Monday, December 29, 2008

Mediating Elder Financial Abuse

A few years ago, my long-time friend, Oakland-based attorney Frederick Hertz made the switch from litigating conflicts over money and property involving family members and partners to mediating them. When he told me that he’d teamed up with another mediator with 20 year’s experience as a family therapist to explore the legal and psychological interface of “family business” gone wrong, I was intrigued. So I sat in on a talk that he and Judy Barber gave at the Mediation Society in San Francisco earlier this year.

Their premise is that family conflicts involving money aren’t just about money. They’re also about longstanding sibling rivalries, parents’ playing off their kids against each other, and other assorted family dynamics and dysfunction. Which means that standard measures of success, like the size of settlements, are rarely adequate and even “winners” are likely to emerge feeling disappointed and wounded. Successful resolution, they contend, requires helping families move past their histories to engage in rational decision-making. That’s not to say that mediators should do family therapy, only that failure to address these issues altogether makes successful resolutions unlikely.

It seemed to me that their approach held tremendous promise for elder financial abuse cases involving family members, partners, and others with whom elders have relationships. Heidi, Li, director of the SF Consortium For Elder Abuse Prevention, agreed and offered to host a presentation to explore the use of mediation in elder financial abuse cases. It took place on December 4.

Elder abuse cases comprise a relatively small proportion of those that Fred and Judy mediate, but the hypothetical they prepared for the event did and had the group nodding in recognition. It involved an 80-year old widow with $2 million in equity and assets who’d borrowed against her home to help out a downwardly mobile son. When Mom started having trouble making the payments and called another son in a panic at the prospect of losing her home, he alerted two other siblings who were furious and wanted to sue their brother for elder abuse.

The first step in analyzing cases like this, according to Fred, is to assess the “real estate” of the transaction--the legal terrain, which includes the terms of the loan and the son’s ability to pay Mom back. But then, mediators need to look at the parties’ differences with respect to:

Their relationships to the property and assets in question. A property that’s seen as an investment to one family member may be “home” to another, with all the emotional attachment that that engenders.

The feelings of the parties (“I deserve this because I was there for Mom and you weren’t” versus “You’re too dependent on Mom; get a life!”)

Decision-making styles, which oftentimes are the result or cause of long-simmering resentments and conflicts.

Judy and Fred acknowledge that elder abuse cases may raise special considerations for mediators. These include uncertainties about capacity and undue influence, the limits of mediation with extreme power imbalances, and the effects of mandatory reporting. The latter factor was demonstrated at the Mediation Society session I attended where someone in the audience described a case he’d mediated in which the parties agreed to have a financial institution suspend activity on an account to prevent end runs while the mediation was in progress. An employee, sensing a problem, made an elder abuse report to the police, thereby potentially derailing the mediation. Still, the session served to convince me and others I spoke to afterwards that the approach clearly warrants further exploration. Seems to me that learning to recognize the factors that give rise to financial conflicts could also potentially lead to more rational estate planning and circumvent problems from arising later on.

The Consortium event ended with a presentation by Mary Joy Quinn, director of the San Francisco Superior Court’s Probate Department, describing a pro bono mediation program that she spearheaded, in which judges and commissioners refer cases to specially trained mediators as an alternative to conservatorships.

I’m delighted to add that I’ll be working with Mary Joy and Eileen Goldman again next year on a new project with the court funded by the Borchard Foundation. Working with California’s Administrative Offices of the Court, we’ll be drawing from research, case law, and practice experience to develop working definitions of undue influence that can be used in assessment and policy development.

For more on Fred and Judy, visit their Web sites at and To learn more about how mediation and other forms of “restorative justice” are being used to prevent elder abuse, click here.

Friday, December 26, 2008

Community Colleges, An Untapped Resource for Preventing Elder Abuse

For the last three years, I’ve been working with faculty at City College of San Francisco (CCSF), under a grant from the Archstone Foundation, to develop a course in elder abuse prevention for students in the paramedic, health care interpreter, and community health worker programs. Along with my colleagues consultant Eileen Goldman and CCSF instructor Robin Roth, we started out teaching Health 9A Elder Abuse as a traditional course. Later, we modified it into a “computer enhanced” class using online reading assignments, forums, and interactive exercises to supplement the classroom activities. Beginning in March, 2009, I’ll be teaching it as a fully online course. For more information, see Health 9A: Elder Abuse.

I’m really enjoying my teaching stint at CCSF and strongly encourage others to get involved with the community colleges in their areas. It’s a great way to reach allied health professionals. According to an article in the magazine of the Faculty Association of California Community Colleges, California’s community colleges “credential 80% of the state’s firefighters, law enforcement officers, and emergency medical technicians; and 70% of nurses.” Specifically, CCSF prepares students for careers as medical assistants, certified nursing assistants, licensed vocational nurses, registered nurses, nutrition assistants, diagnostic medical imaging technicians, radiology technicians, cardiovascular technicians, EKG technicians, pharmacy technicians, and dental assistants. They also offer programs in the administration of justice, trauma, and drug and alcohol counseling. The schools work closely with their local communities to meet workforce shortages and to make sure that they’re preparing students for the real world. Which also means that they place a strong emphasis on diversity and cultural competence. Truly an untapped resource.

Friday, December 05, 2008

Powers of Attorney, Elder Justice, Help Hiring Helpers, and No More Minnesota Nice

New Report on Powers of Attorney (POAs)

On Thursday, AARP’s Public Policy Institute released Power of Attorney Abuse: What States Can Do About It. Written by Lori Stiegel and Ellen Klem of the American Bar Association’s Commission on Law and Aging, the 89-page document compares state laws on POAs and highlights measures that offer special protections against abuse, which include:

Clear statements of agents’ duties to act in good faith, within the scope of their authority, and according to principals’ expectations or best interests; and to follow principals’ estate plans, keep careful records, and cooperate with health care proxies.

Special language used to signal “hot powers,” particularly risky or questionable actions like changing beneficiaries.

Provisions permitting third parties to refuse to honor POAs when there's good reason to believe they’re being used to commit abuse and requiring the parties to report to APS.

Requiring those that have used POAs to misappropriate property or assets to pay it back.

Imposing sanctions for those who refuse to accept legitimate POAs.

In a USA Today article about the report, Naomi Karp, strategic policy adviser for the AARP Public Policy Institute, offered the following advice to anyone who's considering executing a POA:
Don't give anyone, even a child or spouse, POA unless you thoroughly trust that person with your finances.

Consider requiring the person who has POA to periodically report to a third party, such as your lawyer or another family member.

Make sure other family members know who has your POA so they can be on the lookout for misconduct.

The report also describes strategies for advocates who want to improve their states' POA laws. Copies are available at Power of Attorney Abuse: What States Can Do About It.

