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S. HRG. 110–308

ABUSE OF OUR ELDERS:

HOW WE CAN STOP IT

HEARING

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

WASHINGTON, DC

JULY 18, 2007

Serial No. 110–12

Printed for the use of the Special Committee on Aging

(

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html 

SPECIAL COMMITTEE ON AGING 

HERB KOHL, Wisconsin, Chairman 

RON WYDEN, Oregon 

BLANCHE L. LINCOLN, Arkansas 

EVAN BAYH, Indiana 

THOMAS R. CARPER, Delaware 

BILL NELSON, Florida 

HILLARY RODHAM CLINTON, New York 

KEN SALAZAR, Colorado 

ROBERT P. CASEY, Jr., Pennsylvania 

CLAIRE McCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

GORDON H. SMITH, Oregon 

RICHARD SHELBY, Alabama 

SUSAN COLLINS, Maine 

MEL MARTINEZ, Florida 

LARRY E. CRAIG, Idaho 

ELIZABETH DOLE, North Carolina 

NORM COLEMAN, Minnesota 

DAVID VITTER, Louisiana 

BOB CORKER, Tennessee 

ARLEN SPECTER, Pennsylvania 

DEBRA WHITMAN, Staff Director 

CATHERINE FINLEY, Ranking Member Staff Director 

(II) 

C O N T E N T S 

Page 

Opening Statement of Senator Herb Kohl ............................................................. 1

PANEL I 

Jennifer Coldren, Rome, NY ................................................................................... 3

PANEL II 

Daniel Fridman, senior counsel to the Deputy Attorney General, U.S. Department of Justice, Washington, DC; accompanied by Marie-Therese Connolly . 8

Gregory Demske, assistant inspector for Legal Affairs, Office of Inspector 

General, U.S. Department of Health and Human Services, Washington, 

DC .......................................................................................................................... 30

PANEL III 

Beverly Laubert, Ohio Long-Term Care Ombudsman and President, National 

Association of State Long-Term Care Ombudsman Programs, Washington, 

DC .......................................................................................................................... 47

Paul Greenwood, deputy district attorney, Office of the District Attorney, 

San Diego, CA ...................................................................................................... 60

Robert Blancato, national coordinator, The Elder Justice Coalition, Washington, DC ............................................................................................................. 65

Daniel Reingold, president and CEO, The Hebrew Home for the Aged, Riverdale, NY; accompanied by Joy Solomon ............................................................. 73

APPENDIX 

Prepared Statement of Senator Gordon Smith ..................................................... 91

Prepared Statement of Senator Hillary Clinton ................................................... 91

Prepared Statement of Senator Robert P. Casey, Jr. ........................................... 93

Response to Senator Smith’s Questions from Gregory Demske .......................... 94

Response to Senator Smith’s Questions from Daniel Reingold ............................ 96

Testimony of Dr. Eric Whitaker MD., M.P.H., director Illinois Department 

of Public Health .................................................................................................... 98

Statement submitted by the National Association of Medicaid Fraud Control 

Units ...................................................................................................................... 103

Letter and Statement from Bruce Yarwood, president and CEO, American 

Health Care Association (AHCA) ........................................................................ 118

Articles submitted by Dr. Laura Mosqueda .......................................................... 122

(III) 

(1)

ABUSE OF OUR ELDERS: HOW WE CAN STOP 

IT 

WEDNESDAY, JULY 18, 2007 

U.S. SENATE, SPECIAL COMMITTEE ON AGING, Washington, DC. 

The Committee met, pursuant to notice, at 12:30 p.m., in room 

SD–628, Dirksen Senate Office Building, Hon. Herb Kohl (chairman of the committee) presiding. 

Present: Senator Kohl. 

OPENING STATEMENT OF SENATOR HERB KOHL 

The CHAIRMAN. All right. Well, we thank you all not only for 

being here today but for bearing with us as a result of activities 

on the floor. I think we were scheduled to start here at 10:30; now 

it is 12:30. So you are pretty sensational to wait for as long as you 

have. 

The hearing itself is going to be conducted in a somewhat different way, because they put a hold on formal hearings as a result 

of activities on the floor. That is something that Senators, under 

unusual situations and conditions, are allowed to do. 

So instead of a formal hearing, we will have an informal hearing, 

which will give all of those who are here to testify an opportunity 

to express yourselves and be heard. I will be somewhat more constrained in asking questions, but certainly we will get to hear everything you have to say. We are looking forward to it. 

I would like to welcome our witnesses and everyone who is here, 

of course, and those who will be watching on television. 

Today we are going to be talking about a really important subject: elder abuse in our society and what we can do to prevent it. 

Naturally, we want to not just talk about it but we want to talk 

about solutions. We want to challenge ourselves here in Washington to do something more to combat elder abuse and to propose 

some concrete things for action. 

I believe we need to enact a common-sense bill, a bill which is 

called the ‘‘Patient Safety and Abuse Prevention Act,’’ which I introduced with my friend from New Mexico, Pete Domenici. This 

bill, if we can get it passed, will protect our most vulnerable Americans who need long-term care by making sure that people who care 

in these facilities and care for them do not have any criminal background in their record. 

We need to keep predators out of our system, not just prosecute 

them after they have ruined people’s lives. What we intend to do 

is set up a national registry of people who have criminal backVerDate 0ct 09 2002 12:18 Mar 12, 2008 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 H:\DOCS\40410.TXT SAGING1 PsN: JOYCE
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grounds, and so that, when they apply for employment in any kind 

of a facility across the country, they will be immediately identified 

and denied employment. 

I am pleased to say that several members of our Committee are 

cosponsors of this bill, including Senators Clinton, Lincoln, Collins, 

Senator Whitehouse and also Senator Casey. So I thank all of them 

very much for their support. 

Also today, I am happy to say that this bill is going to be introduced in the House of Representatives by Congressman Tim 

Mahoney, who also understands how important this issue is to our 

Nation’s seniors. 

This bill is going to be modeled on a pilot program that has been 

occurring in seven States across our Nation over the last few years. 

The program, in its pilot aspects, has been very successful. Over 

the last 3 years, more than 5,000 individuals in these seven States 

who had a criminal background have been identified and denied 

employment in long-term-care facilities. 

In Michigan, which is the State that had the most comprehensive 

pilot program, fully 5 percent of applicants for long-term-care jobs 

were excluded because their background check uncovered a serious 

criminal history. You can imagine the mayhem that they might 

have caused had they been able to become employed. 

The bottom line is that, in every State where the pilot programs 

have been established, that they have worked. I believe that is very 

important, and that is a victory for our elders. 

So we are going to be hearing from people about elder abuse, the 

‘‘Elder Abuse Act,’’ as well as this criminal background check registry, which is going to hopefully be part of the ‘‘Elder Abuse Justice Act,’’ which is making its way through Congress. 

My colleague, Senator Blanche Lincoln, introduced this bill, the 

‘‘Elder Justice Act,’’ and I am an original cosponsor. Both Senator 

Lincoln’s bill and mine, as I said, protect seniors and save lives, 

and we need to pass those bills this Congress. 

So we are going to start this hearing today with a story from a 

brave young woman who has traveled all the way from New York 

to talk to us today about what happened to her grandmother one 

day when a predator who never should have been allowed to work 

in a medical facility became employed and found her grandmother 

alone. 

We will then have testimony from two Federal agencies about 

the Federal Government’s attempts to address elder abuse. 

Finally, we will hear in our third panel from four of the leading 

experts in the United States who are working at the front lines of 

advocacy, of law enforcement and of service delivery to stop the 

scourge of elder abuse. 

We welcome you all here today. 

I would like to introduce our first witness. 

We are very happy to have you here, Jennifer. 

Jennifer Coldren is here from New York, the community of 

Rome, NY. Ms. Coldren is here to testify about the needless suffering that her grandmother encountered while recuperating in a 

long-term-care facility. The horrific crime was perpetrated by a 

criminal who never should have been employed but slipped through 

because of the patchwork system of background checks. 

3

So, Jennifer, thank you so much for coming. We are delighted to 

listen to whatever you have to say. 

STATEMENT OF JENNIFER COLDREN, ROME, NY 

Ms. COLDREN. Chairman Kohl and distinguished members of the 

Committee, thank you for inviting me to testify this morning. The 

place I had hoped one day to be being able to share and have the 

opportunity to tell what happened to my beloved grandmother and 

my family, hoping that by having this chance to tell her story 

somehow will make a difference and help change the laws governing all facilities that take care of our elderly so something this 

horrifying doesn’t happen to anyone else. 

My name is Jennifer Coldren. I live in Rome, NY, in the vicinity 

of Syracuse. 

The nightmare for my family began last year when my grandmother, who was 90 years old at the time, who had never had one 

act of violence done against her, was raped and assaulted by an 

employee of the residential facility she was in. 

He was 45. The man had a criminal record, and it was only the 

third time he had worked on the floor. He worked on the floor as 

needed, and his permanent job had been working on the surgical 

unit of the hospital. 

Had there been an effective background check performed, he 

would not have had the opportunity to harm my grandmother. 

Mr. Turtora’s office prosecuted this criminal this spring, and this 

criminal received up to 25 years in prison for what he did to her. 

Her abuser showed no remorse for what he had done, and the 

judge called him a sick man and said what he did was second to 

murder. 

Before we lived this, our family believed that, with society the 

way it is today, that safeguards were already in place to protect 

our elderly from abuse. Unfortunately, we had to learn a tragic lesson that they weren’t. 

I respectfully ask you to do something to prevent other similar 

crimes and further abuse of the elderly from happening in assisted 

care and medical facilities, for we were outraged that policies and 

laws were not in place to prevent something like this from happening. 

In this situation, a background check could take 30 to 120 days 

to come back. A lot of damage can be done in that time. My grandmother’s story is an example of what that timeframe can do. 

This is what happened to my grandmother. First, to give you an 

idea what this did to her family, I would like to start by summing 

up our feelings into words, what we felt living this nightmare: disbelief, fear, numbness, pain, anger, bitterness, shock, outrage, and 

our hearts broken. We also shed a thousand tears for her. 

