Older Victims of Financial Exploitation Shelly L. Jackson, Ph.D. Visiting Fellow Office for Victims of Crime

2013 VOCA National Training Conference St. Louis, MO August 20, 2013

Elder Justice Act PUBLIC LAW 111–148 (2010)

O Patient Protection and Affordable Care Act

World Elder Abuse Awareness Day June 15

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim June 15, 2013, as World Elder Abuse Awareness Day. I call upon all Americans to observe this day by learning the signs of elder abuse, neglect, and exploitation, and by raising awareness about this growing public health issue.

Brooke Aster Case

New York Times (May 15, 2005)

Who's Preying on Your Grandparents? By Gretchen Morgenson

The Perfect Storm O Living longer - increasing older population O Decline of traditional pensions O The increasing complexity of financial tools O Low levels of financial literacy O Rising rates of dementia

It’s All Gone

State Definitions O Age-based (regardless of vulnerability) O Vulnerability-based (regardless of age) O Age-and-vulnerability-based

Forms of Financial Exploitation O O O O O O O O O O O

Consumer fraud Internet fraud/theft Investment fraud Scams Embezzlement Identity theft Medicaid/Medicare Fraud Conversion Forgery Affinity scam Extortion

O Sweetheart scams O Theft O Homicides that are O O O O O

committed for profit Misuse of a power of attorney Improper use of assets Denial of care to reserve funds Denial of access to funds Promises exchanged

Consumer Fraud O Door-to-door sales persons (home repair scams) O Through the internet or email O Telemarketers (international lottery scams) O Through the mail

Sweepstakes & Lottery

Healthcare Fraud & Medicaid/Medicare Fraud O Carried out by unethical doctors, nurses, hospital

personnel, and other professional care providers

O Not providing healthcare, but charging for it O Overcharging or double-billing for medical care or O O O O

services Getting kickbacks for referrals to other providers or for prescribing certain drugs Overmedicating or under-medicating Recommending fraudulent remedies for illnesses or other medical conditions Medicaid fraud

Tax Fraud

Investment Fraud

Mortgage Fraud

Affinity or Charity Scam

Sweetheart Scam

Identity Theft

Conversion

Forgery

Theft

Misuse of Power of Attorney

Denial of Needed Care

Denial of Access to Funds

Promises Exchanged

Improper Use of Assets

Family Members

Professional Caregivers O Only 28 states require licensing

Neighbors and Friends

Financial Professionals

Strangers/Scammers

Victim-Offender Relationship O Family (buffers or offenders) O Theft

O Trusted other O Theft

O Professionals O Fraud

O Stranger

O Scams O Sweepstakes/lottery

The Complexity of Victims and Perpetrators O Continuum of victims O Victim complicity/complacency

O Continuum of offenders O Duffis to maleficence

Complexity of Financial Exploitation O Multiple types of financial exploitation O Multiple types of victims O Multiple types of offenders

Polyvictimization O Multiple forms of victimization occurring simultaneously O 30% to 40% of older adults experience multiple forms

of victimization by the same offender (APS data)

O Hybrid financial exploitation O Use PA/N to obtain money O Separate acts O Worse Outcomes O Guardianship O Removal from their home

James and Etta Jennings Richmond, VA

Cultural Sensitivity O Cultures have different financial norms

Victims: Who is at Risk?

Gender & Financial Exploitation O Women live longer O Husbands act as buffer O Wives had less financial role O … gender is non-significant

Risk Factors for Financial Exploitation Related

Not Related

Possibly Related

Depression

Gender

Age

Dementia

Income

Race

Poor health

Social support

Trauma

ADLs/IADLs

Education

Living alone Marital status

Depression in Older Adults O Depression prevalence of 11.19% O Related to elder abuse O Screen O Interferes with decision making O Treating the underlying causes of financial

incapacity such as depression and anxiety can increase financial management skills.

Dementia O 13.9% have some form of dementia O 22.2% having some form of cognitive

impairment without dementia

O 5 million over age 65 have Alzheimer Disease O MCI is not dementia O Subjective and objective memory decline greater than expected (does not meet criteria for dementia)

Why are Older Adults Vulnerable? O 70% of all funds deposited in financial institutions O More trusting O Financially unsophisticated or illiterate O Lonely O Inability to deny children’s requests for money O Fear of institutionalization O Isolated/lack of oversight O Concerns about financial stability after retirement O Periods of vulnerability

Why are Older Adults “Gullible”? Neurological Explanations

O Cognitive capacity (judgment) O Neurological deficits in “skepticism” O Neurological deficits in ability to detect lies and

sarcasm

O Inability to recognize untrustworthy facial features

Cognitive Capacity O Assessment of the individual’s psychological

abilities to form rational decisions O Domains of incapacity

O Fluctuates throughout the day and over time O Psychiatric disorder does not imply incapacity

