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SUBCOMMITTEE HEARING ON 

IMPACT OF PREDATORS IN LONG-TERM CARE ON 

SMALL BUSINESS OPERATORS 

INVESTIGATIONS AND OVERSIGHT 

SUBCOMMITTEE 

COMMITTEE ON SMALL BUSINESS 

UNITED STATES HOUSE OF 

REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

JULY 23, 2008 

Serial Number 110-107 

Printed for the use of the Committee on Small Business 

( 

Available via the World Wide Web: www.access.gpo.gov/congress/house 

HOUSE COMMITTEE ON SMALL BUSINESS 

NYDIA M. VELA ́ ZQUEZ, New York, Chairwoman 

HEATH SHULER, North Carolina 

CHARLES GONZALEZ, Texas 

RICK LARSEN, Washington 

RAUL GRIJALVA, Arizona 

MICHAEL MICHAUD, Maine 

MELISSA BEAN, Illinois 

HENRY CUELLAR, Texas 

DAN LIPINSKI, Illinois 

GWEN MOORE, Wisconsin 

JASON ALTMIRE, Pennsylvania 

BRUCE BRALEY, Iowa 

YVETTE CLARKE, New York 

BRAD ELLSWORTH, Indiana 

HANK JOHNSON, Georgia 

JOE SESTAK, Pennsylvania 

BRIAN HIGGINS, New York 

MAZIE HIRONO, Hawaii 

STEVE CHABOT, Ohio, Ranking Member 

ROSCOE BARTLETT, Maryland 

SAM GRAVES, Missouri 

TODD AKIN, Missouri 

BILL SHUSTER, Pennsylvania 

MARILYN MUSGRAVE, Colorado 

STEVE KING, Iowa 

JEFF FORTENBERRY, Nebraska 

LYNN WESTMORELAND, Georgia 

LOUIE GOHMERT, Texas 

DAVID DAVIS, Tennessee 

MARY FALLIN, Oklahoma 

VERN BUCHANAN, Florida 

MICHAEL DAY, Majority Staff Director 

ADAM MINEHARDT, Deputy Staff Director 

TIM SLATTERY, Chief Counsel 

KEVIN FITZPATRICK, Minority Staff Director 

SUBCOMMITTEE ON INVESTIGATIONS AND OVERSIGHT 

JASON ALTMIRE, PENNSYLVANIA, Chairman 

CHARLES GONZALEZ, Texas 

RAUL GRIJALVA, Arizona 

MARY FALLIN, Oklahoma, Ranking 

LYNN WESTMORELAND, Georgia 

(II) 

C O N T E N T S 

OPENING STATEMENTS 

Page 

Altmire, Hon. Jason ................................................................................................. 1 

Fallin, Hon. Mary .................................................................................................... 2 

WITNESSES 

Steele, Hon. Kris, Oklahoma House of Representatives ...................................... 6 

Banning, Ms. Sandy, Jacksonville, FL ................................................................... 7 

Bledsoe, Mr. Wes, Founder and Citizen’s Advocate, A Perfect Cause, Oklahoma City, OK ...................................................................................................... 9 

Coble, Mr. Tom, President, Elmbrook Management Company, Ardmore Ok ..... 11 

McDonough, Mr. Sean, Dougherty, Leventhal, and Price, LLP, Moosic, PA ...... 13 

APPENDIX 

Prepared Statements: 

Altmire, Hon. Jason ................................................................................................. 25 

Fallin, Hon. Mary .................................................................................................... 27 

Steele, Hon. Kris, Oklahoma House of Representatives ...................................... 29 

Banning, Ms. Sandy, Jacksonville, FL ................................................................... 31 

Bledsoe, Mr. Wes, Founder and Citizen’s Advocate, A Perfect Cause, Oklahoma City, OK ...................................................................................................... 36 

Coble, Mr. Tom, President, Elmbrook Management Company, Ardmore Ok ..... 45 

McDonough, Mr. Sean, Dougherty, Leventhal, and Price, LLP, Moosic, PA ...... 50 

(III) 

(1) 

SUBCOMMITTEE HEARING ON THE IMPACT 

OF PREDATORS IN LONG-TERM CARE ON 

SMALL BUSINESS OPERATORS 

Wednesday, July 23, 2008 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON SMALL BUSINESS, 

Washington, DC. 

The Subcommittee met, pursuant to call, at 10:00 a.m., in Room 

1539 Longworth House Office Building, Hon. Jason Altmire [chairman of the Subcommittee] presiding. 

Present: Representatives Altmire and Fallin. 

Chairman ALTMIRE. Call the hearing to order. 

OPENING STATEMENT OF CHAIRMAN ALTMIRE 

This hearing on sexual predators in nursing homes is now called 

to order. 

To put a loved one in a nursing home is never an easy one to 

make. For most it is emotionally fraught and painstaking process, 

but once a selection has been made, most families take comfort in 

knowing that their loved one will be well cared for and looked 

after. 

For America’s elderly and impaired, nursing homes have historically been places of security, and yet for many residents that is no 

longer the case. As a result of insufficient data and conflicting regulations, sex offenders have managed to infiltrate many of our 

country’s nursing homes, and today millions of our most vulnerable 

citizens remain at risk. 

In this morning’s hearing we will discuss the threat that sexual 

predators pose not only to our elderly, but also to the small health 

care providers that protect them. This troubling issue is of particular concern to our Committee given that the overwhelming majority of nursing homes are also small businesses. According to a 

2006 GAO report, close to three percent of nursing homes are now 

harboring sex offenders, and for these people, advancing age is of 

little hindrance. 

In fact, the belief that older sexual predators are harmless is a 

dangerous misconception. Studies have shown that sex offenders 

continue to be violent well past middle age. 

It is also worth noting that not all nursing home residents are 

elderly. The truth is that these facilities are often home to younger 

people with serious mental and physical handicaps. These younger 

residents can be both victims and perpetrators of nursing home violence. 

2 

The question is: how did these predators break into our longterm facilities? This is at least partially the result of unreliable detection systems. While the National Sex Offender Registry attempts to name all convicted sex offenders, there are notable holes 

in the database. For one, the registry fails to include predators that 

were convicted or released from prison prior to its 1996 inception. 

In addition to this problem, recent offenders often fail to selfidentify and, therefore, cannot be added to the registry at all. 

As a result of these two system flaws, GAO believes that the registry under counts sexual predators by nearly 60 percent. Given the 

database’s limited reach, it is reasonable to assume that nursing 

homes may house more sexual offenders than the three percent 

originally thought. 

A tangle of conflicting rules and regulations have made it all but 

impossible for facilities to address their problems with sex offenders. Small health care providers are now governed by some 70 

pages of fine print in the Code of Federal Regulations. As a result, 

the system is a challenge to navigate. This is particularly true 

when it comes to reconciling safety policies with privacy concerns. 

Once a sexual predator has been identified, it is often difficult for 

a facility to act on that information. Under the Health Insurance 

Portability and Accountability Act, commonly called HIPAA, for example, sharing information about prior convictions can in some 

cases be considered a privacy violation. And, in fact, nursing home 

staff and residents’ families are rarely informed of the status of 

other residents’ offender status. 

In an attempt to fix this broken system, one state is already 

moving forward. Following a series of incidences in Oklahoma 

nursing homes, the state legislature passed a bill to create separate 

facilities for sex offenders. In doing so, they hoped to attack this 

issue head on and set a precedent that can be a model nationwide. 

Today we will discuss that particular piece of legislation and look 

for other potential solutions to this problem. Nursing homes have 

traditionally been a safe haven for America’s elderly and disabled, 

and it is important that we do everything in our power to keep 

them that way. 

With that I would like to thank all of the witnesses in advance 

for being here and turn it over to my good friend, the Ranking 

Member, Ms. Fallin, from Oklahoma for her opening statement. 

And I would say that she deserves the credit for this hearing. This 

is something that Oklahoma, her home State, has taken the lead 

on. This was her idea to put this hearing together. I thank her for 

her leadership on this, and would turn it over to her at this time. 

