Intersections Between Elder Financial Exploitation and Other Types of Abuse
Jeannie Beidler, Shelly Jackson  -  2013/12/4
http://ovc.ncjrs.gov/ovcproviderforum
 
 
What is the best way to handle a case when you have a victim that is covering for their abuser due to the fear of being removed from their home and being placed in a nursing home if the authorities become involved?
 
1.  Shelly
 You are describing a common situation. The first thing to do is to acknowledge their fear. Most older adults do not want to be placed in a nursing home. They may also have a strong emotional attachment to their abuser so try to stay neutral when discussing the abuser. Contact APS in your state (http://www.ncea.aoa.gov/Stop_Abuse/Get_Help/State/index.aspx) to find out if there are options for keeping the victim in their own home with some outside assistance, and if so, then you can assure the victim they can remain at home and safe (at least for the time being). If this is not an option, you’ll need to be honest.
 
2.  Jeannie
 An ECO (Emergency Custody Order) can be obtained from a magistrate allowing the removal of your loved one from the dangerous environment. Of course it’s only natural that a victim would be fearful. If your loved one is a victim, they need protection from the abuser. If your loved one needs skilled nursing care, that is a separate issue. It’s a scary path for all parties involved. Your strength and perseverance could help save your loved ones life. You must be the rational and logical person when your loved one isn’t able to see the situation for what it is.
 
3.  Jeannie
 My best advice would be to quickly coordinate efforts for a professional intervention. Collect evidence and document any of your concerns. If you have ample evidence, petition the court for an order of protection prevent the perpetrator from further exploiting or abusing your loved one. You can contact your local prosecutor’s office and victim witness services for assistance/guidance in pursuing this option. Inform the police and sheriff’s department along with Adult Protective Services of your concerns. You can request that law enforcement conduct a welfare check at any time. Voice your concerns to social services and follow up! Insist on action if your loved one is in imminent danger.
 
4.  Jeannie
 Reassure your loved one that you are concerned and want to ensure their well-being. However, first and foremost is the victim’s safety and welfare. I had to remind myself of this when I chose to go against my grandmother’s wishes and have her removed from her home. She would have died there otherwise. I had to accept the fact that she might be angry with me. Fortunately, dementia prevented her from holding a grudge and she lived happily ever after. However, I had to take the risk that protecting her might damage to our relationship. To me, that was better than knowing she continued to suffer.
 
 
What do you do if you suspect elder abuse by nonfamily caregivers? Who and what do you report to make sure an investigation is opened?
 
1.  Shelly
 States differ in their criteria for accepting a report of elder abuse, but I would start by contacting adult protective services in your area which you can find at the following website (click on your state) (http://www.ncea.aoa.gov/Stop_Abuse/Get_Help/State/index.aspx). And again, different states (and even local jurisdictions) have different criteria for investigating a report of elder abuse so I cannot tell you exactly what information is needed to ensure an investigation is opened, but I would advise you to have as much detail about the situation as possible.
 
2.  Jeannie
 If you suspect elder abuse, please report it immediately. Call your local law enforcement agency and APS. You should have a local hotline number to call 24/7 to report such concerns. Report any information you have, no matter how trivial. It could be that you are not the only one reporting concerns. Don’t stop at making a report! You must follow up, likely repeatedly. Document who you spoke to and any action taken. Identify local “elder advocacy” groups in your area as they can likely direct you to elder law attorneys that can assist you. Don’t give up until you are satisfied with the action taken. It’s frustrating and consuming, but necessary.
 
 
Intervention for senior victims is difficult in cases where the seniors do not believe they are victims. Example: family member is residing with the senior and draining all the funds - no signs of physical abuse - senior voluntarily giving family member anything requested OR senior is victim of fraud, such as a lottery scam and continues to participate in spite of police/law enforcement efforts to educate the senior. Which State APS agencies have the strongest protocols in place to help these victims? What are best practices for intervention? How do we help the seniors who we know are being exploited, but cannot see it?
 
1.  Jackie Buckley
 Are there any state or national thinking tanks trying to address this population of victims? Clearly victimized, but not in enough cognitive decline for APS or law enforcement intervention.
 