Give a Shout to the New Administration
Marie-Therese (MT) Connolly, Senior Scholar at the Woodrow Wilson International Center for Scholars (and former Coordinator of DOJ’s Elder Justice and Nursing Home Initiative) is circulating a proposal urging the new Administration to appoint high-level special advisors on elder justice at the Department of Health and Human Services and the Department of Justice to help set priorities and work with Congress and stakeholders around 3 priorities:
Improve research, evaluation, and data collection;

Enhance interventions and responses; and

Increase public awareness

Questions can be directed to MT at

New Web Site to Help Hire In-home Helpers
Safe Help in Your Home is a new Web site created by Lynn Loar and Jane Tamagna to guide people through the process of screening, hiring, and managing in-home aides. The content is slated for inclusion in their forthcoming book And You Thought Talking to Your Parents About Sex Was Hard—Finding Out What Your Parents Want toward the End of Their Lives. Lynn Loar is a licensed clinical social worker with expertise in abuse and neglect across the lifespan and Jane Tamagna is a social issues editor who has worked for the Bureau of National Affairs and is on the faculty of American University's School of Public Affairs.

The site is for people who are thinking of hiring in-home help for themselves, relatives, or friends; for care providers who want to show clients that they’re capable, trustworthy and responsible; and for agencies that want to provide capable, trustworthy, and responsible aides to clients.

What’s unique about Loar's and Tamagna’s tools, which include comprehensive checklists, are that they go beyond the standard steps (e.g. references, criminal background checks, etc.) to address such common-sense yet critical concerns as matching clients' and caregivers' personality types to avoid conflict. They also advise employers to check child and sex abuser registries and ask potential employees for copies of credit histories and DMV files. Their work draws from their experiences in the field of child abuse prevention, which is significantly ahead of ours in this arena, and they respond (justifiably, if not too gently) to common excuses and justifications they’ve heard from our ranks for why we don’t do more (“It’s too expensive,” “Aren’t we exposing ourselves to more liability by digging deeply? etc.).
Visit the site at Safe Help in Your Home. For more on elder abuse by paid caregivers, see Abuse by Paid Caregivers.

No More “Minnesota Nice"
As a native Minnesotan, I got a kick out of the Minnesota Department of Public Safety’s anti-scam campaign, “No More Minnesota Nice,” which warns Minnesotans about lottery and sweepstakes scams. I’d assumed that the point of the campaign was to urge us Minnesotans to eschew our notorious niceness and hang up on fraudsters as quickly as possible or tell them where to go. Which makes sense since criminal telemarketers know that the longer they can keep someone on the phone, the more likely they’ll be able to complete a scam. But the campaign’s promotional materials fall short of actually promoting or scripting rudeness. So, I thought I'd do it for them:

“The next time you’re contacted by a telemarketer, just say “!!#$%!!#!!”

I hope I haven’t offended.

For more on mass marketing fraud, see Mass Marketing Fraud.

Friday, October 31, 2008

Getting Our Minds (and Laws) Around Undue Influence

Undue influence. We know it when we see it, and those of us in elder abuse prevention see it often: elders who are ill, lonesome, isolated, impaired, or grieving being persuaded to give away assets, sometimes homes and life savings, to new acquaintances, suitors, family members, or even cunning cons in other countries. They use various devices--trust documents, powers of attorney, wills, sweepstake offers, bogus charities, or quickie marriages--but the results are the same: getting vulnerable elders to do things they wouldn’t have done otherwise.

Still, defining undue influence for legal purposes hasn't been easy. Maybe it’s because for some, the very prospect of outlawing persuasion or protecting people from being wooed is offensive. After all, in our consumer culture, we’re used to being lured and won over. We romanticize risk taking, gambling on long shots, or taking leaps of faith that those charming suitors really do love us.

When does persuasion become undue influence? The answer is when powerful individuals use unfair means: deception, exploiting disabilities, fostering dependency, playing on fears, emotional blackmail, and isolating elders from those they trust. But how do we set the bar in defining and measuring undue influence? What circumstances should we include and what penalties should apply? These are questions that advocates and policy makers in California are tackling in earnest these days. Here are updates on three initiatives.

Senate Bill 1140 Passes
Written by San Francisco Attorney Steve Riess and authored by Senator Darrell Steinberg, Senate Bill 1140 adds undue influence to the definition of financial abuse in California’s elder and dependent adult abuse civil protection code, providing new remedies to vulnerable elders and "fundamentally changing the obligations of those who contract with them."

In his rationale for the bill, Riess points out that we already have laws on the books that address undue influence, but they’re inadequate for elder financial abuse. Establishing that someone exercised undue influence under current law simply serves to negate contractual consent and rescind agreements, which, in non-legalese, means that it stops improper transactions. It doesn’t allow for damages or lawyers’ fees so abusers have little incentive to stop doing what they’re doing and lawyers have little incentive to take undue influence cases. By including undue influence as a basis for elder financial abuse, Senate Bill 1140 allows for the recovery of damages, attorneys’ fees, and court costs, making it more feasible for victims to initiate lawsuits and, hopefully, making would-be perps think twice. For more on the bill, see: The New Elder Financial Abuse Law: Big Changes Are Coming!

It won’t be long before the new law is put to the test. In a December 2007 New York Times article, Charles Duhigg reported that more than 760 civil lawsuits claiming elder abuse, mostly financial abuse, had been filed in the previous year, a 98% increase from five years earlier. Other states are seeing similar trends.

SB 1259 Fails
On the criminal side, SB 1259 attempted to add undue influence to the definition of elder financial abuse in California’s elder abuse criminal code (Penal Code §368). Sponsored by the California District Attorney’s Association, the bill was a response to People v. Brock, in which Norman Roussey, who had a cognitive impairment, lost his home and nearly $700,000 to his “friend” Ronald Brock who worked in the law firm that was handling Roussey’s deceased mother’s estate. (See Undue Influence is Not a Crime and Postscript on Elder Abuse is Not a Crime. The prosecutor in the case, Melissa McKowan, successfully argued that Brock had committed theft by undue influence, and Brock was sentenced to five years in prison and ordered to return the money. Later, however, an appellate court overturned the conviction. While acknowledging that Brock’s conduct was “manipulative” and “oppressive” and that Brock knew that Roussey was cognitively unable to resist his demands, the court ruled that the conduct wasn’t a crime in California. SB 1259 would have made it one by amending Penal Code §368 to include “criminal undue influence,” which it defined as:

The exploitation by a person of a known physical or mental infirmity or other physical, mental, or emotional dysfunction in a vulnerable elder or dependent adult for financial gain by one of the following methods:

• Using a position of trust or confidence or using any real or apparent authority over the vulnerable elder or dependent adult for the purpose of obtaining an unfair advantage over the vulnerable elder or dependent adult.

• Knowingly taking an oppressive and unfair advantage of a vulnerable elder or dependent adult's weakness of mind, necessities, or distress.

SB 1259 provided for a defense if the accused believed that their victims had the capacity to consent to the transactions. But for the defense to apply, the transactions had to have taken place “openly.” If defendants attempt to conceal their actions, the defense wouldn’t fly.

SB 1259 also upped the ante for repeat acts of financial elder abuse by allowing for sentence enhancements for prior convictions. It also would have expanded the scope of persons protected by broadening the definition of dependent adults and elders. Under the expanded definitions, protected parties would have included all elders (as opposed to only those with disabilities) and adults with physical as well as cognitive impairments.

The bill’s primary opponent was the California Public Defenders Association, which objected on the grounds that:
1. The proposed definitions were too broad and paternalistic in including physically disabled adults and seniors with no significant cognitive disabilities.

2. Given the budget shortfall and prison overcrowding, any legislation that increases penalties is ill timed and poor public policy.

