Saturday, June 15, 2019

Watchdog: Thousands of cases of abuse and neglect in nursing facilities unreported despite federal rules

Health and Human Services Office of Inspector General Deputy Inspector General for Audit Services Gloria Jarmon poses for a photograph in her office in Washington, Monday, June 10, 2019. Nursing facilities have failed to report thousands of serious cases of potential neglect and abuse of Medicare beneficiaries even though the federal government requires it, says a watchdog report due out Wednesday, June 12, that calls for a new focus on protecting frail patients.
WASHINGTON — Nursing facilities have failed to report thousands of serious cases of potential neglect and abuse of seniors on Medicare even though it's a federal requirement for them to do so, according to a watchdog report released Wednesday that calls for a new focus on protecting frail patients.

Auditors with the Health and Human Services inspector general's office drilled down on episodes serious enough that the patient was taken straight from a nursing facility to a hospital emergency room. Scouring Medicare billing records, they estimated that in 2016 about 6,600 cases reflected potential neglect or abuse that was not reported as required. Nearly 6,200 patients were affected.

"Mandatory reporting is not always happening, and beneficiaries deserve to be better protected," said Gloria Jarmon, head of the inspector general's audit division.

Overall, unreported cases worked out to 18% of about 37,600 episodes in which a Medicare beneficiary was taken to the emergency room from a nursing facility in circumstances that raised red flags.

Responding to the report, Administrator Seema Verma said the Centers for Medicare and Medicaid Services does not tolerate abuse and mistreatment and slaps significant fines on nursing homes that fail to report cases.

Verma said the agency, known as CMS, is already moving to improve supervision of nursing homes in critical areas such as abuse and neglect and care for patients with dementia.

CMS officially agreed with the inspector general's recommendations, including clearer guidance to nursing facilities about what kinds of episodes must be reported, improved training for facility staff, and requirements that state nursing home inspectors record and track possible problems as well as incidents reported to law enforcement.

Neglect and abuse of elderly patients can be difficult to uncover. Investigators say many cases are not reported because vulnerable older people may be afraid to tell even friends and relatives much less the authorities. In some cases, neglect and abuse can be masked by medical conditions.

The report cited the example of a 65-year-old woman who arrived at the emergency room in critical condition. She was struggling to breathe, suffering from kidney failure and in a state of delirium. The patient turned out to have opioid poisoning, due to an error at the nursing facility. The report said a nurse made a mistake copying doctor's orders, and the patient was getting much bigger doses of pain medication as a result. The woman was treated and sent back to the same nursing facility. The nurse got remedial training, but the facility did not report what happened. The report called it an example of neglect that should have been reported.

The American Health Care Association, which represents the nursing home industry, said in a statement from its vice president for quality, David Gifford, that it would "fully support more transparent reporting." The group said Medicare's current definition of neglect "is vague and creates confusion about what should be reported."

The nursing facilities covered by the report provide skilled nursing and therapy services to Medicare patients recovering from surgeries or hospitalization. Many facilities play a dual role, combining a rehabilitation wing with long-term care nursing home beds.

Investigators said they faced a challenge scoping out the extent of unreported cases. It wasn't like they could query a database and get a number, since they were looking for cases that weren't being reported to state nursing home inspectors.

To get their estimate, auditors put together a list of Medicare billing codes that previous investigations had linked to potential neglect and abuse. Common problems were not on the list. Instead it included red flags such as fractures, head injuries, foreign objects swallowed by patients, gangrene and shock.

The investigators found a total of 37,600 records representing 34,800 patients. Auditors then pulled a sample of cases and asked state inspectors to tell them which ones should have been reported. Based on the expert judgment of state inspectors, federal auditors came up with their estimate of 6,600 unreported cases of potential neglect and abuse.

Medicare did not challenge the estimates but instead said that billing data comes with a built-in time lag and may not be useful for spotting problems in real time.

Separately, the report also flagged potential problems with state nursing home inspectors reporting documented cases of abuse or neglect to local law enforcement. Federal auditors pulled a sample of 69 cases across five states in which inspectors verified that nursing facility patients suffered neglect or abuse. Only two were reported to local law enforcement, although reporting is required.

In one case, a male resident was sitting in the facility's dining room when an employee walked by and pushed the back of his head, then kept walking. The employee denied it, but his actions were captured on surveillance video. The report said state inspectors verified what happened but did not report it to local law enforcement.

Full Article & Source:
Watchdog: Thousands of cases of abuse and neglect in nursing facilities unreported despite federal rules

Terminally ill man, partially disabled woman victims of financial exploitation

A former Shalimar resident has been charged with exploiting a partially disabled 75-year-old and her terminally ill 80-year-old husband while working as their housekeeper and helper between September 2018 and April 2019.

The Okaloosa County Sheriff's Office has arrested 45-year-old Ellissa Pedersen on charges of exploitation of elderly persons between $10,000 and $50,000 fraudulent use of credit cards, false verification of ownership to a pawnbroker and criminal use of personal identification information.

The release from the Okaloosa County Sheriff's Office says the victims paid Pedersen $400 a week to help with house work, cooking, getting the mail and various other similar tasks.

The victim was contacted by Discover Card regarding suspicious charges and stated she never owned or applied for a Discover Card , the release says.