O Cognitive screens

Financial Capacity O The ability to manage one’s financial affairs in

a manner that is consistent with self-interest and personal values

O Measures of

financial capacity

Warning Signs of Diminished Financial Capacity O

Memory lapses: increasing memory lapses resulting in failure to fulfill financial obligations (failing to pay bills, paying the same one several times)

O

Disorganization: increasing disorganization and misplacement of financial and other documents at home, with associated failures such as missing tax and other deadlines

O

Declines in checkbook management skills: changes in a person’s ability to use a checkbook and check register to carry out everyday transactions

O

Arithmetic mistakes: noticeable declines in everyday math skills, such as those employed when making change to pay for things at the store, or when computing an appropriate tip in a restaurant

O

Conceptual confusion: increasing confusion and loss of general knowledge regarding basic financial terms and concepts such as mortgage, will, or annuity

O

Impaired judgment: loss of judgment about financial investments and use of money, manifested frequently as a new and abiding interest in get-rich-quick schemes, as well as unfounded anxiety about the nature and extent of one’s personal wealth

Screens and Measures of Financial Exploitation O Elder Abuse Screens O Elder Abuse Suspicion Index (EASI)

O Screen for multiple forms of abuse O Financial exploitation underlies self-neglect

O Older Adult Financial Exploitation Measure (OAFEM)

Who is at Risk of Offending?

Offenders O Gender - Half male (56%) and half female O 25% cohabitate with victim O Younger age

Psychopathology O Two Studies O 30%/29% financial problems/financially dependent O 38%/43% drug or alcohol problems O 22%/24% chronic unemployment

O Single Studies O 23% gambling problems O 46% perpetrators of intimate partner violence O 33% experienced childhood family violence O 13% serious mental illness O 40% criminal record

Offender Motivation O Entitlement O Greed O Opportunity

Financial Abuse Costs Elderly Billions

Consequences O

$2.9b annually - Poverty and financial hardship

O

Loss of independence and security

O

Fearful, depressed, or even suicidal

O

Inability to afford their needed medications and basic necessities

O

Tarnished credit scores or find obtaining credit difficult

O

Hospitalization

O

Stress associated with depletion of funds mental and physical health problems

O

Secondary victims

O

Loss of transfer of wealth

Financial Recovery and Restitution Unlikely

Elderly Often Have More to Lose in Financial Abuse

Why Should We Intervene? O It’s the right thing to do O Financial dependence upon family or the state O Diminished quality of life

Financial Exploitation in a Long-Term Care Facility O Theft O Staff O Sentimental value

Detection O Unobservable until it’s too late O Detection is difficult O O O O O O O O

Gateway Programs Neighborhood Watch Faith-Based Organizations Financial Institutions Health Care Professionals (EIFFE program) Family TRIADs Coalitions

Indicators of Financial Exploitation O O O O O O O O O O O O O O O

Withdrawals of money that are erratic or not consistent with the older person’s spending habits Withdrawals of money that are inconsistent or out of the budget of the older person’s income Changing a will or property title to leave a home or other valuable assets to “new” friends or relatives The older person “can’t find” or seems to always “misplace” jewelry or valuable personal belongings Strange or suspicious activity on credit card accounts Lack of basic necessities or amenities, when the older person could afford them Not getting their prescriptions filled or untreated medical problems The level of care-giving is not commensurate with the old person’s income or assets Missing documents Forged or suspicious signatures on documents Changes to financial documents New acquaintances, particularly those who take up residence with the adult Redirected mail Failure to receive services that have been paid for Overcharged for services

“I Just Didn’t Know”

Talk to Your Parents O People are uncomfortable talking with their parents about

finances

O Start the conversation while

parents are competent

O Graduated financial management

assistance

O Oversight

O Put structures – and protections - in place to protect assets O Duel durable power of attorney O Ask bank to provide notification of activity to third party O Have a copy of statements sent to the POAs

Mandatory Reporting O Forty-seven states and the District of

Columbia have provisions for mandatory reporting

O Check with your state statute

Financial Institutions O Detection (warning signs) O Mandatory reporting O Confidentiality

Society’s Response O Adult Protective Services O Law Enforcement O Long-Term Care Ombudsman program O State regulatory and licensing agencies O Medicaid fraud units

APS vs. LE Reports Type of Abuse

APS-Referred (%)

Emotional abuse

8.8

Law EnforcementReferred (%) 55.4

Financial exploitation

65.8

14.7

Neglect

37.9

12.0

Physical abuse

33.7

54.1

Sexual abuse

0.15

0.12

Skills Required to Respond O Familiarity with financial institutions O FI’s personnel and practices O An understanding of complex financial transactions O Skills in distinguishing legitimate from fraudulent acts O Knowledge about relevant licensing and regulatory

entities for financial professionals

Multidisciplinary Teams O O O O O O O O O O

Geriatricians Sexual assault nurse examiners Neuropsychologists/clinical psychologists Law enforcement Mental health practitioners Civil attorneys and/or bar members specializing in family and elder law or legal aid Adult Protective Services (APS) Long-term care ombudsman program Domestic violence advocates Sexual assault advocates

