hearing on sexual predators sexual predators and nursing homes is now called the order the decision to put a loved one in a nursing home is never an easy one to make for most it's emotionally fraught and painstaking process but once a selection has been made most families take comfort in knowing that their loved one will be well cared for and looked after for america's elderly and impaired nursing homes have historically been places of security and yet for many residents that is no longer the case as a result of insufficient data and conflicting regulations sex offenders have managed to infiltrate many of our country's nursing homes and today millions of our most vulnerable citizens remain at risk in this morning's hearing we will discuss the threat that sexual predators pose not only to our elderly but also to the small health care providers that protect them this troubling issue is of particular concern to our committee given that the overwhelming majority of nursing homes are also small businesses according to a two thousand and six g a o report close to three percent of nursing homes are now harboring sex offenders and for these people at vance ng age is of little hindrance in fact the belief that older sexual predators are harmless is a dangerous misconceptions studies have shown that sex offenders continue to be violent well past middle age and is also worth noting that not all nursing home residents are elderly the truth is that these facilities are often home to younger people with serious mental and physical handicaps these younger residents can be both victims and perpetrators of home nursing home violence the question is how did these predators break  long term facilities this is at least partially the result of unreliable detection systems while the national sex offender registry attempts to name all convicted sex offenders there are notable holes in the database for one the registry fails to include predators that were convicted or released from prison prior to its one thousand nine hundred six inception in addition to this problem recent offenders often failed to self identify and therefore cannot be added to the registry at all as a result of these two system flaws g a o believes that the registry undercount sexual predators by nearly sixty percent given the database is limited reach it's reasonable to assume that nursing homes may house more sexual and the three percent originally thought a tangle of conflicting rules and regulations have made it all but impossible for facilities to address their problems with sex offenders small health care providers are now governed by some seventy pages of fine print in the code of federal regulations as a result the system is a challenge to navigate this is particularly true when it comes to reconciling safety policies with privacy concerns once a sexual predator has been identified it is often difficult for a facility to act on that information under the health insurance portability and accountability act commonly called hipaa for example sharing information about prior convictions can in some cases be considered a privacy violation and in fact nursing home staff and residents families are rarely informed of the status of residence offender status in an attempt to fix this broken system one state is already moving forward following a series of incidences in oklahoma nursing homes to state legislature passed a bill to create separate facilities for sex offenders in doing so they hope to attack this issue head on and set a precedent that can be a model nationwide today we will discuss that particular piece of legislation and look for other potential solutions to this problem nursing homes have traditionally been a safe haven for america's elderly and disabled and it's important that we do everything in our power to keep them that way with that i would like to thank all the witnesses in advance for being here and turn it over to my good friend the ranking member ms fallon from oklahoma for her opening statement and i would say that she deserves the credit for this hearing this is something that oklahoma her home state has taken the lead on this was her idea to put this hearing together i thank her for her leadership on this and would turn it over to her at this time thank appreciate your very kind words but more importantly i appreciate your assistance in putting this hearing together and allowing us as the opportunity to come together to discuss a very important topic and i will say that i'm very proud of the state of oklahoma and our legislature and our governor and working together in a bipartisan manner to tackle one of our states and one of our nation's most important issues and that is protecting our seniors and those  long term care or nursing homes and so thank you to all of our panelists who have joined us today and our expert witnesses and i thank you and your committee and all they have done to put this together along with my staff who i know is work very very hard well as has been mentioned we're here today to discuss the impact of predators on long term care and small business operators and most of our nursing homes and our long term care facilities are small businesses and that's that's why you're for the small business committee to find an angle to get yours so we could talk about this important issue and the purpose is to examine the impact of the placement of criminals and sexual predators on the operations of small businesses that have long term care  facilities and this is a very important issue because it affects many of our parents our grandparents our answer uncles our friends across our country federal law and regulations are designed to ensure that residen and nursing homes have certain basic rights and clued ng to be free of physical harm and abuse these rights are frequently intersect with the placement of individuals in nursing homes who have a record of physical assaults including sexual predators seniors residing in assisted living facilities are some of the most vulnerable of our citizens any time their safety or their health is threatened is both concerning and alarming as someone who has had a mother and i will even say two grandmothers all in the same facility at the same time in a nursing home in my home town were represented crystal represents into kemp's oklahoma and i have tremendous respect and tremendous admiration for the services that the nursing home sensitive states provided to my relatives and i just want to say out front that nursing homes and launch into europe are still these deserve our respect as were discussing this and they have a very special job and it takes a very special person to have a job in a long term care facility or a nursing home to care for the elderly and the infirmed but in some instances have over these facilities and their staff can be unaware that there could be predators living in their facility or even without the means to ensure the safety of their residents the rare cases of sexual assault and abuse have been documented in these  they are particularly poor and i handed this hearing this week to investigate both the scope of the problem and even possible roles that the federal government might play to help eliminate it and i sure am looking for to hearing from her nursing home representative mr coble today who i know is just as interested in this topic as we are in taking care of our elderly and informed infirmed and i know that he wants along with his industry to guarantee the safety of his employees the safety of his patients in the seniors and even for the families who are abusing this illinois my kickstand a very special welcome and thank you to all of our witnesses who have traveled a long ways to join us here today and spend their time to provide your expertise and as i mentioned i specialized to welcome our state representative crystal who's the author of the oklahoma legislation who held many hearings in our state list all sides all parties involved in this very important issue and i know brought industry together along with families along with patient advocates and the legislators and of course the