2.  Shelly
 I have the same concern. The only way to determine whether the person has mild cognitive impairment is to have them tested by a professional. But yes, there are typically few or now outward signs.
 
3.  Jackie Buckley
 My concern is specifically for those seniors with mild cognitive issues. Those who present as sharp enough to care for themselves in most every other way, but whose judgement may be impaired. Capable enough to pass a doctor's examination, but continually subjecting themselves to victimization.
 
4.  Shelly
 You are right, and these scenarios are so common. We have to persuade victims that what they are experiencing is a crime. That is in part why these cases take longer to intervene. Sometimes APS (and/or another entity) has to make multiple trips to the victim’s home, sometimes talking with them, sometimes providing some concrete evidence. Unfortunately, most APS caseworkers do not have the luxury of making multiple trips to a victim’s home. Sometimes there is some underlying fear driving their behavior, for example, they are fearful there is not enough money to live independently. Try to identify that fear and address it. Finally, the victim may need to be screened for a cognitive impairment as financial exploitation has been shown to be related to cognitive impairment.
 
5.  Jeannie
 I can respond to the part of your question about helping seniors who don’t see they’re being exploited. It’s quite difficult to convince a senior, or any person actually, that a loved one is exploiting them. Denial is strong and often times, dementia helps the family member continue with the financially exploitation. Trying to convince a senior may be a futile effort and may only exasperate the issue. Instead, I would recommend bringing your concerns to your local APS or police department.
 
 
In your work under the NIJ grant have you become aware of any state APS agency protocols and/or policies on how to handle victims who are educated about a scam (e.g. lottery scams) yet continue to send money to the fraudsters? One would think it would be enough to determine the victim is incapable of caring for themselves (i.e. unable to manage their assets) and/or to protect themselves from abuse. Because APS agencies were created to prevent premature institutionalization of the elderly one would think the act of knowingly sending money/assets to thieves until it is exhausted would most certainly streamline the victim to institutionalization. Do you see agencies doing anything for these victims before their money/assets are completely exhausted?
 
1.  Shelly
 financial fraud. In the United Kingdom, seven subpopulation groups were created and fraud prevention materials were developed individually for each group. A prevention program to prevent investment fraud will surely differ from a prevention program to prevent an overseas lottery fraud. In terms of intervention, there is very little. There are call centers in California and Seattle (see ftc.gov) for financial fraud victims. While they have had some success in preventing further fraud for some victims, the effects are relatively limited and not widespread. One thing we’ve been advocating is oversight of some sort for older adults. We too often hear adult children say “I just didn’t know what was happening.”
 
2.  Shelly
 I make a distinction between financial exploitation and financial fraud. You are asking about financial fraud (which in some states is not covered under the APS statute). Unfortunately, APS is most typically contacted “after the fact”, after the person has lost some or significant amounts of money. Primary prevention has been primarily in the form of education, but as you can see, education has had limited success. Researchers are identifying neurological deficits that help to explain some financial fraud. And some older adults experience very real fears about their financial independence that is driving some vulnerability to financial fraud. So there are likely a range of underlying causes of vulnerability to
 
3.  Jeannie
 In my experience, APS would only intervene if a senior was deemed to be “imminent danger.” Unfortunately, even still it was quite difficult to orchestrate an intervention for my grandparents. The financial exploitation piece was not even addressed. Had I chosen to pursue such charges, I would have had to personally bring forth a law suit against my uncle/the caretaker.
 
 
Who are the most likely criminals committing these type of crimes?
 
1.  Shelly
 Perpetrators of financial exploitation include both family and non-family members. Unfortunately, there are no national prevalence studies to confirm which is more prevalent, although there is a general sense that family members are more often the offenders. Non-family member offenders include professional caregivers, friends, neighbors, other service personnel, to name a few. I make a distinction between these individuals, who are at least somewhat known to the victim, and strangers such as perpetrators of internet scams, lottery scams, and investment scams, and the like.
 
2.  Jeannie
 I read a daunting statistic that in over 2/3 of substantiated cases of elder abuse, the abuser is a family member. Typically, an adult child living in the home with substance abuse and/or mental health issues.
 