3. The defense requirement to prove that financial transactions were done "openly" isn’t dealt with adequately. “Openly" is subject to interpretation and the law isn’t clear about who should interpret it.

For more, see Analysis of SB 1259.

Prohibited Transfers (Probate Code §21350)
The California Law Revision Commission recently released a report and recommendations about the "prohibited transfers" provisions in the state’s Probate code, which deal with undue influence. (The Commission, which includes reps from both houses of the state assembly and the executive branch, studies “defects and anachronisms” in California law and recommends legislation reforms.)

The prohibited transfers statute was originally enacted in response to a high- profile case involving an estate-planning attorney who named himself and members of his family as fiduciaries for, and beneficiaries of, clients’ estates. The prohibited transfer law prevents certain professionals from inheriting assets from clients unless they can demonstrate that they didn’t use fraud, menace, duress, or undue influence to get them. The law covers “care custodians,” essentially saying that those who receive last-minute bequests from dependent adults are presumed to have exercised undue influence, even if they were close friends of the deceased. There are several exceptions, including gifts to family members and gifts that have been reviewed by independent attorneys who certify that they aren’t the product of menace, duress, fraud, or undue influence.

The prohibited transfers statute was challenged in Bernard v. Foley, a case involving 97-year-old Carmel Bosco, who left her half million-dollar estate to two friends who cared for her during the last months of her life. While under their care, Bosco amended her living trust several times, giving more and more to the caregivers until, a few days before her death, she made them the beneficiaries of her entire estate. Bosco’s family, the original beneficiaries, sued, claiming that the caregivers had exerted undue influence over Bosco while she was gravely ill and heavily sedated. The case got down to whether the friends were in fact “care custodians,” and therefore, covered under the prohibited transfers law. The caregivers claimed that they were just “performing acts of kindness on a purely volunteer basis as good friends often do for others.”

The court found in the caregivers’ favor but the family appealed, and the appeals court reversed the decision, stating that “a caregiver may be a personal friend, and in fact, personal friends are uniquely positioned to unduly influence the elderly for whom they care.” It affirmed that the caregivers were covered under Probate Code §21350 and had failed to satisfactorily rebut the statutory presumption of undue influence.

Despite the finding, the statute has continued to raise concerns and questions, including:

• How should caregivers or caretakers be defined? Should the law differentiate between long and short–term caregivers and between those who are paid and unpaid?

• Who needs protection and how should “dependent adult” be defined?

• Will the law inhibit old friends or acquaintances from assisting elders for fear of losing any transfers that the elder may make?

• Should the law exempt families, the most common offenders in financial abuse cases?

These were among the concerns the Commission was charged to consider. Specifically it was asked to review “the proper scope of the statutory presumption of fraud and undue influence that applies when a “dependent adult” makes a gift to that person’s “care custodian.”

The Commission concluded that the care custodian presumption is broader than it needs to be, protecting people who are not necessarily subject to any heightened risk of undue influence (adults with physical disabilities) and gifts to care custodians that do not seem to be “unnatural” (i.e., gifts to friends and other volunteer caregivers). The Commission is further proposing to narrow the definition of “care custodian” to only include caregivers who provide services for remuneration (i.e., volunteers would not be included). A copy of the Commission’s report and tentative recommendations is available on its Web site at online at Recommendations. The minutes of the Commission’s meeting where the recommendations were discussed are also available online at Minutes.

Definitional Debates
Like other legislation initiatives, including SB 1259 (described above), the effort to revise Probate Code §21350 essentially gets down to how terms like “dependent and elder adults” and “caregivers” are defined. Although the definitional debates in our field may have been academic in the past, our failure to resolve them has become a barrier to effective public policy. Not only do we need to reach agreement within our own network, we're going to have to start working with those other stakeholders with whom we’re increasingly coming into conflict. These include the California Public Defenders Association, which helped kill SB 1259, and Protection and Advocacy, Inc., an advocacy group for people with disabilities in California, which is actively working with the California Law Commission on Probate Code §21350. Strangely, advocates for the elderly in California are increasingly being branded by as ageist in these conflicts owing to the broad definitions we use in defining elder abuse (unlike many states that limit protections to “vulnerable and dependent elders,” many of California’s elder abuse laws cover all elders). Surely, we could resolve some of these conflicts through upfront advocacy and consensus building. One would hope that our common interests exceed our differences.

Tuesday, September 23, 2008

Remembering Del Martin

“When you add our society’s propensity toward violence with ageism and sexism, you have a dangerous situation.”

Del Martin, 1995

The flags at San Francisco’s City Hall flew at half-mast on August 28 in memory of Del Martin, a pioneering figure in the fight for the rights of women, lesbians, survivors of domestic violence, and the elderly. Her seminal book Battered Wives, published in 1976 and updated in 1981 (Volcano Press), has been acclaimed as the first to explore domestic violence in the United States. In it, Del made the case that domestic violence wasn’t grounded in interpersonal dynamics but rather, in historical attitudes toward women, economy inequalities, and inadequacies in the legal and social service systems. Just two months before her death at the age of 87, she was still making history. She and her partner, Phyllis Lyon, were the first gay couple to be "remarried" when the California Supreme Court declared marriage for same-sex couples a fundamental right. Their earlier marriage, along with thousands of others, was nullified four years ago.

In the mid 1990s I interviewed Del for nexus, a publication for affiliates of the National Committee for the Prevention of Elder Abuse. At the time, she was serving on the Advisory Committee for the San Francisco Consortium for Elder Abuse’s “Developing Services for Older Battered Women,” a pilot project funded by the Administration on Aging (DHHS) to explore the link between elder abuse and domestic violence. Her insights and advice are as relevant to our field today as they were when we spoke 13 years ago.

Domestic Violence Activist Speaks out on Elder Abuse
The domestic violence movement has always been a grass roots, self help movement. In the early days, many feminists who had given up on the system got involved. To a great extent, it was women who had left abusive relationships who ran the shelters and led the movement. At one point, we even had an underground railroad to send women who were leaving abusive relationships to other states with other identities. Some women would go from state to state to get away from abusive men. Just leaving a relationship doesn’t mean a woman is free.

The concept of support groups came from the women’s movement. Earlier, when we talked about support groups, we discussed whether women who were not able or willing to leave abusive relationships should be in groups with women who had chosen to leave. My feeling is that it’s wonderful for these women to interact with others who have made it. Somebody who’s had the same experiences is going to be more effective than a professional who knows the concepts but who doesn’t have the personal involvement and understanding.

The feminist viewpoint is “we don’t want to compete, we’ve got to work together to accomplish anything.” When California first allocated funds for starting a pilot project in domestic violence, we said “okay, we’ll take the money but we would like to split it up and use it in various locations.” We didn’t want to compete for money, we wanted to work together. The state had never heard of that before. Ultimately, six pilot projects were initiated.

Domestic violence programs have long recognized that some of the worst cases of physical abuse involved elderly victims. Domestic violence against the elderly is more difficult to address because it’s complicated by dependency issues and having to deal with pensions or Social Security. I have also thought about how difficult it is to reach the frail elderly who are at the mercy of their caretakers. Those are the ones I am really worried about.

