[Senate Hearing 107-105]
[From the U.S. Government Publishing Office]
S. Hrg. 107-105
SAVING OUR SENIORS: PREVENTING ELDER
ABUSE, NEGLECT, AND EXPLOITATION
=======================================================================
HEARING
before the
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
JUNE 14, 2001
__________
Serial No. 107-8
Printed for the use of the Special Committee on Aging
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74-685 WASHINGTON : 2001
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SPECIAL COMMITTEE ON AGING
JOHN B. BREAUX, Louisiana, Chairman
HARRY REID, Nevada LARRY CRAIG, Idaho
HERB KOHL, Wisconsin CONRAD BURNS, Montana
JAMES M. JEFFORDS, Vermont RICHARD SHELBY, Alabama
RUSSELL D. FEINGOLD, Wisconsin RICK SANTORUM, Pennsylvania
RON WYDEN, Oregon SUSAN COLLINS, Maine
BLANCHE L. LINCOLN, Arkansas MIKE ENZI, Wyoming
EVAN BAYH, Indiana TIM HUTCHINSON, Arkansas
THOMAS R. CARPER, Delaware PETER G. FITZGERALD, Illinois
DEBBIE STABENOW, Michigan JOHN ENSIGN, Nevada
JEAN CARNAHAN, Missouri CHUCK HAGEL, Nebraska
Michelle Easton, Staff Director
Lupe Wissel, Ranking Member Staff Director
(ii)
C O N T E N T S
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Page
Opening statement of Senator John Breaux......................... 1
Statement of Senator Larry Craig................................. 3
Statement of Senator Debbie Stabenow............................. 26
Statement of Senator Herb Kohl................................... 29
Panel I
Stuart E. Schiffer, Acting Assistant Attorney General, U.S.
Department of Justice, Washington, DC.......................... 4
Panel II
Sara C. Aravanis, Director, National Center on Elder Abuse,
National Association of State Units on Aging, Washington, DC... 31
Joanne Hopper, Fruitland, ID..................................... 44
Dr. Laura Mosqueda, Director of Geriatrics, University of
California, Irvine, CA......................................... 49
Paul R. Greenwood, Deputy District Attorney and Head, Elder Abuse
Prosecution Unit, San Diego, CA................................ 58
Ricker Hamilton, Protective Program Administrator, Department of
Health and Human Services, Bureau of Elder and Adult Services,
Portland, ME; on behalf of the National Association of Adult
Protective Services Administrators............................. 65
APPENDIX
Statement by the National Indian Council on Aging................ 87
Testimony by the Social Services Block Grant Coalition........... 90
Statement from the American Bar Association...................... 98
Recommended Guidelines for State Counts handling cases involving
elder abuse.................................................... 101
(iii)
SAVING OUR SENIORS: PREVENTING ELDER ABUSE, NEGLECT, AND EXPLOITATION
----------
THURSDAY, JUNE 14, 2001
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The committee met, pursuant to notice, at 9:34 a.m., in
room SD-562, Dirksen Senate Office Building, Hon. John B.
Breaux (chairman of the committee) presiding.
Present: Senators Breaux, Kohl, Stabenow, Craig, and Burns.
OPENING STATEMENT OF SENATOR JOHN B. BREAUX, CHAIRMAN
The Chairman. The Committee on Aging will please come to
order.
As my first act in this position with the gavel, I want to
thank Senator Craig for his great leadership. There has never
been a committee that has worked in such a bipartisan fashion,
because there are no Democratic or Republican positions on
Aging; it is the committee. We have had that type of
relationship and will continue that type of relationship in the
future so that we can go about the business of paying attention
to the subject matter with which this committee is charged, and
that is the condition of our Nation's senior citizens.
Today's hearing is entitled, ``Saving our Seniors:
Preventing Elder Abuse, Neglect, and Exploitation.'' I think it
clearly reflects the charge of this committee to improve the
quality of life of all of our older Americans.
We all recognize that the quality of life is not just how
long we live, but also how well we live in our later years, and
we truly understand, I think, that the quality of life depends
on, among other things, access to affordable transportation and
housing and nutrition and appropriate health care services. But
we also know that improving the quality of life of our seniors
also means that we cannot allow conditions to exist that
compromise the health and safety of our Nation's seniors, and
to make sure we do everything we can to eliminate the potential
for abuse of our Nation's seniors.
During a recent hearing, this committee heard testimony
indicating that an astounding 95 percent of all long-term care
in this country is not provided by institutions or professional
caregivers but by family members in the home. That is good
news, and it is also bad news in the sense of the burden that
it puts on families who are charged with caring for their
senior family members.
Many times, these families do not have adequate training,
do not have adequate financial wherewithal, do not have the
means to handle the extra burdens that are put on their
families as they attempt to care for their loved ones.
In many cases, family caregivers are so overwhelmed by the
extra duties that they themselves have difficulties and
problems, and sometimes their problems affect the seniors that
they are charged with taking care of. Often, these problems go
unnoticed and unreported, and therefore unsolved.
Victims of abuse, neglect, and exploitation are often
unable to speak for themselves. Therefore, it is important that
those of us in Government who have access to the means to make
sure that these problems do not go undetected are aware of the
seriousness of these problems.
I want to also point out that this hearing reflects the
good work of Senator Craig in putting it together in his former
capacity as chair of the committee. The entire hearing today
was structured by him and his staff, and we credit them and
recognize them for that accomplishment and continue to look
forward to the good working relationship that we have.
I recognize Senator Craig now for any comments that he
might have.
[The prepared statement of Senator Breaux follows:]
Prepared Statement of Senator John Breaux
As my first official act as Chairman of the Senate Special
Committee on Aging, I would like to thank Senator Craig for his
leadership of the committee during the past several months and
to express my sincere appreciation for the bipartisan way in
which he has guided the committee's work. The issues that
affect our older citizens are truly issues on which we find
common ground and I am certain that we will continue to go
forward in the same spirit of bipartisanship that has become
synonymous with the Special Committee on Aging.
I would also like to thank Senator Craig and his staff for
their initiative in putting this hearing on our agenda and for
their hard work in preparing for the hearing. While I have the
good fortune today to be presiding as Chairman, much of the
credit for bringing this important issue to the attention of
the Senate and the nation should go to Senator Craig.
Today's hearing, ``Saving our Seniors: Preventing Elder
Abuse, Neglect and Exploitation,'' clearly reflects this
committee's goal of improving the quality of life of older
Americans. We recognize that quality of life is just as
important--if not more so--as length of life and we truly
understand that one's quality of life depends, among other
things, on access to affordable transportation and housing,
adequate nutrition and appropriate health care services. But we
also know that improving the quality of life of our seniors
includes eliminating those conditions that may compromise their
safety or endanger their lives. That issue is the focus of our
hearing today.
During a recent hearing this committee heard testimony
indicating that an astounding 95 percent of all long term care
is provided informally by family members or community-based
caregivers--a fact that is both good news and bad news. On a
positive note, most of our seniors are cared for in their homes
and community-based settings. With that care however, we shift
most of the physical, emotional and financial burdens to
families who may not have adequate resources to provide that
care or to strangers who may not have substantial interest in
providing quality assistance. In some cases, family caregivers
become overwhelmed by these circumstances and neglect or
unintended abuse may occur. Other cases may involve individuals
who purposely target seniors for acts of intentional abuse or
exploitation. Far too often, these problems go unnoticed and
unreported. The victims of abuse, neglect or exploitation are
often unable to speak on their own behalf or may have no
alternative sources of care. The purpose of today's hearing is
to bring awareness and credibility to this problem and to give
the members of this committee an opportunity to hear victims of
elder abuse and their advocates speak about the causes of these
problems and possible means for alleviating this abuse.
STATEMENT OF SENATOR LARRY E. CRAIG
Senator Craig. Mr. Chairman, thank you very much.
I want the record to show that I appreciate the flexibility
and the cooperative effort with which John and I have worked on
the whole effort of keeping this very important committee on
track.
John is right--this hearing was well underway when the
transition occurred, and thanks to him and his staff, they
picked it up and worked with us to continue it and to shape it,
because we think it is so important that this aspect of the
whole universe of senior care and senior life be recognized.
I want to thank our witnesses for being here this morning,
and a very special thanks to Joanne Hopper of Fruitland, ID. If
you understand Idaho, you would say, ``Oh, that is just down
the road from Payette,'' and Payette is my home town. So we do
appreciate Joanne being here, and I want to thank her for her
courage and her willingness to come to Washington to share her
story with us.
Today we will shed light on an insidious aspect of elder
abuse that remains largely hidden below the surface of public
awareness--the abuses that tragically occur in non-
institutional settings, including the elder's own home.
The physical and emotional consequences of elder abuse can
be devastating. There is ample evidence indicating that abuse
shortens lives and can even end the life of a vulnerable
victim. Because we are serious in our commitment to promote
secure independent living for our seniors, we must address this
difficult issue. No one should live in fear of being abused or
mistreated--no one--not a child, and not a senior.