executive branch of our governor to pass significant first time model legislation our nation to be able to separate out sexual predators and have some options for states to be able to look at that and so i appreciate you coming today i want to also say a special welcome to mr coble who is representing the health care nursing home industry we appreciate him coming today i told him you know our purpose today is not to knock around nursing homes or long term care facilities but to work with you and to do the best we can to create a safe environment because we do appreciate and respect the great service that you provide in our nation he has been a longtime owner and operator of nine long term care facilities and then w what with a perfect cause has started this crusade many many years ago it's been around the state of oklahoma for a long time lobbied me when i was lieutenant governor of oklahoma on this particular issue and i know him as a work with our you do he has tremendous documentation on this subject across the whole nation not just in our state but he isn't a lot of research is personally affected him and his family and they don't want to also thank senator banning his joining us here today who lost her mother as a victim of sexual assault in a florida in a nursing home and i know this is a very important issue for you and you're very passionate about it and she has been seen on national television giving information about how important it is that we try to work together to do what we can for our seniors some long term care people and then mr down here i haven't had a chance to meet but we welcome you and i appreciate you coming today to lend your expertise and thank you for being here and just welcome to our committee you know that your information be extremely helpful i want to just say a couple things and i want to go too long here but according to the most recent compilation of so to six the center for medicare and medicaid services estimates that there are fifteen thousand seven hundred sixty two nursing home facilities in the united states with one point seven million beds and slightly more than forty percent forty six percent a nursing home facilities in the united states are independent businesses and not associated with another nursing home over two thirds are operated for for profit bases and those approximately eighty one percent had revenue and are ten million dollars and short are nursing homes are highly localized mostly small business have no enterprise controls more than five percent of the beds in the no enterprise controls more than five percent of the beds in the industries and nursing homes of course play a critical role in providing the care for americans who are physically or mentally unable to take care of themselves and don't have a loved one who can help them federal regulations established a rise of nursing home residents which include the right to be free from physical abuse including sexual abuse and to reside  environment that maintains her dignity and quality of life as a condition of medicare medicaid participation nursing homes and long term care facilities mess report incidents of abuse according to state requirements our nursing homes and long term care homes faced divergent and conflicting federal laws that make it difficult for them to satisfy the multiple mandates that are put upon them depending upon state regulations many long term care facilities and their residents may not be aware that there are residents who are fenders though all sex offenders are required to register by an actual national sex offender registry twenty five percent of them never do register and the extent to which states require and have laws that apply to sex offenders registering and reporting to the long term care facilities greatly varies while facility residents are known offenders different ng when facility residents are known offenders differing interpretations exist among the sites themselves and the industry and even federal officials whether to disclose the information and the chairman mention it amend to go that it could violate federal state privacy laws but in some instances long term care facilities are not always notified when individuals with prior convictions and or in the assessment tools for these facilities to determine the health care needs of the residents typically do not give their information about prior convictions and so on dish in addition that there is no federal law to notify a long term care facility of a sex offender who has been placed in their facility and that is one of our main concerns so we in congress must look at federal law to ensure that there is a healthy environment long term care residence when it is free from ballance in abuse to federal residents shares fellow residents and it is important to make sure that sexual presidents predator data is accurate and available to nursing homes and their families so that we can assure that they will be protected in these facilities so thank you so much for joining us here today we are looking forward to your testimony and th we will now move into the testimony from the witnesses we will introduce formally each of you want at a time ms fallon winner douceur four witnesses on or deuce mr mcdonough before each of you go i want to explain the five minute rule many i'm sure have testified before you will have five minutes for your testimony there will be a green light for the first four minutes when you see the light turned yellow that means you have one minute remaining if you could start to summarize the red light means your five minutes is up so please conclude your remarks at that time at this point we turned over this file and introduce representatives do this chairman chris still is our state representative from oklahoma who is author of the law he represents the twenty sixth district he has been a member the house and two thousand one he's a member of the public health committee better and subcommittee human services committee answers as chair of the health subcommittee and alleged fighter he was very instrumental in passing this bill which will establish separate and secure long term care health facilities for violent sexual offenders the bashers degree religion and a masters and al so associate minister is associate minister with wesley united methodist church in shawnee oklahoma and we're glad to have you here thank you for coming thank you very much bill good morning i would first of all like to say thank you to congresswoman fallon mr chairman and members of the committee on small business it is indeed an honor and a privilege to participate in this discussion with such distinguished group of individuals greetings from the great state of oklahoma i'm here today to talk about the impact of predators in long term care facilities on small business operators let me begin by saying that protecting senior adults especially those who are vulnerable should be a primary function a top priority of government this year the oklahoma legislature enact as a proactive measure intended to reduce the risk of abuse and provide appropriate safeguards for seniors living in their sing homes a growing number of registered sex offenders sparked a discussion of where to place those individuals who have served their time of incarceration and yet are no longer capable of independent living and in depth study on this issue resulted in the creation of house bill twenty four zero seven which directs the department of health to request bid from the private sector for the operation of a standalone specialized long term care facility that will house elderly sex offenders registered sex offenders the request for proposal will also set forth certain specifications to designate the heightened security measures necessary to protect the public and the residents of the said facility according to the oklahoma department of corrections an estimated two thousand four hundred fifty inmates commit convicted of sex crimes or violent crimes will be released from prison in oklahoma in the next ten years twenty six percent of these individuals will be age fifty one or