WITH RESPECT TO SENIOR DELAWAREANS:

A NEEDS ASSESSMENT AND
RECOMMENDATIONS CONCERNING
SENIOR CRIME VICTIMS IN DELAWARE

May 22, 2003

The Report of the Delaware Attorney
General's Task Force on Senior Victims

PREFACE

I am pleased to share with you the publication, With Respect to Senior Delawareans: A Needs Assessment and Recommendations Concerning Senior Crime Victims in Delaware. [1] This report presents the findings and recommendations of the Delaware Attorney General’s Task Force on Senior Victims.

For a number of months, the Task Force has been engaged in efforts to identify ways in which the public and private sectors can join forces to improve the State of Delaware’s response to one of the most unconscionable, reprehensible, and invisible forms of criminal activity occurring in our society today – the victimization of our senior citizens. At the heart of the Task Force’s efforts was the belief that, although not of epidemic proportions, the problem of senior victimization in Delaware is greater than indicated by available data. This conclusion, in turn, suggested that not only is senior victimization a more extensive problem than is generally recognized, but that, tragically, some seniors who have been victims of crime are not receiving services to assist them in coping with the consequences of their victimization.

Accordingly, the Task Force comprised of a broad coalition, adopted a multidisciplinary strategy for meeting the needs of senior crime victims that would begin with improving the reporting and detection of suspected incidents of crimes against seniors, and result in enhancements in the availability and accessibility of services for seniors who are victims of crime. In the course of its deliberations, the Task Force underscored the critical need to improve communication, coordination, and cooperation among justice system officials and social services providers in meeting the needs of senior crime victims. It called for enactment of legislation to enhance the penalties for crimes committed against senior citizens; emphasized the importance of increasing public awareness of the problem of senior victimization; and proposed policies and protocols to improve the investigation, prosecution, and management of cases involving crimes against seniors.

The work of the Task Force comprises a blueprint for improving the State of Delaware’s response to the problem of senior victimization. It is a beginning – a good one – that reflects the Task Force’s commitment to reducing the victimization of seniors in Delaware, and its promise that help will be there for seniors who are the victims of crime. In the months to come, we urge all responsible agencies, companies and organization to move forward with implementation of the Task Force recommendations. We must meet our commitments and keep our promises to senior Delawareans.

ACKNOWLEDGMENTS

Many people gave generously of their time and expertise to the work of the Delaware Attorney General’s Task Force on Senior Victims. First and foremost, I am deeply indebted to each member of the truly impressive group of individuals who comprised the Task Force itself. These individuals ably represented a broad and diverse spectrum of and interests. The breadth of their collective knowledge and experience contributed to the comprehensiveness of the Task Force’s work, and is reflected in each of the Task Force recommendations. For their numerous contributions to this initiative, I am grateful. An extra ration of my gratitude is in order for those Task Force members who took on the added responsibility of chairing a Task Force subcommittee.

Dawn K. Thompson of my staff provided staff support for the Task Force, efficiently and graciously handling meeting logistics, developing the minutes of Task Force meetings and editing this final report.

Finally, my special thanks to Gwen A. Holden, a consultant to the Task Force, who guided the Task Force members in organizing their work and formalizing their recommendations, and who assisted in the development of this final report on the Task Force’s behalf.

[1]A copy of the full report is available on the Delaware Department of Justice Web Site: attorneygeneral.delaware.gov, or by calling 302-577-8338.

RECOMMENDATIONS OF
THE ATTORNEY GENERAL’S TASK FORCE ON SENIOR VICTIMS

Understanding Senior Victimization

Issue

The development and implementation of strategies for addressing the problem of crimes against senior citizens in Delaware currently is hampered by the lack of a comprehensive and complete picture of the nature and extent of that problem in the state.

Commentary

At the inception of its work, the Task Force characterized the problem of crimes against seniors as one that frequently "occurs behind closed doors" and which, therefore, is largely "invisible." Moreover, the Task Force asserted that owing to deficiencies in data on senior victimization in Delaware, the true extent of the problem is unknown. In the course of its deliberations, the Task Force learned that data concerning senior victimization, including incidents involving crimes against senior citizens, currently is collected by many public and private agencies and organizations which come in contact with, or provide services to, seniors. However, the Task Force found that these data and information are not analyzed or shared routinely. The Task Force concluded that analysis of information concerning senior victimization and the sharing of that information on an interagency and an interdisciplinary basis could help to inform efforts within the State of Delaware to reduce incidents of crimes against seniors and improve the delivery of services to senior crime victims. The Task Force also observed that there is no single, centralized source of data and other information on senior crime victims in the state. The Task Force rejected the idea of pursuing the creation of a new division or bureau of state government to fill this gap, proposing instead that efforts be undertaken to explore the possibility of building upon and expanding the capabilities of an existing public or private agency or organization, such as the University of Delaware, Clearinghouse on Abuse and Neglect of the Elderly, to meet this need.

The Task Force recommends:

1. Protocols should be developed and implemented for collecting, integrating and analyzing data that would produce a comprehensive and complete picture of the problem of crimes against seniors in Delaware. These protocols should include strategies for:

   • Identifying which public and private agencies currently are collecting data on Delaware senior crime victims;

   • Identifying gaps in data needed to develop a comprehensive picture of the problem of crimes against seniors in Delaware;

   • Identifying existing sources of information, such as the Delaware Nursing Home Residents’ Quality Assurance Commission’s annual report on the quality of care of nursing home residents, that might provide insight into, and data concerning, the victimization of the elderly in long-term care facilities, including nursing homes;

   • Initiating efforts to begin the collection of data and other information concerning the victimization of the elderly in assisted-living facilities.

2. Research should be initiated to determine the prevalence of senior crime victimization in Delaware, and to identify the types of crimes that are being committed against the elderly, and the demographics of senior crime victims;

3. The feasibility of amending protocols for reporting crime incidents in Delaware to flag incidents involving senior victims should be explored;

4. Opportunities should be explored for institutionalizing, and increasing the availability of staff and financial support for the University of Delaware’s Clearinghouse on Abuse and Neglect of the Elderly (CANE) to permit CANE to:

   • Enhance the availability and accessibility of its extensive database of information concerning abuse and neglect of the elderly;

   • Engage in the analysis of data and other information concerning the victimization of seniors in Delaware.

5. The feasibility of creating an interdisciplinary "Death Review Team" to examine suspicious deaths of elderly persons and to gather information on conditions that may have caused, and strategies that might be pursued to prevent, such deaths should be explored;

6. A review of higher education curricula on the aging in Delaware should be undertaken to identify opportunities for enhancing these curricula to encompass course content on elder abuse and neglect, to include instruction on the following topics:

   • Types of abuse, and causal factors of abuse and neglect;

   • Cultural and ethnic characteristics affecting service needs and the delivery of services to vulnerable older adults;

   • Case assessment;

   • Victim and abuser profiles; and,

   • he problem of "self-neglect."

Identifying Senior Crime Victims

Issue

Seniors who have been the victims of crime may be reluctant, unwilling or unable to report their victimization.

Commentary

The Task Force members observed that seniors who have been the victims of crimes oftentimes are reluctant, unwilling or unable to report their victimization. Senior crime victims may be uncertain about where or how to report a crime. Moreover, seniors who have been the victims of such criminal activities as financial exploitation or scams, such as telemarketing fraud, may blame themselves for their victimization and, consequently, be too embarrassed to report the crimes. In other instances, senior crime victims may be mentally or physically disabled, and therefore unable to initiate contacts with law enforcement officials or victim service providers to report crimes.
The Task Force members concluded that steps should be taken to encourage professionals who work, or regularly come in contact, with the elderly to report suspected incidents of abuse, neglect, and exploitation. Categories of professionals whose assistance might be enlisted in efforts to increase the identification of senior crime victims include:

• Hospital social workers;

• Physicians in private practice;

• Police officers;

• Emergency medical service personnel;

• Emergency room staff;

• Senior center staff;

• Volunteers working with the elderly;

• Home healthcare workers;

• Social service agency social workers;

• Public health, parish, and visiting nurses;

• Residential care facility staff;

• Front-line personnel in banks and other financial institutions;

• Personal financial services providers, such as stockbrokers and certified public accountants; and,

• Employees of businesses and industries within the community, such as grocers, pharmacists, fuel oil dealers, mail and newspaper carriers, and meter readers, who have regular opportunity for contact with seniors.

The Task Force recommends:

1. Expand present mandatory reporting laws in Delaware to include personnel in additional professions and that responsible agencies assess their protocols for timeliness and resources:

2. The availability of educational materials on elder abuse, neglect, and exploitation should be expanded for persons in professions that are in contact regularly with older citizens. These educational materials should encompass information concerning:

   • Forms, signs, and symptoms of elder abuse, neglect and exploitation;

   • Laws and regulations concerning the rights of elder citizens, including privacy and confidentiality provisions, and governing the reporting of suspected incidents of abuse, neglect, and exploitation;

   • Contacts for agencies and organizations that should be notified of suspected incidents of elder abuse, neglect, or exploitation.

3. Protocols should be developed, and the availability of training curricula expanded, on elder abuse, neglect, and exploitation for persons employed in professions that are in contact regularly with older citizens. These protocols and training curricula should encompass procedures for and instruction in identifying, assessing, documenting, and reporting suspected incidents of elder abuse, neglect, or exploitation.

