Aging and Money: Reducing Risk of Financial Exploitation and Protecting Financial Resources (Aging Medicine)

Increasingly, we hear of more and more elders falling victim to financial exploitation. Although this form of elder abuse has been recognized for years, its incidence, prevalence, and impact on the common individual has been only more recently brought to the spotlight. Despite these circumstances, recognition of risk factors and indicators of financial exploitation are not widely disseminated. Additionally, once situations are identified and confronted, the knowledge of what to do next is lacking. These gaps are present within the medical community, law-enforcement, and the finance community – areas where opportunities for recognition and intervention are common. Our elders often have no idea of what to do when they see their own risk or when they fall victim. __Aging and Money: Reducing Risk of Financial Exploitation and Protecting Financial Resources__ helps clinicians to integrate identification of such indicators of abuse into their geriatric assessment as well as guide them in performing an assessment of an individuals’ financial decision making capacity when appropriate. __Aging and Money: Reducing Risk of Financial Exploitation and Protecting Financial Resources__ is an essential new text that provides the practicing clinician with information on identifying risk factors and clinical clues associated with financial exploitation and how to incorporate these steps into their practice. Preface 6 Acknowledgements 8 Contents 10 Contributors 12 Chapter 1: Financial Exploitation of the Elderly: Review of the Epidemic—Its Victims, National Impact, and Legislative Solutions 15 Overview 15 Aging in the United States and Risk of Financial Exploitation 15 Definitions of Elder Abuse and Financial Exploitation 16 Landmark US Studies of Elder Abuse Prevalence and Incidence 17 The Many Faces of Financial Exploitation: A Profile of the Victims 19 The National Impact of Elderly Financial Exploitation 22 Elder Abuse, Financial Exploitation, and Legislative Solutions 24 Formation of APS: A Safeguard for the Elderly 25 The Elder Justice Act: Inception, Revisions, and Passage 26 Additional Protections for the Financially Exploited Elder 28 Conclusions and Future Directions in Curbing Financial Exploitation in the Elderly 29 References 29 Chapter 2: One Piece of the Puzzle-Financial Exploitation and Elder Abuse 33 Introduction 33 Scope of the Problem 34 Pure Financial Abuse Versus Hybrid Financial Abuse 35 Types of Elder Financial Abuse 36 Victims and Perpetrators 37 Victims 37 Perpetrators 38 Undue Influence and the Psychodynamics of Exploitation 38 Combating Elder Financial Abuse as Part of an Overall Strategy Against Elder Abuse 41 Detection 41 Protection 43 Conclusion 43 References 43 Chapter 3: Barriers to Recognition 45 Who Reports 45 Barriers to Self-Reporting 47 Barriers to Physician Reporting 48 Eliminating Barriers 50 References 50 Chapter 4: Financial Abuse of the Elderly: Risk Factors 52 Risk Factor Recognition 53 Victim’s Risk Factors 53 Mental Illness 55 Substance Abuse 56 Predictable Behavior 56 Fear 56 Low Income 57 Perpetrator Characteristics 57 Personality of the Abuser 58 Victim–Perpetrator Relationship 58 Financial Dependence 58 Substance Abuse 59 Social Stressors 59 Mental Illness 60 The Environment 60 Living Situation 60 Awareness of the Modern World 60 Into Action: A Team-Based Approach 61 Conclusion 62 References 62 Chapter 5: Screening Older Patients for Risk Factors Associated with Financial Exploitation 65 Introduction 65 Overview of the Literature 66 What Clinicians Can Do 68 Screening for Patients’ Vulnerability to Financial Exploitation 69 Referral and Reporting 73 EIFFE and Investor Education Resources 75 Authors’ Notes and Acknowledgements 75 References 76 Chapter 6: Clinical Assessment of Financial Decision Making Capacity 78 Introduction 78 The Physician’s Dilemma 79 Screening for FDMC 79 Red Flags 80 Dementia and FDMC 80 Assessment Tools 82 Confirmation and Next Steps 83 Conclusion 84 References 85 Chapter 7: Next Steps: Documentation and Accessing Community Healthcare Resources 86 Background on Financial Exploitation Experienced by Older Adults 86 Importance of Documentation by Healthcare Professionals 87 Key Qualities of Effective Documentation 88 Structure and Content of Documentation 88 Documentation Across the Five Phases of Clinical Management 89 Detection 89 Assessment 89 Planning 90 Intervention 91 Follow-up 91 Examples of Tools to Assess and Document Abuse 91 Accessing Community Resources 93 Community Resources for Reporting Suspected or Actual Financial Exploitation 93 Adult Protective Services 94 Long-Term Care Ombudsman 95 Law Enforcement and Emergency Reports 95 Community Resources for Training and Educating Professionals on Financial Exploitation 96 Multidisciplinary Teams 96 Elder Abuse Specialists 97 Other Resources for Training and Educating Professionals on Financial Exploitation 97 Limitations of Community Resources 98 References 99 Chapter 8: Financial Exploitation: The Legal Perspective 102 Introduction 102 Financial Exploitation: A Blurred Line 103 The Concept of Undue Influence as a Mechanism to Exploit 105 The Role of the Clinician 108 The Legal System: A Focus on Victim or Perpetrator 109 Civil Justice and the Concept of Protection for the Elderly 110 The Role of the Medical Profession in the Civil Context 111 The Criminal Justice System at Work 113 The Case of L.S.: The Need for Multidisciplinary Awareness and Interaction to Protect the Vulnerable from Devastating Loss 114 Recommendations and Conclusions 117 Chapter 9: Financial and Legal Methods to Protect Individuals from Financial Exploitation 119 Introduction 119 Who Is at Risk? 120 Who Are the Perpetrators? 