Elder Fraud on Better Call Saul

I love Bob Odenkirk. More specifically, I love Bob Odenkirk as lawyer-with-a-heart-of-gold Jimmy McGill in AMC’s Breaking Bad spinoff, Better Call Saul. After bottoming out as a criminal lawyer, Jimmy’s decided to try his hand, pretty successfully, at Elder Law.
Need a Will? Call McGill!

In last night’s episode “RICO”, our hero takes on Sandpiper Crossing, an assisted living facility that’s been bilking it’s senior residents out of their pension and social security monies by overcharging for goods and services ($14 for a box of Kleenex!) The reason this episode rings so true, unfortunately, is the story is altogether too believable. Great premise, great episode, great show.

Elder abuse and neglect can take many forms — physical, sexual, emotional, and financial. Of the four, the financial exploitation of seniors seems to be the most prevalent. Seniors are especially vulnerable to financial abuse because they are usually dependent on others for help and give access to their “helpers.” Many times, if the abuser is a family member, the senior doesn’t want to “get them in trouble” or are embarrassed by the abuse. We don’t know the actual extent of the abuse, since so much goes unreported, but the National Center on Elder Abuse estimates that 1 in 10 elderly Americans is abused or neglected each year.

Besides the obvious — taking money or property, abusers can forge the senior’s signature on documents, coerce powers of attorney, and use the older person’s possessions without permission. Of course, seniors are especially susceptible to scams.

The National Institute on Financial Issues and Services for Elders, a division of the National Council on Aging, gives these as signs of elder financial abuse:

  • Unusual or inappropriate bank account activity
  • Frequent checks for cash are written to a caregiver or financial professional.
  • The elderly person's living conditions are well below his or her financial resources.
  • Bills go unpaid or are overdue when someone is supposed to be paying them.
  • The senior transfers assets (like the title for their home) for no apparent reason.
  • Large, frequent gifts are made to a caregiver.
  • Personal belongings are missing.
  • Attempts are made by to isolate the senior from others.
  • Changes are made in a will
  • The older person takes out large, unexplained loans.

By 2050, 20 percent of the total U.S. population will be aged 65 and older. The fastest growing segment of America’s population is 85 and up. In 2010, there were 5.8 million people aged 85 or older. It’s vital that our senior caregivers are able to recognize the signs of elder abuse. All comprehensive caregiver training should include learning the types of senior abuse, legal requirements for reporting, and how to proactively protect a senior from physical, emotional, sexual and financial abuse. And storylines like the one on Better Call Saul shine a spotlight on the problem and make it easier for us to recognize abuse.

California Enacts Minimum Caregiver Training

Cases of elder abuse and elder neglect can be found everywhere. Abuse can be physical, psychological, and/or emotional. Seniors can be the victims of neglect when caregivers fail to fulfill their duties and obligations to provide even the most basic elder care. Seniors can be the victims of financial exploitation, especially when they entrust their caregiver with their funds and assets. If a caregiver is going to mistreat someone in their care, they’d be hard-pressed to find an easier victim than a vulnerable senior.

Senior care experts agree that there is a correlation between caregiver training and elder abuse. Regrettably, there is no federal mandate for caregiver training. It is up to each state to set its own guidelines for nursing assistant, home health aide, and personal care aide training and supervision. Most senior care agencies have minimum training requirements for their employees, but are not required by law to do so.

California has taken steps to rectify that situation with its Home Care Services Consumer Protection Act. Per Assembly Bill 1217, on and after January 1, 2015, home care agencies would be duty-bound to establish and continuously update a home care aide registry and would require criminal background check clearances for home care aides.

Caregiver training would include a minimum of five hours of entry-level training prior to working with a client. This includes:
(1) Two hours of orientation training outlining the role of a caregiver.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
(3) An additional five hours of annual training. The annual training will include, but not be limited to:

  • Clients’ rights and safety.
  • How to assist a client’s activities of daily living.
  • How to prevent, detect, and report abuse and neglect.
  • How to assist a client with personal hygiene.
  • How to safely transport a client.

The training may be completed through an online training program, as long as that training can be verified.