It is important to emphasize that these cases are not just
isolated incidents. National statistics indicate that 470,000
cases of elder abuse were reported to authorities nationwide in
the year 2000. Over 2,100 of those cases were reported in my
home State of Idaho the same year. Perhaps more disturbing is
the fact that these statistics represent maybe one in five
cases reported to State and local officials.
These challenges facing us in fighting elderly abuse are
formidable. Our investigations have revealed that State efforts
to address these situations are often ineffective. The
perpetrators are seldom prosecuted and front-line responders
often lack the training needed to adequately address the
problem. Various Government agencies all too often fail to work
in a collaborative and focused manner.
Today we seek to determine how existing State and Federal
efforts might be enhanced to promote a more collaborative and
multidisciplinary approach for resolving some of these complex
cases.
Existing Federal resources can and should be targeted
toward providing more technical training and assistance in the
collaborative identification, investigation, and prosecution of
crimes perpetrated against the elderly.
The DOJ recently awarded the State of Idaho a Stop Violence
Against Women Grant. I would like to see a similar opportunity
for States to apply for grants specifically related to elder
abuse prevention.
John, thank you again for convening the hearing. This issue
has been ignored for far too long by everyone, and I hope that
today we can begin to shed light on and maybe begin to help
shape existing resources at the Federal, State and local levels
to step forward in the stopping of this form of abuse.
Thank you.
The Chairman. Thank you, Senator Craig.
Are there any other comments from committee members? [No
response.]
If not, we would like to welcome our first witness, the
Acting Assistant Attorney General, since I think almost
everyone over there is in an acting capacity except the
Attorney General.
Mr. Stuart Schiffer will talk about the Justice
Department's role in elderly abuse and prevention and
prosecution.
Mr. Schiffer, thank you for being with us.
STATEMENT OF STUART E. SCHIFFER, ACTING ASSISTANT ATTORNEY
GENERAL, U.S. DEPARTMENT OF JUSTICE, WASHINGTON, DC
Mr. Schiffer. Thank you, Mr. Chairman. Good morning,
Senator Craig, members of the committee.
I very much appreciate the opportunity to be here today.
With the chair's permission, I will submit my prepared
statement for the record and simply make a few general
observations and then take any questions.
The Chairman. Without objection.
Mr. Schiffer. We continue to be grateful for the leadership
role which this committee has consistently had in dealing with
issues of elder abuse and victimization. These issues certainly
are not new; they are, however, being brought into ever sharper
focus, and they need to be brought into ever sharper focus by
population changes and other factors.
As the committee knows, these demographic shifts are
startling. It is estimated that the number of American citizens
over age 65 is going to more than double from the present
number of approximately 34 million to 70 million in 30 years.
None of the issues that we deal with is new. We all
confront these issues not simply as public officials, but in
our own family and personal lives. Elder abuse and elder
justice issues can take many forms, and not surprisingly, those
citizens who are most vulnerable to physical and psychological
abuse are equally vulnerable to financial exploitation and many
other areas that we have to deal with.
At present and in the future, the real leadership in
dealing with these issues will continue to come at the State
and local levels. At the same time, as I attempted to outline
in my written statement, we in the Federal Government have a
variety of tools available to us, such as civil enforcement and
criminal statutes and financial assistance in the form of
formula and discretionary grants of the type Senator Craig
referred to.
We have found that as we continue to enhance our own
coordination within the Department and with other Federal
agencies, principally the Department of Health and Human
Services but others as well, in applying our resources, we
equally increase our ability to provide training and guidance
to State and local governmental entities and to the host of
private social service and related entities, many of which are
represented here, such as AARP, for example, whose efforts are
vital. There are myriad numbers of private sector agencies that
work in this area, and we really owe it to them to enhance
their own training and to coordinate their efforts with those
that governments can provide.
Again, my written statement mentions a number of the
training programs and symposia which we have either hosted or
participated in. Those of my colleagues and I who have worked
most of our time in the litigation arena I think tend to focus
more on problems than we do on successes, and I do think it is
important even as we deal with these often horrible problems,
that we recognize that there are large numbers of dedicated
providers of services and caregivers while at the same time, we
continue our efforts to deal with those who abuse our older
citizens.
I would be happy at this point to answer any questions.
[The prepared statement of Mr. Schiffer follows:]
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The Chairman. Thank you, Mr. Schiffer, for that summary of
your testimony.
Let me just try to get an understanding of how the
Department of Justice works in these areas of elderly abuse. Is
there a section over there that specializes in that, or under
what assistant secretary is this activity pursued?
Mr. Schiffer. These issues are so broad in their dimension
that they really cut across areas within the Department. We
have efforts underway in the Civil Division where I reside, in
the Civil Rights Division, the Criminal Division, and the
grant-makers in the Office of Justice Programs.
What we have tried to do, and I think we are succeeding in
doing in recent years and certainly are continuing to do, is to
coordinate those efforts. We have appointed nursing home
coordinators, for example, who try to bring together the
resources of the entire Department.
The Chairman. If you had it spread out in the Civil
Division, the Criminal Division, and I think you said the
fraud--or, the Civil Rights Division----
Mr. Schiffer. That is correct.
The Chairman. So you have three different divisions, I take
it, looking at problems with seniors. Has anybody ever thought
about whether it would make sense to have one, single senior
coordinator who oversees this instead of having it in three
different buildings where they probably do not talk to each
other very much?
Mr. Schiffer. But we do talk to each other; we talk to each
other more and more, and I think there have been very healthy
coordination efforts going on. There is real expertise in these
areas that sometimes cuts across not just elder abuse but child
abuse and domestic violence, and I think there is something to
be said for continuing to have this multidisciplinary focus as
long as there is coordination taking place.
The Chairman. So if I didn't know what you just told me,
and I was a new Member of Congress, and I decided to call the
Justice Department, and I said, ``I want to talk to the person
who the chief protector of seniors in this country,'' whom
would I talk to?
Mr. Schiffer. If we were dealing with nursing homes,
certainly we would put you in touch with our nursing home
coordinator.
The Chairman. Suppose I want to talk to someone who has
been the subject of telemarketing fraud; where would I go?
Mr. Schiffer. You could always call me, Mr. Chairman. I
would be glad to take your calls.
The Chairman. I understand that, but what I am trying to
figure out is if there is not a better way to coordinate this
kind of activity, and instead of having it in three different
divisions--and I am not being critical; it has probably been
like this for decades--I am just saying would it not be an idea
that should be pursued to have a single coordinator of programs
to look at and prosecute and coordinate activities dealing with
senior problems.
Mr. Schiffer. I am certainly not suggesting, Mr. Chairman,
that there are not better ways to do it and that we should not
explore those ways. We will continue to do so, but I think we
really do need to be able to call on the expertise that exists
in various components of the Department, and we are doing a
remarkably better job when you talk about telemarketing
efforts, for example, within the Criminal and the Civil
Divisions in bringing those cases.
The Chairman. Is the major responsibility in this country
for dealing with senior abuse and fraud a State matter or a
Federal matter?
Mr. Schiffer. As I said in my opening remarks, I think the
State and local government officials will always have the
leadership role. We do pursue these cases. Our jurisdiction
tends to follow Federal funds, for example, where Medicare and
Medicaid funds have been at issue. There is much that we can
do, but I think we can also do much with respect to training
and education of State and local officials.
The Chairman. Tell the committee a little bit about--we
spend $270 billion a year on Medicare in this country and a
substantial amount on Medicaid, and much of it covers
nursing homes, for instance, and institutional care--tell us
how cases of abuse in nursing homes, for instance, are handled.
If someone knows about abuse in a nursing home, where is the
first stop? Is it the U.S. Attorney, or is it the local
sheriff? Who prosecutes people who are mistreated in
institutions in this country?
Mr. Schiffer. People should be free to go either to the
local U.S. Attorney or to State and local officials hopefully
to get a response in either of those areas. We bring such cases
on the civil side, to recover funds, to seek the appointment of
monitors and other forms of injunctive relief to bring nursing
homes into compliance, and we bring criminal prosecutions. But
we are never going to cover the entire waterfront.
The Chairman. Is there some kind of memorandum of
understanding between State Attorneys General and the United
States Department of Justice with regard to how these
prosecutions are to be handled, or is there sort of a catch-as-
catch-can procedure?
Mr. Schiffer. Most of those understandings are worked out
at the local level between a local United States Attorney and
his State and local officials, because we find that our U.S.
Attorneys tend to have close relationships with the State and
local officials.
The Chairman. So there is no official memorandum of
understanding as to how that is to be handled that you know
about?
Mr. Schiffer. I do not know about something of that order.
The Chairman. Do you think that would be helpful?