Ms. FALLIN. Thank you, Mr. Chairman. 

OPENING STATEMENT OF RANKING MEMBER FALLIN 

I appreciate your very kind words, but more importantly, I appreciate your assistance in putting this hearing together and allowing us the opportunity to come together to discuss a very important 

topic. 

And I will say that I am very proud of the State of Oklahoma 

and our legislature and our governor in working together in a bipartisan manner to tackle one of our state’s and one of our nation’s 

3 

most important issues, and that is protecting our seniors and those 

who are infirm in long-term care or nursing homes. 

And so thank you to all of our panelists who have joined us today 

and our expert witnesses. I thank you and your Committee and all 

they have done to put this together, along with my staff, who I 

know has worked very, very hard. 

As has been mentioned, we are here today to discuss the impact 

of predators on long-term care and small business operators. Most 

of our nursing homes and our long-term care facilities as small 

businesses, and thus, that is why you are in front of the Small 

Business Committee. We wanted to find an angle to get you here 

so that we could talk about this important issue. 

The purpose is to examine the impact and the placement of 

criminals and sexual predators on the operations of small businesses that have long-term care facilities, and this is a very important issue because it affects many of our parents, our grandparents, our aunts, our uncle, our friends across our country. 

Federal law and regulations are designed to insure that residents 

in nursing homes have certain basic rights, including to be free of 

physical harm and abuse. These rights frequently intersect with 

the placement of individuals in nursing homes who have a record 

of physical assaults, including sexual predators. Seniors residing in 

assisted living facilities are some of the most vulnerable of our citizens. Any time their safety or their health is threatened, it is both 

concerning and alarming. 

As someone who has had a mother, and I will even say two 

grandmothers, all in the same facility at the same time, in a nursing home in my home town where Representative Kris Steele represents in Tecumseh, Oklahoma, I have tremendous respect and 

tremendous admiration for the services that the nursing home, 

Sunset Estates, provided to my relatives, and I just want to say up 

front that nursing homes and long-term care facilities deserve our 

respect as we are discussing this, and they have a very special job 

and it takes a very special person to have a job in a long-term care 

facility or a nursing home to care for the elderly and the infirm. 

But in some instances, however, these facilities and their staff 

can be unaware that their could be predators living in their facility 

or even without the means to insure the safety of their residents. 

The rare cases of sexual assault and abuse have been documented 

in these facilities, and they are particularly abhorrent. 

I am having this hearing this week to investigate both the scope 

of the problem and even possible roles that the federal government 

might play to help eliminate it, and I sure am looking forward to 

hearing from our nursing home representative, Mr. Coble, today 

who I know is just as interested in this topic as we are in taking 

care of our elderly and infirm, and I know that he wants, along 

with his industry, to guarantee the safety of his employees, the 

safety of his patients and the seniors, and even for the families 

who are visiting facilities. 

I would like to extend a very special welcome and thank you to 

all of our witnesses who have traveled a long way to join us here 

today and spend their time to provide your expertise, and as I mentioned, I would especially like to welcome our state representative, 

Kris Steele, who is the authority of the Oklahoma legislation, who 

4 

held many hearings in our state, listened to all sides, all parties 

involved in this very important issue, and I know brought industry 

together along with families, along with patient advocates, and the 

legislators and, of course, the executive branch with our governor 

to pass this significant, first time, model legislation in our nation 

to be able to separate out sexual predators and have some options 

for states to be able to look at that. 

And so I appreciate you coming today. I want to also say a special welcome to Mr. Coble, who is representing the health care 

nursing home industry. We appreciate him coming today. I told 

him, you know, our purpose today is not to knock around nursing 

homes and long-term care facilities, but to work with you and to 

do the best we can to create a safe environment because we do appreciate and respect the great service that you provide in our nation. He has been a long time owner and operator of nine long-term 

care facilities. 

And then Wes Bledsoe with a perfect cause has started this crusade many, many years ago, has been around the State of Oklahoma for a long time, lobbied me when I was lieutenant governor 

of Oklahoma on this particular issue, and I know has worked with 

our legislators. So, Wes, thank you for all that you do. 

He has tremendous documentation on this subject across the 

whole nation, not just in our state, but he has done a lot of research. It has personally affected him and his family. 

And then I want to also thank Sandra Banning who has joined 

us here today, who lost her mother as a victim of sexual assault 

in Florida in a nursing home, and I know this is a very important 

issue for you and you’re very passionate about it. 

She has been seen on national television giving information 

about how important this is that we try and work together to do 

what we can for our seniors and long-term care people. 

And then, Mr. McDonough, I have not had a chance to meet you 

yet, but we welcome you, and I appreciate you coming today to lend 

your expertise and thank you for being here. 

And just welcome to our committee. We know that your information will be extremely helpful. 

I want to just say a couple things. I don’t want to go too long 

here, but according to the most recent compilation of statistics, the 

Center for Medicare and Medicaid Services estimate that there 

were 15,762 nursing home facilities in the United States with 1.7 

million beds and slightly more than 46 percent of the nursing home 

facilities in the United States are independent businesses and not 

associated with another nursing home. Over two-thirds are operated for a for-profit basis, and of those, approximately 81 percent 

had revenue under $10 million. 

In short, our nursing homes are highly localized, mostly small 

business, and no enterprise controls more than five percent of the 

beds in the industries, and nursing homes, of course, play a critical 

role in providing the care for Americans who are physically or mentally unable to take care of themselves and do not have a loved one 

who can help them. 

Federal regulations established the rights of nursing home residents, which include the right to be free from physical abuse, inVerDate Aug 31 2005 15:36 Oct 21, 2008 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 G:\CLERK SB\HEARINGS\TRANSCRIPTS\42951.TXT RUSS
5 

cluding sexual abuse, and to reside in an environment that maintains their dignity and quality of life. 

Now, as a condition, Medicare and Medicaid participation nursing homes and long-term care facilities must report incidents of 

abuse according to state requirements. However, nursing homes 

and long-term care homes face divergent and conflicting federal 

laws that make it difficult for them to satisfy the multiple mandates that are put upon them. 

Depending upon state regulations, many long-term care facilities 

and their residents may not be aware that there are residents who 

are offenders. Though all sex offenders are required to register by 

the National Sex Offender Registry, 25 percent of them never do 

register, and the extent to which states require and have laws that 

apply to sex offenders registering and reporting to the long-term 

care facilities greatly varies. 

When facility residents are known offenders, differing interpretations exist among the states themselves and the industry and even 

federal officials whether to disclose the information, and the Chairman mentioned that a minute ago, that it could violate federal and 

state privacy laws. 

But in some instances, long-term care facilities are not always 

notified when individuals with prior convictions enter, and the assessment tools for these facilities to determine the health care 

needs of the residents typically do not gather information about 

prior convictions. And so in addition to that, there is no federal law 

to notify a long-term care facility of a sex offender who has been 

placed in their facility, and that is one of our main concerns. 

So we in Congress must look at federal law to insure that there 

is a health environment for long-term care residents, one that is 

free from violence and abuse to a fellow resident, and it is important to make sure that sexual predator data is accurate and available to nursing homes and their families so that we can assure that 

they will be protected in these facilities. 

So thank you so much for joining us here today. We are looking 

forward to your testimony, and thank you, Mr. Chairman. 

Chairman ALTMIRE. We will now move into the testimony from 

the witnesses. We will introduce formally each of you one at a time. 

Ms. Fallin will introduce her four witnesses. I will introduce Mr. 

McDonough. 

Before each of you go, I want to explain the five-minute rule. 

Many of you, I am sure, have testified before. You will have five 

minutes for your testimony. There will be a green light for the first 

four minutes. When you see the light turn yellow, that means you 

have one minute remaining. If you could, start to summarize. The 

red light means your five minutes is up, and so please conclude 

your remarks at that time. 

At this point I will turn it over to Ms. Fallin to introduce Representative Steele. 

Ms. FALLIN. Thank you, Mr. Chairman. 

