[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 U.S. GOVERNMENT PRINTING OFFICE 74-685 WASHINGTON : 2001 ---------------------------------------------------------------------------- For Sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpr.gov Phone: toll free (866) 512-1800; (202) 512�091800 Fax: (202) 512�092250 Mail: Stop SSOP, Washington, DC 20402�090001 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 ---------- 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:] [GRAPHIC] [TIFF OMITTED] T4685.001 [GRAPHIC] [TIFF OMITTED] T4685.002 [GRAPHIC] [TIFF OMITTED] T4685.003 [GRAPHIC] [TIFF OMITTED] T4685.004 [GRAPHIC] [TIFF OMITTED] T4685.005 [GRAPHIC] [TIFF OMITTED] T4685.006 [GRAPHIC] [TIFF OMITTED] T4685.007 [GRAPHIC] [TIFF OMITTED] T4685.008 [GRAPHIC] [TIFF OMITTED] T4685.009 [GRAPHIC] [TIFF OMITTED] T4685.010 [GRAPHIC] [TIFF OMITTED] T4685.011 [GRAPHIC] [TIFF OMITTED] T4685.012 [GRAPHIC] [TIFF OMITTED] T4685.013 [GRAPHIC] [TIFF OMITTED] T4685.014 [GRAPHIC] [TIFF OMITTED] T4685.015 [GRAPHIC] [TIFF OMITTED] T4685.016 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:] [GRAPHIC] [TIFF OMITTED] T4685.017 [GRAPHIC] [TIFF OMITTED] T4685.018 [GRAPHIC] [TIFF OMITTED] T4685.019 [GRAPHIC] [TIFF OMITTED] T4685.020 [GRAPHIC] [TIFF OMITTED] T4685.021 [GRAPHIC] [TIFF OMITTED] T4685.022 [GRAPHIC] [TIFF OMITTED] T4685.023 [GRAPHIC] [TIFF OMITTED] T4685.024 [GRAPHIC] [TIFF OMITTED] T4685.025 [GRAPHIC] [TIFF OMITTED] T4685.026 [GRAPHIC] [TIFF OMITTED] T4685.027 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:] [GRAPHIC] [TIFF OMITTED] T4685.028 [GRAPHIC] [TIFF OMITTED] T4685.029 [GRAPHIC] [TIFF OMITTED] T4685.030 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:] [GRAPHIC] [TIFF OMITTED] T4685.031 [GRAPHIC] [TIFF OMITTED] T4685.032 [GRAPHIC] [TIFF OMITTED] T4685.033 [GRAPHIC] [TIFF OMITTED] T4685.034 [GRAPHIC] [TIFF OMITTED] T4685.035 [GRAPHIC] [TIFF OMITTED] T4685.036 [GRAPHIC] [TIFF OMITTED] T4685.037 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:] [GRAPHIC] [TIFF OMITTED] T4685.038 [GRAPHIC] [TIFF OMITTED] T4685.039 [GRAPHIC] [TIFF OMITTED] T4685.040 [GRAPHIC] [TIFF OMITTED] T4685.041 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:] [GRAPHIC] [TIFF OMITTED] T4685.042 [GRAPHIC] [TIFF OMITTED] T4685.043 [GRAPHIC] [TIFF OMITTED] T4685.044 [GRAPHIC] [TIFF OMITTED] T4685.045 [GRAPHIC] [TIFF OMITTED] T4685.046 [GRAPHIC] [TIFF OMITTED] T4685.047 [GRAPHIC] [TIFF OMITTED] T4685.048 [GRAPHIC] [TIFF OMITTED] T4685.049 [GRAPHIC] [TIFF OMITTED] T4685.050 [GRAPHIC] [TIFF OMITTED] T4685.051 [GRAPHIC] [TIFF OMITTED] T4685.052 [GRAPHIC] [TIFF OMITTED] T4685.053 [GRAPHIC] [TIFF OMITTED] T4685.054 [GRAPHIC] [TIFF OMITTED] T4685.055 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 ---------- [GRAPHIC] [TIFF OMITTED] T4685.056 [GRAPHIC] [TIFF OMITTED] T4685.057 [GRAPHIC] [TIFF OMITTED] T4685.058 [GRAPHIC] [TIFF OMITTED] T4685.059 [GRAPHIC] [TIFF OMITTED] T4685.060 [GRAPHIC] [TIFF OMITTED] T4685.061 [GRAPHIC] [TIFF OMITTED] T4685.062 [GRAPHIC] [TIFF OMITTED] T4685.063 [GRAPHIC] [TIFF OMITTED] T4685.064 [GRAPHIC] [TIFF OMITTED] T4685.065 [GRAPHIC] [TIFF OMITTED] T4685.066 [GRAPHIC] [TIFF OMITTED] T4685.067 [GRAPHIC] [TIFF OMITTED] T4685.068 [GRAPHIC] [TIFF OMITTED] T4685.069 [GRAPHIC] [TIFF OMITTED] T4685.070 [GRAPHIC] [TIFF OMITTED] T4685.071 [GRAPHIC] [TIFF OMITTED] T4685.072 [GRAPHIC] [TIFF OMITTED] T4685.073 [GRAPHIC] [TIFF OMITTED] T4685.074