An Introduction to Elder Abuse for Professionals: Financial Exploitation

Preventing Elder Abuse Training For All Staff

An Introduction to Elder Abuse for Professionals:Financial Exploitation

NCEA Financial Exploitation1Understanding Financial ExploitationNCEA Financial Exploitation2Learning ObjectivesAt the end of this presentation, you will be able to:Define and describe financial exploitationIdentify indicators of financial exploitationIdentify strategies to respond to possible financial exploitation situations

NCEA Financial Exploitation3Teaching Point

Review the learning objectives on the slide.

NCEA Financial Exploitation3

Case ExampleFred convinced Mildred (his 85-year-old mother) to create a trust and name him as co-trustee Fred used over $1.5 million from the trust to pay his expenses, credit card bills, and to purchase insurance policies None of these transactions were authorized by Mildred. NCEA Financial Exploitation4Presenters note Consider using a video example of an older victim, or that highlights an actual financial exploitation case if time permits (see Supplemental Materials for suggested videos****).

Teaching Point

Review the case examples on this slide and the next two slides to illustrate some key dynamics of financial exploitation. Often financial exploitation is committed by family members.Many older victims have cognitive capacity. Some victims have diminished capacity and may be vulnerable to financial exploitation.

NCEA Financial Exploitation4Case Example (Cont.)Bessie received a telephone call from Al who said he was a good friend of her grandson. He said he had bad news and that her grandson had been arrested while traveling through a distant state. Al said the grandson needed $10,000 immediately so he could post bail. Bessie sent $10,000 via Western Union to AlShe later learned that her grandson had not been arrested.NCEA Financial Exploitation5Teaching Points

Some financial exploitation are scams committed by a stranger.While $10,000 seem like a small amount compared to the media accounts of other older adults losing a million dollars, for many older victims even a relatively small amount of resources can be devastating.NCEA Financial Exploitation5Case ExampleAt a local restaurant, Jennifer befriended Oliver, an elderly man with mild dementia. Within a few weeks, he agreed to pay her mothers medical bills and they were married. Within months, Jennifer had depleted Olivers life savings of $300,000 and had disappeared. Even though, Jennifer had a boyfriend and children, she befriended several elderly men, married them and then quickly depleted their assets.

NCEA Financial Exploitation6Teaching Points

In some cases, an older adult is befriended by a person for the purpose of financial exploitation.After discussing these three case examples, consider asking participants for examples of financial exploitation. If asking for case examples, remind participants to keep victim privacy and their agency confidentiality policies in mind.

Presenters Note

Keep these case examples in mind during the presentation. Refer back to them whenever possible to illustrate key teaching points.

NCEA Financial Exploitation6Financial ExploitationThe illegal or improper use of a vulnerable adult's funds, property, or assets.

(National Center on Elder Abuse)

NCEA Financial Exploitation7Teaching PointsWith 70% of the nations private wealth owned by persons over 50 (MetLife, 2009) and persons 65 and older holding $15 trillion in assets (Glaciel, 2009) the elderly are often targeted for financial exploitation.Several studies have found that financial exploitation is the most prevalent form of elder abuse and one of the most complex.Financial exploitation may take many forms including theft by a family member, misuse of a power of attorney, extortion and robbery, and scams and frauds committed by a family member or a stranger who is targeting older adults. It may cross not only state lines but international borders and may involve the use of technology and the internet. This form is also called financial abuse and material abuse.If you want to discuss prevalence and incidence data, consider these studies:Cooper and colleagues (2008) found a financial abuse prevalence rate of between 1.3 and 5 percent; Acierno and colleagues (2009) found a prevalence rate for financial abuse committed by a family members of 5.2 percent; Laumann et al (2008) found a 3.5 percent prevalence for financial abuse; The New York Under the Radar study found a documented rate of 0.96/1000 and a self reported rate of 42.1/1000.NCEA Financial Exploitation7Consider adding state, tribal, or territorial statutes relating to physical abuse here. These may be found in criminal law, protective services, or other, statutes.

