A Report of Proceedings

U.S. Department of Justice

Office of Justice Programs

AN

OJP

ISSUES &

PRACTICES 

REPORT

OJP

A National Symposium sponsored by U.S. Department of Justice 

and U.S. Department of Health and Human Services
Our Aging Population:

Promoting Empowerment,

Preventing Victimization, and

Implementing Coordinated

Interventions

A National Symposium Sponsored by the 

U.S. Department of Justice and the 

U.S. Department of Health and Human Services

A Report of Proceedings



Office of Justice Programs

December 2000

NCJ 186256
Contents

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Opening Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Plenary I: Building the Case: Why Policymakers 

Should Focus on Elder Victimization . . . . . . . . . . . . . . . . . . . . . . . . 3

Plenary II: Financial Exploitation and Consumer 

Fraud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Lunch: Investigating the Systems That Protect and Care for 

Vulnerable Populations: A Reporter’s View . . . . . . . . . . . . . . . . . . 11

Financial Exploitation and Consumer Fraud Workshops

Workshop 1: Federal and State Initiatives To Educate 

Consumers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Workshop 2: Effective Interventions To Address Consumer 

Fraud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Workshop 3: Innovative Approaches to Financial Exploitation . . . . . . . . . . . 21

Workshop 4: Enhancing Prosecution of Financial Exploitation. . . . . . . . . . . . 23

Workshop 5: Combating Consumer Fraud Through Litigation . . . . . . . . . . . . 27

Plenary III: Elder Abuse and Neglect at Home . . . . . . . . . . . . . . . . 29

Elder Abuse and Neglect at Home Workshops

Workshop 1: Strengthening Interventions for Victims With Dementia . . . . . . . 33

Workshop 2: Working Across Systems To Improve Services for Victims of

Domestic Violence and Sexual Assault . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

An OJP Issues & Practices Report iii
Our Aging Population: A Report of Proceedings

Workshop 3: Engaging Law Enforcement, Prosecution, and the Judiciary . . . . 43

Workshop 4: Augmenting the Role of Medical Professionals. . . . . . . . . . . . . 47

Workshop 5: Enhancing Victim Services . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Opening Remarks: Day Two. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Plenary IV: Institutional Abuse and Neglect. . . . . . . . . . . . . . . . . . 55

Institutional Abuse and Neglect Workshops

Workshop 1: Creative Initiatives To Educate Professionals and the Public . . . . 61

Workshop 2: Joining Resources To Combat Institutional Abuse and Neglect . . 65

Workshop 3: Enhancing the Survey and Regulatory Process. . . . . . . . . . . . . 69

Workshop 4: Holding Institutions Accountable Through Prosecution . . . . . . . . 71

Closing Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Appendix 1: Agenda

Appendix 2: Participant List

Appendix 3: A Guide to Featured Programs

Appendix 4: State and Tribal Team Strategies

Appendix 5: Tribal Caucus Recommendations

iv An OJP Issues & Practices Report
An OJP Issues & Practices Report v

Executive Summary

Hundreds of policymakers and practitioners representing public safety, social services, health care, and advocacy assembled in Washington, D.C., October 30–31, 2000, for a rare opportunity to share information across

disciplines about innovative ideas and programs to enhance efforts to prevent, reduce, and respond to the crime

victimization of older people throughout the country.

Background

Experience has demonstrated that multidisciplinary approaches, combining diverse expertise and the tools of

a variety of entities, are most effective in addressing crime against older people. Indeed, experts and practitioners

strongly and consistently urge greater coordination among those who serve our aging population, those who create and regulate programs that serve older persons, and those who enforce laws designed to prohibit and redress

abuse, exploitation, fraud, and neglect. With this in mind, the U.S. Departments of Justice (DOJ) and Health

and Human Services (HHS) combined their respective public safety and social services approaches in planning

this symposium. The symposium featured promising programs and projects that have brought together social

service agencies, advocates, medical professionals, public safety officials, law enforcement personnel, and others

to work toward empowering older people to live safely and implementing more effective strategies to prevent and

respond to victimization.

The symposium was framed around three topical themes: financial exploitation and consumer fraud, elder

abuse and neglect at home, and institutional abuse and neglect. Each topic was addressed in a plenary session

and a number of associated workshops focusing on promising approaches featuring strong collaborations

between the public safety and social services disciplines.

Symposium Attendees

Reflecting this emphasis on public safety and social services collaboration, nominations were invited from

each state attorney general (and from the District of Columbia Corporation Counsel) and the director of each

state unit on aging (and in the District of Columbia)—representing the public safety and aging/social services

fields, respectively. Additionally, a number of Indian tribes were invited to send delegates to the symposium.

Because the focus of the symposium was on policy and program development, the nomination of individuals at

the policymaking level actively engaged in issues related to the victimization of older persons was sought. The

symposium was aimed at participants who would use the symposium as an opportunity to gather information

that would enable them to provide leadership in policy and program development at the state, tribal, and local

levels.

Symposium attendees were organized into state and tribal teams, which were given an opportunity each day

of the symposium to meet and begin formulating plans for collaboration on elder victim issues. The symposium’s

closing session provides an opportunity for participants to hear from Attorney General Janet Reno and then for

selected teams and the Tribal Caucus to report to Attorney General Reno. The participants were then invited to

engage in a discussion with her.
vi An OJP Issues & Practices Report

Building the Case: 

Why Policymakers

Should Focus on

Elder Victimization

The opening plenary session provided participants with the framework on policy and collaboration

for the symposium and set out in broad terms the

impact of the victimization of older people. Panelists

conveyed the importance of policymakers focusing on

elder victimization and thereby set the stage for the

three thematic plenaries and respective workshops.

The need to demonstrate the prevalence of elder

abuse is a central issue in generating public support

and funding for prevention efforts. Dr. Rosalie Wolf,

President and Founder of the National Committee for

the Prevention of Elder Abuse, explained that policymakers continue to underestimate the occurrence of

elder abuse, thereby limiting political awareness and

financial support for prevention, intervention, prosecution, and further research. Dr. Wolf cited examples

in which obscure and inadequate research has prevented progress in the field and suggested that a

reporting mechanism using those who have close contact with potential victims would elicit a more accurate number of abuse and neglect cases and reveal the

extensive nature of the problem.

Financial fraud is a seriously debilitating element

in the lives of many seniors. Telemarketing scams,

Medicare fraud, investor fraud, and a host of new

fraudulent practices related to the Internet are widespread. John Rother, Director of Legislation and

Public Policy for AARP, said the organization is focusing its efforts on combating consumer fraud, and

already has many effective programs in place. AARP

has devoted much effort to educating older people

who are susceptible to intimidation and harassment,

and has committed to opening an office in every state

in order to work more closely with law enforcement,

legal, and medical services.

David Baldridge, Executive Director of the

National Indian Council on Aging, provided insight

into the issues that directly and indirectly affect elder

abuse in the tribal nations. Poverty, enormous stresses

on the family, serious long-term health problems,

increasing violence, and constraints on community

resources for the care of older people are contributing

factors. Additionally, the cycle of alcohol abuse, gangrelated deaths, and suicides among younger tribal

members has undermined the community’s ability to

sustain time-honored values of family-based support.

Mr. Baldridge concluded, “If our teens are not believing in and taking care of themselves, how can we ask

them to take care of their elders?”

Victims often suffer from embarrassment and

shame and need sensitivity from the agencies and personnel who provide help. Sue Ward, representing the

National Association on Units of Aging, and Andrew

Ketterer, representing the National Association of

Attorneys General, each discussed the importance of

being alert to older people’s needs for self-respect and

self-determination. Elderly people should be involved

in planning elder programs and should not be made

to feel dependent when they are victimized. Respect

for diversity and cultural history is critical.

Financial Exploitation

and Consumer Fraud

The second plenary session provided an overview

of the problems of financial exploitation and consumer

fraud and their impact on society and individual victims. Under the control of a financially motivated

stranger, elder citizens are vulnerable. Jill Thomas

related the personal experience of her father and a

woman who became a part of his life after he won

$6 million in the Florida lottery. This woman gained

increasing control over the father’s life and excluded

family members, especially after he suffered a stroke.

Investigators and courts offered no recourse and no

consolation to the Thomas family, and argued that

the law did not permit them to conclude that he had

lost the capacity to decide how to dispose of his money.

Financial crimes are difficult to investigate and

difficult to prosecute, and there is often confusion

about which jurisdiction (local, state, or federal) has

authority over a given case. Lisa Nerenberg, a private

consultant, identified a fundamental issue of financial

fraud: “[These] cases really challenge our understanding of decisionmaking capacity. We are trying to figure

out what someone understood as informed consent.”

The challenge for investigators is similar across different domains: they must protect victims’ rights to

Our Aging Population: A Report of Proceedings
Executive Summary

An OJP Issues & Practices Report vii

choice and self-direction, and in cases of undue influence and financial exploitation they must discover

whether a victim’s capacity to decide is diminished.

Lee Norrgard, Senior Program Coordinator for

the Consumer Protection Section of AARP, noted

that several surveys have shown older people’s vulnerability to consumer fraud, especially telemarketing

fraud. He noted that focus groups have shown that

educating older people about the existence of scams

may not be enough to prevent the crime.

Included in the mission of the HHS Office of

the Inspector General is prevention, detection, investigation, and prosecution of fraud, said Inspector

Barbara Harriman. The percentage of people who

commit fraud is small, but the outcome has been devastating; in 1996, the country lost $23 million in

health care fraud and abuse. By 1999, there had been

a significant decrease in losses due to fraud, but new

financial scams appear faster than investigators and

policymakers can act.

Elder Abuse and

Neglect at Home

The focus of the third plenary session was elder

abuse and neglect at home, the forms it takes, and its

impact, framing the many issues involved.

Joyce Speakman shared with participants the story of how her mother died of abuse and neglect at the

hands of a financially dependent, mentally ill daughter. Ms. Speakman’s story exposed how the lack of

awareness, education, and system response among various agencies can lead to extreme suffering, continued

abuse, and sometimes death. Eva Kutas, president of

the National Association of Adult Protective Service

Administrators, noted, “Stories like this tell us we are

at the very beginning” of addressing the problem.

Ms. Kutas spelled out the responsibilities that

Adult Protective Services (APS) has to the elder community. The agency is legally obligated to respond to

concerns of abuse in every state. It provides a system

through which workers go into the home to investigate

and ameliorate the situation with legal, psychological,

and medical support. While APS is resource-poor in

many states and struggles with funding issues, they

continue to work on finding better tools for evaluation

and pushing authorities to challenge undue influence

by relatives with intentions to control older family

members.

Bonnie Brandl, Project Coordinator of the National

Clearinghouse on Abuse in Later Life, brought attention to policies and protocols that are in place to deal

with elder abuse, and challenged conference participants to realize that victims are not always protected

under present systems. In several examples, she noted

that law enforcement often is reluctant to arrest or

remove abusive husbands, and interventions such as

caregiver support to relieve stress do not change the

pattern of abuse at home. “Victims fall between the

cracks” and are left to the domination of abusers,

Ms. Brandl said. She asked participants to consider

whether the current interventions truly address the

suffering of victims.

Elder sexual abuse, discussed by Dr. Holly

Ramsey-Klawsnik, a sociologist and licensed marriage

and family therapist, is extremely difficult for most

people to contemplate, and many agencies are reluctant to credit evidence and investigate. This kind of

abuse is particularly insidious for vulnerable elder

adults, some of whom are completely dependent on

their perpetrators for care, food, and medicine and

therefore have few options. The system does not provide safe havens for abused and chronically ill elderly

women. Dr. Ramsey-Klawsnik reminded participants

that the circumstances of elder sexual abuse are heinous,

but rather than deny the occurrence of sexual abuse, the

system needs to develop a more sophisticated response.

Institutional Abuse and

Neglect

The fourth plenary panel was devoted to issues

surrounding the abuse and neglect of older people living in long-term care facilities. There are multiple

legal tools to combat abuse and neglect in nursing

homes and other institutions caring for older people.

States in the best position to take advantage of those

tools are those with multidisciplinary teams that can

share information and resources. The levels of pain

and suffering in many institutions are extraordinary,

and states often are ill-prepared to respond to families’

pleas to help their loved ones.
viii An OJP Issues & Practices Report

Senora Russell told of her father’s suffering

because a nursing home staff delayed care and ignored

family requests for hospitalization until it was too

late. In another account, Michelle Lujan-Grisham,

Director of the New Mexico State Agency on Aging,

found similar abuse and incompetence when she went

undercover to evaluate first-hand the conditions of a

small residential facility. Reporting extreme isolation,

improper feeding, and emotional abuse, Ms. LujanGrisham advised participants to hold facilities

accountable. By linking Medicaid payments to facility

complaints and preventing access to funds until complaints are resolved, facilities could become financially

motivated to improve the care of residents.

Medicaid fraud, too, is a complex area to investigate and prosecute. Officials often have to pursue cases without sufficient medical evidence and without

witnesses. Medicaid Fraud Control Units receive tens

of thousands of referrals and prosecute hundreds of

cases each year. David Waterbury, Director of the

Washington State Medicaid Fraud Control Unit, noted that law enforcement relies heavily on others to

respond to these cases. There is “no other area of law

enforcement that requires so much collaboration, networking, and partnership.” 

DOJ’s Nursing Home Initiative has worked to

bring people from a wide variety of disciplines together to focus on elder abuse. Coordinator Marie-Therese

Connolly reported that the Initiative recently sponsored four regional conferences to help participants

identify roles and issues and to provide training. The

Initiative has three areas of focus: enhanced enforcement, evaluation, and recertification of nursing homes;

prosecution of criminal and civil cases; and information sharing. State working groups that developed as a

result of the Initiative also have identified a national

problem in prosecuting abuse and neglect: the lack of

research into the signs and symptoms of abuse and

neglect in the elderly.

Closing Session 

In the closing session, Attorney General Janet

Reno delivered remarks to the participants. “Today,

about 34 million Americans are over the age of 65,

and in 30 years that number will more than double,”

she said. “Today, too many older Americans are victims of abuse and neglect in places where they should

be safe: in their homes, in long-term care facilities.

And too many are victims of fraud. We can do a lot

better than we have.”

“I think this whole effort is about the defense of

the human spirit,” the Attorney General told conference participants. “We have got to make sure that this

nation is not just focused on its future, but on its present, the present in terms of the remarkable human

spirit, the wisdom, and the greatness of older people.

They will overcome if we give them half a chance.”

Attorney General Reno outlined an agenda for

the future of the elder justice movement. The first

priority, she said, is prevention. For example, by promoting an economic infrastructure that helps older

people remain self-sufficient, the country also can

promote respect for aging Americans. The next priority is to form multidisciplinary efforts to design interventions, and to move quickly in creating them. “The

quicker you see it, the faster you move, the lesser the

problem,” she said. The third priority is prosecution,

and the Attorney General pledged that DOJ is committed to pursuing hard cases, coordinating closely

with HHS and others. She also encouraged efforts at

the community and individual levels and praised

community advocates and community policing in

building a foundation of neighborhood concern and

shared local support.

The Attorney General told conference participants that, “We have got to develop a comprehensive,

coordinated, well-funded national plan to prevent elder abuse in the first place, and to pursue it correctly

if it has occurred. But we don’t have to reinvent the

wheel ... We can learn so much from one case to the

other.” She encouraged participants to collaborate with

experts from many fields and to seek out best practices.

Attorney General Reno outlined several collaborative

efforts DOJ has pursued:

■ In the late 1980s, DOJ began funding the

Triad Program, a collaboration of AARP volunteers, the National Sheriff’s Association,

and the International Association of Chiefs

of Police (IACP).

■ In 1998, DOJ established five elder fraud prevention teams, composed of AARP volunteers,

and federal, state, and local law enforcement

officials, to educate older consumers about

scams.

Our Aging Population: A Report of Proceedings
Executive Summary

An OJP Issues & Practices Report ix

■ The Office of Justice Programs has awarded

grants to train lawyers and victim advocates

about elder abuse, to provide technical assistance to programs dealing with domestic violence in later life, and through its formula

grant programs, to support direct services for

victims of elder abuse.

■ Since 1999, the Nursing Home Initiative has

sponsored cross training for more than 1,000

federal and state law enforcement, regulatory,

social service, public safety, and health care

professionals. 

■ DOJ has formed multidisciplinary state working groups to provide infrastructure and focus

on these issues at the state and local levels.

■ DOJ remains committed to regular productive

interagency coordination with the Health Care

Financing Administration and HHS Office of

Inspector General on cases and policy issues.

Throughout the conference, the state and tribal

caucus teams met to discuss how they could use information from the conference to enhance collaboration

on elder victimization issues in their jurisdictions.

Eight teams were selected to report to the Attorney

General and the other conference participants on their

plans: South Carolina, Nevada, New Hampshire,

Yakama Nation, Texas, Minnesota, Montana, and

Northern Cheyenne Tribe.

Included were plans to:

■ Develop collaborations among all the key

players dealing with elder abuse, establish

common languages and protocols, and resolve

jurisdictional and turf issues.

■ Make elder abuse a community policing 

priority.

■ Create or improve legislation and codes 

dealing with elder abuse.

■ Establish an emergency shelter.

■ Create more training programs for law

enforcement.

■ Ensure better reporting from law enforcement.

■ Develop stronger educational efforts for

judges, law enforcement, the legal and medical

communities, and the general public, especially elders.

■ Develop a pool of experts that prosecutors

can call on in elder abuse cases.

■ Convene a Tribal Summit and state conferences on elder abuse.

■ Develop the capacity for telemedicine and

teleconferencing.

■ Improve data collection.

■ Establish a tribal Elder Review Board.

Additionally, at a Tribal Caucus on the first

evening of the symposium, the tribal teams and several state teams and other state representatives formulated recommendations that were reported to the

Attorney General.
Opening Remarks

Speaker:

Daniel Marcus

Acting Associate Attorney General

U.S. Department of Justice

Washington, D.C.

Daniel Marcus, Acting Associate Attorney General, welcomed participants and told them that Attorney

General Janet Reno has made addressing elder abuse and neglect a priority. DOJ works with other departments

and national organizations to build prevention programs, encourage multidisciplinary interventions, and prosecute cases of elder abuse, neglect, and fraud.

A growing concern about elder abuse led to a groundbreaking multidisciplinary roundtable discussion in

October among scholars and professionals in health care, social services, and law enforcement regarding the medical forensics issues in elder abuse and neglect. Crucial issues were identified and communications among experts

in the field were strengthened, Mr. Marcus said.

HHS also has engaged in comprehensive efforts to combat elder abuse and has made significant reforms

through its nursing home quality of care programs and working through the Administration on Aging and its

Long-Term Care Ombudsman Program.

Early collaborations have been successful and are beginning to make an impact on public awareness, Mr.

Marcus said. But elder abuse and neglect is significantly underreported and therefore efforts to address it do not

receive as much funding and general support as they need. He invited conference participants “to explore what

more can be done to address elder abuse.” 

An OJP Issues & Practices Report 1
Plenary I

Building the Case: Why Policymakers Should Focus on

Elder Victimization

Moderator:

Mary Lou Leary

Acting Assistant Attorney General

Office of Justice Programs

U.S. Department of Justice

Washington, D.C.

Presenters:

David Baldridge

Executive Director

National Indian Council on Aging Inc.

Albuquerque, New Mexico 

The Hon. Drew Ketterer

Attorney General, State of Maine 

President, National Association 

of Attorneys General

Augusta, Maine

John Rother

Director, Legislation and Public Policy

AARP

Washington, D.C.

Mary Lou Leary, Acting Assistant Attorney General for the U.S. Department of Justice, Office of Justice

Programs (OJP), explained that the purpose of the conference was to bring together multidisciplinary teams

from around the country so that participants could “develop or enhance the action strategy in your [own] community.” She noted that participants would have an opportunity to meet with their state and tribal teams to

focus on these issues. Ms. Leary suggested that participants use the opportunity to learn from each other, get to

know the needs of other states and tribal nations, and network with the purpose of stimulating ideas and actions.

Ms. Leary stated that the purpose of the opening plenary was for presenters to provide a framework for the symposium, focusing three topical themes: financial exploitation and consumer fraud, elder abuse and neglect at

home, and institutional abuse and neglect.

In this session, presenters conveyed the importance of policymakers focusing on victimization of older persons, thereby setting the stage for the three areas to be addressed. Panelists presented the central issues for participants to consider as they developed strategies to enhance multidisciplinary approaches to elder abuse and neglect

in their jurisdictions.

An OJP Issues & Practices Report 3

The Hon. Sue Ward

Secretary, Board of Directors, National 

Association of Units on Aging

Secretary, Maryland Department on Aging

Baltimore, Maryland

Rosalie S. Wolf

President and Founder

National Committee for the Prevention 

of Elder Abuse

Worcester, Massachusetts
Our Aging Population: A Report of Proceedings

Dr. Rosalie Wolf, President and Founder of the

National Committee for the Prevention of Elder

Abuse, offered an overview of the development of the

theoretical conception of elder abuse and neglect over

the past 20 years. The lack of statutory and theoretical

definitions of elder abuse and neglect has hindered

legal and scientific understanding, she said. Traditional

conceptions have discounted the cultural context in

which abuse and neglect occur, instead focusing on

the individual pathology of the perpetrators. More

recently, experts have begun to place elder abuse and

neglect within an ecological framework, suggesting

that such violence results from individual, interpersonal, social contextual, and societal factors. This shift

mirrors similar progressions that have occurred in

the analysis of child abuse and domestic violence.

In applying the ecological model to elder abuse, the

frame of reference is broadened, allowing providers to

better determine the cause of the problem and to promote interventions at all levels of the environment. At

the individual level, such a framework suggests treatment for both victims and perpetrators. The interpersonal level analysis allows for the introduction of

social services for situational problems within the

home. At the community level, there can be improved

responses to mental illness, substance abuse, and

unemployment, among other contributing problems.

And for society, the ecological model urges changes in

cultural values and beliefs that have fostered ageism

and sexism.

The lack of an agreed definition has hindered

research to determine the prevalence of this problem.

According to Dr. Wolf, there have been five such

research studies conducted in five different countries.

Despite the differing methodologies, these studies all

placed the prevalence of elder abuse and neglect at

between four and six percent of the population. A

survey of state programs by Adult Protective Services

found that the number of reported cases of elder

abuse and neglect in the United States increased from

117,000 in 1986 to 296,000 in 1996. A more recent

national elder abuse incident study mandated by

Congress used the sentinel approach, which assumes

that reported cases are only the tip of the iceberg.

This study not only looked at case information

obtained from Adult Protective Services, but also

examined data from agencies and programs serving

older persons, such as hospitals, clinics, law enforcement agencies, and banks. In the 20 counties that

served as the sample, the study found that in 1996,

450,000 persons aged 60 or older were abused, neglected or exploited. However, only 71,000 cases were

reported and substantiated by APS. Dr. Wolf cautioned that this study has some flaws, including the

small sample size of 20 counties (of a total 3,300 in

the United States) and the failure to account for those

older persons who are homebound or isolated.

What little research that has been conducted in

the first 20 years of the elder abuse movement has

focused primarily on mistreatment in family settings,

ignoring the problem within institutions. Dr. Wolf

suggested a number of risk factors within institutional

settings that could lead to abuse, including the lack

of staff training, low regard for older persons, inadequate facilities and management skills, employees

who are ill-suited by temperament or history for their

positions, communication and cultural differences

between staff and residents, and staff turnover and

shortages. In pointing toward the future of the elder

abuse and neglect agenda, Dr. Wolf cited some positive legal processes that had been instituted such as

the emergence of Medicaid Fraud Control Units, the

1987 Nursing Home Reform Act, and this year’s public awareness campaign initiated by the Health Care

Financing Administration. However, elder abuse and

neglect involves medical, legal, psychological, social,

environmental, and ethical issues that require intense

coordination among different agencies. 

Dr. Wolf concluded by asserting that “policymakers need to focus on a system to ensure cultural competence among practitioners; reduce fragmentation

among the forms of family violence; create better

tools for identification and diagnosis; support research

on prevalence, risk factors, consequences, and other

aspects of the problem; promote evaluation of elder

abuse interventions; and encourage collaboration

among the multiple systems that are involved with

elder abuse, neglect, and exploitation.”

John Rother, Director of Legislation and Public

Policy at AARP, discussed the steps that AARP was

taking to combat consumer fraud perpetrated on older persons, and announced that by next year the

organization will have staffed offices in all 50 states

to better coordinate efforts with local groups. AARP

is working to change the attitudes and raise awareness

among the older population in the areas of telemarketing and health care fraud. According to a 1996

4 An OJP Issues & Practices Report
An OJP Issues & Practices Report 5

AARP survey, 56 percent of all telemarketing fraud

victims were aged 50 or older, yet this age group

makes up only 26 percent of the U.S. population.

Annually, telemarketing fraud costs $40 billion dollars, with the most popular forms being prizes and

sweepstakes scams, slamming, pay-for-call services,

work at home sales, and magazine sales. The major

types of health care and investment fraud that AARP

has documented include Medicare fraud, living will

scams, and home improvement fraud. Determining

the prevalence of consumer fraud perpetrated on the

older population is hindered by their reluctance to

report such incidences. This reluctance stems from

embarrassment, as well as fear that they will lose their

independence, control of their financial decisionmaking, or even be institutionalized. Mr. Rother identified several steps that AARP is taking to prevent and

intervene in consumer fraud, including providing

consumer education; working with business associations to set and monitor standards; promoting early

detection by educating people who come in contact

with older persons daily, such as bank tellers and

postal carriers; and pushing for effective enforcement

of existing laws.

David Baldridge, Executive Director of the

National Indian Council on Aging, informed participants that in the 558 Indian tribes across the nation,

honoring older persons is a universal value, yet the

incidence of elder abuse is very high. To explain this

discrepancy, he pointed to socioeconomic disparities

between tribal communities and the rest of the country. The poverty rate for older Indians is three times

the overall U.S. rate. A U.S. Department of Housing

and Urban Development (HUD) report found that

33 percent of Indian homes are overcrowded compared with 5 percent in the general population. The

federal expenditure for health care is 34 percent less

per person in Indian communities. Additionally, there

are only 12 nursing homes in Indian Country with

90 percent of long-term care being provided by family

members who are themselves under severe stress. 

This stress often leads to drug use and violence:

19.6 percent of Indian teenagers use illegal drugs.

Alcoholism impacts 95 percent of Indian families

with alcohol-related deaths among 15–24 year olds

at 17 times the national average. According to a 1997

Department of Justice report on law enforcement in

Indian Country, there are only 1.3 officers for every

1,000 citizens compared with 2.9 in non-Indian communities. The homicide rate for Indian males is nearly three times higher than that of white males. And

there are a total of 375 Indian gangs with 5,000

members. Given these grave statistics, Mr. Baldridge

contends, “we’re losing the battle of belief.” And he

asked those present, “So how will we as tribal leaders,

as providers, as advocates, deal with these questions

of human belief with hope, with the will to change? I

think that’s our challenge.”

Sue Ward, Secretary of the Maryland Department on Aging, spoke on behalf of the National

Association of State Units on Aging (NASUA) and

stressed the importance of collaboration in addressing

elder abuse and neglect. NASUA is the lead agency

for the National Center on Elder Abuse, a partnership

of six organizations (the others are the American Bar

Association Commission on Legal Problems of the

Elderly, the Clearinghouse on Abuse and Neglect of

the Elderly at the University of Delaware, the Goldman Institute on Aging/San Francisco Consortium

for the Prevention of Elder Abuse, the National

Association of Adult Protective Services Administrators, and the National Committee for the Prevention of Elder Abuse) funded by the Administration

on Aging.

Explaining that the demographic shift (or, alternatively, the aging of the population) will increase the

number of vulnerable older persons, Ms. Ward said

“Collaboration has to be our watchword. Neither the

social service nor the public safety systems can respond

to current challenges or prepare for the future without

talking to each other. None of our programs, individually, has the resources necessary; none has the specific expertise needed to respond to these difficult

situations. We know that referrals for adult protective

service assessments are not simple one dimensional

situations: cases often involve multiple issues such as

transfer of property, alcoholism/drug dependence,

hoarding behavior, eviction, depression, mental illness, family dysfunction, spousal abuse, assault, and

theft. Each of these issues requires a special expertise

to (a) assess and document the problem, and (b) clarify the options for assistance and/or intervention. It is

only through collaboration and coordination that we

can effectively offer assistance.”

Andrew Ketterer, Attorney General of Maine and

President of the National Association of Attorneys

Plenary I: Building the Case: Why Policymakers Should Focus on Elder Victimization
Our Aging Population: A Report of Proceedings

6 An OJP Issues & Practices Report

General, addressed the unique challenges that law

enforcement faces in working with older persons. On

the whole, older persons are reluctant to admit that

they have been victimized and to seek help, he said.

In cases of domestic violence when the perpetrator is

a family member, it is even more difficult for the older victim to report abuse. To improve services to older

victims, Mr. Ketterer suggested that all prosecutors

receive elder abuse training, that public education

programs be offered to increase awareness of older

persons’ issues, and that state attorneys general take

the lead in coordinating the efforts of professional

and community organizations. There is a long way to

go in improving law enforcement response to older

victims. At present, there is no statutory consistency

from state to state on how to address elder abuse.

There are no national standards or best practice

guidelines, no model statutes, no research think tanks,

and no consistent data collection or reliable data

management systems. In addressing these deficiencies,

Mr. Ketterer stressed that the diversity of the elder

population must be recognized and that older people

must be included in the planning process. 
Plenary II

Financial Exploitation and Consumer Fraud

Moderator:

Diane Justice

Principal Deputy Assistant Secretary for Aging

U.S. Department of Health and Human Services

Washington, D.C.

Presenters:

Barbara Harriman

Inspector, Office of the Inspector General

U.S. Department of Health and Human Services

Washington, D.C.

Lisa Nerenberg

Consultant in Elder Abuse Prevention

Redwood City, California 

Older people are especially vulnerable to financial exploitation in a variety of forms, often aggravated by violence or the threat of violence, because they tend to be more trusting and less cynical than younger people in

dealing with fraudulent telemarketers and other scam artists. They are especially vulnerable to home-repair

scams, since so many own their own homes but cannot do their own repairs. Aging may bring disability and

dependence upon caregivers, some of whom may prove exploitative. To others, the older person’s dependence

may seem like complicity in their own abuse.

On a panel mediated by Diane Justice, Principal Deputy Assistant Secretary for Aging at the Department of

Health and Human Services, presenters outlined a variety of schemes to defraud older persons directly. Panelists

described the way HHS and DOJ, employing partnerships with such agencies as the Internal Revenue Service

(IRS) and Federal Bureau of Investigation (FBI), gather evidence and act to prevent or prosecute fraud and

abuse. There was general agreement that judges and others in the legal system need to be educated about elder

abuse so that they have a better understanding of the use of undue influence and alienation of affection to

exploit older persons. Older people, too, need better education about the dangers of financial abuse.

These efforts can build on existing collaborations, some of them long-term, between HHS and DOJ against

health care fraud and abuse, noted Ms. Justice. She cited the Nursing Home Quality Initiative and other efforts

to fight health care fraud and abuse throughout the country; the Long-Term Care Ombudsman program, advocating for residents of nursing homes for the past 25 years; and the elder abuse prevention program, which provides funding to the states for education and services related to elder abuse. 

Jill Thomas, a consultant and specialist in geriatric nursing home care, highlighted the problems of financial

exploitation by telling a painful story about the exploitation of her father by a “gold digger” and the inability of

Florida agencies to protect him.

An OJP Issues & Practices Report 7

Lee Norrgard

Senior Program Coordinator 

Consumer Protection Section

AARP

Washington, D.C.

Jill Thomas

Independent Consultant

Bay Village, Ohio
8 An OJP Issues & Practices Report

Ms. Thomas’ father was a divorcee of 69 when,

in 1994, he won $6 million in the Florida lottery. He

enjoyed his newfound wealth, and began searching

for female companionship. He met Stephanie, a 40-

year-old woman of obscure background. The two dated on and off for a while, then went their separate

ways. Ms. Thomas’ father suffered a stroke and was

recuperating in a rehabilitation hospital, with both

physical and mental impairments, when Stephanie

turned up again. 

In the following few weeks, she took effective

control of his life. She secured control of his assets

through a power of attorney, and placed her name on

his deeds, bank accounts, and even the trust fund Ms.

Thomas’ father had established for himself and his

four adult children. After he left the hospital, he and

Stephanie sold his “beloved” beachfront condominium. 

Stephanie has succeeded in cutting off all contact

between the father and his old friends and with his

family. Ms. Thomas has learned that her father has

been in and out of a succession of assisted-living facilities and hospitals, and is currently in a nursing home

in the Tallahassee area. The last time Ms. Thomas saw

or spoke with her father was in court, in 1998, when

she and her brother attempted unsuccessfully to gain

guardianship of their father. “I’m worried about my

father,” Ms. Thomas said, “and I don’t want him to

die alone without being reunited with his children,

who have always been a very important part of his

life.” 

In years of court hearings and trials that cost tens

of thousands of dollars, the Florida court system has

offered no help or relief, she said. A detective in the

Tallahassee Sheriff’s Department Fraud Division told

her that while current Florida law would not help, the

problem of financial abuse of elders had grown so

large that it might be time to set a precedent. He

referred her to Adult Protective Services, which told

her, “It’s your father’s money, and he can give it to

anybody that he wants.” In her search for a solution,

she contacted the FBI, police, and sheriff’s departments in Florida and Georgia, the Florida Attorney

General’s Office, and U.S. Senators in a committee

hearing at which she testified. All agreed that crimes

had been committed, but after learning of the failed

guardianship attempt and the APS response, they all

said there was nothing they could do. 

Ms. Thomas recommended more standardized

testing and requirements for guardians, and greater

judicial discretion in financial exploitation cases. In

her father’s case, Ms. Thomas originally saw no

immediate need to seek legal redress, and was afraid

of alienating him until Stephanie’s intentions became

quite obvious. But when the adult children applied

for guardianship—even though the examining committee reports stated he could not handle his own

finances or drive—a committee recommended against

the guardianship, and the judge, the only one who

heard the family’s side, felt that his hands were tied

and that he was required to deny the guardianship.

(Professionals who reviewed the reports said that

either her father was not competent or that the testing was inadequate.)

Ms. Thomas also recommended that state legal

systems recognize alienation of affection in cases like

her father’s. When Stephanie sued the family for

defamation of character, Ms. Thomas and her brother

filed a countersuit on the only legal ground their

lawyer could find: “impediment of inheritance,”

since Florida law doesn’t recognize alienation. (The

countersuit ended when the court dismissed Stephanie’s

suit as “frivolous.”)

Lisa Nerenberg, a consultant in elder abuse prevention in Redwood City, California, explained that

financial abuse of older persons spans a broad spectrum. It includes the attendant who steals from a

charge; the teenager who uses his grandmother’s credit

card to buy stereo equipment; the son or daughter

who is in financial trouble or is addicted to alcohol,

drugs, or gambling, who sees the older person as a

way out of the difficulty; and the expectant heir who

wants to accelerate the time of inheritance.

Other forms of financial abuse include criminal

home-repair scammers and predatory lenders who

trick, mislead, or coerce older homeowners into taking out home equity loans they can’t possibly repay

because of inflated fees and balloon payments. Ms.

Nerenberg also noted telemarketing scams for overpriced or nonexistent products, and “sweetheart”

scams, in which a person uses an older person’s emotional vulnerability to bilk them out of money.

“Identity theft,” in which a criminal obtains a person’s

Social Security number or other personal information

and runs up debts or gains control of assets, is another 

Our Aging Population: A Report of Proceedings
Plenary II: Financial Exploitation and Consumer Fraud

An OJP Issues & Practices Report 9

problem. Victims of identity theft who have handled

their finances for a lifetime can end up harassed by

creditors for debts they never contracted.

The abuse or misuse of legal documents and legal

authority—such devices as joint bank accounts, powers of attorney, trusts, and guardianships—is another

aspect of financial abuse. These legal devices were created as protections, she said, but have in some cases

become “licenses to steal.” It is necessary now to build

more accountability into them.

If pressure, coercion, and trickery don’t do the

job, financial exploiters may turn to other forms of

elder abuse, including violence and neglect. Caregivers withhold care or food, or both, to hasten

decline or death. It is difficult to investigate such cases, Ms. Nerenberg said. The evidence is in the hands

of the perpetrator, and there is confusion about jurisdiction—civil or criminal; state, local, or federal.

Finally, she said, it is impossible to talk about

financial elder abuse without discussing capacity—

whether the victim understood and had sufficient

capacity to exercise informed consent when he or she

signed a document or gave a gift. Formerly, people

were deemed incompetent if they were diagnosed

with dementia or were making what were considered

poor decisions; sometimes they were deemed incompetent simply on the basis of age. Now, the all-ornothing concept of incompetence has given way to

the idea of using a “functional assessment” to determine capacity and of looking at what level of understanding is necessary to execute a particular legal

document. To execute a will, for example, one must

understand how much one has and the “natural

objects of one’s bounty.” In cases of suspected elder

abuse, more often questions arise as to the capacity

needed to give a gift or get married. And while 

an older person has a right to choice and selfdetermination, she said, some complex psychological

choices come into play. Many victims do not realize

they have been abused and refuse to take action

against their abusers; some even seem complicit.

Recently, Ms. Nerenberg said, there has 

been increasing interest in the concept of undue

influence—this is when a strong person gets a 

weaker one to do something they would not 

otherwise have done—and the techniques used 

by abusers to exert it. These include isolating the victim, inducing fear, and convincing them that the

manipulator is the only person to be trusted.

It is important that outreach programs warn people about abuse, Ms. Nerenberg said, but it is also

important to hold perpetrators accountable. To do

that, victims must come forward, even though it

may be traumatic for them to go to court. There

should be more incentives to come forward, she

argued. Currently, victims agree to go to court in

order to get back something that was stolen and to

prevent the same thing from happening to other 

people. But few victims now get retribution, and the

current sentences do not discourage predators. Ms.

Nerenberg recommended stronger penalties, some for

restitution to victims, and services for victims that

address their psychological traumas.

Lee Norrgard, Senior Program Coordinator for

the Consumer Protection Section of AARP, noted

that several surveys have shown older people’s vulnerability to consumer fraud, especially telemarketing

fraud. For example, a 1996 Princeton University survey of victims of telemarketing fraud found that 56

percent were 50 and older. They were not, as had

been assumed, socially isolated; they had friends and

relatives nearby. Nor were they stupid, but they were

less wary and generally unable to recognize signs of

fraud. Focus groups of victims and non-victims

revealed a qualitative difference: The victims were

looking for evidence of legitimacy; they wanted to 

give people the benefit of the doubt. The non-victims

were immediately ready to hang up when they first

heard something suspicious. As a result, Norrgard

said, AARP changed its message to “Fraudulent telemarketers are criminals. Don’t fall for a telephone

line.” and this has proved effective. 

That survey also showed older persons’ vulnerability to home-repair fraud and predatory home lending. Mr. Norrgard noted that 86 percent of those over

55 own their own home, and 89 percent of them

want to remain in their homes. They live in aging

housing stock, which often needs repairs. Half the

homeowners older than 65 had made repairs in the

past 2 years, and 80 percent of them used an outside

contractor (often they couldn’t climb around to make

repairs, or even to check on the repairs). The fact that

persons older than 65 have far less debt than younger 
10 An OJP Issues & Practices Report

people makes them especially lucrative targets for

unscrupulous contractors, who often act as mortgage

brokers. 

Educating older people about the existence of

scams may not be enough to prevent the crime. Mr.

Norrgard noted the results of a focus-group interview

of eight victims of senior fraud, plus one adult child,

conducted jointly by AARP and the Attorney General

of Wisconsin. One woman, who had a master’s degree,

was quite familiar with telemarketing scams, but still

found herself unable to hang up on the telemarketers.

More generally, a 1998 survey commissioned by

AARP examined a sample of 1,504 persons aged 18

and older regarding, in part, broad knowledge of

financial matters. Only 8 percent were in the category

of high-vulnerability to financial exploitation. Twentyfive percent of older persons own stocks or mutual

funds, and more than one-third of the older people

(but only one-fifth of the entire group) thought the

FDIC would cover losses if they lost money in a

mutual fund purchased at a bank. Only half the older

people thought that diversification reduced the risks

of investment. More than 20 percent were unaware

that truth-in-lending requires disclosure of the annual

percentage rate of a loan. More than 20 percent of

people 65 and older were unaware they had a right to

see their own credit reports. Of the 8 percent in the

high-vulnerability category, Mr. Norrgard said, 20

percent were women aged 75 and older and 15 percent were men in the same age group.

Barbara Harriman, of the HHS Office of

Inspector General (OIG), noted that the abuse of federal health care programs serving older persons can be

especially costly. For example, the Medicare Trust

Fund has lost billions to health care fraud or abuse in

which medical providers billed for services that were

not provided or filed false cost reports. The fraud,

Ms. Harriman said, occurs not only in large cities but

in communities of all sizes throughout the country.

The amounts involved may be small in specific

instances, but taken together, they constitute a large

deficit in the Medicare Trust Fund. 

The fraudulent parties, she said, can be doctors,

podiatrists, ophthalmologists, hospitals, nursing

homes, and laboratories. Examples include: 

■ An ophthalmologist who had his receptionist

diagnose cataracts, and even operated on people who had no cataracts. 

■ The operator of a chain of nursing homes who

charged expenses for redecoration and refurbishments to his private residence that included a baby grand piano, an Olympic pool, a

bowling alley, and Persian rugs. Investigation

showed he allowed two cents per resident per

day for food in his nursing homes. 

■ A physician who hired an unlicensed layman

to care for patients while he was on vacation,

and billed as if he was performing the services.

The 1996 Health Insurance Portability Act

(HIPA) provided funding that enabled the OIG

Office of Investigations to add criminal investigators

and open state offices, services that will be extended

to every state in 2001. Due to HIPA, Ms. Harriman

said, there was a 42 percent reduction in fraud and

abuse in 1999—down from $23 billion a year to

$13.5 billion. A major result of that savings is that

the Medicare Trust Fund’s solvency has been extended

from 1999 to 2025.

The OIG Office of Investigations also has been

included in important and effective national, state,

and local outreach programs, such as the “Who Pays?

You Pay” program, throughout the country. As a

result, the office’s telephone tip line last year received

more than a half-million telephone calls.

Our Aging Population: A Report of Proceedings
An OJP Issues & Practices Report 11

Lunch

Investigating the Systems That Protect and Care

for Vulnerable Populations: A Reporter’s View

Introduction:

D. Jean Veta

Deputy Associate Attorney General

U.S. Department of Justice

Washington, D.C.

Speaker:

David Jackson

Investigative Reporter

The Chicago Tribune

Chicago, Illinois

D. Jean Veta, Deputy Associate Attorney General for the Department of Justice, recognized the importance

of the media’s role in uncovering the “victimization of older people,” and welcomed David Jackson, Pulitzer

Prize-winning investigative reporter for The Chicago Tribune, as someone who has demonstrated repeatedly how

to use public records and other investigative techniques to help protect those in need.

Mr. Jackson explained that he has focused much of his work on children in poverty. At the Tribune he was

recognized for his investigative reporting on the significant privatization of juvenile detention facilities and foster

care programs, and how that privatization affected the provision of care and services. On previous assignments he

used his investigative skills to track the Oklahoma City bombers through Missouri and Kansas, to unveil the

secret financial deals of Nation of Islam leader Louis Farrakhan, and to uncover the inner-city empire of Chicago

slumlord Lou Wolfe. Acknowledging the diversity of his topics, Mr. Jackson noted that his investigative strategies

“work just as well for examining the conditions of care for institutionalized people.”

Through several case studies, notably his exposé of the Westbridge Treatment Center, a detention center for

troubled adolescents in Phoenix, Arizona, Mr. Jackson outlined for conference participants the “basic tools of the

investigative reporter’s trade.” He noted that “the methods that I have learned may be of some practical value in

your unsung work of protecting older Americans from abuse, neglect, and exploitation.” 

Initially viewed as an “island of hope” in the landscape of despair that for so long has defined juvenile justice, the Westbridge Treatment Center received front page coverage in the Tribune for its innovative approach.

Only 2 years later, however, Mr. Jackson’s series revealed patterns of sexual abuse of young residents by their 

older peers.

With increased reliance on private entrepreneurs creating a “fundamental shift” in the way America handles

its troubled youths, Mr. Jackson noted that the “lucrative” private programs touted as an “antidote to wretched

conditions found in state institutions” were themselves found to be rife with corruption and abuse. Mr. Jackson

observed that he and his colleagues found that “in the best of circumstances, private detention and foster care
12 An OJP Issues & Practices Report

programs offer a host of potential benefits, but while

some children unquestionably fared better in private

hands, there was no conclusive evidence that those

sent to private programs as a whole were better off,

or that taxpayers saved money as the companies had

promised.”

Elder abuse and victimization are becoming

increasingly important, Mr. Jackson acknowledged,

and although his comments addressed the “opposite

end of life’s spectrum,” the “challenge” of penetrating

institutions that house these “imperiled lives” where

care is supposed to be dispensed remains the same—

“the tools you use to get inside are also the same.”

Mr. Jackson outlined three basic tools of investigative

research: first, the use of “public records” that can be

viewed by any citizen in public agencies, and municipal, state, and federal courts; second, “relationships

with people who can give you a view from the 

interior”; and third, the Freedom of Information

Act “to obtain government files, databases, and 

government reports.” 

Mr. Jackson showed conference participants how,

by using public records to uncover the Westbridge

story, he gained access to a “closed world.” To begin

the investigative process, the “Rosetta Stone” is the

blue pages, or the government listings of any local

telephone book, he said. “Chances are the person or

organization being studied has had contact with a

variety of government agencies listed in the blue

pages,” he noted. “[At] the Bankruptcy Court ...

you’ll find a wealth of data in the court proceedings

... [At] the County Recorder of Deeds ... a quick

check of land records will show liens and court judgments ... [And] county and federal court records ...

can offer a rich portrait of an organization’s corporate

ownership and finances.” Using this method, Mr.

Jackson discovered federal court records showing that

a $25 million dollar bank debt threatened

Westbridge’s parent company, “driving down conditions of care at the facility.”

Reviewing public records, Mr. Jackson recounted,

provided “the blueprint of the second stage of my

work—locating people who could tell me what went

on inside.” A good investigation reaches out to the

“full range of employees,” he observed, “from janitors

to skilled professionals and administrators, treating

every one, every fact, diary, or correspondence file

that they offer, with an equal mix of welcome and

skepticism.” In the Westbridge investigation, he

talked with the former clinical director, who told him

that she resigned when she realized that the facilities’

“marketing promises were hollow—instead of two

kids to a room we had three, and violent kids were

mixed with psychiatric patients.” 

These human resources led Mr. Jackson to the

third phase of his investigation, using the Freedom of

Information Act (FOIA). Information provided by

individuals closely associated with the Westbridge

facility told him about the types of inspections and

monitoring reports filed with various local, state, and

federal agencies. Obtained by Mr. Jackson through

FOIA requests, these reports showed the human cost

of the cutbacks that the former clinical director at

Westbridge had described. Mr. Jackson recalled how

“a 13-year-old sexual predator had been placed in a

children’s unit where he bullied smaller youth into

a sex ring, according to Phoenix police and other

records. Documents obtained through an FOIA

request showed that a 10-year-old youth told Phoenix

police that he was being molested repeatedly.” In the

end Mr. Jackson concluded, “Illinois officials who’d

sent more than 40 children to the Westbridge facility

were unaware of the $25 million dollar lawsuit revealed

in federal court records, or of its implications.”

Mr. Jackson contended that many of the tools of

reporters are not used by state governments, noting

that he was “surprised that skilled investigators did

not know the power of public records.” A lot of the

basic research that a reporter employs in looking up

public records and developing sources “would profit

state agencies enormously,” he observed. “If you were

able to couple a reporter’s toolbox with a state investigator’s powers and skills,” he concluded wistfully,

“you’d have a bionic investigator.”

Our Aging Population: A Report of Proceedings
Financial Exploitation and 

Consumer Fraud

Workshop 1: Federal and State Initiatives To Educate

Consumers

Moderator:

Lee Norrgard

Senior Program Coordinator, Consumer Protection Section

AARP

Washington, D.C.

Panelists:

Alexis Barbieri

Executive Deputy Attorney General

Pennsylvania Attorney General’s Office

Harrisburg, Pennsylvania

Dan Drake

Executive Assistant U.S. Attorney

Office of the U.S. Attorney 

for the District of Arizona

Phoenix, Arizona

Lee Norrgard, Senior Program Coordinator of the Consumer Protection Section at AARP, opened the workshop by opining that tracking down, arresting, and prosecuting those who defraud or abuse older persons is

important. However, he added, preventing those crimes in the first place—by marshaling public and private

resources in a team effort to educate as many consumers as possible about the threats and how to counter

them—casts a much wider net and leads to better results overall.

The need for new protection strategies has never been greater. Alexis Barbieri of the Pennsylvania Attorney

General’s Office reported that in Pennsylvania, for example, 15 percent of the population is older than 65, and

nearly 1 million residents there will turn 75 this year. Likewise, Jeff LaGrew of the Kentucky Attorney General’s

Office noted that in Kentucky, some 600,000 of the state’s 4 million residents are older than 60; indeed, about

3,000 are 100 or older, reflecting the fact that centenarians make up the fastest-growing age group in the United

States.

But making potential victims aware of elder fraud and abuse is not easy. Among the hurdles:

■ Many older persons live independently. These difficult-to-reach individuals are a prime target for telemarketing scams, sweepstakes pitches, and other schemes.

■ Many older persons don’t believe that those who perpetrate fraud are really criminals.

An OJP Issues & Practices Report 13

Robert Kuykendall

Federal Trade Commission

Washington, D.C.

Jeffrey LaGrew

Assistant Deputy Attorney General 

Kentucky Attorney General’s Office

Frankfort, Kentucky
14 An OJP Issues & Practices Report

■ Expecting agencies to fight elder fraud and

abuse single-handedly is unrealistic.

■ Many fraud-awareness efforts, such as forums,

typically engage small numbers of older persons, so their impact may be small.

■ Many older people don’t know about the myriad antifraud services available to them or

whom to call when they have been victimized,

in part because there is so much overlap

among agencies.

States are tackling these and other challenges in

different ways. Pennsylvania Attorney General Mike

Fisher launched the 90-member Task Force for the

Protection of Elder Pennsylvanians in 1998 by convening experts from throughout the state, according

to Ms. Barbieri. The task force comprised six regional

groups including representatives from law enforcement, consumer-protection, and Medicaid fraud

agencies; the legislature; AARP; providers of services

to older persons; and other groups.

Each of the six regional groups, in turn, investigated an elder fraud-related topic, such as homeimprovement fraud, health care fraud, elder abuse, or

telemarketing and sweepstakes scams, by taking public testimony at hearings on that topic. Two years of

work culminated in a July 2000 report of findings

and recommendations.

Arizona discovered it had much more clout in

battling elder fraud if it boosted awareness by rallying

law enforcement officials, care providers, elected officials, businesses such as grocery stores, the media, and

other parties to join the fight. Authorities there were

recovering only about 4 percent of all money lost in

telemarketing swindles. “That’s a horrible rate,” said

panelist Dan Drake from the Office of the U.S.

Attorney for the District of Arizona, “so we decided

we don’t need more prosecutions—we need fewer 

victims.”

In the past 2 years, the Arizona Elder Fraud

Prevention Team has made or staged more than 60

presentations or events, many targeted to large audiences. One event was a 3-day “reverse telethon” at a

public television station; instead of donating money,

callers posed questions—a total of about 900—to a

bank of experts. Another effort was a newspaper message about elder fraud, sponsored by a local supermarket

chain, that reached about 1 million readers each time

it was published. 

The fraud-prevention team also worked with the

publicity-minded Arizona Cardinals, a professional

football team, over a 12-week period to get the word

out about telemarketing fraud. The campaign included calling and warning older individuals whose names

had appeared on “mooch lists.”

The Kentucky Attorney General’s Seniors Crime

College is a 2.5-hour educational session built around

the slogan “Aware, Avoid, Alert.” Experts make participants aware of the elder fraud threat, teach them how

to avoid being victimized (measures range from door

locks to proper lighting and trimmed bushes around

a house) and explain who to call when they are suspicious. Each graduate receives a booklet about elder

fraud that includes appropriate toll-free telephone

numbers. A local, uniformed police officer or sheriff

lends a great deal of credibility to these sessions, said

Mr. LaGrew.

Noting that “there’s no reason to reinvent the

wheel,” Mr. LaGrew explained that he borrowed

many ideas from programs in other states, such as

Massachusetts, Florida, and Arizona, when he established the Seniors Crime College 2 years ago. More

than 10,000 older persons have attended thus far.

On the national level, Consumer Sentinel, the

Federal Trade Commission’s (FTC’s) antifraud program, mailed out 120 million cards in November

1999 containing helpful fraud-fighting information,

including toll-free telephone numbers. The card contents, said FTC’s Robert Kuykendall, were based on

results from focus groups and national surveys.

Kuykendall also maintains a widely accessible database of fraud complaints nationwide.

Elder fraud and abuse may always be fixtures

on the crime landscape. But there have been serious

efforts in recent years to gauge the nature and extent

of these problems and to learn which weapons work

best against them. In addition to supporting the

proven methods of using team approaches and reaching out to large audiences, panelists noted these 

recommendations:

■ Increase sentences for crimes against older 

persons.

Our Aging Population: A Report of Proceedings
Federal and State Initiatives To Educate Consumers

An OJP Issues & Practices Report 15

■ Provide more legal protections against certain fraudulent practices, such as homeimprovement scams and the unauthorized

release of Social Security numbers, dates of

birth, financial information, and other personal information that can lead to identity fraud

and other illegal practices.

■ Require telemarketers and advertisers to abide

by do-not-call and do-not-send lists of names.

■ Require licensing of health care workers to

screen out the unscrupulous.

■ Better educate those in the justice system

about elder fraud and abuse.

■ Provide more state funds to train caregivers so

they are better able to recognize instances of

elder abuse and neglect.

■ Obligate financial institutions to report cases

of financial exploitation without incurring liability for doing so.

■ Develop a directory of toll-free numbers of

organizations that help victims of elder fraud.

■ Give seniors useful, bite-size nuggets of information. Telling them that elder fraud in the

U.S. costs $40 billion a year is less helpful

than telling them about the guy down the

street who lost $5,000.

■ Tailor antifraud efforts to local demographics.

Avoid national, one-size-fits-all approaches.

■ Don’t hold antifraud sessions at senior housing

developments, because many older individuals

live independently. Malls are a better option. 

“I guess if there was a lesson here,” Mr. Drake

said, “it was, ‘Be vigorous in terms of reaching out to

partners.’ Get as many partners as possible and think

in nontraditional ways [about antifraud strategies].

The people who can help you the most are those you

haven’t used before.” 
Financial Exploitation and 

Consumer Fraud

Workshop 2: Effective Interventions To Address

Consumer Fraud

Moderator:

John Firman

Coordinator for Research Services

International Association of Chiefs of Police

Alexandria, Virginia

Panelists:

Cynthia Alexis

Project Coordinator

Special Emphasis on Elder Abuse

Office of the District Attorney

San Francisco, California

Jacqueline Case

Director, New York City Long-Term Care 

Ombudsman Program

New York, New York

(on behalf of Faith Fish, New York State 

Long-Term Care Ombudsman, New York State 

Office for the Aging, Albany, New York)

John Firman, Coordinator for Research Services at the International Association of Chiefs of Police (IACP),

guided the panelists through a discussion of consumer fraud against older people, including various subpopulations. Panelists discussed several programs that might provide models for preventing fraud and successfully intervening when it occurs. These included programs addressing predatory lending in the senior African American

community of San Francisco; collaborative efforts of law enforcement agencies and senior organizations in the

work of Triad; overcoming cultural barriers to seeking help among Hispanic older immigrants; and the successful

efforts of New York City’s Long-Term Care Ombudsman Program.

Cynthia Alexis, a Victim Services Representative from the San Francisco District Attorney’s Office, discussed

effective interventions created by the We Are Family Leadership Group in the African American community.

Primarily involved in mortgage, home equity, life insurance, and burial insurance fraud, the We Are Family 

program also was challenged by other issues of elder abuse such as the “over-extension of seniors as multigenerational caregivers.” Racism coupled with literacy problems—“elders were signing documents they did not understand”—further complicated efforts to stem abuse.

An OJP Issues & Practices Report 17

Marta Sotomayor

President 

National Hispanic Council on Aging

Washington D.C.

Jim Wright

Program Director

Triad and Operation Fraud Stop

National Sheriffs’ Association

Alexandria, Virginia
18 An OJP Issues & Practices Report

To respond to the needs of the community, We

Are Family hosted a number of community events in

senior centers and health fairs to raise awareness concerning the issues of mortgage and home equity fraud

and other crimes committed against the elderly.

Focusing on the strengths of the African American

community, the program sought out partnerships

with churches “as a gateway” into the population.

The program’s underlying philosophy of “intervening early through education,” rather than engaging

in “litigation, when it’s far too late” has led to a number of successes. Partnerships include the city’s Public

Guardian’s office, the Sheriffs’ department, the Department of Adult Protective Services, and the District

Attorney’s office. “African American seniors are closeto-the-vest about their finances. For them to even talk

about finances is a major accomplishment,” Ms.

Alexis said. The We Are Family program provides culturally appropriate educational interventions with a

great deal of success. For cases when litigation is necessary, the program, in collaboration with the Bar

Association of San Francisco, trained more than 160

attorneys so they could handle mortgage and home

equity fraud cases pro bono.

Jim Wright, Program Director for Triad and

Operation Fraud Stop at the National Sheriffs’

Association (NSA) in Alexandria, Virginia, discussed

the successful partnership of Triad. It began 12 years

ago when IACP, NSA, and AARP—the Triad—came

together to identify ways to keep seniors safe from

crime. The organization has grown to represent partnerships in communities across the country in 47

states, 750 counties, and 1,600 individual towns and

cities. Partnering representatives from sheriffs’, police,

and fire departments with public sector agencies such

as offices on aging, Adult Protective Services, and

social services and older volunteers such as retired

teachers, retired federal employees, and members of

the faith communities, Triad welcomes “whoever

wants to come to the table to participate in keeping

seniors safe from crime.”

A fundamental principle of programs developed

by Triad members is that programs must be “implemented in the community according to community

need.” For example, the Baltimore County Office on

Aging, funded by a grant from the U.S. Department

of Justice, Office for Victims of Crime (OVC), developed a program titled “Are You O.K.?” in which older

volunteers go to the local police station or sheriff’s

office and call other older people, typically shut-ins,

and ask “Are you O.K.?” Protocols are established for

nonrespondents while opportunities to overcome isolation are offered through direct communication.

Other programs developed by Triad partnerships

include police visitations, in which police officers and

sheriff’s deputies drop by; and “adopt-a-senior” programs, in which volunteers offer to do home repairs

and conduct safety inspections. Many Triad organizations send speakers to nursing homes, take older people to health fairs, and connect pharmacologists with

older persons to discuss medications, but the “primary

focus” of the work of Triad, Mr. Wright affirmed, are

“law enforcement issues and crime prevention.”

Citing statistics that “seniors are typically about

5 percent of all crime victims while they represent 13

percent of the population,” Mr. Wright noted “that’s

not the case in consumer fraud or financial fraud—it’s

probably the reverse. Seniors are far more likely to be

victimized.” As a result, Triad has begun to look more

closely at how older people are affected by consumer

fraud and financial exploitation. Preventive efforts,

such as those used by the Baltimore County Office

on Aging, employ crime prevention and community

policing officers to present lectures to older people

about “different kinds of scams, such as home repair

scams, deceptive telemarketing tactics, and foreign

lotteries.”

Working with AARP, Triad has produced a “Stop

Fraud” kit available for distribution to senior centers,

health fairs, and law enforcement agencies. With

funding from OVC, the Triad produced a three-part

videotape in an effort to educate law enforcement

personnel about crimes related to seniors. The videotape, to be viewed during police and sheriff departmental “roll calls,” is designed to be shown over a

3-day period. The videotape is based on the idea that

most first responders to crimes against older persons

are young male and female law enforcement personnel, mostly men and women in their 20s and 30s,

who “don’t know a lot about seniors.” Mr. Wright

observed, “We think the roll call videotape will be

an effective intervention if it brings young officers

up one notch in terms of what they know about consumer fraud, particularly fraud affecting the senior

community.” Where crime prevention fails, Triad has

developed a “court watch program” that helps older

crime victims get through the court process.

Our Aging Population: A Report of Proceedings
Effective Interventions To Address Consumer Fraud

An OJP Issues & Practices Report 19

Marta Sotomayor’s work with the older Hispanic

immigrant population is often times dictated by cultural norms. Dr. Sotomayor, President of the National

Hispanic Council on Aging, a membership-based

organization with chapters and affiliates throughout

the country, advocates for older Hispanic immigrants

through numerous programs dedicated to capacity

building, skills development, technical assistance,

demonstration projects, policy analysis, and the development of educational materials and research. She

notes that older Hispanic immigrants are most vulnerable to fraud for a number of reasons: “An innate

mistrust of government, limited English proficiency,

difficulty in understanding and navigating government agencies and systems, and perceived and real

anti-immigrant sentiment that prevents contact with

police agencies.” 

A Council project focused on telemarketing

fraud is in its third year of funding through OVC.

The project educates older Hispanics so “they can

defend themselves.” Two issues have been special challenges. First, Dr. Sotomayor noted, the size of and

cultural differences among the Hispanic and Latino

populations makes these populations “very difficult

to work with because it requires many areas of intervention.” As diverse as Spanish-speaking populations

are, so too are the problems that need to be solved.

Second, she noted, telemarketing fraud often is

eclipsed by other crimes and is not taken as seriously

by law enforcement agencies serving Hispanic and

Latino neighborhoods in some areas where “violent

crime rates and drug use are very high.” 

Dr. Sotomayor’s approach to overcoming these

problems has been to build coalitions and establish

strong partnerships in the communities. She cites the

development of a Spanish language brochure on consumer fraud, paid for and distributed by Radio Shack,

and the production of a Spanish language videotape,

produced with funds from an OVC grant, as examples of successful collaborations. “An effective method

of reaching this population,” she concludes, “results

from integrating, interfacing, or ‘piggybacking’ fraud

issues with other projects designed to reach Spanishspeaking populations—such as diabetes awareness

campaigns coupled with the issue of provider

Medicaid/Medicare fraud.” 

The New York City Long-Term Care Ombudsman Program (LTCOP) is a federally mandated 

advocacy program created to protect the rights and

improve the quality of life of residents in nursing

homes, homes for adults, and board and care facilities, said Director Jacqueline Case. Her program oversees approximately 55,000 beds with a staff of 5 and

an “army of senior volunteers.” Although the LTCOP

does not have citation powers, it does have “the right

to access,” Ms. Case noted, “which is critically important.” Every facility in New York City must accept an

LTCOP representative at least “once a week,” she

observes. With this “special right of access,” trained

volunteers, usually older people themselves, work

with residents to “address concerns, advocate, and

try to get what the resident wants or needs.” 

Another feature of Ms. Case’s program, Operation Restore Trust, focuses on the issue of fraud in the

supply and quality of durable medical equipment,

such as “electric wheelchairs that constantly breakdown,” which is viewed as “a fraudulent practice.”

Operation Restore Trust, a program established by

the Administration on Aging, recaptured over $25

million dollars from providers for the provision of

fraudulent durable medical equipment in New York

State alone. 

Ms. Case acknowledged that a large part of the

program is getting people to see that “abuse and neglect in nursing homes is not just the prosecutable portion,” such as physical abuse, “but it is also the lack

of quality care or the lack of attention.” She reported

that more than 40 percent of LTCOP-generated complaints are resident care complaints. “Providers are

getting a tremendous amount of money for the provision of service,” she noted. “There’s no reason why I

should be getting complaints that ‘my mom’s diaper is

changed once a shift.’ ” Ombudsmen provide an

invaluable service, Ms. Case opined.

Concluding the workshop, John Firman noted

four themes that emerged from the session: the

importance of information-sharing and education,

the use of partnerships, the use of technology, and

the importance of volunteers.
Financial Exploitation and 

Consumer Fraud

Workshop 3: Innovative Approaches to Financial

Exploitation

Moderator:

Patrick Donely

Senior Litigation Counsel, 

Criminal Division-Fraud Section

U.S. Department of Justice

Washington, D.C.

Panelists:

Chayo Reyes

Law Enforcement Officer (Retired)

Proprietor, Elder Financial Protective Services

Cerritos, California

(on behalf of Susan Aziz, WISE Senior Services, 

Santa Monica, California)

Aileen Kaye

Program Coordinator, Abuse Prevention Unit

Senior and Disabled Services Division

Salem, Oregon

In order to address and prevent the financial exploitation of the older population, a coordinated response

from many different public and private entities must be implemented. Moderator Patrick Donely, Senior

Litigation Counsel of the DOJ Criminal Division-Fraud Section, led panelists through a description of specific

programs established to counter such abuse in four communities. Each presenter highlighted the importance of

networking and information sharing in ensuring a program’s success.

The Los Angeles County Fiduciary Abuse Specialist Team (FAST) is a public/private partnership composed

of law enforcement, medical, and financial services personnel, which proactively prevents and investigates cases

of elder financial exploitation. In describing the team, Cesario “Chayo” Reyes emphasized the importance of

working through the hurdles imposed by the many bureaucracies involved in support of the older victim. FAST

works closely with bank personnel to gather information and secure assets of older persons at risk of exploitation.

Mental health specialists train team members to administer assessments in order to determine if an older person

is under undue influence or has diminished capacity. Law enforcement personnel on the team educate bank

employees about their legal rights and liability in disclosing information to investigators in cases of suspected

exploitation. Ultimately, by working through the bureaucracy, FAST makes it less likely that an older person

will be financially exploited and, therefore, become dependent upon the government or family for survival.

An OJP Issues & Practices Report 21

Kathleen Quinn

Chief, Bureau of Elder Rights

Illinois Department on Aging

Springfield, Illinois

LaVerne Wyaco

Director

Navajo Area Agency on Aging

Window Rock, Arizona
22 An OJP Issues & Practices Report

Aileen Kaye, Abuse Prevention Program

Coordinator of the Oregon Senior and Disabled

Services Division, described an initiative by her

agency to combat elder financial exploitation. The

state attorney general formed a task force in 1994 to

identify the major issues relating to elder abuse and

neglect. The task force identified financial exploitation and focused on the crucial role that banks play in

prevention. In many cases, the banks were reluctant

to report suspected exploitation, the task force discovered, because they were unclear about their rights and

liability regarding disclosure of confidential information. Despite the fact that Oregon law allows banks to

report such information, they requested, and the legislature added, a provision granting banks immunity

in such instances. 

Additionally, the task force identified training

of bank personnel as a key issue. Working with the

Oregon Bankers Association, AARP, the state department of justice, and local agencies serving older people, with funding from OVC, a training program

with materials was developed to educate bank personnel of the importance of and avenues for reporting

suspicious activity. Ms. Kaye emphasized the crucial

role that state banking associations play in reaching

many institutions across the state and highlighting

the importance of this issue. A pilot program in eight

counties recently has been initiated as well, whereby

retired financial experts are trained to investigate and

gather evidence in cases of suspected elder financial

exploitation. These experts assist local prosecutors by

gathering all of the information needed to try a case.

The program has already resulted in one indictment.

A similar task force was established in Illinois

recently. According to Kathleen Quinn, Chief of the

Bureau of Elder Rights for the Illinois Department

on Aging, more than half of the reports of elder abuse

that her agency receives involve financial exploitation.

This exploitation often is tied to other abuse; securing

the older person’s money is, in many instances, a

motivating factor for other physical or mental abuse. 

Task force members were selected from state

aging organizations, the Illinois Bar Association, the

banking community, and major state agencies such

as the attorney general and police and prosecutors to

ensure a broad-based group with influence and the

power to implement the task force’s recommendations. The first task was to educate these members

on the issues relating to elder financial exploitation,

and the efforts that already were underway. Although

the task force has not yet completed its work, Ms.

Quinn did discuss some of the possible recommendations. These include securing permanent funding to

institutionalize a pilot program whereby state police

lead investigations into elder financial exploitation.

State police are equipped to handle these cases, which

are often time consuming and span many jurisdictions. The task force also is considering recommending funding to support multidisciplinary teams to

work on this problem, as well as more public education and training.

In tribal communities, there are unique circumstances that must be considered in attempting to

establish elder abuse and neglect prevention programs.

LaVerne Wyaco, Director of the Navajo Area Agency

on Aging, cited the tribal council bureaucracy as the

chief obstacle facing her tribe. Additionally, the Navajo

Nation spans three states, creating additional jurisdictional hurdles. In 1996, the Elder Protection Act was

passed but there was no funding attached. Under this

Act, the Navajo Elder Protection Program was established to assist older people with abuse, neglect and

mental health issues. The program was able to secure

some funding over the past 2 years, which allowed it

to develop a marketing poster and provide services.

The program focuses on elder rights and providing

legal, health insurance, and benefits assistance. In

addition, a Long-Term Care Ombudsman Program

position recently was filled to coordinate the filing of

nursing home complaints with the states. In collaboration with AARP, Indian Health Services, and Social

Security offices, an outreach counseling component

also has been added to assist older tribe members with

entitlement issues. Despite the lack of funding and

the bureaucratic hurdles, Ms. Wyaco stressed that the

program continues to work to ensure that older Navajos

receive all the necessary protections and services.

Our Aging Population: A Report of Proceedings
Financial Exploitation and 

Consumer Fraud

Workshop 4: Enhancing Prosecution of Financial

Exploitation

Moderator:

Newman Flanagan

Executive Director

National District Attorneys Association

Alexandria, Virginia

Panelists:

The Hon. Jane Brady

Attorney General

State of Delaware

Wilmington, Delaware

Judith Kozlowski

Assistant U.S. Attorney

Office of the U.S. Attorney for the 

District of Columbia

Washington, D.C.

Moderator Newman Flanagan, Executive Director of the National District Attorneys Association, recalled

that the crime of elder abuse was not even on his radar screen until 1982 when, as head of a national task force,

he held public hearings around the country that prompted a “rude awakening.” More recently, prosecutors are

finding new ways to pursue successfully those who financially exploit the elderly. In some areas of the country,

their more aggressive and creative efforts, together with greater awareness of the problem, tougher state laws, and

multidisciplinary teams, are increasing the number of prosecutions and convictions. 

Jane Brady, Attorney General of Delaware, got a glimpse of the financial exploitation threat more than 25

years ago after her grandfather died. Her grandmother was victimized by gypsies who put “black goop” on her

roof, then wrote a check for the grandmother to sign.

At the beginning of her tenure 6 years ago, Attorney General Brady, learned that nursing home residents, at

least in her state, have far more access to abuse services than other older persons do. She, like other panelists, also

discovered that police shied away from instances of financial exploitation, viewing such cases as strictly civil matters. These findings prompted Attorney General Brady to hire a retired police officer to review current laws and

suggest changes. Among other tasks, this person also makes law enforcement officers aware of their legal responsibilities—and duty to help victims—in financial exploitation cases. On another front, the Securities Division in

her office helps prosecutors follow complex paper trails.

An OJP Issues & Practices Report 23

Chayo Reyes

Law Enforcement Officer (Retired)

Proprietor, Elder Financial Protective Services

Cerritos, California

Audry Rohn

Deputy District Attorney

Ventura County District Attorney’s Office

Ventura, California
24 An OJP Issues & Practices Report

The Attorney General’s office also:

■ Trains police and nursing home employees

how to spot and report financial abuse.

■ Trains bank tellers to detect signs of financial

exploitation.

■ Encourages banks and credit card companies

to adopt electronic systems that automatically

monitor accounts for unusual activities. (The

nation’s largest credit card issuers are based in

Delaware.)

■ Trains older persons as peer advocates to guide

abuse victims through the legal and medical

services maze. These advocates remind victims

about appointments, accompany them to

court, arrange transportation, and even participate in initial interviews by police.

In addition, Attorney General Brady’s office was

instrumental in winning passage of the Delaware

Home Solicitation Sales Act. This law regulates doorto-door sales organizations, which often victimize older persons. A pending bill, the result of 3 years of

work with AARP and legitimate telemarketers such

as banks and telephone companies, would require that

telemarketers be registered and bonded.

The Ventura County (California) District

Attorney’s Office also had made great strides in combating elder abuse. In 1994, when Deputy District

Attorney Audrey Rohn was assigned to focus on identifying, prosecuting, and preventing elder abuse (the

first attorney there to do so), she handled two elder

abuse cases; this year, she will prosecute about 150

cases.

In addition to persuading state lawmakers to

crack down on exploiters, Ms. Rohn worked with a

“plethora of players”—multidisciplinary teams of

prosecutors, law enforcement officers, Adult Protective Services, legal aid societies and others—who,

working together, could bring far more resources to

bear on helping victims than any single player could.

Building bridges was not easy at the outset. When

the District Attorney’s (DA’s) Office began attending

multidisciplinary team meetings and seeking cases to

prosecute, it faced questions like, “Where have you

been for the last 10 or 15 years? Why should we trust

you?” It had to win the trust of law enforcement and

APS personnel, which are often the first agencies to

respond to elder abuse. The DA’s office also reached

out to fire departments and emergency room doctors

and nurses, who started referring cases too.

The Ventura County DA learned that with

waivers from older persons or with the help of guardians or conservators, it could freeze victims’ assets and

“stop the bleeding” when there were signs of foul play.

One new weapon is a protocol, developed with input

from police, which spells out for all players the best

ways to investigate and prosecute financial crimes.

Ms. Rohn noted that police must learn not to dismiss

older persons as confused when investigating cases,

because such behavior may signal a swindle. The DA’s

office now routinely seeks speedy trials in elder abuse

cases to help ensure that older victims will be able to

testify. It also videotapes victims’ testimony to ensure

the durability of the evidence. Beginning in 2001,

Ms. Rohn said, new laws will allow prosecutors to

present powerful evidence in court showing that

defendants previously have committed acts of elder

abuse—financial, physical, sexual, or emotional.

In order to get a case into federal court, Judith

Kozlowski, an assistant U.S. attorney who heads the

Economic Crimes Section of the Office of the U.S.

Attorney for the District of Columbia, said she hunts

down “a mailing, a phone call, anything” that will

serve as solid evidence and perhaps lead to forfeiture

of exploiters’ assets. She also consistently pursues

money-laundering charges, because in all financial

exploitation cases perpetrators must move money out

of victims’ accounts and into another account, “and I

charge that as fast as I can.”

Ms. Kozlowski agreed that search and seizure

warrants work well because they stop money from

flowing out of victims’ accounts. She also has been

able to reverse the transfers of house deeds and to

track down notaries who have colluded in financial

exploitation. In plea bargains, she may settle for less

jail time in exchange for significant restitution, such

as the return of a house or land.

A new financial-abuse consulting team in the

District of Columbia comprises about 30 specialists

from a broad spectrum of society—bankers, doctors,

real estate experts, ethicists, and experts in estate law,

among others. From their ranks, Ms. Kozlowski can

quickly assemble a response team to speak with a 

Our Aging Population: A Report of Proceedings
Enhancing Prosecution of Financial Exploitation

An OJP Issues & Practices Report 25

victim, find out what really happened, and take action.

In one instance, a retired judge told her about possible exploitation by a disbarred lawyer. Within 3 days,

Ms. Kozlowski had assembled a team (herself, a police

detective, an APS worker, and another investigator to

scope out other possible victims), had tracked down

the suspect and was ready to prosecute.