older and potentially in need of long term care numerous studies confirm that certain sex offenders are highly resistant to rehabilitation registered sex offenders living in the nursing homes can create a dangerous environment for the other residents in the home it is estimated that approximately thirty individuals listed on the oklahoma sex registry offender registry currently reside and nursing homes today in two thousand and five oklahoma passed a law requiring nursing homes to post public notification when a registered sex offender is admitted this measure also directed the department of corrections to notify local law enforcement entities about the location of sex offenders residing in their homes within their community however because of low staff levels in a short supply security guards some long term care operators have experience difficulty improperly monitoring sex offenders residing in their facilities federal regulations also prevent nursing homes from restraining residue it's except in very rare circumstances offenders living in a nursing homes also presented a challenge for small businesses knowing in offenders living in a particular facility creates a sense of unease enos a sense of unrest and a sense of uncertainty for family loved ones and the other residents the perception is that no one is safe in a home with an offender yet federal law all requires that states pay for long term care services for those individuals who are medicaid in medicare eligible regardless of whether or not they're convicted felons an interim study conducted in the fall of two thousand and seven result of the nursing home officials encouraging lawmakers to prevent those six offenders those convicted the six crumbs from be emplaced in with the general population in addition advocate groups such as a r p and others expressed support for the establishment of a separate facility for registered offenders in need of long term care by encouraging the private sector to stablish a nursing home with additional security measures for registered offenders it is the belief of our state that better protections would be afforded to the aging population while meeting the needs of those who have served their debt to society yet remain at risk of reoffending protecting our senior adults again should be a primary responsibility and probably already of government our goal should be focused on creating safe environments so that our senior adults can live the latter part of their lives free from the fear of harassment or assault implementing appropriate safeguards for the elderly is imperative in making this goal a reality again thank you for the opportunity to address you about this topic right thank you so much represent is still our next witness miss manning and she's a mother a victim of sexual assault in samsara her mother was a victim of sexual assault in jacksonville florida nursing home she was featured on the today show broadcast in april as an advocate for nursing home resident protection from sexual offenders she's also appeared on c b s evening news along with other media and one with other media from around the state of florida and she is  serving as the medical staff manager for the u s navy medicine support command in her capacity which she has had for fifteen years and has been a government employee for over twenty eight years and we welcome you and thank you for coming to share your very p story thank you congresswoman fallon chairman outlier distinguished members i've never dressed such an august body before so if my lips trembled please forgive me july twenty third two thousand and eight today july twenty third two thousand and two six years ago today i'd be edwards took his wheelchair into my mother's room he placed that wheelchair under the handle of her door turned it sideways so he couldn't be disturbed he climbed into bed with my mother and he raped her i received a call that night from the nursing home staff and said mrs banning we caught a man in bed with your mother but he was just lying there nothing was going on she's asleep do you want to send her to the sexual assault response center and i said are you sure nothing happened they said yes he was just lying there i suppose god sakes don't scare to death no don't wake her up the next morning at work ten o'clock i received a call from the social worker from the same nursing home said mrs banning more courage last night than we originally told you and we're going to have to send your mother to the sexual assault response center i said you not senator anywhere till i get there so when i got there i was met by my mother by the police by the members of the staff and my mother looked at me and said hi and i said hi mama and i said do you know why i'm here and she said for a visit and i said no as i said i'm on the last night you were right my mother's expression was oh my god my worst fear was realized i place my mother in a home for care so that she would be safe because in her own home she walked the streets at night and i would say mom what you're going to get right to if you walk the they put everything in for evidence i'd be edwards was taken to police before i was ever called to tell be told that she had been right when i be edwards was arrested it was his fifty ninth arrest had been arrested since the nineteenth forty's among them sexual assault child molestation burglary heinous crimes but the court system placed v edwards in the nursing home with my mother from a homeless shelter because he was a danger to society and others no one not my mother not her family not her daughter should have to hold her hand wash she undergoes sexual assault examination and watch the tears streaming out her face because someone had taken from her which she did not give voluntarily my mother was married to my father for twenty three years to the best of my knowledge no one ever touched my mother except my father until  control so what i ask is that congress take steps to put in place a regulation a law some sort of guarantee that your mother your father your brother your sister yourself won't be out there and placed in a home with another i v edwards we have to make a change we have to protect those that cannot protect themselves we protect the children but when you look at our nursing home residents there are two three four five years old in their mind so let's protect them too thank you so much for the opportunity to address and i appreciate and i hope so much that we can make some changes thank you mr fanning we are appreciating your sharing such a very personal story with that as in and we will use what is meant for evil for good here organization he has been very tired most and his work that he has began on a disabled and elderly after the death of his own grandmother in may of two thousand and alan he uncovered her nursing homes attempt to cover person on this particular issue and with us we appreciate all your research in your work and push you come in today give testimony thank you congresswoman and thank you mr chairman members the committee and staff i think for this opportunity talk about the impact of predators and long term care facilities and small business operators printers and nursing homes are bad for business much like a dead canary in a mind it is a signal of invisible danger that requires immediate action so too the predators in nursing homes have a lot of information that i can share with you today and so i'd like to just get down to  key bullet points and hopefully you can ask questions and i can provide more detail to you as we move forward what's this about and this about the delivery of a product good quality career in nursing homes which is mandated by federal legislation by state legislation across this country we're talking about rapes sexual assaults physical assaults and even murders committed by violent and sexual offenders who reside as residents in long term care facilities so far we've document over sixty of these crimes committed by these offenders against residence female as well as male staff and even one three year old little girl who is visiting her great