Consider inserting elder abuse reporting laws in the Response section. NCEA Financial Exploitation8Presenters Note

Consider adding state, tribal or territorial statutes. These laws are most often found in criminal, restraining order, and protective services statutes.

This placeholder slide should be replaced by your local statutes slides if you decide to include them. This slide should be deleted.

Keep your audience in mind when creating the slides. Statutes may not be relevant for all audiences. Others will be interested in an overview. Participants from disciplines such as the justice system and/or adult protective services may want to see and discuss some of the specific language in statutes.

Be sure to create slides that are easy to read from anywhere in the room. Consider putting fewer words on the slides and using handouts for specific language.

8NCEA Financial ExploitationFinancial Exploitation ( Cont.)May occur by itself, or May occur in conjunction with:Physical abuseNeglectPsychological/emotional abuseSelf-neglect may be an outcome of financial lossCo-occurring forms may make it easier to commit financial exploitation


Financial exploitation can be committed without other forms of abuse or it can co-occur with other forms. Financial exploitation co-occurring forms are believed to be the more common form. Some abusers will use emotional and/or physical abuse, or neglect to gain compliance. When the victim refused to sign over her Social Security check to her son-abuser, he pushed her into a wall, smashed her head against the wall, and strangled her. She agreed to sign the check over in return for him stopping his violence; A daughter told her mother that if she reported the daughters thefts of her mothers jewelry and cash the mother would end up in a nursing home, alone and forgotten.Self neglect may be an outcome of financial exploitationAn older adult is impoverished as result of financial abuse and becomes hopeless, depressed, and unable to manage personal affairs. The person neglects personal hygiene, medical needs, and residence which falls into disrepair.

NCEA Financial Exploitation9Two Kinds of Financial ExploitationResearch shows that there are two distinct forms of elder financial exploitation:1) Pure financial (financial exploitation only)Perpetrators are non-relatives, not financially dependent on the victim and physically healthyShorter duration than hybrid form; primarily fraud Lower financial loss per case


Researchers conducted a study using separate semi structured interviews of 71 Virginia APS workers and their clients (or non-offending relatives who were familiar with the elderly victims situation) to examine and compare pure financial and hybrid financial exploitation cases in domestic settings. The study also compared pure financial exploitation with physical abuse, neglect, and hybrid financial exploitation.

Presenters Note

If this information is included in a presentation, the instructor should review the study. It is worth recalling that the study size is relatively small, and reflects matters reported to Adult Protective Services (APS). Financial exploitation is severely underreported in general and Virginia APS is authorized only to investigate and serve vulnerable adults (persons 18 and older with significant disabilities who are unable to protect their legal rights and provide for their basic needs).

NCEA Financial Exploitation10Hybrid Financial Abuse2) Hybrid (co-occurs with physical abuse or neglect)Relatives financially dependent on the elderly victimVictim typically financially independent but physically dependent on the perpetratorLonger duration than pure form; primarily theftGreater loss per case (Jackson and Hafemeister, 2011)


PerpetratorsPersons the Older Adults Knows and TrustsIntimate partners, family members, and friendsCaregivers Persons who befriend an older person (e.g., sweetheart scams)People with unique trust relationships

StrangersNCEA Financial Exploitation12Teaching PointsFinancial exploitation may be committed by persons known to the victim or strangers.Persons known to the victim can include spouses, partners, family or caregivers.The case example of Jennifer and Oliver is an example of a sweetheart scam. In these cases, a person begins as a stranger but quickly targets an older adult and establishes a trusted relationship. Generally the older adult believes that the two have a relationship while the perpetrator takes advantage of the persons emotional and cognitive vulnerabilities to commit theft.Persons in unique trust relationships include lawyers, doctors, faith leaders, and interpreters for Deaf and persons who need assistance with the English language.Finally strangers may target older adults to conduct financial scams. Examples include:A telephone scam in which an elderly person receives a call on behalf of a grandchild who is allegedly in custody and needs money to post bail. (The case of Bessie and Al is an example of a stranger scam)Organized groups of individuals who target older persons from a particular cultural group and offer to pray over their money to remove spells or bad omens.

