Posted by: Richie Bernardo

1. Main Findings
2. Ask the Experts
3. Methodology

Main Findings Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/28754/geochart.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="http://ift.tt/2k1Flvk; States with the Best Elder-Abuse Protections

Overall Rank	State	Total Score	‘Prevalence’ Rank	‘Resources’ Rank	‘Protection’ Rank
50	Wyoming	18.18	48	26	45
51	South Carolina	12.49	50	39	37

 

Ask the Experts < >

• Ronald W. Costen Professor Emeritus in the School of Social Work at Temple University
• Donna Wagner Dean of the College of Health and Social Services at New Mexico State University
• Thomas G. Blomberg Dean and Sheldon L. Messinger Professor of Criminology and Executive Director of the Center for Criminology and Public Policy Research in the College of Criminology and Criminal Justice at Florida State University
• Debra Tyler-Horton State Director of AARP Georgia
• Maria Duggan Adjunct Assistant Professor in the Virtual Academic Center at the University of Southern California Susan Dworak-Peck School of Social Work
• Sheying Chen Professor of Public Administration and Social Policy in the Dyson College of Arts and Sciences at Pace University
• Meredith Hawkins Pitt Assistant Professor of Gerontology and Advisor to the Gerontology Club in the College of Health Professions at The University of Findlay
• Luci Bearon Associate Professor and Extension Specialist in Adult Development and Aging at North Carolina State University
• Angela M. Goins Lecturer in the Social Work Program at the University of Houston-Downtown
• Daniel B. Kaplan Assistant Professor of Social Work at Adelphi University School of Social Work

Ronald W. Costen Professor Emeritus in the School of Social Work at Temple University

What are the most common types of elder abuse?

The most common types of elder abuse that I confront are theft of assets from the older adult, and neglect by caregivers resulting in bodily injury or serious bodily injury. Theft is the most common form of mistreatment and in my experience, the person engaging in the theft is usually a family member of the older adult, who may be classified as a caregiver. Often, the so-called caregiver keeps the older adult in his or her home, or that of the caregiver, even when the older adult needs some form of long-term care and attention.

This is particularly true when the older adult has a significant amount of assets or property. This becomes the turning point, as long-term care services in a nursing home for someone with assets can run between $250 to $400 per day. If the family member caregiver were to place the older person in that setting, that older person's assets would be significantly depleted by the cost of the long-term care, thus the decision to keep the older adult, regardless of need, out of specialized care. If the older adult's assets are depleted, that means that the inheritance of the caregiver would be depleted, thus the desire to keep the older adult out of long-term care.

Another form of theft is for the family member, or non-family caregiver, to have the older adult execute a power of attorney, often by deception, that gives that person the status of being the POA agent. In the POA document, the agent sees to it that there is an "unlimited gifting" category that would allow that person full access to the funds and property of the older adult. As older adults become more involved in numerous conditions or illnesses, one of the last things that they are concerned with is managing their assets. Thus, the POA agent may with impunity, and lack of scrutiny, engage in spending the older adult's assets freely, with no fear of discovery.

In fact, older adults, when told by Area Agency on Aging investigators that they have uncovered theft of assets by the POA agent, often refuse to believe that this is true, in that as we age, we are much less likely to want to be involved in any emotionally charged and disruptive circumstances with caregivers and family. Thus, older adults will often ignore what they are told and allow the agent to continue to steal. This can only be remedied by some agency or other family member applying to a probate court to have the older adult declared incapacitated, and having the court revoke the power of attorney and appointing a guardian that will be under the supervision of the court. Guardianship can only be pursued when the older adult is cognitively incapacitated.

How can policymakers protect the elderly from abuse, financial or otherwise?

Policymakers can protect the elderly by requiring banks to report when significant assets of an older adult (in Pennsylvania, a person 60 years of age or above) are being taken out by a newly appointed co-owner of the account, or by a power of attorney agent that has been appointed by the older adult. Banks see all of these transactions, and they also have a standard diagram of how each depositor generally spends their assets on a monthly basis. Thus, seeing an older adults’ expenditures rise from a total of $1,200 per month to over $4,000 should be a red flag that law or regulation should require that banks report to local area agencies on aging. These are social and health services agencies, which also provide protective services to people (60 and up) who are being victimized financially or bodily.

The question of discovering those older adults who are being neglected comes from careful scrutiny of personal care homes (board and care homes) and nursing homes by the licensing agencies. Finding older adults that are neglected in the community is more difficult, but advertising campaigns, watchful Meals on Wheels delivery personnel and neighbors can be a source of information about mistreated in the community, if the information is shared with the local area Agency on Aging.

Should there be legal restrictions against caregivers financially benefitting from the death of the person he/she was caring for?

Pennsylvania is now considering developing legislation that would prohibit caregivers who either steal from the older adult or are involved in neglecting the older adult, to the point of injury or death, from being able to take under a will or an insurance policy. There are many pros and cons to this legislative thought process. Now, in Pennsylvania, the law ("The Slayer Act") prohibits anyone involved in killing another person from benefiting from any insurance policy or standing as a beneficiary in a will. We are thinking of modeling legislation along those lines. But, much work to do.

What can families do to protect elderly family members from being abused financially?

The best way that older adults can be protected from financial abuse is to have a third disinterested party, that has no way of profiting from those assets, involved in reviewing how the older adult's funds are being spent. This can be done through a power of attorney document or an agreement between the older adult and a trusted party, such as an attorney, clergyperson or other reputable party that has the interest of the older adult at heart, and has no ability to profit financially.

Donna Wagner Dean of the College of Health and Social Services at New Mexico State University

What are the most common types of elder abuse?

Elder abuse includes a wide array of abuse, including financial exploitation, physical abuse, sexual abuse, neglect and psychological abuse. It’s difficult to say which of these are the most common, as the research generally focuses on one set of abuse practices, or a cluster with common themes. If I had to guess, I would say the financial abuse and neglect might be the most common. Abusers are also a diverse group, from spouses, to adult children, to grandchildren or other relatives, to neighbors and others.

A common theme in domestic abuse situations is a dependence of the elder on the abuser -- this is not to be confused, however, with a cause and effect relationship. If you are caring for your older grandmother who is dependent on you, you are not at risk of becoming an abuser. Abuse behavior includes a complicated set of personal characteristics, that are often unrelated to the situation in which the abuse occurs. My own research centers on family caregiving, and I often hear at meetings people’s report that abuse is a consequence of the stress of family caregiving. Caregiving is stressful, but that does not mean that all caregivers will eventually, based on increasing stress levels, begin to abuse the care recipient. People who engage in elder abuse come from all types of backgrounds, of different age categories and an array of relationship categories.

Substance abuse problems can play a role in elder abuse, as well. Like domestic violence situations involving younger people, it’s often a family secret that has been ongoing for a long time, and one that is kept secret by other family members. Abuse can include physical violence towards the elder, withholding medication or food, exploitation of the resources of the elder, and neglect of the elder’s physical, psychological and/or spiritual needs. It’s a big tent that includes diverse relationships and types of abuse. Because abuse is generally something that occurs in the home, it is difficult for law enforcement or social service professionals to identify the abuse. Physicians may see signs of abuse when they examine older persons, but these signs might also be explained away by the elder as the result of a fall or other accident, in order to avoid the embarrassment of admitting that their adult child is abusing them.

Thomas G. Blomberg Dean and Sheldon L. Messinger Professor of Criminology and Executive Director of the Center for Criminology and Public Policy Research in the College of Criminology and Criminal Justice at Florida State University

What are the most common types of elder abuse?

Over 50 percent of the reported cases of elder financial exploitation, namely illegal seizure of funds or other assets, are carried out by family members or friends rather than strangers. In our study of elder financial exploitation in the Florida Villages retirement community, the largest retirement community in the U.S., we found that the majority of non-family and close friends incidents of "stranger" financial exploitation related to home services or disputes with contractors. A number of individuals described incidents where a deposit was given for home repairs/services, and services were never received.

How can policymakers protect the elderly from abuse, financial or otherwise?

Our Village findings highlight the need and potential usefulness of "Community Service Centers" (CSCs). Many of the residents fell victim to exploitation, in part, because they lost their social network when they moved to the Villages and/or experienced significant life changing events. CSCs could serve as a surrogate family and support network, where residents of retirement communities could turn for advice and assistance.

p>Should there be legal restrictions against caregivers financially benefitting from the death of the person he/she was caring for?

I believe legal restrictions need to be in place for caregivers and/or guardians to help protect the elderly and their estates. Our current laws are inadequate and elderly abuse and financial exploitation will continue to grow, as our population of 65 or older is the fastest growing segment of the population, expected to increase to 55 million in 2020. Such legal restrictions will need to be well-thought-out.

What can families do to protect elderly family members from being abused financially?

The major concern voiced by elders in our study in the Villages, and found in other studies as well, is to maintain their independent living arrangement. They do not want to move in with their children or to be moved to assisted living facilities. As a result, elders often suffer from abuse and financial exploitation in silence, for fear that their "well-meaning" children, if they are aware of the abuse, will take away their independent living arrangement. Families need to be open with elders and supportive of their wishes -- letting them know that as long as humanly possible, they will live as they choose and are able. Open communication and listening to our elders is essential for providing our elders dignity, safety, and self-determination to the extent possible.

Debra Tyler-Horton State Director of AARP Georgia

What are the most common types of elder abuse?

Financial, physical and emotional.

How can policymakers protect the elderly from abuse, financial or otherwise?

This year, the Georgia Legislature passed the Uniform Power of Attorney Act, which will help protect vulnerable adults and provide their caregivers with the tools they need to make important financial decisions. In 2018, advocacy efforts will continue on behalf of the creation of an Abuser Registry, so families and loved ones can prevent hiring of caregivers with a known history of abusing vulnerable adults. Also, this year, Governor Deal added $766,000 to the Budget for additional Adult Protective Service workers who investigate the abuse of the elderly and disabled, over $2 million was added to increase the salaries of those who monitor nursing homes in the state, while over $100,000 was added for a prosecutor to help put abusers in jail. Support for these types of initiatives is critical in curbing elder abuse and exploitation.

Maria Duggan Adjunct Assistant Professor in the Virtual Academic Center at the University of Southern California Susan Dworak-Peck School of Social Work

What are the most common types of elder abuse?

Elder abuse has a prevalence nationally of 7 to 11 percent, and is most likely underreported (National Center on Elder Abuse). There are several kinds of elder abuse. These include physical and sexual abuse, neglect, financial abuse and institutional abuse (such as neglect in nursing homes). Physical abuse is the most common, often resulting in recognizable patterns of injury, such as certain injuries to the neck and head (Lachs & Pillemer, 2015). Most commonly, the perpetrator of elder abuse is an adult child or spouse, usually male. For example, a typical perpetrator would be an adult male child of the victim.

Risk factors include characteristics such as chemical dependency or mental health problems in the perpetrator, and he may come to depend on the victim for financial support and a place to live. The perpetrator is usually poorly equipped to deal with the stresses of caring for his elderly relative. Past domestic violence in a family is also a risk factor, particularly when a spouse is caring for the elderly victim (Harris, 1996). Elderly victims themselves also have risk factors. The greater the degree of dependence, the higher the risk of abuse or neglect. Dementia and behavior problems are also associated with victimization.

In most states, all health care providers and law enforcement are mandated reporters. This means that if abuse or neglect is suspected, a report be made to Adult Protective Services or to the supervising body for an institutional case (such as the DPH which supervises nursing homes in some states), or the ombudsman.

How can policymakers protect the elderly from abuse, financial or otherwise?

In 2010, President Obama signed the Elder Justice Act, which has implications for states and their handling of elder abuse and neglect. The Administration for Community Living (ACL) gives block grants to states for Adult Protective Services (APS), which are the state agency tasked with investigating and dealing with elder abuse and neglect. Each state has its own laws and definitions of elder abuse and neglect. Policymakers could positively impact the incidence of elder abuse and neglect by providing continuous funding for the agencies that deal with the problem on a local level. These include APS, Councils on Aging (COA’s), and the proper medical insurance to provide elders with consistent long-term health care that is accessible, through the ACA. In addition, legislators could better fund the updated version of the Elder Justice Act. It is still funded at its initial 2010 level, while the population of elders and elders at risk is increasing every day.

In terms of long-term care and policy, much could be done to improve the situation of elderly residents in nursing homes. For example, increased reimbursement to the homes for their care of the elderly, many of whom are covered only by Medicaid (not Medicare, which is intended for short-term rehabilitation in nursing homes). Improved supervision and support of the most important staff people in nursing care, Certified Nursing Assistants (CNA’s) is absolutely key. These workers are poorly paid, yet do the most important activities of daily care. They receive little recognition for their important work and have very little say or control over their work duties or environment. With low staff-to-resident ratios neglect is common in nursing homes (Hawes, 2002).

Should there be legal restrictions against caregivers financially benefitting from the death of the person he/she was caring for?

Only if the deceased was mentally incompetent at the time that the will was established. It is the legal right of persons to designate their own beneficiaries. If a beneficiary commits a crime then he or she should be prosecuted per the law.

What can families do to protect elderly family members from being abused financially?

This is a timely topic which will be especially important for our population as it ages. First, families should plan ahead, including advance directives designating financial powers of attorney, should the need arise. Families should be educated on how SSI and SSDI are used to cover nursing home placements, and the issue of spend-downs for Medicaid coverage. Planning should occur long before the crisis of placement of the elder in long-term care. Often, this is when financial abuse by family members is discovered, and the nursing home must petition the court to provide a guardian or conservator.

Second, the elderly must be protected from predatory financial extortion. Often, persons who take an elder’s money take advantage of their vulnerability, loneliness, and isolation. We protect our elders from all abuse and neglect by preventing social isolation and promoting social support networks (which may be part of state and federally funded entities, such as COA’s). In certain states, bank tellers are mandated reporters; training across involved parties, such as banks, retail, credit card companies, etc., would be helpful in preventing extortion of the elderly and their often-limited resources. In addition, when financial abuse and theft is discovered, law enforcement must collaborate with family and the above entities to resolve the crime.

Sheying Chen Professor of Public Administration and Social Policy in the Dyson College of Arts and Sciences at Pace University

What are the most common types of elder abuse?

Elder abuse may be looked at in terms of domestic, institutional, and self-abuses. More specifically, there are seven common types of elder abuse: physical abuse; emotional/psychological abuse; sexual abuse; neglect, abandonment; financial/material exploitation; and self-neglect/abuse (see National Center on Elder Abuse). Neglect and emotional abuse are among the most common types of elder abuse, while some other cases of abuse (including confinement and willful deprivation) may be more severe. And financial exploitation poses dramatically increasing and serious challenges to our socioeconomic and legal systems.

How can policymakers protect the elderly from abuse, financial or otherwise?

Policymaking and implementation are both crucial in protecting the elderly from abuse. Legislators need to address limited, outdated and unclear legal definitions and provisions with a systematic review of all existing laws, involving protective services (as many of them fail to adequately cover elder abuse, such as non-violent financial exploitation). Administrators should aim at prevention and providing elderly victims greater access to resources, such as legal assistance, shelter, and mental health services. There is a need for stronger regulatory oversight of not only residential care facilities, but also domestic services (e.g., home-care workers), as well as financial dealing with the elderly. There is also a need for more professionals required to help report suspected elder abuse (given the alarming estimates that only 1 in 14 to 23 cases of abuse are reported to authorities), and provide related services.

Should there be legal restrictions against caregivers financially benefitting from the death of the person he/she was caring for?

Simply “benefitting from the death of” an elderly person sounds problematic or even scary, leaving incentives or legal loopholes for potential criminals. Businesses and individuals should only benefit reasonably from taking good care of the elderly in this market economy. Therefore, there should be strict legal ban against theft, fraud, misuse of authority, extortion and manipulation in the name of care and in the event of death of the elderly. Deceptive business practices targeting elders, as well as manipulation of their death for unfair financial gain must be stopped. While elderly persons do have the right to designate their own beneficiaries, there should be background checks and legal restrictions for caregivers to financially benefit from the persons they are caring for based on the quality of care and length of service, subject to certain ceiling as service providers (especially in the case of death of the person cared for).

What can families do to protect elderly family members from being abused financially?

Studies have found that nearly 90 percent of abusers are family members or trusted others (see National Adult Protective Services Association: Elder Financial Exploitation). So, the first and foremost thing families can do to protect the elderly from being abused financially is to stop such abuse in the family (like using a Power of Attorney as a license to steal the victim’s monies, taking advantage of joint bank accounts or stealing checks/ATM cards to withdraw monies from the victim’s accounts, or forcing the victim to agree to such doing). For family members who are concerned about their loved ones, signs of potential abuse include excessive withdrawals from a bank account, unnecessary services or goods, and financial activities that couldn’t be completed by the senior person.

If financial abuse is suspected or confirmed, family members should work with their banks to recognize, report and investigate the cases in cooperation with law enforcement. Families may also contact a local Adult Protective Services office or the National Committee for the Prevention of Elder Abuse, or similar organizations for a list of resources.

Meredith Hawkins Pitt Assistant Professor of Gerontology and Advisor to the Gerontology Club in the College of Health Professions at The University of Findlay

What are the most common types of elder abuse?

For the purpose of this information, the older adult population is considered to be 60 years and over in the state of Ohio. Adult Protective Services is mandated by statute (ORC 5101.60) to investigate those cases where the adult is 60 years and older and lives in an “independent living arrangement” (ORC 5101.60(B)). An independent living arrangement is one where the adult lives in a domicile of the person’s own choosing, and it can also include a residential facility that is licensed that provides accommodations, supervision, and personal care services for three to sixteen unrelated adults. Any other types of facilities do not fall within the purview of Adult Protective Services in Ohio. Cases that arise from any long-term care facilities are referred to the facility’s ombudsman and the state’s ombudsman program.

According to information from APS, in 2015, there were 16,422 reports of abuse, neglect, or exploitation for this population. Abuse encompasses those acts that are emotional, physical, or sexual. Neglect is divided into two categories: neglect by others and self-neglect. Finally, exploitation is those acts that involve the financial well-being of the individual, including scams that are perpetrated by individuals or entities (grandparent scam, international or national lotteries, fake calls from the IRS or the Social Security Administration regarding taxes owed or benefits waiting for bank account update information).

The most commonly reported cases are those of neglect, specifically self-neglect. Reports numbered over 7,500 per year for the older adult population. Self-neglect occurs when the older adult fails to provide for themselves adequate food, water, shelter, or medication. However, when an individual makes the conscious decision at their own volition, and they are deemed to be mentally competent, these cases do not fall within the purview of Adult Protective Services.

Of the abuse cases, emotional abuse is the most prevalent, with 1,198 emotional abuse cases reported. Physical abuse was noted in 1,049 cases and 47 cases alleged sexual abuse.

How can policymakers protect the elderly from abuse, financial or otherwise?

Policymakers need to be behind the departments that are charged with educating the public about elder abuse. One in four individuals will experience some form of abuse, neglect, or exploitation. However, only 1 in 23 of those cases will be reported. There are a number of reasons for not reporting these cases.

The victim might be embarrassed, especially if the perpetrator is a loved one. The victim might also be afraid to report, thinking that, by their reporting, they are admitting that they can no longer continue to live on their own. Many want to continue to be in control of where they live. If they admit that they are not taking care of themselves, or someone is not treating them well, or they have made a number of poor choices (especially if being financially exploited), they fear they will lose that control. Finally, there might be an overall lack of education regarding what abuse looks like to the victim.

Additionally, there are individuals who are considered to be mandatory reporters. However, some of those individuals might not know who to report to, how to make a report, or whether they actually have the authority to report. Many might also be afraid that their report will result in repercussions against them if their claim of alleged abuse is proven to be false. In Ohio, statutory law mandates certain individuals to be reporters, with the statement that a report should be made when the reporter has “reasonable cause to believe” that an adult has suffered abuse, neglect, or exploitation (ORC 5101.63). This does not mean that the reporter has to prove, beyond a reasonable doubt, that a crime has been committed. The reporter’s belief is based on an informed decision that abuse, neglect, or exploitation might have occurred.

Should there be legal restrictions against caregivers financially benefitting from the death of the person he/she was caring for?

Finally, policymakers need to be aware of the needs of their Adult Protective Services departments. Financial support in the form of educational materials, as well as training of individuals who can speak to the general public to raise awareness of elder abuse, are absolute necessities. Another necessity is to maintain well-staffed departments. Reports that are made need to be investigated within a certain period of time. Overall, in the state of Ohio, there has been an increase in the number of reports received. However, some offices remain drastically understaffed. For example, one county in Ohio has one social worker who is in charge of APS reports with a county population of over 75,000.

What can families do to protect elderly family members from being abused financially?

In the state of Ohio, a principal can appoint an attorney-in-fact who can act on the principal’s behalf covering financial, business, personal, and real estate matters. The first step that a family can take is to assure that their loved one appoints someone as an attorney-in-fact. This does not mean that the attorney-in-fact can make all of the decisions for the elderly family member if the family member does not give them that authority to do so. For example, a son who is named in a financial power of attorney document can make decisions only when the parent is unable to make those decisions on their own, or the parent has chosen to turn over that decision-making to the son.

In cases where no document has been executed, the best advice for families would be to routinely check on their loved ones. Are they receiving suspicious mailings? Are they receiving purchases they do not remember making, or are they making purchases that seem excessive? The very least that families can do is to stay as informed and involved in the elderly family member’s life without being intrusive. It can be a very fine line to traverse.

Pay attention to what is needed around their residence. If any work needs to be done by a contractor, make a phone to the local Better Business Bureau or the state Attorney General’s office. Make sure that the contractor is licensed and bonded. Be careful of transient contracting companies, especially in situations where there has been widespread damage due to forces of nature (wind, hail, tornado, hurricane, fire).

Other schemes to be aware of can be found at the Better Business Bureau’s website. Unfortunately, criminals tend to prey on the elderly. Nobody should ever give personal information out over the phone, including bank account information, Social Security numbers, or credit card information. Being aware of the scams and schemes that are lurking out there is the best defense any family can have.

Luci Bearon Associate Professor and Extension Specialist in Adult Development and Aging at North Carolina State University

What are the most common types of elder abuse?

It is a sad fact that many older adults experience or are at risk for abuse, neglect and violence. There are several ways of categorizing types of elder abuse, but most fit into the categories of neglect (by others), physical abuse, sexual abuse, psychological abuse, financial abuse and exploitation, and self-neglect. Some forms of abuse occur in the home, where a family member or non-relative mistreats a dependent older adult; some occur in long-term care facilities, where an employee mistreats a resident; some occur when in contact with a friend or neighbor or other acquaintance or salesperson; some abuses occur by phone or online, with an unknown person using stolen credit cards or doing identity theft. Recent media coverage has also reported incidents of residents doing bullying in nursing homes, as well as employees secretly photographing residents and posting offensively revealing photos to social media.

How can policymakers protect the elderly from abuse, financial or otherwise?

There are public programs, policies and laws in place designed to protect older adults from various forms of abuse, but there are significant challenges for providing preventive approaches and for intervening in abusive situations. Preventive approaches require planning ahead and increasing the awareness of the public about the numbers and consequences for people at risk. Studies have shown that many abuses go unreported -- because the victims are often compromised by physical or cognitive disabilities or by fear, shame, and embarrassment. More public dialogue, advocacy and action for "elder justice" will be essential to gaining public support and sustaining the necessary funding for the growing population of older adults.

What can families do to protect elderly family members from being abused financially?

Families can help their older family members avoid or minimize financial abuse and fraud by including the topic in family conversations. Family members of all ages can benefit from lifelong learning about the world of finance, and about the more common errors and pitfalls people can fall prey to. Also, family members should stay current and vigilant as new scams are introduced, new products are developed and technologies bring new options and challenges. If family members perceive that an elder is having problems managing their money, they may offer to assist with record-keeping or other financial transactions. For some elders, this will be met with appreciation, but for others, this assistance or intervention may be unwanted or even unneeded and may threaten an elder's autonomy. As with many difficult family conversations, it is important to be respectful of the dignity and rights of all concerned.

Angela M. Goins Lecturer in the Social Work Program at the University of Houston-Downtown

What are the most common types of elder abuse?

Physical abuse, physical self-neglect of the older adult to himself of herself, and exploitation by a person who has assumed a caregiver (not necessarily family member) role for the elder. The forms or types of elder abuse include:

• Physical abuse (hitting, punching, slapping an older adult).
• Verbal (yelling, hollering and screaming at the older adult and threatening them verbally).
• Psychological abuse (speaking demeaning to older adults and threatening to hurt them).
• Caregiver physical neglect (caregiver not providing the required goods or resources for an older adult they have assumed a caregiver role for, to prevent them from being in a neglectful situation). E.g., not paying their bills timely, or not buying groceries for them when the caregiver manages the older adult's money.
• Caregiver medical neglect (caregiver not providing required medical attention or resources for the older adult they have assumed a caregiver role for). E.g., not getting them to the doctor when they need attention, or not getting the medication they need, when they have the financial means.
• Physical self-neglect of the older adult to himself or herself (an older adult who, because of cognitive decline or physical decline, is not able to provide or obtain resources or services to keep them from being in a state of self-neglect). E.g., can't pay light, gas or water bill due to cognitive decline, and the lights may be at disconnect as a result.
• Medical self-neglect of the older adult to himself or herself (not taking medication that can be life-sustaining or not seeking medical attention in a medically life-threatening health issue).
• Financial exploitation (by a caregiver or person who has assumed a caregiver role).
• Sexual abuse (by a caregiver or someone identifies as a caregiver).
• Mental health neglect (neglect of an older adult to himself or herself due to mental decline).

How can policymakers protect the elderly from abuse, financial or otherwise?

One way that policymakers can protect the elderly from abuse, financial or otherwise, is by supporting legislation that gives attention (education/data) to elder abuse as a growing issue that is prevalent in our country. Another way policymakers can protect the elderly from elder abuse is by lobbying and advocating for funds be allocated to agencies/groups on the federal, state, county and city levels to work with victims of elder abuse, along with funds for education and prevention of elder abuse.

What can families do to protect elderly family members from being abused financially?

• Prevention. Speak to their loved ones about who can they trust to manage their money in the event they are not able to manage their own finances at some point (suggesting financial power of attorney over financial affairs while they have mental capacity).
• Visiting the elderly more often (isolation is one of the top risk factors for elder abuse to occur in general), so they know when something seems out of the ordinary (such as strangers befriending the older adult and taking money from them, an older adult sending money to people they do not know -- scams -- or the older adult being without basic resources and goods to survive because the money comes up missing), and checking with the family member managing the money to ensure that they are using the elderly person's money for elder's needs only.
• Encourage the older adult to have his/her Social Security check or pension sent to a bank and not through the mail, to ensure that checks and fund can be easily traced and accounted for.