4. Title 10 of the Delaware Code should be amended to provide employees of financial institutions and businesses immunity from criminal or civil liability for making reports of suspected incidents of financial exploitation of the elderly;

5. Educational materials should be developed to inform families and guardians of elderly persons about forms, signs, and symptoms of abuse, neglect, and exploitation of seniors;

6. Options should be explored for improving the assessment of elderly persons who are brought into hospital emergency rooms for suspected abuse, which options might include:

   • Examining policies, protocols, and procedures currently followed by Delaware hospitals to conduct assessments of elderly persons who are brought into emergency rooms for suspected abuse;

   • Expanding the role of S.A.N.E. nurses to include conducting examinations and making assessments.

Providing Services for Senior Crime Victims and Their Families

Increasing the Availability of Services for Senior Crime Victims

Issue

The State of Delaware should offer a continuum of services for senior crime victims, to include resources targeted to preventing senior victimization and responding to the needs of senior victims.

Commentary

The Task Force noted a marked expansion in the availability of publicly and privately financed and operated services for senior crime victims in Delaware in recent years. Nevertheless, the Task Force observed that, notwithstanding accomplishments to date, several gaps currently exist in the array of available services. The Task Force asserted that efforts must be directed to identifying and filling these service gaps.

The Task Force recommends:

1. Monitoring HB 84, "the Money Management Bill" which authorizes funding for the Division of Services for Aging and Adults with Physical Disabilities to create a program to provide senior citizens assistance in managing their financial affairs, including the paying of bills, should be endorsed;

2. The Legal Handbook for Older Delawareans should be updated, and its distribution increased;

3. An information "card" should be developed for seniors that would contain information concerning how to avoid being victimized, and include the contact numbers and Websites for the Delaware Helpline and Senior Victim Advocates Program as well as 1-800-VICTIM1;

4. Efforts should be made to expand the availability of volunteer initiatives geared towards reducing the isolation and loneliness of seniors and increasing the identification of senior crime victims, which efforts should include:

   • Encouraging faith-based and community groups to organize "friendly visiting" programs for elderly crime victims who are incapable of leaving their homes or who reside in nursing homes;

   • Encouraging churches, schools, and community organizations to develop "Adopt-A-Senior" programs.

5. Efforts should be made to reduce incidents of senior victimization by family members and other caregivers by expanding the availability and variety of support groups for full-time caregivers of elderly persons, which efforts might include encouraging faith-based and community groups to organize "respite" programs for full-time caregivers of elderly persons;

Improving the Accessibility of Services for Senior Crime Victims

Issue

Services for senior crime victims in Delaware are under-utilized and that may be because elderly victims are not aware of the availability of these resources to assist them in coping with their victimization.

Commentary

As a first step in its deliberations, the Task Force sought to compile a list of services for senior crime victims in Delaware. The Task Force found that an impressive array of public and private agencies and organizations in Delaware are engaged in providing services and other resources for senior crime victims [2]. However, several Task Force members, who represent agencies and organizations who provided services for, or work directly with, senior citizens asserted that many services for senior crime victims are under-utilized. These Task Force members expressed the belief that many senior crime victims are not receiving the services that they need because they either are not aware of the existence of, or do not know how to access, these resources. Based upon these observations, the Task Force concluded that steps must be taken to enhance senior crime victims’ access to services that can assist them in coping with their victimization.

The Task Force recommends:

1. The database of the Delaware Helpline should be expanded to include information concerning services for senior crime victims;

2. Existing strategies for distributing information concerning services for senior crime victims should be assessed, and appropriate steps taken to improve seniors’ access to this information;

3. The scope of the Guide to Services for Older Delawareans, published by the Delaware Division of Services for Aging and Adults with Physical Disabilities, should be expanded to include a more complete list of agencies and organizations that provide services to senior crime victims in the state, and more extensive descriptions of the services offered by each resource included in the directory;

[2] See Appendix D, List of Services and Other Resources in Delaware For Senior Crime Victims.

Enhancing the Delivery of Services to Senior Crime Victims

Issue

Agencies, organizations, and individuals which provide services to the elderly must have the necessary knowledge, capacities, and skills to carry out their responsibilities.

Commentary

The Task Force observed that agencies and organizations that provide services for senior crime victims oftentimes are plagued by insufficient financial support and inadequate qualified staff. Accordingly, some programs may not be able to provide the services and resources that they advertise. Moreover, many programs have difficulty providing their services to senior crime victims who do not speak, or have difficulty communicating in, English. The Task Force asserted that it is important that information concerning agencies and organizations that serve senior crime victims accurately describe the services and resources that these agencies and organizations actually provide. In addition, the Task Force underscored the need to adequately fund and staff services for senior crime victims, and to take steps to ensure that these services are available and accessible to any senior crime victim in Delaware who may be in need of support and assistance.

The Task Force recommends:

1. Agencies and organizations that provide services to senior crime victims should be encouraged to take steps to ensure that information that has been provided for inclusion in the Delaware Helpline’s database is reviewed regularly for currency, completeness, and accuracy;

2. The Delaware Helpline should be encouraged to formalize information and referral protocols, to include:

   • A protocol for validating that information listed in its database concerning agencies and organizations that provide services for senior crime victims is current, accurate, and valid;

   • A protocol and mechanism for following up on class for service from senior crime victims to determine whether callers are receiving the services that they requested.

3. Efforts to reduce the financial exploitation of senior citizens should include the development of training programs and educational materials to instruct prospective guardians and attorneys-in-fact in their fiduciary and other obligations;

4. Efforts should be made to enhance the availability and accessibility of crime victim services to elderly Hispanic citizens, which efforts should include:

   • Increasing the availability of culturally sensitive direct services for elderly Hispanic citizens;

   • Encouraging agencies to make victim services information available in Spanish, as well as in English;

   • Increasing Spanish-speaking staff in existing agencies and organizations that provide services to the elderly.

5. Initiatives to identify and address senior crime victim service needs and priorities in Delaware should involve active constituency participation from the senior community.

Issue

Coordination, cooperation, and communication should be increased among agencies and organizations that handle cases involving, and provide services to, senior crime victims.

Commentary

The Task Force expressed concern that agencies and organizations that provide services to senior crime victims do not coordinate with one another in their respective efforts to develop strategies to address these victims’ service needs, or routinely communicate and cooperate on an interagency basis in the delivery of services to that constituency. The lack of coordination, cooperation, and communication among service providers can lead to costly and inefficient duplication and overlap in the development of services. Moreover, the efficacy of assistance and support provided to individual senior crime victims may be undermined when two or more service providers that are involved with the same victim do not communicate concerning their interactions with that victim.

The Task Force recommends:

1. Quarterly meetings of agencies and organizations that comprise the Task Force or otherwise provide services to senior crime victims should be held to encourage and facilitate regular communication, coordinate, and cooperation among service providers on such topics as:

   • Exploring prevention strategies;

   • Assessing case management strategies;

   • Developing strategies for resolving problems and issues concerning the delivery of services to senior victims.

2. Options should be examined for creating an interagency, interdisciplinary mechanism for reviewing and managing cases involving the victimization of senior citizens, which mechanism’s functions would include:

   • Reviewing case management and processing protocols and procedures;

   • Establishing protocols for the regular review of individual cases, which reviews would encompass:

     • case management strategies;

     • service-related recommendations;

     • outcomes of service delivery.

3. Delaware should to build upon the strengths of interdisciplinary community-oriented collaborations which bring together law enforcement officials, Delaware Justice Department officials, and senior advocates to develop and implement strategies to address the problem of senior crime victimization.

4. A survey and a protocol should be developed that could be used by hospital officials in assessing incidents involving the suspected abuse or sexual assault of a senior citizen, and that would produce information to guide law enforcement and social services agencies’ management of specific cases.

Issue

Senior citizens should be protected from victimization by caregivers, guardians, persons designated to transact business for elderly principals, financial services providers, and businesses, including telemarketers and contractors.

Commentary

The Task Force observed that older Delawareans, in particular, those senior citizens incapacitated by physical or mental disabilities, may be especially vulnerable to victimization or exploitation by family members, caregivers, and unscrupulous contractors, home service maintenance personnel, and personal financial services providers. These crimes are particularly difficult to detect, the Task Force noted, and oftentimes are not reported by their victims, who may be reluctant, unable or too embarrassed to contact the police. Moreover, such incidents may be most emotionally damaging and impose the greatest hardship on their victims. Putting safeguards in place, therefore, to prevent such crimes from occurring, is an important component of any plan to address this issue.

The Task Force recommends:

1. Unions and professional associations representing contractors, heating and air conditioning service personnel, and other home improvement and maintenance service providers should be encouraged to develop professional standards of conduct and training programs to inform these service providers’ interactions with the elderly;

2. Steps should be taken to increase oversight of the activities of guardians on behalf of seniors, which steps might include:

   • Increasing the enforcement of the state statutory requirement that guardians report annually on financial transactions undertaken on behalf of seniors;

   • Collaborating with the Delaware Bar Association and the Delaware Court of Chancery to create a mechanism for reviewing reports submitted by guardians for possible instances of misuse or misappropriation of seniors’ financial resources and property;

   • Exploring the possibility of adapting, for implementation in Delaware, the American Association of Retired Persons’ "Volunteer Guardianship Monitoring Program," under which court-certified volunteers review guardianship reports for possible misuse or misappropriation of the financial and other resources of elderly wards.

