Best Practice
NOTES
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| Vol. 10, nos. 1 & 2 | On Delivery of Legal Assistance to Older Persons |
December 1999 |
Meet the Orphan of the Elder Rights System
By: Natalie Thomas
Georgia Legal Services Developer
"If a program is mandated, expected to achieve goals and carry out afew express and many implied responsibilities but is never funded andhardly supported, can it still succeed?"
That depends, one should say, on the program and the people involved. That is the perfect setup for a new question: "Is there a need for the Legal Services Development Program, and the State Legal Services Developer even though there are more barriers in place against success than stepping stones to achieve it?" Being somewhat biased as the Legal Services Developer (LSD) for the State of Georgia and as Vice Chair of the National Association of Legal Services Developers (NALSD), my answer is an unconditional and emphatic "Yes, there is!"
In doing a job every day, year after year, getting to know that role so well, it can become easy to assume that people throughout the state and throughout the country know what I and other Legal Services Developers (LSDs) do. Unfortunately, as I have found, this is not the case.
In April 1999, I was asked to conduct a joint presentation with Esther Houser, Oklahoma State Long Term Care Ombudsman (SLTCO), at the Annual Meeting of the National Association of State Ombudsman Program (NASOP) held in Atlanta, Georgia. The purpose of the session was to help clarify the role of LSDs, with the ultimate goal of improving overall the working relationship between State Long Term Care Ombudsmen and State Legal Services Developers.
For my part of the presentation, I chose to use a survey to determine how much the State Long Term Care Ombudsmen in attendance knew about the role of the State Legal Services Developer.1 I developed the survey using Title III and Chapter 4 of Title VII of the Older Americans Act (OAA)2 which specifically address the role of the Title III-B legal provider and the role of the person charged with the development of legal services for the elderly, amongst other duties and experiences gathered from being a LSD.
Since the 1975 amendments to the OAA, legal services has been one of the priority services that each state was required to have to ensure the receipt of Title III funding. In 1976, the Administration on Aging (AoA) issued a Program Instruction announcing the State Legal Services Development Program. The purpose of the program was to provide within State Units on Aging (SUA) the capacity for leadership in order to be able to promote legal services for the elderly within each state.3 The 1992 amendments to the OAA added provisions to Titles III and VII requiring each state to have a LSD to provide state leadership in developing legal services for older persons.
The survey was distributed to each SLTCO to be completed and returned en masse to maintain anonymity. Ombudsmen, the very people with whom I personally believe LSDs should work closest, showed me just how little is known about LSDs and what they do. A week later, in the same fashion, at the request of the SLTCO, I asked LSDs to complete the same survey while attending the 6th Annual NALSD Symposium in Boulder, Colorado.
The NASOP workshop was a most illuminating forty-five minutes. The preliminary question and answer session at the workshop, if indicative of the actual knowledge that State Long-Term Care Ombudsmen have of LSDs, revealed that self-promotion is obviously not one of our strong traits. During the 45-minute session with people (SLTCO) whom I believe LSDs should work closest, I’m afraid I found out just how much like orphans LSDs are. For example, of the 34 SLTCO present and 37 states represented–
• 10 knew what their LSD does
• 3 did not know that they had a LSD
• 8-10 have LSDs who are attorneys
• 8-10 have LSDs who are non- attorneys
• 5 can get general questions of law related to either a specific long term care issue or long term care resident’s issue answered by their LSD
Among the duties/functions believed appropriate, at least one is identified by AoA as the basic role "developing and supporting legal assistance programs throughout the state." AoA characterized an additional function of the legal assistance developer pursuant to the 1992 amendments to the OAA, elder rights system development. Interestingly enough, the clarification of these roles of the LSD, which would require one to compile the June 1976 AoA Program Instruction, the August 1976 TA Memoranda,6 Program Instructions, Technical Assistance Memoranda and Model Job Descriptions would still be inadequate to establish the orphan Legal Services Development Program as a vital component with clearly identified roles within the Elder Rights System such as the Elder Abuse Prevention, State Long Term Care Ombudsman and the Outreach Counseling and Assistance Programs are as a result of the language in the OAA and the resultant guidance from AoA.
