Friday, February 8, 2008

Elder Abuse Resources and Information

ELDERLY ABUSE

 

 

 

One must also recognize that there is considerable physical abuse on the elderly. The U.S. House of Representatives Select Committee on Aging found that 5% to 10% of the elderly may be victims of moderate to severe abuse- which is also considered to be far less likely to be reported than other types. A professor at the University of New Mexico said that the elderly with disabilities are unlikely to complain about abuse, neglect or victimization under the fear that they will lose whatever support, even abusive, they have and that their complaints will trigger reprisals or get them sent to an institution.

It's not just the fact that they are old that causes the abuse- it's also a realization that many people that were not nice when they were young are even less nice when they get old. Putting up with mean spirited people tends to shorten the fuses on many caregivers- particularly when they are not getting the recognition for the help they are giving. This comment is not to justify any caregivers inappropriate actions, but to make future caregivers aware that they may want to do anything in order to avoid taking care of an elderly parent that is almost sure to cause problems.

Regarding that last section, recognize that the children/caregivers may be mean spirited or cold people as well. Double that with , essentially, forcing a child to give unwanted support and you invariably lead to a problem in the making. For the patient, it's not always, "better the devil you know than the devil you don't know". Nursing homes are not perfect environments, but they sure are better than situations that effectively foretold of abusive arrangements.

ABUSE: The National Center for Elder Abuse found that female victims constituted 62% of elder abuse cases. More than 12% involved financial or material exploitation. In those cases, 62% of the perpetrators were family members. Several ways to stop some abuse

  • Use a POD account rather than the regular joint tenancy. POD means paid on death which allows the beneficiary to receive funds but only upon death. It should stop the draining of the account while the benefactor is still alive
  • Directly deposit social security checks. But remember, if the account is jointly held with the abuser, the financial abuse may continue.
  • Consider bill paying services. They will control the money outflows.
  • Appoint a representative payee to receive, sign and cash check s for federal benefits.

ARE YOU ABUSED: (Victim Services)

Does your partner

  • Become overly protective or extremely jealous
  • Constantly criticize you and your abilities
  • Threaten to hurt you, your family, friends, pets, children
  • Prevent you from seeing family or friends
  • Have sudden and frequent bursts of anger
  • Destroy personal property
  • Deny you access to family assets or control all finances and force you account for what you spend.
  • Use intimidation or manipulation to control you or your children; hit, punch, slap, kick or shove you
  • Prevent you from going where you want to go
  • Force you to have sex when you don't want to
  • Humiliate or embarrass you in front of others

ELDER ABUSE: The National Center for Elder Abuse indicated that there were 241,000 reports of elder abuse in 1994, a 106% increase from a 1986 study. Some state its even worse with 1:14 elderly actually being abused. The study also showed that 62% of the cases were on women. More than 12% of cases involved financial or material abuse. In 35% of substantiated cases, an adult child was responsible, 13,4% for a spouse and 13.6% with other relative. Overall, 62% of the abuse problems emanated with family members.

ELDER ABUSE: "More than half of home care clients said they had been victims of abuse or neglect by personal care aides, in a study by Julianne Oktay and Catherine Tompkins of the University of Maryland School of Social Work. The researchers found personal care aides had little training and low pay, leading to a high potential for abuse of home care clients. An anonymous study was conducted of 158 personal care clients of all ages. The most common forms of abuse reported were theft, verbal abuse and neglect." (Older Americans Report, 11/4/94, p. 370)

 ELDERLY NEGLECT: (University of Maryland School of Social Work) (1998) "More than half of home care clients said they had been victims of abuse or neglect by personal care aides. The researchers found personal care aides had little training and low pay, leading to a high potential for abuse of home care clients. An anonymous study was conducted of 158 personal care clients of all ages. The most common forms of abuse reported were theft, verbal abuse and neglect."

The Challenges and Opportunities of an Aging America noted that "over 1,000,000 older Americans are physically, financially, and emotionally abused by their relatives or loved ones annually." 1.5 million elders abused annually.

From David Cutler and Louise Sheiner- "The marginal source of community care for the institutionalized elderly appears to be support from children or other helpers, rather than living alone. Almost all of the elderly in nursing homes would have lived with children or others had they been in the community. In addition, as the ease of acquiring Medicaid increases or Medicaid payments become more generous, fewer elderly receive substantial day to day help from their children."

New York Times- "The Federal agency that oversees Medicare points to the program's tiny overhead as proof it is well administered. But recent reports suggest that Medicare's administrative costs are shockingly low, below 2 percent of costs, because Medicare is shockingly unsupervised. The amount of fraud and waste is huge, and supervision of the quality of medical care provided recipients is largely non existent...In recent weeks, Federal auditors have estimated that $23 billion in Medicare payments last year- about one dollar in every seven- was due to fraud or mistakes. In Medicare's home health program, which spends about $20 billion a year treating about four million elderly people, fraud and waste account for perhaps 40 percent of expenditures."