But we also were proud, for my grandmother was not only a victim but a hero. She prevented him from hurting her again and 

from hurting anyone else on the floor that night. If she hadn’t told 

anyone what happened, it made us wonder how long the abuse 

would have gone on before he had been caught and stopped and 

just how many more elderly people he would have harmed. See, my 

grandmother had dementia at the time, and we knew just how 

4

lucky we were she got her story out, and terrified of what it could 

have been if she hadn’t. 

Before this took place, my grandmother had a smile for everyone. 

After this happened, she no longer smiled, cried all the time and 

had told us numerous times she wanted nothing more but to be an 

angel and for God to take her. She kept her feelings bottled up inside, did not discuss what happened with us or psychiatrists. 

Through her depression, her mind and body weakened. About 5 

weeks after, she had a stroke. She could no longer put full sentences together anymore and her words became mumbles. She had 

given up on life. 

My family had made the decision to bring her home. See, I 

couldn’t live with myself leaving her there. I didn’t trust anyone for 

her care anymore and was scared that something else bad could 

happen to her. The day we took her out of the facility, she smiled 

ear to ear—the first time since this happened to her. 

Our decision also came from when we found out that her abuser 

had also worked in another long-term-care facility and also in a 

State facility prior to this that works primarily with the elderly 

and severely handicapped people. He had also had numerous complaints of a sexual nature, inappropriate touching complaints, and 

they were all unfounded. He slipped through so many cracks. We 

felt we had no choice but to take her out of there. 

My grandmother has lived with me and my husband now for the 

past 5 months. It hasn’t been an easy road, for she has Alzheimer’s 

dementia, which presents new struggles and challenges every day, 

but she is beginning to be happy again. For us, our family, we have 

peace of mind, knowing she is safe and sound and happy. We made 

the right decision. 

The way things are, this tragedy can happen again in any nursing home, hospital, home care setting, and anywhere our vulnerable elderly are being taken care of by someone hired to take care 

of them. 

I ask the Committee for a moment to put yourself in our shoes. 

How would you feel if this happened to your mother, grandmother 

or someone else you love? 

We need to protect our aging loved ones who can’t protect themselves, because if we don’t, who will? Someday we will be old too. 

For my family, we will never forget what happened, and I am reminded every time I look into my grandmother’s eyes what happened to her. I will never forget for the rest of my life. 

Our hope is something good will come out of this nightmare for 

us and that together we can come up with a solution for a growing 

problem so this never happens to another elderly person and their 

families again. 

In closing, we cannot change the past or what happened to my 

grandmother, but we can change things for the future generations 

so no one will ever know the fear and pain my grandmother and 

family has endured through all this. This is our hope, to be a part 

of that by being here today. 

Thank you for letting me speak and share her story today. 

The CHAIRMAN. Jennifer, that is really a moving story and so, so 

very well told by you. We know how difficult it is for you to stand 

up and—or sit down, come here and speak today. This has not been 

5

an easy experience for you but maybe somewhat cathartic, and certainly it does result in putting into place a system that will prevent, as you point out, prevent it from happening again. Certainly, 

I know you will feel that the time you spent here today was more 

than worthwhile. 

Because I am sure that is your number-one goal to see happen 

and occur, is that a system is put in place. Is that right? 

Ms. COLDREN. Yes. 

The CHAIRMAN. How many years ago was that, Jennifer? 

Ms. COLDREN. It was last year. 

The CHAIRMAN. One year ago? 

Ms. COLDREN. It was in May of last year that this happened. 

The CHAIRMAN. Oh, just over a year. 

Ms. COLDREN. Yes. 

The CHAIRMAN. Your grandmother is now living with you? 

Ms. COLDREN. Yes, 5 months now. 

The CHAIRMAN. How is she doing? 

Ms. COLDREN. She has her good days and her bad, but she is a 

lot happier now——

The CHAIRMAN. Happier with you? 

Ms. COLDREN [continuing]. That she is with us—yes—than she 

was in the nursing home. 

The CHAIRMAN. She does have dementia? 

Ms. COLDREN. Yes. 

The CHAIRMAN. Progressive dementia? 

Ms. COLDREN. Yes. Some days she is her old self, and then other 

days she has really bad days. That is hard to watch. 

The CHAIRMAN. She is in her 90’s, did you say? 

Ms. COLDREN. She had her 91st birthday this past April. We had 

a big party for her. 

The CHAIRMAN. That is wonderful. She is pretty lucky to have 

you. 

Thank you so much for coming. 

Ms. COLDREN. Thank you. 

The CHAIRMAN. You have done a real public service. 

Ms. COLDREN. Thanks. 

[The prepared statement of Ms. Coldren follows:]

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The CHAIRMAN. At this time, we will turn to our second panel. 

Our first witness on our second panel will be Dr. Daniel 

Fridman, who is senior counsel to the deputy attorney general in 

the Department of Justice. In this capacity, Mr. Fridman advises 

the deputy attorney general on national criminal policy issues, including health-care fraud, child exploitation, immigration enforcement, as well as bankruptcy fraud. Mr. Fridman was an assistant 

U.S. attorney from the Southern District of Florida, where he had 

served as a trial attorney prosecuting violent crimes and other offenses. Currently, Mr. Fridman is on detail in Washington. 

Accompanying Mr. Fridman is Marie-Therese Connolly, a senior 

trial counsel in the civil division. Ms. Connolly is charged with coordinating the Elder Justice and Nursing Home Initiative at DOJ. 

Our second witness is Gregory Demske, who is the assistant inspector for legal affairs in the office of the Health and Human 

Services inspector general. Mr. Demske is responsible for administrative health-care fraud actions on behalf of the HHS OIG. He has 

worked in the OIG’s counsels office for the past 15 years. He has 

also served as a special assistant U.S. attorney in the District of 

Columbia. 

So we thank you both for being here. 

Mr. Fridman, we will take your testimony. 

STATEMENT OF DANIEL FRIDMAN, SENIOR COUNSEL TO THE 

DEPUTY ATTORNEY GENERAL, U.S. DEPARTMENT OF JUSTICE, WASHINGTON, DC; ACCOMPANIED BY MARIE–THERESE 

CONNOLLY 

Mr. FRIDMAN. Thank you, Mr. Chairman. Thank you for inviting 

the Department of Justice to discuss its work fighting elder abuse. 

Appalling stories of abuse, like the one that Ms. Coldren had the 

courage to come here today and describe, remind us that there is 

still much work to be done. 

We also want to commend and recognize the work of Mr. 

Turtora, the New York State prosecutor who works with the Medicaid fraud control unit there, who brought Ms. Coldren’s grandmother’s abuser to justice. 

The MFCUs—the Medicaid fraud control units—State attorneys 

general offices, and local D.A.s, like Paul Greenwood, who is here 

today, bring most of the prosecutions against individuals who 

abuse and neglect elders. 

The elder-abuse cases that the Department of Justice pursues 

primarily involve systemic wrongdoings in facilities. We pursue 

those Federal cases under civil and criminal statutes, such as 

health-care fraud and other legal theories, working closely with our 

colleagues at the HHS Office of Inspector General. 

We also pursue financial crimes targeting elders, such as our 

identity-theft cases, our telemarketing cases, some Part D cases, 

which are described in my written testimony. 

I know I speak for the thousands of dedicated prosecutors, litigators, agents and grant-makers in the Department when I say that 

these are the kinds of cases that really make our blood boil. These 

cases that involve egregious human harm and suffering really motivate us to work to find a way to find justice for the victims. 

9

I am an assistant U.S. attorney from Miami on detail to Main 

Justice, where I advise the deputy attorney general on health-care 

fraud enforcement policy. In that capacity, I have a bird’s eye view 

of what the Department’s many components are doing to fight elder 

abuse and to hold their abusers accountable. 

Within DOJ, this effort involves each of our 93 U.S. Attorneys 

Offices; the Criminal, Civil and Civil Rights Divisions; the Office of 

Justice Programs; the Office on Violence Against Women; and the 

FBI. 

Let me give you some snapshots of some of the Department’s 

most recent work. 

In the Borne case in Louisiana, the owner of a small nursing 

home diverted millions of Federal health-care dollars to buy his 

$1.2-million residence and his opulent estate called Annedelle Gardens, which had 150 acres, man-made streams and waterfalls and 

ponds that were stocked with exotic black swans that cost $5,000 

apiece. 

At the same time, his nursing homes were chronically understaffed and rundown, lacking vital basics: soap, linens, sheets, 

wound-care supplies, and disinfectants. The relatives of one resident even brought in a truckload of turnip greens one evening so 

that everyone could be fed. 

Many residents in Borne’s facilities suffered terribly, including 

from bed sores and malnutrition. Borne was prosecuted, sentenced 

to 37 months’ imprisonment, and forfeited his lavish estate and 

residence. 

A recent St. Louis case, AHM, involved the suffering of numerous 

patients in three facilities. One woman had red ants crawling all 

over her eyes, mouth, ears and genitalia, as she lay there dying. 

Another patient died of a treatable bowel obstruction, which she 

had begged for staff to treat. Another was beaten to death by an 

aide. This case resulted both in a Civil False Claims Act settlement 

of $1.25 million, and the CEO of the three facilities pled guilty to 

felony charges. 

When the facility in question is a publicly run facility, that is 

where our Civil Rights Division can pursue cases under the Civil 

Rights of Institutionalized Persons Act, also known as CRIPA, to 

address conditions that violate Federal statutory and constitutional 

requirements. 

In a recent New Mexico case, a 71-year-old patient with lifethreatening low blood sugar levels died when the staff failed to recognize and treat obvious signs of distress. 

Another patient that was admitted for rehabilitation following 

hip surgery died a week later of aspiration pneumonia because 

staff didn’t follow proper procedures in feeding her. This case was 

resolved with a court-enforceable agreement where New Mexico 

will correct the systemic problems in its nursing homes. 

The focal point of the Department’s elder-abuse efforts has been 

the Elder Justice and Nursing Home Initiative, which is spearheaded by my colleague sitting next to me, Marie-Therese 

Connolly. She supports prosecutors’ failure-of-care cases, coordinates with numerous other entities on a broad scope of elder justice 

activities, and oversees a budget that funds grants for elder justice 

training as well as groundbreaking research in the field. 

