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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.
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:
-
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.
-
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;
-
The feasibility of
amending protocols for reporting crime incidents
in Delaware to flag incidents involving senior
victims should be explored;
-
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.
-
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;
-
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:
-
Expand present
mandatory reporting laws in Delaware to include
personnel in additional professions and that
responsible agencies assess their protocols for
timeliness and resources:
-
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.
-
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.
-
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;
-
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;
-
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:
-
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;
-
The Legal Handbook
for Older Delawareans should be updated, and its
distribution increased;
-
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;
-
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.
-
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:
-
The database of the
Delaware Helpline should be expanded to include
information concerning services for senior crime
victims;
-
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;
-
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:
-
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;
-
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.
-
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;
-
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.
-
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:
-
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.
-
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.
-
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.
-
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:
-
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;
-
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.
-
The Adult Abuse
Registry should be expanded to encompass
information concerning in-home health aides who
are convicted of crimes against seniors;
-
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;
-
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:
-
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]
-
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;
-
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;
-
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;
-
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:
-
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.
-
The corps of senior
peer advocates in the Delaware Attorney
General’s Office’s Senior Victim Advocates
Program should be expanded;
-
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:
-
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;
-
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:
-
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;
-
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.
-
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;
-
The media should be
encouraged to cover the prosecution of cases
involving senior crime victims.
APPENDICES
-
List Of The Members
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
-
List of Services And
Other Resources In Delaware
For Senior Crime Victims
-
Proposed Amendments
To Title 11 Of The
Delaware Code
-
Proposed Amendments
To Title 10 Of The
Delaware Code
-
Draft Of The Model
Police Department Senior
Victim Policy
-
About The
Clearinghouse On Abuse And Neglect
Of The Elderly At The University Of Delaware
-
About The Delaware
Department Of Justice Medicaid Fraud Control
Unit
-
About The Delaware
Department Of Justice Medicaid Fraud Control
Unit, Patient Abuse Unit – Nursing Home Staff
Training Curriculum
-
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
Elder Abuse
Prevention
Christine Frystacki, Chair
Colleen Anderson, Esq.
Bill Clark
Carolee Kunz, Esq.
Katie McMillan
Olha Rybakoff
Olha Rybakoff, Esq.
Financial Fraud
Robert Glen, Chair
Francis Babiarz
David Bakerian
Howard Jester
James Ropp, Esq.
Gregory Sacco
Hon. Carl Schnee
Michael Undorf, Esq.
Law Enforcement
Chief Michael Capriglione, Chair
Chief Richard Baldwin
Dr. Leo Burns
John Miller
Chief William Topping
Legislative
Timothy Barron, Esq., Chair
Kathryn Bunville, Esq.
David Ferry, Esq.
Richard Kiger, Esq. |
Medical
Services
Dr. Leo Burns, Chair
Sue Bardsley, RN
Dr. Patricia Curtin
Dr. Howard Rubinstein
Dr. David Simpson
Physical Abuse
Vickie Artis, Chair
Gary Alderson, Esq.
Dr. Leo Burns
Dr. Richard Callery
Polli Funk
Gerard Spadaccini
Ruth Townsend
Residential Services
Thomas Murray, Chair
Timothy Hoyle
John Miller
Steve Tanzer
Resources
Robin Williams-Bruner, Chair
Vickie Artis
Jennifer DeJesus
Carlos de los Ramos
Mariann Kenville-Moore
Richard Harper
Richard Kiger, Esq.
