Risks of Financial Elder Abuse

Course Leader

Elizabeth (Dr Liz) has over twenty years of experience in providing medical care to the elders. She is board-certified in Internal Medicine, Geriatric Medicine and Palliative Care Medicine. Dr Landsverk founded ElderConsult Geriatric Medicine, a house calls practice, to address the challenging medical and behavioral issues often facing older patients and their families.

Dr Landsverk was an assistant professor of Medicine at University of California, San Francisco, an adjunct professor of Medicine at Stanford University, as well as consultant to the San Francisco Elder Abuse Forensics Center and Hospice Medical Director. She is currently the Medical Director for Silverado and Kensington Dementia Care Communities, as well as on the Scientific Panel for the Alzheimer’s Association. Dr Landsverk graduated from Stanford University, and trained at Cambridge Hospital, Harvard University, and Mt Sinai Medical School.

As a House Calls Geriatrician, she collaborates with local physicians to address the needs of complicated vulnerable elders to alleviate pain, agitation and discomfort through the utilization of geriatric and palliative care techniques.

Learning Objectives

Lesson 1 – What is Financial Elder Abuse?

This lesson introduces the learner to financial elder abuse. Identifying features are discussed, alongside exploration of the diversity and range of people

On completion of this lesson the learner will:

• Be able to give a clear definition of the nature of financial elder abuse
• Understand the diverse and varied social demographic of those people who commit financial elder abuse
• Understand why elders, particularly those with dementia, are more vulnerable to financial elder abuse.

Lesson 2 – Quick, Simple Assessments for Dementia

This lesson discusses commonly used simple assessments for dementia, such as filling in or reading the numbers on a clock face. The value of asking simple questions and identifying disparities between elder and family member answers is discussed. The implications of these disparities are discussed.

On completion of this lesson the learner will:

• Be able to summarize commonly used simple tests for dementia
• Understand the implications of confusion in the areas being assessed such as medications and household finances.

Lesson 3 – Don’t be fooled by Normal Tests

This lesson examines both the Mini Mental Test and Montreal Cognitive Assessment. The positives of using these tests are discussed, alongside identification of the flaws of both methods. The need for a holistic method looking not only at test scores but behavior and other changes is emphasized.

On completion of this lesson the learner will:

• Be able to describe the features, positives and negatives of using different assessments used during clinical diagnosis of dementia.
• Understand the need for a whole person, holistic assessment examining all changes the elder is undergoing – including test results but not dismissed if normal scores obtained.

Lesson 4 – Elders Need Help With Financial Decisions

This lesson briefly discusses the Iowa Gambling Test as an alternative to other assessments for dementia, and its particular suitability for people with frontal-temporal lobe damage. The challenges faced by, and potential threat to this group is discussed in relation to Financial Elder Abuse.

On completion of this lesson the learner will:

• Understand how the Iowa Gambling Test may be useful for assessment in people with normal scores in other tests but impaired risk assessment skills.
• Understand the challenges people experience when relinquishing control of finances
• Understand the consequences financial elder abuse could have on this group and their assets.

Lesson 5 – What are Adult Protective Services?

This lesson introduces the learner to Adult Protective Services, their role and scope of practice. The discussion is illustrated by anecdotal evidence from Dr Liz’s personal family experiences.

On completion of this lesson the learner will:

• Understand the Role of Adult Protective Services, their scope, and limitations in relation to financial elder abuse.
• Understand the essential nature of early planning and discussion of potential need for financial and medical safeguards.

Lesson 6 – Red Flags of Elder Abuse

This lesson explores red flags of financial elder abuse in people with or without a diagnosis of dementia. Issues such as risky decision making, financial secrecy and hiding information from loved ones are discussed, alongside the pertinence of getting help if red flags are present.

On completion of this lesson the learner will:

• Understand that financial elder abuse does not happen only to people with dementia.
• Know the common warning signs of financial elder abuse.
• Understand the essential nature of getting help once red flags are present.

Lesson 7 – What is Undue Influence?

This lesson outlines the key features of undue influence, and illustrates this with examples.

On completion of this lesson the learner will:

• Know the identifying features of undue influence and what groups are most vulnerable.

Lesson 8 – Why Should you go to an Elder Law Attorney?

This lesson outlines the services provided by an Elder law attorney. Durable power of attorney is discussed. The value and protection offered by setting up irrevocable trust is discussed.

On completion of this lesson the learner will:

• Understand the role of and services supplied by an Elder Law Attorney.
• Understand the definition and role of Durable power of Attorney.
• Understand the definition and role of irrevocable trust.

Lesson 9 – Seeking Guardianship or Conservatorship

This lesson discusses the definition, function and appropriateness of conservatorships and guardianships. The potential benefits of conservatorships and guardianship are discussed; alongside the protections they maintain long term from outside abusive forces.

On completion of this lesson the learner will:

• Understand the definition and function of guardianship/conservatorship
• Understand the role guardianships and conservatorships in protecting elders from financial abuse
• Have knowledge about the stage of dementia at which a guardianship/conservatorship may be needed and appropriate for the elders in their care.

Lesson 10 – What is a Fiduciary?

This lesson explores the role and function of a fiduciary in protecting elders from financial abuse. The differences between a certified fiduciary and regular stock broker/ financial advisor are discussed. The importance of, and rationale for using a certified fiduciary in relation to elder finance management is discussed. The role of a care manager is also discussed.