10

Let us talk about some of that research. 

There is a consensus that there is a paucity of experts and research in the area of elder abuse. Responding to this, the Department’s research arm, the National Institute of Justice, issued one 

of the first-ever solicitations for research grants relating to elder 

abuse in 2005. NIJ now has several research projects under way, 

and we have results from at least one of them already. 

This project related to bruising in elders, and the conclusions 

were as follows: No. 1, contrary to conventional wisdom, you cannot 

date a bruise simply by looking at its color. No. 2, 90 percent of 

accidental bruises in the elders studied appeared on limbs and 10 

percent on the torso. Well, why is this important? Well, now practitioners know that if an elder has a bruise in another location, 

someone should be asking more questions about where that bruise 

came from. 

One of the most important sources of funding the Department relies on for this work are the funds provided by the Health Care 

Fraud and Abuse Control Account, which was established by 

HIPAA in 1996. Since 1997, these funds have helped the Department maintain dedicated prosecutors, litigators and FBI investigators who focus on health-care fraud cases. Our Elder Justice Initiative is funded out of these same funds. 

But since 2003, those funds remained constant without inflationary adjustment under a statutory cap until this year, when 

Congress passed and the President signed an inflationary cap adjustment to the funds each year until 2010. The President’s 2008 budget requests an additional $17.5 million 

to supplement the Department of Justice’s HCFAC allocation, and 

we would appreciate your support for full funding of the President’s 

request so that we can continue growing in these important efforts. 

I will conclude by saying that the cost of elder abuse, both 

human and economic, is high. The Department is committed to expanding the fight against this problem as America ages. 

[The prepared statement of Mr. Fridman follows:]

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The CHAIRMAN. Thank you for your testimony, Mr. Fridman. We 

will get back to you and Ms. Connolly in just a moment. 

Now we have as our second witness, as I said, Mr. Demske, who 

has particularly made an effort to be here today, because, as we 

understand, your wife is having a baby as we speak or something 

like that. Is that correct? 

Mr. DEMSKE. Well, in a few hours, yes. [Laughter.] 

The CHAIRMAN. Congratulations. 

Mr. DEMSKE. Thank you, sir. 

The CHAIRMAN. Go ahead. 

STATEMENT OF GREGORY DEMSKE, ASSISTANT INSPECTOR 

GENERAL FOR LEGAL AFFAIRS, OFFICE OF INSPECTOR GENERAL, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON, DC 

Mr. DEMSKE. Good morning, Chairman Kohl. I appreciate the opportunity to join you here this morning. 

Stopping elder abuse requires a multifaceted commitment from 

Federal and State agencies, providers and other stakeholders, 

many of whom are represented here today. 

The Office of Inspector General at HHS advances this important 

goal of preventing elder abuse in three ways: We do oversight, enforcement and guidance. 

First, in our oversight role, we evaluate the programs and systems involved in regulating quality of care and make recommendations to the Centers for Medicare and Medicaid Services. OIG reviews have examined the effectiveness of oversight and enforcement by CMS and the States, screening of long-term-care employees, and the effect of reimbursement systems on access to care and 

the quality of that care. 

As an example, in testimony before this Committee in 1998, we 

recommended enhanced efforts to require criminal background 

checks and development of a national-abuse registry for long-termcare employees. 

The second broad area of our work is enforcement. Although 

most cases of elder abuse are investigated and prosecuted by 

States, the Office of Inspector General works with the Department 

of Justice to investigate cases of systemic substandard care. 

You have heard some examples of those types of cases. Among 

the types of things that we have seen in nursing homes in cases 

we have investigated are patients suffering from dehydration, malnutrition, untreated broken bones, avoidable amputations, drug 

overdoses and deaths. 

In order to better team with States to address these issues, OIG 

has, over the past year, initiated extensive joint training programs 

and enhanced coordination with MFCUs, with a particular emphasis on jointly developing failure-of-care cases. 

With respect to administrative enforcement, OIG has excluded 

many individuals from participation in Federal health-care programs. Last fiscal year, we excluded over 2,000 individuals who either had been convicted of patient abuse or neglect or had lost 

their license to perform health care for reasons bearing on their 

professional performance or competence. 

31

In cases involving failure of care in which we do not require exclusion, we require the organization to enter into a corporate integrity agreement with our office. These corporate integrity agreements require the organization to hire an independent quality monitor selected by the OIG. These monitors have access to the providers’ facilities, staff, programs and records. Using that access, 

they make recommendations to the providers about how to make 

systemic changes to protect the safety and well-being of the patients. 

The third major component of our quality-related work is our 

guidance to the health-care provider community. For example, in 

2000, we issued the ‘‘Compliance Program Guidance for Nursing 

Facilities.’’ As part of that document, we provided guidance to facilities about what they should include in voluntary compliance 

programs, including steps to safeguard the safety and security of 

patients. 

OIG is also increasingly focusing on the role of boards of directors in safeguarding quality of care. We believe it is essential for 

board members to focus at least as much attention on the quality 

of care furnished by a provider as they do on the financial performance of the provider. Just last month, we issued a guidance document for members of boards of health-care providers to outline 

steps they could take to fulfill their oversight responsibilities with 

respect to quality of care. 

In conclusion, elder abuse in our health-care system can only be 

stopped through a concerted, multidimensional effort by many parties. OIG is committed to advancing this goal through review of 

CMS and State oversight, vigorous investigation and enforcement 

of wrongdoers, and guidance to leaders at health-care providers 

about how they can enhance quality of care. 

Thank you. 

[The prepared statement of Mr. Demske follows:]

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The CHAIRMAN. Thank you, Mr. Demske. 

I would like to ask all three of you—maybe we will start with 

you, Ms. Connolly, because you haven’t had a chance yet to express 

yourself—how vital, how important, how urgent is it that we put 

in place a background check system that can be accessed and used 

by facilities all across the country? 

Ms. CONNOLLY. Senator, first, thank you very much for holding 

this hearing. 

I believe that the Department of Justice believes firmly that elders should be protected from convicted criminals. We have the legislation that you have introduced under review by our various components at this time. 

Mr. FRIDMAN. Yes, Senator, the Department does agree that all 

people who come into contact with elders in a nursing home or 

long-term-care facility should have Federal background checks. We 

should be making sure that the background checks are complete 

and cover all the bases. 

As you know, the FBI has been participating in the pilot project, 

the $25-million pilot project, that was started by the MMA. It is 

available in seven states right now. The FBI tells me that, as of 

March 2007, they have run 165,000 background checks and they 

have identified 1,100 individuals for disqualification from the 

checks. The pilot concludes in September, and the results of the 

pilot will then be analyzed. 

The FBI tells me that they are working on getting some of the 

technology aspects that are called for in the bill, like the wraparound technology that will, if a person passes with a clean check, 

gets employed by a nursing home, and then subsequently commits 

a crime, the system will then alert the State and the nursing home 

that the person has had an arrest or conviction. 

They are working on the technology. They have seen the legislation, and they have some concerns about timing and logistics that 

we could certainly discuss with your staff. But the Department is 

available to work with you and your staff to address any issues. 

The CHAIRMAN. That is very good. 

Mr. Demske. 

Mr. DEMSKE. The OIG believes that criminal background checks 

are one of several mechanisms that can be helpful in screening out 

potentially abusive caregivers at facilities. 

We have been, as I mentioned in my testimony, on the record 

since 1998 as advocating criminal background checks as well as exploring ways to establish a national registry of employees at longterm-care facilities. With a national long-term care employee registry we can avoid some of the issues that arise from having a 

patchwork system in various States. In some of our reports, we 

have identified systemic problems of facilities in one State checking 

the registry in that State but not checking registries where the person may have worked before. As a consequence, people who are 

listed on one State registry for abuse can become employed in another State by a different facility. 

The CHAIRMAN. Very good. 

Well, we thank you, all three of you for coming here today. 

We are talking, naturally, about physical but also financial abuse 

and emotional abuse, abuse of all kinds, on the elderly. That is 

47

what we are focusing on with the ‘‘Elder Justice Act,’’ as well as 

the background check system contained within the act. 

We really do hope that, with the help that you are providing, we 

can get that act passed, and passed this year. I think, if we can, 

we will all feel as though we made jointly a real contribution to the 

elderly population and their security. 

So we thank you so much. 

Again, we wish you well with your impending arrival. If you 

would let me know, I would like to send your wife some flowers. 

[Laughter.] 

So let me know what hospital she is in. Will you do that? 

Mr. DEMSKE. I sure will. Thank you very much. 

The CHAIRMAN. Thank you. 

Thank you all for coming. 

All right, well, we will get on to the organizations. Mr. Blancato 

is the recipient of many honors, including one in 1999 from the 

American Society of Aging for his contributions to the field of 

aging. 

We do have a fourth witness, who is Daniel Reingold, president 

and CEO of The Hebrew Home for the Aged in Riverdale, NY. The 

Hebrew Home offers more than 3,000 older people a range of residential and long-term-care services. 

Most importantly for our discussion today, The Hebrew Home for 

the Aged also created our country’s first comprehensive elder-abuse 

center, known as the Weinberg Center, with the Pace Women’s 

Justice Center. Accompanying Mr. Reingold here today is Joy Solomon, who is of the Justice Center. 

So we will start now, and maybe we will go from my left to right. 

Ms. Laubert, would you like to make your comments? 

STATEMENT OF BEVERLY LAUBERT, OHIO LONG-TERM-CARE 

OMBUDSMAN AND PRESIDENT, NATIONAL ASSOCIATION OF 

STATE LONG-TERM-CARE OMBUDSMAN PROGRAMS, WASHINGTON, DC 

Ms. LAUBERT. I certainly will. Thank you so much. 

Thank you for the opportunity to talk with you today about the 

problem of abuse and neglect in long-term-care facilities. Calling 

abuse and neglect a problem sounds trivial; it is better identified 

as a horrific problem, a tragedy or a crisis that is an embarrassment to our country. 

Every day of my 20 years as a long-term-care ombudsman, I 

have been touched by the bravery of residents and family members, 

like your first witness, who entrust their care to strangers. 