Victims need to know that they are not alone. Older, abused individuals often think they are the “only one” and remain silent. Because I am a lesbian, I understand the “only one” belief very well. But the only way you can do anything about a problem is to talk about it and discuss what you are going to do about it. You may not do anything immediately; I know from experience that people will write down the telephone number of an agency and call a couple of years later. This has been true in both domestic violence and outreach to lesbians. I think the point is, if you don’t do anything, there may be an escalation of violence.’’

We also need to get more information out to the media-TV and print in particular-because there are so many people who cannot be reached any other way. There has been more media attention to domestic violence lately and we need to keep pushing it. It may sound cynical, but elder abuse is another angle, and the media is always looking for “another angle.” When my book came out, it got a lot of attention but the hardest thing was to maintain the focus on domestic violence. People from the media would say they had already done one program on it. Well, one program does not do it. It is a continuing problem. We need to identify people at the stations who will cover the issue.

My kick right now is the urgency of political awareness and involvement at the national level. Service providers need to be keyed in politically. If they don’t have political clout, they are vulnerable. We also need to be involved at the state level. In California, the Alliance on Domestic Violence held trainings years ago on how to influence legislators. One of our goals was to help legislators understand the connection between child abuse and spousal abuse. People should get lists of senators, members of congress, and committees, and make contact when issues come up.

We also need to change societal values. We need to raise everyone’s consciousness about ageism, which is rampant, and violence. We’ve tried to get rid of guns in the home because we know that they are more likely to be used on people who live there than to defend the home. When you add our society’s propensity toward violence with ageism and sexism, you have a dangerous situation.

Tuesday, August 12, 2008

Summer Reads in Elder Abuse

I’m not a fan of pulp mystery writer Sue Grafton, but when I heard that her latest book, “T” is for Trespass, was about elder identity theft, I was curious and grabbed a copy I found in a discount sales bin. Unless you’ve been living under a rock, you’ve probably heard of Grafton’s alphabet mystery series, beginning with “A” is for Alibi, which features plucky private eye Kinsey Millhone. As a sometimes writer of fiction myself, it occurred to me that by the time Grafton got to T, she may well have regretted her decision to use the alphabet device and dubbed her latest “T” is for Tedium.

I’m always interested in how service providers are portrayed in the popular media and had planned to cut to the point in the story where Kinsey seeks their help (after checking out the acknowledgments to find out who she’d talked to). But in the first few pages, Grafton paints a chilling portrait of the sociopath as a little girl, which got me hooked:

She operated as a creature apart, without empathy. She pretended to be like the little girls and boys in her grade, with their bickering and tears, their tattling, their giggles, and their efforts to excel. She observed their behavior and imitated them, blending into their world until she seemed much the same. She chimed in on conversations, but only to feign amusement at a joke, or to echo what had already been said. She didn’t disagree. She didn’t offer an opinion because she had none. She expressed no wishes or wants of her own. She was largely unseen—a mirage or a ghost—watching for little ways to take advantage of them.

The set-up reads like many of the cases we review at MDT meetings. The victim is Kinsey’s elderly neighbor, Gus, whose great-niece hires the perp to provide care after he’s injured in a fall. Even Kinsey is duped at first; she’d helped the niece screen workers and hadn’t realized that she’d mistaken the fake Solana Rojas for the real one, a licensed vocational nurse with impeccable credentials. Kinsey, however, eventually realizes her mistake, unlike the APS worker assigned to investigate who sides with the fake Solana against Kinsey. And when the fake Solana files to become Gus’ conservator under yet another fake name, the court appoints her. The story dissolves into utter lunacy as Kinsey turns action hero and literally disarms one of her adversaries (don’t ask).

The book reminded me of Hastened to the Grave, a true crime novel about a real abuse case here in the Bay Area in the early 90s. Dubbed the “Foxglove Case” by police because the perpetrators poisoned their victims with digitalis, a common heart medication made from the foxglove plant, it too starred an intrepid blond PI. I interviewed Faye Faron, who was known professionally as Rat Dog Dick, years ago about the case and Elder Angels, a non-profit she started that offered pro bono private investigations in elder abuse cases.

Hastened to the Grave stuck pretty close to the real case, which needed no embellishment. Faron was originally hired to investigate the alleged abuse of an 82-year-old woman who'd been befriended by a younger man who insinuated himself into her life and talked her into signing what she thought was a simple tenancy lease. It turned out to be a joint-tenancy agreement, which entitled him to take possession of her home when she died. Her sudden subsequent death prompted the executor of her estate to hire Faron, and by the time the executor called off the investigation, Faron was well on her way to unearthing a con game that included the younger man’s mother, sister, and sister’s boyfriend and the death of four men under their care. Undeterred by the lack of a client, Faron continued to investigate as she attempted to get the police, APS, and DA involved. Olsen’s portrayal of the real life professionals involved in the case was no more flattering than Grafton’s, except for Faron, with whom he was obviously infatuated. He especially sticks it to San Francisco’s PD and DA, whose handling of the case was clearly not their finest hour. There were blunders made at every point.

But it turned out to be a landmark case that highlighted the myriad real life problems involved in prosecuting sweetheart scams, which often involve lonely, isolated victims who are too embarrassed to admit they’ve been had. Until recently, cases like these were seen as civil matters at worst, and those that were investigated by police or prosecutors were bounced back and forth between homicide and fraud units. Cases fell apart if victims died, and perpetrators finessed quick cremations to destroy evidence. The Foxglove case was further plagued by politics, changes in departmental administration, allegations of racism (the perps were Rom), and police misconduct.

As I thumbed though the Olsen book, I was struck by how much progress there's been in the last decade thanks to the pioneering work of police, prosecutors, judges, forensics experts and researchers, policy makers, and many others. Today, hundreds of these cases are being successfully prosecuted and a case like Foxglove would undoubtedly be handled differently.

To anyone who's seen the suffering these cases cause, the notion of elder abuse as entertainment may seem perverse. But you have to admit that some real life cases have every bit as much suspense and drama as say, a Sue Grafton novel. If we’re ever going to see positive portrayals of colleagues and coworkers though, it’s clear we’re going to have to create our own heroes.

Happy reading.

For more on elder identity theft, visit my Web site at

Tuesday, July 15, 2008

Wall Street Journal Looks at Home Care Aide Crisis

Readers know that the shortage of in-home workers and elders’ vulnerability to abuse by criminal caregivers has long been a concern of mine. So I was delighted with Phil Shiskin’s in-depth article on the subject that appeared in today’s Wall Street Journal. It focuses on California and mentions Napa's effort to develop a local screening program. Check it out at Caregiver Abuse.

For more on the topic and some of the initiatives cited in the article, see the Elder Abuse By Paid Caregivers page of my Web site.

Friday, July 04, 2008

More on Identify Theft

Just wanted to let readers know that I’ve posted a new page on my Web site on ID theft against the elderly. It's in the Learn About Elder Abuse section. Highlights include:

Researchers disagree about who the culprits are: techies who hack or acquaintances who steal IDs the old fashioned way. Are corporate interests at play here?

The American Bar Association is urging legal aid attorneys to help ID theft victims.

“Combo crimes” involving thieves who use stolen identities to steal homes appear to be on the rise.

Other additions to the site include “Blog Brousing,” summaries and links to past postings, for your summer reading enjoyment.