NCEA Financial Exploitation12Forms of Financial Exploitation (GAO, 2012)Forms of Elder Financial Exploitation by Type of PerpetratorFamily members, friends, in-home caregivers, legal guardians, representative payees, etc.Financial services providers (brokers, financial advisors, insurance agents, or others in the financial services industry)Strangers

Examples of ConductTheft of cash or other valuables Withdrawals from bank accounts or use of credit cards Transfer of deeds Misuse of an older adults power of attorney Misappropriation of an incapacitated older adults income or assets Identity theft Sale of fraudulent investments (Ponzi or pyramid schemes) Sale of financial products or services unsuitable for an older adults circumstances, such as long-term annuities Lottery, mail, telephone, or Internet scams Door-to-door home repair scams Identity theft


Review the content on the slide.

Presenters Note

The US Government Accountability Office conducted several studies on various aspects of financial exploitation. In this study, they summarized three categories of types of abusers and methods each employed to commit financial exploitation.


Abuse of Legal AuthorityPowers of Attorney (POA)A written document created by a person with capacity (principal) authorizing another (agent) to make decisions for the principalAgents authority is limited to what is stated in POAGuardianship/conservatorship A person appointed by the court to manage the personal or financial affairs of an incapacitated person unable to handle his or her own affairsSupervised by the courtNCEA Financial Exploitation14Teaching Point

Review the definitions on the slide.

Presenter Note

Please review your jurisdictional definitions of these terms and substitute as appropriate.

NCEA Financial Exploitation14Legal Authority and Financial ExploitationGuardianships/conservatorships and powers of attorney and are not licenses to steal!

Improper use of POAs and guardianships/conservatorship may be a crime.


Persons who have legal authority to act on behalf of an older person must act in the best interest of that person. They must preserve assets, use them prudently, and use them to meet the older persons needs.Some abusers misuse their legal authority and use the older adults assets for personal gain. Some have made unauthorized gifts and loans to themselves, made expensive purchases for their own enjoyment, and invested in personal ventures. Such acts are not only beyond the scope of the legal authority but may be criminal acts.

NCEA Financial Exploitation15ConsentMental capacityPerson giving consent must have decision making capacity Knowledge of true nature of actAny fraud, deceit, misleading statementsActed freely and voluntarily

NCEA Financial Exploitation16Teaching Points:

The most common explanation or defense for why an older adult gave another person assets or legal authority to act on their behalf is permission, or consent. Consent may be described as a gift, a loan, salary, or she wanted me to have it.

Consent has specific elements all of which must be present before a claim of consent is established. These include:The older adult has decision making capacity at the time they gave consent; and The older person must have had knowledge of the true nature of the act, i.e., no one made false or misleading statements or promises to them; there was no fraud in information they were given; and They must have acted freely and voluntarily when they consented, i.e., there was no intimidation, duress, or force used to get their agreement.If any of these elements is missing, there is no legal consent. NCEA Financial Exploitation16Undue InfluenceSimilar to brainwashing, an exploiter uses manipulation to convince another person to make decisions contrary to his/her own best interest Commonly involves deception to take over victims free willProcess not an event pattern of behaviorsVictim may lack capacity but not alwaysVictims may be vulnerable due to grief or isolation


Undue influence is a process by which a person, the exploiter, takes over the free will of another. The process includes developing a trusting relationship and then using a variety of tactics including: Isolation from other people and informationPrey on vulnerabilitiesCreate dependency in the exploiterIntermittent acts of kindnessKeep unawareCreate fearCrete lack of confidence in own abilitiesInduce shame and secrecyIn most jurisdictions, undue influence is a method to commit a crime and not itself a crime. Undue influence may be hard to detect and may not be discovered until well after assets have been taken or after the older persons death.Anyone can be a victim of undue influence. Victims are most likely to be ill, lonely, grieving or isolated. Some victims have dementia or lack capacity.NCEA Financial Exploitation17 Indicators: Potential Victim Changes in the older adults appearance, health status, personal habitsChanges in long time banking or spending patternsA confused older person signs something without understanding consequences

NCEA Financial Exploitation18Presenters Note

Consider making this segment more interactive using a small group activity or class discussion. Please refer to A Guide to Planning Your Elder Abuse Presentation for directions.