Chairman Kohl, NASOP appreciates your many years of support 

for our important work advocating for residents who are often otherwise without a voice. Your leadership and the leadership of 

George Potaracke, the Wisconsin State ombudsman, give us hope. 

Our network of 1,300 staff and 9,200 volunteer ombudsmen seek 

resolution of problems and advocate for the rights of residents of 

long-term-care facilities. 

Tens of thousands of long-term-care professionals and paraprofessionals provide loving, compassionate and competent care to 

our Nation’s older and disabled citizens. But today I want to tell 

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you about conditions that we have seen that can and must be 

changed. 

Someday, with your help, perhaps we can say with confidence 

that all of our Nation’s older citizens are receiving the care they 

deserve where they choose to receive it. However, in a few minutes 

I will introduce you to Anna’s story, which provides evidence that 

we aren’t there yet. 

In 2005, ombudsmen received over 20,000 complaints of abuse, 

neglect and exploitation. Those are just the complaints in which 

someone used the words ‘‘abuse’’ or ‘‘neglect.’’ We collect data on 

complaints that are not called abuse but result from abusive or neglectful behavior. Nationwide, we received 92,000 complaints related to resident care, such as improper handling and pressure 

sores. 

I applaud the introduction of the ‘‘Patient Safety and Abuse Prevention Act.’’ It would buildupon the work of States that have developed systems to check criminal records of caregivers. I have 

found that although most States do some type of screening at the 

time of employment, the methods are inconsistent. 

Mr. Chairman, we thank you for your steadfast pursuit of this 

critical area for ensuring quality care. The pilot program that you 

helped to secure has led us to this important juncture where Congress should now step forward and ensure a national, consistent 

approach to doing background checks. 

We are hopeful Congress will also address broader elder-abuse 

issues this year with the ‘‘Elder Justice Act,’’ which is another 

stride along the critical path of justice for this Nation’s older 

adults. The bill would establish a national, coordinated approach to 

elder justice and research, as well as support for building a welltrained long-term-care workforce. 

Every provision in the groundbreaking ‘‘Elder Justice Act,’’ including training for surveyors, improving ombudsman capacity and 

training, and funding Adult Protective Services in every State, 

must be passed as soon as possible. 

Ohio’s criminal background check law has been in place since 

1997, and my written testimony provides details of what that law 

does. There are several areas of inconsistency among the States, so 

an older adult cannot rely on a blanket of safety wherever he or 

she resides. 

My written testimony details examples of the variations: differences in whether fingerprints are used and whether they are obtained using ink cards or electronic equipment; differences in the 

timing of background checks; differences in the use of FBI 

searches; and differences in the data bases used. 

It is time to establish a nationwide system to improve the effectiveness of screening. As written, the proposed Federal law would 

address the problem of caregivers moving from State to State, 

thereby avoiding effective scrutiny. Unsupervised volunteers having similar duties as direct-care staff involving one-on-one contact 

with residents would be included in screening requirements. A 

wrap-back provision would identify caregivers who committed 

crimes after employment. 

To personalize the issue of abuse and neglect, as you have seen 

today, is heart-wrenching. I keep a folder in my office labeled ‘‘ReVerDate 0ct 09 2002 12:18 Mar 12, 2008 Jkt 000000 PO 00000 Frm 00052 Fmt 6633 Sfmt 6633 H:\DOCS\40410.TXT SAGING1 PsN: JOYCE
49

minders,’’ and every now and then, I open that folder and bolster 

my resolve to help residents and to be their voice to people like you 

who have the power to truly make a difference. 

I encourage you to read about Anna’s story at the end of my testimony. Her family wrote to Governor Strickland in Ohio and sent 

pictures that are included in my written testimony of Anna and the 

problems that she had in a long-term-care facility. As my ‘‘Reminders’’ folder bolsters my resolve as an advocate, I hope Anna’s story 

encourages and supports your efforts to make life better for America’s older adults receiving long-term care. 

My time is getting close to expiring, so I will stop now, but I welcome the opportunity to share additional examples and answer 

your questions. 

Thank you. 

[The prepared statement of Ms. Laubert follows:]

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The CHAIRMAN. That was very good, Ms. Laubert. 

Ms. LAUBERT. Thank you. 

The CHAIRMAN. Mr. Greenwood. 

STATEMENT OF PAUL GREENWOOD, DEPUTY DISTRICT 

ATTORNEY, OFFICE OF THE DISTRICT ATTORNEY, SAN 

DIEGO, CA 

Mr. GREENWOOD. Good afternoon, Chairman Kohl. Thank you for 

allowing us this opportunity. I am honored to speak not just on behalf of my office, the San Diego D.A.’s office, but on behalf of a 

growing list, fortunately, of dedicated local prosecutors around the 

country who are seeing elder abuse as a significant major problem 

in our society today. 

Over the 11 years that you have indicated I have been able to 

prosecute these cases, I have become a true believer in the collaborative system. I believe the reason that our unit has prospered is 

because we have seized the opportunity to work with agencies such 

as Adult Protective Services and law enforcement and medical personnel. 

If I can just briefly mention five areas that we feel that we have 

made an indent in the road: First, we have created an elder-death 

review team, which has been very significant. 

Second, my office arranges, every 3 to 4 weeks, brown-bag 

lunches in the community, all around the county, where we invite 

members of the public and other agencies to come and address 

issues of elder abuse. That has been tremendously helpful to all of 

us. 

Third, we have been very involved with training banks, credit 

unions and other institutions, first responders such as paramedics 

and law enforcement, in what to look for in terms of red flags of 

elder abuse. 

Fourth, Adult Protective Services have created a tremendous 

awareness campaign called ‘‘Silence is not Golden,’’ and we have 

put our weight behind that too, to ensure that the public know who 

to call if they suspect that elder abuse is occurring in their community. 

Finally, I am proud of a project that has been funded by 

Archstone, a nonprofit organization, that allowed my office to have 

wrap-around services for elderly victims of crime through the Family Justice Center. 

Senator, I believe one of the major important steps as a prosecutor is to try to educate prosecutors around the country and to 

destroy the misconceptions that seem to stay with elder-abuse prosecutions. 

For example, there is a myth that elderly witnesses are going to 

make poor witnesses. In my 11 years, to the contrary: They make 

the most compelling, fascinating and believable witnesses in the 

courtroom. 

Second, there is a myth that financial elder-abuse cases are difficult to prosecute because of cognitive issues of the victims. But we 

are learning new ways to overcome that. 

Third, that even though victims of physical abuse, who may have 

been assaulted by their own loved ones or by a nurse in a nursing 

home, will be reluctant to testify, nevertheless there are ways that 

61

we can learn how to prosecute those cases, because we can learn 

from the tremendous example given to us by domestic violence 

prosecutions. 

Fourth, there is this myth that, for example, home repair fraud, 

which is rampant amongst elderly homeowners in your State and 

every other State in this country, that those cases are somehow 

civil in nature. They are not. These are insidious criminal cases, 

and we should aggressively prosecute them. 

Senator, I have thought long and hard about this, but I have outlined seven areas which I think are crucial for us to move forward 

in this country with regard to prosecuting elder-abuse cases. 

First, absolutely we need the passage of the ‘‘Elder Justice’’ bill 

this year. Thank you for your lead in trying to make sure that this 

is happening. This will create such encouragement amongst the 

rank and file of prosecutors, law enforcement, Adult Protective 

Services, so many dedicated agencies who see this bill as being absolutely pivotal in helping them do their job. 

With that, we urge the passage of the ‘‘Patient Safety and Abuse 

Prevention Act.’’ For those people who will say that this act would 

be too expensive, let me tell them that if we can prevent folks like 

this gentleman that we have heard about today in New York from 

working amongst elders, how much will we save from having to 

prosecute those people? Over the past 11 years, I have prosecuted 

countless numbers of prior-convicted felons who have abused elders. 

Second, we need to improve State laws and make sure that every 

State has laws that reflect the severity of the crime, so that they 

should be felonies and not misdemeanors. 

Third, to create or expand the list of mandated reporters in each 

State, so that there are classes of groups of people who are mandated by law to report elder abuse. 

Fourth, to make the courts more accessible to elderly victims and 

witnesses and for us to take a leaf out of the book of Judge Julie 

Conger from Alameda County, who has made her court so elderand user-friendly. 

Fifth, that every urban area in this country should have a dedicated police unit that has investigators just primarily focusing on 

investigating elder-abuse cases. I am very blessed that in San 

Diego we have such a unit. 

Sixth, for district attorneys around the country to develop these 

multidisciplinary teams and to realize that collaboration is the way 

to go. We cannot prosecute these cases on our own; we have so 

much to learn from everyone else. 

Finally, for everyone to invest in awareness campaigns so the 

public can feel confident that if they suspect elder abuse in a nursing home or in a private setting that there is a number that they 

can call and that they have the confidence that their call will not 

go unanswered. 

So I want to take this opportunity to thank you, Senator, for 

your listening. It has been a difficult day for you. But thank you 

for the priority you place on this terribly important issue. 

[The prepared statement of Mr. Greenwood follows:]

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The CHAIRMAN. That was great testimony. Thank you so much. 

Mr. Blancato. 

STATEMENT OF ROBERT BLANCATO, NATIONAL COORDINATOR, THE ELDER JUSTICE COALITION, WASHINGTON, DC 

Mr. BLANCATO. On behalf of the nonpartisan, 545-member Elder 

Justice Coalition, I am pleased to participate in today’s hearing. 

We applaud the bipartisan leadership of this Committee and its 

work over several Congresses to promote elder justice. Today is another important contribution. 

Mr. Chairman, we commend your steadfast efforts to fight elder 

abuse and promote a national criminal background check system 

for those working in long-term care. Our coalition supports your 

bill, S. 1577. We hope for its consideration either as a stand-alone 

bill, part of the ‘‘Elder Justice Act,’’ or in some other legislation. We 

also appreciate your cosponsorship of S. 1070, the ‘‘Elder Justice 

Act.’’ 

But with all due respect to all this work, the Nation has waited 

long enough. We have good bills before the House and the Senate, 

the product of much work, negotiation and concession by major 

stakeholder groups. It is time for Congress to finish the job. 