The release says Pedersen was listed as an authorized user on the account.

According to the release the victim said she discovered charges she did not make on department store cards and discovered purchases made with her bank credit card on

The release says the victim has never even had an Amazon account.

In addition, she suspected jewelry and some of her husband's medication was missing, the release states.

The investigator says he showed her a photo of jewelry that had been pawned by Pedersen in January 2019 and the woman began to cry - positively identifying pieces of jewelry belonging to her and her husband, along with other items, the release revealed.

Pedersen had also taken and pawned gold chains belonging to the husband and a unique “I love you” inscribed wedding pendant that both victims had designed together, which cannot be recovered as it was melted down, the release states.

The husband's wedding band is also missing and has not been recovered.

Pedersen also allegedly funded a trip to New Orleans on the Discover Card.

An active warrant for Pedersen was approved on May 16th and the case was featured by Emerald Coast Crime Stoppers in June. Facebook posts indicated Pedersen had gone to Michigan and Detroit area Crime Stoppers also assisted in publicizing the search.

Pedersen turned herself in on Monday and was taken to the Okaloosa County Jail.

She is being held on no bond.

Full Article & Source:
Terminally ill man, partially disabled woman victims of financial exploitation

A Doctor Has Designed Tiny House as a Replacement for Nursing Homes

Do we work hard for most of our lives so that one day we wake up in some nursing facility or retirement home? Definitely not. As we enter our golden years we should live in comfort. Although many nursing home facilities say they offer great amenities for their residents, many people have found out that this just isn’t true. Unfortunately, many people have found out that their parents are not only uncomfortable but also not being treated well inside some of these facilities. But one doctor has come up with a solution that could work for many seniors. Dr. Kenneth Dupin came up with the idea of tiny houses built solely for the elderly. This also solves the problem of having to leave so many of your personally treasured items with a family member or storage unit. Living in a tiny house gives seniors the opportunity to bring special personal belongings with them to their new dwelling.

These homes have been nicknamed “granny pods” and are also called MEDCottages. Dr. Dupin was inspired by a story of a woman who had to leave most of her personal belongings behind before moving into a nursing home. Dupin began to think of a way seniors could keep much of their sentimental treasures and still be close to family and friends. The tiny house makes seniors feel at home, literally, unlike most nursing home environments that tend to resemble hospitals with nothing personal around to remind these seniors of the life they left behind. The “granny pods” rent for approximately $2000 per month and also comes with the latest in technology.

Full Article & Source:
A Doctor Has Designed Tiny House as a Replacement for Nursing Homes

Friday, June 14, 2019

Boston Broadside Cited in Yet Another Court Action: Broadside Reveals Certain Lawyers vs. John Savanovich

You couldn’t find John Savanovich’s case file online. You couldn’t find any reference to it in the regular electronic court postings. He charged that his case was being handled in virtual secrecy and that certain lawyers tricked him into signing over millions of dollars worth of property, as well as his bank holdings, and then stuck him in assisted living, taking away all his freedoms, when all he asked for was some help to get his properties fixed up and sold.

We pledged to John that we would review his case and whatever documentation we could obtain. John spoke clearly, coherently, and in great detail, as he has in multiple conversations.

Fast forward a bit: Well, The Boston Broadside has been cited once again in probate court, this time attacked for printing portions of John’s impounded court record, with his permission.

Judge Saddles John with ‘Connected Lawyer’

Norfolk Probate and Family Court Judge George F. Phelan has thus far refused to allow John to pick his own lawyer – instead John is saddled with one appointed by and with close working relations to the judge, John’s would-be choice of attorney charges.

At a recent hearing, the judge refused to allow John to speak in court, and refused to allow John to have Attorney Lisa Belanger, whom John reached out to after reading of her case in the Broadside, speak on his behalf. Atty. Belanger filed a motion against the judge, exposing multiple areas of conflict of interest between the judge and the lawyer he saddled John with, and asked the judge to recuse himself from further action in the case. That didn’t go well, and we’ll report more on it in an upcoming edition.

Silencing John

Now that we’ve exposed the court’s actions, things are heating up to totally silence John.

On May 21, 2019, Judge Phelan placed his signature on a two-page document that calls for a court-ordered evidentiary hearing to be held on July 19, 2019 at 9:00 a.m. in his court, the purpose of which is to declare John nuts – a competency hearing.

The judge has prohibited John from hiring any attorney other than that assigned by the judge, and the judge has locked down all further actions from any public scrutiny.

In essence, John has been isolated: He’s allowed to be present for a “Zaltman” hearing, but he’s represented only by court-appointed folks who are billing against John’s accounts, without John’s permission, saying that John is nuts.

We’ll be printing a lot more on this case (file no. 181286, 18P1287) in an upcoming edition.

