September 2006 | Volume 8 | No. 10

Policy & Legislation

Senate Special Committee on Aging Hearing Examines Guardianship Abuses

On September 7, 2006, U.S. Senate Special Committee on Aging Chairman Gordon Smith (R-OR), lead sponsor for the proposed Elder Justice Act, held a hearing on "Exploitation of Seniors: America's Ailing Guardianship System."

The hearing was held partly in response to the recent high-profile family battle over the care of philanthropist Brooke Astor in New York City. Witnesses testifying underscored the need for greater oversight and coordination by courts handling guardianships and by the Social Security and Veteran's Affairs representative payment programs.

Chairman Smith in opening remarks underscored the public concern. "Every state in the country requires a license to practice medicine, law, or even drive. Unfortunately, the same cannot be said for guardians, who in most states remain largely unregulated and unsupervised," he said.

Experts invited to speak at the hearing include:

  • Ira Salzman, Esq., New York City, attorney for Philip Marshal, Brooke Astor's grandson
  • Barbara Bovbjerg, U.S. Government Accountability Office
  • Carol J. Scott, Missouri State Long Term Care Ombudsman
  • The Honorable Mel Grossman, Administrative Judge, Probate Division, 17th Judicial Circuit, Broward County, FL
  • Terry Hammond, National Guardianship Association

Below are excerpts from the written testimony:

An important lesson of the Astor case is that guardianship proceedings can be a powerful weapon in the battle to stop elder abuse. It is also important to note that guardianship is by no means a universal solution to the problem of elder abuse.
– Ira M. Salzman, Esq., New York City, attorney for Philip Marshal,
Brooke Astor's grandson
Guardians and representative payees do not always act in the best interest of the people they are appointed to protect. Some have conflicts of interest that pose risks to incapacitated people. While many people appointed as guardians or representative payees serve compassionately, often without any compensation, some will act in their own interest.
– Barbara Bovbjerg, U.S. Government Accountability Office, Washington, DC
At this time, no one knows how many guardianships there are in America. This is because guardianship is a uniquely local process, governed by state law and administered on a local level - often county by county. For example, in Texas there are 254 counties, each of which administers guardianships slightly differently.
– Terry Hammond, Executive Director, National Guardianship Association
In Missouri we have a system that has an elected official in each county, who assumes the role of guardian for our citizens who have no one else or for whom there is a dispute over who should be the guardian. There are no requirements for being elected; these people have less than 30 hours of training, and yet control the lives and finances of many people. Their only oversight is from the judge in their county.
– Carol J. Scott, Missouri State Long Term Care Ombudsman
If we, as judges, are to exercise one of the most awesome powers available to any court, that is the removal of rights that all of us in this room enjoy, and we place someone in charge to protect the ward, it seems to me that the Court has both a legal and a moral obligation to insure that the ward is being truly protected. If we do not take measures to insure that, then what point is there in removing those rights?
– The Honorable Mel Grossman, Administrative Judge, Probate Division,
17th Judicial Circuit, Broward County, FL

Click here to read the full testimony by witnesses >>

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Elder Justice Watch – Progress Update

The latest tally shows thirteen additional members of Congress have signed on as cosponsors of the Elder Justice Act. On the Senate side, new supporters for S. 2010 include Senators Arlen Specter (R-PA), Tim Johnson (D-SD), Bill Nelson (D-FL), Robert Menendez (D-NJ), Ken Salazar (D-CO), and Jack Reed (D-RI).

On the House side, the latest H.R. 4993 cosponsors are Representatives Sherrod Brown (D-OH), Marcy Kaptur (D-OH), Gwen Moore (D-WI), Jim Ramstad (R-MN), Robert Wexler (D-FL), and Lynn Woolsey (D-CA).

The totals are now 27 bipartisan cosponsors in the Senate and 42 in the House.

Congress is scheduled to adjourn by early October. For bill status updates, contact the Elder Justice Coalition at (202) 782-4140 or e-mail [email protected].

