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    Subject Term: "Elderly persons"

    12 publications with a total of 25 open recommendations
    Director: Seto Bagdoyan
    Phone: (202) 512-6722

    2 open recommendations
    Recommendation: To enhance consumer understanding of agency oversight roles and to strengthen agency oversight of Internet marketing, the Secretary of the Department of Health and Human Services and the Chair of the FTC should develop and provide additional guidance to consumers delineating the agencies' differing roles in their shared oversight of memory supplement and other dietary supplement marketing on the Internet.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To enhance consumer understanding of agency oversight roles and to strengthen agency oversight of Internet marketing, the Secretary of the Department of Health and Human Services and the Chair of the FTC should develop and provide additional guidance to consumers delineating the agencies' differing roles in their shared oversight of memory supplement and other dietary supplement marketing on the Internet.

    Agency: Federal Trade Commission
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Allison Bawden
    Phone: (202) 512-7215

    6 open recommendations
    Recommendation: To preserve the balance between the importance of repaying federal student loan debt and protecting a minimum level of Social Security benefits put in place by the Debt Collection Improvement Act of 1996, Congress should consider modifying Social Security administrative offset provisions, such as by authorizing the Department of the Treasury to annually index the amount of Social Security benefits exempted from administrative offset to reflect changes in the cost of living over time.

    Agency: Congress
    Status: Open

    Comments: As of August 2017, Congress has not yet taken action on this matter.
    Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should inform affected borrowers of the suspension of offset and potential consequences if the borrower does not take action to apply for a TPD discharge. Such information could include notification that interest continues to accrue and that offsets may resume once their disability benefits are converted to retirement benefits.

    Agency: Department of Education
    Status: Open

    Comments: The Department of Education does not currently notify borrowers of the suspension of offset, but plans to implement a process to do so in the future using a new mailing sent to affected borrowers by their default servicer. The current budget situation does not allow for this type of enhancement, and it is not clear when that will change. In the interim, the agency is exploring alternative notification approaches that could be put in place prior to the implementation of an automated solution. We will monitor the agency's progress.
    Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should revise forms sent to borrowers already approved for a TPD discharge to clearly and prominently state that failure to provide annual income verification documentation during the 3-year monitoring period will result in loan reinstatement.

    Agency: Department of Education
    Status: Open

    Comments: The Department of Education stated that the current Office of Management and Budget (OMB) TPD-Post discharge forms contain the recommended language in the first bullet of the Earned Income Section. In order to more clearly provide this information they recommended that the new OMB form, which is in its public comment period, (1) use a larger font size for the form and (2) use "plain language." GAO will consider closing this recommendation when the agency has completed this effort.
    Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should evaluate the feasibility and benefits of implementing an automated income verification process, including determining whether the agency has the necessary legal authority to implement such a process.

    Agency: Department of Education
    Status: Open

    Comments: The Department of Education stated that over the next six months, they are committed to working with SSA to determine the feasibility and benefits of implementing an automated income verification process. The verification will address both the legal authority to implement such a process as well as operational and budgetary feasibility. We will monitor the agency's progress.
    Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should inform borrowers about the financial hardship exemption option and application process on the agency's website, as well as the notice of offset sent to borrowers.

    Agency: Department of Education
    Status: Open

    Comments: The Department of Education agrees with the recommendation and said that they will include this change in upcoming revisions to the agency's web content. The agency reported that the Notice of Offset to borrowers is sent by Treasury and that they will share this recommendation with Treasury and discuss possible changes to the notice. We will consider closing this recommendation when the agency has completed this effort.
    Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should implement an annual review process to ensure that only eligible borrowers are exempted from offset for financial hardship on an ongoing basis.

    Agency: Department of Education
    Status: Open

    Comments: The Department of Education reported that it plans plan to fully automate their process for tracking hardships and other exceptions from offset. However, due to competing priorities and funding limitations, full implementation of these improvements have not been scheduled. As they fully implement this process, they will review complementary strategies to assist borrowers in complying with annual reporting requirements. We will monitor the agency's progress.
    Director: John Dicken
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: The Executive Director of NCD should assign responsibilities for conducting future campaign activities and develop an evaluation plan for its activities.