 
Practitioners are often reminded that older adults may be less likely to report because talking about anything having to do with sex is sometimes uncomfortable for them. Unfortunately, there is not often a follow-up to this reminder. As a practical matter, are there things we can do to ease the pain of those conversations, even when it is impossible to have someone from the survivor's generation conduct the interview?
 
1.  Shelly
 I would encourage you to contact Sue Hall Dreher, Sexual Assault Services of Midcoast Maine, who has done considerable work in this area. I have learned a lot from her and she is far more qualified to respond to your question.
 
2.  Jeannie
 When dealing with sensitive and/or embarrassing issues, if it’s possible to have someone of the same sex conduct the interview, that would be helpful. Also, if possible, bringing in a trusted family member or friend may very well provide the victim with the additional support they need to acknowledge the situation. In my grandparent’s situation, I was invited to participate in the intervention because I was someone my grandparents recognized and trusted.
 
 
Who should I contact when I suspect that nursing home administrators are covering for neglect and/or abuse on the part of their staff?
 
1.  Patrick
 That is interesting that they have someone who looks into these types of events, but why is it that they continue to happen? why isn't there someone put in place to prevent them from happening?
 
2.  Jeannie
 Unfortunately, I think this happens far more than we realize. Ask your nursing home administrator to identify their “Ombudsman”. In my area, the Ombudsman is a lawyer who works for a local Area Agency on Aging. Her role is to oversee the happenings in skilled nursing facilities (aka SNF) and assisted living facilities (aka ALF). The Ombudsman investigates reports brought forth by residents of a facility and other concerned individuals.
 
 
What is the best course of action if I have reported a case of elder financial abuse/exploitation to APS (the patient has complained of never having money for food), but after conducting a home visit, APS determined that there is no financial abuse/occurring?
 
1.  Shelly
 APS has to follow particular policies when investigating a case and it may be that the information they reviewed indicated an absence of financial exploitation. The question to ask is whether not having enough money for food is a new situation. Is there someone you suspect is taking her money and causing this shortage? Has the patient made a complaint/disclosure to you other than not having enough money?
 
2.  Jeannie
 What you’ve described was exactly my grandparent’s situation and went on for over 5 years. If you are not satisfied with the response of APS, let them know this! Then, contact your local law enforcement agency and after hours behavioral health crisis team. I called everyone and anyone who would listen to my concerns for nearly 4 days before my grandparents were rescued. You can always gather any evidence you have and go before a judge to petition for a protective order as well. In this case, photos of empty kitchen cabinets/pantry, fridge, etc. would be helpful. Can you obtain copies of bank statements with deposits and withdrawals, checks written, etc.? I may sound repetitive, but don’t give up. Persist. Call and call again.
 
 
Are you aware of any agencies or on line forums that have support groups for the adult children of foreign lottery victims? I several adult children that are in the process of taking charge of their parents but are have difficulties with the emotional issues of the role reversal.
 
1.  Shelly
 I am not familiar with any such support group, but what a wonderful idea. While you are in this mode, I would encourage you think about advocating for adult children to develop financial management plans with their parents earlier rather than later. As I mentioned earlier, and you bear witness, the adult children often say “I just didn’t know.” Adult children are going to need to take a more active role in their parents’ finances (I don’t mean control), although both adult children and parents are uncomfortable talking about finances.
 
2.  Jeannie
 Support is so important when intervening on behalf of an elder abuse victim. We become so consumed with providing for their care and protection that we neglect our own needs. I would recommend that you contact your local victim witness office (typically attached to the police department) and ask them. Victim witness workers are trained to compassionately offer support and resources in such situations.
 
 
What would you suggest to do if the abuser is a nursing home resident? Both the victim and the abuser have dementia.
 
1.  Jeannie
 If you believe abuse is happening, alert the facility administrator of your suspicion as well as the social worker(s). Be ever present. Show up at various times unannounced. If not possible, find someone who can. Document your concerns. An isolated incident may not seem significant, but can quickly add up to obvious abuse or mistreatment over time.
 