Teaching Point

Review the indicators on this slide.


Indicators: Potential ExploiterAnother person:Cashing an older adults check or using credit/debit card without authorization or permissionForging the older adults signatureCoercing or deceiving the older adult into signing any document




Other Indicators Unexplained changes in wills or title documents Increased telephone solicitations for fundsMissing personal property Funds wired out of country for mysterious reasonsMissing or redirected mailMissing personal propertyNames added to older adults bank accounts




Impact and CostA 2010 MetLife Study based on newspaper articles estimates financial exploitation costs the U.S. $2.9 billion a year Gunther (2011) suggests that financial exploitation costs Utah seniors, the Medicaid program and financial institutions $1 million a week

NCEA Financial Exploitation21Teaching Points Determination of the actual costs of financial exploitation is difficult to measure. Losses include: direct (out of pocket) losses by victims and their familieslost wages as the victim and family members deal with the aftermath of the exploitationmedical and mental health costs for care and treatmentlosses to state and federal programs which now must pay for the older adults needs and care, etc.. The MetLife study in 2010 reviewed newspaper stories of suspected financial exploitation over a 6 weeks period and estimated costs and multiplied those numbers for the entire year. Because data is based on newspaper accounts, reported information was not tested for accuracy. Based on this process, the studies concluded that financial exploitation costs the US $2.9 billion a year. A Utah study examined that states losses due to older adult financial exploitation to the states actual victims, the Medicaid program, and financial institutions. This study estimates that financial exploitation costs Utah seniors, the Medicaid program and financial institutions $1 million a week..

NCEA Financial Exploitation21Financial Exploitation Impact on VictimsPhysical health effectsFinancial effects Mental health and social effectsNCEA Financial Exploitation22Teaching Points

In addition to the financial losses, exploitation takes a significant toll on victims in the following ways:

Physical health effects: Inability to sleep or eat, weight changes, high blood pressure, strokes, heart attacks, and declining health

Financial effects: Financial ruin with little chance of restitution or replacing lost assets

Mental health and social effects: older adults loss of trust in others and in own ability to manage financial matters; fearfulness of additional victimization; isolation from, and conflict with, family members; depression; hopelessness; and suicide

NCEA Financial Exploitation22Response to Financial Exploitation23NCEA Financial ExploitationVictim SafetyAll responses and interventions must consider and prioritize victim safety.

NCEA Financial Exploitation

24Teaching Point

This section focuses on potential responses. Consider victim safety when asking potential victims questions; responding to potential elder abuse cases; reporting or referring. Participants should always be mindful of victim safety and undertake actions in ways that do not increase danger.NCEA Elder Abuse Overview24What You Can DoRecognize the Signs of Financial Exploitation

Ask

Report or Refer

25NCEA Financial ExploitationTeaching Points

What can you do to help? Everyone of us can make a difference in the life of a victim of elder abuse. With this training you will have information that will assist you and those with whom you work to recognize the signs of abuse that should raise suspicion that physical abuse is presentWhen you see something suspicious you can show empathy and compassion to the older victim. You may be the first person to validate the victim's feelings or experiences.You can, and in some instances, may be required by law to report suspected abuse. Whether a report is made or not, you can refer or link the older vicitm to community services. The following slides will discuss these responses in more detail.


If the older adult can answer questions, consider asking:Who makes decisions about your finances?Who handles your finances? How were your finances handled a year ago? Two years ago?Do you know how much money is/are in your bank account(s)?

NCEA Financial Exploitation26Presenters Notes

Consider making this segment more interactive using a small group activity or class discussion. Please refer to A Guide to Planning Your Elder Abuse Presentation for directions.


If the older adult can answer questions, consider asking:Have your spending patterns changed? Have you created or changed an existing power of attorney? Trust? Other accounts?Has anyone asked you to sign something you did not understand? Did not want to sign?Do you have any concerns about your finances?


Remind participants to take care when asking potential victims about abuse. Make sure the older adult is in a safe place where their responses cannot be overheard. When information is obtained, protect the confidentiality and safety of the older person. Unless a release of information has been signed, Information should only be shared if required by statute, such as mandatory reporting laws.

