Financial Exploitation of the Elderly

I've recently finished reading this excellent book describing how the elderly become victims of financial abuse.  The author, Joe Roubicek, was a detective in the Fort Lauderdale Police Department for many years, and he investigated over 1000 cases of exploitation of the elderly during that period on the police force.  The book describes some of the cases he investigated and discusses the shortcomings of state laws protecting the elderly from financial abuse.

Roubicek clarifies the differences between exploitation of the elderly and fraud.  Exploitation occurs when someone takes advantage of a disabled elderly person to deprive that person of his or her assets.  For example, an in-home caregiver might take advantage of her employer's memory deficits to ask for grocery money five times in a single day.  Fraud occurs when a "false and deceptive statement of fact induces the victim to give up a valuable item that he or she owns."  Fraud laws are written under the assumption that the victim has the mental capacity to weigh information and make decisions.  For example, if a roofing contractor takes a deposit for work on a house with quality materials and workmanship and returns to do the job with defective materials, then fraud may have occurred.

Unfortunately, financial elder abuse often occurs in the gray area between the fraud and the exploitation statutes.  Many of the cases described in the book involve victims who lived alone and were stripped of their assets by contractors, care givers, and others.  It was often difficult for the police to prove that the victim lacked mental capacity at the time of the asset transfers, which is a crucial element of a conviction for exploitation.  At the same time, the police could not make a case for fraud because the assets were typically "gifted" to the recipient, and there was no provable deception.  This gray area gives a huge advantage to elder abusers who gain the trust of mentally and physically feeble victims and then strip them of their assets. 

This situation reinforces the importance of having friends or relatives monitoring the mental as well as the physical condition of the elderly.  It's also a call to action to plan for possible mental infirmity by setting up durable powers of attorney to designate trusted people to manage your financial affairs if you do become incompetent.

One of the very interesting sections was Myths about elder financial abuse.  They are:

1. Exploiters usually have criminal records.  Roubicek found that the majority of the suspects he investigated did not have criminal records and that many had reputable backgrounds.  One was even a Catholic priest and another was a court-appointed guardian.  However, most of these abusers had financial troubles and viewed their elderly victims as the solutions to their money troubles.  This also means that having a criminal background check performed on an in-home caregiver might not dramatically reduce the risk of financial abuse.
2. The greater the victim's income level, the greater the risk of exploitation.  Roubicek found that all income levels were represented in the cases he worked.  Some of the amounts stolen were as little at $50 and other amounts were over $1M.
3. Elderly persons with mental disabilities process information slower but their experience and wisdom offset this mental processing issue.  Roubicek says that elderly people who have short-term memory loss or other mental infirmities lack the capacity to understand financial issues and lack the capacity to give consent to financial transactions.  Wisdom and experience does not help the folks afflicted with memory deficits.

This is not a feel-good book about how the police and state laws protect the elderly.  Many of the suspects in Detective Roubicek's cases get away with their abuse because of the difficulties associated with proving exploitation.  The book is a wake up call to protect yourself and the elderly people you care about.

Financial Abuse of the Elderly is written in the same straightforward style that Detective Roubicek probably used in his police reports and court testimony.  There are some grammatical mistakes, but they don't detract from this very interesting and timely book.   If you have elderly parents, relatives, or friends, I recommend that you read this book, and then use this information to help your elderly loved ones protect themselves from financial abusers.

Preventing Financial Fraud for Seniors

The May edition of the AARP Bulletin announced that the New York City Department for Aging has just launched an interactive game called, "It's My Money," to teach older adults to protect themselves from financial fraud.  The game is available in English, Spanish, Chinese, and Russian, and it's available for free download from the Department for Aging's website -- www.nyc.gov/aging.

Just scroll down the web page until you see the article titled, "City Launches It's My Money," and then click the link to "download the free game."

Online Safety for Elders

Photo by David Lat

In April, I spent a few days visiting with my mother.  My mother has been using a computer and the Internet for at least ten years so I'd always assumed that she was reasonably safe online.   She got my attention though when she mentioned that someone had sent her an email to tell her that her computer had a "bug" and that she could fix it by just clicking a link in the email.  She did click the link as instructed, and nothing happened.  I immediately turned on her Mac and checked it.  It seemed to operate normally -- I think the fact that it is a Mac protected it from an infection.

