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74–685 PDF 2001

S. HRG. 107–105

SAVING OUR SENIORS: PREVENTING ELDER

ABUSE, NEGLECT, AND EXPLOITATION

HEARING

BEFORE THE

SPECIAL COMMITTEE ON AGING

UNITED STATES SENATE

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

WASHINGTON, DC

JUNE 14, 2001

Serial No. 107–8

Printed for the use of the Special Committee on Aging

(

SPECIAL COMMITTEE ON AGING

JOHN B. BREAUX, Louisiana, Chairman

HARRY REID, Nevada

HERB KOHL, Wisconsin

JAMES M. JEFFORDS, Vermont

RUSSELL D. FEINGOLD, Wisconsin

RON WYDEN, Oregon

BLANCHE L. LINCOLN, Arkansas

EVAN BAYH, Indiana

THOMAS R. CARPER, Delaware

DEBBIE STABENOW, Michigan

JEAN CARNAHAN, Missouri

LARRY CRAIG, Idaho

CONRAD BURNS, Montana

RICHARD SHELBY, Alabama

RICK SANTORUM, Pennsylvania

SUSAN COLLINS, Maine

MIKE ENZI, Wyoming

TIM HUTCHINSON, Arkansas

PETER G. FITZGERALD, Illinois

JOHN ENSIGN, Nevada

CHUCK HAGEL, Nebraska

MICHELLE EASTON, Staff Director

LUPE WISSEL, Ranking Member Staff Director

(II)

C O N T E N T S

Page

Opening statement of Senator John Breaux ......................................................... 1

Statement of Senator Larry Craig ......................................................................... 3

Statement of Senator Debbie Stabenow ................................................................ 26

Statement of Senator Herb Kohl ............................................................................ 29

PANEL I

Stuart E. Schiffer, Acting Assistant Attorney General, U.S. Department of

Justice, Washington, DC ..................................................................................... 4

PANEL II

Sara C. Aravanis, Director, National Center on Elder Abuse, National Association of State Units on Aging, Washington, DC ............................................. 31

Joanne Hopper, Fruitland, ID ................................................................................ 44

Dr. Laura Mosqueda, Director of Geriatrics, University of California, Irvine,

CA .......................................................................................................................... 49

Paul R. Greenwood, Deputy District Attorney and Head, Elder Abuse Prosecution Unit, San Diego, CA ............................................................................... 58

Ricker Hamilton, Protective Program Administrator, Department of Health

and Human Services, Bureau of Elder and Adult Services, Portland, ME;

on behalf of the National Association of Adult Protective Services Administrators ................................................................................................................... 65

APPENDIX

Statement by the National Indian Council on Aging ........................................... 87

Testimony by the Social Services Block Grant Coalition ..................................... 90

Statement from the American Bar Association ..................................................... 98

Recommended Guidelines for State Counts handling cases involving elder

abuse ..................................................................................................................... 101

(III)

(1)

SAVING OUR SENIORS: PREVENTING ELDER

ABUSE, NEGLECT, AND EXPLOITATION

THURSDAY, JUNE 14, 2001

U.S. SENATE,

SPECIAL COMMITTEE ON AGING,

Washington, DC.

The committee met, pursuant to notice, at 9:34 a.m., in room

SD–562, Dirksen Senate Office Building, Hon. John B. Breaux

(chairman of the committee) presiding.

Present: Senators Breaux, Kohl, Stabenow, Craig, and Burns.

OPENING STATEMENT OF SENATOR JOHN B. BREAUX,

CHAIRMAN

The CHAIRMAN. The Committee on Aging will please come to

order.

As my first act in this position with the gavel, I want to thank

Senator Craig for his great leadership. There has never been a

committee that has worked in such a bipartisan fashion, because

there are no Democratic or Republican positions on Aging; it is the

committee. We have had that type of relationship and will continue

that type of relationship in the future so that we can go about the

business of paying attention to the subject matter with which this

committee is charged, and that is the condition of our Nation’s senior citizens.

Today’s hearing is entitled, ‘‘Saving our Seniors: Preventing

Elder Abuse, Neglect, and Exploitation.’’ I think it clearly reflects

the charge of this committee to improve the quality of life of all of

our older Americans.

We all recognize that the quality of life is not just how long we

live, but also how well we live in our later years, and we truly understand, I think, that the quality of life depends on, among other

things, access to affordable transportation and housing and nutrition and appropriate health care services. But we also know that

improving the quality of life of our seniors also means that we cannot allow conditions to exist that compromise the health and safety

of our Nation’s seniors, and to make sure we do everything we can

to eliminate the potential for abuse of our Nation’s seniors.

During a recent hearing, this committee heard testimony indicating that an astounding 95 percent of all long-term care in this

country is not provided by institutions or professional caregivers

but by family members in the home. That is good news, and it is

also bad news in the sense of the burden that it puts on families

who are charged with caring for their senior family members.

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Many times, these families do not have adequate training, do not

have adequate financial wherewithal, do not have the means to

handle the extra burdens that are put on their families as they attempt to care for their loved ones.

In many cases, family caregivers are so overwhelmed by the

extra duties that they themselves have difficulties and problems,

and sometimes their problems affect the seniors that they are

charged with taking care of. Often, these problems go unnoticed

and unreported, and therefore unsolved.

Victims of abuse, neglect, and exploitation are often unable to

speak for themselves. Therefore, it is important that those of us in

Government who have access to the means to make sure that these

problems do not go undetected are aware of the seriousness of

these problems.

I want to also point out that this hearing reflects the good work

of Senator Craig in putting it together in his former capacity as

chair of the committee. The entire hearing today was structured by

him and his staff, and we credit them and recognize them for that

accomplishment and continue to look forward to the good working

relationship that we have.

I recognize Senator Craig now for any comments that he might

have.

[The prepared statement of Senator Breaux follows:]

PREPARED STATEMENT OF SENATOR JOHN BREAUX

As my first official act as Chairman of the Senate Special Committee on Aging,

I would like to thank Senator Craig for his leadership of the committee during the

past several months and to express my sincere appreciation for the bipartisan way

in which he has guided the committee’s work. The issues that affect our older citizens are truly issues on which we find common ground and I am certain that we

will continue to go forward in the same spirit of bipartisanship that has become synonymous with the Special Committee on Aging.

I would also like to thank Senator Craig and his staff for their initiative in putting this hearing on our agenda and for their hard work in preparing for the hearing. While I have the good fortune today to be presiding as Chairman, much of the

credit for bringing this important issue to the attention of the Senate and the nation

should go to Senator Craig.

Today’s hearing, ‘‘Saving our Seniors: Preventing Elder Abuse, Neglect and Exploitation,’’ clearly reflects this committee’s goal of improving the quality of life of

older Americans. We recognize that quality of life is just as important—if not more

so—as length of life and we truly understand that one’s quality of life depends,

among other things, on access to affordable transportation and housing, adequate

nutrition and appropriate health care services. But we also know that improving the

quality of life of our seniors includes eliminating those conditions that may compromise their safety or endanger their lives. That issue is the focus of our hearing

today.

During a recent hearing this committee heard testimony indicating that an astounding 95 percent of all long term care is provided informally by family members

or community-based caregivers—a fact that is both good news and bad news. On a

positive note, most of our seniors are cared for in their homes and community-based

settings. With that care however, we shift most of the physical, emotional and financial burdens to families who may not have adequate resources to provide that care

or to strangers who may not have substantial interest in providing quality assistance. In some cases, family caregivers become overwhelmed by these circumstances

and neglect or unintended abuse may occur. Other cases may involve individuals

who purposely target seniors for acts of intentional abuse or exploitation. Far too

often, these problems go unnoticed and unreported. The victims of abuse, neglect or

exploitation are often unable to speak on their own behalf or may have no alternative sources of care. The purpose of today’s hearing is to bring awareness and

credibility to this problem and to give the members of this committee an opportunity

3

to hear victims of elder abuse and their advocates speak about the causes of these

problems and possible means for alleviating this abuse.

STATEMENT OF SENATOR LARRY E. CRAIG

Senator CRAIG. Mr. Chairman, thank you very much.

I want the record to show that I appreciate the flexibility and the

cooperative effort with which John and I have worked on the whole

effort of keeping this very important committee on track.

John is right—this hearing was well underway when the transition occurred, and thanks to him and his staff, they picked it up

and worked with us to continue it and to shape it, because we

think it is so important that this aspect of the whole universe of

senior care and senior life be recognized.

I want to thank our witnesses for being here this morning, and

a very special thanks to Joanne Hopper of Fruitland, ID. If you understand Idaho, you would say, ‘‘Oh, that is just down the road

from Payette,’’ and Payette is my home town. So we do appreciate

Joanne being here, and I want to thank her for her courage and

her willingness to come to Washington to share her story with us.

Today we will shed light on an insidious aspect of elder abuse

that remains largely hidden below the surface of public awareness—the abuses that tragically occur in non-institutional settings,

including the elder’s own home.