Mr. Chairman, your ‘‘Patient Safety and Abuse Prevention Act’’ 

is critical to the effort to help stop elder abuse. The 2003 legislation 

instituted the seven-State, 3-year pilot projects to determine ways 

States can implement systems to cost-effectively screen applicants 

for employment in long-term care. Data provided by pilot States 

show that each program has successfully excluded individuals with 

histories of substantiated abuse and criminal backgrounds. 

However, as pointed out, these pilots expire in September. How 

do we go beyond the pilots, take their successes, and move to a 

more national system? 

Your bill has one approach: Expand the pilot framework into all 

States between 2008 and 2010, and in 2011 institute a permanent 

prohibition for providers who knowingly employ an individual with 

a history of substantiated elder abuse or a criminal conviction for 

a relevant crime. 

The issue of national criminal background checks needs to be addressed by this Congress. Elder abuse is increasing. A 2004 report 

points to a 19.7 percent increase in reported elder and vulnerable 

adult abuse cases just since 2000. Adult Protective Service agencies 

received 566,000 reports of suspected elder and vulnerable adult 

abuse. We also know of at least 20,000 cases of abuse in nursing 

homes from just one reporting source, the 2003 report of State 

Long-Term-Care Ombudsmen. 

Far more elder abuse goes unreported. A 2000 Consumers Digest 

article says that only one in 25 cases of financial exploitation is reported. Consumer Action estimates that while adults 60 and over 

make up less than 15 percent of the population, they make up 30 

percent of fraud victims. This Committee has made estimates of up 

to 5 million overall victims of elder abuse, neglect and exploitation. 

Elder abuse is also current news. Three headlines just in this 

past week: Arizona Daily, ‘‘A nurse in a Flagstaff nursing home 

was arrested after allegedly punching a 93-year-old patient in the 

face.’’ ABC–2 News in Baltimore, ‘‘A Westminster woman, hired to 

66

clean and run errands for an elderly woman, has pleaded guilty to 

embezzling nearly $250,000 from the woman’s estate.’’ Ann Arbor, 

MI, ‘‘The daughter of a Salem Township woman who froze to death 

in March has been charged with vulnerable adult abuse for leaving 

her mother, who had Alzheimer’s, alone for 26 hours. The mother 

was found dead in a ditch five miles from home, and she was not 

wearing a coat.’’ The current Federal response to elder abuse is 

piecemeal and minimal. Less than 2 percent of all Federal funds 

spent on abuse prevention goes to prevent elder abuse. 

As our population ages, so this problem grows. Today, the most 

common victim is an older woman, 75 years or older, living alone. 

Today, half of women 75 and over live alone. As financial abuse increases more quickly than other abuse, more and more wealth is 

being controlled by people 50 and over. 

The ‘‘Elder Justice Act’’ offers a comprehensive response. It provides dedicated funding for Adult Protective Services, grants to improve ombudsmen’s capacity, create a national training institute 

for surveyors of long-term-care facilities, grants for stationary and 

mobile forensics centers, and require the immediate reporting to 

law enforcement of crimes in long-term-care facilities. 

Our focus needs to be directed, as this Committee has always indicated, to first helping victims of elder abuse; second, preventing 

new victimization; and third, helping those who are working with 

victims and on prevention. 

It will be 30 years next year when Congress first addressed elder 

abuse in hearings of the old House Select Committee on Aging. 

This is the fourth consecutive Congress with an elder justice act 

and criminal background legislation that is waiting to pass. It is, 

frankly, incomprehensible, but not impossible to remedy. 

As advocates, we say, let us work together—Administration and 

Congress, Senate and House, Democrats and Republicans, national, 

State and grassroots groups—to achieve the final passage of elder 

justice legislation so we can genuinely help some of the most vulnerable people in our society: victims of elder abuse. 

Thank you, Mr. Chairman. 

[The prepared statement of Mr. Blancato follows:]

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The CHAIRMAN. That was very good. Thank you so much. 

Mr. Reingold. 

STATEMENT OF DANIEL REINGOLD, PRESIDENT AND CEO, 

THE HEBREW HOME FOR THE AGED, RIVERDALE, NY; 

ACCOMPANIED BY JOY SOLOMON 

Mr. REINGOLD. Thank you, Mr. Chairman. 

I am pleased to testify today on behalf of The Hebrew Home at 

Riverdale and the American Association of Homes and Services for 

the Aging. We strongly support ‘‘Patient Safety and Abuse Prevention Act’’ and the ‘‘Elder Justice Act.’’ 

The Hebrew Home is a nonprofit organization in New York, 

founded 90 years ago. We are a long-term-care provider, and we 

are very much in favor of a national registry. It will make our lives 

easier and the care of our residents better. 

AAHSA represents 5,700 nonprofit, mission-based organizations 

who are providing services to over 2 million people a year, and all 

of our members have been protecting elders for all of their history. 

The Hebrew Home provides nursing care, housing, home care 

and daycare, and today I will describe the Nation’s first comprehensive elder-abuse shelter. 

In our written testimony, we detailed the numerous activities of 

AAHSA, but today I want to focus on the shelter as a template and 

prototype for our Nation. So today, what I am presenting to you 

and to the Committee is the role of a nonprofit long-term-care facility stepping in to provide shelter and resources for victims of elder 

abuse in the community. 

Elder abuse is often invisible. Unlike children, elders are isolated, they are shut in, they don’t have public places where their 

abuse may be observed. 

As difficult as it is for women, as well, to escape an abusive relationship and find a safe haven, it can be even more difficult for the 

elderly. Victims we have seen in the shelter suffer from cognitive 

and physical frailties, and they are frequently lacking in financial 

resources. So domestic violence shelters that exist can not serve the 

elderly. Many of the victims are men, who are not appropriate for 

the typical shelter that exists. 

So victims are frequently brought to emergency rooms, homeless 

shelters, or, worse, they are returned to the abusive situation. We 

observed that, and we decided that we needed to step in and make 

a change. We came up with the model which allows The Hebrew 

Home and the Weinberg Center to provide shelter for these victims. 

It exists in a nonprofit, mission-based long-term-care facility. We 

provide short-term emergency housing. We provide legal assistance 

and support services, with the goal of returning victims to their 

home. This is a short-term emergency shelter. 

It is a prototype, and we are seeking, through our partnership 

with AAHSA to replicate this model in every community, because 

every community has a nonprofit nursing home that can be used 

as an emergency shelter. 

We have the expertise. We have the facilities. We are elderfriendly. We operate 24–7. It is in keeping with our faith-based 

mission and our tax-exempt privilege. 

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Joy Solomon, who is the director and managing attorney of the 

Weinberg Center, is joining me today and will describe some of our 

partnerships and the unique training initiatives, some of which Mr. 

Greenwood alluded to, which we are implementing in New York 

City. 

Ms. SOLOMON. Thank you for allowing me to testify, Senator 

Kohl. 

One of the most significant features of the Weinberg Center is 

its partnerships with law enforcement and community agencies. 

We successfully collaborate with area district attorneys’ offices, 

Adult Protective Services, area offices on aging, and hospitals to 

prevent duplication but to assure that all the victims’ needs are 

met. 

We train judges, law enforcement professionals, EMTs, social 

service personnel and other people who may come in contact with 

victims who are shut in. 

The beauty of our model is that it can be adapted by any community. In New York City, doormen know everything. In a unique 

partnership with their union, we are training New York City doormen to identify abuse and contact us. In a rural community, on the 

other hand, this model could reach letter carriers, clergy, or other 

eyes and ears. 

The center also has an extensive outreach program, visiting senior centers, retirement communities and shopping centers to disseminate information. Awareness, as Mr. Greenwood said, is critically important. 

The Hebrew Home Research Division also tracks and documents 

our cases to identify the prevalence and incidents of elder abuse. 

Our work will be even more effective with the creation of forensic 

centers, as called for in the act, with your support. 

Mr. REINGOLD. Senator, I wish to stress, in closing, three major 

points. 

First, as mission-driven organizations, nonprofit providers have a 

moral obligation to assist elder-abuse victims, and we have the 

knowledge and ability to do so. There are nonprofit homes in every 

community. We can provide the physical shelter. Through our existing or newly created network, we can provide medical care, social work and legal assistance. 

Second, protecting elders requires education and collaboration. 

We are training these people in the community to recognize and respond to elder abuse, and we collaborate with the police, prosecutors, hospitals, domestic violence shelters and seniors directly. This 

is not about doing it alone. It involves all of us in the community 

who come into contact with elders and who can provide assistance. 

Third, we see the Weinberg Center as a way to raise awareness 

about elder abuse and to help Federal and State policy. For example, we would hope to convince the Center for Medicare Services to 

make elder abuse a diagnosis for which Medicare or Medicaid reimbursement can be issued. Right now, we accept people without regard to pay and without regard to the possibility of payment. 

As with child abuse and domestic violence, the problem is multidimensional and multidisciplinary. Our model can be replicated 

throughout the United States, and we commend you for including 

in the act grants for creating new and innovative programs. 

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In closing, Senator, creating the elder-abuse shelter has been an 

extraordinarily rewarding experience for our staff, our board of directors and our community. An elder-abuse shelter housed in nonprofit facilities throughout America is a goal that The Hebrew 

Home, in partnership with the American Association of Homes and 

Services for the Aging, is aggressively pursuing. 

We appreciate the opportunity to discuss these issues with you 

today. On behalf of AAHSA and The Hebrew Home, we congratulate you on your efforts and your leadership. We look forward to 

working with you in protecting our Nation’s most vulnerable citizens. 

Thank you. 

[The prepared statement of Mr. Reingold follows:]

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The CHAIRMAN. We thank you. 

We thank you. 

Your testimony was really good. 

Mr. Greenwood and Ms. Laubert, to what extent are crimes 

against the elderly going underreported? Why is that so in our society? 

Mr. GREENWOOD. Senator, yes, it is going unreported by the victims themselves for several reasons. 

Obviously, some of our victims don’t have the mental cognitive 

ability to know how to report or to be able to articulate what happened to them. 

Second, many of our victims, particularly victims of financial 

elder abuse, are ashamed and embarrassed to report to the police. 

