A 36 Billion Cottage Industry
Don’t stand by while your patient’s joy is stolen.
Earlier in May, a Nursing home administrator in North Louisiana pleaded guilty to stealing about $400,000.00 from a patient[1]. Her address for the next ten years will include an inmate number.
A woman, believing she had won a large lottery payout, drained her bank account, took a reverse mortgage on her home, and cashed in a life insurance policy to pay the ‘fees and taxes’ associated with such a large win. When reduced to borrowing money from relatives and realizing she was scammed, the woman from Moss Bluff, Louisiana committed suicide.
An assistant manager at a bank befriended a couple in their 80’s and stole $100,000.00. She alleged that the husband afflicted with Dementia had given her the money. In turn, the remaining two years of their life was spent blaming and bickering with each other. The assistant manager of the bank was found guilty and jailed but only after the deaths of her victims[2].
Research shows that the elderly who are financially exploited deteriorate at a rate three times faster than their peers. The crime involves not only money but also the independence it represents. At a time in life when people are needing more help, many seniors are not able to keep the lights on or feed themselves.
According to a recent Wells Fargo study, almost one in five elderly persons are the victim of financial exploitation resulting in as much as 36.5 Billion in losses. This study was limited to those seniors with $25,000.00 of investable assets and does not include those patients who have family at home waiting on a monthly social security check or have pain medications misappropriated to be used to fuel someone’s habit or sold for cash.
Of course, this is sad but why does it matter to you? The 2018 Conditions of Participation for Home Health Agencies mandates:
(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law[3].
Because you must first notice, identify or recognize (in the normal course of providing services) incidences of mistreatment and then report them, it may be too late to do anything of value for your patients who become victims of financial exploitation. Furthermore, we are health care providers, not detectives. It’s hard to find time to document visits. Reenactment of old Columbo episodes would likely be an epic fail. How can we help without taking on another burden?
The 2018 Conditions of Participation offer a solution to this dilemma as well. Each patient, upon admission, must receive a list of contact information for local agencies including:
(i) Agency on Aging,
(ii) Center for Independent Living,
(iii) Protection and Advocacy Agency,
(iv) Aging and Disability Resource Center; and
(v) Quality Improvement Organization[4].
If warranted, contact law enforcement as well.
Attempts to investigate a crime that you know or strongly suspect has been committed may alienate you from the patient and/or their family. Often, this means that a patient will request to be discharged even if the request is made under duress leaving the patient without necessary care. Consider that a person willing to steal from a vulnerable individual could be willing to point a finger at others including the agency staff. The agencies listed above have experience and skills to investigate, leaving you free to care for your patients. All states have provisions that reporting can be anonymous.
Educate your staff on the provision in the Conditions of Participation that states if a patient has been adjudged to lack mental capacity, he or she is free to make decisions to the extent allowed by the court. This judgement is to have been made in a court of ‘proper jurisdiction’ in the state where the patient lives[5]. Elderly Protective Services should also be able to assist agencies in deciphering these legal documents. If any documents in dispute by the patient, contact your agency’s legal counsel to determine if they are valid because frankly, as clinicians, we are simply not equipped or inclined to make such determinations. But if you want to approach a judge and ask why he or she is competent to make such a determination, feel free to do so and tell us how it goes.
So, the real burden on home health agencies is to:
- Report incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property immediately to the HHA and other appropriate authorities in accordance with state law.
- Advise the patient or representative of the contact information for the community agencies listed; Agency on Aging, Center for Independent Living, Protection and Advocacy agency, and the Quality Improvement agency.
- Understand and respect the rights the patient retains if he or she has been adjudged to lack legal capacity.
Going further, agencies may (should) choose to have representatives of their local Elderly Protective Services agency provide education directly to the visiting staff. If your area has a task force dedicated to financial crimes, it may be useful to invite a speaker from it to educate your staff along with Elderly Protective Services.
To use buzzwords and jargon, this is one industry that should be disrupted.
Further information as well as patient brochures may be accessed by clicking on the links below. If you can’t find what you are looking for, be assured that a google search will yield more results than you will ever be able to read.
Information from the National Adult Protective Services
Scam Alerts. Information from the FTC.
DOJ Compilation of National and State information. Justice Department information and links about elderly abuse.
How the Elderly Lose Their Rights A Horror Story from The New Yorker’s award winning Rachel Aviv.
If any of your patients have been victimized, please share with us if you are able to do so while respecting the HIPAA Privacy Rule. And as always, your questions and comments are welcome in the comments section or you can email us directly.
Well said
Well said, Thank you!
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