    Agency: National Council on Disability
    Status: Open

    Comments: As of July 2017, the National Council on Disability (NCD) had developed a plan for conducting campaign activities that had assigned responsibilities. However, as a result of recent changes in leadership and staff, several key activities do not have staff assigned and will need to be updated to ensure responsibility for completing the plan. Additionally, NCD said that they plan to conduct an internal audit in December 2017 to monitor the progress of their activities. While this audit is helpful in identifying progress to date, our recommendation suggests that NCD should also plan to evaluate the effectiveness of its activities.
    Director: Daniel Garcia-Diaz
    Phone: (202) 512-8678

    3 open recommendations
    Recommendation: To better inform Congress and improve what is known about the extent to which elderly residents of Section 202 properties are assisted by service coordinators, the Assistant Secretary for Housing should implement HUD's guidance on processes to improve the accuracy of information on Section 202 properties with budget-based service coordinators, and take steps to evaluate whether the guidance has improved the reliability of this information.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: In November 2016, HUD noted that the Multifamily Housing's Office of Program Systems Management is working to make adaptive changes to iREMS to better support data for the Service Coordinator program. Upon completion of this effort, written instructions will be made available in the iREMS user guide. HUD plans to complete this effort by December 31, 2017.
    Recommendation: To better inform Congress and improve what is known about the extent to which elderly residents of Section 202 properties are assisted by service coordinators, the Assistant Secretary for Housing should develop and implement written guidance that describes how HUD staff should assess Section 202 properties' compliance with the program's supportive services requirement. Such guidance should include information on the roles and responsibilities of HUD staff for (1) identifying stand-alone Section 202 properties and (2) monitoring the supportive services requirement for Section 202 properties with grant- and budget-based service coordinators, Section 202 properties that do not have service coordinators, and stand-alone Section 202 properties.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: In November 2016, HUD noted that it is in the process of working with a consulting firm to develop guidance and training related to Quality Assurance providers (which Section 202 properties have the option of funding to oversee the quality of Service Coordinators). The guidance is intended to standardize the role of Quality Assurance providers. HUD plans to complete this effort by December 2017. HUD also noted that it will create a working group to develop additional guidance that might assist in monitoring the supportive services requirement for Section 202 properties, including stand-alone properties. HUD plans to complete this effort by December 2019.
    Recommendation: To better inform Congress and improve what is known about the extent to which elderly residents of Section 202 properties are assisted by service coordinators, the Assistant Secretary for Housing should develop and implement policies and procedures for (1) verifying the accuracy of a sample of the performance information that Section 202 properties submit through semiannual performance reports and (2) analyzing the performance information collected.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: In November 2016, HUD noted that it is developing a new grant reporting framework, which will be piloted in 2017. According to HUD, the pilot will inform HUD's efforts to improve reporting, verification, and analysis of performance data related to HUD's grant programs. HUD plans to complete this effort by October 2017.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    4 open recommendations
    Recommendation: To ensure that it provides all eligible populations access to its services and that its eligibility requirements are consistent with currently accepted practices, the Library of Congress should re-examine and potentially revise its requirement that medical doctors must certify eligibility for the NLS program for those with a reading disability caused by organic dysfunction.