120 Examples of Types of Fraud 121 Action Plans 125 Protecting Oneself from Financial Abuse 126 Protect One’s Home 127 Caregiver/Family Interventions 128 Benefits of Preventative Interventions 129 Available Resources 129 Future Directions 130 Three Major Credit Bureaus 131 Suggested Resources 130 Chapter 10: Critical Documents Associated with Aging: An Organized Guide to Personal Files 133 Introduction 133 Medical and Privacy Issues 133 Medicare 136 Caregivers, Care Managers, and Financial Concerns 137 Managing Care in the Home 137 Financial Concerns 144 Legal Issues and Advance Directives: End of Life Care 145 Advance Directive 152 Do Not Resuscitate Order (DNR) 152 POST Form (Physician’s Orders for Scope of Treatment) 153 Ethical Will 153 Living Will 153 Last Will and Testament 153 Probate, Briefly Explained 156 Attorney-in-Fact (AIF) 157 Power of Attorney (POA) 157 Durable Power of Attorney (DPOA) 157 Healthcare Power of Attorney (HCPOA) 157 Healthcare Surrogate 157 Guardian 158 Capacity 159 Undue Influence 159 Privacy 159 HIPAA Standards 159 References 160 Resources 161 Chapter 11: Who Can You Turn To: The Role of Adult Protective Services (APS) and Other Community Resources 162 What is APS? 162 The Guiding Principles of APS [2] 163 What Happens When a Report is Made to APS? 164 Intake 164 Investigation 165 Care Plan 166 Ongoing Monitoring 167 Multidisciplinary Approaches 167 APS Resources 168 Law Enforcement 168 Other Victim Services Agencies 169 Aging Services 169 Conclusion 170 References 170 Chapter 12: Being the Advocate-Disseminating Knowledge About Financial Exploitation to the Community 171 Public Policy Scope 173 Community 175 Healthcare Community 178 Coalition Building 180 Media 183 Developing an Action Plan and Measuring Outcomes 185 References 186 Chapter 13: Future Directions: Public Policy and Advocacy 189 Introduction 190 Historical Perspective of United States Policy [Where We Have Been] 190 Current Policy Initiatives [Where We Are] 193 Future Directions [Where We Need to Be] 194 Research/Professional Policy 194 Professional Advocacy 196 Self-Advocacy 200 The Future 201 References 202 Index 205 Increasingly, We Hear Of More And More Elders Falling Victim To Financial Exploitation. Although This Form Of Elder Abuse Has Been Recognized For Years, Its Incidence, Prevalence, And Impact On The Common Individual Has Been Only More Recently Brought To The Spotlight. Despite These Circumstances, Recognition Of Risk Factors And Indicators Of Financial Exploitation Are Not Widely Disseminated. Additionally, Once Situations Are Identified And Confronted, The Knowledge Of What To Do Next Is Lacking. These Gaps Are Present Within The Medical Community, Law-enforcement, And The Finance Community ? Areas Where Opportunities For Recognition And Intervention Are Common. Our Elders Often Have No Idea Of What To Do When They See Their Own Risk Or When They Fall Victim. Aging And Money: Reducing Risk Of Financial Exploitation And Protecting Financial Resources Helps Clinicians To Integrate Identification Of Such Indicators Of Abuse Into Their Geriatric Assessment As Well As Guide Them In Performing An Assessment Of An Individuals? Financial Decision-making Capacity When Appropriate. Aging And Money: Reducing Risk Of Financial Exploitation And Protecting Financial Resources Is An Essential New Text That Provides The Practicing Clinician With Information On Identifying Risk Factors And Clinical Clues Associated With Financial Exploitation And How To Incorporate These Steps Into Their Practice.--back Cover Financial Exploitation Of The Elderly: Review Of The Epidemic-its Victims, National Impact And Legislative Solutions -- One Piece Of The Puzzle: Financial Exploitation And Elder Abuse -- Barriers To Recognition -- Financial Abuse Of The Elderly -- Risk Factors -- Screening Older Patients For Risk Factors Associated With Financial Exploitation -- Clinical Assessment Of Financial Decision Making Capacity -- Next Steps: Documentation And Accessing Community Healthcare Resources -- Financial Exploitation: The Legal Perspective -- Financial And Legal Methods To Protect Individuals From Financial Exploitation -- Critical Documents Associated With Aging: An Organized Guide To Personal Files -- Who Can You Turn To?-the Role Of Adult Protective Services (aps) And Other Community Resources -- Being The Advocate: Disseminating Knowledge About Financial Exploitation To The Community -- Future Directions: Public Policy And Advocacy. Ronan M. Factora, Editor. Includes Bibliographical References And Index. Front Matter....Pages i-xiii Financial Exploitation of the Elderly: Review of the Epidemic—Its Victims, National Impact, and Legislative Solutions....Pages 1-18 One Piece of the Puzzle-Financial Exploitation and Elder Abuse....Pages 19-30 Barriers to Recognition....Pages 31-37 Financial Abuse of the Elderly: Risk Factors....Pages 39-51 Screening Older Patients for Risk Factors Associated with Financial Exploitation....Pages 53-65 Clinical Assessment of Financial Decision Making Capacity....Pages 67-74 Next Steps: Documentation and Accessing Community Healthcare Resources....Pages 75-90 Financial Exploitation: The Legal Perspective....Pages 91-107 Financial and Legal Methods to Protect Individuals from Financial Exploitation....Pages 109-122 Critical Documents Associated with Aging: An Organized Guide to Personal Files....Pages 123-151 Who Can You Turn To: The Role of Adult Protective Services (APS) and Other Community Resources....Pages 153-161 Being the Advocate-Disseminating Knowledge About Financial Exploitation to the Community....Pages 163-180 Future Directions: Public Policy and Advocacy....Pages 181-196 Back Matter....Pages 197-204