grandfather in a richardson texas nursing home one of the types of centers and we've mentioned richard sex offender is a problem but there's other types of the fenders we have key concerns about and those offenders include inmates parolees violent offenders found accomplish stand trial mr chairman as you pointed out it's not just registered sex offenders there are many sex offenders who are not required to register they were grandfathered out before the registration laws registration laws were  enacted and there's also richard sex offenders who don't have to register for life we also have convicted felons and then we have a group of residents who assault others in long term care facilities with a never charged or prosecuted because either they or their victim are diminished capacity who places these offenders in long term care facilities district court judges county sheriff's adult protective services organizations departments of corrections and sometimes there are agencies to find housing for offenders being released from the parma corrections facilities as well as individual offenders commit themselves or their families and with them into these facilities we've heard all kinds of justification which we refer to as fairytales used by officials to justify the placement of these residents in facilities we hear that there are all old not true much like the g a o report is documented in the reports and we have also conducted over half of these are fenders are under sixty five years of age with down one thousand year old wretch or sex offenders living as residents in nursing homes old offenders don't pose a threat i v edwards is one of those examples there are other examples were elderly offenders do absolutely pose a threat to their incapacitated and will cheer as they can't harm anybody again not true i v edwards's in a wheelchair and other offenders those with partially amputated feet have also raped and assaulted fellow residents in long term care facilities they were told the child molesters say because they don't pose a threat to those old people again documented cases that we have provided to this comm e through court records police records and media reports show again that that is absolutely false nursing homes are capable of handling these offenders there is not any training for nursing home staff and how to deal with these criminal offenders or the prior offenses are minor or these crimes happened long ago again not true most of these crimes again being committed within the last fourteen years that with found these offenders living in long term care facilities in the crimes the crimes are committed for we're not out you're in aiding in public behind a bush or in the alley these crimes are rape assault and murder these offenders are paid their debt to society we've heard that a lot we have documented cases where fenders were sent directly to nursing homes and other long term care facilities well ever going to a department of corrections facility they went from jail on a conviction to a nursing home and even a doctor this where they said that they pose a serious threat to the safety themselves and others what can we do we have several recommendations i'd like to respond to during the question period and i can share those recommendations with you thank you for this opportunity come forward i hope tonight that founder and c e o of healthcare management company about to hama which specializes in creating long term care based integrated hared health care delivery systems and h m c partners with organizations to evaluate develop and operate medicare advantage special needs plans for its two tional and community based health care plans health community based health plans he also owns and operates eight skilled nursing facilities and assisted living facility in a rehabilitation company and is the president of the oklahoma socialist health care providers and we appreciate you joining us here today well thank you thank you chairman all our ranking member f and members of this committee i am grateful for the opportunity to be with you here today to offer our professions perspective on the very difficult and complex issue of sex offenders in our nursing facilities i'm honored to be here today representing the american health care association americans are living longer in our nation's aging population is growing many of these individuals have medical and cognitive conditions which require care in a nursing facility currently more than three million americans each year rely on the care and services delivered in one of the nation's nearly sixteen thousand nursing facilities the forecast for the demand for nursing care is alarming a march two thousand and eight report from the net from the national investment center for senior housing and care industry indicates the man for long term care services will more than double by two thousand and forty even with this high demand and rapidly growing need of the nation's aging population nursing homes have continued to improve quality and proud of the efforts and initiatives advanced by the association that i represent today and seek to enhance improved quality of care and services provided in our nation's nursing facilities each day i'm here today to discuss the impact of predators and long term care on small business operators reported problems involving sex offenders have been rare but any incident is unacceptable expansion given the age and infirmity of those involved some of stated that there is a simple or easy solution to this very complex issue but unfortunately that is just not the case providing long term care and other health services for those who have any topic criminal past as a critical societal issue any solution must in compass not only health care providers and their patients but also law enforcement and federal and state agencies the basic question seems to be lot in whose ethical and legal obligation it is to ensure that individuals who have paid their debt for prior criminal activity have their healthcare needs met as members of our society when these individuals reach an age or exhibit physical condition or cognitive impairments that require long term care services wherein how should their health care needs be met to insure everyone safety and security as you're aware nursing homes provide a residential setting with twenty four hour care and services for millions of individuals who require significant assistance due to physical or mental limitations it is critical for this committee and others to understand that these facilities fill necessary role caring for the frail elderly and disabled who can no longer safely be cared for in their homes or communities the most important aspect of the charming appropriate services is in any nursing facility patient includes including security issues is the individual patient assessment currently a federally mandated assessment must occur upon admission to a facility in order to create an individual care plan for each resident that ensures their clinical needs are met as well as addresses any safety or security concerns a resident who is known to have a criminal history is known to be a registered sex offender and may or may not require additional supervision or separation from the general facility population and the it individualized care plan for convicted criminal or sex offender in a persistent vegetative state would clearly be different from a nambla tory resident who has no criminal past but has exhibited behavioral issues in two thousand and six the g a o issued a report on registered sex offenders in long term care facilities while the study focused on the issue sexual offenders residing in there as in facilities we were dismayed that the report stopped short of issuing any recommendation about the profession should address this issue presently in most states long term care facilities are not notified by law enforcement officials of an incoming resident status as a sex offender or their criminal background which prevents a facility of accurately evaluating the potential risks posed by the former sex offender as an individual basis while