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Statement Of Nick Monreal, Jr.

Environmental Protection Agency
Aging Initiative Public Listening Session
San Antonio, Texas
April 8, 2003

Nick Monreal, Jr.
Bexar County Area Agency on Aging Ombudsman


The Elderly and The EPA:
"A Right to Breathe Better and Longer"

A presentation prepared for The Environmental Protection Agency's
2003 National Listening Conference - San Antonio, Texas
Introduced by:

Nick Monreal, Jr.
Managing Local Ombudsman
Long Term Care Services
Bexar Area Agency on Aging
Alamo Area Council of Governments

Protecting our Nation's Most Fragile Resources, the Icons of our mere existence,
"Our Senior Citizens&quot

Nick Monreal, Jr., Bexar Area Agency on Aging Ombudsman, 'The Elderly and the EPA: A Right to Breathe Better and Longer,' San Antonio, TX, April 8    

Proposal Justification: EPA National Strategic Plan


Goal 4 Preventing Pollution and Reducing Risks in Communities, Homes, Workplaces and Ecosystems -

Objectives 01: Reduce Public Ecosystem Exposure to Pesticides;
Objective 02: Reduce Lead Poisoning
Objective 04: Healthier Indoor Air
Objective 05-01: Pollution Prevention

Goal 7 Expansion of Americans' Right to Know About their Environment -

Objective 07-01: Increase Quality/Quantity of Education/Outreach, Data Availability
Objective 07-01-01: Improve Environmental Education for K-12 (adaptable to elderly)
Objective 07-01-07: Increase Environmental Information


Project Correlation to EPA 2002 Priorities:

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Proposed Research-based Demonstration Project: ABSTRACT

Environmental Problems Identified:

Older Americans spend up to 100% of their time indoors where pollutant levels often exceed outdoor levels of Particulate Matter (EPA studies of human exposure to air pollutants indicate that indoor levels of pollutants may be 2-5 times, and occasionally more than 100 times, higher than outdoor levels). Environmental risk indoors includes exposure to air toxics, hazardous chemicals, water contaminants, temperature extremes, carbon monoxide, molds, second hand smoke and pesticides. NEEDED is a project which will evaluate the cumulative environmental threats from all media indoors and offer a plan to prevent potential future exposures and to reduce existing exposure where necessary.
"Currently, there are no programs that develop environmental quality of care, specifically addressing the quality of life and quality of care for the elderly".

At-risk Elder Population:

The Elderly residing in Long Term Care Facilities, have been historically subjected to poor conditions, regarding Indoor Air Quality.

Preliminary research, conducted by the Bexar Area Agency on Aging / Ombudsman Program, indicates that the main factor contributing to these poor air quality conditions, is the fact that most of the Nursing Homes in Bexar County (and this case can be made for most Nursing Homes around the state and U.S.), were built in the late 60's and 70's, and as recently stated during an interview with a Life Safety Code expert, these facilities are just plain "Tired Buildings", whose HVAC systems and building structures are aging, and are in dire need on renovations. The Nursing Facility Requirements for Licensure and Medicaid Certification, as set forth by the Texas Department of Human Services, outlines the "Minimum Standards" on:

Since these Minimum Standards apply primarily to the facility construction, and "while no federal mandate exists on this issue", the standards fall short of meeting 21st Century "Critical Indoor Air Quality Measures" especially as they relate to the aging, frail and ill (in comparison to those IAQ initiatives that are being "voluntarily addressed" by school districts, in partnership with the Association of School Administrators, the EPA and the Department of Energy); These standards, then actually become the "Maximum Standards", as they apply to the elderly in Texas and the United States.