Kris Steele is our state representative from Oklahoma, author of 

the law. He represents the 26th District. He has been a member 

of the House since 2001. He is a member of the Public Health Committee, Veterans Subcommittee, Human Services Committee, and 

serves as the chair of the Health Subcommittee in the legislature. 

6 

He was very instrumental in passing this bill which will establish separate and secure long-term care health facilities for violent 

and sexual offenders. 

He has a Bachelor’s degree in religion and a Master’s and also 

is Associate Minister with Wesley United Methodist Church in 

Shawnee, Oklahoma. 

And we are glad to have you here. Thank you for coming. 

STATEMENT OF REPRESENTATIVE KRIS STEELE, DISTRICT 26, 

OKLAHOMA HOUSE OF REPRESENTATIVES 

Mr. STEELE. Thank you very much. 

Well, good morning. I would, first of all, like to say thank you 

to Congresswoman Fallin, Mr. Chairman, and members of the 

Committee on Small Business. It is, indeed, an honor and a privilege to participate in this discussion with such a distinguished 

group of individuals. 

Greetings from the great State of Oklahoma. 

I am here today to talk about the impact of predators in longterm care facilities on small business operators. Let me begin by 

saying that protecting senior adults, especially those who are vulnerable, should be a primary function and a top priority of government. This year the Oklahoma legislature enacted a proactive 

measure intended to reduce the risk of abuse and provide appropriate safeguards for seniors living in nursing homes. 

A growing number of registered sex offenders sparked a discussion of where to place those individuals who have served their time 

of incarceration and yet are no longer capable of independent living. An in-depth study on this issue resulted in the creation of 

House Bill 2407, which directs the Department of Health to request 

bids from the private sector for the operation of a stand alone, specialized, long-term care facility that will house elderly sex offenders, registered sex offenders. 

The request for proposal will also set forth certain specifications 

to designate the heightened security measures necessary to protect 

the public and the residents of the said facility. According to the 

Oklahoma Department of Corrections, an estimated 2,450 inmates 

convicted of sex crimes or violent crimes will be released from prison in Oklahoma in the next ten years. Twenty-six percent of these 

individuals will be age 51 or over and potentially in need of longterm care. 

Numerous studies confirm that certain sex offenders are highly 

resistent to rehabilitation. Registered sex offenders living in nursing homes can create a dangerous environment for the other residents in the home. It is estimated that approximately 30 individuals listed on the Oklahoma sex offender registry currently reside 

in nursing homes today. 

In 2005, Oklahoma passed a law requiring nursing homes to post 

public notifications when a registered sex offender is admitted. 

This measure also directed the Department of Corrections of notify 

local law enforcement entities about the location of sex offenders 

residing in nursing homes within their community. 

However, because of low staff levels and a short supply of security guards, some long-term care operators have experienced difVerDate Aug 31 2005 15:36 Oct 21, 2008 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 G:\CLERK SB\HEARINGS\TRANSCRIPTS\42951.TXT RUSS
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ficulty in properly monitoring sex offenders residing in their facilities. 

Federal regulations also prevent nursing homes from restraining 

residents except in very rare circumstances. Offenders living in 

nursing homes also present a challenge for small businesses. 

Knowing an offender is living in a particular facility creates a 

sense of uneasiness, a sense of unrest, and a sense of uncertainty 

for family, loved ones, and the other residents. The perception is 

that no one is safe in a home with an offender. Yet federal law requires that states pay for long-term care services for those individuals who are Medicaid and Medicare eligible regardless of whether 

or not they’re convicted felons. 

An interim study conducted in the fall of 2007 resulted in nursing home officials encouraging lawmakers to prevent those convicted of sex crimes from being placed in with the general population. In addition, advocate groups, such as AARP and others, expressed support for the establishment of a separate facility for registered offenders in need of long-term care. 

By encouraging the private sector to establish a nursing home 

with additional security measures for registered offenders, it is the 

belief of our state that better protections would be afforded to the 

aging population while meeting the needs of those who have served 

their debt to society yet remain at risk of reoffending. 

Protecting our senior adults, again, should be a primary responsibility and priority of government. Our goal should be focused on 

creating safe environments so that our senior adults can live the 

latter part of their lives free from the fear of harassment or assault. Implementing appropriate safeguards for the elderly is imperative in making this goal a reality. 

Again, thank you for the opportunity to address you about this 

topic today. 

[The prepared statement of Rep.Steele can be found in the 

appendis at page 29.] 

Ms. FALLIN. Thank you so much Representative Steele. 

Our next witness is Ms. Banning, and she is a mother and a victim of sexual assault. I am sorry. Her mother was a victim of sexual assault in a Jacksonville, Florida nursing home. She was featured on the Today Show broadcast in April as an advocate for 

nursing home resident protection from sexual offenders. 

She has also appeared on CBS Evening News along with other 

media from around the State of Florida. She is serving as the medical staff manager for the U.S. Navy Medicine Support Command 

in her capacity which she has had for 15 years and has been a government employee for over 28 years. 

And we welcome you and thank you for coming to share your 

very personal story. 

STATEMENT OF SANDRA BANNING, JACKSONVILLE, FLORIDA 

Ms. BANNING. Thank you, Congresswoman Fallin, Chairman 

Altmire, distinguished members. I have never addressed such an 

august body before. So if my lips tremble, please forgive me. 

July 23rd, 2008, today. July 23rd, 2002, six years ago today, Ivy 

Edwards took his wheelchair into my mother’s room. He placed 

8 

that wheelchair under the handle of her door, turned it sideways 

so that he couldn’t be disturbed. He climbed into bed with my 

mother, and he raped her. 

I received a call that night from the nursing home staff and said, 

‘‘Ms. Banning, we caught a man in bed with your mother, but he 

was just lying there. Nothing was going on. She’s asleep. Do you 

want us to send her to the Sexual Assault Response Center?’’ 

I said, ‘‘Are you sure nothing happened?’’ 

They said, ‘‘Yes, he was just lying there.’’ 

I said, ‘‘For God’s sakes, don’t scare her to death. No, don’t wake 

her up.’’ 

The next morning at work, ten o’clock, I received a call from the 

social worker from the same nursing home who said, ‘‘Ms. Banning, 

more occurred last night than we originally told you, and we’re 

going to have to send your mother to the Sexual Assault Response 

Center.’’ 

I said, ‘‘You’re not sending her anywhere till I get there.’’ 

So when I got there, I was met by my mother, by the police, by 

the members of the staff, and my mother looked at me and said, 

‘‘Hi.’’ 

And I said, ‘‘Hi, Mamma.’’ I said, ‘‘Do you know why I’m here?‘‘ 

And she said, ‘‘For a visit?’’ 

And I said, ‘‘No.‘‘ I said, ‘‘Mamma, last night you were raped.’’ 

My mother’s expression was, ‘‘Oh, my God.’’ My worst fear was 

realized. I placed my mother in a home for care so that she would 

be safe because in her own home she walked the streets at night, 

and I would say, ‘‘Mamma, you’re going to get raped if you walk 

the streets at night.’’ 

And she’d say, ‘‘Oh, Sandra, who’d rape an old woman?’’ 

Ivy Edwards would. Ivy Edwards was arrested at 2:30 that 

morning. The nursing home bagged my mother’s clothes, as they 

termed it. They put everything in for evidence. Ivy Edwards was 

taken to the police before I was ever called to be told that she had 

been raped. When Ivy Edwards was arrested, it was his 59th arrest. He had been arrested since the 1940s. Among them sexual assault, child molestation, burglary, heinous crimes, but the court 

system placed Ivy Edwards in the nursing home with my mother 

from a homeless shelter because he was a danger to society and 

others. 

No one, not my mother, not her family, not her daughter, should 

have to hold her hand while she undergoes sexual assault examination and watch the tears stream out her face because someone had 

taken from her what she did not give voluntarily. 