The physical and emotional consequences of elder abuse can be

devastating. There is ample evidence indicating that abuse shortens lives and can even end the life of a vulnerable victim. Because

we are serious in our commitment to promote secure independent

living for our seniors, we must address this difficult issue. No one

should live in fear of being abused or mistreated—no one—not a

child, and not a senior.

It is important to emphasize that these cases are not just isolated incidents. National statistics indicate that 470,000 cases of

elder abuse were reported to authorities nationwide in the year

2000. Over 2,100 of those cases were reported in my home State

of Idaho the same year. Perhaps more disturbing is the fact that

these statistics represent maybe one in five cases reported to State

and local officials.

These challenges facing us in fighting elderly abuse are formidable. Our investigations have revealed that State efforts to address

these situations are often ineffective. The perpetrators are seldom

prosecuted and front-line responders often lack the training needed

to adequately address the problem. Various Government agencies

all too often fail to work in a collaborative and focused manner.

Today we seek to determine how existing State and Federal efforts might be enhanced to promote a more collaborative and multidisciplinary approach for resolving some of these complex cases.

Existing Federal resources can and should be targeted toward

providing more technical training and assistance in the collaborative identification, investigation, and prosecution of crimes perpetrated against the elderly.

The DOJ recently awarded the State of Idaho a Stop Violence

Against Women Grant. I would like to see a similar opportunity for

States to apply for grants specifically related to elder abuse prevention.

4

John, thank you again for convening the hearing. This issue has

been ignored for far too long by everyone, and I hope that today

we can begin to shed light on and maybe begin to help shape existing resources at the Federal, State and local levels to step forward

in the stopping of this form of abuse.

Thank you.

The CHAIRMAN. Thank you, Senator Craig.

Are there any other comments from committee members? [No response.]

If not, we would like to welcome our first witness, the Acting Assistant Attorney General, since I think almost everyone over there

is in an acting capacity except the Attorney General.

Mr. Stuart Schiffer will talk about the Justice Department’s role

in elderly abuse and prevention and prosecution.

Mr. Schiffer, thank you for being with us.

STATEMENT OF STUART E. SCHIFFER, ACTING ASSISTANT

ATTORNEY GENERAL, U.S. DEPARTMENT OF JUSTICE, WASHINGTON, DC

Mr. SCHIFFER. Thank you, Mr. Chairman. Good morning, Senator

Craig, members of the committee.

I very much appreciate the opportunity to be here today. With

the chair’s permission, I will submit my prepared statement for the

record and simply make a few general observations and then take

any questions.

The CHAIRMAN. Without objection.

Mr. SCHIFFER. We continue to be grateful for the leadership role

which this committee has consistently had in dealing with issues

of elder abuse and victimization. These issues certainly are not

new; they are, however, being brought into ever sharper focus, and

they need to be brought into ever sharper focus by population

changes and other factors.

As the committee knows, these demographic shifts are startling.

It is estimated that the number of American citizens over age 65

is going to more than double from the present number of approximately 34 million to 70 million in 30 years.

None of the issues that we deal with is new. We all confront

these issues not simply as public officials, but in our own family

and personal lives. Elder abuse and elder justice issues can take

many forms, and not surprisingly, those citizens who are most vulnerable to physical and psychological abuse are equally vulnerable

to financial exploitation and many other areas that we have to deal

with.

At present and in the future, the real leadership in dealing with

these issues will continue to come at the State and local levels. At

the same time, as I attempted to outline in my written statement,

we in the Federal Government have a variety of tools available to

us, such as civil enforcement and criminal statutes and financial

assistance in the form of formula and discretionary grants of the

type Senator Craig referred to.

We have found that as we continue to enhance our own coordination within the Department and with other Federal agencies, principally the Department of Health and Human Services but others

as well, in applying our resources, we equally increase our ability

5

to provide training and guidance to State and local governmental

entities and to the host of private social service and related entities, many of which are represented here, such as AARP, for example, whose efforts are vital. There are myriad numbers of private

sector agencies that work in this area, and we really owe it to them

to enhance their own training and to coordinate their efforts with

those that governments can provide.

Again, my written statement mentions a number of the training

programs and symposia which we have either hosted or participated in. Those of my colleagues and I who have worked most of

our time in the litigation arena I think tend to focus more on problems than we do on successes, and I do think it is important even

as we deal with these often horrible problems, that we recognize

that there are large numbers of dedicated providers of services and

caregivers while at the same time, we continue our efforts to deal

with those who abuse our older citizens.

I would be happy at this point to answer any questions.

[The prepared statement of Mr. Schiffer follows:]

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The CHAIRMAN. Thank you, Mr. Schiffer, for that summary of

your testimony.

Let me just try to get an understanding of how the Department

of Justice works in these areas of elderly abuse. Is there a section

over there that specializes in that, or under what assistant secretary is this activity pursued?

Mr. SCHIFFER. These issues are so broad in their dimension that

they really cut across areas within the Department. We have efforts underway in the Civil Division where I reside, in the Civil

Rights Division, the Criminal Division, and the grant-makers in

the Office of Justice Programs.

What we have tried to do, and I think we are succeeding in doing

in recent years and certainly are continuing to do, is to coordinate

those efforts. We have appointed nursing home coordinators, for example, who try to bring together the resources of the entire Department.

The CHAIRMAN. If you had it spread out in the Civil Division, the

Criminal Division, and I think you said the fraud—or, the Civil

Rights Division——

Mr. SCHIFFER. That is correct.

The CHAIRMAN. So you have three different divisions, I take it,

looking at problems with seniors. Has anybody ever thought about

whether it would make sense to have one, single senior coordinator

who oversees this instead of having it in three different buildings

where they probably do not talk to each other very much?

Mr. SCHIFFER. But we do talk to each other; we talk to each

other more and more, and I think there have been very healthy coordination efforts going on. There is real expertise in these areas

that sometimes cuts across not just elder abuse but child abuse and

domestic violence, and I think there is something to be said for continuing to have this multidisciplinary focus as long as there is coordination taking place.

The CHAIRMAN. So if I didn’t know what you just told me, and

I was a new Member of Congress, and I decided to call the Justice

Department, and I said, ‘‘I want to talk to the person who the chief

protector of seniors in this country,’’ whom would I talk to?

Mr. SCHIFFER. If we were dealing with nursing homes, certainly

we would put you in touch with our nursing home coordinator.

The CHAIRMAN. Suppose I want to talk to someone who has been

the subject of telemarketing fraud; where would I go?

Mr. SCHIFFER. You could always call me, Mr. Chairman. I would

be glad to take your calls.

The CHAIRMAN. I understand that, but what I am trying to figure

out is if there is not a better way to coordinate this kind of activity,

and instead of having it in three different divisions—and I am not

being critical; it has probably been like this for decades—I am just

saying would it not be an idea that should be pursued to have a

single coordinator of programs to look at and prosecute and coordinate activities dealing with senior problems.

Mr. SCHIFFER. I am certainly not suggesting, Mr. Chairman, that

there are not better ways to do it and that we should not explore

those ways. We will continue to do so, but I think we really do need

to be able to call on the expertise that exists in various components

of the Department, and we are doing a remarkably better job when

23

you talk about telemarketing efforts, for example, within the

Criminal and the Civil Divisions in bringing those cases.

The CHAIRMAN. Is the major responsibility in this country for

dealing with senior abuse and fraud a State matter or a Federal

matter?

Mr. SCHIFFER. As I said in my opening remarks, I think the

State and local government officials will always have the leadership role. We do pursue these cases. Our jurisdiction tends to follow Federal funds, for example, where Medicare and Medicaid

funds have been at issue. There is much that we can do, but I

think we can also do much with respect to training and education

of State and local officials.

The CHAIRMAN. Tell the committee a little bit about—we spend

$270 billion a year on Medicare in this country and a substantial

amount on Medicaid, and much of it covers nursing homes, for

instance, and institutional care—tell us how cases of abuse in nursing homes, for instance, are handled. If someone knows about

abuse in a nursing home, where is the first stop? Is it the U.S. Attorney, or is it the local sheriff? Who prosecutes people who are

mistreated in institutions in this country?

Mr. SCHIFFER. People should be free to go either to the local U.S.

Attorney or to State and local officials hopefully to get a response

in either of those areas. We bring such cases on the civil side, to

recover funds, to seek the appointment of monitors and other forms

of injunctive relief to bring nursing homes into compliance, and we

bring criminal prosecutions. But we are never going to cover the

entire waterfront.

The CHAIRMAN. Is there some kind of memorandum of understanding between State Attorneys General and the United States

Department of Justice with regard to how these prosecutions are

to be handled, or is there sort of a catch-as-catch-can procedure?

Mr. SCHIFFER. Most of those understandings are worked out at

the local level between a local United States Attorney and his State

and local officials, because we find that our U.S. Attorneys tend to

have close relationships with the State and local officials.

The CHAIRMAN. So there is no official memorandum of understanding as to how that is to be handled that you know about?