I spent some time talking to my mother about how hackers might send malicious emails like the "bug" email hoping to either infect her computer with a virus or take control of her computer as part of a bot net.  I also talked about how phishing works with emails that appear to be from legitimate companies that direct the unsuspecting to phony websites.  It was hard to have the conversation and describe the various dangers on the Internet without scaring her so much that she'd refuse to return to the Web, but I hope I succeeded.  I suspect that this conversation is one that happens too rarely with seniors who remain active on the Internet without much knowledge of online threats to security and privacy.

I recently received a bogus email that looked like it was from Chase and referenced the actual last four digits of my Chase credit card number while directing me to a "Chase" website.  Because the listed Chase web address was different from the address I usually use to access my account, I was suspicious and called Chase.  The Chase telephone representative listened to my story and confirmed my suspicion that the email was bogus.  I thought again of my mother, and I was certain that if she'd gotten this very convincing email, she might have clicked on the link to the bogus website and entered her account information.

If you have elderly friends or relatives who are active online, they would probably appreciate being warned of the security and privacy dangers associated with the Web.  This is a list of the items I discussed with my mother -- hopefully the list can be a starting point for your discussions.

1. If you don't recognize the sender of an email, don't open it.
2. If someone you know sends you an email asking for money, don't respond.  I've received several emails purportedly from people I know from Linkedin and Facbook, and these emails describe a crisis like being in London without any money and request that I send emergency funds.  I don't know these folks well enough receive a request for help like that.  But I told my mother the story and hopefully impressed on her to avoid sending money in response to any online requests for help.
3. If a pop up message appears warning of a virus and asks Mom to click a link to remove the virus, don't do it.
4. Don't order items online with a credit card.  Other seniors might do this with appropriate caution, but my mother has shopped online and now may not be the time to start.
5. Don't send information like credit card numbers, social security numbers, and account user names and passwords in an email to anyone ever.

You may suggest that your favorite senior consider purchasing a MacBook.  Macs remain less vulnerable to viruses and they don't require the purchase of anti-virus protection.  If the senior has a problem with the computer, he or she can take it to the Genius Bar of the local Apple store to have the problem corrected.  Apple also offers in-store, one-on-one instruction to Mac purchasers for $99 per year -- what a bargain!

These are a starting list of warnings and cautions about seniors online, but the list isn't complete.  If you have warnings to add to the list, please contact me or leave a comment.

Some HIPAA Questions Answered for Elder Care

The U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects the privacy of individually identifiable health information, sets security standards for that information when maintained on computers, and protect individually identifiable health information being used to improve patient safety.  HIPAA is administered by the U.S. Department of Health and Human Services and it's enforced by that Department's Office of Civil Rights.

Unfortunately, HIPAA may also be used as a pretext by medical and nursing home staff to avoid disclosing health information to the friends and relatives of the elderly.  Before that happens to you, take a look at the Department of Health and Human Services website to better understand your rights and the rights of your elderly friends and relatives.   Here are some of the highlights of the website's frequently-asked-questions section.

• Does the HIPAA Privacy Rule allow hospitals and other health care facilities inform visitors or callers about a patient's location in a facility and general condition?  Yes! Hospitals and health care providers can use a facility directory to inform callers and visitors certain information about the patient – name, location in the facility,  and health condition expressed in general terms that does not communicate specific medical information about the individual.  Health care facilities may also include religious preference information in the directory for disclosure to members of the clergy.  The patient must be informed of the information to be included in the directory and may elect to restrict disclosure, orally or in writing.  If the patient is in emergency treatment or is incapacitated, the health care provider may still disclose this information if it's deemed to be in the best interest of the patient.  In these cases, when practicable the patient should be informed of his or her right to restrict the disclosure of directory information.
• If a patient’s family member, friend, or other person involved in the patient’s care or payment for care calls a health care provider to ask about the patient’s condition, does HIPAA require the health care provider to obtain proof of who the person is before speaking with them?  No.  If the caller states that he or she is a family member or friend of the patient, or is involved in the patient’s care or payment for care, then HIPAA doesn’t require proof of identity.  However, a health care provider may establish his or her own rules for verifying who is on the phone.  In addition, when someone other than a friend or family member is involved, the health care provider must be reasonably sure that the patient asked the person to be involved in his or her care or payment for care.  The right to decide about restricting information disclosure ultimately rests with the patient.
• Can I have another person pick up my prescription drugs, medical supplies, or X-rays?  Yes. HIPAA allows health care providers (such as pharmacists) to give prescription drugs, medical supplies, X-rays, and other health care items to a family member, friend, or other person you send to pick them up.  The health care provider may have its own rules, but HIPAA would not prevent a friend or family member from picking up a prescription.