On completion of this lesson the learner will:

• Understand the role and function of a fiduciary in protecting elders from abuse, and the differences between a fiduciary and stockbroker/financial advisor.
• Have sound rationale as to why using a fiduciary, rather than a stockbroker or financial advisor is essential when managing the financed of elders with impaired judgement.
• Understand in what capacity use of a care manager may be useful/appropriate.

Lesson 11 – How to Prevent Financial Elder Abuse

This lesson provides a summary of the information provided in lessons 1-10.

On completion of this lesson the learner will have consolidated the learning and information discussed throughout the course.

Finances

Part 2 – Mom’s Not Paying Her Bills So Now What?

This section of the course comprises a series of short videos outlining some practical challenges and solutions surrounding financial abuse, particularly in relation to people living with dementia. This part of the course equips caregivers with real world knowledge how to assess, identify and deal with the risk and realities of elder abuse.

Lesson 1- Dementia puts Elders at Risk for Scams

This lesson discusses the tactics of scammers and criminals in targeting vulnerable people, such as elders and those with dementia.

On completion of this lesson the learner will:

• Understand the techniques used by scammers to target the vulnerable.
• Be able to identify risk factors that may increase vulnerability to financial elder abuse

Lesson 2 – Dementia puts Elders at Risk of Abuse

This lesson outlines the dangers posed to elders by opportunists such as ‘contractors’ knocking door to door. The increased vulnerability of elders with impaired judgment and risk assessment skills is explored.

On completion of this lesson the learner will:

• Be aware of the increased vulnerability of people with impaired judgment and risk assessment functions
• Understand how these vulnerabilities increase the risk of elders being taken advantage of by scam contractors etc.

Lesson 3 – Who Can the Elder Lean on For Help?

This lesson emphasizes the importance of maintaining aspects of the elder’s life that hold value for them. The support network required to maintain independence is outlined. The importance of a meeting between the elder and all the people involved in maintaining their independence is discussed.

On completion of this lesson the learner will:

• Understand the importance of person-centered caregiving in maintaining independence for elders with dementia.
• Understand the need for a meeting between all involved family/friends/caregivers and the elder, before the elder is unable to make decisions.
• Understand the range of people that may be required to maintain independence and safety of the elder.

Lesson 4 – Is Fiduciary a Good Idea?

This lesson expands on the previous exploration of fiduciaries in lesson 10 of part 1. Real life practicalities such as help with medical choices, bill paying, durable power of attorney and general finances are discussed. The official responsibility of fiduciaries is emphasized.

On completion of this lesson the learner will:

• Understand the practical role of fiduciaries in managing elders finances
• Understand the official responsibility of fiduciaries.

Lesson 5 – Who is the Best Person to Help?

This lesson discusses the importance of selecting the most appropriate person to help the elder. The importance of making everyone aware of the elder’s wishes to avoid family conflicts later is discussed. Strategies to enable reluctant elders to get the help they need are explored, alongside the importance of engaged caregivers who can maintain the elder’s interest in activities is discussed. The importance of the support network around the elder in maintaining financial and physical safety is emphasized.

On completion of this lesson the learner will:

• Understand the importance of planning, communication and selecting the correct person to help the elder.
• Have knowledge of different strategies to assist elders in getting or accepting help.
• Understand the importance of the support network in maintaining the elder’s financial and physical safety.

Lesson 6 – When is Professional Help Needed?

This lesson discusses the worst-case scenarios of elders refusing help or being taken advantage of by a new romantic partner. Next steps are discussed including obtaining a medical diagnosis, and the types of physicians able to diagnose dementia. The Montreal Cognitive Assessment (MoCA) is discussed including its limitations in regard to financial judgment.

On completion of this lesson the learner will:

• Understand the steps that need to be taken in the worst-case scenario of elders refusing help or a new romantic partner abusing their finances.
• Understand the importance of obtaining a medical diagnosis for those without capacity.
• Understand the function and limitations of the MoCA.

Lesson 7 – Stepping Up for the Elderly

This lesson covers the potential risk to vulnerable elders and their assets from phishing, phone scams and charity campaigns asking for donations. Steps to take are covered, along with an explanation of agnosia, and how this can create challenges in keeping the elder safe.

On completion of this lesson the learner will:

• Understand the danger to elders and their assets from phishing, phone scams and charity campaigns.
• Know what actions to take if elders are affected.
• Be able to define agnosia and understand the challenges it can cause when attempting to keep elders and their assets safe.

Lesson 8 – Are More People at Risk?

This lesson discusses the increased incidence of dementia, correlating with greater life expectancy. Medications that can affect the function of people with dementia are discussed, alongside the negative effects of alcohol, caffeine and nicotine.

On completion of this lesson the learner will:

• Understand the relationship between increased life expectancy and higher incidence of dementia
• Understand the potential negative effects of medicines, alcohol, nicotine and caffeine on people with dementia.

Lesson 9 – When They Take it the Wrong Way

In this lesson Dr Liz discusses a personal account of challenges from a viewer of the ‘High Noon’ series. Anger and negative emotions are discussed, alongside potential medications that may be able to help the viewer’s husband.

On completion of this lesson the learner will understand the potential challenges posed by negative emotions experienced by the elder, alongside the potential need for pharmacological intervention.

Summary

This course explores all aspects of financial elder abuse. On completion of the course learners will be able to identify those at risk of abuse and know the signs and red flags of ongoing financial elder abuse. They will also be equipped with the appropriate knowledge of the correct steps to take to safeguard against and deal with financial elder abuse. Learners will also be equipped, by completion of part two, with practical real world solutions to the common challenges of managing elder finances.