Transcript Abuse & Neglect of Nursing Home Residents: What are we

TIPS AND TOOLS:
PREVENTING, DETECTING AND
REPORTING FINANCIAL EXPLOITATION
IN LONG-TERM CARE FACILITIES
Wednesday, March 5, 2014
Please call 1-866-740-1260 and use access code
3322275 to join the audio portion of today’s webinar
Overview
• Welcome and Introductions
• Naomi Karp, Policy Advisor, Consumer Financial Protection
Bureau (CFPB) Office of Older Americans
• Ann-Maria Beard, Deputy Director, Office of Supplemental
Security Income and Representative Payment Policy, Social
Security Administration
• Question and Answer for Presenters
• Scenario and Discussion Questions
• Closing
Poll Question #1
Prevalence of Abuse
• Abuse, Neglect and Exploitation (ANE)*
• Estimated that 1 in 10 elders experience ANE
• Only 1 in every 23 cases are reported
• As many as 1 in 2 individuals with dementia are victims of ANE
• Family, friends and caregivers are the perpetrators in 70-90% of all
ANE**
• Financial Exploitation
• Illegal or improper use of an older adult’s money or belongings
• The fastest growing form of elder abuse
• Grossly underreported
*Kathleen Sebelius, Secretary, Department of Health & Human Services, speaking to the Elder Justice Coordinating Council,
October 11, 2012 and NCEA “Why Should I Care About Elder Abuse?” fact sheet
http://www.ncea.aoa.gov/Resources/Publication/docs/NCEA_WhyCare_508.pdf
**Ageless Alliance www.agelessalliance.org
Financial Exploitation in Long-Term Care
Facilities
Poll Question #2
March 5, 2014
Tips and Tools for Preventing,
Detecting and Reporting Financial
Exploitation
Naomi Karp
Consumer Financial Protection
Bureau, Office for Older
Americans
Consumer Voice Webinar
Disclaimer
 This presentation is being made by a Consumer Financial
Protection Bureau representative on behalf of the Bureau. It does
not constitute legal interpretation, guidance or advice of the
Bureau.
 Note: This document was used in support of a live discussion. As
such, it does not necessarily express the entirety of that discussion
nor the relative emphasis of topics therein.
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Consumer Financial Protection Bureau (CFPB)
 Created in Dodd-Frank Wall Street Reform and Consumer
Protection Act; launched July 2011
 Mission: make markets for consumer financial products and
services work for Americans — whether they are applying for a
mortgage, choosing among credit cards, or using any number of
other consumer financial products
 Core functions: educate, enforce and study
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Office for Older Americans (OA)
 Mission: help consumers 62+ to get the financial
education and training they need to:

Prevent unfair, deceptive and abusive practices
aimed at seniors
Help seniors make sound financial decisions as
they age.
 The only office in the federal government
specifically dedicated to the financial health of
seniors

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www.consumerfinance.gov/older-americans/
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Background on Elder Financial Exploitation
 Definition: Illegal or improper use of an older adult’s funds,
property, or assets.
 The most common form of elder abuse—but only a small
fraction of incidents are reported.
 Perpetrators include family members, caregivers, scam artists,
financial advisers, home repair contractors, fiduciaries and others.
 Attractive targets: significant assets or home equity
 Vulnerable due to: isolation, cognitive decline, physical disability,
health problems, recent loss of partner/family member/friend
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Common signs of financial exploitation
 Money or property seems to be missing.
 Sudden changes in spending or savings, e.g.

Large withdrawals without explanation

Using ATM a lot

Can’t pay bills that usually are paid

Makes new or unusual gifts to family or others, e.g. “new best friend”

Changes beneficiaries
 Fear of relative, caregiver or friend
 Relative, caregiver or friend keeps older adult from having visitors
or phone calls, doesn’t let her speak for herself
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Tips for preventing scams
 Don’t share numbers or passwords for accounts, credit cards or
Social Security.
 After hearing a sales pitch, take time to compare prices.
 Sound too good to be true? It probably is.
 Watch out for deals only “good today” and pressure to act fast.
 Never pay up front for a promised prize.
 Watch for signs that someone has already been scammed.
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Tips for preventing or minimizing financial exploitation
 Trust, but verify. Only appoint someone you trust as your agent
under power of attorney. Require them to report to third party.
Tell trusted others about the arrangement.
 Not written in stone. You can revoke or change the person
named to handle your finances.
 Avoid appointing paid caregivers or helpers as POA.
 Beware of “new best friend” who offers to handle finances.
 Avoid abuse by caregivers and in-home helpers.