Stay tuned. We’ve only just begun.  ♦

NOTE:  Judge’s Order is below.  You’ll note, he’s saddled John with ANOTHER lawyer – not of JOHN’s choosing – and JOHN HAS TO PAY FOR THE LAWYER (or rather, the lawyers appointed by the judge pay the other lawyers with John’s money, against John’s wishes, and also pay themselves to talk to one another about this, to view accounts, have checks written, have e-mail communications, write reports, etc….basically, they’re sucking away at John’s accounts….oh, all to “help” John.) OH, and you’ll note the judge specifically lets his lawyers have full access to anything of John’s (files, etc.), but specifically PROHIBITS Attorney Belanger – John’s choice – from having any view of anything.   Message to Attorney Belanger:  ANYTHING JOHN HAS SHARED WITH THE BOSTON BROADSIDE, WE WILL FULFILL OUR COMMITMENT TO HIM TO GET HIS MESSAGE OUT – TO LET OTHER SENIORS KNOW WHAT IS HAPPENING, and we will share anything with you that he has, is, or will share with us in the future.   Stay tuned. We’ll have more to post.

Note: Subsequent to the above directive, the Judge issued a “Mueller-like” extensive NEW directive – hired a lawyer to videotape John in isolation, without any aid of counsel (except those which may be directed by the judge). The lawyer is also to pursue all kinds of things, basically trying to find out how John got his information out when the judge had locked down everything about John.   John’s a lot smarter guy than he may perhaps appear to the judge? Because while John might not be perfect (who of us is), John has repeatedly from the start attempted to file complaints – in writing – against what the court and lawyers are doing to him, and, our pledge to give ‘voice to the voiceless’ continues.

Full Article & Source:

Ex-teller at Athol bank gets month in prison for stealing over $100K

WORCESTER — An Athol bank teller who stole more than $100,000 from elderly customers, including a man dying of cancer, was sentenced Monday in federal court to a month in prison.

Jessica Vargas, 35, of Athol received the sentence in U.S. District Court as several people from whom she stole, including a 90-year-old woman, looked on. She was also ordered to pay $108,171 in restitution.

“I don’t believe the sentence fits the crime,” Cheryl D’Ambra, an executive at Athol Savings Bank, said afterward. She fears the punishment will not be enough to deter others from similar crimes.

Ms. Vargas was arrested in March 2018 after an investigation by Athol Savings Bank determined she stole more than $108,000 from eight elderly customers over a period of 17 months.

In a victim impact statement Monday, Ms. D’Ambra, executive vice president for retail banking, said Ms. Vargas’ crime had a “dramatic impact” on the bank and its customers.

One by one, she ticked off the names and ages of elderly people from whose accounts Ms. Vargas, a branch manager, pilfered money.

“In one case, she preyed upon the account of an individual who she knew had only a short time to live, as he was dying from cancer,” Ms. D’Ambra said.

According to the bank executive, Ms. Vargas made four withdrawals from the 68-year-old man’s account totaling $8,000. The man is now dead.

“Stealing from a bank is not a victimless crime,” Assistant U.S. Attorney Kristen M. Noto said in requesting that Judge Timothy S. Hillman impose a 12-month sentence.

Ms. Noto said 12 months would be on the “low end” of the recommended sentencing guidelines and said the sentence is needed as a deterrent to others. She noted that at least one family had to deal with not only the death of a loved one, but also the complications caused by Ms. Vargas’ theft from that person.

Ms. Vargas’ court-appointed attorney, Charles P. McGinty of the federal public defender’s office, acknowledged that his client’s acts were wrong, but stressed that her motive was not greed.

Mr. McGinty said that at the time of the thefts, Ms. Vargas, by virtue of her husband’s disability, was the sole provider for her family as well as other family members she took in during tough times.

Mr. McGinty said she was providing for as many as 15 people, including her three daughters — who were in the courtroom Monday — along with her mother-in-law, her half-sister from Colombia and her half-sister’s three children.

Mr. McGinty also hinted at unfortunate circumstances that he said were included in the Probation Department’s pre-sentencing report, but did not go into further detail. The pre-sentencing report, like most such reports, was not made available for public view.

Mr. McGinty asked Judge Hillman to balance the harm Ms. Vargas caused her victims with the “enormous pain and difficulty” her crime has caused her family. In arguing for time served, he said Ms. Vargas got and quickly lost a job after her new employer heard of her arrest, and that there was a risk of homelessness.

Judge Hillman consulted with the Probation Department before handing down a sentence of 1 month in prison followed by 2 years of supervised release. He also ordered Ms. Vargas to pay $108,171 in restitution to Athol Savings Bank, which reimbursed all the customers after discovering the thefts.

The restitution will be in the form of a money order that Ms. Vargas will owe the bank. No money was seized from her, Ms. Noto said.

In her statement, Ms. D’Ambra said the bank can’t place a value on its reputation.

“We cannot put a dollar loss on the business we may never get,” she said, adding that the bank prides itself on serving generations of families.

As she walked out of the courthouse with a 90-year-old victim — who asked that her name not be used — Ms. D’Ambra said the sentence didn’t sit right with her.

“There’s very little accountability for what she did,” Ms. D’Ambra said. It bothered her that part of the defense lawyer’s argument was that Ms. Vargas had no prior criminal history.

“So you get one free?” she asked incredulously. In her statement, she’d noted that not only had Ms. Vargas stolen, but, when asked about money missing from an account a month before she was caught, she lied and suggested she must have just accidentally shredded a deposit slip.

“She left my office and instead of being scared and saying to herself, ‘I better stop,’ she stole money seven more times for a total of $25,750,” Ms. D’Ambra said.

Ms. Vargas, who pleaded guilty in February to one felony count of bank fraud and two felony counts of bank embezzlement, stole 55 times in all from the eight customers, Ms. D’Ambra said.