Legislative proposals concerning Elder Justice

State News

California Seeks Reforms to Strengthen Probate Conservatorship System

In late August just before its fall adjournment, the California Legislature passed the Omnibus Conservatorship and Guardianship Reform Act of 2006, a package of four bills designed to increase court oversight of conservators and guardians and protect frail and vulnerable adults from abuse. The bills include:

  • AB 1363 Omnibus Conservatorship and Guardianship Reform Act of 2006
    Makes a number of reforms of the probate conservatorship system, including enhanced review of conservatorships primarily through increasing the frequency and scope of court investigations.
  • SB 1116 Conservatorships
    Increases court oversight of moves of conservatees and the sale of their homes. Also creates a presumption that the least restrictive appropriate setting for the conservatee at the commencement of the conservatorship is his or her home.
  • SB 1550 Professional Fiduciaries Act
    Among other things, requires a person acting or holding him or herself out as a professional fiduciary to be licensed as a professional fiduciary, unless he or she is licensed as an attorney. Creates a Statewide Registry within the Department of Justice to oversee conservators, guardians, and trustees, and the coordination of complaint information among courts.
  • SB 1716 Conservatorships
    Allows the court, on its own motion or upon request, to order a review of the conservatorship at any time. Additionally, it requires the court investigator's evaluation to include the appropriateness of the conservatee's placement, the conservatee's quality of care, and the conservatee's financial condition.

The legislative history indicates that this package arose out of an in-depth investigatory series, "Guardians for Profit," published November 2005 by the Los Angeles Times and a joint hearing held by the California Assembly and Senate Judiciary Committees. The bills are currently awaiting the signature of the Governor.

Links to bills

Related background

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California Predatory Lending Law Targets Reverse Mortgages

On September 5, Governor Arnold Schwarzenegger signed into law a bill, SB 1609, which toughens reverse mortgage predatory lending protections for seniors.

The new legislation bars lenders from accepting a reverse mortgage application or assessing any fees until the potential borrower has received independent counseling regarding the loan. Under this law, it is also illegal to coerce a borrower into buying an annuity as a part of the transaction.

As a further protection, the law requires lenders to translate contracts into Spanish, Chinese, Tagalog, Vietnamese, or Korean if a loan is primarily negotiated in one of those languages.

SB 1609 Chaptered >>

Related information

Sharing Ideas: Promising Practices Spotlight

Advocates Showcase Five Promising New Ideas from the Field
by Sara Aravanis, NCEA Director, National Association of State Units on Aging

Sharing ideas, practice and experience is a hallmark mission of the National Center on Elder Abuse. Before a standing-room-only-crowd at the 2006 Annual Conference of National Adult Protective Services Association (NAPSA) held earlier in the month in San Francisco, California, leaders in several states showcased some impressive developments.

 Statewide Safeguards to Protect Nursing Home Residents
Kathleen Quinn, [email protected], incoming Executive Director of NAPSA and policy advisor to the Illinois Attorney General, called attention to new statewide safeguards to protect nursing home residents at risk of abuse by repeat criminal offenders.

Quinn noted that facilities that house felons and sex offenders are now required by Illinois law to provide a plan for resident safety and notify residents of the offenders' background. Additionally, a statewide criminal background check is required for all current and incoming nursing home residents.

Also, in Illinois, more facility death review teams and sexual assault teams are likely to emerge over the next several months as new emphasis is placed on implementing an existing state law requiring them, Quinn said.

 Law Enforcement Training
NAPSA President-Elect Art Mason, [email protected], Director of Lifespan's elder abuse prevention program in New York, showcased the in-roads being made in educating law enforcement officers on elder abuse issues. He described a Violence Against Women Act training grant as a key tool for developing a comprehensive, 4-hour training program and improving linkages with law enforcement.

What works? Mason said it is critical that an APS/elder abuse representative co-teach the session with a law enforcement trainer. The curriculum will soon be available on DVD for use in other locations.

 APS Systems Reform
Tim McGinnis, [email protected], Director of APS Policy and Program Operations in Texas, provided an update on Texas APS reform. Overall, the state is making solid progress, he said.