The following queries and comments raised by SLTCO during the NASOP workshop clearly indicate that the lack of specific language in the OAA detailing the functions of the State Legal Services Developers contributes to the lack of information and understanding some SLTCO and others in the aging network have about LSDs:
• What exactly is a Legal Services Developer supposed to do? I’m not sure that I understand the function/purpose of a LSD.• How does a non-attorney LSD have the credibility to deal with legal issues?• How is it that LSDs seem to have so many different things to do that seem unrelated to the whole area of elder rights?• I remember years ago the person who was developer did one thing and people after that person have done different things from the one before. Has the position itself evolved?• I see the role of the LSD as a facilitator and not one who provides actual services to clients or to the local or State Ombudsman.• The core function of the LSD has to be ensuring that adequate legal services for the elderly exist. They should be able to do something if a program is not delivering adequate legal services and make sure that whatever problems are corrected. LSDs shouldn’t do anything else unless this core job is done. No coordination of other programs, services, advocacy, etc.
These comments demonstrate the fundamental level on which individuals, even those within the Aging Network, lack an understanding of what LSDs do. As discussed briefly above, this lack of understanding is likely due to a combination of the language of the Older Americans Act (OAA), the variation from state to state of LSD duties, and a lack of self-promotion on the part of the LSD. Whatever the cause, it is crucial that the role of the LSD be clear to everyone the LSD works for and with -- legal services providers, members of the Aging Network, the general public, and most importantly, the LSD him- or herself. This NASOP workshop and the responses to the surveys from both the SLTCO and the LSDs clearly indicate the need for improvement in this area.
Survey Results
Of the 30+ SLTCO present at the NASOP meeting and the approximately 20 LSDs in attendance at the NALSD Symposium, ten (10) completed surveys were returned from each of the two meetings. The survey walked through Chapter 4 of Title VII, which specifically addresses the requirement of the LSD and the State Units on Aging’s responsibilities under the Legal Services Development Program whether carried out through the LSD or other personnel.
Questions in the survey are divided into three sections:
(1) What does the Older Americans Act require the LSD to do?
(2) What do you wish that your LSD did?
(3) Describe the working relationship between the LSD and the SLTCO in your state.
Each section contained a series of multiple choice questions; details on the sections are discussed below.
Section 1: What Does the OAA Require the LSD to Do?
Section 1 listed a series of activities carried out by LSDs under the Older Americans Act (OAA) and asked respondents to answer two questions: (1) whether the activity is "required," "optional," or "prohibited" by the OAA; and (2) whether the respondent’s particular LSD "does," "doesn’t do," or "don’t know."
Of those SLTCO responding to the survey, at least 50% accurately stated that the following activities are required by the OAA. Interestingly, nearly the exact proportion of respondents reported that the LSD in their state performs these duties:
1. Provide state leadership in developing legal services for older persons;
2. Provide or ensure technical assistance (TA) and training is provided to AAAs, LTCOs, legal services providers and others;
3. Work with AAAs and legal providers to develop and maintain standards for delivering legal services to older persons;
4. Provide TA to AAAs to assist them in monitoring legal providers;
5. Assist states in establishing focal points for elder rights, policy review, analysis and advocacy at the state level;
6. Provide TA to insurance counseling and elder abuse prevention programs;
7. Provide or ensure education and training of professionals and volunteers and older persons on elder rights and public benefits;
8. Conduct education/training on the benefits of specific law requirements and in the elder rights area;
9. Assess the state periodically on the problems and unmet need for legal assistance and benefits related problems;
10. Serve as state’s leader in securing and maintaining legal rights of older individuals; and
11. Review and analyze legislation concerning any of the elder rights programs or issues.
In comparison, responses of the LSDs to the survey matched the results of the SLTCO on all of the above named duties except for the last one for which only 40% of LSDs considered this a required duty; 60% believed it optional but 80% actually perform it.
In addition, at least 50% of the LSDs also identified the following as required duties and said that they actually perform them in their states:
• Actually coordinate legal services for older persons
• Monitor legal providers for quality and quantity of legal services to older persons
• Assist LTCO in obtaining legal services for residents in long term care facilities
• Review delivery of legal services to ensure that target population is being reached
• Ensure that legal providers are considering as priorities for case representation: income related issues; health care; long term care; nutrition; housing; utilities; protective services; defense of guardianship; abuse, neglect and age discrimination
• Ensure that legal providers for elder persons are coordinating with Legal Services Corporation (LSC) grantees
• Promote development of and provide TA on expanding access by older persons to legal assistance, advocacy and vulnerable elder rights protection activities
• Work with adult protective services, ombudsmen and other state entities on elder abuse issues
Of these additional eight (8) duties that SLSDs felt are required and believe they do, at least 50% of the SLTCO responding to this survey7 indicate that the last four duties listed above are required but are not performed by the LSDs in their states.