In fact, I have sat down with many elderly victims, and we found 

out about these crimes from other sources. When I sit with them 

and gently ask them, ‘‘Why didn’t you want to tell anybody this 

happened to you? ’’, the answer I keep getting is, ‘‘Mr. Greenwood, 

I would rather lose $50,000 to the crook than run the risk of losing 

my independence.’’ Because, unfortunately, there is a misconception in the elderly population that, if you are a victim, that we are 

all going to gather around and take away their independence. We 

are not in that business. We want to take away the independence 

of the perpetrator and not the victim. 

The CHAIRMAN. That is very good. 

Ms. Laubert. 

Ms. LAUBERT. Mr. Greenwood makes very good points. 

The experiences that we have seen with people who are receiving 

home-care services—I remember one woman in particular who said 

that the home health aide, or the homemaker, who went grocery 

shopping for her would come back and wouldn’t give her change or 

would have lost the receipt. So when we said, ‘‘Well, let us do 

something about that,’’ she said, ‘‘Well, Jackie has been taking care 

of me so well for so long, and she had to have her car repaired last 

year, so she really needs the money, and I will be OK.’’ 

What we see in home care is that the relationships that are 

formed between the client, who is vulnerable and feeling alone in 

their home, and the caregiver are very strong, and they don’t want 

to make waves. 

I think about my own personal experiences with my parents having medical issues and being hospitalized for long periods of time. 

‘‘Well, Mom, what do you mean they kept you awake all night 

cleaning the carpet? Let us do something about that.’’ ‘‘Oh, it is 

OK. I don’t want to make waves.’’ I think that that is a part of that 

generation. My generation is not going to accept those things. So, 

I think we need to be ready. 

I want to also tell you something very quickly, to give Congress 

a deadline. In 1998, my office received a call from a man named 

Daniel Broadman, who wanted to complain about a nurse in a 

nursing home where he worked who had not responded to a resident who was in distress and the resident died. The ombudsman 

got involved, investigated. The State survey agency got involved. 

About four years later, Daniel Broadman was in jail for passing 

bad checks. He confessed that he was the one who had killed that 

88

resident 4 years earlier. So he had three or four years, moving from 

one long-term-care facility to another. 

He is due to get out of prison for involuntary manslaughter in 

2009 in Ohio. I know he won’t be able to work in long-term care 

in Ohio again, but without a comprehensive Federal law, he may 

be able to go to a neighboring State and work in long-term care. 

The CHAIRMAN. That is very——

Ms. LAUBERT. So there is a deadline. 

The CHAIRMAN [continuing]. Very good. 

So we take it that, in many ways, you are much like your mother, but, however, you are much more assertive than your mother. 

Ms. LAUBERT. Right. [Laughter.] 

The CHAIRMAN. Good for you. 

OK. Mr. Blancato, you talked about the importance of getting 

that national registry included as part of the ‘‘Elder Justice Act,’’ 

which, as you know, is one of our priorities. Would you like to 

make any other comment on that, as we move forward? 

Mr. BLANCATO. Well, all I would add is that, as a coalition, that 

we have a wide group of people from the nursing home industry, 

the nursing home rights groups, and we believe that the strongest 

possible elder justice legislation needs to emerge in this Congress, 

and we include that in that. The work that you have done, I think, 

deserves being given serious consideration this year. 

I think the issue—and we have watched this advocacy movement 

around elder justice emerge over the past 4 or 5 years. Senator, I 

assure you, it has strong grassroots components. It has strong 

interdisciplinary elements to it. I think this is the year where, you 

know, we can see that come to fruition with the passage of meaningful legislation. We, again, commend you for your leadership in 

that area. 

The CHAIRMAN. Thank you. 

Folks, what can you tell us by way of things we can and should 

be doing to encourage the development of Weinberg Centers across 

the country? 

Mr. REINGOLD. The act provides for grants for innovative programs, and these are very cost-effective programs that we are describing. We are currently working with three other organizations 

to replicate the Weinberg Center. The startup time to open a shelter and get it running could be as soon as 30 days. 

There are some innovative ideas that have to be adapted to a 

particular community’s needs. But with very little support, very 

minimal financial support, we believe that nonprofit long-term-care 

providers can step in, as they have stepped in on so many other 

issues, to provide a very innovative solution that is cost-effective, 

that is appropriate and that is nurturing. 

The CHAIRMAN. Ms. Solomon. 

Ms. SOLOMON. I just wanted to go back to the question that you 

asked before, about the underreporting. What we are seeing a lot 

of is that it is the family member who is abusing their parent or 

grandparent, whether it is financial, physical or sexual abuse. 

So, when you ask, ‘‘Why is there underreporting? ’’, I think that 

the reality is that it takes a lot of incidents to occur before a grandmother is willing to report her grandson to a prosecutor or to the 

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police. That is one of the reasons that things are not being reported. 

But if, as a community, we create these partnerships together to 

provide support, then that grandmother could get some support 

and her grandson could get some support too. It wouldn’t necessarily mean that he goes to jail, but that they get some support 

in the community to live safely together. 

Because, often, elder-abuse victims want to maintain these ‘‘loving’’ relationships even when they have gotten to a point of lack of 

safety or theft or some of the other things we are hearing about. 

So we need to create safety nets for the families and for the older 

people, certainly. 

The CHAIRMAN. That is a very important point that you are 

stressing, that elder abuse often occurs within a family. 

Ms. SOLOMON. Yes. 

The CHAIRMAN. That is something that we need to note and understand. 

Well, we thank you all for being here today. Your testimony has 

been just great. 

I want to tell you, on behalf of the Committee, that we are going 

to work extremely hard to get the ‘‘Elder Abuse,’’ as well as the national registry, passed this year. I think we have a good chance to 

get it done. I think you will all feel more than recompensed for 

your efforts in being here today if we can get that done. You can 

be assured we are going to do our very best. 

So we thank you for coming, and we thank you all for your patience in awaiting this hearing. It has been a great hearing, and 

it gives a lot of inspiration to those of us who are listening to you 

to get the job done. So thank you for coming. 

We thank you all for being here. This hearing is finished. 

[Whereupon, at 1:35 p.m., the Committee was adjourned.] 

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A P P E N D I X 

PREPARED STATEMENT OF SENATOR GORDON H. SMITH

I want to thank Senator Kohl for holding this important hearing today. The issue 

of nursing home quality and safety has long been an issue of particular interest for 

me and I thank the panelists for being here today. The essential work that they 

do—whether monitoring care or advocating for nursing home residents—supplies 

the framework that helps so many of our elderly family members age with dignity. 

The past two decades have revealed a true culture shift occurring within the 

world of long-term care, including services that put the patient at the center of care, 

encourage inclusion of families in decision-making and giving more choices in the 

location of the care, such as community-based and in-home settings. However, with 

those advances has come the need to pay greater attention to the quality of care 

that is provided to seniors in all types of long-term care settings. 

Ensuring patient safety is a responsibility that rests with no one party or entity. 

It is shared by the federal and state governments, law enforcement agents, local 

agencies and community advocates. It is a responsibility that I take very seriously, 

as I know my colleagues do. I believe there is a need for all stakeholders to work 

more collaboratively to curb the incidence of elder abuse. We owe that to the millions of seniors who have placed their trust in our nation’s long-term care system. 

Apart from improving communication and cooperation of enforcement activities, 

there may need to be new, stronger policies in place to ensure that seniors receive 

the safest long-term care possible. I plan to reintroduce the ‘‘Long-Term Care Quality and Modernization Act’’ with Senator Lincoln. This bill will encourage a number 

of important improvements to nursing homes and the long-term care system that 

aim to enhance the quality and safety of care provided to our seniors. I look forward 

to working with many of the advocates, industry representatives and regulators 

here today to ultimately pass this legislation. 

I would like to applaud the work Senator Kohl has done in this area as well, especially in regard to helping nursing homes and other facilities better identify potential bad actors in the workforce. It is essential that we find more effective ways to 

help poorly performing facilities operate at a much higher level of care, or consider 

ways that they can be phased out of the system. We cannot let the inappropriate 

actions of a few continue to destroy the trust our nation’s seniors have placed in 

the long-term care system. 

I am confident that the fine panels of experts Senator Kohl has assembled today 

will be able to provide a fresh insight on the work that is being done at the federal, 

state and local levels to reduce elder abuse and provide the safest, highest quality 

care possible. 

Thank you. 

PREPARED STATEMENT OF SENATOR HILLARY RODHAM CLINTON

I would like to thank Chairman Kohl and Ranking Member Smith for convening 

today’s listening session on the growing problems of elder abuse in our country and 

what we can do to reduce and prevent incidents of neglect, mistreatment, and violence against older Americans. 

I’d also like to thank the panelists—several of whom traveled from New York—

to share their expertise and personal stories on this critical issue. 

I’d like to personally extend a special thank you to Ms. Coldren for being here 

today to share her grandmother’s harrowing experience in a residential care facility. 

My heart goes out to your grandmother for what she endured and to you and the 

rest of your family for the pain and suffering you’ve experienced. Although it was 

under horrific circumstances that your grandmother came to live with you in your 

home, I am very glad to know that she is in the good care of you and your husband 

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and that her happiness is beginning to return now that she is in a safe and loving 

environment. 

I am also relieved to learn that your grandmother’s abuser has been brought to 

justice, thanks in large part to the work of Mr. Tortora who has accompanied you 

here today. 

Mr. Tortora and others like him in Medicaid Fraud Control Units are on the front 

lines of looking out for older Americans, who constitute one of our nation’s most vulnerable populations. Older adults with Alzheimer’s and other dementias, such as 

Ms. Coldren’s grandmother, are especially in need of protection. 

As the baby boomers begin to reach retirement, it becomes increasingly important 

to have federal policies that promote positive aging and protect the well-being of our 

nations’ seniors. 

I am proud to represent a state that has model examples of how residential care 

facilities can incorporate elder abuse shelters, such as the Hebrew Home for the 

Aged in Riverdale, NY, which provides support and health care services as well as 

legal advocacy for older adults who have been victimized. I welcome Mr. Daniel 

Reingold, president and CEO of Hebrew Homes, and commend you for the work 

you’re doing nationally to expand the number of nursing homes that include elder 

shelters. 