The man who died at 68 was the youngest. The ages of the other customers and the amounts stolen were 80 ($2,000), 84 ($53,425 over 24 withdrawals), 86 ($2,000), 87 ($12,950), 89 ($12,216), 90 ($6,950) and 90 ($10,630).

Ms. D’Ambra told the court the bank concluded its internal controls were sufficient, and that there was nothing it could have done to avoid what occurred.

“We just had a bad employee,” she said, at one point addressing Ms. Vargas and saying, ‘Jessica, you will have to live with this the rest of your life.’ ”

Moments after Ms. D’Ambra concluded her remarkes, Ms. Vargas was given an opportunity to address the court, and did so briefly.

“I just want to say that I’m very sorry for what I did and for those people that I stole from,” she said. “I’m just very sorry.”

Ms. Vargas was ordered to self-surrender to the Bureau of Prisons by July 1. Under the law, she could have been sentenced to up to 90 years in prison and fined up to $3 million.

Judge Hillman declined to impose a fine beyond standard court costs, noting that his priority is to see the bank repaid.

Full Article & Source:
Ex-teller at Athol bank gets month in prison for stealing over $100K

Michigan Attorney General Dana Nessel visiting Oakland County during Elder Abuse Listening Tour

By Mark Cavitt
Nessel Press Conference

Attorney General Dana Nessel speaks during a press conference on Thursday, Feb. 21, 2019 at the Frank Kelley Law Library in the Williams Building in Lansing, Mich. Nessel gave updates on Michigan State University, the catholic church and Flint water investigations. (Jake May/The Flint Journal via AP)

Michigan Attorney General Dana Nessel will join with two Michigan Supreme Court justices during her 10-city Elder Abuse Listening Tour.

The listening tour will provide a brief overview of the state's new Elder Abuse Task Force and give seniors the opportunity to provide feedback and offer comments to help the task force address the issue of elder abuse, which often goes unreported and unrecognized.

According to the Attorney General's Office, more than 73,000 older adults in Michigan are victims of elder abuse. They experience physical abuse, financial exploitation, emotional abuse, or neglect.

Nessel said the listening tour is about providing a voice to those who don’t often have a chance to speak up and speak out.

“We want to hear directly from our state’s seniors about the issues and challenges they face so we can make certain our new task force is prepared to properly address the troubling issue of elder abuse," said Nessel.

Justices Megan Cavanagh and Richard Bernstein will join Nessel is hearing from Michigan's seniors during the tour, which has a scheduled stop in Farmington on Tuesday, July 23.

Listening tour stops

  • Grand Rapids - 1 p.m. Friday, June 14 at Kent County Courthouse
  • Traverse City - 10:30 a.m. Friday, June 21 at Traverse Area District Library
  • Benton Harbor – 10 a.m. Monday, July 8 at the Berrien County Health Department
  • Kalamazoo – 10 a.m. Tuesday, July 9 at the Kalamazoo County Juvenile Home
  • New Baltimore – 9 a.m. Monday, July 22 at the 42nd District Court
  • Ann Arbor – 2:30 p.m. Monday, July 22 at Washtenaw Community College
  • Farmington – 10:30 a.m. Tuesday, July 23 at the Farmington Community Library
The Attorney General’s Elder Abuse Task Force, which was formed in March, is made up of nearly 50 different organizations including law enforcement, state agencies, the Michigan House, Senate and Congressional delegation, and advocacy groups.

The task force's initiatives, of which nine have already been created, include requiring professional guardians to become certified, developing statutory basic rights for families, reviewing the process of a guardian removing a ward from his or her home, and limiting the number of wards per guardian.

Michigan residents are being urged to report any signs or concerns about elder abuse to Nessel's office, which has established an elder abuse hotline for anonymous tips: 844-24-ABUSE (844-242-2873) or online at

Full Article & Source:
Michigan Attorney General Dana Nessel visiting Oakland County during Elder Abuse Listening Tour

Family, friends, and neighbors are at the heart (and the heart) of elder justice

By Philip C. Marshall

Informed by research and demonstrated need, the New York City Elder Abuse Center (NYCEAC) created a unique Elder Abuse Helpline for Concerned Persons, a non-emergency phone and email service for a concerned person—a family member, friend, or neighbor of an elder abuse victim (residing in New York City).

Below, I provide the persepective of a concerned person—a family member—to underscore the need and opportunity to engage concerned persons, more. I acted to save my grandmother from abuse and exploitation by her only child, my father.


To cut to the chase, I feel there are three reasons I am invited to advocate for elder justice:
  • I am the grandson of a famous philanthropist who was abused by her only child;
  • I am a concerned person who acted to save an older adult from abuse;
  • We were successful due to the efforts of those in my grandmother’s circle of support.
  • Most people do not have a famous grandmother
  • Most people do not act, against abuse
  • And, if they do, most people never share such success
What is considered less than our success is the trauma that took its toll on each of us throughout our ordeal, as concerned persons.

The same trauma is suffered by an estimated 73 million concerned persons across America. (Breckman, et al. 2018)

Concerned persons are (non-abusing) family, friends, and neighbors who serve as informal network supporters for older adults suffering from abuse and financial exploitation.

As informal network supporters there is nothing ‘informal’ about the stress endured.