Mr. SCHIFFER. I do not know about something of that order.

The CHAIRMAN. Do you think that would be helpful?

Mr. SCHIFFER. It may sound trite to say it; I think flexibility is

often helpful as well, though. I think that local circumstances differ

greatly; the resources of our U.S. Attorneys differ. And I still prefer

to see those matters worked out in that fashion, provided they are

worked out and provided they are effective.

The CHAIRMAN. Is there any area that you are concerned about

that seems to be slipping through the cracks as far as enforcement

is concerned?

Mr. SCHIFFER. I think I could name almost any area and say that

we have to be concerned about it. Certainly at this stage, we cannot appear here and say that these problems are being fully addressed.

The CHAIRMAN. But there is no area that stands out as more of

a problem or a greater problem than any other?

24

Mr. SCHIFFER. I would have said, obviously, nursing home

abuses, but I certainly cannot disagree with both your opening

statement and Senator Craig’s when you point as well to problems

with even family caregivers that are rampant.

The CHAIRMAN. Thank you very much, Mr. Schiffer.

Senator Craig.

Senator CRAIG. Stuart, thank you for being here. I think Senator

Breaux in his line of questioning has demonstrated that while the

issue is important, it covers a broad category or scattered areas

within DOJ and that there is not, if you will, a collective, organized, central point at which you deal with these issues.

That is very reflective of our experience in Idaho. I mentioned

2,100 cases last year—but that is after a concerted effort to educate

and train and cause to understand prosecutors to have some ability

at the county level to even be able to cope with it or identify it.

And we could not go to the Justice Department for that training.

I am told that in my State, we had to outreach to other States that

had developed a level of expertise on their own; that there was no

one within the official legal community who could offer that kind

of training to prosecutors.

Therefore, as you know well, if prosecutors cannot be secure in

what they are doing and have a base of knowledge from which to

identify whether it is a bruise that is a result of falling or a bruise

inflicted by a caregiver, or have people who can help identify that

as we now have developed some expertise in the area of child

abuse. Then they will walk away from those kinds of things. If

there is not the ability to track a financial transaction that may

strip an individual elder or senior of his or her property, then,

there is tendency to step back from that.

I have a couple of questions for you, Stuart. Does current law

provide sufficient flexibility for DOJ to target funds addressing the

problem of elder abuse even in the absence of specific line item appropriation?

Mr. SCHIFFER. I think it is always difficult to draw lines between

the desire, frankly, of the Congress on the one hand to provide formula grants, and on occasion to earmark funds, and the need for

flexibility. I think that until we are satisfied that we are fully

using the tools we have available, I am not in a position today to

propose, for example, legislation. But there is always a need for

flexibility as we learn more about the area, as we increase our own

training efforts. We have ways of dealing even with areas like formula grants, where money is mandated by statute to be given out

according to a certain formula. The acting assistant Attorney General for our Office of Justice Programs, for example, recently wrote

a letter to the State formula grant administrators urging them to

pay careful attention to areas of elder abuse and target funds

whenever possible in these areas.

So we do try to maintain maximum flexibility within some of the

constraints that we have.

Senator CRAIG. Is there need for more flexibility, specifically designated by Congress in the appropriations process?

Mr. SCHIFFER. I suspect that those who administer, for example,

grants would always say they could use more flexibility. I am not

sure that I am in a position to specify right now.

25

Senator CRAIG. What does DOJ do to provide training and grant

money to entities addressing the problem itself? You had mentioned some reference to—is there an effort or has there been an

effort to present a program within which training can be identified

and States and their legal systems can utilize it?

Mr. SCHIFFER. If you had asked me that question 5 years ago,

I think I would have had to tell you that we are really just at a

beginning stage. Those efforts are growing. We have put on regional symposia, for example, for State and local officials, private

sector officials. We have trained about 1,000 officials in some of our

programs. We need to do more, and we are going to continue to do

more.

Senator CRAIG. Does DOJ’s website make any reference to elder

abuse and any listing of grants or programs that might be utilized

for the purpose of addressing this problem?

Mr. SCHIFFER. Given my own lack of computer literacy, I have

difficulty discussing websites, but I am told that our website is

there and that our website needs to be enhanced, and that is something that we are going to concentrate on.

Senator CRAIG. So it probably does not.

Mr. SCHIFFER. It does make reference; it needs to be updated and

made more thorough.

Senator CRAIG. Could a task force similar to the Bureau of Justice Assistance Telemarketing Fraud Task Force be created for

elder abuse that might assist in both prevention and prosecution?

Mr. SCHIFFER. We do have task forces in that area. We do not

have the full equivalent of the task force you mention, where I

think there are specific funds appropriated for that purpose. I know

that anybody who appears before you says we need more funds. I

am constrained in my ability to——

Senator CRAIG. What I am asking is—more funds are going to be

difficult to get; they always are—is there a way to reshape what

we have and for Congress to give direction to the Justice Department to reshape some of what we have and to be able to offer those

kinds of programs out to the States in this area, and is there a way

to build with current abuse identification education programs an

elder component or a senior component which would allow a broadening of that training experience by local prosecutors and law enforcement?

Mr. SCHIFFER. I think ‘‘yes’’ is the short answer. We are looking

for ways to enhance our efforts. I think we are doing a much better

job, and we need to work specifically with this committee and its

staff to see that we bring our resources to bear in a more efficient

manner.

Senator CRAIG. Mr. Chairman, Stuart, thank you.

The CHAIRMAN. Thank you.

Senator Kohl.

Senator KOHL. Thank you, Mr. Chairman. With your permission,

I will yield to Senator Stabenow, who has to leave shortly.

The CHAIRMAN. Certainly.

Senator Stabenow.

Senator STABENOW. Thank you, Senator Kohl, and Mr. Chairman, thank you for providing this important hearing, and I apoloVerDate 11-MAY-2000 13:35 Oct 05, 2001 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6633 74685.TXT saging1 PsN: saging1
26

gize for running in and out this morning. I am trying to be in two

places at once, as we often try to do.

I did want to ask, however, to submit for the record comments

about this area and particularly note that Citizens for Better Care

in Michigan have been designated as a national model for prevention and education. They do a train the trainer program, and as

Senator Craig was speaking about those issues, I would just urge

that you look closely at what is being done in Michigan, because

there is an excellent training program that is occurring, and we

appreciate very much what is happening in Michigan. So I would

appreciate being able to enter that in the record.

Thank you, Mr. Chairman.

The CHAIRMAN. Thank you. Without objection, it will be made

part of the record.

[Statement of Senator Stabenow follows:]

PREPARED STATEMENT OF SENATOR DEBBIE STABENOW

I would like to thank the committee for convening this hearing on the extremely

important topic of elder abuse. This is a difficult problem to quantify. For example,

it is estimated that only 1 in 14 cases of domestic elder abuse ever come to the attention of authorities. The State of Michigan issued a report last December entitled,

‘‘Elder Adults at Risk.’’ According to the report, 9,000 adults received services from

the state as the result of reported elder abuse. However, this number only represents a fraction of the abuse that experts believe is happening in our state. As

our population ages and individuals live longer lives and spend more time in the

care of others, it is sad fact that the incidence of elder abuse has the potential to

increase substantially.

Michigan has a wonderful elder abuse prevention and education program, run by

Citizens for Better Care, which has been listed as a national model by the National

Ombudsman Resource Center. As we know, the Older Americans Act mandates that

Area Agencies on Aging address elder abuse issues and in my state the majority

of our agencies have contracted with Citizens for Better Care to meet that requirement. As an aside, I would like to pitch that increased funding would be very beneficial and would only strengthen our program not just in Michigan but programs

across the nation, as well.

In Michigan, Citizens for Better Care offers a ‘‘Train the Trainer’’ program under

the skilled leadership of Anne Marie Koebel. Nursing homes, adult day care programs, home health agencies and other interested groups send one of two members

of their staff to the training program and then they take what they have learned

back to their colleagues. This sharing of information has proven to be very successful. The program defines elder abuse according to State law, examines the reasons

that it occurs and offers viable solutions for preventing abuse. I am so pleased that

such a model program exists in my state.

I also think we need to pay increased attention to domestic elder abuse. Some

elder abuse is the continuation of a long-standing pattern within a family of domestic violence and I think that elder abuse should be a part of any debate on domestic

violence. Other types of elder abuse often are the result of stressed or ill family

members who are not equipped with counseling our support to care for their loved

ones. The National Family Caregiver Program, the topic of one our previous hearings, is an excellent way to get services to these families who need help.

Another issue that merits attention is variance from state to state in their definitions of elder abuse. For example, some states include financial exploitation in their

definition, others do not. It would take careful analysis, but I think it would be helpful to examine the usefulness of a national minimum definition of elder abuse to

help clarify the issue.

I look forward to the testimony of all the witnesses and I am very interested in

working with the committee to find solutions for this national problem.

The CHAIRMAN. Senator Burns.

Senator BURNS. Thank you, Mr. Chairman.