Bank and credit-union staff must “grow a spine”

when it comes time to freeze a victim’s bank account,

said panelist Chayo Reyes, owner of Elder Financial

Protective Services in Cerritos, California. A retired

Los Angeles police detective, Reyes is co-author of a

state law that authorizes law enforcement officers and

APS to secure and protect the assets of older persons

or dependent adults during an investigation.

Bankers typically demand to see a subpoena,

search warrant, or court order barring them from

releasing a victim’s funds, yet time and again Mr.

Reyes has been able to convince bankers, without presenting such papers, to halt withdrawals by contacting

the bank’s chief lawyer. The lawyer provides information, sometimes in the form of a declaration signed

under penalty of perjury, to the effect that the 

depositor/victim and bank appear to be at risk and

that there is probable cause to suspect a crime is being

committed. Mr. Reyes explains to the bank that under

the circumstances it could be held liable if it allowed

the money to be withdrawn. Using this tactic, his

former agency has secured more than $91 million

of victims’ assets in California since 1987.

Financial exploitation of older persons can be prevented if bank staff and others are on the same page

as those who fight abuse, including public guardians,

APS, ombudsmen, and police. There is always a pattern in the way both victims and suspects manage

their money. Bank employees can spot a departure

from that pattern, and coordination among players

alerts everyone to potential fraud. 

Panelists agreed that education and outreach

play a key role in curbing exploitation. One common

obstacle is the long-held belief on the part of law

enforcement officers that such exploitation is a civil,

rather than criminal, matter. Nevertheless, panelists

noted that successful prosecutors are now: 

■ Freezing victims’ bank accounts quickly, with

or without warrants for search or seizure, to

“stop the bleeding.”

■ Training police and medical and social workers

to be on the alert for signs of abuse and to

work with prosecutors in building legal cases.

■ Collaborating with bank staff to detect and

halt suspicious account activities.

■ Promoting legislation to regulate telemarketing.

■ Seeking restitution and forfeiture of assets in

federal court.

■ Charging perpetrators with money laundering. 
Financial Exploitation and Consumer

Fraud

Workshop 5: Combating Consumer Fraud Through

Litigation

Moderator:

The Hon. William Sorrell

Attorney General

State of Vermont

Montpelier, Vermont

Panelists:

Jackie DeGenova

Assistant Chief, Consumer Protection Section

Ohio Attorney General’s Office

Columbus, Ohio

David Kirkman

Assistant Attorney General

North Carolina Attorney General’s Office

Raleigh, North Carolina

Vermont Attorney General William Sorrell moderated the panel, which featured litigation efforts to fight

consumer fraud. Scamming older persons has a long and storied history, and finding and punishing the perpetrators can be difficult. Scam artists often work in collaboration with each other and agencies that work in isolation

against them face an uphill battle.

A large part of the answer to bringing these criminals to justice is working with other agencies—both private and public. “There is no need to reinvent the wheel. There is experience out there; there is case law out

there,” said Jackie DeGenova, Assistant Chief in the Consumer Protection Section of the Ohio Attorney

General’s Office. 

Many states have formed initiatives such as North Carolina’s Senior Consumer Fraud Task Force to bring

together diverse agencies. In addition to traditional law enforcement, agencies that can be enlisted include Adult

Protective Services, social services, AARP, departments on aging, U.S. Customs, the U.S. Post Office and Federal

Express, Western Union, and bankers’ associations.

David Kirkman, Assistant Attorney General in North Carolina, said the genesis of his state’s task force was

a highly organized group of “Travelers” based in North Carolina who worked the Southeast in an ongoing home

repair scam against the elderly. He said the scammers work on those with cognitive problems or those in the 

early stages of Alzheimer’s. 

An OJP Issues & Practices Report 27

Deborah Zuckerman

Senior Attorney, Consumer Protection Unit

AARP

Washington, D.C.
28 An OJP Issues & Practices Report

The scam ring would meet on Mondays and fan

out across the southeast, victimizing older homeowners with inferior, bogus, or sometimes nonexistent

home repairs. Others from the group would go back

later and victimize the same individuals. Some homeowners lost more than $100,000. “This was way too

big. We needed to get together with other people,”

Mr. Kirkman said.

He formed a task force of 36 agencies which met

every month in Raleigh. It started with a list of 12

suspects and ended up with 152. The task force

learned the techniques, tracked scammers on computers, and learned which homeowners had been cheated. Even with this evidence, though, the victims were

reluctant to testify. Eventually, the son of one of the

ring’s kingpins was arrested on drug charges and, facing prison for the rest of his life, began to incriminate

others in the fraud scheme. “That brought the whole

house of cards down,” Mr. Kirkman said.

But many of the con artists just moved on, a

common problem, according to Ms. DeGenova.

“Don’t be surprised if they come to your state next,”

she said. Ohio formed its own Senior Protection

Initiative Task Force to make the same kind of collaborative effort as North Carolina. The task force members concluded that because legal action needed to

come from county prosecutors, it was essential to

work closely with them, avoid turf battles, do training

with judges and prosecutors, attend judicial conferences, and educate the bar and the judges on the

issues of elder fraud.

Getting cooperation from a county prosecutor

still can be difficult because the prosecutors are more

accustomed to dealing with street crime. They are not

used to litigating complex cases involving a great deal

of paperwork, cases that often are time-consuming

and difficult.

One often-successful tactic cited by Ms. DeGenova

is to go to local senior citizens centers or AARP and

recruit older people to pack courtrooms in elderly

fraud cases. “You’d better believe that judge is going

to take notice,” said Ms. DeGenova. She added that

she was not bothered by ethical questions of trying to

influence the judicial process by bringing in the older

people. “It’s either that or see another 25 seniors victimized. Use the influence wherever you can. It’s a

collaborative effort,” she said.

According to Deborah Zuckerman, a Senior

Attorney in the Consumer Protection Unit of AARP’s

Washington, D.C., headquarters, AARP is involved in

those collaborative efforts in every state. AARP’s primary role is filing amicus briefs at the appellate level.

Consumer fraud and protection cases such as vehicle

title pawn, payday loan, home repair, predatory lending, and privacy issues are typical. Two such cases

recently were brought by the attorney general’s office

in West Virginia against a large sweepstakes promoter.

Another involved protecting older consumers in a

pre-need funeral home bankruptcy.

The range of issues AARP takes up is broad but

it does not involve itself in guardianship and conservatorship issues. Typically AARP is approached by

either a private attorney or a state or county office.

Many attorneys general have a standing relationship

with AARP in consumer education and phone banking, but not in litigation.

Occasionally AARP will serve as a plaintiff

instead of just filing an amicus brief. Getting AARP

authorization through its internal review process can

be difficult. “It’s a cumbersome process,” Ms.

Zuckerman said.

AARP primarily looks for cases that have the

potential to have a broad impact such as victimization

by a national company, or a pattern or practice likely

to affect a large number of people or a particular

industry. “The plaintiffs don’t have to be 50 or older,

but that certainly helps,” Ms. Zuckerman said.

Our Aging Population: A Report of Proceedings
Plenary III

Elder Abuse and Neglect at Home

Moderator:

Kathryn Turman

Director

Office for Victims of Crime

U.S. Department of Justice

Washington, D.C.

Panelists:

Sara Aravanis

Director

National Center on Elder Abuse

Washington, D.C.

Bonnie Brandl

Program Director, National Clearinghouse 

on Abuse in Later Life

Wisconsin Coalition Against Domestic Violence

Madison, Wisconsin

Eva Kutas

President

National Association of Adult Protective 

Service Administrators

Salem, Oregon

Moderator Kathryn Turman, Director of the Office for Victims of Crime, opened the session by noting that

older persons were identified by her office as an underserved group of victims several years ago, and said there

has been subsequent development of new programs. The issue now is to facilitate cooperation among these programs and ensure that the varied needs of victims of elder abuse are being met. “As critical as it is to identify and

coordinate law enforcement and prosecutorial resources around the victimization of the elderly,” she said,

“appropriate systems must be in place to assist these vulnerable victims who may have complex problems and

need multiple services. It requires creativity and coordination to meet their needs and move them on to a safe

place.”

Despite the fact that elder abuse and neglect in the home is an increasing phenomenon, only about one in

five incidents gets reported and efforts to identify and address situations of abuse are often ill informed, disjointed, lacking in resources, and ineffective. This is partly due to the complexity of the issue; elder abuse in the

home is often carried out by family members, which not only inverts societal expectations of familial care but

also makes it difficult for investigators to detect and determine the extent of the abuse. Long-term patterns of

domestic abuse make it less likely that an older person will seek help, the isolation of the victim is more easily

enforced by the abuser when the older person lives at home, and consideration of civil liberties makes the job of

An OJP Issues & Practices Report 29

Holly Ramsey-Klawsnik

Sociologist/Social Worker/Marriage and Family 

Therapist

Klawsnik & Klawsnik Associates

Canton, Massachusetts

Joyce Speakman

Oakland, California
30 An OJP Issues & Practices Report

the investigator who suspects elder abuse in the home

an extremely difficult one. 

Until recently there has been minimal funding

directed toward educating professionals and the public on the issue of elder abuse in the home, and laws

concerning the rights of the abused and prosecution

of the abuser vary considerably from state to state.

Numerous agencies and individuals who work with

older persons are attempting to rectify this situation,

and panelists presented different ways of understanding, responding to, and addressing the problem. 

Joyce Speakman’s personal experience highlighted

the importance of the issue and the suffering that can

be caused by elder abuse by family members. Ms.

Speakman said that her mother, Hazel Speakman,

who died in August 1998 at the age of 78, endured

years of physical and emotional abuse and neglect in

her own home at the hands of her youngest adult

daughter, Joyce’s sister. Five years before her mother’s

death, Ms. Speakman knew nothing about elder

abuse and thought her suspicions were disloyal to

the family, but she eventually contacted the county’s

Adult Protective Services agency. She found the

agency representatives to be committed, compassionate, and eager to get at the truth, but each labored

under the same limitations: her sister prohibited APS

workers from interviewing her mother and thus they

concluded that no determination of elder abuse could

be made. 

In her quest to discover the extent of her mother’s abuse, Ms. Speakman involved numerous other

agencies and individuals, including a nonprofit case

worker who was sympathetic but inexperienced, a

church pastor who was conciliatory but ineffectual,

and the local mental health system which attempted

to address, though only temporarily, her sister’s mental health disorders. No one suggested involving the

police, and when Ms. Speakman contacted them after

her mother’s death, they reported they would not

investigate the prior circumstances of a dead victim.

Medical records obtained after her death revealed

that, among other things, Hazel Speakman had suffered 12 serious falls and numerous broken ribs. 

Though Ms. Speakman realizes that her sister’s

efforts to isolate her mother made the APS agency’s

original investigation difficult, she was disillusioned

by their conclusions and believes a more indepth

understanding of the dynamics of elder abuse and risk

factors for potential abusers would have been helpful.

“The laws on elder abuse need to be strengthened,”

she said, “so that the suspected abuser is unable to

prevent an investigation of abuse, and so that service

providers, attorneys, and police can work together to

find solutions to stop this kind of abuse.”

It is the legal obligation of the APS agency to

respond to reports of abuse, neglect, and exploitation

of vulnerable adults, including older persons, noted

Eva Kutas, President of the National Association of

Adult Protective Service Administrators (NAAPSA).

The agency provides the system that receives reports

of elder and adult abuse, investigates complaints, and

attempts to ameliorate abuse. It operates under a

mandate to protect safety, health, and civil liberties,

and the social services it provides can include linkage

with law enforcement, and legal, medical, transportation, housing, and psychiatric services.

APS caseworkers must make critical, life-changing

decisions in complex situations, which can include

matters of financial concern, legal issues, mental

health concerns, issues regarding physical and sexual

assault, and a wide variety of family situations. Consequently, agency administrators attempt to develop

multidisciplinary teams that bring together representatives from the mental health system, law enforcement, victim services, domestic violence, and others. 

NAAPSA recently conducted a survey of state

APS programs and gathered data for 1999. Preliminary analysis of the survey data indicated that APS

agencies in 48 jurisdictions, including the District of

Columbia and Guam, had received 443,000 complaints of abuse, neglect, and exploitation, and that a

majority of these incidents had occurred in the victim’s home. As research indicates that one of every

five cases of elder abuse is reported, there may be millions of older people who are abused, neglected, or

exploited. Despite this overwhelming need, APS is

resource-poor, funded primarily by state and local

dollars. Ms. Kutas noted that the only federal funding

available for elder abuse services continues to be

directed solely at prevention, and has remained stable

at $4 million to $5 million per year. In comparison,

she said, NAAPSA has determined that domestic violence services receive approximately $200 million in

federal funding, and those addressing problems of

child abuse receive about $4 billion.

Our Aging Population: A Report of Proceedings
Plenary III: Elder Abuse and Neglect at Home

An OJP Issues & Practices Report 31

APS systems differ significantly from state to

state but as Ms. Kutas pointed out, there is no federal

elder abuse statute. She challenged conference attendees to investigate their state’s laws as well as the

resources available for identifying and combating elder abuse.

Bonnie Brandl, Program Director of the National

Clearinghouse on Abuse in Later Life, Wisconsin

Coalition Against Domestic Violence, discussed elder

abuse in the context of domestic violence. While

many people find the actions of those who abuse older persons to be incomprehensible, it is important to

understand that both abusers and those who seek to

intervene on the behalf of the abused operate within

particular belief systems. Ms. Brandl argued that in

order to understand what type of tactics abusers use

and how victims are affected by abuse, belief systems

on both sides of the problem must be examined.

She noted that family members who abuse other

family members believe they are entitled to use whatever tactic they want to dominate or punish their victims, including physical abuse, sexual abuse, financial

exploitation, isolation from other family members,

the withholding of medication, the abuse of beloved

pets, the ridiculing of spiritual beliefs, and a range of

other behaviors and threats. Some of the belief systems subscribed to by abuse prevention and treatment

professionals are more complex. They include the following theories about elder abuse:

■ It is a problem of caregiver stress, and

should involve social services rather than

law enforcement.

■ What happens within the family is a private

matter, and law enforcement should make

every attempt to fix the situation without

making arrests.

■ Some abusive situations are not particularly

dangerous, and law enforcement officers

should be discouraged from bringing abusers

who might be older or disabled into a system

that has no place for them.

■ Most elder abuse victims will not access services anyway, so money and effort spent supplying them is wasted.

These belief systems do not consider the victim’s

safety to be of paramount importance. As a result,

victims are caught between their abuser and a community that does not want to think of this as an issue

of power and control, or is not looking to make an

arrest, or is not developing services for the abused. It

is necessary to understand what barriers the victims

face when the system fails them, said Ms. Brandl, and

to use victim input to inform what types of programs

are developed. “A lot of us measure success by

whether we close cases or get funding or start a new

program,” she said, “but I would encourage you to

measure success based on whether victims are safer as

a result of the intervention options you create in your

state.” 

Dr. Holly Ramsey-Klawsnik, a social worker and

family therapist, noted that one form of elder abuse

often overlooked or ignored is sexual abuse, as there

is a prevailing myth that elders and sex do not go

together. She warned, however, “we’ve unfortunately

had to get used to the idea that sometimes parents

molest their children, and we also have to get used to

the idea that sometimes adult children molest their

elders. It is a difficult but necessary piece of information to swallow.”

Elder sexual abuse occurs when a senior is forced,

manipulated, or coerced into unwanted sexual activity,

or when a senior lacks the capacity to grant informed

consent to sexual activity. Dr. Ramsey-Klawsnik discussed a number of substantiated cases of sexual

assault of elderly victims perpetrated by paid or volunteer caregivers, family members, or spouses. Her

cases illustrated that while the majority of identified

victims are female, disabled males also are vulnerable.

Most identified perpetrators are male; however, some

cases have involved female perpetrators.

Several factors are correlated with the impact of

sexual abuse on victims. These include the victim’s

pre-abuse level of function, and the type of abuse sustained (“hands-off” offense such as sexual harassment,

“hands-on” offense such as rape or molestation, or

harmful genital practices such as a caregiver unnecessarily performing invasive cleansing procedures).

Victim impact also is related to the extent of abuse

suffered (single versus recurrent episodes), and whether

or not appropriate interventions are offered to assist

the victim.

Professional and community response to elder

sexual abuse often is denial or minimization. It is an
32 An OJP Issues & Practices Report

abhorrent issue to contemplate and discuss, and

therefore it is easy to dismiss indicators and deny the

existence of this type of victimization. Those involved

with older persons need to realize that if signs and

symptoms exist in an older person that would suggest

sexual assault in an 8-, 20-, or 40-year-old, the matter

should be investigated.

Sara Aravanis, Director of the National Center

on Elder Abuse (NCEA), opined that identifying

and addressing all types of elder abuse requires the

involvement of more than just family members and

caregivers. She theorized that older persons should be

seen to be at the center of a number of different circles. Abuse prevention and treatment professionals

make up the outer circle, with the ability to assess a

client for social, mental health, and medical needs,

determine whether abuse is occurring, offer solutions,

and bring the force of the law to bear on criminal situations. These professionals rely, however, on the

information they receive from people who are close

to the everyday life of older people, and who thus

make up the inner circles around the older person at

the center. The National Center on Elder Abuse calls

these inner circle members “sentinels.” They can

include home-delivered meal providers, senior center

daycare workers, respite providers, long-term care

ombudsmen, housing managers, health care professionals, pharmacists, pre-hospital service providers

such as paramedics and ambulance drivers, and even

utility and postal service workers. 

Educating and engaging these sentinels is a vital

part of the effort to help victims of elder abuse, Ms.

Aravanis said. NCEA recently granted funds to five

entities throughout the country to help create models

on what is needed to educate sentinels on abuse identification and involve them in addressing the problem. “I’m convinced,” said Ms. Aravanis, “that if we

learn how to work effectively with these sentinels,

they will eventually link these cases of elder abuse

with the helping system, one by one.”

Our Aging Population: A Report of Proceedings
Elder Abuse and Neglect at Home

Workshop 1: Strengthening Interventions for Victims

With Dementia

Moderator:

Nancy Coleman

Director, Commission on Legal Problems of the Elderly

American Bar Association

Washington, D.C.

Panelists:

Georgia Anetzberger

Associate Director for Community Services

The Benjamin Rose Institute

Cleveland Heights, Ohio

Frederick Brand

Director of Program Services

Alzheimer’s Association, Greater

New Jersey Chapter

Denville, New Jersey 

Nancy Coleman, Director of the American Bar Association Commission on Legal Problems of the Elderly,

began the session with a comment: “At lunch, someone asked, ‘Isn’t elder abuse like child abuse?’ I said,

‘Absolutely not,’ because most of us who are growing old have capacity, and we exercise capacity.” 

To help adults with dementia, each person who has contact with them needs to take account of factors that

are outside their normal field of expertise. They must respect each individual’s ability to make his or her own

decisions, yet find ways to help these adults when their judgment fails. At the same time, dementia is a risk factor for elder abuse; caregivers of people with dementia are more likely than other caregivers to be physically or

psychologically abusive to their care recipients, and dementia contributes to older adults’ self-neglect.

“A Model Intervention for Elder Abuse and Dementia” was a 2-year program in Ohio addressing the lack of

communication between Adult Protective Services and local Alzheimer’s Associations. “What we found in greater

Cleveland is, even though there is correlation between elder abuse and dementia, the systems dealing with these

problems don’t come together,” said Georgia Anetzberger, Associate Director for Community Services at the

Benjamin Rose Institute. During the 10 years prior to the start of the project, the local Alzheimer’s Association

referred fewer than 10 cases to APS, and APS referred a similarly small number of cases to the Alzheimer’s

Association—despite the fact that APS gets 2,000 reports of elder abuse each month and the Alzheimer’s

Association sees between 300 and 500 caregivers in the same time period.

An OJP Issues & Practices Report 33

Anne Mastro

Nurse Practice Manager 

Geriatric Evaluation and Management Service

Kimball Medical Center

Lakewood, New Jersey
34 An OJP Issues & Practices Report

This lack of communication was due to many

factors. The two systems distrusted each other and

shared a feeling that “If I make a report, I’m going to

lose this case” to the other agency. Staff in one system

did not understand the strengths—or limitations—of

the other system. Workers did not even understand

how to make reports or referrals to the other organization if they wanted to, or what would happen if they

did make a report, Ms. Anetzberger said. 

With $130,000 in funding from the Cleveland

Foundation, The Benjamin Rose Institute collaborated with several other organizations to improve service

delivery to people with dementia who were experiencing elder abuse or were at risk for elder abuse. The

project had three main goals: to remove service barriers, to increase knowledge and skills, and to increase

referrals and reports.

The project involved local Alzheimer’s Associations, APS, the local elder abuse network, and the

Northeast Ohio University College of Medicine,

which had experience in developing curriculums.

Together, this consortium produced two major products. The first was a 156-page education curriculum

for providing cross-training to APS workers and

Alzheimer’s Association staff and volunteers. The 

curriculum had three modules: the first, concerning

dementia and dementia care, was intended for APS

workers; the second, on elder abuse and protective

interventions, was intended for the Alzheimer’s

Association staff; and the third module concentrated

on bringing systems together to work cooperatively,

and contained many case exercises, considerations of

legal and ethical issues, and ways to collaborate. The

curriculum includes faculty guides, participant workbooks, and interactive exercises. It also distinguished

between the legal definition of competency under

state guardianship laws and capacity under the state

protective services law. A “gray-zone grid” helped

readers see what abilities and deficits meet these 

definitions.

The second product was a set of screening tools

and a referral protocol for use in elder abuse and

dementia cases. As before, the dementia screening

tools were intended for APS workers, while the abuse

screening tools were meant for Alzheimer’s Association staff. These tools were “embedded” in the educational curriculum as well. The referral protocols

informed both groups whom to ask for assistance in

areas outside their area of expertise, and what assistance would be provided. “The referral protocol also

provides feedback loops, which is extremely important,” said Ms. Anetzberger.

The project also developed a handbook for caregivers of people with dementia. This 10-page guide

contains advice on care and three self-test scales, so

that caregivers can assess their own risks of stress,

becoming overburdened, and elder abuse. If the caregivers identify these problems within themselves, the

guide tells them where to turn for assistance. 

When the project was evaluated, training participants had improved their knowledge and skills and

had an increased understanding of the other agency’s

problems and strengths. In the first year after the

training, there were more reports and referrals made

between the agencies than in the previous 10 years.

The Alzheimer’s Association made 27 referrals to

APS, 15 of which were substantiated as cases of abuse,

and it made 18 referrals of potentially abusive situations to The Benjamin Rose Institute, 17 of which

were accepted for service intervention. APS also began

case collaboration with the Alzheimer’s Association in

many instances in which adult abuse victims were

found to have dementia. 

The curriculum is currently used throughout the

state, and has been used in Florida, Alaska, and other

states.

The Lakewood, New Jersey, Safe Outreach for

Seniors (SOS) program had a less formal beginning,

said Anne Mastro, Nurse Practice Manager of the

Kimball Medical Center Geriatric Evaluation and

Management Service (GEMS). The SOS program

trains police to identify older adults who may be suffering from the early stages of dementia. The program

is run by Ms. Mastro, with no additional training

materials or support. “It’s something I do in between

other duties,” said Ms. Mastro.

The program was begun in Ocean County, New

Jersey, where 130,000 residents are over the age of 65,

approximately 27 percent of the county’s population.

In the wake of the driving death of an elderly woman

who had been scheduled to be evaluated for dementia, Ms. Mastro talked with local police about their

encounters with this woman. “I asked the police 

Our Aging Population: A Report of Proceedings
Strengthening Interventions for Victims With Dementia

An OJP Issues & Practices Report 35

officers, ‘Did you know the woman who was killed?’

And they said, ‘Oh yes, oh yes. We’ve been to her

house several times,’ ” said Ms. Mastro. The woman

insisted that someone was trying to enter her house

and would call the police department frequently to

check on nonexistent prowlers—yet the police had

never checked to see if this woman was still driving.

Ms. Mastro’s subsequent conversations with local

police revealed that there were several local residents

who made frequent 911 calls. “The officers said,

‘They call us because there’s someone in the attic, and

they don’t even have an attic,’ ” said Ms. Mastro.

Police did not know how to respond to these calls. 

The SOS program began as a way to train police

to identify dementia in older persons who had motor

vehicle accidents. The program has expanded to

include cases of frequent 911 calls, multiple driving

infractions, and older persons who are lost, or simply

wandering at the side of the road. “It was just amazing—and the police honestly did not know what to

do with them because they weren’t sure if they were

APS cases or just a little confused,” said Ms. Mastro.

Police are trained to do home assessments, looking at several factors. Poor personal appearance and

housekeeping can be signs of dementia, or signs of

long-term habits. “They’re taught because it’s neat

and clean, and the person inside is neat as a pin, that

doesn’t necessarily mean that there’s nothing going

on. Long-term behavior remains intact with dementia,” said Ms. Mastro. Police are trained also to look

in the refrigerator and kitchen cabinets, to see if the

resident has adequate food, and to examine the person’s car, to see if there have been frequent small accidents that might indicate confusion or poor

judgment. Officers also ask questions that require

judgment—“What would you do if there were a

fire?”—and questions that test the person’s orientation

in time and place. 

Ms. Mastro teaches her program at the local

police academy and four local police departments. In

addition to the Alzheimer’s training, young recruits

become more sensitive to older persons’ problems by

putting on glasses and gloves that simulate cataracts

and arthritis disabilities, so they can experience firsthand just how difficult it can be to do things like

make change in a supermarket line. “The strength

of this program is the phenomenal way the police

have responded, the phenomenal assessments, and

the capability that I never thought law enforcement

would have, as far as the assessment bit. Some people

in nursing don’t have these skills,” said Ms. Mastro. 

New Jersey police officers also participate in a

nationwide program for persons with dementia called

Operation Safe Return, a program of the Alzheimer’s

Association that is funded by the Department of

Justice. Between 60 and 70 percent of people with

Alzheimer’s disease will wander at least once during

their illness; Operation Safe Return seeks to help

these older adults get back to their homes.

The number of adults with dementia who are

prone to wandering is staggeringly high. “Nationwide,

there are 4 to 5 million people with Alzheimer’s or

related dementias. Seventy percent of those people

with Alzheimer’s disease or related dementias actually

live in the community in homes, with families, or

alone,” said Frederick Brand, Director of Program

Services of the Alzheimer’s Association, Greater New

Jersey Chapter in Denville. People with Alzheimer’s

disease can wander at any time of day, in any weather.

Often, they will simply pace back and forth inside

their rooms, but many become separated from their

caregivers and their homes, and can become lost in

the most familiar places. If these wanderers are found

within 24 hours, they are almost always safe, but 50

percent of the adults who are found after 24 hours

have passed are dead. “They are victims of an illness

they can’t control,” said Brand. Locating these lost

adults quickly is imperative.

In 1994, the National Alzheimer’s Association,

in partnership with DOJ, created Operation Safe

Return, a nationwide identification, support, and registration program to reunite Alzheimer’s disease victims with their loved ones. For a onetime cost of

$40, the registry records the adult’s first name, photo,

identifying characteristics, and emergency contacts;

the registered adults are given bracelets or necklaces

with their first name, the fact that they are memory

impaired, and a 24-hour toll-free number for anyone

who finds them. When these adults are reported missing, Safe Return faxes their ID and photo to local

law enforcement agencies. The Greater New Jersey

Chapter of the Alzheimer’s Association offers scholarships to caregivers who cannot afford the registration

fee, and also will send broadcast faxes to emergency

rooms, multiple police stations, and other contacts.
36 An OJP Issues & Practices Report

The New Jersey Department of Law and Criminal Justice started working with the two New Jersey

chapters of the Alzheimer’s Association in 1997 to

create a statewide education program on Alzheimer’s

disease and Safe Return. Together, these groups

worked to establish mandatory training as part of disability training for new recruits, and to encourage voluntary training among veteran officers. The goal was

to help police become more effective at dealing with

wandering adults with Alzheimer’s disease. A second

goal was to increase the number of registrants in Safe

Return. “Safe Return talks about having 60,000 to

70,000 people nationwide registered in the program,

but with 4 to 5 million people nationwide with

Alzheimer’s disease, you can tell that we are just hitting the surface,” said Mr. Brand.

The Initiative, which has distributed training

materials to 611 law enforcement agencies and police

academies, includes:

■ A letter of support from the state attorney

general encouraging training.

■ A curriculum for training personnel.

■ A book titled “Victim, Not Criminal,” which

illustrates the types of incidents likely to occur

with people with Alzheimer’s disease and how

to intervene effectively. This has since been

replaced by a pamphlet titled “A Guide for

Law Enforcement Officials.”

■ A 12-minute video describing Alzheimer’s disease, Safe Return, and intervention techniques

to use with wanderers.

■ Laminated wallet cards listing basic communication techniques to use with people with

Alzheimer’s disease.

■ Safe Return registration forms.

After 1 year, 30,000 wallet cards were distributed, and 7,000 New Jersey police got training

through their departments or the Alzheimer’s Association. There was a 38-percent increase statewide

in registrations for Safe Return. The Alzheimer’s

Association chapters continue to provide training,

especially to new police officers. 

One other important group needs training in

dealing with dementia: caregivers, who may inadvertently or unthinkingly abuse their charges. “Caregivers must be given the tools and services to learn

how to care. Many people don’t know any different,”

said Mr. Brand. “From the moment of diagnosis, the

education and the information that goes along with

that diagnosis has to be provided to them so they

understand options, so they understand which caregiving techniques work better than others.” Mr.

Brand stated that behavioral management techniques

can reduce and prevent problems, and that caregivers

can be taught to use them. 

Restraints are a common ethical problem for

caregivers and for APS agencies. APS workers commonly get calls from neighbors who are concerned

about people with dementia who are tied or restrained

by their caregivers. If there are no adverse physical

consequences, this practice may be legally acceptable,

if abusive. As part of a study of intergenerational 

attitudes toward elder abuse in different cultures

(European Americans, African Americans, Puerto

Ricans, and Japanese), Ms. Anetzberger discovered

that the older people themselves had mixed feelings

about restraints. “In most regards, the older people

themselves thought that that was not abuse if it facilitated adequate caregiving. Their own definition was

that there should be some accommodations made for

caregivers, recognizing how difficult their task was,

and how ethically charged it could be,” said Ms.

Anetzberger. 

Older adults who are restrained cannot wander,

but they also cannot escape fires or other disasters

inside the building. Ms. Mastro recalled telling a

woman who restrained her husband when she left the

house, “If you go out, and there’s a fire, that’s abuse.”

Medication and adult medical day care are alternatives

to leaving an adult with dementia restrained and

alone.

The way to find resources for training, psychiatric evaluations, and other services for adults with

dementia is to “start working with the local chapter

of the Alzheimer’s Association, as many chapters are

developing their own state public policy aspects as

part of their services, setting platforms and priorities,”

Our Aging Population: A Report of Proceedings
Strengthening Interventions for Victims With Dementia

An OJP Issues & Practices Report 37

said Mr. Brand. In Cleveland, geriatric assessment

units are funded by Medicaid/Medicare reimbursement, Ms. Coleman said. For law enforcement 

officials who want geriatric evaluations of adults, 

Ms. Coleman suggested contacting medical and 

nursing societies and other organizations. “Working

with Alzheimer’s Associations in your neighborhoods,

have them put the pressure on, just as AARP statewide offices and other groups that have effectively

used the public policy/legislative arenas are very

important here in pressing for these kinds of needs.” 
Elder Abuse and Neglect at Home

Workshop 2: Working Across Systems To Improve

Services for Victims of Domestic Violence and Sexual

Assault

Moderator:

Catherine Pierce

Deputy Director for Program Development

Violence Against Women Office

U.S. Department of Justice

Washington, D.C.

Panelists:

Bonnie Brandl

Program Director, National Clearinghouse 

on Abuse in Later Life

Wisconsin Coalition Against Domestic Violence

Madison, Wisconsin

Amy Judy

Systems Advocacy Program Coordinator

Wisconsin Coalition Against Sexual Assault

Madison, Wisconsin

Moderator Catherine Pierce, the Deputy Director for Program Development of the Violence Against

Women Office (VAWO), U.S. Department of Justice, led a discussion highlighting promising approaches to

address domestic violence and sexual assault against older individuals. There is still less known about the scope,

causes, and impact of sexual and domestic violence in older populations than in young and middle aged populations. Lack of federal, state, and local resources for research and services to elderly abuse and/or assault victims

further complicates the design and delivery of effective services to this population.

Bonnie Brandl, Program Director of the National Clearinghouse on Abuse in Later Life at the Wisconsin

Coalition Against Domestic Violence, noted several factors that are important for effectively identifying and

responding to the needs of older victims of abuse and/or assault:

■ Documenting the number of older people experiencing abuse/assault and documenting the types of services needed is important when developing services or building a case for funding. Ms. Brandl suggests

collecting information from a variety of sources, including Adult Protective Services, aging programs, and

domestic violence programs.

■ A multidisciplinary approach to problem exploration, service design and delivery, and fundraising is more

effective than organizing a single entity to do it all. This collaborative approach, though difficult in the

An OJP Issues & Practices Report 39

Mary Lynn Kasunic

Executive Director

Area Agency On Aging, Region One

Phoenix, Arizona
40 An OJP Issues & Practices Report

beginning, is more likely to sustain the effort

over the long term because it allows each

organization to contribute based on its recognized strengths.

■ Participants in a collaboration should take

time to develop a common language and clear

definitions of terms so that all participants

understand the values, principles, governance,

and operating structures that direct the provision of services.

■ The collaborative environment should allow

for honest, up-front discussions about inevitable issues of turf, ego, and control. In

order to get through this difficult time in

collaboration-building, it is critical that relationships of trust and respect be established

early in the process. One way to develop these

relationships is by sharing quality information

with each other, both in terms of organizational limitations as well as strengths.

Using the development of her organization as an

example, Ms. Brandl noted there were several struggles among various entities in the early stages. These

struggles often resulted from the fact that most organizations that were being asked to collaborate were

already overwhelmed by the demand for services and

yet underfunded.

Ms. Brandl recalled the initial response from

many providers to a call to focus on older victims

was, “we don’t do that work ... we see our population

as 18 to 40 years of age and we’re having a hard time

even keeping up with that population. We can’t begin

to think about how we’d start working with older victims.” But persistence and well-documented information about the need for services paid off. In 1994–96,

funds were allocated by the Administration on Aging

to develop a demonstration project to address the

needs of the abused older population.

The collaborative service model that evolved was

the product of a statewide multidisciplinary task force

that included representatives from aging services,

domestic violence shelters, batterer treatment programs, health care efforts, faith-based organizations,

and other community-based organizations. After

building a common understanding about the issues,

the goals of the new organization were set: promoting

the safety of the victims and holding perpetrators

accountable for their actions.

The approaches chosen to achieve these goals

included the development of educational materials,

training, and technical assistance. The group then set

priorities for target audiences. The first priority was to

get the information, training, and technical assistance

out to direct service providers—for example, domestic

violence and sexual assault programs, victim witness

coordinators, aging programs, and APS. 

The second target audience was the criminal justice system. The initial material was enhanced with a

booklet specifically designed to address the questions

and concerns of justice system professionals. It

described typical symptoms and behavior patterns

that might be seen in victims of domestic violence,

and noted appropriate responses and services that

were available when abuse was suspected.

The health care community was targeted as the

third audience, and the fourth target will be the faith

communities; material still is being developed for the

latter group.

The following approaches can help increase the

effectiveness of collaborations, Ms. Brandl said:

■ Take the time to build relationships of trust

and respect among the collaborators.

■ Be clear about the goals.

■ Use data and information as the starting point

for conversations about the scope of the problem and the potential solutions.

■ Build on the strengths of the members of the

collaboration.

■ Clearly define and understand the target audience for services.

Amy Judy, Systems Advocacy Program Coordinator for the Wisconsin Coalition Against Sexual

Assault (WCASA), began developing services for older

victims of sexual assault when she noted two facts:

services for older and/or disabled victims do not necessarily include services for victims of sexual assault,

and most services for sexual assault victims focus on

young populations. Using the model developed by the

National Clearinghouse on Abuse in Later Life as a

guide, Ms. Judy and her colleagues began collecting

Our Aging Population: A Report of Proceedings
Working Across Systems To Improve Services for Victims of Domestic Violence and Sexual Assault

An OJP Issues & Practices Report 41

information about sexual assaults on people who are

older or who have disabilities. When research indicated a need for services, WCASA developed an educational manual and a video titled, “Widening the

Circle: Sexual Assault and Abuse Against People with

Disabilities and the Elderly.” 

The WCASA staff identified two priority target

audiences: members of WCASA, and the state’s 37

rape crisis centers. “Our work would not be successful

if we didn’t have the support of professionals from

many different disciplines coming together to work

collaboratively,” Ms. Judy said. She defined collaboration as:

■ A process of building strong relationships

among professionals from multiple disciplines

that allows for the development of a common

agenda.

■ Continual learning about each other as individuals and as professionals representing multiple organizations with various missions,

philosophies, and policies.

■ Building on the strength and capacity of each

collaborating organization without getting

frustrated with organizational limitations.

The Maricopa Elder Abuse Prevention Alliance

(MEAPA) in Phoenix, Arizona, also has developed a

model for addressing the needs of older abuse and

assault victims. Mary Lynn Kasunic, Executive

Director of the Area Agency on Aging in Phoenix,

said MEAPA developed a program that emphasized

alternatives to guardianship, combating financial

exploitation, development of elder abuse assessment

guidelines, advocacy, community mobilization, and

public and professional education. 

MEAPA began as a coalition of 20 individuals

who wanted to work together to provide professional

education on elder abuse. The membership now has

grown to more than 100. It is multidisciplinary,

including individuals from social services, APS, law

enforcement, medicine, public health, Alzheimer’s

service organizations, nursing homes, and others.

MEAPA research in 1995 on issues affecting 

older victims found that:

■ There was underutilization of domestic violence shelter services by older women.

■ Emergency shelter policies, most of which

were designed to address the provision of services to younger women and their children,

often were not appropriate for older victims.

■ Older women required more time than

younger women to “get back on their feet”

and to develop a plan for self-sufficiency.

■ Transitional housing, a core component of

services to victims of domestic violence, was

geared to younger women with children, leaving many older women with no place to go if

they decided to leave an abusive environment.

With this understanding of the problem, members of MEAPA began developing an agenda for

responding to the needs of elder abuse victims. Again,

the key to success was a collaborative relationship

among many community agencies. The relationships

necessary to sustain collaboration were developed in a

large degree through an educational campaign that

included brochures, posters, training sessions, and the

presentation of a one-act play called “The Dance.”

The play later was developed as a video and widely

distributed.

The expanded model of services that ultimately

was developed included not only education, training,

and technical assistance, but also the establishment

of older women’s support groups and a process and

structure to provide emergency housing for elder

abuse victims. This model’s success is dependent on

key stakeholders working together. The stakeholders

include local police, APS caseworkers, local hospital

emergency room personnel and social workers, volunteer victim’s advocates, local care homes and nursing

facilities, and staff from domestic violence shelters.

“When the police or APS identify someone who

is a victim, we ask them to take that person to the

nearest emergency room,” Ms. Kasunic said. “The

emergency room is very important because the staff

there does the initial screening to ensure that the victim is drug-free and sober and is agreeable to emergency housing. Once the screening is completed, the

volunteer advocate is notified and they have a list of

the homes and nursing facilities that have vacancies.

The advocate and the emergency room personnel and

hospital social worker coordinate arrangements for

shelter placement with the care home or nursing facility. Upon arrival at the care home or nursing facility,
42 An OJP Issues & Practices Report

the victim signs an agreement noting they can stay

there for free for a maximum of 10 days to 2 weeks.

Then, within 24 hours, staff from the domestic violence shelter visit and they work with the victim to

develop a care and discharge plan that includes the

identification and coordination of services needed by

the victim.”

Because it tends to take longer to develop the

support system necessary for self-sufficiency for an

older victim of abuse, there is a need for longer-term

transitional housing, Ms. Kasunic said, and MEAPA

currently is developing plans to address this need.

Other workshop participants noted the discrepancy in services between urban and rural areas.

Panelists agreed that services in rural areas often are

very limited, and noted that current responses to rural

elderly victims usually involve connecting them to

ongoing support groups, working with them by telephone, and/or developing individual peer contacts

who can be called on for support.

Other participants questioned how to help older

victims who do not want to leave their homes, especially if they do not want to go into a shelter of any

kind. Panelists discussed several ways to provide support in such situations, including providing legal

advice and assistance regarding removal of the abuser

from the home, obtaining a restraining order and filing for divorce, providing support groups specifically

designed for those victims who choose to stay in their

homes, and ensuring the availability of phone crisis

lines.

Ms. Pierce noted that there are funds available

through DOJ that can be used to address some of the

issues discussed during the workshop. She encouraged

participants to speak with their state’s administrator

of the STOP Violence Against Women formula funds

to find out more about how to access DOJ resources.

Our Aging Population: A Report of Proceedings
Elder Abuse and Neglect at Home

Workshop 3: Engaging Law Enforcement, Prosecution,

and the Judiciary

Moderator:

Cabell Cropper

Executive Director

National Criminal Justice Association

Washington, D.C.

Panelists:

Candace Heisler

Consultant and Trainer

Assistant District Attorney (Retired) 

San Francisco, California

Charles Mendonca

Public Relations Officer for the Elderly

Pascua Yaqui Tribe of Arizona Law 

Enforcement Services

Tucson, Arizona

Cabell Cropper, Executive Director of the National Criminal Justice Association, told workshop participants

that his association is fairly new to the problem of elder abuse. The association comprises state agencies that

administer federal and state funding and set criminal justice policies and practices. While the association is new

to the issue, many of the constituent state agencies have been working in the field of elder abuse, using both federal and state grants to set up programs. 

Charles Mendonca, Public Relations Officer for the Elderly in the Pascua Yaqui Tribe of Arizona Law

Enforcement Services, is an investigator. He described how he set up his one-man police program against elder

abuse on the reservation in the 14 months since the tribe funded its program on elder abuse. The tribal code in

1984 defined elder abuse, established a duty to report it, and set penalties. But the funding to enforce it was

delayed 12 years. Funding was provided finally because older persons complained to the director of the senior

center and to some council members that their needs were being neglected. Resources remain limited. For example, there is no Adult Protective Services worker on the reservation.

The first thing Officer Mendonca had to do was learn about elder abuse. “That took some time,” he said.

Once he had an idea what he was dealing with, he had to educate social workers, health care workers, other

police officers and firefighters—nearly all tribal employees. The first referrals began to dribble in, but very slowly.

So Officer Mendonca moved his office from the police station to the senior center—“the perfect environment”

for it. He had to gain the confidence of older tribal members (he is not a member of the tribe) and this was easier on their turf. Now, he said, older people come in frequently, converse, and gradually get around to making

their complaints. 

An OJP Issues & Practices Report 43

Lori Stiegel

Associate Staff Director, Commission on Legal 

Problems of the Elderly

American Bar Association

Washington, D.C.

C. Ronald Stromberg

Assistant Director

Division of Aging and Adult Services

Salt Lake City, Utah
44 An OJP Issues & Practices Report

As he investigates, he works closely with other

departments, and this also involves education. At one

time, the prosecutor was unaware of the tribal code

section on elder abuse and Officer Mendonca had to

educate him. He holds other departments accountable

for doing their duty. A social worker who fails to

report some aspect of abuse has to explain the circumstances to him. Sometimes, he said, a social worker is so concerned with confidentiality that he has to

pry out the information, or even resort to subpoenas.

But through establishing his own consistency and

through education, that situation is improving.

Officer Mendonca is a lay advocate in civil cases

in the Tribal Court, and he considers himself an advocate for elder rights. If he finds an older person in

need of services, he goes to the housing or social services department for help. “Wearing a badge—that

helps,” he said. “It really opens doors when I need

to get somebody help.” For example, a woman complained to him that she had no heat, and Officer

Mendonca asked the Housing Authority maintenance

director why he had not fixed the woman’s furnace.

The director suggested the woman was a malcontent,

and finally said there was no money in the budget. “I

advised him that if he didn’t fix it, it was abuse of an

older person. He fixed it. It [the badge] works.” 

Officer Mendonca has obtained several convictions and hopes to add a social worker to his office.

In every case, he relies on education, and works with

other departments, such as the Arizona APS. He also

participates on a task force in Pima County to educate people about elder abuse. He believes he is the

only one doing this work “in Indian Country,” and

appealed to state and federal policymakers not to “forget the people in Indian Country. We have the same

problems as everybody else. We just want to be part

of the solution.”

In Utah, the first problem was simply to get the

law to recognize elder abuse explicitly, said C. Ronald

Stromberg, Assistant Director of the Division of

Aging and Adult Services. APS was part of the child

welfare system until 1993, when the present APS system was created to investigate abuse, neglect, and

exploitation of people who are older or who have disabilities. The law on adult abuse consisted of just one

paragraph, stating that it was illegal, so Mr. Stromberg

and other elder advocates worked to broaden and

strengthen the law. Their efforts were successful in

1996, which marked the first time that the term 

“elder abuse” had ever appeared in Utah law.

But when they showed the law to the police and

said, “Okay, let’s go get ’em,” the police responded,

“We investigate macho crimes—not $300 Social

Security checks but $300,000 bank robberies,” Mr.

Stromberg recalled. When he sought to speak on elder

abuse at the annual Utah Prosecutors Conference, he

got an e-mail stating that elder abuse “doesn’t rise to

the level of our concern.” 

APS felt they might solve the problem by training police in elder abuse, but the response to invitations was “less than overwhelming,” Mr. Stromberg

said. Essentially, the police were not interested in talking with social workers. Finally, a state police unit

dealing with white-collar crime told them, “you guys

need your own cop.” The agency contracted with the

State Department of Public Safety for one officer to

work with APS, with statewide authority. 

The officer was inundated with cases that had

been backlogged for years. To deal more effectively

with such a caseload, he began training local police;

the agency found that local police were willing to listen to a fellow officer. Even in rural areas where only

a few officers have attended training sessions, the

result has been an increase in referrals. The current

goal is to train at least one officer in each jurisdiction

in the state, so that APS has someone to call for assistance with cases. So far, several hundred officers have

been trained, and in Salt Lake City, every uniformed

officer is receiving training. Statewide, elder abuse,

neglect, and exploitation are now part of the training

curricula for all new police officers.

Mr. Stromberg also noted the usefulness of a

police officer’s badge in getting the attention of

abusers. When the APS officer participates in a visit

to the home of an exploiter, flashes a badge, and says,

“What you’re doing is a felony,” the suspect is more

apt to say, “Oh, you didn’t understand. This was a

loan. I will have it paid back within the next 2 days.

Can you give me 2 days to get the money back?”

And often the individual does give it back, Mr.

Stromberg said. 

Arrests have increased dramatically, from none at

all to a dozen or so a year, Mr. Stromberg said, and

prosecutions have risen somewhat because the police

officers know what evidence is needed and discuss the

Our Aging Population: A Report of Proceedings
Engaging Law Enforcement, Prosecution, and the Judiciary

An OJP Issues & Practices Report 45

cases with prosecutors. But the APS is “still battling

for the hearts and minds of prosecutors,” he said. 

The volume of cases is still a problem for the

officer assigned to APS, who not only teaches but

doubles as a consultant to any officer in the state who

needs help, in addition to investigating cases no other

officer will take on. Another problem is continuity:

the officers who do good jobs are promoted away

from APS. 

Candace Heisler, a retired assistant district attorney in San Francisco and now a consultant and trainer, said a multidisciplinary approach, in which APS,

long-term care ombudsmen, police, prosecutors, medical experts, and others contribute, is required to

develop materials and effectively train police and

prosecutors in elder abuse. An APS worker might

know more about a subject than even an experienced

prosecutor like herself, she noted, but that expert will

be more credible to law enforcement if backed up by

police officers. 

The format for instruction should be tailored to

different audiences, urban and rural, using a wide

variety of materials, including publications, videos,

and CD–ROMs. Training can be more effective

when it is delivered to a multidisciplinary group,

Ms. Heisler said. The National College of District

Attorneys uses multidisciplinary training at the

national level, and the California District Attorneys

Association does the same at the state level for both

domestic violence and elder abuse. 

But even the greatest training program is useless

if it does not attract an audience. Ms. Heisler told

conferees, “You gotta have a gimmick; you gotta have

a hook,” and gave these examples: 

■ Hang it on a legislative mandate. Police in

California, for example, became interested

only when a state law was passed requiring

that they be trained in elder abuse. 

■ The best hook for attorneys is mandatory continuing legal education (CLE). If there is an

attractive program, plus CLE credits, the

lawyers will come.

■ Local ordinances establishing elder abuse committees on which police and prosecutors are

required to serve are very effective.

■ Seek help from the press in publicizing highprofile cases of elder abuse, those involving

deaths or frauds for large amounts of money.

■ Encourage political candidates to use protection of older persons as a campaign issue.

■ Urge inclusion of elder abuse outreach and

training in efforts such as community policing

and similar efforts by prosecutors.

■ Persuade community agencies, including

police and prosecutors, to participate in 

multidisciplinary teams. Then use the teams,

including police and prosecutors, to give 

training on elder abuse and exploitation.

■ Draw on multidisciplinary teams including

prosecutors, police, and social workers to

develop CDs and training courses on elder

abuse.

The chances of a judge being trained in elder

abuse are virtually nil, but there is hope, said Lori

Stiegel, Associate Staff Director of the Commission

on Legal Problems of the Elderly of the American Bar

Association. The Commission has developed three

model curriculums for judges and court staff on elder

abuse, published in 1998. This emerged from an earlier project, also funded by the State Justice Institute,

that found judges and court staff needed a better

understanding of elder abuse. After testing in two

states, the Commission produced a book of materials

and background information for instructors, judges,

and others taking the course. One of the curricula is

designed to help judges understand the connections

between domestic violence and elder abuse. Another

curriculum is tailored to staff members who, Ms.

Stiegel said, are the “front line of the court system”—

the first people to encounter and identify cases of elder abuse. This is particularly important as lawyers

grow more expensive and more people represent

themselves, she said. The manual was widely distributed throughout the country, and Ms. Stiegel said the

material is readily available. 

The curriculums are probably ahead of their

time, Ms. Stiegel said; they have not been widely

used. However, the basic curriculum for judges has

been employed in Washington, Florida, and Georgia,

and in a 21

/2-day session for judges in Wisconsin. Ms.

Stiegel said that Becky Morgan, from Stetson Law
46 An OJP Issues & Practices Report

School in Florida, teaches elder issues at the National

Judicial College and uses the ABA model curriculum.

But she said the issue is not yet a priority for national

judiciary associations, and probably will not be until

the number of cases increases. 

The concerns about training judges are similar to

those in training police and prosecutors, Ms. Stiegel

said. With judges, though, it is necessary to understand the ways judges and court staff are trained.

Judicial educators generally plan programs a year in

advance. It is also important to identify which official

or body in the state court system—the chief justice,

the court administrator, the judicial training committee—actually has the power to decide on training. It

is critical to have a judge with clout among his or her

colleagues champion the idea of training on elder

abuse. It is probably better to offer the training as

part of an overall judicial conference rather than as a

freestanding event, and better to draw a sparse crowd

of people who really care than a large group of indifferent judges.

In advocating judicial training, Ms. Stiegel said,

it is best to put the need in the context of a growing

problem, rather than a failure by the courts, and

relate it to increased involvement by police and prosecutors. She urged participants to use the ABA guidelines and materials, to cite the imprimatur of the ABA

and the State Justice Institute, both of which enjoy

great respect among judges. 

Other conference participants offered suggestions

for improving the education of judges. A police officer argued that one way to gain the attention of

judges is to take “a hundred” seniors to court. “When

they see their old schoolteacher” supporting an elder

victim in court, he said, “it has a lot of impact.” A

Maryland prosecutor said she usually asks for a session in the judge’s chambers before an elder abuse

case opens, during which she explains the nature of

elder abuse. The defense lawyers often do not want

to accept this, she said, but they usually go along in

order to avoid looking bad. 

In many states and localities, law enforcement

and judicial authorities are poorly educated about elder abuse and neglect, and resistance to prosecuting

such cases is still strong because authorities lack both

familiarity and experience with the elder abuse laws.

However, once police are given training, they often

become advocates for elder victims. The multidisciplinary approach advocated in other areas also is important in providing training to police, prosecutors, and

judges. Training programs sponsored by national and

state law enforcement, prosecutorial, and judicial

associations, such as the American Bar Association

and national and state associations of district attorneys, are now available. “Hooks” such as local ordinances and publicity can heighten interest in training

courses.

Our Aging Population: A Report of Proceedings
Elder Abuse and Neglect at Home

Workshop 4: Augmenting the Role of Medical

Professionals

Moderator:

Sidney Stahl

Chief, Health Care Organization and Social Institutions

National Institute on Aging, National Institutes of Health

Washington, D.C.

Panelists:

Carmel Dyer

Associate Professor of Medicine

Baylor College of Medicine

Houston, Texas

Laura Mosqueda

Director, Geriatrics

Associate Clinical Professor, Family Medicine

College of Medicine

University of California-Irvine

Orange, California

Sidney Stahl, Chief of Health Care Organizations and Social Institutions at the National Institute on Aging,

opened the workshop with an overview of the issues. Medical issues, not just social issues, can play a key role in

the genesis of elder abuse and neglect at home. Although the connections might not be obvious at first glance,

underlying ailments that may contribute to these problems include dementia, depression, psychosis, alcoholism,

and early cognitive loss.

This relatively new understanding highlights the need for medical professionals to work with Adult Protective Services, law enforcement, and other parties to help diagnose and treat elder abuse and neglect. Yet physicians generally have done a poor job in this regard. Among other reasons, doctors are unaware of the need, have

not been trained to recognize abuse and neglect cases, or fear that such cases will drag them into court or obligate them to provide free services. Lessons can be learned from experts in child abuse, criminal justice, social

services, and victim advocacy, in addition to the medical community, that can help overcome these problems.

The Texas Elder Abuse and Mistreatment (TEAM) Institute, established in 1997, seeks to improve the lives

of abused and neglected elders through clinical care, research, and education. It is an interdisciplinary collaboration between the Baylor College of Medicine Geriatrics Program at the Harris County Hospital District and the

Adult Protective Services program of the Texas Department of Protective and Regulatory Services.

According to TEAM research, 90 percent of self-abuse cases among patients in Texas involved persons older

than 65. In one small study, said panelist Dr. Carmel Dyer, Associate Professor of Medicine at Baylor College of

An OJP Issues & Practices Report 47

Randolph Thomas

Manager, Domestic Investigations Unit

South Carolina Department of Public Safety

Law Enforcement Academy

Columbia, South Carolina
48 An OJP Issues & Practices Report

Medicine, TEAM found that 62 percent of abuseand-neglect patients were depressed compared with

12 percent of those in the control group, and that 50

percent had dementia compared with 28 percent of

the controls.

The clinical portion of TEAM’s work entails an

inpatient unit for abused or neglected older persons,

the research portion involves outcome studies, and

the education portion includes sending all third-year

medical students at Baylor on APS investigations.

“We don’t want any one of them graduating from

medical school not knowing what those three letters

stand for,” Dr. Dyer said.

TEAM has encountered some hurdles. One is

that different disciplines assess the capacity of, and

care for, patients in different ways. Medical experts,

for example, use objective measures in coming up

with differential diagnoses, while social workers and

APS specialists use subjective measures.

Medical practitioners devote far more attention

and expertise to abuse and neglect among children

than they do to that among older persons. As a result,

Dr. Laura Mosqueda, Director of Geriatrics at the

University of California-Irvine Medical Center, studied child abuse and domestic violence care models to

see how they might apply to elder abuse and neglect.

That led to the creation of VAST (Vulnerable Adult

Specialist Team) and the California Medical Training

Center. 

VAST includes Dr. Mosqueda, a nurse practitioner, a pharmacist, a psychologist, a social worker,

and a gerontologist. Among its many duties, the team

investigates and examines the medical and psychological injuries of older victims, documents injuries for

subsequent legal action, encourages dialogue among

an array of experts about the best role of medicine in

such cases, is developing a standardized tool for documenting elder abuse, and educates health care providers, attorneys, law enforcement, and older persons.

Dr. Mosqueda said housecalls, as compared to evaluations on caregivers’ turf, are much more insightful

because they reveal the physical and emotional environment in which older victims live.

The California Medical Training Center hosts

day-long courses for medical practitioners on elder

abuse. Instructors include a pediatrician and a district

attorney.

Officials in South Carolina also realized the

importance of developing a standard way to collect

medical evidence in elder abuse cases, as better evidence means better criminal prosecutions. Randy

Thomas, Manager of the Domestic Investigations

Unit in the South Carolina Department of Public

Safety’s Law Enforcement Academy, said that after

2 years of input from—and “sometimes interesting

debate” among—physicians, victim advocates, and

experts in criminal justice and social services, and

after pilot testing and fine-tuning, the South Carolina

Vulnerable Adult Medical Protocol was launched in

1995.

The protocol relies on body charts to ensure

that people who investigate cases of elder abuse and

neglect collect evidence in a consistent way that will

stand up in court. To boost awareness of the abuse

and neglect problem, Mr. Thomas put together a

videotape that was sent to doctors, nurses, law

enforcement officers, and others. However, it is

unclear how many professionals actually watched

and understood the video.

Further, some medical practitioners simply don’t

use the protocol, Mr. Thomas said. And the protocol

cannot catch elder abuse and neglect at facilities

where the perpetrators may be the ones responsible

for reporting such cases. Finally, some physicians are

reluctant to participate in the protocol for legal reasons. “If you want to clear out all the physicians in

an emergency room,” said Mr. Thomas, “wave a 

subpoena.”

How can society do a better job of battling elder

abuse and neglect? Panelists offered these additional

ideas:

■ Make education a top priority. There are only

9,000 geriatricians in the United States to treat

the 20% of the older population who are frail.

More public resources, such as Medicare

funds, should be devoted to training geriatricians. And more medical professionals need to

know that tools such as the medical protocol

are available.

■ More funds should be earmarked for research

and for testing of practical measures to see

what really works.

Our Aging Population: A Report of Proceedings
Augmenting the Role of Medical Professionals

An OJP Issues & Practices Report 49

■ Using federal funds, medical schools should

designate a clinical team to partner with APS

or forensic specialists in fighting elder abuse

and neglect.

■ APS workers should be trained how to make

referrals to medical consultants.

■ Multidisciplinary teams must meet regularly to

overcome stylistic differences and to engender

trust.
Elder Abuse and Neglect at Home

Workshop 5: Enhancing Victim Services

Moderator:

Diane Alexander

Director, Field Services

National Center for Victims of Crime

Arlington, Virginia

Panelists:

Shanny Augare

Assistant Executive Director, Child & Family 

Advocacy Center

Director, Violence Prevention Program

Browning, Montana

Judy O’Neal

Manager, Victim Witness Branch

Governor’s Office of Criminal Justice Planning

Sacramento, California

Moderator Diane Alexander, Director of Field Services at the National Center for Victims of Crime, stated

that victims of elder crime are more likely to benefit if public agencies build bridges with each other when they

establish programs and provide services. The agencies are more likely to benefit, too, because collaboration

increases the likelihood of prosecutions and other successes. Collaboration is especially critical when a federal

crime involves thousands of victims spread out over a number of jurisdictions.

Not the least of obstacles standing in the way of these efforts is the geographic size of some service areas.

The U.S. Attorney’s Office for the Western District of Texas, for example, has just eight offices to serve everyone,

not just victims of elder crime. Moreover, law enforcement districts at the Federal Bureau of Investigation,

Immigration and Naturalization Service, and other agencies may not coincide with other criminal justice districts. And fighting elder crime requires basic skills and awareness that may be lacking on the front lines.

Perhaps nowhere has cooperation proved more fruitful than in California, a large and very diverse state with

a burgeoning older population. Using state and federal funds, California launched the Elder Abuse Special

Emphasis and Special Victims Program in 1997, the Elder Abuse Advocacy and Outreach Program in 1999, and

the Elder Abuse Vertical Prosecution Program earlier this year. Together, they funnel more than $4.5 million to

county-based elder-crime efforts. 

In setting up these state programs, it became clear that the “missing link” was communication among agencies, said panelist Judy O’Neal, Manager of the Victim Witness Branch of the Governor’s Office of Criminal

Justice and Planning in California. So, in order to win grant funding under the Special Victims Program, local

applicants now must explain how they would coordinate efforts among the courts, probation departments, prosecutors, law enforcement, long-term care ombudsmen, social and mental services, victim-witness programs and

other parties.

An OJP Issues & Practices Report 51

Kathi West

Victim-Witness Coordinator

Office of the U.S. Attorney for the 

Western District of Texas

Austin, Texas
52 An OJP Issues & Practices Report

California has been very aggressive in reaching

out to older people, using displays at bus and rapidtransit stops, freeway billboards, public service

announcements on radio and television, and other

tactics. Such efforts greatly boosted the number of

elder abuse cases for investigation and prosecution.

An outgrowth of that success is the new Vertical

Prosecution Program, which focuses on severe

felony cases.

Those who battle elder abuse locally may not

know at times whom they should call at the federal

level for help. That’s when a federal victim-witness

coordinator can fill the gap, said panelist Kathi West,

Victim-Witness Coordinator with the U.S. Attorney’s

Office for the Western District of Texas. These coordinators, unlike most harried U.S. attorneys, typically

know who the best person to contact is, given the

particular circumstances of a case.

Ms. West alone serves 22 federal prosecutors,

without a secretary. Aside from the workload, among

the special challenges she faces are tracking down, for

restitution purposes, people who may have relocated

or died since they were victimized years earlier.

Ms. West has found that older people are much

more likely to report crimes by phone if they can

reach her directly through an 800 number and leave

messages on a dedicated voice-messaging system. She

believes that in contacting older individuals by mail,

it’s best to avoid form letters and legalese, and it is

critical to use large type and to tailor thorough messages in each instance so recipients fully understand

why they are being contacted and what action they

need to take.

Reaching out to other advocates for older persons

also can be important. As Assistant Executive Director

of the Child and Family Advocacy Center for the

Blackfeet Tribe in Browning, Montana, which was

started in 1998, Shanny Augare surveyed a crosssection of key players at the reservation—nursing

home workers, housing authorities and authorities

with the tribal business council, Indian Health

Services, Bureau of Indian Affairs, and law 

enforcement—to identify how older persons and 

others would most benefit from the advocacy center.

The reservation encompasses about 9,000 square

miles and 600 older members of the tribe.

The survey revealed a need to train criminal

and civil investigators specifically about crimes

against older persons, and to train the staff of an

elder-protection team for which there is yet no funding. Mr. Augare also learned that current tribal and

state laws don’t adequately safeguard older persons. 

Panelists offered these other tips for enhancing

services to older crime victims:

■ Consider training to be a key part of countering elder abuse. Staff must know how to reach

out to older people and assuage their fears or

embarrassment about having been swindled.

Also, the general public must learn to detect

signs of elder abuse.

■ Attach strings to federal and state grant funds

as a way to hold grant applicants accountable. 

■ Make sure grant applicants have the full support of their department heads. Otherwise,

their programs may languish. 

■ Victims’ individual needs vary; a one-size-fitsall approach is not effective.

■ Give older victims information that will help

prevent further victimization.

■ Pair victim advocates with law enforcers. Such

teams are more likely to gain the cooperation

of those in a dispute, and to lead to stronger

legal cases and more prosecutions. 

Before a trial begins, arrange for victims to visit

the courtroom so they become more comfortable with

the surroundings, and especially with the witness

stand, using the microphone and responding to questions. Prosecutors, in turn, can learn in advance if

witnesses have medical problems or difficulty hearing,

seeing, understanding dialogue, or moving about.

Our Aging Population: A Report of Proceedings
Opening Remarks 

Day Two

Speaker:

Alexa Verveer

Deputy Assistant Attorney General

U.S. Department of Justice

Washington, D.C.

Alexa Verveer, Deputy Assistant Attorney General, Office of Justice Programs, U.S. Department of Justice,

opened the second day of the symposium by welcoming the participants back and commending them for the

productive discussion of the previous day. She thanked participants for their hard work to crystallize their thinking on the problem of elder abuse and on the steps needed to improve collaboration on this issue between public

safety and social services professionals in their communities.

Ms. Verveer assured participants that their work at the symposium also would assist the Departments of

Justice and Health and Human Services to understand better the “state of the nation” in preventing and responding to the victimization of older persons and what the federal role in these efforts should be. She also encouraged

participants to use the time during the closing session to share their thoughts on elder abuse issues with the

Attorney General. She emphasized that a hallmark of the Attorney General’s tenure has been the importance of listening to those at the state, tribal, and local levels and her rejection of a “top-down” approach to problem solving.

An OJP Issues & Practices Report 53
Plenary IV

Institutional Abuse and Neglect

Moderator:

Steven Pelovitz

Director, Survey and Certification Group

Health Care Financing Administration

U.S. Department of Health and Human Services

Baltimore, Maryland

Panelists:

Marie-Therese Connolly 

Coordinator, Nursing Home Initiative

U.S. Department of Justice

Washington, D.C.

Michelle Lujan-Grisham

Director

New Mexico State Agency on Aging

Santa Fe, New Mexico

In a discussion led by Steven Pelovitz, Director of the Survey and Certification Group in the Health Care

Financing Administration (HCFA), this panel examined the issues surrounding the problem of institutional

abuse and neglect from the local, state, and federal perspectives.

To effectively prevent and stop abuse, agencies need to work together. Effective prosecution of abuse and

neglect requires expert medical testimony, especially in cases where there are no competent witnesses, expertise

that Medicaid fraud investigators or Adult Protective Service workers seldom have. Effective prevention of the

problem involves interagency collaboration to enforce existing laws, strong financial sanctions for abuse and neglect, and more research into the signs of abuse, so that the problem can be detected early. In some states, new

legislation to criminalize neglect will be required.

Several state and federal agencies already are working together to reduce abuse, and can help local efforts to

improve nursing home care. Due to recent federal legislation, state Medicaid Fraud Control Units (MFCUs) can

help investigate a broad range of institutional abuse and neglect. DOJ’s Nursing Home Initiative has brought

cases against nursing home operators under civil, bankruptcy, criminal, and civil rights statutes, and HHS’

Health Care Financing Administration has done studies on minimum necessary staffing levels to prevent abuse

and neglect. 

Tennessee nursing home activist Senora Russell highlighted the problems by describing how her father died

of nursing home neglect, despite frequent visits and intervention by Ms. Russell and her three siblings. An active,

cheerful, outgoing man, octogenarian Willoughby Russell entered the Crestview Nursing Home in 1996 after he

had begun to become disoriented at home. Crestview seemed like a good facility, and was one block away from

one brother’s home. “I was particularly concerned about finding a nursing home that would be good because I

An OJP Issues & Practices Report 55

Senora Russell

Nashville, Tennessee

David Waterbury

Director, Medicaid Fraud Control Unit

Washington State Office of the Attorney General

Tacoma, Washington
56 An OJP Issues & Practices Report

had worked briefly in a nursing home laundry myself.

I saw feces-soiled clothes being given back to residents

as clean clothing, and there was no infection control,

so I was worried about what would go on behind the

scenes, that the public could not see,” Ms. Russell

recalled. The siblings visited their father frequently,

and he seemed well, but the family soon began to

have doubts about his care. “Even though our family

was in the facility all the time, it was hard for us to

note what was actually going on,” she said. Medicaid

helped pay for Mr. Russell’s care.

In April 1997, a visitor found Mr. Russell in his

bed, quiet and withdrawn. “That was so unlike him,

we knew something had to be wrong,” Ms. Russell

said. The nursing home ignored the family’s requests

for medical help, until they insisted that Mr. Russell

be taken to a hospital. There, doctors discovered that

he had a broken hip. Crestview never explained how

he had broken his hip, or why there had been no

medical intervention.

Mr. Russell’s condition deteriorated in the hospital. In May 1997, Mr. Russell was transferred to the

Bethany Health Care Center, a skilled nursing facility,

where Medicare and Medicaid paid for his care. After

Mr. Russell had spent 3 months there, the family

learned that he had developed decubitus ulcers (bedsores) on his back. “[We] were told from time to time

that he had infections, but we did not realize that it

was infected bedsores,” Ms. Russell remembered. “We

thought that they meant that he had some kind of

internal sickness. We saw that he had bandages, but

we did not remove the bandages to look at the ulcers

ourselves.” She and her brother asked that their father

be treated for his infections at a hospital, but were

told that any medical transfers had to be ordered by

the medical director, who could be contacted only

by Bethany personnel. The Russells did not press the

issue. “I was worried that if we pushed too hard,

someone might be cruel to Dad when we were not

around,” she said.

Late in 1997, after Mr. Russell had been in

Bethany for 8 months, the family was so worried that

they decided to talk to facility administrators. Russell

found her father with feces in his hand on one visit,

and it was clear that he had not been bathed. She

cleaned him herself, and spoke to a sympathetic nursing supervisor, who apologized. “She ... said that to

some of the staff, my father was just a body without a

soul,” said Russell. 

Before the family could meet with the administrators, Bethany staff called Ms. Russell’s brother on

January 2, 1998, and told him that Mr. Russell was

unresponsive, and might have to be taken to the hospital. Ms. Russell called the facility, and asked them

to hospitalize her father immediately. He was not

transferred until several hours later, when he was

“near death,” Ms. Russell said; he was given three

units of blood. 

“When they removed the bandages from his

ulcers, the smell was so terrible that one of the nurses

was overcome by nausea,” she remembered. Her

father had sores on his elbows, back, testicles, heels

and buttocks, all deep and infected. “The hospital

staff was so upset at his condition, that we suspect

that the nursing home delayed transferring him so

other medical people would not see his condition

before he died,” she said. He died in the hospital a

month later. 

Nurses at the hospital were horrified at Mr.

Russell’s condition, and referred Ms. Russell to the

state health department’s regulatory board for nursing

homes, which is composed primarily of nursing home

operators. She began a long series of fruitless attempts

to have her father’s death investigated. A state inspector who had asked her for more information was never heard from again. The next time Ms. Russell called

his office, she was told that he was “no longer there.” 

When it became clear that the state would not

take her case, Ms. Russell’s family tried contacting

other agencies. The Tennessee Justice Center, a public

interest law firm, referred her to two law firms that

might take her case, both of which turned down her

request. “The Justice Center lawyer told me later that

the reason those firms turned me down was that they

felt the costs of bringing the case to trial were just too

great, and because of Dad’s age and medical condition

when he went to Bethany, they did not think they

could get enough in damages to justify the risk of 

taking the case,” she said. 

In 1998, the year Mr. Russell died, Bethany

received $4,873,394 in Medicaid payments, and

$779,567 from Medicare. “Those government payments provided Bethany’s owners with 74 percent

Our Aging Population: A Report of Proceedings
Plenary IV: Institutional Abuse and Neglect

An OJP Issues & Practices Report 57

of their revenue. Bethany has never had to account

for what happened to my Dad,” Ms. Russell said.

The abuse Mr. Russell suffered is far too common. “There are financial and exploitation types of

abuses, there are physical and emotional types of

abuses, there is absolute neglect, and this is happening

in most of the facilities, whether they are for-profit or

not-profit or small or big chains all across the country,” said Michelle Lujan-Grisham, Director of the

New Mexico State Agency on Aging. Overworked

and overstressed nursing home staff often give poor

and reckless care.

States have made laws and regulations to protect

the rights of nursing home residents and assure a high

quality of care. However, the sheer number of different agencies charged with safeguarding older adults

makes it difficult to hold abusive institutions accountable for the harm they do. All states have a long-term

care residents’ rights program, usually termed a “longterm care ombudsman program,” and most have

MFCUs, and inspectors general staff in their human

services department to account for Medicaid funds,

as well as social services staff, and APS units. In New

Mexico, “five entities, all charged with accounting for

funds, assuring quality care, making sure people are

not abused or exploited in any fashion, assuring other

rights outside of an abuse, neglect or exploitation setting ... the reality is we trip over each other in those

investigations,” Ms. Lujan-Grisham said. “There are

some folks who investigate and substantiate and some

folks who don’t substantiate, which leads to the sort

of evidentiary chain that leads others to conclude that

these are poor and difficult cases to bring, or it’s not

clear if abuse occurred or didn’t occur.”

Frustrated with the chaotic state of investigation,

Ms. Lujan-Grisham decided to go undercover, and

check herself into a long-term care facility. In 1998,

Ms. Lujan-Grisham’s father checked her into a small

board and care home for 3 days. Her cover story was

that she was a young disabled adult, who could not

perform any self-care, and could not eat, use a toilet,

or move herself. She arrived with no records, no doctor’s orders, but with $200 cash for a weekend’s care.

“Cash talks!” said Ms. Lujan-Grisham. The home

admitted her without an interview, and did not ask

for any emergency phone numbers or contacts. 

Ms. Lujan-Grisham was placed in a room with

another resident, and had to wait 6 hours before she

was toileted, or unpacked, or told anything about the

facility. She was not toileted or fed properly, and was

dressed only in an open day robe when she was put in

the day room with all the other residents, including

many men. 

After Ms. Lujan-Grisham’s experience, her office

did three more undercover investigations, in one state

and two private facilities: one big chain and one

small, local home. “We found even more serious

problems,” she said. Undercover workers saw urine

left on the floor, residents left in their feces, call lights

taped to the foot of the bed so residents could not

request care, residents left naked on top of their beds

and, most ominously, intercom buttons taped down

so that nursing staff could listen to residents’ complaints when the ombudsman came to interview the

residents. Medical care was poor, and one home falsified records to show that an undercover worker was

checked every 15 minutes, when that worker was

missing for 12 hours before his absence was reported. 

In response to these investigations, the state of

New Mexico created a litigation task force to take on

cases of institutional neglect, and made it easier to sue

nursing homes for wrongful death. “We have improved

the setting for damages, that these are good clients,

that demented clients are viable clients, that wrongful

death statutes are not prohibitive.” The state has

passed legislation to continue the undercover program, and it is looking at Medicaid funds recovery.

“Why would we pay for services in these facilities

that are absolutely not received?” asked Ms. LujanGrisham. Under the funds recovery proposal, the state

would put Medicaid payments into escrow when

complaints are substantiated, and not release the

money until the complaint is resolved. 

Nursing home abuse also is important to MFCUs,

said David Waterbury, Director of the Washington

State MFCU. In 1978, federal legislation allowed

states to apply for funding to establish MFCUs within their states to investigate the misuse of Medicaid

funds; today, 47 states and the District of Columbia

have these units.

MFCUs are “strike forces” involving attorneys,

investigators, and auditors working together on a daily basis, generally in a state attorney general’s office.
58 An OJP Issues & Practices Report

Although the MFCUs were organized to investigate

fraud, Congress has mandated that MFCU investigators should also look at patient abuse in Medicaidfunded facilities. “All units participate in patient abuse

and resident abuse cases on a regular basis,” said Mr.

Waterbury. The units also belong to the National

Association of Medicaid Fraud Control Units 

(NAMFCU), which has been publishing guidelines

for conducting patient abuse cases since 1988,

including model statutes and policy language. 

Initially, MFCUs only could investigate facilities

that received Medicaid money. In 1999, federal legislation was enacted that allowed MFCUs to investigate

fraud in other federally funded health care programs,

and allowed sponsoring agencies (such as state attorneys general) to let MFCUs conduct investigations in

non-Medicaid funded facilities. An MFCU “can be a

bigger player in resident abuse than in the past, thanks

to this legislation,” Mr. Waterbury said. NAMFCU is

concentrating more and more of its resources on the

connection between fraud and resident abuse, when

diversion of resources leads to inadequate care—a situation known as “corporate neglect.”

Federal legislation requires that the MFCUs

review referrals of patient abuse and take action where

it is appropriate. The units are not required to investigate or prosecute cases, but they can take action

where no other agency acts. “It’s as close as I can see

to enabling legislation to ‘do the right thing,’ ” Mr.