HIPAA is a complex program and some health care staff members might not understand it and might invoke it as a reason for refusing to disclose information about an elderly patient.  If this happens, you might refer the staff member to this information on Health and Human Services website.  Lots of great information here!

Thinking About Parents Moving In With You?

Photo by Jorc Navarro

I recently read an excellent article by Nanette Lavoie-Vaughan titled, "Role Reversal -- Your Parents Moving In," on the Military Officers Association of America website.  The article discusses parents moving in with adult children, and provides a great list of considerations for anyone contemplating this move.  Here are some of them:

• Evaluate the level of care and assistance your parents will need and how this would be provided in your home.
• Assess the activities of daily living that your parents can perform independently.
• Determine how comfortable you are with providing personal hygiene care -- bathing, help with the bathroom, diapers, etc. -- it that level of care is necessary.
• Be honest about your health and physical condition in considering whether you can provide care.
• Research the availability and cost of services like in-home care and adult day care.
• Discuss a backup plan if you or your parents find that the situation doesn't work.
• Determine the level of medical care needed by your parents and its availability in your community.
• Discuss the relocation with siblings and other family members to determine their feelings about the change.

These are all great topics to discuss before you and your parents make the move.  There some other topics that could be added to the discussion based on my personal experience and the experiences of friends.

• Talk about how the relocation might affect your parents' social lives.  My mother has a friend who moved in with her son and his wife after her husband passed away.  This friend and her husband had maintained an active social life while living in an apartment community close to the downtown area of a small Virginia city.  Now, she's located in a rural area miles from downtown with no way to visit friends or take advantage of the many activities available to senior residents of this very senior-friendly community.  Her son's house is located at the top of a small mountain with a narrow and winding road as the only means of access.  My mother's friend feels isolated and alone.
• Consider how might your career plans affect the arrangement.  A career-mandated move across country with a live-in parent would be a difficult and unwelcome challenge to someone already facing health issues.
• Do you or your parents have pets?  Are your pets compatible with your parents and are their pets compatible with you?  This might seem like an easy issue to solve, but it's not.  For many of us, our pets are very close to children and putting them down or sending them to a shelter and an uncertain fate are gut-wrenching decisions.

This is not an easy situation for your or your parents.  Hopefully, you'll be able to have these discussions before a move becomes absolutely necessary.  If you've faced this decision, please share your thoughts about better ways to evaluate the relocation.

Signs of Poor In-Home Caregivers

I've been reading a wonderful book which is full of excellent advice on topics related to eldercare.  The book by Robert F. Bornstein and Mary A. Languirand, Ph.D. is titled, When Someone You Love Needs Nursing Homes, Assisted Living, or In-Home Care.  It provides general guidance for those involved in eldercare or making eldercare decisions and includes hints for responding well and wisely to the many emotionally and physically stressful issues associated with eldercare.  The book also contains useful checklists for managing eldercare arrangements and lists websites, addresses, and phone numbers for researching eldercare options.

One very useful list contains warning signs that in-home caregivers may not be honest or competent or both.  Here's the list:

• When you phone to check on your loved-one, the phone is unanswered or you get busy signals.
• The television or radio remains on throughout the day.
• The caregiver has a pattern of late arrivals, early departures, or absences during the work shift.
• Health care equipment including needles and syringes are just thrown in the trash and are handled as medical waste.
• The cleanliness of the home is deteriorating.
• You find evidence of illegal drug or alcohol use.
• The caregiver allows friends into the home or brings friends or children to work.
• Frequent complaints from the care receiver or a deterioration in the care receiver's mood or even fear of the care giver.
• Reports from neighbors or visitors that something is wrong.
• Signs that abuse, neglect or exploitation are taking place.

When you have suspicions that something is wrong, the authors advise that you document the problem, terminate the service and begin looking for a replacement service, and report the problem to the in-home care provider and any local accreditation or certification agencies.

Much of the checklist applies when you check the care your loved one is receiving in a nursing home.  I recently reviewed the Medicare inspection reports for local nursing homes and two of these facilities were recently cited for hiring employees with histories documenting patient abuse.  Needless to say, you'd also want to look for signs that something is wrong whenever you visit a loved one in a nursing home.

The Importance of a Durable Power of Attorney

Photo by Patrick Moore

Some form of durable power of attorney should be part of everyone's planning planning for aging and possible incapacity.  The durable power of attorney appoints an agent or "attorney in fact" to act for the grantor in making financial and healthcare decisions when the grantor is unable to make those decisions due to incapacity.  The grant of powers ends at death or when the grantor regains the capacity to make decisions.   If you have a durable power of attorney, and you have a car accident, a head injury, or a stroke or if you suffer from severe dementia, your designee will be able to manage your financial affairs and make decisions affecting your medical care until you are capable of making those decisions again yourself.