    Agency: Library of Congress
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has contracted for a study of how eligibility based on reading disability should be certified. This study will look at medical advances in the diagnosis of reading disabilities, the NLS authorizing statute, and the potential impact of a regulatory change on the program. The expected completion date is December 2017. To close this recommendation, the Library of Congress must demonstrate that this study has been completed and that NLS has determined whether a change in its requirements is warranted.
    Recommendation: To ensure funds are directed to the most cost-effective outreach efforts, NLS should evaluate the effectiveness of its outreach efforts, including the extent to which different outreach efforts have resulted in new users.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has begun revising the program application form so that it captures information on how applicants were referred to the program. NLS expects to have all libraries nationwide using this revised application by sometime in 2018. In addition, the Library of Congress indicated that NLS has contracted for a multi-year, multi-media advertising campaign. This effort will assess the effectiveness of different approaches by connecting direct responses to ads with verified program enrollment. The campaign is expected to be fully underway by January 2018. To close this recommendation, the Library of Congress will need to demonstrate that NLS has fully implemented one or more of its planned new approaches for evaluating outreach.
    Recommendation: To help it determine the most cost-effective approach for its next audio player, NLS should comprehensively assess the alternatives of designing its own specialized audio player versus providing commercially available players to its users.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has contracted for a study of the different commercially available audio players for their usability, life-cycle costs, maintenance needs, and durability. The study is expected to be completed by December 2017, and will guide NLS in its decision about how to develop its next generation of audio players. To close this recommendation as implemented, the Library of Congress will have to demonstrate that this study has been conducted and that NLS has considered its findings in making a decision about its next generation audio player.
    Recommendation: To help it determine whether to supplement its collection of human-narrated audio materials with text-to-speech materials, NLS should thoroughly assess the text-to-speech option versus continuing to provide only human-narrated materials.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has developed a library of 100 text-to-speech (synthetic speech) talking books. In September 2017, NLS will begin a 3-month pilot in which a group of NLS users try out these talking books and provide input to NLS. Also, NLS will require that its next generation of audio players have the capacity to play synthetic speech talking books, and the study it has contracted of commercially available players will consider this requirement among other factors. To close this recommendation as implemented, NLS needs to demonstrate that it has completed its text-to-speech pilot and has decided on an approach going forward with regards to expanding this program.
    Director: J. Alfredo Gómez
    Phone: (202) 512-3841

    1 open recommendations
    Recommendation: To enhance HHS's ability to protect public health from the impacts of climate change, the Secretary of HHS should direct CDC to develop a plan describing when it will be able to issue climate change communication guidance to state and local health departments, to better position relevant officials to effectively communicate about the risks that climate change poses to public health and address requirements of the Climate Ready States and Cities Initiative.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of December 2016, CDC has taken steps to start developing a communications strategy, and expects this process to include the development of guidance for public health officials to help them more effectively communicate about the health effects of climate change. CDC expects the strategy to be completed by the fall of 2017.
    Director: Kay Brown
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: The Secretary of the Department of Health and Human Services should facilitate development of a cross-agency federal strategy to help ensure that federal resources from Administration for Community Living, CMS, USDA, HUD, and DOT are effectively and efficiently used to support a comprehensive system of HCBS and related supports for older adults. Through such a strategy the agencies could, for example, define common outcomes for affordable housing with supportive services, non-medical transportation, and nutrition assistance at the federal level; develop lessons learned for the local networks that area agencies on aging and community-based organizations are forming; and develop strategies for leveraging limited resources.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation, noting that it continually strives to improve its strategic coordination and described ways that it facilitates cross agency strategic efforts, including a community-living initiative with HUD and an interagency workgroup on Olmstead requirements. HHS also described collaboration by HHS and HUD on policy research projects concerning housing and supportive services for older adults, including a comparison of health service utilization by older adults who live in assisted housing with those who do not and an evaluation of a demonstration in Vermont that provides services and supports to residents of HUD-assisted housing. We continue to encourage HHS to engage all five agencies to develop a cross agency federal strategy for administering home and community-based services for older adults. Using the eight practices to enhance and sustain interagency collaboration that we identified in prior work could help the five agencies address some of the challenges. In May 2016, HHS reported that it believes it addressed the recommendation and plans no additional action.
    Director: Iritani, Katherine M
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: The Secretary of HHS should expand its outreach and educational efforts aimed at reducing antipsychotic drug use among older adults with dementia to include those residing outside of nursing homes by updating the National Alzheimer's Plan.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In May of 2015, the Department of Health and Human Services (HHS) noted that the agency believes GAO's recommendation is worth pursuing, but that due to the timing of the 2015 update to the National Plan to Address Alzheimer's Disease, inclusion in 2015 was not possible. HHS further stated that the GAO recommendation was being considered for inclusion in the 2016 update to the Plan as a part of an expansion of the Centers for Medicare & Medicaid Services' National Partnership to Improve Dementia Care program. However, HHS did not address the recommendation in the August 2016 update. As of September 2017, HHS had not updated its National Plan to Address Alzheimer's Disease in a manner that addresses our recommendation. Until HHS specifically targets its outreach and education efforts relating to antipsychotic drug use to settings other than nursing homes, older adults living outside of nursing homes, their caregivers, and their clinicians in these settings may not have access to the same resources about alternative approaches to care.
    Director: Andrew Sherrill
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: Depending on the outcome of the litigation, the Secretary of Labor should take steps to ensure the agency will be positioned to conduct a meaningful retrospective review consistent with the Executive Order at an appropriate time. These steps should be taken in consultation with the Centers for Medicare & Medicaid Services, and could include, for example, identifying metrics that could be used to evaluate the rule, and implementing a plan to gather and analyze the necessary data.