To strengthen staff competencies, reforms and actions in Texas include web-based model training with proficiency exams; classroom education/preparation; and initial capped caseload levels for new direct service hires. Subject experts are available to help with APS investigations of financial abuse and self neglect.

Other critical actions include an automated, multi-domain, risk assessment tool and a multi-level case review system to help document client outcomes. Special task units functioning as multi-disciplinary teams offer assistance on "tough cases" in some counties. Community action plans are developed to guide public education activities. To ensure the progress of these reforms, the state reports to the Texas Legislature each quarter.

 LTC Ombudsman/APS Partnership
Guided by a comprehensive Memorandum of Understanding, Georgia's Long Term Care Ombudsman Becky Kurtz [email protected] and Adult Protective Services Program Director Mary Martha Rugg [email protected] explained how they work together to assure resident-centered advocacy and protection.

In a tandem effort relating to emergency management, for example, they advocated for the passage of "Mattie's Call Act." Signed by Governor Sonny Perdue in April 2006, the act, HB 728, provides for a statewide alert system for missing adults with disabilities and roles for the media and law enforcement when a person with dementia is missing.

 Zero-Tolerance Policy
New Mexico's Interim APS Division Director Bill Belzner, [email protected], showcased his state's "Zero Tolerance of Elder Abuse" strategy, a multi-pronged initiative launched by Governor Bill Richardson. Belzner said that in the initial phase, the focus has been on staffing the recently reorganized New Mexico Aging and Long-Term Care Service Department's Adult Abuse Prevention and Enforcement Unit and coordinating funding streams.

Other priorities include developing an integrated intake and data system; training medical and law enforcement professionals; establishing fatality review teams; and, importantly, revising the New Mexico Adult Protective Services Act.

NCEA is proud to be a co-sponsor of the 2006 NAPSA conference and this unique learning opportunity. NAPSA is a partner in the National Center on Elder Abuse. For more information, please visit

NCEA News & Resources

Upcoming NCEA Webcast

 Thursday, October 12  2 PM Eastern Time
A Primer on Evaluating Field Programs and Projects

The National Center on Elder Abuse recognizes the importance of evaluation in assessing what works. The now familiar buzzword is "Outcomes-based Evaluation." Loosely translated, it means, "How do we know that what we're doing is really making a difference?" For public and privately-funded programs alike, that's a legitimate and important question.

This Webcast is a basic introduction to outcome-based program evaluation, tailored to the needs of organizations with scarce resources. You'll learn how to make outcome-based evaluation an integral part of your project/program instead of an "afterthought" or add-on. You'll learn the basic steps of planning an evaluation strategy. You'll learn how to write objectives that are outcomes-based, and simple methods for measuring whether or not you're achieving the results intended.

Dr. Karen Stein is Director of Educational Assessment at the University of Delaware, and a partner in the National Center on Elder Abuse. She directs the Clearinghouse on Abuse and Neglect of the Elderly, and has made multiple national and international presentations in the program evaluation area.

Target Audience: Beginner

This Webcast is not intended for those who are well-experienced in program evaluation, as we will only skim the surface. But those who are novices to the area will find useful, practical tips and strategies that will serve as a valuable starting point to designing better evaluation plans.

Register Online

Not Able to Participate?
A taped replay will be available within 24 hours on the Web conferencing site at >>

Suzanne Stack, Program Associate
National Center on Elder Abuse
National Association of State Units on Aging
[email protected]

NCEA Webcast Archive >>

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New Releases

 New in the CANE Bibliography Series –
Financial Exploitation of the Elderly: An Update of the Literature

An updated bibliography of the literature 2004-2006 has been prepared by the Clearinghouse on Abuse and Neglect of the Elderly (CANE) to support the work of practitioners, scholars, and others in combating the exploitation of seniors.

Available on the NCEA Web site at >>

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 Analysis of 2005 State Legislation Amending APS Laws New!