Mark Litow- "Medicaid and Medicare are often cited for their administrative costs of 5% and 2%, respectively. In comparison, private insurance reports an industry cost average of between 12% and 20%... [but] in an 'apples to apples' comparison, government spends more than half again as much (66% more) to provide a dollar of Medicare and Medicaid benefits as private insurance spends to provide a dollar of health insurance benefits....

"Medicaid also causes the private [nursing home] price to be higher than it would be in the absence of Medicaid demand and overall supply restrictions." (Christine E. Bishop)

ELDER ABUSE: 1998 (Senior Update) This includes psychological and emotional abuse such as threats, fear and humiliation; physical abuse from beating to prolonged deprivation of food water; financial abuse which is the abuse of money, jewelry or property; neglect which includes failure to assist personal hygiene to failure to protect from safety hazards; and abandonment such as a willful force taking of another by a person responsible for the care and custody.

Elder Abuse: (CA Dept of Social Services) 1999 Though these statistics are only for California, I submit that they are representative of the nation overall.

Types of Elder and dependent Adult abuse

Neglect 28%
Financial 25
Mental Suffering 23
Physical 21
Abandonment 2
Sexual 1

Reported cases of abuse 20%- unreported 80%. "Sometimes family members unintentionally engage in cruel behavior because they are overwhelmed"-  Dr. Jim Mittleberger, a geriatrician.

Elderly Abuse INTERNET SITES (2000):

About Nursing Home Abuse and Neglect: http://www.nursinghomeabuse.com/brgi1.html
Abuse of Elders: http://otpt.ups.edu/Gerontological_Resources/Gerontology_Manual/Alton_J.html
Elder Abuse and Neglect: http://www.merck.com/pubs/mm_geriatrics/111x.htm
Elder Abuse Prevention: http://www.oaktrees.org/elder/
Elder Abuse: http://www.aces.uiuc.edu/~uplink/family/elderabuse.html
Elder Abuse: http://www.efmoody.com/miscellaneous/elderlyabuse.html
New York Elder Abuse Coalition: http://www.ci.nyc.ny.us/html/dfta/html/nyeac_home.html

Substantiated cases of Elder Mistreatment 1996 (Adult Protective Services 2001)

Type Number of Reports Percent of Total
Neglect 34,525 487%
Emotional/Psychological Abuse 25,142 35.4
Financial/ Material Exploitation 21,427 302
Physical Abuse 18,144 256
Abandonment 2,560 3.6
Sexual Abuse 219 0.3
Other 994 1.4
Total 70,942

8/27: Reporters of Substantiated Abuse 1996

Reporter Number of Reports Percent of total
Family Member 14,169 20.0%
Hospital 12,290 17.3
Police/Sheriff 8,031 11.3
In house SErvice Provider 6,816 96
Friend/Neighbor 6,476 9.1
Victim 6,216 8.8
Physician/Nurse 5,925 8.4
Out of home Service Provider 3,716 5.2
Bank 305 0.4
Other 10,764 15.2
Total 70,942

Abuse, Neglect, and Exploitation of the Elderly (Elder Law Ebulletin)

Elder abuse takes on many forms. (2001) Accurate information on the frequency of occurrences is difficult to obtain, for many reasons, including non-reporting of abuse and incapacity of the victim.

In the November 5th eBulletin, we reported the case of United States v. Shepard. The Defendant met the victim while working as a hospital social worker. She moved into the home of the victim on the invitation of the victim's guardian. The defendant and her husband proceeded to drain the victim's accounts of about $92,000. The Defendant's husband was convicted of mail fraud and money laundering, and sentenced to pay restitution of $165,000. This amount was evidently based on the settlement amount paid by the hospital (exploiter's employer) in a lawsuit brought by victim's estate.

On appeal, the Circuit Court of Appeals found that the patient was the victim, not the hospital, and that restitution should be limited tothe actual loss plus reasonable interest. The court noted that the purpose of restitution is torestore the victim to the condition she was in prior to the crime. Full case: United States v. Shepard, Seventh Circuit, October 23, 2001,

The reality in many of the elder abuse cases is that by the time the exploiter is caught, charged and found guilty, the exploiter has no funds with which to pay any court-ordered restitution.

In researching elder abuse opinions, we have found that many of the reported elder abuse cases concern not the act of elder abuse but procedural errors occurring during the trial. Those that do discuss the elder abuse claims illustrate the devastation visited on the elderly victims by the exploiters and abusers.

One recent case involved a combined appeal of an attorney's fee award. The attorney, a well-known elder law attorney, represented conservators in extensive and contentious litigation protecting the wards' assets. (On a side note, the attorney drafted California's elder abuse statute.) The cases involved impaired elders who had been "befriended" by a non-relative who quickly took over the elders' finances. The attorney's argument against a fee award reduction (the subject of the appeal) was to avoid dissuading attorneys from taking financial abuse cases. Elder abuse cases are difficult to litigate and require a certain level of experience. Reducing the attorney's fee award would discourage other experienced attorneys from taking these cases.