Prohibited Duties According to SLTCO
An interesting difference between the responses from the SLTCO and LSDs was found in what are and are not considered "prohibited activities." In the list of activities provided on the survey, LSDs did not indicate any were prohibited. However, each of the following duties was indicated by at least one SLTCO as being a prohibited duty for a LSD:
• Actually coordinate legal services for older persons;
• Provide or sees to it that Technical Assistance is provided to AAAs, ombudsmen, legal providers and others;
• Work with law schools and other institutions of higher learning on program and curricula;
• Develop as necessary, working agreements with SSA, HCFA, VA and other federal agencies;
• Serve as the state’s leader in securing and maintaining legal rights of older individuals; and
• Review and analyzes legislation concerning any of the elder rights programs or issues.
None of the activities listed above are actually prohibited by the Older Americans Act.
Optional And Unperformed Duties According to LSDs
At least 50% of LSDs responding included the following as optional duties that they do not perform in their states:
• Promote the development of and provide technical assistance on Alternative Dispute Resolution;
• Work with law schools and other institutions of higher learning on programs and curricula;
• Assess the state periodically on the problems and unmet needs for other programs and services established under Title III of the OAA;
• Develop as necessary working agreements with the Courts, the Consumer Protection agency; the Attorney General, other state agencies;
• Develop as necessary working agreements with SSA; HCFA; VA and other federal agencies;
• Help to develop and provide TA to hotlines.
While multiple choice answers are somewhat limiting in revealing additional thoughts respondents might have, comments associated with the questions, which all were at liberty to provide, were a little more revealing.
From SLTCO, some of the more notable comments include:
• Our state has a LSD in name only. This position was assigned to the only attorney in our office and he does nothing. No one has ever explained the duties to him or required any particular action of him. Prior to that assignment the SLTCO functioned as the LSD and is not at all familiar with what is required of a LSD.
• The primary function of the LSD [in my state] appears to be to provide legal advice to the SUA, draft legislation for the SUA, and act as the SUA’s spokesperson in the legislature. The position was originally within the LTCOP and was advocacy oriented.
• Although the LSD provides/ensures the provision of training to legal services providers, the LSD does not include AAAs, and Ombudsmen.
• The LSD provides education/training of professionals, volunteers and older persons on elder rights except for elder abuse and long term care.
• The LSD does not assist ombudsmen in obtaining legal services for residents in long term care facilities, this is done by the SLTCO.
• Not only does our LSD assist with technical assistance to the legal hotline but has become almost an adjunct staff member to the hotline.
The LSDs also offered comments to Section 1 of the survey:
• I don’t work with the AAAs and legal providers to develop, revise and maintain standards for delivering legal assistance and I don’t know if this required or not.
• I’m not sure whether assisting the ombudsmen in obtaining legal services for residents in long term care facilities is a required duty.
• It is a requirement that I fulfill to provide or ensure that training is provided to AAAs, and legal providers and others but it is optional [emphasis added] to provide such to the ombudsmen.
• Reviewing and analyzing legislation concerning any of the elder rights programs or issues is a requirement but as the LSD, I’m not allowed to perform this duty in this state.
Section 2: What Do You Wish That Your LSD Did?
Section 2 of the survey listed a variety of possible activities for LSDs and asked respondents to note (1) whether they "wish their LSD did", "their LSD does", "would not want their LSD to do"; and (2) whether they believe the listed activity is an "essential duty for an effective LSD."
