The need as indicated by stakeholders

We have received letters of support for this research from the Wyoming Center on Aging, the Colorado Organization for Victim Assistance, the Wyoming Division of Aging, and the New River Valley Agency on Aging, Pulaski, Virginia (one team researcher is at Virginia Tech). All these letters were written in July 2016 for a grant proposal submitted in August 2016. Also, we have received grants Kappa Omicron Nu and Phi Upsilon Omicron (funded twice), both honor societies in Family and Consumer Sciences; and the University of Wyoming Social Justice Research Center that funded this research three times. Phi Upsilon Omicron funded it twice.  Most recently we received a letter of support from and Kelly Davis, Elder Attorney in Cheyenne, Wyoming and member of the National Association of Elder Law Attorneys (NAELA).

The importance of this research

Elder financial exploitation (EFE) “is the third most frequent form of abuse after neglect and emotional abuse” (Arizona Elder Abuse Commission, 2007, p.4).  Defined as the illegal or improper use of an adult's resources for another's profit or advantage, EFE has been growing since the 1980s.  This problem is destined to increase as the elderly population (over 60 years of age) worldwide is predicted to reach two billion by 2050 (Global Action on Aging, 2011).  In the U.S. the 60 and older age group is predicted to increase from just under 57 million in 2010 to over 92 million in 2030 and over 112 million in 2050 (Population Division, U.S. Census Bureau, 2008).  

Characteristics of vulnerable elders: Exploitation occurs in different income classes, genders, ethnicities, and among vulnerable elders of different ages. Risk factors for elder financial exploitation include being the oldest of the old, especially those who are over age 70 and especially over 80; and/or those who have recently gone through a major life transition such as a sudden illness or loss of a loved one. Elders are more vulnerable if they are lonely, suffering from one or more cognitive and/or sensory impairments which can affect decision-making capacity, judgment, and memory, and/or experiencing limitations in daily living activities, all of which can create dependency on others (Moschis, Mosteller, and Choong, 2001; Rabiner, OKeeffe, and Brown, 2004). Those with visible and substantial assets (Rabiner, OKeeffe, & Brown, 2006), such as their own homes, are more likely to suffer exploitation. Women make up the majority of elder victims of financial exploitation, perhaps because they live longer and are therefore a larger proportion of the oldest of the old. They may be perceived as weak and vulnerable, they may be less familiar with their own finances, the decisions that need to be made, and the methods for handling financial transactions (including electronic banking), and thus may be more vulnerable to abuse. In addition, to complicate matters they may be even unaware that they are being exploited (Rabiner, et al., 2006).

Characteristics of perpetrators: According to MetLife studies (2009, 2011), more than any other type of abuse, substantiated cases of financial abuse involve an adult child (60% of cases), grandchild (9.2%), or other relative (9.7%). Professionals (18%) and caregivers (20.2%) are also common perpetrators. Men and women commit exploitation at about the same rates, but men’s abuses are more likely to be covered in the news media. Perpetrators are commonly 40-49 years old and may feel a sense of entitlement to elders’ money and possessions belonging to parents or other elderly family members. Their sense of entitlement also may result from negative attitudes toward older people or a particular older person. They may also assume consent to transfer assets that were not, in fact, given or they may take advantage of elders’ vulnerabilities such as those described above to exert physical or emotional pressure or undue influence (a deliberate effort to take control of elders’ decision-making) (Rabiner et al., 2006).

Conditions that create an environment for exploitation: Physical and social isolation such as living alone creates a vulnerable environment for an elder. A close relationship between the elder and the exploitive family member and previous abuse may lead an elder to think financial exploitation is normal and not a crime. Elders’ ignorance of who can help, embarrassment or shame, fear of retaliation or fear that exploitation may be seen as evidence of their own incompetence and therefore result in loss of their independence through guardianship or institutionalization may also create reluctance to report exploitation. All these conditions contribute to the perfect environment for financial exploitation (Dessin, 2003; Rabiner et al., 2006).

Consequences of elder financial exploitation:
The financial, cognitive, and physical status of elders can influence the size and scope of EFE. The financial resources for wealthy elders may be sufficient for them to withstand the financial shock resulting from EFE, whereas similar levels of abuse may leave others economically devastated. According to Rabiner, et al. (2004), losing assets that have been accumulated over a lifetime through hard work and deprivation can be devastating, with significant practical and psychological consequences to the victim. Financial exploitation can also have physical and emotional consequences including a loss of a sense of security and trust. In sum, it can affect the overall quality and length of an elder’s life.