My mother was married to my father for 23 years. To the best 

of my knowledge, no one ever touched my mother except my father 

until Ivy Edwards took control. So what I ask is that Congress take 

steps to put in place a regulation, a law, some sort of guarantee 

that your mother, your father, your brother, your sister, yourself 

will not be out there and placed in a home with another Ivy Edwards. 

We have to make a change. We have to protect those that cannot 

protect themselves. We protect the children, but when you look at 

our nursing home residents, they are two, three, four, five years old 

in their mind. So let’s protect them, too. 

9 

Thank you so much for the opportunity to address. I appreciate, 

and I hope so much that we can make some changes. 

[The prepared statement of Ms. Banning can be found in the 

appendis at page 31.] 

Ms. FALLIN. Thank you, Ms. Banning. We appreciate your sharing such a very personal story with us, and we will use what is 

meant for evil for good here. 

Now it is my pleasure to welcome Wes Bledsoe, who has been a 

very dedicated founder of a group called the Perfect Cause, which 

is a citizen advocacy organization. He has been very tireless in his 

work that he has begun on the disabled and elderly after the death 

of his own grandmother in May of 2000 at Eunice Allen. He uncovered her nursing home’s attempt to cover up the negligent acts that 

led to her death and has since exposed patterns of some abuse and 

neglect that have been in nursing home for long-term care residents and has been a very outspoken person on this particular 

issue. 

And, Wes, we appreciate all of your research and your work and 

appreciate your coming today to give testimony. 

STATEMENT OF WES BLEDSOE, FOUNDER AND CITIZENS’ 

ADVOCATE, A PERFECT CAUSE 

Mr. BLEDSOE. Thank you, Congresswoman, and thank you, Mr. 

Chairman, members of the Committee and staff. Thank you for this 

opportunity to talk about the impact of predators in long-term care 

facilities and small business operators. 

Predators in nursing homes are bad for business. Much like the 

dead canary in a mine, it is a signal of invisible danger that requires immediate action. So, too, do predators in nursing home. 

I have a lot of information that I can share with you today, and 

so I would like to just get down to key bullet points and hopefully 

you can ask questions that I can provide more detail to you as we 

move forward. 

What is this about? It is about the delivery of a product, good 

quality care in nursing home, which is mandated by federal legislation, by state legislation across this country. 

What we are talking about are rapes, sexual assaults, physical 

assaults, and even murders committed by violent and sexual offenders who reside as residents in long-term care facilities. So far 

we have documented over 60 of these crimes committed by these 

offenders against residents, female as well as male, staff, and even 

one three year old little girl who was visiting her great grandfather 

in a Richardson, Texas nursing home. 

What are the types of offenders? And we have mentioned registered sex offenders as a problem, but there are other types of offenders we have key concerns about, and those offenders include 

inmates, parolees, violent offenders found incompetent to stand 

trial. 

Mr. Chairman, as you pointed out, it is not just registered sex 

offenders. There are many sex offenders who are not required to 

register. They were grandfathered out before the registration laws 

were enacted. And there is also registered sex offenders who do not 

have to register for life. 

10 

We also have convicted felons, and then we have a group of residents who assault others in long-term care facilities but were never 

charged or prosecuted because either they or their victim are of diminished capacity. 

Who places these offenders in long-term care facilities? District 

court judges, county sheriffs, adult protective services organizations, Departments of Corrections, and sometimes they are agencies to find housing for offenders being released from Department 

of Corrections facilities, as well as individual offenders can admit 

themselves or their families admit them into these facilities. 

We have heard all kinds of justification which we refer to as fairy 

tales used by officials to justify the placement of these residents in 

facilities. We hear that they are all old. Not true. Much like the 

GAO report has documented and the reports that we have also conducted, over half of these offenders are under 65 years of age. We 

found 19 year old registered sex offenders living as residents in 

nursing homes. 

Old offenders do not pose a threat. Ivy Edwards is one of those 

examples. There are other examples where elderly offenders do absolutely pose a threat. 

They are incapacitated. They are in wheelchairs. They cannot 

harm anybody. Again, not true. Ivy Edwards was in a wheelchair 

and other offenders, bilateral amputees, those with partially amputated feet have also raped and assaulted fellow residents in longterm care facilities. 

They were told that child molesters are safe because they don’t 

pose a threat to those old people. Again, documented cases that we 

have provided to this Committee through court records, police 

records and media reports show, again, that that is absolutely 

false. 

Nursing homes are capable of handling these offenders. There is 

not any training for nursing home staff on how to deal with these 

criminal offenders. 

Other prior offenses are minor or these crimes happened long 

ago. Not true. Again, most of these crimes have been committed 

within the last 14 years. We have found these offenders living in 

long-term care facilities. And the crimes, the crimes they were committed for were not out urinating in public behind a bush or in the 

alley. These crimes are rape, assault, and murder. 

These offenders have paid their debt to society. We have heard 

that a lot. We have documented cases where offenders were sent 

directly to nursing homes and other long-term care facilities without ever going to a Department of Corrections Facility. They went 

from jail conviction to a nursing home, and even in documents 

where they said they pose a significant threat to the safety of 

themselves and other. 

What can we do? We have several recommendations I would like 

to respond to you during the question period, and I can share those 

recommendations with you. 

Thank you for this opportunity to come forward. I hope tonight 

that you will give thought to what is happening to our residents 

and what happened to Sandy Banning’s mother. 

Thank you very much for this opportunity. 

11 

[The prepared statement of Mr. Bledsoe can be found in the appendix at page 36.] 

Ms. FALLIN. Thank you, Mr. Bledsoe. We appreciate you coming 

today. 

And now I would like to introduce Mr. Tom Coble, who is the 

founder and CEO of Health Care Management Company of Oklahoma, which specializes in creating long-term care based integrated health care delivery systems. HMC partners with organizations to evaluate, develop and operate Medicare Advantage special 

needs plans for institutional, home, and community based health 

plans. 

He also owns and operates eight skilled nursing facilities, an assisted living facility, and a rehabilitation company, and is the 

president of the Oklahoma Association of Health Care Providers, 

and we appreciate you joining us here today. Welcome. 

STATEMENT OF TOM COBLE, PRESIDENT, ELMBROOK MANAGEMENT COMPANY ON BEHALF OF THE AMERICAN 

HEALTH CARE ASSOCIATION 

Mr. COBLE. Thank you. Thank you, Chairman Altmire, Ranking 

Member Fallin, and members of this Subcommittee. 

I am grateful for the opportunity to be with you here today to 

offer our profession’s perspective on the very difficult and complex 

issue of sex offenders in our nursing facilities. 

I am honored to be here today representing the American Health 

Care Association. Americans are living longer, and our nation’s 

aging population is growing. Many of these individuals have medical and cognitive conditions which require care in a nursing facility. Currently more than three million American each year rely on 

the care and services delivered in one of the nation’s nearly 16,000 

nursing facilities. 

The forecast for the demand for nursing care is alarming. A 

March 2008 report from the National Investment Center for Senior 

Housing and Care Industry indicates that demand for long-term 

care services will more than double by 2040. 

Even with this high demand and rapidly growing need of the nation’s aging population, nursing homes have continued to improve 

quality. I am proud of the efforts and initiatives advanced by the 

association that I represent today and seek to enhance improved 

quality of care and services provided in our nation’s nursing facilities each day. 

I am here today to discuss the impact of predators in long-term 

care on small business operators. Reported problems involving sex 

offenders have been rare, but any incident is unacceptable, especially given the age and infirmity of those involved. Some have 

stated that there is a simple or easy solution to this very complex 

issue, but unfortunately that is just not the case. 

Providing long-term care and other health services for those who 

have any type of criminal past is a critical societal issue. Any solution must encompass not only health care providers and their patients, but also law enforcement and federal and state agencies. 

The basic question seems to be what and whose ethical and legal 

obligation it is to insure that individuals who have paid their debt 

12 

for prior criminal activity have their health care needs met as 

members of our society. When these individuals reach an age or exhibit physical condition or cognitive impairments that require longterm care services, where and how should their health care needs 

be met to insure everyone’s safety and security? 