A concerned person is a supporting actor helping an older adult maintain the lead role in their own lives.

Explicitly, concerned persons, as supporting actors, need support, too.


For a concerned person, one of the greatest consternations is to hear, from authorities, that “elder abuse is not a crime.”

In filing a guardianship petition for my grandmother, it was my na├»ve hope was that this ‘family affair’ would be quietly settled.

But, for my grandmother, and millions of older adults across America, elder abuse is not a family affair, nor a ‘civil’ matter.

Elder abuse is a crime; it needs to be treated as such so victims (and their concerned supporters) are not re-victimized by perpetrators — and by society’s lack of responsibility and response.
Burnes, Breckman, Henderson Lachs, and Pillemer. (2018) Informal Network Supporters Make a Difference in Facilitating Use of Formal Support Services for Elder Abuse Victims.

Concerned persons

As concerned persons…it’s our concern, we are concerned.

It’s our concern — it’s our moral and legal responsibility to stand up against abuse.

We are concerned; we are worried, anxious, even traumatized about the wellbeing of an older adult, our efforts to help, and ourselves.
Victims of Crime Act 1984, Violence Against Women Act 1994, Crime Victims’ Rights Act 2004 • Linda R.S. vs. Richard D., 410 U.S. 614 (1973), Final Report of the President’s Task Force on Victims of Crime (1982), History of Victims’ Rights, National Crime Victim Law Institute


Just as concern is compounded, many concerned persons do not feel they are a full ‘person.’ Let me explain.

My grandmother’s circle of support, her A-Team, felt fortunate.

I remain grateful to Liz Loewy—now, co-founder of Eversafe — at the time, lead prosecutor of the elder-abuse unit in the Manhattan District Attorney’s Office.

As we entered the criminal justice system, Liz coupled compassion with Kleenex, helping us to find our voice and tell our story — allowing us to advance from taking a stand, and helping my grandmother, to taking the stand, in criminal court, for the greater cause of elder justice.

As concerned persons, we felt we had ‘standing.’

We felt both our concern and our selves, as persons, were recognized and respected.

Too often, concerned persons bear the burden of concern, all the while compromised; they feel they are not a full person as they are not seen as having standing in the eyes of authorities.

This diminishes concerned persons, and our collective response to injustice.

As recently as the 1980s, crime victims had no standing, no rights. Crime victims were “nameless/faceless non-players in [the] criminal justice system.” (NCVLI)

Concerned persons are not just the at the heart, they are the heart, of our connections with communities, older adults included.

When fighting crime, it’s time that concerned persons have standing, and our trust.
Trust, in paradox. • “The entire point of the book is that in the real world it is hard to disentangle ethics on one hand from knowledge and competence on the other.”—Talib, Nassim Nicholas. Skin in the Game: Hidden asymmetries in daily life. 2018 . Taleb’s fifth book in Incerto (on Medium)

Trust twins

All-too-prevalent fraud and ‘pure’ elder financial exploitation aside, elder abuse is the betrayal of trust.

Elder justice is the promise of trust, in paradox.

For too long, I felt unworthy of my grandmother’s trust in me.

For trust is twofold and entails equity, with each element in equal measure.

As concerned persons know, trust involves the ‘trust twins’: ethics and agency.

Our ethical responsibility must be matched by our ‘response ability’ — our ability to respond — otherwise we feel helpless and hopeless.

As elder-justice experts your agencies can help concerned persons achieve agency — agency to act against abuse, agency toward self-care.

And, for family members, agency to step beyond the affliction of ‘normalized’ trans-generational schema and power dynamics that set the stage for abuse.
Brooke Astor with family and caregivers at Holly Hill, Briarcliff Manor, NY. July 2007.

Full Circle

Our effort to help my grandmother started with the idea that independently, then collectively, we couldn’t image not doing whatever possible to respect my grandmother’s goal and wish to spend her last days at her country house…which she did, with family and friends — and free from fear.

It was because of grandmother’s circle of support that she was able to come full circle.

Our ‘old age’ must never be considered a terminal stage, but one where life re-turns, full circle, cradled in trust.
1—Promittere “…foretell; assure beforehand, promise.” Etymonline • 2—Burnes and Lachs. (2017) The Case for Individualized Goal Attainment Scaling Measurement in Elder Abuse Interventions; Baumeister and Vohs. (2016) Introduction to the Special Issue: The Science of Prospection. [Review of General Psychology] • 3—Wish to live and (testamentary) wish to give

Trust triad

To return full circle, our promise of trust must extend beyond the ‘trust twins’ ethics and agency, to a ‘trust triad.’

Trust must include knowledge—knowledge of a senior’s goals and wishes, exemplified in David Burnes’ keynote.

This knowledge is possible…
  • when we acknowledge seniors, and their strengths and needs;
  • when seniors confide, with confidence, about their deepest fears and hopes;
  • through prediction, pragmatic planning, and formative assessment;
  • and when concerned persons can serve as proxy, so informed.
This is where David Burnes’ and Mark Lachs’ individualized goal attainment scaling measurement is so helpful for “protective response interventions” to elder abuse. (2017)

This person-centered community-based approach may also help toward proactive prevention, facilitated by the Elder Abuse Risk Assessment and Evaluation© tool (EARAE), developed by colleagues at Lifespan of Rochester, and other ‘forward-looking’ tools. In the future, these can be harnessed toward proactive prevention.