Mr. Schiffer. It may sound trite to say it; I think
flexibility is often helpful as well, though. I think that
local circumstances differ greatly; the resources of our U.S.
Attorneys differ. And I still prefer to see those matters
worked out in that fashion, provided they are worked out and
provided they are effective.
The Chairman. Is there any area that you are concerned
about that seems to be slipping through the cracks as far as
enforcement is concerned?
Mr. Schiffer. I think I could name almost any area and say
that we have to be concerned about it. Certainly at this stage,
we cannot appear here and say that these problems are being
fully addressed.
The Chairman. But there is no area that stands out as more
of a problem or a greater problem than any other?
Mr. Schiffer. I would have said, obviously, nursing home
abuses, but I certainly cannot disagree with both your opening
statement and Senator Craig's when you point as well to
problems with even family caregivers that are rampant.
The Chairman. Thank you very much, Mr. Schiffer.
Senator Craig.
Senator Craig. Stuart, thank you for being here. I think
Senator Breaux in his line of questioning has demonstrated that
while the issue is important, it covers a broad category or
scattered areas within DOJ and that there is not, if you will,
a collective, organized, central point at which you deal with
these issues.
That is very reflective of our experience in Idaho. I
mentioned 2,100 cases last year--but that is after a concerted
effort to educate and train and cause to understand prosecutors
to have some ability at the county level to even be able to
cope with it or identify it. And we could not go to the Justice
Department for that training. I am told that in my State, we
had to outreach to other States that had developed a level of
expertise on their own; that there was no one within the
official legal community who could offer that kind of training
to prosecutors.
Therefore, as you know well, if prosecutors cannot be
secure in what they are doing and have a base of knowledge from
which to identify whether it is a bruise that is a result of
falling or a bruise inflicted by a caregiver, or have people
who can help identify that as we now have developed some
expertise in the area of child abuse. Then they will walk away
from those kinds of things. If there is not the ability to
track a financial transaction that may strip an individual
elder or senior of his or her property, then, there is tendency
to step back from that.
I have a couple of questions for you, Stuart. Does current
law provide sufficient flexibility for DOJ to target funds
addressing the problem of elder abuse even in the absence of
specific line item appropriation?
Mr. Schiffer. I think it is always difficult to draw lines
between the desire, frankly, of the Congress on the one hand to
provide formula grants, and on occasion to earmark funds, and
the need for flexibility. I think that until we are satisfied
that we are fully using the tools we have available, I am not
in a position today to propose, for example, legislation. But
there is always a need for flexibility as we learn more about
the area, as we increase our own training efforts. We have ways
of dealing even with areas like formula grants, where money is
mandated by statute to be given out according to a certain
formula. The acting assistant Attorney General for our Office
of Justice Programs, for example, recently wrote a letter to
the State formula grant administrators urging them to pay
careful attention to areas of elder abuse and target funds
whenever possible in these areas.
So we do try to maintain maximum flexibility within some of
the constraints that we have.
Senator Craig. Is there need for more flexibility,
specifically designated by Congress in the appropriations
process?
Mr. Schiffer. I suspect that those who administer, for
example, grants would always say they could use more
flexibility. I am not sure that I am in a position to specify
right now.
Senator Craig. What does DOJ do to provide training and
grant money to entities addressing the problem itself? You had
mentioned some reference to--is there an effort or has there
been an effort to present a program within which training can
be identified and States and their legal systems can utilize
it?
Mr. Schiffer. If you had asked me that question 5 years
ago, I think I would have had to tell you that we are really
just at a beginning stage. Those efforts are growing. We have
put on regional symposia, for example, for State and local
officials, private sector officials. We have trained about
1,000 officials in some of our programs. We need to do more,
and we are going to continue to do more.
Senator Craig. Does DOJ's website make any reference to
elder abuse and any listing of grants or programs that might be
utilized for the purpose of addressing this problem?
Mr. Schiffer. Given my own lack of computer literacy, I
have difficulty discussing websites, but I am told that our
website is there and that our website needs to be enhanced, and
that is something that we are going to concentrate on.
Senator Craig. So it probably does not.
Mr. Schiffer. It does make reference; it needs to be
updated and made more thorough.
Senator Craig. Could a task force similar to the Bureau of
Justice Assistance Telemarketing Fraud Task Force be created
for elder abuse that might assist in both prevention and
prosecution?
Mr. Schiffer. We do have task forces in that area. We do
not have the full equivalent of the task force you mention,
where I think there are specific funds appropriated for that
purpose. I know that anybody who appears before you says we
need more funds. I am constrained in my ability to----
Senator Craig. What I am asking is--more funds are going to
be difficult to get; they always are--is there a way to reshape
what we have and for Congress to give direction to the Justice
Department to reshape some of what we have and to be able to
offer those kinds of programs out to the States in this area,
and is there a way to build with current abuse identification
education programs an elder component or a senior component
which would allow a broadening of that training experience by
local prosecutors and law enforcement?
Mr. Schiffer. I think ``yes'' is the short answer. We are
looking for ways to enhance our efforts. I think we are doing a
much better job, and we need to work specifically with this
committee and its staff to see that we bring our resources to
bear in a more efficient manner.
Senator Craig. Mr. Chairman, Stuart, thank you.
The Chairman. Thank you.
Senator Kohl.
Senator Kohl. Thank you, Mr. Chairman. With your
permission, I will yield to Senator Stabenow, who has to leave
shortly.
The Chairman. Certainly.
Senator Stabenow.
Senator Stabenow. Thank you, Senator Kohl, and Mr.
Chairman, thank you for providing this important hearing, and I
apologize for running in and out this morning. I am trying to
be in two places at once, as we often try to do.
I did want to ask, however, to submit for the record
comments about this area and particularly note that Citizens
for Better Care in Michigan have been designated as a national
model for prevention and education. They do a train the trainer
program, and as Senator Craig was speaking about those issues,
I would just urge that you look closely at what is being done
in Michigan, because there is an excellent training program
that is occurring, and we appreciate very much what is
happening in Michigan. So I would appreciate being able to
enter that in the record.
Thank you, Mr. Chairman.
The Chairman. Thank you. Without objection, it will be made
part of the record.
[Statement of Senator Stabenow follows:]
Prepared Statement of Senator Debbie Stabenow
I would like to thank the committee for convening this
hearing on the extremely important topic of elder abuse. This
is a difficult problem to quantify. For example, it is
estimated that only 1 in 14 cases of domestic elder abuse ever
come to the attention of authorities. The State of Michigan
issued a report last December entitled, ``Elder Adults at
Risk.'' According to the report, 9,000 adults received services
from the state as the result of reported elder abuse. However,
this number only represents a fraction of the abuse that
experts believe is happening in our state. As our population
ages and individuals live longer lives and spend more time in
the care of others, it is sad fact that the incidence of elder
abuse has the potential to increase substantially.
Michigan has a wonderful elder abuse prevention and
education program, run by Citizens for Better Care, which has
been listed as a national model by the National Ombudsman
Resource Center. As we know, the Older Americans Act mandates
that Area Agencies on Aging address elder abuse issues and in
my state the majority of our agencies have contracted with
Citizens for Better Care to meet that requirement. As an aside,
I would like to pitch that increased funding would be very
beneficial and would only strengthen our program not just in
Michigan but programs across the nation, as well.
In Michigan, Citizens for Better Care offers a ``Train the
Trainer'' program under the skilled leadership of Anne Marie
Koebel. Nursing homes, adult day care programs, home health
agencies and other interested groups send one of two members of
their staff to the training program and then they take what
they have learned back to their colleagues. This sharing of
information has proven to be very successful. The program
defines elder abuse according to State law, examines the
reasons that it occurs and offers viable solutions for
preventing abuse. I am so pleased that such a model program
exists in my state.
I also think we need to pay increased attention to domestic
elder abuse. Some elder abuse is the continuation of a long-
standing pattern within a family of domestic violence and I
think that elder abuse should be a part of any debate on
domestic violence. Other types of elder abuse often are the
result of stressed or ill family members who are not equipped
with counseling our support to care for their loved ones. The
National Family Caregiver Program, the topic of one our
previous hearings, is an excellent way to get services to these
families who need help.
Another issue that merits attention is variance from state
to state in their definitions of elder abuse. For example, some
states include financial exploitation in their definition,
others do not. It would take careful analysis, but I think it
would be helpful to examine the usefulness of a national
minimum definition of elder abuse to help clarify the issue.
I look forward to the testimony of all the witnesses and I
am very interested in working with the committee to find
solutions for this national problem.
The Chairman. Senator Burns.
Senator Burns. Thank you, Mr. Chairman.
I went through a situation with one of my aunts in regard
to a telemarketing scam. I also had a mother who was in a
nursing home.