In an unpublished opinion involving a criminal case, the caregiver, who had married the enfeebled elder, was charged with embezzlement and elder abuse. She appealed the conviction on procedural grounds involving her right to assert a good faith belief defense that the elder had consented.

Elder law attorneys need to be familiar with the signs of elder abuse, whether physical or emotional abuse, neglect or financial exploitation. Develop a checklist for use in cases where abuse is suspected. The National Center for Elder Abuse is an excellent resource.

In drafting powers of attorney (whether or not durable), take care to limit the agent's powers as narrowly as possible to accomplish the task at hand while limiting the chances of abuse. Check any applicable provisions in the state statute. Consider including a reporting requirement in a separate, companion agreement to the power of attorney that is signed by both the principal and the attorney-in-fact. The reporting requirement could be triggered by a transaction over a certain dollar amount or submitted at certain specified intervals.

Basic language might be along the lines of something such as: "Monthly/quarterly/annually, my attorney-in-fact shall submit to John Jones a verified accounting and supporting documentation." or "My attorney-in-fact shall be required to submit to John Jones a verified accounting and supporting documentation for every transaction over $100." John Jones might be another sibling, an accountant or attorney, or any person that the principal trusts to act as a watchdog over the attorney-in-fact.

Or, a more comprehensive reporting requirement: "Monthly/quarterly/annually, my attorney-in-fact shall account to me and, during any period of time in which I am incapable of considering and reviewing such accounts, to John Jones. John Jones shall have the power to demand an accounting at any time. John Jones shall also have the power to remove my attorney-in-fact [and name a successor?] if John Jones, in his/her discretion, determines that such removal and replacement would be in my best interests. Any exercise by John Jones of the power to remove and replace my attorney-in-fact hereunder shall be exercised by a writing signed by John Jones, recorded in the County Recorder's office in the county in which I then reside, and delivered to my attorney-in-fact and any other person John Jones reasonably knows to be then relying on this power of attorney. In the event that my attorney-in-fact cannot be located, notice of such removal and replacement shall also be given by publication in a newspaper of general circulation in the county in which I then reside, but such removal and replacement shall be effective upon the date of execution of the notice, whether or not publication is completed."

Who should receive the accounting? It might be the principal, if the principal is not incapacitated. Still, this may not be effective if the principal might be unduly influenced by the attorney-in-fact. Where the attorney-in-fact is the principal's child and the principal has several children, the attorney-in-fact could be required to submit a regular accounting to her siblings. Although the accountings could be sent to the principal's attorney, questions may arise as to how closely the accountings must be reviewed and the attorney's liability for reviewing the accountings.

Some state power of attorney statutes provide a procedure for an accounting. For example, the Missouri statute contains a provision for the principal or legal representative of the attorney-in-fact to petition the court for an accounting. On termination of the authority of the attorney-in-fact, California provides for the attorney-in-fact to deliver copies of records pertaining to transactions, on the request of the person who receives possession or control of the property. It may provide more protection for the principal, however, to require reporting without the need of a court order or waiting until the agent's authority is terminated.

Another option is to have the principal direct his or her financial institution to send monthly account statements to someone other than the attorney-in-fact. This may reveal some irregularities that signal abuse.

If the client needs to employ a caregiver, draft a contract that prohibits the caregiver's acceptance of gifts or loans from the client, whether inter vivos or testamentary. Include a clause in the contract that restrict the caregiver's access to or use of the elder's accounts and prevents the caregiver from filling out checks for the client. Require the caregiver to obtain an adequate bond.

Elder abuse is a growing problem that has devastating effects on clients. Although elder law attorneys may not handle these cases, they still need to educate themselves and their clients on the signs and remedies."

It's the money (elderly abuse pdf) One recent case involved a combined appeal of an attorney's fee award. The attorney, a well-known elder law attorney, represented conservators in extensive and contentious litigation protecting the wards' assets. (On a side note, the attorney drafted California's elder abuse statute.) The cases involved impaired elders who had been "befriended" by a non-relative who quickly took over the elders' finances. The attorney's argument against a fee award reduction (the subject of the appeal) was to avoid dissuading attorneys from taking financial abuse cases. Elder abuse cases are difficult to litigate and require a certain level of experience. Reducing the attorney's fee award would discourage other experienced attorneys from taking these cases.

11/25: ELDER ABUSE LAWS LINK: (Timothy L. Takacs, CELA, Robert B. Fleming, CELA, and Professor Rebecca C. Morgan)

In drafting powers of attorney (whether or not durable), take care to limit the agent's powers as narrowly as possible to accomplish the task at hand while limiting the chances of abuse. Check any applicable provisions in the state statute. Consider including a reporting requirement in a separate, companion agreement to the power of attorney that is signed by both the principal and the attorney-in-fact. The reporting requirement could be triggered by a transaction over a certain dollar amount or submitted at certain specified intervals.