Presenters Note

Ask participants if they have other questions they would pose. Transition by commenting now that you have a concern about neglect, we will look at reporting and referral options.


Report - ReferREPORT

911 or law enforcement (life threatening or possible crime)Adult protective servicesMedicaid Fraud Control Unit (in State Offices of the Attorney General)REFER

Area Agency on Aging (AAA)Aging network agencyOmbudsman (if abuse is in a facility)

28NCEA Financial ExploitationTeaching PointsIf a professional reports financial exploitation because they have been asked by the older abused person to do so, because of a duty to do so, or for other reasons they will typically report to law enforcement, adult protective services, or a state Attorney Generals Medicaid Fraud Control Units (MFCU). MFCUs investigate and prosecute Medicaid fraud and patient abuse and neglect in health care facilities. . The purpose of a report is to enable an investigation to be conducted.Each of these agencies conducts a different kind of investigation with a different purpose and focus.If there is an immediate threat to human life, the report should be made to local law enforcement as it is the only entity providing a 24-hour response Separate from, or in addition to a report, a professional may want to refer an older victim of physical abuse for help from a community based organization. These may include:Area Agency on Aging (AAA) are funded to provide information and referral for older adults in need of financial and other assistance.An agency in the Aging Services network (e.g., senior center, meals on wheels, case management program, financial management program)The Long Term Care Ombudsman Program for older adults who reside in nursing facilities..NCEA Financial Exploitation28Consider Inserting Slides Describing the Local Jurisdictions Elder Abuse/Vulnerable Adult Reporting LawNCEA Financial Exploitation29Presenters Note

The presenter should consider if he or she wants to present information on:The jurisdictions elder abuse/vulnerable adult abuse reporting lawWhere reports could be made, e.g. Adult Protective Services, local or state Law Enforcement Agency, licensing and regulatory agencies, Long Term Care Ombudsman Program, etc.What happens when a report is made

If there is no duty to report, every state authorizes voluntary reporting.

Replace or delete this slide before your presentation.

29NCEA Financial Exploitation Consider adding local resources and programs. (See A Guide to Planning Your Elder Abuse Presentation at ***** for more information.)

30NCEA Financial ExploitationPresenters Note

Research local programs, resources, and contact information. Create one or more slides describing services and programs including hours of operation and contact information.

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Additional ResourcesState Medicaid Fraud Control Unit (usually in the State Office of the Attorney General) See https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.aspFederal Trade Commission, Bureau of Consumer Protection, see http://www.ftc.gov/bcp/index.shtmlConsumer Financial Protection Bureau, see http://www.consumerfinance.gov/NCEA Financial Exploitation31Teaching Point

Here are some additional national resources and websites that may also provide useful information regarding financial exploitation.

There are more resources listed on the next slide.


Additional Resources ( Cont.)American Bar Association, Commission on Law and Aging, http://www.americanbar.org/groups/law_aging/publications.htmlAARP Scams and Fraud Page , see http://www.aarp.org/money/scams-fraud/Elder Financial Protection Network, see http://www.bewiseonline.org//National Association of Area Agencies on Aging, see http://www.n4a.org/NCEA Financial Exploitation32Teaching Point

Here are some additional national resources and websites that may also provide useful information regarding financial exploitation.

NCEA Financial Exploitation32For more information, visit us!ncea.aoa.govAlso on Facebook, Twitter, YouTubecenteronelderabuse.orgAlso on Facebook, YouTube

33Teaching Points

Are additional questions or comments?Thank participants for attending. Refer participants to the websites of the National Center on Elder Abuse and the Center of Excellence on Elder Abuse & Neglect for additional information and references on elder abuse.

NCEA Neglect33For additional resources, visit www.ncea.aoa.govThis slide set was created for the National Clearinghouse on Abuse in Later Life for the National Center on Elder Abuse and is supported in part by a grant (No. 90AB0002/01) from the Administration on Aging, U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging or DHHS policy.

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An Introduction to Elder Abuse for Professionals: Financial Exploitation