Mr. Schiffer, your hands are kind of tied unless you get a
complaint. It is my experience talking to nursing homes and
talking to elderly who are in nursing homes or in home care or
even in the care of their own families, that if they have been
abused, they will not say anything. They are afraid to. And
that is where we find most of our problems occur, when people
are either afraid to admit or are afraid that they will be
further abused if action is not taken.
We are finding that nursing homes in small towns are
struggling for the right kind of personnel, the ability to pay
them for the work that they do, and it creates an environment
where abuse happens. It even happens within families.
Can you tell me as a person who follows this dilemma that
we have with our elderly how much abuse occurs, for example, in
a care facility and also under the care of the family?
Mr. Schiffer. First, I think the Senator is certainly
correct--there is consensus that crimes affecting the elderly
are underreported and perhaps more so than in many other areas.
I attempted in my opening remarks to make clear that there are
many honest and decent providers and caregivers out there. The
percentage, though, with respect to nursing homes is a matter
of great concern. We sometimes see reports that in as many as
half of the individual nursing homes, there are instances of
abuse and neglect.
Senator Burns. But what is the percentage--do you also get
complaints when a person is under the care of a family or
staying in the family home? Do you get those kinds of
complaints as well?
Mr. Schiffer. Those are probably the hardest matters to
have brought to the attention of law enforcement authorities. I
think the major effort and the effort of this hearing today is
to focus people on the need to report these.
We have similar experiences with domestic abuse. Those were
always things that were thought to be private, things that
should not be reported, and I think there is growing awareness
in this country, frankly, that these are very, very serious
issues that need to be dealt with.
Senator Burns. Let us say I am in a skilled care facility,
and I think I am being abused, and I pick up the telephone and
call the sheriff. What happens?
Mr. Schiffer. There should be State regulatory authorities
dealing with these problems. Something should happen. People
should look into these promptly, and they should be brought to
the attention of either law enforcement or State regulators.
Senator Burns. Does the sheriff turn it over to another
agency in the State or in the country for prosecution or
investigation?
Mr. Schiffer. We find that that differs widely from
jurisdiction to jurisdiction. Just as our own Federal lines are
sometimes less than clear, the same is true in State and local
areas.
Senator Burns. Well, I think this is an important hearing,
and why I think it is important is not that I do not think we
need more laws, but this is an awareness thing that we want
people to step forward without fear so that if they think they
are being abused, they can report it, and the abuser can be
dealt with in a proper fashion.
If we look at our nursing homes now, even in the medium
areas, but especially in rural areas where nursing homes tend
to be smaller and it becomes very difficult to get good help,
that creates a situation where abuse does take place. But they
are also reluctant to report for the simple reason that they
cannot find the people.
Mr. Schiffer. Well, the Senator is correct. You alluded a
few moments ago to telemarketing, where it tended to be an
embarrassment; when an elderly citizen was victimized, even to
the extent that the citizen realized that he or she had been
victimized, it was an embarrassment. We see there, for example,
growing awareness. We see efforts by organizations like AARP.
We have vastly increased the number of cases that we are
bringing. Recently, for example, in the last several years, we
have started bringing cases in Canada, where we see
telemarketers located in Canada preying on elderly American
citizens, aware that the Canadian authorities, just as is true
in this country, have limited resources and are less likely to
be able to apply those resources where Canadian citizens are
not involved, and we have brought four or five cases against
telemarketers there.
Senator Burns. Let me tell you how I finally got my old
aunt to admit. We kept finding receipts where she was wiring
money to somebody in Atlanta, GA. Now, this lady lived in
northwest Missouri, and every time I could go by to see her,
there would be more receipts there. I asked her about those
receipts, and she just would not talk about it. I mean, she
would just clam up. I also asked her if she knew anything about
her grandfather, who was my great-grandfather, and she asked,
``What do you want to know about that for?''--I think he was a
crook or something, although I am not real sure--he rode with
Jesse James.
Senator Craig. A horse thief.
Senator Burns. Well, yes. He rode with Jesse James. That is
pretty good.
Anyway, I will tell you that the FBI in their magazine had
an article about telemarketing scams. So I took that magazine,
opened it up to that article, and left it at her house when I
left one day. And the next time I visited a couple of weeks
later, she finally said we have a problem.
I had called the district office in Saint Joseph, MO, and
we got these guys--we nailed them. So that is what you have got
to do. But I will tell you that it takes somebody who really
wants to get in there, and it takes a nephew, or a niece, or a
son, or whatever, once you set your satchel down, because the
elderly person is not going to admit it and will not cooperate,
because they find it embarrassing--and then, some of them are
so lonely that that is the only phone call they get, and they
have found a friend, and if it costs 100 bucks, it costs 100
bucks. But they got this aunt of mine for $125,000--and my
Lincoln--no. So I am telling you it is something that is a real
problem.
So the point is that the family or some interested member
is going to have to take it under their wing and carry it out,
because your hands are tied until you get a complaint; those
complaints are very, very difficult to get, and once they are
received, they are very difficult to handle with our elderly.
So I think, John, this is a very, very important hearing,
but it will be more to elevate awareness of some things that go
on with our aging population. So I thank you for that.
The Chairman. Thank you, Senator.
Senator Kohl.
Senator Kohl. Thank you, Mr. Chairman.
Mr. Schiffer, in 1998, Congress gave home health care
agencies and nursing homes the ability to use the FBI criminal
background check system to weed out potential employees with
criminal histories. In February of this year, the Department of
Justice issued a report that found that so far, 7 percent of
those background checks have come back with serious criminal
convictions, including such things as rape and kidnapping.
Unfortunately, too few providers are using this tool, in
part because they do not know about it. What is the Department
doing about informing providers that there is such a system to
be used?
Mr. Schiffer. This is certainly a very serious area. We
have established, and we have, I think, very productive monthly
Nursing Home Steering Committee meetings in the Department,
attended by not only components of the Department, but the
Department of Health and Human Services. We are reaching out to
the extent we can to the State regulators, to our own inspector
general at HHS, and trying to deal with the very, very serious
staffing problems, both understaffing and the failure to report
that the Senator mentioned.
Senator Kohl. Maybe you did not quite understand what I was
saying. I was saying that there is a tool that can be used,
which is the FBI background check system. Is there a reason why
we would not like to see or could not insist or could not be
sure to let every provider know that there is such a system
that they can access to determine whether potential employees
have background problems?
Mr. Schiffer. There is no reason why we should not be doing
that, and I will see that we redouble our efforts to do that.
Senator Kohl. It would seem to me that the first line of
defense in this problem is to weed out those potential
employees who obviously should not be employed because they
have problems in their past, and if the FBI is there to help us
do it, and if we are really serious, which I know we are, about
trying to keep these people off the payrolls to begin with, it
seems to me that the FBI background check is a great place to
start.
Mr. Schiffer. The Senator is certainly correct.
Senator Kohl. Thank you.
[The prepared statement of Senator Herb Kohl]
Prepared Statement of Senator Herb Kohl
Thank you, Mr. Chairman. I appreciate your holding this
hearing on this very important, but tragic, topic of elder
abuse.
There is absolutely no excuse for abuse or neglect of the
elderly at the hands of those who are supposed to care for
them. Our parents and grandparents deserve to live out their
days with dignity and the highest quality care.
Unfortunately, we know this is not always the case. I know
that the majority of caregivers are dedicated and do their best
under difficult circumstances. But too often, the elderly are
starved, shamed, abused, and exploited. And the systems that
are in place today are not enough to protect them.
Later today, I along with Senator Reid, will reintroduce
the Patient Abuse Prevention Act. This legislation is a first
step to prevent Elder Abuse by long-term care workers--
including home health agency workers.
Specifically, my bill would create a National Registry of
Abusive Long-Term Care Workers, which will prevent abusers from
moving from state to state continuing to find work with
vulnerable patients. Second, it requires an FBI criminal
background check to prevent people with violent criminal
convictions from working with vulnerable patients.
There is clear evidence that this is needed. In 1998, at my
request, this Committee held a hearing on this issue. The HHS
Inspector General presented a report which found that, in the
two states they studied, between 5-10 percent of employees
currently working in nursing homes had serious criminal
convictions in their past. They also found that among aides who
had abused patients, 15-20 percent of them had at least one
conviction in their past.
But even more compelling, we heard from Richard Meyer of
Libertyville, IL, whose 92-year old mother was raped by a
nursing home worker who had a previous conviction for child
sexual abuse. A criminal background check could have prevented
this tragedy. But even more appalling, there is nothing in
current law that prevents her assailant from travelling 50
miles to my home town of Milwaukee and finding another job in a
home health agency.
There's no greater illustration of the need for background
checks than this. But for those who need hard data, there is
more evidence. In 1998, I offered an amendment which became law
that allowed long-term care providers to voluntarily use the
FBI system for background checks. So far 7 percent of those
checks have come back with criminal convictions.
Clearly, this is a critical tool that long-term care
providers should have--they don't want abusive caregivers
working for them any more than families do. My legislation
won't prevent all instances of elder abuse, but it is a common-
sense first step we can take to protect our seniors.
Again, I thank you, Mr. Chairman, for holding this hearing.
With the aging of our nation, we cannot afford to ignore the
issue of Elder Abuse, wherever it occurs. I look forward to
hearing from our witnesses.
The Chairman. Thank you very much, Senator Kohl.
Thank you, Mr. Schiffer. I wish you well in this endeavor.
It is very, very important, and this committee is going to stay
in touch with the Justice Department as to how we handle these
areas, and we want to work with you to improve the quality of
service.
Mr. Schiffer. We very much want to do that, Mr. Chairman,
and we look forward to doing so.
Thank you.
The Chairman. Thank you.
The Chairman. I would like to welcome a panel now that will
consist of Ms. Sara Aravanis, who is Director of the National
Center on Elder Abuse located here in Washington; Dr. Laura
Mosqueda, who is Director of Geriatrics at the University of
California in Irvine, who will discuss her professional
experiences in the area of elder abuse; Mr. Paul Greenwood, who
is Deputy District Attorney and Head of the Elder Abuse
Prosecution Unit in San Diego and has prosecuted more than 600
cases of elder abuse; and our final panel member will be Mr.
Ricker Hamilton, who is Protective Program Administrator for
the Department of Human Services in the State of Maine and is
representing the National Association of Adult Protective
Service Administrators.
Senator Craig, I understand you have someone from Idaho you
might want to present.
Senator Craig. Yes. We are very pleased, as I mentioned in
my opening comments, Mr. Chairman, to have Joanne Hopper with
us this morning from Fruitland, ID. She has a very unique and I
think important story to tell this committee.
Please come forward, Joanne.
The Chairman. We welcome all of you, and we have listed
first Ms. Sara Aravanis.
Ms. Aravanis, please.
STATEMENT OF SARA C. ARAVANIS, DIRECTOR, NATIONAL CENTER ON
ELDER ABUSE, NATIONAL ASSOCIATION OF STATE UNITS ON AGING,
WASHINGTON, DC
Ms. Aravanis. Good morning. This hearing is a welcome event
for the field of aging. Many years ago, Claude Pepper was the
national spokesperson on elder abuse. We miss his consistent
and tenacious attention to the problem. We hope that you, Mr.
Chairman, and the committee will help our Nation address what
some have called ``the dark side of aging'' in this country.
I represent the National Center on Elder Abuse, which is
funded by the Administration on Aging, NASUA. The National
Association of State Units on Aging is the lead agency. We have
five partner organizations that bring special capacity and
skills to our work.
Our mandate is broad. We provide research, training, and
technical assistance for all direct service professionals. We
educate the public, foster research, promote coordination, and
disseminate good practices. Our accomplishments include an
award-winning website; a list-serve of 700 members; technical
assistance manuals; a leadership institute; special support for
State and local Elder Abuse Coalitions; a Native American
Project; and training sentinels to find hidden cases.
Every day, we strive to be the source of information and
assistance on elder abuse.
Elder abuse is not a new issue. In the seventies,
congressional investigations and field researchers uncovered
the problem and gave it a name--``granny-bashing.'' In the
eighties, following the child abuse model, mandated reporting
emerged in State law, and during that decade, the Family
Violence Network acknowledged elder abuse as part of the
picture. Also, OBRA called for nursing homes to be abuse-free.
In the nineties, abuse definitions were included in The
Older Americans Act. The new Title VII started funding
education and prevention activities, and a National Nursing
Home Abuse Prevention Initiative was launched.
Although there are many other significant events, the
history of the problem is connected to the aging population
shift and the lack of a national long-term care policy.
Through adult protective services, States have the heaviest
financial and programmatic burden for responding to elder
abuse, but Older Americans Act programs, elder abuse
prevention, the ombudsman, and legal assistance play a
significant role. Coordination with other Federal resources is
necessary.
Several charts have been prepared to illustrate the
problem. The first graph shows the steady increase in the
number of reports over a 10-year period. Last year, more than
470,000 reports were made--a 300 percent increase over the base
year of 1986.
Almost half of the reports were about self-neglect. About
one-quarter of them involved physical abuse. Other categories
include caregiver neglect, financial exploitation, emotional
and sexual abuse.
It is very much a family issue. Adult children, spouses,
and other family members are the most frequent abusers. Formal
caregivers are also involved.
Moving to the ``iceberg'' chart, it shows that most of the
cases simply are not reported. For each case referred to adult
protective services, there are four additional cases out there,
hidden from view and hidden from those who can offer
assistance. And this data presented here does not even include
reports of abuse in nursing homes and other facilities. The
Long-Term Care Ombudsman Program received over 18,000
complaints of abuse, gross neglect, and exploitation in nursing
and board-and-care facilities in 1999.
This too is only part of the picture. Data from Medicare
fraud agencies, State licensure and survey, law enforcement is
missing.
The elder abuse field is at a great disadvantage because
there is no vehicle to collect and analyze information across
agencies and funding streams. Further, in both domestic and
institutional settings, it is likely that many incidents are
hidden, not reported or identified at all. This lack of data
makes it difficult to fairly allocate resources for elder
abuse.
In addition to the concerns about data, there is a long
list of issues facing the field of elder abuse. They include
public recognition that abuse occurs; adequate funding for
adult protective services; the difficulty of establishing
cross-agency multidisciplinary interventions; assuring that
serious cases are indeed prosecuted, that all components of the
law enforcement, justice, and health care systems are
effectively trained to work with adult protective.
More research is needed on causes and preventive
strategies. We need access to experts in complex financial
abuse cases.
Finally, we need to identify and fill the gaps in services,
the community-based interventions necessary to prevent and help
victims.
What can the committee do? First, the committee could
develop a joint resolution and establish a ``National Elder
Abuse Prevention Week.'' This would encourage Governors to
follow suit and spearhead many collaborative State and local
activities.
Second, the committee could offer its support for restoring
funding for the Social Service Block Grant, an important
resource for adult protective services.
Third, additional funding for The Older Americans Act,
Title VII, the elder abuse prevention activities, could be used
to develop more collaborative interventions at the State and
local level.
Finally, later this year in collaboration with AOA and the
Department of Justice, the Center will convene a National
Policy Summit on Elder Abuse. National experts will develop an
action agenda, a road map for addressing many of the most
serious problems. We hope the committee will play a part in
this summit and in the implementation of its recommendations.
On behalf of the partner organizations comprising the
National Center on Elder Abuse, we congratulate you, Senator
Breaux and Senator Craig, for having this hearing, and we look
forward to working with you on the challenge of elder abuse.
Thank you.
The Chairman. Thank you very much, Ms. Aravanis. We
appreciate your being with us.
[The prepared statement of Ms. Aravanis follows:]
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The Chairman. We would like to hear next from Joanne
Hopper. Thank you very much for being with us.
STATEMENT OF JOANNE HOPPER, FRUITLAND, ID
Ms. Hopper. Thank you for having me.
My statement is on power-of-attorney abuse and caregiver
abuse, two issues.
I had a massive heart attack and realized that I was going
to have to have power-of-attorney because I was incoherent. I
selected my son, who had always been an excellent kid,
trustworthy and so on. I thought everything was fine, and all
of a sudden, they asked if they could move into my home.
They built an addition on, and before it was finished, they
left it, because they could not get along with the builder.
However, they had used my signature for the loan because he had
power-of-attorney. They also had chalked up a lot of bills.
They had somebody come in and get me up in the morning and put
me to bed at night. I wondered how they were paying for it--
well, I was paying for it.
They mortgaged a home I had in town. I just could not
figure out how somebody could go into a bank and sign my name
and walk out with $34,000 and not be accountable.
Anyway, they have completely and totally wiped me out
financially. If I have to go to the grocery store to buy
groceries, there is not a cent for me to do that. I have been
eating Meals-on-Wheels.
It has been turned over to the prosecuting attorney, and so
far it is just being considered a misdemeanor. I cannot
understand. I am yelling, but nobody is hearing me, so I am
going to yell some more.
Then I had caregiver abuse. I had to get a caregiver
because the kids moved out. One day, I had to discuss a
situation that was kind of against her grain, and she was very
mad, got me up from a nap and sat me in this scooter that I am
sitting on. She used a belt around my waist to transfer me from
the bed or to the scooter or wherever, and that got caught on
the armrest, and I was over like this--and I have an internal
pump, because I have MS--it was caught, and my feet were all
under, and she just flat up and left me that way.
I waited, and waited, and waited, and she did not come
back. I carry a phone with me, and it was really hard--like an
hour--for me to get the phone. Finally, I got it, called the
operator--because my hands are curved, it is hard to dial--and
called a friend to come and get me. She did, and we called
adult protection--it just happened that I knew of adult
protection through an attorney that I had; otherwise I would
not have known about adult protection, and I think that that
should be advertised--to see if I could get a new caregiver.
