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A weekly newsletter for directors of senior citizen.' programs. Includes news of all relevant federal agencies with programs affecting the elderly, including Social Security. Reports on budget changes and legislation, regulations, and policies at the fede
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Rate of dying from Alzheimer's grows as longevity rises, gaps narrow.(Brief Article)
March 4, 2005... The latest numbers from the National Center for Health Statistics portray a nation that is living longer than ever, with the average life expectancy at birth growing by almost four months from 2002 to 2003, from 77.3 years to 77.6.
The...
Panel recommends freeze in payments for nursing homes, home health.(Medicare Payment Advisory Commission )
March 4, 2005... The Medicare Payment Advisory Commission this week told Congress that nursing home and home health care providers deserve no inflation update for Fiscal Year 2006, drawing protests from industry leaders who see Medicare as a bulwark against the...
Insurance Commission orders refunds to doctors on malpractice coverage.
March 4, 2005... Washington Insurance Commissioner Mike Kreidler this week ordered Physicians Insurance to refund $1.3 million in premiums charged to doctors in 2003 and pay a $90,000 fine. He also released data that may shed light on what is driving such...
AoA challenges cities, counties to compete for livability label.(Administration on Aging)(Brief Article)
March 4, 2005... Being an All-American City is not enough any more, according to the Administration on Aging. Rather, cities and counties must make it easy to age in place if they do not want to be overwhelmed by changing demographics.
With that in mind,...
Pension legislation gets second wind, but advocates express concerns.(Brief Article)
March 4, 2005... Sens. Chuck Grassley (R-Iowa) and Max Baucus (D-Mont.) will soon reintroduce the National Employee Savings and Trust Equity Guarantee (NESTEG) Act in an effort to protect employee pensions. The bill was introduced last session along with a...
Designing for Alzheimer's.(conference on designing spaces for people with Alzheimer's disease)(Brief Article)
March 4, 2005... DESIGNING FOR ALZHEIMER'S. The Hillsborough County Department of Aging Services in Tampa, Fla., is sponsoring a conference on designing spaces for people with Alzheimer's disease. Pitched at a wide audience, the April 1 event, titled Cutting...
Veterans budget critiqued.(Brief Article)
March 4, 2005... VETERANS BUDGET CRITIQUED. On behalf of the GOP members of the Senate Veterans Affairs Committee, Chairman Larry Craig (R-Idaho) last month asked Budget Committee Chairman Judd Gregg (R-N.H.) to reject certain aspects of President Bush's budget...
Breaux lends prestige.(John Breaux)(Brief Article)
March 4, 2005... BREAUX LENDS PRESTIGE. John Breaux may be out of the Senate, but the Louisiana Democrat is still working to get his Elder Justice Act through Congress and has agreed to serve as honorary chairman of the Elder Justice Coalition. Meanwhile,...
Amenities can make or break affordable rental projects.(Housing)
March 4, 2005... Amenities and design are the factors that drive quality for affordable senior rental apartments, says the developer of an award-winning Atlanta project.
Columbia Heritage in Atlanta has 132 units, including 80 affordable apartments and 52...
Phone directories are popular as key part of housing search.(Housing)(Brief Article)
March 4, 2005... When it comes to finding assisted living or other senior housing, families may turn not to friends or relatives but to a familiar resource in the home--phone directories.
The heading "Assisted Living/Nursing Homes" section of the Yellow...
Universities explore potential for alumni-focused CCRCs.(Housing)(continuing care retirement communities)
March 4, 2005... Colleges and universities are among the newest entrants in the Continuing Care Retirement Community market, as higher education leaders see a way to bring alumni back to campus and create an intergenerational atmosphere.
Tiger Place at the...
Correction.(Correction Notice)
March 4, 2005... The financing of an assisted living facility in Batesville, Ark., was misrepresented ("Financing a Major Issue in Growth of Affordable Assisted Living," Feb. 25, p. 62). The White River Area Agency on Aging received tax credits and other...
AoA: AAA survey.(Federal Register)(Administration on Aging )(agencies on aging )(Brief Article)
March 4, 2005... AoA: AAA survey. The Administration on Aging plans to survey area agencies on aging on the extent to which they have integrated their service delivery systems. Data will be used to evaluate the Title III-B program, to refine the analysis of all...