the patient's history may contribute to an alter the individual care plan is important to understand that even with the information about a patient's criminal past long term caregivers might be unable to deny admission when placement is court ordered also of note or the strict federal and state discharge requirements which may prevent the timely discharge of patients discovered to have a criminal past or more significantly be exhibiting behaviors that actually pose safety and security issues health care providers government oversight agencies and enforcement must come together whether on a state or national level to begin to address reasonable and appropriate solutions to this growing cause deeply concerned about the issue of sexual predators in nursing homes and will continue to work to ensure all residents family and staff are safe in their facilities however specifically is can only do so much in the current system  national database of sex offenders as well as a consistent standard definition of the term need to be created in policy makers law enforcement also have a responsibility to provide clear policies for long term care facilities to deal with this issue that addresses resident protection as well as compliance with federal privacy laws cause committed to quality long term care for all residents and we are continually working to improve and enhance quality in all facilities a collaborative effort between long term care providers cronk congress and law enforcement is necessary to achieve the highest levels of safety for all residents i would like to in my testimony today on a personal note i have four family members living in our facilities right now including my mother and my wife's grandfather i live in the community where i was born in will be buried every day i help to take care of the people who help raise educate and prepare me for life i take the responsibility of caring for them very seriously and i strive to provide the highest quality of care possible long term caregivers have many employment choices but they choose to come to work in our facility each day providing care to the  society they are heroes of long term care and i entrust the care of my loved ones to them each day thank you for the opportunity to offer these comments on behalf of millions of professional compassionate long term caregivers in the millions of frail elderly and disabled americans i serve each day i look forward to responding to your questions thank you mr coble mr mcdonough mr sean mcdonagh is an attorney from pennsylvania and his law firm recently represented the victims of is an assault in a nursing home and in that case the court found that a nursing home was negligent in allowing a resident with a criminal background to be enrolled in the facility without notifying the residents are taking steps to protect their safety mr mcdonough is a board certified in trial advocacy by the national board of child advocacy and a member of the american board of child advocates thank you for being here mr dunne and we look forward your testimony good morning congressman meyer ranking member f and members and staff of the committee i have been asked to provide testimony this morning on the issue of the impact of predators and long term care facilities on small business operators as the congressman noted my firm myself and my partner pat daugherty recently represented a woman by the name of lillian guernsey who's now deceased and her son thomas an early arising out of two documented sexual saw perpetrated upon mrs guernsey by thirty one year old daniel to state them overview of the circumstances surrounding mr state thems admission to the country living personal care home demonstrate in graphic fashion the need for some legislation to assist small business operators in avoiding the myriad of problems associated with accepting sexual offenders at their facilities without appropriate screening or consideration as to whether these individuals should be accepted into a setting where some of our most vulnerable citizens are placed for care steps need to be taken to ensure that our elderly and infirm citizens country living personal care home he had had prayed eight prior adulteress three convictions and two adult commitments to correctional facilities in one thousand nine hundred two alone he had been charged with no less than eleven offenses some of which were violent offenses and many of which he was not prosecuted for because he was determined to be incompetent to stand trial however in one thousand nine hundred four state them was arrested in lackawanna county pennsylvania as a result of an assault on his girlfriend and he was sentenced to serve one to three years in prison shortly thereafter he pled guilty to a charge of aggravated indecent assault in northeastern pennsylvania in wayne county and was sent to serve three to six years in a state correctional facility in that case state them a taking a thirteen year old girl into a wooded area and raped her state them refused to participate in a sexual offender treatment program during his period of incarceration and as a result he maxed out a sentence and this is where the case really becomes troubling at the completion of mr state's thems sentence he did not provide the commonwealth of pennsylvania with an address where he could go as a result of that the commonwealth directed the state police to take him to the northumberland county prison at that time the judicial system in northumberland county brought state them before the court  and he was sentenced to time served and six months excuse me six months probation when the court made an inquiry as to whether that probation was in the mitigated range for the offense a probation officer indicated quote i have no idea we have no information on the defendant at are four states and was permitted to leave the prison and taken first to the omni one personal care home and then country living without even a rudimentary pre sentence investigation having been performed the order of court which we've incorporated into the materials which we submitted for the consideration of the panel stated the following the court directs the defendant to take a bus to a halfway house in scranton and to maintain his residence in north county it was established during mrs guernsey's trial against country living that northumberland county prison officials had notified the personal care homes both personal care homes where mr state them h resided prior to the rape that he had been sentenced for a violent sexual offense and that he was being released directly from a correctional facility lilian guernsey was raped on february twenty seventh two thousand and two my partner and i tried that case exactly four years to the day beginning on february twenty sixth of two thousand and six the events of february twenty seventh two thousand and two could have been prevented if the some initiatives which mr bledsoe has been proposing around the country had been implemented the sexual offender assessment report which i have referenced in the materials provided to the panel  indicate in graphic detail the indignities visited upon lillian guernsey by daniel state them on that tragic evening lillian story needed to be told as to what occurred to her on that evening and her victim and victim on unfolded during the trial which occurred after she was assaulted lilian returned to memphis tennessee with their son tom and he cared for his mom in his own home as best he could but she lived out her days in a nursing home outside of memphis william guernsey died within two months of the conclusion of the trial brought on her behalf against country living personal care home she was ninety years old at the time of her death as a result of the attack on daniel states and was charged with rape sexual assault and indecent assault he currently is serving an extended prison sentence at the state correctional institution it can pill as a final observation i would suggest to the members of this panel with the very honorable work the original in here today that some initiatives need to be in place by the time daniel