O O O O O O O O O O

Regulatory agencies Guardianship programs Aging services organizations Faith communities Financial institutions Meals on Wheels (community serving agencies with access to isolated elderly persons) Consumer protection agencies Hospital discharge planner Probation and parole (Community corrections) Emergency Medical Treatment (EMT)

FAST– Experts in… O Trust accounts O Real estate (e.g. O O

O O

realtors, public interest lawyers) Estate fraud (escrow officers) Insurance (e.g. licensed agents or representatives from state departments of insurance) Stockbrokers Trust attorneys

O Estate planners O financial planners O Medicaid fraud

investigators O Regional representatives of the SSA O Guardians O Daily money management services

Refusal of Services O If competent, right to refuse O Revolving Door clients

O Refusal might be due to…

Why Doesn’t She Just Leave? O

A sense of commitment, concern for, and responsibility for the offender.

O

Concern about what will happen to their offender if the victim leaves

O

Social attitudes towards abusive behavior were tolerated

O

Feelings of guilt if an adult child is abusive towards them

O

Maintaining an important relationship with a loved one is more important than safety

O

Fail to perceive the actions as “abuse”

O

Feel their only alternative is a congregate living facility

O

Inability to leave the situation if physically dependent upon the offender

Engagement O It may take more than one visit O Understand reason for refusal O Never denigrate the offender O Address their fears O Offer services for abuser

Victim’s Services O Little is Known O Over 10,000 victim service organizations O Fewer older adults use victim services

Victim Service Providers O O O O O O O O O O O

APS LTC ombudsmen Law enforcement Medicaid Fraud Control Unites Areas on Aging Legal Services Victim Services (for victims whose case has advanced to the criminal justice system) Domestic violence programs Financial services Mental health services Family and caregiver support services

Victim Services O Emotional support/listening O Safety services O Professional therapy O Criminal justice advocacy O Individual needs assessments/personal

advocacy/service planning O Civil legal assistance

Financial Crime Victims O Immediate health and safety (emergency food,

clothing, transportation, and shelter)

O Replace for caretaker (cost of child or adult care while

victim attends court; materials translated into Braille)

O Credit counseling advocacy or other special services

(working on behalf of victim with creditors)

O Restitution advocacy (either individually or in a group

provide assistance with the restitution process)

Financial Management Assistance O AARP Money Management Program O American Association of Daily Money Managers

Emergency Housing & Shelters O Our shelters are all ADA compliant now and

we got them to change their policy so now a caregiver can enter the shelter with the older victim.

O The Guam Housing and Urban Renewal

Authority is building a new emergency receiving home for seniors to house up to 10 senior citizens who face imminent danger.

Support Groups

Prosecution O Relatively rare O Older adults eschew prosecution O Prefer prosecution when O Persuading older adults to cooperate O Federal emphasis on prosecution

Treating Financial Exploitation Victims Holistically O The Harry & Jeanette Weinberg Center for

Elder Abuse Prevention

O Emergency shelter O Legal services O Full range of support services for victims

Outcomes: We Don’t Know O What are the outcomes of victim services

O Research O Legal assistance O Technology O Capacity building

External Barriers to Victim Services O Ageism - Talking with an older adult in a loud or baby voice O Provision of services only for victims of violence O Financial crime victims treated like second class victims O Fragmented service delivery system O Shelters O Support groups O Practical help O Transportation

Facilitators O No Wrong Door O Case management or

coordinated response O Going out to the victim O Provide linkages, not referrals O Addressing the needs of offender

Interviewing Elderly Victims O Takes longer to communicate O Hearing and vision issues O Cannot sit too long at a time O Mornings are best

Voluntary Interventions O A program to prevent further abuse & facilitate long-

term recovery

O Interventions are relatively ineffective, and sometimes

even counterproductive

O Only 14 elder abuse intervention studies, all with

disappointing results

O Caregiver education programs O Money management programs O Treating elder abuse victims/psychotherapy

Call Centers O Victims of financial fraud O Peer counseling O Follow up

Involuntary Interventions O Guardianship O 7% of elder abuse cases

(Dyer et al., 2005)

O Guardianship associated with financial exploitation

O Conservatorship ($) O Institutionalization O 3.1% (U.S. Census, 2011) O Increased risk after APS investigation (FE?)

Interventions for Abusers O Counseling and treatment O Financial inaccessibility O Respite and assistance O Education O Law enforcement and courts O Limited or no contact with victim O Alternative living arrangements O Vocational training (to reduce financial dependency)

Avoiding Financial Exploitation

Website Resources O StopFraud.gov O ElderJustice.gov O Printable brochures O Articles O Videos

StopFraud.gov

StopFraud.gov

Elder Justice Website