Reaching Beyond Conventional Roles: Strengthening The Voice of Older Adults Through Activism and Advocacy Margaret P. Norris, Ph.D. Geropsychologist, Retired, Independent Practice Consultant

 Laws and public policies define regulations and budgets  These determine access, delivery, and financing of services  Only we can inform policymakers of patient needs See Hinrichsen (2010) Why must we be advocates of our professions? 4/22/16Margaret P. Norris, Ph.D.

 Primarily, poor awareness of public policy issues  Less Important:  Disinterest in participating  Lack of time  Doubt in ability or effectiveness See Heinowitz et al, 2012 Barriers to Advocacy Work 4/22/16Margaret P. Norris, Ph.D.

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 Research dollars  Access to clinical services  Graduate training  Expanding workforce  Social and health programs  Healthcare systems and public health Most Common Issues in Advocacy 4/22/16Margaret P. Norris, Ph.D.

 Elimination of cap on mental health services  Medicare Improvements for Patients and Providers Act of 2008 (MIPPA): eliminated the discriminatory 50% coinsurance for outpatient mental health treatment Triumphs in Advocacy Efforts 4/22/16Margaret P. Norris, Ph.D.

 CMS mandate that contractors cannot deny claims solely on the basis of a dementia diagnosis  Development of Health & Behavior services More Triumphs 4/22/16Margaret P. Norris, Ph.D.

 AMA’s RUC sets the “work value” factor of all fees  Closed to public  Favors high tech services  Price fixing See Haley Sweetland Edwards, 2013, July/August Failure in Advocacy Efforts 4/22/16Margaret P. Norris, Ph.D.

“When a roomful of professionals from the same trade meet behind closed doors to agree on how much their services should be worth… it’s called price-fixing. And in any other industry, it’s illegal”. Haley Sweetland Edwards, /22/16Margaret P. Norris, Ph.D.

 Local level  Professional organizations  Federal level  Legislators See Digilio & Elmore (2015) How can we be advocates for the older adults we serve? 4/22/16Margaret P. Norris, Ph.D.

 Involvement in organizations that serve older adults, e.g. Alzheimer’s Asso, Area Agency on Aging, senior community services  Networking with agencies and colleagues Local Advocacy 4/22/16Margaret P. Norris, Ph.D.

 APAPO Stand for Science  APA Federal Action Network  APA Committee on Aging  APA Society of Clinical Geropsychology  See handout for other professional organizations’ advocacy work Psychology’s Professional Organizations 4/22/16Margaret P. Norris, Ph.D.

 National Coalition of Mental Health and Aging  Gerontological Society of America  Elder Workforce Alliance  National Alliance for Caregiving  Medicare Rights Center More Professional Organizations 4/22/16Margaret P. Norris, Ph.D.

 submit comments on proposed government agency plans, e.g. CMS  White House Conference on Aging  Congressional briefings, (e.g. “Can We Prevent Dementia? Cutting Edge Research and Interventions.”)  Lobby with Congress on pending bills and amendments to laws (e.g. GPE, Older Americans Act) Federal Level Advocacy 4/22/16Margaret P. Norris, Ph.D.

 Letters, s, calls, town hall meetings, campaign contributions  Meeting in home and national offices  Testifying as the experts in science, best practices in clinical services, population needs  Providing data, personal stories, dispel common myths Lobbying with Legislators 4/22/16Margaret P. Norris, Ph.D.

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1)Member of Congress drafts bill; advised by interest groups, private and public agencies 2)Members sponsor bill; bill given # 3)Bill assigned to Committee / Subcommittee 4/22/16Margaret P. Norris, Ph.D.

4)Most bills die in Committee 5)If not, Chair schedules a “markup” for formal review and amendments 6)Committee votes on bill 7)Bill goes to House or Senate; majority leader may bring bill to floor Many more steps…. And then… 4/22/16Margaret P. Norris, Ph.D.

8)Bill is debated; important time for grassroots advocacy 9)Once passed, it goes to other chamber; go back to step 1 10) Similar bill may be passed 11) Different bill versions are sent to “Conference Committee” And then… 4/22/16Margaret P. Norris, Ph.D.

12) Compromise bill goes to both chambers for final vote 13) If both pass it, bill goes to President for either signature or veto 14) Congress can override veto by 2/3 majority in both chambers And then… 4/22/16Margaret P. Norris, Ph.D.

 In , ~15% of 8,900 bills passed committee and were sent to the floor.  Of these 1,333 bills, 21% became law What’s the odds? 4/22/16Margaret P. Norris, Ph.D.

 Sponsor and co-sponsor are committee chairs  Got past committee in a previous Congress  Referred to Senate and House Appropriations and other important committees  Sponsor is in majority party and 1/3 cosponsors are in minority party Important Factors 4/22/16Margaret P. Norris, Ph.D.

Senator Richard Shelby (Rep, 1987 ) 1)Chair of Comm. on Banking, Housing and Urban Affairs, 2) Comm. on Rules and Administration 3)Comm. on Appropriations and several Appropriations Subcommittees U.S. Legislators for Alabama 4/22/16Margaret P. Norris, Ph.D.

Senator Jeff Sessions (Rep,1997) 1)Comm. On Armed Services, 2)Comm. on the Judiciary, 3)Comm on the Budget, 4)Comm. On Environment and Public Works U.S. Legislators for Alabama 4/22/16Margaret P. Norris, Ph.D.

1) Comm. On Financial Services, Permanent Select Comm on Intelligence 2) Primarily sponsors bills on Civil Rights and Liberties, and Minority Issues 3) first women elected to Congress from Alabama in her own right and first African American woman to ever serve in the Alabama Congressional delegation Representative Terri Sewell (Dem, 2011, 7 th district) 4/22/16Margaret P. Norris, Ph.D.

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 Authorizes federal assistance to state Adult Protective Services  Funds training in prevention and services  Establishes a national APS Resource Center Elder Protection and Abuse Protection Act S /22/16Margaret P. Norris, Ph.D.

 Encourages nutrition providers to distribute information on diabetes, elder abuse, neglect, financial exploitation, and Medicare wellness exam  Improve APS response to abuse, neglect, exploitation in home care and LTC residents and establishes data collection More on S /22/16Margaret P. Norris, Ph.D.

 Mental Health Reform Act of 2016  Reducing Disparities Using Care Models and Education Act of 2015 (ReDUCE Act  RAISE Family Caregivers Act  Lifespan Respite Reauthorization Act Other Current Bills 4/22/16Margaret P. Norris, Ph.D.

 House Committees: Children and Senior Advocacy; Health  Senate Committees: Health and Human Services, Veterans and Military Affairs  Where is higher ed??  Bill to protect vulnerable adults against financial exploitation, passed 04/12/16 Alabama State Legislature 4/22/16Margaret P. Norris, Ph.D.

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