Financial Abuse, FinancialMismanagement and Dementia:

What are the Issues for Practitioners?

Professor Linda Rosenman

The University of QueenslandAustralia

• Financial and asset management and caring for older people

• Deliberate mismanagement or misappropriation of older people’s assets i.e. financial abuse

Assets and ageing research program• Series of interlinked projects

– Financial planning for old age and retirement, especially women

– Legal provisions for substitute decision making – direct care workers identifying and acting on financial

mismanagement or abuse– Knowledge and understanding of substitute financial

management by carers and older people• Subgroups: rural areas; indigenous

– National survey of prevalence of asset management– Research with care facilities into managing residents’

financial affairs – Community demonstration project aiming to educate

• older people and carers about asset management and • public and private providers on identifying cases of

abuse and mismanagement

Financial/Asset Management

• Financial management is a significant and important part of preparing for and coping in old age

• Older people have a large asset base– Small asset bases particularly require prudent

management• Capacity to manage their money and assets

– lack of experience or preparation – lack of capacity – complexity

0

50,000

100,000

150,000

200,000

250,000

15-24 25-34 35-44 45-54 55-64 65-74 75+

Total Income $p.a.

Net Wealth $

Income and Wealth by Age, Australia

Financial and asset management

• Managing an older person’s money and assets is a significant, under-recognised and under-supported task for carers– Limited preparation– Lack of understanding of substitute decision

making requirements by carers– Barriers, to respect client privacy/autonomy

by banks and financial institutions – complexity

Financial and asset management• 26% of population helped an older person with managing

finances and assets• 20% reported some difficulty

– Capacity to communicate (dementia a particular challenge)

• inability to articulate or identify wishes• risk of accusations of theft or misappropriation of

possessions or assets by older person/family– no power of attorney

• range and number of financial management tasks• task complexity

– multiple and large assets eg selling an asset, – negotiating tax, pension health and care payments

• Lack of community based assistance especially by/from financial institutions

Financial and asset management: Issues for practitioners

• Knowledge/expertise • How to support carers• How to identify and deal with mismanagement• Obligations, protections and risks of

involvement in client financial matters • How to identify and deal with financial abuse

Financial abuse

• Financial abuse: misappropriation, fraud and theft of assets within a relationship of trust

• one of the most common forms of elder abuse• majority of workers dealing with aged do not

have experience in identification, substantiation and intervention in financial abuse of older adults

Financial abuse

• Practitioners working in generic services see relatively few cases of abuse

• Lack of knowledge of law re: guardianship and establishing mental capacity of older person

• Understanding volition, rights and wishes of older person and implications for older person and carer of intervention

• Lack of appropriate referral and intervention services

How is financial abuse identified?

• Community living– access to older person often mediated through

carer– Fragmentation of services – no single case

manager or point of contact• Lack of money or assets to pay for care or

services• Neglect of physical/psychological needs

regardless of assets• Evident use of older persons assets – car,

home

How is financial abuse identified?

• Hospitalisation• Belated attempt to gain EPA• Undue pressure to change will

• Long term Care facility• Falsifying assets on admission• Failure to pay bills

Decision making by practitioners on financial abuse

• How are decisions made about whether abuse is occurring?

• How are decisions made about whether and how to intervene?– Difference between identifying and

substantiating financial abuse and taking action

• Assessment of situation– characteristics of the alleged abuse– characteristics of the older person– characteristics of the alleged abuser

• Decision to intervene– Individual variation in threshold for taking

action– Impact of intervention

Decision making by practitioners on financial abuse

Characteristics of alleged abuse

• Pattern of incidents one-off /ongoing• Intentionality – ignorance, opportunistic vs.

targeted • Visibility vs. secretiveness • Asset management arrangements – orderly and

easily monitored vs. loose and chaotic

Characteristics of older person

– Cognitive or physical incapacity– Attitudes and beliefs – Extent of isolation from social networks– Characteristics of the relationship with alleged

abuser– History of any type of abusive behaviour in

the relationship– Quality of relationship – Distribution of power in the relationship– Degree of reciprocity in the relationship

Characteristics of alleged abuser

• Attitudes and beliefs– Sense of entitlement – No harm to the older person

• Responses to issues being raised– Unwillingness to acknowledge problem/issue

• Passive to overt resistance• Lifestyle problems

– Mental health/substance abuse – Unemployment, poverty– Living beyond means, debts, gambling

Action factors• Personal impact on older person• Distress older person has regarding the situation• Degree to which abuse reduces care options or

service provision • Degree to which abuse physically or emotionally

endangers the older person• Meaning of assets lost to older person• Financial impact on older person• Extent to which person can afford to lose what is

disappearing• Degree to which person is at risk of losing

financial independence

Decision to intervene

• Impact of intervention– Referral or intervention options– How amenable suspected abuser is to

intervention by practitioner– Impact of intervention on long term

carer/client relationship

Summary• Financial management is a significant part of providing

care for older people• Practitioners need to

– recognise it as a significant caring role – support carers in carrying out what may be an

unfamiliar and complex task of care– be familiar with major characteristics of financial

management and the legal requirements for acting on behalf of another person

– identify financial mismanagement and financial abuse

– make decisions on if and how to intervene

• Organisational responses– Financial management for older people

• What assistance is there to support carers in financial management

• What training/information is there to prepare practitioners re: legal requirements for substitute decision making and understanding financial obligations

Organisational responses

• What triggers are in place to identify financial abuse?

• What referral mechanisms are in place?• What training is there for staff in identifying and

acting on financial abuse?• What protections are there for staff in identifying

suspected financial abuse?