The forms and names of these document vary by state, and in some states the durable power of attorney is split into two documents called the powers of attorney for healthcare decisions and for financial decisions.  Your state's customary form is not important for this discussion.

Here are some things to think about in reviewing a durable power of attorney:

• When and under what circumstances does the agent or attorney in fact have the power to act for the grantor?  Some powers of attorney will include provisions requiring a physician's determination of incapacity before becoming active, and others confer powers on the attorney in fact from the time of signing and grantor trusts the attorney in fact to not use the conferred powers prematurely.  I've also used a separate agreement between the grantor and the attorney in fact that specifies the conditions under which the power of attorney will "spring to life."  The advantage of using the separate agreement for a "springing power" is that when the attorney in fact presents the power of attorney document to a financial institution, the financial institution doesn't have to require proof that any provisions describing incapacity determinations have been met.

• Does the power of attorney provide a workable arrangement for managing financial affairs and/or healthcare decisions?  A couple of years ago, I recommended that my mother update her durable power of attorney and other estate planning documents, and I recommended a lawyer friend to do the work.  Unfortunately, the documents he created for my mother would have created a management mess, and I had to recommend that she have her estate planning documents redone by another lawyer.  One of the management issues was his designation of two attorneys in fact, given similar but not identical powers, who were explicitly directed that they had no duty to cooperate or communicate.  In this case, my sister and I both would have had the duty to manage my mother's financial affairs, half a continent away from each other and from my mother, with no duty to cooperate.  Could we have done it despite the language of the power of attorney?  Sure, but why work with a power of attorney that makes the process more difficult?

• Does the power of attorney make sense in all of its provisions?  Another issue with the problem power of attorney created by my lawyer friend was that he had worked from a draft created for another client.  Because he had not proofread the document before presenting it to my mother for signature, a provision from the other client's power of attorney was included in my mother's document.  This errant provision named someone unknown to my mother to review the performance of her attorneys in fact.  You should carefully read all of your estate planning documents and any documents that name you as an attorney in fact and ensure that you understand all of the provisions.

Talk to your lawyer if you need to update your durable power of attorney and become familiar with the powers of attorney created for your parents.  You should understand the provisions of this document before being called to act under them.

How to Research Nursing Homes with Online Local Search

There are a number of websites that provide useful information about nursing homes.  One such site is the Medicare.gov website providing quality ratings and inspection results for all Medicare and Medicaid approved nursing homes.  However, it's also a wise idea to look for online comments and reviews from people who have used the nursing homes.

One way to do that is to use Google's local search features.  Just type a search for "nursing home" and the area of interest and Google will provide a list of nursing homes along with a map showing the location of each one, at the top of the search results page.  This list below resulted from my search for "nursing home houston tx."

Note that each listing provides a link to the nursing homes' websites, if they have one, plus a link to reviews if any have been posted online.   If I click the "2 reviews" link for one of the facilities, I'll see the following reviews.

The first review is from a website called OurParents.com.  I've seen a number of these "Our Parents" reviews and they always seem to be summaries of recent Medicare/Medicaid inspections, written in a standard format.  Certainly, these summaries provide useful information, but they are not consumer reviews.  The second review looks like it was written by someone with actual experience at this nursing home, and the review was posted to a website that contributes reviews to Google, called Citysearch.com.  If I click on the title link "Looks nice on the outside-neglectful," I'm taken to more reviews for this nursing home at Citysearch.com.  Here is one of the other reviews I found at Citysearch.com, written in late March of 2010.

You should read each consumer review and make a credibility assessment.  Does it seem to be written by someone I can relate to?  Do I find the facts stated in the review to be believable?  If a positive review, could it be a fake posted by the facility management, or if a negative review, could it have been posted by competitors.

If you find this review to be credible, it might make you cautious about placing a loved one at this facility.  At the least, the reviews might provide material for questions you might ask of the nursing home administrator before someone you care about is placed there.

Do good nursing homes get negative reviews?  You can't please everyone all the time, so I'm sure that most do receive poor reviews at some time or another; however, a list of consistently poor reviews could be a warning sign of potential trouble at a nursing home.  The wise nursing home researcher will use the information from these consumer reviews and from state and federal inspections, plus your impressions from actual visits, when deciding where to place a friend or relative.