3. The Adult Abuse Registry should be expanded to encompass information concerning in-home health aides who are convicted of crimes against seniors;

4. Protocols and procedures should be developed for following up on individuals who are listed in the Adult Abuse Registry to ensure that they do not secure positions in the home healthcare field;

5. Steps should be taken to improve health care professionals’ awareness of the provisions of the Advanced Health Care Directives, which steps should include developing educational programs and materials concerning obligations and responsibilities under the Directives.

Investigating Crimes Against Seniors

Issue

Policies and protocols should be developed to guide police officers in responding to and handling initial encounters with elderly crime victims. In addition, police officers should receive basic and on-going specialized training to assist them in properly assessing emergency situations that they may encounter involving senior citizens. Police agencies should consider expanding the capacities of existing intra-agency crime victims units to meet the specialized needs of senior crime victims. Finally, linkages should be established between police agencies and agencies and organizations that provide services to senior crime victims to ensure both that police officers have ready access to resources, including professionals experienced in working with senior citizens, to assist them in assessing situations involving senior citizens.

Commentary

Most citizens’ first instincts when confronted with crisis or emergency situations is to contact the police. The Task Force observed that police officers, therefore, oftentimes are the "first responders" to emergency class made by, or concerning, senior citizens. Whether the caller is reporting a suspected crime, a medical emergency, or is unable to clearly articulate or explain the reason for the call, the responding officer will be required to make a field assessment of, and intervene in, the situation quickly. Making an accurate assessment of the situation may be particularly difficult when a call for assistance involves the possible victimization, exploitation, abuse, or neglect of a senior citizen. A police officer may suspect, for example, that a senior citizen who has sustained a physical injury has been the victim of abuse by a caretaker or family member. A senior citizen who is incapacitated by mental or physical disabilities may be unable to explain the events that precipitated the call for assistance. In other circumstances, the senior who has been injured, in fact, may claim that the injury was inflicted by a family member, while the attendant family member disputes that claim. The responding officer may find himself or herself in a situation wherein he or she is uncertain how to proceed or where to turn for assistance in determining whether the injury was the result of abuse.

The Task Force Recommends:

1. A statewide policy and protocol to inform police officers’ handling of cases involving the suspected abuse, neglect or exploitation of an elderly person should be developed and submitted to the Delaware Police Chiefs Council for review and endorsement; [3]

2. Police organizations that operate domestic violence units should be encouraged to consider designating one member of their respective units to specialize in the handling of cases involving senior victims of crimes;

3. Police agencies should be encouraged to consider creating a position of "special assignments officer," patterned after the school resource officer, to engage in outreach and to senior citizens and organizations and agencies within the community that provide services for the elderly;

4. Elder abuse training should be included as a mandatory component of the basic training curricula that police recruits receive at any Delaware Law Enforcement Training Academy;

5. Consideration should be given to requiring police officers to participate in in-service training concerning the handling and investigation of crimes against the elderly.

[3] See Appendix G: Draft of the Newport Police Department Senior Victim Policy.

Prosecuting Crimes Against Seniors

Issue

The Delaware Department of Justice should explore opportunities for building up its achievements to date in serving senior crime victims by improving the processing of cases involving senior crime victims and expanding the availability of victim assistance and support to this constituency.

Commentary

The Task Force noted that under the Delaware Department of Justice’s existing protocols and procedures for prosecuting cases, several units within that agency are involved in prosecuting cases involving the abuse and neglect of senior citizens. For example, the Department’s Fraud Division, Consumer Protection Unit, and Medicaid Fraud Unit all handle cases involving crimes against seniors. The Task Force concluded that consolidation of all cases involving crimes against seniors under the authority of a single unit within the Department would facilitate the development of special skills in handling, and improve the overall prosecution, of cases involving crimes against seniors. Moreover, senior crime victims whose cases are to be prosecuted may be intimidated by the legal process, and have difficulty understanding that process and what will be expected of them in the course of the prosecution of their cases. The Task Force asserted that senior crime victims need guidance and support in navigating the criminal justice process. The Task Force suggested that the Department of Justice expand its Senior Advocate Program. Finally, the Task Force expressed concern that senior crime victims who reside in nursing homes may not be receiving the assistance and support that they need in the aftermath of their victimization. The Task Force concluded that the scope of the Department of Justice’s Senior Advocate Program should be expanded to encompass these senior crime victims.

The Task Force recommends:

1. The Delaware Attorney General should designate and specially train, specified Deputy Attorneys General to handle cases involving abuse and neglect of elderly persons for the Delaware Department of Justice.

2. The corps of senior peer advocates in the Delaware Attorney General’s Office’s Senior Victim Advocates Program should be expanded;

3. Certain Senior Victim Advocates from the Delaware Attorney General’s Office should be assigned to provide assistance, support, guidance, and services to senior crime victims who reside in nursing homes.

Providing Penalties for the Abuse, Neglect or Exploitation of the Elderly

Issue

Persons who commit crimes against senior citizens in Delaware are not subject to sufficiently severe sanctions under existing laws.

Commentary

The Task Force stated that senior crime victims comprise a special population of crime victims under Delaware state law. Accordingly, the victimization of a senior citizen carries enhanced penalties for the perpetrators of these crimes. The Task Force concluded, however, that the Delaware Code should be amended, as follows, to clarify and expand the crimes for which enhances penalties may be imposed in cases involving elderly victims.

The Task Force recommends:

1. Relevant sections of Titles 11 and 30 of the Delaware Code should be amended to conform the age criterion that triggers enhanced penalties for crimes committed against the elderly to provide that an elderly person is anyone of the age of 62 or older;

2. The Delaware Code should be amended to enhance penalties for crimes involving the victimization of the elderly. These statutory amendments should include:

   • Amending Title 11 of the Delaware Code to expand the crimes for which enhanced penalties may be imposed in cases involving elderly victims to include assault, first and second degree; terroristic threatening; burglary, first and second degree; robbery, first degree; carjacking, first degree; theft; extortion; home improvement fraud; unlawful use of a credit card; menacing and sexual assault of elderly persons;

   • Establishing criminal penalties to sanction guardians and legal agents (attorneys in fact under powers of attorney) who intentionally abuse their fiduciary responsibilities to care for the person and/or property of an elderly ward by amending Title 11 of the Delaware Code to include in the definition of theft any fraudulent conversions by guardians or attorneys-in-fact under powers of attorney of the property belonging to their principals.

Educating the Public Concerning Senior Crime Victimization

Issue

The public, including senior citizens, lack sufficient knowledge and understanding of the problem of senior victimization.

Commentary

Efforts to focus statewide attention on the problem of senior victimization are inhibited by citizens’ lack of awareness of that problem. Moreover, senior citizens themselves may be unaware of factors and conditions that may increase their vulnerability to victimization. The Task Force believes that citizens, including the elderly, must be full partners in the development and implementation of strategies to reduce and address crimes against senior citizens. Furthermore, the Task Force asserted that increasing public awareness of the problem of senior victimization is an important step in mounting and sustaining initiatives to intervene in senior victimization.

The Task Force recommends:

1. A comprehensive program should be developed to educate the public on the problems of abuse, neglect, and exploitation of the elderly, which program would include information concerning recognizing forms, signs, and symptoms of senior victimization; understanding the causes of victimization; preventing victimization; reporting suspected victimization; and accessing services for senior crime victims;

2. Consumer outreach initiatives should be developed to raise senior citizens’ awareness of personal safety and security issues, and to educate them on how to protect themselves from being victimized. These educational outreach initiatives might include:

   • Topical public seminars on preventing fraud and financial exploitation;

   • A consumer hotline that seniors can access for information concerning laws, regulations, predatory lending practices, and prevalent scams to defraud the elderly that they should be aware of, and take into consideration, in entering into contractual agreements with financial service providers, such as personal financial advisors, and home service providers, such as building contractors, maintenance and repair companies; and lawn care and landscaping services;

   • A speakers bureau comprised of volunteers from law enforcement agencies, victim services organizations, and agencies and organizations that work with the elderly, that would respond to invitations from membership and service organizations of senior citizens and professional and community groups for presentations on topics relating to preventing the elder abuse, neglect, and exploitation;

   • Brochures and posters that can be made available in banks, credit unions, and other financial institutions; supermarkets and shopping malls; senior centers, libraries, and other public buildings to:

     • provide seniors information to help them avoid becoming the victims of predatory lending practices and prevalent scams to defraud the elderly; and,

     • inform senior citizens of their rights under law and to how to access assistance if they suspect that these rights are being violated.

   • Brochures and educational programs to inform seniors concerning procedures to revoke or change a power of attorney, and issues and factors that seniors should take into consideration in determining whether to pursue power of attorney alternatives, such as adding family members to bank accounts.