Waterbury said. The units’ roles vary in the states. 

Prosecuting abuse and neglect cases is difficult,

and requires extensive collaboration. Expert testimony

on medical issues and nursing home operations can be

crucial, especially in cases where there are no competent witnesses. Many states do not even have statutes

to allow criminal prosecution of neglect cases. “These

are the kinds of things I think you all can help these

units do,” Mr. Waterbury said. “You have these connections, you have this knowledge, you have history,

oftentimes you have relevant evidence that can be

introduced in trials, that people like me would never

know unless you come forward and help us with

that.” He also urged conference participants to ask

their states’ MFCUs for help. “Contact your Medicaid

Fraud Control Units, help them develop their role,

help them exercise their jurisdictional mandate, and

let them know your feelings about what your needs

are in your particular state, and how you can work

with them,” he said.

Even persuading law enforcement staff to intervene in abuse and neglect cases can be hard. “Lots of

times, local law enforcement ... will say something

like, ‘You know, this isn’t something that my city

prosecutor or county prosecutor will prosecute. It’s

just not,’ ” Waterbury noted. “Well, so what? Your

job is not just to go work up a case that will be prosecuted, and you don’t do anything about public safety

unless that’s an attainable goal .... Law enforcement

is supposed to move into situations that are highly

charged, and oftentimes emotional and dangerous,

and separate the parties, whether somebody’s prosecuted or not. That’s what you do before somebody

gets hurt.” MFCUs also train law enforcement personnel and social service agencies to be sensitive to

evidence-gathering in abuse and neglect cases, and

to law enforcement’s role in these cases. 

DOJ’s Nursing Home Initiative brings lawsuits

against negligent and abusive nursing homes, said

Marie-Therese Connolly, the Coordinator. The

Initiative has three broad mandates: enhance enforcement, enhance training, and enhance coordination. 

DOJ’s lawsuits are in four main categories: civil

and false claims work, civil rights, bankruptcy, and

criminal cases. The False Claims Act allows DOJ

attorneys to prosecute service providers who knowingly submit claims to the U.S. Government for services

that were not rendered, or rendered so poorly as to

constitute no services at all. DOJ started bringing

false claims cases in Pennsylvania, seeking not just

money but also remedies that would improve conditions in those institutions. There, consent decrees

imposed a temporary monitor on nursing homes,

and specific requirements relating to problem areas

such as wound care or diabetes management. By comparison, the Civil Rights of Institutionalized Persons

Act allows DOJ to pursue public facilities for abuse

and neglect. 

DOJ also has been collaborating with other agencies to pursue cases against bankrupt nursing home

operators. “Five of the seven largest providers are now

in bankruptcy,” said Ms. Connolly. In these cases,

DOJ seeks to balance efforts to recoup Medicaid and

Medicare payments from bankrupt providers—punishing and deterring wrongdoing—with its efforts to

Our Aging Population: A Report of Proceedings
Plenary IV: Institutional Abuse and Neglect

An OJP Issues & Practices Report 59

protect current and future residents. “That’s a complicated mix, and it’s a constant balancing that requires

the type of collaborative effort that you’ve heard mentioned here today,” Ms. Connolly said. “We at the

Department of Justice don’t have either the training

or sufficient knowledge to make those decisions on

our own, and we have been relying heavily on our

partners at the Department of Health and Human

Services and others to help guide us through these

turbulent waters.”

DOJ also has been litigating some criminal cases

involving false statements and fraud. In one case, a

woman who had “eloped” from a nursing home was

found bleeding in a ditch by the side of the road.

The nursing home brought her back, and falsified

the records to say that she had fallen out of bed. The

woman died within 24 hours of her return. The nursing home administrator and assistant director of nursing were convicted of lying to federal officials and are

now in prison.

Training has been a high priority at DOJ, which

has sponsored four regional conferences on institutional abuse and neglect. These conferences were

intended to train federal and state law enforcement

workers—such as attorneys, investigators, paralegals,

auditors, and service providers (including APS workers and long-term care ombudsmen)—about abuse

and neglect cases. One important issue at these conferences was information sharing. “Law enforcement

doesn’t play well with others,” and has a reputation

for being secretive, Ms. Connolly noted. In some 

cases, there are good reasons for law enforcement’s

secrecy, as when a grand jury is considering a case.

However, in cases of elder abuse and neglect, collaboration is vital to protect victims, and absolute secrecy

is counterproductive. 

Many health care providers are nervous about

working with law enforcement and feel that court cases and jails may not be the best remedy for all abuse.

“By working together, we are going to be able to better identify how to make law enforcement a force for

good. Law enforcement doesn’t come into play until

other systems break down,” Ms. Connolly said. 

State working groups that developed as a result of

the Initiative also have identified a national problem

in prosecuting abuse and neglect; the lack of research

into the signs and symptoms of abuse and neglect in

the elderly. “I had a firefighter, a medical examiner,

[and an] emergency room doctor get up and say, ‘We

don’t know how to detect where there is abuse or neglect. We don’t know when we go into a nursing

home whether these bruises are signs of abuse and

neglect, or whether they’re some natural phenomenon,

whether these dehydrations or these ulcers are a sign

of abuse and neglect,’” Ms. Connolly recalled. “... If

the folks on the front line don’t know how to distinguish between what is abuse and neglect and what

isn’t, then we have a problem. Back one step further,

there isn’t very much research on this area. We don’t

know what patterns of bruising are indicative of

abuse. We don’t know what types of fractures are.

There isn’t the research in this area, and if there isn’t

the research, how do we train, and if we don’t have

the training, then how do we detect?” That is why, on

October 18, 2000, DOJ brought together a panel of

experts to address this and other forensic issues related

to elder abuse. DOJ is looking at how different agencies put together training, evaluate research proposals,

and “how to move the ball forward,” she said.

DOJ also is trying to improve nursing home care

from a corporate standpoint, by encouraging nursing

homes to screen employees through use of the FBI

database, which contains criminal records for 39 million people. Public Law 105–277 allows nursing

homes to make requests to the FBI database and to

run criminal background checks on their employees. 

While DOJ is prosecuting nursing homes for

inadequate care, HCFA has been investigating what

a nursing home needs to run well. Each year, HCFA

performs a survey via state agency contracts of the

quality of care in nursing homes. “Information, 

and sharing of information, is critical to how we go

about our jobs and how successful we are,” said 

Mr. Pelovitz. HCFA’s “Nursing Home Compare” 

Web site gives information about nursing homes,

including the last survey results, and some selfreported staffing levels.

Unfortunately, it is difficult to compare results of

these programs across states, as deficiencies and problems are reported differently across the nation. “We

don’t expect ... that every state will look exactly like

each other. That would be as false as what we have

now. But we do need to have a common, consistent

basis for how we cite deficiencies, how we react to 
60 An OJP Issues & Practices Report

them, what the outcomes we are trying to achieve

[are], and then we can compare performance on a

more effective basis,” Mr. Pelovitz said.

Last year, HCFA submitted to Congress a report

on Phase 1 of a staffing study of nursing homes.

Phase 2 will be finished next summer. Phase 1 contained three sections: a history of work done on nursing home staffing, a time and motion study of the

work necessary to deliver a set of tasks for residents,

and research on whether there was a correlation

between staffing levels and quality of care. The

researchers found that in order to perform five tasks

to care for a nursing home resident—feeding, toileting, repositioning a person in bed, performing “morning care,” and helping a person exercise—2.9 hours of

certified nurse assistant time per resident per day was

required. “Ninety-two percent of homes in this country do not meet that number,” Mr. Pelovitz noted.

The study also found that when staffing falls

below 2 hours of certified nurse assistant time per resident per day, and below three-quarters of an hour a

day of combined licensed nurse/registered nurse time,

the quality of care dropped dramatically. “Homes that

were above that minimum level [were where] 2 percent of the residents ended up in the hospital for

avoidable occurrences ... When staffing dropped

below that point, the incidence was 22 percent,” he

said. This data was taken from three states. HCFA

plans to examine the issue again, with data from more

states, and also to take into account the “case mix,”

i.e., how the relative health of residents in a given

home affects the requirements for care levels. HCFA

also will “price out” what it would cost to increase

staffing to minimum levels.

HCFA has collaborated with DOJ and the Inspector General’s office on several issues. “Part of

it was putting aside personal organizational accomplishments to achieve the outcomes we wanted ....

Sometimes, it’s best if Justice takes the lead, sometimes it’s best if the IG [Inspector General] takes the

lead, sometimes it’s best if HCFA takes the lead, and

sometimes ... we’ve found a way for all of us to

advance all of our needs, by saying, ‘No, this is a federal government position, not a DOJ, IG, and HCFA

position’” Mr. Pelovitz said.

In the end, preventing nursing home neglect and

abuse is about preventing harm to people. “It’s very

easy to fall into the trap of talking about residents, or

beneficiaries, or patients, if you’re talking about some

institutional settings, and to lose sight that who we’re

talking about, in nursing homes at least, are our

grandparents, our parents ... and someday ourselves,”

he said. “You need to remember that when you talk

about a resident, you’re talking about a human being.

And if you keep that in mind, we will do a lot better

job of getting to where we need to.”

Our Aging Population: A Report of Proceedings
Institutional Abuse and Neglect 

Workshop 1: Creative Initiatives To Educate Professionals

and the Public

Moderator:

Nolan Jones

Director, Human Resources Group

National Governors’ Association

Washington, D.C.

Panelists:

Barbara Doherty

Adult Protection Consultant

Aging and Adult Services Division

Minnesota Department of Human Services

St. Paul, Minnesota

Diane Menio

Executive Director

Center for Advocacy for the Rights and 

Interests of the Elderly

Philadelphia, Pennsylvania

Moderator Nolan Jones, Director of the Human Resources Group at the National Governors’ Association,

introduced the panelists and guided a discussion highlighting innovative approaches to educating professionals

and consumers about elder abuse and neglect that occur in institutions. Keys to preventing elder abuse and neglect are better information about the environments in which older people live and more extensive education of

those who regularly come in contact with older people, including local law enforcement, nurse aides, Adult

Protective Services workers, nursing home staff, state regulators, fraud fighters, long-term care advocates, and

family members. Instead of simply responding to incidents of abuse and neglect with limited resources, advocates

for older persons in some parts of the country have developed creative programs to accomplish these goals. For

example:

■ Developing creative, more effective, and more precisely tailored educational methods—through the use

of computers, the Internet, and satellite programs—to reach larger audiences at lower costs than can be

achieved through classroom teaching. 

■ Encouraging a greater focus on elder abuse and neglect in curriculums.

■ Designing tools that make it easier to detect and evaluate abusive and neglectful environments.

■ Fostering accountability through networks of personal contacts at public agencies so cases don’t “fall

through the cracks.”

An OJP Issues & Practices Report 61

David Waterbury

Director, Medicaid Fraud Control Unit

Washington State Attorney General’s Office

Tacoma, Washington

Pam Vocke

Director, Division of Quality Improvement 

and Training

Health Care Financing Administration

U.S. Department of Health and Human Services

Washington, D.C.
62 An OJP Issues & Practices Report

Pam Vocke, the Health Care Financing Administration’s Director of Quality Improvement and

Training, said she has found that inviting advocates

and care providers to training sessions is a good way

to impart valuable information. “Training the trainers” and developing educational materials that apply

to different audiences can make a big difference. 

In all this, Ms. Vocke said it is important to keep

in mind that elder abuse and neglect can occur in a

variety of settings, not just in nursing homes. Less

obvious settings include acute care facilities, hospices,

dialysis centers, and organ-procurement facilities.

Rather than only evaluating such facilities in terms

of how many older people they can accommodate,

Ms. Vocke said specialists must examine patient outcomes to ensure that people are getting proper care.

One hurdle, according to Diane Menio, Executive Director of the Center for Advocacy for the

Rights and Interests of the Elderly (CARIE) in

Philadelphia, is that some care providers at nursing

homes don’t have the right temperament for their

work and haven’t learned ways to cope with stress

and conflict on the job. Caregivers can feel particularly stressed, for example, when they are in a rush to

feed incapacitated residents. Ms. Menio said abuse,

which she described as both “subtle” and “even institutionalized,” is more likely to occur when there is

conflict between caregiver and patient.

Tests show that the attitudes and behavior of

workers improve if they receive training about abuse

and neglect. CARIE’s training program teaches workers how to assess whether they are dealing with stress

and conflict appropriately. It also teaches them about

residents’ rights and how to bathe, dress, and provide

other care to residents in ways that will minimize

problems. Indeed, Pennsylvania now requires that

abuse and neglect instruction be part of the curriculum for nurse aides, who must also undergo annual

in-service training.

Like Pennsylvania, Washington is taking a much

more proactive approach than it once did. The catalyst for this turnabout was a series of revealing articles

in the Seattle Times about elder abuse and neglect.

They prompted the state attorney general to issue a

reform challenge to David Waterbury, Director of the

state’s Medicaid Fraud Control Unit.

There are about 250 law enforcement agencies

in Washington State. In the past, said Mr. Waterbury,

the MFCU, which has only two investigators and a

supervisor, sent abuse and neglect referrals to the

appropriate agencies, but not to any particular individual there. Accountability for followup was lacking,

and many cases languished. 

The unit built a contact network in which one

person at each agency and one in each prosecutor’s

office would be responsible for referrals. That enables

Mr. Waterbury’s outfit to “work a case from the bottom up or the top down,” he said. If a sheriff’s office

didn’t provide a contact name, the unit sent referrals

to the sheriff personally; after a week of referrals, this

tactic typically generated a contact name.

Mr. Waterbury also persuaded the state police

academy to add training about elder abuse and neglect to its curriculum. “We knew that wasn’t going to

help our case immediately because [academy students]

were not detectives,” he said. “But it was the only way

to break out of this cycle and reach a new generation.”

The MFCU has taken other steps, as well. For

example, it now queries law enforcement agencies

about their needs in battling elder abuse and neglect,

instead of assuming the unit itself knows best. Those

needs may include stiffer state laws, guidelines for

determining whether abuse or neglect has occurred,

and more training of law enforcement personnel.

In addition, the unit issued a fact book to law

enforcement agencies that makes it clear that they,

rather than the MFCU, should be first to respond to

reports of elder abuse and neglect. The book lists

public entities that are fighting abuse and neglect,

and addresses of group, boarding, and other homes

for the elderly so authorities can monitor these places.

The book also is a best-practices manual for conducting investigations.

Early next year, Minnesota will begin testing a

“risk profile tool”—a quality yardstick—that public

servants can use to spot potential problems at nursing

homes. The Aging and Adult Services Division of

Minnesota’s Department of Human Services and the

National Center on Elder Abuse together created the

tool based on the results of a statewide survey of nursing home residents and staff, county adult protection

and advocacy staff, and family members.

Our Aging Population: A Report of Proceedings
Creative Initiatives To Educate Professionals and the Public

An OJP Issues & Practices Report 63

Barbara Doherty, an Adult Protection Consultant

with the Aging and Adult Services Division in the

Minnesota Department of Human Services, said the

survey asked these four questions: 

■ What resident and/or family characteristics

would put residents at higher risk and how

could that risk be quantified? 

■ What staff or facility issues might contribute

to a higher risk? 

■ Are there any prevention systems currently in

place to adequately address these issues? 

■ What are your recommendations?

Risk factors include the potential for financial

exploitation of nursing home residents. Ms. Doherty

said it’s important for everyone at a nursing home to

understand unequivocally, from the outset, who is

responsible for managing each resident’s money. The

risk profile tool shows, among other things, that the

more money there is at stake, the higher the risk for

exploitation.
Institutional Abuse and Neglect 

Workshop 2: Joining Resources To Combat Institutional

Abuse and Neglect

Moderator:

Barbara Zelner

Counsel

National Association of Medicaid Fraud Control Units

Washington, D.C.

Panelists:

Marie-Therese Connolly

Coordinator, Nursing Home Initiative

U.S. Department of Justice

Washington, D.C.

Nicholas Cox

Bureau Chief, Economic Crimes Unit, Tampa

Florida Attorney General’s Office

Tampa, Florida

Moderator Barbara Zelner, Counsel of the National Association of Medicaid Fraud Control Units, introduced the panelists and asked them to outline various ways in which government agencies, nonprofit organizations, and individuals dedicated to identifying, prosecuting, and preventing institutional abuse and neglect can

join forces. 

Nicholas Cox, Bureau Chief of the Economic Crimes Unit in the Florida Attorney General’s Office, described

Operation Spot Check, an initiative that resulted from the increase in the older population of Florida, a similar

increase in nursing homes and assisted-living facilities, and a “staggering” problem of neglect in those institutions.

The Agency for Health Care Administration, responsible for licensing the institutions, was so bogged down that

facilities could anticipate when inspectors were coming—every year for nursing homes, every 2 years for assisted

living facilities—and put their best foot forward for the brief period required to qualify for a license. 

So a group of agencies combined to create and operate Operation Spot Check. Participating agencies

include the state attorney general’s office, the Long-Term Care Ombudsman’s Program, the Agency for Health

Care Administration (which administers Medicaid in Florida), state and local fire marshals, sheriff’s offices,

police, and the Department of Children and Families, as well as the departments that enforce building codes.

The object is to target abuse and neglect in nursing homes and assisted living facilities. Teams including representatives of participating agencies make random, surprise inspections of the facilities.

Participating agencies identify problematic facilities and Mr. Cox’s office schedules spot checks. They tell no

one, not even the agencies taking part, when the spot checks will be made. Only when the team members report

An OJP Issues & Practices Report 65

The Hon. Frankie Sue Del Papa

Attorney General 

State of Nevada

Carson City, Nevada

Becky Kurtz

State Long-Term Care Ombudsman

Division of Aging Services, 

Department of Human Resources

Atlanta, Georgia
66 An OJP Issues & Practices Report

to a staging area for the visit is the target announced.

Secrecy is paramount, Mr. Cox said. 

In a spot check, the representative of the Medicaid

Fraud Control Unit inspects the medical records for

staffing and quality-of-care problems. Other members

of the team apply the “smell test,” to see that diapers

have been changed and clothing and beds are not

soiled. Team members interview patients and, if possible, their families, about how they are treated. They

also interview employees about the food served and

other conditions. 

A registered nurse checks medical records, and

an LTCOP representative checks drug security (they

usually find the drug closets open). Police and the

Department of Children and Families are alerted to

stand by, ready to take action in case the team finds

evidence of neglect or abuse. Results have ranged

from the issuance of warnings or fines to several outright closures. In a recent example, the team found

raw sewage standing in the basement, as well as animal waste throughout an assisted living facility that

housed older persons and persons with mental disabilities. It was shut down immediately. 

To counter opposition to the spot checks by

some nursing homes and assisted living facilities, Mr.

Cox’s office notifies facilities when their spot checks

have found good conditions, and works with responsible operators to demystify the process. When a legislator, angered at an inspection in her jurisdiction

about which she had not been notified, threatened

to hold a press conference, Mr. Cox said he’d like to

attend. “The press eats it up,” he said.

Operation Spot Check requires no additional

funding, Mr. Cox noted. It does a job the participating agencies are required to perform, but now they do

it jointly and more quickly. “It really works,” he said.

In Georgia, a coalition of elder advocates, law

enforcement, provider agencies, and others sought

legislation to strengthen criminal penalties for elder

abuse and give agencies, police, and prosecutors more

tools to deal with patient abuse, said Becky Kurtz,

the State Long-Term Care Ombudsman for the

Georgia Division of Aging Services. She directs the

state’s advocacy for residents of nursing homes and

personal care homes. 

Included in the coalition were the Georgia

Bureau of Investigation, the state attorney general’s

office, the MFCU, Adult Protective Services, district

attorneys, the Prosecutors Council, social service

agencies, and the Coalition of Advocates for Georgia’s

Elderly, which adopted the effort as one of its three

top priorities for the year and headed a successful

effort to combine all the desired changes into an “elder abuse umbrella.” The group sought inclusion of

elder exploitation in forgery and a fraudulent practice

statute, increased penalties for simple and aggravated

battery and assault, felony penalties for cruelty to older people, and stronger fiduciary obligations of persons who handle the financial affairs of older

individuals. 

Strong opposition from defense lawyers and lobbyists for the nursing home industry resulted in a significant weakening of the bill. A few improvements

in the law survived that process: an extension of the

statute of limitations so that it begins only when a

report is made; a clarification of who must report

abuse, and to whom; and a requirement that police,

prosecutors, and social service agencies participate in

joint training on elder abuse.

Despite these modest accomplishments, Ms.

Kurtz said, the process of working for change was

helpful in itself. Participating organizations and agencies developed stronger relationships and continue

working together; they have an increased awareness

of each other’s roles and needs. Police, sheriffs, and

prosecutors developed an increased awareness of elder

abuse, and learned new ways to share resources in

fighting it. While there have been no prosecutions

under the new law so far, Ms. Kurtz said, the increased

interest in elder abuse from police and prosecutors

bodes well for the future in terms of joint efforts on

training and the prospect of more prosecutions. As

an example of raised awareness, Ms. Kurtz cited the

Elder Rights 2000 conference in Georgia for APS

workers, her own office, legal services providers, and

the Health Insurance Program staff. It was an opportunity to bring in law enforcement, which was enthusiastic in setting up working teams to focus on elder

rights. 

Frankie Sue Del Papa, Attorney General of

Nevada, created the Nevada Medicaid Fraud Control

Unit and chairs the state’s Domestic Violence

Our Aging Population: A Report of Proceedings
Joining Resources To Combat Institutional Abuse and Neglect

An OJP Issues & Practices Report 67

Prevention Council. Elder advocates in Nevada have

worked to strengthen penalties for elder abuse and

coordinate and improve protective services. Critical to

these efforts has been the establishment of statewide

task forces that involve all key players. Such task

forces identify problems and develop plans to address

them, but they can be successful only if they assign

specific responsibilities and set deadlines for getting

jobs done, she said.

Attorney General Del Papa noted that closing

down bad nursing homes is a good thing, but highprofile programs like Mr. Cox’s Operation Spot Check

have statewide effects and should be supported by a

media and marketing campaign. Before she does any

“sting” operations (such as one to expose tobacco sales

to children or an auto repair scam), Attorney General

Del Papa holds a press conference to “let them know

we’re coming.” She doesn’t say where or when she’s

coming, she said, “But it helps with the good guys in

the industry, and it acts as a deterrent.” 

Attorney General Del Papa said her office is currently concentrating on guardianship, due to the

marked increase in the older population in Nevada.

She offered copies of videotapes, distributed throughout Nevada, in which such film stars as Shirley Jones,

Robert Conrad, and Vickie Lawrence dramatize guardianship issues and police training in them. Her office

will conduct a “guardianship summit” in February

2001. It is important, also, to educate mandatory

reporters of elder abuse, and Nevada task forces have

issued separate publications on this. With limited

resources, Attorney General Del Papa’s office looks

for partners. For example, the Peace Officers Training

Group was a partner in the videotape project. 

Marie-Therese Connolly, Coordinator of DOJ’s

Nursing Home Initiative, described two of the state

working groups that developed as a result of the

Initiative’s training efforts. 

The Louisiana group includes assistant U.S.

attorneys, the MFCU, prosecutors, an FBI agent,

the state inspector general, the state survey agency,

the state long-term care ombudsman, and the state

Department of Labor. The group identifies substandard nursing homes and long-term care institutions,

and pursues “the worst actors” of all. The U.S.

Attorney’s Office has now retained a nurse investigator who reviews medical records. Such collaborations

between legal and medical experts are necessary for

successful prosecutions, Ms. Connolly noted. The

group also provides an efficient and informal referral

process, in which the ombudsman, for example, can

give a victim’s family member the telephone number

of an appropriate police office, rather than going

through a complicating reporting procedure or compromising privacy. 

At the first meeting of the Virginia working

group, attendance was unexpectedly high and participation intense, Ms. Connolly said; the pent-up

demand among participants for a forum in which to

work together more effectively was remarkable. The

group includes a wide variety of players: authorities

with licensing authority over professionals hired in

nursing homes; firefighters; ambulance and EMS

technicians; medical examiners; and emergency room

doctors. They have worked on getting pertinent information quickly to responding entities—police, regulators, and social service agencies. A remarkable result

of the process is the new protocol used by local fire

departments to begin a referral process. When firefighters see signs of neglect or abuse of elders—for

example, when a nursing home operator states that a

person died 10 minutes ago but the death obviously

occurred much earlier—they notify supervisors, who

determine where to report the incident. 

Virginia also is creating elder abuse forensic centers similar to those that exist for child abuse, domestic

violence, and sexual abuse. Practitioners see patients or

check records to make diagnoses that can be used in

court cases. This seems to be unique to Virginia so

far, Ms. Connolly said, but there is discussion of creating a national elder abuse forensic center.

Finally, Ms. Connolly told of several volunteer

peer programs and networks of older people, formed

through both AARP and the Corporation for

National Service. They include more than a halfmillion volunteers, a resource so far untapped by

elder abuse organizations.
Institutional Abuse and Neglect 

Workshop 3: Enhancing the Survey and Regulatory

Process

Moderator:

Helene Fredeking

Health Care Financing Administration

U.S. Department of Health and Human Services

Baltimore, Maryland

Panelists:

Debra Green 

Supervising Attorney

Texas Department of Human Services

Austin, Texas

Catherine Morris

Assistant Commissioner 

New Jersey Department of Health

and Senior Services

Trenton, New Jersey

Moderator Helene Fredeking of the Health Care Financing Administration facilitated this discussion, which

addressed some state efforts related to the institutional survey and regulatory process. State agencies are the front

line in providing protective services for institutionalized older people, and surveys are a major tool used to ensure

that protection. They especially can provide the basis for making long-term care facilities accountable, and often

are a critical evidentiary tool for prosecutors.

States use surveys for a wide variety of purposes. Some examine statistical patterns and are designed in accordance with strict statistical standards. Others are used by multidisciplinary teams for highly focused objectives.

Some are used to gather evidence of neglect and abuse. 

New Jersey is an example of a state that uses surveys for statistical purposes. It begins with the federally

mandated Minimum Data Set (MDS) through which there is an assessment done annually of every long-term

care resident in federally certified nursing homes. A standard database of resident-level information is created. In

many states, MDS has been expanded beyond the federally certified nursing homes to state-certified homes and

other facilities, noted Catherine Morris, Assistant Commissioner of the New Jersey Department of Health and

Senior Services.

The reports show patterns of resident conditions in long-term facilities. Factors such as fractures, pressure

sores, number of restraints, and hydration issues are examined. In addition, New Jersey provides a list of 24 indicators to help identify problems. These indicators generate an onsite, resident-oriented, outcome-focused process.

A public report of findings is published on the HCFA Web site.

An OJP Issues & Practices Report 69

Joyce Stockwell

Assistant Director, Residential Care Services

Washington State Department of Social 

and Health Services

Olympia, Washington
70 An OJP Issues & Practices Report

Although surveyors are rigorously trained and

certified and their reports form the basis of many 

cases that are prosecuted, the New Jersey reports still

cannot always meet the strict evidentiary standards

required for prosecution. “There are frustrations

working with the legal people because they expect

more from the survey process than it provides,” Ms.

Morris said.

Texas, on the other hand, makes a conscious

effort to provide evidence of neglect and abuse that

will stand up in court. Surveyors take photographs of

alleged abuse and neglect and are provided with boilerplate forms which take into account the legal

requirements for affidavits.

The surveys generate a wealth of information

on the 1,150 registered nursing homes in that state.

But Debra Green, Supervising Attorney for the Texas

Department of Human Services, said unlicensed—

and thus unsurveyed—homes were a large problem.

In Houston, an initiative was begun to identify these

homes by creating a task force that included law

enforcement, the county prosecutor, ombudsmen,

Social Security Administration officials, and licensed

assisted living facilities providers, which are in competition with the unlicensed homes.

The task force used monthly Social Security

check addresses to identify targets. It identified every

home to which three or more of these checks were

being delivered to residents who were unrelated to

the home owner. More than 400 possible addresses

were discovered and surveyors investigated each one.

“Through that effort we got a number of folks

to get licenses or we went to court and shut them

down,” Ms. Green said. “Unfortunately, once you

take the pressure off, they go back to doing it again.”

Some unlicensed operators would find out that

surveyors were coming and would drive residents

around in vans for hours. Others would ignore

injunctions, requiring contempt orders to be sought

and fresh evidence to be obtained, since prosecutors

demanded evidence to be gathered within a week of

court action. The surveyors complied. “If you don’t

take action, if you don’t show them you mean it, they

will continue to violate the law,” Ms. Green said.

Joyce Stockwell, Assistant Director of Residential

Care Services for the Department of Social and

Health Services in the state of Washington, reported

that collaboration also is a major factor in her state.

Quality assurance nurses, funded through Medicaid,

are a vital part of the state agency’s elder protective

program. These nurses are sent into nursing homes to

ensure that Medicaid dollars are being spent appropriately on funded care and services. With these nurses

and state surveyors, there is an enforcement official in

each nursing home 10 to 15 times annually.

The state also brings together the provider community, the long-term care ombudsmen program,

advocacy groups, and residents to look at the entire

issue of abuse and neglect. Forums are held at which

they can discuss how to improve the practices in facilities. A guidebook is sent to every nursing home in

the state, listing what is expected of the home, how

to perform self-investigations, what constitutes abuse

and neglect, and when the state has to be called. 

“What we’ve found is that when you have both

the providers and advocates there, the framework that

comes out for the state agency is much more balanced,”

said Ms. Stockwell. The state Medicaid Fraud Control

Unit, law enforcement agencies, and prosecutors also

are part of the collaboration. “In resident protection

cases, we make a call to law enforcement agencies to

see who is going first. And many times we go together,” she said.

Keeping open licensed nursing homes that are

not violating the law has become a problem in Texas,

said Ms. Green. Homes are rapidly closing there, even

when residents’ needs are being met, because of bankruptcy. In these cases, the jobs of surveyors change.

Approximately 320 of the 1,150 nursing homes

in Texas are currently affected by bankruptcy, Ms.

Green said. That number includes homes from both

national and local chains. When bankruptcy becomes

an issue, surveyors monitor the homes with a check

sheet to make sure there are supplies and to ensure

that the staff is showing up. “You never can tell what

staff is going to do when they learn a facility is bankrupt,” she noted. When a chain of nursing homes

missed a payroll recently, state agency staff monitored

the homes and worked with other state agencies that

have nurses on staff so that if the nursing homes’ staff

walked out, the facility could be covered until trustees

took over. No walkouts occurred and the payroll was

met a short time later.

Our Aging Population: A Report of Proceedings
Institutional Abuse and Neglect 

Workshop 4: Holding Institutions Accountable Through

Prosecution

Moderator:

David Hoffman

Assistant U.S. Attorney

Office of the U.S. Attorney 

for the Eastern District of Pennsylvania

Philadelphia, Pennsylvania

Panelists:

Freda Fishman

Chief, Consumer Protection and Antitrust Division

Massachusetts Attorney General’s Office

Boston, Massachusetts

Randy Hey

Assistant District Attorney

Office of the Santa Clara District Attorney

San Jose, California

Moderator David Hoffman, Assistant U.S. Attorney in the Office of the U.S. Attorney for the Eastern

District of Pennsylvania, guided a discussion of federal, state, and local efforts to enhance prosecution of residential

institutions for elder abuse and neglect. He noted that it is critical to hold nursing homes and other institutions

accountable for abuse, neglect, and exploitation of older persons. Methods for doing so range from criminal prosecutions against both institutions and individuals, civil suits, and administrative remedies. All depend on collaboration among public agencies and on the initiative and courage of attorneys and prosecutors. Because it is the

older victims who are likely to report abuse, this effort requires a search for evidence and witnesses.

In addition, powerful sanctions—such as cutting off federal funds, closing an institution, or strict monitoring of an institution for years to make sure it meets standards—can be imposed in administrative procedures.

More generally, it is critical that all parties—prosecutors, judges, police, care providers, watchdog agencies, and

the general public—be educated about abuse and neglect.

Mr. Hoffman cited a number of hurdles, particularly in cases involving institutions:

■ Getting a report of elder victimization is easier said than done. If the victim is in an institution, who

there will file the report? Generally, said Mr. Hoffman, the family is reluctant to do so, fearing recriminations against their loved one. A medical director or doctor is not likely to report such cases to prosecutors

because that often can entail self-incrimination. Nurses or aides fear losing their jobs and not being able

to find work in the future.

An OJP Issues & Practices Report 71

Andrew Penn

Senior Counsel, Office of the Inspector General

U.S. Department of Health and Human Services

Washington, D.C.

Linda Purdy

Director, Medicaid Fraud Control Unit

Vermont Attorney General’s Office

Waterbury, Vermont
72 An OJP Issues & Practices Report

■ Police and prosecutors often do not know how

to investigate and prosecute quality-of-care

cases. Prosecutors may not think of a nursing

home as a crime scene. 

■ Physical abuse, as when an aide hits a patient,

is more likely to be prosecuted because police

are familiar with assaults. But people with

dementia often are not good witnesses, and

the defense can delay until the victim is unable

to testify. Neglect, which is not a traditional

crime, is even more difficult to prosecute, as

police often do not call experts before a jury in

such cases and “reasonable doubt” is the result.

Civil cases are easier, Mr. Hoffman said. He noted that he has brought several cases using the failureof-care theory, when the quality of care amounted to

no care at all. The argument is that if the government

knew that the level of care it was paying for led to

malnourishment, multiple pressure ulcers, severe

dehydration, and chemical restraint, it would not

have provided funds, he said. When an institution

submits bills for substandard care, they are committing fraud. 

The key is proper investigation and evaluation

of such cases, Mr. Hoffman said. Not all malnourishment means fraud, any more than pressure ulcers do,

but they must be investigated. When neglect is discovered, it is not enough for a nursing home to say

“we’ll do better,” especially if it has been cited in the

past. The government’s role in such cases is to prosecute in criminal or civil court, or seek administrative

remedies.

Beyond financial penalties, the mandated remedy

is constant surveillance of the institution. Geriatric

nurse practitioners routinely visit to check on compliance with settlement agreements, with federal regulations, and with agreed-upon protocols. Noncompliance

entitles prosecutors to seek contempt citations. One

possibility is appointment of a temporary manager. 

Randy Hey, Assistant District Attorney in Santa

Clara County, California, once used a misdemeanor

charge of neglect to take Guardian, a national corporate chain of nursing homes, to court. The strategy

worked. This case arose when a patient’s bandage had

not been changed for a month, and the wound was

maggot-infested. Mr. Hey saw this as an institutional

failure; he did not think that six overworked nurses

should be held accountable, and instead filed charges

against management. 

There were very large hurdles, however. Authorities in Santa Clara County thought it unlikely that

“a local prosecutor in a little county” could have an

impact on so many patients (he would prove them

wrong). Also, there was a risk that if the nursing

home were shuttered, it might cause more harm than

good in the form of “transfer trauma.” Meanwhile,

Guardian’s public relations troops pressured the district attorney to drop the case. 

Mr. Hey overcame these challenges “and the payoff was tremendous,” he said. The publicity caused

the quality of care at other nursing homes to rise.

“They all know that we’ll prosecute for neglect, and

that could put them out of business.” But for 5 years,

Guardian nursing homes nationwide had paid the

maximum fines and penalties for neglect. Management apparently considered them a cost of doing

business, more sensible than making improvements

in their homes.

At one point in the process, Guardian called

Andrew Penn, Senior Counsel in the Department of

Health and Human Services Office of the Inspector

General, to complain. The company argued that the

incident was “just a case of a couple of rotten eggs”

and “a wild DA out there” who “doesn’t know what

he’s doing,” Mr. Penn recalled. 

But in speaking with Mr. Hey, and with counselors and surveyors at the California Department of

Health, Mr. Penn learned that the problem—a funding shortage—was corporation-wide. Mr. Penn and

Mr. Hey negotiated a corporate integrity agreement

with Guardian under which the two worst facilities

pleaded guilty and the others were to be closely monitored for 5 years.

A provider can lose its funding under Medicare

and other federal health care programs if it files false

claims or provides poor care, Mr. Penn explained.

That exclusion can be waived if a company accedes

to monitoring under a corporate integrity agreement.

But Mr. Penn said he uses his exclusion powers judiciously, ever mindful of the potential impact on nursing home residents. Mr. Penn is entering into corporate

integrity agreements with many nationwide firms, one

of which has 500 facilities.

Our Aging Population: A Report of Proceedings
Holding Institutions Accountable Through Prosecution

An OJP Issues & Practices Report 73

Oftentimes, said Mr. Penn, the Inspector

General’s office pursues higher level staff members

who have caused harm, “not just the direct-care worker who may have abused a patient. It also could be

the facility administrator or the corporate head of a

chain who has become so tight with the purse strings

that the facility is short-staffed—a situation like

Guardian, where there just aren’t enough people to

attend to the basic care needs.” Such pursuit is driven

in part by the severity of wrongdoing, how long it lasted, whether it was an isolated instance, and whether

the facility can be trusted to make amends. However,

when a provider is convicted of a health-care-related

crime or of elder abuse, the only option is exclusion. 

Litigation in elder abuse cases is a kind of classroom for police, prosecutors, judges, and the public,

said panelist Linda Purdy, Director of the Medicaid

Fraud Control Unit in the Vermont Attorney General’s

Office. Ms. Purdy cited the case of a maintenance man

who sexually assaulted a 74-year-old woman who had

Alzheimer’s disease. The perpetrator was sentenced

to prison even though he pleaded guilty a few days

before trial, when Purdy, in a 3-hour hearing, cited

the impact that the man’s actions had on the victim,

the victim’s family, and the nursing home. 

In another aspect of public education, she said,

her office issues press releases on every case, misdemeanor or felony, involving crimes against older residents, alerting institutions that they will be held

accountable. 

The cases Ms. Purdy prosecutes include those

involving physical abuse, as when a nurse or staff

worker hits or slaps a patient; criminal neglect, as

when a patient is found with decubitus ulcers; sexual

abuse, which occurs all too often in nursing homes;

and financial exploitation. Prosecution targets are

usually particular caregivers or other individuals who

committed the abuse or exploitation.

Ms. Purdy’s office employs the traditional felony

statutes against abuse, sexual abuse, and assault, as

well as a comprehensive patient abuse statute enacted

in the mid-1990s, similar to those now on the books

in most states. Another way to hold institutions

accountable, she said, is through the mandatory

reporting laws. She also works with the U.S. Attorney’s

Office on quality-of-care cases, and anticipates working with the Office of the Inspector General inspector,

whose first assignment will be to investigate a nursing

home that is being monitored after a long series of

deficiencies.

Ms. Purdy said collaborations often generate

referrals of cases, but that other agencies are not

always reliable partners. She cited the case of a woman

in failing health, with moderate dementia, who was

scheduled for close monitoring but who wandered out

of the nursing home one night when it was 30 below

zero. She was found 6 hours later, dead of hypothermia. Ms. Purdy did not learn about the case from

Adult Protective Services but from an outside source,

and her licensing and protection people asked her,

“What do you care?” She got the same reaction when

a person recovering from pneumonia in a nursing

home was given a lethal dose of morphine. 

Obviously, she determined, more education was

needed on roles and responsibilities in protecting elders from neglect and abuse. She analyzed the roles

of agencies involved, and stressed to all involved the

need to act quickly, start an investigation, preserve

essential evidence, and at times, to treat nursing

homes as crime scenes. 

Ms. Purdy argued that abusers “should go to

jail,” and noted several cases to make the point. APS

referred her office to a nursing home in which an Xray technician had sexually molested a 94-year-old

woman. Investigation showed that the same man had

molested an 86-year-old woman 4 days earlier in a

New Hampshire nursing home. They coordinated

the prosecution with the New Hampshire Medicaid

Fraud Unit. In another case, a licensed nursing assistant volunteered to handle the finances of an 83-yearold man, and wrote herself $10,000 worth of his

checks.

According to Ms. Purdy, her office learned that

people in the early stages of dementia can make “great

witnesses.” But it’s necessary to videotape testimony

as soon as possible, and file appropriate documents

with the courts to be used in lieu of testimony, in the

event of incapacity. It is also imperative to get an early

trial date, since you’re “working against the clock.”

Ms. Purdy’s office “borrows” a victim advocate from

the Attorney General’s Criminal Division to work with

older victims. They also have filed many motions to

accommodate the special needs of older victims; in

one instance, they were able to bring a man to court

in a bed.
74 An OJP Issues & Practices Report

Ms. Purdy’s aggressive stance has been noticed by

nursing home staff. She recalled receiving a phone call

recently from a registered nurse who reported that

every time nurse surveyors visited, his nursing home

succeeded in concealing the fact that the staff was too

small to care properly for the patients. He wanted to

know if something could be done. “So we must be

doing something right,” she said. 

Freda Fishman, Chief of the Consumer Protection

and Antitrust Division in the Massachusetts Attorney

General’s Office, termed herself “an evangelist” for

holding nursing homes civilly accountable through

the use of consumer protection laws. But the words

“consumer fraud” in this context narrow the focus

and tend to make attorneys, particularly in the offices

of state attorneys general, believe there is more of a

burden than is actually the case. 

Consumer protection laws exist in every state in

one form or another, and they prohibit unfair activities in the conduct of a business. Therefore, Ms.

Fishman said, “you don’t need fraud.” It is sufficient

to show that “this isn’t right,” which is an easier standard to reach. As to what type of nursing home abuse

is “unfair,” she said, “you name it.” Whatever is

exploitative and robs people of dignity or money. It

is unfair to the taxpayers, to residents, to families,

to regulators, and to the employees of the nursing

homes, she said. Such cases are easier to pursue in

part because they do not require the testimony of

patients. “All we have to prove,” she said, “is that this

is happening and it’s unfair.”

Ms. Fishman noted the limited resources often

available for fighting elder abuse, and argued that participants should take resources wherever they can find

them, usually through alliances. 

She recalled a recent case in a nursing home in

which both the patients and staff were ethnic Chinese.

Ideally, to conduct the investigation, her office needed

linguists, psychopharmacologists, actuaries, CPAs,

and bankruptcy specialists. Such specialists were not

available, but she still pursued the case. “You have to

take what you can get,” she said, and work with that. 

Potential partners often are anxious to help once

they understand the stakes, or when the issue is properly framed. “These cases really grab people’s hearts;

they want to do the work when they know the work

is there to do.” One source of potential support, she

noted, is women’s organizations, especially when they

see it as a civil rights issue in which poor black women

are caring for poor white women without proper institutional support.

Our Aging Population: A Report of Proceedings
Closing Session

The following is a transcript of the closing session of the symposium. The session began with remarks by Attorney

General Janet Reno to the participants, followed by the presentations of eight selected state and tribal teams who reported their team plans to address elder victimization, formulated over the day-and-a-half meeting. Additionally, the

Attorney General heard the recommendations of the Tribal Caucus which met on the evening of the first day. After the

reports, the Attorney General engaged in a discussion with participants.

MARY LOU LEARY: This is an exciting day for all of us, I think. I am so pleased, as I know we are all so

pleased, that you are able to take the time out of your schedule to join us at this closing session. And as you

know, Ms. Reno, we’ve asked a number of the teams here today to report to you about what they’ve learned

and what they’re planning to do back home with all of the interesting and stimulating information that we’ve

acquired over the last day-and-a-half. I know that all of you have been working so hard to develop your action

plans to take home and I want to thank you for your commitment to this work, to improving the response to

crime and other issues faced by older Americans. Your input will be extremely helpful to you I’m sure, when

you go home, but it’s also going to be really helpful to us as we move into a transition period and we make our

efforts to ensure that this issue does not fall off the radar screen and that it continues to be a priority. As you

know, during her tenure, the Attorney General has really re-energized the Department of Justice’s efforts to combat crime against the elderly. She’s placed a very high priority on this issue and on all the problems that we’ve

been discussing at this symposium in the last day-and-a-half. We’re very honored that she can be with us.

Without any further ado I want to introduce my hero, Janet Reno.

ATTORNEY GENERAL RENO: The truth is that I talk a good line, but it’s Mary Lou, you and people like

you all across this country that make me look good. So you are my heros and heroines.

I’m delighted that so many of you are here to discuss this issue because it is of critical importance to this

nation, to me, to all of us, if we care about humanity and if we care about the human spirit. I suggested to Mary

Lou that I let you go first because I’m here to learn. But I would like to spend just a few minutes outlining

where I think we need to go as a nation to address this issue.

Today about 34 million Americans are over the age of 65. In 30 years that number will more than double.

Today too many older Americans are victims of abuse and neglect in places where they should be safe, in their

homes, in long-term care facilities, and too many are victims of fraud. We can do a lot better than we have.

That’s the reason your work is so important. At the same time that we are supporting collaboration at the

state and local levels, Secretary Shalala and I, along with our Departments, are continuing a very productive collaboration that we have pursued for the past 7 years, including this symposium. The efforts of the Department

of Health and Human Services to promote healthy and safe aging are critical and they work nicely with our

efforts in achieving elder justice.

Our justice system, if we are to truly achieve elder justice, must be responsive to the needs of older

Americans. There’s a wonderful statement on the wall of the Ninth Street side of the Department of Justice that

says: “The common law issues from the will of mankind ... is derived from the will of mankind, issuing from

the life of the people, framed by mutual confidence, and sanctioned by the light of reason.”

When too many people do not have access to the law, then the law becomes more meaningless. We have got

to make sure that all our elderly have access to the law and to justice. But I never met anybody that would rather

achieve justice in a court than achieve it by not having the event happen to them at all. So I think we first have

got to look, as I have looked in terms of youth violence or any other initiative: What can we do to prevent it?

An OJP Issues & Practices Report 75
76 An OJP Issues & Practices Report

I think this nation has got to take this number

of people, organize itself in terms of the economic

delivery of services that are designed to keep older

people self-sufficient, involved, productive, and I

think we can do a lot better than we have. I think we

can provide answers to questions that enable people

to be productive, how they can stay in their own

home, what they can do—exercising, meals catered,

so many other things. But we have got to develop an

economy of service that will permit more Americans

to afford it.

Old age does not have to be not fun. My mother

was dying, but she always liked to go. So I said “Well,

we can still go.” And she says “Oh.” I said, “You want

to go to the rain forest in Costa Rica? I’ll take you to

the rain forest in Costa Rica. You want to travel across

Canada by train and stay in the Rockies? We’ll go do

that. You want to go up the St. John’s River in a

houseboat? Let’s go do that. You want to go to Maine

to see your brother? I can’t do that.”

(Laughter.)

“Why can’t you do that?” “Because I like to sleep

too much.” “Come on, we’ll get in a recreational

vehicle and you can sleep whenever you want to.”

Now, people say that gets arduous. At the time it

seemed arduous, but those are wonderful memories,

and she even had fun after Hurricane Andrew.

Looking at the desolation, she could recall the first

hurricane she was in.

We can do so much to make older years fun,

interesting, exciting, and productive. And it was her

brother who first taught me about the Internet, he

being age 75, so it doesn’t take these 17-year-olds.

(Laughter.)

So prevention is the first part. It’s critical. We

need to develop and expand programs that teach older people how to avoid financial exploitation, mistreatment at home, and mistreatment in institutional

settings. We should also be creative in thinking about

how we tackle these problems, by using the Internet

to warn and train people about consumer scams.

When people are caring for their loved ones at home,

we need to provide these caregivers with training and

support to enhance their ability to provide better care.

It was amazing to me to reach out to find out

how I made somebody comfortable. She wasn’t dying

that soon, so there were limited opportunities, but I

found some people who could help. It’s amazing what

one bed, what one shift—you can do so much, and

you can teach people so much, things that they don’t

learn if they major in chemistry and go to law school

and decide to pursue a career in the law and public

service.

You can really make a tremendous difference if

we start thinking of this part of the economy as an

area of a group of people that can still be extraordinarily productive. But there is an increasing recognition that prevention won’t do it all, that we need

multidisciplinary early interventions in this complex

area. Such efforts are vital, not only at the state and

local levels, but also at the national level. The quicker

you see it, the faster you move, the lesser the problem.

Recognizing this, the Department has supported

and pursued a number of multidisciplinary approaches, including the following. In the late 80s, the

Department began funding the Triad program, a collaboration of AARP volunteers, the National Sheriffs’

Association, and the International Association of

Chiefs of Police. The goal of Triad, now present in

730 counties, is to reduce victimization of older people, especially by street crime. In 1998 we established

five elder fraud prevention teams composed of AARP

volunteers and federal, state, and local law enforcement officials, to educate older consumers about

scams. Our Office of Justice Programs has awarded

grants to train lawyers and victim advocates about

elder abuse, to support technical assistance on domestic violence in later life, and through its formula

grant programs to support services for victims of

elder abuse.

Since 1999 our Nursing Home Initiative has

sponsored cross-training for more than 1,000 federal,

state, and local law enforcement, regulatory, social

service, public safety, and health care professionals.

We also formed multidisciplinary state working

groups to provide infrastructure and focus on these

issues at the state and local levels, and we plan to continue our regular productive interagency coordination

with the Health Care Financing Administration and

the Office of the Inspector General on case and policy

issues.

Our Aging Population: A Report of Proceedings
Closing Session

An OJP Issues & Practices Report 77

Earlier this month, the Department sponsored a

multidisciplinary roundtable discussion among health

care, social service, and law enforcement professionals

about medical forensic issues related to elder abuse

and neglect. It is very difficult to prosecute a case or

to intervene or to know what the trouble is if you

can’t identify what the injury is or what the harm is.

“She fell out of bed.” The good forensic physician can

tell you she didn’t fall out of bed; that’s a blow that

caused that injury.

We have got to have the capacity both for intervention and for prosecution, to be able to prove what

happened before we can take effective action in terms

of the criminal justice system.

Community advocates also have the potential to

play a key role in advancing elder justice. For example, those working in the Senior Corps, the Corporation for National Service, are a tremendous resource.

The Corporation for National Service has collaborated with AARP in a demonstration program called

Experience Corps for Independent Living, to promote

independent living for older persons, provide respite

services to caregivers, and supplement the efforts of

professional providers.

Older volunteers such as these help prevent elder

victimization. With proper training, older Americans

can recognize and facilitate interventions when victimization appears to be occurring.

Our elders have so much wisdom. She, my

mother, put a sign over where she sat that said,

“Treachery and old age will overcome youth and

skill.” I said, “Mother, don’t you mean wisdom?”

(Laughter.)

Whether it be wisdom or treachery, they have

so much to give if only we can ask and make simple

arrangements that can facilitate what they do.

Other exciting collaborative approaches are being

used by some of our medical schools, where geriatric

teams are working with Adult Protective Services and

others to provide clinical care, multidisciplinary training, evaluations, interventions, and, where appropriate, referrals to law enforcement where elder abuse or

neglect is suspected.

Community policing is another very valuable

tool that can be used. You get a police officer that

knows the neighborhood, suddenly realizes that Mrs.

Jones hasn’t been out, he waved at her, but there’s

some pattern that’s not right, he can intervene or

knock on the door or a call to Mrs. Jones’ daughter.

Or sitting with Mrs. Jones on a door stoop on an

afternoon watching the sun go down, he can learn.

He can hear the tone. If he’s properly trained, he can

sense the depression setting in and make recommendations to Mrs. Jones’ daughter to do something

about it or, if we got ourselves organized right, call

somebody, if Mrs. Jones’ daughter lived halfway across

the country, to make a difference.

But sometimes the appropriate course is going

to be tough prosecution, and when I talk to people

they say, “That’s right.” And then when I tell them,

but there are difficulties: “Yeah, you’re like those other

prosecutors; they say it’s impossible to prosecute those

cases.” It’s not impossible to prosecute those cases.

I’ve done it, but they are very difficult.

We have got to remember, when we get into the

prosecution we are in a situation where we’ve got to

prove that case beyond and to the exclusion of a reasonable doubt. We have got to be able to prove, not

just we think he did it, not just we think she had a

blow rather than a fall, but proof beyond and to the

exclusion of a reasonable doubt. 

So rather than berate prosecutors, we’ve got to

make sure the prosecutors have the tools in terms

of forensic expertise, in terms of witnesses skilled in

interviewing elderly people, and in terms of prosecutors who have the same skills to make a difference.

But it is vital, absolutely vital, that we not shy away

from pursuing the hard cases.

The Department is strongly committed to pursuing cases against nursing homes and other health care

providers under the False Claims Act and the Civil

Rights of Institutionalized Persons Act where failures

of basic care lead to profound malnutrition, pressure

ulcers, and other harm. These cases raise novel and

complex issues, particularly where there’s financial distress or the potential for nursing home closures. We

will continue coordinating closely with the Department of Health and Human Services and others to

fashion remedies that balance enforcement goals,

recouping lost funds, and punishing and deterring

wrongdoing with the public health goals of protecting

today’s and tomorrow’s older citizens.
78 An OJP Issues & Practices Report

Something else we can do. I have discovered

when you go sometimes to a community they will say,

“We just can’t do it; we’ve tried.” The best thing you

can show them is something like what they’re trying

to do that worked, that has a track record, that’s overcome the same obstacles that they are faced with.

We’ve got to organize ourselves so that we show nursing homes how you can run a good nursing home or

a good long-term care facility the right way, providing

appropriate service at a price people can afford, in a

humane way. It’s possible, but we’ve got to show the

best practices to make people believe that they can do

the same.

We’ve got to develop a comprehensive, coordinated, well-funded national plan to prevent elder

abuse in the first place, to pursue it correctly if it has

to occur. But we don’t have to reinvent the wheel. At

the program on medical forensics, it was extraordinarily helpful to have a pediatrician who was an expert

in forensic issues there. We can learn so much from

one case to the other.

I really think that this whole effort is about

defense of the human spirit. There is nothing so 

wonderful as an old person talking to that child and

telling them what it was like to grow up long ago,

when there were not all the things that we have now;

to tell them what it was like to go fishing in a stream

or to go scuba diving when they got older.

We’ve got to make sure that this nation is not

just focused on its future, but on its present, the present in terms of the remarkable human spirit, the wisdom, the greatness of older people. They will overcome

if we give them half a chance.

(Applause.)

MARY LOU LEARY: Thank you, Ms. Reno. As you

know, we have a number of teams who will be reporting to you this morning and I’d like to call the first

team. We’ll go in this order: it will be South Carolina,

Nevada, New Hampshire, Yakama Nation, Texas,

Montana, Northern Cheyenne, and then we’ll hear

from the Tribal Caucus. So if we can hear from the

representative from South Carolina please. And that

is Catherine Christophillis. She’s the Director of Elder

Abuse and Adult Protection in the Office of the

Attorney General. And I should tell you because we

have a five minute rule here, I’ll be “refereeing” and I’ll

hold up my pamphlet when you have a minute left.

ATTORNEY GENERAL RENO: Okay. If she’s right

in the middle of something can I ...?

MARY LOU LEARY: You can do whatever you want.

(Laughter)

CATHERINE CHRISTOPHILLIS: Thank you for

this opportunity. It’s truly an honor to be recognized.

I would also like to thank Randy Thomas from the

Criminal Justice Academy, Jeff Moore from the South

Carolina Sheriff’s Association, and Jennifer Aldrich,

the [Assistant] U.S. Attorney here as part of our team.

South Carolina’s ongoing collaborative efforts include

a legislatively mandated adult protection coordinating

council which has conducted interdisciplinary training, developed a training manual, and facilitated

development of memorandums of understanding and

agreement to improve system response. At the present

time we have a state-level financial exploitation team

and a multidisciplinary committee to study system

responses for facility investigation. South Carolina

also has developed a medical protocol for abuse and

neglect cases. Strategies that we helped develop as a

result of this symposium include specific recommendations for legislative change as follows. First, to

improve our banking reporting for financial exploitation modeled, after the seminar I went to, from

Oregon statutes and training kits. We would also

want to strengthen how our powers of attorney are

administered to encourage accountability, modeled

after the Illinois statute, which I heard from. Also, we

want to allow law enforcement to freeze assets, recover victim assets. We will establish a fatality review

team. We will add a victim representative to our adult

protection coordinating council. And we will contact

our medical community to develop multidisciplinary

teams to address medical issues. We will ensure that

our mandatory criminal domestic violence statutes

include elder abuse training, and we will establish

emergency shelters. Our biggest challenges in South

Carolina are our resources, including the time, the

people and funding, educating our judges and prosecutors, lack of public awareness and protecting our

victims through education, and making elder issues

part of the community policing and community prosecution environment which exists in South Carolina.

Our biggest assets are our strong leadership through

the adult protection coordinating council. We have an

excellent statute in our omnibus adult protection act

which was passed in 1993, which includes powers for

Our Aging Population: A Report of Proceedings
Closing Session

An OJP Issues & Practices Report 79

investigative entities of APS and the Ombudsman

including subpoena powers. We have enhanced penalties. For example, it is a 30-year felony in South

Carolina if you cause a death of an elder by abuse or

neglect. We are a small state, which is an asset because

we are geographically close to each other. We have

established personal relationships between our agencies and we trust each other. And we have a special

unit in the attorney general’s office that was established a little bit over a year ago, and I, as that prosecutor, have been able to reach different communities

in our state. In our first case we prosecuted, we assisted a small town in the state of South Carolina where

a 64-year-old vulnerable adult was financially exploited; she lost over $350,000 on the pretext of home

repairs. From the attorney general’s office I was able

to work with the local town police in investigating

and prosecuting that case. The jury in a trial convicted the defendant of 15 counts of financial exploitation. He had used all this woman’s money for crack

cocaine. She will never, unfortunately, get it back, but

the judge sentenced the man to 41 years in prison

which was an extensive sentence—the greatest sentence that we’ve had in this kind of area in South

Carolina’s history. The woman, the victim, was reluctant to testify, but did testify and she couldn’t hear

through the whole trial, but she sat through the

whole trial and at the end when the defendant was

convicted and sentenced she walked out of the courtroom together with me and said, “Well, I guess he

won’t be bothering me anymore.” So that was a great

feeling and we are just honored to be here. It’s been a

very good learning experience for our whole team and

we look forward to going back to our state and

accomplishing the goals that were set forth at this

symposium. Thank you.

(Applause.)

MARY LOU LEARY: From Nevada. Bonnie Brand

from the Office of the Attorney General.

BONNIE BRAND: Good afternoon, Attorney

General Reno. It is an overwhelming pleasure to be

here and I thank you greatly for putting this together.

Our entire team is grateful to you and we have had a

wonderful and enlightening experience. Most of all it

is just wonderful to be in a room full of people who

are impassioned about helping the elderly as I have

been for a long, long time. We do have a number of

strengths in our state. As some of you may know

we’re the fastest growing state in the nation and

because of our lovely weather in the south it’s becoming quite a retirement mecca. So these issues have

been important to us for quite some time. In 1996 we

made an Elder Abuse Action Plan, bringing together

all sorts of people including industry people as well as

government people, and law enforcement and social

workers as well. And that has continued on with an

annual Elder Abuse Council Meeting that we have.

We also have a law enforcement protocol, which was

entered into with the major law enforcement people

in our state and that includes an investigatory plan

and how the social workers will work together with

law enforcement. We have been doing the multidisciplinary thing for a long, long time and the people

here, we all know each other, we’re all in communication and we’re thrilled to death with e-mail because

we’re going to be able to do all these things without

saying it twice or three times. A couple of the important things that we intend to do as a result of this is

to contact our statewide associations. For one thing

the sheriffs’ and chiefs’ associations will hear from us.

We need more reporting from their offices. Our aging

division needs those statistics in order to get the money that we need from our legislatures, so we need that

law enforcement reporting. We have a very strong

conviction that there’s a whole lot of reporting going

on that doesn’t come to Aging Services, it doesn’t

come to our attention. Another thing we plan to do is

contact the Nevada League of Cities and the Nevada

League of Counties; we need help from those levels to

publicize this and to get their help with implementing

prosecution and training for law enforcement. We did

do some wonderful training, we got some legislative

money—$60,000—to produce some videos and we

used movie stars to do it—Vicki Lawrence and Bob

Conrad from Wild, Wild West. And those videos

have been sent out to law enforcement and there’s a

quiz that goes with it so they get postcredit for watching that and for taking their quiz and succeeding.

Lastly we came up with an idea that we would like

you to consider and that is for publishing a nationwide resource for all of us to know the resources that

all of us have. I’ve just mentioned two videos that we

have and at this conference I’ve heard that California

has a pretty good law enforcement video training program and if we could have sort of a resource directory

that would tell all of us who has expertise in what

area of law, I think it would be very, very helpful.

And again with e-mail I think we can keep each other
80 An OJP Issues & Practices Report

abreast of important cases and breakthroughs and

ways to help our prosecution of these cases. We know

prosecution is difficult and one of the things we’ve

done in our state is pass a civil law that allows for

double recovery for civil cases that are won in the

areas of elder abuse, neglect, and exploitation. And

we’re starting to see some of that because the proof

level is lower and the cases can be won more easily.

Lastly we’d just love it if we could have a copy of

everybody’s questionnaire because we think we would

sure learn from that. So we thank you so much for

putting this together and for coming to speak to us

yourself.

ATTORNEY GENERAL RENO: Thank you.

(Applause.)

MARY LOU LEARY: Thank you Bonnie. We will be

providing copies of the questionnaires—we’ll find a

way to put it all together and get it out to all of you

because they were extremely, extremely helpful. From

New Hampshire, Ann Butenhof, from the New

Hampshire Legal Assistance Office.

ANN BUTENHOF: I’d like to thank the Department

of Justice and Department of Health and Human

Services on behalf of New Hampshire for hosting this

conference and sponsoring us to be here—providing

the cost of our way certainly encouraged us to have

good participation. Our New Hampshire team is

composed of representatives from our Department

of Health and Human Services, our attorney general’s

office, local law enforcement, as well as the legal services program. So it’s pretty wide representation. To

give you some background, New Hampshire has

many collaborative efforts that are currently in place,

from reverse boiler room efforts to drafting legislation

on mandatory bank reporting and strengthening adult

protective laws. We have an active Triad program. We

have ongoing community education related to consumer fraud issues and an innovative aspect is our

quarterly meetings of Adult Protective Services

administrators from six states in our region where

everyone can learn about initiatives in the neighboring states. Despite these ongoing partnerships we’re

recognizing that our efforts have been quite fragmented and we were really struck at this conference by,

“Boy, what if we did something very similar back

home?” And so we proposed that we really need

to get all the players at the same table and have a

conference very similar to this. We want to raise the

awareness of the emerging issues in this area and to

encourage multidisciplinary collaboration. We believe

that for this really to be successful in New Hampshire

that we would like to have leadership from the very

top, so part of our plan was to approach our governor

to get involved and we believe that the time is right

for this in our state. To plan a symposium similar to

this in New Hampshire we would use a collaborative

model in the planning. I would want to involve elder

consumers. We have many organizations who work

with elders; we’d like to include the volunteers and

elder advocates. Cosponsors would include Adult

Protective Services, the AG’s office, the Governor,

AARP, Legal Services, and I’m sure we may have a

couple more sponsors as well. We have envisioned

two primary goals of our symposium; one is to create

a statewide consortium relating to all elder abuse

issues. This is important because we do have task

forces and different regions of the state that are doing

very good work, but it’s not a statewide effort and so

we’d like to make this statewide, and to have task

forces that come out of the consortium that would be

working on specific areas of their expertise. Our second goal would be to create a coordinated statewide

education plan. As I mentioned, we do have ongoing

education taking place; we’d like to see it more coordinated and make sure that it’s ongoing and repetitive. Our biggest challenges are funding—that’s not

surprising—and our fragmented elder advocate network. Our strengths are that we have many organizations in New Hampshire that are involved in elder

advocacy. We have a lot of strongly committed people. We’re a small state—we think that is a strength

similar to South Carolina—and we have many strong

volunteer organizations. So thank you for allowing us

to make this presentation.

(Applause.)

MARY LOU LEARY: We have a number of tribes

represented here today. We’re going to hear now from

the Yakama Nation, from Anna Ward who is the

Deputy Director of Justice Services.

ANNA WARD: Good afternoon, Madam Attorney

General. I’d like to recognize our team: our Tribal

Councilman, Clifford Moses; Tribal Councilman,

Leo Aleck; our Chairman of our Yakama Nation

Elders Advisory Board, Joe Sampson; the Director

of Area Agency on Aging, Arlene Olney; our Police

Our Aging Population: A Report of Proceedings
Closing Session

An OJP Issues & Practices Report 81

Commissioner, Jonathan Whitefoot. We appreciate

the opportunity to be here and for us to speak. The

Yakama Nation is located in Toppenish, Washington,

and we currently have a Tribal court system and

police department that the people have access to for

reporting incidence of abuse, theft, mistreatment by

family and caretakers and that can assist in the protection and efforts to provide security and safety to elders in their living environments. In addition, the

Yakama Nation has the long-standing Area Agency on

Aging Office (AOA) and we are service area 10, and

within that we have an active Elders Advisory Board

and Advocates that address the complex issues of our

aging population on the reservation. They involve the

IHS—Indian Health Services—domestic violence

program, mental health, and they work with outside

agencies such as APS, AARP, and People for People in

ongoing discussion towards the education and development of ways to protect the elders, their interests,

their right to a better life. The Yakama Nation has

adopted a strategic plan, which addresses the need for

elder issues and the adoption of an elder abuse code.

Currently, we are serving the elders and we need to

work on the redevelopment of a comprehensive elder

abuse code that deals with criminal and civil penalties. We need to establish an elder review board that

includes a comprehensive team of personnel that deal

in those issues. We want to provide for continued

education of service providers to improve the quality

of the courts, the prosecutors, the judges, the

guardian ad litem advocates, and social services for

elders. We want to utilize the courts, newspapers,

AOA, Indian Health Services, to provide educational

forums to educate with articles, newsletters, brochures

on issues such as where to get help, how to get help,

what their rights are, and what to do when they realize that they really need help, have an opportunity to

participate in a Native American Elder Abuse

Conference where we can share codes and issues relative to Indian Country. Our biggest challenge is jurisdiction of the Yakama Nation relative to the

protection of the elderly from abuse by non-Indians

that live on our reservation. We have a challenge for

the need of money and qualified human resources

allocated to those kind of programs that are necessary

to assist the elders. We have the need for a complete

and comprehensive code adopted by Tribal Council

and presented to the General Council. Our biggest

asset is that we have a Tribal Council supportive in

the revision of the Elder Abuse Code and a willingness

to work with the codification of diverse and comprehensive issues to protect the elders and their families.

The Tribal Courts and the Police Department are

willing to exercise jurisdiction on behalf of the elderly

for the protection of their rights, dignity, and the protection of their interests. And we have an Area Agency

on Aging Program that is established and provides

services to the elders in the community. Thank you.

MARY LOU LEARY: Thank you.

(Applause.)

MARY LOU LEARY: And from the state of Texas,

Carmel Dyer, who’s with the Baylor College of

Medicine.

CARMEL DYER: Good afternoon, Ms. Reno, and

other dedicated interested parties in the room. There

are nearly 20 million elderly people in the state of

Texas. We have the third highest number of nursing

home beds in the country. We have an ethnically

diverse state. There are over 254 counties that are

both urban and rural. It takes 12 hours to drive across

the state from end to end. Or as we say in Texas we

have miles and miles and miles of miles.

(Laughter)

So there you see some of our challenges—geography and population. Also we felt that a challenge was

a need for more public awareness, but then of course,

once the public is more aware, what interventions

are we going to apply once there are more cases?

Certainly lack of research we identified as a challenge.

The need for federal legislation and also, oh yes,

funding. 

(Laughter)

Our assets are the commitment of the involved

organizations, including law enforcement, medicine,

and social services. We have a strong state APS that is

centrally located and organized with centralized training that is standardized. We have a central database

which has been a repository of information and the

first publication on that will be in the fall, next year.

We have good working relationships among the

organizations I described. Our ongoing collaborative

efforts include a lot of initials, there’s Triad, there’s

FACT, the Financial Abuse Cessation Team, there’s

SAF–T, the Seniors Against Fraud in Texas, there’s

CRCG, Community Resource Coordinating Groups,
82 An OJP Issues & Practices Report

which help HHS deal with and help Alzheimer’s

patients. There’s APS collaboration with the DHS

long-term care regs and services, MHMR advocacy’s

all working on institutional abuse. There’s a TEAM

Institute, which is our medical geriatrics team that’s

collaborating with the Adult Protective Services and

based on the recommendations of Olga Trujillo from

OVC we are now beginning to work with law

enforcement. There’s also a banking project that

involves the APS, the AG offices, the Texas

Department of Banking and other financial entities,

modeling that which is being done in California,

Utah, Oregon, and Massachusetts. But now what

steps are we going to take from what we have learned

here at the conference and this opportunity to meet?

One, we’re going to develop a pool of experts as a

resource for law enforcement. We’re going to hold a

Texas summit to pull together interested parties.

That’s going to be sponsored by Triad and the TEAM

Institute. Mark Jeffers is going to organize it and it

will be in the first week of December.

(Laughter)

We hope to expense TEAM Institute with other

entities so there’s more funding. We have such a big

space so we have vowed to use more telemedicine and

teleconferencing. And, of course, we’re going to seek

different ways to fund research on the issues that we

have all identified that are so very important. We’re

grateful for this opportunity to be here today. The

entire conference has defined the word collaboration.

And we are committed to go back to our state and

implement the things that we learned here, take

action on our action items, and hopefully turn those

miles into smiles for the vulnerable adults in Texas.

(Applause.)

MARY LOU LEARY: Thank you. And Mark, if you

need to leave early so you can get going on that conference .... You’ve got a lot of work to do. Minnesota—

we’ll hear from Barbara Doherty who is the Adult

Protection Consultant at Department of Human

Services there.

BARBARA DOHERTY: Good afternoon. I’d just like

to echo the thank you from all of the other speakers to

those who hosted this conference for bringing us

together. I was chatting with Lori earlier and I said I

think we got picked just because we said our priority

was to go back and train the judiciary.

(Laughter)

So we’ve decided we’ve got a big task ahead of us.

Our group has been meeting as an interagency focus

group since the December 1999 conference hosted by

DOJ in Iowa, and it’s a very broad-based team representing the state attorney general’s staff, the U.S.

Attorney, a HCFA representative, our state long-term

care ombudsman, the Department of Adult Protective

Services at the state level and the local level, and we

have really focused in on training and working

together to coordinate that training as a key effort.

And we do seriously recognize that within our state

the next area that we have to approach is, in fact, the

judiciary and the appeals refs who do hear the cases.

We’ve made some progress, we feel, in terms of crosstraining with law enforcement and regulatory inspectors in terms of cooperating on those investigations

and with county APS, but we have not yet made any

significant inroads into the judiciary and we realize

that training them at their conferences, on their turf,

with their colleagues will, in fact, be our hopefully

successful contact with that group. We have been

quite successful in coordinating training to date. As I

said before, there’s a specific statute line for the Adult

Protective Services Law in Minnesota that mandates

that training continue on an annual basis with the

named lead agency investigators and law enforcement.

But that does not include, as I have said earlier, the

judiciary, so we’ve identified them as the next group

that our collaborative task force will work with. I

don’t believe we are going to say we’ll do this in

December, but we will definitely do it in the year

2001. And again I thank you for the opportunity to

come to the conference. We’ve all learned a lot. And

if you’d like to come to Minnesota some time in the

year 2001 and help us with this task we’d be glad to

invite you.

(Laughter.)

(Applause.)

MARY LOU LEARY: Thank you. And from

Montana, Rick Bartos, who’s Chief of Protection

Services in Montana.

RICK BARTOS: Madam Attorney General, on

behalf of the Montana delegation, again we extend

our appreciation for the opportunity to be here. We

have representatives from the Montana Attorney

General’s Office, the U.S. Attorney’s Office, the state

Our Aging Population: A Report of Proceedings
Closing Session

An OJP Issues & Practices Report 83

Insurance Commissioner, Adult Protective Services,

the Medicaid Fraud Control Unit. We know each

other very well. We’re a small state in terms of population so when we have to take on elderly issues we

wear multiple hats and we do our best to collaborate

as much as possible. There are a number of ideas that

we have learned through this conference, and thoughts

that really enhance what we have been doing in Montana. There’s a Billings Chapter on the Prevention of

Elder Abuse, which is a nonprofit organization and

has just released their financial exploitation packet

following the examples of Oregon and Massachusetts.

We have a very proactive and very active Department

of Commerce, Telemarketing Fraud Unit. The State

Insurance Commissioner has bent over backwards

with his staff to help collaborate in these areas. We

have a Medicaid Fraud Control Unit that is very

closely aligned with Adult Protective Services. We

know that as a result of the Los Angeles Conference

on Nursing Facilities, again sponsored by the Department of Justice, there has been continued collaboration between the U.S. Attorney’s Office and Adult

Protective Services teams. It’s unheard of to have representatives of the U.S. Attorney’s Office meet almost

on a monthly basis with Adult Protective Services

teams and that is very important to link the federal

and state government. But we went through some

self-examination as we heard the various presentations

here today and we do recognize that we have some

limitations. Montana has seven Indian reservations;

each reservation is governed by tribal government.

Each tribe of (inaudible) sovereignty is an important

component of their existence. There are no state collaborative efforts or at least components that help to

bring the various tribal organizations and the state

together in terms of Adult Protective Services. Consequently a lot of Adult Protective Services’ and our

response to elder abuse, exploitation, and neglect is

done on a case-by-case basis, on an individual basis by

individuals such as Adult Protective Service workers

in collaboration with Indian Services, social service

workers, the local deputy sheriff, local nonprofit

organizations in each area. Describing briefly the

strategies that we’re going to develop as a result of this

conference and our self-examination is that we will

invite the tribal, APS, and social service personnel to

state training. Attempt to collaborate again more and

more of the importance of knowing that we are one

people and elder abuse is the same whether it’s on the

reservation or off the reservation. We are going to

request the assistance of the state’s Indian Coordinator

to assist us in bringing these individuals together for

purposes of providing training. We’re going to continue to serve all persons on the Indian reservations if a

referral is made, realizing that individuals that live on

the reservation are also citizens of the state of Montana

and we can let the jurisdiction issues kind of work

themselves out; we’re more interested in protecting the

individual. We’re going to approach the Montana/

Wyoming Tribal Council, Chief Council—it’s a group

of 11 or 12 Tribal Chiefs who meet periodically to

talk about common issues and attempt to seek some

consensus on broad ranges of abuse, neglect, and

exploitation. What is our biggest challenge, well there

are a number of challenges, and again I won’t repeat

those that you have heard today, but like Texas,

Montana is the fourth largest geographic state in size.

Our population is less than 900,000 people; in fact,

we have more Elk than we do people in Montana.

(Laughter.)

We have what we call the Eastern Region in

Montana composed of 17 counties; that territory is

larger than the size of Delaware and Rhode Island

combined. In that one area there are only 21

/2 social

workers dedicated to Adult Protective Services to

serve that entire area. It is not unusual and it’s the

average mileage per one Adult Protective Services

worker to travel 15,000 miles a year in order to provide social services. Our biggest challenge is tribal sovereignty and state jurisdiction issues as they relate to

criminal prosecution and investigation; that is sometimes way above the heads of our social workers or

the people that are directly involved in the protection

of human beings. Many times that gets in the way.

What is our biggest asset? Our biggest asset is the

willingness of the state, the attorney general, the State

Insurance Commissioner, the U.S. Attorney’s Office

to work together. We see opportunities of inviting

individuals from the tribes as well as the state to help

collaborate. We have a big asset that everybody has

intended and continues to intend to cooperate as best

as we can with the resources we have. And again, we

extend our appreciation to this conference and on

behalf of Montana and the tribes. We extend our

appreciation for you to visit the Northern Cheyenne

Tribe this last summer and have an opportunity to

see eastern Montana. We will be following now with

Jackie Tang, who is the Director of Social Services for

the Northern Cheyenne Tribe.
84 An OJP Issues & Practices Report

MARY LOU LEARY: Thank you. Great basketball

program.