A new informative analysis from NCEA Partner, the American Bar Association Commission on Law and Aging tracks and summarizes key provisions in state Adult Protective Services laws enacted in 2005.

The changes in state law address a wide variety of issues, including: Civil liability of the perpetrator; criminal penalties; emergency/involuntary APS, evidence/testimony; government oversight of APS; the role of APS as guardian; information/record disclosure; investigations; multidisciplinary teams; outreach to victims; and protection of victims' assets.

Available on the NCEA Web site at >>

Also new >> Summary chart of 2003-2005 APS amendment categories

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Sign up today for the National Center on Elder Abuse Listserve

NCEA Elder Abuse listserve provides a free, 24-hour, 7-day-a-week online link to others who are working on elder abuse issues. The NCEA listserve is a discussion forum for professionals working in elder abuse or allied fields. Membership is restricted to adult protective services practitioners and administrators, aging services practitioners and administrators, educators, health professionals, judges, lawyers, law enforcement officers, prosecutors, policy makers, and researchers.

To request a subscription to the Elder Abuse listserve, just fill out the form at, or If you prefer, you can e-mail the list manager at [email protected]. All requests must include the information below:

  • Your name, profession, and e-mail address
  • A statement of your interest or expertise in elder abuse or adult protective services
  • Employer's name (if applicable) and address
  • Phone number (so that you can be contacted in the event of an e-mail problem)

See our Web site for more details.

On the Front Lines

Mississippi Facts & Stats1

  • In 2004, Mississippi APS caseworkers investigated 1,399 reports of alleged abuse, neglect, and exploitation of elder and vulnerable adults.
  • According to state figures, 192 of the "evidenced reports" in 2004 involved physical neglect; 35 physical abuse; 26 medical neglect; 22 financial abuse/exploitation; 17 emotional abuse; and 8 sexual abuse.
  • Mississippi law defines a vulnerable adult as any adult 18+ or any minor whose ability to perform normal activities of daily living is impaired due to a mental, emotional, physical, or developmental disability or dysfunction, or brain damage or the infirmities of aging. The term "vulnerable adult" also includes residents or patients, regardless of age, in a care facility.
  • More than half (52%) of all Mississippians 65 and older live in rural areas.

Source: Mississippi Division of Family and Children Services, Adult Abuse/Neglect Statistics for Calendar Year 2004, Issued May 2005; Mississippi Division of Aging and Adult Services, Profile of Older Mississippians, 2005

1The statistics highlighted in this column are gathered from a variety of state-specific data sources and should be cited using the sources referenced. Readers should note that elder abuse incidence and prevalence rates vary among states and differ depending upon the definitions used and state laws regarding reporting. The National Center on Elder Abuse cannot guarantee and assumes no responsibility for the accuracy or completeness of the information.

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Mississippi Online Resources



Research & Scholarship

Special Issue Edition: Elder Abuse and Neglect
Journal of Gerontological Social Work, Vol. 46, No. 3/4 / May 2006

 "Elder Abuse and Neglect among Veterans in Greater Los Angeles: Prevalence, Types, and Intervention Outcomes"
by A. Moon PhD, University of California, Los Angles; K. Lawson MSW, MSG, Beach Cities Health District; M. Carpiac MSW, University of California, Los Angeles; and E. Spaziano MSW, VA Greater LA Healthcare System

Medical record review and analysis of 575 cases at a Veterans Affairs Geriatric Outpatient Clinic in Los Angeles, CA revealed 31 veterans (5.4%) who had an elder abuse report filed on their behalf. According to the research, the prevalence of elder abuse/neglect was higher among older (80+) and Caucasian and African American veterans. Eight of 31 victims suffered more than one type of maltreatment, including self-neglect. Financial abuse and self-neglect were the two most common forms of elder abuse reported. Almost one-half of the victims had dementia, and eight were clinically depressed. The research also revealed that moving the person to another environment (nursing home/board and care) and arranging for conservatorship were the most frequent interventions.