3. Efforts should be enhanced to encourage employers to adopt and implement personnel policies that are supportive of, and permit flexible scheduling for, workers who are full-time caregivers of elderly persons;

4. The media should be encouraged to cover the prosecution of cases involving senior crime victims.

APPENDICES

1. List Of The Members Of The Delaware Attorney
   General’s Task Force On Senior Victims

2. List Of The Subcommittees Of The Delaware Attorney
   General’s Task Force On Senior Victims

3. List of Services And Other Resources In Delaware
   For Senior Crime Victims

4. Proposed Amendments To Title 11 Of The
   Delaware Code

5. Proposed Amendments To Title 10 Of The
   Delaware Code

6. Draft Of The Model Police Department Senior
   Victim Policy

7. About The Clearinghouse On Abuse And Neglect
   Of The Elderly At The University Of Delaware

8. About The Delaware Department Of Justice Medicaid Fraud Control Unit

9. About The Delaware Department Of Justice Medicaid Fraud Control Unit, Patient Abuse Unit – Nursing Home Staff Training Curriculum

10. lder Abuse Protocol For Medical Facilities

APPENDIX A: LIST OF THE MEMBERS OF THE DELAWARE
ATTORNEY GENERAL’S TASK FORCE ON
SENIOR VICTIMS

LIST OF MEMBERS OF THE
DELAWARE ATTORNEY GENERAL’S TASK FORCE ON SENIOR VICTIMS

M. Jane Brady, Attorney General, Chair
Gary Alderson, Esq. - Deputy Attorney General, Delaware Department of Justice
Vickie Artis - Adult Protective Services Administrator, DHSS
Francis Babiarz - Deputy Bank Commissioner for Supervisory Affairs
Office of the Delaware State Bank Commissioner
Sue Bardsley, - RN Christiana Care Health Systems
Shirlynn Barne - Milford Manor Nursing Home
Timothy Barron, Esq. - Director, Medicaid Fraud Control Unit, Delaware Department of Justice
Robert Bonniwell - Modern Maturity Center, Dover, Delaware
Kathryn Bunville, Esq. - Deputy Attorney General, Delaware Department of Justice
Leo Burns, MD - Emergency Medical Services, Christiana Care Health Systems
Richard Callery, MD - Chief Medical Examiner, Director, Forensic Sciences Laboratory, DE Department of Health & Social Services
Michael Capriglione - Chief of Police, Town of Newport, DE
Patricia Curtin, MD - Chief of Geriatric Medicine, Christiana Care Health Systems
Jennifer DeJesus Coordinator, - Senior Advocate Program, DE Department of Justice
Carlos de los Ramos - Latin American Community Center
David Ferry, Esq. - Attorney at Law
Christine Frystacki Director (former), - Services for Aging/Adults with Physical Disabilities
Polli Funk - Delaware Coalition Against Domestic Violence
Robert Glen - Delaware State Bank Commissioner
Richard Harper - Sussex County Senior Services, CHEER
Timothy Hoyle - Delaware Department of Health & Social Services
Richard Johnson - President, Delaware Chapter, AARP
Mariann Kenville-Moore Director, - Victims & Witness Services, DE Department of Justice
Kathleen Keuski - Meals on Wheels, Sussex County, DE
Richard Kiger, Esq. - Chief Deputy, New Castle County Register of Wills
Carolee Kunz, Esq. - Director, Services for Aging & Adults with Physical Disabilities
Thomas Murray DE - Division of Long Term Care Resident Protection
Howard Rubinstein, MD - Director of Emergency Medicine, St. Francis Hospital, Wilmington, DE
Olha Rybakoff - Senior Advocate
Olha Rybakoff, Esq. - Director, Consumer Protection Unit, DE Department of Justice
Gregory Sacco Director, - Fraud Prevention Bureau, DE Department of Insurance
David Simpson, MD - Christiana Care Outpatient Geriatric Assessment Program
Philip Soule Medicaid Director, DE - Department of Health & Social Services
Gerard Spadaccini - Deputy Principal Assistant, Delaware Medical Examiner’s Office
Karen Stein, PhD. - Coordinator, Clearinghouse on Abuse & Neglect of the Elderly,
University of Delaware
Dawn Thompson - Delaware Department of Justice
Ruth Townsend - Investigator, Medicaid Fraud Control Unit, DE Department of Justice
Robin Williams - Bruner Public Guardian

APPENDIX B: LIST OF THE SUBCOMMITTEES OF THE DELAWARE
ATTORNEY GENERAL’S TASK FORCE ON
SENIOR VICTIMS

LIST OF THE SUBCOMMITTEES OF THE
DELAWARE ATTORNEY GENERAL’S TASK FORCE ON SENIOR VICTIMS

APPENDIX C: LIST OF SERVICES AND OTHER RESOURCES IN DELAWARE FOR SENIOR CRIME VICTIMS

APPENDIX D: PROPOSED AMENDMENTS TO TITLE 11 OF THE DELAWARE CODE TO CONFORM THE AGE CRITERION THAT TRIGGERS ENHANCED PENALTIES FOR CRIMES COMMITTED AGAINST THE ELDERLY; EXPAND THE CRIMES FOR WHICH ENHANCED PENALTIES MAY BE IMPOSED FOR CRIMES AGAINST THE ELDERLY; AND IMPOSE CRIMINAL SANCTIONS FOR FRAUDULENT CONVERSION BY FIDUCIARIES OF PROPERTY BELONGING TO THEIR PRINCIPALS


AN ACT TO AMEND TITLE 11 OF THE DELAWARE CODE RELATING TO CRIMINAL STATUTES IN WHICH THE VICTIM IS AN ELDERLY PERSON OR THE AGE OR STATUS OF THE VICTIM IS AN ELEMENT OF AN OFFENSE OF A SENTENCING ENHANCER.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1. Amend § 222, Title 11 of the Delaware Code be redesignating paragraphs "(9)" through and including "(26)" thereof as paragraphs "(10)" through and including "(27)" thereof and by inserting a new paragraph "(9)" thereto to read as follows:

"(9) ‘Elderly person’ means any person who is 62 years of age or older. Thus, the terms ‘elderly person’ and ‘person who is 62 years of age or older’ shall have the same meaning as used in this Code and in any action brought pursuant to this Code."

Section 2. Amend Chapter 4, Title 11 of the Delaware Code by adding a new section § 454 to read as follows:

"§ 454. Knowledge of Victim’s Age.

Notwithstanding any provision of law to the contrary, it is no defense for an offense or sentencing provision defined in this title, or Titles 16 or 31 of the Delaware Code, which has an element of such offense or sentencing provision the age of the victim, that the accused did not know the age of the victim or reasonably believed the person to be of an age which would not meet the element of such offense or sentencing provision unless the statute defining such offense or sentencing provision or a statute directly related thereto expressly provides that knowledge of the victim’s age is an element of the offense or that lack of such knowledge is a defense."

Section 3. Amend § 612 (a)(5), Title 11 of the Delaware Code by deleting the phrase "65 years of age or older" as it appears in that paragraph and substituting in lieu thereof the phrase "62 years of age or older."

Section 4. Amend § 613 (a)(7), Title 11 of the Delaware Code by deleting the phrase "65 years of age or older" as it appears in that paragraph and substituting in lieu thereof the phrase "62 years of age or older."

Section 5. Amend § 621 (b), Title 11 of the Delaware Code by deleting the symbol "." At the end of the first sentence of that subsection and inserting in lieu thereof the phrase "except where the victim is a person 62 years of age or older in which case any violation of subjection (a)(1) of this section shall be class G felony."

Section 6. Further amend § 621 (b), Title 11 of the Delaware Code by inserting the phrase "or any long term care facility in which elderly persons are housed" between the phrase "vocational-technical school," and the phrase "in which case" as those phrases appear in the second sentence of that subsection.
Section 7. Amend § 825, Title 11 of the Delaware Code by deleting the symbol "." At the end of the last sentence of that section and inserting in lieu thereof the phrase "except where the person who suffers physical injury is a person 62 years of age or older in which case any violation of this section shall be class D felony."

Section 8. Amend § 826, Title 11 of the Delaware Code by deleting the symbol "." At the end of the last sentence of that section and inserting in lieu thereof the phrase "except where the person who suffers physical injury is a person 62 years of age or older in which case any violation of this section shall be class B felony."

Section 9. Amend § 832 (a)(4), Title 11 of the Delaware Code by deleting the phrase "65 years of age or older" as it appears in that paragraph and substituting in lieu thereof the phrase "62 years or age or older."

Section 10. Amend § 841 (c)(1), Title 11 of the Delaware Code by deleting the phrase "60 years of age or older" as it appears in that paragraph and substituting in lieu thereof the phrase "62 years of age or older, or an ‘infirm adult’ as defined in § 3902 (1) of Title 31 of this Code, or a ‘disabled person’ as defined in § § 3901(a)(1) or 3901(a)(2) of Title 12 of this Code,’.

Section 11. Amend Section 841 (c)(2), Title 11 of the Delaware Code by deleting the phrase "60 years of age or older" as it appears in that paragraph and substituting in lieu thereof the phrase "62 years of age or older or an ‘infirm adult’ as defined in § 3902 (1) of Title 31 of this Code, or a ‘disabled person’ as defined in § § 3901 (a)(1) or 3901 (a)(2) of Title 12 of this Code,".

