older persons find themselves in—which involve violence, abuse, neglect, economic security, health, nutrition, and independent living—need to be addressed immediately. It is critical that member states focus on practical measures which can deliver relief in concrete, timely ways.

For example, in the United States we have focused on developing practical measures to address the rights of older persons. President Obama signed into law the Elder Justice Act in 2010 which is dedicated to the prevention, detection, treatment, intervention, and prosecution of elder abuse, neglect, and exploitation, while recognizing and advocating for every individual to live without any form of these experiences.

We have established the Elder Justice Coordinating Council for the coordination of activities relating to elder abuse, neglect and exploitation and other crimes against older persons. The Council consists of the heads of 12 Federal departments and other government entities identified as having responsibilities, or administering programs, relating to elder abuse, neglect, and exploitation. To develop its recommendations, the Council has reviewed issues and sought input from elder justice experts in four primary topic areas: Financial Exploitation; Public Policy and Awareness; Enhancing Response; and Advancing Research. The agencies represented on the Council have been working collaboratively to improve existing systems and to enhance federal responses to elder justice issues.

Further, we have been engaged actively in building partnerships and heightening public awareness of private and public sector entities through highly visible events at the White House and at the United Nations commemorating World Elder Abuse Awareness Day. We provide technical assistance for state, tribal, and local partners through our National Center on Elder Abuse and our National Indigenous Elder Justice Initiative, focused on culturally appropriate information and community education materials on elder abuse. We all recognize that the world is aging and that there are difficult challenges facing every country as our populations of older persons increase. We also need to be alert to the abuse and exploitation faced by older persons and to the human, economic, and political costs we will face if we allow ourselves to wait too long to address their needs. We have many paths forward to make a difference in the lives of older persons. We need to move ahead now. The human rights of older persons are not the rights of someone else—they are the rights of all of us.

Thank you for your attention. Our delegation looks forward to engaging in the coming days with the stakeholders present at this meeting.

For more about the Working Group on Ageing, visit the UN website at http://social.un.org/ageing-working-group/. A webcast of the meeting will be available here: http://webtv.un.org/.

Chronic health conditions are, unfortunately, often a part of the aging process. Ninety-two percent of people over age 65 live with at least one chronic health condition, such as diabetes, heart disease, arthritis, or cancer. Seventy-seven percent live with two or more such conditions. Chronic health conditions can create challenges that affect every aspect of a person’s life. However, learning to manage those conditions enables people to stay healthy, active, and engaged in their communities. The Administration on Aging (AoA) currently provides Affordable Care Act Prevention and Public Health Fund grants to a National Resource Center and 22 states to deliver evidence-based chronic disease self-management programs. These programs empower thousands of older Americans to successfully manage their chronic conditions so they can maintain their independence and dignity.

Research has shown that when older adults learn how to successfully manage chronic conditions, they experience better overall health. They also experience less depression and fewer lifestyle limitations. The best known evidence-based self-management program is Stanford University’s Chronic Disease Self-Management Program. The program is a six-week community-based intervention, typically held in senior centers, churches, health clinics, and libraries. The two-and-a-half -hour workshops are led by trained group leaders who are successfully managing their own chronic health conditions. Program participants learn skills to help them handle the difficulties of life with a chronic condition. Topics include: problem-solving and decision-making skills; symptom-management techniques; nutrition and exercise; medication use; coping with emotions; and communicating with physicians.

Because social connectedness is an important component of well-being, the workshops are highly interactive and foster peer support. Participants share their progress in learning new skills and work together to find solutions to common problems. This, in turn, builds confidence and reduces social isolation.

Feedback from workshop participants reflects the way these programs are changing lives. Participants use works like "realistic," "practical," and, most importantly, "fun!" One woman said, "I learned more from [this program] in six weeks than I have in 23 years of going to different doctors." And it’s not just the program participants who benefit. The workshop leaders experience high rates of satisfaction, too. As one leader put it, "I am really proud to be helping veterans learn how to better manage their diseases. It is refreshing to be the person that brings attention to the struggles veterans face."

We couldn’t agree more. AoA is proud of the work it has done to encourage healthy aging through chronic disease self-management. I would like to thank our aging-services network and their partners for continuing to promote these and other evidence-based programs and practices that contribute to healthy aging. Your commitment to raising awareness about chronic disease self-management is helping a generation of older Americans take charge of their health.

In recent years, the United States has experienced a number of significant natural disasters. Several of these events happened with little or no warning. One key lesson that we have learned from these unfortunate circumstances is to "be prepared," a message that is especially important for older Americans and people with disabilities. September is officially designated National Preparedness Month, but preparedness is something we should be thinking about all year long.

Unfortunately, natural disasters can disproportionately impact older people and those with disabilities. These populations are frequently less able to withstand periods of time without food, water, medication, and rest—and they may have mobility or communications limitations that impact their ability to respond. Half of the people who died during and after Hurricane Katrina were over the age of 75. People with disabilities who rely on service providers for meals, personal care, and medical assistance often go without critical support systems during a crisis. As we saw during Hurricane Sandy, the loss of electricity to power medical devices, such as ventilators, or assistive technology, can be life-threatening.