Wednesday, May 28, 2008

Luring Health Care Providers into Geriatrics

Supporters of loan forgiveness programs aimed at encouraging health care providers to specialize in geriatrics got a boost from a report issued last month by the Institute of Medicine (IOM). Retooling for an Aging America: Building the Health Care Workforce is based on the findings of an ad hoc committee that looked at the health care needs of the 78 million baby boomers who’ll soon be turning 65. The group estimates that there are currently only about 7,100 doctors certified in geriatrics in the US, one for every 2,500 older Americans, a shortage they attribute to a lack of training programs and low Medicare reimbursement rates for geriatricians compared to other specialists. The report comes just as the government prepares to cut Medicare physician payments this July. The group has called for increased reimbursement rates, loan forgiveness programs, and student scholarships.

I was pleased to see that the report also addressed the need for more direct-care workers, including nurse aides, home health aides, and personal care aides. Unlike geriatricians, who have high job satisfaction rates (the highest, in fact, of any specialty), these hands-on workers are generally dissatisfied and have high rates of turnover due to low pay and working conditions, high rates of on-the-job injury, and few opportunities for advancement. Turnover among nurse aides, for example, averages 71% annually, and 90% of home health aides leave their jobs within the first two years. In response, the committee is calling for more opportunities for career growth, higher pay, and access to fringe benefits. They also recommend that all health care workers be trained in basic geriatric care and treating older patients.

As I've said many times before, we can screen and regulate all we want to prevent worker abuse and neglect, but it’s not going to do much good until we make these jobs tenable and have an adequate pool of workers for seniors to choose from.

At the national level, Senator Boxer’s Caring for an Aging America Act of 2008 (S. 2708) would amend the Public Health Service Act to attract professionals and direct care workers by earmarking $130 million for a loan forgiveness program. Those covered include physicians, physician assistants, advance practice nurses, social workers, and psychologists. The legislation would also create the Health and Long-Term Care Workforce Advisory Panel for an Aging America to advise the Secretary of Health and Human Services, the Secretary of Labor, and Congress on workforce issues related to elder healthcare. The bill has bipartisan support and counts among its supporters the American Geriatrics Society, the National Council on Aging, the Alzheimer's Association, AARP, American Academy of Physician Assistants, American College of Nurse Practitioners, American Psychological Association, Coalition of Geriatric Nursing Organizations, and the National Association of Social Workers.

Here in California, our loan forgiveness program is also making headway. AB 2543, which was developed by the California Senior Legislature under the leadership of Shirley Krohn and introduced by Assembly member Patty Berg, is called the California Geriatric and Gerontology Workforce Expansion Act of 2008. To qualify, loan recipients would have to commit to a minimum of three years of service in geriatric care settings. Covered under the bill are physicians, dentists, psychologists, registered nurses, and social workers.

I thought I’d end with an excerpt from the terrific New Yorker article "The Way We Age Now," by surgeon Atul Gawande, which I cited in a posting last fall (see Geriatricians, Angry and Otherwise):

Several years ago, researchers in St. Paul, Minnesota, identified five hundred and sixty-eight men and women over the age of seventy who were living independently but were at high risk of becoming disabled because of chronic health problems, recent illness, or cognitive changes. With their permission, the researchers randomly assigned half of them to see a team of geriatric specialists. The others were asked to see their usual physician, who was notified of their high-risk status. Within eighteen months, ten per cent of the patients in both groups had died. But the patients who had seen a geriatrics team were a third less likely to become disabled and half as likely to develop depression. They were forty per cent less likely to require home health services.

Little of what the geriatricians had done was high-tech medicine: they didn’t do lung biopsies or back surgery or PET scans. Instead, they simplified medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe.

How do we reward this kind of work? Chad Boult, who was the lead investigator of the St. Paul study and a geriatrician at the University of Minnesota, can tell you. A few months after he published his study, demonstrating how much better people’s lives were with specialized geriatric care, the university closed the division of geriatrics.

“The university said that it simply could not sustain the financial losses,” Boult said from Baltimore, where he is now a professor at the Johns Hopkins Bloomberg School of Public Health. On average, in Boult’s study, the geriatric services cost the hospital $1,350 more per person than the savings they produced, and Medicare, the insurer for the elderly, does not cover that cost. It’s a strange double standard. No one insists that a twenty-five-thousand-dollar pacemaker or a coronary-artery stent save money for insurers. It just has to maybe do people some good. Meanwhile, the twenty-plus members of the proven geriatrics team at the University of Minnesota had to find new jobs.

Seems to me that the need for more geriatric training is pretty much a no-brainer.

Saturday, May 10, 2008

Guardianship Under Assault

Indictments of guardianship and guardians are flying fast and furiously these days on Web sites and blogs:

A new site, operated by a group calling itself the National Association to Stop Guardian Abuse, explains guardianship this way:

"At present, it operates to ensnare the most vulnerable people in a larger and larger trawling net, now including those merely physically "incapacitated"! It has become a feeding trough for unethical lawyers and other "fiduciaries" appointed by the courts to protect, but many of whom become nothing more than predators."

Another, called “Abusive Guardianships of the Elderly,” exhorts readers to share their stories:
Has someone you love been victimized by the guardianship racket? Please share your experience. We must look to each other for ideas and support if we are to stop the blatant exploitation our elderly and infirm suffer at the hands of the system and the law who is charged to protect them.”

And, in a recent response to my Feb 12, 2007 posting “Feel Good Laws or Real Reform?” about California’s conservatorship reform package, a respondent named “Sherry” had this to say:
"(The vulnerable) have become the prey for a predatory and lucrative guardianship/ conservatorship industry. In case after case, the ward's estate is pilfered by the guardian, while the ward is isolated in a nursing home against his will, not allowed contact by family members or friends, and eventually dies, bewildered and alone, all with the blessing of the court!"

Some of these critics have personal tales to tell. I don’t doubt their stories or their motives. We all know that abuses happen more often than they should. And I can think of nothing more disturbing than when “helping professionals” exploit those they’re charged to serve. Whether the offenders work for public agencies; private, non-profits; or they’re in private practice; their misdeeds leave colleagues feeling betrayed and demoralized. It casts a shadow on our field and undermines the public’s trust. But the wholesale vilification of the system and those involved, which seems to be accelerating, is deeply troubling.

The censure isn’t just coming from the public. Among professionals too there’s a tendency to impugn “the system” rather than those who corrupt it. And there’s been far too little meaningful discussion about how to fix problems, promote promising practices, offer safe alternatives, and provide the public with accurate and balanced information.

Guardianship was created to protect the vulnerable and prevent abuse and neglect. For the most part, that’s what it does. California’s Administrative Offices of the Court recently released a report, Effective Court Practice for Abused Elders, which includes the findings of a file review of conservatorships. In over 70% of the petitions filed in one county, there were allegations, suspicions by court investigators, or other indications of abuse or neglect by family members, neighbors, businesses, and others. (The report, which was funded by the Archstone Foundation, is available on line at Effective Court Practice.

The stories behind these cases—estates that have been saved and predators who’ve been thwarted--don’t get much attention or make headlines. They are, however, well known to those of us who have seen the system at its best. I admit that many of us in the San Francisco Bay Area are a bit biased as we have some of the best courts, attorneys, and professional guardians around. When I directed the San Francisco Consortium for Elder Abuse Prevention, members of our multidisciplinary team often breathed a collective sigh of relief when a particularly thorny abuse case was referred to the court, where we knew it would be rigorously reviewed.