JACKIE TANG: Good afternoon, my name is ... oh,

he already told you my name. 

(Laughter)

The Northern Cheyenne Tribe has one ordinance

in the Tribal Law Order Code which deals with elderly exploitation. This ordinance has never been

enforced. There are nonexistent laws to protect the

elderly. Tribal prosecution and Social Services sometimes handle financial exploitation. Social Services

sometimes become the payee to monitor the elderly

and sometimes the disabled income such as Social

Security payment, SSI, and lease payments. Abuse and

neglect at home—any abuse or neglect at home—is

usually reported to Child Protective Services since

there is no Adult Protective Services on the reservation. Child Protective Services sometimes reports to

the public health nurses; CPS and PHN sometimes

conduct investigations together. Family members are

referred to other agencies to assist them in their care

of the elderly. Institutional care and abuse complaints

are usually referred to the supervisor of the caretaker.

We don’t have an institution, but we have an elderly

complex, which houses the disabled and the elderly.

Strategy: to begin looking for funding for an adult

protection services position. Begin a local team of

professionals to discuss and implement a referral system and how to handle the referrals. Referrals will

include financial exploitation, abuse, and neglect at

home, medical neglect, institutional abuse and neglect. As a team they will decide how each referral

should be handled and what services are to be provided. The team will also create tribal laws to handle elderly abuse and to define it. The team will also develop

a tracking and monitoring system. Collaboration with

other agencies will be a challenge since the elderly are

one of the most important resources to the Tribe. I

don’t know if they’ll let us do it. Funding is limited

for Indian tribes, especially for our Tribe—we don’t

have funding. I think we just have limited funding

from the state to feed the elderly; I don’t know what

other funding we have. Educating the public will be

challenging due to the public’s reluctance to try anything new. [Another strategy is to work] with the

Tribal Council in implementing a law on mandatory

reporting of elderly abuse. Our Administration, Tribal

Administration, has just changed—elections are 

coming up next week and hopefully we’ll get people

in that will help us enforce the ... work with our idea

here. The Tribe, there’s only two of us from our Tribe:

Joanne Wolfblack, she’s with the Elderly Program;

and I’m with the Social Services. So we’re the only

two from the Northern Cheyenne Tribe and hopefully

we’ll go back and ... well, we will go back and try all

this and hopefully, people will listen. Thank you.

(Applause.)

MARY LOU LEARY: Thank you. And Ms. Reno,

last night, with some assistance from Norena Henry

who you know from Office of Justice Programs, a

Tribal Caucus got together. They didn’t have enough

working all day from 8:15 a.m. till 6:30 p.m. here in

conference—they met until after 10:00 p.m. in a tribal group and they have some recommendations. So

we will be hearing from Charlotte Bradley who’s a

Zuni Pueblo Tribal Council member.

CHARLOTTE BRADLEY: Attorney General Reno,

Keshi, this is a greeting from the Zuni Pueblo. Last

night we met; there were about 10 tribes and some

state representatives that met to discuss the recommendations that would best assist our Indian tribes.

At this time I’d like to recognize the group, if you

would all stand, who were in that caucus last night.

(Applause.)

The group has asked me to present to you a list

of 10 action items. These action items will assist

Indian tribes in our response to continue to protect

and care for our elders. They also will ensure the

accountability of the offenders. Briefly the action

items listed focus on: (1) increased resources, which is

the funding; (2) interagency collaboration; (3) training; (4) tribal cultural development and implementation; (5) confidential testimony; (6) traditional

mediation; (7) national summit for Indian Country;

(8) Indian family violence and elder abuse; (9) interagency agreement; (10) data collection.

Our goal is to ensure safety of our community

members, especially our tribal elders—they are the

keepers of our religion, history, and our culture. Here

is the list of items that we had presented. Lastly, I

would like to thank the Department of Justice and

the Department of Human Services for putting on

this conference. It really opened our eyes and we

learned that there are so many resources that we could

Our Aging Population: A Report of Proceedings
Closing Session

An OJP Issues & Practices Report 85

plug into and develop—our tribal codes and all the

other regulations that we need to get together. So we

want to thank those that help put on this conference.

Thank you.

MARY LOU LEARY: Thank you. 

(Applause.)

MARY LOU LEARY: Yes. (recognizing participant)

LEO ALECK: Good morning. I was a member of

that caucus meeting last night ... all the Indian tribes

representing their sovereign nations. Always address

an honorable representative of the United States government as a trust responsibility person. And also,

that these persons will honor the treaties that were

made with the various Indian tribes. And lastly that

the government-to-government consultations, in this

regard, with our elderly people, need to be at least

addressed in the formal terminology of government to

government as well as the honoring of the treaties.

And once again, we want to thank the Honorable

head law enforcement person of these United States.

Thank you very much.

ATTORNEY GENERAL RENO: You’re quite correct. And the most important thing for me is early on

I decided that we talk too much and that we should

go listen to our Native American friends with whom

we have a government-to-government relationship,

and for whom we have indeed a trust responsibility

created by treaties. In Albuquerque, I listened in what

has to be the most extraordinary day-and-a-half that

I’ve had as Attorney General. And then the second listening conference was, of all places, Harvard Law

School. And then there was one in South Dakota.

These have been immensely important for me and I

just thank all the tribal representatives for being here

and want to tell you that in whatever time I have as

Attorney General and after that, both with my

Miccosukee friends in south Florida and those friends

I have met across the country, I’m going to try to do

everything I can to see that the United States complies with its trust responsibilities. Thank you.

(Applause.)

MARY LOU LEARY: And now we’ll open it up for

questions, suggestions, and discussion. Yes. (recognizing participant)

LAURA MOSQUEDA: Once a year I take the skeleton out of my closet. My name is Laura Mosqueda.

I’m a geriatrician with University of California-Irvine.

I have four suggestions that I’d like to present based

on what I’ve heard here and in previous forums. One:

I think that the Department of Justice should have a

section on elder justice, just as you have a lot of funding in agencies related to child abuse. And I think the

elder justice section needs to be appropriately funded

and it needs to be truly supported by the people in

power at the DOJ.

(Applause.)

Two: I’d like to recommend a national task force

that will drive and guide a national agenda on elder

abuse. And that this task force really should include

people from justice, social sciences, medical sciences,

etc. Three: I think there needs to be increased federal

funding for research from all agencies that have an

interest in this area; that includes DOJ, CDC, NIA,

etc ... because the science must catch up with the

issues in elder abuse and we’re very far from that.

Four: I think that with your help and leadership we

really need to raise public awareness about this issue.

The citizens of this country should be outraged and

we’re not. Thank you.

(Applause.)

MARY LOU LEARY: Are there more questions out

there? Here’s your chance.

ATTORNEY GENERAL RENO: Can I ask some

questions?

MARY LOU LEARY: You certainly may.

ATTORNEY GENERAL RENO: Go ahead sir.

(recognizing participant)

DAVE KESSLER: My name is Dave Kessler and I’m

with the Ohio Attorney General’s office and I just

want to play on the woman’s comments which were

right on. My prior career: I retired as a Police Officer

from the State of Georgia. To be quite frank with

you, there are so many law enforcement people in this

country and the people in this room, we have to fight

to do the right thing because the people at the level

that can make the decisions aren’t really attuned to

what the problem is that we’re dealing with when we

go into the homes, or we go in the nursing homes

and we see the devastation. Now one thing we have
86 An OJP Issues & Practices Report

to do is scales of justice—they should be like this with

these types of offenses. Unfortunately, we’re not recognizing them to be equivalent to our rapes, our robberies, our violent offenses, because when you sit with

these elderly and you interview them and you take

the time to do it right you don’t get eye contact

because of the shame, the embarrassment, humility.

Their self-esteem is stripped. You can’t put a price and

label these as property crimes. We have to train our

police officers, our first-line level guys and women, 

to go out to the home, go to the nursing homes

because they’re not recognizing these as the offenses

that they truly are. They’re violent offenses. You may

not see the bruises, you may not see the blood, and

particularly financial exploitation. They tell me “Mr.

Kessler, I would much rather have been knocked out,

beat up, my purse stolen, my wallet stolen than to

have my dignity stripped.” And until we recognize

that these are crimes against persons, rather than

equivalent on a police report where theft occurred; we

have to realize that that’s what we’re dealing with.

And there’s very few people in this country—and I’ve

had the opportunity to go around and teach on this

subject—the Paul Greenwoods of San Diego, the

Don Hendersons of Atlanta, Georgia, we have to take

those people who say bring it to me, I want to prosecute it, I want to handle it, it’s just as important as

child abuse, it’s just as important as the rape. And

until we bring that awareness, whether it’s the prosecutor, the law enforcement, or the judges, we have to do

that to make it successful. Thank you very much.

(Applause.)

ATTORNEY GENERAL RENO: I would be interested ... one of the things that I have not heard as

much about is how we organize this nation to deliver

services to elder people so that they can continue to

remain more self-sufficient than they have. Does anybody have any program under way or any knowledge

of private sector efforts that are successful? Skeleton?

LAURA MOSQUEDA: (inaudible) Well, I think that

the program that Dr. Dyer has at Baylor and a program that I have at UCI where we have ... we do a

lot of house calls and we work closely with APS in

doing house calls so that we can help with assessment.

We’re just collecting the data on it right now, but we

at least believe, from our preliminary look, that we’re

helping keep people at home safely. That by working

with APS and law enforcement, rather than taking

the elder out of the home, we get the perpetrator out

of the home. And find other ways to get services so

that the elder remains there safely and we believe that

we’re helping to avoid institutionalization.

ATTORNEY GENERAL RENO: What ... yes. (recognizing participant)

JOANNE WOLFBLACK: Hi. I’m from the

Northern Cheyenne Reservation and we are the only

Indian reservation in the whole United States that

has a program called Congregate Housing Services

Program, which we are very proud of. That’s a program that has what Jackie had mentioned—we have

a residential complex that houses elderly only. And

we give them a minimum amount of services, which

allows them to remain out of institutions, which is a

meal service, housekeeping, and personal care. It

started initially as a demonstration project with our

Tribe 10 years ago and is in the last year of funding.

And hopefully with the new Administration we’ll get

funded again because that has proved to be something

that has given our people a will to live longer rather

than send them off to a nursing home, which we

don’t have, which would be off-reservation and we

can keep them there at home and that has worked.

(Applause.)

ATTORNEY GENERAL RENO: We’ll take that person, and then you, is that okay?

ANN MASTRO: My name is Ann Mastro. I’m from

the New Jersey team. New Jersey has a very large population of elderly and in Ocean County where I live,

27 percent of the population are 65 and older. We

identified that early identification of at-risk seniors

could only be done by training law enforcement. And

we’ve come up with a program called Safe Outreach

for Seniors, where the officers are trained to identify

seniors that are living at home or possibly driving

that should not be alone, living alone. The officers

are trained to look in the refrigerator, they’re trained

to look at the clothing to see if they’ve lost weight,

they’re trained to ask judgment questions. And in

doing so we’ve been able to identify dementia extremely early on, involve families, get Adult Protective

Services, get outreach involved so these people are

able to live at home with dignity and quality of life.

Thank you.

Our Aging Population: A Report of Proceedings
Closing Session

An OJP Issues & Practices Report 87

ATTORNEY GENERAL RENO: Let me ask you

this. Do you think healthy elderly who want to be

involved could learn the same means of identification?

ANN MASTRO: Yes, I do, because a lot of neighbors, they try very hard to protect that other neighbor

who may be in the beginning with dementia, so

therefore they cover for them, they do the shopping

for them. But I think if they understood that they

were doing more damage [by doing this] rather than

enlisting the help of some of the outreach programs

that are available [like the one] in Ocean County, I

think it would be a wonderful program.

ATTORNEY GENERAL RENO: Thank you.

ANN MASTRO: Thank you.

MICHELLE LUJAN-GRISHAM: I’m Michelle

Lujan-Grisham and I’m the State Agency on Aging

Director in New Mexico, and I think that you’re right

on in terms of looking at preventing the kinds of

problems that we’ve been discussing for the last dayand-a-half. And I think that we’ve demonstrated, but

on a small scale, primarily through the Administration on Aging’s funding stream for home- and

community-based services, that you can do an effective, cost-effective, aggressive campaign for in-home

and community-based services. But I think here are

still the barriers. One, federal policy in both Medicare

and Medicaid is high and acute medical care, institutional care services—and as long as that’s where all

of our money is invested, lower cost home- and 

community-based investments are going to be scattered, depending upon the strength of a particular

state. Now I think that the U.S. Supreme Court decision in Olmstead is going to help, but it’s not going

to do anything to address the medical model preference in Medicare. And I think that part of that stems

still from a sense in this country (it’s patronizing) that

older people are clearly going to be safer in hospitals

and nursing homes and institutional care environments and what we know is that is absolutely not

true. People fall in nursing homes and people wander

away from nursing homes and people die in nursing

homes from lack of care and medical neglect. And we

have to change that bias. And I’ll tell you something

else that I believe in absolutely, that regardless what

we really decide, that supporting people to be independent in their homes and communities—your

economy of scale and your earlier remarks—

absolutely works because we’ve got competition and

prices are lowered and people have more options. And

to get there, let’s do life-plan clinics with families so

that they know about the issues for their adult parents

and grandparents and help people plan. It’s very complicated to understand retirement, and health care

and custodial care and Medicare rules, Medicaid rules.

And let’s not impoverish people so that they can’t take

care of themselves, which is the basic body of

Medicaid policy anyway. I think if we do those things

and you harness seniors to take care of themselves—

they want to, they want to be engaged, they can help

make a difference, they’re a wealth of knowledge and

opportunity—we can reverse this terrible pattern

we have in this country to warehouse older people

instead of to empower and engage them. Thank you.

(Applause.)

ATTORNEY GENERAL RENO: I have a concept—

forgive me other lawyers in the crowd—but I have a

concept that we can develop a better and more effective way of delivering services to people that is quasilegal or legal if we recognize that there can be some

areas of specialties where community advocates, who

charge a fee, but a fee commensurate with the service

that they’re providing, and have a sufficient volume so

that they can do it well. And I would foresee training

people in advocacy for the elderly for planning, for

services, for access, for all the questions that you

raised. They would not have to go to law school;

they’d get a four-year degree in elderly advocacy but

they would touch on these legal issues and have

training in that as well. And I think that could be

a tremendous step forward. I’d like to see what we

could do in terms of organizing or providing some

incentive to the private sector to become better organized in the delivery of services. There are some efforts

afoot in the Federal Government to develop technology that will be more ... technology to provide for

safe, healthy, constructive older years. And there is

just so much that we can do if we take the volume of

people, the number and the increasing population

and say “Hey you guys, you want a market, this is

going to be your market, you better make them ... if

you’re not interested in it because of common

humanity concerns, then be interested in it from the

dollar because that’s where your market’s going to be.”

MICHELLE LUJAN-GRISHAM: I think that you’re

exactly right. I mean these are the consumers. Whole
88 An OJP Issues & Practices Report

global economies will fail if we continue to practice

health and long-term and independent living services

the way in which we currently do. And there’s someone in our state, I probably shouldn’t do this, but to

brag on her, her name is Virginia Sears and she is in

her late 80s. I think she has a terminal illness and she

has been advocating and teaching seniors, most people think she’s an attorney. She’s incredible, does legal

clinics, lifetime clinics and solves people’s problems so

that they can obtain their living arrangement successfully and they understand about life-planning and

they understand about these government benefits and

they can get for free pharmaceuticals from the Pharm

program. And she has a wonderful knowledge, but

she’s able to deliver it in a way that’s nonthreatening,

very empowering, and she’s having real results in even

the most rural settings of our state. And I’ll tell you

she’s my role model and mentor.

ATTORNEY GENERAL RENO: Great. Thank you.

MICHELLE LUJAN-GRISHAM: Thank you.

(Applause.)

MARY BEALS LUEDTKA: My name is Mary Beals

Luedtka and I supervise an Elder Rights Unit. And

I’m not a lawyer. I used to be a nurse and I kind of

do paralegal work so I kind of fit right where you are.

We have a volunteer program; we include Medicare

benefits counseling, ombudsman and legal advocacy

for seniors, and I supervise legal advocacy for seniors

with a supervising attorney’s assistance. We have 40

volunteer attorneys in northern Arizona that also

assist us if litigation becomes necessary. And I think

it’s a model program because we have 50 volunteers

that are taught to be advocates in their communities.

Our Area Agency on Aging, geographically, is the

largest in the United States. I go from the Utah border to the New Mexico border, almost to Phoenix,

over to Congress, if that means anything to those of

you who know Arizona. And these volunteers are seniors. And they’re seniors that are advocating for seniors, and our mission of the Elder Rights Unit is to

empower seniors to advocate for themselves. It

includes education, public awareness, and also, at the

attorney general’s office, senior advisory counsel. I

hostess a local television program on senior issues as

well to help educate on life-planning, on benefits, on

what’s available, and how can we come together. So I

think that is a good model for those ideas.

ATTORNEY GENERAL RENO: That’s great.

Thank you. I think we have time for one more. Sir.

JEFF CZARNEC: From the New Hampshire team.

I’m glad we’re able to address some of the logistical

efforts that we can make with regard to elder abuse,

but I think I’d like to see the government become

more involved in monitoring what cultural philosophy [our country] seems to be heading in. It’s pervasive ageism, which is occurring in this country right

now. As a father of four kids, all of whom consider

me at age 42 over the hill, I’m finding that they’re

getting most of their cues, to be quite frank, from the

media. There’s a number of children’s channels out

there that are fanatically antiparent. They consider

parents and elders as people that are either washedup, useless and should have no attention, or pay no

attention to any of the activities that they’re involved

in. To be quite frank, with this type of cue that

they’re taking from the media where in this country

here, young is beautiful and nothing else serves that

purpose. I’d like to see the government at least monitor some of this, the ageism that’s occurring and that’s

extremely pervasive within the media. With regards to

especially directing your attention towards the largest

consumer group in this country right now which is

our teens. And as a parent and I’m sure maybe a lot

of other people can attest to this, there is a great deal

of ageism that’s occurring that is going to continue

unabated at this point in time.

ATTORNEY GENERAL RENO: That’s certainly

true when you look at the television programs and see

the programming.

I couldn’t write fast enough to get all the points

down, so I do want to get your notes and comments,

and I understand that will be available. First of all,

I want to pay tribute to the state attorneys general.

They have been in this issue for some time now and

you can see the impact in attorney general’s offices

across the country, and you all have done a great job.

I want to pay my respect to the tribes who are

here. It is wonderful that you are here. I made the

comment about the basketball court. When I was at

the Northern Cheyenne Reservation, it was wonderful, and I am on the front page of the Billings newspaper with a basketball shot like that (indicating).

How are the tee shirts going?

Our Aging Population: A Report of Proceedings
Closing Session

An OJP Issues & Practices Report 89

One of the points that I think is overwhelming

and the message is loud and clear—we need to figure

out how we can organize op-ed pieces and comments

and how we can raise public awareness and put it in

very graphic terms so that people will understand.

Secondly, I think your point about ageism is correct, but one of the things that I have discovered is

that young people are far more idealistic than we give

them credit for, certainly than the media gives them

credit for. They are yearning for opportunities to help

others. They oftentimes have a particular affinity for

the elderly. They can be kind and supportive and they

are really very special. Don’t ignore young people as a

source of tremendous compassionate service to the

elderly.

I think we can do more in terms of training and

I’d like to see what we can do in terms of distance

learning, in terms of interactive video, in terms of

video conferencing, and see if we can’t get ourselves

organized across this country in a way that provides

a Web site that lists the latest training opportunities,

then refers you to helpful hints to caregivers that

you can follow, and then you can have resources and

materials that you can follow that list the videos, that

provides everything in terms of resources, expertise,

training, the latest technology—all of these on the

Web and otherwise available.

I think research is key. I would like to see the

medical schools of the country joining with other professional schools in our university system to really

focus on this issue. I think it is imperative that we figure what can be done in terms of technology, what can

be done in terms of psychological and other supports.

Let me ask you one question. Is there any institute in this country that is doing something in terms

of the whole approach of prevention, intervention,

and prosecution?

LISA CURTIS: I’m Lisa Curtis with the Denver

District Attorney’s Office. I’m with the economic

crime unit. My position in that unit is strictly to do

crime prevention. We also have something we call a

SWAT team approach to elder abuse, financial abuse,

where our investigators immediately go out and do

emergency intervention involving financial exploitation. Prosecution of elder abuse cases takes the highest

priority in our unit.

ATTORNEY GENERAL RENO: What I’m interested in, though, is an institute, both academic and otherwise, that is developing the latest technology or

finding the latest technology that’s elderly friendly,

that is developing the latest research in terms of geriatrics and the issues associated with it, that is collecting it and then distributing it across the nation,

because I think, in addition to raising public awareness, we’ve got to look for something that can

address—let’s put it this way: There are veterinarian

schools in a number of universities across this country, but there is none, there is no institute or university, that has become the specialist on these issues that

we have discussed today. 

Think of what we could do if we organized ourselves in that way. There would be tribally sensitive

issues, there would be suggestions to the private sector

as to what could be done. You could have a business

school operating with some of these issues in mind. 

Just don’t put any boundaries on your thoughts.

Let’s see what we can do to really address the issue and

create an economy, an infrastructure, an approach, an

academic approach to the issues of the elderly that

can ensure appropriate service.

One of the things I thought about in justice

training is seeing what can be done in terms of the

State Justice Institute and otherwise, and we will

explore that—what can be done in terms of the multidisciplinary efforts through, again, the community

police. I’m going to go back—I thought the points

with reference to the community police were extremely important.

I’ve got the other notes here. I will try to do

everything I can in the 3 months that I have left

before I go home. I’m going to go home, figure out

what I’m going to do when I grow up, get settled,

and then get in my red truck and go. So, Northern

Cheyenne, just wait; the red truck’s coming.

(Laughter.)

But one of the things I do not intend to do is

stop my concern and my interest in this area, and I

want to continue to do everything I can after I leave

office, because this is extremely important to me and

I think we have so much to do.
90 An OJP Issues & Practices Report

I would appreciate any suggestions you have. I

think we need to follow through with these symposiums with an op-ed piece and other pieces carefully

placed across the country to spur concern. One of the

things we might do, Mary Lou, is maybe with the

state AGs, the state aging offices, have an organized

effort around the country on a Thursday morning for

my Thursday morning press availability, talking about

the results of these conferences, talking about the

demographics, talking about what can be done, and

that we do not have to see what’s happening.

Now, with public awareness, I suggest to you that

America is far more aware of what’s happening than

it lets on, because there are too many people that just

feel like they’re at the end of their rope, that they can’t

cope, that they don’t know where to turn or where to

go. There are too many caregivers that are at the end

of their rope, that don’t know how to cope and don’t

know where to go, and they are yearning for answers.

Let’s provide them the answers.

(Applause.)

MARY LOU LEARY: Ms. Reno, thank you so much.

You are an inspiration to all of us. I’d like to just take

a moment to again say thank you to our colleagues at

HHS who have been so helpful in this forum, including Secretary Shalala; Jeanette Takamura, Assistant

Secretary for Aging; Diane Justice, Deputy Secretary

of the Administration on Aging; and Carole Crecy

from the Administration on Aging. I want to thank

all of you for your tremendous energy and creativity.

My mother will thank you also because I can tell you

I have been rethinking a number of issues over the

last day-and-a-half; I barely slept last night. My family

will thank you for the efforts. And I hope that you

will take useful thoughts, ideas, connections home

with you, that you’ll be in a better position to work

together as catalysts and advocates for older Americans

in your communities. Have a safe trip home.

Our Aging Population: A Report of Proceedings
Appendix 1

1

Our Aging Population: 

Promoting Empowerment, Preventing Victimization, and 

Implementing Coordinated Interventions

A National Symposium Sponsored by

the U.S. Department of Justice

and the U.S. Department of Health and Human Services

The Washington Monarch Hotel

October 30–31, 2000

Washington, DC 

AGENDA

Monday, October 30, 2000

7:30–8:30 a.m. Continental Breakfast and Registration Lower Level Foyer

8:30–8:45 a.m. Opening Remarks Grand Ballroom

(Ballroom Level)

Speaker: Daniel Marcus

Acting Associate Attorney General

U.S. Department of Justice

Washington, DC

8:45–10 a.m. Plenary I–Building the Case: Grand Ballroom

Why Policymakers Should Focus on (Ballroom Level)

Elder Victimization

Moderator: Mary Lou Leary

Acting Assistant Attorney General

Office of Justice Programs

U.S. Department of Justice

Washington, DC

Panelists: Rosalie Wolf, Ph.D.

President and Founder

National Committee for the Prevention of Elder Abuse

Worcester, MA 

John Rother

Director of Legislation and Public Policy

AARP

Washington, DC
2

David Baldridge 

Executive Director

National Indian Council on Aging, Inc.

Albuquerque, NM

Sue Ward 

Secretary, Board of Directors, National Association of Units on Aging

Secretary, Maryland Department on Aging

Baltimore, MD

The Honorable Andrew Ketterer 

Attorney General, State of Maine

President, National Association of Attorneys General

Augusta, ME

10–10:30 a.m. State and Tribal Team Discussions Grand Ballroom 

(Ballroom Level)

10:30–10:45 a.m. Break Lower Level Foyer

(Ballroom Level)

10:45 a.m.–noon Plenary II–Financial Exploitation and Grand Ballroom

Consumer Fraud (Ballroom Level)

Moderator: Diane Justice

Deputy Assistant Secretary for Aging

U.S. Department of Health and Human Services

Washington, DC

Panelists: Jill Thomas 

Independent Consultant

Bay Village, OH 

Lisa Nerenberg

Consultant in Elder Abuse Prevention

Redwood City, CA

Lee Norrgard 

Senior Program Coordinator, Consumer Protection Section

AARP

Washington, DC

Barbara Harriman

Inspector, Office of the Inspector General

U.S. Department of Health and Human Services

Washington, DC
3

Noon–1:15 p.m. Working Lunch Grand Ballroom

(Ballroom level)

Introduction: D. Jean Veta

Deputy Associate Attorney General

U.S. Department of Justice

Washington, DC

Investigating the Systems That Protect and Care

for Vulnerable Populations: A Reporter’s View

Speaker: David Jackson 

Investigative Reporter

The Chicago Tribune

Chicago, IL

1:30–2:30 p.m. Financial Exploitation and Consumer Fraud 

Workshops

Workshop #1: Federal and State Initiatives Sulgrave

To Educate Consumers (Third floor) 

Moderator: Lee Norrgard 

Senior Program Coordinator, Consumer Protection Section

AARP

Washington, DC

Panelists: Alexis Barbieri 

Executive Deputy Attorney General

Pennsylvania Office of Attorney General

Harrisburg, PA

Dan Drake 

Executive Assistant United States Attorney

United States Attorney’s Office for the District of Arizona

Phoenix, AZ

Robert Kurkendall

Federal Trade Commission

Washington, DC

Jeffrey LaGrew 

Assistant Deputy Attorney General

Office of the Kentucky Attorney General

Frankfort, KY
4

Workshop #2: Effective Interventions Executive Forum

To Address Consumer Fraud (Ballroom level)

Moderator: John Firman

Coordinator for Research Services

International Association of Chiefs of Police 

Alexandria, VA

Panelists: Cynthia Alexis 

Project Coordinator

Special Emphasis on Elder Abuse

San Francisco, CA

Faith Fish 

New York State Long Term Care Ombudsman

New York State Office for the Aging

Albany, NY

Marta Sotomayor, Ph.D. 

President

National Hispanic Council on Aging

Washington, DC

Jim Wright 

Program Director, Triad and Operation Fraud Stop

National Sheriffs’ Association

Alexandria, VA

Workshop #3: Innovative Approaches Roosevelt

to Financial Exploitation (Ballroom level)

Moderator: Patrick Donely

Senior Litigation Counsel, Criminal Division–Fraud Section

U.S. Department of Justice

Washington, D.C.

Panelists: Susan Aziz 

Vice President, Advocacy and Education Programs

WISE Senior Services

Santa Monica, CA 

Aileen Kaye

Program Coordinator, Abuse Prevention Unit

Senior and Disabled Services Division

Salem, OR
5

Kathleen Quinn 

Chief, Bureau of Elder Rights

Illinois Department on Aging

Springfield, IL

LaVerne Wyaco 

Director

Navajo Area Agency on Aging

Window Rock, AZ

Workshop #4: Enhancing Prosecution Grand Ballroom

of Financial Exploitation (Ballroom level)

Moderator: Newman Flanagan

Executive Director 

National District Attorneys Association

Alexandria, VA

Panelists: The Honorable Jane Brady 

Attorney General

State of Delaware

Wilmington, DE

Judith Kozlowski

Assistant United States Attorney

Office of the United States Attorney for the District of Columbia

Washington, DC

Chayo Reyes 

Law Enforcement Officer (Retired)

Proprietor, Elder Financial Protective Services

Cerritos, CA

Audry Rohn 

Deputy District Attorney

Ventura County District Attorney’s Office

Ventura, CA

Workshop #5: Combating Consumer Fraud Colonnade

Through Litigation (Lobby level)

Moderator: The Honorable William Sorrell 

Attorney General

State of Vermont

Montpelier, VT
6

Panelists: Jackie DeGenova 

Assistant Chief, Consumer Protection Section

Ohio Attorney General’s Office

Columbus, OH

David Kirkman 

Assistant Attorney General

State of North Carolina Office of the Attorney General 

Raleigh, NC

Deborah Zuckerman 

Senior Attorney, Consumer Protection Unit

AARP

Washington, DC

2:30–2:45 p.m. Break Lower Level Foyer

(Ballroom level)

2:45–4 p.m. Plenary III–Elder Abuse and Neglect at Home Grand Ballroom

(Ballroom level)

Moderator: The Honorable Kathryn Turman

Director, Office for Victims of Crime

Office of Justice Programs

U.S. Department of Justice

Washington, DC

Panelists: Joyce Speakman 

Oakland, CA

Eva Kutas 

President

National Association of Adult Protective Service Administrators

Salem, OR

Bonnie Brandl

Program Director, National Clearinghouse on Abuse in Later Life

Madison, WI

Holly Ramsey-Klawsnik, Ph.D.

Sociologist/Social Worker/Marriage and Family Therapist

Klawsnik & Klawsnik Associates

Canton, MA

Sara Aravanis 

Director, National Center on Elder Abuse

National Association of State Units on Aging

Washington, DC
7

4:15–5:15 p.m. Elder Abuse and Neglect at Home Workshops

Workshop #1: Strengthening Interventions Sulgrave

for Victims With Dementia (Third floor)

Moderator: Nancy Coleman 

Director, Commission on Legal Problems of the Elderly

American Bar Association

Washington, DC

Panelists: Georgia Anetzberger 

Associate Director for Community Services

The Benjamin Rose Institute

Cleveland Heights, OH

Frederick Brand 

Director of Program Services

Alzheimer’s Association, Greater New Jersey Chapter

Denville, NJ

Anne Mastro

Nurse Practice Manager

Geriatric Evaluation and Management Service, Kimball Medical Center

Lakewood, NJ

Workshop #2: Working Across Systems Executive Forum

To Improve Services for Victims of Domestic (Ballroom level)

Violence and Sexual Assault

Moderator: Catherine Pierce

Deputy Director for Program Development

Violence Against Women Office

Office of Justice Programs

U.S. Department of Justice

Washington, DC

Panelists: Bonnie Brandl 

Program Director, National Clearinghouse on Abuse in Later Life

Madison, WI

Amy Judy 

Systems Advocacy Program Coordinator

Wisconsin Coalition Against Sexual Assault

Madison, WI
8

Mary Lynn Kasunic 

Executive Director

Area Agency on Aging, Region One

Phoenix, AZ

Workshop #3: Engaging Law Enforcement, Grand Ballroom

Prosecution, and the Judiciary (Ballroom level)

Moderator: Cabell Cropper

Executive Director

National Criminal Justice Association

Washington, DC

Panelists: Candace Heisler 

Consultant and Trainer 

San Francisco Assistant District Attorney (Retired)

San Francisco, CA

Charles Mendonca 

Public Relations Officer for the Elderly

Pascua Yaqui Tribe of Arizona Law Enforcement Services

Tucson, AZ 

Lori Stiegel 

Associate Staff Director, Commission on Legal Problems of the Elderly

American Bar Association

Washington, DC

C. Ronald Stromberg 

Assistant Director

Division of Aging and Adult Services

Salt Lake City, UT

Workshop #4: Augmenting the Role Roosevelt

of Medical Professionals (Ballroom level)

Moderator: Sidney Stahl, Ph.D.

Chief, Health Care Organization and Social Institutions

National Institute on Aging, National Institutes of Health

Washington, DC

Panelists: Carmel Dyer, M.D.

Associate Professor of Medicine

Baylor College of Medicine

Houston, TX
9

Laura Mosqueda, M.D.

Director, Geriatrics/Associate Clinical Professor, Family Medicine

University of California, Irvine–College of Medicine

Orange, CA

Randolph Thomas 

Manager, Domestic Investigations Unit

South Carolina Department of Public Safety

Columbia, SC

Workshop #5: Enhancing Victim Services Colonnade

(Lobby level)

Moderator: Diane Alexander

Director, Field Services

National Crime Victims Center

Washington, DC

Panelists: Shanny Augare

Assistant Executive Director, Child & Family Advocacy Center

Director, Violence Prevention Program

Browning, MT

Judy O’Neal 

Manager, Victim Witness Branch

Governor’s Office of Criminal Justice Planning

Sacramento, CA

Kathi West 

Victim-Witness Coordinator

Office of the United States Attorney for the Western District of Texas

Austin, TX

5:15–6 p.m. State and Tribal Team Discussions

State and Tribal Teams A–N Grand Ballroom

(Ballroom level)

State and Tribal Teams O–Z Colonnade

(Lobby level)

7:30–9:30 p.m. Tribal Team Caucus
10

Tuesday, October 31, 2000

7:30–8:15 a.m. Continental Breakfast and Registration Lower Level Foyer

(Ballroom level)

8:15–8:30 a.m. Opening Remarks (and Charge to State Teams) Grand Ballroom

(Ballroom level)

Speaker: Alexa Verveer 

Deputy Assistant Attorney General

Office of Justice Programs

U.S. Department of Justice

Washington, DC

8:30–9:45 a.m. Plenary IV–Institutional Abuse and Neglect Grand Ballroom

(Ballroom level)

Moderator: Steven Pelovitz

Director, Survey and Certification Group

Health Care Financing Administration

U.S. Department of Health and Human Services

Baltimore, MD

Panelists: Senora Russell

Nashville, TN 

Marie-Therese Connolly 

Coordinator, Nursing Home Initiative

U.S. Department of Justice

Washington, DC

David Waterbury 

Director, Washington State Medicaid Fraud Control Unit

Washington State Office of the Attorney General 

Tacoma, WA

Michelle Lujan Grisham 

Director

New Mexico State Agency on Aging

Santa Fe, NM

Toby Edelman 

Center for Medicare Advocacy

Healthcare Rights Project

Washington, DC
11

9:45–10 a.m. Break Lower Level Foyer

(Ballroom level)

10–11 a.m. Institutional Abuse and Neglect Workshops

Workshop #1: Creative Initiatives To Educate Roosevelt

Professionals and the Public (Ballroom level)

Moderator: Nolan Jones

Director, Human Resources Group

National Governor’s Association 

Washington, DC

Panelists: Barbara Doherty 

Adult Protection Consultant, Aging and Adult Services Division

Minnesota Department of Human Services

St. Paul, MN

Diane Menio 

Executive Director, Center for Advocacy for the Rights and 

Interests of the Elderly (CARIE)

Philadelphia, PA

David Waterbury 

Director, Washington State Medicaid Fraud Control Unit

Washington State Office of the Attorney General 

Tacoma, WA

Pam Vocke

Director, Division of Quality Improvement and Training

Health Care Financing Administration, HHS

Washington, DC

Workshop #2: Joining Resources To Combat Colonnade

Institutional Abuse and Neglect (Ballroom level)

Moderator: Barbara Zelner 

Counsel

National Association of Medicaid Fraud Control Units

Washington, DC

Panelists: Marie-Therese Connolly 

Coordinator, Nursing Home Initiative

U.S. Department of Justice

Washington, DC
12

Nicholas Cox 

Bureau Chief, Economic Crimes, Tampa

Florida Attorney General’s Office 

Tampa, FL

The Honorable Frankie Sue Del Papa 

Attorney General

State of Nevada

Carson City, NV

Becky Kurtz 

State Long Term Care Ombudsman

Division of Aging Services, Department of Human Resources

Atlanta, GA

Workshop #3: Enhancing the Survey Executive Forum

and Regulatory Process (Ballroom level)

Moderator: Helene Fredeking

Health Care Financing Administraton

U.S. Department of Health and Human Services

Baltimore, MD

Panelists: Debra Green 

Supervising Attorney

Texas Department of Human Services

Austin, TX

Catherine Morris 

Assistant Commissioner

New Jersey Department of Health and Senior Services

Trenton, NJ

Joyce Stockwell 

Assistant Director, Residential Care Services 

Washington State Department of Social and Health Services

Olympia, WA

Workshop #4: Holding Institutions Accountable Grand Ballroom

Through Prosecution (Ballroom level)

Moderator: David Hoffman 

Assistant United States Attorney

United States Attorney’s Office for the Eastern District of Pennsylvania

Philadelphia, PA
13

Panelists: Freda Fishman 

Chief, Consumer Protection and Antitrust Division

Massachusetts Attorney General’s Office

Boston, MA

Randy Hey 

Assistant District Attorney

Office of the Santa Clara District Attorney

San Jose, CA

Andrew Penn 

Senior Counsel, Office of the Inspector General

U.S. Department of Health and Human Services

Washington, DC

Linda Purdy 

Director, Medicaid Fraud Control Unit

State of Vermont Office of the Attorney General

Waterbury, VT

11–11:45 a.m. State and Tribal Team Discussions

State and Tribal Teams A–N Grand Ballroom

(Ballroom level)

State and Tribal Teams O–Z Colonnade

(Lobby level)

11:45 a.m.–noon Break

Noon–1:15 p.m. Closing Session with the Attorney General Grand Ballroom

(Ballroom level)

Moderator: Mary Lou Leary

Acting Assistant Attorney General

Office of Justice Programs

U.S. Department of Justice

Washington, DC

Speaker: The Honorable Janet Reno

Attorney General

U.S. Department of Justice

Washington, DC

Reporters: Representatives From Selected State and Tribal Teams

1:15 p.m. Adjourn
Appendix 2

Our Aging Population: Promoting Empowerment,

Preventing Victimization, and Implementing Coordinated Interventions

The Washington Monarch Hotel

Washington, DC

October 30-31, 2000

Participant List

Jennifer Aldrich

Assistant U.S. Attorney

U.S. Attorney's Office

District of South Carolina

1441 Main Street, Suite 500

Columbia, SC 29201

Phone: 803-343-3176 

Fax: 803-733-5966

Leo Aleck

Tribal Councilman

Yakama Nation Tribe Council

P.O. Box 151

Toppenish, WA 98948

Phone: 509-865-5121 ext. 4334

Fax: 509-865-5745

E-mail: aaleck@yakama.com

Diane Alexander

Director

Field Services

National Center for Victims of Crime

2111 Wilson Boulevard, Suite 300

Arlington, VA 22201

Phone: 703-276-2880 

Fax: 703-276-2889

E-mail: dalexander@ncvc.org

Lynn Alexander

Director

Office of Services to the Aging

P.O. Box 30676

Lansing, MI 48909

Phone: 517-373-7876 

Fax: 517-373-4092

E-mail: alexanderl@state.mi.us

Cynthia Alexis

Project Coordinator

Special Emphasis on Elder Abuse

850 Bryant Street, Room 320

San Francisco, CA 94103

Phone: 415-551-9541 

Fax: 415-551-9582

Genevieve Allaire-Johnson

Special Assistant to the Attorney General

Rhode Island Attorney General's Office

150 South Main Street

Providence, RI 02903

Phone: 401-274-4400 

Fax: 401-751-2860

Alane Allman-Dent

Deputy Investigator

Special Committee on Aging

Senate Office Building, Hart 825

Washington, DC 20510

Phone: 202-224-6090 

Fax: 202-224-8660

E-mail: alane_allman@aging.senate.gov

Bill Anderson

Volunteer Senior Advocate

Aging Services Division

Department of Human Services

1814 Brookhaven Boulevard

Norman, OK 73072

Phone: 405-364-7904 

Fax: 405-364-7905

Shane Anderson

Program Assistant

National District Attorney's Association

American Prosecutor's Research Institute

99 Canal Center Plaza, Suite 510

Alexandria, VA 22314

Phone: 703-518-4386 

E-mail: shane.anderson@ndaa-apri.org

Georgia J. Anetzberger

Associate Director for Community Services

The Benjamin Rose Institute

2373 Euclid Heights Boulevard

Cleveland Heights, OH 44106

Phone: 216-791-8000 

Fax: 216-791-8030

E-mail: georgia@benrose.org
Sara Aravanis

Director

National Center on Elder Abuse

National Association of State Units on

Aging

1225 I Street NW., Suite 725

Washington, DC 20005

Phone: 202-898-2578 

Fax: 202-898-2583

E-mail: saravanis@nasua.org

Sandra Arenas

Assistant Attorney General

Office of the Attorney General

110 Sherman Street

Hartford, CT 06105

Phone: 860-808-5420 

Fax: 860-808-5587

E-mail: sandra.arenas@po.state.ct.us

David Aronberg

White House Fellow

U.S. Department of the Treasury

1500 Pennsylvania Avenue NW., Room

2209

Washington, DC 20037

Phone: 202-622-2143 

Fax: 202-622-0032

E-mail: davearonberg@hotmail.com

Vickie Artis

Social Service Administrator 

Adult Protective Services

Division of Services for Aging and Adults

with Physical Disabilities

256 Chapman Road, Suite 200

Newark, DE 19702

Phone: 302-453-3820 ext. 41

Fax: 302-453-3836

E-mail: vartis@state.de.us

Shanny Augare

Director

Triad Program of Blackfeet Tribe

P.O. Box 870

Browning, MT 59417

Phone: 406-338-5180 

Fax: 406-338-5660

Judy Austad

Investigator

Attorney General's Office

Department 125

600 East Boulevard Avenue

Bismarck, ND 58505

Phone: 701-328-4605 

Fax: 701-328-3535

E-mail: jaustad@state.nd.us

Deborah H. Baer

Assistant Attorney General

Department of Justice

301 Main Street, Suite 1250

Baton Rouge, LA 70801

Phone: 225-342-2753 

Fax: 225-342-9637

E-mail: baerd@ag.state.la.us

Kathleen Baker

Chief

Division of Long Term Care Field Operations

Department of Public Health

525 West Jefferson Street, Fifth Floor

Springfield, IL 62761

Phone: 217-785-2629 

Fax: 217-785-9182

E-mail: kbaker@idph.state.il.us

David Baldridge

Executive Director

National Indian Council on Aging, Inc.

10501 Montgomery Boulevard NE., Suite 210

Albuquerque, NM 87111

Phone: 505-292-2001 

Fax: 505-292-1922

Grady Balentine

Assistant Attorney General

Department of Justice

P.O. Box 629

Raleigh, NC 27602

Phone: 919-716-6840 

Fax: 919-716-6758

E-mail: gballent@mail.jus.state.nc.us
Doris Ball

Program Manager

Office of Adult Services

Department of Human Resources

50 Ripley Street

Montgomery, AL 36125

Phone: 334-242-1355 

Fax: 334-353-1052

E-mail: dball@dhr.state.al.us

Alexis L. Barbieri

Executive Deputy Attorney General

Public Protection Division

Office of the Attorney General

Strawberry Square, 14th Floor

Harrisburg, PA 17120

Phone: 717-787-9716 

Fax: 717-787-1190

E-mail: abarbieri@attorneygeneral.gov

Dorothy Bargholz

Chief of Staff

Division of Consumer Affairs

Department of Law and Public Safety

124 Halsey Street, Seventh Floor

Newark, NJ 07102

Phone: 973-504-6534 

Fax: 973-648-3538

E-mail: bargholzd@smtp.lps.state.nj.us

Karyn Barquin

Program Coordinator

Long Term Care

Office on Aging

441 Fourth Street NW., Suite 900 South

Washington, DC 20001

Phone: 202-727-8367 

Fax: 202-724-4979

E-mail: kbarquin-age@dcgov.org

Rick Bartos

Chief

Protective Services Organization

P.O. Box 1057

Helena, MT 59624

Phone: 406-444-4541 

Fax: 406-444-7743

E-mail: user882963@aol.com

Dwight D. Becker

Program Coordinator

Division of Senior Services

3601 C Street, Suite 310

Anchorage, AK 99503

Phone: 907-269-3674 

Fax: 907-269-3648

E-mail: dwight_becker@admin.state.ak.us

Rudy I. Bedonie

Director

Dine Elderly Protection Program

Navajo Area Agency on Aging

P.O. Box 1390

Window Rock, AZ 86515

Phone: 520-871-6536 

Fax: 520-871-6793

E-mail: rbedonie@nndoh.nn.ihs.gov

William Betjemann

Project Director

Division of Criminal Justice Services

Four Tower Place

Albany, NY 12203

Phone: 518-457-9787 

Fax: 518-485-2728

E-mail: wbetjemann@drjs.state.ny.us

Kristine Blackwood

Assistant U.S. Attorney

Office of the Attorney General

Federal Building

300 North Los Angeles Street, Room 7516

Los Angeles, CA 90012

Phone: 213-894-7155 

Fax: 213-894-2380

E-mail: kristine.blackwood@usdoj.gov

Henry Blanco

Program Administrator

Aging and Adult Administration

1789 West Jefferson

Phoenix, AZ 85007

Phone: 602-542-4446 

Fax: 602-542-6575

E-mail: hblanco@mail.de.state.az.us
Tom Blankenship

Health Care Fraud Investigator

U.S. Attorney's Office

District of Montana

2929 Third Avenue N., Suite 400

P.O. Box 1478

Billings, MT 59103

Phone: 406-247-4673 

Fax: 406-657-6989

Wayne A. Bortz

Lieutenant

Alaska State Troopers

5700 East Tudor Road

Anchorage, AL 99507

Phone: 907-269-0390 

Fax: 907-269-5033

E-mail: wayne_bortz@dps.state.ak.us

Charlotte Bradley

Zuni Adult Day Care Coordinator

Zuni Senior Center

P.O. Box One

Zuni, NM 87327

Phone: 505-782-5541 

Fax: 505-782-5678

M. Jane Brady

Attorney General

Department of Justice

State of Delaware

820 North French Street

Wilmington, DE 19801

Phone: 302-577-8338 

Fax: 302-577-2610

E-mail: jbrady@state.de.us

R. Maria Brady

Director

Victim Witness Services

Law Enforcement Planning Commission

8172 Sub Base, Suite 3

Charlotte Amslie, VI 00804

Phone: 304-774-6400 

Fax: 340-776-3317

Bonnie Brand

Deputy Attorney General

Office of the Attorney General

1325 Airmotive Way, Suite 340

Reno, NV 89502

Phone: 775-688-1824 

Fax: 775-688-1822

E-mail: bsbrand@ag.state.nv.us

Frederick Brand

Director of Program Services

Alzheimer's Association

Greater New Jersey Chapter

400 Morris Avenue, Suite 251

Denville, NJ 07834

Phone: 973-586-4300 

Fax: 973-586-4342

E-mail: frederick.brand@alz.org

Bonnie Brandl

Project Coordinator

National Clearinghouse on Abuse in Later

Life (NCALL)

307 South Paterson, Suite 1

Madison, WI 53703

Phone: 608-255-0539 

Fax: 608-255-3560

E-mail: bonnib@inxpress.net

Debbie S. Brantley

Chief

Elder Rights Section

Division of Aging

2101 Mail Service Center

Raleigh, NC 27699

Phone: 919-733-8395 

Fax: 919-715-0868

E-mail: debbie.brantley@ncmail.net

Fran Bridges

Director

Division of Aging and Adult Services

Department of Human Services

750 North State Street

Jackson, MS 39209

Phone: 601-359-4929 

Fax: 601-359-9664

E-mail: fbridges@mdhs.state.ms.us

Gail E. Bright

Assistant Attorney General

Office of Kansas Attorney General

120 Southwest Tenth Avenue, Second Floor

Topeka, KS 66612

Phone: 785-296-3751 

Fax: 785-291-3699

E-mail: brightg@ksag.org
Thelma Chichester Brown

Chief

Domestic Violence Unit

Office of the Corporation Counsel

441 Fourth Street NW.

Washington, DC 20001

Phone: 202-724-8503 

Fax: 202-727-3737

E-mail: tbrown@occ.dcgov.org

Deborah Buckley

Bank Examiner

Department of Banking

State of Connecticut

260 Constitution Plaza

Hartford, CT 06103

Phone: 860-240-8187 

Fax: 860-240-8167

E-mail: deborah.buckley@po.state.ct.us

L. Gale Buckner

Director

Criminal Justice Coordinating Council

503 Oak Place, Suite 540

Atlanta, GA 30349

Phone: 404-559-4949 

Fax: 404-559-4960

E-mail: gbuckner@cjcc.state.ga.us

Ann N. Butenhof

Directing Attorney

Senior Citizens Law Project

New Hampshire Legal Assistance

1361 Elm Street, Suite 307

Manchester, NH 03101

Phone: 603-668-2900 ext. 225

Fax: 603-625-1840

E-mail: abutenhof@nhla.org

Robert J. Campanelli

Executive Assistant to the Director

Division of Consumer Affairs

124 Halsey Street

Newark, NJ 07202

Phone: 973-504-6313 

Fax: 973-648-5358

E-mail: campanellib@smtp.lps.state.nj.us

Brenda F. Campbell

Assistant Deputy Director

Division of Aging

615 Howerton Court

Jefferson City, MO 65102

Phone: 573-526-3627 

Fax: 573-751-8493

E-mail: bcampbel@mail.state.mo.us

Betsy Cantrell

Volunteer

AARP and Triad

41 West Chops Point Road

Bath, ME 04530

Phone: 207-386-0508 

Fax: 207-386-0509

E-mail: valueneed@ime.net

Michael J. Capriglione

Chief of Police

Town of Newport Police Department

P.O. Box 3053

226 North James Street

Newport, DE 19804

Phone: 302-995-1411

Fax: 302-995-1306

E-mail: mcapriglione@newportpd.state.de.us

Eric H. Carlson

Director of Nursing Home Advocacy Project

Bet Tzedek Legal Services

145 South Fairfax Avenue, Suite 200

Los Angeles, CA 90036

Phone: 323-549-5849 

Fax: 323-549-5880

E-mail: milodon@pacbell.net

Nancy Carrales

Program Administrator

Office of the Governor

P.O. Box 12428

Austin, TX 78711

Phone: 512-463-1927 

Fax: 512-475-2440

E-mail: ncarrales@governor.state.tx.us

Jacqueline Case

Director

New York City Ombudsman Program

11 Park Place, Suite 1111

New York, NY 10007

Phone: 212-962-2720 

Fax: 212-962-2723
Edie J. Casella

Lieutenant Colonel

Illinois State Police

500 Iles Park Place, Suite 102

Springfield, IL 62718

Phone: 217-782-7938 

Fax: 217-524-8140

E-mail: ecasella_2665@yahoo.com

Janis Cheney

Division Director—Life Health

Senior Health Insurance Counseling

North Dakota Insurance Department

Department 401

600 East Boulevard

Bismarck, ND 58505

Phone: 701-328-2977 

Fax: 701-328-4880

E-mail: jcheney@state.nd.us

William Joseph Childers

Director

Medicaid Fraud Control Unit

Office of the Attorney General

323 Center Street, Suite 200

Little Rock, AR 72201

Phone: 501-682-8131 

Fax: 501-682-8135

E-mail: childersj@ag.state.ar.us

Catherine Christophillis

Director of Elder Abuse and Adult

Protection

Office of the Attorney General

620 North Main Street

Greenville, SC 29601

Phone: 864-241-1133 

Fax: 864-241-1154

E-mail: agcchristo@ag.state.sc.us

Denise Chrysler

Assistant Attorney General

Community Health Division

Department of Attorney General

P.O. Box 30217

Lansing, MI 48909

Phone: 517-373-3488

Fax: 517-373-0241

E-mail: chryslerd@ag.state.mi.us

Brandt Chvirko

Elder Rights/Legal Services Specialist

Administration on Aging

U.S. Department of Justice

Cohen Building

330 Independence Avenue SW., Room 4751

Washington, DC 20201

Phone: 202-619-0011 

Fax: 202-260-1012

E-mail: brandt.chvirko@aoa.gov

Peggy Claborn

Coordinator

Information, Advocacy, and Caregiver Support

Department of Elder Affairs

4040 Esplanade Way

Tallahassee, FL 32399

Phone: 850-414-2338 

Fax: 850-414-2002

E-mail: clabornp@elderaffairs.org

Deanna Clingan-Fischer

Legal Services Developer

Department of Elder Affairs

200 Tenth Street, Third Floor

Des Moines, IA 50309

Phone: 515-242-3319 

Fax: 515-242-3300

E-mail: deanna.clingan@dea.state.ia.us

Barb Cobb

Meeting Manager

National Criminal Justice Reference Service

2277 Research Boulevard, MS 7D

Rockville, MD 20850

Phone: 301-519-5625 

Fax: 301-519-5355

E-mail: bcobb@aspensys.com

Debra L. W. Cohn

Deputy Attorney General for Policy

Office of the Attorney General

120 Broadway

New York, NY 10271

Phone: 212-416-8054 

Fax: 212-416-8942

E-mail: debra.cohn@oag.state.ny.us
Felicia Cohn

Study Director

National Research Council

Institute of Medicine

2101 Constitution Avenue NW., HA 156

Washington, DC 20418

Phone: 202-334-2354 

Fax: 202-334-3829

E-mail: fcohn@nas.edu

Nancy Coleman

Director

Commission on Legal Problems of the

Elderly

American Bar Association

740 15th Street NW.

Washington, DC 20005

Phone: 202-662-8685 

Fax: 202-662-8698

E-mail: colemann@staff.abanet.org

Marie-Therese Connolly

Coordinator

Nursing Home Initiative

U.S. Department of Justice

601 D Street NW., Room 9428

Washington, DC 20530

Phone: 202-514-6831 

Fax: 202-616-3085

E-mail: marie.connolly.usdoj.gov

John Connor

Chief

Special Prosecutions Unit

Office of Attorney General

305 North Roberts, Room 168

Halena, MT 59620

Phone: 406-444-5791 

Fax: 406-444-4628

E-mail: jconnor@state.mt.us

Jeanne Cook

Executive Policy Specialist

Department of Aging

555 Walnut Street, Fifth Floor

Harrisburg, PA 17101

Phone: 717-783-1550

Fax: 717-772-3382

E-mail: jecook@state.pa.us

Cynthia M. Cooper

Deputy Attorney General

Criminal Division

Department of Law

301 K Street, Suite 501

Anchorage, AK 99515

Phone: 907-269-6379 

Fax: 907-269-6305

E-mail: cynthia_cooper@law.state.ak.us

Rita K. Coutee

Program Manager

Governor's Office of Elderly Affairs

412 North Fourth Street

Baton Rouge, LA 70802

Phone: 225-342-6879 

Fax: 225-342-7144

E-mail: lkcoutee@gosa.la.us

Nicholas B. Cox

Assistant Attorney General

Economic Crimes Chief

Office of the Attorney General

2002 North Lois Avenue, Suite 520

Tampa, FL 33607

Phone: 813-871-7255 

Fax: 813-871-7262

E-mail: nick_cox@oag.state.fl.us

Talaya D. Crawford

Meeting Registrar

National Criminal Justice Reference Service

2277 Research Boulevard, MS 2B

Rockville, MD 20850

Phone: 301-519-6460 

Fax: 301-519-5711

E-mail: tcrawford@aspensys.com

Carol Crecy

Director for State and Community Programs

Administration on Aging

U.S. Department of Health and Human

Services

Cohen Building

330 Independence Avenue SW., Room 4735

Washington, DC 20201

Phone: 202-619-2617 

Fax: 202-260-1012

E-mail: carol.crecy@aoa.gov
Delores Croft

Policy Advisor, Senior Issues

Office of the Attorney General

100 West Randolph Street, 11th Floor

Chicago, IL 60628

Phone: 312-814-2823 

Fax: 312-814-3212

E-mail: dcroft@atg.state.il.us

Cabell C. Cropper

Executive Director

National Criminal Justice Association

444 North Capitol Street NW., Suite 618

Washington, DC 20001

Phone: 200-624-1440

Fax: 202-508-3859

E-mail: cccncja@sso.org

Lisa Curtis

Director

Consumer Services

District Attorney's Office

303 West Colfax, Suite 1300

Denver, CO 80204

Phone: 720-913-9178 

Fax: 720-913-9177

E-mail: llc@denverda.org

Jeff Czarnec

Detective

Manchester Police Department

351 Chestnut Street

Manchester, NH 03101

Phone: 603-668-8711 

Fax: 603-668-8941

E-mail: jczarnec@ci.manchester.nh.us

Clyde Dailey

Senior Policy Specialist

Department of Insurance

840 Helena Avenue

P.O. Box 4009

Helena, MT 59604

Phone: 406-444-2040

Fax: 406-444-1980

E-mail: cdailey@state.mt.us

Cynthia Darling

Program Specialist

Office for Victims of Crime

U.S. Department of Justice

810 Seventh Street NW.

Washington, DC 20531

Phone: 202-616-3571 

Wavette Davis

Program Manager

Division of Public Safety Planning

Office of Justice Programs

401 North West Street

P.O. Box 23039

Jackson, MS 39225

Phone: 601-359-7889 

Fax: 601-359-7832

E-mail: wdavis@dps.state.ms.us

Linda Dawson

Deputy Chief Counsel

Office of Legal Counsel

Department of Health and Family Services

One West Wilson Street, Room 651

Madison, WI 53702

Phone: 608-266-0355 

Fax: 608-267-1434

Jackie DeGenova

Assistant Section Chief

Consumer Protection Section

Office of the Attorney General

30 East Broad Street, 25th Floor

Columbus, OH 43215

Phone: 614-466-1306

Fax: 614-466-8898

E-mail: jdegenova@ag.state.oh.us

Kenneth W. Dekrey

Committee Member

Governor's Committee on Aging

1312 Sixth Avenue NE.

Valley City, ND 58072

Phone: 701-845-2060 

Fax: 701-845-0781

Frankie Sue Del Papa

Attorney General

Office of the Attorney General

State of Nevada

100 North Carson Street

Carson City, NV 89701

Phone: 775-684-1100 

Fax: 775-684-1108

E-mail: mdpennin@ag.state.nv.us
Angela DeLeon

Masters Program Coordinator

People's Bank

850 Main Street

Bridgeport, CT 06604

Phone: 203-338-4225 

Fax: 203-338-3461

E-mail: axdeleo@peoples.com

John DeMattia

Deputy Assistant State Attorney

Division of Criminal Justice

300 Corporate Place

Rocky Hill, CT 06067

Phone: 860-258-5800 

Fax: 860-258-5858

Fenton B. DeWeese, II

Deputy Administrator for Federal-State

Programs

Department of Human Services

750 North State Street

Jackson, MS 39205

Phone: 601-359-2845 

Fax: 601-359-4477

E-mail: fdeweese@mdhs.state.ms.us

Darlene Dewegeli

Deputy Director

Division of Consumer Protection

Department of Commerce

160 East 300 South

P.O. Box 146704

Salt Lake City, UT 84114

Phone: 801-530-6601 

Fax: 801-530-6001

E-mail: ddewegel@br.state.ut.us

Barbara Doherty

Adult Protection Consultant

Department of Human Services

444 Lafayette Road

Saint Paul, MN 55155

Phone: 651-296-5563 

Fax: 651-297-3500

E-mail: barb.doherty@state.mn.us

Marian M. Dolliver

Program Manager

Stop Medicare/Medicaid Fraud

Virginia Association of Area Agencies on

Aging

530 Main Street, Suite 428

Richmond, VA 23219

Phone: 804-644-2804 

Fax: 804-644-5640

E-mail: mdolliversmp@aol.com

Patrick M. Donely

Senior Litigation Counsel

Fraud Section-Criminal Division

U.S. Department of Justice

Bond Building

1400 New York Avenue NW.

Washington, DC 20005

Phone: 202-514-0819

Fax: 202-514-0152

E-mail: patrick.donely2@usdoj.gov

Robert T. Donovan

Program Manager

Drug Control and System Improvement

Program

Pennsylvania Commission on Crime and

Delinquency

P.O. Box 1167

Harrisburg, PA 17108

Phone: 717-787-8559 ext. 3064

Fax: 717-772-0551

E-mail: rdonovan@state.pa.us

Margaret Dosedo

Director

Zuni Senior Center

P.O. Box One

Zuni, NM 87327

Phone: 505-782-5541 

Fax: 505-782-5678

Daniel Drake

Executive Assistant U.S. Attorney

U.S. Attorney's Office

District of Arizona

230 North First Avenue, Suite 4000

Phoenix, AZ 85025

Phone: 602-514-7623 

Fax: 602-514-7586

E-mail: dan.drake@usdoj.gov
Joy Duke

Adult Protective Services Administrator

Department of Social Services

730 East Broad Street

Richmond, VA 23219

Phone: 804-692-1260 

Fax: 804-692-2215

E-mail: jod2@dss.state.va.us

Sandie Durgin

Supervisor

Abuse/Neglect Detail

Las Vegas Metropolitan Police

Department

3010 West Charleston Boulevard, Suite

120

Las Vegas, NV 89102

Phone: 702-229-3077

Fax: 702-229-3073

Carmel Bitondo Dyer

Associate Professor of Medicine

Baylor College of Medicine

3601 North MacGregor Way

Houston, TX 77004

Phone: 713-525-4872 

Fax: 713-525-4896

E-mail: cdyer@bcm.tmc.edu

Pat Egan

Social Caseworker

Department of Elderly Affairs

160 Pine Street

Providence, RI 02903

Phone: 401-222-6161 

Fax: 401-222-1420

E-mail: pate@dea.state.ri.us

Cynthia Elliott

Meeting Supervisor

National Criminal Justice Reference

Service

2277 Research Boulevard, MS 7D

Rockville, MD 20850

Phone: 301-519-5497

Fax: 301-519-5355

E-mail: celliott@aspensys.com

Tanya Feliciano

Assistant Attorney General

Office of the Attorney General

State of Connecticut

55 Elm Street

P.O. Box 120

Hartford, CT 06141

Phone: 860-808-5210 

Fax: 860-808-5385

E-mail: tanya.feliciano@po.state.ct.us

John Firman

Coordinator for Research and Analysis

International Association of Chiefs of Police

515 North Washington Street

Alexandria, VA 22314

Phone: 703-836-6767 

Fax: 703-836-4543

E-mail: firmanj@theiacp.org

Freda K. Fishman

Chief

Consumer Protection and Antitrust Division

Office of the Attorney General

One Ashburton Place, 19th Floor

Boston, MA 02108

Phone: 617-727-2200 ext. 2926

Fax: 617-727-5765

E-mail: freda.fishman@ago.state.mass.us

Terry Flamand

Assistant Administrator

Blackfeet Tribe

P.O. Box 1070

Browning, MT 59417

Phone: 406-338-3482 

Fax: 406-338-3480

Newman Flanagan

Executive Director

National District Attorney's Association

99 Canal Center Plaza, Suite 510

Alexandria, VA 22314

Phone: 703-519-1650 

Fax: 703-683-0356

E-mail: connie.hepler@ndaa-apri.org
Lisa Forman

Acting Director

Investigative and Forensic Science

Division

National Institute of Justice

U.S. Department of Justice

810 Seventh Street NW., Seventh Floor

Washington, DC 20531

Phone: 202-307-6608 

Fax: 202-307-9907

E-mail: formanl@ojp.usdoj.gov

Christina Frank

Grants Specialist Supervisor

Office of the Attorney General

The Capitol, PL-O1

Tallahassee, FL 32399

Phone: 850-414-3340 

Fax: 850-487-3013

E-mail: christina_frank@oag.state.fl.us

Helene Fredeking

Health Care Financing Administration

U.S. Department of Health and Human

Services

7500 Security Boulevard, MS S2-14-26

Baltimore, MD 21244

Phone: 410-786-7304

Fax: 410-786-0194

Renee S. Fredericksen

Program Consultant

Office of Ombudsman for Older

Minnesotans

Department of Human Services

444 Lafayette Road

Saint Paul, MN 55155

Phone: 651-215-1946 

Fax: 651-297-7855

E-mail: renee.fredericksen@state.mn.us

Sandra Friedman

Paralegal

Civil Rights Division

U.S. Department of Justice

8718 Drexel Hill Place

Montgomery Village, MD 20886

Phone: 301-208-9410 

Shirley Frink

Program Analyst

U.S. Department of Health and Human

Services

330 C Street SW.

Washington, DC 20201

Phone: 202-401-9320 

Fax: 202-401-5916

Robinsue Frohboese

Deputy Chief

Special Litigation Section

Civil Rights Division

U.S. Department of Justice

601 D Street NW.

Washington, DC 20004

Phone: 202-514-6259 

Fax: 202-514-0212

E-mail: robinsue.frohboese@usdoj.gov

Lauren L. Fuller

Chief Investigate Counsel

Senate Special Committee on Aging

G-31 Dirksen Senate Office Building

Washington, DC 20510

Phone: 202-224-5364 

Fax: 202-224-8660

E-mail: lauren_fuller@aging.senate.gov

Vinton J. Gachu

Sergeant

Zuni Police Department

P.O. Box 339

1203-B State Highway 53

Zuni, NM 87327

Phone: 505-782-2476 

Fax: 505-782-2522

Connie Gallagher

Director

Crime Victims Assistance Section

Department of Justice

1162 Court Street NE.

Salem, OR 97310

Phone: 503-378-5348 

Fax: 503-378-5738

E-mail: connie.gallagher@doj.state.or.us
Jerry Gardner

Instructor/Coordinator

Mississippi Law Enforcement Officers'

Training Academy

3791 Highway 468 W.

Pearl, MS 39208

Phone: 601-933-2133 

Fax: 601-933-2200

Elizabeth Gattine

Legal Services Developer

Bureau of Elder and Adult Services

11 State House Station 

35 Anthony Avenue

Augusta, ME 04333

Phone: 207-624-5335 

Fax: 207-624-5361

E-mail: elizabeth.gattine@state.me.us

Julie Gefke

Senior Forensic Analyst

National Institute of Justice

U.S. Department of Justice

810 Seventh Street NW., Seventh Floor

Washington, DC 20531

Phone: 202-305-8774 

Fax: 202-307-9907

E-mail: gefkej@ojp.usdoj.gov

Dale Gillette

Deputy Sheriff

Ross County Sheriff's Office

28 North Paint Street

Chillicothe, OH 45601

Phone: 740-773-1186 

Fax: 740-773-1248

Gregory Giuliano

Director of Protective Services

Executive Office of Elder Affairs

One Ashburton Place, Fifth Floor

Boston, MA 02108

Phone: 612-222-7464 

Fax: 617-727-9368

E-mail: gregorygiuliano@state.ma.us

Bobby Gordon

Social Service Manager

Clark County Social Services

1600 Pinto Lane

Las Vegas, NV 89106

Phone: 702-455-5722 

Fax: 702-455-5950

E-mail: bxg@co.clark.nv.us

William Graham

Assistant Counsel

Legal Services Developer

New York State Office for the Aging

Two Empire State Plaza

Albany, NY 12223

Phone: 518-474-0609 

Fax: 518-474-0608

E-mail: bill.graham@ofa.state.ny.us

Anita Granbois

Program Coordinator

Office of Crime Victims Advocacy

P.O. Box 48304

Olympia, WA 98504

Phone: 360-725-2892 

Fax: 360-586-7176

E-mail: anitag@cted.wa.gov

Theresa Gray

Assistant Attorney General

Attorney General's Office

NCL Tower, Suite 900

445 Minnesota Street

Saint Paul, MN 55101

Phone: 651-296-7013 

Fax: 651-297-4139

E-mail: theresa.gray@state.mn.us

William R. Gray

Coordinator of Adult Protection

Aging and Adult Services

1221 Ironwood Drive, Suite 102

Coeur d'Alene, ID 83814

Phone: 800-786-5536 

Fax: 208-667-5938

E-mail: aps@agingadultsvcs.org

Debra Green

Supervising Attorney

Texas Department of Human Services

701 West 49th Street

Austin, TX 78714

Phone: 512-438-3107 

Fax: 512-438-4749
Paul R. Greenwood

Deputy District Attorney

Head of Elder Abuse Prosecution

San Diego District Attorney

330 West Broadway, Suite 1220

San Diego, CA 92101

Phone: 619-531-3464 

Fax: 619-515-8825

E-mail: pgreen@sdcda.org

Nancy Gresham

Public Outreach Specialist

Office of the Attorney General

State of Texas

P.O. Box 12548

Austin, TX 78711

Phone: 512-936-1317 

Fax: 512-499-0712

E-mail: nancy.gresham@oag.state.tx.us

Tanya L. Gunn

Grant Program Specialist

Bureau of Justice Assistance

U.S. Department of Justice

810 Seventh Street NW.

Washington, DC 20153

Phone: 202-514-5997 

Fax: 202-305-2542

E-mail: gunnt@ojp.usdoj.gov

Leslie A. Hagen

Violence Against Women Training

Attorney

Prosecuting Attorneys Association of

Michigan

116 West Ottawa, Suite 200

Lansing, MI 48913

Phone: 517-334-6060 ext. 833

Fax: 517-334-6787

E-mail: hagenl@state.mi.us

Ricker Hamilton

Protective Program Administrator

Department of Human Services

Bureau of Elder and Adult Services

161 Marginal Way

Portland, ME 04101

Phone: 207-822-2150 

Fax: 207-822-2162

E-mail: ricker.hamilton@state.me.us

Barbara Harriman

Inspector

U.S. Department of Health and Human

Services

Office of the Inspector General

Office of Investigations

330 Independence Avenue SW., Room 5409

Washington, DC 20201

Phone: 202-619-2754 

Fax: 202-401-0502

E-mail: bharrima@os.dhhs.gov

Barbara Harris

Assistant Attorney General

Prosecution Services Bureau

303 North Roberts, Room 168

Helena, MT 59620

Phone: 406-444-2036

Fax: 406-444-4628

E-mail: bharris@state.mt.us 

Kathryn Harrison

Tribal Council Chairperson

The Confederated Tribes of the Grand Ronde

Community of Oregon

9615 Grand Ronde Road

Grand Ronde, OR 97347

Phone: 503-879-2304 

Fax: 503-879-5964

E-mail: www.council@grandronde.org

Despina Hatton

Directing Attorney

Senior Law Project

1155 East Ninth Street

Reno, NV 89512

Phone: 775-328-2592 

Fax: 775-328-6193

Richard Hawkins

Social Services Specialist

Office of Aging Services

275 East Main Street, 5W

Frankfort, KY 40621

Phone: 502-564-6930 

Fax: 502-564-4595
Edward Hazewski

Special Investigator

Department of Justice

820 North French Street

Wilmington, DE 19801

Phone: 302-577-8508 

Fax: 302-577-6499

E-mail: ehazewski@state.de.us

Candace J. Heisler

Assistant District Attorney (Retired)

Consultant and Trainer

54 Miraloma Drive

San Francisco, CA 94127

Phone: 415-661-4410 

Fax: 415-665-3962

E-mail: cjheisler@aol.com

Dora Hemphill

Program Manager

Office of Criminal Justice Programs

William R. Snodgrass Tennessee Tower

312 Eighth Avenue N., Suite 1200

Nashville, TN 37243

Phone: 615-253-1983 

Fax: 615-532-2989

E-mail: dhemphill@mail.state.tn.us

Donald (Don) E. Henderson

Deputy Chief Solicitor-General

De Kalb Solicitor-General's Office 

Consumer Fraud/Elder Abuse Unit

556 North McDonough Street

Decatur, GA 30030

Phone: 404-687-3594 

Fax: 404-687-3582

E-mail: dehender@co.dekalb.ga.us

Steven E. Hillman

Lieutenant-Commander

Public Information Office

Indiana State Police

100 North Senate Avenue

IGC-North, Third Floor

Indianapolis, IN 46204

Phone: 317-232-8204 

Fax: 317-232-5682

E-mail: shillman@isp.state.in.us

Donna J. Hodges

Special Assistant Attorney General

Office of the Attorney General

802 North State Street, Suite 200

P.O. Box 56

Jackson, MS 39202

Phone: 601-359-4220 

Fax: 601-359-4214

E-mail: msag18@ago.state.ms.us

David R. Hoffman

Assistant U.S. Attorney

U.S. Attorney’s Office

Eastern District of Pennsylvania

615 Chestnut Street, Suite 1250

Philadelphia, PA 19106

Phone: 215-861-8337 

Fax: 215-861-8594

E-mail: david.hoffman@usdoj.gov

Robert L. Hudson

President

Oklahoma District Attorney's Association

606 South Husband, Room 202

Stillwater, OK 74074

Phone: 405-372-4883 

Fax: 405-372-4590

E-mail: hudsonr@odawan.net

Carolyn A. Hutchinson

Regional Ombudsman

Long Term Care Ombudsman Program

New Mexico State Agency on Aging

1410 San Pedro NE.

Albuquerque, NM 87110

Phone: 505-255-0971

Fax: 505-255-5602

E-mail: carolyn.hutchinson@state.nm.us

Laura Wilkerson Hyman

Assistant Attorney General

Department of Law

40 Capitol Square SW.

Atlanta, GA 30334

Phone: 404-656-3388 

Fax: 404-463-1062

E-mail: laura.hyman@law.state.ga.us
Carol Isaacs

Deputy Director

Health Legislation and Policy

Development

Department of Community Health

320 South Walnut Street

Lausing, MI 48913

Phone: 517-373-2559 

Fax: 517-241-1200

E-mail: isaacsc@state.mi.us

Joanne M. Ivancic

Deputy Investigator

Senate Special Committee on Aging

G-31 Dirksen Senate Office Building

Washington, DC 20510

Phone: 202-224-5364 

Fax: 202-224-8660

E-mail: joanne_ivancic@aging.senate.gov

David Jackson

Reporter

Chicago Tribune

435 North Michigan Avenue

Chicago, IL 60611

Phone: 312-222-5569 

Fax: 312-222-2550

E-mail: dyjackson@tribune.com

B.J. Jacobs

Protection Specialist

Cabinet for Families and Children

275 East Main Street, 3E-C

Frankfort, KY 40621

Phone: 502-564-7043 

Fax: 502-564-3096

E-mail: bj.jacobs@mail.state.ky.us

Lynne Jacobson

Elder Rights Administrator

Aging Services Division

Department of Human Services

600 South Second Street, Suite 1C

Bismarck, ND 58504

Phone: 701-328-8915 

Fax: 701-328-8989

E-mail: sojacl@state.nd.us

Mark Jeffers

Director

Field Operations/Regulatory

Long Term Care

Department of Human Services

701 West 51st Street

Austin, TX 78751

Phone: 512-438-2626 

Fax: 512-438-5204

E-mail: markjeffers@dhs.state.tx.us

Elizabeth Johnson

Deputy Chief

Special Litigation Section

Civil Rights Division

U.S. Department of Justice

601 D Street NW.

Washington, DC 20004

Phone: 202-514-6248 

Fax: 202-514-2412

E-mail: elizabeth.johnson@usdoj.gov

Melanie Johnson

APS Program Manager

Aging and Adult Services Administration

P.O. Box 45600

Olympia, WA 98504

Phone: 360-725-2531 

Fax: 360-438-8633

E-mail: johnsmc2@dshs.wa.gov

Jane Jones

Director

Area Agency on Aging

Cape Fear Council of Governments

1480 Harbour Drive

Wilmington, NC 28401

Phone: 910-395-4553 ext. 209

Fax: 910-395-2684

E-mail: jjones@capefearcog.org

John W. Jones

Executive Director

Virginia Sheriff's Association

701 East Franklin Street, Suite 706

Richmond, VA 23219

Phone: 804-225-7152 

Fax: 804-225-7162

E-mail: usavsi@virginiasheriffs.org
Nolan Jones

Director

Human Resources Group

National Governor's Association

444 North Capitol Street NW., Suite 267

Washington, DC 20001

Phone: 202-624-5360 

Fax: 202-624-5978

E-mail: njones@nga.org

William P. Jones

Assistant Attorney General

Office of the Attorney General

350 Capitol Street, Room 730

Charleston, WV 25301

Phone: 304-558-3227 

Fax: 304-558-4577

E-mail: wjones@wvdhhr.org

Amy Judy

Systems Advocacy Program Coordinator

Wisconsin Coalition Against Sexual

Assault

600 Williamson Street, Suite N-2

Madison, WI 53703

Phone: 608-257-1516 

Fax: 608-257-2150

E-mail: systems@wcasa.org

Diane Justice

Principal Deputy Assistant Secretary

Administration on Aging

U.S. Department of Health and Human

Services

330 Independence Avenue SW.

Washington, DC 20201

Phone: 202-401-4541 

Fax: 202-260-1012

John Kardys

Director

Community Services Administration

Office of Adult Services

Department of Human Resources

311 West Saratoga Street, Room 259

Baltimore, MD 21201

Phone: 410-767-7317 

Fax: 410-333-0079

E-mail: jkardys2@dhr.state.md.us

Mary Lynn Kasunic

Executive Director

Area Agency on Aging, Region One

1366 East Thomas Road, Suite 108

Phoenix, AZ 85014

Phone: 602-264-2255 

Fax: 602-230-9132

E-mail: kasunic@aaaphx.org

Aileen P. Kaye

Abuse Prevention Program Coordinator

Senior and Disabled Services Division

500 Summer Street NE.

Salem, OR 97310

Phone: 503-945-6399 

Fax: 503-947-5044

E-mail: aileen.p.kaye@state.or.us

David M. Kessler

Chief Investigator

Consumer Protection Section

Office of the Attorney General

30 East Broad Street, 23rd Floor

Columbus, OH 43215

Phone: 614-466-2601 

Fax: 614-995-0123

E-mail: dkessler@org.state.oh.us

Andrew Ketterer

Attorney General

State of Maine

Six State House Station

Augusta, ME 04333

Phone: 207-626-8566 

Fax: 207-287-3145

E-mail: andrew.ketterer@state.me.us

Barbara Kidder

Program Manager

Adult Protective Services

Oklahoma Department of Human Services

Aging Services Division

312 Northeast 28th Street

Oklahoma City, OK 73105

Phone: 405-521-3660 

Fax: 405-521-2086

E-mail: barbara.kidder@okdhs.org
David Kirkman

Assistant Attorney General

Consumer Protection Division

North Carolina Department of Justice

P.O. Box 629

Raleigh, NC 27602

Phone: 919-716-6033 

Fax: 919-716-7050

E-mail: dkirkman@mail.jus.state.nc.us

Patsy Klaus

Statistician

Bureau of Justice Statistics

Office of Justice Programs

U.S. Department of Justice

810 Seventh Street NW., Room 2217

Washington, DC 20537

Phone: 202-307-0776 

Fax: 202-307-5846

E-mail: klausp@ojp.usdoj.gov

Kitty Kocol

Executive Director

Office of Crime Victims Services

Wisconsin Department of Justice

P.O. Box 7951

Madison, WI 53707

Phone: 608-264-9497 

Fax: 608-264-6368

E-mail: kocolkm@doj.state.wi.us

Sandi Koll

Program Manager

Adult Protective Services

Department of Human Services

Hoover Building

1305 East Walnut Street

Des Moines, IA 50319

Phone: 515-281-6219 

Fax: 515-242-6884

E-mail: skou@dhs.state.ia.us

Larry E. Kopko

Sheriff

Warren County Sheriff's Office

407 Market Street

Warren, PA 16365

Phone: 814-723-7553 

Fax: 814-726-2113

E-mail: warrenso@cji.net

Judith Kozlowski

Assistant U.S. Attorney

U.S. Attorney's Office

District of Columbia

555 Fourth Street NW.

Washington, DC 20001

Phone: 202-514-6964 

Fax: 202-307-2304

E-mail: judith.kozlowski@usdoj.gov

Becky Kurtz

State Long-Term Care Ombudsman

Georgia Long-Term Care

Ombudsman Program

Two Peachtree Street NW., Suite 36.233

Atlanta, GA 30312

Phone: 404-657-5327 

Fax: 404-463-8384

E-mail: bakurtz@dhr.state.ga.us

Eva Kutas

President

National Association of Adult Protective

Service Administrators

P.O. Box 14250

Salem, OR 97309

Phone: 503-945-9491 

Fax: 503-945-9893

E-mail: eva.kutas@state.or.us

Bob Kuykendall

U.S. Postal Inspector

U.S. Postal Inspection Service

600 Pennsylvania Avenue NW., Room 284

Washington, DC 20580

Phone: 202-326-3182 

Fax: 202-326-3392

E-mail: bkuykendall@ftc.gov

Adrian Kwock

Chief

Grants and Planning Branch

Crime Prevention and Justice Assistance

Division

Department of the Attorney General

235 South Beretania Street, Suite 401

Honolulu, HI 96813

Phone: 808-586-1155 

Fax: 808-586-1373

E-mail: akwock@lava.net
Jeffrey LaGrew

Assistant Deputy Attorney General

Office of the Attorney General

700 Capitol Avenue

Frankfort, KY 40601

Phone: 502-696-5610 

Fax: 502-564-8310

E-mail: jeff.lagrew@law.state.ky.us

Mary Larkin

Chief Attorney-Administration

Oakland County Prosecutor's Office

1200 North Telegraph Road

Pontiac, MI 48341

Phone: 248-858-5558 

Fax: 248-452-2208

E-mail: larkinm@co.oakland.mi.us

J. Chris Larson

Trial Attorney

Fraud Section

Commercial Litigation Branch

Civil Division

U.S. Department of Justice

601 D Street NW., Room 9704-PHB

Washington, DC 20004

Phone: 202-616-8132 

Fax: 202-616-3085

E-mail: j.chris.larson@usdoj.gov

Patricia K. Lashway

Director

Residential Care Services

Department of Social and Health Services

P.O. Box 45600

Olympia, WA 98504

Phone: 360-725-2400 

Fax: 360-438-7903

E-mail: lashwpk@dshs.wa.gov

Beverly Laubert

State Long-Term Care Ombudsman

Ohio Department of Aging

50 West Broad Street

Columbus, OH 43215

Phone: 614-644-7922 

Fax: 614-644-5201

E-mail: blaubert@age.state.oh.us

Maria Laurence

Consultant

4211 South 32nd Road

Arlington, VA 22206

Phone: 703-575-9632 

Fax: 703-575-9647

E-mail: marialau@mindspring.com

Ann Leamy

Social Caseworker

Department of Elderly Affairs

160 Pine Street

Providence, RI 02903

Phone: 401-222-6161 ext. 327

Fax: 401-222-1420

E-mail: ann@dea.state.ri.us

Mary Lou Leary

Acting Assistant Attorney General

Office of Justice Programs

U.S. Department of Justice

810 Seventh Street NW.

Washington, DC 20531

Phone: 202-307-5933 

Fax: 202-514-7805

Todd Leatherman

Director

Consumer Protection Division

Office of the Attorney General

1024 Capital Center Drive

Frankfort, KY 40601

Phone: 502-696-5389 

Fax: 502-573-8317

E-mail: todd.leatherman@law.state.ky.us

Ellen Leitzer

Co-Director

Senior Citizens Law Office, Inc.