    Agency: Department of Labor
    Status: Open

    Comments: The Department of Labor's Wage and Hour Division (WHD) agreed with this recommendation and reported that it is working to develop data collection plans and explore a potential evaluation that is focused on the Home Care Rule. As part of this effort, WHD noted that it will continue to work with HHS and other federal partners. In FY16, WHD reported that such an evaluation of how stakeholders and affected industries have responded to the rule would be beneficial. However, litigation has delayed implementation and enforcement of the rule significantly, and WHD believes an evaluation at this stage would be premature and would be unlikely to fully and accurately capture stakeholders' responses to the rule and the resulting impacts. Delaying the evaluation would allow WHD to monitor the results of its own investigations and the effects of ongoing compliance assistance, both of which would be extremely difficult to measure at this early stage. WHD will continue to monitor early implementation to determine the appropriate start for any evaluation.
    Director: David J. Wise
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To promote and enhance federal, state, and local coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and define and report on desired outcomes and collect related data to track and measure progress in achieving results, including the extent of coordination efforts that are under way, such as improved services for older adults. This effort could be conducted as a part of the Coordinating Council's process to update its strategic plan, which we have also recommended in a concurrent report.

    Agency: Department of Transportation
    Status: Open

    Comments: The Federal Transit Administration (FTA) has taken steps to enhance older adult mobility. For example, the agency and the Coordinating Council on Access and Mobility (CCAM) developed a draft strategic plan, which is being reevaluated in light of requirements in the Fixing America's Surface Transportation Act of 2015. FTA officials will provide GAO with an update on the status of those efforts after the July 2016 CCAM meeting.
    Director: Dave Wise
    Phone: (202) 512-2834

    3 open recommendations
    Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and complete and publish a new or updated strategic plan that, among other things, clearly outlines a strategy for addressing NEMT and how it can be coordinated across federal agencies that fund NEMT service.

    Agency: Department of Transportation
    Status: Open

    Comments: The Federal Transit Administration (FTA) concurred with this recommendation. As of November 2016, FTA stated that Administrator-level members of the Coordinating Council on Access and Mobility (CCAM) met in July 2016 to begin the process of developing a strategic plan. A follow-up meeting of the same group is planned for December 2016. According to FTA, it is anticipated this meeting will result in agreement on a strategic plan framework and that interagency working groups will begin implementation of the framework in early 2017. Based on the minutes of the July 2016 CCAM meeting, emerging themes identified for the strategic plan included improved access to medical care and to better coordinate transportation planning, particularly integrating transportation planning into healthcare planning. This recommendation will be kept open pending finalization of the strategic plan framework and how it relates to NEMT.
    Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and finalize and issue a cost-sharing policy and clearly identify how it can be applied to programs under the purview of member agencies of the Coordinating Council that provide funding for NEMT.

