Office of the Vermont Attorney General

Listening Tour – Themes and Findings

In April and May of 2018, representatives from the Vermont Attorney General’s Office (AGO) visited each of Vermont’s fourteen counties to meet with older Vermonters and organizations that provide services to them to explore two questions:

  • What are older Vermonter’s greatest concerns, needs and vulnerabilities?
  • How can Vermont’s systems for elder support and protection be improved?

During the course of the listening tour, the AGO’s staff visited with dozens of older Vermonters at senior centers, senior meal sites and senior housing units, and approximately 230 representatives of 65 different organizations, including Area Agencies on Aging, Support and Services at Home, Meals on Wheels, home health agencies, hospitals, Veterans Affairs, the Vermont Chapter of the Alzheimer’s Association, the University of Vermont Center on Aging, AARP-VT, COVE and Vermont Legal Aid.

Throughout these meetings, Vermonters repeatedly expressed questions or concerns about the following issues. The AGO’s Elder Protection Initiative will consider these themes as it undertakes its work. To be clear, the AGO has not independently verified these questions or concerns. The purpose of this summary is simply to report concerns of Vermonters. The following were some of the most commonly-expressed concerns among those we spoke with.

Isolation & lack of transportation
  • Many older Vermonters live alone or with one other in rural areas with limited or no access to transportation;
  • Lack of transportation impedes ability to access food, healthcare and community engagement;
  • Isolation heightens concerns of safety (in-home accidents; criminal activity);
  • Isolation can be underlying condition of vulnerability to financial exploitation (by scammers or those whom the elder becomes dependent upon, including family members and other caregivers);
  • For these reasons, and others, isolation heightens the challenge of aging in place;
  • Isolation can be difficult to transcend where a home is difficult to sell, where fear exists that a sale would create income that would disqualify an individual from needed benefits, and/or where there are multi-year waitlists for senior housing (independent living units).
Healthcare related concerns

Challenges to accessing needed healthcare

  • Affordability of in-home and long-term care, generally;
  • Shortage of home healthcare providers & limitations on in-home services (including homemaking services) covered by Medicaid Choices for Care;
  • Lack of availability of Medicaid Moderate Needs services;
  • Lack of long-term care beds available to individuals with dementia & mental illness;
  • Hospital social workers face difficulty identifying long-term care facilities able and/or willing to accept Medicaid patients and/or patients with dementia and mental illness;
  • More training needed in long-term care settings for dementia, mental illness and substance abuse;
  • Complexity of processes in identifying and obtaining proper health care insurance;
  • Lack of insurance coverage for dentures, hearing aids and glasses;
  • Lack of ability to afford dentures/teeth impedes eating/health, socialization and dignity;
  • Affordability of prescription drugs;
  • Elder care clinicians who make home visits needed.

Dementia & Alzheimer’s

  • Who helps individuals with dementia and their families understand and navigate next steps?
  •  Where family and/or friends aren’t able or willing, how does a person with dementia find assistance managing day-to-day financial affairs?
  • Concerns expressed that availability of services to protect vulnerable adults, such as Office of the Public Guardian, have limited access to resources.

Self-neglect

  • Agencies and service providers challenged with how to address self-neglect;
  • Where is the line between permissible & impermissible self-neglect, under the law?
Safety
  • Individuals expressed not feeling safe in their homes
  • Relating to concerns about falls and accidents, particularly where they live alone;
  • Due to activity related to the opioid epidemic, including drug-related burglaries and arrests in their communities.
Housing
  • Lack of affordable/subsidized senior housing;
  • Multi-year waitlists for (independent living) senior housing, which complicates planning for transition to senior housing;
  • Many older Vermonters living on fixed incomes can’t afford to repair their homes, but fear they can’t sell their homes if the sale income would disqualify them from needed benefits;
  • Elders with felony convictions are disqualified from HUD housing & therefore have difficulty accessing affordable housing;
  • Homelessness & lack of homeless shelters.
Food & nutrition insecurity
  • Many experiencing food insecurity & making trade-offs between paying for food, medicine/healthcare, and/or other expenses;
  • Many rely on Meals on Wheels food delivery for sustenance;
  • Meals on Wheels drivers report that they are sometimes one of a home-bound elder’s only touches with community.
Heat
  • Affordability of fuel/heat.
Physical Abuse & Financial Exploitation
    • Concern for circumstances where one family member (child) financially exploits another (parent) but the parent appears to consent to avoid conflict/maintain needed daily support/stay in home/avoid having to go to long-term care;
    • Scam attempts (by phone, mail and internet) are rampant, and many know someone who has lost money to a scam;
    • Dementia enhances vulnerability to financial exploitation;
    • Adult Protective Services
      • Concerns expressed that investigative services to protect vulnerable adults, such as Adult Protective Services, have limited access to resources;
      • Clarity would be useful on what is reportable to APS / actionable by APS;
    • Restorative Justice model as useful in addressing financial exploitation within families and communities.
Information and Resources
  •  Both older Vermonters and service providers expressed that they did not know where to go with questions regarding what programs or services are available in their towns or regions (e.g., transportation, food, housing, volunteers), and suggested that a resource be created that provides this information;
  • Challenge of getting information to older Vermonters who do not have computer access and/or are not online.
Senior centers
  • The potential for senior centers / community centers to play more significant roles in their communities;
  • Some senior centers are municipally funded; some are not. Concern that senior centers are under-resourced by the state & municipalities;
  • Perceived stigma around visiting/participating in “senior” centers. Would “senior centers” be more highly valued/resourced if they were positioned as “community centers”?
Volunteers
  • Need for community volunteers to support older Vermonters;
  • Currently, many volunteers are older and soon to be retiring from volunteerism;
  • Concern by would-be transportation volunteers regarding potential liability associated with transporting older Vermonters.