Richard Johnson
Dr. Karen Stein |
APPENDIX C: LIST
OF SERVICES AND OTHER RESOURCES IN DELAWARE FOR
SENIOR CRIME VICTIMS
Alzheimer’s
Disease
Alzheimer Association:
NC 633-4420
K/S 1 (800) 219-7666
Contact – Delaware, Inc.: 1 (800) 262-9800
Alzheimer’s Day Treatment Program,
Evergreen Center: NC 995-8448
K/S 422-1575
Delaware Elwyn:
NC 658-8860
Death and Bereavement
Compassionate Care Hospice of Delaware:
NC 683-1000
K/S 1 (800) 219-0092
Delaware Hospice, Inc.: NC 478-5707
K 678-4444
S 856-7717
Statewide………………… 1 (888)
838-9800
Oncology Care: NC 455-1500
Visiting Nurse Association K 424-4801
S 855-9700
Statewide………………… 1 (888)
862-0001
Employment Counseling and Job Training
Senior Employment Programs – 55+:
Wilmington Senior Center: NC 651-3440
Modern Maturity Center: K 734-1200
First State Community Action: S 856-7761
Financial Assistance – Emergency
Catholic Charities: NC 654-6473
K 674-4016
S 684-8694
Delaware Helpline: 1 (800) 464-4357
Information and referral only
Salvation Army: NC 656-1667
K 678-9551
S 628-2020
Financial Counseling
Consumer Credit Counseling Service: NC
996-9004
Debt management 1 (800) 642-2227
K 672-7772
Delaware Cooperative Extension: NC 831-1239
Budget counseling K 697-4000
S 856-7303
Delaware Money Management Program: 1 (800)
223-9074
Statewide (for seniors and disabled)
Interfaith Housing: NC 995-7428
K 424-4650
Health Insurance Matters
ELDERinfo:
1 (800) 336-9555
Health insurance counseling for
K 739-6266
people with Medicare
Consumer Services:
1 (800) 282-8611
Automobile and homeowners insurance K 739-4251
Fraud Prevention:
1 (800) 632-5154
Insurance Fraud K 739-4257
Homemaker/Home Health Care Services
Cheer Home Services:
S 856-5187
Division of Services for the Aging and
Adults with Physical Disabilities:
NC 453-3820
1 (800) 223-9074
K/S 422-1386
Generations Home Care:
NC 658-6731
Statewide………….. 1-888-810-5422
Home Health Care Corp.:
NC 738-9756
K 697-7125
Christina Care Visiting Nurse Association:
Statewide…………. 1 (888) 862-0001
|
Housing
Information
Community Housing, Inc.: NC 652-3991
Delaware State Housing Authority: NC 577-5001
K 739-4263
S 337-0219
Dover Housing Authority: K 678-1965
Housing Opportunities of Northern Delaware: NC
429-0794
New Castle County Community Services: NC
395-5600
Newark Housing Authority: NC 366-0826
Wilmington Housing Authority: NC 429-6700
Legal Problems
Community Legal Aid Society, Inc: NC 575-0660
Low income, elderly or handicapped or 1 (800)
292-7980
K 674-8500
or 1 (800) 537-8383
S 856-0038
or 1 (800) 462-7070
Delaware Department of Justice:
Victims Services (Statewide)
1 (800) 870-1790
NC 577-8500
Senior Advocate Program
NC 577-8500
K/S 739-4211
Consumer Protection Unit
NC 577-8600
K/S 1 (800) 220-5424
Medicaid Fraud Control Unit
NC 577-8938
(Patient Abuse Unit)
NC 577-8303
K 739-4211
S 853-5353
Delaware State Police (Statewide)
1 (800) VICTIM1
Delaware Volunteer Legal Services:
NC 478-8680
Low income, elderly or handicapped,
1 (800) 773-0606
civil law cases only
Legal Help Link:
NC 478-8850
Lawyer Referral Services K/S 1(800) 733-0606
Legal Services Corporation:
NC 575-0408
K/S 734-8820
Victims Advocacy Program:
NC 577-2200 Ext. 3098
Senior Citizens
Academy of Lifelong Learning:
NC 573-4417
American Association of Retired Persons:
1(800) 897-2277
Meeting at various locations
Cheer Connection:
S 856-5187
Division of Services for the Aging and
Adults with Physical Disabilities:
NC 453-3820
1 (800) 223-9074
K/S 422-1386
HOME Program, Lutheran Community Services:
NC 654-8886
Home repair for seniors
Interfaith Volunteer Caregivers:
NC 225-1040
K 284-4825
S 732-3371
Senior Citizens Affordable Taxi (SCAT):
1 (800) 355-8080
Social Security Administration:
1 (800) 772-1213
Telephone Reassurance Programs:
Generations Home Care
S 856-7774
RSVP, Modern Maturity Center
K 734-1200
Senior Rollcall NC 239-5151
Volunteering
R.S.V.P. (Senior Citizens Volunteers):
NC 577-4965
K 734-1200
S 856-5815
Volunteer Link: NC 577-7378
K/S 739-7378
Statewide………... 1 (800) 815-5465
|
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:_________________________
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