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"Psycho-Educational Support Groups for Older Women Victims of Family Mistreatment: A Pilot Study"
by Patricia Brownell PhD and Deborah Heiser PhD, Isabella Geriatric Center, New York, NY

This research evaluated outcomes of an elder mistreatment psycho-social support group pilot for cognitively unimpaired older female victims of mistreatment by family members and significant others for whom they are providing care or support. The support group pilot was an adaptation of a model designed by NOVA House, an elder abuse shelter program in Manitoba, Canada. While the significance of findings is limited by the small number of pilot participants, the model intervention and evaluation instrument developed for the study may be utilized for study replication.

You may also be interested in …
NCEA's interview with Dr. Patricia Brownell in National Center on Elder Abuse Newsletter , Vol. 7, No. 2 / November 2004

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Self-Determination and Elder Abuse: Do We Know Enough?;
by L. Rene Bergeron MSW, PhD, Department of Social Work, University of New Hampshire, Durham, NH

The author concludes that the principle of self-determination and the notion of competency are overly simplified in the social work and elder abuse literature and may be misused by allowing abused older victims to choose to remain in often life-threatening situations. While her main focus is adult protective services, the author asserts that protecting older people, assisting in creative interventions, and developing needed services is a shared professional responsibility.

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Other Papers in the Issue
Journal of Gerontological Social Work, Vol. 46, No. 3/4 / May 2006

  • "Communities Respond to Elder Abuse"
  • "A Policy Perspective on Elder Justice Through APS and Law Enforcement Collaboration"
  • "Social Inclusion: An Interplay of the Determinants of Health - New Insights into Elder Abuse"
  • "Use of a Single Page Elder Abuse Assessment and Management Tool: A Practical Clinician's Approach to Identifying Elder Mistreatment"
  • "An Elder Abuse Shelter Program: Build It and They Will Come "
  • "Consumer Fraud and the Elderly: A Review of Canadian Challenges and Initiatives,"
  • "Ethical and Psychosocial Issues Raised by the Practice in Cases of Mistreatment of Older Adults"
  • "Hearing the Voices of Abused Older Women"
  • "Effects of Dependency on Compliance Rates Among Elder Abuse Victims at the NYC Department for the Aging, Elderly Crime Victim's Unit"

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Note: Scholarly literature is often published online before print publication. Check individual publisher sites for full-text availability. Many publishers offer pay-per-article service.

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To see abstracts of more published studies, visit the Clearinghouse on Abuse and Neglect of the Elderly at For assistance in obtaining references, e-mail CANE at [email protected].

Trends and Statistics

Nursing Home Complaint Investigations
by Mark Miller, Elder Rights/Ombudsman, National Association of State Units on Aging

Consumer Reports (CR) recently published the results of a new investigative study, Nursing homes: Business as usual, which reveals that, in spite of federal nursing home reform regulations that have been in place for almost two decades, bad care still persists at many nursing homes.

The recent trend, according to the CR analysis, has been an easing off of federal enforcement. Although the number of deficiency citations is up since 2003, fewer serious deficiencies are being cited. The report also highlights the point that the federal government has failed to collect monetary fines levied against poor performing facilities.

These findings correspond to a study released in July by the HHS Office of Inspector General, Nursing Home Complaint Investigations.

Consumer Reports advises that before choosing a home, consumers should read the state's inspection reports, contact the ombudsman to see if any complaints have been made, and make unannounced visits to observe the care and environment first hand. Contacting the ombudsman is important in light of the finding that in the last three years, 657 nursing homes were cited for failing to make their inspection results readily available to the public.

The Consumer Reports Nursing Home Quality Monitor identifies nursing homes that are likely to provide better-quality care and those likely to provide poorer-quality care.

Click here to learn more >>

Funding Opportunities

 EARLY ALERT: 2007 Training Grants to Stop Abuse and Sexual Assault Against Older Individuals or Individuals with Disabilities

The Office on Violence Against Women (OVW) recently announced that it plans to release a solicitation for the Training Grants to Stop Abuse and Sexual Assault Against Older Individuals or Individuals with Disabilities Program in Winter 2006/2007.