As you are aware nursing homes provide a residential setting 

with 24-hour care and services for millions of individuals who require significant assistance dues to physical or mental limitations. 

It is critical for this Committee and others to understand that 

these facilities fulfill a necessary role caring for the frail, elderly 

and disabled who can no longer safely be cared for in their homes 

or communities. 

The most important aspect of determining appropriate services in 

any nursing facility patient, including security issues is the individual patient assessment. Currently a federally mandated assessment must occur upon admission to a facility in order to create an 

individual care plan for each resident that insures their clinical 

needs are met, as well as addresses any safety or security concerns. 

A resident who is known to have a criminal history, is known to 

be a registered sex offender may or may not require additional supervision or separation from the general facility population. An individualized care plan for a convicted criminal or sex offender in 

a persistent vegetative state would clearly be different from an ambulatory resident who has no criminal past but has exhibited behavioral issues. 

In 2006, the GAO issued a report on registered sex offenders in 

long-term care facilities. While the study focused on the issue of 

sexual offenders residing in nursing facilities, we were dismayed 

that the report stopped short of issuing any recommendation about 

the profession should address this issue. 

Presently in most states long-term care facilities are not notified 

by law enforcement officials of an incoming resident status as a sex 

offender or of their criminal background which prevents a facility 

of accurately evaluating the potential risk posed by the former sex 

offender as an individual basis. While the patient’s history may 

contribute to and alter the individual care plan, it is important to 

understand that even with the information about a patient’s criminal past, long-term care givers may be unable to deny admission 

when placement is court ordered. 

Also of note are the strict federal and state discharge requirements which may prevent the timely discharge of patients discovered to have a criminal past or, more significantly, be exhibiting 

behaviors that actually pose safety and security issues. 

Health care providers, government oversight agencies, and enforcement must come together whether on a state or national level 

to begin to address reasonable and appropriate solutions to this 

growing problem. AHCA is deeply concerned about the issue of sexual predators in nursing homes and will continue to work to insure 

all residents, family and staff are safe in their facilities. 

However, facilities can only do so much in the current system. 

A national database of sex offenders as well as a consistent and 

standard definition of the term need to be created. Policy makers 

and law enforcement also have a responsibility to provide clear 

policies for long-term care facilities to deal with this issue that adVerDate Aug 31 2005 15:36 Oct 21, 2008 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6633 G:\CLERK SB\HEARINGS\TRANSCRIPTS\42951.TXT RUSS
13 

dresses resident protection, as well as compliance with federal privacy laws. 

AHCA is committed to quality long-term care for all residents, 

and we are continually working to improve and enhance quality in 

all facilities. A collaborative effort between long-term care providers, Congress, and law enforcement is necessary to achieve the 

highest levels of safety for all residents. 

I would like to end my testimony today on a personal note. I 

have four family members living in our facilities right now, including my mother and wife’s grandfather. I live in the community 

where I was born, raised, and will be buried. Every day I help to 

take care of the people who helped raise, educate, and prepare me 

for life. I take the responsibility of caring them very seriously and 

I strive to provide the highest quality of care possible. 

Long-term caregivers have many employment choices, but they 

choose to come to work in our facility each day providing care to 

the frailest of our society. they are heroes of long-term care, and 

I entrust the care of my loved ones to them each day. 

Thank you for the opportunity to offer these comments on behalf 

of millions of professional, compassionate, long-term caregivers and 

the millions of frail elderly and disabled Americans they serve each 

day. 

I look forward to responding to your questions. 

[The prepared statement of Mr. Coble can be found in the appendix at page 45.] 

Chairman ALTMIRE. Thank you, Mr. Coble. 

Mr. McDonough, Mr. Sean McDonough is an attorney from Pennsylvania, and his law firm recently represented the victim of an assault in a nursing home, and in that case the court found that the 

nursing home was negligent in allowing a resident with a criminal 

background to be enrolled in the facility without notifying the residents or taking steps to protect their safety. 

Mr. McDonough is Board certified in child advocacy by the National Board of Child Advocacy and a member of the American 

Board of Child Advocates. 

Thank you for being here, Mr. McDonough. We look forward to 

your testimony. 

STATEMENT OF SEAN McDONOUGH, ESQ., DOUGHERTY, 

LEVENTHAL, AND PRICE, LLP 

Mr. MCDONOUGH. Good morning, Congressman Altmire, Ranking 

Member Fallin, and members and staff of the Committee. I have 

been asked to provide testimony this morning on the issue of the 

impact of predators on long-term care facilities on small business 

operators. As the Congressman noted, my firm, myself and my 

partner, Pat Dougherty, recently represented a woman by the 

name of Lilian Guernsey, who is now deceased, and her son Thomas Itterly arising out of two documented sexual assaults perpetrated upon Ms. Guernsey by 31 year old Daniel Statham. 

An overview of the circumstances surrounding Mr. Statham’s admission to the Country Living Personal Care Home demonstrate in 

graphic fashion the need for some legislation to assist small business operators in avoiding the myriad of problems associated with 

14 

accepting sexual offenders at their facilities without appropriate 

screening or consideration as to whether these individuals should 

be accepted into a setting where some of our most vulnerable citizens are placed for care. 

Steps need to be taken to insure that our elderly and infirm citizens do not suffer the type of violent attack experienced by Lilian 

Guernsey at the hands of Mr. Statham. 

Mr. Statham was 31 years old at the time he raped Lilian Guernsey. At the time that he arrived at the Country Living Personal 

Care Home, he had had eight prior adult arrests, three convictions,a dn two adult commitments to correctional facilities. In 1992 

alone, he had been charged with no less than 11 offenses, some of 

which were violent offenses and many of which he was not prosecuted for because he was determined to be incompetent to stand 

trial. 

However, in 1994, Statham was arrested in Lackawana County, 

Pennsylvania as a result of an assault on his girlfriend, and he was 

sentenced to serve one to three years in prison. Shortly thereafter, 

he pled guilty to a charge of aggravated indecent assault in northeastern Pennsylvania in Wayne County and was sentenced to serve 

three to six years in a state correctional facility. 

In that case Statham had taken a 13 year old girl into a wooded 

area and raped her. Statham refused to participate in a sexual offender treatment program during his period of incarceration, and 

as a result he maxed out his sentence, and this is where the case 

really becomes troubling. 

At the completion of Mr. Statham’s sentence, he did not provide 

the Commonwealth of Pennsylvania with an address where he 

could go. As a result of that, the commonwealth directed the State 

Police to take him to the Northumberland County Prison. At that 

time, the judicial system in Northumberland County brought 

Statham before the court and he was sentenced to time serve in six 

months’ probation. 

When the court made an inquiry as to whether that probation 

was in the mitigated range for the offense, the probation officer indicated, ‘‘I have no idea. We have no information on the defendant 

at all.’’ 

Therefore, Statham was permitted to leave the prison and taken 

first to the Omni One Personal Care Home and then Country Living without even a rudimentary presentence investigation having 

been performed. The order of court, which we have incorporated 

into the materials which we submitted for the consideration of the 

panel stated the following: ‘‘the court directs the defendant to take 

a bus to a halfway house in Scranton and to maintain his residence 

in Northumberland County.’’ 

It was established during Ms. Guernsey’s trial against Country 

Living that Northumberland County prison officials had notified 

the personal care homes, both personal care homes where Mr. 

Statham had resided prior to the rape that he had been sentenced 

for a violent sexual offense and that he was being released directly 

from a correctional facility. 

Lilian Guernsey was raped on February 27, 2002. My partner 

and I tried that case exactly four years to the date beginning on 

February 27 of 2006. The events of February 27, 2002 could have 

15 

been prevented if some initiatives, which Mr. Bledsoe has been proposing around the country, had been implemented. 

The sexual offender assessment report, which I have referenced 

in the materials provided to the panel, indicates in graphic detail 

the indignities visited upon Lilian Guernsey by Daniel Statham on 

that tragic evening. Lilian’s story needed to be told as to what occurred to her on that evening, and her victimization unfolded during the trial which occurred. 