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Proposed Demonstration Project: NARRATIVE

The proposed project will develop the resources to evaluate the various environmental exposures faced by the elderly in Long Term Care Facilities. The Project Design Team will examine existing EPA / IAQ programs which are presently addressing similar issues in U.S. Schools. This program research will include, but not be limited to projects such as the "National Indoor Air Quality Tools For Schools" program and the Region 6 "Healthy Environments and Living Places for Kids", which with some modifications, may be adapted to incorporate issues specific to the Elder Care Environment, an environment that is subjected to Pollutants that come from:

OUTDOOR SOURCES - Polluted Outdoor Air (pollen, dust, fungal spores, industrial emissions and vehicle emissions); Nearby Sources (loading docks, dumpsters, unsanitary debris or building exhausts near air intakes); Underground Sources (radon, pesticides, leakage from underground storage tanks).

BUILDING EQUIPMENT - HVAC Equipment (microbiological growth in drip pans, ductwork, coils, and humidifiers); Improper Venting (of combustion products and dust or debris in ductwork); Non - HVAC Equipment (emissions from office equipment / volatile organic compounds, ozone, emissions from shops, labs, cleaning process).

COMPONENTS / FURNISHINGS - Components (microbiological growth on or in soiled or water -damaged materials or furnishings); Dry Traps (that allow the passage of sewer gas); Materials (containing volatile organic compounds, or damaged asbestos, and materials that produce dust particles, emissions from new furnishings or flooring).

OTHER INDOOR SOURCES - (laboratories, arts and crafts areas, copy/print areas, food preparation areas, smoking lounges, cleaning materials, emissions from trash, pesticides, odors and volatile organic compounds from paints or adhesives, occupants with communicable diseases, office materials such as dry-erase markers and similar pens or markers, insects and other pests, and personal care products).

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Proposed Demonstration Project: PLAN OF ACTION

The proposed demonstration project will set, as its "Benchmarks" to address, through research-based planning and program design, the EPA Aging Initiative's three-pronged priorities for the National Agenda on the Environment and the Aging (Which evolved from "The Differential Susceptibility of Older Persons to Environmental Hazards" workshop, as convened in 2002 by the National Academies of Sciences).

  1. To prioritize and study environmental health threats to older persons;

  2. To examine the affect that a rapidly growing aging population might have on our environment;

  3. To encourage older persons to volunteer in their own communities to reduce hazards and protect the environment.

The Project will be implemented through the Bexar Area Agency on Aging / Ombudsman Program, of the Alamo Area Council of Governments in San Antonio, Texas.

Established in 1967, the Alamo Area Council of Governments (AACOG) is a voluntary association of local governments and organizations that serves its members through planning, information and coordination activities. The agency is also designated as the regional clearinghouse that reviews and comments upon grant applications submitted to state and federal funding by organizations throughout its 12 county region. AACOG programs address critical issues, such as air quality, community revitalization, criminal justice, housing, human services, transportation, and workforce development.

Ombudsmen are Advocates for Elders' Rights:

During Lyndon B. Johnson's presidency, the Older Americans Act of 1965 became law and in 1978 Congress amended this Act to establish the Ombudsman Program.

The AACOG / Bexar Area Agency on Aging Ombudsman Program is composed primarily of Volunteers. The program is administered by the Managing Local Ombudsman, which supervises the Certified Volunteer Ombudsmen, Staff Ombudsman and Assisted Living Special Projects Ombudsman. The program staff is responsible for recruiting and training the volunteers, and educating others on the rights of residents. A specialized training program, Certified by the Texas Department on Aging, educates the volunteers on how to do their job.

Ombudsmen are extraordinary volunteers, that come from all walks of life, and bring with them a vast array of "life's work experience". Many are retired and/or active nurses, former nursing home administrators, teachers, military personnel, religious and civic leaders, homemakers, business executives. The common thread that brings these dedicated volunteers together is the desire to want to make a difference in the level of quality of care and quality of life for our community's elderly.

Ombudsmen visit the elderly in Nursing Homes and Assisted Living Facilities, and frequently are the only visitors or source of contact with the outside world for a resident. Volunteer Ombudsmen develop trusting relationships, advocate for quality of life and quality of care of the residents, and assist in the development of resident and family councils.

