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Today's Elderly Residents Are At Risk of Financial Fraud

2011; Elsevier BV; Volume: 12; Issue: 1 Linguagem: Inglês

10.1016/s1526-4114(11)60001-2

2377-066X

Joanne Kaldy,

Housing, Finance, and Neoliberalism

Senior contributing writer Joanne Kaldy is a freelance writer in Harrisburg, Pa., and a communications consultant for AMDA and other organizations. Long-term care facilities keep vulnerable people as safe as possible from harm, but even the most secure physical cocoon can fail to protect residents against financial fraud. With continuing care retirement communities and assisted living facilities enabling residents to enjoy more independence than ever, and more elderly people using e-mail and the Internet, this population is highly susceptible to modern financial crime, say experts who have begun to focus on the problem. According to the 2010 Elder Investor Fraud Survey from the Investor Protection Trust nonprofit, one out of every five people over age 65, or 7.3 million older Americans, has been the victim of a financial swindle. The survey also found that half of older Americans gave some answers that suggest they are currently being victimized by a stranger, friend, or family member. The risk in long-term care facilities may be even greater because so many residents there may have compromised judgment owing to mild cognitive impairment. If physicians and other interdisciplinary team members are to protect their long-term care facility residents from fraud and possibly the loss of the resources that they need to stay in facilities that have become their homes, medical professionals must be attentive to red flags and willing to report suspicious activities to law enforcement authorities, according to the Investor Protection Trust and others. Those are challenging tasks, say the people who face them. Pennsylvania-based medical director J. Kenneth Brubaker, MD, CMD, said it isn't uncommon for elderly patients with dementia to have delusions about people stealing, but “you should take all complaints or concerns seriously.” The situation often isn't what it seems, he stressed. “I had one patient whose daughter – I believed – really wanted to do the right thing. Then I found out from the social worker that the family was stealing money from [the mother]. Sometimes you just don't know.” There are many signs of financial indiscretions that physicians and others can watch for without treading on a resident's independence. These include bills that aren't being paid, residents who previously had money to spend but suddenly don't, family members who visit only on the days Social Security checks are delivered, and residents spending hours on the computer or watching shopping TV channels with credit cards in hand. Even casual conversations with residents can uncover problems. “I asked an elderly resident if he needed anything, and he said ‘a Thermos,’” said David Smith, MD, CMD, a Texas-based medical director. “So I wrote an order for the social worker to use his money to get him a Thermos.” The incident revealed that the resident's family had taken his money. Eventually, the situation was resolved, and the patient got his Thermos. “It's just a matter of being alert,” said Dr. Smith. “We tend not to involve ourselves in financial matters, but if you see a hint that something's not right, you have a responsibility to jump on it.” Alec Pruchnycki, MD, CMD, a physician in New York who works with many assisted living residents, agreed. “Watch for someone complaining about not being able to afford medications or [experiencing] weight loss from not eating.” Sometimes, the abuse is more subtle. “I've seen instances where a family member comes in and cleans out an elderly person's refrigerator.” This isn't financial fraud, but it suggests that the family is willing to steal from the elder and put him or her at risk, said Dr. Pruchnycki. Financial issues are harder to detect in nursing facilities, he said. “You can ask patients about financial issues, but they won't always answer directly.” Sometimes, caregivers have to distinguish fraud from dysfunction. When a cognitively intact elderly resident gives away money or possessions seemingly rashly, there is little a medical professional can do, said Dr. Pruchnycki. For example, he knew an assisted living resident whose son was homeless and unemployed. The resident moved out of an excellent facility to a one-room hotel so that she could care for her son. She knew he was hopeless, but she selt she, ad to take care of him, said Dr. Pruchnycki. Dr. Smith described another such case. A wealthy woman gave most of her assets to her children and as a result, had to move out of a facility. “Sometimes, these situations are just poor judgment and not abuse,” said Dr. Smith. In these cases, the physician or other caregiver can alert a social worker, who then can offer help finding a financial adviser. However, no one who is competent can be forced to seek assistance. “I have had a number of occasions where attorneys have asked tfor financial-capacity]thvaluations at the office when an elderly person with money was going to enter into a contract or make or change a will,.” said Dr. Smith. But such assessments aren't easy. Researchers at the University of Alabama School of Medicine have developed a financial-capacity assessment tool, but it must be administered by a trained professional, such as a clinical psychologist. The need for assessment and help is great, however, said Jason Karlawish, MD, associate director of the Penn Memory Center at the University of Pennsylvania, Philadelphia. “Research shows that most older adults with cognitive impairment have some financial impairment and take longer to do financial tasks,” he said. “Some already are making mistakes with financial management, especially relating to checkbook management.” Robert Roush, EdD, of the section of geriatrics at the Baylor College of Medicine, Houston, said, “In one study, researchers used two decks of cards with cognitively impaired people. With the first deck, they win big at first and then ultimately lose. With the second deck, they lose at first and then win slowly over time. People with brain changes preferred the first deck, even though they lose” in the end. Based on these data, all residents with even, mild cognitive impairment, should be considered at risk for financial abuse, fraud, or exploitation, said Dr. Roush. Staff should be alerted to watch for red flags, and such residents should be questioned periodically about financial issues. Clinicians interviewed for this story said that their colleagues should watch for conditions or medications that can cause or exacerbate risky financial behavior. For example, certain Parkinson's disease drugs can trigger compulsive gambling. Even some gentle questioning can distinguish poor judgment from incapacity. For example, said Dr. Smith, if family members are getting money from a resident, an answer from that person such as “I know they're not always honest with me, but I love them and I've got plenty of money” suggests financial competence. But if the resident clearly does not realize that he or she is being lied to, is afraid or confused, or can't afford to give away money, a red flag should go up. Dr. Pruchnycki explained what he and his colleagues do in such cases. “We track who visits, and we will say something to the person we suspect to let them know that we're watching them.” Other times, counseling is appropriate. “We had a resident who was giving away money she couldn't afford to lose. So we made sure she got professional counseling about what she could afford.” Dr. Pruchnycki explained that there are private and government agencies, such as area agencies on aging and church groups, that can help. Even though it is not the physician's role to solve the problem, said Dr. Pruchnycki, he or she has a responsibility to report it to someone who can. Said Dr. Smith, “If someone is stealing money or possessions from an elder, that is theft. The proper authority for this is the police.” If someone is tricking an older person or using undue influence that is abuse and should be reported to adult protective services. Different states have different reporting requirements concerning suspected fraud. A state's adult protective services office is a good starting point, said Dr. Karlawish (www.longtermcarelink.net/eldercare/ref_adult_protective_services_elder_abuse.htm). The National Adult Protective Services Association is another useful resource (www.apsnetwork.org). But monitoring and follow-up by the facility are essential, he said. By establishing a trusting relationship with patients, the physician can have conversations that alert elders to the potential for financial pitfalls and how to protect themselves, said Dr. Roush. “The physician can say, ‘Hey, this is a problem, and here's what you need to watch for.’ If the practitioner broaches the subject gingerly, people generally aren't offended. … Health care providers aren't used to asking questions about money, but we need to help clinicians understand this issue and what they can do.” A nursing facility's medical director can work with the administrator to promote family night programs on financial fraud and abuse. “I've found these to be well received, and they provide an excellent springboard for residents and families to discuss concerns they have,” said Dr. Roush. “We cannot prevent all bad financial decisions from being made, but we can help educate people about financial fraud and abuse, identify at-risk individuals, and prevent or stop instances of financial exploitation.”