CMS: DME boundaries.(Federal Register)(Centers for Medicare and Medicaid Services )(Durable Medicare Equipment )(Brief Article)
March 4, 2005... CMS: DME boundaries. The Centers for Medicare and Medicaid Services changes the boundaries of four regions used for paying Durable Medicare Equipment claims. The changes are part of a larger restructuring in which 23 Medicare Administrative...
CMS: PACE for-profit demo.(Federal Register)(Centers for Medicare and Medicaid Service)(Program of All-Inclusive Care for the Elderly)(Brief Article)
March 4, 2005... CMS: PACE for-profit demo. The Centers for Medicare and Medicaid Services reinstates a solicitation for bids by for-profit groups that wish to participate in the Program of All-Inclusive Care for the Elderly. The agency cancelled the...
CMS: Part D reinsurance.(Federal Register)(Centers for Medicare and Medicaid Services )(Brief Article)
March 4, 2005... CMS: Part D reinsurance. The Centers for Medicare and Medicaid Services launches a demonstration program for Part D providers who want to fill the drug coverage gap but cannot obtain reinsurance because reinsurance is not available until...
FCC: VRS incentives.(Federal Register)(federal communications commission)(video relay services)(Brief Article)
March 4, 2005... FCC: VRS incentives. The Federal Communications Commission says an incentive program offered by a provider of video relay services (VRS) is illegal. Under its "Brown Bag Rewards Program," a VRS provider called Hands On defrayed the DSL or cable...
HUD: accessibility guidelines.(Federal Register)(department of housing and urban development)(Brief Article)
March 4, 2005... HUD: Accessibility guidelines. The Department of Housing and Urban Development endorses the accessibility components of the 2003 International Building Code, giving builders safe harbor from claims under the Fair Housing Act's protections for...
HUD: fair market rents.(Federal Register)(department of housing and urban development)(Brief Article)
March 4, 2005... HUD: Fair market rents. The Department of Housing and Urban Development revises its Fair Market Rents based on comments received after the FY05 standards were promulgated on Oct. 1, 2004. Fair Market Rents are used in calculating the level of...
SSA: unsuccessful work attempts.(Federal Register)(social security administration )(Brief Article)
March 4, 2005... SSA: Unsuccessful work attempts. The Social Security Administration clarifies its rules for deciding whether someone is eligible for disability benefits despite having worked for brief periods. Periods of employment will be disregarded and...
VA: benefit update.(Federal Register)(veterans affairs)(Brief Article)
March 4, 2005... VA: Benefit update. The Department of Veterans Affairs makes a 2.7 percent cost-of-living adjustment to benefits for service-connected disabilities and to surviving spouses. Payments for service-connected disabilities range from $108 per month...
Workshop gives older women chance to learn common household repairs.
March 4, 2005... While scholars in Cambridge, Mass., including a certain former Secretary of the Treasury, debate whether women have what it takes to pursue the more ticklish problems in physics, an area agency on aging in Binghamton, N.Y., is trying to level...
Florida aging chief named.(FYI)(Carole Green new leader of department of elder affairs)(Brief Article)
March 4, 2005... FLORIDA AGING CHIEF NAMED. Gov. Jeb Bush (R-Fla.) has asked Carole Green to lead the Department of Elder Affairs. Green was previously head of the division of long-term care and before that served in the state legislature, where she was a...
More on drugs.(FYI)(online drug information)(Brief Article)
March 4, 2005... MORE ON DRUGS. Individuals can go online to learn about their medication options from the Drug Effectiveness Review Project of Oregon Health and Science University. The website explains in lay terms how the drugs work and what the side effects...
Inflation would exact heavy toll if spending caps are adopted.(Brief Article)
March 11, 2005... When President Bush submitted his budget for FY06, he proposed to flat-fund the Administration on Aging and many other agencies. What is not as well known is that he intends to keep this freeze in effect indefinitely, causing a gradual but...
Advocates oppose plan to kill program that fosters shift in long-term care.(Real Choice Systems Change)
March 11, 2005... Few things are forever, but a plan to eliminate the Real Choice Systems Change program, which helps states develop alternatives to institutional care, has caught advocates by surprise.
Real Choice was launched in 2001, just before President...
