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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 webinarSlide2
OverviewWelcome 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 Slide3
Poll Question #1Slide4
Prevalence of Abuse Abuse, Neglect and Exploitation (ANE)
*Estimated that 1 in 10 elders experience ANE
Only 1 in every 23 cases are reportedAs 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
T
he
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
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Financial Exploitation in Long-Term Care FacilitiesSlide6
Poll Question #2Slide7
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 WebinarSlide8
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 2011Mission: 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 ExploitationDefinition: 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 exploitationMoney or property seems to be missing.Sudden changes in spending or savings, e.g.Large withdrawals without explanationUsing ATM a lotCan’t pay bills that usually are paid
Makes new or unusual gifts to family or others, e.g. “new best friend”Changes beneficiariesFear 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 scamsDon’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 exploitationTrust, 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, statementsMonitor bank accounts, phone billsNever let caregivers use credit/debit card for errands, purchases
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OA Initiatives: Managing Someone Else’s MoneyPROBLEM: 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’dCFPB 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’dWhat is a fiduciary? Anyone named to manage money or property for someone elseFour main duties:Act only in the person’s interest – avoid conflicts
Manage the money and property carefullyKeep the person’s money and property separate from yours
Keep good recordsGuides 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’dNational guides available for download http://www.consumerfinance.gov/older-americans/ (see third paragraph) and free in bulk
http://promotions.usa.gov/cfpbpubs.html#specialUpcoming: 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 FacilitiesPROBLEM: 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 AdultsSlide23
OA Initiatives: Money Smart for Older AdultsPROBLEM: 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 exploitationGuard against identity theftPlan for unexpected loss of the ability to manage finances
MODULE TOPICS:Common types of elder financial exploitationIdentity theft
Scams targeting homeowners and older veteransPlanning for unexpected life eventsHow to be financially prepared for disasters
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Downloading and ordering Money Smart materialsTo 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 KarpSenior Policy Analyst – Office for Older Americans
Consumer Financial Protection BureauNaomi.karp@cfpb.gov
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Poll Question #3Slide28
SOCIAL SECURITY’s REPRESENTATIVE PAYEE PROGRAMRESPONSIBILITIES and OVERSIGHT
Consumer Voice Webinar -
Tips and Tools for Preventing, Detecting and Reporting Financial Exploitation Slide29
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?Slide30
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 ?Slide31
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; andReturn any payments to which the beneficiary is not entitled to SSA.
WHAT ARE A PAYEE’S RESPONSIBILITIES ?Slide32
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?Slide33
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, orYou 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-abuseHOW CAN SOMEONE REPORT POTENTIAL MISUSE?Slide34
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 payeeObtaining restitution from the misuserReissuing 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? Slide35
Questions? Slide36
DiscussionSlide37
ScenarioA 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. Slide38
Scenario QuestionsHow 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? Slide39
Poll Question #4Slide40
Discussion #1Do 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?Slide41
Discussion #2What successful approaches have you seen long-term care facilities implement in order to prevent, detect and respond to financial exploitation? Slide42
Discussion #3Please share how you engaged local law enforcement in order to improve their response, investigation and prosecution of financial exploitation.Slide43
Discussion #4Please share an example of how you’ve increased public awareness of financial exploitation.Slide44
Discussion #5Which organization, agency or group have you found to be essential to collaborate with in order to address financial exploitation?Slide45
Discussion #6How 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? Slide46
Financial Exploitation – A RecapIndicators
Unpaid bills
Lack of necessities – clothing, shoes, etc.Gifts to staff
Pressure from a family member/friend to sign documents immediately
Missing personal possessionsSlide47
Three Types of Financial Exploitation*
Metlife Study of Elder Financial Abuse (2011)
https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf Slide48
Impact of Financial Exploitation (FE)
Harm to ResidentsEmotional 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,
f
ines/corrective action, legal
f
ees
*Metlife Study of Elder Financial Abuse (2011)
https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf
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Facility ResponsibilitiesPREVENTION
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
RemedySlide50
How Can You HelpLearn 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)Slide51
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
/
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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)Slide53
ResourcesNational 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
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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
.