Along with the financial damage to the individual and the family, financial exploitation also increases the incidences of elders needing Medicaid and other forms of public support, thus creating direct costs to society. Additionally, such family betrayal often results in psychological trauma for family members, leaving those involved feeling that their world, family, sense of safety, and faith in life itself are permanently damaged (American Society of Adult Abuse Professionals and Survivors [ASAAPS], 2005). After such an experience, other family members may be concerned about whom to trust when they need a financial representative.

Power of Attorney: Many financial planners, lawyers, and healthcare providers recommend establishing a power of attorney (POA) document to assist in legal and financial transactions should individuals become incapacitated. POA can help the elderly manage their finances and maintain some level of independence. However, since Power of Attorney documents often give another person complete control over another’s finances, it can create a perfect storm for exploitation when an elder unwittingly gives powers of attorney to an untrustworthy individual. In addition, weak protective measures and limited oversight allow abuses to occur. The National Council on Aging (2017) reported that almost 90% of elder abuse and neglect incidents are perpetrated by a family member with two thirds being adult children or spouses (Lachs, Psaty, Psaty, & Berman, 2011). Why do trusted relatives betray that trust? What within families increases the likelihood that trusted family-member POA agents will become a perpetrators of EFE?

Prevalence. It is difficult to estimate incidences (number of new cases in a particular period of time) or prevalence (total number of cases at a given point in time) (Rabiner, et al., 2004) because there is no federal agency or reporting system that collects incidences and prevalence of elder financial exploitation. Within states, there are no agencies that compile data across all the state agencies that handle different types of elder exploitation in all the settings in which they occur (American Society of Adult Abuse Professionals and Survivors [ASAAPS], 2005). There have been a few state-level studies that have tried to identify the extent of the problem. There is no system that gathers data directly from elders and their families. In relation to prevalence of elder financial exploitation, several recent national studies of elder maltreatment (Acierno, Hernandez, Amstadter, Resnick, Steve, & Muzzy, 2010; Laumann, Leitsch, & Waite, 2008; Lowenstein, Eisikovits, Band-Winterstien, & Enosh, 2009) have found that while elder neglect is the most common form of elder maltreatment (with rates of neglect from 5.9% to 18%), financial exploitation (FE) is the next most common form of maltreatment. Rates in two U.S. national samples were 3.5% and 5.2%, and a similar rate of financial exploitation (6.4%) was reported in a national sample of Israeli elders (Lowenstein, et al., 2009).

Because research has documented some characteristics of perpetrators and victims, contextual factors, and opportunities for exploitation, there are expanding resources to help professionals, older adults, and family members recognize financial abuse and what to do if it is suspected, but this data is all based on reported cases with little known about experiences of unreported cases, estimated to be as many as 10-44 cases per reported case (Lachs et al., 2011). Because of this frequency of underreporting and the difficulties associated with prosecuting when reported, much more needs to be understood about the whole of the problem. Anecdotal evidence seems to indicate that underreporting stems from shame, close relationships with the perpetrator, fear of isolation, lack of awareness of exploitation and unfamiliarity with resources and remedies concerning factors that increase the likelihood of POA abuse. Even when it is suspected, family loyalty, family and/or personal pride, embarrassment, and lack of understanding of the legal system also discourage reporting and encourage secrecy even within families.

Many government and non-profit organizations are trying to address this problem through adoption of the model Uniform Power of Attorney Act, and development of educational materials, workshops and webinars, and trainings for professionals, but what is missing is an understanding of risk and protective factors that provide a basis for careful analysis of family members and the family system that could better inform decisions about who should be designated POA agents and what arrangement in the planning documents and among family members that would increase the likelihood of success (lack of exploitation) during the waning years of elders’ lives. There is urgency in addressing this problem to forestall the escalation of this predicted familial and societal crisis.

Conceptual Framework: Because there are multiple levels of opportunities and barriers that people experience in maintaining financial well-being in later life, we argue that Bronfenbrenner’s (1979; 1986) Ecological Systems Theory is an extremely useful framework for understanding individuals who have been victims of EFE and who are embedded within a system of hierarchical contexts. As an organizing framework for intervention and its sustainability, the model provides a focus on the elder victim and four influencing systems (See Attachment A):  (a) the microsystem is the elder victim within his or her environment, (b) the mesosystem represents the relationship between the victim and relatives and friends; (c) the exosystem represents environments external to the victim (e.g., community services) that may affect his or her well-being; and (d) the macrosystem includes broad ideological values, norms, and cultural and institutional patterns (e.g., state/federal programs and regulations /policies) (Parra-Cardona, Meyer, Schiamberg, & Post, 2007; Horsford, Parra-Cardona, Post, & Schiamberg, 2010).