Programs targeted for cuts include housing for people with disabilities.(Brief Article)
March 11, 2005... The Real Choice Systems Change program is not the only item that President Bush would like to reduce or eliminate in Fiscal 2006 (see story, p. 73). Other targets include:
* Direct Service Worker Grants, HHS, $3 million. These funded...
In Tennessee, systems change means altering the way intakes are done.
March 11, 2005... Merging two forms might not seem like a huge task, let alone something that would take three years and $291,000 in federal funds.
But for Steven Hopper, chief of long term care operations at TennCare, Tennessee's Medicaid program, few...
Advocates say new Medicare rule will make appeals more difficult.
March 11, 2005... The Centers for Medicare and Medicaid Services this week outlined new procedures for handling Medicare appeals, a task that is being transferred from the Social Security Administration (see item, p. 80). But advocates say the new system will...
Health plans tout track record of Medicaid Managed Care.(Brief Article)
March 11, 2005... In state capitals as well as in Washington, D.C., Medicaid has acquired the reputation of a program in crisis, and President Bush has proposed cutting the program by $60 billion over 10 years. But budgetary pressures should not obscure the good...
Aspirin benefits weighed.(Brief Article)
March 11, 2005... ASPIRIN BENEFITS WEIGHED. In a 10-year, double-blind study, women over 65 who took low-dose aspirin reduced their risk of major cardiovascular events by 26 percent, according to the National Heart, Lung and Blood Institute. However, aspirin...
Remodeling effort helps seniors stay longer in their own homes.(Housing)
March 11, 2005... Low-income older Americans can live longer in their own homes with free short-term help to make their residences more senior citizen-friendly, say sponsors of a nationwide community assistance program.
Rebuilding Together enlists skilled...
Firm plans appeal.(Housing Briefs)(Brief Article)
March 11, 2005... FIRM PLANS APPEAL. A Texas jury has awarded $19.5 million to a family in connection with alleged negligence at an Emeritus Assisted Living facility in San Antonio. Emeritus announced the verdict, but a company statement labeled it an "unjust"...
ALFA selects officer.(Housing Briefs)(Assisted Living Federation of America)(Brief Article)
March 11, 2005... ALFA SELECTS OFFICER. Leila Ebrahimian is the new chief marketing and business development officer at the Assisted Living Federation of America (ALFA) in Fairfax, Va. Most recently, she spent five years as the director of marketing for the...
Seniors may not want a move to smaller homes, study says.
March 11, 2005... The stereotype of senior citizens ready to downsize to smaller homes may not apply to today's older Americans, says a new survey that dispels some of the conventional wisdom about senior housing needs.
A new survey of seniors age 50 and...
Study tracks housing needs of older adults with HIV.(Brief Article)
March 11, 2005... Older Americans with the HIV virus have more stable housing arrangements than younger HIV sufferers, even though they may face more health risks, a new study shows.
Access to subsidized housing may be a factor in this stability, said David...
Tracking trials.(clinical trials)(Brief Article)
March 11, 2005... TRACKING TRIALS. In an effort to create more transparency in pharmaceutical research, Sen. Charles Grassley (R-Iowa), chairman of the Finance Committee, has introduced legislation that would force the FDA to make public its internal drug safety...
Pension agency at risk.(Brief Article)
March 11, 2005... PENSION AGENCY AT RISK. The Government Accountability Office last week told a panel of the House Government Reform Committee that the Pension Benefit Guaranty Corporation "faces moral hazard" because it "lacks the authority, unlike other...
Registries flawed.(Brief Article)
March 11, 2005... REGISTRIES FLAWED. Twenty-four of 38 states surveyed by the HHS Inspector General failed to update their nurse aide registries within 10 days of substantiating a finding of abuse, neglect or theft, as required. In addition, more than 1,500...
Dangerous products.(Brief Article)
March 11, 2005... DANGEROUS PRODUCTS. Almost 1.5 million people over 65 went to emergency rooms in 2002 for injuries related to consumer products, says the Consumer Product Safety Commission. This number is 73 percent higher than in 1991, meaning the rate of...
Supporters of stem cell research renew bid to undo restriction.(Brief Article)
March 11, 2005... Legislative efforts began anew last month to overturn a policy that limits federal funding for stem cell research to stem cells created by Aug. 9, 2001, when President Bush went on television to say he did not want to encourage the destruction...