The BAAA Ombudsman Program will expand on its successful community networking with the Elders' Advocacy Network:

In addition to the Elders' Advocacy Network, the Project will solicit input from / but not limited to and including professional stakeholders in the field of aging and health, mental health associations, long term care regulatory and adult protective services agencies, as well as academics and others.

The Project will collaborate with a special Aging Initiatives Committee from the Texas Health Care Association (composed of nursing home administrators and health science professionals), which combined with the Elders' Advocacy Network and other Stakeholder organizations, will participate in a series of Focus Group meetings, to design the necessary strategies and implementation instruments necessary to:

Nursing Homes, in particular, have special characteristics generally not shared by other public facilities and office buildings. Many of these facilities, including the brand new ones, were not designed with good interior air quality in mind. Shrinking construction budgets, and rising costs of staffing and operations, anticipated cuts in Medicaid Funding, work to the detriment of Indoor Air Quality, as owners and operators of these facilities trim expenditures by deferring critical maintenance and repairs. In addition facility personnel may simply be unaware of the effect that certain housekeeping and maintenance procedures have on Indoor Air Quality.

Once the Project Methodology has been created to assess these environments, the Bexar Area Agency on Aging Ombudsman Program will establish a "Model Program" within its jurisdiction. The Model will provide, technical assistance, systems, and tools on:

PROGRAM FUNDING AND RESOURCE DEVELOPMENT are paramount to successful transportability and replication efforts. Therefore, Model Program innovators will focus on resources from various local, state, federal, and private sector agencies, in developing a strategy for Environmental Health Protection for the Elderly.

This strategy will certainly include collaborative opportunity resources such as:

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Proposed Demonstration Project: SUMMARY

This Proposed Project's Vision is to address an unmet need in protecting the health of Older Americans. It encompasses the three priorities set-forth in the National Agenda on the Environment and the Aging. The Project's Goals and Objectives center on improving Indoor Air Quality for the Elderly residing in Long Term Care Facilities. Upon completion of the Planning, Research, and Design Process, Project Developers propose to implement a research-based "Best Practices" Model Program, that will provide access for future Regional Transportability and Replication. Thereby incorporating and expanding on the successful Program Design created through the initial Planning and Research Process, of this IAQ based multidisciplinary and crosscutting model which meets the NAEA priorities.

It is conceivable to expect that by utilizing and expanding on the Regional Replication efforts of the Program Model, that Program Transportability can be achieved throughout the United States in a manner which will make training, education, media and information equally accessible throughout all 50 states, reaching all populations and stakeholders.

Working with the identified Long-Term Care Network, and the project's strategic partners and stakeholders, the Bexar Area Agency on Aging / Ombudsman Program, will implement programs that generate a multigenerational / sociocultural approach towards creating and implementing Indoor Air Quality Measures that are conducive to the improved Quality of Life, and Health Care of the Elderly in Long Term Facilities.

This Best Practice Replication Model will be provided through established linkages to the National Aging Network:



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TALKING POINTS

The Elderly and The EPA:
"A Right to Breathe Better and Longer"

Older Americans spend up to 100% of their time indoors where pollutant levels often exceed from 2-5 times, and are occasionally more than 100 times higher than outdoor levels.

Environmental Risk indoors
includes exposure to air toxics,
hazardous chemicals, water contaminants,
temperature extremes, carbon monoxide,
molds, second hand smoke and pesticides.

NEEDED is a project which will evaluate the cumulative environmental threats from all media indoors and offer a plan to prevent potential existing and future exposures to the elderly.

"Currently, there are no programs that develop environmental quality of care, specifically addressing the quality of life and quality of health care for the elderly".

The Elderly residing in Long Term Care Facilities, have been historically subjected to poor indoor air quality conditions.