At least 40% of the SLTCO selected the following activities as ones they wish their LSD did, and at least 40% of SLTCO also indicated that these activities are ones their LSD did not do:
• Available to work with the Title III-B legal providers on structure of programs, individual cases, legal issues
• Conducts on-site visits to the local legal providers
• Monitors legal providers
• Coordinates with SLTCO on legislation concerning matters common to both
• Works closely with the legislature on legislation and issues of importance to the aging community
• Assists the ombudsmen in locating legal representation on problem cases
• Works with state ombudsman to resolve disputes between local ombudsman programs and local legal programs
• Advocates within the agency and the aging network on behalf of long term care residents, ombudsmen and elder rights programs other than legal services
• Ensures that local legal providers provide advice and representation to residents referred by SLTCOs
• Ensures that the long term care residents are a priority for representation by the Title III-B legal programs
• Assists the ombudsmen in providing assistance to residents who need but lack the mental capacity to request legal assistance
• Ensures that SLTCO are included in some trainings and conferences for legal providers
• Develops educational materials that can be used by legal providers, ombudsmen and the aging network in general
• Has or would develop a specific educational material upon request by the state or local SLTCO
• Involves the SLTCO in discussions with other programs which might have some affect on the ombudsman program or long term care residents
• Assists the SLTCO, ICAs, Advocacy, and Elder Abuse Prevention programs in finding, securing and analyzing legislation upon request
• Assists in locating and/or writing grants for elder rights programs other than legal
• Promotes or conducts cross trainings and/or joint trainings with other programs and/or other agencies: APS; ICAs; EAP; SLTCO
In comparison, the LSDs responding had a much shorter list of activities they wish they did but are currently not doing. At least 40% of the responding LSDs said they wish they would/could:
• Assist in contracting process of selecting the Title III-B legal providers by either reviewing RFPs or voicing assessment of potential providers to the AAA or actively approving or rejecting potential providers;
• Work closely with the legislators on legislation and issues of importance to the aging community;
• Develop educational materials that can be used by legal providers, ombudsmen and the Aging Network in general; and,
• Assist in providing or monitoring fiscal management for funding for local legal providers.
While cross-comparisons of the responses cannot be made, the dramatic difference in the number of activities listed by SLTCOs and LSDs can certainly be read as yet more evidence that what LSDs do and what they are perceived as doing do not necessarily match up. At the very least they reflect the extreme variation in the duties of LSD from state to state.
The responses also provide clear evidence that SLTCO are supportive and desirous of LSDs expanding the scope of their activities in their states and being more involved in LTCO-related activities. My work as Vice Chair of NALSD has shown me that just because I do the job of LSD a certain way in Georgia does not mean that every LSD throughout the country does the job the same way. Quite the contrary. Just as every person is different from another, so is each state and US territory different from another; the same is true for each LSD in his or her own state.
Comments from Section 2 of the Survey
Two significant comments were made by LSDs in this section of the survey. One expressed the desire to be able to conduct periodic site visits to local legal providers because this is viewed as an essential duty for an effective LSD. The other comment came from a LSD who apparently is required to assist the SUA and/or umbrella agency in legal matters which are not related to elder rights and indicated this is an activity that he/she would not want a LSD to do.
Significant comments made by the SLTCO:
• The LSD will coordinate with the SLTCO office on legislation which concerns matters common to both only if the SLTCO initiates the coordination.
• It’s essential for an effective LSD to provide legal advice on issues affecting residents to the SLTCOP but our LSD does not. I believe that most states have an alternative resource to perform this function.
• On occasion the LSD provides legal advice on issues affecting residents to the SLTCOP and assists the ombudsmen in locating legal representation on problem cases.
• The SLTCOP wishes that the LSD could provide advice and representation to residents referred by the local LTCOPs and that these residents were a priority for representation by the Title III-B legal programs.
These responses demonstrate that, in at least four states, LSDs are either not maximizing or are not permitted to maximize the working relationship with the SLTCO. This relationship is extremely important to ensure effective elder rights advocacy.
Section 3: Describe the Working Relationship Between the LSD and the SLTCO
The results of this section are shown as provided in the survey in order to offer readers the opportunity to compare the responses. Bear in mind that the 10 SLTCO responding may not be from the same states as the 10 SLSDs responding.