Difficult conversations are critical to have with seniors; if we hesitate it may be too late as we can’t trust our preferred presumptions as proxy, uninformed.
Elder Abuse Helpline for Concerned Persons, NYC Elder Abuse Center. Call 212–746–6905 (M-F, 9AM-5PM Eastern) if you seek support for yourself while helping an older adult who lives in New York City.

NYCEAC Helpline

Before I acted, I was filled with angst, frustration, and a sense of impotence as I watched my grandmother’s world, which had spanned the globe and a century, become so diminished and compromised by her only child, my father.

Today, reflecting on my grandmother’s sad circumstances, I wonder how many trusted family, friends, and neighbors share a similar situation yet do not know what to do or who to turn to.
I wish the New York City Elder Abuse Center helpline was available in 2006 when I needed help.

This week, a concerned person called me up. She was in tears as she chronicled her attempt to help her mother from abuse and exploitation. She had no idea how to respond to her mother’s chronic abuse, quote, “along with all the other responsibilities in my life.” She knew it was going to get worse before it got better, with help.

Luckily her mother is in New York. I could direct her to NYCEAC’s helpline, which provides access to a trained service specialist who, in turn, “is backed by a culturally competent, compassionate, and caring team of professionals with many years of experience in the elder justice field.” This includes many of you, here today.

I filed a guardianship petition (which was awarded, thanks in part to Ira Salzman, with us today) to help my grandmother and those trying to help her, her A-Team—concerned persons, all. We were lucky.

Many concerned persons act alone, and feel alone — as isolated as seniors they are trying to protect — just as they reach out to society for help.

Nancy Oatts is a concerned person who had a singular journey no one would wish to repeat, but plays out city- and country wide every day.

Nancy’s journey is an inspiration to all of us, and her hard-learned insight informs our next steps along the way, together—and our panel presentation, now.
Nancy Oatts, Nancy Oatts Design; member of the NYCEAC Helpline Advisory Board • David Burnes, Ph.D., Assistant Professor at the University of TorontoDavid Gimbel, Ph.D., member of the Steering Committee, NYCEAC • Leslie Mantrone, LMSW, Helpline Specialist, WCM/NYCEACPhilip C. Marshall, Founder, Beyond Brooke; member of the NYCEAC Helpline Advisory Board. Photograph: Bess White, Weill Cornell Medicine (WCM)/NYCEAC

Remarks prepared for the 14th Annual NYC Elder Abuse Conference: Making a Measurable Difference — June 5, 2019

Family, Friends, and Neighbors in the Lives of Elder Abuse Victims: A population of concern and promise — This workshop discusses research which led to creating the New York City Elder Abuse Center’s (NYCEAC) Elder Abuse Helpline for Concerned Persons, a non-emergency phone and email service. Insights from the pilot year will facilitate a conversation about what more can be done for concerned persons.

  • Risa Breckman, LCSW, Director, Weill Cornell Medicine (WCM)/NYCEAC (represented by David Burnes)
  • David Burnes, Ph.D., Assistant Professor at the University of Toronto
  • Leslie Mantrone, LMSW, Helpline Specialist, WCM/NYCEAC
  • Nancy Oatts, Nancy Oatts Design; member of the NYCEAC Helpline Advisory Board—a concerned person, as chronicled in My Neighbor Miss D
  • Philip C. Marshall, Founder, Beyond Brooke; member of the NYCEAC Helpline Advisory Board—a concerned person

Full Article & Source:
Family, friends, and neighbors are at the heart (and the heart) of elder justice

Thursday, June 13, 2019

Texas U.S. Attorney: Texas Personal Assistant Charged With Fraud for Stealing From Her Elderly Client

HOUSTON, Texas, June 5 -- The U.S. Attorney for the Southern District of Texas, Ryan K. Patrick, issued the following news release:

A 40-year-old Richmond woman has been indicted for fraud and making false statements regarding her participation in a scheme to defraud her 94-year-old client who is now legally blind, announced U.S. Attorney Ryan K. Patrick along with Special Agent in Charge Perrye K. Turner of the FBI and Harris County Precinct One Constable Alan Rosen.

A federal grand jury returned the four-count indictment against Amy Anglin aka Amy Powell May 30, 2019. Today, law enforcement took her into custody. She is expected to make her initial appearance before U.S. Magistrate Judge Frances H. Stacy at 2:00 p.m. today.

"Because of the complex nature of these case, the Department of Justice is uniquely suited to investigate and prosecute elder fraud," said Patrick. "As the Attorney General has stressed, elder fraud will not be taken lightly and sadly this is just one of many similar allegations that we see routinely. I thank the family for bringing this case to the attention of law enforcement and we will do everything in our power to make sure justice is served on Ms. Anglin."

Anglin is charged with two counts of fraud and two counts of making false statements to federal employees.

"Our investigators worked tirelessly on this appalling case to ensure Ms. Anglin was brought to justice for her alleged crimes," said Assistant Special Agent in Charge Darryl Wegner. "Ms. Anglin allegedly capitalized on an elderly man's vulnerability without any regard for his well-being. The FBI, alongside its local, state and federal partners, will continue to work every day to protect our elderly neighbors from fraud and abuse. We urge anyone with information about elder fraud or abuse to contact law enforcement immediately."

