How I Spent My Vacation

No, don’t panic. Summer’s not over yet. The vacation I’m referring to is my extended hiatus from posting. My excuse is that I‘ve been hard at work helping to launch the California Elder Justice Workgroup (CEJW), a mammoth and exciting undertaking.

It started with a few of us who are involved in projects funded by the Archstone Foundation as part of its Elder Abuse and Neglect Initiative (EANI). In the hope of stirring up synergy, Archstone brings together EANI project personnel at “convenings,” day-and-a-half sessions three times a year; it was at a convening that we started talking about how many of the day-to-day headaches we faced in our work were tied to big-picture, systemic problems. Those of us working on grants to train mandated reporters in their reporting duties, for example, couldn’t get the agencies charged with investigating to agree on such basics as what’s reportable, who investigates, and which clients are eligible for protective services. Multidisciplinary teams weren’t clear about what information they could share and what they can protect. The obstacles went on and on. So we started a list.

Woody Allen’s oft-quoted line "Eighty percent of success is showing up” clearly applies to advocacy work, and members of our group continued to show up for monthly telephone meetings to add to our list and flesh out the issues. The other thing our group had going for it was members’ deep roots in key stakeholder networks, planning skills, and a penchant for identifying opportunities. Our gripe list started to turn into a plan. We got an enormous boost last October when Archstone awarded us an 18-month grant to host a  summit and enlist the help of others in developing a blueprint. 

The summit took place on April 29-30 in San Francisco, with 92 researchers, advocates, practitioners, court personnel, legal professionals, experts in nursing home reform, and many more. After plenary sessions by Bill Benson, who provided an update on the newly passed Elder Justice Act, and Daniel Marson, who described his work in legal decision-making capacity, an issue at the heart of many of the problems we’d identified, delegates broke into four groups for focused presentations and discussions:

•       A Reporting and Response group began with a presentation on structured assessment, an approach designed to improve consistency in assessing abuse referrals that’s being tested in Riverside County. The group also discussed barriers to reporting abuse in long term care (LTC) facilities, some of which stem from the fact that California is one of a handful of states that charge Ombudsmen with investigating cases reported under mandatory reporting laws on top of their federal mandate to advocate on patients’ behalf. The problem is balancing the roles of patient advocate and objective finder-of-fact. Some of the reporting issues they discussed aren’t unique to California—e.g. the need for guidance in handling cases involving “unbefriended” or “unrepresented” residents (those who lack legal decision-making capacity, responsible parties, or surrogates). 
•             The Justice System group explored the need for greater coordination among the branches of the legal system that have a role in abuse prevention. Retired judge Julie Conger led off by describing Alameda County’s “elder court,” which she started. Afterwards, the group, which included legal professionals involved in criminal, probate, and family law;  representatives from the Archstone-supported elder forensics centers; private and legal aid attorneys, and the Administrative Offices of the courts, identified the need for training to legal professionals, public education on legal issues, forensics expertise, and policy reform.  
•       The “Safeguarding the Long Term Care (LTC) Safety Net” group focused on bridging the chasm between the elder abuse and LTC networks, the latter of which includes family caregiver and dementia care programs, mental health service providers, and advocates for adults with disabilities. The importance of the LTC network in reducing vulnerability to elder abuse has come into sharp relief in light of the draconian cuts to basic services we’ve witnessed in recent months. The group recommended adding elder abuse risk factors to screening tools used by LTC programs and promoting interdisciplinary education by academic institutions. Also discussed were ways to keep dangerous people out of the LTC workforce though better screening, training, and workforce development.
•            And finally, the Financial Abuse and Exploitation discussed the rising tide and devastating impact of such high impact crimes as mass marketing fraud and predatory lending. A primary focus was on the need for more precise instruments to measure financial deficits that heighten vulnerability to exploitation and the critical need for legal and mental health services for victims. Promising preventative approaches discussed included simple policies that senior centers can adopt to block fraudsters and unscrupulous vendors who pose as objective financial advisors from gaining access to participants. Group members also agreed to explore ways to achieve greater parity for seniors by mental health and victim service programs, which have historically prioritized other populations.

Assistant Secretary of Aging Kathy Greenlee joined us on the second day with an update on the Administration on Aging’s plans and took questions and recommendations about the reauthorization of the Older Americans Act. Perhaps the highlight of the event was a “commitment ceremony” where small groups reported on their findings and delegates committed to follow-up action. We’re still in the process of sifting through the commitments, which range from hammering out protocols for reporting, developing reference materials on alternatives to conservatorship (California’s term for adult guardianships), exploring universal assessment tools for aging programs that include elder abuse risk factors, designing forensics centers that focus on abuse in LTC and financial exploitation, to tweeting about abuse.

CEJW is benefiting from the wisdom and support of non-California friends and allies. A partner and inspiration is the Vulnerable Adult Justice Project (VAJP), a coalition in Minnesota directed by Iris Freeman and housed at the William Mitchell Law School, which is about a year ahead of us in getting started. We’re also in the process of assembling a “technical advisory group” of experts in a wide range of fields. 

As long as I'm pushing the seasons here, I'll end with a resolution: To resume posting and provide regular updates on CEJW's work. You can also learn more by visiting our wiki site  at http://cejw.pbworks.com/ 

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.

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 marie.connolly@wilsoncenter.org

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.

In Memory of Phil Lucas and More

I recently learned that Phil Lucas, director of the wonderful film Restoring the Sacred Circle, died in February. The news came from Dave Baldridge, president of the National Indian Project Center, a cohort of mine, along with advocate Bill Benson, on a project on elder abuse in Indian Country for the National Center on Elder Abuse. Other Phil fans include Aileen Kaye, who worked closely with him on the film, which was produced by the Oregon Department of Human Services. I had the privilege of standing in for them during a screening at the 2002 American Indian Film Festival in San Francisco after the film won the Best Public Service Award. A Choctaw, Phil worked on over 107 films as a director, writer, and producer; and won numerous awards, including an Emmy. For more on his remarkable legacy, click here.

Sage Publications just released the third edition of Victims of Crime, which includes a chapter on victims of financial crime, which Debbie Deem, Richard Titus, and I co-authored. Debbie is a victim specialist with the FBI and has taught me everything I know about mass marketing fraud. Richard, who’s done groundbreaking research on financial crimes for the U.S. Department of Justice (he retired in 2004), spent a summer during his undergraduate years working as a con artist and got an insiders's view of how financial criminals search out victim vulnerabilities and exploit them. For more on the book, see Sage's website.

Debbie and I will be co-leading a workshop on mass marketing fraud at the upcoming Weaving the Safety Net Conference sponsored by Legal Assistance for Seniors in Oakland. We’re delighted that there’s a whole track devoted to the sorely overlooked issue of restitution, which includes sessions by victim-turned-advocate Marty Plone; Bob Quigley, who served as an “asset investigator” for a cutting edge (and unfortunately, now defunct) federal restitution recovery pilot project in the U.S. Attorney’s Office in San Francisco; and Steve Dippert who runs the San Jose Restitution Court project. Undue influence expert Bennett Blum, Lisa Gibbs from UCI’s elder abuse forensics center, and I are doing plenary sessions. For more information, click here.