They could not get me a new caregiver, so a friend of mine
is still helping me every day, and if things do not change, I
will probably have to go to a nursing home in a month or two.
Hopefully, things will change, but we just do not know.
I do not want to be a ward of the State. I had never
planned on being a ward of the State, ever. I had enough money
to last forever, but I guess mom's money was not too bad after
all. It is really sad.
On power-of-attorney, I think there should be more than one
person signing when that money needs to be used for whatever
the person needs.
On the caregiver issue, really, that is just a hard
situation. I do not know what to do. But you guys are smart.
The Chairman. Ms. Hopper, thank you so much. The committee
really appreciates your coming, and we thank Senator Craig for
making the arrangements for you to be with us and tell your
story. It is a tragic story, and we apologize that it happened
to you, but I think that by your telling it, it helps us look
for solutions so that it does not ever happen again.
[The prepared statement of Ms. Hopper follows:]
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The Chairman. We have a vote that has just started, but I
think we can hear from Dr. Laura Mosqueda. So if you would like
to go ahead and give your statement now, Dr. Mosqueda, we will
hear it.
STATEMENT OF DR. LAURA MOSQUEDA, DIRECTOR OF GERIATRICS,
UNIVERSITY OF CALIFORNIA, IRVINE, CA
Dr. Mosqueda. Good morning, Senator Breaux, Senator Craig.
Thank you for inviting me. I am very grateful for the
invitation.
My name is Laura Mosqueda. I am a family physician and
geriatrician at the University of California, Irvine, UCI,
where I am the Director of Geriatrics and an associate
professor of family medicine.
While I have one foot in academics, my other foot is
planted firmly in the trenches, which allows me to see that we
have great needs in the areas of research and education, but we
have very urgent needs in the area of care for individuals who
are affected by abuse.
I am the principal investigator of a project funded by the
Archstone Foundation, where we have formed a medical response
team for our local county, Orange County in California, for
elder abuse.
Our team responds to requests from Adult Protective
Services, the district attorney's office, and law enforcement
agencies to help them look at medical aspects of elder abuse.
At this point, we have been involved in over 100 cases, and I
have done many dozens of house calls with APS workers, looking
at possible abuse cases.
We are about halfway through this 3-year project right now,
and there are a few points that I would like to share that our
team is learning as we go along.
One is that APS workers are often doing a very heroic job
at low pay for the degree of training they have and the work
they are doing, and they have no medical backup whatsoever on a
regular basis.
We have learned that geriatricians and psychologists or
psychiatrists can and should be integral members of an elder
abuse multidisciplinary team.
We have learned that police officers and detectives are
often frustrated in dealing with the elderly. They have
received little training; they do not know what to do when they
are trying to interview a person who may be a victim and who
suffers from, say, dementia or severe depression, or somebody
who has trouble with hearing or vision, leading to a
frustrating experience for all involved.
We have learned that physicians are terrible at detecting,
documenting, and reporting elder abuse.
I have also learned that our system of response to elder
abuse is fragmented and sporadic and truly inadequate. I think
that in our level of understanding of elder abuse, we are
probably 20 years behind that of child abuse. We know little
about prevalence and incidence, risk factors, markers. As one
of the other Senators mentioned earlier, how do we know when we
can distinguish a bruise that has been caused by an accident
from something that was inflicted? The same goes for issues
like malnutrition, pressure sores; so many of the diseases that
are common in the elderly can either mimic or mask markers of
elderly abuse. And we know little about the consequences of
elder abuse.
We have a great opportunity to learn from our colleagues in
child abuse and the domestic violence arenas to understand what
models have been successful so that we do not have to reinvent
the wheel. We can take those models and see how they can be
modified and applied to elder abuse.
I am sure that we will find that the causes of elder abuse
are just as complicated and multifaceted as the solutions will
be.
There are some agencies and organizations that have begun
to take action in the area of elder abuse. The National
Institute on Aging recently commissioned a panel from the
National Academies to help set a research agenda in the area of
elder abuse. The Department of Justice has sponsored a forensic
roundtable on this issue. The American Geriatric Society of
which I am a member has now incorporated elder abuse into its
core lecture series, and there is the beginning of an interest
group within the organization.
But as you know, there are not enough geriatricians to go
around in the country, and there is even a smaller subset
interested in elder abuse.
As recommendations come forth from these different panels,
agencies, and organizations, there will need to be new funding
to implement the recommendations. I think Congress should make
every effort to understand the financial cost of the problem as
it currently stands--how much did it cost in the examples that
we have heard about to have to go and look at nursing home
care? How much is this costing Medicare and Medicaid when we
are not catching it at an earlier phase or preventing abuse
from happening to begin with?
I think your timing for holding these hearings is
excellent. You can capitalize on a growing interest across the
country. It is amazing to me that we see a few pilot projects
popping up here and there across the country, spearheaded by a
variety of professionals, spearheaded by APS supervisors,
police officers, prosecutors like Mr. Greenwood, health care
providers--and all of us really have one common motivation. We
know that elders are being victimized, and we know that our
current system is failing them.
I very much appreciate your insight and courage in holding
these hearings. I think it is important for your leadership to
bring this topic to the attention of Congress and to the
attention of our Nation as you have done with other important
issues for seniors. We need your leadership to develop a
coordinated, comprehensive legislative approach and funding
that support the research, education, and service needs.
Thank you.
The Chairman. Thank you very much, Dr. Mosqueda.
[The prepared statement of Dr. Mosqueda follows:]
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The Chairman. We have two recorded votes going on now on
the Senate floor, so the committee will take a short recess,
probably 10 minutes or so, and then come back to complete the
testimony of the panel.
The committee will stand in recess.
[Recess.]
Senator Craig [presiding.] Thank you all very much for your
patience. The committee will reconvene.
Chairman Breaux, because of the length of the vote, had to
go on to another engagement, so in the bipartisan fashion in
which we enjoy operating this committee, we will proceed.
Let me turn now to Paul Greenwood, Deputy District Attorney
and head of the Elderly Abuse Prosecution Unit in San Diego.
Paul, welcome to the committee. Please proceed.
STATEMENT OF PAUL R. GREENWOOD, DEPUTY DISTRICT ATTORNEY AND
HEAD, ELDER ABUSE PROSECUTION UNIT, SAN DIEGO, CA
Mr. Greenwood. Thank you, and good morning, Senator Craig.
It is a real honor to be invited to speak here.
I have the privilege of heading the Elder Abuse Prosecution
Unit in the San Diego District Attorney's Office since January
1996. My boss, Paul Pfingst, probably was a visionary back
then, when he felt that it was important to devote resources in
this area.
I have to confess, Senator, that when I was asked to do
this job in January 1996, I had never heard of the term ``elder
abuse'' and did not really know where to begin.
But over the last 5\1/2\ years, being, like Dr. Laura
Mosqueda here, basically on the front line of the trenches, my
eyes have been opened, and if there is one thing that I would
urge you to take back to your fellow Senators on this
committee, it is that I believe this issue is one of the top
three issues of crime in this country in the next 5 years, and
it is only going to escalate and get worse.
Just by way of example to show you that I am in the
trenches, last Friday, I was prosecuting a case involving a 73-
year-old female in a residential facility. She has a mental age
of 7, and she was sexually assaulted by a male employee of that
facility who is currently on active felony probation for child
molestation.
That is the kind of case that we grapple with on a daily
basis, Senator.
In 1996, I prosecuted 17 felony cases. In 1997, it went up
to about 37; in 1998, to 75; in 1999, to 97; and last year, we
did 124 felony cases of either physical or financial elder
abuse. This current year, we anticipate well over 200 felony
case.
Now, I am not proud of those statistics, and I believe that
they are just the tip of the iceberg in the County of San
Diego. But I think it demonstrates that much of the negativity
that seems to surround the prosecution of elder abuse is a
myth, and we have been able to demonstrate through the lessons
learned from domestic violence and child abuse prosecutions
that these cases can and should be investigated and should be
prosecuted.
You mentioned that in your home State of Idaho, there were
2,100 cases last year. I would imagine that probably fewer than
40 of those cases were prosecuted.
So we have got to do a lot more, but I think it is at the
grassroots-level, Senator, where this is going to happen, and I
am grateful to you for bringing out Joanne from your home State
just to give us all a sense of what is going on in the
communities.
There are four things that I can basically share from the
years I have had prosecuting these cases as being lessons that
we have learned.
First, no agency knows every answer, and we have benefited
from a multidisciplinary approach. We meet very regularly with
Public Guardian, county mental health, adult protective
services--and I cannot sing their praises enough; they are so
underappreciated in this country, and people just do not know
what they do. We have heard about child protective services,
but people need to know more about what adult protective
services does. We meet with them; we meet with paramedics,
fire, police, sheriffs, and the medical community. This is the
way to go, and I think prosecutors have a wonderful opportunity
to be the catalyst in the local counties to actually bring
these agencies together.
