Elder Abuse: A global problem with local solutions .

1. June 16th, 2010 Detroit, Michigan Elder Abuse: A global problem with local solutions�.

2. Presented by Paul Greenwood, Deputy District Attorney, San Diego County, California

4. Career prosecutors

5. The views expressed by the presenter are not necessarily those of the San Diego District Attorney�s Office WARNING!

6. By the way we care for our very young, the elderly and the defenseless How are we to measure a community?

7. Sadly, some victims are overlooked, ignored, disbelieved, or simply are abandoned All victims deserve our utmost response

8. �Our debt to the heroic men and valiant women in the service of our country can never be repaid. They have earned our undying gratitude. America will NEVER forget their sacrifices.� President Harry S. Truman Inscription at WWII Memorial Why should we care?

9. A Crime Going unpunished Predictable Affecting both urban & rural areas Where child abuse & DV were 30 years ago Escalating Elder Abuse is��...

10. Between 1950 & 2000, the total population increased by 87% Age 65+ - by 188% 85+ - by 635% By 2030 - 65+ will triple to over 70 million The aging of America

11. 71,000 Americans are 100+ By 2010 there will be 114,000 By 2020, there will be 241,000 Demographics of living longer

12. Fastest growing age group No known cure for dementia etc. Victims often do not report Third fastest growth job is home care Minimal background checks High temptation, low risk factors ELDER ABUSE IS EXPLODING

13. Fears of many seniors Leads to underreporting Feelings of shame Concern that exposure will lead to loss of independence Sometimes accompanied by threats from perpetrator UNDERSTANDING THE DYNAMICS

14. 65+

15. Some of these myths affect all forms of elder abuse Some affect only financial elder abuse Destroying the myths�.My top ten�.

16. Elderly people make terrible witnesses Myth #1

17. Forgetful Senile Longwinded Grumpy Disabled Fragile AVOID STEREOTYPING OF SENIORS

18. If elderly victim refuses to provide information, there is nothing that can be done Myth # 2

19. We can still build a case by talking to other key witnesses Start on the outside and work your way to the middle Let the DA figure out a way to break through victim�s wall of silence

20. Self -determination is not the answer LESSONS LEARNED FROM DOMESTIC VIOLENCE

21. If not punished, the perp WILL abuse again We CAN convict even without the assistance of the victim Abuse is a crime against NOT JUST the abused Why self-determination is a problem

22. If elderly victim gives the money voluntarily, it is not a crime Myth # 3

23. There are times when the apparent voluntariness has been diluted by fraud, undue influence or by exploiting the mental limitations of the victim

24. If the financial institution reimburses the elderly victim and then declines to seek prosecution, we have no victim Myth # 4

25. Once a victim, always a victim! Restitution can NEVER remove the stigma

26. If victim is deceased before we discover the theft, we cannot prosecute Myth #5

27. Wrong! Treat such a case as if it were a murder There are some situations in which we do not need the victim for a prosecution

28. Any case where the elderly victim is involved in a home repair & there is a dispute over money � this is ALWAYS a civil matter. Myth # 6

29. Is the �contractor� licensed? Are there other victims out there? Did he get the money up front? What services did he promise? What did he deliver?

30. Suspects of elder abuse crimes NEVER call 911 Myth # 7

31. Wrong! Dispatchers need training As do paramedics

32. There is no point in reporting this incident to local law enforcement; they won�t do anything about it. Myth # 8

33. The impact of a letter! Persevere

34. Elderly people die from natural causes Myth # 9

35. The importance of an elder death review team

36. 20,000 deaths a year 52% are reportable Criteria is �not seen by MD in last 20 days/not a �natural� death Out of 11,000 possible cases 7,000 are waived automatically. Out of 4,000 cases that come in, only 2,700 autopsies Deaths in San Diego County

37. Dr. Harold Shipman Charles Cullen Lessons to learn from�.

38. Cullen admitted to having killed 5 more patients by injecting them with lethal doses of drugs Cullen had already admitted to killing 24 patients June 27th, 2005

39. Classic elder abuse murder case

40. There are more important cases out there that are taking up my time Myth # 10

41. APS/Ombudsman program Law enforcement Prosecutors Coroner Public Health Seniors Public Guardian/Probate Court Elder law attorneys Building blocks to form collaborative approach

42. Every County must have a reporting line Billboards Posters Radio and TV PSA�s # of calls WILL increase APS/ OmbudsmanCreating/promoting referral line:

43. Recognize red flags of elder abuse Respond to referral of an elder abuse case Take initial report and make sure case is assigned to a detective for follow up Law enforcement

44. It cannot be a crime - she gave him the money It can�t be filed - he does not want us to prosecute The prosecutor won�t file the case - the victim will make a terrible witness It is a civil matter - it involves a Power of Attorney Common reactions among law enforcement

45. It�s not just a civil matter

46. People vs. Renee Nieblas

47. These cases are worthy These cases are provable We should get more creative in our charging We should not be obsessed with a win-loss record We need to talk to APS Prosecutors

48. Train ME Investigators who take calls from police after a death Establish a protocol for reviewing suspicious deaths of elders Can instigate an elder death review team Coroner /Medical examiner

49. Remind them of their mandated reporter obligations Develop training at every hospital, E.R., clinic Watch for unexplained injuries or inconsistent explanations Public health

50. Reaching them through day centers, senior fairs and other workshops Provide a positive message! Top ten tips for safety � Door prizes & a free lunch Use them as volunteers - RSVP, DA�s office TRIAD Involving seniors