Daniel B. Kaplan Assistant Professor of Social Work at Adelphi University School of Social Work

What are the most common types of elder abuse?

Recent research suggests that approximately 10 percent of all older adults are victims of mistreatment. Elder abuse leads to serious consequences, including injuries and pain, poorer health, premature nursing home placement, depression, anxiety, and loss of financial security. When a person known to the older adult is the reason for such risks, we call it elder abuse. Caregiver neglect is the most common form of elder abuse, accounting for about 1 in 5 cases. These situations involve an informal caregiver, like a spouse or an adult child, who is overwhelmed by the intense stresses of caregiving and, in many cases, struggling to manage other aspects of their lives, such as other family burdens, family dysfunction, addiction, or mental illness.

Emotional abuse is the second most prevalent form of elder mistreatment and is implicated in about 15 percent of reported cases. The other forms of mistreatment include financial exploitation, physical abuse, and sexual abuse. Family members are the perpetrators in nine out of every ten cases of elder abuse.

How can policymakers protect the elderly from abuse, financial or otherwise?

It is important to understand that fewer than 20 percent of abuses are reported to the systems which are designed to respond to such allegations, in order to assure that mistreated older adults have access to help. What's worse is the fact that many of our states have protective service systems that are truly challenged to provide appropriate interventions. Overall, the elder protective service system is uncoordinated, disconnected, and under-resourced, with incredible variation in structure, regulation, and funding across states.

A policy solution will need to help create a comprehensive knowledge base, to better understand the problem, as well as a coordinated response to this tragic and growing public health problem. Local lawmakers at the county and state levels could seek to build policies and adopt best practices which emulate those used in jurisdictions that have robust elder protective service programs, such as in the example of Massachusetts, while also advocating for a national protective service system. The ideas put forth in the Elder Justice Act would allow for dramatic improvements in our efforts to prevent and respond to cases of elder abuse, but only if its full potential impact could be realized through public policy and budgeting.

Should there be legal restrictions against caregivers financially benefitting from the death of the person he/she was caring for?

Throughout history, families have been caring for their ailing elders. Similarly, most people hope that an inheritance of assets and funds will allow their loved ones to experience some relief from the financial hardships and pressures that most families face. We know that intergenerational transfers of wealth and homeownership are keys to breaking free from cycles of poverty.

The solution to elder financial exploitation should not include impediments to wealth transfer, which will have disproportionately harmful effects on marginalized communities, but should instead focus on building public awareness of appropriate ways to both provide care to our loved ones, and to gain access to professional services offered by an elder care system that is sufficiently infused with the investments required to assure high-quality care. I often ask my social work students, "If your children were to become overwhelmed by meeting your care needs in late life, which of you would be excited to live in a nursing home?" The absence of raised hands illustrates how far we need to go in order to achieve a quality of care that is both appropriate and realistic.

What can families do to protect elderly family members from being abused financially?

Many older adults are exploited by family members, friends, and neighbors. The reasons for vulnerability to this type of exploitation also exposes elders to scams and hustles that target large numbers of older people. Families should feel empowered to vigilantly watch for the contextual warning signs of exploitation. Is the older adult confused about recent financial arrangements, or reluctant to talk about such matters? Is someone in the family helping with care, when he or she has no income or other means of support? Is the family caregiver overly concerned about the elder's finances or speaking on behalf of the elder when these topics are raised? Is the caregiver restricting access to the older adult or refusing to allow others to help with bill paying tasks?

Any of these warning signs are enough reason to justify a consultation with a protective services program. We often find such concerns coincide with evidence of numerous account withdrawals, forged checks, unauthorized use of credit cards, and recent changes to trusts and wills, when the elder is clearly incapable of making informed decisions about legal and financial matters. When families engage in open dialogue about the financial affairs of their older loved ones, transparency and accountability are easier to achieve, and warning signs of exploitation can be discovered.

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