SLTCO SLSD
|
True |
Not True |
True But Wish It Was Not |
Not True But Wish It Was |
|
True |
Not True |
True But Wish It Was Not |
Not True But Wish It Was |
|
7 |
3 |
|
|
LSD & SLTCO housed in the same agency |
10 |
|
|
|
|
2 |
8 |
|
|
LSD & SLTCO in the same unit |
9 |
1 |
|
|
|
4 |
6 |
|
|
LSD has staff |
|
6 |
|
3 |
|
1 |
6 |
|
2 |
SLTCO has staff |
7 |
2 |
|
|
|
3 |
5 |
|
2 |
LSD & SLTCO frequently consult on cases/issues |
8 |
1 |
|
1 |
|
|
10 |
|
|
LSD & SLTCO have personality clashes |
|
10 |
|
|
|
4 |
3 |
1 |
2 |
SLTCO respects LSD’s expertise, position, function |
8 |
1 |
|
1 |
|
|
9 |
1 |
|
LSD seems resentful of OAA status of SLTCO i.e. funding; legislative mandates |
|
8 |
1 |
|
|
2 |
8 |
|
|
Relationship between LSD & SLTCO has a negative impact on ability of SLTCO to do job effectively |
|
10 |
|
|
|
2 |
8 |
|
|
Relationship between LSD & SLTCO has a negative impact on ability of SLSD to do job effectively |
1 |
9 |
|
|
|
8 |
1 |
2 8 |
|
LSD could be more effective |
5 |
1 |
3 |
|
|
1 |
4 |
1 |
|
LSD is as effective as can be with current circumstances i.e. agency, legislative status, funding |
8 |
1 |
1 |
|
|
4 |
5 |
|
1 |
NALSD should take full responsibility for strengthening the position of LSDs |
2 |
8 |
|
|
|
10 |
|
|
|
If LSD position were stronger within the OAA, LSDs would be more effective |
6 |
1 |
1 |
2 |
|
True |
Not True |
True But Wish It Was Not |
Not True But Wish It Was |
|
True |
Not True |
True But Wish It Was Not |
Not True But Wish It Was |
|
8 |
1 |
|
1 |
If the OAA expressly authorized LSDs to advocate with legislators, LSDs would be more effective |
6 |
2 |
|
2 |
|
8 |
2 |
|
|
The SLTCO has tried to include LSD and local legal providers in trainings/conferences |
7 |
1 |
1 |
1 |
|
8 |
2 |
|
|
Neither the LSD or SLTCO should supervise the other |
10 |
|
|
|
|
|
9 |
|
1 |
The function of the LSD is not critical to the provision of legal services to other persons |
|
10 |
|
|
|
1 |
9 |
|
|
The LSD is not critical to the states focus on elder rights |
|
10 |
|
|
Comments from Section 3 of the Survey
Notable comments:
LSDs: "Even if the OAA language expressly gave LSDs the right to advocate with legislators as it does for the Ombudsmen, it would still not be allowed in my state."
SLTCO: "The fact that the relationship between the SLTCO and the LSD has a negative impact on the LSD’s ability to do an effective and productive job has more to do with the person than the position."
Survey Summary
As discussed above, the Legal Services Development Programs began in the mid-1970’s. Since 1984, the OAA has required SUA’s to assign personnel to provide state leadership in developing legal assistance programs. In the 1992 Amendments to the OAA, the Title VII Elder Rights section was adopted which included explicit language requiring each SUA to have a Legal Assistance Developer. Yet, for a program that has been in existence since the mid-1970’s, there is still a great deal of confusion about what the LSDs are required to do to be effective and how LSDs relate to other Title VII programs, including the SLTCO. That confusion exists among not only the SLTCOs but also among LSDs, SUAs, AAAs, and the entire aging network. Sadly, there is no official move to resolve the confusion.
While the first section of the survey dealt with major categories of responsibility and demonstrated a lack of consistency in understanding of what responsibilities LSDs actually have, the second section addressed specific activities in which LSDs can engage. It also presented a pretty detailed wish list of what can actually be characterized as needs identified by both SLTCO and LSDs. If these are things wished for, it is fair to say that these are things that are not currently being done in at least 1-20 states.
While attributable to several factors, it is also possible to read the low response rate to the survey as further evidence that some SLTCO may actually have no idea what their LSD is doing. I fear the other 10 or so LSDs who failed to respond may have failed to do so for similar reasons; either they are not sure they are fulfilling the role of LSD, or they could possibly have been so unfamiliar with the duties that they felt uncomfortable trying to respond to questions about them. Obviously other factors such as survey length, etc. could have played a role in the response rate. It is a certainty though that the types of activities wished for by the SLTCO and the LSDs are necessary for the building of strong Legal Services Development and Elder Rights Programs.
The LSDs discussed this presentation and this survey at the 1999 NALSD Symposium. We discovered that there is a need to make a place on our program to deal with these issues; to provide training and clarification on roles and responsibilities. We already share best practices but that sharing is going to have to delve deeper into everyday functions and duties. Unfortunately, every state has yet to see the utility of the NALSD Symposium. We have yet to have a meeting at which a representative for each state attended. This amounts to yet another barrier that must be overcome.