In line with this perspective and rather than focusing on a single issue, our study will elucidate a broader understanding of the challenges faced by families who experience EFE by a family member POA agent. Because the etiology of EFE and the variables that influence a perpetrator’s decision to engage in exploitative behaviors are so complex, it is important to comprehensively examine EFE within the family structure. People are not isolated agents; they are embedded within and influenced by intricate social and environmental networks. Thus, a broad perspective increases an understanding of these complicated issues.

Within this ecological framework, Rabiner et al. (2004) developed their Conceptual Model of Elder Financial Exploitation. See Attachment B for a graphic representation. They admit that much still needs to be understood about the characteristics of families that are likely to experience this problem, its etiology, and consequences. Although their model focuses primarily on understanding the likelihood of a series of events leading to elder financial exploitation, it does not include an understanding of the consequences of elder abuse on family systems as well as individual members beyond the exploited elder. Built upon an earlier model reported in a 2003 National Research Council Report, Rabiner et al. (2004) argue that use of their applied ecological perspective including a family systems model nested within and connected to other systems, has been successfully used to study elder abuse and neglect and various public health problems.

This framework draws attention to multiple processes occurring over time among the victim, perpetrator, and other interested parties (family and non-family) across and within environments as the older person changes physically, psychologically, and socially (Rabiner et al., 2004). Their proposed model has two dimensions: microprocess and macroprocess levels. The microlevel includes factors associated with risk of financial exploitation such as characteristics of the elder and relevant attributes of the perpetrator, and interactions between them based on such factors as social and economic dependence (status inequality), the type of social relationships they have (quality of the relationships between the victim and perpetrator and whether it has improved or deteriorated over time), and then extent of power and exchange that occurs between them. The macrolevel includes the sociocultural and policy contextual factors such as cultural norms, views of older persons in general, public policies, programs, and statutes focusing on protecting elders, criminal and civil remedies, and prevention programs.

This model also includes group factors which Rabiner et al. (2004) refer to as social networks which support victims and the perpetrators. These social networks can serve as monitors, informants, and social controllers. They also describe the model as including both short-term and long-term outcomes. Short-term outcomes could include whether the exploitation is episodic or recurrent, whether it occurs in isolation, and the amount of resources taken. Long-term outcomes could include financial, physical, and emotional well-being of the victim and the perpetrator, the durability of the caregiving relationship, and the elders’ sense of security and trust. The interactions can be reciprocal in that a mistreated elder might become depressed and further isolated which creates greater vulnerability. This increased vulnerability may embolden a perpetrator to repeat the financial exploitation.

This multistate project will use this model, but will focus on 1) identifying risk and protective factors within family systems that could assist elders and professionals working with them of what to consider when selecting a person with fiduciary responsibility to manage their affairs when they cannot. This is a proactive approach to preventing EFE rather than trying to stop it when it is recognized. The family system is foundational to the wellbeing of elders and 2) identifying consequences of  exploitation not only on the elders themselves, but also on the victims’ family system. This can  serve as a motivator to plan carefully with an understanding of the individuals, values, interaction patterns, conflicts and other strengths and challenges within their family system. Within a family system, the social networks of the victim and perpetrator overlap, thus this research should increase understanding of outcomes for the victims and the perpetrators social network (particularly his/her family system). Rabiner et al. (2004) indicated the perpetrators’ social (and family) network has been studied very little. Thus, this proposed project will expand on the Conceptual Model of Financial Exploitation of Rabiner et al. (2004).

What the likely impacts will be from successfully completing the work.