3117 Silver Avenue SE.

Albuquerque, NM 87106

Phone: 505-265-2300 

Fax: 505-265-3600

E-mail: abqsclo@aol.com

Peter K. Levitt

Assistant U.S. Attorney

U.S. Attorney’s Office

District of Massachusetts

One Courthouse Way, Suite 9200

Boston, MA 02210

Phone: 617-748-3355 

Fax: 617-748-3971

E-mail: peter.levitt@usdoj.com
Christine Lewis

Director of Elderly Services

Department of Social Services

25 Sigourney Street

Hartford, CT 06106

Phone: 860-424-5277 

Fax: 860-424-5301

E-mail: christine.lewis@po.state.ct.us

Carol Lieske

Program Manager

Adult Protective Services

Department of Health and Human

Services

Special Services for Children and Adults

P.O. Box 95044

Lincoln, NE 68509

Phone: 402-471-9190 

Fax: 402-471-6352

E-mail: carol_lieske@hhss.state.ne.us

Mary Beals Luedtka

Legal Advocate

Elder Rights Unit Supervisor

Northern Arizona Council of Governments

Area Agency on Aging

119 East Aspen

Flagstaff, AZ 86001

Phone: 520-774-1894 

Fax: 520-214-7235

E-mail: aging@futureone.com

Michelle Lujan-Grisham

Director

State Agency on Aging

228 East Palace Avenue

Santa Fe, NM 87501

Phone: 505-827-7640 

Fax: 505-827-7649

E-mail: michelle.grisham@state.nm.us

Brian Lutz

Executive Assistant, Fraud and Abuse

Administration on Aging

U.S. Department of Justice

Cohen Building

330 Independence Avenue SW., Room

4748

Washington, DC 20201

Phone: 202-690-7525 

Fax: 202-260-1012

E-mail: brian.lutz@aoa.gov

Terri Lynch

Director

Arlington Agency on Aging

3033 Wilson Boulevard

Arlington, VA 22201

Phone: 703-228-1733 

Fax: 703-288-1148

E-mail: tlynch@eo.arlington.va.us

Catherine Lyon

Program Administrator, APS

Division of Aging and Adult Services

P.O. Box 1437 - Slot 1412

Little Rock, AR 72203

Phone: 501-682-8496 

Fax: 501-682-6393

E-mail: catherine.lyon@mail.state.ar.us

Anne Macaluso

Geriatic Nurse Practitioner

Saint Barnabas Health Care System

1200 River Avenue, Suite 5

Lakewood, NJ 08701

Phone: 732-367-4422 

E-mail: amacaluso@sbhcs.com

Myra Magee Red Fox

Discharge Planner

Indian Health Services

Blackfeet Community Hospital

P.O. Box 1468

Browning, MT 59417

Phone: 406-338-6231 ext. 231

Fax: 406-338-6207

Daniel Marcus

Acting Associate Attorney General

U.S. Department of Justice

950 Pennsylvania Avenue NW.

Washington, DC 20530

Barbara Martin-Worley

Director

Denver Extension

Colorado State University

110 16th Street, Suite 300

Denver, CO 80202

Phone: 720-913-5266 

Fax: 720-913-5289

E-mail: bmw@coop.ext.colostate.edu
Theresa Martinac

Chief

Division of Criminal Justice

Office of Victim-Witness Advocacy

25 Market Street

P.O. Box 085

Trenton, NJ 08625

Phone: 609-588-7900 

Fax: 609-588-7890

E-mail: martinact@smtp.lps.state.nj.us

Anne Mastro

Coordinator of S.O.S Program

Kimball Medical Center

1200 Route Nine, Suite 5

Lakewood, NJ 08701

Phone: 732-367-4422 

Fax: 732-370-2077

E-mail: amastro@sbhcs.com

Lora Maynard

Justice Programs Specialist

West Virginia Division of Criminal Justice

Services

1204 Kanawha Boulevard E.

Charleston, WV 25301

Phone: 304-558-8814 ext. 210

Fax: 304-558-0391

E-mail: lmaynard@wvdcjs.org

Barbara McBrayer-Brice

Elder Rights and Advocacy Section

Manager

Division of Aging Services

Department of Human Resources

Two Peachtree Street NW., Room 36-103

Atlanta, GA 30303

Phone: 404-657-5325

Fax: 404-657-5285

E-mail: bmbrice@dhr.state.ga.us

John G. McDermott

State Long Term Care Ombudsman

Executive Office on Aging

One Capitol District

250 South Hotel Street, Suite 109

Honolulu, HI 96813

Phone: 808-586-7268 

Fax: 808-586-0185

E-mail:

jgmcderm@mail.health.state.hi.us

Jeanmarie McKinney

Compliance Nurse Supervisor

Long Term Care Residents Protection

Health and Social Services

Three Mill Road, Suite 308

Wilmington, DE 19806

Phone: 302-577-6661 ext. 230

Fax: 302-577-6672

E-mail: jemckinney@state.de.us

Douglas McNutt

Administrator

Division of Elder and Adult Services

129 Pleasant Street

Concord, NH 03301

Phone: 603-271-4681 

Fax: 603-271-4643

E-mail: dmcnutt@dhhs.state.nh.us

William L. McReynolds

Sheriff

Racine County Sheriff's Department

717 Wisconsin Avenue

Racine, WI 53403

Phone: 262-636-3203 

Fax: 262-637-5279

E-mail: williamm@racineco.com

Ronald McVeigh

Systems Manager

Kansas Sentencing Commission

700 Southwest Jackson Street, Suite 501

Topeka, KS 66603

Phone: 785-296-0923 

Fax: 785-296-0927

E-mail: rmcveigh@cjnetworks.com

Jan McWilliams

Program Manager

Division of Victim Services

2301 Central Avenue

Cheyenne, WY 82002

Phone: 307-777-6681 

Fax: 307-777-6683

E-mail: jmcwil@state.wy.us

Pamela J. Meister

Assistant Attorney General

Office of Attorney General

One Ashburn Place

Boston, MA 02118

Phone: 617-727-2200 ext. 2920

Fax: 617-727-5762

E-mail: pam.meister@ago.state.ma.us
Charles Mendonca

Police Officer

Pascua Yaqui Tribe of Arizona

7474 South Camino de Oeste

Tucson, AZ 85746

Phone: 520-879-5500 ext. 5536

Fax: 520-879-5510

E-mail: pyit@liveline.com

Diane Menio

Executive Director

CARIE

1315 Walnut Street, Suite 1000

Philadelphia, PA 19107

Phone: 215-545-5728 

Fax: 215-545-5372

Bettye M. Mitchell

Director

Adult Protective Services

Department of Protective and Regulatory

Services

701 West 51st Street

Austin, TX 78751

Phone: 512-438-3209 

Fax: 512-438-4881

E-mail: mitchebm@tdprs.state.tx.us

Ken Mitchell

Georgia State Director

AARP

999 Peachtree Street NE., Suite 1645

Atlanta, GA 30309

Phone: 404-870-3780 

Fax: 404-881-6997

E-mail: kmitchell@aarp.org

Martin C. Mooney

Deputy Attorney General

Division of Criminal Justice

Prosecutors and Police

Hughes Justice Complex

P.O. Box 085

Trenton, NJ 08625

Phone: 609-984-2814 

Fax: 609-341-2077

E-mail: mooneym@dcj.lps.state.nj.us

Debra Moore

Older Iowans Advocate and Consumer

Educator

Office of the Attorney General

Hoover Building

1300 East Walnut

Des Moines, IA 50319

Phone: 515-281-8770

Fax: 515-281-4209

E-mail: dmoore@ag.state.ia.us

Jeffrey B. Moore

Executive Director

South Carolina Sheriffs Association

7338 Broad River Road

Irmo, SC 29063

Phone: 803-749-0265 

Fax: 803-732-0325

E-mail: sheriffsc@aol.com

Rebecca Morgan

Professor of Law

Stetson Law School

1401 61st Street

Saint Petersburg, FL 33704

Phone: 727-562-7872 

Fax: 727-343-9319

E-mail: morgan@law.stetson.edu

Wendy Morgan

Chief

Public Protection Division

Office of the Attorney General

109 State Street

Montpelier, VT 05609

Phone: 802-828-0269 

Fax: 802-828-2154

E-mail: wmorgan@atg.state.vt.us

Catherine Morris

Assistant Commissioner

Department of Health and Senior Services

P.O. Box 367

120 South Stockton Street

Trenton, NJ 08625

Phone: 609-633-8977 

Fax: 609-633-9060

E-mail: cmorris@doh.state.nj.us
Rebecca Morris

President

Conference Reports & Internet Services

27 Freeman Street

Arlington, MA 02474

Phone: 781-643-6311

Fax: 781-646-2628

E-mail: morris@conferencereports.com

Margaret Morrow

Special Assistant

Office of the Assistant Attorney General

Office of Justice Programs

U.S. Department of Justice

810 Seventh Street NW.

Washington, DC 20531

Phone: 202-305-2986 

Fax: 202-514-7508

E-mail: meg@ojp.usdoj.gov

Clifford Moses

Tribal Councilman

Yakama Nation Tribal Council

P.O. Box 151

Toppenish, WA 98948

Phone: 509-865-5121 ext. 4337

Fax: 509-865-5745

E-mail: cynthia@yakama.com

Laura Mosqueda

Director of Geriatrics

Associate Clinical Professor

Family Medicine

Irvine College of Medicine

University of California

Pavilion III, ZC 1150

101 The City Drive

Orange, CA 92868

Phone: 714-456-5530 

Fax: 714-456-7933

E-mail: mosqueda@uci.edu

Jeanne Mullgrav

Deputy Director of InterGovernmental

Relations

Office of the Attorney General

120 Broadway, 25th Floor

New York, NY 10271

Phone: 212-416-8003 

Fax: 212-416-8942

E-mail: jeanne.mullgrav@oag.state.ny.us

Christine Murphy

Presidential Management Intern

Administration on Aging

U.S. Department of Justice

200 Independence Avenue SW., Room 352 

Washington, DC 20201

Phone: 202-205-5756 

Fax: 202-619-0850

E-mail: christine.murphy@aoa.gov

Sidney Murphy

Executive Director

Preston County Senior Citizens, Inc.

P.O. Box 10

Kingwood, WV 26537

Phone: 304-329-0464 

Fax: 304-329-2584

E-mail: pcsc@access.mountain.net

John Thomas Murray

Chief of Investigative Section

Long Term Care Residents Protection

Department of Health and Social Services

Three Mill Road, Suite 308

Wilmington, DE 19806

Phone: 302-577-7295 ext. 212

Fax: 302-577-6673

E-mail: johmurray@state.de.us

Pam Murray

Meeting Coordinator

National Criminal Justice Reference Service

2277 Research Boulevard, MS 7D

Rockville, MD 20850

Phone: 301-519-6455 

Fax: 301-519-5355

E-mail: pmurray@aspensys.com

Jeffrey H. Myers

Principal Counsel

Department of Aging

301 West Preston Street, Room 1007

Baltimore, MD 21201

Phone: 410-767-1110 

Fax: 410-337-7943

E-mail: jhm@mail.ooa.state.md.us
Karen L. Nenstiel

Special Agent

Financial Crime Investigation

Department of Justice

Bureau of Investigation

540 North Blount Street

P.O. Box 11308

Raleigh, NC 27604

Phone: 919-716-0000 

Fax: 919-733-4717

E-mail: knenstiel@mail.jus.state.nc.us

Lisa Nerenberg

Private Consultant

1906 Barton Street

Redwood City, CA 94061

Phone: 650-306-0253 

Fax: 650-306-0211

E-mail: lnerenberg@aol.com

Scott C. Newman

Prosecuting Attorney

Marion County Prosecutor's Office

560 City-County Building

200 East Washington Street

Indianapolis, IN 46204

Phone: 317-327-5662 

Fax: 317-327-5325

E-mail: snewman@indygov.org

Caroline G. Nicholl

Program Manager/Family Violence

Metropolitan Police Department

300 Indiana Avenue NW.

Washington, DC 20001

Phone: 202-727-5029 

Fax: 202-727-0711

E-mail: carolinenicholl@hotmail.com

Darci Nielsen

Detective

City of Phoenix Police Department

620 West Washington

Phoenix, AZ 85003

Phone: 602-256-4347 

Fax: 602-495-0871

E-mail: dnielsen@ci.phoenix.az.us

Lee Norrgard

Senior Program Coordinator

AARP

601 E Street NW.

Washington, DC 20049

Phone: 202-434-6053

Fax: 202-434-7683

E-mail: lnorrgard@aarp.org

Judy O'Neal

Chief

Victim Witness Branch

Office of Criminal Justice Planning

1130 K Street, Suite 300

Sacramento, CA 95814

Phone: 916-323-7727 

Fax: 916-324-8554

E-mail: judy.oneal@ocjp.ca.gov

Gloria One Feather

Probation Officer

Oglala Sioux Tribe

Congleska, Inc.

P.O. Box 3003

Pine Ridge, SD 57770

Phone: 605-867-1035 

Fax: 605-867-1728

Kristine Orlando

Bureau of Justice Assistance

U.S. Department of Justice

810 Seventh Street NW.

Washington, DC 20531

Phone: 202-616-3209 

E-mail: orlandok@ojp.usdoj.gov

Joanne M. Otto

Program Administrator

Adult Protective Services

Aging and Adult Services

Department of Human Services

1575 Sherman Street, Ground Floor

Denver, CO 80302

Phone: 303-866-2651 

Fax: 303-866-2696

E-mail: joanne.otto@state.co.us
Catherine Schuster Pascale

Assistant Attorney General

Medicaid Fraud Control Unit

Office of Attorney General

200 St. Paul Place, Suite 1800

Baltimore, MD 21202

Phone: 410-576-6530 

Fax: 410-576-6521

E-mail: cpascale@oag.state.md.us

Sharon Patnode

Assistant Secretary

Department of Health and Environment

400 Southwest Eighth Avenue, Suite 200

Topeka, KS 66603

Phone: 785-296-7032 

Fax: 785-368-6368

E-mail: spatnode@kdhe.state.ks.us

Steve Pelovitz

Health Care Financing Administration

U.S. Department of Health and Human

Services

7500 Security Boulevard

Baltimore, MD 21244

Phone: 410-786-3160 

Fax: 410-786-0194

Andrew Penn

Senior Counsel

Office of the Inspector General

330 Independence Avenue SW., Room

5527

Washington, DC 20201

Phone: 202-205-9505

Fax: 202-205-0604

Susana Perry

Program Specialist

Women's Health and Consumer

Protection

Administration on Aging

U.S. Department of Health and Human

Services

330 Independence Avenue SW., Room

4757

Washington, DC 20201

Phone: 202-251-7459 

Fax: 202-260-1012

E-mail: susana.perry@aoa.gov

Joseph Persia

Grant Administrator

Rhode Island Justice Commission

Administration Building

One Capitol Hill

Providence, RI 02908

Phone: 401-222-4498 

Fax: 401-222-1294

E-mail: joep@gw.doa.state.ri.us

Glen R. Petersen

Assistant U.S. Attorney

U.S. Attorney’s Office

Middle District of Louisiana

777 Florida Street, Suite 208

Baton Rouge, LA 70801

Phone: 225-389-0443 

Fax: 225-389-0561

E-mail: glen.petersen@usdoj.gov

Deborah R. Peterson

Manager

Medicaid Fraud Division

Office of the Attorney General

NCLTower, Suite 700

445 Minnesota Street

St. Paul, MN 55101

Phone: 651-297-1093 

Fax: 651-282-5801

E-mail: deborah.peterson@state.mn.us

Loretta Petty

Director

Center for Elder Rights

Virginia Department for the Aging

1600 Forest Avenue, Suite 102

Richmond, VA 23229

Phone: 804-662-9333 

Fax: 804-662-9354

E-mail: aging@vdh.state.va.us

Katrina C. Pflaumer

U.S. Attorney’s Office

Western District of Washington

601 Union Street, Suite 5100

Seattle, WA 98101

Phone: 206-553-1291 

Fax: 206-553-2054

E-mail: kate.pflaumer@usdoj.gov
Catherine Pierce

Deputy Director

Program Development Division

Violence Against Women Office

Office of Justice Programs

U.S. Department of Justice

800 K Street NW., Room 920

Washington, DC 20531

Phone: 202-307-3913 

Fax: 202-305-2589

James H. Pietsch

Associate Professor and Director 

University of Hawaii Elder Law Program

University of Hawaii School of Law

2515 Dole Street

Honolulu, HI 96822

Phone: 808-956-6785 

Fax: 808-956-9439

E-mail: jpietsch@hawaii.edu

Linda Purdy

Director

Medicaid Fraud Control Unit

Office of the Attorney General

MFCU

43 Randall Street

Waterbury, VT 05671

Phone: 802-241-4440 

Fax: 802-241-4447

E-mail: lpurdy@atg.state.vt.us

Allen K. Pyles

Senior Health and Human Resource

Specialist

Office of Social Services 

Department of Health and Human

Resources

300 Capitol Street, Room 691

Charleston, WV 25301

Phone: 304-558-7980 

Fax: 304-558-4563

E-mail: apyles@dhhr.org

Rebecca Quam

Acting Program Director

Tribe Social Services

Pueblo of Zuni

P.O. Box 339

Zuni, NM 87327

Phone: 505-782-4481 ext. 141 

Fax: 505-782-5077

Kathleen M. Quinn

Chief

Bureau of Elder Rights

Department on Aging

421 East Capitol Avenue

Springfield, IL 62701

Phone: 217-785-3386 

Fax: 217-524-9644

E-mail: kathleen.quinn@aging.state.il.us

Holly Ramsey-Klawsnik

Sociologist, Licensed Marriage and Family

Therapist

Klawsnik and Klawsnik Associates

24 High Street

Canton, MA 02021

Phone: 781-828-0784 

Fax: 781-828-0784

E-mail: jak1999@mediaone.net

Jane A. Raymond

Advocacy and Protection Systems Developer

Bureau of Aging and Long Term Care

Resources

One West Wilson Street, Room 450

P.O. Box 7851

Madison, WI 53707

Phone: 608-266-2568 

Fax: 608-267-3203

E-mail: raymoja@dhfs.state.wi.us

Vic Reichman

First Assistant Attorney General

Office of the Attorney General

1525 Sherman Street, Fifth Floor

Denver, CO 80203

Phone: 303-866-3416 

Fax: 303-866-3955

E-mail: vic.reichman@state.co.us

Janet Reno

U.S. Attorney General

U.S. Department of Justice

950 Pennsylvania Avenue NW.

Washington, DC 20530
Cesario Chayo Reyes

Proprietor

Elder Financial Protective Services

17209 Antonio Avenue

Cerritos, CA 90703

Phone: 562-926-7380 

Fax: 562-926-7380

E-mail: chayo@iol7.com

Sarah Reznek

Consumer Protection Project Director and

Counsel

National Association of Attorneys General

750 First Street NE., Suite 1100

Washington, DC 20002

Phone: 202-326-6016 

Fax: 202-408-6998

Bette Jane Riordan

Paralegal

Consumer Protection

Office of the Attorney General

33 Capitol Street

Concord, NH 03301

Phone: 603-271-3643 

Fax: 603-271-2110

E-mail: briordan@doj.state.nh.us

Ruth A. Ritthaler

Assistant District Attorney

18th Judicial District

Office of District Attorney

535 North Main

Wichita, KS 67203

Phone: 316-383-7002 

Fax: 316-383-4669

E-mail: rritthal@sedgwick.gov

Edgar Rivas

Vice President for Policy

National Hispanic Council on Aging

2713 Ontario Road NW.

Washington, DC 20001

Phone: 202-745-2521 

Fax: 202-745-2522

E-mail: edgarrivas@att.net

Sister Mary Simon Robb

Coordinator

Division of Senior Affairs

Adult Protective Services

P.O. Box 807

Trenton, NJ 08625

Phone: 609-588-3464 

Fax: 609-588-3601

Leo Rognlin

Police Officer 

Community Relations

Crime Prevention Officer

Fargo Police Department

222 Fourth Street N.

P.O. Box 150

Fargo, ND 58107

Phone: 701-241-1343 

Fax: 701-297-7789

E-mail: larognlin@ci.fargo.nd.us

Audry Rohn

Deputy District Attorney

Ventura County District Attorney's Office

800 South Victoria Avenue

Ventura, CA 93009

Phone: 805-654-2288 

Fax: 805-654-3850

E-mail: audry.rohn@mail.co.ventura.ca.us

Larry Ross

Investigator

Special Litigation Section

Civil Rights Division

U.S. Department of Justice

601 D Street NW.

Washington, DC 20004

Phone: 202-514-6255 

Fax: 202-514-0212

E-mail: larry.ross@usdoj.gov

John Rother

Director

Legislation and Public Policy

AARP

601 E Street NW.

Washington, DC 20011

Phone: 202-434-3701 

Fax: 202-434-3714

E-mail: jrother@aarp.org
Beverly Rowley

State Long Term Care Ombudsman

Department on Aging

421 East Capitol Street, Suite 100

Springfield, IL 62701

Phone: 217-785-3143 

Fax: 217-524-9644

E-mail: browley@age084r1.state.il.us

Maria Rubio

Program Analyst

Training and Technical Assistance

Division

COPS Office

U.S. Department of Justice

1100 Vermont Street NW.

Washington, DC 20530

Phone: 202-633-1352 

Fax: 202-633-1354

E-mail: maria.rubio@usdoj.gov

Laurie E. Rucoba

Assistant U.S. Attorney

U.S. Attorney's Office

Southern District of Florida

500 East Broward Boulevard, Suite 700

Ft. Lauderdale, FL 33394

Phone: 954-356-7314 ext. 3613

Fax: 954-356-7180

E-mail: laurie.rucoba@justice.usdoj.gov

Senora Russell

Nashville, TN 

Rosalie Sacks

APS Program Manager

Kansas Department of Social and

Rehabilitation Services

Docking State Office Building

915 Southwest Harrison, Room 681-West

Topeka, KS 66612

Phone: 785-296-3349 

Fax: 785-296-0146

E-mail: sacks@srskansas.org

Joe Sampson

Chairman

Advisory Board

Yakama Nation Area Agency on Aging

P.O. Box 151

Toppenish, WA 98948

Phone: 509-874-2184 

Fax: 509-865-2098

Cathy Sanders

Deputy Division Director

Office for Victims of Crime

U.S. Department of Justice

810 Seventh Street NW.

Washington, DC 

Phone: 202-616-3578 

Fax: 202-514-6383

E-mail: cathy@ojp.usdoj.gov

Tom Sawyer

Sheriff-Coroner

Merced County Sheriff's Department

2222 M Street

Merced, CA 95340

Phone: 209-385-7451 

Fax: 209-385-7696

E-mail: 5708@ca.merced.us.ca

Mary E. Schaefer

Director of Planning and Development

Mid-East Area Agency on Aging

14535 Manchester Road

Manchester, MO 63011

Phone: 636-207-0847 

Fax: 636-207-1329

E-mail: mideast4@mid-eastaaa.org

Stephen Schneider

Attorney

Oregon Senior and Disabled Services

Division

500 Summer Street NE.

Salem, OR 97310

Phone: 503-378-2546 

Fax: 503-378-2558

E-mail: stephen.schneider@state.or.us

Holly Schumann

Presidential Management Intern

Administration on Aging

U.S. Department of Health and Human

Services

200 Independence Avenue SW., Room 3526

Washington, DC 20201

Phone: 202-619-7592 

Fax: 202-619-0850

E-mail: holly.schumann@aoa.gov
Linda Scott

Aging Programs Analyst II

Long-Term Care Ombudsman 

Department of Aging

1600 K Street

Sacramento, CA 95814

Fax: 916-323-7299

E-mail: lscott@aging.state.ca.us

James D. Sewell

Regional Director

Department of Law Enforcement

4211 North Lois Avenue

Tampa, FL 33614

Phone: 813-878-7890 

Fax: 813-878-7303

E-mail: jimsewell@fdle.state.fl.us

Judith Sgrillo

Program Manager, Assurance and

Licensure

Department of Health Services

1647 East Morten, Suite 130

Phoenix, AZ 85020

Phone: 602-674-9725

Fax: 602-395-8910

E-mail: jsgrillo@hs.state.az.us

Pete Shepherd

Special Counsel to Attorney General

Hardy Myers

Department of Justice

1162 Court Street NE.

Salem, OR 97310

Phone: 503-378-6002 

Fax: 503-378-4017

E-mail: pete.sheperd@doj.state.or.us

Gerald G. Shockley

Senior Special Agent

Office of the Attorney General

11 South Union Street

Montgomery, AL 36104

Phone: 334-353-7979 

Fax: 334-353-8796

E-mail: gshockley@ago.state.al.us

Chris Shoemaker

Senior Management Analyst II

Department of Children and Families

Building Six, Room 366

1317 Winewood Boulevard

Tallahassee, FL 32399

Phone: 850-488-2881 

Fax: 850-922-4193

E-mail: chris_shoemaker@dcf.state.fl.us

Richard Sicchio

Executive Director

Northern Area Agency on Aging

P.O. Box 1028

Rhinelander, WI 54501

Phone: 715-365-2532 

Fax: 715-365-2534

E-mail: rsicchio@bfm.org

Rose Sigler

Director, Investors Savings Bank

Co-Chair, A Subcommittee of The New

Jersey Committee on Aging

Assisted Independence and Money

Management

44 Arlene Court

Fanwood, NJ 07023

Phone: 908-889-4836 

Fax: 908-889-8778

E-mail: rose57607@aol.com

Wanda C. Simmons

Director

Southwest Tennessee Area Agency on Aging

27 Conrad Drive, Suite 150

Jackson, TN 38305

Phone: 901-668-6403 

Fax: 901-668-6421

E-mail: swaaa@aeneas.net

Terri Skladany

Special Counsel for Ethics, Professionalism,

and Training

Arizona Attorney General's Office

1275 West Washington

Phoenix, AZ 85007

Phone: 602-542-8080 

Fax: 602-542-1964

E-mail: tskladan@ag.state.az.us
Adrienne Smith

Assistant Attorney General

Office of the Attorney General

670 Woodland Square Loop SE.

P.O. Box 40124

Olympia, WA 98504

Phone: 360-459-6052 

Fax: 360-459-6689

E-mail: adriennes@atg.wa.gov

Joyce Smith

Director of Community Based Services

Department on Aging

New England Building

503 South Kansas

Topeka, KS 66603

Phone: 785-291-3356 

Fax: 785-296-0256

E-mail: joyces@aging.wpo.state.ks.us

Kerry Smith

Director of Consumer Education

Office of Consumer Affairs and Business

Regulation

One Ashburton Place, Room 1411

Boston, MA 02108

Phone: 617-573-7320 

Fax: 617-227-6094

E-mail: kerry.smith@state.ma.us

Susan B. Somers

Assistant Commissioner

Bureau of Adult Services

Office of Children and Family Services

40 North Pearl Street Riverview Six

Albany, NY 12234

Phone: 518-402-6782 

Fax: 518-474-8572

E-mail: sbsomers@dfa.state.ny.us

William Sorrell

Attorney General of Vermont

Office of the Attorney General

109 State Street

Montpelier, VT 05609

Phone: 802-828-0269 

Fax: 802-828-2154

E-mail: wsorrell@atg.state.vt.us

Marta Sotomayor

President

National Hispanic Council on Aging

2713 Ontario Road NW.

Washington, DC 20009

Phone: 202-265-1288 

Fax: 202-265-8153

E-mail: nhcoa@worldnet.att.net

Joyce L. Speakman

MFT Training

John F. Kennedy University

554 Valle Vista Avenue

Oakland, CA 94610

Phone: 510-834-2513 

Fax: 510-444-7476

E-mail: joycespeakman@hotmail.com

Vivian Spence

Investigator

Department of the Attorney General

150 South Main Street

Providence, RI 02903

Phone: 401-274-4400 ext. 2225

Fax: 401-222-5110

E-mail: vspencer@riag.state.ri.us

Kari Spottiswood

Assistant Corporation Counsel

Abuse and Neglect

Office of the Corporation Counsel

441 Fourth Street NW., Sixth Floor N.

Washington, DC 20001

Phone: 202-442-9758 

Fax: 202-727-3737

E-mail: kspottiswood@occ.dcgov.org

Daniel G. Stackis

Administrator

Aging Division

Department of Health

6101 Yellowstone Road, Room 259B

Cheyenne, WY 82002

Phone: 307-777-7986 

Fax: 307-777-5340

E-mail: dstack@state.wy.us
Sidney M. Stahl

Chief

Health Care and Social Institutions

National Institute on Aging

National Institute of Health

Gateway Building, Suite 533

Bethesda, MD 20892

Phone: 301-402-4156 

Fax: 301-401-0051

E-mail: sidney_stahl@nih.gov

Ezzard Charles Stamps

Program Manager

Division of Public Safety Planning

Office of Justice Programs

401 North West Street

P.O. Box 23039

Jackson, MS 39225

Phone: 601-359-7892 

Fax: 601-359-7832

E-mail: cstamps@dps.state.ms.us

Ken Steele

Tribal Consultant

Ogalala Sioux Tribe

P.O. Box 316

Manderson, SD 57756

Phone: 605-455-1244 

Lori Stiegel

Associate Staff Director

Commission on Legal Problems of the

Elderly

American Bar Association

740 15th Street NW.

Washington, DC 20005

Phone: 202-662-8692 

Fax: 202-662-8698

E-mail: lstiegel@staff.abanet.org

Jan Stiles

Program Consultant

Protective Services Division

Department of Family Services

Hathaway Building, Third Floor

Cheyenne, WY 82002

Phone: 307-777-6137 

Fax: 307-777-3693

E-mail: jstile@state.wy.us

Joyce Pashley Stockwell

Assistant Director

Residential Care Services

P.O. Box 45600

Olympia, WA 98504

Phone: 360-725-2404 

Fax: 360-438-7903

E-mail: stockjp@dshs.wa.gov

C. Ronald Stromberg

Assistant Director

Division of Aging and Adult Services

120 North 200 West

Salt Lake City, UT 84103

Phone: 801-538-4591 

Fax: 801-538-4395

E-mail: rstrombe@hs.state.ut.us

Lori Sywensky

Criminal Justice System Planner

Pennsylvania Commission on Crime and

Delinquency

3101 North Front Street

Harrisburg, PA 17110

Phone: 717-783-0551 ext. 3044

Fax: 717-772-4331

E-mail: lsywensky@state.pa.us

Deanna Taha

Social Work Supervisor of Senior Citizens

Protective Services

Clark County Social Service

3827 Maryland Parkway

Las Vegas, NV 89119

Phone: 702-455-8687

Fax: 702-455-8682

E-mail: dmt@co.clark.nv.us

Jackie Tang

Director

Northern Cheyenne Social Services

P.O. Box 128

Lame Deer, MT 59043

Phone: 406-477-8321 

Fax: 406-477-8333

Audrey D. Thibodeaux

Program Director

Elderly Crime Victim Assistance Program

St. Martin Parish Sheriff's Office

437 West Mills Avenue

Breaux Bridge, LA 70517

Phone: 337-332-2131 

Fax: 337-332-3411
Jill Thomas

RNC

620 Millard Drive

Bay Village, OH 44140

Phone: 404-835-6516

Fax: 440-871-3586

E-mail: jillthomas@aol.com 

Randolph W. Thomas

Law Enforcement Instructor

Criminal Justice Academy

Department of Public Safety

5400 Broad River Road

Columbia, SC 29212

Phone: 803-896-7756 

Fax: 803-896-7776

E-mail:

thomas_randolphw@scdps.state.sc.us

Tonia Thomas

Justice Programs Specialist

Division of Criminal Justice Services

1204 Kanawha Boulevard E.

Charleston, WV 25301

Phone: 304-558-8814 216

Fax: 304-558-0391

E-mail: tthomas@wvdcjs.org

Samuel E. Tillman

Special Assistant to the Attorney General

Office of the Attorney General

40 Capitol Square SW.

Atlanta, GA 30334

Phone: 404-651-9452 

Fax: 404-657-8733

E-mail: samuel.tillman@law.state.ga.us

Susan G. Tobin

Supervising Attorney

Ohio Legal Rights Services

Eight East Long Street, Fifth Floor

Columbus, OH 43215

Phone: 614-466-7264 

Fax: 614-644-1888

Olga Trujillo

Director

Special Projects Division

Office for Victims of Crime

U.S. Department of Justice

810 Seventh Street NW., Room 8331

Washington, DC 20531

Phone: 202-616-3585 

Fax: 202-514-6383

E-mail: olga@ojp.usdoj.gov

Kathryn Turman

Director

Office for Victims of Crime

U.S. Department of Justice

810 Seventh Street NW.

Washington, DC 20531

Phone: 202-307-5983 

Mary S. Twomey

Director

Consortium for Elder Abuse Prevention

Goldman Institute on Aging

3330 Geary Boulevard

San Francisco, CA 94118

Phone: 415-750-4180 ext. 225 

Fax: 415-750-4136

E-mail: mtwomey@giou.org

Michael Uhlarik

Chief

Elders and Persons with Disabilities Unit

Assistant District Attorney

Suffolk County

One Bulfinch Place

Boston, MA 02114

Phone: 617-619-4262 

Fax: 617-619-4270

E-mail: michael.uhlarik@state.ma.us

Omar Valverde

Adult Protection Coordinator

Commission on Aging

3380 Americana Terrace, Suite 120

Boise, ID 83706

Phone: 208-334-3833 

Fax: 208-334-3033

E-mail: ovalverd@icoa.state.id.us
Jim Varpness

Executive Director

Minnesota Board on Aging

444 Lafayette Road

Saint Paul, MN 55155

Phone: 651-296-1531 

Fax: 651-297-7855

E-mail: jim.varpness@state.mn.us

Nancy Vehr

Assistant Attorney General

Office of the Attorney General

123 Capitol Building

Cheyenne, WY 82002

Phone: 307-777-7376 

Fax: 307-777-3687

E-mail: nvehr@state.wy.us

Alexa Verveer

Deputy Assistant Attorney General

Office of Justice Programs

U.S. Department of Justice

810 Seventh Street NW.

Washington, DC 20531

Phone: 202-307-5933 

Fax: 202-514-7805

D. Jean Veta

Deputy Associate Attorney General

U.S. Department of Justice

950 Pennsylvania Avenue NW.

Washington, DC 20530

Phone: 202-616-9456 

Fax: 202-307-3904

Pamela Vocke

Director

Division of Quality Improvement and

Training

Health Care Financing Administration

7500 Security Boulevard, MS 53-13-15

Baltimore, MD 21244

Phone: 410-786-3486 

Fax: 410-786-1008

E-mail: pvocke@hcfa.gov

Edwin L. Walker

Director for Program Operations and

Development

Administration on Aging

U.S. Department of Justice

Cohen Building

330 Independence Avenue SW., Room 4733

Washington, DC 20201

Phone: 202-619-0011 

Fax: 202-260-1012

E-mail: edwin.walker@aoa.gov

Mark T. Walsh

Detective

Elder Abuse and Financial Exploitation

Investigator

Department of the Attorney General

Six State House Station

Augusta, ME 04333

Phone: 207-626-8594 

Fax: 207-287-3120

E-mail: mark.t.walsh@state.me.us

Anna C. Ward

Deputy Director of Justice Services

Yakama Nation

P.O. Box 151

Toppenish, WA 98948

Phone: 509-865-5121 

Fax: 509-865-5745

E-mail: anna@yakama.com

Sue Ward

Secretary

Maryland Department on Aging

301 West Preston Street, Suite 1007

Baltimore, MD 21201

Phone: 410-767-1100 

Fax: 410-333-7943

Carol C. Warner

Director

Adult Protective Services

Family and Social Services Administration

Bureau of Aging and In-Home Service

402 West Washington Street, MS-21

P.O. Box 7083

Indianapolis, IN 46207

Phone: 317-232-7900 

Fax: 317-232-7867

E-mail: cwarner@fssa.state.in.us
David W. Waterbury

Senior Counsel/Director

Medicaid Fraud Control Unit

Office of the Attorney General

Washington Building

1019 Pacific Avenue, Third Floor

Tacoma, WA 98402

Phone: 253-593-2154 

Fax: 253-593-5135

E-mail: davidw1@atg.wa.gov

Kathi West

Victim-Witness Coordinator

U.S. Attorney's Office

Western District of Texas

816 Congress Avenue, Suite 1000

Austin, TX 78701

Phone: 512-916-5858 

Fax: 512-916-5854

E-mail: kathi.west@usdoj.gov

Marilyn C. Whalen

Program Director

Adult Protective Services

Department of Human Services

400 Deaderick Street, 14th Floor

Nashville, TN 37248

Phone: 615-313-4784 

Fax: 615-741-4165

E-mail: mwhalen@mail.state.tn.us

Sara White

Conference Reports & Internet Services

27 Freeman Street

Arlington, MA 02474

Phone: 781-643-6311

Fax: 781-646-2628

Jonathan Whitefoot

Police Commissioner

Yakama Nation

P.O. Box 151

Toppenish, WA 98948

Phone: 509-865-5121 ext. 4568

Fax: 509-865-5745

E-mail: jfoot@yakama.com

Carter Williams

Assistant Attorney General

Department of Health and Human Resources

Office of the Attorney General

15 Grant Street, Suite 1

Petersburg, WV 26847

Phone: 304-558-2365 

Fax: 304-588-4577

E-mail: carterwilliams@wvdhhr.org

Ernestine A. Williams

Administrator

Health Facilities Survey Coordinator

Department of Health and Mental Hygiene

Spring Grove Center

55 Wade Avenue

Catonsville, MD 21228

Phone: 410-402-8189 

Fax: 410-402-8212

E-mail: ewilliams@dhmh.state.md.us

Rosalie S. Wolf

Executive Director

Institute of Aging

Memorial Health Care

University of Massachusetts

119 Belmont Street

Worcester, MA 01605

Phone: 508-334-6166 

Fax: 508-334-6906

E-mail: wolfr@ummhc.org

Joanne Wolfblack

Director

Elderly Program

P.O. Box 470

Lame Deer, MT 59013

Phone: 406-477-8707 

Fax: 406-477-8167

E-mail: ncelderly@mail.ncheyenne.net

Collin Wong

Executive Director

Bureau of Medi-Cal Fraud and Elder Abuse

Department of Justice

1425 River Park Drive

Sacramento, CA 95815

Phone: 916-274-2994 

Fax: 916-274-2929

E-mail: cwong@hdcdojnet.state.ca.us
Erica Wood

Associate Staff Director

Commission on Legal Problems of the

Elderly

American Bar Association

740 15th Street NW.

Washington, DC 20005

Phone: 202-662-8693 

Fax: 202-662-8698

E-mail: ericawood@staff.abanet.org

Kimberly R. Woodard

VAWA Program Manager

Justice Grants Administration

717 14th Street NW., 12th Floor

Washington, DC 20005

Phone: 202-727-6537 

Fax: 202-727-1617

J. Michael Wright

Investigator

Medicaid Fraud Control Unit

1807 Capitol Avenue, Suite 108

Cheyenne, WY 82001

Phone: 307-635-3597 

Fax: 307-635-6196

E-mail: mwrigh1@state.wy.us

Jim Wright

Program Director

National Sheriff's Association

1450 Duke Street

Alexandria, VA 22314

Phone: 703-836-7827 

Fax: 703-519-8567

Ruth Wright

Grant Services Coordinator

Crime Victim Assistance Division

Department of Justice

100 Court Avenue, Suite 100

Des Moines, IA 50319

Phone: 515-281-8513 

Fax: 515-281-8199

E-mail: rwright@ag.state.ia.us

LaVerne Wyaco

Director

Navajo Area Agency on Aging

P.O. Box 1390

Window Rock, AZ 86515

Phone: 520-871-6783 

Fax: 520-871-6793

E-mail: lwyaco@nndoh.nn.ihs.gov

Munna Yasiri

Policy Coordinator-Aging Initiative

Department of Human Services

444 Lafayette Road N.

Saint Paul, MN 55155

Phone: 651-297-1920 

Fax: 651-297-1920

E-mail: munna.yasiri@state.mn.us

Theodore D. Zacher

Senior Deputy District Attorney

Douglas County District Attorney

P.O. Box 1006

Roseburg, OR 97470

Phone: 541-440-4388 

Fax: 541-440-4403

E-mail: tdzacher@co.douglas.or.us

Jan Michael Zavislan

Deputy Attorney General

Department of Law

Office of the Attorney General

1525 Sherman Street, Fifth Floor

Denver, CO 80203

Phone: 303-866-5183 

Fax: 303-866-4745

E-mail: jan.zavislan@state.co.us

Barbara Zelner

Counsel

National Association of Medicaid

Fraud Control Units

750 First Street NE., Suite 1100

Washington, DC 

Phone: 202-326-6020 

Fax: 202-326-0884

E-mail: bzelner@naag.org

Deborah Zuckerman

Senior Attorney

AARP

601 E Street NW.

Washington, DC 20049

Phone: 202-434-6045 

Fax: 202-434-6424

E-mail: dzuckerman@aarp.org
Appendix 3

A Guide to Featured Programs

Our Aging Population:

Promoting Empowerment, Preventing Victimization,

and Implementing Coordinated Interventions

A National Symposium Sponsored by

the U.S. Department of Justice

and the U.S. Department of Health and Human Services

Washington, D.C.

October 30-31, 2000
Table of Contents

Introduction i

Financial Exploitation and Consumer Fraud

Workshop 1 – Federal and State Initiatives to Educate Consumers

Alexis Barbieri – Task for the Protection of Older Pennsylvanians 1

Daniel Drake – Arizona Elder Fraud Prevention Team 3

Jeff LaGrew – Kentucky Attorney General’s Senior Crime College 5

Bob Kuykendall – Federal Trade Commission’s Consumer Sentinel Program

 (not available)

Workshop 2 – Effective Interventions to Address Consumer Fraud

Jim Wright – Triad and Operation Fraudstop 7

Cynthia Alexis – San Francisco Consortium for Elder Abuse Prevention

 “We Are Family” Project 9

Marta Sotomayor – National Hispanic Council on Aging Telemarketing

 Fraud Project 11

Faith Fish – Operation Restore Trust - Senior Medicare Patrol Project 13

Workshop 3 – Innovative Approaches to Financial Exploitation 

Susan Aziz – Los Angeles County Fiduciary Abuse Specialist Team (FAST) 15

Aileen Kaye – Oregon Bank Reporting Project and R2T2 17

Kathleen Quinn – Illinois Governor’s Task Force on Financial Exploitation 

 of Older Persons 19

LaVerne Wyaco – Navajo Nation Elder Protection Program 21

Workshop 4 – Enhancing Prosecution of Financial Exploitation

Chayo Reyes – Law Enforcement Recovery of Exploited Assets 23

Audrey Rohn – Identifying, Prosecuting and Preventing Elder Abuse 25

Jane Brady – Delaware Attorney General’s “Elder Abuse and Exploitation Project” 27

Judith Kozlowski – Team-Building Strategies in the District of Columbia 29

Workshop 5 – Combating Consumer Fraud Through Litigation

Jackie DeGenova – Ohio Attorney General’s Senior Protection Initiative 31

Deborah Zuckerman – AARP Foundation Litigation 33

David Kirkman – North Carolina Attorney General’s Senior Consumer

 Fraud Task Force 35
Elder Abuse and Neglect at Home

Workshop 1 – Strengthening Interventions for Victims with Dementia

Fred Brand – Operation Safe Return 37

Georgia Anetzberger – A Model Intervention for Elder Abuse and Dementia 39

Anne Mastro – Safe Outreach for Seniors (S.O.S) 41

Workshop 2 – Working Across Systems to Improve Services for Victims of 

 Domestic Violence and Sexual Assault

Bonnie Brandl – Older Battered Women’s Project 43

Mary Lynn Kasunic – MEAPA’s Domestic Violence Initiatives 45

Amy Judy – Wisconsin Coalition Against Sexual Assault

 “Widening the Circle” Project 47

Workshop 3 – Engaging Law Enforcement, Prosecution, and the Judiciary

C. Ronald Stromberg – Adult Protective Services and Law Enforcement

 Teamwork Approach 49

Candace Heisler – Educating Law Enforcement and Prosecutors about 

 Elder Abuse 51

Lori Stiegel – Elder Abuse Curricula for Judges, Court Staff and

 Victim Advocates 53

Charles Mendonca – Encouraging Tribal Law Enforcement 55

Workshop 4 – Augmenting the Role of Medical Professionals

Laura Mosqueda – California Vulnerable Adult Specialist Team (VAST) 57

Carmel Dyer – Texas Elder Abuse and Mistreatment (TEAM) Institute 59

Randy Thomas – South Carolina Vulnerable Adult Medical Protocol 61

 

Workshop 5 – Enhancing Victim Services

Judy O’Neal – California’s Victim-Witness and Prosecution Initiatives for

 Elder Abuse Victims 63

Shanny Augare – Child and Family Advocacy Center/Triad Program

 of the Blackfeet 65

Kathi West – Victim-Witness Efforts of the U.S. Attorney for the Western

 District of Texas 67

Institutional Abuse and Neglect

Workshop 1 – Creative Initiatives to Educate Professionals and the Public

Diane Menio – CARIE’s Abuse Prevention Training Program 69

David Waterbury – Washington State Medicaid Fraud Control Unit Project 71

Barbara Doherty – Risk Assessment Tool Demonstration Project 73

Pamela Vocke – HCFA’s Division of Quality Improvement and Training 75
Workshop 2 – Joining Resources to Combat Institutional Abuse and Neglect

Marie-Therese Connolly – Department of Justice State Working Groups 77

Nicholas Cox – Florida’s Operation Spot Check 79

Frankie Sue Del Papa – Nevada Elder Abuse Prevention Council (NEAPC) 81

Becky Kurtz – Elder Rights Advocacy and Law Enforcement 83

Workshop 3 – Enhancing the Survey and Regulatory Process

Catherine Morris – New Jersey Department of Health and Human Services 85

Joyce Stockwell – Collaboration to Improve the Regulatory Process 87

Debra Green – Texas Department of Human Services (not available)

Workshop 4 – Holding Institutions Accountable Through Prosecution

Linda Purdy – Vermont Medicaid Fraud Control Unit Initiatives 89

Freda Fishman – Consumer Fraud Remedies for Nursing Home 

 Misrepresentations (not available)

Andrew Penn – HHS Office of the Inspector General’s Role in Nursing

Home Matters 91

Randy Hey – Santa Clara County District Attorney’s Prosecution (not available)
i

Introduction

Workshop presenters were asked to submit information about their programs in order to

provide a “snapshot” of each program for compilation in this handout. This guide is intended to

provide background information about each program and thereby help participants determine

which workshops to attend. 

The symposium planners hoped that the request for information would help guide presenters in

thinking and presenting about the policy issues on which the symposium is focused. 

Additionally, the program descriptions will be compiled and published in the report of

symposium proceedings that will be disseminated to presenters, participants, and other

interested persons soon after the symposium. 

A few of the program descriptions are missing from this handout. They will, however, be

included in the report of symposium proceedings. 

Because of the variety of efforts to be featured at the symposium, the word “program” was

used generically to include such things as a program, project, initiative, collaboration, policy

direction, or implementation, as well as litigation or prosecution effort.
1

Financial Exploitation and Consumer Fraud

Workshop 1: Federal and State Initiatives to Educate Consumers

_______________________________________________________________

Task Force for the Protection of Older Pennsylvanians

Pennsylvania Attorney General’s Office

Harrisburg, Pennsylvania

Program Contact: Materials Contact:

Alexis L. Barbieri

Executive Deputy Attorney General

Director, Public Protection Division

14th Floor, Strawberry Square

Harrisburg, PA 17120

Phone: 717-787-9716

Fax: 717-787-1190

abarbieri@attorneygeneral.gov

Office of the Attorney General

16th Floor, Strawberry Square

Harrisburg, PA 17120

Phone: 717-772-0907

Fax: 717-772-4526

fdonoghue@attorneygeneral.gov

Description of Program

Attorney General Mike Fisher assembled a diverse group of experts from across the state to identify

critical issues facing elderly citizens in Pennsylvania and to recommend solutions to problems such as

domestic violence, home improvement fraud, senior health care issues, financial exploitation, and

telemarketing and sweepstakes exploitations.

Why Program Was Developed

The task force was established because of the need to identify the concerns and specific problems of

older Pennsylvanians, and to determine what, if any, possible remedies or solutions there might be to

these problems.

How Program Was Developed

The program was initiated in September 1998, when Attorney General Mike Fisher identified and

brought together experts on issues affecting the elderly from throughout the state, and established

regional groups to address these issues. Invitations were sent to individuals who were known to have

an interest in these issues, including representatives of service organizations, the legal community,

local law enforcement, and others.

Accomplishments and Lessons Learned

First, regional meetings were held across Pennsylvania to identify areas of concern. Then public

hearings were held in five locations throughout the state, to address and focus on the areas of concern

that had been identified as a result of the regional meetings. At the conclusion of these hearings, a

report was issued that described the hearings and the issues raised and made recommendations

regarding possible remedies or solutions to deal with these problems.
2

While the project has not faced any obstacles since its inception, it is likely that many challenges will

arise during the process of implementing the recommendations issued by the task force.

The key lesson learned is the importance of getting participation of community leaders and other

individuals who are concerned with issues affecting older persons. This includes representatives from

the law enforcement community, health care and other aging services. The perspective of these

individuals and their ability to help older persons is significant, and their contributions are invaluable.

The Task Force for the Protection of Older Pennsylvanians Report is available at no charge.
3

Financial Exploitation and Consumer Fraud

Workshop 1: Federal and State Initiatives to Educate Consumers

________________________________________________________________

Arizona Elder Fraud Prevention Team

United States Attorney’s Office for the District of Arizona

Phoenix, Arizona

Program Contact: Materials Contact:

Daniel R. Drake

Executive Assistant U.S. Attorney

United States Attorney’s Office - District of

Arizona

230 N. First Avenue, Rm. 4000

Phoenix, AZ 85018

Phone: 602-514-7623

Fax: 602-514-7586

dan.drake@usdoj.gov

Same as program contact

Description of Program

The U.S. Attorney’s Office (USAO), in conjunction with AARP and the FBI, developed an education

program about consumer fraud against the elderly. The goal of the program is to reduce, through

preventive measures, the number of elders being victimized by fraud, and the impact of that fraud.

The program’s objectives are:

• to inform and educate elders who might be targeted for fraud;

• to inform and educate family members, friends, and caregivers about frauds targeting elders and

the warning signs that someone might be falling victim;

• to inform and educate government and provider organizations about frauds targeting elders so they

might respond more effectively; and

• to raise the level of public awareness and discussion of frauds targeting elders and the devastating

impact they can have.

Why Program Was Developed

The program sponsors recognized that there was a high incidence of telemarketing fraud aimed at the

elderly in Arizona, and public awareness needed to be raised.

How Program Was Developed

In 1998, due to increased telemarketing-scam activity, the Justice Department was scouting four or

five different sections of the country for program implementation. Jon Rusch of the Department of

Justice visited Phoenix and met separately with the USAO, FBI, and AARP to encourage them to

develop a program. The USAO, AARP, and the FBI began convening meetings in November 1998.
4

Agencies currently involved in the program are: USAO, FBI, Postal Inspection Service, Social

Security Administration, Secret Service, Health & Human Services, Veteran’s Affairs, Securities and

Exchange Commission, Federal Trade Commission, Arizona Attorney General’s Office – Elder

Affairs Program, Arizona Corporation Commission – Securities Division, AARP, Better Business

Bureau, Arizona Cardinals, CellularOne, Basha’s Supermarkets, and KAET-TV, the local public

television station.

Accomplishments and Lessons Learned

The program has made staged more than 60 public presentations or events, including the largest public

education campaign in the history of Arizona.

The USAO organized and conducted a reverse boiler room operation, using community members

(including members of the Arizona Cardinals football team) and FBI agents to call seniors targeted for

fraud on a telemarketing list in order to warn them of the dangers of the telemarketing scams. A local

grocery store, AARP, and CellularOne, each of which has an intense interest in community service,

provided support for the operation. A local talk-show host interviewed people who were involved,

which increased awareness about the program. These events kicked off a 12-week public-awareness

campaign to educate seniors, their families, and caregivers about telemarketing fraud.

Perhaps the greatest obstacle has been the fact that the population is widely dispersed in Arizona,

making travel to more remote areas lengthy and sometimes prohibitive. It takes more than 10 hours to

drive from one corner of the state to another. The program has tried to give personal service to some

of the more remote areas, which has cost considerable time and energy. To overcome these obstacles,

the program has tried to make connections with local leaders, such as the county attorneys and

sheriffs, the chiefs of police, local media and others, in order to increase their capacity to direct local

programs.

Key lessons learned are:

• It is worthwhile to spend more time trying to develop and improve the capacity of the local

agencies and organizations to spread the program’s message and assist with program activities.

This can be challenging, however, because the lack of reporting by victims often means that local

leaders don’t see “the big picture.” A more consistent and sustainable effort would likely stem

from having local agencies conduct the education presentations. The use of distance learning

technology would help as well.

• It is critical to constantly think of ways by which to involve old and new partners who can share

and support program efforts.

Materials are available for the cost of reproduction.
5

Financial Exploitation and Consumer Fraud

Workshop 1: Federal and State Initiatives to Educate Consumers

_____________________________________________________________

Kentucky Attorney General’s Senior Crime College

Office of the Attorney General

Frankfort, Kentucky

Program Contact: Materials Contact:

Jeffrey F. LaGrew

Assistant Deputy Attorney General

Office of the Attorney General of Kentucky

700 Capital Avenue

Frankfort, KY 40601

Phone: 502-696-5610

Fax: 502-564-8310

Jeff.LaGrew@law.state.ky.us

Same as program contact

Description of Program

The “Seniors Crime College” teaches crime prevention to Kentucky’s senior population. The program

employs the slogan “Aware, Avoid, Alert” and educates seniors about how to recognize potential

crimes, either physical or financial, before they occur. By making seniors aware of what cons and

crooks are trying to do, they are better able to avoid becoming a victim. In addition, seniors are taught

whom to alert, so that law enforcement has a better chance of getting these criminals off the street.

Why Program Was Developed

Seniors Crime College was developed by the Office of the Attorney General of Kentucky, because it

became clear, through information obtained from the Kentucky Attorney General’s Division of

Consumer Protection, Victims Advocacy and Medicaid Fraud, that senior citizens of Kentucky were

being victimized at a disproportionately larger rate than the rest of the population, and that this would

continue until some positive action was taken. Realizing that crime prevention is the most effective

tool available, Attorney General Ben Chandler formed the Office of Senior Protection in 1998. The

2000 General Assembly continued the funding of the initiative.

How Program Was Developed

The program was initially put in 20 locations for approximately 2,000 people in 1998, and had a very

positive response that justified continuation and expansion. The following year, the Seniors Crime

College was held in more than 60 locations throughout the state and 6,000 additional seniors learned

about crime-prevention issues. These efforts have continued into 2000, with numerous presentations

this spring and more than 10,000 seniors attending to date. The success of this program has created

such a demand that programs are already scheduled through September 2001.
6

While the program remains under the direct control of the attorney general, numerous organizations

are involved in supporting the program, either by providing speakers or assisting with logistics: the

Sheriffs Association, Police Chiefs Association, Kentucky State Police, Kentucky Crime Prevention

Coalition, AARP, Retired Senior Volunteer Programs (RSVP), the local area agencies on aging,

Kentucky Bankers Association, local law enforcement agencies and local businesses. All funding for

the program has come from the attorney general’s office.

Accomplishments and Lessons Learned

The program has been successful in raising public awareness about crime and the aging population. It

was successful in getting legislation passed on identity theft, has raised awareness of con games, and is

pressing for expansion of truth in advertising legislation to stop misleading practices for solicitations

by mail.

To date, the Seniors Crime College has been held at more than 100 locations throughout Kentucky,

and more than 18,000 seniors have been educated about crime prevention issues. In addition, more

than 1,000 bank employees have been taught to recognize signs of elder abuse. The Seniors Crime

College has been made a part of the Kentucky State Police in-service training to raise awareness

among law enforcement of these crimes against seniors and how to deal with seniors. The Seniors

Crime College was selected as the outstanding community service program of 2000 by the Southeast

Association of Area Agencies on Aging.

The primary obstacle for the program has been getting past preconceived views by seniors that this

information does not apply to them. However, through persistence and positive feedback from those

that attend the program, the response continues to grow. Favorable media coverage and a very strong

relationship with local law enforcement agencies, senior services providers and seniors groups have

helped generate very favorable publicity.

Lessons learned include the importance of involving local law enforcement and seniors groups from

the beginning. In addition, talking with seniors in each area before beginning a program allows

appropriate customization rather than a less useful one-size-fits-all approach.

Program handbooks and speaker outlines are available at no charge.
7

Financial Exploitation and Consumer Fraud

Workshop 2: Effective Interventions to Address Consumer Fraud

_____________________________________________________________

Triad and Operation Fraudstop

National Association of Triads, Inc.

Alexandria, Virginia

Program Contact: Materials Contact:

James A. Wright

Program Director

National Association of Triads, Inc.

1450 Duke St.

Alexandria, VA 33214

Phone: 703-836-7827

Fax: 703-519-8567

jwright@sheriffs.org

Same as program contact

Description of Program

Triad is a national community-policing program that partners law enforcement professionals with

older volunteers for the purpose of reducing crime against older persons. Triads typically form a

council made up of community representatives, including public officials, and then survey the older

members of the community to ascertain their concerns. These councils then develop and implement

programs to address the needs of those older persons.

In 1998, the Department of Justice Office for Victims of Crimes (OVC) awarded Triad a grant to

combat telemarketing fraud aimed at older persons. The program, dubbed Operation Fraudstop,

attempts to reduce the incidence of telemarketing fraud by working to enhance line officers’

understanding of the issue and providing them with the tools necessary for early intervention in the

fraud process. The underlying premise is that once older people fall victim to telemarketing fraud,

they are likely to be re-victimized.

Why Program Was Developed

Representatives from the National Sheriffs’ Association, the International Association of Chiefs of

Police, and AARP (then known as the American Association of Retired Persons) created Triad after

they recognized how the concept of community policing could benefit older persons.

How Program Was Developed

The Triad concept was conceived in 1988 by the three organizations named above. The first Triad

agreement was signed in 1989 in St. Martin Parish, Louisiana. Nearly three-fourths of the Triad

agreements have been signed since about 1994.
8

Presently, only the National Sheriffs’ Association supports Triad on a national level, but local police

chiefs and local AARP chapters provide enormous support and resources. The Triad program has

grown more inclusive over time. Now any interested community member or organization is welcome

to participate.

The Department of Justice has long funded the program, awarding grants to the National Sheriffs’

Association as the lead agency. Triad formerly received its full operating funds from the Department’s

Bureau of Justice Assistance. Several years ago, OVC began contributing to the program as well, but

now the DOJ award is only about 20 percent of the total operating budget.

Accomplishments and Lessons Learned

More than 750 counties have signed Triad agreements, the public statement of partnership.

Although the general outcome of Triad programs tends to be about 50 percent crime prevention, 20

percent victim assistance (in cases where prevention fails), and 30 percent quality of life, the program

has remained true to its mission of reducing crimes committed against the older persons.

Two primary obstacles are unreliable funding and unenforced overall program guidelines. Funding

waxes and wanes depending on unrelated variables such as political interests, making financial

planning difficult. Triad came about as a grass-roots program without the benefit of a strong national

voice setting program criteria. Guidelines were established, but not always followed. Triad is working

to overcome these obstacles.

Another obstacle is that local program managers sometimes resist seeking private support because of

the strings attached to such funding. That leaves public funding their only option, however, and poses

quite a challenge to program continuation.

One key lesson learned is that it would have been beneficial to first establish a national program, rules,

chapter requirements, etc., and then form local efforts (rather than the other way around, as Triad did).

Second, it is not wise to rely on only one opinion or one method for getting out the organization’s

message.

It Isn’t Just About the Money, an in-service training video for law enforcement officers, is available at

a cost of about $10 per copy. It can be obtained from NATI at the address provided above.
9

Financial Exploitation and Consumer Fraud

Workshop 2: Effective Interventions to Address Consumer Fraud

_____________________________________________________________

“We Are Family” Project

San Francisco Consortium for Elder Abuse Prevention

San Francisco, California

Program Contact: Materials Contact:

Cynthia Alexis

Project Coordinator

Special Emphasis on Elder Abuse

850 Bryant Street, Room 320

San Francisco, CA 94103

Phone: 415-551-9541

Fax: 415-551-9582

Description of Program

In 1990, We Are Family (WAF) was established as a subcommittee of the Goldman Institute on

Aging’s San Francisco Consortium for Elder Abuse Prevention (CEAP). The primary purpose of WAF

is advocacy, education, and outreach to older African-Americans and professional service providers.

WAF develops strategies for disseminating information and improving access to services to both older

persons and caregivers who need them. WAF seeks to empower older persons and strengthen

communities by building on the solid traditions of African-American culture. WAF works in

partnership with service providers to find solutions that promote positive outcomes and respects the

wisdom of older African-Americans.

The CEAP is a network of over 40 public, private, and city departments. It was formed in 1981, to

address the needs of abused and vulnerable older persons living in San Francisco.

Why Program Was Developed

WAF grew out of a deepening concern that older African-Americans, for a host of reasons, were

under-utilizing valuable community resources and thus increasing their risk for abuse. WAF set out to

explore the nature of elder abuse in the African-American community. To its surprise, members of the

group discovered extremely complex and difficult issues. Some of the issues WAF has explored are

burial and life insurance fraud, home equity fraud, family violence, health and nutrition, literacy,

racism, and the extreme stresses of grandparenting.

How Program Was Developed

The first step was to assemble a group of African-American service providers with expertise in aging

and community issues, as well as individuals who had access to African-American churches. After

considerable deliberation, the committee designed an approach that created opportunities to offer

information and services, while at the same time, it acknowledged and reinforced the strengths of the
10

African-American families. The leadership group then articulated a set of principles for guiding

outreach activities.

Accomplishments and Lessons Learned

• Conducted a one-day workshop for professional service providers, 2000.

• Conducted community conversations to obtain information on how to reach and serve older

African-Americans, 2000.

• Featured in an article in the Journal of Elder Abuse and Neglect, 1993.

• Featured in workshops at:

• The annual Texas Adult Protective Services Conference

• Silent Suffering Conference sponsored by FHP Foundation (now known as Archstone

Foundation); Long Beach, California, 1997

• Elder Abuse in Minority Communities Conference sponsored by the Archstone

Foundation and the American Public Welfare Association, Long Beach, California, 1997.

• Received an award from Consumer Action for work in preventing older African-Americans from

losing their homes through foreclosure, 1997.

• Received a recognition award from the California Assembly, 1997.

• Conducted numerous information fairs to alert older African-Americans to the risks involved in

home equity loans, acquaint them with ways to tap into other community resources or stretch their

own existing resources and reduce expenses, and introduce them to professional service providers

who have expertise in this area.

• Conducted training programs to help older African-Americans reduce their risk of mortgage fraud.

• Collaborated with Bar Association of San Francisco, Volunteer Legal Services Program (VLSP) to

establish and advertise the mortgage fraud “hotline.”

This has been a labor-intensive project. It requires consistent funding and a dedicated group of

individuals who understand the intricate aspects of elder abuse. Project staff had hoped churches

would have a more visible role in the project’s advocacy and outreach activities. Unfortunately, WAF

has not been able to fully engage churches in addressing elder abuse. Also, it has been difficult for

project staff to measure outcomes.
11

Financial Exploitation and Consumer Fraud

Workshop 2: Effective Interventions to Address Consumer Fraud

_____________________________________________________________

National Hispanic Council on Aging Telemarketing Fraud Project

National Hispanic Council on Aging

Washington, DC

Program Contact: Materials Contact:

Edgar E. Rivas, Project Administrator

National Hispanic Council on Aging (NHCoA)

2713 Ontario Road, NW

n Washington, DC 20009-2107

Phone: 202-745-2521

Fax: 202-745-2522

edgarrivas@att.net

Same as program contact

Description of Program

The National Hispanic Council on Aging (NHCoA) Telemarketing Fraud Project increases older

Latinos’ awareness of telemarketing fraud and their capacity to protect themselves from such

victimization through education and coordination of prevention and intervention services at the local

level. Geographic areas with large Latino elder populations at risk for telemarketing fraud were

selected for interventions.

Currently, the Latino Education Project of Corpus Christi, Texas; La Liga Nacional de Consumidores

of Indio, CA; and the State of Arizona’s Office of the Attorney General are implementing the project

at the local level as subcontractors. Others agencies have been involved with this project over time.

For instance, AARP and outside production consultants assisted with the development of the video on

telemarketing fraud (see below); and a consultant from New Mexico Highlands University conducted

a survey on the incidence and prevalence of tele-marketing fraud among older Latinos.

Why Program Was Developed

The Telemarketing Fraud Project was established to raise the level of awareness of older low-income

Latinos and their families who are at-risk for becoming victims of telemarketing fraud because of their

cultural upbringing and the preponderance of low literacy levels among that population.

How Program Was Developed

This project was first established in March 1998 with support from the Department of Justice Office of

Victims of Crime and with the cooperation of NHCoA consultants and chapters in Corpus Christi,

Texas (The Latino Education Project). The Department of Justice realized that telemarketing fraud

also adversely affects older persons within communities of color throughout the nation. Recognizing

that generalities about the Latino population cannot be made, the NHCoA originally targeted Mexican-
12

American and Central American communities with concentrations of older persons. Since then, most

project activities have centered around locations where NHCoA chapters are strongest, which tend to

concentrate on Mexican-American families. Funding support from the Department of Justice has

totaled $558,760 through December 2001.

Accomplishments and Lessons Learned

Materials have been developed and translated into Spanish for dissemination to Latino populations.

Also, a video on telemarketing fraud (see below) was produced. This year, the project has

concentrated on integrating this project’s information and activities with other activities within the

partner chapters to maximize local outreach and use of resources such as the peer counselors, etc.

The greatest lesson learned from this project has been the importance of educating the Latino public

on all types of fraud issues. While older Latinos are susceptible to telemarketing fraud in general,

health care fraud, banking irregularities, scam artists in the communities, etc. are all forms of

fraudulent activities that target vulnerable populations. The need to fight fraud never ends because

fraud schemes never end; they spread and evolve over time and distance.

A video entitled Avíspese: No se deje engañar!! is available for $8.95 from NHCoA offices. This

thirteen-minute Spanish language video was developed as a training tool to be used with older Latinos

and their caregivers. The video conveys information on identifying and avoiding telemarketing fraud.
13

Financial Exploitation and Consumer Fraud

Workshop 2: Effective Interventions to Address Consumer Fraud

_____________________________________________________________

Operation Restore Trust – Senior Medicare Patrol Project

New York State Office for the Aging

Albany, New York

Program Contact: Materials Contact:

Faith E. Fish

State Long Term Care Ombudsman

New York State Office for the Aging

2 Empire State Plaza, 2nd Floor

Albany, NY 12223-1251

Phone: 518-474-7329

Fax: 518-474-7761

Faith.fish@ofa.state.ny.us

Sandra M. Abrams

Grant Project Assistant

New York State Office for the Aging

2 Empire State Plaza, 2nd Floor

Albany, NY 12223-1251

Phone: 518-474-7329

Fax: 518-474-7761

Description of Program

The Operation Restore Trust-Senior Medicare Patrol Project is a federally funded initiative to train

retired persons to serve in their communities as volunteer expert resources and educators in combating

health care waste, fraud, and abuse in the Medicare and Medicaid programs.

Why Program Was Developed

The U.S. Department of Health and Human Services, Office of Inspector General, estimates that,

combined, Medicare and Medicaid lose about $36 billion dollars a year due to waste, fraud, and abuse.

Unscrupulous activities by some health care and medical equipment providers leads to this loss and

depletes funding for the programs for current and future generations as well as adversely affecting the

quality of services and care provided to beneficiaries.