So how do we go about restoring trust? An important first step, I believe, is to shed light on the system so that we fully understand and can explain both its strengths and shortcomings. To date, we lack such basic information as how many guardianships there are nationally, why they’re established, and how well they’re doing what they’re supposed to.

We also need to dispel damaging and persistent myths and misperceptions. As the quotes above suggest, there’s widespread belief that anyone who has a mental impairment can be placed under guardianship and that courts go “trawling’ for wards. We need to get the word out that while nearly 50% of people over 85 suffer from cognitive impairments, only a small proportion need guardianships. We also need to inform both professionals and the public about who initiates guardianships (not courts), and why—often, it’s because less restrictive legal devices like powers of attorney or trusts have been misused or when APS, police, or emergency personnel discover gravely disabled elders living in horrible conditions as a result of dementias. Once appointed, guardians can remove wards’ assets from wrongdoers’ control, initiate lawsuits to recover misappropriated assets or property, evict wrongdoers from elders’ residences, purchase needed services, authorize medical treatment, and arrange for elders to live in safe places.

Probably the most common complaint against guardianship is that it’s overly restrictive. For that reason, it’s considered the option of last resort. But as I pointed out in “Feel Good Laws or Real Reform?” the fact is, there are few alternatives. Those that are typically cited -- case management, daily money management, powers of attorney, and other advance directives--aren’t really alternatives. They might have circumvented the need for guardianship had they been implemented prior to the onset of incapacity; but once someone loses capacity, it’s too late to execute advance directives, and many social service providers can’t accept clients who are incapable of giving informed consent.

The few options available for those who have already lost capacity include representative payeeship, limited guardianships, and the appointment of surrogate decision makers on a one-shot or temporary basis. Rep payeeship, which can protect clients whose primary income is from public benefits, can be put in place for those who are unwilling or unable to consent. Under Georgia’s Health Care Placement Decision-Maker for An Adult Act, any person can petition the court to authorize placements in long-term care facilities. A few states have “protective custody,” which allows for vulnerable adults to be hospitalized for a few days when they lack capacity to consent to protective services and are in imminent danger or at risk of death. While in “custody,” their capacity and protective service needs are carefully assessed.

California has explored several options, which I discussed in my earlier posting. But for the most part, they’re untested, and many aren’t being used. Some, like Probate Code section 2952, which allows public guardians to freeze the assets of vulnerable elders when there’s cause to believe that they’ve been the victims of financial abuse, are coming into use gradually. Although the statute was enacted years ago, most counties continued to rely on temporary conservatorships (t-cons) in these circumstances. It appears that PGs have been using section 2952 more since the passage last year of a new law that requires courts to complete full investigations of t-cons. California also has a protective custody law, Welfare & Institutions Code Section 15703 - 15705.40, which has only been adopted in a few counties.

Clearly, these options need to be carefully scrutinized. For years, I’ve been calling for a statewide group to identify policy needs and perhaps more importantly, track what laws have been implemented, why some haven’t, how they’re working, and if they need tinkering.

As the population ages, more people are going to need guardianships and safe alternatives. It’s time to seriously address the problems in the system, explore alternatives, dispel myths, and earn the public’s trust and confidence. The longer we wait, the harder it’s going to be to turn things around.

Monday, March 24, 2008

Undue Influence: There Oughta be a Law (or Two)

When undue influence was “discovered” as a significant factor in elder abuse a decade ago, it immediately struck a chord with advocates and service providers who'd been seeing the phenomenon for years. They may not have had a term for it, but they knew it when they saw it.

But translating undue influence into law, or more specifically, translating it into an infraction of the law, hasn’t been easy. See Undue Influence is Not a Crime (Nov 20, 06), Postscript on Undue Influence is Not a Crime (Dec 4, 06), PPS on Undue Influence: The Civil Side (Dec 14, 06), and Long Distance Undue Influence (June 20, 06). For links to these postings and more on undue influence, visit my Web site at Prevent Elder Abuse.

This year, advocates in California are tackling the problem full force. The California District Attorney's Association has teamed up with California Senator Bob Margett to broaden the definition of financial abuse used in California’s penal code (PC 368) to include “undue influence upon an elder or dependent adult for financial gain.”
 The bill, SB 1259, came largely in response to the criminal case against Ronald Brock that I described in “Elder Abuse is Not A Crime.” In that landmark case, Brock was convicted of theft based on undue influence, but an appeals court overturned the conviction on that grounds that obtaining money by consent is only theft if the defendant uses coercion or misrepresentation and that the judge had erred in allowing a conviction for conduct that was "little more than overpersuasion." See SB 1259.

SB 1140, sponsored by State Senator Darrell Steinberg, would amend sections of the state’s Welfare and Institutions code pertaining to financial abuse to allow elders to recover property (and lawyers’ fees) when property is taken from them through undue influence or when they lack full mental capacity. See SB 1140.

Drawing the lines between persuasion, overpersuasion, and unlawful acts clearly isn’t going to be easy. It requires rethinking old assumptions and reevaluating deeply held values. Our society reveres and rewards the ingenuous and entrepreneurial who succeed in anticipating and responding to both real and fabricated needs and desires. Enticement and seduction are a fact of life. But as we come to understand the vulnerabilities engendered by advanced age, we need to balance our commitment to personal freedom and choice with our obligation to protect and defend. In short, we need to define the point at which society has a responsibility to step in and call foul.

Wednesday, March 12, 2008

Expanding our Notion of Accountability

A couple weeks ago, I was in the middle of writing a proposal to explore restorative justice approaches to elder abuse when I happened to see the new Pew Center report on incarceration (see Pew Report) that showed that more than one in 100 American adults are behind bars. That’s 1.6 million, the highest rate of any nation in the world. And it gets worse: one in 36 Hispanic and one in 15 adult Black men are incarcerated. Among young Black men, the figure is one in nine. The racial divide extends to women too, with one in 100 Black women aged 35 to 39 incarcerated compared with one in 355 for Whites.

After I got past my initial shock and depression, I went back to work with new resolve, more convinced than ever of the need for new approaches to elder abuse.

Be assured, I’m a huge fan of the police, prosecutors, forensics researchers and everyone else responsible for the enormous strides our field has made in improving prosecution rates in elder abuse cases. And a lot still remains to be done. That’s particularly true, I believe, in the case of financial abuse, where so many predators operate with impunity; some brazenly brag that the risk of getting caught and the flimsy penalties and sentences they face are simply the cost of doing business. But, as our field embraces criminal justice approaches, we ought be careful. We need to be sure, for example, that the approaches we advocate for are fair and appropriate. We need to guard against becoming so focused on prosecution that it overshadows other promising approaches. We need alternatives that we can divert offenders to when it’s appropriate. And, we need to be watchful and honest about unintended consequences.

It used to be that prosecutions were rare and few police and prosecutors received training. Things started to change quickly in the 90s with the infusion of domestic violence theory, policy, and practice into our field. In addition to offering such promising new interventions as support groups, safety planning, shelters, and orders of protection, it prompted us to focus on the criminal justice system. A significant amount of federal and state dollars now go for training police and prosecutors, for advancing forensics research, and for letting the public know that abuse is a crime.

All well and good. We’ve “criminalized” elder abuse under the banner of accountability, and clearly, it’s one way to achieve accountability. But accountability goes beyond punishing offenders. It requires that perpetrators acknowledge the harm they’ve caused and make amends to their victims and communities. If we’re serious about accountability, it’s time we stopped shrugging our shoulders at the fact that few perpetrators pay restitution, assuming that nothing can be done about it. It’s time to hold ourselves and “the system” accountable for ensuring that the needs of victims aren’t overlooked. It seems to me that the resources now directed toward the criminal justice system far exceed those devoted to restitution recovery, victim compensation, advocacy, preventative services, legal assistance, or social services aimed at healing, protecting, and empowering. Or seeing to it that offenders with mental health problems get the services they need, which is what so many victims want.

It’s my belief in the need to expand our view of accountability that’s led me to explore restorative justice (RJ). RJ isn’t a single intervention, but rather multiple techniques like victim-offender mediation in which victims confront their abusers in safe settings to tell them how they were affected, seek answers, and negotiate remuneration. Although I’m not aware of traditional victim-offender mediation being used in elder abuse, innovative programs and courts across the country are using mediation to resolve conflicts among family caregivers, as an alternative to guardianship, and to reach settlements in abuse cases, with promising results. Another RJ approach, family group conferencing (or talking circles), is currently being explored by several Indian tribes in the US and a mainstream program in Canada. The groups draw upon the potent power of family relationships and support networks to support the vulnerable, motivate or pressure members to get help for mental health problems, negotiate settlements, and support caregivers sanction offenders. For more on RJ, see the page on my Web site Restorative Justice Approaches to Elder Abuse Prevention.

RJ advocates contend that approaches like these may, in some respects, ensure greater accountability than the traditional criminal justice system. For example, in the traditional system, offenders plead innocent, leaving it up to prosecutors to prove their guilt. In contrast, RJ creates incentives for offenders to step up, admit what they’ve done, and make amends. In the traditional system, perpetrators often don’t hear the full extent of the pain, loss, and suffering they’ve caused, and victims don’t have the satisfaction of been heard. Police dramas would have us believe that the only outcome that satisfies victims is when their offenders receive harsh punishments. But victim advocates tell us that having a voice in the process, being compensated, hearing perpetrators’ explanations and expressions of remorse, and negotiating solutions can be both healing and empowering.

There are other reasons to be cautious about criminal justice approaches to elder abuse. In previous postings I’ve discussed the unintended consequences of some criminal justice approaches on certain victims. For example, mandatory arrest laws, which many states have adopted to combat domestic violence, have resulted in dramatic increases in the arrest of women as “mutual combatants” despite the fact that most women are acting in self-defense. That’s because the laws don’t typically distinguish between one-time and chronic violence, or between minor and severe violence, This is particularly true for poor women, women of color, and undocumented immigrant women. Makes me wonder if that’s reflected in the PEW findings.

It was while working on a project for the National Indian Council on Aging (NICOA) that I first got interested in RJ, as several tribes had programs. As former NICOA director Dave Baldridge put it, “Restorative justice was once an unspoken, widely-accepted aspect of American Indian tribal cultures. As Native communities were family-based and relationship oriented rather than relying on rules of law, many Native people—elders most of all--still adhere to restorative justice concepts.”

Again, I’m not knocking criminal justice approaches. I simply think we need to expand our way of thinking about accountability and focus attention and resources on approaches that empower, compensate, and restore as well as punish. RJ holds promise for doing that. I’ll keep you posted on my proposal.

Friday, February 01, 2008

Abuse and Home Care Workers: Giving Policymakers the Lowdown

APS workers, prosecutors, and aging service providers know the frustration well: They discover that a personal care attendant who is being paid with public funds is abusing an elder. When they prevail upon public entities to fire the worker, they’re told “no can do.” When abusive caregivers are hired and supervised by elders, only the elders can fire them.

We also know that seniors sometimes refuse to fire abusive attendants and why. Some are afraid of their workers or of what will happen if they can’t find replacements. Attendants may be threatening them or exercising undue influence. Some seniors don’t realize they’re victims, especially when the workers have been surreptitiously draining bank accounts or transferring property. The elders may have subtle cognitive deficits. Or, they may want to help out troubled family members who need jobs.

I’ve written about the issue often, as well as the related issues of the rising numbers of caregivers who have criminal histories, the need for background checks on caregivers, and the lack of research on which to base screening decisions. I’ve devoted a page on my Web site to the issue. See Elder Abuse by Caregivers.

You’d think that the prospect of government-subsidized abuse would raise more of a hue and cry, but federal policymakers seem largely impassive. The Centers for Medicare & Medicaid Services (CMS) has addressed the need for better screening of nursing home employees, but not independent home care workers. This is despite the fact that in-home workers may spend hours, alone and unsupervised, in the homes of society’s most vulnerable members.

The concept of “self-directed care,” which is intended to empower Medicaid recipients to select, direct, and manage their own services and caregivers, stems from the independent living movement of the 1960s, which was premised on the concept that people with disabilities should have the same civil rights, options, and control over choices in their own lives as others. In recent years, members of the aging and dementia care networks have joined with advocates for the younger disabled in singing the praises of self-directed care, also known as “consumer choice” programs. And the little research that’s been done suggests that people who direct their own care are more satisfied than those who hire workers through licensed agencies. They claim that while abuses may occur, we have a safety net to address them, most notably APS and law enforcement.

Self-directed care is a boon for loving family caregivers who are struggling to manage financially. But in the elder abuse arena, we see the dark side. We see the seniors who hire the wrong caregivers for the wrong reasons. We see others being preyed upon by predators and criminals.

A recent call from the Centers for Medicare & Medicaid Services (CMS) regarding a proposed rule change that would extend the self-directed personal assistance services plan option (Cash and Counseling) may provide an opportunity to raise our concerns:

On January 14, 2008, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule change that would allow states to adopt a self-directed personal assistance services plan option in their Medicaid programs. This option would permit Medicaid beneficiaries who quality for personal care services to receive a cash allowance that could be used to hire, direct and train their own personal care workers - including qualified family members - rather than receiving home care services from an agency. Many states currently have such options allowed under temporary waivers in their Medicaid programs. This rule change would allow such programs to become permanent state options. The notice of proposed rulemaking was published in the January 18, 2008 issue of the Federal Register. Public comments regarding the proposed rule change are due February 19, 2008. To comment, go to CMS.

The request for comments, which explains the programs and CMS’ goals is over 100 pages long. Buried deep within (beginning on page 52) are the sections on “risk management” (the document does not directly mention potential abuse). The proposed regs require states to provide plans for mitigating risk to consumers, including measures for determining who is eligible to serve as workers and when surrogate, or representative, decision makers should be assigned for those with impairments. Among the issues that CMS is asking for comments on is whether criminal background checks should be required. Seems to me like an excellent opportunity to bring up some of the problems we’ve been struggling with. My own list of recommendations includes:

The Need to:

Strengthen the safety net. As more elders hire persons who are unsupervised by agencies, it has clearly placed greater demands on APS, law enforcement, public guardians, and others. In addition to added resources, these entities need guidance and authority to intervene.

Provide guidance and help to elderly consumers in finding, screening, hiring, and supervising workers. Specifically, consumers need screening processes that identify high risk workers, including but not limited to criminal background checks

Conduct research to identify high-risk situations, including research in how to assess criminal background data

Expand the pool of workers

Clearly the protective service networks have a stake in these plans and in working with the consumer choice network. I urge you to make your ideas and experiences known.

Saturday, January 26, 2008

Chat with M.T. Connolly

As an update to my last post, M.T. has an article running in the Outlook section of today's Washington Post. See A Hidden Crime.

On Monday, she’ll be taking questions about the article, abuse, and what can be done about it on the Post’s Web site at 1 p.m. Eastern Time.You can submit questions and comments before or during the session.

Tuesday, January 08, 2008

The Year in Elder Abuse Prevention

The journalistic tradition of year-end “news roundups” provides an excellent ruse for cleaning out my file of items I didn’t get to last year. Here are a few:

Under the rubric of “Congratulations and Transitions”:

Marie Theresa Connolly left her post at the Department of Justice to accept a fellowship at the Woodrow Wilson International Center for Scholars, where she’ll be writing a book on elder abuse. She is one of 21 fellows at the “quasi-federal entity with an ongoing mission of linking the worlds of ideas and policy.” I’m thrilled for M.T. who’s been doing groundbreaking work in the field for years. She is an expert in prosecuting abuse in nursing homes and played a leading role in crafting the Elder Justice Act while on loan from DOJ to the Senate Special Committee on Aging. She also spearheaded efforts to advance medical forensics in elder abuse, organizing the first national symposium on the issue and subsequent research. Fortunately, she plans to continue working in the field of elder justice in some capacity when she’s done. Here's what she had to say about the book:
"Despite broad bipartisan support, the Elder Justice Act, first introduced in 2002 and in every Congress since, remains unenacted in the face of chronically insufficient resources, data, infrastructure, expertise, training and public awareness. As a result of this paralysis, my goal is to write an accessible book about elder abuse that will propel change by raising public awareness about the problem through the stories of real people, and serve as a resource and catalyst for policy-makers, researchers, practitioners and the public."

M.T. will be presenting “Emerging from Obscurity: Elder Abuse's Slow Journey Toward the National Agenda” at the Elder Abuse: Medical Abuse and Multidisciplinary Aspects conference sponsored by the University of California, Irvine on February 11-12. You can also hear her talk about the book online at M.T. Connolly

Forensic psychiatrist Bennett Blum was ordained as a rabbi by the Academy for Jewish Religion, an “alternative-minded trans-denominational rabbinical school” in L.A. As an expert in cognitive assessment and undue influence, Bennett often testifies in court cases; it was a case involving a rabbi, in which he was asked to base his legal argument on Jewish sources, that he got to thinking about how ancient rabbinic views on deceptive and manipulative practices applied. He went on to write an article on the subject, which led others to "use Talmudic perspective for formulating their arguments." He is also hoping to start a non-profit organization to foster collaboration between clergy and social service providers. What sets his approach apart from most faith-based programs is that he hopes to engage clergy not simply as gatekeepers to get congregants into the legal and social service systems, but rather, to appeal to them to draw from the wisdom of their traditions to teach, guide, and heal. For more on Bennett, see undue influence.

Family justice center maven and former San Diego District Attorney Casey Gwinn is the new CEO of San Diego’s YWCA. Casey founded San Diego’s Family Justice Center, a “one-stop shop” for domestic violence victims, which serves as the prototype for centers across the U.S., Canada, Mexico, and England and the National/International Family Justice Center Alliance, which provides technical assistance to centers worldwide. A few years ago, the San Diego Center began serving victims of elder abuse with support from the Archstone Foundation. Casey will continue to be involved with the Alliance. In November, he was one of three community leaders awarded The California Wellness Foundation’s 15th annual California Peace Prize.

Heidi Li has replaced Mary Twomey, who, in 2000, replaced me as Director of the San Francisco Consortium for Elder Abuse Prevention (Mary is the new co-director of the Elder Abuse Forensic Center of Orange County). Heidi, a lawyer, has a background in fair housing and anti-predatory lending consumer protection. She was a founding co-director of Housing and Economic Rights Advocates (HERA), a statewide non-profit legal service and advocacy organization, and previously worked as a senior staff attorney for the Fair Housing Law Project (FHLP) where she helped develop San Jose’s predatory lending screening clinic. Her background in law advocacy is sure to be a boon to the Consortium.

And, more on the advocacy front:

The Elder Justice Act continues to languish in Congress, which supporters blame on Congress’ partisanship, its preoccupation with Iraq, the difficulty of passing a stand-alone bill, and the fact that the wide-ranging bill spans multiple committee jurisdictions, which means that multiple leaders have to vet the bill, which takes time. On the bright side, there doesn’t seem to be much opposition. Rahm Emanuel, the bill’s main sponsor in the House, has said he’s hoping to get pieces of the bill included in other legislation. The bill provides for: elder justice offices in the U.S. Departments of Justice and Health and Human Services, $400 million for state adult protective services over four years, creating a federal coordinating committee, forensic centers, and penalties for nursing homes for failure to report crimes quickly. Emanuel's bill also would require the attorney general to develop a plan for prosecuting elder abuse cases and provide grants to assist state and local prosecutors.

Another bill I’m following is the Restitution for Victims of Crime Act of 2007, which would improve the collection of victim restitution and criminal fines (which fund victim services and compensation). The bill was introduced in response to a GAO report that estimated federal criminal debt at $46 billion, most of which is owed to victims. The bill also removes barriers to collecting restitution and helps federal prosecutors prevent criminal defendants from spending or hiding their assets by setting up pre-conviction procedures. The bill has strong support from such prominent and far ranging advocates as the National Center for Victims of Crime, Mothers Against Drunk Driving, and the National Coalition Against Domestic Violence.

The problem of restitution was explored in the recently released Repaying Debts, which was produced by the Council of State Governments. The report assumes a wide-angle view of the problem, emphasizing, for example, that when prisoners are released, many are so far in debt to myriad entities that paying what they owe is virtually impossible. Those responsible for collection, which include probation departments, courts, attorney generals’ offices, and child support enforcement offices, operate at cross purposes, and victims and children are usually at the end of the queue for getting what they’re owed. The report calls for cleaning up the entire system, which includes providing for a single agency to coordinate repayment, set priorities, and create more opportunities for criminals to repay what they owe through work and community service programs. See Repaying Debts.

And in California, several important new laws go into effect this year:

Cal Senate Bill 611 allows judges to freeze assets in cases of financial abuse until victims’ claims are resolved so that defendants cannot spend or hide them before the case is decided. The legislation was sponsored by California Advocates for Nursing Home Reform (CANHR), AARP, and the California Alliance for Retired Americans.

Cal Assembly Bill 1298 requires that California residents be notified when their electronic medical information or health insurance information has been exposed, thereby raising their risk of identity theft. The new law expands on California's earlier data-breach notification law, the first of its kind in the country, which inspired similar laws in more than 40 states. The 2003 law only covered financial information, with the new law coming in response to a report on medical identity theft issued by San Diego’s non-profit World Privacy Forum in 2006. The report revealed that a quarter of a million people per year are victims of this crime.