I went through a situation with one of my aunts in regard to a

telemarketing scam. I also had a mother who was in a nursing

home.

27

Mr. Schiffer, your hands are kind of tied unless you get a complaint. It is my experience talking to nursing homes and talking to

elderly who are in nursing homes or in home care or even in the

care of their own families, that if they have been abused, they will

not say anything. They are afraid to. And that is where we find

most of our problems occur, when people are either afraid to admit

or are afraid that they will be further abused if action is not taken.

We are finding that nursing homes in small towns are struggling

for the right kind of personnel, the ability to pay them for the work

that they do, and it creates an environment where abuse happens.

It even happens within families.

Can you tell me as a person who follows this dilemma that we

have with our elderly how much abuse occurs, for example, in a

care facility and also under the care of the family?

Mr. SCHIFFER. First, I think the Senator is certainly correct—

there is consensus that crimes affecting the elderly are underreported and perhaps more so than in many other areas. I attempted in my opening remarks to make clear that there are many

honest and decent providers and caregivers out there. The percentage, though, with respect to nursing homes is a matter of great

concern. We sometimes see reports that in as many as half of the

individual nursing homes, there are instances of abuse and neglect.

Senator BURNS. But what is the percentage—do you also get

complaints when a person is under the care of a family or staying

in the family home? Do you get those kinds of complaints as well?

Mr. SCHIFFER. Those are probably the hardest matters to have

brought to the attention of law enforcement authorities. I think the

major effort and the effort of this hearing today is to focus people

on the need to report these.

We have similar experiences with domestic abuse. Those were always things that were thought to be private, things that should not

be reported, and I think there is growing awareness in this country, frankly, that these are very, very serious issues that need to

be dealt with.

Senator BURNS. Let us say I am in a skilled care facility, and I

think I am being abused, and I pick up the telephone and call the

sheriff. What happens?

Mr. SCHIFFER. There should be State regulatory authorities dealing with these problems. Something should happen. People should

look into these promptly, and they should be brought to the attention of either law enforcement or State regulators.

Senator BURNS. Does the sheriff turn it over to another agency

in the State or in the country for prosecution or investigation?

Mr. SCHIFFER. We find that that differs widely from jurisdiction

to jurisdiction. Just as our own Federal lines are sometimes less

than clear, the same is true in State and local areas.

Senator BURNS. Well, I think this is an important hearing, and

why I think it is important is not that I do not think we need more

laws, but this is an awareness thing that we want people to step

forward without fear so that if they think they are being abused,

they can report it, and the abuser can be dealt with in a proper

fashion.

If we look at our nursing homes now, even in the medium areas,

but especially in rural areas where nursing homes tend to be smallVerDate 11-MAY-2000 13:35 Oct 05, 2001 Jkt 000000 PO 00000 Frm 00031 Fmt 6633 Sfmt 6633 74685.TXT saging1 PsN: saging1
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er and it becomes very difficult to get good help, that creates a situation where abuse does take place. But they are also reluctant to

report for the simple reason that they cannot find the people.

Mr. SCHIFFER. Well, the Senator is correct. You alluded a few

moments ago to telemarketing, where it tended to be an embarrassment; when an elderly citizen was victimized, even to the extent that the citizen realized that he or she had been victimized,

it was an embarrassment. We see there, for example, growing

awareness. We see efforts by organizations like AARP. We have

vastly increased the number of cases that we are bringing. Recently, for example, in the last several years, we have started

bringing cases in Canada, where we see telemarketers located in

Canada preying on elderly American citizens, aware that the Canadian authorities, just as is true in this country, have limited resources and are less likely to be able to apply those resources

where Canadian citizens are not involved, and we have brought

four or five cases against telemarketers there.

Senator BURNS. Let me tell you how I finally got my old aunt to

admit. We kept finding receipts where she was wiring money to

somebody in Atlanta, GA. Now, this lady lived in northwest Missouri, and every time I could go by to see her, there would be more

receipts there. I asked her about those receipts, and she just would

not talk about it. I mean, she would just clam up. I also asked her

if she knew anything about her grandfather, who was my greatgrandfather, and she asked, ‘‘What do you want to know about that

for?’’—I think he was a crook or something, although I am not real

sure—he rode with Jesse James.

Senator CRAIG. A horse thief.

Senator BURNS. Well, yes. He rode with Jesse James. That is

pretty good.

Anyway, I will tell you that the FBI in their magazine had an

article about telemarketing scams. So I took that magazine, opened

it up to that article, and left it at her house when I left one day.

And the next time I visited a couple of weeks later, she finally said

we have a problem.

I had called the district office in Saint Joseph, MO, and we got

these guys—we nailed them. So that is what you have got to do.

But I will tell you that it takes somebody who really wants to get

in there, and it takes a nephew, or a niece, or a son, or whatever,

once you set your satchel down, because the elderly person is not

going to admit it and will not cooperate, because they find it embarrassing—and then, some of them are so lonely that that is the

only phone call they get, and they have found a friend, and if it

costs 100 bucks, it costs 100 bucks. But they got this aunt of mine

for $125,000—and my Lincoln—no. So I am telling you it is something that is a real problem.

So the point is that the family or some interested member is

going to have to take it under their wing and carry it out, because

your hands are tied until you get a complaint; those complaints are

very, very difficult to get, and once they are received, they are very

difficult to handle with our elderly.

So I think, John, this is a very, very important hearing, but it

will be more to elevate awareness of some things that go on with

our aging population. So I thank you for that.

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The CHAIRMAN. Thank you, Senator.

Senator Kohl.

Senator KOHL. Thank you, Mr. Chairman.

Mr. Schiffer, in 1998, Congress gave home health care agencies

and nursing homes the ability to use the FBI criminal background

check system to weed out potential employees with criminal histories. In February of this year, the Department of Justice issued

a report that found that so far, 7 percent of those background

checks have come back with serious criminal convictions, including

such things as rape and kidnapping.

Unfortunately, too few providers are using this tool, in part because they do not know about it. What is the Department doing

about informing providers that there is such a system to be used?

Mr. SCHIFFER. This is certainly a very serious area. We have established, and we have, I think, very productive monthly Nursing

Home Steering Committee meetings in the Department, attended

by not only components of the Department, but the Department of

Health and Human Services. We are reaching out to the extent we

can to the State regulators, to our own inspector general at HHS,

and trying to deal with the very, very serious staffing problems,

both understaffing and the failure to report that the Senator mentioned.

Senator KOHL. Maybe you did not quite understand what I was

saying. I was saying that there is a tool that can be used, which

is the FBI background check system. Is there a reason why we

would not like to see or could not insist or could not be sure to let

every provider know that there is such a system that they can access to determine whether potential employees have background

problems?

Mr. SCHIFFER. There is no reason why we should not be doing

that, and I will see that we redouble our efforts to do that.

Senator KOHL. It would seem to me that the first line of defense

in this problem is to weed out those potential employees who obviously should not be employed because they have problems in their

past, and if the FBI is there to help us do it, and if we are really

serious, which I know we are, about trying to keep these people off

the payrolls to begin with, it seems to me that the FBI background

check is a great place to start.

Mr. SCHIFFER. The Senator is certainly correct.

Senator KOHL. Thank you.

[The prepared statement of Senator Herb Kohl]

PREPARED STATEMENT OF SENATOR HERB KOHL

Thank you, Mr. Chairman. I appreciate your holding this hearing on this very important, but tragic, topic of elder abuse.

There is absolutely no excuse for abuse or neglect of the elderly at the hands of

those who are supposed to care for them. Our parents and grandparents deserve to

live out their days with dignity and the highest quality care.

Unfortunately, we know this is not always the case. I know that the majority of

caregivers are dedicated and do their best under difficult circumstances. But too

often, the elderly are starved, shamed, abused, and exploited. And the systems that

are in place today are not enough to protect them.

Later today, I along with Senator Reid, will reintroduce the Patient Abuse Prevention Act. This legislation is a first step to prevent Elder Abuse by long-term care

workers—including home health agency workers.

Specifically, my bill would create a National Registry of Abusive Long-Term Care

Workers, which will prevent abusers from moving from state to state continuing to

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find work with vulnerable patients. Second, it requires an FBI criminal background

check to prevent people with violent criminal convictions from working with vulnerable patients.

There is clear evidence that this is needed. In 1998, at my request, this Committee held a hearing on this issue. The HHS Inspector General presented a report

which found that, in the two states they studied, between 5–10 percent of employees

currently working in nursing homes had serious criminal convictions in their past.

They also found that among aides who had abused patients, 15–20 percent of them

had at least one conviction in their past.

But even more compelling, we heard from Richard Meyer of Libertyville, IL,

whose 92-year old mother was raped by a nursing home worker who had a previous

conviction for child sexual abuse. A criminal background check could have prevented

this tragedy. But even more appalling, there is nothing in current law that prevents

her assailant from travelling 50 miles to my home town of Milwaukee and finding

another job in a home health agency.