How Program Was Developed

In 1995 the New York State Office for the Aging (NYSOFA) participated in a two-year demonstration

project for the purpose of identifying innovative ways to fight health care fraud, waste, and abuse in

Medicare and Medicaid. Education and outreach was identified as a primary component to that goal.

In 1997 NYSOFA was awarded a grant by the Administration on Aging to recruit and train state and

local long term care ombudsmen, health insurance counselors, the network of aging service agencies,

older persons and their families, and retired professionals to identify and report waste, fraud and

abuse. A State Workgroup was convened, with the NYS Long Term Care Ombudsman serving as

Chair.

The Workgroup consists of the following members:

• State agencies: Department of Health, Attorney General, Medicaid Fraud Control Unit, Office of

State Comptroller, Division of Criminal Justice Services, Commission on Quality of Care.
14

• Federal agencies: Administration on Aging (AoA), Office of Inspector General, Health Care

Financing Administration.

• Medicare Carriers: Empire Medicare Services, GHI-Medicare, and Upstate Medicare

The Workgroup met bi-monthly during the first year to develop training goals, objectives and

materials. Training consisted of educating individuals on what constitutes fraud and abuse, how to

identify it when they see it, and where to report it. During the first year the Workgroup conducted 12

on-site full-day training events. The second year members provided refresher training and first year

training to three additional counties. The third year the Workgroup trained by means of a teleconference downlinked to approximately 61 sites. They also conducted two training conferences for

Long Term Care Ombudsman Program (LTCOP) Coordinators.

NYSOFA also awarded funding to seven local LTCOP and Health Insurance Information, Counseling

and Assistance Program (HIICAP) Coordinators to conduct local ORT education and recruitment after

those coordinators received training by the Workgroup.

Additionally, the training developed by the Workgroup was incorporated into the 36-hour certification

training required to become a local LTCOP Volunteer. The role of a LTCOP volunteer is to advocate

for the rights and quality of care for residents in Nursing Homes and Adult Homes. ORT is consistent

with that role and LTCOP volunteers are in a unique position to provide health care information to

beneficiaries of these programs and their families.

The Workgroup continues to meet on an on-going basis to update and refine training materials and to

coordinate future training events. Currently they are taking the lead on the development of a National

Teleconference. New York is one of four states funded by AoA to be a National Consumer Protection

Technical Resource Center for the purpose of replicating and expanding consumer education and

awareness to targeted populations throughout the country.

Accomplishments and Lessons Learned

The training programs described above were a significant accomplishment. In addition, the

partnership formed through the program have led to systemic changes. To illustrate, as a result of the

project the Medicare and Medicaid programs in New York began sharing information, resulting in the

identification of $47.9 million in double payments over a three-year audit period.

Important lessons learned include:

• Coalition building techniques should be applied consistently to keep partner participation at its

highest and most effective level.

• Keeping the training message alive should be a priority. Use of various media forms and methods

of distribution is recommended. For example, the project has developed manuals, brochures,

personal medical record handbooks, videos, public broadcasting television shows, articles for the

NYSOFA "Aging News" quarterly newsletter, posters, teleconferences, and materials about

coalition-building best practices. Materials are distributed through a variety of forums: on-site

group training to small or large groups; one-on-one discussion; nursing home resident councils

and/or family councils; libraries; senior centers; congregate meal sites; and, national, state and

local governmental agencies, etc.
15

Financial Exploitation and Consumer Fraud

Workshop 3: Innovative Approaches to Financial Exploitation

_______________________________________________________________

Los Angeles County Fiduciary Abuse Specialist Team (FAST)

Wise Senior Services

Santa Monica, California

Program Contact: Materials Contact:

Susan J. Aziz

Vice President, Advocacy & Education Programs

WISE Senior Services

P.O. Box 769

Santa Monica, CA 90406-0769

Phone: 310-394-9871

Fax: 310-395-4090

saziz@wiseseniorservices.org

Same as program contact

Description of Program

The Los Angeles County Fiduciary Abuse Specialist Team (FAST) is a countywide multidisciplinary

team that provides: (1) consultation on difficult-to-resolve cases of elder financial abuse to

caseworkers of Adult Protective Services (APS), the Long-Term Care Ombudsman Program, the

Office of the Public Guardian (PG), and county- and city-funded care-management programs; and (2)

education and training to service providers, members of the financial community, and the public on

preventing, identifying, reporting, and stopping elder financial abuse.

The FAST has two goals: (1) to help these agencies serve their financially-abused clients, by aiding

victims in recovering or preventing further loss of assets and in improving the quality of their lives;

and (2) educating professionals and the public about elder financial abuse and how to combat it.

Why Program Was Developed

The FAST was established in 1993 because APS and the Long-Term Care Ombudsman Program

lacked skills and training to investigate and resolve increasingly complex cases of elder financial

abuse.

How Program Was Developed

FAST was developed through a collaborative public/private partnership of the Los Angeles County

and City Area Agencies on Aging and WISE Senior Services, the contract agency that coordinates the

countywide and citywide Elder Abuse Prevention Program that began in 1992. That same year,

representatives of the three agencies identified the need for the team. WISE Senior Services reviewed

existing models of multidisciplinary teams and conceptualized the FAST model with significant input

from all of the partners. The model was presented to key agencies such as the APS, the Ombudsman,

the Public Guardian, law enforcement and prosecution agencies, and others for constructive feedback

and to elicit their participation and active support. A three-session training program for these agencies
16

and for care managers, utilizing team consultants as trainers, was planned and implemented prior to

the first team meeting, in order to establish a good knowledge base.

Additional organizations now involved with FAST include the County of Los Angeles District

Attorney’s Office, Los Angeles City Attorney’s Office, several law enforcement agencies, Community

Care Licensing, public interest and private legal services, financial institutions, care-management

programs, and community-based social service organizations. Other team members include securities

and real estate brokers, and experts in finance, insurance, probate, gerontology, geriatrics, psychology,

and psychiatry.

Initial funding for FAST was provided by the county and city area agencies on aging through their

Older Americans Act monies, with matching funds from WISE. Currently, the county area agency on

aging and WISE provide $103,959 and $9,172 in funding, respectively (plus in-kind).

Accomplishments and Lessons Learned

Key accomplishments include:

• recovering or preventing the loss of millions of dollars in client assets;

• improving the ability of member agencies to intervene in financial abuse cases;

• enhancing networking opportunities among public and private sector organizations and

professionals, resulting in increased access to technical knowledge and to resources;

• increasing understanding of member agencies’ respective roles and responsibilities; and

• improving communication, cooperation, collaboration, and coordination of services.

The major program partners have utilized FAST members in numerous educational programs. These

have included presentations to more than 1,325 bankers and fraud investigators statewide on

“Financial Abuse of Seniors: How to Protect Your Customer and Financial Institution”; a conference

on “Combating Elder Abuse: How to Build Your Criminal or Civil Case” for 275 police, prosecutors,

investigators, and civil attorneys; and “Senior Action Fairs – Protect Yourself Against Fraud &

Abuse” for 1,725 seniors, family members, and caregivers.

The FAST has faced two significant obstacles since it began. First, discontinuation of funding by both

the city and county area agencies on aging during the federal budget crisis resulted in the temporary

closure of the WISE Elder Abuse Prevention Program that coordinates the team. During that time,

two FAST consultants assumed leadership and solicited support from the other team members in order

to keep the team operating for three months until the funding was restored. Second, the large size of

the team poses challenges that the FAST is working to overcome.

Two lessons learned from these experiences are that (1) all team members should have been invited to

attend the three training programs that were offered to APS and the ombudsman and public guardian

programs so that everyone would have had a similar knowledge base prior to the formal team

orientation and commencement of the team meetings; and (2) it is critical to build mutually supportive

and collaborative working relationships, and to recruit team consultants who not only have desired

technical expertise but who are effective communicators and team players.

A description of the FAST model, guidelines for replicating it and job descriptions are available by email free of charge and by mail for $7.
17

Financial Exploitation and Consumer Fraud

Workshop 3: Innovative Approaches to Financial Exploitation

_______________________________________________________________________

Oregon Bank Reporting Project and R2T2

Department of Human Services, Senior and Disabled Services Division

Salem, Oregon

Program Contact: Materials Contact:

Aileen P. Kaye

Abuse Prevention Program Coordinator

Consumer Relations & Community Education

Section

Abuse Prevention Unit

Department of Human Services, Senior and

Disabled Services Division

500 Summer St., NE, 3rd Floor

Salem, OR 97310-1015

Phone: 503-945-6399

Fax: 503-947-5044

Aileen.P.Kaye@state.or.us

Stephen J. Schneider, Attorney at Law

Consumer Relations & Community Education

Section

Abuse Prevention Unit

Department of Human Services, Senior and

Disabled Services Division

P.O. Box 14750

Salem, OR 97309-0466

Phone: 503-378-2546

Fax: 503-378-2558

Stephen.Schneider@state.or.us

Web site:

www.sdsd.hr.or.us/programs/elderfinance.htm

Description of Program

Oregon’s bank reporting project built upon and expanded upon the first bank reporting project,

developed in Massachusetts. The goals of the Oregon project were:

• to train bank employees how to recognize and report suspected elder financial exploitation; and

• to teach bank employees how to develop and conduct seminars in their own communities in order

to educate older persons about how to avoid becoming victims of financial exploitation and

telemarketing scams.

Why Program Was Developed

The idea for the program germinated in 1995 when the Attorney General’s Task Force on Elder Abuse

became aware that the banks were not comfortable reporting possible elder abuse or exploitation. The

bankers wanted to report these instances to Adult Protection Services, but they were concerned about

liability and confidentiality issues.

How Program Was Developed

In 1995 the attorney general met with the CEO of the Oregon Bankers Association (OBA). As the

ability of bankers to contact local authorities about possible violations was already covered in state

law, the attorney general and OBA decided to add an immunity clause to the Oregon statutes

addressing financial institutions. The OBA made it clear that they did not want banking institutions to

become “mandatory reporters.” All on the attorney general’s task force agreed that since the bankers
18

wanted to report, they did not need to be mandatory reporters. This resulted in smooth passage of the

legislation.

A year later the OBA sponsored a day-long statewide conference for APS and bankers in order to

increase awareness of the new law. The conference created a great deal of enthusiasm about the

project.

After this conference, the project developed materials supporting the two aforementioned goals of the

project. The project received a $198,000 grant in 1998 from the Department of Justice Office for

Victims of Crimes. Grant funds were used to prepare and disseminate nationally a training kit for

bankers, and to conduct outreach to victims of telemarketing scams.

The organizations involved in the program were the Oregon Attorney General’s Task Force on Elder

Abuse, the Oregon Senior and Disabled Services Division, the Oregon Bankers Association, the

Oregon Association of Area Agencies on Aging and Disabilities, and AARP Oregon. The Education

Foundation of the American Bankers Association and the National Association of Attorneys General

also were involved in the promotion and distribution of the banker kits.

As a result of these efforts, the APS offices, law enforcement and the district attorney’s office were

being inundated with referrals. Therefore, a new pilot program “Retiree Response Technical Team”

(R2T2) was recently launched with funding from a private foundation. The R2T2 volunteers will assist

local APS and other multidisciplinary team members in collecting and analyzing financial records for

possible prosecution.

Accomplishments and Lessons Learned

To date, the program has distributed 1,500 training kits to each Oregon bank branch, three

complimentary kits to each state, as well as hundreds of kits to other states and four other countries

upon request. The program has provided numerous training sessions in Oregon and at national

conferences and provided technical assistance to two other states in the development and passage of

immunity legislation for bankers.

Obstacles include not having enough staff to meet the training need. To remedy this, the SDSD has

encouraged banks to call the local APS office in their area to assist with training. SDSD has also

conducted annual statewide multidisciplinary training sessions to train prosecutors and law

enforcement personnel. Oregon’s credit unions have requested similar training to the banks, but

resources were not adequate to allow the project to send free copies of the kit to each credit union.

The key lesson learned is that it is necessary to start the project with strong statewide partners,

especially the state bankers association. Bankers trust other bankers and will check with each other

before adopting the project. Also, it is very important to realize that bankers are extremely busy and

must keep up with numerous regulations. Timeliness and a businesslike attitude are crucial to gain

their trust.

A training kit for bankers entitled, “Preventing Elder Financial Exploitation: How Banks Can Help”

includes two manuals with two videos in a hardbound package, and is available for $55.
19

Financial Exploitation and Consumer Fraud

Workshop 3: Innovative Approaches to Financial Exploitation

__________________________________________________________________________

Illinois Governor’s Task Force on Financial Exploitation of Older Persons

Illinois Department on Aging

Springfield, Illinois

Program Contact: Materials Contact:

Kathleen Quinn, Chief

Bureau of Elder Rights

Illinois Department on Aging

421 E. Capitol, Suite 100

Springfield, IL 62710

Phone: 217-785-3386

Fax: 217-524-9644

kathleen.quinn@aging.state.il.us

Same as program contact

Description of Program

The Elder Abuse Task Force is a statewide group that is studying and developing recommendations

for the Governor of Illinois on ways that the state can better address the problem of financial abuse of

older persons.

Why Program Was Developed

The task force was developed to address the growing problem of financial exploitation of older

persons. Its creation represented fulfillment of a campaign promise by the Governor to address these

issues.

How Program Was Developed

Illinois Governor George Ryan appointed the task force in May 2000. It has met twice since then to

learn about financial exploitation, to find out what Illinois is already doing to address the problem, and

to hear what other states are doing. At future meetings the task force will focus on developing

recommendations to present to the governor and General Assembly on how the state can further

address this issue.

The Department on Aging recommended potential members to the governor’s office. The current list

of organizations and members includes:

• Alzheimer’s Association;

• AARP;

• Attorney General Jim Ryan;

• Bloomington, Illinois, Police Department;

• Central Illinois Area Agency on Aging;

• Coalition of Limited English Speaking Elderly;
20

• Community Bankers Association of Illinois;

• Council for Jewish Elderly;

• Chicago Bar Association;

• Illinois Association of Area Agencies on Aging;

• Illinois Association of Chiefs of Police;

• Illinois Bankers Association;

• Illinois Coalition on Aging;

• Illinois Council of Case Coordination Units;

• Illinois Criminal Justice Information Authority;

• Illinois Department of Human Services;

• Illinois Elder Rights Coalition;

• Illinois Guardianship & Advocacy Commission;

• Illinois Law Enforcement Training and Standards Board;

• Illinois Sheriffs’ Association;

• Illinois State Bar Association;

• Illinois State Police;

• Illinois State Triad;

• National Caucus & Center of Black Aged; and

• States Attorneys’ Appellate Prosecutors Office.

Accomplishments and Lessons Learned

Accomplishments of this very new program include forming and learning about financial exploitation

and how it is currently being addressed.

The only obstacle the program has faced thus far is the need to educate the task force members on the

issues very quickly so that recommendations can be made.

Lessons learned include the importance of thinking carefully about the specific goal of the task force

and then deliberately selecting as task force members the organizations and people who can

accomplish that goal.

A copy of the report can be obtained in January 2001.
21

Financial Exploitation and Consumer Fraud

Workshop 3: Innovative Approaches to Financial Exploitation

___________________________________________________________________

Navajo Nation Elder Protection Program

Navajo Area Agency on Aging

Window Rock, Arizona

Program Contacts: Materials Contact:

LaVerne Wyaco

Director

Navajo Area Agency on Aging

P.O. Box 1390

Window Rock, AZ 86515

Phone: 520-871-6783

Fax: 520-871-6793

lwyaco@nndoh.nn.ihs.gov

Seferino Flores

Ombudsman

Pascua Yaqui Tribe of Arizona

7474 S. Camino De Oeste

Tucson, AZ 85746

Phone: 520-883-5180

Same as second program contact

Web Site: www.nn.ihs.gov

Description of Program

The Navajo Area Agency on Aging (NAAA) administers the Dine’ Elder Protection Program (DEPP),

which uses caseworkers and court advocates to assist victims of elder abuse. The goal of the Dine’

Elder Protection Program (DEPP) is to protect elders within the jurisdiction of the Navajo nation from

abuse, neglect, exploitation, and maltreatment, consistent with the Dine’ Elder Protection Act.

Why Program Was Developed

The DEPP was developed because elder abuse in all its forms presents a major health and law

enforcement problem to the people of the Navajo nation. The program reflects the belief that elder

abuse can be prevented, alleviated, and deterred through the intervention of law.

How Program Was Developed

Following several years of discussion about the problems of elder abuse and the need for an

appropriate program, the DEPP was established by the Navajo Nation Council in 1996. The president

of NAAA was very instrumental in obtaining support from the Health and Social Services Committee

(HSSC) of the Navajo Nation Council. Originally, the Division of Social Services had responsibility

for DEPP, but ultimately responsibility was shifted to the Navajo Division of Health, through the

NAAA.
22

The Navajo Nation Council appropriate $191,864 for five caseworker positions, one court advocate,

and one-half the time of the DEPP director in 2000. Other sources of funding include $19,675 from

Title III of the Older American Act, and $1,891 from New Mexico.

Accomplishments and Lessons Learned

The NAAA has signed a protocol with the Division of Health and Division of Social Services that

provides for a consistent and professional working relationship, prevents the duplication of services,

and allows maximum and quality implementation of the case management systems from the Social

Service and Health divisions. The NAAA’s next goal is to seek amendment of the Dine’ Elder

Protection Act so that it will be more specific, akin to the Nation’s Children Code.

The DEPP was enacted without any funding. In 1999, for the first time the Tribal Council provided

funding in the amount of $135,000. This year’s appropriation of $191,864 represents a significant

increase and is a major accomplishment for the program. More funding is needed, however, and the

lack of funding poses the greatest obstacle to the program.

The DEPP was the first program of its type every established on the Navajo reservation; its progress

indicates that a key lesson to be learned from it is the necessity of perseverance.

The Dine’ Elder Protection Program is available in bound copies for the general public.
23

Financial Exploitation and Consumer Fraud

Workshop 4: Enhancing Prosecution of Financial Exploitation

_____________________________________________________________

Law Enforcement Recovery of Exploited Assets

Los Angeles, California

Program Contacts: Materials Contact:

Chayo Reyes

Los Angeles Police Department Detective (ret.)

PO Box 5032

Cerritos, CA 90703

Phone: 562-926-7380

Fax: 562-926-7380

CHAYO@IOL7.COM (not actually in caps, but

otherwise the L is mistaken for a 1 (one))

Marc Hankin, Attorney

10680 West Pico Blvd., Suite 315

Los Angeles, CA 90064

Phone: 310-204-8989

Fax: 310-204-8985

marc@marc-hankin.org

Same as first program contact

Description of Program

The Los Angeles Police Department developed a proactive approach to securing and recovering the

assets of elder and dependent adults during the course of financial abuse investigations.

Why Program Was Developed

In Los Angeles County, there were many elder victims of financial exploitation. The program was

developed to protect victims’ assets from further dissipation during an investigation of financial abuse.

The process works by freezing the victim’s remaining assets while the investigation is conducted,

usually for a period of up to five days, and while efforts are made to take other available legal actions

(such as appointment of a public guardian) to protect the assets.

How Program Was Developed

The program was developed in 1987 by Chayo Reyes, who founded the Elder Person’s Estate Unit for

the Los Angeles Police Department. The agencies involved with this program are Adult Protective

Services, the Los Angeles County Fiduciary Abuse Specialist Team (FAST), as well as various banks

and other financial institutions.
24

Accomplishments and Lessons Learned

The program has secured or recovered more than $100 million for victims of financial exploitation.

This recovery vastly improves the quality of life of the victims, as they can maintain their

independence using their own funds rather than relying on family members or the government for

help.

Chayo Reyes and his former partner, Dave Harned, have provided training about the Elder Estate

Recovery Unit and the tactics they used to law enforcement officers, APS workers, and many others

across the nation.

In order to expand use of the Elder Estate Recovery Unit methodology across California, Chayo Reyes

and Dave Harned co-authored a bill supporting program expansion. That bill, California SB 1742,

was signed into law by Governor Gray Davis on September 28, 2000.

The major obstacle faced by the program has been that many law enforcement officers and prosecutors

are not aware of the procedure to freeze assets or the attendant law.

The key lessons learned are the importance of:

• educating law enforcement officers and prosecutors about procedures and laws that enable them to

protect victim assets;

• networking with APS, the ombudsman, and other organizations and establishing a FAST; and

• enacting early on a law supporting the use of the Elder Estate Recovery Unit concept.

Materials are available at no charge.
25

Financial Exploitation and Consumer Fraud

Workshop 4: Enhancing Prosecution of Financial Exploitation

_____________________________________________________________

Identifying, Prosecuting and Preventing Elder Abuse

Office of the Ventura County District Attorney

Ventura, California

Program Contact: Materials Contact:

Audry L. Rohn

Deputy District Attorney

Ventura County District Attorney

800 S. Victoria Avenue

Ventura, CA 93009

Phone: 805-654-2288

Fax: 805-654-3850

audry.rohn@mail.co.ventura.ca.us

Jose Velasco

Victim Advocate

Victim Services

Ventura County District Attorney

800 South Victoria Avenue

Ventura, CA 93009

Phone: 805-654-3314

Fax: 805-654-3850

jose.velasco@mail.co.ventura.ca.us

Description of Program

The Ventura County District Attorney, Michael D. Bradbury, created an elder abuse program to

prevent and protect older persons from abuse and to prosecute their offenders. This is done by

reaching out to the community and by educating seniors on how to identify, prevent, and report crimes

committed against them. Great effort is put into recovering monies taken from senior victims and in

enforcing restitution ordered by courts.

Why Program Was Developed

The program initially was established due to the recognition that older victims have special needs.

Those needs can best be served by offering specially trained victim advocates, prosecutors, and

investigators to work with them and handle their cases.

How Program Was Developed

The team has grown from one deputy district attorney (DDA) and one victim advocate in 1994 to two

DDAs, one investigator, three investigative assistants, and three victim advocates.

After appointing a DDA to prosecute elder abuse offenders, the office started networking with other

partners. Ventura County had a previously established Interagency Elder Abuse Council. The

members of the council included Adult Protective Services (APS), law enforcement, Long Term Care

Ombudsman, Area Agency on Aging, senior nutrition, senior outreach, mental health, Grey Law (nonprofit), among others. The members of the council placed little trust in the DA’s office, law

enforcement, or APS since, historically, little had been done to protect Ventura County seniors. APS

staff had been cut to the bone and they rarely cross-reported incidents of abuse to law enforcement,

despite legal requirements to do so, due to (1) a lack of interest by law enforcement; (2) a philosophy

that was hostile toward permitting law enforcement to criminalize abuse situations; and (3) a refusal

to breach perceived “client confidentiality.”
26

The District Attorney’s office took the lead in uniting these critical partners by reaching out and

establishing lines of communication with these groups. It worked with APS and encouraged them to

cross-report incidents of abuse to law enforcement and educated them on what they could disclose

without violating client confidentiality. The office trained law enforcement on how to investigate elder

abuse cases and trained both APS and law enforcement on elder abuse prosecution and how their work

is essential in successfully protecting seniors and punishing their offenders.

Presently, the office is involved with the District Attorney’s Elder Abuse Prosecution Team, the

Ventura County Interagency Elder Abuse Council, and the Adult Case Management Council (ACMC).

The ACMC meets monthly, and APS workers profile seemingly impossible cases of abuse and neglect

in a confidential setting. Partners work together to offer solutions to these particularly difficult cases.

The DA’s work on elder abuse has been funded by three grants from state VOCA monies totaling

$377,500 as well as an Area Agency on Aging grant of $25,000.

Accomplishments and Lessons Learned

One of the proudest accomplishments of the program has been creating a working, multi-disciplinary

team. Through great effort, mutual cooperation has been established among the DA’s office and Adult

Protective Services, the Long Term Care Ombudsman, the Department of Social Services Community

Care Licensing Division, the Ventura County Public Guardian, and local law enforcement. Training

has been provided to these groups on identification and prosecution of elder abuse.

The office has conducted an extensive community outreach campaign, including posters at bus stop,

radio PSAs in both English and Spanish, presentations to thousands of seniors in a variety of settings,

and dissemination of hundreds of thousands of senior crime prevention materials packets. The Elder

Abuse Prosecution Team members have presented to audiences throughout California, Utah, Texas,

and in nationwide symposiums.

The office has reviewed more than 250 cases of elder abuse since 1994. Cases are prosecuted

vertically to ensure continuity for the victims and expertise in the area of elder abuse among the

prosecutors. To date, the office has a 100 percent success rate in elder abuse prosecution.

One of the ongoing obstacles involves training law enforcement at the street level to spend sufficient

time to properly investigate elder abuse cases. Elder abuse crimes require a great deal of investigative

time and resources. Financial crimes require the gathering of information on numerous banks and real

estate transactions, and other documentation. In many fraud cases, a professional must assess the

mental capacity of an older victim. Law enforcement, which already is overtaxed, must find a way to

provide ongoing training to their street officers and permit them to conduct proper investigations.

Key lessons learned include the importance of establishing lasting, trusting relationships through good

communication. Be persistent. Don’t be afraid to ask for help and don’t be afraid to use the press as a

tool for change and dissemination of ideas.

A Law Enforcement Protocol, prescription cards, place mats, Senior Crime Prevention Handbooks,

Senior Resource cards, and other materials are published in English and Spanish and include audio

tapes for the visually impaired.
27

Financial Exploitation and Consumer Fraud Workshops

Workshop 4: Enhancing Prosecution of Financial Exploitation

__________________________________________________________________________________

Delaware Attorney General’s “Elder Abuse and Exploitation Project”

Delaware Department of Justice

Wilmington, Delaware

Program Contact: Materials Contact:

M. Jane Brady

Attorney General

State of Delaware

820 North French Street

Wilmington, DE 19801

Phone: 302-577-2610

Fax: 302-577-2610

jbrady@state.de.us

Lester Johnson

Special Investigator

State of Delaware

Department of Justice, Criminal Division

45 The Green

Sykes Building

Dover, DE 19901

Phone: 302-739-4211

Fax: 302-739-2570

ljohnson@state.de.us

Description of Program

Since 1995, the Delaware Attorney General’s Elder Abuse and Exploitation Project has hired two

investigators to work on complaints and lend investigative support to police agencies investigating

financial exploitation cases. In addition, a full-time prosecutor has been assigned to prosecute these

cases. The goal of the project is to provide prosecution-based assistance to elderly victims of abuse,

neglect, and exploitation.

Why Program Was Established

The project was established due in large part to the Attorney General’s commitment to protect the

most vulnerable segments of the population. Prior to the inception of this program, financial

exploitation cases were for all intents and purposes, not actively investigated. Traditional law

enforcement agencies viewed most reported incidents as civil cases and would refer the complainant to

private legal council or to a civil court. Therefore, General Brady assigned a Deputy Attorney General

to meet informally with Adult Protective Services (APS) workers and screen their cases for

prosecutorial merit. It became apparent that social services and law enforcement were not on the same

page regarding how the cases should be addressed. The concept for the project was developed from

these early meetings.

How Program Was Established

The project was established in October 1995. Initially, the project involved the Department of Justice,

APS, and law enforcement agencies throughout the state. The project received $115,225 in Federal

funds (Victims of Crime Act monies) and the State contributed $28,806 during the three-year year

period. The funding was used to hire personnel, purchase equipment, and cover other operating costs.
28

Because of this program, the Attorney General’s office now has two investigators who actively work

on complaints and lend investigative support to police agencies investigating financial exploitation

cases.

The project now involves the entire aging network, as well as others interested in elder issues. All of

these groups were brought to the table by the Attorney General while forming the Attorney General’s

Senior Victim Task Force. The task force is composed of representatives from the criminal justice

system, social service agencies, volunteer service providers, community organizations, the banking

and insurance industries, the medical community, and the community at large. The group meets

monthly and has been broken down into subcommittees, which are examining the laws of Delaware,

the policies of the courts and agencies, the communication and cooperation between and within the

public and private sectors, and the coordination of services to address the needs of older victims. Of

special note is the development of a statewide law enforcement protocol as well as significant changes

to criminal statutes dealing with offenders who victimize the elderly/infirmed.

Accomplishments and Lessons Learned

Prior to the inception of this program, financial exploitation cases were not actively investigated.

Traditional law enforcement agencies viewed most reported incidents as civil cases and would refer

the complainant to private legal counsel or to a civil court. In 1993, APS investigated more than 200

cases of financial exploitation. During that year, the number of referrals by APS for criminal

prosecutions was negligible because of lack of police and prosecutorial resources. By contrast, in the

year 1997, APS referred 121 cases to the Attorney General’s office, 84 percent of which represented

allegations of financial exploitation. Augmented by the assignment of a full-time prosecutor, the

project initiated prosecution in 25 cases, achieving an enviable 100 percent conviction rate. The great

majority of those convicted were sentenced to jail terms despite sentencing guidelines suggesting

probation.

The program has raised public awareness regarding the vulnerability of older citizens living in the

community, either in their own home or the home of a relative/caregiver. In addition, the program has

heightened awareness in the law enforcement community that these issues are not only a social service

problem, but also a police problem. Raising both public and professional awareness have been

accomplished through aggressive public education and in-service training programs.

The major obstacle in the Elder Abuse and Exploitation Project has been trying to improve the

communication among social service and law enforcement agencies. However, through an aggressive

training program and regular interaction with social service and law enforcement agencies, headway is

being made. The statewide law enforcement protocol mentioned above is also helping to overcome

this obstacle.

The key lesson learned is that interagency cooperation is essential to this sort of project.

Materials are available at no cost.
29

Financial Exploitation and Consumer Fraud

Workshop 4: Enhancing Prosecution of Financial Exploitation

_____________________________________________________________

Team-Building Strategies in the District of Columbia

Office of the U.S. Attorney for the District of Columbia, Economic Crime Section

Washington, DC

Program Contact: Materials Contact:

Judith Kozlowski

Assistant United States Attorney

U.S. Attorney’s Office, District of Columbia

Economic Crime Section

555 Fourth Street, NW

Washington, DC 20001

Phone: 202-514-6964

judith.kozlowski@usdoj.gov

Karyn Barquin

DC Office on Aging

Chair, Financial Abuse Committee

441 Fourth Street, NW

Washington, DC 20001

Phone: 202-727-8367

kbarquin-age@dcgov.org

Description of Program

The goal of the Financial Abuse Consulting Team (FACT) is to provide a structure within which cases

of financial exploitation of the elderly in the District of Columbia can be presented, assessed, and

referred as appropriate. By providing a multidisciplinary team approach involving law enforcement

and social services resources as well as other areas of specific expertise, this program seeks to

evaluate, investigate, and prosecute more quickly and effectively cases of financial exploitation in both

the local and federal court systems.

Why Program Was Developed

FACT was formed to provide ready expertise in many areas to members of the Adult Abuse

Prevention Committee who routinely handle financial exploitation cases. The professional expertise

brought to these cases by the FACT will enable committee members, including the U.S. Attorney’s

Office Economic Crime Section, the District’s Office of the Corporation Counsel Family Services

Division, Adult Protective Services, and the Long-Term Care Ombudsman program, to work more

quickly and effectively to reduce the harm suffered by victims of this form of abuse. Before FACT

was formed, cases of financial exploitation languished because there was no central repository of

information on how to handle them.

How Program Was Developed

The Financial Abuse Consulting Team (FACT) program is based on the Los Angeles County

Fiduciary Abuse Specialist Team (FAST) model. The program was developed this year through the

Adult Abuse Prevention Committee and the District of Columbia Office on Aging.
30

Accomplishments and Lessons Learned

This is a new program, but through an informal program of the same nature and purpose, 40 cases

have been referred, investigated, and prosecuted in the last three years.

The members of FACT are actively cooperating in drafting proposed legislation to encompass both

civil and criminal issues that touch on financial exploitation of the elderly. Team members are

seeking grant funding for the project.

The obstacles faced by the project to date include:

• the need to constantly create awareness of the severity and rampant nature of financial exploitation

of the elderly; and

• the need to constantly educate others about the enormous time commitment involved in

prosecuting cases of financial exploitation and the resulting need for adequate law enforcement

resources.

The key lesson learned so far is that every single case needs a multidisciplinary approach and that

teamwork and communication is critical to achieve successful prosecution.

Available materials include an outline of the FACT program based on the Los Angeles County FAST

model, and a directory of participants. The outline is free of charge.
31

Financial Exploitation and Consumer Fraud

Workshop 5: Combating Consumer Fraud Through Litigation

_____________________________________________________________

Ohio Attorney General’s Senior Protection Initiative

Office of the Attorney General

Columbus, Ohio

Program Contact: Materials Contact:

Jackie DeGenova

Assistant Chief

Consumer Protection Section

Ohio Attorney General’s Office

30 E. Broad Street, 25th Floor

Columbus, OH 43215

Phone: 614-466-1305

Fax: 614-466-8898

JdeGenova@ag.state.oh.us

Judy Stansbury

Senior Initiative Coordinator

Ohio Attorney General’s Office

30 E. Broad Street, 25th Floor

Columbus, OH 43215

Phone: 614-466-5610

Fax: 614-995-0123

jstansbury@ag.state.oh.us

Web site: www.ag.state.oh.us

Description of Program

The Senior Protection Initiative is an effort of the Ohio Attorney General’s Office that aims to

establish statewide resource development, consumer education, and training opportunities for those

working with senior citizens, people with disabilities, low income people, victims of abuse and victims

of natural disasters. Under the Initiative, the Attorney General’s Office has sponsored a statewide

conference and formed an interdisciplinary task force. The Initiative also involves a number of

litigation efforts.

Why Program Was Developed

The Senior Protection Initiative began in March, 2000, as a means of gathering and exchanging

information between organizations and individuals dedicated to assisting senior citizens and other

vulnerable populations on Ohio. Attorney General Montgomery has pledged to identify and prosecute

fraudulent conduct by unscrupulous businesses that prey upon Ohio’s most vulnerable populations.

How Program Was Developed

In June, 2000, the Ohio Attorney General’s office hosted a state-wide conference, designed to identify

successful programs, unmet needs, duplications of services, and goal setting for a more cohesive

means of meeting the needs of Ohio’s vulnerable populations. A task force developed as a result of the

conference, including members of AARP, law enforcement, state and agency administrators, victim

advocates, and adult protective services, to name a few.
32

Accomplishments and Lessons Learned

Collaborations with other professionals and agencies, such as victim advocates, social services, and

law enforcement are very important in helping to identify fraud against seniors. Victim advocates

have prepared victim impact statements, which are submitted to the court. In addition, the advocates

and social services professionals are trained to assist victims’ emotional well-being. This, in turn,

facilitates investigation and prosecution. Other important collaborations have involved state, federal

and Canadian law enforcement, Triad, AARP, the Federal Emergency Management Agency, the Ohio

Peace Officers Training Academy, Adult Protective Service, Meals on Wheels, the Ohio Department

of Aging, the Columbus Urban League, Retired Seniors Volunteer Program, and the Ohio State

University Extension.

As a direct result of the June conference, the Consumer Protection Section received several referrals

for investigation. This collaboration has resulted in successful prosecutions and civil actions to obtain

restitution. Of the 50 criminal cases currently active in the Section, half involve seniors as victims.

The office has had tremendous success in criminal and civil cases made possible by the cooperative

efforts with senior services agencies and law enforcement. These have involved coin con artists, home

improvement fraud, telemarketing, cemetery scams, and “sweetheart swindles.” Many of these cases

involved multi-state issues, thereby making it necessary to work with federal entities as well as law

enforcement and prosecutors in other states.

The primary obstacle to establishing collaboration with the various agencies was identifying what

assistance already existed for vulnerable populations, where overlap of services existed, and how the

Attorney General’s office could be effective with the existing services. While the obstacles continue,

overcoming them has been facilitated by networking and good communication among those involved.

Lessons learned include the importance of discussing cases involving fraud (civil or criminal) with

local law enforcement, prosecutors, and judges and meeting with local and state senior services and

professionals. Education of the public as well as those in the judicial system is crucial to getting the

victimization recognized and prosecuted.

Materials about the Senior Protection Initiative and consumer fraud litigation are available at no

charge. Call 614-466-8831 or toll-free in Ohio at 800-282-0505.
33

Financial Exploitation and Consumer Fraud

Workshop 5: Combating Consumer Fraud Through Litigation

_____________________________________________________________

AARP Foundation Litigation

AARP Foundation

Washington, DC

Program Contacts: Materials Contact:

Deborah M. Zuckerman

Senior Attorney

AARP Foundation

601 E Street, NW

Washington, DC 20049

Phone: 202-434-6045

Fax: 202-434-6424

dzuckerman@aarp.org

Stuart Cohen

Managing Attorney

AARP Foundation Litigation

601 E Street, NW

Washington, DC 20049

Phone: 202-434-2063

Fax: 202-434-6424

scohen@aarp.org

AARP Foundation Litigation

601 E Street, N.W.

Washington, D.C. 20049

Phone: 202-434-2063

Fax: 202-434-6424

Web Site: www.aarp.org/foundation/litigation.html

Description of Program

The AARP Foundation has filed a lawsuit with the Florida Attorney General’s Office that challenges

the marketing and sales practices of two living trust companies. Several amicus curiae (friend of the

court) briefs have been filed in consumer protection cases brought by various attorneys general. The

AARP Foundation learned about cases and found co-counsel through the National Association of

Consumer Advocates, the National Consumer Law Center, the National Association of Attorneys

General Elderly and the Law Committee, and the National Association of Consumer Agency

Administrators.

Why Program Was Developed

The living trust companies against whom the lawsuit were filed targeted older people and used

AARP’s name in their marketing materials. The amicus curiae briefs filed by the AARP Foundation

have involved the following issues: the authority of the attorneys general to seek restitution for

consumers; the rights of pre-need funeral purchasers when the funeral home goes out of business;

whether an auto title pawn shop is entitled to the pawn shop exemption under a state consumer

protection statute; and whether there was sufficient proof to support a judgment against a large

sweepstakes promoter.
34

How Program Was Developed

Collaborations with the organizations indicated above were established by conducting outreach to the

organizations and their members, participating on their listserves, and by speaking at and attending

their annual conferences.

Accomplishments and Lessons Learned

A settlement has been reached with one living trust company defendant which requires the defendant

to stop the practices alleged in the complaint and provide restitution to customers (unfortunately, the

latter is unlikely since the company declared insolvency). The case is proceeding against the other

defendant.

The major obstacle encountered is the failure of enforcement agencies to realize or remember that

AARP is available as a resource to act as co-counsel, co-plaintiff, amicus, and/or as a source of

possible victims. While this is most probably an oversight, a way of overcoming this is to make sure

that the AARP is considered when an agency is investigating or initiating enforcement actions.

Moreover, in some cases, an enforcement agency may decide not to bring an action that still might be

appropriate for private litigation, and AARP might be able to represent the victims. Confidentiality

issues are likely to arise in some instances, but probably can be overcome on a case-by-case basis.

A key lesson learned is that more outreach to these organizations, on a more regular basis, might help

the organizations remember that the AARP Foundation is looking for good cases to litigate and

support.

A short “fact sheet” is available free of charge, and there are materials on the web site. Also

available are copies of amicus curiae (“friend of the court”) briefsin federal and state court cases

challenging a range of financial fraud and unfair and deceptive acts and practices around the country.
35

Financial Exploitation and Consumer Fraud

Workshop 5: Combating Consumer Fraud Through Litigation

_____________________________________________________________

North Carolina Attorney General’s Senior Consumer Fraud Task Force

Office of the Attorney General

Raleigh, North Carolina

Program and Materials Contacts:

David N. Kirkman

Co-Chair, North Carolina Senior Consumer Fraud

Task Force

Assistant Attorney General

Consumer Protection Section

North Carolina Department of Justice

P.O. Box 629

Raleigh, NC 27602-0629

Phone: 919-716-6000

Fax: 919-716-6050

dkirkman@mail.jus.state.nc.us

Robert Jackson

Co-Chair, North Carolina Senior Consumer Fraud

Task Force

State Director, AARP

225 Hillsborough Street, Ste. 440

Raleigh, NC 27603

Phone: 919-755-9757

Fax: 919-755-9684

rjackson@aarp.org

Description of Program

The North Carolina Senior Consumer Fraud Task Force is comprised of three dozen agencies and

associations, including the Federal Bureau of Investigation (FBI), U.S. Attorneys, Postal Inspectors,

Better Business Bureaus, AARP, the State Bureau of Investigations, local police departments, the

North Carolina Attorney General, the State Division of Aging, the Department of Insurance, the North

Carolina Cooperative Extension Service, the Federal Retirees Association, local councils of

government, the Senior Tarheel Legislature and the North Carolina Securities Division. Efforts

include litigation, advocating for passage of responsible lending legislation, and other efforts to end

improper practices involving senior citizens.

Why Program Was Developed

Often, social service or health care professionals are the first to spot a scam against senior citizens.

After the identification of a scam, law enforcement can pursue the matter from there.

How Program was Developed

Initially, collaborations were established through cases on which law enforcement officials worked

together and developed relationships of trust. The North Carolina Attorney General also worked with

non-law enforcement groups to promote public awareness of scams and frauds. The North Carolina

Senior Consumer Fraud Task Force and similar initiatives resulted from a desire to merge law

enforcement and non-law enforcement interests and efforts. The Task Force was formed in 1998 and

since then, other groups have heard about the Task Force and have joined. The Task Force meets

quarterly and Senior Fraud Alerts go out to members every couple of weeks.
36

Accomplishments and Lessons Learned

Collaboration with social service agency participants has proved highly beneficial. The North

Carolina Senior Consumer Fraud Task Force has been responsible for successful litigation in a number

of lawsuits on issues such as home repair fraud, mail fraud and telemarketing fraud. Additionally, the

Task Force also is a participant in two new federally funded projects: Senior Fraud Patrol and the

North Carolina Telemarketing Fraud Demonstration Site. Senior Fraud Patrol will train senior

volunteers and others to spot and report “discrepancies’ involving Medicare and Medicaid billings and

reimbursement. The Demonstration Site was established in January 2000 and involves the Task Force

teaming up with law enforcement officials from across the United States and Canada, to thwart

telemarketing fraud.

However, there have been obstacles to overcome. Obstacles regarding collaboration among state,

local and federal law enforcement officials primarily involve “turf” issues. Additionally, personal

dislikes among members based on past case collaboration efforts were a cause for concern. Each

agency has its own way of operating, and integrating these operations, even when a common goal was

at stake, was difficult. Turf issues and personal dislikes were overcome by seeking out law

enforcement agents with a demonstrated, abiding concern for elderly consumers.

An ongoing problem involves the amount of time that investigators and prosecutors can devote to

Task Force activities. This has resulted in the task force becoming rather “lopsided” with

representatives who are not law enforcement officials. Another problem is that many agents are now

being taken off senior scams and are being thrown into investigating the new area of Internet fraud.

The key lesson learned is the importance of getting people invested in the idea of spotting and

stopping senior scams and educating them on how to go about it. Also important is letting non-law

enforcement participants know how important their efforts are. Giving credit all around when a case is

brought is of paramount importance. Additionally, cooperative task force approaches need an

administrator who can plan and keep operations flowing smoothly. The North Carolina Task Force

has lacked such a person much of the time.

A pamphlet describing the Senior Consumer Fraud Task Force and a brochure on North Carolina’s

new Predatory Lending Law are available from the materials contact indicated above.
37

Elder Abuse and Neglect at Home

Workshop 1: Strengthening Interventions for Victims

with Dementia

________________________________________________________________

Operation Safe Return

Greater New Jersey Chapter Alzheimer’s Association

Denville, New Jersey

Program Contact: Materials Contacts:

Frederick S. Brand

Director of Programs

Greater New Jersey Chapter

Alzheimer’s Association

400 Morris Ave., Suite 251

Denville, NJ 07834

Phone: 973-586-4300

Fax: 973-586-4342

Frederick.Brand@alz.org

For New Jersey-specific information, same as

program contact

For national information:

Brian Nance, Associate Director

National Alzheimer’s Association

Safe Return Program

Phone: 312-335-5756

Fax: 312-335-5710

Brian.Hance@alz.org

Web site: www.alz.org

Description of Program

The mission of the national Safe Return Program is to assist in the safe and timely return of

individuals with Alzheimer’s disease and related dementias who wander and become lost, and to

provide wandering awareness, education, and training.

A key part of the program has been training law enforcement and emergency personnel about

recognizing and managing dementia. This training has made an enormous difference, not just in cases

of wandering but also in other instances involving alleged abuse or inappropriate behavior in which

law enforcement and emergency personnel become involved.

The New Jersey program goals were:

• to increase law enforcement officials’ awareness of wandering, Alzheimer’s disease, and Safe

Return; and

• to enable law enforcement officials to respond more effectively when a wandering incident occurs

in their area.

Why Program Was Developed

Attorney General Reno’s recognition that law enforcement officials were coming in contact more

frequently with situations involving people with Alzheimer’s disease or dementia and wanted to

ensure their proper handling and safe return prompted the development of the program by the national

office of the Alzheimer’s Association.
38

How Program Was Developed

The program began in January 1997 with a series of meetings with the national Alzheimer’s

Association, the local New Jersey Chapters, and the Department of Law and Public Safety Division of

Criminal Justice. The Division of Criminal Justice reached out to the Alzheimer’s Association with the

idea of adopting the Safe Return Program in New Jersey. The New Jersey chapter attended a program

where another state chapter of the Alzheimer’s Association talked about similar efforts in their state.

The program received formal support from Department of Law and Public Safety Division of Criminal

Justice. Those state agencies and the New Jersey chapters of the Alzheimer’s Association contributed

equally to establish a $6,000 budget to begin the program in New Jersey.

Accomplishments and Lessons Learned

Key accomplishments include:

• 30,000 New Jersey police officers received wallet cards that contain common guidelines for

interacting with persons with Alzheimer’s;

• every municipal, county, and state police department received the Roll Call law enforcement

training video, a 12-minute video made specifically for law enforcement officers that provides

common scenarios and handling for them when dealing with those stricken with Alzheimer’s;

• police academies throughout New Jersey received the Roll Call training video; and

• 7,000 police officers were trained in the first year of the project.

Other important accomplishments of the Safe Return program are:

• making Safe Return available to multicultural populations;

• making available financial scholarships for Safe Return registration; and

• beginning important discussions among law enforcement about older persons’ issues.

The program faced important obstacles, including:

• the process of establishing training programs at police academies took longer than expected;

• ongoing efforts were needed to keep the training a priority among law enforcement officials and in

local Alzheimer’s Association chapters, and

• personnel changes and lack of follow-up made it a challenge to keep momentum going.

Lessons learned included the importance of:

• understanding the structure of each organization involved;

• being realistic and flexible about what can be accomplished in a public/private collaboration and

about timelines;

• incorporating into your plans possible changes in personnel and priorities;

• ensure continuity of project, even after the initial rollout;

• debriefing participants about how to move forward 2-3 years post-inception; and

• incorporating the curriculum into law enforcement training academies.

The following materials can be checked out from the Alzheimer's Association Green-Field Library by

calling 312-335-5767: a January 1997 letter from the New Jersey attorney general; a Safe Return Roll

Call training video for law enforcement; wallet-sized cards for law enforcement that address effective

techniques for communicating with people from Alzheimer’s disease or dementia; the Safe Return

Alzheimer’s curriculum used by police academies in New Jersey.
39

Elder Abuse and Neglect at Home

Workshop 1: Strengthening Interventions for Victims

 with Dementia

______________________________________________________

A Model Intervention for Elder Abuse and Dementia

The Benjamin Rose Institute

Cleveland Heights, Ohio

Program Contact: Materials Contact:

Georgia J. Anetzberger, Ph.D.

Associate Director for Community Services

The Benjamin Rose Institute

2373 Euclid Heights Blvd.

Cleveland Heights, OH 44106

Phone: 216-791-8000

Fax: 216-791-8030

georgia@benrose.org

Barbara Palmisano, MA, RN

Office of Geriatric Medicine/Gerontology

Northeastern Ohio University

College of Medicine

PO Box 95

Rootstown, OH 44272

Phone: 330-325-6359

brp@neoucom.edu

Development/Marketing

The Benjamin Rose Institute

2373 Euclid Heights, Blvd.

Cleveland Heights, OH 44106,

Description of Program

This program brought together the leading agencies of the elder abuse and dementia service networks

in the greater Cleveland area to build a community-response system that increased case identification,

improved care planning and intervention, and promoted prevention of abuse, neglect and/or

exploitation of persons with dementia.

Why Program Was Developed

Research over the past 15 years has shown that dementia and abuse often occur together.

Despite this evidence, service providers tend to focus primarily on either abuse or dementia and

receive very limited training regarding interface of the two problems. There is also a lack of trust and

knowledge about how other agencies deal with the sensitive issues of elder abuse and dementia. Staff

and volunteers in the dementia network, even those who are legally mandated to report suspected elder

abuse, are hesitant to report suspected abuse to Adult Protective Services (APS) for fear of eroding the

hard-won rapport with their clients and families.

How Program Was Developed

The program was developed with the involvement of personnel at several levels from the Benjamin

Rose Institute, Cleveland Chapter Alzheimer’s Association, the Cuyahoga County Department of

Senior and Adult Services/APS, Northeastern Ohio Universities College of Medicine, and the Western

Reserve Consortium for the Prevention and Treatment of Elder Abuse (now called the Consortium

Against Elder Abuse).
40

The project Advisory and Work Groups both faced challenging issues during the program’s

development. Initial meetings were spent dispelling misconceptions about partner agency roles and

discussing agency responsibilities and limitations. Members clarified legal, financial, and staffing

constraints of their respective agencies. Issues of client confidentiality and violation of trust in terms

of cooperative case management were examined. Clear lines of responsibility and authority were

established to avoid confusion and duplication of effort when multiple agencies were involved in a

case.

A variety of local foundations and the local area agency on aging funded the two-year project. Total

funding equaled $142,656. Two additional grants have funded product dissemination.

Accomplishments and Lessons Learned

Accomplishments included:

• an educational curriculum on issues of elder abuse, a parallel curriculum on dementia, and an

integrative curriculum on effective intervention in situations of elder abuse and dementia;

• cross-training for Alzheimer’s Association and APS staff and volunteers based on the educational

curricula;

• a screening tool for use by Alzheimer’s Association staff and volunteers to identify abusive and

potentially abusive situations, and tools useful in identifying cognitive impairment for APS staff;

• a handbook for caregivers to self-assess the risk of elder abuse and to identify community

resources for assistance;

• protocols for referral and intervention among the three service-providing partners;

• increased and improved communications and referrals between the three service-providing

agencies;

• dissemination of the curriculum across the national Alzheimer’s Association network and various

other agencies;

• training based on the curriculum for law enforcement personnel from 13 local police departments;

and

• an extension of the project in order to develop a grid as a clinical guide for decision-making about

involuntary protective intervention and guardianship.

Lessons learned suggest that the following elements are necessary for effective collaboration:

• a perceived value in interagency collaboration manifested in the release of staff time and

commitment of agency leadership;

• a capacity to build and sustain trust, evident in the ability to risk and set aside past suspicions and

misconceptions;

• a willingness to identify and solve problems, which requires honest and open communication.

These elements made it possible for the project members to face and overcome the challenges to

successful collaboration that were discussed previously.

A three-module manual containing a comprehensive curriculum for cross-training service providers in

elder abuse and dementia is available for $125 from Barbara Palmisano. A handbook for caregivers,

including a self-assessment guide that identifies risk of mistreatment for caregivers of persons with

dementia, is available from The Benjamin Rose Institute. An article describing the Model Intervention

project was published in the Gerontologist and is available from Georgia Anetzberger.
41

Elder Abuse and Neglect at Home

Workshop 1: Strengthening Interventions for Victims

with Dementia

_____________________________________________________________

Safe Outreach for Seniors (S.O.S.)

Geriatric Evaluation and Management Service (GEMS)

Lakewood, New Jersey

Program Contacts: Materials Contact:

Anne Mastro R.N., SANE

Practice Manager

Geriatric Evaluation and Management Service

(GEMS)

Kimball Medical Center

1200 Route 9, Suite 5

Lakewood, NJ 08701

Phone: 732-367-4422

Fax: 732-370-2077

Anne Macaluso, R.N., GNPC

Director, GEMS

Kimball Medical Center

1200 Route 9, Suite 5

Lakewood, NJ 08701

Phone: 732-367-4422

Fax: 732-370-2077

Sam Crawford

Vice President of Geriatric/Senior Services

Community, Kimball and Monmouth Medical

Centers

99 Route 37 W

Toms River, NJ 08755

Phone: 732-240-8204

Fax: 732-240-8206

Same as first program contact

Web site: www.sbhcs.com

Description of Program

The Safe Outreach for Seniors (SOS) program provides law enforcement officers with comprehensive

training about the signs and symptoms of Alzheimer’s disease and other types of dementia so that they

will be able to identify older adults at risk who are living alone and/or driving. The training also

informs law enforcement officers about referral sources for follow-up of older adults identified within

the community who may be at risk for exploitation, emotional, and physical abuse as well as safety

problems. The SOS programs serves as one of those referral sources, as well.

Why Program Was Developed

The SOS program was implemented in 1997, after a female patient, who was scheduled for a dementia

evaluation, was killed in an automobile accident while she was driving. After talking with the family,
42

it was revealed that the police had received multiple calls from the home for possible breaking and

entering and that those calls had indicated paranoia, hallucinations, and delusional behavior. Many

agencies in the county had been in contact with the patient, but no one had questioned her ability to

drive. Further investigation indicated that officers were unaware of the agencies to which they could

refer at-risk individuals. It became obvious that education in identifying dementia and a referral

system was needed.

How Program Was Developed

The SOS program was established in 1997 by the Geriatric Evaluation and Management Service

(GEMS) at Kimball Medical Center, an affiliate of the Saint Barnabas Health Care System. GEMS

contacted local police departments, which often had called on GEMS when situations arose with

geriatric patients and help was needed. Law enforcement officers were very receptive to the training

that GEMS offered, and the training eventually became part of the police academy curriculum.

Currently, Kimball Medical Center, four Ocean County police departments, and the Ocean County

Police Academy are all involved with SOS.

Accomplishments and Lessons Learned

To date, SOS has trained successfully more than 400 police officers. In the last year and a half, more

than 200 seniors at risk have been identified and referred to the SOS program from four police

departments. Reasons for referral include: hallucinations and or paranoia, confusion, wandering, motor

vehicle infractions, domestic violence and frequent 911 calls. The average age of the client referred to

the SOS program was 81. Of these seniors 59 percent lived alone, 32 percent with a spouse or friend, 6

percent with families, 2 percent in an assisted living facility and 1 percent with a live-in caregiver.

Outcomes from these referrals show that 14 percent were hospitalized, 19 percent had family

intervention, 36 percent were referred to Adult Protective Services, 14 percent for geriatric evaluation,

10 percent for psychiatric screening and 7 percent refused assistance.

With the growth of the senior population in Ocean County – 112,000 seniors age 65 and over living in

80 retirement communities – the number of referrals is growing. The obstacle encountered is the need

for additional staffing, which is essential for the growth of the program.

The most important lesson learned is that communication is the key to a collaborative relationship

with community and law enforcement agencies. A good relationship with the county office of aging

services is vital as well.

Materials are made available at the time of training at the Ocean County Police Academy. A training

video and manual may be available in the future, but the cost has not yet been determined.
43

Elder Abuse and Neglect at Home

Workshop 2: Working Across Systems to Improve Services for

Victims of Domestic Violence and Sexual Assault

________________________________________________________________

Older Battered Women’s Project

Wisconsin Coalition Against Domestic Violence (WCADV)

Madison, Wisconsin

Program Contact: Materials Contact:

Bonnie Brandl, Project Coordinator

National Clearinghouse on Abuse in Later Life

Wisconsin Coalition Against Domestic Violence

307 South Paterson, Suite 1

Madison, WI 53703

Phone: 608-255-0539

Fax: 608-255-3560

bonnib@inexpress.net

Wisconsin Coalition Against Domestic Violence

307 South Paterson, Suite 3

Madison, WI 53703

Phone: 608-255-0539

Fax: 608-255-3560

Description of Program

The mission of the Wisconsin Coalition Against Domestic Violence (WCADV) Older Battered

Women’s Project is to end abuse in later life. Our goal is to ensure that older victims of family

violence are offered safety, support and services, and that abusers are held accountable. To achieve our

goals, we provide technical assistance, written materials, and training to professionals from a variety

of fields in order to encourage a local collaborative response to the needs of older victims.

Why Program Was Developed

The project was created to because domestic violence organizations traditionally have focused on

working with women ages 18 to 45. It was necessary to determine whether older women had different

needs for safety, support and services than younger women. It also was clear that professionals in the

fields of elder abuse and aging were not working with domestic violence and sexual assault advocates

on the local level. WCADV wanted to create and provide a vehicle to begin collaboration.

How Program Was Developed

The issue of domestic abuse in later life was identified by staff at the Department of Health and

Family Services in 1988. Jane Raymond, from the Bureau on Aging, approached the state domestic

violence unit and governor’s council on domestic abuse to discussed working collaboratively, but she

was rebuffed. She was told that neither group worked with or wanted to work with older women. It

took many years of discussion and negotiation before domestic violence organization in Wisconsin

recognized the importance of addressing the needs of women across the life span.

WCADV began working with the Department of Health and Family Services informally in 1988.

Funding came in 1990 from the Milwaukee Foundation for interviews of older abused women in that

city and for development of recommendations about services. In 1992, AARP contracted with

WCADV staff to complete a national survey of existing services for older abused women and a

manual. In 1994-96, WCADV received one of six national demonstration grants on older victims of

domestic violence from the Administration on Aging. In June of 1999, the Violence Against Women
44

Office gave WCADV a national technical assistance grant to open the National Clearinghouse on

Abuse in Later Life.

Project staff have worked closely with the Department of Health and Family Services, the Elder Law

Center of the Coalition of Wisconsin Aging Groups, the state attorney general’s office, Wisconsin

Coalition Against Sexual Assault, Wisconsin Council on Developmental Disabilities and local

domestic abuse programs. As the project has gained national recognition, staff has worked with

numerous national, state, and local domestic violence and elder abuse organizations.

Accomplishments of and Lessons Learned from Program

Key accomplishments of the project since 1988 include:

• Organizing a statewide advisory committee including several older battered women as well as

representatives from social services, aging, elder abuse, domestic violence, justice, health care,

faith-based communities and batterers treatment.

• Developing and implementing a day-long cross-training program for professionals from domestic

violence, sexual assault, aging, elder abuse and victim/witness organizations.

• Writing and disseminating a legal remedies booklet to help justice and law enforcement identify

the range of criminal and civil responses possible in many cases of elder abuse. The remedies

booklet has been used to train judges, prosecutors, victim/witness coordinators, legal services

organizations, and other justice professionals on abuse in later life.

• Writing and disseminating a booklet for health care providers. The booklet was endorsed by the

State Medical Society and distributed by the Department of Health and Family Services to more

than 10,000 health care providers in Wisconsin. This booklet also provided the basis for a training

module and project staff have trained numerous health care professionals throughout the state.

• Creating and disseminating a safety plan that incorporates concerns for victims of any age.

• Writing and disseminating a manual titled “Developing Services for Older Battered Women.”

• WCADV staff and speakers bureau members have trained thousands of professionals throughout

the country and written numerous articles that have been published in national journals and

newsletters.

As a result of the project, leaders in the domestic violence and elder abuse fields have become more

inclusive of older victims of domestic violence in their protocols, training and materials. Obstacles

remain, however, including:

• finding an ongoing stable funding source for the project and local battered women’s support

groups;

• helping professionals understand the power and control dynamics present in many family violence

situations and the importance of focusing on safety for victims and holding abusers accountable;

• finding the time and resources to create new materials and training on abuse in later life for others

(e.g., faith-based communities, mental health and substance abuse professionals); and

• ensuring visibility for older victims in the domestic violence movement.

Lessons learned include the importance of working collaboratively with professionals from domestic

violence, sexual assault, elder abuse, aging, social services, justice, health care, and other disciplines;

and of including the voices of victims in all product development.

Available materials include booklets on working with justice professionals and health care providers;

a manual on developing services for older abused women (written for domestic abuse programs); for

victims, several safety planning tools, including one focusing on financial safety planning; numerous

articles about domestic abuse in later life. Contact WCADV for cost information.
45

Elder Abuse and Neglect at Home

Workshop 2: Working Across Systems to Improve Services for

Victims of Domestic Violence and Sexual Assault

__________________________________________________________________________________

MEAPA’s Domestic Violence Initiatives

Area Agency on Aging

Phoenix, Arizona

Program Contact: Materials Contact:

Mary Lynn Kasunic, M.S., R.D., CPM

Executive Director

Area Agency on Aging, Region One

1366 E. Thomas Rd., Ste. 108

Phoenix, AZ 85014

Phone: 602-262-2255

Fax: 602-230-9132

kasunic@aaaphx.org

Same as program contact

Web site: www.aaaphx.org

Description of Program

The program, “Domestic Violence Does Not Respect Age,” was created to address a hidden

population of domestic violence victims – the older battered women. The program addresses public

awareness, professional education, and victim assistance.

Why Program Was Developed

The late-life domestic violence initiative was established in 1995 by Area Agency on Aging (AAA),

Region One, and Maricopa Elder Abuse Prevention Alliance (MEAPA), with more than 100 members,

because neither the general domestic violence community nor the aging community were addressing

older victims of domestic violence.

How Program Was Developed

In 1995 MEAPA conducted a survey that revealed that fewer than 20 older women per year were

utilizing domestic violence shelters in the county. Subsequently, educational materials, including a

play, The Dance (later rewritten and produced as a video), were developed, training was provided to

all domestic violence shelter staff in the county, and four older battered women support groups were

established.

Some of the victims in the support groups needed emergency housing. The county’s domestic

violence shelters are almost always full and turn away many victims. Older victims often do not feel

comfortable at traditional shelters. Therefore, the Maricopa Elder Emergency Housing Program was

established.

In addition to the AAA and MEAPA, there are currently 15 on-call volunteer advocates, 17 hospitals,

and 30 assisted-living centers and skilled nursing facilities involved with the program.
46

Accomplishments and Lessons Learned

The program’s many accomplishments include:

• In-service training to staff of domestic violence shelters. Topics include the aging process;

communication skills with older adults; elder abuse incidence and causation; dynamics of late-life

domestic violence; and community resources for older adults.

• Educational materials with the theme “Domestic Violence Does Not Respect Age” were created

and are widely distributed among older adults. This also included The Dance, a video that depicts

the life of an older battered woman.

• Older battered women support groups, four of which were created throughout Maricopa County.

• Free temporary emergency housing was created in Maricopa County for victims of both elder

abuse and late-life domestic violence, utilizing volunteer on-call advocates, hospital emergency

room personnel, and donated space by assisted living homes and skilled nursing facilities. Victims

may stay for up to two weeks in a facility. The AAA’s domestic violence specialist works with the

victim to identify options and community resources and provides support to begin the healing

process.

Small grants have been received to develop the program and produce the video. Most of the on-going

support is provided by volunteers and a small VOCA grant ($24,500 per year) from the Arizona

Department of Public Safety. The AAA also provides on-going financial support from its internal

budget and is continually seeking more funding for late-life domestic violence programs.

The biggest obstacle for the program is lack of funding for staff to do more outreach to older victims.

The number of older victims served is only about 200 annually, as compared with general domestic

violence programs, which serve thousands annually. As a result, it is very difficult to convince

domestic violence funders that older victims are a priority. In addition, after two weeks of emergency

housing, 50 percent of victims end up going back to the abuser because there is no transitional housing

for older victims. The Area Agency on Aging and MEAPA are working to develop transitional

housing.

The most difficult issue for the emergency-housing program is determining what level of client frailty

to accept. Initially, only persons who were completely independent were accepted, but in the last year,

with the addition of skilled nursing facilities as sites, the program now accepts victims with

impairments in ADLs (activities of daily living).

The key lessons learned are:

• Having a staff person dedicated to the program is essential.

• As the domestic violence initiative became known in the community, individuals less than 60

begged to utilize the services because they felt more comfortable with the older population rather

than the very young domestic violence victim. As a result, the program eligibility was dropped to

50 years of age.

• Collaboration is the key to success.

The following materials are available: “The Dance,” a 28-minute video depicting the life of an older

battered woman and her struggle to break free, $100; Older Battered Women Support Groups:

Facilitators Guide, $20; Maricopa Elder Emergency Housing Program Manual, $15; Mesa LEAPS

(Leads in Elder Abuse Prevention Strategies): A Comprehensive Community Strategy to Combat Elder

Abuse, $14.
47

Elder Abuse and Neglect at Home

Workshop 2: Working Across Systems to Improve Services for

Victims of Domestic Violence and Sexual Assault

_________________________________________________________________________________

Wisconsin Coalition Against Sexual Assault “Widening the Circle” Project

Wisconsin Coalition Against Sexual Assault

Madison, Wisconsin

Program Contact: Materials Contact:

Amy E. Judy

Systems Advocacy Program Coordinator

Wisconsin Coalition Against Sexual Assault, Inc.

600 Williamson St., Ste. N-2

Madison, WI 53703

Phone: 608-257-1516

Fax: 608-257-2150

Systems@wcasa.org

Wisconsin Coalition Against Sexual Assault Inc.

600 Williamson Street, Suite N-2

Madison, WI 53703

Phone: 608-257-2150

wcasa@wcasa.org

Web site: www.wscasa.org

Description of Program

The Wisconsin Coalition Against Sexual Assault (WCASA) “Widening the Circle” Project was

established to:

• initiate and/or enhance collaboration among human services, victim services, and criminal justice

systems regarding sexual assault and abuse against people with disabilities and the elderly; and

• assist in identifying the needs of these systems and develop appropriate materials and training

opportunities in order to enhance current responses to sexual assault and abuse occurring in

institutional and community-based settings.

Why Program Was Developed

WCASA recognized three problems that needed to be addressed:

• lack of awareness and/or recognition of the prevalence of sexual assault and abuse against the

elderly and persons with disabilities;

• lack of appropriate response by systems and individuals who provide direct support to older

persons or persons with disabilities who disclose that they have been sexually assaulted or abused;

and

• the systems’ inability to hold perpetrators accountable for sexual assault and abuse against the

elderly and persons with disabilities and to provide support services to those victims.

How Program Was Developed

After years of remaining absent from initiatives to enhance services to abuse victims who are older or

who have disabilities, WCASA recognized the importance of serving those populations largely due to

the “indefatigable determination” of Wisconsin’s Advocacy & Protection Systems Developer (who

administers the state APS program). Project-focused efforts began in 1997 with funding from the

Centers for Disease Control Rape Prevention Education Grants. The formal project was commenced

in July 2000 with $54,804 in funding from the Violence Against Women Act STOP Formula Grants

administered by the Wisconsin Office of Justice Assistance.
48

This effort began as a project with one staff person adding responsibilities to other supervisory and

program operations duties. As a result of the growth of interest in this area and increased technical

assistance requests, the project was developed into an organizational program and staff members were

added to work permanently on these efforts.

Accomplishments and Lessons Learned

WCASA has provided initial training to Wisconsin’s sexual assault service provider programs and

other state sexual assault coalitions regarding prevention and intervention services to the elderly and

people with disabilities. WCASA has produced a guide/manual and accompanying video resource

titled Widening the Circle: Sexual Assault/Abuse and People with Disabilities and the Elderly

(available for $45.)

WCASA and the Wisconsin Coalition Against Domestic Violence jointly convened an ad hoc work

group focusing on elder abuse in facility settings. The work group, composed of numerous other

pertinent organizations and service providers, is defining the problems faced by older victims of abuse

and/or sexual assault and making recommendations for improvement in intervention. In addition,

WCASA is meeting and working with several statewide agencies and organizations to initiate

additional efforts for public awareness and service enhancement.

Two obstacles have surfaced:

• general lack of awareness among systems and the public of sexual assault and abuse against the

elderly and people with disabilities; and

• lack of resources available to governmental agencies, service systems, and domestic violence and

sexual assault organizations to respond to such abuse.

Efforts are underway in Wisconsin, spearheaded by many stakeholders, to overcome these barriers.

The most important lessons from this effort have been the value of systems collaboration and what is

necessary to foster collaboration. Those who seek collaboration must realize that many individuals

within other systems know a tremendous amount about their own systems. In order to initiate real

change, partnerships must be formed that respect that knowledge and the culture within each system:

its role, resources, and limits. Working in collaboration with Adult Protective Services (APS), criminal

justice, and other systems provides the foundation from which real change in this area can occur –

lasting change cannot be achieved alone.

A guide/manual and accompanying video resource, “Widening the Circle: Sexual Assault/Abuse and

People with Disabilities and the Elderly,” was authored by several experts in the disability/elderly

and/or sexual assault arenas, including Holly Ramsey-Klawsnik, Ph.D. It is close-captioned and

available for $45, including shipping and handling. In the fall of 2000, WCASA will produce a

booklet about sexual assault and/or abuse and older adults in English, Spanish and large print

versions. Additional information is available on the web site.
49

Elder Abuse and Neglect at Home

Workshop 3: Engaging Law Enforcement,

Prosecution, and the Judiciary

_____________________________________________________________

Adult Protective Services and Law Enforcement Teamwork Approach

Division of Aging and Adult Services

Salt Lake City, Utah

Program Contact: Materials Contact:

C. Ronald Stromberg

Assistant Director

Division of Aging and Adult Services

120 North 200 West

Salt Lake City, UT 84103

Phone: 801-538-4591

Fax: 801-538-4395

rstrombe@hs.state.ut.us

Same as program contact

Description of Program

In 1996, the State Department of Human Services hired a full-time law enforcement officer to work

with its Adult Protective Services and law enforcement agencies throughout the state on elder abuse

and exploitation cases. The program was established through a contract between Human Services and

the State Department of Public Safety.

The goals of the program are:

• to consult with Adult Protective Services (APS) investigators regarding cases of financial

exploitation of persons who have disabilities or are elderly and to screen those cases to assess

whether law enforcement involvement is appropriate;

• to provide training and consultation to local law enforcement agencies on abuse, neglect and

exploitation of persons who have disabilities or are elderly;

• to attempt to have at least one highly trained officer in each jurisdiction who can work with APS

and handle adult and elder abuse cases;

• to serve as a consultant to APS and local law enforcement officers on individual case

investigations;

• to work with county and district attorneys in an attempt to have cases prosecuted and establish

good case law.

Why Program Was Developed

In the mid-1990s, Utah law enforcement agencies were not always aggressive in pursuing elder abuse

cases, often due to lack of training and resources. Previous attempts to train law enforcement officers

about violations of elder abuse statutes, using social workers, had not been successful. Therefore,

APS was seeking some way to create a cooperative working relationship with law enforcement to help

stop elder exploitation.
50

How Program Was Developed

A joint meeting between APS and the State Criminal Investigation unit on a specific case of

exploitation led to a discussion of the problems APS faced generally when trying to get law

enforcement to take a case. A brainstorming session generated the idea that APS needed a law

enforcement officer who could talk “cop talk” and work directly with law enforcement agencies.

Administrators in Human Services and Public Safety welcomed the idea of a contractual arrangement.

It was a politically appropriate way to demonstrate cooperation between two large departments of state

government and to serve a vulnerable population. APS used funding it already had for an existing

vacant APS worker position; in essence, APS gave up a worker position to hire the law enforcement

officer.

Currently involved with the program are the Department of Human Services, Department of Public

Safety and local law enforcement agencies. Local prosecutors and the state attorney general’s office

also have become involved in individual cases.

Accomplishments and Lessons Learned

Program accomplishments include:

• several hundred law enforcement officers trained by APS and the APS Law Enforcement Officer;

• several officers in local jurisdictions identified as resources for APS;

• a number of cases investigated jointly and charges filed.

Partially as a result of the program and the stronger focus on elder abuse issues, a new Elder Abuse

Criminal Code statute was passed by the state legislature in 1996.

Most of the program time is spent in training personnel and investigating individual cases; one

program goal is to provide training to every law enforcement agency in the state. The biggest obstacle

is getting some local law enforcement agencies to recognize the seriousness of working with older

victims. As a general rule, county attorneys continue to resist prosecution of elder abuse cases, even

when law enforcement has developed an excellent case, and many prosecutors have been unwilling to

participate in the extensive training that is now available. Prosecutors see relatively few cases of elder

abuse and exploitation. The issue is not a major focus for them, and they often are unfamiliar with the

procedures and paperwork requirements for handling these cases.

A key lesson from this program is that properly trained law enforcement officers are more effective

and productive in dealing with elder abuse and exploitation than Adult Protective Services working

alone.

Materials available at no charge.
51

Elder Abuse and Neglect at Home

Workshop 3: Engaging Law Enforcement,

Prosecution, and the Judiciary

_____________________________________________________________

Educating Law Enforcement and Prosecutors about Elder Abuse

Commission on Peace Officer Standards and Training (POST)

Sacramento, California

Program Contact: Materials Contacts:

Candace J. Heisler

San Francisco Assistant District Attorney (ret.)

Consultant and Trainer

P.O. Box 31028

San Francisco, CA 94131-0028

Phone: 415-661-4410

Fax: 415-665-3962

cjheisler@aol.com

Jan Bullard or Ray Bray

Commission on Peace Officer Standards and

Training

1601 Alhambra Blvd.

Sacramento, CA 95814

Phone: 916-227-4887 (Jan Bullard)

jbullard@post.ca.gov

Phone: 916-227-4892 (Ray Bray)

rbray@post.ca.gov

Fax: 916-227-4011 (both)

Description of Program

The Commission on Peace Officer Standards and Training (POST) develops training for California

law enforcement agencies using a variety of formats. POST has developed elder abuse training, the

goals of which are:

• to increase law enforcement awareness of the forms and indicators of elder abuse, the relationship

to other forms of abuse such as family violence, skills for interviewing older adults, reporting laws

and responsibilities, criminal statues, evidence collection and case building, methods to protect

older adults, community resources, and how to work with adult protective services (APS); and

• to demonstrate the value of working collaboratively with other disciplines.

Why Program Was Developed

The Commission on POST was developed to certify minimum standards for law enforcement

competency and to establish statewide guidelines in handling a variety of law enforcement situations

and categories of crime, such as domestic violence. Over time, it became clear that law enforcement

officers needed education about domestic violence (including elder domestic violence) and elder abuse

and thus those courses were developed.

How Program Was Developed

The Domestic Violence Subject Matter Expert Committee, including representatives from the law

enforcement, prosecution, and advocacy arenas, grew out of a legislative mandate and was organized

in 1992 to develop guidelines for response to domestic violence. Committee members developed
52

curricula for various domestic violence courses. Those experts, who represented law enforcement,

prosecution, victim witness programs, and advocacy, later helped develop the elder abuse training

curricula. They also helped to identify experts from other areas including aging services, APS,

medicine, legal services for the elderly, conservatorship organizations and Medi-Cal/Medicaid fraud.

Most of the domestic violence and elder abuse curricula have been developed since 1997. Funding

has come from the regular POST budget from the California legislature and from California’s

Violence Against Women Act STOP formula grant monies.

Accomplishments and Lessons Learned

The commission has developed several telecourses, classroom courses, and a CD-ROM program that

address elder abuse in various ways. These include:

• courses on elder abuse (1997); domestic violence and culture (1998); and court orders (2000);

• a 40-hour classroom course for domestic violence investigators that addresses elder abuse in a

specific segment on elder domestic violence and contains other segments on dynamics,

investigation, mandates, lethality assessment, safety planning, and court orders;

• an eight-hour course for first responders in domestic violence that briefly reviews elder abuse

criminal laws;

• an eight-hour sexual assault course for first responders that includes a lengthy article on elder

sexual assault; and

• a 24-hour domestic violence course for field training officers that reviews elder abuse criminal

statutes.

The curricula address many policy-related issues, including the different needs of urban and rural

victims, abusers, and law enforcement agencies and the complexities posed by the many cultures,

languages, and underserved populations (e.g., elderly, same sex relationships) in California.