Section 12. Amend § 846, Title 11 of the Delaware Code by deleting the symbol "." At the end of the last sentence of that section and inserting in lieu thereof the phrase "except where the victim is a person 62 years of age or older in which case any violation of this section shall be class D felony.".

Section 13. Amend § 903(c), Title 11 of the Delaware Code by deleting that subsection in its entirety and inserting lieu thereof a new subsection "(c)" to read as follows:

"(c)(1) Except where the victim of any violation of this section is a person 62 years of age or older, unlawful use of a credit card is a class A misdemeanor unless the value of the property or services secured or sought to be secured by means of the credit card exceeds $1,000, in which case it is a class G felony.

(2) Where the victim of any violation of this section is a person 62 years of age or older, unlawful use of a credit card is a class G felony unless the value of the property or services secured or sought to be secured by means of the credit card exceeds $1,000, in which case it is a class F felony."

Section 14. Amend Section 916 (c)(4), Title 11 of the Delaware Code by deleting the phrase "65 or older" as it appears in that paragraph and substituting in lieu thereof the phrase "62 years of age or older".

SYNOPSIS

This Act brings conformity to the age thresholds at which enhanced penalties are provided for those who victimize our older citizens. It defines an elderly person as being one of the age 62 or older for all purposes of Title 11. The Act also adds "infirm adults" and "disabled persons" to those receiving greater protection under certain statutes by subjecting those convicted of stealing from such victims to enhanced penalties.

The Act also makes it clear that, unless specifically expressed in the statutory language of a criminal offense, it is not the intent of the General Assembly to require the State to prove that a defendant knew the age of his or her victim when the defendant committed a crime in which age is an aggravating circumstance. E.g. 11 Del.C. § § 612(a)(5), 613(a)(7), 621, 633, 634, 825, 826, 832, 841(c), 846, 903, 916, 4209(e), etc.

APPENDIX E: A PROPOSED AMENDMENT TO TITLE 10 OF THE DELAWARE CODE TO ENCOURGE BUSINESSES AND FINANCIAL INSTITUTIONS TO VOLUNTARILY REPORT SUSPECTED INCIDENTS OF FINANCIAL EXPLOITATION OF THE ELDERLY BY PROVIDING CRIMINAL AND CIVIL IMMUNITY FOR MAKING SUCH REPORTS


AN ACT TO AMEND TITLE 10 OF THE DELAWARE CODE RELATING TO REPORTING FINANCIAL FRAUD OF THE ELDERLY AND INFIRM.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1 Amend Title 10 of the Delaware Code by adding a new § 8142 as follows:

"§ 8142. EXAMPTION FROM CRIMINAL AND CIVIL LIABILITY FOR
REPORTING FINANCIAL FRAUD OF THE ELDERLY AND INFIRM

(a) For purposes of this section:

(1) "Reporting program" means an internal written policy, program, plan or procedure adopted by a person fro the purpose of establishing protocols for the reporting of suspected financial fraud to law enforcement or other authorities.

(2) "Elderly person" has the same meaning as defined in 11 Del.C. § 222 (9).

(3) "Infirm adult" has the same meaning as defined in 31 Del.C. § 3902 (1).

(4) "Person" means any individual, corporation, partnership, limited liability company, unincorporated association, or other entity.

(5) "Financial fraud" means any act of illegally acquiring, appropriating or using the money, financial resources, assets or property of an elderly person or inform adult through fraud, trickery or deceit.

(b) (1) No person shall be subject to criminal liability or to suit, directly, derivatively, or by way of contribution or indemnification, for any civil damages or any type as a result or participating in a reporting program with respect to any act, omission, failure to act or failure to report pursuant to such reporting program.

(2) A person who reports suspected financial fraud to a law enforcement authority or Adult Protective Services when that report is not made pursuant to a reporting program shall not be subject to criminal liability or to suit, directly, derivatively, or by way of contribution or indemnification, for any civil damages of any type resulting from such report if the report is made under a good faith belief that financial fraud has occurred.

(c) Any regulation, statue, court rule or judicial opinion designating a
communication or information as privileged or confidential shall not apply to any report made pursuant to a reporting program.

(d) This section shall not apply to any person who perpetrates any financial fraud.

(e) No person may be compelled to adopt a reporting program."

Section 2 If any provision of this Act or the application of any section or part thereof
to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of this Act that can be given effect without the invalid provision or application.

Section 3 The provisions of this Act shall be effective upon its enactment into law.


SYNOPSIS

This bill is intended to encourage the reporting of suspected financial fraud of the elderly and infirm adults by providing immunity from criminal and civil liability for making such reports. Under the bill, anyone who makes a good faith report to law enforcement authorities of such suspected activity is immune from criminal and civil liability for making that report. In addition, any person that adopts a formal written program for reporting suspected financial fraud is immune from civil or criminal liability for any report, act, or omission under that program. Participation in reporting programs is voluntary.


APPENDIX F: DRAFT OF THE MODEL POLICE DEPARTMENT SENIOR VICTIM POLICY


_______________POLICE DEPARTMENT SENIOR VICTIM POLICY


Purpose

Law enforcement must play a critical role in developing a comprehensive strategy that will meet the needs of the growing number of elderly in this country. Older citizens in our communities deserve and require a tailored law enforcement response to provide them with effective services.

The purpose of this policy is to establish procedures for investigating crimes involving victims who are elderly citizens; to insure that all appropriate measures are taken to assist senior victims; and to establish parameters for the regular training of officers in the investigation of crimes against elderly citizens.

Definition

Senior victim – Any crime victim who is 60 years old or older.

Discussion

When elderly citizens are victimized, they often suffer greater physical, mental and financial injuries than other age groups. Elderly victims are twice as likely to suffer serious physical injuries which require hospitalization than victims from any other age group. The physiological process of aging brings with it a decreasing ability to heal after injury, both physically and mentally. Thus, elderly victims may never recover from the trauma of their victimization. The trauma that elderly victims suffer may be worsened by their financial situation. Because many of our nation’s elderly citizens live on fixed or low incomes, even a small monetary loss may have severe consequences to them. They may not be able to afford the professional services which could help them in the aftermath of a crime.

Senior victims face additional factors which may hinder their physical and psychological well being after a crime. They may doubt their ability to meet the expectations of law enforcement and worry that the investigating officer may view them as less competent than others. They may fear that relatives will learn of their victimization and consider them incompetent or unable to live alone. They may fear retaliation from the perpetrator or experience guilt for "allowing themselves" to be victimized.

The actions and manner of the police officer interacting with a senior victim may assist the victim in the recovery process by helping to preserve the victim’s dignity and restore a sense of order and security after such a critical event.

Policy

The _____________Police Department recognizes that criminal seek to take advantage of the age and perceived infirmity of our state’s elderly citizens. We recognize that elderly citizens are often the victims of a variety of crimes, including theft and fraud, sexual and non-sexual abuse, domestic violence, harassment, confidence games and other forms of crime. It is the policy of the __________Police Department that crimes involving senior victims be investigated thoroughly and expeditiously, and that these investigations be conducted with the utmost concern and respect for the victims. To that end, these polices and procedures are ordered:

Procedures

Communications

Communications personnel are an integral part of the team approach to dealing with elderly abuse and exploitation. Police should be dispatched on a priority basis to any elderly victims who are involved in any such situations as:

• Crimes in progress;

• An abuser on the premises in violation of an order of protection;

• A risk of substantial loss of property;

• A risk of serious abuse, neglect or exploitation where a caseworker or other responsible authority cannot gain access to investigate.

Responding officer’s responsibilities

The responding officer’s role is to diffuse, assess and stabilize the immediate situation and to preserve the crime scene. This may include effecting forced entry, providing emergency care, removing the victims, checking on the elderly victim’s well-being, taking preliminary statements, preserving evidence and arresting the offender. The officer may be called to conduct an investigation in concert with Adult Protective Services. Officers should not assume that they are relieved of their responsibilities to collect and preserve evidence because an APS representative is present. In general, the officer should conduct a preliminary investigation in the same manner as he or she would in any other situation.

Supervisory notification

Whenever a police officer is dispatched to a complaint involving a senior victim, the officer shall determine the facts of the case and notify a supervisor of the facts of the case as soon as practical. In cases involving death, serious physical injury or serious criminal conduct, the responding officer shall notify a supervisor immediately. The officers will review the investigative actions taken and determine the course of further investigation. The supervisor shall determine at this time if his response or the assistance of additional units is necessary to complete the investigation.

Roll call notification

Any officer who responds to a complaint involving a senior victim shall provide the facts of the case to his or her relief upon being relieved of duty for the day. The responding officer shall relay to his relief any requests for additional steps, such as condition checks, follow-ups, checks on the victim’s welfare or property, or other tasks, as necessary to further the investigation of promote the well being of the victim.

Filing of criminal charges

Officers should be mindful that some criminal offenses include enhanced penalties when the victim is a senior citizen. Officers should take care to insure that the appropriate charge is filed in cases where the victim’s age will increase the class or status of the crime.

Assisting senior victims

All appropriate assistance shall be rendered to the victim whenever possible, such as transporting a senior victim to court who wishes to sign a warrant but has no other means of transportation.