states them is released from prison thank you thank you mr mcdonough and thank you to all the witnesses will now enter into the question answer portion and what we'll do is a couple of rounds i'll ask a few questions and turn it over to this file and then we'll do it again i wanted to start with mr blitzer we appreciate you being here with the expertise that you bring to the table on this issue and states have widely differing procedures regarding the issues that we're discussing today and i wondered if you had some recommendations on states in the country that we could use as a model that have taken the leadership role and taken steps to address this issue and work congress to get involved on the legislative side what states could we use to to exemplify with regard to this issue represent of steel senator tom adelson from oklahoma a ten percent of the legislators in oklahoma co sponsored this bill the long term care sex offenders bill out of twenty seven zero four in oklahoma that bill separating offenders from non offenders is the most concrete legislation that we can do at the federal level and at each state level it absolutely removes predators from the price so that would be my first recommendation sekret condition is we need to you need to do criminal background checks on all residents coming into facilities illinois conducted criminal background checks on their residence and while we document about one hundred retro sex offenders living as residents and long term care facilities in the illinois when they did criminal background checks they found over a thousand convicted felons were living in their facilities so criminal background checks will answer a lot of questions in response to some issues that mr cole brought up about how we screen these people and how we decide what kind of level security we need to be providing for them notification is an absolute necessity between a criminal background checks and until the time we have these secure long term care facilities following oklahoma's example in place staff residents families and visitors these facilities absolutely need to know if there's a cruel offender in the facility oh home is one of those states that has some of that notification would like to see more we also need to make sure that crimes are being reported to law enforcement many of these crimes are never port of law enforcement there needs to be legislation to make sure that crimes are mandatory reporting law enforcement when they're found or suspected there are statutes across the country with this with the relatively loose and they need to be tightened up another recommendation is we need to absolutely track these criminal offenses that take place in  long term care we need to track the offense where it occurred as well we need to track the offender when an offender commits a crime long term care facility if we haven't already done a criminal background check we need to do a criminal background check on that offender and see what kind of history they had that way in the future as we move forward with this system we can monitor it we can evaluate it and we can modify it accordingly and then we should also look at video monitoring and make that an option for residents who want to have video monitoring in their rooms in this way we can see who it is it's been assaulting them in a dignified whether that's a staff member whether it's a visitor or has a fellow resident and who it is so we can take appropriate action mr mcdonough in your lawsuit the court found that there were no reasonable attempts to create safeguards to protect residents can you identify some of the basic steps that nursing homes can take moving forward to address this type of problem i think in and i'm sensitive as congressman not meyer to mr calls concerns relative to the management of risk and i think that the nursing home industry in the personal care home industry should agre look toward government i know regulation is typically considered to be a bad thing but in this particular instance it's a good thing in our case as i tried to highlight unfortunately the criminal justice system in the court was essentially complicit in the victimization of mrs guernsey and it seems to me that the most appropriate step has to be a very detailed reporting requirements with respect to pas criminal history so that nursing home operators without unnecessary government interference can certainly have the tools available to them to make an informed decision as to whether or not a particular individual is an appropriate candidate for their facility so it would seem to me that particularly when someone is referred to a long term care facility directly from the criminal justice system as was the case with daniel state them that the referring agency should have an affirmative obligation to specifically detail that individual's past criminal history i think is a threshold that is that is a very minimum requirement that could be instituted in that case the now in our particular case it was established that the owner of the facility didn't fact or had been made aware of mr state thems background so that wasn't quite as much an issue in our case and it was one of the things that the court found to be particularly egregious about the holmes conduct but there has to be knowledge on the part of the operators of these facilities as to the the nature of the person's prior offenses so do you believe mr mcdonough th e state registries and background checks are adequate safeguards or you're recommending them as a minimum well there's certainly a minimum safeguard and then there has to be some some additional consequences for the failure  properly notify the personal care homes in the nursing homes about the person's background here we had a breakdown in two separate probation departments one in wyoming county where the personal care facility is at issue was located as well as northumberland county so certainly the registration procedures for meghan's law offenders in the commonwealth of pennsylvania which is currently in place needs to be enforced and i think that federal congressional oversight of this issue is certainly warranted in light of the tragic consequences that have been documented before the panel this morning thank you and i'll give one more follow up question to mr coble and then we'll turn it over to congresswoman fallon you've heard what mr blitzer mr mcdonough the other witnesses have said well what is the impact on the nursing home industry of this type of recommendation a notification where everyone coming into the nursing home would be aware of the background of everybody else in the nursing home as it relates to this issue what would that do to your industry well we sort our industry certainly agrees mr chairman with the need to be notified and we don't want to take anyone to any of our fill these who is a danger to any of our residents our visitors our staff  anyone we need notification we need databases that are accurate we don't need the courts ordering people and there are facilities that are a danger to anyone  be there and so our industry is for quality and safety as i said my mother lives there i'm not going to put anyone in one of my facilities that would harm on the other the the other thing that will be a challenge to our legislation in oklahoma is proper federal privacy laws as the health department starts to build a framework around the legislation that was passed and also some very strict federal regulations around discharge and transfers of residents who reside in our facilities many times we want to move residents from our facilities and we cannot do it because federal law prohibits us from being able to do that and so it would be very helpful you can do many things up here that would allow all the legislation that we  oklahoma to advance mr chairman to follow up on your comment tom about federal law prohibits you from transferring do you find a little bit further if if you have so if you know that you have an offender in your home are you saying that you're perhaps it from transferring them if we if we have someone in our home whether it's a sexual predator or someone who has some really inappropriate behavior that could cause them to be a safety or a danger to another person we it is very difficult to transfer them they have to be a danger to themselves to the point or to others that we cannot meet their needs or bicycle or the fact that they're just not paying for their care and so those are the only two circumstances for which and then at that point point in time it's very difficult to get them out because the department human services with on been intercede on their behalf and we're not allowed to get rid of them and that's why you know the legislation that representative still came forward with and and championed i mean all parties sitting in this type bill were locked in arms in support of and so we need a place that when we do identify them that if as a small business owner it's causing concern and distress to family members residents staff that we can then move that person to are there any challenges you see with medicare medicaid as far as receiving federal government help to house these offenders to be able to put them in a separate standalone facility like the legislation oklahoma's past you see any type of hend stanfield you know anything we need to be addressing on the federal side well i would reiterate the fact that both medicaid and medicare are entitlement programs and as i understand both of those programs of a person qualifies meets the eligibility criteria then he or she is eligible for the funding for those long term care services and with the legislation that we are talking about today this standalone facility is a nursing home it's not a prison  meaning that the residents in that facility would be treated just like other nursing homes that would have stricter supervision a higher level of surveillance and security but the residence was still be free within that facility and today i'm not aware of any thing that would prohibit medicaid or medicare funding for individuals who may be placed in this particular facility are there any changes  see that the nursing home industry would need to be able to have this separate sanlam facility in law well in oklahoma we are primarily a rule say we're proud of that fact  have a lot of nursing homes in our state that are at or below capacity right now and so i think the idea for what we want to do in oklahoma is to utilize an existing building for the operation of this the industry would have to meet the additional security measures that the department of health will create as they continue to put together the request for proposal in order to qualify as a potential president or potential shown you talked about some of the legal issues how do we address the privacy issue of the patients versus actually being able to get good detailed information that mr kobler so that he needs how do we be able to balance the two well i it certainly is a question of balance i think as i indicated in my in my earlier remarks first and foremost is to have an a and adequate criminal background check on the individual and there are there are existing laws in place on the state level that require registration of particularly in the case of sexual offenders and i think while there are other violent type people in these in these holmes that criminal background checks on these individuals for convicted offenses in my view do not implicate the privacy issues that exist with respect to health care  records say if someone is diagnosed with a with some type of a mental illness that's an issue separate and apart from the the criminal background that many of these people bring to the facilities so i don't see a privacy issue with respect to the criminal predators with respect to violent tendencies is a function of mental disability that's an in that's a different issue congresswoman that candidly i don't have the answer to well i think most of the changes in the law really give us the freedom to operate don't have a cost to them but we feel that the criminal background checks should be done  enforcement or started agencies and provided at a point where we can access them and look into them because they have access to the information and the ability to assimilate that so that we can i want to ask represented steele a couple questions about his bill provide for the creation of a separate facilities for sex offenders and i'm interested in the cost of this is this something that you feel that there's adequate support in the nursing home industry that they would operate this independently and feel like they would be able to make money doing this and do it on their own or is this something that you would need state or federal money or some other source to help fund it's a great question and i appreciate the question the idea at this point is to put together a quest for proposal and allow the private industry to use an existing building so that there would be no money in new construction other than perhaps what it would take to bring the facility up to meet the heightened security and surveillance measures that the department of health would put forward i can only reiterate what mr coble has said in the beginning we worked with the industry and with the advocates for a number of years to get to this point and again i think the idea is to not use any taxpayer dollars necessarily or any more additional money for sex offenders in need  of long term care rather we want to try to do in a fuss situation that can truly be a win win situation a win situation in reducing the risk associated with a very vulnerable population of people who are currently living in our nursing homes in a win situation for those individuals who have served their time of incarceration are registered sex offenders may be prone to reoffend and in the of long term care thank you and on that same note with the process governor henry recently signed the bill and you passed it and acted it now can you talk a little bit about any opposition that may have come up where there advocacy groups or for some group on the other side what did you have to overcome as far as points against the legislation as it was moving through the process well with an issue like this as much as anything it comes down to communication and i think because we've been work on this particular issue for a number of years with people from the industry people  within the avoca c groups in really tried to take our time and understand and communicate along the way we haven't experienced a whole lot of opposition because people seem to understand what we're trying to accomplish with this pick particular piece of legislation and it has been truly a bipartisan initiative i mean without governor henry's help without senator adelson who is a different party than myself working and working hard for this particular just place in the senate would never have become a reality but truly this is one of those issues that transcends party politics it transcends the political minutia that sometimes we can get caught up with it's an issue that is truly about helping people and and we feel like that we've at least come up with an of all the recommendations that you've heard today being someone who has had to deal with this personally have you found this these suggestions to be helpful to protect a senior like your mother or are there further steps that we need to be taking this is probably been one of the most exciting days i've had to hear the suggestions wes and i have had dialogue over the last few years he's told me proposals i've done research on my own my biggest concern i have the edwards was found unfit to stand trial put in a mental institution was released in two thousand and five back into the nursing home so he's out there again he's eighty eight years old just a measure to prevent that from happening a separate facility if these individuals were done a five a floor of a facility a wing of a facility to let the family speaking as a family member had i know that there was someone that could have caused harm such as ivy or words to my mother i would have left her there for one day i think that the families deserve to