The domestic violence curricula committee faced obstacles when it commenced. These included a

history of distrust and public finger pointing between many of the participants. Some law enforcement

representatives lacked experience handling domestic violence cases and did not see the issue as

significant. With time these problems disappeared, particularly as persons unwilling to change their

attitudes and persons inexperienced with handling domestic violence were replaced. The remaining

experts began to work together and with experience the obstacles were overcome.

The key lessons learned are that collaboration is necessary to develop and implement effective

training; careful screening of committee members is necessary to assure they can work together and

are not hostile to the project; involvement of agency leadership is critical in order to assure that elder

abuse and related topics are an agency priority; and it is necessary to secure a funding stream that will

continue past grant periods.

Copies of telecourses are available from the Commission on POST. Call 916 227-4889. Telecourses

often are available through local law enforcement agencies in the US that regularly download POST

courses. The approximate charge for videos is $100.
53

Elder Abuse and Neglect at Home

Workshop 3: Engaging Law Enforcement,

Prosecution, and the Judiciary

________________________________________________________________

Elder Abuse Curricula for Judges, Court Staff and Victim Advocates

American Bar Association Commission on Legal Problems of the Elderly

Washington, DC

Program Contact: Materials Contacts:

Lori A. Stiegel

Associate Staff Director

American Bar Association (ABA)

Commission on Legal Problems of the Elderly

740 15th Street, NW

Washington, DC 20005

Phone: 202-662-8692

Fax: 202-662-8698

lstiegel@staff.abanet.org

Same as program contact

Web Sites:

Commission on Legal Problems of the Elderly

www.abanet.org/elderly

National Center on Elder Abuse:

www.elderabusecenter.org

Description of Program

The ABA Commission on Legal Problems of the Elderly (ABA Commission) has developed model

national curricula on elder abuse for judges, court staff, and victim services providers. The curricula

are intended for use by state judicial educators, victim services providers, and others in planning and

implementing educational programs for their constituencies on the unique nature of and considerations

related to cases involving elder abuse.

The goals of the ABA Commission’s two curricula projects are:

• to heighten the sensitivity and knowledge of participants about the growing problems of elder

abuse and about the laws and programs related to elder abuse; and

• to expand the awareness among judges who hear family violence cases or serve on family violence

coordinating councils and among victim services providers that many instances of elder abuse are

part of the continuum of family violence.

Why Program Was Developed

The judicial and court staff curricula project was developed because of the recognition that the number

of elder abuse cases in the courts is growing. The project implemented the first recommendation of

the ABA Commission’s State Justice Institute-funded project, “Recommended Guidelines for the State

Courts in Handling Elder Abuse Cases,” which called for training judges and court staff about elder

abuse.
54

The curriculum for victim services providers was developed for similar reasons. The changing

approach to handling elder abuse cases and the growing number of cases in the criminal justice system

mean that victim services providers will increasingly be called upon to assist victims of elder abuse.

Additionally, a DOJ focus group on elder victimization had recommended that such a curriculum be

developed.

How Program Was Developed

The State Justice Institute funded the judicial and court staff curricula project in 1996. The ABA

Commission conducted it in conjunction with the National Association of Women Judges. Each of the

three curricula for judges and court staff was pilot tested once during the course of the grant project

that funded the curricula development.

The DOJ Office for Victims of Crime funded the victim services provider curriculum in 1998. This

curriculum has been pilot tested five times: twice at the National Organization for Victim Assistance

annual meeting and at victim services conferences in Missouri, Washington and Pennsylvania. This

curriculum will be available in 2001.

Accomplishments and Lessons Learned

Judges in Tennessee and Illinois and court staff in Tennessee were educated about elder abuse during

the pilot phase of the curricula project. Since that time, the judicial curricula have been used at the

annual meeting of the National Association of Women Judges and at judicial conferences in

Washington, Florida (twice), Georgia, Ohio and Wisconsin.

Widespread implementation of the judicial and court staff curricula has faced obstacles. It seems likely

that many judges and court staff, and the professionals responsible for developing education programs

on their behalf, are still not seeing many cases of elder abuse and thus are not willing to expend the

effort to learn about that issue.

In the states where the judicial and court staff curricula were pilot tested or subsequently implemented,

it took concerted efforts by one or more concerned judges, judicial educators and advocates for elder

abuse victims to make that happen.

The key lesson learned is that there are three critical factors for successful implementation of these

model curricula:

• the support -- and preferably the active leadership -- of a concerned and well-respected member of

the target audience;

• a multidisciplinary team of planners who represent and understand the target audience and who

can and will adapt the curricula to the needs of the target audience; and

• a multidisciplinary team of trainers, led by one or more peers of the target audience, who

understand the work done by and the specific laws, programs and issues affecting the target

audience, and who can and will target their presentations to the needs of that audience.

Elder Abuse in the State Courts – Three Curricula for Judges and Court Staff is available from the

ABA Commission at no cost to organizations that plan to use it for the purpose for which it was

intended. The curriculum for victim services providers will be available from the DOJ Office for

Victims of Crime in 2001.
55

Elder Abuse and Neglect at Home

Workshop 3: Engaging Law Enforcement,

Prosecution, and the Judiciary

__________________________________________________________________________________

Encouraging Tribal Law Enforcement

Pascua Yaqui Police Department

Tucson, Arizona

Program Contact: Materials Contact:

Charles Mendonca

Police Officer

Pasqua Yaqui Police Department

7474 S. Camino De Oeste

Tucson, AZ 85746

Phone: 520-879-5500

Fax: 520-879-5510

Dan Liston

Chief of Police

Pasqua Yaqui Police Department

7474 S. Camino De Oeste

Tucson, AZ 85746

Phone: 520-879-5500

Fax: 520-879-5510

Same as first program contact

Description of Program

The goal of this program is to provide a focal point for elderly residents of the tribe to help them

resolve family problems and prevent elder abuse.

Why Program Was Developed

While the tribal council adopted an elder abuse code in the 1980s, no one was appointed to enforce it

and there was no focal point in the community for elder abuse prevention or enforcement.

How Program Was Developed

Police Chief Dan Liston established the program in June 1999 by appointing Officer Charles

Mendonca as the investigating officer on elder abuse and giving him responsibility for responding to

elder complaints. The program operates solely within the police department; no outside funding has

been obtained. All cases involving victims 55 years old or older are referred to Officer Mendonca’s

office for review, as are all elder complaints generally. Officer Mendonca functions partly as a

“social worker” or “public relations officer for the elderly.” He works with other organizations to find

solutions, including the Housing Authority, Social Services, Behavioral Health, Adult Protective

Services (APS), and shelter programs for the elderly.
56

Accomplishments and Lessons Learned

This program has established a safe environment for seniors to communicate honestly with law

enforcement about their situations. The program also has had success in mediating family disputes. In

addition, elders now know whom they can call when they are unable to obtain services or otherwise

resolve issues on their own.

There have been a number of obstacles in establishing this program. These include denial, the feeling

of many of the tribe’s elders that they are being neglected by the tribal government, and the

withholding of confidential information from law enforcement by social workers and counselors due

to a lack of understanding about immunity from prosecution. Through education and implementation

of the program, however, more elders are coming forward to seek the help they need.

A key lesson learned is that it is important to place the right person in the right job. The police officer

investigating cases and interviewing victims has to be part social worker and think “outside the box”

of traditional law enforcement.

Materials available.
57

Elder Abuse and Neglect at Home

Workshop 4: Augmenting the Role of Medical Professionals

________________________________________________________________

California Vulnerable Adult Specialist Team (VAST)

University of California at Irvine Medical Center

Orange, California

Program Contact: Materials Contact:

Laura Mosqueda, M.D.

Director of Geriatrics and Associate Clinical

Professor of Family Medicine

UCI Medical Center

Pavilion III, ZC1150

101 The City Drive

Orange, CA 92868-3298

Phone: 714-456-5530

Fax: 714-456-7933

mosqueda@uci.edu

Tessa Janian, M.A.

Program Coordinator

VAST

UCI Geriatric Department

101 The City – Pavillion III

Orange, CA 92868

Phone: 714-456-5735

tjanian@uci.edu

Same as second program contact.

Description of Program

The purpose of the Vulnerable Adult Specialist team (VAST) is to design, implement, and evaluate the

usefulness of an interdisciplinary medical team in the assessment, diagnosis, investigation, and

prosecution of elder abuse cases.

The goals for this program are:

• to create a team of experts consisting of a geriatrician, nurse practitioner, pharmacist,

psychologist, social worker, and gerontologist;

• to examine the medical and psychological injuries of elder abuse victims;

• to document injuries for subsequent legal action;

• to assess the cognitive ability of the victims and/or the alleged perpetrators;

• to stimulate discussion among a group of experts representing a diverse group of disciplines

(criminology, law, ethics, social services, law enforcement, geriatrics) in order to establish the

optimal role of the medical component;

• to develop criteria for addressing which victims would benefit most from the health team’s

evaluation and treatment;

• to send a geriatrician and/or nurse practitioner to community-based meetings on elder abuse;

• to provide urgent (within 48 hours) availability of individual team members for consultation with

Adult Protective Services (APS) staff;
58

• to provide agencies and lawmakers sufficient and compelling information to enact legislation

based upon the outcomes of the project;

• to develop a standardized tool for documenting elder abuse;

• to educate health care providers, attorneys, law enforcement, and seniors;

• to create a practical and replicable approach to elder abuse in which social, medical, and legal

services coordinate efforts in order to successfully recognize, report, examine/document, and

prosecute elder abuse and neglect.

Why Program Was Developed

The program was developed to address the recurring complaint among people who work in the field of

elder abuse that there is a lack of knowledgeable, trained medical clinicians to assist them.

Additionally, the program is seeking to address other problems related to medical

examination/documentation of elder abuse cases such as the lack of standardized tools for screening

for elder abuse or documenting the signs and symptoms of elder abuse. By working with child abuse

experts who have faced similar problems, the program is developing tools that will improve the quality

of elder abuse examination and documentation, as well as the quality of evidence available to the

criminal justice system.

How Program Was Developed

The program was developed by the Program in Geriatrics, University of California Irvine, College of

Medicine. It was funded in April 2000 through a three-year grant totaling $881,775 from the

Archstone Foundation.

Organizations currently involved with the program include adult protective services, the county mental

health unit for elders, the local long-term care ombudsman, an advocacy group for community

services, the local domestic violence shelter, the Public Guardian, the Orange County District

Attorney, Family Violence Subcommittee on Elder Abuse, and the Orange County Financial Abuse

Specialist Team. The program anticipates that as it grows other organizations will become involved.

Accomplishments and Lessons Learned

The team has responded to 37 inquiries by APS and consulted about or conducted home visits on 19

documented cases in the first six months. Two cases have resulted in prosecution; there has been one

conviction and the other case is in progress.

The program has experienced challenges in determining which APS cases would benefit most from the

team’s expertise. VAST has received referrals that need medical intervention but do not necessarily

involve abuse; however, the consultant role does not permit the team to take on primary-care patients.

To deal with this challenge, the team meets regularly with referring parties in order to encourage

cross-training and learn more about unmet needs.

Two key lessons have been learned. First, it would have been beneficial if the program had conducted

training for APS workers on using the medical consultants before it began accepting referrals.

Second, there is a need for integration of a medical team into the current system.

Materials are available free of charge.
59

Elder Abuse and Neglect at Home

Workshop 4: Augmenting the Role of Medical Professionals

________________________________________________________________

Texas Elder Abuse & Mistreatment (TEAM) Institute

Baylor College of Medicine

Houston, Texas

Program Contacts: Materials Contact:

Carmel Bitondo Dyer, M.D.

Associate Professor of Medicine

Baylor College of Medicine

Director of the Geriatrics Program

Harris County Hospital District

3601 N. MacGregor Way

Houston, TX 77004

Phone: 713-525-4872

Fax: 713-525-4896

cdyer@bcm.tmc.edu

Nicolo Festa, M.S.W.

Texas Department of Protective and Regulatory Services

Adult Protective Services Division

P.O. Box 149030

Austin, TX 78714-9030

Phone: 512-438-3212

Fax: 512-438-4881

FESTANA@auste654a.aust.tdprs.state.tx.us

Same as first program contact

Description of Program

The Texas Elder Abuse and Mistreatment (TEAM) Institute is a collaboration between the Baylor

College of Medicine Geriatrics Program at the Harris County Hospital District and the Texas

Department of Protective and Regulatory Service. The goal of the program is to improve the lives of

abused and neglected elders through clinical care, education, and research.

Why Program Was Developed

The TEAM Institute was developed to use an interdisciplinary geriatric medicine team as an adjunct to

existing Adult Protective Services (APS) intervention in order to improve outcomes in the care of

abused or neglected elders.

How Program Was Developed

The TEAM Institute was developed in December 1997 by the Baylor College of Medicine Geriatrics

Program at the Harris County Hospital District and the Texas Department of Protective and

Regulatory Services –Adult Protective Service Division.
60

Additional organizations that have become involved with the TEAM Institute include: the Houston

Area Women’s Center; the Departments of Internal Medicine and Family Practice, Baylor College of

Medicine; the VIVA Clinic at Ben Taub General Hospital; and the Harris County Attorney’s Office.

The TEAM Institute has found that it addresses the following policy issues:

• care of minority elders;

• care of the uninsured and underinsured;

• advancement of research agendas in the area of elder mistreatment;

• the care of mistreated elders delivered by public agencies;

• educational imperatives for medical, nursing, and social work students;

• the education of APS specialists in the area of common medical conditions seen in elders;

• guardianship in elders who lack capacity to make decisions for themselves; and

• the root medical causes of elder abuse and neglect.

Accomplishments and Lessons Learned

To date, the TEAM Institute has accomplished the following:

• provided direct care to more than 300 abused or neglected senior citizens;

• established an interdisciplinary team that includes physicians, nurse practitioners, social workers,

and APS specialists;

• had more than 400 medical students accompany APS specialists on in-home investigations;

• trained more than 300 students of different disciplines in the TEAM Institute approach;

• made more than 30 presentations in eight states, educating APS specialists, physicians, nurses, and

social workers about the TEAM approach;

• published five papers on various aspects of TEAM Institute’s research and clinical approach;

• conducted a number of research studies and have five ongoing studies; and

• begun the process of expanding the program to multiple regions in the state of Texas.

The obstacles faced by the program relate to the differences in approach to patient/client care by the

various disciplines. Traditionally, medical teams develop a list of differential diagnoses and then

narrow down the possibilities using objective measures. Social workers and APS specialists have been

trained to gather as much information as possible to broaden the possibilities and to use subjective

data. Another obstacle, one faced by each discipline, is the assessment of capacity of the clients.

The obstacles are being overcome by holding regular meetings and a joint training course on

assessment of capacity. In addition, the program is establishing guidelines for the referrals sent to the

medical team.

The key lesson learned is that it is critical for members of APS specialist teams and geriatric medicine

teams to meet regularly, to get to know each other, and develop trust with each other.

Materials are available at no charge.
61

Elder Abuse and Neglect at Home

Workshop 4: Augmenting the Role of Medical Professionals

_____________________________________________________________

South Carolina Vulnerable Adult Medical Protocol

South Carolina Department of Public Safety

Columbia, South Carolina

Program Contact: Materials Contact:

Randolph W. Thomas

Law Enforcement Instructor

South Carolina Department of Public Safety

5400 Broad River Rd.

Columbia, SC 29212

Phone: 803-896-7756

Thomas_RandolphW@scdps.state.sc.us

Mavis Riley

Adult Protection Coordinating Council

P.O. Box 8206

Columbia, SC 29202

Phone: 803-898-2719

RILEY@dhhs.state.sc.us

Description of Program

The South Carolina Vulnerable Adult Medical Protocol was designed to provide a standardized means

for collecting evidence to support improved criminal prosecution in cases of elder abuse. The goals of

the protocol are:

• to provide documentation of medical evidence for the prosecution of perpetrators;

• to enhance awareness of the problem of vulnerable adult abuse and neglect among physicians and

other medical providers;

• to serve as an assessment tool to assist physicians.

Why Program Was Developed

The South Carolina Adult Protection Coordinating Council, a statewide body, saw a need to develop a

medical protocol for vulnerable adults in order to enhance the collection of evidence that will support

improved criminal prosecution in cases of elder abuse.

How Program Was Developed

The South Carolina Adult Protection Coordinating Council and the South Carolina Medical

Association developed the protocol in 1995 through a multidisciplinary process that insured input

from the criminal justice system, medical community, social services and victim advocates. The

subcommittee charged with drafting the document looked at the protocols used in the child abuse

community as a departure point for development of the vulnerable adult protocol.

There was a great deal of discussion in the medical community about the length and difficulty of the

protocol. These issues were resolved through a pilot program that tested the form and made the

necessary changes that ultimately resulted in consensus.
62

The form currently is supported through the South Carolina Law Enforcement Division, which

manages the process for both vulnerable adult and child medical protocols.

The South Carolina Law Enforcement Division and the South Carolina Division of Victim’s

Assistance bear the costs of this program (printing, distribution and administration of the protocol).

Accomplishments and Lessons Learned

A training program about the curricula has been developed and presented through South Carolina

Educational Television.

The major obstacle faced by the program has been one of usage. The protocol has been distributed to

all hospitals and other locations where vulnerable adults may go for medical treatment. However, the

majority of abuse and neglect cases have not come from hospitals. They have been “in-home” or

facility cases – e.g., nursing homes, residential-care facilities – and these incidents generally do not

result in the victim coming in contact with medical personnel who are aware of or have been trained in

the use of this procedure. While the protocol is an excellent tool for forensic screening, it doesn’t reach

the majority of victims at the present time. In order to reach the entire medical community, extensive

training would have to occur; resources for this do not currently exist.

The key lesson learned is the importance of “getting the word out” and educating those medical

professionals who need to use the protocol.

Materials are available at no charge.
63

Elder Abuse and Neglect at Home

Workshop 5: Enhancing Victim Services

________________________________________________________________

California’s Victim-Witness and Prosecution Initiatives for Elder Abuse Victims

Governor’s Office of Criminal Justice Planning (OCJP)

Sacramento, California

Program Contact: Materials Contact:

Judy O’Neal

Chief, Victim Witness Branch

Governor’s Office of Criminal Justice Planning

1130 K St., Ste. 300

Sacramento, CA 95814

Phone: 916-323-7727

Fax: 916-324-9167

Judy.ONeal@ocjp.ca.gov

Same as program contact

Web Site: www.ocjp.ca.gov

Description of Programs

The office has three programs focusing on elder abuse.

• The Elder Abuse Advocacy and Outreach Program is the largest. Its goal is to provide a

coordinated multidisciplinary team response to the needs of elder and dependent adults who have

become victims or have the potential of becoming victims of abuse, either financial or physical.

• The Elder Abuse Special Emphasis and Special Victims Program also focuses on providing direct

victim services, but moves a step further into serving underserved populations. Successful

applicants select an ethnic minority population of elder citizens and spend at least 50 percent of

their time working within the target community itself.

• The Elder Abuse Vertical Prosecution Program is a new arm of the overall effort of OCJP to

provide consistent holistic approaches to solving problems in the criminal justice system and

victim services. The goal of the program is to enhance or create special units in prosecutor’s

offices in California that handle felony crimes against the elderly or dependent adults through

investigations and vertical prosecution of cases.

Why Programs Were Developed

California has a burgeoning elder population, and this group of vulnerable citizens deserves

recognition and services aimed at their protection and safety.

How Programs Were Developed

The Elder Abuse Advocacy and Outreach Program began in April 1999; it was established by OCJP at

the request of the Governor and State Legislature. It is providing $1.7 million in VOCA funds to 24

counties.
64

The Elder Abuse Special Emphasis and Special Victims Program began operation in July 1997 and

was developed by the OCJP due to internal recognition of the need to focus on this growing

population. It is providing $630,000 in VOCA funds to 6 counties.

The Elder Abuse Vertical Prosecution Program began in April 2000 and was established by legislative

act at the request of OCJP in order to provide a multi-disciplinary approach to the problem. Funding

is provided to 17 counties with $2.217 million in federal Byrne monies and state general funds.

All these programs are continuing to grow as the communities begin to show results and media

response shows the effectiveness of their efforts. More agencies become involved as more media

attention is focused on the issue. Outreach efforts include billboard displays in prominent freeway

commute areas; displays on rapid transit systems; bus kiosks; radio and television public service

addresses and posters in emergency rooms of hospitals.

Accomplishments and Lessons Learned

Accomplishments include:

• recognition that care facilities need constant monitoring by regulatory agencies to ensure

compliance with safety requirements;

• improved community awareness that has resulted in overwhelming caseloads of abuse for

prosecutors and law enforcement;

• consideration of new legislation that will allow banks to make disclosures about suspected

financial abuse to law enforcement without fear of violating confidentiality laws; and

• expansion of advocacy by creating new positions has allowed more outreach and direct victim

services particularly on a 24-hour call back basis.

The biggest obstacles have been the lack of training when task forces are established and the need for

more personnel at the state funding agency to provide one-on-one technical assistance to each project.

To overcome this, the office is starting grant programs with a mandatory meeting of the management

of each agency to provide them with the policy and state and federal reporting requirements.

The following are the key lessons learned.

• Any new program created, whether a victim service or a criminal justice program, must address

the need to educate the program respondents about the tasks ahead.

• Alliances with other state and federal programs to put in place all the services seen as critical to

achieving program goals can help to overcome inadequate.

• Gathering all relevant agencies together and looking at the problem is challenging, but results in

more success.

Requests for Proposals for Prosecution and or Advocacy programs are available through the

Governor's Office of Criminal Justice Planning Victim Witness Branch at 916-324-9128. Individual

model projects within these two areas also may be requested by contacting a Program Specialist at

that number.
65

Elder Abuse and Neglect at Home

Workshop 5: Enhancing Victim Services

_____________________________________________________________

Child and Family Advocacy Center/Triad Program of the Blackfeet

Blackfeet Tribe

Browning, Montana

Program Contact: Materials Contact:

Shanny Augare, Director

Blackfeet Child & Family Advocacy Center

P.O. Box 870

517 E. Boundary St.

Browning, MT 59417

Phone: 406-338-5180

Fax: 406-338-5660

club@3rivers.net

Same as program contact

Description of Program

The purpose of the Blackfeet Child & Family Advocacy Center, located on the Blackfeet Indian

Reservation, is crime prevention and victim services. Its mission is to “to promote the health and

well-being of children and families.” The main goals of the program are:

• to establish a Victims Office which provides crime prevention education and victim services;

• to provide training to all service providers about types of crime and their effects;

• to identify the needs of elder victims of crime; and

• to develop and implement policies and procedures, laws, protection codes, and criminal and civil

ordinances.

As indicated by the third goal, the Center has focused a portion of its efforts on specifically addressing

the needs of elderly crime victims.

Why Program Was Developed

A survey of Personal Care Attendant workers conducted by the Center identified a significant need for

training, protocols, and services related to crimes against the elderly. Therefore the Center has

targeted this issue as part of its overall mission.

How Program Was Developed

The Child & Family Advocacy Center developed the program in 1998. A Victims of Crime Act

(VOCA) grant of $25,000 provided support for establishing the Victims Office and completing a

community needs assessment.
66

Agencies currently involved with the program include the Blackfeet Eagle Shield Program, the Heart

Butte Senior Citizen Program, the Reservation nursing home, law enforcement, and community health

agencies.

Accomplishments and Lessons Learned

The Center’s accomplishments include:

• completion of a community needs assessment;

• completion of a survey of personal care attendants;

• establishment of a planning and advisory council;

• establishment of a domestic violence protocol and other policies and procedures;

• establishment of a Domestic Abuse Victims Program, which has served more than 100 abused

women and their children (including four elders) this year.

An Office for Victims of Crime evaluation in July 2000 found that the project had “achieved all

objectives with limited funding,” had “good staff/management skills,” had established a “good

computer data base,” and that the “program has the capability to be used as a model program for other

tribes.”

The major obstacle is lack of funding to meet all the current needs, such as a permanent, specially

trained investigator; training for law enforcement, the Tribal court, probation, and other criminal

justice professionals; development of new laws; a domestic violence shelter; crime prevention

education; emergency services; and a resource library.

Key lessons learned include:

• the value of having a qualified accountant when establishing a non-profit program to keep

adequate financial records, complete tax reports and federal financial reports, do the payroll, and

manage the drawdown of funding;

• the need to train all staff instead of a selected few; and

• the importance of adding indirect costs to grants to cover overhead expenses such as audits and

building maintenance.

Materials available.
67

Elder Abuse and Neglect at Home

Workshop 5: Enhancing Victim Services

_____________________________________________________________

Victim-Witness Efforts of the U.S. Attorney for the Western District of Texas

U.S. Attorney’s Office for the Western District of Texas

Austin, Texas

Program Contact: Materials Contact:

Kathi West

Victim-Witness Coordinator

U.S. Attorney’s Office for the Western District of

Texas

816 Congress Avenue, Suite 1000

Austin, TX 78701

Phone: 512-916-5858 or 1-800-286-8771

Fax: 512-916-5854 or 512-370-1281

Description of Program

The role of the federal Victim-Witness Coordinator is defined by statute in the Victims’ Rights and

Restitution Act of 1990 and the Attorney General Guidelines for Victim and Witness Assistance

(1991). Variations exist between districts and between victim assistance programs within the districts.

These variations are dependent upon the available resources in the district, level of the victim-witness

coordinator’s expertise, and the direction set by each U.S. Attorney’s Office (USAO). After

indictment, the USAO Victim-Witness Coordinators serve as the contact person for all crime victims,

including elderly crime victims, going through the federal criminal justice system.

Why Program Was Developed

The purpose of the Victim-Witness Programs in the United States Attorneys Offices is to ensure that

federal crime victims are afforded their rights.

How Program Was Developed

In order to provide comprehensive services, the federal victim-witness programs must rely on others in

the service delivery system to provide necessary information and resources. Victim service delivery

depends on information in possession of the Assistant U.S. Attorney, as well as federal law

enforcement agencies, the courts, probation, corrections, and the local community service programs.

The federal coordinators must keep up-to-date on all the various agencies within their districts that

offer assistance to victims and maintain a good working relationship with these agencies. This

collaboration is imperative in the event of a large multi-victim federal crime involving thousands of

crime victims.

The Victim-Witness Coordinator can take the lead in educating the agents and prosecutors on a case

involving elderly victimization and can advocate for a more victim-oriented approach.
68

Accomplishments and Lessons Learned

The USAO for the Western District of Texas has established a “flexible” protocol for working large

multi-victim fraud cases involving hundreds or thousands of older victims. The USAO set up a tollfree victim and witness line to encourage older victims to call when they have questions. This number

is included on all correspondence from the U.S. Attorney’s Office. The USAO doesn’t use form

letters and staff members avoid using legalese in written correspondence to older victims. The USAO

prosecutors also often conduct a group court preparation session in the courtroom before the trial

begins, letting each victim/witness take the stand to get comfortable with the room, microphone and

prosecution team. An additional benefit of this procedure is that it allows the prosecution to determine

what special needs each victim may have (hearing loss, vision problems, mobility and cognitive

issues, medical problems, etc.).

Lessons learned include the importance of:

• NOT forcing older victims to use a complex voice mail system in order to leave a message

• NOT using form letters

• NOT forcing older victims to travel by air early in the morning or late in the evening

• providing a toll-free number for victims to call

• explaining thoroughly how the restitution process works

• making your program responsive to the victims’ needs on a case-by-case basis

• being creative and providing older victims with prevention and resource information to prevent

further victimization.

Many federal districts have a website that lists the phone numbers and addresses of each U.S.

Attorney’s Office field office in each federal district. To locate the U.S. Attorney’s Office in your area

you can go to www.usdoj.gov and then click on Alpha list of U.S. Attorney’s components. Each

federal district has a federal Victim-Witness Coordinator.
69

Institutional Abuse and Neglect

Workshop 1: Creative Initiatives to Educate

Professionals and the Public

________________________________________________________________

CARIE’s Abuse Prevention Training Program

Center for Advocacy for the Rights and Interests of the Elderly

Philadelphia, Pennsylvania

 Program Contact: Materials Contacts:

 Diane A. Menio

 Executive Director

 Center for Advocacy for the Rights and Interests of the

 Elderly (CARIE)

 1315 Walnut St., Ste. 1000

 Philadelphia, Pa. 19107

 Phone: 215-545-5728, ext. 244

 Fax: 215-545-5372

 menio@carie.org

Beth Hudson Keller

Director of Training and Education

keller@carie.org

Bonnie Tabas

Training Coordinator

tabas@carie.org

Both at CARIE with the same address, general

phone number, and fax as for program contact

Web site: www.carie.org

 Description of Program

The Center for Advocacy for the Rights and Interests of the Elderly (CARIE) created “Competence With

Compassion: A Training Guide” to educate certified nursing assistants (CNAs) in nursing homes about

abuse of residents. The three goals of the curriculum are:

• to increase staff awareness of abuse, neglect, and potential abuse in any setting where people are

dependent upon others for assistance;

• to equip staff with appropriate conflict intervention strategies so abuse can be avoided;

• to reduce incidences of abuse, thus improving the quality of life for both the person who requires care

and the caregiver.

Why Program Was Developed

Recent studies by Dr. Karl Pillemer, the Senate Committee on Aging, and the General Accounting Office

established in research the same resident abuse and staff training problems that CARIE had anecdotally

identified through its Long-term Care Ombudsman program and Elder Abuse Task Force.

How Program Was Developed

CARIE received funding from the Retirement Research Foundation in Chicago for its abuse prevention

training programs in 1989. Additional funding later was made available through other foundations and the

Pennsylvania Department on Aging. The Pennsylvania Department of Education funded a related project

in 1999. Currently, the Pennsylvania Commission on Crime and Delinquency is funding statewide training

using federal Byrne Grant funds.
70

Accomplishments of and Lessons Learned from Program

Thousands of direct long-term care staff and hundreds of trainers have been educated. The program has

been replicated throughout the United States and abroad.

Evaluations have been conducted to assess participants’ satisfaction with the training program; their level

of stress; conflict and resident aggression experienced by staff; staff reports of their own abusive behavior;

and supervisors’ ratings of participants performance on items related to the training. The response to the

training has been overwhelmingly positive with 95 percent reporting they felt comfortable discussing the

training topics. Ninety-five percent also stated they could relate the material covered to their own

experience on the floor, and 98 percent reported they would recommend the training program to other

nursing assistants.

Interestingly, one outcome of the training appears to be a decrease in aggression toward staff by residents,

with 70 percent of staff reporting having been pushed, grabbed, shoved, or pinched two or more times in

the last month at the pre-test, and only 45 percent reporting the same at the post-test.

Additionally, supervisors of participants were asked to rate the nursing assistants’ performance in several

areas during pre-test and post-test with handling conflict: 16 percent were reported to do this well at the

pre-test and 26 percent were cited for good conflict resolution skills at the post-test.

The major obstacle has been maintaining funding. It has been overcome basically through the

establishment of a fee-for-service program and the distribution of the training curriculum.

The key lesson learned is that the training program is most effective when trainees are actively engaged.

The training makes use of exercises that maximize participation, including role-playing and group

problem-solving.

Materials are available for a fee.
71

Institutional Abuse and Neglect

Workshop 1: Creative Initiatives to Educate

Professionals and the Public

__________________________________________________________________

Washington State Medicaid Fraud Control Unit

Office of the Attorney General

Tacoma, Washington

Program Contacts: Materials Contact:

David W. Waterbury

Senior Counsel/Director

Medicaid Fraud Control Unit

Office of the Attorney General

1019 Pacific Ave.

Tacoma, WA 98402

Phone: 253-593-2154

Fax: 253-593-5135

Davidw1@atg.wa.gov

Jennifer A. Boharski

Assistant Attorney General

Office of the Attorney General

1019 Pacific Ave.

Tacoma, WA 98402

Description of Program

The Washington State Medicaid Fraud Control Unit has established an education initiative and

“contact network” in order to improve the state’s response to elder abuse. The objectives of the

project are:

• to aid law enforcement in understanding and responding to allegations of elder abuse;

• to make sure referrals go to the appropriate agency; and

• to initiate dialogue on issues.

Why Program Was Developed

The program was created to improve the response of law enforcement agencies to elder abuse. The

Medicaid Fraud Control Unit (MFCU) cannot handle all cases and therefore it needs law enforcement

partners in the communities where crimes occur.

How Program Was Developed

The Washington State Attorney General called together a work group in July 1999 to review the

state’s response to elder abuse. The work group was made up of senior-level representatives from the

MFCU, law enforcement statewide, the Washington State Prosecutors Association, and social service

agencies.
72

Currently involved are the Washington State Attorney General, MFCU, Department of Social and

Health Services, Washington State Prosecutor's Association, and approximately 250 law enforcement

agencies. In September 2000 each of the 39 county prosecutors designated a contact person in each

office to help coordinate local law enforcement.

Accomplishments and Lessons Learned

The most important accomplishment was establishment of the fundamental recognition that elder

abuse is the responsibility of each agency and should not be handed around from agency to agency.

All agency representatives present at the first work group meeting through their response to elder

abuse was appropriate until they realized that the existing system was not coordinated. Another

accomplishment is the establishment of a contact network so that, for the first time, referrals are being

received by the appropriate law enforcement organizations. Additionally, the Basic Law Enforcement

Academy has begun providing training on elder abuse.

Obstacles included the scope of effort involved in building the contact network, which required

soliciting cooperation from approximately 250 distinct law enforcement agencies. Notebooks were

then prepared for each network member; these will be regularly updated and supplemented. The

dedication of resources, follow-up with concerned agencies, and the high priority placed on project by

the Attorney General allowed the obstacles to be overcome.

Key lessons learned include the importance of seeking partnerships, of continually reevaluating

circumstances, and of addressing problems systemically and not just solving one problem at a time.

The MFCU “should have begun this project years ago” and “been more insistent that agencies take

responsibility.”
73

Institutional Abuse and Neglect

Workshop 1: Creative Initiatives to Educate

Professionals and the Public

________________________________________________________________

Risk Assessment Tool Demonstration Project

Minnesota Dept. of Human Services Aging and Adult Services Division

St. Paul, Minnesota

Program Contact: Materials Contact:

Barbara Doherty

Adult Protection Consultant

Minnesota Department of Human Services

Aging and Adult Services Division

444 Lafayette Rd.

St. Paul, MN 55155-3842

Phone: 651-296-5563

Fax: 651-297-3500

barb.doherty@state.mn.us

National Center on Elder Abuse

C/O National Association of State Units on Aging

1225 Eye Street NW Suite 725

Washington, DC 20005

Phone: 202-898-2586

Fax: 202-898-2583

Web site: www.elderabusecenter.org

Description of Program

The Minnesota Department of Human Services, Board on Aging, was selected by the National Center

on Elder Abuse (NCEA) as a demonstration site to develop a nursing home abuse risk profile tool.

The goal of the project is to design and demonstrate a tool that will assist in targeting prevention and

early intervention efforts on the facilities where residents are at the greatest risk for incidents of abuse,

neglect, and financial exploitation. The project began in May 2000, with a grant of $18,325 from the

NCEA.

Working in conjunction with NCEA staff at the National Association of State Units on Aging, the

Board on Aging is developing and will pilot test the risk assessment tool. The pilot test will involve

utilization of the risk assessment tool by the targeted audience: nursing home staff, county and state

adult protection staff, advocates, ombudsmen, staff of prosecutors’ offices, and nursing home

regulators.

Why Program Was Developed

This project was established to develop a tool that can be used by adult protection staff, ombudsmen,

advocates, regulators, and others in order to assess whether the environment of a nursing home is such

that incidents of abuse, neglect, and financial exploitation of residents may be likely to occur. The

Minnesota Board on Aging and the National Center on Elder Abuse are conducting the project with

funding from the Administration on Aging and the Health Care Financing Administration.
74

How Program Was Developed

The National Center on Elder Abuse (NCEA) developed the project and then invited all states to

submit proposals to serve as the demonstration site. Minnesota was selected. A nursing home task

force already established by the Minnesota Attorney General supported the Minnesota Department of

Human Services/Board on Aging bid for the project.

Accomplishments and Lessons Learned

The Board on Aging convened a state advisory committee, which has met four times. All of the

recommended stakeholders have participated in the state advisory committee since its formation; these

include the for-profit and nonprofit nursing home associations, the Minnesota Department of Health

nursing home regulators, the Minnesota attorney general’s staff, advocates and ombudsmen, and

county adult protection staff. Project staff held a focus group for key informants and surveyed a broad

category of interested parties in order to provide background on the project and solicit input in

developing the tool. Among those surveyed were residents, family members, advocates, ombudsmen,

county adult protection workers, and nursing home administrators and staff.

The work on this project has led the state advisory committee to recommend that the use of the risk

profile be expanded beyond nursing home residents to include vulnerable persons residing in the

community or in assisted-living facilities.

A significant obstacle was concern among nursing home industry participants about the intended use

of the tool and whether it would be detrimental to their programs to provide additional documentation

of risk faced by residents. However, nursing home industry staff has continued to participate actively

in the survey, the focus group, and on the state advisory committee, and are willing to stay involved on

a good-faith basis that the risk profile will benefit their residents.

Two key lessons have been learned:

• It would have been beneficial for project staff initially to spend more time discussing the project

with nursing home participants in order to give them more background on it.

• It is very important to have a mix of urban, suburban, and rural participants in all phases of such a

project.

Materials will be disseminated by the National Center on Elder Abuse following the conclusion of the

project.
75

Institutional Abuse and Neglect

Workshop 1: Creative Initiatives to Educate

Professionals and the Public

_____________________________________________________________

HCFA’s Division of Quality Improvement and Training

Health Care Financing Administration

Baltimore, Maryland

Program Contact: Materials Contact:

Pamela Vocke

Director, Division of Quality Improvement and

Training

Center for Medicaid and State Operations

Health Care Financing Administration

7500 Security Blvd. S3-13-15

Baltimore, Maryland 21244

Phone: 410-786-3486

Fax: 410-786-1008

pvocke@hcfa.gov

Description of Program

The Health Care Financing Administration (HCFA) is responsible for overseeing the Medicare and

Medicaid programs. The Survey and Certification program ensures that institutions providing health

care services to Medicare and Medicaid beneficiaries meet Federal health, safety and quality

standards. This program provides initial inspections of providers who request participation in the

Medicare and Medicaid programs, annual recertification inspections of nursing homes and

intermediate care facilities for the mentally retarded, and periodic recertification inspections of other

health care providers. In addition, HCFA requires investigation of complaint allegations received

concerning certified providers. The Division of Quality Improvement and Training is responsible for

developing and providing training for the survey and certification professionals.

Why Program Was Developed

The survey and certification program focus has moved from inspecting for the providers’ capacities to

provide care to the quality of care provided to the individual beneficiary. For example, in the nursing

home setting, the Omnibus Budget Reconciliation Act of 1987 (OBRA87) strengthened the

protections for residents of nursing homes and emphasized quality of life, quality of care and resident

rights. More recently, in the hospital setting, there are new requirements concerning patient rights that

include restrictions on the use of restraints. Ongoing training of the survey and certification

professionals is necessary because:

• different regulatory requirements exist for different care settings (e.g., inpatient or residential care

vs. outpatient care);

• different types of rules apply across settings (e.g., newer regulatory requirements are beneficiary

centered and outcome oriented while older requirements focus on the capacity of the provider);

and

• standards of professional practice across care settings continue to evolve.
76

How Program Was Developed

HCFA is mandated to provide training for survey and certification professionals. The training program

is funded as part of the HCFA budget within the annual Department of Health and Human Services

appropriation.

Accomplishments and Lessons Learned

Efforts to balance the mandate for training a specific audience with the desire to provide this

information to a broader audience lead Division staff to do the following:

• Search for common ground across requirements for various providers/care settings. Aim for

consistency in messages whenever possible. Examples include adopting common definitions of

“abuse” and “neglect” which apply across all care settings; developing common guidelines for all

Medicare and Medicaid settings and all types of inspections and investigations in determining

whether patient health or safety are in a crisis (or “immediate jeopardy”) situation; and identifying

key components of systems to prevent abuse across care settings.

• Use creative and expansive approaches to training when possible. Training developed by

professional instructional designers who follow a “systems approach to training” results in

streamlined, efficient courseware addressing a variety of learning styles, focusing on critical tasks

and knowledge, and including front end buy-in on the message. It is important to use themes

throughout training, e.g., for abuse and neglect training being developed, we will teach the

inspector how to review the facility throughout the survey process, even when there has been no

specific complaint or no obvious evidence of abuse and neglect exists. Another approach is to

consider content development that goes beyond the primary audience, e.g., in addition to the

inspectors, what does the provider/facility, family, caregiver or advocate need to know, and can

this information be included in the training?

• Distribute training content in more expansive ways, including classroom training, development of

replicable curricula and train-the-trainer materials, and distance learning media such as satellite

broadcasts, webcasts, self-instructional CDs or manuals. It is also useful to disseminate materials

directly to providers and post policies, procedures and training materials on the agency web site or

make them available for purchase through the National Technical Information Service (NTIS).

A critical lesson learned is the need to get the views and needs from the end user of the information

early in the planning process. Whenever possible, take advantage of common ground and common

needs to make precious resources stretch as far as possible and reach the largest possible audience.

Whenever possible, partner with other agencies, businesses, organizations, educational institutions,

etc. to achieve common goals.

Information is available on HCFA’s website, www.hcfa.gov. To access information on quality of care,

click “quality-of-care” in the third paragraph of text on the home page, then click “Medicare and

Medicaid Survey and Certification”. For information on nursing homes and continuing care

providers, click on “nursing home and continuing care providers” in the third paragraph of text on

the home page.
77

Institutional Abuse and Neglect

Workshop 2: Joining Resources to Combat

Institutional Abuse and Neglect

_____________________________________________________________

Department of Justice State Working Groups

U.S. Department of Justice, Nursing Home Initiative

Washington, DC

Program Contact: Materials Contact:

Marie Therese Connolly

Nursing Home Initiative Coordinator

U.S. Department of Justice

601 D St. NW, Room 9428

Washington, DC 20530

Phone: 202-514-6831

Fax: 202-616-3085

marie.connolly@usdoj.gov

Carol Cribbs

Justice Management Division

U.S. Department of Justice

1331 Pennsylvania Avenue, NW

National Place Building, Suite 1209N

Washington, DC 20530

Phone: 202-307-2834

Fax: 202-305-7370

carol.s.cribbs@usdoj.gov

Description of Program

The Department of Justice (DOJ) Nursing Home Initiative strives to enhance and focus coordination

and communication relating to the prevention of nursing home abuse and neglect. It does this through,

among other things, the provision of training and technical assistance to federal, state, and local

prosecutors, law enforcement agencies, and other organizations serving victims of nursing home abuse

and neglect. It also provides training and technical assistance to 25 state working groups that

developed as a result of the Initiative.

Why Program Was Developed

The Nursing Home Initiative was established to promote and enhance multi-disciplinary and

interagency communication and coordination on nursing home-related issues of all types.

How Program Was Developed

The United States Department of Justice established the Initiative, working with other federal, state

and local entities. The 25 state working groups formed as a result of the Initiative’s four regional

Nursing Home Abuse and Neglect Prevention conferences that were held in the latter half of 1999 and

early in 2000. In June 2000, the Initiative hosted a meeting of state working group members to

provide a forum for them to share their successes and challenges and to discuss new opportunities.

Depending on the state, participants in the state working groups include federal, state and local law

enforcement (including criminal and civil prosecutors, investigators, auditors, and police), federal and

state regulators, surveyors, licensing entities, state and local long term care ombudsman programs,
78

adult protective services agencies, medical examiners, fire fighters and emergency medical services

personnel, professional licensing entities, emergency room staff, and others. Some state working

groups are reaching out to nursing home industry representatives, private advocates and nongovernment entities.

Accomplishments and Lessons Learned

The existence of the state working groups is an important accomplishment. Some of those groups are

taking steps to enhance inter-agency referrals, enforcement, and compliance; members are also

seeking to improve training opportunities and relevant legislation.

DOJ is considering ways by which it can strengthen its support of the state working groups. These

groups face numerous obstacles, including:

• extremely busy members, for whom state working group involvement is just one more task that is

not likely to be part of their job description

• lack of training, referral protocols, funding, and infrastructure

• lack of the ability to easily communicate with state working group members in other states to

compare and learn from the others’ successes and challenges.

Two important lessons have been learned by Initiative staff and state working group members. First, it

is critical to provide a forum for the many relevant entities to gather, discuss, and address these issues

on a regular basis. Second, it is important to carefully evaluate the needs of relevant professionals

when starting federal, state, or local collaborations to address nursing home abuse and neglect. For

example, some state working groups have found that those working on the front lines have not been

trained to recognize examples of abuse and neglect and thus those cases are not being referred to law

enforcement. As a result, those state working groups have determined that it is necessary to first

focus on training for the relevant parties and establishing effective referral protocols.

DOJ Nursing Home Initiative staff are presently preparing materials that will be available at no cost.

Contact Carol Cribbs (contact information provided above) in Spring 2001 to request a copy.
79

Institutional Abuse and Neglect

Workshop 2: Joining Resources to Combat

Institutional Abuse and Neglect

________________________________________________________________

Florida’s Operation Spot Check

Florida Office of the Attorney General

Tampa, Florida

Program Contact: Materials Contact:

Nick Cox

Bureau Chief, Economic Crime

Office of the Attorney General

2002 N. Lois Ave., Suite 520

Tampa, FL 33607

Phone: 813-871-7255

Fax: 813-871-7262

Nancy E. Barshter

Special Counsel

Office of the Attorney General

444 Brickell Ave., Suite 950

Miami, FL 33131

Phone: 305-377-5441

Fax: 305-377-5655

Same as first program contact

Description of Program

Operation Spotcheck is a collaborative project designed to conduct random, unannounced inspections

of long-term care facilities (nursing homes and assisted-living facilities). It involves the Office of the

Attorney General along with several other governmental enforcement agencies and industry

watchdogs. The ultimate goal is to have the industry respond by consistently providing a safe and

healthy environment for those in long-term care.

Why Program Was Developed

Reports of abuse and neglect within long-term care facilities have been on the rise, especially in

facilities that cater to Medicaid/Medicare and other government-subsidized patients. This rise also

correlated with the drastic increases in the senior population and the number of long-term care

facilities and beds. The annual schedule for facility inspections meant that facility management

personnel were aware of when the inspections were to take place and would be prepared for the

inspection; this meant that it was impossible for surveyors to get a true measure of the quality of care

provided in and cleanliness of that facility. Often, abuses would be reported during periods when the

facility was not facing re-licensing or undergoing an active investigation.

How Program Was Developed

The program was initiated approximately four to five years ago by the Florida Office of the Attorney
80

General, local prosecutors, the Florida Agency for Health Care Administration, the Long-term Care

Ombudsman program, the Department of Children and Families, local code enforcement officers, and

local and state fire marshals. All of these agencies are still involved with the program. Representatives

of each agency are included on the Operation Spotcheck inspection team, or else they are on standby

in the event that a surprise inspection indicates the need for a criminal investigation.

Each of the regulatory and enforcement agencies involved were contacted and invited to take part in

the program. Local authorities also were notified of the intention to begin conducting Operation

Spotcheck within their jurisdiction when conducting a spot check. After that, teams were formed and

the program began. All agencies that were invited to take part in the program agreed to do so; this is

not a difficult program to “sell” to other agencies (or the public). No funding has been provided or

sought for the program; participants view these unannounced inspections as part of their jobs.

Accomplishments and Lessons Learned

The program has singled out numerous facilities with minor to severe deficiencies. As a result of some

of these findings, many facilities have been given warnings, cited, and fined, and in some instances

facilities have been closed. In most other cases, facilities have promptly and appropriately corrected

the deficiencies, thus improving the quality of life of the persons residing within them.

The major obstacle has been the opposition of nursing home and assisted living industries to Operation

Spotcheck. Most of those stating objections claim that the industry is already overregulated by

government and that this is just further evidence of excessive regulation and industry scrutiny. Some

of these objections have been made to certain members of the state legislature by members of the

industry, and these legislators have at times asked for clarification on how the inspections are

conducted. When this happens, project members respond by fully explaining the program, answering

questions, or dispelling any rumors or misinformation that the legislators may have heard. Claims of

over-regulation have not played well in the media; the obvious response is that if the facility is

providing quality care and is well maintained, then management and staff have nothing to fear from

Operation Spotcheck. No formal procedures or legislative action have been taken to curb this project.

It has been a very popular program publicly and within the aging network.

The following important lessons have been learned:

• Taking the time to quickly answer facility questions about the program and speaking about it at

meetings of the long term care facility associations is very valuable. After the program is

explained, opposition from the industry or the facility decreases somewhat.

• Praising those facilities that get good marks from the inspection team is very important.

• Managing the program in one state agency is very useful. This enables the program to have one

protocol and to ensure that the same method of operation is used statewide. The entire program

can be at risk if varying methods are used in different parts of the state and in different facilities.

Minimal materials are available from Nick Cox at no cost.
81

Institutional Abuse and Neglect

Workshop 2: Joining Resources to Combat

Institutional Abuse and Neglect

_____________________________________________________________

Nevada Elder Abuse Prevention Council (NEAPC)

Office of the Attorney General

Carson City, Nevada

Program Contact: Materials Contact:

Frankie Sue Del Papa

Nevada Attorney General

100 North Carson Street

Carson City, NV 89701-4717

Phone: 775-684-1100

Fax: 775-684-1108

fdelpapa@govmail.state.nv.us

Nevada Attorney General’s Office

100 North Carson Street

Carson City, NV 89701-4717

Phone: 775-684-1100

Web site: http://ag.state.nv.us

Description of Program

The primary goal in creating the Nevada Elder Abuse Prevention Council (NEAPC) was to develop a

coordinated and comprehensive approach to the growing problems of abuse, neglect and financial

exploitation of the elderly in Nevada. The NEAPC has focused on the following: legislative changes;

coordinating and improving the response (protective services, investigation, and prosecution ) to elder

abuse reports; educating mandatory reporters, seniors, and the general public to encourage proper

reporting of elder abuse; and assessing resources and developing them, especially those relating to

guardianship issues.

Why Program Was Developed

Nevada’s Attorney General Frankie Sue Del Papa formed a partnership with the Division for Aging

Services to assemble more than 60 advocates dedicated to protecting Nevada’s fast-growing senior

population from abuse, neglect, and financial exploitation.

How Program Was Developed

Attorney General Del Papa and staff from the Division for Aging Services held meetings in northern

and southern Nevada, bringing together in round table discussions representatives from more than 20

public and private agencies that shared an interest in preventing elder abuse. In the fall of 1996, they

formed the Nevada Elder Abuse Prevention Council (NEAPC).

Organizations involved in the NEAPC are the Attorney General’s Office and its Medicaid Fraud

Control Unit, Division for Aging Services, Division for Health Care Financing and Policy (Nevada’s

Medicaid and Welfare agency), AARP, Clark County Senior Services, Clark County District Attorney

Office, Clark County Public Guardian Office, Bureau of Licensure and Certification, Peace Officer

Standards and Training, Washoe District Attorney Office, Washoe County Senior Services, Washoe
82

County Public Guardian Office, U.S. Attorney’s Office, the office of Sen. Harry Reid (D-NV), the

Department of Veteran’s Affairs, representatives from local law enforcement agencies, and individual

advocates.

Funding for specific projects have come from different sources. Most of the funding has come from

the Division for Aging Services. However, a law enforcement training video project was funded by

the legislature in the amount of $60,000. The Bureau of Licensure and Certification used sanction

money received from nursing facilities to fund publication of the Guide for Mandatory Reporters of

Elder Abuse and materials used in a certified nursing assistants training project with the State Board of

Nursing.

Accomplishments and Lessons Learned

The following publications were created as a result of the project: “Elder Abuse: An Action Plan to

Better Protect Nevada’s Elderly,” “Guide for Mandated Reporters of Elder Abuse,” “Elder Abuse

Neglect and Exploitation Protocols,” and three brochures: “Elder Abuse Is a Crime,” “A Practical

Guide to Long-Term Care, and Preventing Financial Exploitation of the Elderly.”

NEAPC sponsored three videos which featured well-known celebrities: “Rx for Abuse,” geared

toward health care professionals and their obligation to report elder abuse; “Help Is on the Way”; and

“It Takes a Little More Time,” which are geared to law enforcement. A training manual and other

materials were included in the training kit provided to law enforcement agencies statewide. The video

trilogy and training materials were produced through a partnership with Nevada’s Division for Aging

Services, Peace Officer Standards and Training Bureau and the Nevada Attorney General’s Office.

In partnership with the Nevada State Board of Nursing, the Medicaid Fraud Control Unit conducted a

statewide training program for certified nursing assistants, which included information about their

mandatory obligation to report elder abuse. NEAPC also spearheaded legislation that increased the

penalties for elder abuse, codified “criminal isolation of the elderly,” and established special civil

remedies for victims of elder abuse.

Obstacles faced by NEAPC include obtaining funding for projects, persuading law enforcement to

require elder abuse training. The population distribution in Nevada, a state in which two counties

contain the major population centers and the remaining counties are very rural and have very limited

resources, also poses challenges. NEAPC still would like to obtain funding for a 24-hour elder abuse

reporting hotline that was authorized by the legislature but not funded.

Lessons learned include that it is critical to:

• identify the problems and needs of one’s state and solicit solutions from the people who will be

able to implement them; And

• spend enough time building the program’s foundation network so that no agency, individual, or

resource is overlooked.

A video starring Shirley Jones and Marty Ingalls entitled “Rx for Abuse,” directed toward health care

professionals and their obligation to report elder abuse, is subject to limited availability from the

Nevada Division for Aging Services, 340 North 11th Street, Ste. 203, Las Vegas, Nevada 89101, phone

702-486-3545. Several publications are available, and a video trilogy and training materials may be

borrowed for review, from the Nevada Attorney General’s Office.
83

Institutional Abuse and Neglect

Workshop 2: Joining Resources to Combat

Institutional Abuse and Neglect

_____________________________________________________________

Elder Rights Advocacy and Law Enforcement

Georgia Division of Aging Services

Atlanta, Georgia

Program Contact: Materials Contact:

Becky A. Kurtz

State Long-term Care Ombudsman

Georgia Division of Aging Services

2 Peachtree Street NW, 36th floor

Atlanta, GA 30303

Phone: 888-454-LTCO(5826)

Fax: 404-463-8384

bakurtz@dhr.state.ga.us

Description of Program

Organizations in Georgia developed an initiative to improve legislation related to elder abuse in 2000.

This collaborative effort grew out of legislative efforts begun in 1999.

Why Program Was Developed

The initiative was developed to improve Georgia ?s response to elder abuse through improved

coordination between the social service and law enforcement/prosecution agencies, and by

coordinating and strengthening Georgia ?s statutes.

How Program Was Developed

Initiated and led by CO-AGE (Coalition of Advocates for Georgia’s Elderly), the effort also involved

the Georgia Council on Aging; the Senior Citizens Advocacy Project (a project of the Georgia

Gerontology Society); the Georgia Division of Aging Services through its Legal Services Developer

and State Long-term Care Ombudsman Program; Adult Protective Services; the Office of Regulatory

Services (responsible for regulating health care facilities) of the Georgia Department of Human

Resources; prosecutors, solicitors, and the Georgia Prosecutors’ Council; and the Georgia Bureau of

Investigation/State Health Fraud Control Unit.

The next step of the project involved implementation of the new law by prosecutors, solicitors, law

enforcement, adult protective services, and aging advocates throughout Georgia. The Elder Rights

2000 Conference, held in May 2000, brought many representatives of these organizations together to

promote local coordination among the various players.
84

Accomplishments and Lessons Learned

The initiative succeeded in updating and strengthening of several laws impacting elder abuse.

However, the final bill lacked a number of the original provisions (e.g., sexual battery, allowance for

victim testimony on two-way closed circuit television, hearsay exceptions) that were defeated by the

defense bar and/or by the nursing home industry.

The amendments have led to increased involvement by law enforcement officers and prosecutors in

Elder Rights educational events and in community multidisciplinary teams, as well as increased

interest by police and prosecutors in pursuing elder abuse cases.

The initiative faced some obstacles including: (1) different goals in the social services and law

enforcement communities that made it impossible to use uniform language in both civil and criminal

statutes; (2) a resistance by prosecutors to developing an entirely new code section focused on elder

abuse (analogous to Georgia’s Family Violence Act), and (3) political opposition to major sections of

the original bill by the defense bar and the nursing home industry. To deal with the second obstacle,

the initiative developed a different approach that strengthened the existing criminal law and APS

statutes. Hindsight indicated that different political strategies might have lessened the objections of

the defense bar to the bill’s provisions.

The most important lesson learned is that it is critical to build relationships among prosecutors, law

enforcement agencies, advocates, and social services agencies in order to develop legislation that has a

chance of passing, get the support to implement the laws once they are enacted, and encourage law

enforcement to focus more on elder abuse issues.

Legislation (SB 407 for 2000; ? Georgia Protection of Elder Persons and Disabled Adults Act of

2000?) in original form and in form that passed can be found at: www.georgianet.org/services/leg/

Fact sheets regarding the legislation and information regarding CO-AGE (Coalition of Advocates for

Georgia?s Elderly) is available from the Georgia Council on Aging, 2 Peachtree Street, 35th Floor,

Atlanta, GA 30303; phone 404/657-5344; www.gcoa.org
85

Institutional Abuse and Neglect

Workshop 3: Enhancing the Survey and Regulatory Process

_____________________________________________________________

New Jersey Department of Health and Senior Services

Trenton, New Jersey

Program Contact: Materials Contact:

Catherine G. Morris

Assistant Commissioner

New Jersey Department of Health and Senior

Services

P.O. Box 367

Trenton, NJ 08625-0367

Phone: 609-633-8977

Fax: 609-633-8980

Association of Health Facility Survey Agencies

105 Sondley Parkway

Asheville, NC 28805

ahfsa@aol.com

Web site: www.members.aol.com/ahfsa

Description of Program

The New Jersey Department of Health and Senior Services is the licensure, survey and regulatory

agency for all health care services and providers that are licensed by the State or certified by HCFA

for Medicare and/or Medicaid participation. The Department is somewhat unique in that all regulatory

activities for facility-based services for older persons, such as long term care, assisted living,

residential health care, alternate family care and adult day health care, are located in the Senior

Services Division of the Department. All the community-based services for older persons, the Public

Guardian, the State Long Term Care Ombudsman Program, Medicaid home and community based

waiver programs, and the Medicaid long term care reimbursement program are housed in the Senior

Services Division as well.

Why Program Was Developed

This organizational structure has been in effect since July 1, 1996. The New Jersey EASE (Easy

Access, Single Entry) Program was established at the same time as the state level reorganization of

Senior Services to provide a single telephone number and single point (usually the County Office on

Aging) of access to aging services providers in each of New Jersey’s twenty-one counties.

How Program Was Developed

Adult Protective Services (APS) at the state level is part of the Department’s Senior Services Division.

When APS has authority for abuse and neglect investigations, the licensure and inspection program

and APS share information as needed about Alternate Family Care providers. The Office of the State

Ombudsman “is housed in but not of” the Department of Health and Senior Services. The

Ombudsman in New Jersey has statutory responsibility for abuse, neglect and exploitation involving

persons age 60 and above residing in institutions including nursing homes, assisted living, and

residential health care facilities. The survey agency has federal survey responsibility for the abuse

prevention protocols in the survey process; the investigation of all consumer complaints; and

investigation of abuse, neglect, and exploitation for those persons under age 60. The two programs
86

meet quarterly to share information and discuss providers and issues of mutual concern. They

communicate regularly on specific cases and conduct joint investigations in some instances.

The organizational relationship between the survey agency and relevant law enforcement agencies

varies depending on the circumstances. Suspected crimes are reported to the appropriate law

enforcement agency. Local law enforcement has been called on to assure surveyor access to

properties or to verify the safety or residents when the surveyors receive an emergency call. Medicaid

Fraud Control Unit (MFCU) investigative staff have accompanied surveyors in the field to monitor a

specific case and to gain a better understanding of the survey process. Additionally, MFCU staff have

used survey file information in case investigations. The Medicaid Fraud Section staff members of the

Attorney General’s Office and the Medicaid reimbursement programs meet regularly to review cases.

Accomplishments and Lessons Learned

The lessons learned are that it is critical to open communications and to develop lines of

communication between agencies and to educate each other as to the roles, responsibilities and

limitations of each agency’s mission and authority.
87

Institutional Abuse and Neglect

Workshop 3: Enhancing the Survey and Regulatory Process

________________________________________________________________

Collaboration to Improve the Regulatory Process

Washington State Department of Social and Health Services

Lacey, Washington

Program Contact: Materials Contact:

Joyce Pashley Stockwell

Assistant Director

Residential Care Services

Aging and Adult Services Administration

Washington State Department of Social and

Health Services

P.O. Box 45600

Olympia, WA 98504-5600

Phone: 360-725-2404

Fax: 360-438-7903

STOCKJP@DSHS.WA.GOV

Same as program contact

Web site: WWW.AASA.DSHS.WA.GOV

Description of Program

Licensure, survey, regulatory, and enforcement are organized and structured in Residential Care

Services (RCS), which is a division of Aging and Adult Services Administration (AASA) within the

Department of Social and Health Services (DSHS). DSHS is the state Medicaid agency and as such,

enforcement for Medicaid certified nursing facilities is delegated to RCS. RCS is responsible for

survey licensing and enforcement activities in nursing homes, boarding homes, and adult family

homes.

Adult Protective Services (APS) is organized in Home and Community Services, another division

within AASA. In long-term care residential settings, APS investigates abuse if the alleged perpetrator

is a family member or visitor. RCS investigates if the alleged perpetrator is a staff member or another

resident.

The long-term care ombudsman program (LTCOP) is an independent program and not part of DSHS.

Why Program Was Developed

Collaboration was established in order to strengthen and enhance the regulatory effort.

How Program Was Developed

RCS and APS are working together at the local level to develop law enforcement contacts. The

Medicaid Fraud Unit has compiled a resource book of specific contacts within each law enforcement

jurisdiction.
88

RCS collaborates with APS and law enforcement on specific cases. The LTCOP investigates issues

and calls in complaints related to abuse and neglect to the RCS centralized complaint intake unit. RCS

holds forums with the ombudsman, provider representatives, advocacy groups, and residents.

The Medicaid Fraud Unit took the lead in developing contacts with local law enforcement. APS is in

a division within the same administration, and so APS and RCS work together at all levels of the

respective divisions. RCS meets periodically with the LTCOP at all levels to address issues and

develop clarity regarding the roles of the respective organizations. Meetings occur regularly to prevent

miscommunication and promote clarity.

Collaboration comes from working together and getting to know each other prior to crisis situations.

If major issues develop, the groups talk through situations and determine what needs to be done

differently in the future.

Relationships among the groups are both formal and informal. There are memoranda of

understandings between DSHS/RCS and Medicaid Fraud and also between DSHS/RCS and the

LTCOP. The relationship between RCS and APS is informal. The fraud memorandum is very broad

and gives a framework. The ombudsman agreement is specific in certain areas and the rest is covered

by regulations. It appears that the relationships work as they have been established.

RCS also has a memorandum of understanding with the Department of Health related to nursing

assistants and licensed staff (LPNs, RNs). RCS also works closely with other advocacy groups.

Accomplishments and Lessons Learned

Each of our partners has different authority and will be in facilities at different intervals. Collaboration

has enabled more organizations/individuals to take responsibility in a more effective manner for the

vulnerable adults in these settings. As a result, the regulatory process has been strengthened and

facility residents are better protected from abuse and neglect.

Some policy issues have arisen regarding the clarity of roles for each group, protocol for joint

investigations, and the development of legislation that would strengthen protection of vulnerable

adults. These issues have been addressed in a collaborative fashion.

The key lesson learned is that open communication is the key to establishing collaborative working

relationships. It is important to understand the underlying operating principles/values so that the

strengths of each group can be utilized for the best possible outcomes.

Materials are available by calling 800-422-3263.
89

Institutional Abuse and Neglect

Workshop 4: Holding Institutions Accountable through Prosecution

___________________________________________________________________

Vermont Medicaid Fraud Control Unit Initiatives

Office of the Attorney General

Waterbury, Vermont

Program Contact: Materials Contact:

Linda A. Purdy

Director

Vermont Medicaid Fraud Control Unit

43 Randall Street

Waterbury, VT 05671-1401

Phone: 802-241-4440

Fax: 802-241-4447

lpurdy@atg.state.vt.us.

Barbara Zelner

Counsel

National Association of Medicaid Fraud Control

Units

750 First Street, NE, Suite 1100

Washington, DC 20002

Phone: 202-326-6020

Fax: 202-408-7014

Description of Program

The Vermont Medicaid Fraud Control Units (MFCU) is a part of the Office of the Attorney General.

Federal law mandates MFCUs and all but a few states, which have received waivers from the federal

government, have them. One of the primary responsibilities of a Medicaid Fraud Control Unit

(MFCU) is to review and prosecute complaints of patient abuse and neglect in health care facilities

that receive Medicaid funds. Traditional state criminal statutes are used by the MFCUs to prosecute

individuals working in facilities who commit physical, sexual, and financial exploitation or abuse.

Why Program Was Developed

MFCUs were established to prosecute patient abuse and mistreatment in residential health facilities

that receive Medicaid funds, as well as fraud committed by Medicaid providers. The MFCU must be

part of the Attorney General’s office or be housed in another state department that “possess(es)

statewide authority to prosecute individuals for criminal violations.” The MFCUs are increasingly

placing emphasis on prosecuting resident abuse and neglect. In addition to prosecuting staff members

and management who abuse or neglect residents or allow such abuse or neglect to happen, many

MFCUs are involved in collaborative efforts about elder abuse with other state agencies.

How Program Was Developed

To create collaboration, the Vermont MFCU first identified the specific agencies, organizations, and

professionals who needed to be involved. The group had an initial meeting with those agencies and

individuals identified to discuss the need for coordination and collaboration. At this first meeting the

group identified the issues and established a smaller working group to come up with a plan and

protocol to handle cases of abuse, neglect, and exploitation in institutional settings.

The MFCUs rely heavily on coordination and collaboration with adult protective service agencies, the

state departments of health, area agencies on aging, departments of mental health and mental
90

retardation, facility employees, the state long-term care ombudsman programs, and nurse surveyors. In

addition, advocacy groups such as the National Citizen’s Coalition for Nursing Home Reform and

AARP are important partners in the efforts of the MFCUs to investigate and prosecute complaints of

patient neglect and abuse in long-term care facilities.

There are a number of actions that MFCUs may take in addition to prosecutions under state law for

resident abuse and neglect. For example, many MFCUs now are pursuing quality-of-care related cases

arising in long-term care facilities; these cases may include charging the persons deemed responsible

for the neglect, such as the nursing home administrator, the director of nursing, or the medical director

of the facility. In addition, if the acts or omissions by corporate employees can be imputed to the

corporation, the MFCU may charge the corporation with various versions of a criminal-neglect statute.

The MFCUs may also use state civil actions and penalties to hold institutions accountable for abuse,

neglect, exploitation, or health care fraud. For example, the MFCU may institute a state civil false

claim action for serious quality-of-care violations or file a civil monetary-recoupment case against an

institution depending upon what the specific state statutes allow.

In some states, such as Florida and California, the MFCUs are involved with programs that make

unannounced inspections of long-term care facilities.

Accomplishments and Lessons Learned

The many successes of MFCUs in prosecuting resident abuse and neglect are chronicled in the

monthly Medicaid Fraud Report produced by the National Association of Medicaid Fraud Control

Units (information on how to obtain the Report is provided elsewhere).

A substantial obstacle is that many of the other agencies with which MFCUs must deal are not well

versed in how a criminal investigation is conducted. This has caused problems when the agency begins

an investigation before law enforcement gets involved. This obstacle can be overcome, however,

through education, regular meetings, and teamwork. Dual training projects work well to bring the

different agencies together with the common goal of protecting the health and welfare of vulnerable

citizens.

Key lessons learned are: identify appropriate players and form task forces; educate agencies, facilities,

and the public on their duties to report resident abuse; and review the applicable laws and pass or

amend legislation to strengthen patient abuse and neglect laws.

The publication “Patient Abuse and Neglect: The Hidden Crime,” May 1997 is available at no

charge. The National Association of Attorneys General Medicaid Fraud Report is published 10 times

a year and subscriptions are available from $150. Direct inquiries to Barbara Zelner.
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Institutional Abuse and Neglect

Workshop 4: Holding Institutions Accountable through Prosecution

_____________________________________________________________

HHS Office of the Inspector General’s Role in Nursing Home Matters

Department of Health & Human Services, Office of Counsel to the Inspector General

Washington, DC

Program Contact: Materials Contact:

Andrew S. Penn

Senior Counsel

Office of Counsel to the Inspector General

U.S. Department of Health & Human Services

330 Independence Ave. SW, Rm. 5527

Washington, DC 20201

Phone: 202-205-9505

Fax: 202-205-0604

apenn@os.dhhs.gov

Same as program contact

Web site: www.dhhs.gov/progorg/oig

Description of Program

Most of the Office of the Inspector General (OIG) investigations dealing with the quality of care in

nursing homes are the result of False Claims Act cases initiated either by the government or by

relators in qui tam suits. (Qui tam – “who sues on behalf of the king as well as for himself”–

is a provision of the Federal Civil False Claims Act that allows a private citizen to file a suit in the

name of the U.S. Government charging fraud by government contractors and other entities who

receive or use government funds, and share in any money recovered.) Collaboration with health care

professionals is very important in the OIG’s investigation efforts.

Reason Program Was Developed

When deciding whether to bring enforcement actions, the OIG relies heavily on health care

professionals to provide expert opinions on the quality of care rendered at facilities. The OIG also

relies on nurses and other health care professionals to monitor consent decrees and corporate integrity

agreements (CIAs) that mandate provision of quality care.

How Program Was Developed

Not applicable.

Accomplishments and Lessons Learned

OIG agents have worked on several Civil False Claims Act cases that have achieved significant results

for both the residents and the government. Consent decrees or CIAs have been signed, imposing

substantial quality-of-care obligations upon the facilities and requiring the appointment of independent

monitors and/or temporary managers in several cases.
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In addition to the False Claims Act cases, the OIG was involved in settlement of a criminal action

against Guardian, a nursing home chain in Northern California with 16 facilities housing

approximately 600 residents. The Santa Clara County District Attorney indicted the entire corporation

under the state’s elder abuse and neglect statute based largely on incidents that occurred at two of

Guardian’s facilities.

The incidents, due to staff shortages, included abominable sanitation problems, failure to change

bedpans and diapers, and failure to provide proper care for bed sores, to name a few. At the time of

the indictment, the district attorney was unaware that if the corporation as a whole was convicted, all

the facilities in the chain would be mandatorily excluded from participation in federal health care

programs pursuant to the Inspector General’s authority under Section 1128(a) of the Social Security

Act.

To avoid the potential transfer trauma to residents from such wholesale closures, the OIG worked with

the DA and the defendants to negotiate a plea and exclusion agreement with the two worst facilities.

Guardian was allowed to reincorporate the two facilities into their own separate corporate entity

known as Guardian North Bay, which pled no contest to the charges. Because of similar concerns of

staff shortages at several of the remaining Guardian facilities, the OIG also entered into a CIA that

requires Guardian to develop an effective internal quality assurance system and to pay for the cost of

an outside monitor selected by the OIG, who will make sure that the CIA is implemented.

Materials are available on the program web site.
Appendix 4

State and Tribal Team Strategies

Over the course of the day-and-a-half symposium, there was time set aside on the agenda for the state

and tribal teams to meet a number of times. The meetings provided the teams with an opportunity to

develop collaborative strategies for responding to elder victimization in their jurisdictions. As a part of this

exercise, each team was asked to complete a questionnaire designed to assist in the development of an

action plan. Reproduced below are the completed questionnaires that were submitted to the conference

organizers. A point of contact has been identified for each team and contact information for each of them

can be found in the participant list, Appendix 2. The point of contact listed is the member identified by the

team to serve as the reporter if their team was selected to present to the Attorney General. Because the

individual was only identified for this purpose, he or she may refer you to another member of their team or

someone else in the state or tribe for more information.

The questionnaire asked the teams to identify: (1) ongoing collaborative efforts related to elder

victimization; (2) any ideas or strategies for collaboration they might try to implement in their jurisdictions

based on what they had learned at the symposium; (3) their biggest challenge in implementing these

strategies; and (4) their biggest asset in implementing these strategies. In answering each question, the

teams were asked to note whether any of the above items specifically related to: (a) financial exploitation

and consumer fraud; (b) elder abuse and neglect at home; or (c) institutional abuse and neglect. In the

reproduced questionnaires, the letters (a), (b), and (c) in lower case and in parentheses are used only in

reference to those specific topics. (In some instances the topics are spelled out and in others they are

not.)

Also, because many of the team questionnaires included acronyms, the following glossary of some of the

more common acronyms is provided:

AAA Area Agency on Aging

AG Attorney General

APS Adult Protective Services

CLE Continuing Legal Education

DA District Attorney

MFCU Medicaid Fraud Control Unit

MOU Memorandum of Understanding

OAA Older Americans Act

POST Peace Officer Standards and Training

SUA State Unit on Aging

VAWA Violence Against Women

VOCA Victims of Crime Act
Alabama

Point of Contact: Doris Ball

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) (1) Joint training efforts with universities to train law enforcement and adult protective

services workers on financial exploitation. 

(2) Increased prosecutions.

(c) (1) Memos of understanding between AG Medicaid Fraud Control Unit and 

Department of Public Health (DPH) on abuse/neglect referrals.

(2) Also memo of understanding between DPH and APS on assisted-living 

facilities.

(3) Increased coordination with Nursing Home Association. Videotaping of residents

proposed.

(4) Governor’s initiative on controlling abuse/neglect/exploitation in assisted-living industry:

(1) revision of regulations; (2) APS workers assessing unlicensed facilities for

abuse/neglect/exploitation; (3) Medicaid funding for care; (4) consideration of certificate

of need.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates (a), (b), or (c) (see above), please so indicate.

(1) Reactive Elder Abuse Task Force to increase interagency coordination and education.

(2) Include APS training in law enforcement and emergency management curriculums. 

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If

your idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Need mandated funding for adequate staffing of APS program.

(2) Define roles of each entity.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Commitment of leadership (Governor, Attorney General) to prevent and remedy

abuse/neglect/exploitation of adults.

(2) Commitment of line staff to make lives better. 
Alaska

Point of Contact: Dwight Becker

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

Adult Protective Services will be developing a new brochure, presentation plan using visual aids for

educating and developing partnerships with law enforcement, district attorneys, and other social service

agencies throughout Alaska, particularly in rural areas. We will develop written agreements specifying

collaborative roles and steps to preventing and stopping abuse, exploitation and neglect.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates (a), (b), or (c) (see above), please so indicate.

(1) Seek more funding.

(2) Develop detailed plan.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Lack of resources. We only have six adult protective services workers statewide.

(2) Need funding for grants for training, designation agreements.

(3) Geographically large. Travel is expensive.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Alaska prides itself on its excellent networking among agencies.

(2) Alaska has a small population which facilitates communication.
Arizona

Point of Contact: Terri Skladany

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

AG

• Law Enforcement Elder Abuse Task Force

• Elder Issues Task Force

• Senior Advisory Council

• Statewide Elder Abuse Task Force

Federal

• Elder Fraud Prevention Team

County

• Maricopa County Attorney’s Protocol Task Force

• Maricopa Elder Abuse Prevention Alliance

• Pima, Yavapai, Pinal/Gelu, Mohava, Yuma, Cochise Counties Task Force

Triad

• Yuma, Pinal, Yavapi, Coconino Counties

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates (a), (b), or (c) (see above), please so indicate.

