experts are beginning to be used by adult protective services, law enforcement agencies, and the rest of the criminal justice system on a small scale, particularly for those elderly persons who are not cognitively able to provide testimony about their abuse- and neglect-related injuries. A few nursing schools offer this type of specialized advance practice training. The first masters level program with this specialty has been established at Johns Hopkins University. Research on the effectiveness of forensic nurses in identifying elder mistreatment (in all settings, including the clinic and the courtroom) would be useful.

Another part of the health care system that often provides the first response to elder mistreatment is the emergency medical technician. While some training has been done locally by adult protective services, recently the national organization of emergency medical technicians, in conjunction with the National Center on Elder Abuse, has completed a curriculum for their members on elder mistreatment. Research on emergency medical technicians who are trained and that call in social services (adult protective services) would provide valuable information on this promising new intervention.

The hospital setting may also offer an opportunity to detect mistreatment and to intervene so as to prevent further occurrences. Hospitals and the health care professionals working in hospitals have an obligation to ensure the safest possible discharge for their patients. As methods of detecting mistreatment improve, perhaps through the detection of sentinel events associated with mistreatment, it will be possible to target interventions at hospitalized patients who have been mistreated prior to admission. The panel encourages research on hospital-based interventions to prevent further mistreatment of hospital inpatients after discharge. This research should include hospital emergency departments, where many mistreated elders may be seen but not ultimately admitted to the hospital prior to discharge. Interventions to detect and manage mistreatment in hospital emergency departments should therefore also be evaluated.

Other interventions occur at the organization level. The rules of governing organizations like the Joint Commission on Accreditation of Health Care Organizations as well as rules connecting continued Medicaid funding to long-term care and community residential facilities include requirements for recognizing and responding to cases of elder mistreatment. The primary requirements include having a policy to assess possible victims and adhering to state legal requirements relating to investigation as well as prevention of further mistreatment. Accreditation policies and practices relating to elder mistreatment should be studied on a systematic and ongoing basis.

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