There’s no greater illustration of the need for background checks than this. But

for those who need hard data, there is more evidence. In 1998, I offered an amendment which became law that allowed long-term care providers to voluntarily use the

FBI system for background checks. So far 7 percent of those checks have come back

with criminal convictions.

Clearly, this is a critical tool that long-term care providers should have—they

don’t want abusive caregivers working for them any more than families do. My legislation won’t prevent all instances of elder abuse, but it is a common-sense first

step we can take to protect our seniors.

Again, I thank you, Mr. Chairman, for holding this hearing. With the aging of our

nation, we cannot afford to ignore the issue of Elder Abuse, wherever it occurs. I

look forward to hearing from our witnesses.

The CHAIRMAN. Thank you very much, Senator Kohl.

Thank you, Mr. Schiffer. I wish you well in this endeavor. It is

very, very important, and this committee is going to stay in touch

with the Justice Department as to how we handle these areas, and

we want to work with you to improve the quality of service.

Mr. SCHIFFER. We very much want to do that, Mr. Chairman,

and we look forward to doing so.

Thank you.

The CHAIRMAN. Thank you.

The CHAIRMAN. I would like to welcome a panel now that will

consist of Ms. Sara Aravanis, who is Director of the National Center on Elder Abuse located here in Washington; Dr. Laura

Mosqueda, who is Director of Geriatrics at the University of California in Irvine, who will discuss her professional experiences in

the area of elder abuse; Mr. Paul Greenwood, who is Deputy District Attorney and Head of the Elder Abuse Prosecution Unit in

San Diego and has prosecuted more than 600 cases of elder abuse;

and our final panel member will be Mr. Ricker Hamilton, who is

Protective Program Administrator for the Department of Human

Services in the State of Maine and is representing the National Association of Adult Protective Service Administrators.

Senator Craig, I understand you have someone from Idaho you

might want to present.

Senator CRAIG. Yes. We are very pleased, as I mentioned in my

opening comments, Mr. Chairman, to have Joanne Hopper with us

this morning from Fruitland, ID. She has a very unique and I

think important story to tell this committee.

Please come forward, Joanne.

The CHAIRMAN. We welcome all of you, and we have listed first

Ms. Sara Aravanis.

Ms. Aravanis, please.

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STATEMENT OF SARA C. ARAVANIS, DIRECTOR, NATIONAL

CENTER ON ELDER ABUSE, NATIONAL ASSOCIATION OF

STATE UNITS ON AGING, WASHINGTON, DC

Ms. ARAVANIS. Good morning. This hearing is a welcome event

for the field of aging. Many years ago, Claude Pepper was the national spokesperson on elder abuse. We miss his consistent and tenacious attention to the problem. We hope that you, Mr. Chairman,

and the committee will help our Nation address what some have

called ‘‘the dark side of aging’’ in this country.

I represent the National Center on Elder Abuse, which is funded

by the Administration on Aging, NASUA. The National Association

of State Units on Aging is the lead agency. We have five partner

organizations that bring special capacity and skills to our work.

Our mandate is broad. We provide research, training, and technical assistance for all direct service professionals. We educate the

public, foster research, promote coordination, and disseminate good

practices. Our accomplishments include an award-winning website;

a list-serve of 700 members; technical assistance manuals; a leadership institute; special support for State and local Elder Abuse

Coalitions; a Native American Project; and training sentinels to

find hidden cases.

Every day, we strive to be the source of information and assistance on elder abuse.

Elder abuse is not a new issue. In the seventies, congressional

investigations and field researchers uncovered the problem and

gave it a name—‘‘granny-bashing.’’ In the eighties, following the

child abuse model, mandated reporting emerged in State law, and

during that decade, the Family Violence Network acknowledged

elder abuse as part of the picture. Also, OBRA called for nursing

homes to be abuse-free.

In the nineties, abuse definitions were included in The Older

Americans Act. The new Title VII started funding education and

prevention activities, and a National Nursing Home Abuse Prevention Initiative was launched.

Although there are many other significant events, the history of

the problem is connected to the aging population shift and the lack

of a national long-term care policy.

Through adult protective services, States have the heaviest financial and programmatic burden for responding to elder abuse,

but Older Americans Act programs, elder abuse prevention, the

ombudsman, and legal assistance play a significant role. Coordination with other Federal resources is necessary.

Several charts have been prepared to illustrate the problem. The

first graph shows the steady increase in the number of reports over

a 10-year period. Last year, more than 470,000 reports were

made—a 300 percent increase over the base year of 1986.

Almost half of the reports were about self-neglect. About onequarter of them involved physical abuse. Other categories include

caregiver neglect, financial exploitation, emotional and sexual

abuse.

It is very much a family issue. Adult children, spouses, and other

family members are the most frequent abusers. Formal caregivers

are also involved.

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Moving to the ‘‘iceberg’’ chart, it shows that most of the cases

simply are not reported. For each case referred to adult protective

services, there are four additional cases out there, hidden from

view and hidden from those who can offer assistance. And this data

presented here does not even include reports of abuse in nursing

homes and other facilities. The Long-Term Care Ombudsman Program received over 18,000 complaints of abuse, gross neglect, and

exploitation in nursing and board-and-care facilities in 1999.

This too is only part of the picture. Data from Medicare fraud

agencies, State licensure and survey, law enforcement is missing.

The elder abuse field is at a great disadvantage because there is

no vehicle to collect and analyze information across agencies and

funding streams. Further, in both domestic and institutional settings, it is likely that many incidents are hidden, not reported or

identified at all. This lack of data makes it difficult to fairly allocate resources for elder abuse.

In addition to the concerns about data, there is a long list of

issues facing the field of elder abuse. They include public recognition that abuse occurs; adequate funding for adult protective services; the difficulty of establishing cross-agency multidisciplinary

interventions; assuring that serious cases are indeed prosecuted,

that all components of the law enforcement, justice, and health

care systems are effectively trained to work with adult protective.

More research is needed on causes and preventive strategies. We

need access to experts in complex financial abuse cases.

Finally, we need to identify and fill the gaps in services, the community-based interventions necessary to prevent and help victims.

What can the committee do? First, the committee could develop

a joint resolution and establish a ‘‘National Elder Abuse Prevention

Week.’’ This would encourage Governors to follow suit and spearhead many collaborative State and local activities.

Second, the committee could offer its support for restoring funding for the Social Service Block Grant, an important resource for

adult protective services.

Third, additional funding for The Older Americans Act, Title VII,

the elder abuse prevention activities, could be used to develop more

collaborative interventions at the State and local level.

Finally, later this year in collaboration with AOA and the Department of Justice, the Center will convene a National Policy

Summit on Elder Abuse. National experts will develop an action

agenda, a road map for addressing many of the most serious problems. We hope the committee will play a part in this summit and

in the implementation of its recommendations.

On behalf of the partner organizations comprising the National

Center on Elder Abuse, we congratulate you, Senator Breaux and

Senator Craig, for having this hearing, and we look forward to

working with you on the challenge of elder abuse.

Thank you.

The CHAIRMAN. Thank you very much, Ms. Aravanis. We appreciate your being with us.

[The prepared statement of Ms. Aravanis follows:]

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The CHAIRMAN. We would like to hear next from Joanne Hopper.

Thank you very much for being with us.

STATEMENT OF JOANNE HOPPER, FRUITLAND, ID

Ms. HOPPER. Thank you for having me.

My statement is on power-of-attorney abuse and caregiver abuse,

two issues.

I had a massive heart attack and realized that I was going to

have to have power-of-attorney because I was incoherent. I selected

my son, who had always been an excellent kid, trustworthy and so

on. I thought everything was fine, and all of a sudden, they asked

if they could move into my home.

They built an addition on, and before it was finished, they left

it, because they could not get along with the builder. However, they

had used my signature for the loan because he had power-of-attorney. They also had chalked up a lot of bills. They had somebody

come in and get me up in the morning and put me to bed at night.

I wondered how they were paying for it—well, I was paying for it.

They mortgaged a home I had in town. I just could not figure out

how somebody could go into a bank and sign my name and walk

out with $34,000 and not be accountable.

Anyway, they have completely and totally wiped me out financially. If I have to go to the grocery store to buy groceries, there

is not a cent for me to do that. I have been eating Meals-onWheels.

It has been turned over to the prosecuting attorney, and so far

it is just being considered a misdemeanor. I cannot understand. I

am yelling, but nobody is hearing me, so I am going to yell some

more.

Then I had caregiver abuse. I had to get a caregiver because the

kids moved out. One day, I had to discuss a situation that was kind

of against her grain, and she was very mad, got me up from a nap

and sat me in this scooter that I am sitting on. She used a belt

around my waist to transfer me from the bed or to the scooter or

wherever, and that got caught on the armrest, and I was over like

this—and I have an internal pump, because I have MS—it was

caught, and my feet were all under, and she just flat up and left

me that way.