Secure valuables, documents, credit cards, statements

Monitor bank accounts, phone bills

Never let caregivers use credit/debit card for errands, purchases
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OA Initiatives: Managing Someone Else’s Money
 PROBLEM:



Declining capacity to handle finances can make older
adults vulnerable
People with diminished capacity often need surrogate to
handle their money
“Lay fiduciaries” – critical source of help; often have no
training; some even commit fraud
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Managing Someone Else’s Money, cont’d
 CFPB INITIATIVE:


Released a set of guides called Managing Someone
Else’s Money
User-friendly “how-to” guides for four types of
fiduciaries: agents under powers of attorney;
guardians; trustees; Social Security representative
payees and VA fiduciaries
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Managing Someone Else’s Money, cont’d
 What is a fiduciary? Anyone named to manage money or property
for someone else
 Four main duties:

Act only in the person’s interest – avoid conflicts

Manage the money and property carefully

Keep the person’s money and property separate from yours

Keep good records
 Guides teach “lay” fiduciaries, i.e. non-professionals, to spot
financial exploitation and protect assets from scams and frauds by
third parties.
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Managing Someone Else’s Money, cont’d
 National guides available for download
http://www.consumerfinance.gov/older-americans/
(see third paragraph) and free in bulk
http://promotions.usa.gov/cfpbpubs.html#special
 Upcoming: state-specific guides for six states: AZ, FL,
GA, IL, OR, VA; and a replication manual for other
states.
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OA Initiatives: Congregate Care Facilities
 PROBLEM:



Residents of assisted living and nursing facilities can become
victims of fraud and financial abuse.
Operators of facilities may see that bills are going unpaid and
residents are threatened with eviction, but they don’t know how
to intervene in cases of financial exploitation.
CFPB INITIATIVE:


Producing a national guide for operators of congregate
facilities.
Provide them with skills to identify and intervene in
exploitation cases further upstream and to have protocols for
doing so.
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OA Initiatives: Money Smart for Older Adults
OA Initiatives: Money Smart for Older Adults

PROBLEM:


Many older Americans, their caregivers, and others in the community
don’t know how to spot and avoid frauds and scams.
CFPB INITIATIVE:

The Office developed an awareness program called Money Smart for
Older Adults in collaboration with the FDIC.
• Materials for trainers to provide presentations on preventing,
recognizing, and reporting elder financial exploitation
• Materials for participants include:
– Examples and activities
– Glossary of terms
– Resources and information on managing money and reporting
financial exploitation
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Money Smart for Older Adults (cont’d)
 OBJECTIVES:

Recognize and reduce the risk of elder financial exploitation

Guard against identity theft

Plan for unexpected loss of the ability to manage finances
 MODULE TOPICS:

Common types of elder financial exploitation

Identity theft

Scams targeting homeowners and older veterans

Planning for unexpected life events

How to be financially prepared for disasters
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Downloading and ordering Money Smart materials
 To download the Money Smart for Older Americans
module, or find upcoming train-the-trainer events, go to
www.fdic.gov/moneysmart
 To order the Participant/Resource Guide, go to
www.promotions.usa.gov/cfpbpubs.html
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Contact
Naomi Karp
Senior Policy Analyst – Office for Older Americans
Consumer Financial Protection Bureau
[email protected]
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Poll Question #3
SOCIAL SECURITY’s
REPRESENTATIVE PAYEE PROGRAM
RESPONSIBILITIES and OVERSIGHT
Consumer Voice Webinar Tips and Tools for Preventing, Detecting and
Reporting Financial Exploitation
WHY DOES SSA APPOINT A PAYEE?
SSA appoints a representative payee if an individual is:



a minor child;
legally incompetent; or
unable to manage or direct the management of
his or her benefits
WHAT ARE A PAYEE’S
RESPONSIBILITIES ?
A payee’s duties are to:
 Determine the beneficiary’s needs and use his or her payments
to meet those needs;
 Save any money left after meeting the beneficiary’s current
needs in an interest bearing account or savings bonds for the
beneficiary's future needs;
 Report any changes or events which could affect the
beneficiary’s eligibility for benefits or payment amount;
WHAT ARE A PAYEE’S RESPONSIBILITIES ?
 Keep records of all payments received and how they are spent
and/or saved;
 Provide benefit information to social service agencies or medical
facilities that serve the beneficiary;
 Help the beneficiary get medical treatment when necessary;
 Notify SSA of any changes in your (the payee's) circumstances that
would affect your performance or continuing as payee;
 Complete written reports accounting for the use of funds; and
 Return any payments to which the beneficiary is not entitled to SSA.
WHAT IF A PAYEE IS NOT PERFORMING HIS/HER
DUTIES?
If you become aware of a representative payee who is
misusing an individual’s benefits, you should report it
to SSA immediately.
HOW CAN SOMEONE REPORT POTENTIAL MISUSE?
 There are several ways to report misuse.
 You may call SSA’s toll-free number – 800-772-1213 (TTY
1-800-325-0778)
 You may contact the local SSA field office, or
 You may contact SSA’s Office of the Inspector General
(OIG)
 by phone at 800-269-0271; or
 on-line at http://oig.ssa.gov/report-fraud-waste-orabuse/fraud-waste-and-abuse
HOW DOES SSA RESPOND TO
MISUSE ALLEGATIONS?
 SSA documents, investigates and resolves all allegations of
misuse by a rep payee.
 If we determine that misuse has occurred, we must take
further action such as:
 Removing the payee
 Obtaining restitution from the misuser
 Reissuing or repaying funds to the beneficiaries in certain
instances.
 We also refer all cases of misuse to the OIG for possible
criminal prosecution.
Questions?
Discussion
Scenario
A nursing home resident contacts you stating that she
received a discharge notice for non-payment. She tells you
that her son is her Representative Payee for her Social
Security benefits and handles her financial affairs, so she
does not understand why is she is in arrears to the facility.
She gives you permission to speak with her son and the
facility to determine why she is in arrears as she does not
want to be discharged.
Scenario Questions
• How would you proceed in this situation?
• What do you do if it appears that the resident’s son did not
fully understand his responsibilities and the issue was a
lack of understanding rather than financial exploitation?
• Would your approach change if based on your discussion
with the resident she appeared to have some memory
issues or cognitive deficits? If so, how?
• Would your advocacy strategies differ if the resident lived
in an assisted living facility/board and care home?
Poll Question #4
Discussion #1
• Do you see differences in the types of financial
exploitation (e.g. scams, health care fraud, identify theft,
theft, inappropriate billing, misappropriation of funds) in
assisted living/board and care homes compared to
nursing homes? If so, what is the difference?
Discussion #2
• What successful approaches have you seen long-term
care facilities implement in order to prevent, detect and
respond to financial exploitation?
Discussion #3
• Please share how you engaged local law enforcement in
order to improve their response, investigation and
prosecution of financial exploitation.
Discussion #4
• Please share an example of how you’ve increased public
awareness of financial exploitation.
Discussion #5
• Which organization, agency or group have you found to
be essential to collaborate with in order to address
financial exploitation?
Discussion #6
• How will you use today’s information in your work to
educate consumers, family members and long-term care
providers about preventing, detecting and reporting
financial exploitation?
Financial Exploitation – A Recap
Indicators
• Unpaid bills
• Lack of necessities – clothing, shoes, etc.
• Gifts to staff
• Pressure from a family member/friend to sign
documents immediately
• Missing personal possessions