CMS: competitive drug purchasing.(Federal Register)(Centers for Medicare and Medicaid Services)(Brief Article)
March 11, 2005... CMS: Competitive drug purchasing. Proposed rule. Starting in 2006, the Centers for Medicare and Medicaid Services will let physicians purchase drugs from vendors who compete for the right to provide such a service. The goal is to lower agency...
CMS: Medicare appeals.(Federal Register)(Centers for Medicare and Medicaid Services)(Brief Article)
March 11, 2005... CMS: Medicare appeals. Interim final rule. The Centers for Medicare and Medicaid Services revises its procedures for handling Medicare appeals. The main change is that a set of Qualified Independent Contractors will reconsider appeals if they...
HHS: poverty guidelines.(Federal Register)(Department of Health and Human Services)(Brief Article)
March 11, 2005... HHS: Poverty guidelines. The Department of Health and Human Services updates its poverty guidelines for 2005. For individuals, the threshold is $9,570; for couples, it is $12,830. Higher rates apply in Alaska and Hawaii. Effective Feb. 18....
SSA: Part D subsidies.(Federal Register)(Social Security Administration)(Brief Article)
March 11, 2005... SSA: Part D subsidies. Proposed rule. The Social Security Administration explains how it will handle applications for Medicare drug subsidies. The subsidies apply both to the premium and to cost-sharing. Seniors who are on Medicaid, who...
Poverty updates affect many programs, including spousal income protection.(Brief Article)
March 11, 2005... The Department of Health and Human Services last month updated its poverty guidelines for 2005, triggering a host of changes in the requirements for various programs.
Medicaid benefits for the aged and disabled, for example, are set at 100...
Senate restores Medicaid cuts of $15b, authorizes one-year commission.
March 18, 2005... Seven Republican senators joined Democrats yesterday to strike a provision of the budget resolution that would have cut Medicaid spending by $15 billion over five years, voting instead to create a commission to study the program.
...
Greenspan endorses private accounts for Social Security, but with caution.
March 18, 2005... Private accounts would give Social Security beneficiaries a stake in society and might dissuade lawmakers from raiding the program for other purposes, Alan Greenspan told members of the Senate Aging Committee this week. But any such system...
Governors mull ways to make Medicaid less biased toward institutional care.
March 18, 2005... If the Senate succeeds in persuading the House to hold off on cutting Medicaid while a commission studies the program, a process will be set in motion that will yield a hefty report and a list of recommendations.
As it happens, however,...
Lawmakers ask colleagues to expand research on Parkinson's disease.(Brief Article)
March 18, 2005... The bulk of research on Parkinson's disease is carried out through the National Institutes of Health, but the Defense Department is also involved through its Neurotoxin Exposure Treatment Research Program at the Army Medical Research and...
Small employers reluctant to pay for elder care consulting.
March 18, 2005... Employers know that many workers are distracted by caregiving duties, but getting companies to invest in a counseling program is difficult, according to John Paul Marosy, president of Bringing Elder Care Home.
The picture is not entirely...
Recruiting older volunteers requires creative thinking, persistence.(Brief Article)
March 18, 2005... Older persons have time to donate to various endeavors, but there is no one right way to encourage them to make that gift.
Much of the confusion stems from an uncertainty about language. For example, some older individuals do not want to be...
Seniors try assisted living model at Chicago-area home for blind.(Housing)
March 18, 2005... Senior citizens with severe vision problems still can live largely on their own with a little help. That's the rationale behind a new facility in Chicago that is providing assisted-living style apartments to the blind and visually impaired.
...
Firm posts loss.(Capital Senior Living Corp., posted a net loss)(Brief Article)
March 18, 2005... FIRM POSTS LOSS. Capital Senior Living Corp., a major operator of senior living communities, posted a net loss of $6.8 million for fiscal year 2004, the company says. During the year, the company also acquired CGI Management Inc., to add 14...
Donation helps project.(Hebrew SeniorLife received $15 million gift from Miriam and Sheldon Adelson)(Brief Article)
March 18, 2005... DONATION HELPS PROJECT. Hebrew SeniorLife of Boston has received a $15 million gift from Miriam and Sheldon Adelson to support a proposed multigenerational community the organization is planning in Dedham, Mass. The project will include senior...