I waited, and waited, and waited, and she did not come back. I

carry a phone with me, and it was really hard—like an hour—for

me to get the phone. Finally, I got it, called the operator—because

my hands are curved, it is hard to dial—and called a friend to come

and get me. She did, and we called adult protection—it just happened that I knew of adult protection through an attorney that I

had; otherwise I would not have known about adult protection, and

I think that that should be advertised—to see if I could get a new

caregiver.

They could not get me a new caregiver, so a friend of mine is still

helping me every day, and if things do not change, I will probably

have to go to a nursing home in a month or two. Hopefully, things

will change, but we just do not know.

I do not want to be a ward of the State. I had never planned on

being a ward of the State, ever. I had enough money to last forever,

but I guess mom’s money was not too bad after all. It is really sad.

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On power-of-attorney, I think there should be more than one person signing when that money needs to be used for whatever the

person needs.

On the caregiver issue, really, that is just a hard situation. I do

not know what to do. But you guys are smart.

The CHAIRMAN. Ms. Hopper, thank you so much. The committee

really appreciates your coming, and we thank Senator Craig for

making the arrangements for you to be with us and tell your story.

It is a tragic story, and we apologize that it happened to you, but

I think that by your telling it, it helps us look for solutions so that

it does not ever happen again.

[The prepared statement of Ms. Hopper follows:]

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The CHAIRMAN. We have a vote that has just started, but I think

we can hear from Dr. Laura Mosqueda. So if you would like to go

ahead and give your statement now, Dr. Mosqueda, we will hear

it.

STATEMENT OF DR. LAURA MOSQUEDA, DIRECTOR OF

GERIATRICS, UNIVERSITY OF CALIFORNIA, IRVINE, CA

Dr. MOSQUEDA. Good morning, Senator Breaux, Senator Craig.

Thank you for inviting me. I am very grateful for the invitation.

My name is Laura Mosqueda. I am a family physician and geriatrician at the University of California, Irvine, UCI, where I am the

Director of Geriatrics and an associate professor of family medicine.

While I have one foot in academics, my other foot is planted firmly in the trenches, which allows me to see that we have great needs

in the areas of research and education, but we have very urgent

needs in the area of care for individuals who are affected by abuse.

I am the principal investigator of a project funded by the

Archstone Foundation, where we have formed a medical response

team for our local county, Orange County in California, for elder

abuse.

Our team responds to requests from Adult Protective Services,

the district attorney’s office, and law enforcement agencies to help

them look at medical aspects of elder abuse. At this point, we have

been involved in over 100 cases, and I have done many dozens of

house calls with APS workers, looking at possible abuse cases.

We are about halfway through this 3-year project right now, and

there are a few points that I would like to share that our team is

learning as we go along.

One is that APS workers are often doing a very heroic job at low

pay for the degree of training they have and the work they are

doing, and they have no medical backup whatsoever on a regular

basis.

We have learned that geriatricians and psychologists or psychiatrists can and should be integral members of an elder abuse multidisciplinary team.

We have learned that police officers and detectives are often frustrated in dealing with the elderly. They have received little training; they do not know what to do when they are trying to interview

a person who may be a victim and who suffers from, say, dementia

or severe depression, or somebody who has trouble with hearing or

vision, leading to a frustrating experience for all involved.

We have learned that physicians are terrible at detecting, documenting, and reporting elder abuse.

I have also learned that our system of response to elder abuse

is fragmented and sporadic and truly inadequate. I think that in

our level of understanding of elder abuse, we are probably 20 years

behind that of child abuse. We know little about prevalence and incidence, risk factors, markers. As one of the other Senators mentioned earlier, how do we know when we can distinguish a bruise

that has been caused by an accident from something that was inflicted? The same goes for issues like malnutrition, pressure sores;

so many of the diseases that are common in the elderly can either

mimic or mask markers of elderly abuse. And we know little about

the consequences of elder abuse.

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We have a great opportunity to learn from our colleagues in child

abuse and the domestic violence arenas to understand what models

have been successful so that we do not have to reinvent the wheel.

We can take those models and see how they can be modified and

applied to elder abuse.

I am sure that we will find that the causes of elder abuse are

just as complicated and multifaceted as the solutions will be.

There are some agencies and organizations that have begun to

take action in the area of elder abuse. The National Institute on

Aging recently commissioned a panel from the National Academies

to help set a research agenda in the area of elder abuse. The Department of Justice has sponsored a forensic roundtable on this

issue. The American Geriatric Society of which I am a member has

now incorporated elder abuse into its core lecture series, and there

is the beginning of an interest group within the organization.

But as you know, there are not enough geriatricians to go around

in the country, and there is even a smaller subset interested in

elder abuse.

As recommendations come forth from these different panels,

agencies, and organizations, there will need to be new funding to

implement the recommendations. I think Congress should make

every effort to understand the financial cost of the problem as it

currently stands—how much did it cost in the examples that we

have heard about to have to go and look at nursing home care?

How much is this costing Medicare and Medicaid when we are not

catching it at an earlier phase or preventing abuse from happening

to begin with?

I think your timing for holding these hearings is excellent. You

can capitalize on a growing interest across the country. It is amazing to me that we see a few pilot projects popping up here and

there across the country, spearheaded by a variety of professionals,

spearheaded by APS supervisors, police officers, prosecutors like

Mr. Greenwood, health care providers—and all of us really have

one common motivation. We know that elders are being victimized,

and we know that our current system is failing them.

I very much appreciate your insight and courage in holding these

hearings. I think it is important for your leadership to bring this

topic to the attention of Congress and to the attention of our Nation as you have done with other important issues for seniors. We

need your leadership to develop a coordinated, comprehensive legislative approach and funding that support the research, education,

and service needs.

Thank you.

The CHAIRMAN. Thank you very much, Dr. Mosqueda.

[The prepared statement of Dr. Mosqueda follows:]

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The CHAIRMAN. We have two recorded votes going on now on the

Senate floor, so the committee will take a short recess, probably 10

minutes or so, and then come back to complete the testimony of the

panel.

The committee will stand in recess.

[Recess.]

Senator Craig [presiding.] Thank you all very much for your patience. The committee will reconvene.

Chairman Breaux, because of the length of the vote, had to go

on to another engagement, so in the bipartisan fashion in which we

enjoy operating this committee, we will proceed.

Let me turn now to Paul Greenwood, Deputy District Attorney

and head of the Elderly Abuse Prosecution Unit in San Diego.

Paul, welcome to the committee. Please proceed.

STATEMENT OF PAUL R. GREENWOOD, DEPUTY DISTRICT ATTORNEY AND HEAD, ELDER ABUSE PROSECUTION UNIT, SAN

DIEGO, CA

Mr. GREENWOOD. Thank you, and good morning, Senator Craig.

It is a real honor to be invited to speak here.

I have the privilege of heading the Elder Abuse Prosecution Unit

in the San Diego District Attorney’s Office since January 1996. My

boss, Paul Pfingst, probably was a visionary back then, when he

felt that it was important to devote resources in this area.

I have to confess, Senator, that when I was asked to do this job

in January 1996, I had never heard of the term ‘‘elder abuse’’ and

did not really know where to begin.

But over the last 51⁄2 years, being, like Dr. Laura Mosqueda

here, basically on the front line of the trenches, my eyes have been

opened, and if there is one thing that I would urge you to take back

to your fellow Senators on this committee, it is that I believe this

issue is one of the top three issues of crime in this country in the

next 5 years, and it is only going to escalate and get worse.

Just by way of example to show you that I am in the trenches,

last Friday, I was prosecuting a case involving a 73-year-old female

in a residential facility. She has a mental age of 7, and she was

sexually assaulted by a male employee of that facility who is currently on active felony probation for child molestation.

That is the kind of case that we grapple with on a daily basis,

Senator.

In 1996, I prosecuted 17 felony cases. In 1997, it went up to

about 37; in 1998, to 75; in 1999, to 97; and last year, we did 124

felony cases of either physical or financial elder abuse. This current

year, we anticipate well over 200 felony case.

Now, I am not proud of those statistics, and I believe that they

are just the tip of the iceberg in the County of San Diego. But I

think it demonstrates that much of the negativity that seems to

surround the prosecution of elder abuse is a myth, and we have

been able to demonstrate through the lessons learned from domestic violence and child abuse prosecutions that these cases can and

should be investigated and should be prosecuted.

You mentioned that in your home State of Idaho, there were

2,100 cases last year. I would imagine that probably fewer than 40

of those cases were prosecuted.

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So we have got to do a lot more, but I think it is at the grassroots-level, Senator, where this is going to happen, and I am grateful to you for bringing out Joanne from your home State just to

give us all a sense of what is going on in the communities.

There are four things that I can basically share from the years

I have had prosecuting these cases as being lessons that we have

learned.

First, no agency knows every answer, and we have benefited

from a multidisciplinary approach. We meet very regularly with

Public Guardian, county mental health, adult protective services—

and I cannot sing their praises enough; they are so underappreciated in this country, and people just do not know what they do.