After she was assaulted, Lilian returned to Memphis, Tennessee 

with her son Tom, and he cared for his mom in his own home as 

best he could, but she lived out her days in a nursing home outside 

of Memphis. Lilian Guernsey died within two months of the conclusion of the trial brought on her behalf against Country Living Personal Care Home. She was 90 years old at the time of her death. 

As a result of the attack on Lilian Guernsey, Daniel Statham 

was charged with rape, sexual assault, and indecent assault. He 

currently is serving an extended prison sentence at the state correctional institution at Camp Hill. 

As a final observation, I would suggest to the members of this 

panel would be very honorable work that you are doing here today, 

that some initiatives need to be in place by the time Daniel 

Statham is released from prison. 

Thank you. 

[The written statement of Mr. McDonough can be found in the 

appendix at page 50.} 

Chairman ALTMIRE. Thank you, Mr. McDonough, and thank you 

to all of the witnesses. 

We will now enter into the question and answer portion, and 

what we will do is a couple of rounds. I will ask a few questions 

and turn it over to Ms. Fallin and we will do it again. 

I wanted to start with Mr. Bledsoe, and we appreciate you being 

here with the expertise that you bring to the table on this issue. 

States have widely differing procedures regarding the issues that 

we’re discussing today, and I wondered if you had some recommendations on states in the country that we could use as a 

model that have taken a leadership role and taken steps to address 

this issue and were Congress to get involved on the legislative side, 

what states could we use to exemplify with regard to this issue? 

Mr. BLEDSOE. Thank you, Mr. Chairman. An excellent question. 

There are several recommendations that I have, some of which 

have been implemented by other states, and some have not. The 

biggest recommendation I have is to follow Oklahoma’s example. 

Representative Steele, Senator Tom Adleson from Oklahoma, ten 

percent of the legislators in Oklahoma co-sponsored this bill, the 

long-term care sex offender’s bill, House Bill 2704 in Oklahoma. 

That bill separating offenders from non-offenders is the most concrete legislation that we can do at the federal level and at each 

state level. It absolutely removes predators from their prey. So that 

would be my first recommendation. 

The second recommendation is we need to do criminal background checks on all residents coming into facilities. Illinois conducted criminal background checks on their residents, and while 

we had documented about 100 registered sex offenders living as 

16 

residents in long-term care facilities in Illinois, when they did 

criminal background checks, they found over 1,000 convicted felons 

were living in their facilities. 

So criminal background checks will answer a lot of questions and 

respond to some issues that Mr. Coble brought up about how we 

screen these people and how we decide what kind of levels of care 

do we need to be providing for them. 

Notification is an absolute necessity between the criminal background checks and until the time we have these secure long-term 

care facilities following Oklahoma’s example in place. 

Staff, residents, families, and visitors at these facilities absolutely need to know if there’s a criminal offender in the facility. 

Oklahoma is one of those states that has some of that notification. 

We would like to see more. 

We also need to make sure that crimes are being reported to law 

enforcement. Many of these crimes are never reported to law enforcement. There needs to be legislation to make sure that crimes 

are mandatorily reported to law enforcement when they’re found or 

suspected. There are statutes across the country for this, but they 

are relatively loose, and they need to be tightened up. 

Another recommendation is we need to absolutely track these 

criminal offenses that take place in long-term care. We need to 

track the offense, where it occurred. As well, we need to track the 

offender. When an offender commits a crime in a long-term care facility, if we haven’t already done a criminal background check, we 

need to do a criminal background check on that offender and see 

what kind of history they have. 

That way in the future as we move forward with this system, we 

can monitor, we can evaluate, and we can modify it accordingly. 

And then we should also look at video monitoring and make that 

an option for residents who want to have video monitoring in their 

rooms, and this way we can see who it is that’s been assaulting 

them and identify whether that’s a staff member, whether it’s a 

visitor, or if it is a fellow resident and who it is so that we can take 

appropriate action. 

Chairman ALTMIRE. Thank you. 

Mr. McDonough, in your lawsuit the court found that there were 

no reasonable attempts to create safeguards to protect residents. 

Can you identify some of the basic steps that nursing homes can 

take moving forward to address this type of problem? 

Mr. MCDONOUGH. I think, and I am sensitive, Congressman 

Altmire, to Mr. Coble concerns relative to the management of risk, 

and I think that the nursing home industry and the personal care 

home industry should aggressively look toward government. I know 

regulation is typically considered to be a bad thing, but in this particular instance it is a good thing. 

In our case, as I tried to highlight, unfortunately the criminal 

justice system and the court was essentially complicit in the victimization of Ms. Guernsey. It seems to me that the most appropriate 

step has to be very detailed reporting requirements with respect to 

past criminal history so that nursing home operators without unnecessary government interference can certainly have the tools 

available to them to make an informed decision as to whether or 

17 

not a particular individual is an appropriate candidate for their facility. 

So it would seem to me that particularly when someone is referred to a long-term care facility directly from the criminal justice 

system, as was the case with Daniel Statham, that the referring 

agency should have an affirmative obligation to specifically detail 

that individuals’ past criminal history. 

I think as a threshold that is a very minimum requirement that 

could be instituted. Now, in our particular case it was established 

that the owner of the facility did, in fact, or had been made aware 

of Mr. Statham’s background. So it was not quite as much an issue 

in our case, and it was one of the things that the court found to 

be particularly egregious about the home’s conduct. 

But there has to be knowledge on the part of the operators of 

these facilities as to the nature of the person’s prior offenses. 

Chairman ALTMIRE. So do you believe, Mr. McDonough, that 

state registries and background checks are adequate safeguards or 

you are recommending them as a minimum? 

Mr. MCDONOUGH. Well, there is certainly a minimum safeguard, 

and then there has to be some additional consequences for the failure to properly notify the personal care homes and the nursing 

homes about the person’s background. 

Here we had a breakdown in two separate probation departments, one in Wyoming County where the personal care facility at 

issue was located, as well as Northumberland County. So certainly 

the registration procedures for Megan’s law offenders in the Commonwealth of Pennsylvania, which is currently in place, needs to 

be enforced, and I think that federal congressional oversight of this 

issue is certainly warranted in light of the tragic consequences that 

have been documented before the panel this morning. 

Chairman ALTMIRE. Thank you. 

And I will give one more follow-up question to Mr. Coble and 

then we will turn it over to Congresswoman Fallin. 

You have heard what Mr. Bledsoe and Mr. McDonough and the 

other witnesses have said. What is the impact on the nursing home 

industry of this type of recommendation, a notification where everyone coming into the nursing home would be aware of the background of everybody else in the nursing home as it relates to this 

issue? What would that do to your industry? 

Mr. COBLE. Well, our industry certainly agrees, Mr. Chairman, 

with the need to be notified, and we don’t want to take anyone to 

any of our facilities who is danger to any of our residents, our visitors, our staff, anyone. 

We need notification. We need databases that are accurate. We 

do not need the courts ordering people into our facilities that are 

a danger to anyone. It is all based around assessment. 

I mean, if that person is in an end of life vegetative state it is 

one thing. If they are, as in some cases we have heard today, able 

to harm another person, they do not need to be there. 

And so our industry is for quality and safety. As I said, my mother lives there. I am not going to put anyone in one of my facilities 

that would harm my mother. 

The other thing that will be a challenge to our legislation in 

Oklahoma is federal privacy laws, as the Health Department starts 

18 

to build a framework around the legislation that was passed, and 

also some very strict federal regulations around discharge and 

transfers of residents who reside in our facilities. 

Many times we want to move residents from our facilities and we 

cannot do it because federal law prohibits us from being able to do 

that, and so it would be very helpful. You can do many things up 

here that would allow the legislation that passed in Oklahoma to 

advance. 

Ms. FALLIN. Thank you, Mr. Chairman. 

To follow up on your comment, Tom, about federal law prohibits 

you from transferring, can you explain that a little bit further? So 

if you know that you have an offender in your home, are you saying 

that you are prohibited from transferring them? 