Liaison with other agencies

The _________Police Department will use all means at its disposal to vigorously prosecute crimes against senior victims, and to endeavor to assist these victims in their recovery from crimes. To that end, each officer will use any resources available to him to aid these victims. The officer will provide victim information to the senior victim. He will notify and work with the members of the Attorney General’s Elderly Abuse Unit and the staff of Adult Protective Services when appropriate and will contact the State of Delaware Victim’s Crime Compensation Board on behalf of the victim when appropriate. He will work with any other government or reputable private agency providing information or assistance to senior victims while protecting the victim’s privacy.

Identification and checking of "at risk" persons

Should any officer become aware of a senior citizen whose situation requires checks of the citizen’s welfare, he shall enter the names, address, telephone number and appropriate detail on the Senior Citizen Check Log. He and each officer relieving him in succession will make appropriate checks of the citizen’s safety and welfare in person or by telephone, as appropriate, and continue to make these checks with the frequency specified on the log until the citizen’s name is removed from the log.

Officer training

The Chief of Police shall select appropriate, concise training materials on the issues of senior victimization and the investigation of these crimes and distribute these training materials to all personnel. These materials will be distributes annually, or more frequently if appropriate.

Roll call training

Any officer who becomes aware through law enforcement activities of through the media of any group seeking to victimize senior citizens of any new "scam" being perpetrated against senior citizens in the area will relay this information directly to all officers through a memo, and will notify his relief of the existence and location of the memo so that the information will reach each officer upon their arrival for duty. In any case where the officer may discover such information, it will also be forwarded on the appropriate intelligence reporting form to the Delaware State Police Intelligence Unit.


APPENDIX G: ABOUT THE CLEARINGHOUSE ON ABUSE AND NEGLECT OF THE ELDERLY, UNIVERSITY OF DELAWARE

CLEARING HOUSE ON ABUSE AND NEGLECT OF THE ELDERLY

The Clearinghouse on Abuse and Neglect of the Elderly (CANE), located at the University of Delaware, is the largest automated collection of elder abuse resources and materials in the nation. CANE’s 3,000-plus holdings include journals, state reports, audio-visual materials, and training manuals and curricula. CANE is capable of performing customized searches of its database to produce annotated bibliographies for researchers, healthcare professionals, members of the public, and other interested parties.

Using single keywords, or a combination of keywords, inquirers of CANE’s database may shape the scope and focus of their searches to obtain references pertaining to a broadly defined or narrowly focused topic in the area of elder abuse and neglect. CANE is capable of performing customized searches of approximately 100 keywords and can search over 2,000 holdings. While users are encouraged to select their own keywords, CANE can perform customized searches if the inquirer provides a brief statement describing the specific area of interest. Last year, CANE provided 274 instances of technical assistance to the elder abuse community.

CANE is a partner of the National Center on Elder Abuse (NCEA). NCEA is funded by the U.S. Administration on Aging, Department of Health and Human Services.


To contact CANE:

Email: CANE-UD@udel.edu
Telephone: (302) 831-3525
or Fax: (302) 831-6081
Website http://db.rdms.udel.edu:8080/CANE/index.jsp
or mail:
Clearinghouse on Abuse and Neglect of the Elderly (CANE)University of DelawareDept.
of Consumer StudiesAlison Hall West- Rm.
211 Newark, DE 19716


APPENDIX H: ABOUT THE DELAWARE DEPARTMENT OF JUSTICE,
MEDICAID FRAUD CONTROL UNIT


THE DELAWARE DEPARTMENT OF JUSTICE,
MEDICAID FRAUD CONTROL UNIT

The Delaware Medicaid Fraud Control Unit (MFCU), located within the Attorney General’s Fraud Division, consists of thirteen members, three of whom, including the Director, are Deputy Attorneys General. In addition, there are six investigators, an auditor, two secretaries, and a paralegal. The Director and one of the other attorneys are cross-designated as Special Assistant United States Attorneys to aid in the prosecution of health care fraud in the Unites States District Court.

The duties and responsibilities of the MFCU under Section 1007.11 of Title 42 of the Code of Federal Regulations are as follows:

(1) The Unit conducts a statewide program for investigating and prosecuting violations of all applicable State laws pertaining to fraud in the administration of the Medicaid program, the provision of medical assistance, or the activities of providers of medical assistance under the State Medicaid Plan.

(2) The Unit also reviews complaints alleging abuse or neglect of patients in health care facilities receiving payments under the State Medicaid Plan and may review complaints of the misappropriation of patient’s private funds in such facilities. The MFCU’s jurisdiction was recently increased to include investigation and prosecution of cases of abuse in board and care facilities. If the initial review indicates substantial potential for criminal prosecution, the unit investigates the complaint and proceeds with prosecution if warranted. If the initial review does not indicate a substantial potential for criminal prosecution, the unit refers the complaint to an appropriate State agency or back to the referring source.

(3) If the Unit, in carrying out its duties and responsibilities, discovers that overpayments have been made to a health care facility or other provider of medical assistance under the State Medicaid Plan, the unit either attempts to collect such overpayment or refers the matter to an appropriate State agency for collections.

(4) The Unit makes available to Federal investigators or prosecutors all information in its possession concerning fraud in the provision or administration of medical assistance under the State plan and cooperates with such officials in coordinating any Federal and State investigations or prosecutions involving the same suspects or allegations.

(5) The Unit safeguards the privacy rights of all individuals and provides safeguards to prevent the misuse of information under the Unit’s control.

To assure a coordinated and multi-disciplinary approach to the investigation and prosecution of cases of patient and resident abuse, the MFCU has recently entered into a Memorandum of Understanding the Division of Long Term Care Residents’ Protection and Delaware’s police departments which provides procedures for the ongoing coordination among the various entities concerned with combating patient abuse.


APPENDIX I: THE DELAWARE DEPARTMENT OF JUSTICE,
MEDICAID FRAUD CONTROL UNIT
PATIENT ABUSE UNIT – NURSING HOME STAFF TRAINING CURRICULUM


Delaware Medicaid Fraud Control Unit
Patient Abuse Unit – Nursing Home Staff Training

Outline & Agenda

I. Introduction

A. Patient Abuse Unit member introductions
B. MFC, DOJ, PAU, DLTCRP, LTCO, DHSS, etc.
C. Jurisdiction – Medicaid nexus, state facilities, long term care facilities
D. Training initiative – Police recruits and in-service, NH staff, Senior Academies, Citizen Academies training, information, feedback, etc.
E. Patient Abuse, "residents’" elder abuse, financial exploitation
F. Criminal investigations, not DLTCRP, Superior Court jurisdiction, role of PAU in nursing homes and long-term care health facilities
G. Miscellaneous

II. Patient Abuse Definitions, Prevention, Reporting Requirements

A. Factors contributing to abuse
B. Definitions of abuse
C. Patient abuse, neglect, mistreatment, financial exploitation
D. Reporting requirements
E. Patient abuse is a crime!

III. Patient Abuse Referrals, Investigations, Prosecutions, Procedures

A. Criminal investigations by MFCU/PAU
B. Referrals – DLTCRP, LTCO, family friend, health care professional, anonymous, visitor, co-worker, etc.
C. Witness in an investigation – expectations, requirements, laws, etc.
D. Suspect in an investigation – expectations, requirements, rights, laws, etc.
E. Prosecutions by the Office of the Attorney General – DAG decision, investigator insight, arrest/indictments, defendants are photographed and fingerprinted, Superior Court jurisdiction, Attorney General’s Probation (factors), Adult Abuse Registry, etc.
F. Miscellaneous.

IV. Wrap-up/Q&A

Nursing Home Staff Training
Patient Abuse 101 For Nursing Home Employees

I. WHAT IS PATIENT ABUSE?

A. PHYSICAL ABUSE – Unnecessarily inflicting pain or injury to a resident including but not limited to hitting, kicking, pinching, slapping, pulling hair or sexual molestation.
Example – Grab and twist arm of resident – physical abuse even if no "marks"

B. EMOTIONAL ABUSE – Includes, but is not limited to, ridiculing or demeaning a resident, making derogatory remarks to a resident or cursing directed towards a resident, or threatening to inflict physical or emotional harm on a resident
Example – Threaten to lay resident with ALS flat in bed.

C. MISTREATMENT – Includes the inappropriate use of medications, isolation, or physical/chemical restraints on or of a resident.
Example – Tie resident to chair with cloth strap so he can’t walk around.

D. NEGLECT – Lack of attention to physical needs of the resident, including but limited to toileting, bathing, meal and safety;
Failure to report resident health problems or changes in health condition; and
Failure to carry out a prescribed treatment plan for a patient or resident.
Example – Fail to make rounds and change incontinent residents leaving them in urine saturated undergarments and bed linens.

II. WHAT DO YOU DO IF YOU BELIEVE A RESIDENT HAS BEEN ABUSED

A. MANDATORY REPORTING – Reasonable cause to believe that resident has been abused, mistreated or neglected SHALL immediately report this to DHSS by oral communication….written report within 48 hours.

B. TELL YOUR SUPERVISOR IMMEDIATELY

III. ABUSE: THINKING ABOUT THE UNTHINKABLE

A. REALITIES OF NURSING HOME WORK – Physically demanding, long hours/shift work, short-staffing, low pay, combative/difficult resident, etc.