Conference set.(American Association of Retired Persons )(Brief Article)
March 18, 2005... CONFERENCE SET. AARP is hosting an International Conference on Livable Communities June 15 in Washington, D.C. The conference is designed to create a dialogue and exchange information about services and living environments for seniors. Contact:...
Ohio Governor plans new effort for assisted living waivers.
March 18, 2005... To reduce senior citizens' need for nursing homes, Ohio Gov. Bob Taft (R) wants his state to have an assisted living option under Medicaid.
Taft is asking for state legislative approval, which is required under federal law before states...
Seniors' second-home purchases help drive housing sale increase.(Brief Article)
March 18, 2005... Senior citizens are a major factor in the recent surge in sales of second homes, particularly those used as vacation properties, the National Association of Realtors says.
Second-home sales reached a record of 2.82 million last year, up 16...
Pain experts reject revised guidance from DEA on controlled substances.(Drug Enforcement Administration)(Brief Article)
March 18, 2005... Arguing that doctors need guidance, not threats of prosecution, when prescribing pain medications, researchers at the University of Wisconsin have asked the Drug Enforcement Administration to renew its commitment to working with legitimate...
Cut the fat or cut it short.(Brief Article)
March 18, 2005... Researchers at the University of Illinois, the University of California and the International Longevity Center say obesity reduces average life expectancies by several months and could bring the average down even further in coming years despite...
Oregon issues update on effect of death with dignity law.(Brief Article)
March 18, 2005... Sixty people received prescriptions for lethal medication under Oregon's assisted suicide law in 2004, according to the Department of Human Services. Of these, 35 actually took the drug, which was either pentobarbital or secobarbital.
When...
CMS: dual eligibles.(Federal Register)(Centers for Medicare and Medicaid Services require states to report number of people qualifying for both Medicare and Medicaid)(Brief Article)
March 18, 2005... CMS: Dual eligibles. Information collection. The Centers for Medicare and Medicaid Services will require states to report monthly the number of people who qualify for both Medicare and Medicaid. This information will be used to determine how...
FTA: human service transportation.(Federal Register)
March 18, 2005... FTA: Human service transportation. The Federal Transit Administration seeks input on what types of technical assistance would help agencies consolidate their human service transportation programs, including those funded by Medicaid and the...
CMS: National coverage determinations.(Other Agency Notices)(Centers for Medicare and Medicaid Services)
March 18, 2005... CMS: National coverage determinations. The Centers for Medicare and Medicaid Services publishes three documents explaining how it handles requests to cover items or services under Medicare. One document describes the process for initiating a...
Calendar update.
March 18, 2005... FINDING SOLUTIONS. The College of William and Mary in Williamsburg, Va., is hosting an event in connection with the forthcoming White House Conference on Aging. The April 14 Solutions Forum will focus on fostering intergenerational connections....
Fox Foundation: Parkinson's disease.(Funding Opportunities+)(Brief Article)
March 18, 2005... Fox Foundation: Parkinson's disease. The Michael J. Fox Foundation for Parkinson's Research has $10 million to support interdisciplinary research on Parkinson's disease, with a focus on developing clinical tools. The deadline for the Linked...
SAMHSA: mental health for older adults.(Funding Opportunities)(Substance Abuse and Mental Health Services Administration )(Brief Article)
March 18, 2005... SAMHSA: Mental health for older adults. The Substance Abuse and Mental Health Services Administration has $4.4 million to help nonprofit groups meet the mental health needs of people over 60. Grantees must spend at least 15 percent of their...
The dispute over Terri Schiavo.(Slants & Trends)(beliefs of Stephen Connor )(Brief Article)
March 25, 2005... THE DISPUTE OVER TERRI SCHIAVO, the brain-damaged woman whose feeding tube was removed last week, has brought attention to Woodside Hospice in Pinellas Park, Fla. For that reason, Stephen Connor, vice president for research at the National...
Penalty for enrolling late in drug plan could exceed 1 percent per month.(Medicare Prescription Drug Act)
March 25, 2005... When the Medicare Prescription Drug Act was passed, many seniors blanched at a key provision: People who sign up late will pay a surcharge of 1 percent for each month they delay--for life. But as CMS emphasized this week in an "interpretation"...
Learning about shingles.(Brief Article)
March 25, 2005... LEARNING ABOUT SHINGLES. One of the hazards of aging is that a body never forgets that it once had chicken pox. Under certain conditions, the virus reemerges, causing lesions called shingles that spread along the nerves where the virus has been...