We all know that there are thousands of competent and compassionate long-term 

care professionals that provide care for seniors in a loving and respectful manner. 

We are indebted to their professionalism and commitment. 

But the available information on elder abuse is truly sobering and staggering. 

Every year, as many as 5 million older Americans are subjected to gross neglect, 

abuse, or exploitation. According to a 2003 report by the National Academies, up 

to two million older Americans over the age of 65 have suffered abuse or mistreatment by those who were charged with their protection and care. 

According to a 2004 Survey of State Adult Protective Services, there was nearly 

a 20 percent increase in reported cases of abuse and neglect of older and vulnerable 

adults between 2000 and 2004. A separate investigation in 2001 found that there’s 

been a national increase in elder abuse in nursing homes, with a three-fold increase 

in abuse violations between 1996 and 2000. 

Abusive behavior has serious consequences: according to an article published in 

the Journal of the American Medical Association, older Americans who are abused 

are three times more likely to die prematurely than older Americans who have lived 

in safe and healthy environments. 

In less than ten years, the first wave of baby boomers will turn 65. In light of 

the growing longevity of Americans, we must consider how we will meet the increasing needs of this elder boom including the protection of their mental, emotional, and 

physical wellbeing. 

This is about more than statistics: it’s about safeguarding the dignity and happiness of older Americans—our grandparents, parents, senior members of our communities—and doing all that we can to support the countless husbands, wives, sons, 

daughters, loved ones and caretakers who give their time to provide support and 

comfort for their grandparents and parents. 

Safety is particularly important for individuals who suffer from Alzheimer’s disease or other dementias. All of us here realize that as the Baby Boomer generation 

ages, there will be a dramatic increase in the number of Alzheimer’s cases. By the 

year 2050, if we do not make headway, up to 16 million Americans are expected 

to suffer from this devastating disease. 

As co-chair of the Senate Task Force on Alzheimer’s Disease with my colleague 

Senator Collins, I have worked to address issues faced by Alzheimer’s patients and 

their caregivers. 

Diseases such as Alzheimer’s can contribute to depression and anxiety for both 

those who suffer from the disease as well as their caretakers. Access to mental 

health services are also crucial for older adults who have been mistreated or victimized. That is why Senator Collins and I introduced the Positive Aging Act of 2007, 

which will integrate mental health services into primary care and community settings, making it easier for older Americans to get the support and treatment they 

need. 

But we need to stop cases of abuse and neglect before they occur. That’s why I 

am proud to join my colleagues in supporting both the Patient Safety and Abuse Prevention Act and the Elder Justice Act. As an original cosponsor of the Patient Safety 

and Abuse Prevention Act, I recognize that we need to strengthen states’ abilities 

to safeguard against abuse and neglect in long-term care facilities. 

This bill would meet these needs, by authorizing and funding a nationwide expansion of programs that screen applicants for employment in long-term care facilities. 

93

Among other provisions, this bill will also provide protections for long-term care 

facilities that fire employees with troublesome histories while also protecting employees from wrongful termination. 

Long-term care workers who pass the background checks would have certification 

of employment that they could take to any long-term care employer for two years. 

In order to recruit and maintain a quality long-term care workforce, we should 

not burden prospective employees with the financial cost of the background checks—

the Patient Safety and Abuse Prevention Act would authorize funds to cover these 

costs. 

As a long-time supporter of IT as an important tool to help improve health care, 

I am especially pleased that this bill would help states establish IT infrastructures 

for screening job applicants at long-term care facilities. 

Improving our ability to detect physical abuse is crucial as well. The Elder Justice 

Act, of which I am a proud cosponsor, would, among other provision, support advances in forensics specific to elder abuse. 

Both the Patient Safety and Abuse Prevention Act and the Elder Justice Act are 

important steps towards ensuring that all older Americans, wherever they may live, 

are able to enjoy their golden years in safe and nurturing environments. 

Again, I thank Chairman Kohl and Ranking Member Smith for convening today’s 

listening session, and for their leadership on this issue. I look forward to continuing 

to working with my colleagues to make progress for our seniors and families on 

these important issues. 

PREPARED STATEMENT OF SENATOR ROBERT P. CASEY, JR. 

I want to thank Chairman Kohl for raising this very critical issue and for all the 

work he has done over the years to protect our older citizens from abuse and ensure 

that they are treated with dignity, respect and compassion by the individuals who 

care for them. As a Senator, I have an abiding obligation to do all I can to protect 

those who fought our wars, worked in our factories and taught our children—those 

who gave us life and love. 

I want to also add that I am proud to co-sponsor Chairman Kohl’s bill, The Patient Safety and Abuse Prevention Act (S.1577) which he introduced a few weeks 

ago and which will address the issue of background checks for workers who care 

for older citizens. Chairman Kohl, you have been a tireless and powerful advocate 

for our older citizens and I thank you for your good work. 

We are here this morning to examine what we can do to stop the abuse, neglect 

and exploitation of our elders. The Bible tells us to ‘‘honor thy mother and thy father.’’ There are no words to truly and adequately convey how very wrong it is that 

our seniors should suffer any kind of neglect or abuse in the twilight of their lives. 

Whenever we have a vulnerable population that suffers abuse or neglect—whether 

it be children, those with disabilities, or our older citizens—it is heartbreaking. 

Elder abuse is a particular problem because we have neither a comprehensive system for collecting data nor a uniform reporting system. Even the definition of elder 

abuse varies from state to state. But regardless of how statutes may define such 

abuse, we are talking about emotional, physical and sexual abuse as well as exploitation, neglect and abandonment. Sadly, shame, vulnerability and the fragility of 

many older men and women often render them unwilling to report crimes against 

them. 

What data we do have suggest strongly that there is a largely silent epidemic of 

elder abuse. Data on elder abuse in domestic settings, for example, suggest that 

only 1 in 14 incidents, excluding incidents of self-neglect, come to the attention of 

authorities. With respect to financial exploitation, current estimates indicate that 

only 1 in 25 cases are reported, suggesting that there may be at least 5 million financial abuse victims each year. A study by the National Center on Elder Abuse 

estimated that for every one case of elder abuse, neglect, exploitation, or self neglect 

reported to authorities, about five more go unreported. 

Pennsylvania has the third largest elderly population in the country—15 percent 

of the state population or 1.9 million citizens. The numbers of elders will dramatically increase as our baby boomer generation continues to age. Nationally, we know 

that approximately 1 in 20 people will experience elder abuse during their lifetime. 

This is an alarming statistic. For Pennsylvania, this means that approximately 

95,000 older citizens will be abused during their lifetimes. This is unacceptable to 

me. I know it is equally unacceptable to the members of this committee and to all 

of you who have come to testify today. 

Before being elected to the Senate, I spent 10 years in state government, eight 

of them as Auditor General, the state’s fiscal watchdog. During that time, I conVerDate 0ct 09 2002 12:18 Mar 12, 2008 Jkt 000000 PO 00000 Frm 00097 Fmt 6601 Sfmt 6601 H:\DOCS\40410.TXT SAGING1 PsN: JOYCE
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ducted performance audits of Pennsylvania’s oversight of long-term care, home 

health care and personal care homes and advocated changes in legislation and policy 

that improved the quality of care. Our audits exposed that Health Department bureaucrats were letting weeks and months elapse before investigating life-threatening complaints about nursing home care and that the state was licensing personal 

care homes without verifying that administrators and staff were properly qualified 

or trained. As a result of our audit work and our advocacy, nursing home residents 

are safer today and the laws governing home health care and personal care homes 

have improved. I am grateful to have the opportunity to continue this critical work 

in the Senate and particularly on this Committee. 

There is no denying this is a very complex issue. We have a health care system 

that has long been geared to address symptoms rather than focus on prevention 

that could provide better health and lower costs in the long run. Consequently we 

have growing numbers of seniors who experience multiple and chronic conditions 

that rob them of their independence and ability to care for themselves, becoming 

increasingly dependent on others to meet their needs. Institutions are under-staffed 

and have unsafe patient-staff ratios. We also have a workforce of direct care workers, many of whom face deplorable working conditions and professional stagnation. 

We must offer these dedicated workers decent salaries, professional respect and opportunities for training and upward mobility. That is the only way we will attract 

the caliber of workers who will care for our older citizens the way we would care 

for them as a family. 

We must do more to stop the abuse and neglect of our older citizens. Chairman 

Kohl’s bill is a positive step in that direction. I welcome the opportunity this hearing 

affords us and I look forward to the experience, expertise and suggestions of the 

three panels of witnesses from whom we will hear this morning. I know you all have 

very important information and stories to share and I thank you for being here. 

RESPONSES TO SENATOR SMITH’S QUESTIONS FROM GREGORY DEMSKE

Question 1: The Federal/State Disconnect 

LEAD IN: In the most recent GAO report on nursing home enforcement, one of 

the findings that struck me was the level of disconnect between CMS here in Washington and the regional offices and state agencies that are tasked with implementing the statutes and guidelines regarding the nursing home industry. 

Question. From your perspective in the Office of the HHS Inspector General, can 

you comment on this discrepancy and offer a few ideas on how this can be remedied 

so that everyone can get on the same page and work towards more uniform enforcement and oversight? 

Answer. OIG’s extensive work related to the nursing home enforcement mechanisms highlights inefficiencies and inconsistencies in how enforcement actions are 

referred and implemented. To illustrate, in one report, State Referral of Nursing 

Home Enforcement Cases (OEI–06–03–00400; 12/05. http://oig.hhs.gov/oei/reports/

oei–06–03–00400.pdf, we found that States failed to refer about 8 percent of cases 

to CMS as required and that late State referrals caused the delay or failure to impose mandatory denials of payment. Failures in the referral process were caused by 

insufficient or incorrect CMS-regional office guidance, inaccurate enforcement data, 

and CMS not recognizing cases as referrals. Inefficiencies in the enforcement tracking systems mean that even when enforcement actions are required, they may not 

be implemented timely or in a manner that would motivate a facility to return to 

compliance. CMS has taken a number of actions, including implementing both case 

and incident-tracking systems, that should help to ensure that referrals are properly 

identified and communicated by the States and CMS and that enforcement actions 

are implemented more timely. 