Look for the announcement on the OVW Web site

Keep in mind the cornerstone of the initiative is partnership. All applicants must have a formal "memorandum of understanding" (MOU) with a law enforcement agency, prosecutor's office, nonprofit, nongovernmental domestic violence or sexual assault victim services program, and one nonprofit program or government agency serving older individuals.

OVW hopes this advance announcement will give prospective interested parties the time to establish the necessary collaboration.

For more information, contact Janice Green, (202) 616-6728, [email protected].

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Resources for Grant Writers

Calendar/Coming Up

  October 22-25
31st National Conference and Annual Meeting of the
National Citizens' Coalition for Nursing Home Reform (NCCNHR)
Featuring Keynote Speaker Erin Brockovich
Hilton Crystal City Hotel, Arlington, Virginia
  November 16-20
59th Annual Scientific Meeting of the Gerontological Society of America
Adam's Mark Hotel, Dallas, Texas

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Check our Web site often for more dates and events

New on the Bookshelf

 Experts Set Guidelines for Disaster Preparedness –
Recommendations for Best Practices in the Management of Disaster Victims

Baylor College of Medicine (BCM) and Harris County Hospital District in Houston have just announced the release of a new disaster planning guide that draws from the Katrina experience to suggest ways planners, clinicians, and policy makers can better assist vulnerable people before and after emergencies.

The new reference guide, Recommendations for Best Practices in the Management of Elderly Disaster Victims, is available online at

"We need to learn from Houston's response to Hurricane Katrina," stated Dr. Carmel Bitondo Dyer, MD, associate professor of medicine at BCM and director of the Harris County Hospital District Geriatrics Program in announcing the publication. "We want to be better prepared to take care of the elderly and other vulnerable adults in the future. I think these recommendations will help tremendously."

A concise, authoritative, and thoroughly illustrated guide, the authors offer historical insights from the Katrina response, as well as practical information on the Seniors without Families Triage (SWiFT™) pre- and post disaster assessment tool, and recommendations.

Major funding for the guidebook was provided by the American Medical Association and AARP Foundation.

See related testimony
Carmel B. Dyer, MD, "Caring for Seniors in a National Emergency: Can We Do Better?" Testimony before the Senate Special Committee on Aging, Washington, DC, May 2006

Professional Development/Distance Learning

 Decision-Making: Autonomy, Valid Consent and Guardianship
University of Miami Geriatrics and Ethics Project

The objective of this online training module, No. 3 in an eight-part Geriatrics and Ethics series, is to provide information and generate discussion about ethical issues associated with health care decision-making in elderly patient populations. The module covers three main themes: Autonomy, Valid Consent, and Guardianship. Questions for discussion and links to references are included.

Click here to access the ethics training module >>

Quote of the Month

"America's guardianship system is failing to protect our nation's aging population. With burgeoning caseloads, lack of oversight, lack of training and certification, and lack of data and monitoring, the environment is ripe for corrupt individuals to take advantage of the elderly. Federal leadership is desperately needed to ensure that our nation's elderly grow old with dignity, while also keeping their fundamental freedoms intact."

— Senator Gordon H. Smith, Chairman, Senate Special Committee on Aging, September 2006

Table of Contents

Policy & Legislation

State News

Sharing Ideas: Promising Practices Spotlight

NCEA News & Resources

  • Upcoming NCEA Webcast

  • On the Frontlines

    Research & Scholarship

    Trends & Statistics

    Funding Opportunities

    Calendar/Coming Up

    New on the Bookshelf

    Professional Development/Distance Learning

    Quote of the Month

    NCEA Newsletter

    is published 10 times a year by


    September 2006
    Volume 8, No. 10
    Sara Aravanis, Director
    Susan Coombs Ficke, Contributing Writer/Editor

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    The NCEA Newsletter is supported in part by a grant, No. 90-AM-2792, from the U.S. Administration on Aging, Department of Health and Human Services.

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    NCEA always welcomes news from the field. Please direct comments and suggestions to the editor, Susan Coombs Ficke [email protected]


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