51. Act for client for many years Replaced without warning by new attorney Obligation to inquire�.. Consult State Bar over attorney/client privilege communications Elder Law attorneys

52. Through public speaking at Rotary, Kiwanis, Lions etc� Front counter personnel at police/sheriff�s station 911 dispatcher Banks & credit unions & Western Union Pharmacies Building the awareness level

53. Train the clergy Most are unaware of the problem Encourage an overhaul in visitation ministry Awareness level cont�d

54. Assaults and batteries Physical and Mental Abuse:

55. Delay in reporting Victim often cannot provide history Physical findings may be �clouded� Resident on resident � dementia? Employee on resident � eye witness? Victim allegations �how to handle? Problems associated with sexual abuse of elderly /dependent adult

56. Neglect Physical abuse cont�d

57. Deprivation of medical attention Deprivation of food Lack of hygiene Lack of ventilation, heat or light Over-medicated Under-medicated Classic neglect cases

58. Malnourished Semi-comatose Dehydrated Coated with fecal matter/ urine stained Inadequately clothed Untrimmed toenails, matted hair Bed sores The classic neglected victim

59. Look for signs of financial exploitation Documents giving control to suspect POA Quitclaim deed New will Correspondence, bank statements Check book, ATM, pawn slips Cross reference with financial abuse

60. Contact Dr. Laura Mosqueda of UC Irvine, Californiamosqueda@uci.edu

61. Manslaughter - neglect causes death Murder Intimidation/Mental & Psychological Abuse False Imprisonment Torture Robbery and extortion Physical and mental abuse cont�d

62. Son in his late 30�s to late 40�s Living at home with Mom Divorced/ returns or single and unmotivated or just out of jail Lazy and unemployed Drugs, alcohol or gambling Feeds habit off Mom Sometimes history of mental illness Profile of the physical abuser:

63. Theft Credit card fraud Real Property transfers Home Improvement scams/burglaries Work by unlicensed contractors/overcharging Telemarketing,sweepstakes & e-mail scams Investment fraud Financial Abuse:

64. Canadian & other foreign lotteries Phishing & identity theft Investment Frauds Bogus charities Current top elder financial scams

65. The grandma scam..........

66. Jewelry Checks ATM card Credit card & identity theft Transfer of title - POA & quitclaim deed Bogus investment scams Typical theft scenarios

67. Taking property belonging to another without consent & with intent to permanently deprive HOW TO PROVE STEALING?

68. To consent to a transaction a person must: Act freely & voluntarily & not under the influence of threats, force or duress Have knowledge of the true nature of the act or transaction involved Possess the mental capacity to make an intelligent choice whether or not to do something proposed by another person Lack of consent: CALJIC 1:23

69. Consent requires a free will and positive cooperation in act or attitude CALJIC continued

70. Classic case of theft from a competent victim Theft from an incompetent victim Theft from a marginally competent victim [by undue influence] Three prosecutable scenarios

71. Victim testifies Did not give permission Did not owe monies to suspect Victim is credible SCENARIO # 1

72. Victim cannot testify Medical testimony that victim suffers from dementia/ Alzheimer�s/ Parkinson's or some other illness that deprives victim of necessary understanding Incapacity was present at time of transaction SCENARIO # 2

73. Is it theft, a loan, or a gift? Victim is marginally competent Suspect exploited victim�s vulnerability Victim was unduly influenced or was defrauded SCENARIO # 3

74. Victim �was pushed in a direction that he did not want to go.� The influence by suspect was sufficient to remove the voluntariness of the transaction No longer free will Victim has been evaluated by a geriatric psychiatrist/psychologist Undue Influence

75. Length of relationship Place of first meeting Prior spending habits Prior �charitability� What is left? Multiple escalating transactions Statements & conduct by suspect How to prove undue influence?

76. Bank teller Pastor Neighbor Doctor, pharmacist, optometrist of V Family Ex- spouse of suspect Business contacts of suspect Witnesses

77. Bank, credit card statements Bank surveillance tapes Prior medical records Look for the inappropriate purchases Ask questions, questions, questions!!! Evidence collection

78. Victim was classic example of theft by undue influence Victim testified Short term memory problems Areas of extreme vulnerability People v. Harris

79. Do you have victim�s testimony from a preliminary hearing? If scenario #2, the death should not affect the proceedings Avoid Grand Jury proceedings wherever possible What happens if victim dies after investigation begins and before prosecution finishes?

80. Obtaining a consent release form If V has mental capacity problems, then do NOT get a release Obtain through search warrant or if after case has been issued, through subpoena Be careful about �...

81. Venue is important Build a rapport Look for achievements Try to identify areas of vulnerability Preserve the interview on video Interviewing an elderly victim

82. We must bring elderly victims into court AT EARLIEST OPPORTUNITY to allow confrontation to take place Investigations are time sensitive Prosecutors should minimize delays in filing Crawford v. Washington

83. Try to avoid any defense request for a continuance Once the victim has testified in a preliminary hearing, the testimony is preserved Crawford v. Washington cont�d

84. Getting them to court Bringing the court to them Waiting at court Testifying in court After court - to prevent further victimization Seniors and the court process:

85. Financial Emotional Residual Assess the impact of the crime

86. Bringing services to the victim The one stop shop concept The next step�

87. We respect and honor you! We commit to seeking justice for you We prosecute with: Passion Purpose Perseverance A Message to Seniors:

88. Paul Greenwood 619-531-3464 paul.greenwood@sdcda.org Please feel free to contact me: