Financial Elder Abuse: Hot Off the Presses

I’ve worked with Pam Teaster, Professor at Virginia Polytechnic Institute and State University, and president of the National Committee for the Prevention of Elder Abuse (NCPEA), on a couple of research projects over the years and have always been impressed by her readiness to design studies that answer questions practitioners most want the answers to. It’s not easy to translate practice wisdom or professionals’ hunches into conceptual frameworks and designs that pass scientific muster. Which is why practice-based studies often end up employing such dubious sounding methods as “convenience” and “snowball” samples. Still, they yield insights that are enormously helpful to the field.

Pam’s recently released study on financial exploitation breaks new ground methods-wise and sheds light on how financial abuse is being addressed by the media around the country. Broken Trust: Elders, Family and Finances was a collaboration of NCPEA, Virginia Polytech, and the MetLife Mature Market Institute, the research branch of the insurance company. Pam and her colleague Karen Roberto analyzed financial abuse cases identified through the electronic clipping service operated by the National Association of Adult Protective Services for the Administration on Aging’s National Center on Elder Abuse. The service draws from Google and Yahoo scans of billions of Web pages a day. The search yielded 266 articles on financial abuse that were posted between April and June of 2008. From these, they collected information about victims and perpetrators, their relationships, victims’ losses, and case outcomes. They also reviewed the academic and trade literature on financial abuse and listed promising practices drawn from a database run by NCEA.

I was a little surprised to see “Medicare/Medicaid fraud” among the forms of abuse that were included since the term typically refers to situations where it’s the “system” that’s ripped off, not program beneficiaries. Like many in the field, I worry about defining elder abuse so broadly that the term becomes meaningless, and I’m always on the lookout for types of abuse that we can exclude. But the example cited in the report, of a physician who performed unnecessary surgeries on 865 elders and charged Medicare or Medicaid over $11 million for them, was certainly compelling. Although it might be argued that it was the system that suffered the financial loss, there’s no denying the trauma and suffering that the patients must have endured. Professionals and courts alike are struggling with the question of whether or not physical abuse, neglect, or other mistreatment, when committed for profit, also constitutes financial abuse. Other forms of financial abuse mentioned in the study include telemarketing fraud, repair and contracting scams, "sweetheart scams," fraudulent advice from insurance salespeople and stockbrokers, abuse of powers of attorney and guardianship, identity theft, and Internet "phishing."

Among the findings that are already being widely cited is the estimate that elder financial abuse costs older Americans at least $2.6 billion a year. The figure was derived by annualizing the total losses reported during the 3-month study period ($400 million) and assuming that the losses in the 40% of cases where no dollar figure was provided were comparable. I found it interesting that the largest single category of abusers was trusted professionals, which includes attorneys and fiduciaries, who accounted for 18% of the cases. They were followed respectively by family members (17%), non-agency caregivers (11%), and agency caregivers (9%). Also of interest was that almost 2/3 of the victims (65%) were women.

I asked Pam what, if anything, she found surprising. She cited the severity and impact of the abuse. “One victim likened the exploitation to being raped. I can easily see it. It would follow that the health effects and the very ability of a person to even address the effects due to diminished resources would be equally devastating.”

She also noted victims’ diversity. “While there are typologies of victims, and we tied to make one, there is enough variance to indicate that healthy and frail alike--can fall prey to exploitation.”

MetLife’s Mature Market Institute, which is directed by Sandy Timmerman, spearheads research, national partnerships, and educational materials for “those in, approaching, or caring for those in the mature market.” The full study is available on the Institute’s website at 
www.maturemarketinstitute.

For more on elder financial abuse, including identity theft against elders, undue influence, and mass marketing fraud, visit my Web site at http://lisanerenberg.com/learn/learn.html.

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 http://lisanerenberg.com/learn/idtheft.html.

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.

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.

Elder ID Theft: Should We be Concerned?

Traditionally, those of us in the field of elder abuse prevention haven’t dealt with “consumer” crimes like telemarketing scams or identity theft. There was no evidence to suggest that elders were targeted, and some studies even suggested that elders were less likely than younger people to be victimized. Besides, our focus was on abuse by family members and acquaintances.

It’s true that only about 10% of victims of ID theft are elderly, but when you consider that over 9 million people reported ID theft last year, we’re talking huge numbers.

Like many people, I used to think of ID theft as a high tech crime committed over the Internet. But according to a report by the Better Business Bureau and Javelin Strategy & Research as an update of the Federal Trade Commission's 2003 Identity Theft Survey Report, “Fully one-fourth of the respondents who had been the victim of a financial fraud said they knew who had committed the crime, and in half those instances the perpetrator turned out to be a friend, relative, or neighbor.” The report further states that most thefts are committed the old fashioned way; the most frequently reported source of information used to commit fraud was a lost or stolen wallet or checkbook.

According to the Identity Theft Resource Center, there are 4 types of ID theft:

Financial ID Theft: Thieves use victims’ names, Social Security numbers, and other identifying information to apply for telephone service, credit cards or loans, buy merchandise, or lease cars or apartments. /strong>

Criminal ID Theft: Imposters provide victims’ information instead of their own when stopped by law enforcement. Eventually, when warrants for arrest are issued, they are in the names of the victims.

Identity Cloning: Imposters use victims’ information to establish new live. This form of ID theft is often committed by undocumented immigrants, criminals avoiding warrants, people hiding from abusive situations, or people who want to leave behind poor work and financial histories.

Business or Commercial Identity Theft: Businesses may also be victims. Typically, perpetrators get credit cards or checking accounts in the names of businesses, which find out when unhappy suppliers send collection notices or their business rating score is affected.

Identity theft is sometimes referred to as an “enabling crime” in that thieves use stolen identities to commit other crimes, including credit card fraud, immigration fraud, Internet scams, and even terrorism. Some thieves take out home equity loans in their victims’ names.

The following “ripped from the headlines” cases serve as examples:

A 100-year-old Tamarac (Florida) man's self-employed caregiver was accused of stealing his identity using his personal identification to open cell phone and cable TV accounts. The caregiver was charged with one count of elder exploitation and one count of using another person's ID without consent.

A home care provider was arrested on charges of elder abuse and burglary for holding an elderly man captive and striking him in the head and body with his own prosthetic leg. The suspect had been working for the man for the last six months under the name of her sister, a certified home care provider. She used her sister's identity to get the position. The suspect had a previous conviction and served jail time under her sister’s name. Specific charges included felony residential burglary, felony elder abuse, false imprisonment and preventing a victim from calling 911 by cutting the phone line.

A 57-year-old Anchorage, Alaska man pleaded not guilty to 17 counts of various forms of ID theft, from criminal impersonation to fraud. According to charging documents, he used an 82-year-old man’s personal information to obtain seven credit cards, which he used to charge $34,000 worth of merchandise.

In Tallahassee, a home health aide employed at an assisted living facility stole the identity of an 89-year-old resident and used the information to run up over $3,500 in fraudulent credit card charges for jewelry, furniture and clothing. She also wrote checks to herself from a bank account belonging to the victim and diverted the woman's mail from the facility to her own home. The case was investigated by the Attorney General's Medicaid Fraud Control Unit. The suspect was charged with exploitation of the elderly, criminal use of personal identification, forgery and grand theft.

Linda Foley, Director of the Identity Theft Resource Center, has pointed out some of the reasons why seniors are particularly vulnerable:

Some hospitals and nursing homes use patients' Social Security numbers as identification. Some even print them on patients’ wristbands.

Some seniors carry their Medicare cards with them in case of emergencies. And the cards contain their Social Security numbers.

Seniors are more susceptible to muggers as a result of their frailty. Which is one of the ways thieves get identifying information.

According to the Resource Center, recent widows and their families are at particularly high risk because ID thieves watch the death announcements, steal death certificates, and go on-line to the Social Security Death Index to get information about the recently deceased. Many take advantage of the fact that financial institutions are not always notified immediately of deaths, and so accounts may remain open for up to 10 years.

I shudder to think of all those years that we routinely advised elderly clients to keep their important legal and financial documents together in one place that was easily accessible in case of emergencies. Clearly, that’s not a good idea anymore and we need to re-educate professionals as well as seniors.

The few existing programs on elder ID theft have focused on educating people about ways to protect their identifying information. The truth is that it’s virtually impossible to protect yourself, and the best line of defense is mitigating risk after the fact.

But is it realistic to assume that frail elders can and will do so? One of the ways that ID thieves identify victims is by hacking into databases. Each time there’s a security breach, it’s followed by advice to those affected. For example, in 2004, hackers broke into a database containing the names, addresses, telephone and Social Security numbers, and birth dates of 1.4 million of California’s In-Home Support Service program clients. The California Department of Social Services, which operates the program, subsequently sent out letters to clients encouraging them to get credit reports and check them for irregularities. In May, 2006 the VA announced that information about 26.5 million veterans was compromised when a long time analyst at the agency took home data and his home was burglarized. The stolen data included names, Social Security numbers, dates of birth and numerical disability ratings. The VA also urged all veterans to check their credit reports and place fraud alerts on their credit files. Credit reports are not easy to interpret for any of us, let alone elders with impairments.

Perhaps a more promising approach is one developed by the AG’s office in Michigan, which was among the first to recognize that ID theft was a problem in nursing homes. After investigators discovered that employees, temp workers, and people posing as employees, were using their positions to get information about residents, the office started a program called “It’s MI Identity,” which tracks ID theft in homes and conducts routine credit checks for residents.

Ohio and several other states have enhanced penalties for people who commit ID theft against elders.

Clergy Against Senior Exploitation (CASE) Partnership, a program operated by the Denver District Attorney’s office, works with faith-based partners to develop and present training programs on elder financial exploitation (including identity theft) for clergy and older congregational members. A community advocate works with the program, to help individuals from the faith communities navigate the legal and social services system, and provides written information, including monthly fraud alerts, for use in newsletters and community bulletins.

Good starting points for learning more about identity theft, including ID theft of seniors, are the websites of the Office for Victims of Crime at the U.S.Department of Justice at http://www.ojp.usdoj.gov/ovc/help/it.htm and the Identity Theft Resource Center at http://www.idtheftcenter.org/index.shtml. The Office of Community Oriented Policing Services published an excellent guide for law enforcement, which is available on line at http://www.cops.usdoj.gov/mime/open.pdf?Item=1271