Conclusion
Well . . . as scrutiny goes, I’d say this experience was rather enlightening to me, if to no one else. Much work is obviously needed among LSDs to clarify our roles and responsibilities even to ourselves. That of course will be difficult with the kind of official guidance and support that we currently have in legislation. Add to that the vast latitude of SUAs to determine what each state’s LSD can and cannot do. AoA has provided some guidance on the issue, but has stayed away from making a commitment to ensuring that the position of Legal Services Developer is anything more than a mandated title that each state must give to someone. Unfortunately, that is all that some states have chosen to do. The failure to do more limits the ability of even the most dedicated and committed individual who wants to do all he or she can to accomplish what some truly believe is the original intent of the position: to use all available tools to be the state’s leader in developing and maintaining quality legal assistance for older persons and to be the foundation for the entire elder rights system and provide guidance and assistance on the legal rights for participants and beneficiaries of all the elder rights programs.
Obviously some LSDs have advanced a lot farther than others in seeking to establish the position and function of the LSD in keeping with this intent. That is in large part due to the individuals in those positions as developers and to the support that many of us get from our SUAs and AAAs and elder rights family members. Unfortunately, many LSDs have not been able to make these advances. In fact, it is probably fair to say that more have not than have.
Can Title III-B legal services for the elderly be as effective as it should be without at least one person in each state taking full responsibility for ensuring that all aspects related to Legal Services Development are in place and properly provided? No, I think not.
Is the LSD vital to the Elder Rights System? Yes. Think about it. Legal assistance is the one service that more often than not is involved in all of the other elder rights system programs. The same simply cannot be said for Elder Abuse Prevention, Long Term Care Ombudsman, Insurance Counseling and Outreach; further, although Advocacy permeates all the others, it still has legal as an integral and inseparable foundation. Therefore, it could be said that legal is at least an underpinning, if not the underpinning of the elder rights system. A weak legal assistance system, i.e. Developer and/or providers, will weaken the entire elder rights system or, at the very least prevent the system from becoming as strong as it could and should be.
The reality is that some individual LSDs do not do everything possible to accomplish the most that they can within the position given the parameters set by their SUA, AoA and the OAA. I look forward to collaborating with other LSDs to meet the challenge of working with those LSDs who are not active in NALSD so that as an organization we can do our part to ensure that all LSDs obtain the knowledge, resource materials, best practice suggestions, and support to become more effective in their own states. Right now this is the only opportunity we have to enhance and increase the quality and quantity of legal services to older persons, the legal support to other elder rights system programs, and the overall effectiveness of LSDs. Will that be enough to move State Legal Services Development from its orphan status in the Elder Rights System and the OAA to being a full-fledged family member, with all its authority, privileges, notoriety and respect? No.
You see, one can put an orphan in the same house with a family and give that orphan the family name but if you limit the amount of interaction the orphan can have with other family members, refuse to give him/her the attention, financial support, nurturing and voice that you give the rest of the family, that orphan can never be more than an orphan within that family.
Why should that matter? It should matter because of the ones who stand to receive the benefits: the most vulnerable persons sixty (60) years of age and older who need legal services and need a strong elder rights system in order to protect their autonomy, their dignity and their health, safety and welfare.
And if what we do is not being done for them, then why else are we doing it?
NOTES
1 The full survey is on file with The Center for Social Gerontology.
2 Older Americans Act § 307; Title Vii, Chapter IV.
3 Chapter II., pp. 1-4 of the Legal Services Developers' Resources Manual (1995) which was taken in part from a Memorandum written by Paul Lichterman in 1980, on behalf of the Department of Health and Human Services, the Bi-Regional Advocacy Assistance Resource and Support Centers.
4 November 14, 1995 letter to State Agency on Aging Directors and Legal Assistance Developers with a Draft Model Job Description for Legal Assistance Developer was distributed for comments.
5 Ibid.
6 AoA TA-76-42 defined activities for LSDs:
7 This was a blind survey and the respondents did not identify themselves or their states to ensure complete freedom in their responses. Therefore, the LSDs responding and the SLTCO responding may not necessarily be from the same states.
8 An SLTCO responding "True" also responded "True But Wish It Was Not True."