tips and tools: preventing, detecting and reporting financial exploitation in long-term care...
TRANSCRIPT
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
Tips and Tools for Preventing, Detecting and Reporting Financial Exploitation
Naomi Karp
Consumer Financial Protection Bureau, Office for Older Americans
March 5, 2014
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 23
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
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Poll Question #3
SOCIAL SECURITY’s REPRESENTATIVE PAYEE PROGRAM
RESPONSIBILITIES and OVERSIGHTConsumer Voice Webinar -
Tips and Tools for Preventing, Detecting and Reporting Financial
Exploitation
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
WHY DOES SSA APPOINT A PAYEE?
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 ARE A PAYEE’S RESPONSIBILITIES ?
If you become aware of a representative payee who is misusing an individual’s benefits, you should report it to SSA immediately.
WHAT IF A PAYEE IS NOT PERFORMING HIS/HER DUTIES?
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-
or-abuse/fraud-waste-and-abuse
HOW CAN SOMEONE REPORT POTENTIAL MISUSE?
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.
HOW DOES SSA RESPOND TO MISUSE ALLEGATIONS?
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/mmi-elder-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 non-
payment)• 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, Numbers
• Person-centered care• Resident history, needs and preferences
and support them• Discuss advance planning, POA,
representative payee, access to personal needs allowance
• 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
ACTION
• Stop the abuse
• Support the victim
• Report
• Investigate
• Remedy
How Can You Help• Learn about financial
exploitation• Identify key resources
• Speak with residents about their rights and the facility’s responsibilities
• Share information regarding financial exploitation• Residents (Resident Councils)• Family Members (Family
Councils)
• Facility Staff (staff in-services)• Other Visitors (friendly visitors,
medical service providers)
• Connect with local and state partners
• Increase public awareness• Media, your agency
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/State-Websites.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
• Know, Plan, Review, Protect
• Protecting Your Loved One
• Understand, Watch, Share, Report
• Separate fact sheets for nursing homes and assisted living
• http://www.theconsumervoice.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.