Preliminary research, by the Bexar Area Agency on Aging / Ombudsman Program, indicates that the main factor contributing to these poor Indoor air quality conditions;

Is the fact that most of the Nursing Homes in Bexar County were built in the late 60's and 70's. An opinion expressed by a Life Safety Code expert, is that these facilities are just plain "TIRED BUILDINGS", whose Heating, Ventilation, and Air-conditioning systems and building structures are aging, and are in dire need on renovations.

(This case can be made for most Nursing Homes around the state and U.S.),

The Nursing Facility Requirements for Licensure and Medicaid Certification, set forth by the Texas Department of Human Services, outlines the "Minimum Stadards"

MOST GLARING:

Environmental Conditions (section 19.309)

The use of deodorants is for air-freshening Purposes that there is no contra-indication on the label of the product indicating that the product should not be used in the presence of aged or ill persons, and that devices, such as ozone generators, ultra-violet generators, and smoke eliminators, must be approved by TDHS;

Heating, Ventilation, and Air-conditioning Systems (section 19.321)

Air systems must provide for the induction and mixing of at least 10% outside fresh air into the facility, unless otherwise approved by DHS. This is unacceptable

(section 19.340) "All air-supply and air-exhaust systems must be mechanically-operated, that ventilation rates shown on table (11) of that subparagraph must be considered as "minimum acceptable rates" and must not be construed as precluding the use of higher ventilation rates.

Since these Minimum Standards apply primarily to the facility construction, and "while no federal mandate exists on this issue", the standards fall short of meeting 21st Century "Critical Indoor Air Quality Measures" and actually represent the "Maximum Standards", as they apply to the elderly in Texas and the United States.

In comparison, the IAQ initiatives that are being "voluntarily addressed" by U.S. School Districts, in partnership with the Association of School Administrators, the EPA and the Department of Energy, set an exemplary precedence, on how government agencies and local stakeholders can work together to ensure safe and comfortable indoor environments for At-Risk Populations.

The Bexar AAA Ombudsman Program is proposing a demonstration project, which will set as its major "Benchmarks" to address, through research-based planning and program design, the EPA Aging Initiative's three-pronged priorities for the National Agenda on the Environment and the Aging.

A product of "The Differential Susceptibility of Older Persons to Environmental Hazards" workshop, as convened in 2002 by the National Academies of Sciences).

  1. To prioritize and study environmental health threats to older persons;
  2. To examine the affect that a rapidly growing aging population might have on our environment;
  3. To encourage older persons to volunteer in their own communities to reduce hazards and protect the environment.

This Project's Vision is to address an unmet need in protecting the health of Older Americans. The Project's Goals and Objectives center on improving Indoor Air Quality for the Elderly residing in Long Term Care Facilities.

Upon completion of the Planning, Research, and Design Process, Project Developers propose to implement a research-based "Best Practices" Model Program.

It is conceivable to expect that by utilizing and expanding on the Regional Replication efforts of the Program Model, that Program Transportability can be achieved throughout the United States in a manner which will make training, education, media and information equally accessible throughout all 50 states, reaching all populations and stakeholders.

This can be achieved by working with the Long-Term Care Network, and the project's strategic partners and stakeholders, through programs that generate a multigenerational / sociocultural approach towards creating and implementing Indoor Air Quality Measures that are conducive to the improved Quality of Life, and Health Care of the Elderly in Long Term Facilities.

This Best Practice Replication Model will be provided through established linkages to the National Aging Network:

NOTE:

The development of this Demonstration Project Concept is subject to the successful attainment of Capacity Building Funding. Interested agencies or private-sector underwriters that would like to offer information on possible funding opportunities, please contact:

Nick Monreal, Jr.
Managing Local Ombudsman
Long Term Care Services
Bexar Area Agency on Aging
Alamo Area Council of Governments
8700 Tesoro Drive, Suite 700
San Antonio, Texas 78217
(210) 362-5236 or email at: nmonreal@aacog.com

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