While this is a great step and in keeping with the many states that require minimum caregiver training, it doesn’t necessarily cover the 400,000 caregivers in California’s $7.3 billion In-Home Supportive Services Program (IHSS) for low-income elderly and disabled residents. Those caregivers are hired, managed and trained by the care recipients themselves. Training requirements for the nation’s largest publicly-funded home care program have been met with resistance because clients want autonomy over their care and how it’s delivered. As a result, only about 12 percent of those caregivers have even basic caregiver training.

Finding official state reports of elder abuse and neglect is a daunting task. The most recent data I could find is from the 2004 Survey of State Adult Protective Services published in 2007. Titled Abuse of Vulnerable Adults 18 Years of Age and Older, a Report of the National Center on Elder Abuse (NCEA), it was prepared by the National Committee for the Prevention of Elder Abuse and the National Adult Protective Services Association. Unfortunately, many states differ in their definitions of what constitutes abuse. For the survey, because states collect very different types of information on the abuse of vulnerable adults, it’s hard to compare apples-to-apples. Thirty two states could provide abuse reports for vulnerable adults aged 18-59 as well as aged 60+; the balance of states don’t collect data by age group, so there’s no telling how many of their reports detailed elder abuse specifically.

The demand for direct-care workers like Personal Care Aides and Home Health Aides will soon outpace the supply. According to the Bureau of Labor Statistics at the U.S. Department of Labor, the projected growth in home health care services from 2012 to 2022 is 67 percent. As the pool of informal caregivers shrinks (family and friends), the demand will need to be filled by a more professional workforce. And in order to to help minimize instances of elder abuse, we believe that workforce should be adequately trained.

Caregiverlist applauds California for taking training initiatives, but is it enough? Should minimum caregiver training be federally mandated? What are the possible downfalls to requiring any senior caregiver to obtain even the most basic caregiver training?

Seniors and Bullying

It’s an irony of life that, in many ways, we end as we begin — dependent, spoonfed pureed foods (is Ensure the geriatric Enfamil?), wearing diapers. If it’s true that at a certain point we our lives begin to Benjamin Button, then maybe it’s true that retirement communities are like high school, replete with the ubiquitous resident mean girls.

In a New York Times Op-ed piece this weekend, Jennifer Weiner writes about the bullying behavior her 99-year-old “Nanna” experienced when she first arrived at her new retirement home. In Mean Girls in the Retirement Home, Ms. Weiner describes that Nanna wasn’t allowed to sit at certain dining tables. Nanna wasn’t invited to play bridge. It sounded to Ms. Weiner (and to me) like classic school bullying.

I thought, is senior bullying really a thing? It is.

With more elderly entering senior care centers, retirement communities, assisted living facilities, and nursing homes, the instances of senior bullying is on the rise. It’s estimated that 10-20% of seniors in these types of communities find themselves objects of bullying by the members of the “controlling group.” Sometimes, residents with dementia will act in a bullying manor out of frustration, anger, and confusion.

Senior-to-senior aggression can be overt or passive-aggressive. Studies show that, much like the bullying found in high school, men tend to be openly abusive, challenging other residents both verbally and physically. Women tend to take part in stereotypical behavior, spreading rumors and ostracizing victims.

Why do seniors engage in bullying? The same reason kids bully. A bully, no matter what age, seeks to control and dominate. Perhaps because they lack power in their own situation, they seek to make themselves feel stronger by making others feel weak and fearful. They also have a lack of empathy.

How do you know if a senior is experiencing bullying? Here are some telltale signs:

  • Isolation
  • Depression
  • Avoidance of certain communal areas
  • Taking circuitous, out-of-the-way routes to get to and from areas
  • Complaints that they are not liked and are not included in activities

Bullying is a form of elder abuse and should not be tolerated. In these instances, a third-party has to get involved. Alert the staff  or on-site social worker if you suspect bullying. If they don’t intervene, contact your state’s long-term care ombudsman to report the abuse. Everyone deserves to live their life with respect in a caring community.

Have you ever experienced senior bullying? What did you do about it? Tell us in the comments.

Justice Department Launches Elder Justice Website

Elder abuse can take many forms. Caregiverlist’s own basic caregiver training helps caregivers recognize abuse and neglect, and learn the legal requirements for reporting physical, emotional, sexual and financial abuse.

Financial abuse of the elderly is a racket that takes in nearly $3 billion dollars every year and that figure rises annually. Because seniors are especially susceptible to scams and frauds, the the U.S. Department of Justice (DOJ) has recently launched the Elder Justice website.