OIG, like GAO, has also found inconsistencies in the citation of all levels of deficiencies (not just the most severe) among States, between Federal and State reviews, and even among individual survey reports. In a March 2003 report, Nursing 

Home Deficiency Trends and Survey and Certification Process Consistency (OEI–02–

01–00600), http://oig.hhs.gov/oei/reports/oei–02–01–00600.pdf, we found that in 

2001, one-third of the nursing homes in Virginia were deficiency-free while none in 

Nevada were. In the same report, we also noted inconsistencies between Federal 

and State surveys-Federal survey teams normally find a larger number of, and more 

serious, deficiencies than state teams. These inconsistencies resulted from variations 

in survey focus, lack of clarity in guidelines, lack of a common review process for 

draft survey reports, and high turnover of surveyor staff. We recommended that 

CMS improve its guidance to State agencies on citing deficiencies by providing 

guidelines that are both clear and explicit, and work the States to develop a comVerDate 0ct 09 2002 12:18 Mar 12, 2008 Jkt 000000 PO 00000 Frm 00098 Fmt 6601 Sfmt 6601 H:\DOCS\40410.TXT SAGING1 PsN: JOYCE
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mon review process for draft survey reports. CMS has taken steps to implement 

these recommendation and is also currently conducting training for state surveyors 

to promote consistency among reviewers regardless of the State. OIG continues to 

monitor the implementation of these recommendations. 

In two other reports, Nursing Home Enforcement: Application of Mandatory Remedies (OEI–06–03–00410; 05/06) http://oig.hhs.gov/oei–06–03–00410.pdf and Nursing Homes Enforcement: The Use of Civil Money Penalties (OEI–06–02–00720; 04/

05) http://oig.hhs.gov/oei/reports/oei–06–02–00720.pdf, OIG found that CMS does 

not apply all mandatory remedies (mandatory denial of payment and mandatory termination) against noncompliant nursing homes are required by statute, that CMS 

does not collect a large portion of Civil Money Penalties (due in part to reduction 

related to waiver of appeal rights, settlements and reductions resulting from appeals), and that CMS frequently imposes CMPs at the lower end of the allowed 

ranges. For the majority of cases requiring mandatory termination of nursing facilities, CMS did not apply the remedy because of both late case referrals by States 

and reluctance to impose this severe remedy. We recommended that CMS provide 

guidance to regional CMS staff and States regarding appropriate CMP dollar ranges 

for the varying types of violations and take required collection steps. We also recommended that CMS terminate noncompliant facilities’ participation in the Medicare and Medicaid programs within the required timeframes. 

In summary, States and CMS should properly and consistently identify deficiencies and demand corrective actions at the earliest possible point. Further, to be 

effective in promoting compliance, civil monetary penalties and other graduated 

sanctions must be implemented fully, and not compromised down unless appropriate 

corrective action has been taken. 

Question 2: Targeting Worst Offenders 

LEAD IN: GAO identified in its 2005 report on nursing home enforcement that 

CMS’s efforts have been further hampered by an expanded workload due to increased oversight responsibilities and initiatives that compete for staff and financial 

resources. The latest GAO report found that we are still not succeeding in removing 

the worst offenders from the system. 

Question. Is there a way to refocus CMS’s energy on oversight tasks and initiatives that are the real underperformers? 

Answer. OIG has identified a number of needed improvements to the survey and 

certification system and enforcement mechanism if CMS and States are to properly 

address the worst offenders. First, deficiencies should be properly cited in the first 

place, so that all poor performers can be identified. Second, it is important to pinpoint the cause of the deficiency so that an appropriate corrective action can be 

taken. For certain facilities, the problems that lead to deficiencies are not only at 

the facility level. OIG has worked with companies under quality of care CIAs to address those systemic issues that gave rise to substandard care at the facility level. 

As one example, a regional director of a nursing home chain placed extraordinary 

pressure on nursing home administrators to keep the census in their nursing home 

high. As a consequence, one facility was accepting dozens of patients each month 

with complicated medical needs; however, the facility did not have staff with the 

specialized skills needed to appropriately meet the needs of these residents. The root 

cause of these issues and the appropriate corrective actions to resolve the issues 

cannot always be identified through the current survey process. 

Finally, when deficiencies are noted, appropriate sanctions should be applied consistently by CMS and States. Without a sense that enforcement remedies will necessarily have an impact on a facility, some owners and managers will not be sufficiently motivated to maintain compliance. CMS and States impose graduated sanctions that become increasingly harsh as the provider fails to comply—termination 

being the most severe. If CMS or the State fails to implement these sanctions as 

they are designed, ensuring compliance may become more difficult. Both State and 

CMS enforcement staff have reported to OIG that they are reluctant to impose what 

are perceived to be harsh remedies that risk putting a nursing home out of business 

or have a negative impact on a facility’s ability to care for residents. For example, 

deficiencies are often related to insufficient staffing and monetary penalties can put 

a further strain on facilities’ financial stability and risk maintaining even the prior 

level of staffing. 

CMS has implemented several initiatives aimed at targeting especially poorly performing nursing facilities. For example, in January 1999, CMS implemented a Special Focus Facility program that involves enhanced monitoring of two nursing homes 

in each State. In December 2004, CMS expanded the scope of its Special Focus Facility program from about 100 homes nationwide to about 135 homes. CMS also revised the method for selecting nursing homes by reviewing 3 years rather than one 

year of deficiency data to better target homes with a history of noncompliance. AddiVerDate 0ct 09 2002 12:18 Mar 12, 2008 Jkt 000000 PO 00000 Frm 00099 Fmt 6601 Sfmt 6601 H:\DOCS\40410.TXT SAGING1 PsN: JOYCE
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tionally, CMS strengthened its enforcement regarding Special Focus Facilities by requiring immediate sanctions for homes that failed to significantly improve their performance from one survey to the next, and by requiring termination of homes with 

no significant improvement after three surveys over an 18-month period. 

Question 3: Marginalizing Lesser Harms? 

LEAD IN: Nursing home quality reports have focused most of their reporting on 

CMS’s oversight of serious harm to residents, those rated at the G level and above. 

Where this focus is addressing the critical and immediate needs of residents, I am 

concerned that the enforcement efforts are neglecting the lower level harms that 

still create dangerous environments for residents and result in lower quality of care 

for our loved ones. 

Question. If CMS and the states are already overextended in monitoring homes 

for the worst offenses, what can be done to assist victims of the lower level harms 

who are still deserving of better treatment? 

Follow Up: What’s to say that a facility will allow harm up to that G threshold 

level, but not beyond, knowing that enforcement efforts likely will not occur unless 

it crosses that point? Are we gambling with resident’s health and well being through 

this approach? 

Answer. 

It is imperative that all deficiencies, including those below a level G, be addressed 

in a timely and complete manner in order to protect facility residents from actual 

and potential harm. CMS and States have a variety of tools to make this happen. 

The survey process, corrective actions plans, and graduated sanctions are the simplest tools that can be used to address deficiencies to prevent them from becoming 

serious deficiencies that cause actual harm to a resident. 

In earlier OIG work examining trends in nursing home deficiencies (see question 

#1), OIG examined all deficiencies, including those below the G level. Although GAO 

noted that serious deficiencies have declined somewhat, our work at that time indicated that deficiencies overall had increased. This increase could be due to a variety 

of factors. For example, a greater number of deficiencies could result from States 

conducting more thorough surveys, while a smaller number of deficiencies could be 

due to surveyors possibly down-coding deficiencies. 

Although OIG has not done work focusing on the compliance of facilities with deficiencies below a ‘‘G,’’ we do not believe there is a high risk that nursing facilities 

would willingly allow harm up to a certain level. By statute, every nursing home 

receiving Medicare or Medicaid payment must undergo a standard survey no less 

than once every 15 months, and the statewide average interval for these surveys 

must not exceed 12 months. Even though a facility may not have been cited for serious deficiencies in a prior survey, it is still subject to regular surveys. Additionally, 

homes with D-level or higher deficiencies are all considered noncompliant. CMS and 

States can demand corrective actions to address the deficiency and can use a variety 

of sanctions to help coerce compliance with quality requirements ranging in severity 

according to the scope and severity of the deficiency, a facility’s prior compliance 

history, and the desired outcome. Serious deficiencies (H or higher, and repeated Glevel deficiencies), however, are subject to mandatory sanctions. If a facility with a 

D-level or higher deficiency does not become compliant within a certain time period, 

then the sanctions are increasingly elevated, with the potential end result of termination of the facility. 

RESPONSES TO SENATOR SMITH’S QUESTIONS FROM DANIEL REINGOLD

Question: Dissemination of their innovative program 

LEAD IN: I was intrigued by the groundbreaking work being done at the 

Weinberg Center to prevent the abuse of elders. I believe such programs are key 

to the broader effort in improving the type of care we provide our seniors. 

Question. What have you done in helping other communities replicate the success 

of these programs? 

Answer. We, too, believe the Weinberg Center model is uniquely effective in the 

intervention and prevention of elder abuse and have made great efforts to encourage 

replication throughout the nation. 

First, we have partnered with AAHSA (American Association of Homes and Services to the Aged) to encourage all of its members to replicate the Weinberg model. 

In doing so, we have set up a link from the AAHSA web site to the Weinberg Center, so that interested affiliates can have access to our model, policies and procedures, and easy connections to the Weinberg Center team for direct communications. The Weinberg Center team has given workshops at numerous AAHSA conferences specifically on how to replicate. 

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Second, through a grant from the Brookdale Foundation for dissemination and 

replication of the Weinberg Center, we have created a how to manual, provided consultations to assist in adapting the Weinberg model, and held day long training for 

replication. 

Finally, The Weinberg Center team has given numerous presentations to professionals, law enforcement, and others who come in contact with older adults on elder 

abuse and the Weinberg Center model. In addition to creating collaborative partnerships, the Weinberg Center Team is nationally and locally active on numerous elder 

abuse coalitions and partnerships, spreading the word about the Weinberg model.

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