That is why it is critical that older adults and people with disabilities plan for emergencies before they happen. Here are three important steps to consider in preparing for a natural disaster:

• Involve your community. When putting together a plan, individuals with disabilities and older adults should talk with their neighbors, family members, caregivers, and community members about emergency preparedness. Planning should be informed by individuals’ needs and preferences and should focus on creating a support team that can assist with evacuation, finding appropriate shelter, and meeting basic needs during a crisis. Planning should also take into account those situations when local services and supports are not available, and an individual needs to relocate out of the community. Consider including out-of-town relatives or friends in disaster preparedness plans.

• Pack an emergency medical kit. People with disabilities and older people with chronic health conditions should pack an emergency kit. It should contain food, water, medication, copies of medical records, instructions for medical devices, and, if necessary, things like extra wheelchair batteries and oxygen tanks.

• Make a plan for pets and service animals. Millions of people have pets and service animals that they love dearly. Owners should create evacuation and emergency response plans that include the needs of their animals. This includes packing an emergency kit for animals with food, water, and medication Pet owners should learn which shelters in their communities accept non-service animals and enlist the support of friends and neighbors to help with pet care if local shelters are not an option.

Every state is unique in terms of the local risks and types of natural disasters that can take place. But no matter where you are, it is important to take time to ensure that older Americans and people with disabilities engage in emergency planning so they are prepared to weather the storms that come.

For more information and links to resources about emergency preparedness for older adults and people with disabilities, please visit ACL’s emergency preparedness webpage.

Today we join communities around the world in observing the International Day of Older Persons. October 1 was designated by the United Nations in 1990 to recognize the vital contributions of older people to the global community and to encourage member nations to thoughtfully address the aging of the population. At the Administration for Community Living, we are working to ensure that this includes the supports and services necessary for older people to live and contribute in their communities.

It is also the first day of Domestic Violence Awareness Month in the United States. Throughout the month, projects and events in communities around the nation will work to raise awareness of this often-unseen crime, support victims and survivors, mourn those who have been lost, and connect those working to end domestic violence.

This makes today an ideal time to talk about domestic violence later in life.

We often do not associate domestic violence with older people. To a degree, this assumption is accurate: data from the CDC (PDF) indicate nearly half of those who are domestic violence victims first experience it between the ages of 18 and 24. But violence does not suddenly stop once a person reaches the age of 60. Older people are the frequent victims of a long list of abusive acts including sexual mistreatment, physical assault, neglect, emotional abuse, exploitation, and financial fraud. A recent UN study (PDF) estimates that 28 percent of women over the age of 60 experience at least one form of violence and abuse. Unfortunately, domestic violence is underreported across all age groups because of the stigma associated with being a victim.

In the U.S., two important pieces of legislation, the Family Violence Prevention and Services Act and the Violence Against Women Act (PDF), protect survivors of all ages through a national network of domestic violence programs and a coordinated community response to abuse. These laws have markedly improved our nation’s response to domestic violence, but can still do more to protect older people.

This is critical, because domestic violence can continue into old age and worsen over time. Further, violence against older people often results in greater injuries. An older person’s ability to escape violence can be hampered by health conditions, functional limitations, poverty and even greater social isolation. Older people may therefore need specialized support in order to access domestic violence services, such as shelters and hotlines.

The theme of this year’s International Day of Older Persons is Leaving No One Behind: Promoting a Society for All. In order to ensure that we do not leave older people behind, we must first expand our conversations about domestic violence to include the experiences of victims in later life. We must provide protection and support for survivors of domestic violence of all ages. And, as I have said before, we must lift up the voices of survivors and let them be our guides. Only by listening to their experiences will we educate ourselves and one another about the realities of domestic violence.

To help start the conversation, I encourage everyone to read and share Domestic Violence: Older Women Can Be Victims Too (PDF), a fact sheet from the National Center on Elder Abuse. Our collective acknowledgement of the impact of violence on older women is the first step to bringing about real change.

A message from Kathy Greenlee to our colleagues in the aging and disability networks

Dear colleagues,

Earlier today, I shared the news with my staff that I will be leaving ACL at the end of July. Edwin Walker, who currently serves as the Deputy Assistant Secretary for Aging, will assume the roles of Acting Administrator of ACL and Acting Assistant Secretary for Aging.

This kind of announcement is really hard. On one hand, it’s no surprise to anyone. It’s an election year, and new administrations mean new administrators. This is how the system works—and it’s good that it does. It’s good to get a fresh perspective and new energy.

But it is still really hard to leave. This has been a wonderful experience and an extremely rewarding seven years. And as I told the ACL team, I am proud of what we have done together. We have brought our communities together in a way that gives us a larger voice and more influence, and ultimately makes us more successful as advocates.

Consolidating aging and disability work in one place raised some eyebrows. These seemed like very different groups of people. And they are. But there are a lot of similarities in the services and supports people need in order to live independently. So it made sense to bring the federal efforts to support community living together under one umbrella.

But it worked because you made the leap of faith with us. You worked with us to build the agency the right way from the beginning, and you’ve continued to work with us as the agency has grown. I want you to know how much I appreciate your advice, support, and even your tough assessments. We’re better because of it.

It has been my great honor and privilege to work with you. I am grateful to Edwin Walker for stepping into these roles. And I am looking forward to seeing ACL continue to build upon the foundation we’ve created together.

Kathy