Monday, June 26, 2006

Remembering Rosalie Wolf

It’s hard to believe that today marks the fifth anniversary of Rosalie Wolf’s death. For many of us, her presence is still very much felt. Almost daily, we see citations to her work, references to JEAN, and news about the organizations she spearheaded and the awards she inspired.

But beyond these tangible reminders is something less concrete. In many ways, Rosalie set the tone for our field. It was a tone of inclusiveness, an insistence that researchers and practitioners make the effort to abide each other’s peculiarities, and that social workers and police listen to each other’s points of view. Interdisciplinary exchange isn't easy in a field as diverse as ours. Our ranks include medical examiners, bankers, judges, FBI agents, fire fighters, private investigators, animal rights activists, prosecutors, researchers, ethicists, clergy, psychiatrists, and many, many others. But the diversity that Rosalie promoted nourished our field and enriched us personally.

In the early days of our field, there was no real downside to being inclusive. There was little competition and few competitors, let alone funds to compete for. When NCPEA’s board argued over whether or not to extend our mission to address the needs of younger, disabled clients or self-neglectors, there was no compelling reason not to. There was always more room at the table. The default was invariably to include.

Things are different today. There are more opportunities, and with them, more potential for conflict. With major public policy on the horizon, how we define elder abuse and the clients we serve matters. The answers to questions like “Is it only abuse when the elder is dependent? When the victim knows the perp? When there is a perp?” have consequences for caseloads, policy and practice. Whom we work with also matters more. New constituencies have emerged posing new headaches and new possibilities. Today, more than ever, we need interdisciplinary discussion and debate. We need the kind of forums that Rosalie created and led. We need the “Rosalie factor.”

Rosalie also set a tone of inquisitiveness. Her curiosity was insatiable and contagious. I never heard her mention retirement; it was unthinkable to her to quit as long as there was something new to explore or a new project to take on. Even as her health declined, she participated in important events like the Our Aging Population symposium and the National Symposium on Forensics Issues in Elder Abuse. She addressed the National Academy of Sciences study panel on abuse. Just weeks before her death, she left the hospital against medical advice to make a speech in Ohio. As nerve-wracking as some of her actions were to those around her, they were her M.O. This was the work she loved and thrived on.

To those of us who considered her a friend, colleague, teacher, collaborator or mentor, she was, above all, an inspiration.

Tuesday, June 20, 2006

Long Distance Undue Influence

Last week, San Diego prosecutor Paul Greenwood posted a message to NCEA’s list serve about an “articulate, coherent and charming” elderly woman who’d sent over $50,000 to telemarketers in Canada despite being warned repeatedly that they were crooks. She described feeling “hypnotized.”

It reminded me of when Dennis Morris, a San Francisco prosecutor, came to a meeting of our multidisciplinary team more than a decade ago and asked if anyone knew of an expert in brainwashing. He was working on a case involving a wealthy elderly woman who’d married her 40-something accountant. The justice of the peace who performed the ceremony insisted that the elderly bride knew what she was doing but Morris knew things weren't right. We thought it was a strange request—nobody was talking about undue influence in relation to elder abuse back then. But someone suggested Margaret Singer, an expert on cults, brainwashing, and persuasion. Morris contacted Singer, who subsequently testified before a grand jury, describing the classic forms of social persuasion that the younger man had used. He was convicted in what became a landmark case, and Singer went on to write and lecture extensively about undue influence in elder abuse. The topic struck a chord because it offered an answer to a fundamental question in elder abuse: Why do victims do what they do? And, perhaps more disturbing,why don't they do what we think they should?

In the early days, we chalked it up to “resistance” or reminded ourselves of clients’ rights to act freely. But over the years, we’ve gained greater insight into the psychology of abuse and victimization. Major milestones include breakthroughs in our understanding of the intricacies of mental capacity, including the subtle and elusive “executive function.” Domestic violence theory and practice helped us understand power and control and the “help-seeking process.”

Paul’s case, I believe, involves “long distance undue influence,” which has been an interest of mine ever since Debbie Deem, a Victim Specialist with the FBI, convinced me it should be. Debbie has a burgeoning caseload of what she refers to as “chronic victims” who repeatedly send money to predators, most of whom operate outside the U.S.,despite warnings from law enforcement, families, banks and social service agencies. Some of her cases are wrenching. One involved an elderly victim who had a check intercepted and sent back to her by a wonderful program involving the Royal Canadian Mounted Police and U.S. law enforcement in Canada. No sooner did she get her money back than the scammer called and convinced her to re-send the check–inside a stuffed animal.