Basic language might be along the lines of something such as: "Monthly/quarterly/annually, my attorney-in-fact shall submit to John Jones a verified accounting and supporting documentation." or "My attorney-in-fact shall be required to submit to John Jones a verified accounting and supporting documentation for every transaction over $100." John Jones might be another sibling, an accountant or attorney, or any person that the principal trusts to act as a watchdog over the attorney-in-fact.

Or, a more comprehensive reporting requirement: "Monthly/quarterly/annually, my attorney-in-fact shall account to me and, during any period of time in which I am incapable of considering and reviewing such accounts, to John Jones. John Jones shall have the power to demand an accounting at any time. John Jones shall also have the power to remove my attorney-in-fact [and name a successor?] if John Jones, in his/her discretion, determines that such removal and replacement would be in my best interests. Any exercise by John Jones of the power to remove and replace my attorney-in-fact hereunder shall be exercised by a writing signed by John Jones, recorded in the County Recorder's office in the county in which I then reside, and delivered to my attorney-in-fact and any other person John Jones reasonably knows to be then relying on this power of attorney. In the event that my attorney-in-fact cannot be located, notice of such removal and replacement shall also be given by publication in a newspaper of general circulation in the county in which I then reside, but such removal and replacement shall be effective upon the date of execution of the notice, whether or not publication is completed."

Who should receive the accounting? It might be the principal, if the principal is not incapacitated. Still, this may not be effective if the principal might be unduly influenced by the attorney-in-fact. Where the attorney-in-fact is the principal's child and the principal has several children, the attorney-in-fact could be required to submit a regular accounting to her siblings. Although the accountings could be sent to the principal's attorney, questions may arise as to how closely the accountings must be reviewed and the attorney's liability for reviewing the accountings.

Some state power of attorney statutes provide a procedure for an accounting. For example, the Missouri statute contains a provision for the principal or legal representative of the attorney-in-fact to petition the court for an accounting. On termination of the authority of the attorney-in-fact, California provides for the attorney-in-fact to deliver copies of records pertaining to transactions, on the request of the person who receives possession or control of the property. It may provide more protection for the principal, however, to require reporting without the need of a court order or waiting until the agent's authority is terminated.

Another option is to have the principal direct his or her financial institution to send monthly account statements to someone other than the attorney-in-fact. This may reveal some irregularities that signal abuse.

If the client needs to employ a caregiver, draft a contract that prohibits the caregiver's acceptance of gifts or loans from the client, whether inter vivos or testamentary. Include a clause in the contract that restrict the caregiver's access to or use of the elder's accounts and prevents the caregiver from filling out checks for the client. Require the caregiver to obtain an adequate bond.

Elder abuse is a growing problem that has devastating effects on clients. Although elder law attorneys may not handle these cases, they still need to educate themselves and their clients on the signs and remedies.

Elder Abuse.  (2002) The Director of the National Center on Elder Abuse told the committee that nationwide reports of elder abuse increased from 117,000 cases in 1986 to 470,000 in 2000 - a 301% increase. These numbers and statistics include seniors abused at home and in the community, as well as those in nursing homes.

Elder Abuse: . Over 470,000 cases of elder abuse were reported to authorities nationwide in 2001.

Elderly  Scams: (LexisNexis 2002) According to the FTC, predatory lenders engage in a range of abusive practices, from loan flipping, equity stripping, or failing to disclose terms of the loan, to loading the loan with additional charges and unwanted benefits.

The FTC Web site describes in detail several different predatory lending practices. In equity stripping, the loan is based on the equity in the home rather than the home owner's income. The home owner has insufficient income to make monthly mortgage payments, but is told to inflate her income to secure loan approval. Once the homeowner misses a payment, the lender moves to foreclose on the home, "stripping" the homeowner of her home's equity.

Hiding loan terms happens frequently, especially in the case of a balloon mortgage where the monthly payments are applied to the interest only, with the principal due in one lump sum balloon payment.

Repeated refinancing, often with the borrowing of increasing amounts of money is referred to as loan flipping. A lender offers to refinance the home, giving the homeowner some extra cash. After a few payments, the lender contacts the homeowner with the offer of an even bigger loan. Every time the loan is refinanced, the lender charges high points and fees for the refinancing, and the interest rate may be increasing with each consecutive loan. If there is a prepayment penalty, it has to be paid each time the homeowner agrees to the new loan. This practice results in the homeowner having more cash, but an even bigger debt. In reality, the cash the homeowner receives may be less than the extra refinancing costs and fees.

Home improvement loan scams, another type of predatory lending, are well known to elder law attorneys whose clients have been victims. In the typical situation, the home owner is contacted by a contractor who offers to perform some kind of repair on the home for what seems to be a very reasonable price. The contractor (who may be paid by the lender) offers to arrange the financing for the repairs through a lender known to the contractor. After signing the papers (usually signed in a rush or under a threat of work stoppage), the homeowner finds out that the papers were for a home equity loan, usually at a high rate of interest, with high points and fees. Often, the contractor's work is shoddy or unfinished.