    Agency: Department of Transportation
    Status: Open

    Comments: FTA concurred with this recommendation. As of November 2016, FTA stated that Administrator-level members of the Coordinating Council on Access and Mobility met in July 2016 to begin the process of developing a strategic plan. A follow-up meeting of the same group is planned for December 2016. According to FTA, it is anticipated the December meeting will result in agreement on a strategic plan framework and that interagency working groups will begin implementing the plan in early 2017. FTA expects development of a cost-sharing policy and proposed model will be an objective in the strategic plan. We plan to keep this recommendation open pending completion of the strategic plan framework and further information related to implementing this recommendation.
    Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and using the on-going work of the Health, Wellness, and Transportation working group and other appropriate resources, (1) identify the challenges associated with coordinating Medicaid and VA NEMT programs with other federal programs that fund NEMT, (2) develop recommendations for how these challenges can be addressed while still maintaining program integrity and fraud prevention, and (3) report these recommendations to appropriate committees of Congress. To the extent feasible, the Coordinating Council should implement those recommendations that are within its legal authority.

    Agency: Department of Transportation
    Status: Open

    Comments: FTA said they concurred in part with this recommendation. FTA announced the selection of 19 Rides to Wellness Demonstration and Innovative Coordinated Access and Mobility pilot projects, totally about $7.3 million, in September 2016. According to FTA, seven of the 19 projects have a NEMT focus. In addition, during 2016 FTA conducted outreach sessions in various cities throughout the United States to discuss partnership opportunities between the health and transportation industries. FTA stated that a new series of NEMT-specific listening sessions is now underway and additional sessions are planned for 2017. The purpose of these sessions is to identify challenges related to NEMT coordination that will be addressed by Coordinating Council on Access and Mobility (CCAM) working groups in the future. CCAM is also in the process of developing a strategic plan framework. FTA anticipates agreement on this framework in December 2016. The Fixing America's Surface Transportation (FAST) Act requires CCAM to develop and publish a strategic plan. FTA anticipates issues related to this recommendation will be developed through 2020. We plan to keep this recommendation open to further monitor CCAM and FTA progress and the extent challenges are identified and addressed related to better coordinating Medicaid and VA NEMT with other NEMT programs in the federal government, through the strategic plan framework or other actions resulting from the listening sessions.
    Director: Brown, Kay E
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To provide the basis for greater consistency across states in assessing elder justice service delivery, the Secretary of HHS, as chairman of the Elder Justice Coordinating Council, should direct the Council to make it a priority to identify common objectives for the federal elder justice effort and define common outcomes.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation and noted the formation of the Elder Justice Coordinating Council (EJCC) as an effort to develop common objectives and plans for action to address elder justice issues. As of June 2014, the EJCC had developed eight recommendations for increased federal leadership in combating elder abuse based on input from elder justice experts in financial exploitation, public policy and awareness, enhancing response, and advancing research. Staff compiled information on best and promising practices for primary, secondary, and tertiary prevention; empirical evidence from peer-reviewed research; approaches used in related disciplines; and information about where gaps exist in the collective knowledge about elder abuse, neglect and exploitation. Staff then turned the suggestions into proposals with accompanying steps for federal action. Those proposals were subsequently presented at two public EJCC meetings (May and September 2013) and were made available for public review and comment. The Secretary of HHS formally accepted the recommendations in May 2014, and they were posted to the EJCC page of the Administration on Aging's website. In May 2015, HHS reported that the EJCC had published these recommendations in a document entitled "Eight (8)Recommendations for Increased Federal Involvement in Addressing Elder Abuse, Neglect, and Exploitation" and stated that the recommendations addressed the issues identified in GAO's recommendation. While we recognized that these 8 recommendations corresponded to the common objectives included in our recommendation, we also sought from HHS information on the status of common outcomes for the objectives. HHS reported that outcomes for the eight common objectives that the EJCC has approved were being discussed, but have not yet been approved. In March 2016,HHS reported that the EJCC's Elder Justice Working Group continued to gather and discuss action steps and outcomes for the eight recommendations. We will monitor the EJCC's progress in agreeing upon outcomes and close the recommendation when agreement on outcomes is reported.