• Bring all existing coalitions together to discuss best practices and common goals

• Share information to avoid duplication

(1) use e-mail/website with minutes of coalitions

(2) chat room

(3) list-serve

• Encourage all counties to have task forces

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Lack of funding

• Vast rural areas

• Lack of prosecution

• Limited law enforcement staff in rural community

• Officer and prosecutor training also judges/JP’s; also social services providers – needs to be at

academy level

• Rigidity among systems 

• Case not followed through from direction to prosecution
• “Problem” of confidentiality – inhibits collaboration

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• This group – multidisciplinary nature/diverse backgrounds

• Excellent collaboration among agencies

• Our Attorney General is committed to fighting elder abuse

• Passion for innovation

• Willingness to share resources
Arkansas

Point of Contact: Catherine Lyon

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

Regrettably, I am unaware of any collaborative efforts other than a recent endeavor of the AG’s office to

collaborate with the Office of Long Term Care (OLTC).

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

The AG’s office and APS have discussed possible areas of collaboration as it could relate to fraud among

community-based service providers. (a) & (b)

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• The first challenge is to promote an ongoing interest/concern. Child abuse takes center stage

with Arkansas’ legislature and to that end they receive the majority of service dollars so funding

follows as a close second.

• Turfism as it relates/facilitates a lack of responsibilities is significant. (b)

• Low provider reimbursements for institutional care further stress and already fragile system that

too easily over looks the cost savings of quality care. (c)

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• The commitment of very small APS unit to make each life a little better for our having been

invited into it. (Using the term “invited” quite loosely). (b)

• The strong leadership exhibited by AG Reno that brings into focus a need to address this issue the

potential or the “political correctness” of getting involved and being a player in the solution(s) to

the variety of long range/long term problems we will ourselves face as we age. (a), (b), & (c)

• Compliments of this gathering, APS and AG’s office have met and agreed to collaborate on cases

that couple our two areas of authority and responsibility. (a) & (b)
Blackfeet Tribe

Point of Contact: Myra Magee-Red Fox

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

State of Montana contracts with the tribe to fund child protective services, but does not provide or fund

for adult protective services on the reservation. Our tribe has a volunteer group that meet 2 times a

month to review cases that are referred by family, individuals, or other concerned persons. Because we

are a volunteer group, there is not the financial support to provide adequate investigation, law enforcement

training, maintaining statistics, legal support, and community outreach and prevention. The volunteer

group consist of BIA Social Services, Blackfeet Housing, Indian Health Services, Senior Citizen Center,

and Personal Care Provider. There is no collaboration between the state of Montana and the Blackfeet

Elderly Protection Team. We are a very creative team and try to utilize all team members, expertise. 

We deal with all the above issues.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

[Not answered.]

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Lack of funding to train law enforcement

(2) High turnover in law enforcement

(3) Outdated equipment for law enforcement officers (vehicles, video equipment, etc.)

(4) Elder Abuse Codes are out dated, need to include issues on aids and hepatitis

(5) Lack of adequate pool of law officers

(6) Need an investigator

(7) Need to educate Tribal Court System

(8) Need to educate the community

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Our elderly protection team is very motivated and has been getting by for the past 5 years on very little

support. We would be a better team and a stronger advocate with some financial support for the above

listed areas. Because we represent different agencies within the tribal system, we have been effective in

many cases.
California

Point of Contact: Laura Mosqueda

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Financial exploitation – Financial abuse specialist teams (FAST) – in particular, Santa Clara

County “Rapid Response Team” which pairs APS workers, public guardian workers, and DAs to

act quickly to stop fraudulent practices (home sales); 8 Counties have FAST.

(2) Abuse at home – U.C. Irvine Medical Response Team – uses geriatrician, pharmacist,

psychologist, social worker, nurse practitioner to examine the medical and psychological injuries

of elder abuse victims.

(3) Institutional Abuse – Operation Guardian – AG’s inter-disciplinary team. Sends in a team of

medicaid fraud investigator, fire code inspectors, doctor, ombudsman, etc., to do spot checks on

nursing homes.

(4) Multidisciplinary teams in most counties.

(5) California nursing home working group.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

Ideas for future collaboration:

(1) Statewide task force of those interested in elder abuse – California APS, law enforcement,

ombudsman, legal assistance, MediCal fraud, etc. – more coordination and communication

amongst the agencies to develop statewide strategies

(2) More involvement of local law enforcement, e.g., one officer (more or less) in every agency is an

elder abuse expert

(3) Use AG’s Office, California Department of Aging and APS (i.e., tripartite commission) to serve

as catalyst to disseminate information and share information, to coordinate the proposed task

force

Task force coalition should include (for example): EMT/paramedics; emergency room

representatives; AARP; California Medical Association; California Advocates for Nursing Home

Reform; California Nursing Association; Office of Criminal Justice Planning; Legal Aid Societies;

federal regulatory agencies; law enforcement; district attorneys; County Welfare Directors’

Association; persons with disabilities

(4) Develop a document that outlines the issues and the agencies involved in dealing with the issues

(5) Educate judges about the complex issues of elder abuse
(6) Surrogate decision-making

(7) Persons with disabilities

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Geography

(2) Funding for task force

(3) Huge group can be unwieldy 

• How do we decide who ought to be on a task force?

• How do we organize a big group so that useful outcomes are achieved and maintained?

(4) Cultural diversity

(5) Significant differences among the counties’ agencies – some counties have strong DA offices,

others have strong probate courts, others have strong APS, etc.

(6) Only 17 of 58 counties in California have prosecutors dedicated to elder abuse

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) People in diverse areas, e.g., DA, law enforcement, APS, ombudsman, healthcare providers, are

committed to their field

(2) There are model programs in many counties, e.g.:

• FAST

• Specialized DA units

• Operation Guardian 

• Medical response teams

(3) Availability of academic institutions 

• Alzheimer’s evaluation centers

• Academic Geriatric Resource Centers on 6 of the UC campuses 

 
Colorado

Point of Contact: Jan Michael Zavislan

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Colorado coalition for Elder Rights and Adult Protection – began in 1993, multi-disciplinary group

includes law enforcement, social services, cooperative extension, financial institutions, district

attorneys, area agencies on aging and OTWS. “Project Colorado” is an out growth of this

coalition, developing curriculum and a video program to train financial institutions to detect

financial exploitation, abuse or neglect. Also “Dr. Be Wary” educational program to teach

seniors about investment fraud also came out of coalition.

(2) County Triads in 20+ counties combining law enforcement and seniors.

(3) Thirty-two adult protection community task forces providing training and case-support under state

mandatory reporting laws.

(4) “November Sweeps” statewide direct mail sweep involving law enforcement, cooperative

exchange and others.

(5) S.A.F.E. (“Seniors Against Fraud & Exploitation) was a precursor to Triad – combining

state/local and federal agencies, and senior organizations.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Last September (1999), Colorado held a day-long seminar on issues of fraud and abuse. One

outcome was the desire to create a statewide clearinghouse to connect virtually every law

enforcement office, prosecutor, adult protection service, mental health service, senior center,

caregiver, financial institution, and others. Purpose is to begin to collect information on fraud and

abuse of elderly throughout Colorado, to provide valuable information to seniors, and to train all of

our partners in detection and prevention of fraud and exploitation. This clearinghouse, to be

known as “senior watch,” is nearing its implementation at this writing.

(2) Create a multi-county or statewide Triad to eliminate the problem of ineffective triads in smallpopulation counties.

(3) Modify P.O.S.T. curriculum to include mandatory training of prospective police officers on elder

issues.

(4) Develop curriculum for county prosecutors and judges training programs on elder fraud and abuse

issues.

(5) Combine resources for legislative solutions, including expanding victims services, mandatory

reporting, licensing and bonding of homecare providers, and others.
Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

In no particular order:

(1) Funding despite huge state surpluses 

(2) Legislature – doesn’t want to spend huge state surplus (also some constitutional limitations on

spending)

(3) Geography – large, mostly rural state with 63 counties, 300+ separate law enforcement agencies,

22 prosecutors, 16 AAA’s, and so on.....

(4) Ethnicity – very diverse population with large Spanish-speaking and Indian populations. Growing

Asian community adds another larger of diversity

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Very strong sense of family, community and partnership has broken down barriers between state and

local agencies. Turf wars have never been an impediment.
Connecticut

Point of Contact: Christine Lewis

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

The Elder Financial Abuse Project is a cooperative effort among Protective Services for the Elderly

(PSE). The Area Agencies on Aging, AARP, State Police and financial institutions to curtail and prevent

financial exploitation of the elderly. The AG’s Office, which provides advice and representation to PSE,

and the Chief States Attorney’s Office, which investigates criminal complaints of abuse and exploitation

of the elderly, were asked to support the project and attend meetings in an advisory capacity. Also,

creation of the Consumer University, a collaborative program between the AG’s Office, law

enforcement, financial institutions, AARP, victims services, Department of Social Services, hospitals, and

Area Agency on Aging. The program also addresses Latino communities. Finally, the Office of the

Chief State’s Attorney as of October 20, 2000 has created an Elder Abuse Unit which will prosecute

financial and physical abuse of Connecticut’s substantial senior population.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• The AG’s Office will soon issue a formal opinion addressing the issue of the extent of information

financial institutions can release to PSE the issue came to the AG’s attention as a result of the

project. 

• The AG’s Office and Department of Social Services will be proposing legislation to bolster

PSE’s is investigative authority and enable financial institutions to cooperate with state authorities

investigating complaints of abuse, exploitation, neglect, and abandonment of elderly persons.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

The biggest challenges will be lack of funding and cooperation of resources.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate. 

The biggest asset is a willingness to collaborate. Representatives who attended this symposium have

agreed to meet regularly to share resources and information and to identify topical issues reported by

consumers and agency personnel.
Delaware

Point of Contact: Vickie Artis

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, (b) institutional abuse and neglect.

The Attorney General of Delaware recently convened the Senior Crime Victim Task Force which

includes representatives from all segments of the aging community. The Task Force meets monthly. It

has been broken down into subcommittees which are working on all three of issues mentioned. Target

areas include prevention, resources, legislation, training and a law enforcement protocol.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

One theme has definitely emerged – you can never do enough. We have gathered some ideas for

presentations which we will develop for a conference that concludes the work of the Task Force. Of

particular interest is the area of service sensitivity, which is applicable to all three issues.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or local team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

This answer applies to (a) Financial Exploitation, and Elder Abuse and Neglect. The biggest challenge is

in changing the mind set of the various disciplines that they cannot operate in a vacuum. The work of the

Task Force will go a long way in addressing that challenge. Multidisciplinary teams, coalitions, and task

forces are critical in finding remedies to this universal challenge.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Our biggest assets include:

(1) Being a small state, it is relatively easy to get all of the key players to the table.

(2) The commitment and passion of our AG on this issue has driven what we have accomplished thus

far and what we will accomplish in the future.
District of Columbia

Point of Contact: Thelma Chichester Brown

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud,(b) abuse

and neglect at home, and (c) institutional abuse and neglect.

D.C. Office on Aging chairs the D.C. Adult Abuse Prevention Committee which is comprised of

organizations involved in all aspects of adult abuse prevention and intervention in D.C. The committee

develops a work plan each year that focus on different aspects of adult abuse.

(a) This year a financial abuse consultation team (FACT) was established to provide expertise to

members working on financial exploitation cases. The committee supports as ongoing Real

Property Tax Program which keeps older people from losing their homes, which they are often in

danger of losing because of financial exploitation.

(b) The past three years the committee has sponsored conferences on aspects of family violence. 

There has been several other initiatives regarding the training of police officers and bankers and

senior service network personnel.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

Revisit bankers initiative. Work through the representatives of the bankers security association and the

D.C. office of banking now active members of FACT to:

• Update use of banking institutions

• Identify reporting barriers of concern to bankers

• Determine need for legislative changes

• Sponsor training for bankers/notaries

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Funding is minimal ($23,000) and supports the volunteer efforts of the committee members but is not

sufficient to support even one staff person to tackle these initiatives in depth on an ongoing basis.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Willingness to collaborate. Strong committee members are willing to give their time to work on initiatives

work well together; relate well personally.
Florida

Point of Contact: Nicholas Cox

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) (1) Banking training in Department of Elder Affairs 

(2) Home improvement stings

(3) Led fraud training in crimes against the elderly

(4) Combination of Office of the Attorney General (OAG), law enforcement officers, Social

Services Agency, Better Business Bureau, efforts in detecting and educating victims and

potential victims of crime

(5) Elder Justice Centers in Tampa and Broward circuit courts that educate, provide victim

assistance, and track guardianship

(6) Work on alienation of affection law

(b) (1) Elder Justice Centers

(2) Use of Meals on Wheels, etc., as possible reporters

(3) Education to seniors to watch for themselves, friends and neighbors 

(4) Use of college resources 

(c) (1) Operation Spot Check with assisted-living facilities and nursing homes

(2) Better Certified Nursing Assistant registries

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what to do to enhance such collaboration after this symposium. If your idea or strategy only

relates to (a), (b), or (c) (see above), please so indicate.

(1) We have organized an OAG, Florida Department of Law Enforcement and Stetson Law School

training/interest seminar

(2) Also hope to pursue the same with the Florida Prosecuting Attorneys Association

(3) We want to further promote bank training

(4) Expanded use of Meals on Wheels and other groups that may frequent seniors’ homes

(5) Promote medical treatment vans (out of senior centers)

(6) Use senior centers for education, etc. in concert with law students as educators/instructors

(7) Senior assessment centers for law enforcement officers

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Funding is always an issue (as usual), but as far as the Office of the Attorney General goes, we

have made extensive use of grant monies and fines recovered from consumer fraud cases.

(2) The senior population in Florida is exploding while resources in agencies that protect or serve

elders remains stagnant. 
(3) Geographically, the state is huge. Thus the need to have these issues addressed by statewide

officials such as the Florida Department of Law Enforcement and the Attorney General with

assistance from Elder Affairs and Children and Families.

(4) One big obstacle has been a certain level of apathy by prosecutors, law enforcement, and others.

Much as with child issues, we need specialists in such agencies for elder issues, but apathy plus

funding prove to be an obstacle.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please to indicate.

(1) Leadership from numerous key individuals – i.e., legislators, law enforcement office heads,

Attorney General, etc. who do not hesitate to use their “bully pulpit.”

(2) Federal and state authorities want to collaborate. 

(3) Using university and law school resources has been vital to these issues.

(4) The impact that private attorneys have also had in bringing problems to public light.
Georgia

Point of Contact: Donald Henderson

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) (a) Consumer Fraud Task Force – 6 years in existence – functions as a statewide neighborhood

watch. Did reverse “Boiler Room” in 2/00 – identified 125,000 victims.

(2) (a) & (c) Office of Fraud and Abuse – Investigate/prosecute Medicare fraud and abuse –

received “Best Health Care Fraud Unit” from HHS in 1999.

(3) (a), (b), & (c) Coordination of Elder Advocates resulting in successful passage of legislation in

identity fraud, elder abuse/exploitation, telemarketing fraud; funeral home industry standards,

emergency relocation fund/ombudsman; 2001 issue is predatory lending; working through

Coalition of Advocates for Georgia’s Elderly (CO-AGE) as advocates.

(4) (a), (b), & (c) Statewide training including Consumer University; Elder Rights Conference;

Commission on Family Violence annual Domestic Violence Conference; Elder Law Amendment

Training; Criminal Justice Coordinating Council Victims Conference (Governor’s Office).

(5) Good media coverage of victim stories.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Coordinate with law enforcement to provide P.O.S.T. training in elder abuse/neglect to police

officers. Utilize grant funding to encourage use of programs. Also, use the leadership of the

Georgia Association of Chiefs of Police and the Georgia Sheriff’s Association to effectuate law

enforcement education in the elder law area.

(2) Organize a meeting and planning session(s) in order for symposium participants to debrief on the

issues and ideas and to form an action committee to implement these ideas.

(3) Host a meeting to encourage and promote collaboration between local law enforcement and adult

protective services officers.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Lack of funding.

(2) Developing strategies to reach rural and diverse communities with services and to promote

education in such areas.
Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate. 

All of the applicable agencies are highly supportive of efforts towards the reduction of victimization of

elders. Also, the state’s elected officials, including the Governor, Lt. Governor, the Attorney General and

the Secretary of State are highly supportive of these efforts in the elder abuse area. This collaboration

has also flowed over to members of private industry resulting in public/private partnerships in the area of

exploitation of the elderly.
Hawaii

Point of Contact: James Pietsch

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

The Governor of Hawaii established a Committee on Elder Abuse in 1999. Last month the committee

voted to make significant changes to the Adult Protective Services statute, the penal code and to

establish an Elder Abuse Coordination System. The Governor’s Elder Abuse Committee consisted of

representatives from law enforcement, disabled/health care, social services, Attorney General, prosecutor,

Aging, AARP, Legal Services, University of Hawaii. A legislative packet is being produced. 

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Look at innovative funding sources.

• Look at different Agency support – other than existing structures.

• Look at resources to develop public awareness, e.g. news media – capitalize on “name

recognition” of Governor’s committee – while it lasts.

• Mobilize information campaign using local and national studies/resources to bolster support.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Lack of funding – Priority: Older persons are not a priority.

• Turf.

• Opposition by policy makers and administrators to change – especially Adult Protective Services

Administrators – even though line-investigators want changes. The Administrators are most

fearful of “opening the flood-gates” of abuse reports.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• Willingness of other agencies to collaborate and work around bureaucratic obstacles.

• Willingness of multi-disciplinary team to approach legislators and other key decision makers to

influence a change in policy.
Idaho

Point of Contact: Omar Valverde

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) Idaho Bank Reporting Project/Financial Review Committee/Protocols Agreements

(b) Protocols agreement – field training (medical professionals – law enforcement)

(c) Protocols agreement – Department of Health and Welfare Ombudsman and APS – field training

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

State Conferences 

[Facility Standards – Ombudsman and APS – AG’s Offices] 

(1) Financial exploitation/law enforcement investigations 

(2) Gray homicide 

(3) Guardianship

(4) Developmentally disabled mentally ill populations – interviewing techniques 

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Funding – staffing – population – education

(2) Deferment of responsibility at the local level

(3) Violence [conflict of interest] – more service representation

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Strong commitment of Idaho Commission on Aging and willingness of all participants to collaborate
Illinois

Point of Contact: Kathleen Quinn

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) (1) IL State Triad B*SAFE (Bank Reporting) 

(2) Elderly Service Officer(ESO) Training (40 hr)

(3) Attorney General Senior summit (Fraud)

(4) Flag (Bank Reporting)

(5) Governors Elder Abuse Task Force, State Police Financial Crimes Task Force

(b) (1) IL State Triad

(2) Elderly Service, Family Violence

(3) Coordinating Councils

(4) VOCA Committee

(5) Domestic Violence

(6) Advisory Council

(7) IL Violence Prevention Authority

(8) Grandparents raising Grandchildren

(c) (1) IL State Triad/ESO Training

(2) Pioneer Movement - Regional Committees

(3) Depts of Public Health/Aging Workgroup 

(4) Dept. Public Health Certified Nursing Assistants Recruitment/Retention Committee

(5) MFCU/Public Health Coordination

(6) Meetings with Families/Surveyors/Ombudsmen Pilot

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) More public and professional education and training on the issue.

(2) Develop resources for efforts to sustain and institutionalize them

(Triad/B*SAFE/ESO/Pioneers/State Police/Ombudsman Program) 

(3) Legislative Initiatives

(4) Develop standards for facility Alzheimer’s units

(5) Improve recruitment and retention of Certified Nursing Assistants in facilities (also home care

workers)

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Lack of funding and staff resources to support efforts.

(2) Olmstead implementation/historical bias toward facilities (IL has one of U.S. highest

institutionalization rates)
(3) Reluctance of some funding sources to address elder abuse (e.g. historically almost no VOCA

funds have gone to elder programs)

(4) Lack of involvement by prosecutors except in 2 largest counties. Central IL workgroup to follow

up on DOJ nursing home abuse conference had to be canceled due to lack of prosecutor interest.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) History of collaborative efforts and strong interest to continue; good working relationships among

most players; strong leadership. 

(2) Enough resources and priority on collaboration to foster wide range of collaborative programs.

(3) Strong legislation addressing issue.
Indiana

Point of Contact: Scott Newman

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

• In Indiana one unique feature is that APS units are located in 18 “hub county” prosecutors’

offices. This situates them well for collaboration with law enforcement and grand jury

investigative units.

• During “after hours,” the Indiana State Police has agreed to answer all APS “hotline” calls, and

to determine whether an immediate response is necessary.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• As a prosecutor, I have come to recognize that the limited resources available to APS unit must

be leveraged through collaboration with other agencies serving the elderly, e.g., State Police white

collar crime unit, Attorney General Consumer Protection and Home Improvement Fraud Sections,

Central Indiana Council on Aging, etc. 

• All parties felt that there has been a shortage of adequate, interdisciplinary training both to raise

awareness and develop competence regarding elder abuse issues.

• There is a need to develop, for use by all agencies, good printed material designed to educate the

elderly to prevent common forms of investigation, and we all need to seek out forums for it

distribution.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Putting aside the pressure of every day, e.g., among police trainers, to make room for this topic on

their agendas.

• Igniting among our colleagues at home the same level of awareness and enthusiasm in evidence

here.

• Some “political” obstacles with changes in leadership and administrations.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• Hoosiers are not by nature contentious – we tend to be trusting and collaborative, wanting to “get

along” and seek common goals.
• Good public safety leadership with long-standing communities and relationships of trust.

• Strong commitment by state government to raise this as a priority issue, and to commit more

resources.

• Strong leadership in central Indiana in the area of health care – potential for new partnerships.
Iowa

Point of Contact: Sandi Koll

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

Efforts include:

• Elderly services officers (2) within Division of Criminal Investigation

• Triad – Training Manual

• Informally – AG, APS and SUA AAA working together

• Agencies working together on adult abuse issues (Public Safety, Human Services, Inspections

and Appeals and SUAs)

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Bring law enforcement and Inspections and Appeals together to a meeting to share and develop a

plan of action – search for funding

• Find out what requirements are for law enforcement for continuing education

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Funding

• Putting issues into practice

• Providing outreach with limited funding and human resources

• Changing peoples’ attitudes about the existence of abuse

• Competing with other significant issues and resources

• Suspect abuse and not sure how to proceed

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your ideas or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Willingness and a history of collaboration

• Strong relationships among state agencies

• Strong commitment to Iowa’s elderly as a large part of the state’s demographics
Kansas

Point of Contact: Ruth Ritthaler

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) Ongoing cooperation Attorney General/DA offices on consumer fraud

(b) Enhanced penalties for violations of Consumer Protection Act when victims elderly

(b), (c) (1) An interagency agreement on abuse involving Secretaries of Aging, Health and

Environment, Social and Rehabilitation Services, Ombudsman regarding abuse

(2) Local elder abuse councils involving numerous agencies

(3) Safe House for elders in Wichita 

Briefly describe the ideas or strategies you have developed in the state and tribal meetings about

what you want to do to enhance such collaboration after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Identify available funding sources for research, education

(2) Inter agency/disciplinary task force (statewide) 

(3) Identify problem laws/statutes/procedures; target list of them that must be changed!

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Lack of funding/resources

(2) Geography

(3) Lack of consistency in administrative/criminal procedures and terminology

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Recognition of barriers of past and willingness to cooperate to develop partnerships
Kentucky

Point of Contact: B.J. Jacobs

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) Financial Exploitation and Consumer Fraud

• Senior Crime College (consumer education on financial fraud and personal protection –

100 sites across the state – AG’s Office, Senior Center, Office of Aging, APS, AARP,

Triad, Area Agency on Aging/Area Development District

• Triad

• Prosecutor’s Advisory Counsel (AG’s Office) coordinates training on crime against

seniors for state and local prosecutors 

• Telemarketing task force (AG’s Office, US Attorney’s Office, FBI, Secret Service) –

collaboration on investigation and prosecution of telemarketing

• Bankers vs. Crimes (AG’s Office, APS, Office of Aging) – training tellers on fraud

scams against seniors and reporting to APS

• Scam Jam (AG’s Office, AARP, Better Business Bureau) – consumer

education/entertainment 

(b) Elder Abuse and Neglect at Home

Statewide Elder Abuse committee – 35-40 public and private agencies represented with the focus

on prevention, intervention, coordination, public awareness, elder rights and public policy;

developing model protocol on elder maltreatment, multidisciplinary teams, Fatality Review Teams,

website on elder abuse, training material and speakers bureau, elder shelter public forums on elder

rights 

(c) Institutional Abuse and Neglect

APS and AG’s Medicaid Fraud and Abuse Central (MF and AC) Division MOU between the

two agencies for APS to report to MF and AC Division all reports of abuse neglect and/or

exploitation that are likely to be substantiated or are substantiated for prosecution or investigation

and prosecution by the AG’s Office 

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Train/educate prosecutors, service providers and judiciary on elder issues to improve successful

prosecution
• Measurable outcome to determine if the victim positively benefitted from intervention

• Review law (adult protection) to remove barriers or make amendments to prosecution and service

provision

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Turfism

• Lack of funding

• Lack of staff

• Issues with confidentiality statute 

• Lack of resources

• Overall plan for coordination of senior [efforts]

• Information about each agency and agency roles is not communicated effectively

• Lack of cooperative at local, regional and state level among agencies

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• A true interest in the issue of elder maltreatment, victim protection and perpetrator treatment

among agencies

• Willingness among agencies to set aside the turf issues, etc. to work toward the development or

enhancement of services regarding elder maltreatment issues 
Louisiana

Point of Contact: Audrey Thibodeaux

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) 1994 legislation formed the statewide Comm. for Coordination of Law Enforcement Services to

Elderly (CCLESE) represented by Council on Aging, AARP, Governor’s Office of Elderly

Affairs, AG-Medicaid Fraud, Sheriff’s, Chiefs, State Police and DAs. Issues (b) and (c).

(2) U.S. Attorney Middle District Nursing Home Task Force – U.S. Attorney, Department of Health

and Human Services, Gov. of Elderly Affairs and Aged Law Enforcement Response Team

(ALERT). Issue (c).

(3) 1999 legislation formed ALERT Program, 45 hr. P.O.S.T. certification provided to candidates

meeting selection criteria. Goal to have 1 ALERT officer per parish. Issues (a), (b), and (c).

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your ideas or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Incorporate additional consumer fraud training into the ALERT Program to educate law

enforcement officers. Currently, this is often seen as just a “civil” matter rather than a criminal

offense against both persons and property. Issue (a).

(2) CCLESE will add financial exploitation and consumer fraud representative from AG’s office to

address issue (a).

(3) Future ALERT initiative in Phase II includes training for district attorneys. The goal is to have

one ALERT trained ADA in each judicial district . Issues (a), (b), and (c).

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Turf issues could present a challenge in ALERT training for ADA’s. Funding for this component of the

training will also present a challenge. Issues (a), (b), and (c).

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Louisiana currently has in place a number of programs relating to issues (a), (b), and (c). Contacts made

and information obtained by symposium attendees has given us much to consider, evaluate and implement

to further improve services related to issues (a), (b), and (c).
Maine

Point of Contact: Ricker Hamilton

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Triads – 11 areas involved in partnership and state steering committee hosted by Attorney

General

(2) Maine Reporting Project for Financial Institutions 

(3) Elder Crime Contact Officers Program – designates and officer in each local and state law

enforcement department for elder issues

(4) Collaboration between APS, Maine Community Policing, Department of Attorney General and

AARP to develop training for law enforcement

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Coordinate, strengthen and improve existing state partnerships – ex: expanding necessary training

for a number of disciplines (including health field, financial community, postal worker and faith

community, EMTs)

(2) Charge the criminal laws to strengthen provisions regarding abuse, neglect and exploitation

(3) Listening sessions, “listening to elders”

(4) Develop multidisciplinary team for southern (most populated) part of state, comprised of APS,

prosecutor, AARP, AAA, domestic violence [advocate], law enforcement, AG, medical

professional (PA)

(5) Train elder abuse victims to talk to older victims about abuse neglect exploitation – increase self

reporting

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Lack of prosecution of abuse, neglect and exploitation (cases substantiated by APS and referred

for prosecution)

(2) Lack of funding – training, resources to meet needs of older victims

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.
People, professionals – large geographic area but small population with strong pool of dedicated

professionals who serve that population who would respond to fresh approaches regarding collaboration.
Maryland

Point of Contact: Jeffrey Myers

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) Project SAFE (Bank reporting project; Senior Sting (mail rip offs)

(c) Statewide prosecutor devoted solely to institutional abuse and neglect

(a), (b), (c) Special docket devoted to prosecuting illegal homes; interagency and 

interdisciplinary groups 

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(a), (b), (c):

(1) Increase prosecutions by educating:

A: APS workers on what is important for prosecutors;

B: Local law enforcement on why elder abuse cases are true crimes;

C: States’ Attorneys on the importance of elder abuse prosecution and ways to deal with some of

the unique difficulties presented by these cases.

(2) Re-engineering the APS referral process to law enforcement.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) People needed to implement are already 118% over-committed.

(2) Different constraints and priorities of various agencies involved.

(3) Providing statistics to prove problem justifies more funding.

(4) Providing statistics to show work will have a measurable impact.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

The Attorney General and Secretaries of Health and Mental Hygiene, Aging, and Human Resources all

see elder/vulnerable adult abuse issues as high priority matters.
Massachusetts

Point of Contact: Gregory Giuliano

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Bank Reporting Project: Massachusetts was the first state to train bank personnel on how to

detect and report financial exploitation of the elderly. This project is led by Executive Office of

Elder Affairs and involves the Attorney General’s office, the Massachusetts Bankers

Association, among others. It is being replicated in many states.

(2) The Attorney General, the Executive Office of Elder Affairs and local DAs are developing

legislation to make it easier to prosecute cases of financial exploitation of elders through joint bank

account abuse.

(3) The Attorney General’s Elder Protection Advisory Committee: This group consists of state and

local providers and consumers in order to promote collaboration among protective service

professionals, law enforcement and others in responding to elder abuse cases. 

(4) Suffolk County Roundtable: This group consists of the local DA, elder service agencies and state

agency representatives for the purpose of collaboration on specific elder cases before the DA’s

office.

(5) State law requires elder protective service agencies to report serious incidents of elder abuse to

the local DA prosecution or other appropriate remedies.

(6) Mass Medical Society Initiative: The Executive Office of Elder affairs and the Mass Medical

Society have developed a manual to train physicians on how to detect and report elder abuse and

on their role on the assessment and treatment of these cases.

(7) Community Education: All protective services agencies are required to conduct a minimum of 15

community education events a year in order to promote reporting and collaboration in responding

to elder abuse cases.

(8) Hotlines: Both the Executive Office and Elder Affairs and the AG’s office have hotlines which

refer elder abuse cases to the appropriate protective services agencies and answer questions for

concerned consumers.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) To promote more consistency in the relationships between protective service agencies and local

DAs, we propose to develop a training curriculum for protective services staff and local DA

offices which will address:

• the types of cases to report to the DA; 

• the types of cases that will be prosecuted; and 

• how other remedies can be used instead of prosecution in certain situations (i.e., restitution 
agreements, treatment for drug-addicted or alcoholic perpetrators).

(2) Develop a training curriculum for law enforcement personnel on how to conduct elder interviews.

(3) Develop training for judges on elder involving protective services.

(4) Intensify our efforts to educate elders on how to prevent themselves from being financially

exploited or otherwise abused.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

The lack of funding and turf issues are the biggest barriers we will face in implementation of our proposed

initiatives. 

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

The biggest asset is that state agencies have strong leadership and willingness to work together. 

Massachusetts is a very activist state. Also, we have many universities in Massachusetts that are very

involved in elder issues and would support our proposals. 
Michigan

Point of Contact: Lynn Alexander/Carol Isaacs

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) Michigan’s Family Independence Agency (FIA) and the Office of Services to the Aging (OSA)

are integral partners in efforts to protect vulnerable adults from financial exploitation. In 1996, the

two agencies formed the Senior Exploitation Quick Response Team (SEQRT) as a response to

the growing community concern of protecting the elderly from financial theft from service

providers, salespeople, family members or other new “friends.” The team is made up of different

agencies or organizations at the state level that have regulatory authority over the banking

industry, funeral homes, real estate, etc. Other team members are representatives from the

Office of Attorney General, the Michigan State Police, the Michigan Prosecuting Attorneys

Association, the private bar, and the financial community. The SEQRT team makes training

available to human service agencies, law enforcement agencies, prosecutors and the general

public on recognizing the signs of exploitation through “Schemes, Scams and Swindles” regional

conferences.

With the enactment of a new law that provides penalties for financial exploitation by those who

have a trusting relationship with a vulnerable adult, OSA and FIA used the SEQRT model and

targeted training seminars at banks, credit unions and other financial institutions throughout the

state to educate and inform business on how to recognize when financial exploitation of an elderly

individual may be taking place. Training was also provided to members of the Prosecuting

Attorneys Association, and since it was so well received, plans are being made to offer this

training to judges. FIA has also developed a “Risk Assessment” device as one other strategy to

prevent or arrest financial abuse among senior citizens. This tool will soon be piloted by Home

Help Agencies as part of an applicant’s screening process for Independent Living Arrangements

to detect incidences or patterns of financial exploitation. FIA will then measure the success of

this instrument for statewide use.

(b) Adult Protection in Michigan is mandated by Public Act 519 of 1982, which requires certain

professionals and other employees in the fields of health care, mental health, social work, law

enforcement, education and other human services to report suspected cases of adult abuse,

neglect or exploitation to the Family Independence Agency. Each FIA local office has an adult

protective services staff that receives and investigates complaints of alleged abuse, neglect, or

exploitation of a vulnerable adult. FIA works in cooperation with local law enforcement agencies

by providing training in correct response to situations involving adults who are at risk so that a

proper referral can be done to an adult protected service worker for investigation. FIA statistics

show that in FY 1999, there have been 9,414 adult protective service referrals, and a caseload of

approximately 3,131 people who were served.

FIA and law enforcement agencies are also integral partners in local outreach efforts, in

particular the establishment of “Community Protection Teams” – a joint effort with aging network

agencies and seniors to educate the public as to the warning signs of exploitation or abuse. One

form of a Community Protection Team is the Michigan Triad, a cooperative crime prevention

program of the Michigan Sheriffs’ Association, Michigan Association of Chiefs of Police, and the

AARP. It is also important to note that some women’s shelters are now becoming active in
providing services to elderly victims of domestic violence and substance abuse.

The Michigan Supreme Court has taken additional steps to improve the protection of adults who

have guardians and conservators assigned to them. The Court’s new emphasis attempts to

protect adults victimized by unscrupulous guardians, and assist communities looking to strengthen

their guardianship programs. The Court will identify problems in the guardianship system, advise

local probate courts on service improvements which include volunteer services, and investigate

complaints of neglect or abuse. Other functions include training all probate judges on the needs of

the elderly, developing more information to help people better understand the guardianship system

and its alternatives, providing available community resources and revising court rules to improve

the guardianship process.

(c) In addition to the aggressive campaigns sponsored by the Office of Services to the Aging and

local area agencies on aging, over the past three years several thousand seniors, advocates and

law enforcement officials have attended conferences that have been held in 11 different locations

around the state. The “Long Term Care Information and Education Campaign” provides

professionals, seniors, and their families with information about how to recognize and prevent

elder abuse and exploitation.

Briefly describe the ideas or strategies you have developed in the state and tribal meetings about

what you want to do to enhance such collaboration after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(a) The Michigan Attorney General’s Office, Consumer Protection Fraud Division, has done, and will

be doing, more work with telemarketing fraud. 

(b) Additional trainings are planned for 2001 that will target elderly victims of domestic violence and

sexual assault. This training will be a partnership with the Prosecuting Attorneys Association of

Michigan and the Office of Services to the Aging.

(c) Michigan continues to look at alternatives to long term care settings. All stakeholders are

included in a statewide steering committee. They bring issues forward to the Human Services

Council and draw stakeholders together for education of seniors and their families. We will

follow nursing home protocol and do a better job of publicizing the work that is going on now at

the state and local level.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Michigan has worked through many turf issues. Lack of funding, and consequently small staffs, is always

a problem. Also, Michigan is a large state with a diverse population. Michigan has 13 federally

recognized tribes and the second largest Arab population outside of the Middle East. Michigan also

experiences seasonal increases in the migrant population. It can be difficult to develop programs and

polices that are responsive to such diversity.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), (c) (see above), please so indicate.
There needs to be a willingness to partner, the courage to be innovative, and the wisdom to draw in

stakeholders as a collaborative team effort. Dedicated professionals in the state have already established

a strong history of collaboration. In the past few years the number of collaborative trainings between

state and local agencies has increased dramatically, particularly in the area of financial exploitation. Also,

particular attention is now being given to direct client services, and training is available for professionals

responding to domestic violence or sexual assault. We know that physical violence to the elderly happens

most frequently in the home. Because of this emphasis on training, more prosecutors and law

enforcement are dedicating staff to these issues.
Minnesota

Point of Contact: Barbara Doherty

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Nursing Home Working Group (Department of Human Services (DHS), Department of Health,

law enforcement, Ombudsman, County Adult Protection, U.S. Attorney): Group meets every 2

months to promote legislative and collaborative focus regarding (a) assisted living and (b) training

and education

(2) Adult Protection Teams: local (at the county level) law enforcement and APS – services

(3) Law Enforcement training team – AG, Department of Public Safety, County Attorney staff, state

and county APS

(4) Pilot project for risk assessment tool

(5) Annual training for lead investigative services – Department of Health, DHS licensing

investigators, county APS, law enforcement, state and local attorneys

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

For (a), (b), and (c):

(1) Training the judiciary – their convention 

(2) Training the DHS appeals referees 

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Turf - biggest obstacle in getting prosecutions 

(2) Lack of knowledge: how to do training for judiciary or referees who don’t typically 

accept training outside of their own profession

community understanding – jury won’t have background in adult

protection as either civil or criminal

(3) Lack of media messages: not consistent 

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.
Collaboration – 3 groups already exist in state so build on this base – bring in more county staff –

especially county attorneys and city attorneys
Mississippi

Point of Contact: Donna Hodges

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

There has been a very loose collaborative effort, developed primarily through training programs financed

through the Mississippi Leadership Council on Aging. The Mississippi Law Enforcement Officers Training

Academy develops and presents the training, with assistance from the Attorney General’s Office,

Department of Human Services, Victims Rights Coordinators, Domestic Violence Unit Representatives,

AARP. Attendance is by local Triad members, local law enforcement officers, ombudsman, and some

social workers. All three topics are covered in the training.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

Team members suggest developing a resource manual, describing services available from different

agencies. In addition, members suggest developing a task force to meet periodically and identify problems

and possible solutions, as well as locating and using funds available.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

The biggest challenge is lack of funding to address abuse and neglect at home. The Attorney General’s

office is very active and proactive in dealing with consumers issues and institutional issues; however, lack

of funding specifically designated for elder issues in the home results in the inability to address those

problems.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

The biggest asset is the willingness to collaborate. Participants at this conference have demonstrated

their willingness to learn and share information, and expressed their desire to work more closely and to

focus on these issues. In addition, leadership is strong in Mississippi on the part of state agency heads and

in the local communities, many of whom are dedicated to individual interests.
Missouri

Point of Contact: Mary Schaeffer/Brenda Campbell

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

Collaborative Efforts

• State-sponsored annual APS Conference includes invitation to law enforcement (with POST/CLE

Credit), Area Agencies, Department of Mental Health (DMH)Attorneys, etc. (No conference

fee)

• New financial exploitation passed last session; working with Missouri Bar Association to develop

training for banking professionals and APS workers together and community advocates and elder

law symposium of St. Louis 

• Annual APS conference has a “thread” of local supports interstate, interdisciplinary team panel

presentation about what’s available in Missouri – prosecutors, law enforcement, Missouri

Highway Patrol, etc., DMH

• Present at police departments, annual conferences for public administrators (Missouri Guardians),

prosecutors, hospital association, etc., when invited/aware

• Missouri AG’s office very active in telemarketing/consumer fraud and sponsors annual

investigator’s training for non-law enforcement investigators

• State Long Term Care Ombudsman Office in St. Louis has VOCA grant – also doing some

advocacy work in hotline calls

• Women Elderly and Battered (domestic violence association) – collaboration regarding elderly

victims – some funding for a study on seniors accessing domestic violence shelters/facilities 

NOTE: In Missouri APS workers are state-employed social service workers who investigate, do pre-long

term care screening, and case management of home- and community-based services

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(a) Deal with financial exploitation (new legislation) through public education and training. Establish

relationship with banker’s industry and train banking professionals and AG’s Office.

(b) Review the report from legislative public hearings on elder abuse (conducted last session) and

establish a state level focus group to develop strategies/action plans for Missouri.

(c) Explore the feasibility of a statewide workshop to educate/deal with new law – 

focus: prosecutors, police, sheriff, highway patrol, APS, AG, AAA, nursing facilities, home care

services providers
Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Resources – staff and money –

• Labor shortage

• Low pay scales

• Legislation that caps state budget/spending

• Growing Medicaid budget (and other entitlements) has funding priority

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• New legislation

• Legislative attention

• Large population of older adults

• Strong leadership in Governor’s Advisory Council, Silver Hair Legislature, Minority Commission,

and (Olmstead) Advocacy Commission and Task Force on Disabled Adults

(NOTE: No AG [or other public safety] representation; Area Agency on Aging and Division of Aging

only.)
Montana

Point of Contact: Rick Bartos

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

Montana has 7 Indian reservations. Each reservation is governed by a tribal government. Each tribe

views sovereignty as an important component for their existence. There is no statewide collaborative

team because of the difficulty in seeking consensus. Collaboration typically occurs on a case-by-case

basis and with local APS, state personnel and interested tribal officials.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Invite tribal APS and social service personnel to state training.

(2) Request assistance of state Indian coordinator to assist.

(3) Continue to serve all persons in Indian reservations if a referral is made to the state APS or other

entity.

(4) Approach Montana/Wyoming Tribal Chief Council requesting consensus on basic

abuse/neglect/exploitation issues.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Montana is the fourth largest geographic state – population +900,000 people – with 30 APS

workers. 2.5 FTE cover 17 counties, a geographic size equal to the size of Delaware and Rhode

Island. On average one APS worker travels 15,000 miles per year.

(2) Tribal sovereignty and state jurisdiction on criminal matters, including prosecution and

investigation.

(3) Fear on part of certain tribes to protect enrolled members.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Willingness of State, AG, Auditor, US Attorney’s Office and APS to collaborate 

(2) Opportunities to invite personnel from tribes to attend state/federal training meetings.

(3) Cooperation is best among people directly involved (APS, Indian Health Service, local sheriff,

etc.) than it is on a state level.

(4) All people on a reservation are also residents of the state of Montana.
Nevada

Point of Contact: Bonnie Brand

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

• Civilian leader of Abuse/Neglect Detail of Law Enforcement – Los Vegas Metro Community

Emergency Response Team (CERT) (Southern Nevada)

Senior Evidence Review Team (SEQRT) (Northern Nevada)

Consumer fraud – not really handled on local levels – only state

Bank reporting project – exploitation brochure

• (TADS – Temporary Adult Displacement; SAFE – Special Advocate for Elders; SALT –

Seniors and Law Enforcement Together

• Ongoing task force

Our state elder abuse council/action plan addresses all three issues – (a), (b), and (c)

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• As a team, approach DAs, Sheriffs and Chiefs Associations

• Sandie Durgin – law enforcement metro – meet with Sheriffs, Chiefs

• Apply for grant funding (VOCA)

• Work to improve law enforcement reporting locally suggest red stamp on reports contact Sheriffs

and Chiefs Associations

• Present to Nevada League of Cities, Counties

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Lack of funding

• Prosecutor reluctance

• Rural areas especially impacted by lack of resources

• Medicaid Fraud Unit cannot work on elder issues outside Medicaid-funded facilities

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implementing these ideas or strategies after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Strong leadership

• Willing to collaborate/communicate

• Small state-encourages collaboration – first name basis – we know the players throughout our

state
New Hampshire

Point of Contact: Ann Butenhof

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

We have a number of collaborative efforts:

(1) Financial exploitation and consumer fraud

• Reverse boiler room - with AG, AARP, FBI, postal, local and Canadian law enforcement

• Department of Health and Human Services (DHHS), private attorneys, courts re: durable

power of attorney laws (strengthening)

• Community education on consumer fraud: AG, local law enforcement and community

leaders

• Legislation re: mandatory bank reporting – DHHS and banking association

(2) Abuse and Neglect

• AG, AARP, DHHS and postal: strengthen adult protective laws and work on protocols

for professionals dealing with abused elders

• Police, sheriff and elderly community: Triad

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

We recognize the need for leadership from the top, and plan to convince the Governor to get involved

(currently, the state does not have an elder commission). We plan to have an Elder Abuse Symposium,

modeled somewhat after this symposium, with the goal of bringing all key players to the table. This is

necessary because although we have many collaborative efforts, we are approaching these issues in a

fragmented way. For planning the symposium, we plan to involve elder consumers and aging

organizations – cosponsors could include: DHHS, AG, Governor, AARP, and Senior Citizens Law

Project. Goals of symposium are to create a statewide consortium relating to all elder abuse issues, with

sub-task forces, and to create a coordinated education plan.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Our elder advocate network is fragmented and funding for elder abuse is limited. There is currently no

funding for new initiatives in our state. Also, New Hampshire has some very rural sections of the state,

so any statewide initiative can be a challenge. 

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

We are a small state, with many committed people. We have strong volunteer organizations.
New Jersey

Point of Contact: Dorothy Bargholz

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

• Attorney General’s Office working with state/county Divisions on Aging. (a)

• Attorney General’s Office working cooperatively with the NJ Department of Health and Senior

Services on its Medicaid fraud and abuse efforts. (c)

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

We propose to develop and sponsor a conference of interested parties state-wide to develop working

teams as the county level – formatted after this conference. Sponsors would be: Attorney General,

Department of Health and Senior Services, AARP. Invitees would include: County Prosecutors, County

New Jersey EASE (Division on Aging) representative, State Police, emergency response, Red Cross,

banking community, and professional health care associations. 

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Assembly of a team of key decision-makers from the above cooperating organizations to develop the

foundation for county-level working teams.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• Leadership of the Administration, Attorney General, and Commissioner of Health and Senior

Services and the already established cooperative efforts.

• Establishment of the first county-level response/enforcement teams.
New Mexico and Pueblo of Zuni

Point of Contact: Ellen Lietzer/Michelle Lujan-Grisham/Margaret Dosedo

Briefly describe any ongoing collaborative efforts in your state or tribe between safety and social

services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse and

neglect at home, and (c) institutional abuse and neglect.

(1) Joint protocol among investigative agencies such as Licensing and Certification, Ombudsman and

Medicaid Fraud to share case information, collaborate on investigations and strengthen

substantiation to prevent one agency from not substantiating when another does, leading to weak

evidentiary components hurting overall prosecution efforts. This is a state-level and statewide

effort.

(2) Legislation authorizing “undercover” care evaluations by New Mexico State Agency on Aging. 

We believe this is only such statute in the country.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Duplicate the state-level protocol at the local level. 

(2) Host and participate in Judiciary Conference to enhance awareness and involvement in elder

abuse cases, including financial exploitation.

(3) Identify funding sources to implement (1) and (2) through fines, penalties and victim restitution.

(4) To enforce adult abuse codes (including tribal codes); funding required to properly staff programs

with investigators, case managers and prosecutors. Will organize cohesive group to collectively

advocate for state legislative funds.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Stigma related to difficult case development and legal arena as well as general fear of industry

perpetrators

(2) Inequity between child abuse and elder abuse funding and policies.

(3) Funding

(4) Knowledge of elder abuse cases 

(5) Turf 

(6) Statutory limitations

(7) Lack of training
Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Enthusiastic leadership

(2) Ability to implement “Zero Tolerance” policy 

(3) Ability to collaborate with diverse public and private entities including the 22 NM Indian tribes
New York

Point of Contact: William Graham

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Multidisciplinary Annual APS/Aging Adult Abuse Conference 

(2) Statewide Triad – also Committee for Coordination of Police Services for Elderly (16 member

committee by legislation)

(3) Operation Restore Trust

(4) MFCU – outreach to nursing homes, senior groups

(5) Statewide Telemarketing Task Force

(6) Reverse boiler room with AARP

(7) Onondaga County Prosecutors Initiative focusing on elder abuse

(8) Training with banks and video

(9) Telephone reassurance – computer automated

(10) Dementia trainings for APS, Alzheimer’s Association, medical personnel and law enforcement

Briefly describe the ideas or strategies you have developed in the state and tribe team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Ongoing team meetings of participants at this conference

(2) Bring together geographic-based groups with issue-based group, local law enforcement, DAs, etc.

(3) Intergenerational programs using teenagers to work with the elderly

(4) Material – development and distribution

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your

state or tribal team will face in implementing these ideas or strategies after this symposium. If your

idea or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Funding

(2) Identifying the problems across a diverse geographic, ethnic and political state

(3) A large rural population, isolation 

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Wide range of academic centers

(2) The diversity within the state

(3) Communication and technology infrastructure

(4) Tradition of an activist government and leadership
North Carolina

Point of Contact: Debbie Brantley

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (1) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) David Kirkman, Co-Chair of Senior Consumer Fraud Task Force, distributes “fraud alerts” to

members of Task Force regularly which provide information on emerging scams, etc., targeting

seniors. Members further distribute the alert to their counterparts. Information is posted in senior

centers and other local agencies/organizations where seniors frequent.

(b), (c) The Division of Aging (state unit on aging) houses the Long Term Care Ombudsman Program. In

North Carolina, the Ombudsman Program includes 25 Regional Ombudsman Programs located in

area agencies on aging. These ombudsmen have utilized the elder abuse funding provided under

the OAA to initiate First Responder Program which is a collaborative effort between social

services, law enforcement, EMS and other medical professionals. The program educates these

individuals on how to identify elder abuse as well as how to report it for further investigation. 

Also, workshops held locally to educate general public, seniors and human service professionals

on elder abuse; materials distributed at health fairs, doctors offices, etc. on elder abuse.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) An area, that we plan to strengthen this year is to work more closely with the North Carolina

Bankers Association to enhance efforts of bankers to identify and report possible financial

exploitation of seniors.

(2) Another area we will be working on includes utilizing the elder abuse funding states (SUAs)

receive to conduct more public awareness efforts which will focus on educating seniors about

types of scams and other deceptive practices are in existence in an effect to reduce the number

who became victims.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal will face in implementing these ideas or strategies after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) The biggest challenges include lack of funding; many agencies on aging have small staffs and don’t

have sufficient time to focus on consumer fraud – although some are doing a lot to combat

consumer fraud and are very effective.

(2) The biggest challenge in regard to consumer fraud continues to be how to help seniors avoid

becoming targets of scams and further deceptive practices.
Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team to implement these ideas or strategies after this symposium. If your idea or strategy only

relates to (a), (b), or (c) (see above), please so indicate.

The biggest asset at this time includes Senior Consumer Fraud Task Force which was established in 1998. 

This task force includes many of the agencies and organization that interact with seniors who may be

victims of scams and deceptive practices – State Bureau of Investigation, law enforcement, aging

advocates/agencies, AARP, Attorney General’s Office, Postal Service, Secretary of State’s Office which

deals with fraud involving securities, promissory notes and investments, Better Business Bureau.

NOTE: We have focused most of our efforts on elder abuse prevention in North Carolina since 1992. As

a result, we are expanding our focus to include financial exploitation. 
North Dakota

Point of Contact: Lynne Jacobson

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

• North Dakota is in the process of organizing vulnerable adult services at the state and regional

level.

• Consumer protection currently collaborates with social workers and law enforcement.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

More coordination between consumer fraud/protection and social services/aging services

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Funding

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Willingness of local/community organizations to contribute/participate
Northern Cheyenne Tribe

Point of Contact: Jackie Tang/Joanne Wolfblack

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, (c) institutional abuse and neglect.

(1) The Northern Cheyenne Tribe has one ordinance in the Tribal Law and Order code which deals

with elderly exploitation. This ordinance has never been enforced. There are no existing laws to

protect the elderly.

(2) Abuse and neglect at home – any abuse or neglect at home is usually reported to Child Protective

Services (CPS), since there is no APS. CPS sometimes reports to the Public Health Nurses

(PHN). CPS and PHN sometimes conduct investigations together. Family members are referred

to other agencies to assist them in their care of the elderly. 

(3) Institutional Abuse/Neglect – complaints are usually referred to the supervisor of the caretaker. 

(4) Tribal Prosecution and Social Services “sometimes” handled financial exploitation. Social Services

“sometimes” become the payee to monitor the elderly’s (and sometimes the disabled) income. 

Such as social security payments, SSI, Lease payments, etc.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

Strategy – to begin looking for funding for an Adult Protection Services position. Begin a local team of

professionals to discuss and implement a referral system and how to handle the referrals. Referrals will

include financial exploitation, abuse and neglect at home, medical neglect, institutional abuse and neglect. 

As a team they will decide how each referral should be handled and what services need to be provided. 

Team will also help create tribal laws to handle “Elderly Abuse” and to define it. Team will also develop a

tracking and monitoring system. Collaboration with other agencies will be a challenge since the elderly are

one of the most important resource to the tribe.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Funding is limited to Indian tribes. 

(2) Educating the public will be challenging due to the public’s reluctance to try something new.

(3) Working with the Tribal Council in implementing a law on mandatory reporting of elderly abuse.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Tribal team is willing to collaborate, with state and other agencies.
Ohio

Point of Contact: Jackie DeGenova

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) Ohio Attorney General Montgomery commenced a “Senior Protection Initiative” in March 2000

designed to gather and exchange information between organizations dedicated to protecting Ohio’s

vulnerable populations. Emphasis is on education, consumer fraud and resource identification.

(b), (c) Collaboration exists between APS and the Ohio Department of Aging but a stronger network is

needed to enforce existing laws and create mechanisms to assist, paralleled to those currently in

place for child abuse issues.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

While Ohio is fortunate today to have 7 representatives (including 2 presenters) at this symposium, we

recognize the need for increased collaboration and education between our agencies to better meet the

needs of our seniors and vulnerable populations. Several of these 7 representatives have over 20 years

experience involved with services for the elderly and law enforcement. We have seen various programs

initiated through several administrations, many with excellent recommendations. The need for follow-up,

however, continues to exist. Our representatives today have agreed to use Ohio Attorney General

Montgomery’s initiative as a springboard to make our recommendation for a state-wide collaborative effort

to combat elder exploitation and abuse. The keys are: education of public and law enforcement;

accountability in enforcing existing laws; and protocol development for collaboration between state

agencies.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Ohio’s biggest challenges lie in the fact that it is a “home rule” state, with 88 very independent

counties and a diverse rural and urban population.

• In addition, Ohio’s regulatory schemes are fragmented into authority, without natural collaboration.

• Finally, follow-through on cooperation and education will be an obstacle to be overcome.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• Ohio’s obstacles can also be seen as its assets: i.e., we have a state of 12 million, with seniors in

rural and urban areas, conservatives and liberals, and an excellent cross-section of the nation. 

Ohio has thus historically been a proactive state, being one of the first to develop protection

intervention services.
• Another asset is the Attorney General’s willingness to be in the forefront in combating elder fraud,

and engaging all aspects of adult services.

• Finally, the preauthorization of the Older American’s Act is a useful asset.
Oklahoma

Point of Contact: Barbara Kidder

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) OK-SAF (Seniors Against Fraud) – collaboration among 40 organizations and state agencies

including the SUA and AG’s Office with funding from AARP and Southwestern Bell Oklahoma –

Seniors Against Fraud provides seniors with information on telemarketing fraud, fiscal scams and

housing repair; has held 2 statewide telethons on public television with responses from over 2,000

people; individual presentations to over 60,000 people by trained advocates using material provided

by AARP, Southwestern Bell, state Attorney General, and Triad.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• State APS needs to contact Department of Public Safety, Chiefs of Police Association and others

regarding training and collaboration -- how we can better work together to accomplish our jobs to

protect vulnerable adults, with particular emphasis on the frail, minority elderly.

• Work to expand OK-SAF website to create more awareness of the problems facing vulnerable

elders.

(NOTE: This questionnaire is being addressed only by the two aging representatives to the symposium.)

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Apparently, lack of interest by most of the state legislature and many law enforcement officials

presents a barrier.

• Turf issues create fragmentation of services.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• The AG’s Medicaid Fraud Control Unit in Oklahoma is excellent. We’d like to see its duties

expanded to include all medical fraud.

• Oklahoma also has a strong, statutorily created State Council on Aging, which was instrumental in

getting advocacy groups included in recent legislation reauthorizing the state long-term care task

force. (c)
Oregon

Point of Contact: Stephen Schneider

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Created a statewide, interagency task force, under the Oregon Attorney General to look at elder

abuse, problem-solve, create legislation and training protocols.

(2) Setup elder abuse multi-disciplinary teams in 85% of our counties. They do: (1) staff codes,

problem-solve; (2) begin cross-training activities between law enforcement and adult protective

services; (3) public education activities for seniors in the community. 

(3) Oregon’s bank project to deal with financial exploitation. Funding by Office for Victims of Crime

and coordinated with the banking, law enforcement and senior services community. Also R2T2

Project.

(4) Statewide training since 1195. Prosecutors college in 2000.

(5) Oregon VOCA funded 6 programs for elders.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates (a), (b), or (c) (see above), please so indicate.

(1) Interested in state Department of Justice to create elder crimes/vulnerable adults unit for

investigation and/or prosecution. County DAs need help in both areas.

(2) Outreach to Oregon tribes including training to protective service, law enforcement and

prosecutors. Assist tribes in elder abuse portions of their tribal codes. 

(3) Expand our retired financial experts program (these people volunteer with elder abuse

multidisciplinary team and help in the investigation of financial exploitation). 

(4) Train law enforcement/prosecutors so they are better able to handle cases with vulnerable adults,

including the disabled, mentally retarded and developmentally disabled/mentally ill.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Lack of funding!

• Staff elder abuse multidisciplinary teams

• Assist Department of Justice and DAs with investigation and prosecution

• Training materials cost money
Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Excellent leadership from AG Ted Kulongoski and his successor Hardy Myers

(2) Funding of specialized APS for mentally ill and developmentally disabled populating

(3) Better leadership and willingness to work on the issue from:

• prosecutors – we are now doing a yearly prosecutors college;

• law enforcement – we teach cadets at the police and state police academy

(4) Good coordination at state and county level on policymaking, legislation, creative funding strategies

including statewide conferences
Pennsylvania

Point of Contact: Alexis Barbieri

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(a) AG Mike Fisher’s Task Force for the Protection of Older Pennsylvanians. 

(b) (1) Act 128 training giver to law enforcement and long term care givers to identify and report

senior abuse and neglect. AG gives training through grant from Pennsylvania Commission

on Council and Delinquency (PCCD).

(2) PCCD grant Department of Aging to instruct on cultural diversity. 

(c) Act 128 – above.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Mandated training for law enforcement in dealing with seniors issues with sensitivity. Applies to

(a), (b), and (c).

(2) Collaboration between law enforcement, Adult Protective Services and other social services

agencies, and financial community to train tellers and bank employees to identify financial abuse

and/or exploitation.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Funding is a big issue. (a), (b), and (c)

(2) Geography of Pennsylvania is a problem. Pennsylvania is a large state with largest rural and

populations in U.S. Also, second largest senior population in U.S. Lack of job opportunities force

young folks to leave so seniors have no caregivers and greater isolation. Relates to (a), (b), and

(c).

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Strong leadership and support from AG.

(2) Strong senior network including area agencies on aging, victim services, AARP, PCCD.

(3) Oldest coalitions for domestic violence and sexual abuse in U.S. Clearinghouse for both in

Pennsylvania.

(4) PCCD provides local match-free training because assumes cost for Byrne Program funding.
Rhode Island

Point of Contact: Vivian Spence

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Working with Department of Attorney General and Department of Elderly Affairs on consumer

outreach program to the elderly.

(2) Department of Attorney General and Department of Elderly Affairs works with issues concerning

financial exploitation. Responding to inquiries on financial exploitation cases.

(3) State Plan on Aging, which meets monthly on neglect and guardianship issues.

(4) Department of Elderly Affairs and Department of Attorney General work with senior centers,

meal sites and local police.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

Establish a statewide curriculum committee to establish training for law enforcement in all 3 areas.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

Breaking agency barriers and making the challenge of working together.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Learning from the experts a better way to network with other states who have programs already in effect

to address these problems.
South Carolina

Point of Contact: Catherine Christophillis

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, (c) institutional abuse and neglect.

South Carolina has a legislatively mandated Adult Protection Coordinating Council. This group has

conducted multidisciplinary training, developed a training manual and facilitated the development of

memorandums of agreement to improve system response. At the present time we have a state level

financial exploitation team and a committee is looking at improving system response to facility

investigations. The state has also developed a medical protocol for abuse and neglect cases. All these

efforts have contributed to an ongoing climate of collaboration in South Carolina.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Legislative changes: improve bank reporting, strengthen power of attorney to encourage

accountability, allow law enforcement to “lock down assets” and recover victim’s assets, fatality

review teams

• Adult Protection Coordinating Council needs victim representation

• Contact medical community to develop a multidisciplinary team for medical issues

• Improved training for all “players” to include the mandatory domestic violence required by statute

(must include judiciary)

• Establish emergency shelters

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above) please so indicate.

• Resources (time, people, funding)

• Reaching judges and prosecutors

• Lack of public awareness

• Taking the program/information to the elderly

• Make it part of “community policing”

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

• Strong leadership (Adult Protection Coordinating Council)

• Excellent statute
• Small state, everybody knows other individuals in the system

• Special Prosecutor at the SC Attorney General’s Office
Tennessee

Point of Contact: Marilyn Whalen

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Statewide workgroup on facility abuse (includes Tennessee Bureau of Investigation, Aging,

Protective Services, Health (regulators), mental health facility investigators, IRS, U.S. Attorneys).

(c)

(2) Annual Elder Abuse Institute with focus on Adult Protective Services and targeted other service

providers and law enforcement (co-sponsored by Tennessee State University and Adult Protective

Services) participants who are invited depend on topics presented (8+ years). (a), (b), (c) 

(3) By using VOCA, Title VII , and assorted grant funding rural West Tennessee area agency on

aging sponsors an elder abuse forum annually which includes APS, law enforcement, other social

workers and aging service providers (3 years). (a), (b), (c)

(4) East Tennessee Coalition on Elder Abuse – multidisciplinary coalition which has provided training

to the network, sponsored changes in state education and now working on banking project. (a),

(b), (c)

(5) APS and State Health Department has developed memos of understanding to enhance

coordination between the licensing/certification staff and APS in investigating licensed and

unlicenced facilities. Also – MOU with Department of Mental Health on investigations in state

mentally retarded/developmentally disabled facilities. (c) 

(6) Statewide Task Force on Adult Protective Services (mid 1990’s). (a), (b), (c)

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what to do to enhance such collaboration after this symposium. If your idea or strategy only

relates to (a), (b), (c) (see above), please so indicate.

TN team will meet to explore the following:

(1) Funding for (VOCA/VAWA?): Development of two additional regional Elder/Vulnerable Adult

Coalitions;

(2) Development of specialized investigative staff in at least one DA’s office to be dedicated to elder

abuse/crimes against frail elderly; and

(3) Development of specialized investigative staff in at least one DA’s office to be dedicated to elder

sexual abuse/assault against frail elderly. 
Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Funding

(2) Willingness to target available funds to this population

(3) Variation in geography/culture

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Team’s willingness to continue the discussion
Texas

Point of Contact: Carmel Bitondo Dyer

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(1) Triad (a), (b), (c)

(2) CRCGS – Community Resource Coordinator Groups – all HHS groups helping Alzheimer’s

victims (b), (c)

(3) APS collaboration with the Department of Human Services (DHS), Mental Health/Mental

Retardation (MHMR), Advocacy working with institutional abuse, personal care homes, MHMR

setting (b), (c)

(4) TEAM Institute – medical geriatric team collaboration with APS, now beginning to involve law

enforcement (b), (c)

(5) Banking Project – APS, AG’s Office, Texas Department of Banking and other financial entities

modeling California, Utah, Oregon, Massachusetts (a)

(6) FACT – Financial Abuse Cessation Team (a)

(7) SAF-T – Seniors Against Fraud in Texas (a), (c)

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what to do to enhance such collaboration after this symposium. If your idea or strategy only

relates to (a), (b), or (c) (see above), please so indicate.

(1) Develop a pool of experts as a resource for law enforcement: APS, medical, victim-witness, AG,

DHS, AARP (a), (b), (c)

(2) Texas Summit – to pull together interested parties, sponsored by Triad and TEAM Institute – begin

with a planning meeting (a), (b), (c)

(3) Possibly expensing TEAM institute with other entities (b), (c)

(4) Utilize telemedicine/teleconferencing (a), (b), (c)

(5) Need to fund research on senior victimization and services currently available (a), (b), (c)

 

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Geography – the size of our state presents challenges because it is difficult to provide

comprehensive coordinated training and service models to such a large and diverse state. The cost

of covering such a large state is also a challenge. (a), (b), (c)
(2) Funding – the lack of funding at the local and national level (a), (b), (c)

(3) Population – Texas has the 3rd largest population of elders in the U.S. (a), (b), (c)

(4) Federal legislation – focus needed on elder abuse to make it a national issue (a)

(5) Public awareness – at all levels, but even with increased awareness, there needs to be increased

staff and interventions to deal with resulting increase in cases (a), (b), (c)

(6) Lack of research (a), (b), (c)

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Commitment of the involved organizations – AG, victim-witness programs, US Attorney, TEAM

Institute, DHS, Baylor College of Medicine, APS

(2) Strong state APS – centrally-organized under the Texas Department of Protective and Regulatory

Services, centralized training

(3) Central database – an important repository of population-based data

(4) Good working relationships – among agencies in the state: DHS, AG’s Office, Department of

Aging, Protective and Regulatory Services, Governor’s Office, US Attorney, Victim Assistance
Vermont

Point of Contact: Linda Purdy

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

(c) The Attorney General’s Medicaid Fraud Control Unit works collaboratively with Licensing and

Protection and the Office of Professional Regulation, and Adult Protective Services in processing

referrals of abuse, neglect and exploitation. We have developed protocols and tracking forms to

follow the referrals and cases: The AG’s Office also has a full time prosecutor assigned to

educating consumers and law enforcement about telemarketing fraud.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what to do to enhance such collaboration after this symposium. If your idea or strategy only

relates to (a), (b), or (c) (see above), please so indicate.

(a) (c) We are going to implement “Operation Elder Reach.” We will identify all of the public, state,

federal agencies, institutions, non-profit groups, advocacy groups that need to be educated on elder

abuse issues and what resources are available to assist victims of elder abuse. To identify all of

these individuals and agencies we will establish a working group to identify education, training and

outreach needs.

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

(a) (c) Vermont is a rural state. Funding is an obstacle, as well as turf issues. Population and geography

are also issues, as all of the individuals who need to come to the table are overworked, underresourced and cover rural, large areas 

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

The biggest asset we have is strong leadership in the Attorney General’s office and incredibly gifted,

dedicated people who want to protect and enhance the lives of elder Vermonters. There is a willingness to

collaborate and by defining a project – “Operation Elder Reach,” we hope to accomplish these goals. 
Virginia

Point of Contact: Joy Duke

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

In Virginia our strengths lie in the beginning collaborative efforts that are ongoing in our state. To list a

few:

(1) Operation Restore Trust Medicare/Medicaid Patrol “Who Pays/You Pay” – slogan (26 public and

private agencies)

(2) Operation Sentinel by the U.S. Attorney (public, private agencies regarding nursing home abuse)

(3) Law enforcement training for APS/elder abuse (Department of Social Services, Department of

Criminal Justice, Virginia Coalition for the Prevention of Elder Abuse)

(4) Opening in fall 2000 of the Virginia Elder Rights Center

(5) Annual Elder Abuse Prevention Conference sponsored by law enforcement and multiple human

resource agencies

(6) Alzheimer’s/Dementia Training for law enforcement

(7) Statewide Coalition for the Prevention of Elder Abuse

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

(1) Collaborative efforts will begin to examine ways of working with banks to facilitate voluntary

referrals to APS when financial abuse is suspected

(2) Collaborative development of strategies for providing information on elder abuse detection to

medical professionals

(3) Work with Interfaith Coalition and other interested groups to train clergy and religions

professionals on detection and reporting of suspected elder abuse

(4) Public awareness campaign in May

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c), please so indicate.

Resources (money, staff), prioritizing 
Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

(1) Commitment to the task

(2) Qualified, knowledgeable people

(3) Willingness to collaborate, to find commonalities 
West Virginia

Point of Contact: Allen Pyles

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

• West Virginia has an active Triad and has had several “Reverse Boiler Rooms” involving AARP,

police, seniors and service providers

• West Virginia has an interagency committee of APS, facility surveyors, ombudsman, advocates,

mental health, Medicaid Fraud discuss quarterly facility problems. 

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

Interagency meeting recognizes potential problems and solutions, recommends corrections, promotes

communication, and at times assists in setting up local multidisciplinary teams from respective agencies 

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Lack of staff to carry programs in a timely manner do to various size of the agencies. 

• Problem is to get police agencies and PA’s to recognize they have a role in APS. Discussions

have occurred with various education committees and they are considering addition of APS issues

to annual training.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

All team members have same responsibility but to carry them out within agency framework.
Wyoming

Point of Contact: Nancy Vehr

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, and (c) institutional abuse and neglect.

• At Risk Adult Group starting – will hold meeting in November to finalize “where to go”

• Senior Patrol Program – Health Care Financing Administration’s “Restore Trust” Program to help

identify medicare fraud (aging and nonprofit organizations and health care industry and legal);

grant received 3 weeks ago

• MFCU referrals to AG Consumer Protection

• Department of Family Services partners with law enforcement in state

-joint investigations/share information

-early involvement to identify criminal matters

• VOCA funding for community projects to do education to elder community on abuse, fraud with

intention of pilot program to take what they learn and apply to other programs

• Elder and Disabled Adult Working Group which includes state agencies of Health, Department of

Family Services, AG, Ombudsman, Aging, Developmentally Disabled

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• Expansion of shareholders

• White paper presentation to other groups to share what we’ve learned and bring in other

stakeholders

• Get on each other agendas so can attend each others trainings and workshops

• Explore funding sources for programs

• Take large committees and spin off specific focus groups; ex: financial exploitation

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate.

All the above, especially geography, funding, turf, population and lack of manpower

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate.

Heightened awareness and desire and willingness to change the system
Yakama Nation

Point of Contact: Anna Ward

Briefly describe any ongoing collaborative efforts in your state or tribe between public safety and

social services professionals related to: (a) financial exploitation and consumer fraud, (b) abuse

and neglect at home, (c) institutional abuse and neglect.

• Police are willing to work with elders on reporting abuse, thefts, mismanagement of assets by

family or caretakers, as victims of crime. Also, willing to educate elders on safety in their homes

and vehicles.

• Indian Health Services (IHS) willing to document and ask if domestic violence occurs in home.

• Yakama Nation has a domestic violence family program and domestic violence team.

• Tribal courts can provide hearings for protection orders, guardianships, restraining orders and other

legal issues over which the courts have jurisdiction.

• The willingness of Yakama Nation programs, APS, AARP, People for People, and other agencies

in ongoing discussions to work towards the education, development of ways to protect elders.

Briefly describe the ideas or strategies you have developed in the state and tribal team meetings

about what you want to do to enhance such collaboration after this symposium. If your idea or

strategy only relates to (a), (b), or (c) (see above), please so indicate.

• The redevelopment of a comprehensive Elder Abuse Code with criminal and civil penalties 

• Establishment of mandatory reporting of elder abuse by medical providers, caretakers, institutions

• Educating Elders to protect themselves from abuse and on recognition of abuse

• Establish a review board on elder abuse

• Continued education of service providers (i.e. courts, prosecutor, police, advocates, social services)

• Utilize courts, newspapers, Area Agency on Aging, IHS to provide an educational forum to

educate with articles, newsletters and brochures on where to get help and how to get help, what

their rights are and recognition of when they need help

• To develop an Elder Outreach Program

• Have an opportunity for an Native American Elder Abuse Conference

Briefly describe the biggest challenge (e.g., lack of funding, turf, population, geography) your state

or tribal team will face in implementing these ideas or strategies after this symposium. If your idea

or strategy only relates to (a), (b), or (c) (see above), please so indicate. 

• Jurisdiction of the Yakama Nation related to protection of elders from various abuses by nonIndians
• Lack of access to telephones by elders in remote areas, due to impoverished circumstances

• Lack of willingness to report abuse by victims (fear)

• Lack of money and human resources allocated to programs.

• The need for a complete, comprehensive code to be passed by Tribal Council and to be presented

to the General Council.

• The need to educate Elders of their rights, the need to have a will, trust, power of attorney, living

will to protect trust and deeded lands and financial assets and designate an

executor/administrator/guardian in the event of incapacity to see to their wishes.

Briefly describe the biggest asset (e.g., strong leadership, willingness to collaborate) your state or

tribal team has to implement these ideas or strategies after this symposium. If your idea or strategy

only relates to (a), (b), or (c) (see above), please so indicate. 

• Strong Elder’s group to advise of their concerns and to advocate for rights

• Police Department willing to work and be involved with the revision and enforcement of Elder

Abuse Code

• Tribal Council support in the revision of Elder Abuse Code and willingness to work on the

codification of a diverse code to protect the Yakama Elders and their families

• Tribal courts are willing to exercise jurisdiction on behalf of the elderly for the protection of their

rights, dignity, and protection of their interests

• Area Agency on Aging Program that is established and provides services to elders in the

community
Appendix 5

Our Aging Population:

Promoting Empowerment, Preventing Victimization, and

Implementing Coordinated Interventions

Tribal Caucus Recommendations

October 30, 2000

Washington, D.C.

Interagency Collaboration

The DOJ should initiate a series of discussions between FBI, Bureau of Indian Affairs, and state and local law

enforcement agencies operating in Indian Country. Topics should include issues related to domestic violence

and elder abuse.

Training

The DOJ should facilitate domestic violence and elder abuse training for Indian Country law enforcement,

judicial personnel, social services, and health care providers. Training should include recognition of financial

fraud and abuse. 

Tribal Abuse Codes

The DOJ should provide funding and technical assistance to develop and refine tribal elder abuse codes.

Confidential Testimony

The DOJ should fund demonstration projects to provide confidentiality for elders who are required to testify

in court. Local and state law enforcement agencies may provide resources and opportunities.

Traditional Mediation

The DOJ should fund demonstration projects to examine the effectiveness of traditional mediation techniques

to resolve domestic violence/elder abuse cases.

Elder Abuse Training

The DOJ should establish an initiative with the Indian Health Service, tribal, and urban Indian health providers

to fund and facilitate training regarding:

! Adult Protective Services;

! forensic recognition of abuse;

! geriatric medicine;

! increased availability of occupational and physical therapy.

National Elder Abuse Summit 

The DOJ should sponsor a national summit on Indian family violence and elder abuse, providing opportunities

for collaboration and sharing of “best case” initiatives. Invitees should include Indian Country law

enforcement, judicial, social services, and health personnel.

Interagency Agreement

The DOJ should join and contribute funding to the recently-established Interagency Agreement (IA) between

the Health Care Financing Administration (HCFA), the Social Security Administration (SSA), and the Indian

Health Service (IHS). The IA, established to provide Indian elder-specific outreach re: federal benefits and

disease education, should be expanded to include abuse education for Indian elders.

Data Collection

The DOJ should develop new databases re: Indian elder abuse. Existing data should play a role in DOJ’s

development of programs and allocation of funding.