Three Types of Financial Exploitation*
Occasion/
Opportunity
• Victimized
because they
are a means to
an end
Desperation
• Perpetrator so
desperate for
money they will
do anything
• Often family or
friends
• Many family
members are
dependent on
the elder (e.g.
housing)
Predation/
Occupation
• Trust is
developed
specifically to
exploit elder in
the future
• Often a new
“friend,”
romantic
interest or
trusted
professional
Metlife Study of Elder Financial Abuse (2011) https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmielder-financial-abuse.pdf
Impact of Financial Exploitation (FE)
• Harm to Residents
• Emotional effects – depression, fear, withdrawal
• Loss of dignity
• Loss of personal funds and/or property – items of value
• Loss of current housing (e.g. discharged from facility due to nonpayment)
• Pain and suffering
• Lost of trust and damaged relationships
• Physical and medical issues
• Cost
• A 2010 study estimated the annual financial loss by victims of financial
abuse to be at least $2.9 billion. That is a 12% increase since the 2008
estimate of $2.6 billion.*
• Medicare, Medicaid, Social Security benefits, pensions, hospitalizations,
fines/corrective action, legal fees
*Metlife Study of Elder Financial Abuse (2011) https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf
Facility Responsibilities
PREVENTION
• Staffing
• Screening, Training, Oversight,
ACTION
• Stop the abuse
Numbers
• Person-centered care
• Resident history, needs and
preferences and support them
• Discuss advance planning, POA,
representative payee, access to
personal needs allowance
• Support the victim
• Report
• Facility Policies and Procedures
• Staff reporting and resident/family
communication (e.g. unpaid bills)
• Strong Leadership
• Communication
• Residents, family members, local
law enforcement, LTCO, APS, state
survey agency, SSA
• Investigate
• Remedy
How Can You Help
• Learn about financial
exploitation
• Other Visitors (friendly visitors,
medical service providers)
• Identify key resources
• Connect with local and state
• Speak with residents about
partners
their rights and the facility’s
responsibilities
• Increase public awareness
• Media, your agency
• Share information regarding
financial exploitation
• Residents (Resident Councils)
• Family Members (Family
Councils)
• Facility Staff (staff in-services)
website/social media,
community education, World
Elder Abuse Awareness Day
(WEADD)
Get to Know…
• Local and State Contacts
• Long-Term Care Ombudsman Program (LTCOP) use
www.ltcombudsman.org to locate your LTCOP and find resources
• State Survey Agency locate your state survey agency using
http://www.medicare.gov/NursingHomeCompare/Resources/StateWebsites.html
• Adult Protective Services (APS) search for your APS agency at
http://www.napsa-now.org/ (National APS Association)
• Local Law Enforcement
• Federal
• Consumer Financial Protection Bureau
http://www.consumerfinance.gov/
• Medicaid Fraud Control Unit (MFCU) use http://www.namfcu.net/ to
find your MFCU
• Senior Medicare Patrol (SMP) use www.smpresource.org to locate
your state SMP and find resources
• Social Security Administration http://www.ssa.gov/
NEW Consumer
Fact Sheets
•
Consumer Fact
Sheets
•
•
Protecting Your
Loved One
•
•
Know, Plan,
Review, Protect
Understand,
Watch, Share,
Report
Separate fact
sheets for nursing
homes and assisted
living
• http://www.thecons
umervoice.org/node
/1230
• 10 Things LTCO
Can Do (NORC)
Resources
• National Consumer Voice for Quality Long-Term Care
•
•
•
•
•
•
www.theconsumervoice.org
National Long-Term Care Ombudsman Resource Center
www.ltcombudsman.org
National Center on Elder Abuse
www.ncea.aoa.gov
Ageless Alliance
www.agelessalliance.org
National Committee for the Prevention of Elder Abuse
www.preventelderabuse.org
Advancing Excellence in America’s Nursing Homes
www.nhqualitycampaign.org
Pioneer Network
www.pioneernetwork.net
The National Consumer Voice for Quality Long-Term Care
(formerly NCCNHR)
www.theconsumervoice.org
The National Long-Term Care Ombudsman Resource Center
(NORC)
www.ltcombudsman.org
This presentation was conducted by The Consumer Voice for the National Center
on Elder Abuse (Grant Number 90-AB0002) and is supported in part by a grant 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. NCEA: www.ncea.aoa.gov.