Second, we have got to encourage every elected prosecutor
who runs either a county prosecutor or a district attorney's
office in municipalities in the major towns and cities of this
country to designate at least one prosecutor in that office to
be what we call a vertical prosecutor in the area of elder
abuse.
Sure, these cases are sometimes complex, are sometimes very
difficult, but because we have trained prosecutors to know how
to prosecute child abuse and domestic violence cases, it does
not take much more to train prosecutors in the area of
prosecuting elder abuse.
Dealing with areas of competency--how do I prove a case
where my victim is suffering from severe dementia or
Alzheimer's or stage 5 Parkinson's--there are ways around it,
and getting vertical units I believe is the way to go.
Third, we need to develop a national training program for
first responders of elder abuse. Every line of police and
deputy sheriff, every paramedic and every firefighter in this
country needs to have a course on elder abuse training and
awareness. So many cases are going undetected, Senator, when
paramedics and firefighters and even police officers go into a
home and simply fail to recognize that if you leave an elderly
widow in her bed with feces and urine and bedsores, that is a
crime. They are trained not to look at it as a crime yet. We
have got to teach our first responders about that issue.
Fourth, we have got to look into the area of legislation. I
agree with the Senator who was here earlier this morning in the
sense that we do have sufficient laws pretty much, but there
are some areas that we can develop.
First, we can develop tougher laws on background checks for
all employees and care providers for seniors in this country so
that the case I just described will never happen again.
Second, we need to extend the group of mandated reporters
who are obliged by law to report these cases.
And there is a side issue--I think we need to sit down with
the financial institutions of this country and make them far
more aware of their responsibilities to the elders and seniors
of this country, because so many financial abuse cases start in
the banks and in the credit unions and do not get reported as
being suspicious, and they need to do that.
If I may just take a couple more minutes of your time, I
think we need to provide mandated training for all first
responders. I think we also need to provide the judges of this
country with courses in sensitivity to deal with cases
involving elderly victims that come into their courtrooms.
Finally on that issue, I think that we need protection for
civil attorneys in this country to allow them the freedom to
report cases of suspected elder abuse where their own clients
are being abused. I know of many civil attorneys who wrestle
with this problem of confidentiality, and they would like to
call me and tell me that they feel they are violating the
ethics of confidentiality even though they know that their own
client is being unduly influenced and exploited by somebody
else.
So I am heartened and encouraged, Senator, by the fact that
you have spearheaded this hearing today. I hope this is the
start of something nationally. I must convince you, though,
that this is grassroots-level. It starts in the counties of
this country where local law enforcement and county prosecutors
sit down and grapple with these issues, and it can spread from
there.
Thank you.
Senator Craig. Paul, thank you very much. Your testimony is
extremely valuable.
[The prepared statement of Mr. Greenwood follows:]
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Senator Craig. Now let me turn to Ricker Hamilton, who is
the Protective Program Administrator, Department of Human
Services Bureau of Elder and Adult Services in Portland, ME.
Please proceed.
STATEMENT OF RICKER HAMILTON, PROTECTIVE PROGRAM ADMINISTRATOR,
DEPARTMENT OF HEALTH AND HUMAN SERVICES, BUREAU OF ELDER AND
ADULT SERVICES, PORTLAND, ME; ON BEHALF OF THE NATIONAL
ASSOCIATION OF ADULT PROTECTIVE SERVICES ADMINISTRATORS
Mr. Hamilton. Thank you. Good morning.
It is an honor to be speaking with you, and thank you for
your invitation, Senator Craig. I would like to submit my
written testimony for the record.
Senator Craig. It will be made a part of the record. Thank
you.
Mr. Hamilton. I am a board member of the National
Association of Adult Protective Services Administrators, or
NAAPSA, as we are known. As a volunteer, nonprofit
organization, our membership consists of senior administrator
of State Adult Protective Services.
APS are those services provided to elderly and disabled
adults who are in danger of abuse, neglect, or exploitation and
who are unable to protect themselves and have no one to assist
them. Most of these victims are unable to ask for our help.
Reports of elder abuse, neglect, and exploitation are
increasing dramatically, but not the budget for Adult
Protective Services. It is estimated that in the United States,
2 million older persons and persons with disabilities are
abused each year. Sixty percent of the abusers are family
members who isolate and intimidate their victims.
The American Academy of Family Physicians reports that ``We
are losing our elders to an epidemic rarely talked about or
even acknowledged; an epidemic that leaves some ashamed, some
afraid, and too many dead.''
With minimal resources, APS programs all over the country
have struggled to develop quality services for our most
vulnerable adult citizens. Although great strides have been
made by APS, we cannot possibly meet the increasing demand and
complexity of the needs facing our clients without Federal
leadership and resources.
I would like to also call your attention to the photos on
the side of the room, which highlight some cases, but I would
also like to review some cases investigated by APS.
In Louisiana, a 75-year-old woman was found wandering in
front of her home and admitted to a hospital. The emergency
room physician found that she suffered from diabetes, moderate
dementia, and was missing four of her toes. The woman had been
living with her daughter in an extremely unsanitary house with
37 dogs and 10 cats. It appeared that the dogs had chewed off
the victim's toes.
Louisiana State law allows for the prosecution of elder
abuse without the testimony of the victim. However, the judge
dismissed charges filed against the daughter when the district
attorney said that the victim was ``too upset to testify.'' In
Maine, an 88-year-old woman was financially exploited by her
two nieces. After becoming her guardian and conservator, the
nieces sold her home, her car, and everything else that was
important to her. They divided the proceeds and continued to
steal her monthly pension from out of State, utilizing an ATM.
The Department of Human Services became her public guardian
and removed the nieces as guardian and conservator. The local
district attorney's office refused to prosecute but promised to
do so if the public guardian received judgment against the
nieces from probate court.
After a year of advocacy, a judgment was secured. The
district attorney, however, refused to prosecute. The attorney
general's office took the case, and both nieces were
prosecuted. One niece received a 6-month jail sentence.
Restitution is part of their probation.
In Nebraska, Adult Protective Services received a report of
a 53-year-old woman with developmental disabilities who had
been physically and verbally abused by her brother. A witness
saw the victim's brother yell at her, slap her across the face,
and drive away, leaving her lying in a fetal position on the
ground. The APS investigation found that she had been
physically abused by her brother for several years. The victim
thought that if she told anyone, she would have no place to
live. She had also been financially exploited by the brother as
he was the payee for her Social Security checks; he had used
the money to support his drinking habit.
The person who witnessed the abusive action would be
willing to testify, but the county attorney refused to
prosecute because the victim does not make a reliable historian
and would not make a good witness.
The very limited funds available through The Older
Americans Act, $4.7 million, are used primarily for elder abuse
prevention and education. In other words, Older American Act
funds are not used to support APS services in the States. Nor
does this program address the needs of thousands of younger
disabled persons, those under age 60, who are also victims of
abuse, neglect, and exploitation.
The Social Services Block Grant is the only source of
Federal funding that specifically provides funds for the
delivery of adult protective services. SSBG has been reduced
over the past few years from $2.8 billion to $1.7 billion, more
than a $1 billion cut in these critical funds. And I understand
that S. 501 is aimed to restore SSBG funds to $2.38 billion.
Last year, the U.S. Department of Health and Human Services
reported expenditures of $4 billion to serve abused children.
The Violence Against Women Act received approximately $200
million. Of the Federal funding available for victims of abuse,
93.3 percent goes to child abuse, 6.7 percent to domestic
violence, and only .08 percent to elder abuse.
Child protective services, domestic violence agencies and
related services need this level of commitment, but the
contrast with funding available for APS is indeed stark and in
fact troubling.
NAAPSA has made a number of recommendations, including:
restore SSBG funds to $2.38 billion; earmark SSBG funds for
protective services, including adult protective services;
develop consistent definitions of abuse, neglect, and
exploitation; provide seed money for an automated data
collection system to develop national statistics, similar to
the seed money provided to child protective services; develop
model enabling legislation for APS to combat the abuse of our
elderly and persons with disabilities--there currently exists
tremendous inconsistency among States, resulting in unequal
protection under the law; provide funding for research efforts;
encourage model programs and community partnerships; and
finally, quantify the link between financial exploitation and
the resulting high costs to public programs like Medicaid.
Sadly, we all know the personal devastation.
In closing, our current generation of older victims has
raised their families, made numerous sacrifices, endured
hardship, and have done so much for America. Now too many of
them are being abused. They need our help, they deserve your
attention, and they have earned the right to be safe in their
older years. The true measure of our society will be how we
treat those who have spent their lives doing for others.
Thank you.