The indictment alleges Anglin began working for a successful real estate developer in Houston in approximately 2015 when he 91 years old and his eyesight was beginning to fail. Anglin allegedly took advantage of the victim's poor health and began to steal money from his bank accounts and misused his credit cards to purchase, among other things, airline tickets for herself and her family. Anglin would get her elderly victim to sign checks he believed were legitimate and authorized expenditures, according to the charges. She would then allegedly have the funds deposited into her personal bank account.

"I cannot articulate how disturbed I am by allegations in this case," said Constable Alan Rosen. "I take seriously any possible crimes against the elderly, particularly those who are disabled. This woman is charged with taking advantage of a man who is 54 years her senior. I appreciate the collaborative efforts of the FBI and U.S. Attorney's Office in pursuing this case and ensuring justice is served."

Anglin would also illegally convert the victim's assets by use of both his bank account and his credit cards, according to the indictment. In addition to using her access to the victim's banking accounts and business credit cards, the charges allege Anglin wired herself large amounts of money and used Western Union to transfer the victim's money to her friends and acquaintances. Anglin allegedly transferred funds from the victim's accounts to pay for vacations in Las Vegas, resorts in Hawaii and trips to her hometown. Anglin also used the stolen money to pay for country club memberships, golf lessons, overdue child support payments and major home improvements, including a hot tub, according to the indictment.

The charges further allege that at no time during the fraud scheme was Anglin authorized to make these transfers or payments.

Anglin's scheme was uncovered when the victim's family began to question certain payments associated with his accounts, according to the indictment.

With the help of a Houston-based attorney, the family has estimated the total amount of fraud associated with Anglin's scheme to be more than $550,000.

The scheme allegedly began in late 2015 and continued until approximately December 2018.
If convicted of wire fraud, Anglin faces up to 20 years in federal prison, while a conviction for making false statements, carries a potential five-year-prison term.

The FBI and Harris County Precinct One Constable's Office conducted the investigation. Assistant U.S. Attorneys Heyward Carter and Steve Mellin are prosecuting the case.

The charges are the result of a renewed effort by law enforcement to protect America's older citizens from elder abuse.

Since President Trump signed the bipartisan Elder Abuse Prevention and Prosecution Act (EAPPA) into law, The Department of Justice has participated in hundreds of enforcement actions in criminal and civil cases that targeted or disproportionately affected seniors. In particular, this past February the Attorney General announced the largest elder fraud enforcement action in American history, charging more than 200 defendants in a nationwide elder fraud sweep. The Department has likewise conducted hundreds of trainings and outreach sessions across the country since the passage of the Act.

Elder justice refers to a society's response to elder abuse, which includes physical abuse, caregiver neglect, financial exploitation, psychological abuse, sexual abuse and abandonment.

Elder fraud complaints may be filed with the FTC or at 877-FTC-HELP. The Department of Justice provides a variety of resources relating to elder fraud victimization through its Office of Victims of Crime. Additional elder justice resources, training, and outreach materials can be found at the Elder Justice Website (

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Texas U.S. Attorney: Texas Personal Assistant Charged With Fraud for Stealing From Her Elderly Client

Hospices Adapt to Support Patients Without Family Caregivers

Cultural changes to family dynamics and demographics may require hospices to adjust their care and business models to care for patients who have no family support.

Since its inception, hospice has been centered on both the patient and family, not only through providing services to the family but also relying on them as an essential part of the patient care team.

Patients often lack caregivers due to outliving their relatives, being childless, divorce, having no siblings, or changes in geographic mobility. Few hospices can maintain round-the-clock care for patients in their homes, thus a lack of family caregivers can contribute to increased hospitalizations or nursing home admissions, as well as create ethical and legal challenges. Many of these patients have limited decision-making capacity and need assistance making health care choices, including decisions regarding hospice enrollment.

A 2014 study found that older adult patients without family support, often called “unbefriended,” often do not enroll in hospice due to inadequate state policies governing third-party medical decisions for these patients. With 1.4 million patients in hospice care and approximately 4% of older adults unbefriended, hospices can expect to see more of these patients as the population ages and hospice utilization continues to rise, according to the American Bar Association’s Commission on Law and Aging,

“Demographically we are going to have to keep thinking about this,” said Katherine Ornstein, M.D., of the Icahn School of Medicine at Mt. Sinai Medical Center in New York. “There is a lot that we don’t know because I think the role of other relationships, friendships, outside of the traditional family that support older adults in the community needs to be studied a bit more, but I think that it is such an important issue. We know how difficult it is for individuals who have devoted family members, what about those who don’t?”

Different states have different mechanisms for how to care for unbefriended patients; many have enacted public guardianship programs, in which a state social services agency appoints an attorney to become the patient’s legal guardian. The State of Indiana operates a Volunteer Advocacy Program in which the attorney appointed as guardian assigns a volunteer trained to make third-party health care decisions to the patient.

However, these types of guardianships introduce a significant potential for conflicts of interest that could lead to unnecessary or undesired use of services by the person under guardianship. It also could result in the denial of necessary services when cost cutting is mandated,  according to Alexia Torke, M.D., associate director, Indiana University Center for Aging Research, Regenstrief Institute in Indianapolis.