We have heard about child protective services, but people need to

know more about what adult protective services does. We meet

with them; we meet with paramedics, fire, police, sheriffs, and the

medical community. This is the way to go, and I think prosecutors

have a wonderful opportunity to be the catalyst in the local counties to actually bring these agencies together.

Second, we have got to encourage every elected prosecutor who

runs either a county prosecutor or a district attorney’s office in municipalities in the major towns and cities of this country to designate at least one prosecutor in that office to be what we call a

vertical prosecutor in the area of elder abuse.

Sure, these cases are sometimes complex, are sometimes very difficult, but because we have trained prosecutors to know how to

prosecute child abuse and domestic violence cases, it does not take

much more to train prosecutors in the area of prosecuting elder

abuse.

Dealing with areas of competency—how do I prove a case where

my victim is suffering from severe dementia or Alzheimer’s or stage

5 Parkinson’s—there are ways around it, and getting vertical units

I believe is the way to go.

Third, we need to develop a national training program for first

responders of elder abuse. Every line of police and deputy sheriff,

every paramedic and every firefighter in this country needs to have

a course on elder abuse training and awareness. So many cases are

going undetected, Senator, when paramedics and firefighters and

even police officers go into a home and simply fail to recognize that

if you leave an elderly widow in her bed with feces and urine and

bedsores, that is a crime. They are trained not to look at it as a

crime yet. We have got to teach our first responders about that

issue.

Fourth, we have got to look into the area of legislation. I agree

with the Senator who was here earlier this morning in the sense

that we do have sufficient laws pretty much, but there are some

areas that we can develop.

First, we can develop tougher laws on background checks for all

employees and care providers for seniors in this country so that the

case I just described will never happen again.

Second, we need to extend the group of mandated reporters who

are obliged by law to report these cases.

And there is a side issue—I think we need to sit down with the

financial institutions of this country and make them far more

aware of their responsibilities to the elders and seniors of this

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country, because so many financial abuse cases start in the banks

and in the credit unions and do not get reported as being suspicious, and they need to do that.

If I may just take a couple more minutes of your time, I think

we need to provide mandated training for all first responders. I

think we also need to provide the judges of this country with

courses in sensitivity to deal with cases involving elderly victims

that come into their courtrooms.

Finally on that issue, I think that we need protection for civil attorneys in this country to allow them the freedom to report cases

of suspected elder abuse where their own clients are being abused.

I know of many civil attorneys who wrestle with this problem of

confidentiality, and they would like to call me and tell me that they

feel they are violating the ethics of confidentiality even though they

know that their own client is being unduly influenced and exploited

by somebody else.

So I am heartened and encouraged, Senator, by the fact that you

have spearheaded this hearing today. I hope this is the start of

something nationally. I must convince you, though, that this is

grassroots-level. It starts in the counties of this country where local

law enforcement and county prosecutors sit down and grapple with

these issues, and it can spread from there.

Thank you.

Senator CRAIG. Paul, thank you very much. Your testimony is extremely valuable.

[The prepared statement of Mr. Greenwood follows:]

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Senator CRAIG. Now let me turn to Ricker Hamilton, who is the

Protective Program Administrator, Department of Human Services

Bureau of Elder and Adult Services in Portland, ME.

Please proceed.

STATEMENT OF RICKER HAMILTON, PROTECTIVE PROGRAM

ADMINISTRATOR, DEPARTMENT OF HEALTH AND HUMAN

SERVICES, BUREAU OF ELDER AND ADULT SERVICES, PORTLAND, ME; ON BEHALF OF THE NATIONAL ASSOCIATION OF

ADULT PROTECTIVE SERVICES ADMINISTRATORS

Mr. HAMILTON. Thank you. Good morning.

It is an honor to be speaking with you, and thank you for your

invitation, Senator Craig. I would like to submit my written testimony for the record.

Senator CRAIG. It will be made a part of the record. Thank you.

Mr. HAMILTON. I am a board member of the National Association

of Adult Protective Services Administrators, or NAAPSA, as we are

known. As a volunteer, nonprofit organization, our membership

consists of senior administrator of State Adult Protective Services.

APS are those services provided to elderly and disabled adults

who are in danger of abuse, neglect, or exploitation and who are

unable to protect themselves and have no one to assist them. Most

of these victims are unable to ask for our help.

Reports of elder abuse, neglect, and exploitation are increasing

dramatically, but not the budget for Adult Protective Services. It

is estimated that in the United States, 2 million older persons and

persons with disabilities are abused each year. Sixty percent of the

abusers are family members who isolate and intimidate their victims.

The American Academy of Family Physicians reports that ‘‘We

are losing our elders to an epidemic rarely talked about or even acknowledged; an epidemic that leaves some ashamed, some afraid,

and too many dead.’’

With minimal resources, APS programs all over the country have

struggled to develop quality services for our most vulnerable adult

citizens. Although great strides have been made by APS, we cannot

possibly meet the increasing demand and complexity of the needs

facing our clients without Federal leadership and resources.

I would like to also call your attention to the photos on the side

of the room, which highlight some cases, but I would also like to

review some cases investigated by APS.

In Louisiana, a 75-year-old woman was found wandering in front

of her home and admitted to a hospital. The emergency room physician found that she suffered from diabetes, moderate dementia, and

was missing four of her toes. The woman had been living with her

daughter in an extremely unsanitary house with 37 dogs and 10

cats. It appeared that the dogs had chewed off the victim’s toes.

Louisiana State law allows for the prosecution of elder abuse

without the testimony of the victim. However, the judge dismissed

charges filed against the daughter when the district attorney said

that the victim was ‘‘too upset to testify.’’ In Maine, an 88-year-old

woman was financially exploited by her two nieces. After becoming

her guardian and conservator, the nieces sold her home, her car,

and everything else that was important to her. They divided the

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proceeds and continued to steal her monthly pension from out of

State, utilizing an ATM.

The Department of Human Services became her public guardian

and removed the nieces as guardian and conservator. The local district attorney’s office refused to prosecute but promised to do so if

the public guardian received judgment against the nieces from probate court.

After a year of advocacy, a judgment was secured. The district

attorney, however, refused to prosecute. The attorney general’s office took the case, and both nieces were prosecuted. One niece received a 6-month jail sentence. Restitution is part of their probation.

In Nebraska, Adult Protective Services received a report of a 53-

year-old woman with developmental disabilities who had been

physically and verbally abused by her brother. A witness saw the

victim’s brother yell at her, slap her across the face, and drive

away, leaving her lying in a fetal position on the ground. The APS

investigation found that she had been physically abused by her

brother for several years. The victim thought that if she told anyone, she would have no place to live. She had also been financially

exploited by the brother as he was the payee for her Social Security

checks; he had used the money to support his drinking habit.

The person who witnessed the abusive action would be willing to

testify, but the county attorney refused to prosecute because the

victim does not make a reliable historian and would not make a

good witness.

The very limited funds available through The Older Americans Act, $4.7 million, are used primarily for elder abuse prevention and

education. In other words, Older American Act funds are not used

to support APS services in the States. Nor does this program address the needs of thousands of younger disabled persons, those

under age 60, who are also victims of abuse, neglect, and exploitation.

The Social Services Block Grant is the only source of Federal

funding that specifically provides funds for the delivery of adult

protective services. SSBG has been reduced over the past few years

from $2.8 billion to $1.7 billion, more than a $1 billion cut in these

critical funds. And I understand that S. 501 is aimed to restore

SSBG funds to $2.38 billion.

Last year, the U.S. Department of Health and Human Services

reported expenditures of $4 billion to serve abused children. The

Violence Against Women Act received approximately $200 million.

Of the Federal funding available for victims of abuse, 93.3 percent

goes to child abuse, 6.7 percent to domestic violence, and only .08

percent to elder abuse.

Child protective services, domestic violence agencies and related

services need this level of commitment, but the contrast with funding available for APS is indeed stark and in fact troubling.

NAAPSA has made a number of recommendations, including: restore SSBG funds to $2.38 billion; earmark SSBG funds for protective services, including adult protective services; develop consistent

definitions of abuse, neglect, and exploitation; provide seed money

for an automated data collection system to develop national statistics, similar to the seed money provided to child protective services;

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develop model enabling legislation for APS to combat the abuse of

our elderly and persons with disabilities—there currently exists

tremendous inconsistency among States, resulting in unequal protection under the law; provide funding for research efforts; encourage model programs and community partnerships; and finally,

quantify the link between financial exploitation and the resulting

high costs to public programs like Medicaid. Sadly, we all know the

personal devastation.

In closing, our current generation of older victims has raised

their families, made numerous sacrifices, endured hardship, and

have done so much for America. Now too many of them are being

abused. They need our help, they deserve your attention, and they

have earned the right to be safe in their older years. The true

measure of our society will be how we treat those who have spent

their lives doing for others.

Thank you.