[The prepared statement of Mr. Hamilton follows:]
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Senator Craig. Ricker, thank you. Both you and Sara
mentioned the importance of the block grant and the flow of
money out of that to these kinds of protective services and
educational programs, and our effort to restore that is
underway. But it is my understanding that only 31 States use
SSBG funding for elderly abuse prevention and adult protection
efforts, and it seems to me that maybe we ought to place focus
at the local level of encouraging States to review elder
protection as a funding priority.
Either of you might respond to this if you would. If States
are not using SSBG funding to assist elder abuse prevention,
why not? Why aren't they in some instances?
Ms. Aravanis. Thank you, Senator, for that question.
I know that many States come through with their own State
and local resources in order to fund adult protective services
as well.
I think the other part of that dilemma is that it is a
limited pot; there are many draws against that pot, and there
are many priorities that are kind of bumping elder abuse and
adult protective services out of the way.
It is always a challenge to try to spread that limited
resource across all the needs, and it is very difficult for us
in the elder abuse arena to say take money from child
protective and give it to adult protective. It is a very
difficult thing to do. But it is just clear that there are
inequities in the extent to which this resource is available
for elder abuse.
Senator Craig. Any additional comments on that?
Mr. Hamilton. I think it is crucial that elder abuse
victims and younger persons with disabilities who are being
abused, neglected, or exploited be identified as a priority
group. Whether we are talking about domestic violence funding,
where the shelter system is set up for younger women and
children, APS programs get older victims of domestic violence.
We need to identify that older victims deserve the same
attention and deserve the same response from our State, local
and Federal level that child abuse victims, younger women and
children in domestic violence, and in fact in some cases, elder
abuse victims have less as far as resources, less as far as
laws and regulations, than some of the humane laws to protect
our animals.
Senator Craig. Thank you.
Joanne, a very special thanks to you for being here today
and sharing with us your tragic experience--and it is certainly
that. I hope that the prosecution of it proceeds to your
benefit.
Can you tell us about adult protective services' response
to the allegations that you were being abused and exploited?
Ms. Hopper. When I called them, they came immediately. They
also called the police, and there was a police report made. It
has been handed over to the prosecuting attorney, but so far,
nothing has been done. I am sure it is going to be a
misdemeanor.
Senator Craig. And you think it will be a misdemeanor in
spite of the fact that it nearly wiped out your finances?
Ms. Hopper. Completely, totally--like $200,000.
Senator Craig. Maybe it was you, Ricker, or possibly you,
Paul, who mentioned that at the bank level, there needs to be
greater accounting and relationship understood between the bank
and the person bearing the power of attorney and a cross-
referencing. Was it you, Paul, who mentioned that?
Mr. Greenwood. Yes. I feel very strongly about that.
Senator Craig. And here, we have an example of that, it
appears, where the son was given power of attorney, and no
questions were asked until the resources were depleted.
Mr. Greenwood. That is correct. And that is exactly what I
am finding, Senator. In fact, I prosecuted a case 4 months ago
where a 24-year-old limousine driver picked up an elderly
woman with severe dementia from her nursing home and got her to
sign a certificate of deposit surrender form for $93,000. He
wheeled her into her bank, he presented it to the bank teller,
and the bank gave a cashier's check for $92,000 to this
stranger without asking questions.
Senator, in a neighboring State of yours, Oregon, they have
done a phenomenal job of a bank reporting project. I would love
to see funds from the Department of Justice to be transferred
possibly to the Office of the Victims of Crime or somewhere, so
that we can replicate this great Oregon project all over the
country, because if they had had somebody trained in that bank,
Joanne's money might still be safe today. So I think you have
hit upon a very, very important point.
Senator Craig. Thank you.
Laura, in your view, how can national efforts best assist
in promoting the inclusion of the medical profession in the
assessment, investigation, and prosecution of elder crime?
Dr. Mosqueda. Well, physicians are scientists, so we always
want to know what the data show. Unfortunately, there have been
very few well-done scientific studies, and it has been a
struggle as we have been creating training programs for health
care providers to try to find primary data to explain the
issues and explain what we ought to do about the issues to our
fellow health care providers.
So I think we need to have a better understanding of the
issue to begin with at a fundamental level. And then, I think
there needs to be the promotion of the need to be aware of the
problem and what to do about the problem.
For health care professionals, just as an example, we
recently put on a 1\1/2\ day training course for geriatricians
on the topic of elder abuse, funded by the California Office of
Criminal Justice Planning, through a program called California
Medical Training Centers. The purpose of this is to train
physicians to be more helpful to folks like Mr. Greenwood who
want to then prosecute these cases. We sent a mailing to over
600 geriatricians in California, and we put it on for free, we
offered continuing medical education credits, and we had 16
practicing physicians come.
So it is a struggle to make health care providers aware of
the problem; and then we have the next obligation, to make them
aware and provide the training. But it is a struggle.
Senator Craig. It appears to me today, or at least, we are
told, and all reference to it seems to be accurate, that with
physicians who treat a child who appears to be abused, there
tends to now be an immediate report, or questions are asked
immediately, and authorities are brought in to examine. That
has come over a period of time of causing general awareness,
but also clearly understanding that that physician has a
responsibility to report.
That appears not to be the case with the elderly. How do we
cause physicians to be as sensitive--through educational
programs, or does there need to be more specificity in the law
as to a responsibility and a requirement to report?
Dr. Mosqueda. Well, of course, the laws are different in
different States, but in most States, there is a mandated
reporting law for elder abuse, and physicians are always
mandated reporters.
As far as I know, there have not been any prosecutions of
physicians for not reporting; I do not know if there will need
to be carrots and sticks. But I think that at a more basic
level, physicians are just missing it. We do not have any data
to help us understand how to distinguish a bruise or a pressure
sore or other signs of injury--a fracture, for example--well,
the person has osteoporosis, and they fracture easily.
So we need to train physicians to start thinking about how
to ask questions and what questions to ask about this. So from
my perspective, I think it lies in research and education and
making it easy for physicians to report--creating forensic
centers, for example, as they have done in child abuse, so that
a physician who is in a busy practice does not feel like, hey,
if I identify this case of abuse, that is going to be my whole
afternoon--if they could have an easy way to turn it over to
somebody who could help them with documentation and
investigation.
Senator Craig. I apologize that I am running out of time
because there are several other things that I would like to ask
you. What we may ask of you is that we be able to submit some
questions in writing for your response.
But Paul, offer me some advice from your experience. You
talk about ``vertical units.'' What are your best
recommendations--you have already given some--for other States
and counties that may want to start their own multiple
disciplinary teams and other prosecuting attorneys' offices
that may want to establish an internal elder crime unit.
Mr. Greenwood. I would try to send out the message to all
elected prosecutors that one of their primary responsibilities
right now is to make sure that they are taking care of their
elder population and to get the backing of their local boards
of supervisors in their counties to be on board with this, and
to assign a prosecutor who believes in the work, is dedicated
to it, and basically fulfills a role outside the courtroom as
well as inside the courtroom, which I think is for adult
protective services to begin outreach, education and training.
I do believe that local prosecutors have a unique
responsibility and opportunity in this country to be able to
fulfill that, but it takes the vision of an elected prosecutor.
Five and a half years ago, it was my boss, Paul Pfingst, who
saw the need, and he allowed me the freedom to develop it in
the way that I have seen fit. But you need more Paul Pfingsts
out there who see that we have got to have this as a primary
resource in every office.
When I go around the country, Senator, and I talk to
elected prosecutors, their first response is, ``Oh, we do not
have the money in the budget.'' And then I follow up with a
question: ``Do you prosecute misdemeanor DUIs?'' And they say,
``Of course, we do.'' And I ask, ``What would happen if,
tomorrow, you went on television and said we cannot prosecute
misdemeanor DUIs because of lack of funding?'' And they say,
``We would have Mothers Against Drunk Driving at our door.'' I
say absolutely--but equally, as my colleague here so succinctly
put it, we owe seniors because of what they have done for us.
We owe them our primary duty to take care of them. And I think
elected prosecutors in this country need to capture that vision
today.
Senator Craig. I wish we could continue this discussion,
but I cannot, and I apologize. But certainly on behalf of
Chairman Breaux and myself and the members of the committee, we
thank all of you for your time, but most important, we thank
you for your commitment and your willingness to become
advocates and speak out. That is clearly a part of the whole
process of educating and understanding.
I am committed, and I think the chairman is, to working
with the Department of Justice to see if we cannot cause a bit
of a different allocation of resources--and my guess is that we
can--that will allow us to begin to reach out to States and to
counties, both in the informational and educational
perspectives, but also the possibility of actually gaining some
resources to train and employ people for the purpose of
advocacy and/or obviously the kind of training that you have
all spoken to.
Thank you all very, very much for coming today. We do
appreciate it.
The committee will stand adjourned.
[Whereupon, at 11:26 a.m., the committee was adjourned.]
A P P E N D I X
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