A common tactic of predatory lenders is to cram unwanted "benefits" into the loan terms as part of the package. A typical example of an added "benefit" is credit insurance. If the homeowner even notices these extras and objects, the lender may pressure the homeowner to sign the loan with the extras included. An example of the pressure that might be applied: the lender claims that if the extras are removed, the loan would have to be rewritten, which might cause the lender's boss to reconsider approving the homeowner's loan.

There are ways that clients can protect themselves from becoming victims of predatory lenders. As with most situations clients face, avoiding the problem may be a lot easier than solving the problem. First and foremost, there is no free lunch. If it sounds to good to be true, it is. The FTC, AARP and other web sites (see links below) offer advice to consumers on how to avoid becoming a victim and what to do if victimized. Attorneys can help their homeowner clients avoid predatory lenders. We have added some tips of our own and compiled this into advice for clients:

Your Financial Situation

Do not lie about or misstate your income in any way even if the lender tells you to do so. If you do not tell the truth in your application, you may be headed for legal problems (criminal and civil) as well as financial difficulties. If you do not have the income to make the monthly payments, do not take out the loan. Do not borrow more money than you absolutely need and do not continue to refinance your home. Make sure you understand exactly the amount of the monthly payments, the costs, the charges for the loan, any hidden fees and the payment terms. Realistically decide if you can afford to take on this additional debt.

The Papers

Make sure to read all of the papers completely. Do not sign them if you do not understand them or if there are any blanks in them. Ask questions and get your questions answered. If the lender doesn't answer your questions, walk away. If the lender tries to rush you, pressure you or put a time limit on the offer, walk away. Make sure you are not signing away the title to your home. Do not agree to any benefits you do not want or do not need -- extra benefits are not one size fits all and you may be paying for something you do not need or will never use. Have your attorney review the papers before you sign them. Keep a copy of everything you sign.

The Lender

Check out the lender and make sure the lender is reputable. Shop around. Get comparisons. There may be a better deal available. If the loan is for repairs, check out the contractor with the local construction licensing agency to make sure the contractor is licensed, bonded and insured. Ask for references and contact information for other customers; then check the references and talk to other customers. Question the contractor about the contractor's relationship with the lender. Say no to solicitations, such as door-to-door, mail or phone solicitations for the loan. If you were not seeking out a loan before you were solicited, do not let yourself be talked into one -- this is not free money.

Getting Help

When a client appears to have been a victim of predatory lending, there are a variety of remedies available, civil, criminal and administrative. Tell the client to contact the FTC and the state attorney general's office. Have the client contact the U. S. Housing and Urban Development (HUD's) ownership center. Check state and federal statutes to see what remedies are available. In addition to common law remedies, check unfair and deceptive acts and practices statutes, banking statutes, and applicable elder exploitation statutes, among others. Talk to the local district attorney's office: many have consumer fraud divisions. Because predatory lending has become such a problem, many states have enacted statutes specifically designed to combat predatory lending. For example, last fall California passed a predatory lending statute that, among other things, responds to the predatory lending problems discussed in this article and provides for administrative and civil remedies.

If your client is house-rich and cash-poor and needs additional money, consider whether a reverse equity mortgage is a solution for your client. Although not the right answer for everyone, a reverse equity mortgage in many instances can provide the homeowner with the needed funds, whether in a lump sum or in a stream of payments. There is no repayment until the client sells the home or dies. Because a reverse equity mortgage does use the home's equity, it may not be the right choice for every client. For more information about reverse mortgages, see AARP (http://www.aarp.org) or the National Center for Home Equity Conversion (http://www.reverse.org).

Violence Against Elderly: (2002) The World Report on Violence and Health, released by the World Health Organization, points out that the problem of violence against elderly is widespread and is likely to grow in line with the aging of the world's population. Information on the extent of elder abuse--physical, sexual, and psychological--is scant. The few population-based studies that have been done suggest that 4-6% of elderly people have been abused in the home, but almost all research has been based in Western countries. "There are no accurate figures for the developing world," says a WHO official, "whatever anyone says is guesswork."

DOMESTIC ABUSE IN LATER LIFE, Abusers

Prevalence and Incidence

Relationships

Types of Abuse

Adult abuse:  (2003) Social Services Block Grant: Underappreciated APS Funding

The primary way in which the Federal government provides financial support to vulnerable adult abuse services is through the Social Services Block Grant, or SSBG.