know they have a right to know who's they are so background checks a simple background check was done in a matter of minutes the detective told me and revealed the fifty nine arrest for ivy edwards the last rest being my mother's so letting the families know i think is imperative for peace of mind if nothing else and having the staff know we sued the nursing home we prevailed and got a judgment for negligence they had no idea the jury had no idea of i b i woods background it was the behaviors that he exhibited while he was there so i think if the nursing home had known upfront what type of individual this was i think that they would have been different measures taken to protect those that are there are is back in long term care facility the attorney general for the state of florida told a news reporter kelley garlock that when she was doing the investigation to find out if ivy edwards was still alive or if he was still in chattahoochee she was told that he was released in two thousand and five that he would never be competent to stand trial and he was released back into the nursing home and history in the state of florida maybe he had any contact with that long term prepare for solti i have checked everyone i can find i cannot find the edwards have you didn't find any it is my understanding from the the ga rip jr report and from just the limited research i've done it you're the expert on this but the g a o report did not identify any similar federal law for notifying facilities sexual offenders like some of the states have i know states have different varying degrees of laws of notification of sex offenders but in my correct about that or is there a federal law that mandates that facilities have to be notified of sexual offenders or people who might be of harm to the residence congressman felon is munder standing there is no such federal law currently on the books do you believe that a federal law would be beneficial do do you think a federal law would be beneficial in requiring nursing homes to perform background checks on residents and also on all staff who may work within that facility but again i think that we need to take into consideration who pays for those background checks the thing that we want to do is not hinder business but rather help business in and i hope that what we've done in oklahoma as we provide is an alternative place for offenders in the long term care to go so that those businesses in oklahoma who primarily care for the general population do not have a negative perception problem that their particular facility is unsafe and i think that what we want to try to get to is a point where family and loved ones and the residents themselves have a peace of mind when they enter into a long term care facility in our nation by following up on that cost who did the state of oklahoma decide what pay their costs for notifying their long term care facilities in two thousand and five i believe it is currently the responsibility of the nursing homes themselves and that's an issue the probably needs to be revisited but as of right now it is incumbent upon the the industry itself to provide those back ground checks i will tell you at that time and i think still today the industry in oklahoma is very willing to do whatever they can do to make sure that they address a problem and that may jeopardize the safety of their residents and so they kind of step and five and said hey we believe this is the right thing to do we believe in it so much that will go the extra mile and will actually pay for those that ground checks ourself in order to ensure the safety of our of our citizens mr kelly any response to that well i just want to follow up on what representative steele has said we in oklahoma and i can think i can say this on behalf of the american healthcare association we want no one in our facility who is a threat or a harm to any resident visitor or a staff member and also the most important thing is we want peace of mind and they miss banning what she was a famil we need to put this to bed so that we can take care of the frail elderly i know that we've had we had a couple ladies that would call our house and oklahoma three years ago when this issue was on the forefront being discussed and they were worried they lived in our system of living and i would call my home and my wife would have to reassure our own that we're doing the appropriate things and we're not going to do that but it i a just a pressure on family members and i'm a provider and a family member both and so i want to ensure that everyone that we take care of is sigh and we provide high quality care mr data do you think that having a stand alone separate facility and using the medicare medicaid many would be able to satisfy society's needs to and when mr bledsoe and i first began to talk about the issue that was one of the first questions that came to mind well in terms of basic human needs these people regardless of their past offenses against society have to be taken care of particularly not so much in the case of mr state them as a thirty one year old who could have resided independently but for some of the the elderly physicians and i think mindful of mr cobol's concerns there will be a market as it were for the housing of these individuals because they have to go somewhere and as i had said earlier from the industry perspective of managing risk facilities that are willing to take these people and at least will do so with their eyes open as to what they're facing and what additional safeguards need to be implemented to ensure that these residents don't harm one another but i think clearly market forces would certainly dictate that there is a there is a place for these facilities in society and that they can indeed be profitable so i found in your studies that by the use of medicare medicaid fans and the ability of the private sector market to adapt to be able to establish one of these facilities that can be paid for in a reasonable manner for the state of eligible medicaid medicare eligible and again those are entitlement programs and so if a person is eligible they receive funding for those long term care services regardless of their criminal history and sultana only it becomes a question of do we want to house these individuals who are sex offenders and who qualify for medicaid or medicare in with the general population or do we want to house them in a separate facility and they would receive the funding no matter where we put the oem is just a matter of where do we need to put them in order to provide the protection that i think that we're all in agreement here today that needs to be provided for a general population and so i think that for the private sector who is willing to designate facility to to house offenders they would receive the funding just like they would say if that that offender were house somewhere else in the home that wasn't a separate facility thank you all for being here today this is a very difficult subject to discuss and we welcome any any further feedback that you had to continue the discussion mr steele mr bledsoe mr mcdonough thank you for your advocacy and your tireless work on behalf of the victims mr coble we realize that we put you in a very difficult position today to as a representative of the industry to discuss what the industry has done while having to address the fact that some have failed within the industry and we realize that it was a difficult position to put you in thank you for your testimony it is banning we certainly realize it's very difficult to discuss on the personal issue what what has happened to you and what happened to your mother and we regret that we had to ask you to come forward but as congresswoman fallon said we're going to make something good come out of what happened and we just can't thank you enough for being able to share the story and under very difficult circumstances come before us thank you thank you to everybody i ask unanimous consent that members of this committee will have five days to submit statements and supporting materials for the record and without objection that is so ordered