Debbie and I have been working together to try to get APS, legal assitance, elder abuse and aging network professionals involved. So far, we haven’t had much luck. It’s not surprising. These cases are daunting, and investigating them ideally involves sting operations, taping conversations, surveillance, international task forces, and other strategies that are well beyond the scope of APS or legal aid. Some in our field don’t consider these cases elder abuse because they don’t fit the classic profile: perps aren’t family members or others in positions of trust or confidence. But a closer look reveals that these guys are hardly strangers. Many call their victims daily, send birthday cards and tell them fake sob stories. To my mind, the only difference between these long distance predators and the sweetheart scammers who befriend elders in supermarket parking lots is that they’re smarter and less likely to get caught. Clearly, investigating these cases is best left to law enforcement, but many victims are desperately in need of legal and protective services including cognitive assessments, money management, advocacy to mitigate the harm, assistance with creditors, housing, identity theft interventions, and lots and lots of support to break their ties to abuser.

A recent San Francisco case shows what can be done. Attorney Nancy Rasch was able to get a conservatorship on an elderly victim who’d lost thousands of dollars in a Canadian lottery by showing that the client had been unduly influenced. Nancy, who has been doing groundbreaking work in elder abuse since the early 80s and has handled hundreds of conservatorship cases, shared Paul’s bewilderment about her client, who was paying her bills and managing her personal affairs just fine. It was clear that the conservatorship prevented further losses as the older woman continued to call Nancy asking her to release her funds because she was convinced that if she made one final payment, she’d get the millions she’d been promised.

Paul’s post has already generated a flurry of responses. One was from psychologist Gary Freedman-Harvey, who pointed out that “vascular dementia” impairs recall and makes it possible for others to “create” memories. Other researchers, including Jacoby, Bishara, Hessels, & Toth (2005) have also suggested a link between memory deficit and vulnerability to scams. Some of the best work in this area that I’ve found is being done by Doug Shadel and Anthony Pratkanis ( and In the quest to understand why clients do what they do, long distance undue influence is clearly the latest challenge.

Tuesday, June 13, 2006

Criminal Caregivers

Criminals shouldn’t be providing care to frail old people. That assumption is what’s driving more and more agencies, states and the federal government to explore criminal background checks for prospective long term care employees.

But ensuring that vulnerable elders have trustworthy caregivers isn’t that easy. When Pennsylvania amended its protective service law prohibiting long-term facilities from hiring or retaining employees convicted of certain crimes, the state’s Supreme Court ruled it unconstitutional. When New Jersey passed a similar law, over 400 current employees, many of whom had worked for years and were dong a good job, were found to have committed disqualifying crimes.

Keeping patients safe when there’s a critical shortage of workers is a balancing act—one that prompted the Office of the Assistant Secretary for Planning and Evaluation (DHSS) to commission “Ensuring a Qualified Long Term Care Workforce: From Pre-Employment Screens to On-the-Job Monitoring,” a study, which explores, among other things, the relationship between past criminal background and subsequent abuse. As a member of the project’s advisory committee, I met recently with other members and staff of the Lewin Group, which conducted the study.

It came as no surprise that the preliminary findings affirm a link between criminal history and abuse. After all, an earlier study by Michigan’s attorney general showed that a quarter of CNAs convicted of crimes against nursing home residents had prior criminal backgrounds. But the group also discussed the need for more research on recidivism and the dissemination of existing information to guide hiring decisions. One advisory committee member cited a recent study that suggests that after 7 years, past criminals are no more likely than others to commit new crimes.

The need for more research to guide hiring decisions became clear to me years ago when a worker at an Oregon agency responsible for hiring home care workers told me about a convicted child abuser who, after being denied employment, successfully challenged the decision claiming that there was no empirical evidence to show that persons who abuse children are likely to abuse elders.

In calling for more research, we will find some unlikely allies. These include offenders’ rights advocates, who hope that new studies will create more opportunities for reformed offenders. They argue that the need for research has become particularly critical in light of Internet technology, which has made checking backgrounds easier than ever to obtain. They furhter caution that the rapid growth of the largely unregulated criminal background check industry poses serious threats to offenders' rights.

Ensuring patient safety at home is even harder--home care workers are in even shorter supply and spend significantly more time with elders alone and unsupervised. The popularity of “consumer choice” programs in long term care, some of which permit low income elders to use public benefits to hire workers on their own (as opposed to using licensed agencies), have forced some frail elderly “consumers” to make hiring decisions on their own in a stunted market with inadequate information. These are clearly issues looming on the policy horizon. Hopefully, the DHHS study is just the start. More on consumer choice programs to come.