Mr. COBLE. If we have someone in our home, whether it is a sexual predator or someone who has some really inappropriate behavior that could cause them to be a safety or a danger to another person, it is very difficult to transfer them. They have to be a danger 

to themselves or to others to the point that we cannot meet their 

needs or basically the fact that they are just not paying for their 

care. 

And so those are the only two circumstances for which, and then 

at that point in time it is very difficult to get them out because the 

Department of Human Services or the ombudsman intercede on 

their behalf, and we are not allowed to get rid of them. 

You know, the legislation that Representative Steele came forward with and championed, I mean, all parties sitting at this table 

were lock in arms in support of, and so we need a place that when 

we do identify them, that if as a small business owner it is causing 

concern and distress to family members, residents, staff, that we 

can then move that person to. 

Ms. FALLIN. Are there any challenges you see with Medicare or 

Medicaid as far as receiving federal government help to house 

these offenders, to be able to put them in a separate, stand alone 

facility like the legislation Oklahoma has passed? Do you see any 

type of hindrances that we need to address on the federal level of 

taking the federal money and using that for a stand alone facility 

to house these offenders? 

Mr. COBLE. I am not aware of any, but AHCA would be glad to 

provide you with that information. 

Ms. FALLIN. Representative Steele, do you know of anything we 

need to be addressing on the federal side? 

Mr. STEELE. Well, I would reiterate the fact that both Medicaid 

and Medicare are entitlement programs, and as I understand both 

of those programs, if a person qualifies, meets the eligibility criteria, then he or she is eligible for the funding for those long-term 

care services, and with the legislation that we are talking about 

today, this stand alone facility is a nursing home. It is not a prison, 

meaning that the residents in that facility would be treated just 

like other nursing homes. 

It would have stricter supervision, a higher level of surveillance 

and security, but the residents would still be free within that facility, and to date I am not aware of anything that would prohibit 

Medicaid or Medicare funding for individuals who may be placed 

in this particular facility. 

19 

Ms. FALLIN. Are there any changes that you see that the nursing 

home industry would need to be able to have this separate, stand 

alone facility in law? 

Mr. STEELE. Well, in Oklahoma, we are primarily a rural state. 

We are proud of that fact, and we have a lot of nursing homes in 

our state that are at or below capacity right now. So I think the 

idea for what we want to do in Oklahoma is to utilize an existing 

building for the operation of this. 

The industry would have to meet the additional security measures that the Department of Health will create as they continue to 

put together the request for proposals in order to qualify as a potential resident or potential provider for this facility. 

Ms. FALLIN. Sean, you talked about some of the legal issues. How 

do we address the privacy issue of the patients versus actually 

being able to get good, detailed information that Mr. Coble has said 

that he needs? How do we be able to balance the two? 

Mr. COBLE. Well, it certainly is a question of balance, but I think 

as I had indicated in my earlier remarks, first and foremost is to 

have an adequate criminal background check on the individual, 

and there are existing laws in place on the state level that require 

registration of particularly in the case of sexual offenders, and 

while I think there are other violent type people in these homes, 

the criminal background checks on these individuals for convicted 

offenses in my view do not implicate the privacy issues that exist 

with respect to health care records. 

Say if someone is diagnosed with some type of a mental illness, 

that is an issue separate and apart from the criminal background 

that many of these people bring to the facilities. So I do not see 

a privacy issue with respect to the criminal predators. 

With respect to violent tendencies as a function of mental disabilities, that is a different issue, Congresswoman, that candidly I do 

not have the answer to in light of the HIPAA regulations, which 

we all know are very stringent. 

Ms. FALLIN. I have one last question here for now. All of the recommendations that you heard from Mr. Bledsoe and also from—do 

you pronounce it McDonough? 

Mr. MCDONOUGH. McDonough. 

Ms. FALLIN. I am sorry. I mispronounced it earlier. 

Did you hear anything that you thought would not be reasonable 

as far as being able to implement some of those recommendations 

or would be cost prohibited? 

Mr. COBLE. Well, I think most of the changes in law really that 

give us the freedom to operate do not have a cost to them, but we 

feel that the criminal background checks should be done by law enforcement or state agencies and provided at a point where we can 

access them and look into them because they have access to the information and the ability to simulate that so that we can check 

against that. 

So outside of those things, no. 

Ms. FALLIN. Okay. Thank you. 

Thank you, Mr. Chairman. 

Chairman ALTMIRE. I wanted to ask Representative Steele a couple of questions about his bill. 

20 

You provide for the creation of separate nursing facilities for sex 

offenders, and I am interested in the cost of this. Is this something 

that you feel that there is adequate support in the nursing home 

industry that they would operate this independently and feel like 

they would be able to make money doing this and do it on their 

own, or is this something that you would need state or federal 

money or some other source to help fund? 

Mr. STEELE. That is a great question, and I appreciate the question. 

The idea at this point is to put together a request for proposal 

and allow the private industry to use an existing building so that 

there would be no money in new construction other than perhaps 

what it would take to bring the facility up to meet the heightened 

security and surveillance measures that the Department of Health 

would put forward. 

I want to reiterate what Mr. Coble has said in the beginning. We 

worked with the industry and with the advocates for a number of 

years to get to this point, and again, I think the idea is to not use 

any taxpayer dollars necessarily or any more additional money for 

sex offenders in need of long-term care. Rather, we want to try to 

identify a situation that can truly be a win-win situation, a win situation in reducing the risk associated with a very vulnerable population of people who are currently living in our nursing homes, and 

a win situation for those individuals who have served their time of 

incarceration, are registered sex offenders, may be prone to reoffend and in need of long-term care. 

Chairman ALTMIRE. Thank you. 

And on that same note, with the process Governor Henry recently signed the bill and you have passed it and enacted it now. 

Can you talk a little bit about any opposition that may have come 

up? Were there advocacy groups or for some group on the other 

side? What did you have to overcome as far as points against the 

legislation as it was moving through the process? 

Mr. STEELE. Well, with an issue like this as much as anything, 

it comes down to communication, and I think because we have been 

working on this particular issue for a number of years with people 

from the industry, people within the advocacy groups, and really 

tried to take our time and understand and communicate along the 

way, we have not experienced a whole lot of opposition because 

people seem to understand what we are trying to accomplish with 

this particular piece of legislation, and it has been truly a bipartisan initiative. 

I mean, without Governor Henry’s help, without Senator 

Adleson, who is a different party than myself, working and working 

hard for this particular legislation in the Senate, it would never 

have become a reality. But truly this is one of those issues that 

transcends party politics. It transcends the political minutia that 

sometimes we can get caught up with. It is an issue that is truly 

about helping people, and we feel like that we have at least come 

up with an idea that is a beginning point for accomplishing that 

goal. 

Chairman ALTMIRE. Thank you. 

I have no further questions. Congresswomen? 

Ms. FALLIN. Just a few more, Mr. Chairman. 

21 

If I could ask Ms. Banning, of all the recommendations that you 

have heard today, being someone who has had to deal with this 

personally, have you found these suggestions to be helpful to protect a senior like your mother, or are there further steps that we 

need to be taking? 

Ms. BANNING. This has probably been one of the most exciting 

days I have had to hear these suggestions. Wes and I have had dialogue over the last few years. He has told me proposals. I have 

done research on my own. 

My biggest concern, Ivy Edwards was found unfit to stand trial, 

put in a mental institution, was released in 2005 back into the 

nursing home. So he is out there again. He is 88 years old. Just 

a measure to prevent that from happening. 

A separate facility if these individuals are identified, a floor of 

a facility, a wing of a facility, to let the families—speaking as a 

family member, had I known that there was someone that could 

have caused harm such as Ivy Edwards to my mother, I would not 

have left her there for one day. 

I think that the families deserve to know. They have a right to 

know who is there. So background checks, a simple background 

check was done in a matter of minutes the detective told me and 

revealed the 59 arrests for Ivy Edwards, the last arrest being my 

mother’s. So letting the families know I think is imperative for 

peace of mind if nothing else. 