This project complements or extends existing knowledge in the field in several ways. The field of elder mistreatment has grown exponentially, particularly the subtype area of financial exploitation.  Research has been conducted in the areas of elder financial capacity (Sherod, Griffith, Copeland, Belue, Krzywanski, Zamrini, Harrell, Clark, Brockington, Powers & Marson, 2009), scope of the problem (Acierno Hernandez, Amstader, Resnick, Steve, Muzzy, & Kilpatrick, 2010; Lachs et al., 2011), outcomes of the problem (Huang & Lawitz, 2016), and types of the problem (Jackson & Hafemeister, 2012).  Most studies reveal that family members are chiefly responsible for the perpetration of EFE; however, the dollar amounts of the exploitation may be higher from other forms of financial exploitation, such as medical fraud, telemarketing fraud, and other scams (Metlife Mature Market Institute, 2009; 2011).  While research has focused on identification of the problem, little work has been conducted on how and why the exploitation occurs, particularly within the family unit.  The closest conceptualization we have found is the Conceptual Model of Elder Financial Exploitation by Rabiner et al. (2004).  This research project will contribute more detail to their conceptualization.

Challenges: There are many challenges for researchers and practitioners who want to address this problem in addition to the privacy and secrecy issues mentioned above. Other challenges include lack of agreement (both in research and state laws) about what defines EFE, and what goes on in unreported cases which is estimated to be a much larger group than reported cases of EFE. Without an identifiable sampling frame due to underreporting, random sampling is impossible, therefore generalizability of quantitative findings will be limited.

In addition, family systems are complex and varied in terms of concepts such as established patterns of interaction, relationships developed since childhood, values, financial management practices individually and within a family system, meanings and assumptions about money, gifting and exchange patterns, and cultural influences. These all affect perceptions (that may vary considerably across family members within a single family) about whether a particular situation constitutes financial exploitation.

The problem can be further exacerbated by the fact that many EFE situations involve elders and relatives living in multiple states with varying laws and elders moving to be nearer relatives during their vulnerable years.

Benefits of this research: There is a paucity of research published on the impact of and on families from this intensely painful and disruptive phenomenon. Data gathered from this study will be helpful to policymakers, health professionals, social workers and other social service practitioners, lawyers and law enforcement officials, clergy, counselors/therapists, financial planners and counselors, and family members. By gaining clarity about 1) risk and protective factors, 2) interactions and exchange patterns in family systems foundational to later exploitation, 3) intrafamilial perceptions and interpretations of family contexts and experiences related to this elder dependency period, and 4) impact of the exploitation on family members and the family system, more information can be provided for professionals and elders to  enable them to make better plans for the dependency period and to make more informed choices about the best person(s) to appoint as POA agent(s) (personal representatives). It can also provide more information to proactively address some of the risk factors that could contribute later to conflict and exploitation.  It could also provide a basis for earlier recognition and intervention and remediation after financial exploitation has occurred.

The technical feasibility of the research

To facilitate collaboration, the team is equipped with the software it needs and a server. We have also assembled the expertise we need: human development and family sciences, gerontology, ethics and public policy, consumer and family economics, psychology, prevention science, statistical and qualitative methods and analysis, Extension experience and networks, fraud investigation and real world insight about EFE cases that are reported to attorneys and the court system. Four members of the research team (Vincenti, Betz-Hamilton, Stum, and Teaster) have previous experience in conducting qualitative research utilizing in-depth interviews.  Four members (Betz-Hamilton, Bolkan, Steinman, and Teaster) of the research team have previous experience in conducting survey research.  Family EFE is an interdisciplinary problem that has benefitted from the specializations of each team member.

The advantages for doing the work as a multistate effort

It would be difficult to assemble in one state all the expertise needed from people who are dedicated to working on EFE prevention research. By coordinating work across multiple state projects, we should gain a more holistic understanding of family EFE than would occur if studies were done independently.  This approach might also shed light on how the variability of state laws with regard to POA documents and reporting of EFE might affect the family experiences and risk and protective factors within families.

A team member from Minnesota is working with a community-based advisory group on a qualitative study of 20 family members, other than the elder victim and the perpetrator(s), to understand the experience, costs, and impact of elder family financial exploitation from a family systems and resiliency perspective. Team members in Wyoming are working on a survey of two groups of participants in families to determine the validity of the currently identified potential risk and protective factors.  The team and other sub teams will need to decide what other studies they want to take responsibility for. For example, the team has decided to focus one study on exploring family perpetrators regardless of the means that are used to commit EFE. This study supports the objectives of “identify risk and protective factors in family systems that increase or decrease the likelihood of family elder financial exploitation” and “identify the range and scope of family experiences foundational to family elder financial exploitation, including the consequences of EFE on family systems”. The team will broaden this EFE research on family-member fiduciary roles beyond POA agent, e.g. trustee, guardian, caregiver, and healthcare proxy.