Getting corporate support.(Brief Article)
March 25, 2005... GETTING CORPORATE SUPPORT. The Cisco Systems Foundation has given $12,500 to support a 24-hour hotline for older people in San Francisco at risk of depression and suicide. The Friendship Line is the nation's only such service, according to the...
Seizing beds.(Brief Article)
March 25, 2005... SEIZING BEDS. At the request of the Food and Drug Administration, the U.S. Marshals Service this week began seizing hospitals beds awaiting distribution by Vail Products of Toledo, Ohio. The Vail 500, 1000 and 2000 Enclosed Bed Systems are...
With music, pictures, even scents, kits provide cues for reminiscing.
March 25, 2005... The place was a senior center or nursing home in Sun Prairie, Wis., and as usual, someone showed up early for one of Lynne Martin Erickson's slide shows about yesteryear.
So Erickson asked the woman if she would read a poem as part of the...
Hawaii home care workers turn out to learn about forming cooperative.
March 25, 2005... At first glance, it might seem odd that a hospital would want to help home health workers organize their own cooperative. Likewise, it might seem strange that a home health company would want to help create an entity with which it might compete...
CCRCs show signs of revival following profitability drop.(Housing)(continuing care retirement communities)
March 25, 2005... After hitting a low in profitability in 2003, continuing care retirement communities (CCRCs) are showing signs of strength, with rising occupancy rates and stronger cash flow, a new analysis states.
The Fitch Ratings analysis finds "strong...
Urban areas show stronger growth in key senior market analyses.(Housing)(Brief Article)
March 25, 2005... Urban areas report higher-than-average occupancy rates for most sectors of the senior housing market, including independent and assisted living as well as skilled nursing, a major database provider told OAR.
In the nation's largest...
Beverly shifts course, plans to hold auction for company.(Housing)
March 25, 2005... Caught in the middle of a bitter takeover battle, a major long-term care and assisted living provider now says it will entertain offers to sell the company.
The board of Beverly Enterprises Inc. voted to put the company up for auction...
Sunrise earns top rank as largest senior housing firm.(Housing)(Brief Article)
March 25, 2005... Sunrise Senior Living is the largest manager of senior housing in the U.S., based on a ranking of the nation's leading firms for 2004.
With 39,310 units, McLean, Va.-based Sunrise outpaced Holiday Retirement Corp., which had 34,962 units...
Calendar update.(Calendar)
March 25, 2005... HELPING PEOPLE WITH ALZHEIMER'S. The Alzheimer's Foundation of America will meet May 3 in Orlando, Fla. Concepts in Care will feature Eric Pfeiffer, director of the Suncoast Gerontology Center, and Fran Carlin-Rogers, a consultant on older...
AoA: Alzheimer's disease.(Funding Opportunities)
March 25, 2005... AoA: Alzheimer's disease. The Administration on Aging has $2.3 million to support the Alzheimer's Disease Demonstration Grants to States Program. At least 50 percent of the funds must be used for direct services such as adult day care or...
AoA: Senior Medicare Patrol.(Funding Opportunities)(Administration on Aging)(Brief Article)
March 25, 2005... AoA: Senior Medicare Patrol. The Administration on Aging will provide up to $180,000 in each of 28 states to sustain the Senior Medicare Patrol program, which recruits older volunteers in an effort to stem fraud and abuse. The states are...
HHS: family violence.(Funding Opportunities)(Brief Article)
March 25, 2005... HHS: Family violence. The Administration on Children, Youth and Families renews its support for family violence hotlines and shelters. The total funding pool is not specified, but each state will receive at least $600,000. The deadline is April...
HUD: Super NOFA.(Funding Opportunities)(United States. Department of Housing and Urban Development)(Brief Article)
March 25, 2005... HUD: Super NOFA. The Department of Housing and Urban Development has several programs for seniors and people with disabilities, either as the primary focus or as part of a broader mission. The annual "Super Notice of Funding Availability,"...
NIA: elder mistreatment.(Funding Opportunities)(Brief Article)
March 25, 2005... NIA: Elder mistreatment. The National Institute on Aging has $1.7 million to support research on elder abuse, neglect and exploitation, saying the state of the science is 30-40 years behind the academic community's understanding of child abuse....