Encouraging referral partners and other health care providers in the community to discuss advance care plans with patients can help prevent later complications in medical decision making, allowing the patient’s wishes to be documented before their decision-making ability becomes impaired.

Early conversations are positively associated with decisions to limit or withdraw life-sustaining treatments, fewer in-hospital deaths, fewer unplanned hospital admissions, shorter hospital stays, satisfaction with end-of-life care, and increased odds of receiving strong opioid pain medications in the last 24 hours of life, according to a study in the March issue of the Journal of the American Medical Directors Association.
“All qualitative research exploring patients’ and family caregivers’ perspectives highlights that it’s up to health care professionals to start these conversations,” Silvia Gonella, R.N., co-author of the study, told Hospice News. “Unfortunately, this often does not happen, for different reasons —lack of time, difficult topic that staff prefers to avoid.”

Advance care planning ideally should begin as early as possible in the course of the patient’s illness, before they reach a crisis. Formal plans include documents such as advanced directives, living wills, and physician orders for life sustaining treatment (POLST forms) that can be entered into the patient’s electronic medical records. A key component of these conversations is to identify a third-party, a friend or relative or other representative, that the patient chooses to make decisions on their behalf should they become incapacitated.

“When you have someone in this category who still has decision-making capacity, it is important to get them to name someone who they would like to oversee their care. Many times, in conversation, they are able to name at least one close friend,” Torke told Hospice News.

In the absence of advanced planning, hospices may find themselves in difficult situations with unbefriended patients. Torke noted that patients with fewer social supports can often end up in acute care situations and may not receive the right care at the right time. And while hospice care can be given in long-term care facilities, patients must often navigate complicated insurance stipulations. This could all lead to higher medical costs and delayed enrollment in hospice.

“Hospices may be harmed a bit, but the person who really suffers is the individual who is walking their last chapters. It is our fiduciary responsibility to educate and provide resources. We need to understand what the patient needs and act on that,” Tim Ihrig, M.D., chief medical officer at Crossroads Hospice in Oklahoma City, said. “We have to understand why these patients are so expensive. It’s not because they’re old, unbefriended, and so on. [Their care] costs so much because of what the health care system does to them that neither enhances their quality of life or longevity.”

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Hospices Adapt to Support Patients Without Family Caregivers

Seniors were sold a risk-free retirement with reverse mortgages. Now they face foreclosure.

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In a stealth aftershock of the Great Recession, nearly 100,000 loans that allowed senior citizens to tap into their home equity have failed, blindsiding elderly borrowers and their families and dragging down property values in their neighborhoods.

In many cases, the worst toll has fallen on those ill-equipped to shoulder it: urban African Americans, many of whom worked for most of their lives, then found themselves struggling in retirement.

Alarming reports from federal investigators five years ago led the Department of Housing and Urban Development to initiate a series of changes to protect seniors. USA TODAY’s review of government foreclosure data found a generation of families fell through the cracks and continue to suffer from reverse mortgage loans written a decade ago.

These elderly homeowners were wooed into borrowing money through the special program by attractive sales pitches or a dire need for cash – or both. When they missed a paperwork deadline or fell behind on taxes or insurance, lenders moved swiftly to foreclose on the home. Those foreclosures wiped out hard-earned generational wealth built in the decades since the Fair Housing Act of 1968.

Leroy Roebuck, 86, rode the bus his entire career to a nearby curtain manufacturer. When he needed to make home repairs, he turned to reverse mortgages after seeing an ad on television.

Ten years ago, he forgot to renew his homeowners insurance, which cost about $2,000 a year. Including fees and penalties, his loan servicer says he now owes more than $20,000.

Roebuck’s first foreclosure notice came in the mail six years ago, and he is still fighting to hold on to the brick walk-up he bought from his parents in 1970, living in it through a special health exemption to foreclosure. 

“I told my son, ‘Never. They ain’t gonna take this house,’ ” Roebuck said. “I’ll go to the deep blue sea, they’re not going to take this house.”

Elderly homeowners and their adult children told similar stories in big city neighborhoods across the USA.

Borrowers living near the poverty line in pockets of Chicago, Baltimore, Miami, Detroit, Philadelphia and Jacksonville, Florida, are among the hardest hit, according to a first-of-its-kind analysis of more than 1.3 million loan records. USA TODAY worked in partnership with with Grand Valley State University, with support from the McGraw Center for Business Journalism.

Consumer advocates said the analysis supports what they have complained about for years – that unscrupulous lenders targeted lower-income, black neighborhoods and encouraged elderly homeowners to borrow money while glossing over the risks and requirements.

USA TODAY found that reverse mortgages end in foreclosure six times more often in predominantly black neighborhoods than in neighborhoods that are 80% white.  

Even comparing only poorer areas, black neighborhoods fare worse. In ZIP codes where most residents make less than $40,000, the analysis found reverse mortgage foreclosure rates were six times higher in black neighborhoods than in white ones.

The foreclosure disparity resembles a more familiar scenario from the late 2000s, when subprime lenders targeted specific neighborhoods with risky loans doomed to fail, according to the nation’s lead reverse mortgage researcher.

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Seniors were sold a risk-free retirement with reverse mortgages. Now they face foreclosure.