At an outreach event earlier this week, Associate Attorney General Tony West stated, “The launch of the Elder Justice website today marks another milestone in reaching our shared goal of keeping older Americans safe from abuse and neglect.” He added, “The more we embrace our elders with respect and care, the stronger our society will be. This tool helps move us closer to that goal.”

The Elder Justice website will serve as a resource victims of elder abuse and their families, who often feel alone, embarrassed, and unsure of where to turn for help. Prosecutors, researchers, and professional practitioners who work with elder abuse will find a forum to share information and resources to fight elder abuse, scams, and financial exploitation in an effort to support older adults.

Nearly one in every 10 Americans over age 60 experience abuse and neglect, and those with dementia are at higher risk for abuse. Most (51%) of elderly fraud is perpetrated by strangers, although abuse by family, friends, and neighbors comes in second at 34%. Elder mistreatment by a known individual is especially prevalent because seniors are vulnerable and trusting in relationships with their families and caregivers.

There are two steps the DOJ along with the Department of Health and Human Services suggest communities, families, and individuals take in combating the epidemic of senior abuse:

  • Learn the signs of elder abuse. Take a look at the Red Flags of Abuse Factsheet, provided by the National Center on Elder Abuse, that lists the signs of and risk factors for abuse and neglect.
  • Report suspected abuse when you see it. Contact your local adult protective services agency. And, of course, make use of the new Elder Justice website.

Do you have an issue you'd like to see tackled on this blog? Connect with Renata on Google+

Seniors Need Protection from Nursing Home Abuse

It’s a story I hate to write or even read, but sticking my head in the sand will not make the problem go away. And because June 15 was World Elder Abuse Awareness Day (WEAAD), I thought it would make sense to talk about the issue today.

Elder abuse takes many forms; physical, emotional, sexual and financial abuse unfortunately affects hundreds of thousands of seniors each year. Nursing home residents are especially vulnerable.

Back in February 2014, a Bronx New York nursing home employee was charged with raping an elderly resident who is unable to communicate. Manhattanville Health Care Center LLC had a Medicare overall rating of 5 stars, whereas, because of its number of reported bedsores and its low C.N.A.-staff-to-resident ratio, the facility’s Caregiverlist’s® Nursing Home Star Rating was a mere 3 stars.

Recently, a Florida nursing home CNA's father received a 7-year sentence in an identity theft case, where he used stolen identification information to file fake tax returns and get refunds, according to an article in McKinght Long Term Care News. Palm Garden in Polk County, Florida, also received only a 3-star Caregiverlist® Nursing Home Rating.

An evaluation published in the Journal of Elder Abuse and neglect details a seven state Criminal History Screening (CHS) program for long-term care workers. The report states that popular support for enhanced criminal history screening (CHS) procedures for long-term care workers in the United States is evident; case studies and news stories regarding abuse, theft, or neglect of long-term care residents are abundant yet repugnant to a society that aims to protect those that are physically and/or mentally frail.

Results of the evaluation found that, of the 204,339 completed screenings, 3.7% were disqualified due to criminal history, and 18.8% were withdrawn prior to completion for reasons that may include relevant criminal history.

The federally-funded pilot program points to a vital need to conduct thorough background checks for any potential senior caregivers, whether they be in an institutional or home setting.

The Administration on Aging has provided these tell-tale signs that a senior may be suffering elder abuse or neglect:

  • Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
  • Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
  • Bruises around the breasts or genital area can occur from sexual abuse.
  • Sudden changes in financial situations may be the result of exploitation.
  • Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
  • Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
  • Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs.

Most importantly, be alert. The suffering is often in silence. If you notice changes in a senior’s personality or behavior, you should start to question what is going on.

President Barack Obama, in his 2012 presidential proclamation decreed June 15 as World Abuse Awareness Day stating, “Every American deserves the chance to live out the full measure of their days in health and security. Yet, every year, millions of older Americans are denied that most basic opportunity due to abuse, neglect, or exploitation. On World Elder Abuse Awareness Day, we call attention to this global public health issue, and we rededicate ourselves to providing our elders the care and protection they deserve.”

If you are a caregiver, consider taking Caregiverlist’s® Caregiver Training Course. With it, you can learn the types of abuse and neglect, legal requirements for reporting (and legal punishments for not reporting) and how to protect your senior client and yourself from physical, emotional, sexual and financial abuse.

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