It is proven that the average American is living longer. Life expectancy in 1900 was 47 years; today it has risen to 77 years. According to Louisiana Senator John Breaux's website, the average person spends 19 years in retirement. Although we know this, many people do not make plans for growing older. You may find a nursing center is your only option, either by your will or the will of your family. Are you aware of the current conditions of nursing centers? The conditions of Missouri's nursing centers can be reviewed at www.dhss.mo.gov/showmelongtermcare. Do you know who is fighting for quality senior care in Missouri? The Division of Senior Services and Regulation, a division of the Department of Health and Senior Services (DHSS), is responsible for inspecting and issuing state licenses to each care facility in Missouri. The Division estimates they inspect and license over 1,230 long-term care facilities. If deficiencies (violations) are found, the nursing center is required to submit a plan of correction to the DHSS, which states how they intend to fix the deficiencies and the date they will be corrected. Deficiencies include building code issues such as not having the required amount of fire exits and lack of a fire alarm system, as well as other deficiencies directly affecting seniors such as lack of nourishment, lack of simple sanitary measures, and lack of assistance with eating and drinking for those that can not help themselves. The Lt. Governor's Office is designated as the state's official elderly advocate. The office is committed to making necessary reforms to nursing homes in our state to ensure that seniors receive quality care. Kyle Clower, Elderly Advocate in the Office of Advocacy and Assistance for the Elderly stated, "The passage of Senate Bill 556 during the 2003 legislative session dramatically changed how nursing homes with repeat or severe violations are addressed by increasing penalties and making fines mandatory for certain violations." One provision stated the DHSS shall provide through their internet website (http://www.dhss.mo.gov/SeniorServices/index.html) the most recent survey of every home health agency and any deficiencies. Words alone can not protect an abused senior that can not speak for themselves. Civil fines for nursing center violations range from $50 for a Class III violation (having an indirect or a potential impact on the health, safety or welfare of any resident) to $10,000 for a Class I violation (presents either an imminent danger to the health, safety or welfare of any resident or a substantial probability that death or serious physical harm would result). Monetary penalties are distributed as follows: 25% to the Elderly Home-Delivered Meals Trust Fund, 25% to the Nursing Facility Quality of Care Fund to be used for the sole purpose of supporting quality care improvement projects with the Office of State Ombudsman for Long-Term Care Facility Residents, and 50% to the Nursing Facility Quality of Care Fund to assist qualified nursing facilities to improve the quality of service to the residents, as stated in the Bill Summary for Senate Bill 556. The Missouri Coalition for Quality Care (MCQC) is a non-profit statewide organization concerned with the care and protection of older and disabled persons receiving long term care in Missouri (www.mcqc.com). Their goal is to improve the quality of care and quality of life of the residents in long term care facilities and recipients of in-home care. Ann Hartmann, the 82 year old president of the Coalition stated, "We need more young people involved. Years pass like lunch time and before you know it you're my age. The condition of our nursing centers is not something people want to think about. They feel it's something they want to avoid. The majority of nursing centers are only concerned about money and stuffing their own pockets. They're not concerned with the care of the residents. They pay their workers less than Wal-Mart does and these people are working with human beings." The MCQC is not only concerned with the well being of seniors and the condition of nursing centers, but they want to also increase physician presence and active participation in nursing centers and in-home care. The coalition is working on changing Missouri's laws and regulations to offer older and disabled persons more information, flexibility and choice about the types of long-term care services they're able to receive to meet their needs. Mrs. Hartmann stated, "More needs to be done, more government officials need to be aware and need to do something about this. Right now we need more people involved to give a voice to those that do not have one." Elder abuse as a crime was not established until 1992. The Department of Health and Senior Services was not established until 2001. The yearly inspections performed by DHSS are typically at the same time each year. On paper seniors have the right to make complaints, the right to confidentiality, the right to a comfortable lifestyle, and the right to not be abused mentally or physically. From 1980 to 2003 there were almost one million abuse/neglect/exploitation calls made to the Central Registry Unit (CRU), the statewide central abuse hotline. Missouri Ombudsman program consists of volunteers serving residents of nursing homes and residential care facilities to provide support and assistance with any problems or complaints. Individual volunteers are recruited by Area Agencies on Aging (AAAs) or their service providers. The program seeks to diminish the sense of isolation experienced by residents, especially those without family. The Ombudsman volunteers strive to reinforce the importance of resident's rights. Even though facilities are required to have a grievance procedure, residents may be hesitant to voice concerns or complaints to a facility staff person for any number of reasons, i.e., fear of retaliation, etc. The Ombudsman volunteer is there to listen and follow through with a resident's complaint, but not without the resident's request and approval to follow through. Although, the Ombudsman volunteers are only assigned to a facility that has agreed to participate in the program, which still does not help all seniors in desperate need of a voice. The Silver Haired Legislature (SHL) was formed in 1973. The (www.dhss.state.mo.us/Senior_Services) is a formally elected body of citizens 60 years of age or older that promote conscientious legislature advocacy for Missouri's older adults, the oldest such organization in the nation. Senior citizens elect the volunteers from each of the ten AAAs during the month of May each year. The volunteers meet to elect officers and begin to ascertain the needs for seniors in their districts. Bills are drawn up and prepared for presentation at the statewide conference in the fall. They select five bills having the highest priority and submit them to the Missouri General Assembly for the upcoming year. Charles Jensen, Speaker of SHL from Rolla, Missouri stated, "The five bills presented this year; providing adequate funding for all meals provided by AAAs, close drug benefit gaps, raise asset level for Medicaid from $999.99 to $2,500 per person, transportation services that would have a provision to pay volunteer drivers, and predator lending and pay day loans to restrict certain fees assessed." Mr. Jensen of the SHL stated, "There was an organization set up by the Lt. Governor dealing with nursing homes. However it isn't very active now." When asked to describe the group Mr. Jensen responded, "A couple of years ago the Lt. Governor called together a large group to assist on nursing homes. It was about the time they put on the internet where you could check on any nursing home in the United States and find out how they fared when they were inspected and make a comparison. I no longer have any information on it."As you can see there are various groups concerned with the care of Missouri seniors and bills protecting their rights. Is it enough? Is it ever too early to start thinking about your long term care or who will be in control of it? Even with the government officials lobbying for senior rights, what can we do to actually protect those being abused or neglected on a daily basis? Get involved and be a voice.