SSBG funds are allocated to states on a formula basis. State legislatures then decide where the money will be spent. Because of this two-step process, many professionals in elder abuse do not realize the importance of SSBG to adult protective services (APS), Bill Benson, member of the SSBG Coalition and National Association of Adult Protective Services Administrators' (NAAPSA) National Policy Advisor, told AAR. There is evidence to support this assertion: in the National Center on Elder Abuse's "2000 Survey of State Adult Protective Services," only 30 of all 50 states' (plus the District of Columbia) respondents were able to give funding information for their state APS program, and of these, only 13 claimed their program got SSBG funds (pp. 37, 65-66). Yet Federal reports show that more than 3/5 of states -- 32 -- use SSBG funds to fund APS (SSBG FY 2001 report, chapter 3).

Indeed, in FY 2001 an estimated 44% of all APS funding came from SSBG. Put another way, $151.5 million in SSBG funds -- about 6% of total SSBG funds -- went to state APS programs. Three jurisdictions -- District of Columbia, Michigan, and Rhode Island -- funded their whole APS program through SSBG funds. SSBG funding made up more than half of all APS funding for nine states. New Mexico used 31% of its total SSBG funds for APS. An estimated 433,000 adults benefited from SSBG-funded APS services in FY 2001, at an average cost of $493 per recipient. (SSBG FY 2001 report, chapters 3 and 4)

However, this is not the full SSBG story. Other programs upon which APS and its clients rely are also funded by SSBG. The following chart lists only the most relevant programs, using FY 2001 figures:

Service Number of States Funding Through SSBG Percentage of total program funding provided through SSBG
Adult day care 25 8%
Adult foster care 13 34%
Case management 28 19%
Congregate meals 11 11%
Home-based services 37 7%
Home-delivered meals 15 26%
Information and referral 16 39%
Legal services 15 24%
Residential treatment
22
5%
Transportation 23 21%

In total, 45 states used $201 million for "Services for Elderly in the Community," and 41 used a total of $352 million for "Services for Adults and Children with Disabilities" 

Elder Abuse: (2003) Categories of abuse. As with most studies that include it as a category, self-neglect is the most common type of abuse: 39% of investigated allegations (N = 118,447) were of self-neglect. Caregiver neglect/abandonment was the second-largest category of allegation, at 19% (N = 59,489), followed by financial abuse/exploitation (13%, or 38,714 investigated allegations). Physical abuse made up 11% of allegations (N = 34,680). Ten percent of allegations (N = 31,298) were classified as "other" (which the report says includes confinement, isolation, and denial of essential services). Emotional/verbal abuse allegations made up 7% of all allegations (N = 20,690); sexual abuse made up only 1% of allegations (N = 4,150).

Number of reports and cases substantiated. As discussed in "Caveats...," language confusion and data inadequacy make it impossible to determine how many of the potential cases of elder/vulnerable adult abuse reported to state APS agencies are screened out and/or not investigated. Although some states did provide different numbers for "reports received" and "reports investigated," it is known that some states with equal numbers of "received" and "investigated" cases actually do screen out some reports before they are investigated, which means that the "total number of reports received" by the states is probably more than the published 472,813. In addition, this figure indiscriminately combines data from the 48.1% of states where reports were only counted if there was no open case with data from the 42.6% of states where the reported number includes additional reports on open cases.

Based on the 41 states that could report both how many cases they investigated and how many they substantiated, the overall national substantiation rate was 48.5%. Individual states, however, ranged from a substantiation rate of 2.2% in Florida to Indiana's 100%. For the "year" reported, there were 40,156 substantiated cases of abuse of vulnerable adults (defined as 18-59) and 101,057 substantiated cases of abuse of those 60+. Since the total number of substantiated cases reported was 166,019 (with many states not reporting the number of cases they substantiated), it's clear these numbers are undercounts.

Who reports. Family members made up the largest of 27 categories of reporters of elder abuse (13.7%), followed by health care professionals (11.1%) and social service agency staff (10.0%). The "other" category made up 9.8% of reporters. Eight percent of cases were self-reported, and five percent came from anonymous sources. Those categories making up less than 1% of referrals were paid caregivers (.5%), long-term care ombudsmen, area agencies on aging, pharmacists, public officials, coroners, EMT/firefighters, psychologists, attorneys, clergy, and bankers (.1%).

Gender of victims and perpetrators. Although it is often alleged that older women are victimized at rates higher than older men, this report shows that when the 5% of cases where the gender of victim is unknown are excluded, elder women make up 59% of substantiated cases' victims, and elder men make up 41% -- exactly their proportions in the 65+ population. (The breakdowns for disabled younger adults were not made available.) Perpetrators, on the other hand, were more often men: in the substantiated cases (not clear if these were of all ages or only elder abuse cases), men made up 61% of identified perpetrators, while women made up 39%.

"Types" of perpetrators. Spouses/intimate partners made up the largest category of abusers in substantiated cases: 30.2%, followed by adult children (17.6%). All told, 61.7% of perpetrators were family members, although this percentage was calculated on a total that included large numbers of "not known" and "other" perpetrators (third and fourth largest categories, respectively). Although the report says only 4.4% of perpetrators are facility and institution staff, it is not clear who is included in the fifth-largest category of "service provider" (8.2% of perpetrators).