And having the staff know. We sued the nursing home. We prevailed and got a judgment for negligence. They had no idea; the 

jury had no idea of Ivy Edwards’ background. It was the behaviors 

that he exhibited while he was there. So I think if the nursing 

home had known up front what type of individual this was, I think 

that there would have been different measures taken to protect 

those that are there. 

Ms. FALLIN. Are you saying that Ivy Edwards is back in a longterm care facility? 

Ms. BANNING. The Attorney General for the State of Florida told 

a news reporter, Kelly Garlock, that when she was doing the investigation to find out if Ivy Edwards was still alive or if he was still 

in Chattahoochi, she was told that he was released in 2005, that 

he would never be competent to stand trial, and he was released 

back into the nursing home industry in the State of Florida. 

Ms. FALLIN. Have you had any contact with that long-term care 

facility? 

Ms. BANNING. I have checked every one I can find. I cannot find 

Ivy Edwards anywhere. 

Ms. FALLIN. Well, I hope you find him and you give them a heads 

up. 

Ms. BANNING. I hope I do, too. Yes, ma’am. 

Ms. FALLIN. I think that will be very important. 

If I could ask Representative Steele a couple more things, my understanding from the GAO report and from just the limited research that I have done, and you are the expert on this, but the 

GAO report did not identify any similar federal law for notifying 

facilities of sexual offenders like some of the states have. I know 

states have varying degrees of laws of notification on sexual offenders, but am I correct about that or is there a federal law that manVerDate Aug 31 2005 15:36 Oct 21, 2008 Jkt 000000 PO 00000 Frm 00025 Fmt 6633 Sfmt 6633 G:\CLERK SB\HEARINGS\TRANSCRIPTS\42951.TXT RUSS
22 

dates that facilities have to be notified of sexual offenders or people 

who might be of harm to the residents? 

Mr. STEELE. Congresswoman Fallin, it is my understanding there 

is no such federal law currently on the books. 

Ms. FALLIN. Do you believe that a federal law would be beneficial? 

Mr. STEELE. I do. I do think a federal law would be beneficial in 

requiring nursing homes to perform background checks on residents and also on all staff who may work within that facility. But, 

again, I think we need to take into consideration who pays for 

those background checks. 

The thing that we want to do is not hinder business, but rather 

help business, and I hope that what we have done in Oklahoma is 

we have provided an alternative place for offenders who need longterm care to go so that those businesses in Oklahoma who primarily care for the general population do not have a negative perception problem that their particular facility is unsafe. 

And I think that what we want to try to get to is the point where 

family and loved ones and the residents themselves have a peace 

of mind when they enter into a long-term care facility in our nation. 

Ms. FALLIN. Well, following up on that cost, who did the State 

of Oklahoma decide would pay that cost for notifying the long-term 

care facilities? 

Mr. STEELE. In 2005, I believe it is currently the responsibility 

of the nursing homes themselves, and that is an issue that probably needs to be revisited, but as of right now, it is incumbent upon 

the industry itself to provide those background checks. 

I will tell you at that time and I think still today, the industry 

in Oklahoma is very willing to do whatever they can do to make 

sure that they address a problem that may jeopardize the safety of 

their residents, and so they kind of stepped forward in 2005 and 

said, ‘‘Hey, we believe this is the right thing to do. We believe in 

it so much that we will go the extra mile and we will actually pay 

for those background checks ourselves in order to insure the safety 

of our citizens.’’ 

Ms. FALLIN. Mr. Coble, do you have any response to that? 

Mr. COBLE. Well, I just want to follow up on what Representative 

Steele has said. We in Oklahoma, and I think I can say this on behalf of the American Health Care Association, we want no one in 

our facility who is a threat or a harm to any resident, visitor or 

staff member, and also, the most important thing is we want peace 

of mind. 

I think Ms. Banning and what she was saying, families, we need 

to put this to bed so that we can take care of the frail elderly. I 

know we had a couple ladies who would call our house in Oklahoma three years ago when this issue was on the forefront being 

discussed, and they were worried. They lived in our assisted living, 

and they would call my home, and my wife would have to reassure 

them that we are doing the appropriate things and that we are not 

going to do that. 

But it is just a pressure on family members, and I am a provider 

and a family member both, and so I want to insure that everyone 

that we take care of is safe and we provide high quality care. 

23 

Ms. FALLIN. Mr. McDonough, do you think that having a stand 

alone, separate facility and using the Medicare/Medicaid money 

would be able to satisfy society’s needs to provide for infirm offenders as human beings? They do need to go somewhere. So is this a 

good alternative for them? 

Mr. MCDONOUGH. I believe that it is. I believe that is, Congresswoman Fallin. When Mr. Bledsoe and I first began to talk about 

the issue, that was one of the first questions that came to mind. 

Well, in terms of basic human needs, regardless of their past offenses against society, have to be taken care of, particularly not so 

much in the case of Mr. Statham as a 31 year old who could have 

resided independently, but for some of the elderly physicians, and 

I think mindful of Mr. Coble’s concerns, there will be a market, as 

it were, for the housing of these individuals because they have to 

go somewhere. 

And as I had said earlier, from the industry perspective of managing risk, facilities that are willing to take these people in at least 

will do so with their eyes open as to what they are facing and what 

additional safeguards need to be implemented to insure that these 

residents do not harm one another. 

But I think clearly market forces would certainly dictate that 

there is a place for these facilities in society and that they can, indeed, be profitable. So I think it is an appropriate alternative and 

a workable one at that. 

Ms. FALLIN. Mr. Chairman, that leads me to one last thought 

here, and I promise this will be it. 

If I could ask Representative Steele, you know, one of the biggest 

concerns in discussing these types of facilities is how do you pay 

for it, and so have you found in your studies that by the use of 

Medicare/Medicaid funds and the ability of the private sector market to adapt to be able to establish one of these facilities that it 

can be paid for in a reasonable manner for the State of Oklahoma 

or even the federal government? 

Mr. STEELE. Well, as I understand it, and I might want to defer 

to Mr. Coble to make sure I have my statistics correct, but about 

70 percent of our nursing home population is Medicaid eligible, 

Medicaid/Medicare eligible, and again, those are entitlement programs, and so if a person is eligible, they receive funding for those 

long-term care services regardless of their criminal history. 

And so ultimately it becomes a question of do we want to house 

these individuals who are sex offenders and who qualify for Medicaid or Medicare in with the general population or do we want to 

house them in a separate facility, and they would receive the funding no matter where we put them. It is just a matter of where do 

we need to put them in order to provide the protection that I think 

we are all in agreement here today that needs to be provided for 

our general population. 

And so I think that for the private sector, who is willing to designate a facility to house offenders, they would receive the funding 

just like they would if, say, that offender were housed somewhere 

else in a home that was not a separate facility. 

Chairman ALTMIRE. Thank you all for being here today. This is 

a very difficult subject to discuss, and we welcome any further 

feedback that you have to continue the discussion. 

24 

Mr. Steele, Mr. Bledsoe, Mr. McDonough, thank you for your advocacy and your tireless work on behalf of the victims. Mr. Coble, 

we realize that we put you in a very difficult position today as a 

representative of the industry to discuss what the industry has 

done while having to address the fact that some have failed within 

the industry, and we realize that it was a difficult position to put 

you in. Thank you for your testimony. 

Ms. Banning, we certainly realize that it is very difficult to discuss on the personal issue what has happened to you and what 

happened to your mother, and we regret that we had to ask you 

to come forward, but as Congresswoman Fallin said, we are going 

to make something good come out of what happened, and we just 

cannot thank you enough for being able to share the story and 

under very difficult circumstances come before us. Thank you. 

Thank you to everybody. 

I ask unanimous consent that members of this Committee will 

have five days to submit statements and supporting materials for 

the record, and without objection that is so ordered. 

And we will conclude the hearing. Thank you. 

[Whereupon, at 11:23 a.m., the Subcommittee hearing was concluded.] 

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