B. EVERYDAY STRESSORS – Problems at home, care giving duties at home, fatigue, financial concerns, frustration, etc.

C. REALITIES OF NURSING HOME WORK + EVERYDAY STRESSORS = POTENTIAL FOR ABUSE INCIDENT…..Potential increases as stress and frustration increase.

D. SOMETIMES GOOD HEALTH CARE WORKERS DO BAD THINGS…In other cases there are individuals who simply don’t belong in healthcare due to their criminal histories and they commit their crimes in nursing homes because they have ready access to vulnerable "easy victims."

E. TO THE MAJORITY OF YOU WHO ARE GOOD HEATH CARE WORKERS….I’M GOING TO DISCUSS WHERE THINGS SOMETIMES GO WRONG CAUSING GOOD HEALTHCARE WORKERS TO DO BAD THINGS.

1. Not recognizing your own personal limitations
Recognize when you have simply "had it" and BACK OFF. People don’t show up for work thinking "tonight’s the night I’m going to abuse a resident." It starts out like any other shift and then things start going wrong. Do yourselves and the residents you care for a favor – recognize when you’ve "had it" and take a break or take a day off.

2. Not knowing the residents you are caring for
Think about the daily routines and habits that you have (Do you eat breakfast before you shower? Do you like to read in bed at night? Do you like to watch the evening news when you eat your dinner?). Now think about someone planning your day for you so that none of these things are possible. Even given the realities of living in a nursing homes…individual preferences can and must be taken into consideration. Talk to the residents, their families, your co-workers…you will not only make life better for your residents when you plan care according to their individual needs but you will make your job easier and more satisfying. Do yourselves and the residents you care for a favor – think of them as real people and not as "the feeder in B bed" etc.

3. Not working as a team
Help each other out. Ask each other questions and for advice on dealing with a particular resident. Communicate with your peers, your supervisor, and the administrator. Even in the most under staffed nursing home there is always another CAN or another nurse to turn to. Do yourselves and the residents you care for a favor – consider yourselves a team and act like a team.

4. Not knowing when you need help
When a situation becomes volatile or explosive and your frustration level soars…ensure that the resident is safe and then get help. Get help. Call your supervisor. Call a co-worker into the room. In every patient abuse case there is a point (and it may only last a split second) where a person makes a choice. Your choice is to react to your frustration or anger by hitting, threatening or neglecting a resident OR to call for back-up. Do yourself and the residents you care for a favor – make the right choice.

IV. PATIENT ABUSE IS A CRIME

A. MFC – Statutory authority and jurisdiction
B. Patient Abuse Investigators – This is all we do. Emphasize thorough investigations.
C. What you can expect if you are a witness or a suspect in a patient abuse case.

 

I. Investigations By Delaware Department Of Justice Medicaid Fraud Control Unit

A. Referrals

1. Ombudsman
2. Law enforcement
3. Patients family or friend
4. Health care professionals
5. Anonymous calls and letters

B. What to expect if you are the suspect or witness in an investigation

1. Interview
a. Witness to an incident can be disturbing
b. Witness could possibly be called to court to testify
c. Law requires reporting of acts of neglect or abuse

C. Prosecution

1. The manner in which a case is prosecuted is up to the Attorney General’s Office.
a. At the conclusion of the interviews and collection of information a decision will be made by a Deputy, not the investigator, whether the incident is prosecuted.
b. The investigators are able to give insight such as - the suspect during the investigation cooperated, appeared to be first offense
c. If the information shows a crime was committed the suspect can be arrested for the appropriate charge.
d. At the time of the arrest the suspect will be photographed and fingerprinted.
e. Each incident, which involves patient abuse or neglect, will go to Superior Court (conviction then public record).
f. On occasion where the case shows the suspect admitted the criminal act and appeared to be remorseful this office has given Attorney General’s Probation.
g. The investigation by this office is separate from the Adult Abuse Registry, however, the outcome of the investigation can lead to a person being placed on the registry.

 

PATIENT ABUSE, NEGLECT AND MISTREATMENT
*The complete text of the statutes pertaining to nursing homes can be found at 16 Del.C. Ch.11

§ 1131. Definitions. Title 16

(1) "Abuse" shall mean:

a. Physical abuse by unnecessarily inflicting pain or injury to a patient or resident. This includes, but is not limited to, hitting, kicking, pinching, slapping, pulling hair or any sexual molestation. When any act constituting physical abuse has been proven, the infliction of pain shall be assumed.
b. Emotional abuse which includes, but is not limited to, ridiculing or demeaning a patient or resident, making derogatory remarks to a patient or resident or cursing directed towards a patient or resident, or threatening to inflict physical or emotional harm on a patient.

(2) "Mistreatment" shall include the inappropriate use of medications, isolation, or physical or chemical restraints on or of a patient or resident.

(3) "Neglect" shall mean:

a. Lack of attention to physical needs of the patient or resident including, but not limited to toileting, bathing, meals and safety.
b. Failure to report patient or resident health problems or changes in health problems or changes in health condition to an immediate supervisor or nurse.
c. Failure to carry out a prescribed treatment plan for a patient or resident.
d. A knowing failure to provide adequate staffing which results in a medical emergency to any patient or resident where there has been documented history of at least 2 prior cited instances of such inadequate staffing within the past 2 years in violation of minimum maintenance of staffing levels as required by statute or regulations promulgated by the Department, all so as to evidence a willful pattern of such neglect.

(4) "Financial Exploitation" shall mean the illegal or improper use or abuse of a patient's or resident's resources or financial rights by another person, whether for profit or other advantage.

(5) "Facility" shall include:

a. Any facility required to be licensed under this chapter;
b. Any facility operated by or for the State which provides long-term care residential services; and
c. The Delaware Psychiatric Center and hospitals certified by the Department of Health and Social Services pursuant to § 5001 or § 5136 of this title.

(6) "Investigation" shall mean the collection of evidence in response to a report of abuse, neglect, mistreatment or financial exploitation of a resident or patient to determine if that resident or patient has been abused, neglected, mistreated or financially exploited. The Division shall develop protocols for its investigations which focus on ensuring the safety and well-being of the patient or resident and which satisfy the requirements of this Chapter.

(7) "Division" shall mean the Division of Long-Term Care Consumer Protection;

(8) "Department" shall mean the Department of Health and Social Services or its designee.

(9) "Person" means a human being and where appropriate a public or private corporation, an unincorporated association, a partnership, a government or governmental instrumentality.

(10) "High managerial agent" means an officer of a facility or any other agent in a position of comparable authority with respect to the formulation of the policy of the facility or the supervision in a managerial capacity of subordinate employees. (65 Del. Laws, c. 442, § 1; 70 Del. Laws, c. 222, § 3; 70 Del. Laws, c. 186, § 1; 70 Del. Laws, c. 550, § 1; 71 Del. Laws, c. 487, § 1; 72 Del. Laws, c. 120, § § 1-4.)

§ 1132. Reporting requirements.

(a) Any employee of a facility or anyone who provides services to a patient or resident of a facility on a regular or intermittent basis who has reasonable cause to believe that a patient or resident in a facility has been abused, mistreated, neglected or financially exploited shall immediately report such abuse, mistreatment, neglect or financial exploitation to the Department by oral communication. A written report shall be filed by the employee or service provider within 48 hours after the employee or service provider first gains knowledge of the abuse, mistreatment, neglect or financial exploitation.

(b) Any person required by subsection (a) of this section to make an oral and a written report who fails to do so shall be liable for a civil penalty not to exceed $1,000 per violation.

(c) In addition to those persons subject to subsection (a) of this section any other person may make such a report, if such persons have reasonable cause to believe that a patient or resident of a facility has been abused, mistreated, neglected or financially exploited.

(d) Any individual who intentionally makes a false report under this subchapter shall be guilty of a class A misdemeanor.

(e) Any correspondence or other written communication from a resident or patient to the Department, the Attorney General's Office and/or a law enforcement agency shall, if delivered to or received by a facility, be promptly forwarded, unopened, by the facility or service provider to the agency to which it is written. Any correspondence or other written communication from the Department, the Attorney General's office and/or a law enforcement agency to a resident or patient shall, if delivered to or received by the facility or other service provider, be promptly forwarded, unopened, by the facility or other service provider to such resident or patient. Failure to comply with this section shall result in a civil penalty not to exceed $1,000 per violation. (65 Del. Laws, c. 442, § 1; 70 Del. Laws, c. 186, § 1; 71 Del. Laws, c. 292, § 1; 71 Del. Laws, c. 487, § § 3, 5, 6.)

§ 1136. Violations.

(a) Any person who knowingly abuses, mistreats or knowingly or recklessly neglects a patient or resident of a facility shall be guilty of a class A misdemeanor. Where the abuse, mistreatment or neglect results in serious physical injury then such person shall be guilty of a class D felony. Where the abuse, mistreatment or neglect results in death then such person shall be guilty of a class A felony.

(b) Any person who knowingly exploits a patient's or resident's resources shall be guilty of a class A misdemeanor where the value of the resources is less than $1,000 and shall be guilty of a class G felony where the value of the resources is $1,000 or more.

(c) Any member of the board of directors or a high managerial agent who knows that patients or residents of the facility are being abused, mistreated or neglected and fails to promptly take corrective action shall be guilty of a class A misdemeanor. (65 Del. Laws, c. 442, § 1; 72 Del. Laws, c. 120, § § 5, 6.)