Abuse (child, partner, elder)

Thousands of elderly people face abuse (2004) Tighter controls need to be put in place to ensure the safety of elderly people

Abuse and violence

Abuse (child, partner, elder)

Child abuse: More than 4.5 million children are forced to endure sexual misconduct by school employees, from inappropriate comments to physical abuse

Elder Abuse and investing: (WSJ 2005) Senior citizens are turning to progressive state elder-abuse statutes to sue financial-services and insurance companies for selling unsuitable investment products geared for retirement.

Annuities, hybrid investment products with a life-insurance wrapper, are at the center of the mounting litigation as more senior citizens purchase these vehicles for a guaranteed stream of income.

Retirement concerns, especially the fear that Social Security has eroded as a safety net, have driven some senior citizens to buy products like annuities that may not be in their best interests in the long-term.

In late January, a class-action suit was filed in Los Angeles County Superior Court against Midland National Life Insurance Co. alleging the company sold deferred fixed annuities to seniors where they didn't receive payment until well after their life expectancy. The suit was filed by a widow whose husband purchased the annuity from Midland -- which didn't allow him to collect until he was 115 years old.

Abuse of Adults 60+: 2004 Survey of Adult Protective Services. This report contains the results of a national survey on elder abuse conducted by the National Center on Elder Abuse (NCEA).

Neglect is defined as the refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care. Neglect typically means the refusal or failure to provide an elderly person/vulnerable adult with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.

Financial or Material Abuse/Exploitation is defined as the illegal or improper use of an older person's or vulnerable adult's funds, property, or assets. Examples include, but are not limited to, cashing an older/vulnerable person's checks without authorization or permission; forging an older person's signature; misusing or stealing an older person's money or possessions; coercing or deceiving an older person into signing any document (e.g., contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.

Self-Neglect is regarded as an adult's inability, due to physical or mental impairment or diminished capacity, to perform essential self-care tasks including (a) obtaining essential food, clothing, shelter, and medical care; (b) obtaining goods and services necessary to maintain physical health, mental health, or general safety; and/or (c) managing one's own financial affairs. Choice of lifestyle or living arrangement is not, in itself, evidence of self-neglect.

Finally, a vulnerable adult is defined as a person who is either being mistreated or in danger of mistreatment and who, due to age and/or disability, is unable to protect himself or herself1.

Categories of Elder Abuse, (2007) Victims Aged 60+

• Self-neglect was the most common category of investigated reports (49,809 reports or 29.4%), followed by caregiver neglect (26.1%) and financial exploitation (18.5%).

• Self-neglect was the most common category of substantiated reports (26,752 reports or 39.3%), followed by caregiver neglect (21.6%) and financial exploitation (13.8%).

Substantiated Reports, Victims Aged 60+

• States reported that 65.7% of elder abuse victims were female (15 states).

• Of the victims aged 60+, 42.8% were 80 years of age and older (20 states).

• The majority of victims were Caucasian (77.1%) (13 states).

• The vast majority (89.3%) of elder abuse reports occurred in domestic settings (13 states).

Substantiated Reports, Alleged Perpetrators of Victims Aged 60+

• States reported that 52.7% of alleged perpetrators of abuse were female (11 states).

• Over three-fourths (75.1%) of alleged perpetrators were under the age of 60 (7 states).

• The most common relationships of victims to alleged perpetrators were adult child (32.6%) and other family member (21.5%) (11 states).

• Twenty-one states (40.4%) maintain an abuse registry or database of alleged perpetrators, while 31 (59.6%) do not.

Interventions and Outcomes, Victims Aged 60+

• Over half (53.2%) of cases were closed because the client was no longer in need of services or the risk of harm was reduced (8 states). Other reasons for closure were the death of the client, client entering a long-term care facility, client refusing further services, client moving out of the service area, unable to locate client, and client referred to law enforcement.

• Only four states, Colorado, Connecticut, Louisiana, and Massachusetts, and Guam provided information on outcomes of APS involvement.

National Center on Elder Abuse, Study on Abuse of Adults Age 60+, http://www.nasua.org/pdf/2-14-06%20FINAL%2060+REPORT.pdf

National Trends- Abuse of Vulnerable Adults of All Ages

• APS received a total of 565,747 reports of elder and vulnerable adult abuse for persons of all ages (50 states, plus Guam and the District of Columbia). This represents a 19.7% increase from the 2000 Survey (472,813 reports).

• APS investigated 461,135 total reports of elder and vulnerable adult abuse for persons of all ages (49 states). This represents a 16.3% increase from the 2000 Survey (396,398 investigations).

• APS substantiated 191,908 reports of elder and vulnerable adult abuse for victims of all ages (42 states). This represents a 15.6% increase from the 2000 Survey (166,019 substantiated reports).