2.  Jeannie
 Such a tragic situation as one would think their loved one was safe in a nursing facility. As we know from the news, this is not always the case. Abuse happens. Unfortunately, I think this happens far more than we realize. Ask your nursing home administrator to identify their “Ombudsman”. In my area, the Ombudsman is a lawyer who works for a local Area Agency on Aging. Her role is to oversee the happenings in skilled nursing facilities (aka SNF) and assisted living facilities (aka ALF). The Ombudsman investigates reports brought forth by residents of a facility and other concerned individuals. Aging adults with dementia are actually more vulnerable to abuse than children! They can not speak for themselves and don't have the capacity to later report the abuse. You must be their voice.
 
 
Why do you think this type of abuse is downplayed so much? In regards to social media, rarely do you see commercials spreading awareness.
 
1.  Patrick
 Proper training is definitely needed, I also think certain agencies need to be more hands on and look into situations like this. Even where there aren't or haven't been reported problems, just to ensure there won't be any.
 
2.  Patrick
 Yeah, that is a valid point you make. We have done so with other issues in the past and well with awareness finally being spread along with events like this there is only one way to go and that is up. Things definitely will improve, but how much? What exactly is going to be done? I know things will get better and these issues will not be downplayed or swept under the rug, but how will they be prevented?
 
3.  Shelly
 You are absolutely right, although there are a number of possible explanations. But if you look back in history, there was a time when we failed to recognize social problems such as child abuse, intimate partner violence, etc. Some people find it hard to believe elder abuse happens; some people think our society doesn't care about older adults. There hasn't been a strong advocacy group for elder abuse, but the momentum is building. I am encouraged and optimistic that elder abuse will be recognized as a serious social problem worthy of response and funding.
 
4.  Jeannie
 I am not so sure it's downplayed as much as there is an overall lack of awareness. I personally believe that law enforcement and other public service agencies need to offer mandatory training on the issue and that additional legislation is necessary to prevent elder abuse. In my grandparent's situation, the police pointed to APS and APS pointed the police. There was a complete lack of collaboration and accountability.
 
 
In NJ, if one set of family members are claiming that another set of family members are financially exploiting an elderly relative, is APS able to investigate this type of abuse? What are the parameters for APS to go out and investigate a call of neglect or physical abuse of an elderly victim?
 
1.  Shelly
 I am not familiar with NJ statutes, but APS is very familiar with this scenario. If the information in the report meets criteria for an investigation (which differs by state), APS will investigate even if the allegations pit one family member against another. If you are concerned, contact APS in your state (http://www.ncea.aoa.gov/Stop_Abuse/Get_Help/State/index.aspx)
 
2.  Jeannie
 I can't speak to NJ APS practices, but I can tell you how it was in my situation. In order for APS to physically investigate a report, the alleged victim(s) must be in imminent danger. Even then, the APS worker who initially visited my grandparents, deemed that they were not in imminent danger. This, despite the fact they were both laying in their own waste, without water or food, and clearly suffering gravely. My grandparents were finally rescued thanks to an after hours crisis unit who heard my cries. ALL that to say, if you suspect abuse and APS doesn't respond to your satisfaction, keep hounding them! Call the police if need be!
 
 
If an elder victim is presented with one type of neglect/abuse how likely is it that other types of abuse is occuring? Is there a standard questionaiire that should be asked? Also will this help to make the victim aware of these incidents/things as abuse and not ignore them.
 
1.  Shelly
 If you look at APS cases, in about 30% - 40% of the cases there is co-occurring abuse. However, we do not know which forms of abuse are co-occurring. There are several elder abuse screening tools, but each one has some shortcoming. Nonetheless, practitioners are encouraged to ask about other types of abuse the victim may be experiencing other than the presenting problem. It may not occur to victims to disclose other types of abuse.
 
2.  Jeannie
 Again, I speak from my personal experience and knowledge base. I definitely see that elder abuse, neglect, and exploitation go hand in hand. If a person is being exploited financially, they are not likely receiving adequate care (food, medical, etc.) because the victim's resources are going to the abuser's interests (gambling, drugs, alcohol, etc). In the same way, if the victim is being neglected, they are likely suffering physically (malnourished, lack of medicine/medical care, etc).
 
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