§ 1140. Jurisdiction.

The Superior Court shall have original and exclusive jurisdiction over violations of this subchapter. (65 Del. Laws, c. 442, § 1.)

Enhanced Penalties

§ 612 Assault in the second degree; Class D Felony
The person recklessly or intentionally causes physical injury to another person who is 65 years or age or older.

§ 613 Assault in the first degree; Class C Felony
The person intentionally causes serious physical injury to another person who is 65 years of age or older.

Note: Hearsay statements of infirm adults or patient/resident victims are now admissible under 11 Del.C.3516.

Delaware Department of Justice
Office of the Attorney General
Medicaid Fraud Control Unit (MFCU)
Patient Abuse Unit

MFCU, New Castle County: (302) 577-8938
(302) 577-8303

MFCU, Kent County: (302) 739-4211

MFCU, Sussex County: (302) 853-5353

MORE THAN "JUST A VISITOR"
HOW NURSING HOMES VISITORS CAN MAKE A
DIFFERENCE FOR NURSING HOME RESIDENTS

Medicaid Fraud Control Unit, Patient Abuse Unit
Office of the Attorney General

I. BE OBSERVANT

A. What do you SEE?

1. Observe the resident’s general appearance, hygiene and living environment.

· Clean? Appropriately dressed? Clothing season appropriate?
· Nails trimmed? Hair combed?
· Look for and report accident hazards such as loose floor tiles or wet floors.
· Physical restraints are not routinely used and should be questioned.
· Except in rare and unusual circumstances the resident should NOT be in bed all the time.
· Signs of recent weight loss? Visit during mealtime and observe.

2. Observe general appearance of other residents.

· Should see activities taking place.
· Residents should appear clean and appropriately dressed.

3. Observe how staff interact with residents.

· How many residents per staff member?
· Is staff assistance available when needed?
· Are staff overly hurried? Do they listen to the resident?

B. What do you SMELL?

1. Report any unusual, persistent odors.

· "Nursing home smell" (urine) is not normal
· Attends and other disposable undergarments should ONLY be used if necessary, not for convenience of staff or because resident is unable to get staff assistance to the bathroom.

C. What do you HEAR?

1. Listen and report resident concerns if the resident hasn’t been able to report them himself.

· Be especially alert for complaints regarding lack of assistance with meals or bathroom use.
· Immediately report any verbalization of abuse and neglect.

2. Listen to how staff members speak to residents.

· Tone should be professional and respectful.
· Report any cursing or inappropriate remarks.

 

II. BE AN ADVOCATE

A. Schedules and Routines

· The resident’s preferred schedule should be followed as much as possible. For example, if they always bathed in the evening the nursing home should make efforts to accommodate this.
· Care is required to be individualized and planned according to the resident’s personal needs and preferences. For example, residents who prefer to go to bed early or sleep late should generally be able to do so. Residents have the right to have their preferences considered.
· "Institutional" atmosphere is not "normal." The environment should be as home-like as possible.

B. Speak Up!

· Report problems but also make positive comments when things are done well. Generally deal with direct care staff and move up the ladder as necessary. Introduce yourself to the Director of Nursing and Administration so that you do not have to meet them for the first time when there is already a problem.
· Attend care plan conferences and family council meetings when possible.
· Individualize the resident so that staff sees them as the unique person they are (i.e. photographs, hobbies, etc.)

III. BE THERE

A. Visiting

· Visitors can make a big difference and can detect potential problems early. Visit at different times and on different days of the week. Get to know the people caring for the resident you are visiting. Small problems caught early and addressed won’t become big problems.
· Look out for the residents in the facility who have no family or regular visitors.

B. Community Involvement

· Organize a group at your church or in your neighborhood to visit nursing homes, perhaps "adopt" a nursing home resident. These facilities are not separate communities – they are part of OUR community and we need to be involved with them.

APPENDIX J: ELDER ABUSE PROTOCOL FOR MEDICAL FACILITIES

The Medical Services Subcommittee throughout its actions and recommendations has endeavored to foster greater cooperation, communication and coordination between the numerous entities involved in serving the victims of elder abuse and neglect. This Subcommittee has recognized that not only do medical professionals care for the physical and emotional injuries brought about by elder abuse and neglect but in many instances the medical professionals act as a facilitators for the elderly victims to receive the legal and social services they may need.

Towards this end, the Subcommittee reviewed various protocols for the identification, treatment and reporting of elder abuse and neglect. It found the current Christiana Care policy to be comprehensive, useful and current. The Subcommittee recommends it as a model for other organizations to emulate. The medical subcommittee will seek to expand its current membership from New Castle County personnel to include key individuals from Kent and Sussex Counties so that protocols from those areas can be developed or reviewed if they already exist.

Protocols are only effective if medical personnel can identify who the victims are. Therefore, the Medical Services Subcommittee supports and recommends continued training of all medical personnel who have potential contact with victims so that victims can be identified. Timely service is also important. The Medical Services Subcommittee recommends using dedicated individuals with forensic training, such as SANE nurses in the emergency department to complete the documentation process.

As with any service program, funding is an issue. The Medical Services Subcommittee seeks to pursue any private, institutional or governmental funding that would defray the cost of such services.

Finally, the problem of elder abuse and neglect will be ongoing and so must be the response. Regular meetings between agencies involved in servicing victims’ needs will be necessary after the Task Force convenes. The Medical Services Subcommittee members will be active participants in these discussions. Through continued education, protocol implementation and interagency cooperation, the Medical Services Subcommittee believes Delaware’s senior victims of violence will receive continually improving care.



SAMPLE ELDER ABUSE PROTOCOL FOR MEDICAL FACILITIES

¨ Dehydration due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Malnutrition due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Inadequate clothing due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Bruising, abrasions, lacerations, burns, decubiti or other injuries due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Diarrhea, incontinence or impaction due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Contractures due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Inappropriate medicine procurement or administration due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Inadequate caregiver observation or monitoring of dependents activities due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Inadequate response from caregiver in seeking medical care for a dependent’s illness or injury
¨ Yes ¨ No ¨ Possibly

¨ Missed medical appointments due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Repetitive E.D. visits or hospital admissions for inadequate health care surveillance due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly

¨ Patient abandonment due to caretaker abuse or neglect
¨ Yes ¨ No ¨ Possibly




Use the following space to provide relevant information from patient and caregiver concerning prior reference medical problems:

Patient:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Caregiver:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


SOCIAL NEEDS ASSESSMENT

¨ Inadequate interactions with family or friends due to caretaker abuse or neglect

¨ Yes ¨ No ¨ Possibly

¨ Inadequate regular social activities due to caretaker abuse or neglect

¨ Yes ¨ No ¨ Possibly

¨ Drug or alcohol abuse in caregiver contributing to abuse or neglect

¨ Yes ¨ No ¨ Possibly

¨ Psychological abuse including but limited to isolation, punishment, threats or harassment by caregiver

¨ Yes ¨ No ¨ Possibly

¨ Psychiatric disease in caregiver preventing adequate provision or dependents needs

¨ Yes ¨ No ¨ Possibly

¨ Concerning emotional or psychological behaviors of dependent due to caretaker abuse or neglect (including but not limited to silence only in the presence of the caregiver, anxiety around caregiver, crying out or avoidance)

¨ Yes ¨ No ¨ Possibly

Use the following space to provide relevant information from patient and caregiver concerning prior referenced social problems:

Patient:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Caregiver:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


FINANCIAL NEEDS ASSESSMENT


¨ Does the caregiver provide a role in the management of any of your finances (including but limited to your home, other real estate, cash, bank accounts, stocks, bonds, pensions, other retirement accounts, medical accounts or personal valuables)

¨ Yes ¨ No ¨ Possibly

¨ Is there a concern that the caregivers financial management is not in the dependents best interest

¨ Yes ¨ No ¨ Possibly

¨ Does the caregiver steal from the dependent or otherwise misuse funds

¨ Yes ¨ No ¨ Possibly

¨ Is the dependent being medical care due to a misuse funds

¨ Yes ¨ No ¨ Possibly



Use the following space to provide relevant information from patient and caregiver concerning prior referenced financial problems:

Patient:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Caregiver:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


PHOTOS:

I. Ask patient for permission. If patient unable to give consent, take photos now, you may need to consult the surrogate decision-maker later.

A. Before treatment, if possible
B. Color film
C. Photo from different angles, full body, and close up
D. Use objects such as a coin or ruler to indicate size
E. Include the patients face in at least one photo
F. At least two pictures of every major trauma area


II. Mark photos promptly/precisely
A. Patients name
B. Injury location
C. Date, time
D. Name of photographer
E. Name of others present when photos were taken



BODY INJURY MAP – SAMPLE

Identify all sites of abnormal findings on body graphic below. Number each site and describe wound parameters in medical record. Note photographs, if any.

Male

Notes:








Signature:______________________________ Date:_________________________
BODY INJURY MAP – SAMPLE

Identify all sites of abnormal findings on body graphic below. Number each site and describe wound parameters in medical record. Note photographs, if any.

Female

Notes:

Signature:______________________________ Date:_________________________

Full Victim Contact List