• The average APS budget per state was $8,550,369, compared to an average of $7,084,358 reported in the 2000 Survey (42 states).

Statewide Reporting Numbers

• APS received a total of 253,426 reports on persons aged 60+ (32 states).

• APS investigated a total of 192,243 reports on persons aged 60+ (29 states).

• APS substantiated 88,455 reports on persons aged 60+ (24 states).

• APS received a total of 84,767 reports of self-neglect on persons aged 60+ (21 states).

• APS investigated a total of 82,007 reports of self-neglect on persons aged 60+ (20 states).

• APS substantiated 46,794 reports of self-neglect on persons aged 60+ (20 states).

• The most common sources of reports of abuse of adults 60+ were family members (17.0%), social services workers (10.6%), and friends and neighbors (8.0%).

Categories of Elder Abuse, Victims Aged 60+

• Self-neglect was the most common category of investigated reports (49,809 reports or 29.4%), followed by caregiver neglect (26.1%) and financial exploitation (18.5%).

• Self-neglect was the most common category of substantiated reports (26,752 reports or 39.3%), followed by caregiver neglect (21.6%) and financial exploitation (13.8%).

Substantiated Reports, Victims Aged 60+

• States reported that 65.7% of elder abuse victims were female (15 states).

• Of the victims aged 60+, 42.8% were 80 years of age and older (20 states).

• The majority of victims were Caucasian (77.1%) (13 states).

• The vast majority (89.3%) of elder abuse reports occurred in domestic settings (13 states).

Substantiated Reports, Alleged Perpetrators of Victims Aged 60+

• States reported that 52.7% of alleged perpetrators of abuse were female (11 states).

• Over three-fourths (75.1%) of alleged perpetrators were under the age of 60 (7 states).

• The most common relationships of victims to alleged perpetrators were adult child (32.6%) and other family member (21.5%) (11 states).

• Twenty-one states (40.4%) maintain an abuse registry or database of alleged perpetrators, while 31 (59.6%) do not.

Interventions and Outcomes, Victims Aged 60+

• Over half (53.2%) of cases were closed because the client was no longer in need of services or the risk of harm was reduced (8 states). Other reasons for closure were the death of the client, client entering a long-term care facility, client refusing further services, client moving out of the service area, unable to locate client, and client referred to law enforcement.

• Only four states, Colorado, Connecticut, Louisiana, and Massachusetts, and Guam provided information on outcomes of APS involvement.

Recommendations

• Accurate and uniform data must be continuously collected at both state and national levels so that abuse trends can be tracked and studied. A concerted effort is necessary to create uniform definitions of, and measures for reporting abuse. As a baseline, all states need to be able to provide the information that this survey requested.

• States should collect detailed age and gender specific information on race and ethnicity of victims and alleged perpetrators. Little is known about the racial composition and ethnic background data of elder abuse victims.

• The inclusion of information on reporters of abuse such as municipal agents, postal service workers, utility workers, and hospital discharge planners suggests that training on the identification of abuse should expand to groups heretofore not known as critical to prevention and intervention efforts.

• It is critical that states collect outcome data on the clients served. This information will be extremely helpful in determining efficacy of APS intervention.

• Increased numbers of reports, investigations, and substantiations lead to the need for increased local, state, and national intervention and education efforts targeted toward the abuse of adults 60+.

• Little information is available about perpetrators and what happens to them as a result of APS intervention. States should collect as much information as possible not only about the victims, but also about the perpetrators. Data collected will inform multiple actors in the elder abuse arena regarding prevention, intervention, and advocacy.

• A national study of APS data, specifically related to the abuse of adults 60+, should be conducted no less than every four years. The increment of every four years is recommended because studies conducted in the past twelve years have been conducted within this time frame. This regularity is desirable for methodological comparability.


 
    
 
Marguerita Ludwig
 
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2 comments:

  1. CONSUMER WARNING - Read this BEFORE you buy from Midland National Life

    This life insurance agent is licensed with Midland National Life Insurance Company or one of its affiliates.

    Don't Trust Midland National Life or Midland Annuity. They have been sued all over the country for their sales practices that amount to ripping off senior citizens.

    If you want to know more, just Google MIDLAND NATIONAL LIFE REVIEW or MIDLAND NATIONAL LIFE COMPLAINT or visit www.midland-national-life-review.com

    Ask your life insurance agent for alternatives to Midland National. If they are unwilling to suggest any you may want to consider another insurance agent. You just have to wonder whether Midland has managed to trash whatever good name they used to have.

    Midland National is part of the Sammons Financial Group and is affiliated with the North American Company for Life and Health and Midland Annuity.

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  2. Thank you so much for this great information. It is too bad that people take advantage of the elderly. My grandparents were recently abused by the local postman. It really made me upset. We are currently suing the city. On the upbeat though, we have already been reimbursed by our long term care insurance. I hope that someday we will live in a world that will respect the elderly for the awesome people that they are.

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