[The prepared statement of Mr. Hamilton follows:]

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Senator CRAIG. Ricker, thank you. Both you and Sara mentioned

the importance of the block grant and the flow of money out of that

to these kinds of protective services and educational programs, and

our effort to restore that is underway. But it is my understanding

that only 31 States use SSBG funding for elderly abuse prevention

and adult protection efforts, and it seems to me that maybe we

ought to place focus at the local level of encouraging States to review elder protection as a funding priority.

Either of you might respond to this if you would. If States are

not using SSBG funding to assist elder abuse prevention, why not?

Why aren’t they in some instances?

Ms. ARAVANIS. Thank you, Senator, for that question.

I know that many States come through with their own State and

local resources in order to fund adult protective services as well.

I think the other part of that dilemma is that it is a limited pot;

there are many draws against that pot, and there are many priorities that are kind of bumping elder abuse and adult protective

services out of the way.

It is always a challenge to try to spread that limited resource

across all the needs, and it is very difficult for us in the elder abuse

arena to say take money from child protective and give it to adult

protective. It is a very difficult thing to do. But it is just clear that

there are inequities in the extent to which this resource is available for elder abuse.

Senator CRAIG. Any additional comments on that?

Mr. HAMILTON. I think it is crucial that elder abuse victims and

younger persons with disabilities who are being abused, neglected,

or exploited be identified as a priority group. Whether we are talking about domestic violence funding, where the shelter system is

set up for younger women and children, APS programs get older

victims of domestic violence. We need to identify that older victims

deserve the same attention and deserve the same response from

our State, local and Federal level that child abuse victims, younger

women and children in domestic violence, and in fact in some

cases, elder abuse victims have less as far as resources, less as far

as laws and regulations, than some of the humane laws to protect

our animals.

Senator CRAIG. Thank you.

Joanne, a very special thanks to you for being here today and

sharing with us your tragic experience—and it is certainly that. I

hope that the prosecution of it proceeds to your benefit.

Can you tell us about adult protective services’ response to the

allegations that you were being abused and exploited?

Ms. HOPPER. When I called them, they came immediately. They

also called the police, and there was a police report made. It has

been handed over to the prosecuting attorney, but so far, nothing

has been done. I am sure it is going to be a misdemeanor.

Senator CRAIG. And you think it will be a misdemeanor in spite

of the fact that it nearly wiped out your finances?

Ms. HOPPER. Completely, totally—like $200,000.

Senator CRAIG. Maybe it was you, Ricker, or possibly you, Paul,

who mentioned that at the bank level, there needs to be greater accounting and relationship understood between the bank and the

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person bearing the power of attorney and a cross-referencing. Was

it you, Paul, who mentioned that?

Mr. GREENWOOD. Yes. I feel very strongly about that.

Senator CRAIG. And here, we have an example of that, it appears, where the son was given power of attorney, and no questions

were asked until the resources were depleted.

Mr. GREENWOOD. That is correct. And that is exactly what I am

finding, Senator. In fact, I prosecuted a case 4 months ago where

a 24-year-old limousine driver picked up an elderly woman with

severe dementia from her nursing home and got her to sign a certificate of deposit surrender form for $93,000. He wheeled her into

her bank, he presented it to the bank teller, and the bank gave a

cashier’s check for $92,000 to this stranger without asking questions.

Senator, in a neighboring State of yours, Oregon, they have done

a phenomenal job of a bank reporting project. I would love to see

funds from the Department of Justice to be transferred possibly to

the Office of the Victims of Crime or somewhere, so that we can

replicate this great Oregon project all over the country, because if

they had had somebody trained in that bank, Joanne’s money

might still be safe today. So I think you have hit upon a very, very

important point.

Senator CRAIG. Thank you.

Laura, in your view, how can national efforts best assist in promoting the inclusion of the medical profession in the assessment,

investigation, and prosecution of elder crime?

Dr. MOSQUEDA. Well, physicians are scientists, so we always

want to know what the data show. Unfortunately, there have been

very few well-done scientific studies, and it has been a struggle as

we have been creating training programs for health care providers

to try to find primary data to explain the issues and explain what

we ought to do about the issues to our fellow health care providers.

So I think we need to have a better understanding of the issue

to begin with at a fundamental level. And then, I think there needs

to be the promotion of the need to be aware of the problem and

what to do about the problem.

For health care professionals, just as an example, we recently

put on a 11⁄2 day training course for geriatricians on the topic of

elder abuse, funded by the California Office of Criminal Justice

Planning, through a program called California Medical Training

Centers. The purpose of this is to train physicians to be more helpful to folks like Mr. Greenwood who want to then prosecute these

cases. We sent a mailing to over 600 geriatricians in California,

and we put it on for free, we offered continuing medical education

credits, and we had 16 practicing physicians come.

So it is a struggle to make health care providers aware of the

problem; and then we have the next obligation, to make them

aware and provide the training. But it is a struggle.

Senator CRAIG. It appears to me today, or at least, we are told,

and all reference to it seems to be accurate, that with physicians

who treat a child who appears to be abused, there tends to now be

an immediate report, or questions are asked immediately, and authorities are brought in to examine. That has come over a period

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of time of causing general awareness, but also clearly understanding that that physician has a responsibility to report.

That appears not to be the case with the elderly. How do we

cause physicians to be as sensitive—through educational programs,

or does there need to be more specificity in the law as to a responsibility and a requirement to report?

Dr. MOSQUEDA. Well, of course, the laws are different in different

States, but in most States, there is a mandated reporting law for

elder abuse, and physicians are always mandated reporters.

As far as I know, there have not been any prosecutions of physicians for not reporting; I do not know if there will need to be carrots and sticks. But I think that at a more basic level, physicians

are just missing it. We do not have any data to help us understand

how to distinguish a bruise or a pressure sore or other signs of injury—a fracture, for example—well, the person has osteoporosis,

and they fracture easily.

So we need to train physicians to start thinking about how to ask

questions and what questions to ask about this. So from my perspective, I think it lies in research and education and making it

easy for physicians to report—creating forensic centers, for example, as they have done in child abuse, so that a physician who is

in a busy practice does not feel like, hey, if I identify this case of

abuse, that is going to be my whole afternoon—if they could have

an easy way to turn it over to somebody who could help them with

documentation and investigation.

Senator CRAIG. I apologize that I am running out of time because

there are several other things that I would like to ask you. What

we may ask of you is that we be able to submit some questions in

writing for your response.

But Paul, offer me some advice from your experience. You talk

about ‘‘vertical units.’’ What are your best recommendations—you

have already given some—for other States and counties that may

want to start their own multiple disciplinary teams and other prosecuting attorneys’ offices that may want to establish an internal

elder crime unit.

Mr. GREENWOOD. I would try to send out the message to all elected prosecutors that one of their primary responsibilities right now

is to make sure that they are taking care of their elder population

and to get the backing of their local boards of supervisors in their

counties to be on board with this, and to assign a prosecutor who

believes in the work, is dedicated to it, and basically fulfills a role

outside the courtroom as well as inside the courtroom, which I

think is for adult protective services to begin outreach, education

and training.

I do believe that local prosecutors have a unique responsibility

and opportunity in this country to be able to fulfill that, but it

takes the vision of an elected prosecutor. Five and a half years ago,

it was my boss, Paul Pfingst, who saw the need, and he allowed

me the freedom to develop it in the way that I have seen fit. But

you need more Paul Pfingsts out there who see that we have got

to have this as a primary resource in every office.

When I go around the country, Senator, and I talk to elected

prosecutors, their first response is, ‘‘Oh, we do not have the money

in the budget.’’ And then I follow up with a question: ‘‘Do you prosVerDate 11-MAY-2000 13:35 Oct 05, 2001 Jkt 000000 PO 00000 Frm 00088 Fmt 6633 Sfmt 6633 74685.TXT saging1 PsN: saging1
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ecute misdemeanor DUIs?’’ And they say, ‘‘Of course, we do.’’ And

I ask, ‘‘What would happen if, tomorrow, you went on television

and said we cannot prosecute misdemeanor DUIs because of lack

of funding?’’ And they say, ‘‘We would have Mothers Against Drunk

Driving at our door.’’ I say absolutely—but equally, as my colleague

here so succinctly put it, we owe seniors because of what they have

done for us. We owe them our primary duty to take care of them.

And I think elected prosecutors in this country need to capture that

vision today.

Senator CRAIG. I wish we could continue this discussion, but I

cannot, and I apologize. But certainly on behalf of Chairman

Breaux and myself and the members of the committee, we thank

all of you for your time, but most important, we thank you for your

commitment and your willingness to become advocates and speak

out. That is clearly a part of the whole process of educating and

understanding.

I am committed, and I think the chairman is, to working with

the Department of Justice to see if we cannot cause a bit of a different allocation of resources—and my guess is that we can—that

will allow us to begin to reach out to States and to counties, both

in the informational and educational perspectives, but also the possibility of actually gaining some resources to train and employ people for the purpose of advocacy and/or obviously the kind of training that you have all spoken to.

Thank you all very, very much for coming today. We do appreciate it.

The committee will stand adjourned.

[Whereupon, at 11:26 a.m., the committee was adjourned.]

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