What Kind of Money Should You Get From Your Doctor?

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Lorena Lane
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Clinical & Ethical Aspects to Elder Investment Fraud/Abuse Irving Faught, JD Lisa Angelotti Tom Teasdale, DrPH Robert Salinas, MD Bob Roush, EdD, MPH, Principal Investigator Aanand Naik, MD,

Director Oklahoma program collaborators Elisa Rodriguez and Kristin Cassidy, Former Assistant Project Directors Jennifer Moye, PhD, Elder Capacity Assessment Consultant Janet Pinner, RN, PGCM,

1 Clinical & Ethical Aspects to Elder Investment Fraud/Abuse Irving Faught, JD Lisa Angelotti Tom Teasdale, DrPH Robert Salinas, MD Bob Roush, EdD, MPH, Principal Investigator Aanand Naik, MD, Co-PI George Taffet, MD, Chair, Internal Advisory Group Larry McCullough, PhD, Member, IAG Nancy Wilson, LMSW, Member, IAG Mark Kunik, MD, Member, IAG Whitney Mills, PhD, Assistant Project Director Oklahoma program collaborators Elisa Rodriguez and Kristin Cassidy, Former Assistant Project Directors Jennifer Moye, PhD, Elder Capacity Assessment Consultant Janet Pinner, RN, PGCM, Nursing Continuing Education Wayne Howell, JD, Investor Education Consultant The physicians, nurses, social workers, and investor educators in focus groups whose opinions and suggestions guided our efforts

2 OK is a Mandatory Reporting State Who Must Report Elder Abuse? Physicians, emergency responders, other medical professionals Social workers, mental health professionals, LTC/residential staff Other health care professionals Community service workers, personal care assistants Staff of domestic violence programs Law enforcement officials Persons entering into transactions with a caretaker or other person who has assumed the role of financial management for a vulnerable adult

3 How can I fit this into my workload? Simple office-based assessment of potential vulnerability to EIFFE Recent article on office-based assessments is available Finances in the Older Patient With Cognitive Impairment JAMA, Feb. 16,

4 Red Flags in Patient/Client History Situations / Reasons Social isolation for Vulnerability Bereavement Dependence on another to provide care Financially responsible for adult child or spouse Alcohol or drug abuse Depression or mental illness

Red Flags from Clinical Observations Cognitive problems Fearful, emotionally labile, or distressed Suspicious, delusional Change in appearance, poor hygiene Accompanied by

5 Red Flags from Clinical Observations Cognitive problems Fearful, emotionally labile, or distressed Suspicious, delusional Change in appearance, poor hygiene Accompanied by caregiver who is overly protective or dominates patient/client Change in ability to perform ADL/IADLs including self care, daily finances, medication management Traits of Vulnerable Patients

6 Introducing the Issue to Your Patient We find that some older adults worry about money; may I ask you a few questions about this? or I just read an article about elders being financially exploited and thought I ought to talk to my mother and my patients, too.

7 Questions You Can Ask Who manages your money day to day? How is that going? Do you run out of money at the end of the month? Do you regret or worry about financial decisions you ve recently made? Have you given power of attorney to another person? Do you have a will? Has anyone asked you to change it?

8 Do I probe deeper or refer? If answers raise suspicion: go to referral section in Clinician s Pocket Guide or probe for further details (use Financial Concerns Checklist, which may be added to the patient/client information packet or completed during intake.)

9 Financial Concerns Checklist

10 What types of referral may be needed? Help with managing money or other care tasks poor resource management or limited resources available; needs assistance with finances, meals, transportation, ADLs Legal advice or protection needs assistance with financial planning or legal documentation Fraud and exploitation may have occurred Might just need legal counsel if evidence exists, reporting to APS is required by law Further medical evaluation for cognitive, neurological, or other conditions

11 Ethical Considerations Concerns about calling any local or state regulatory agency, even though it is mandatory and failure to do so is unlawful Literature suggests that it is best to talk individually with each of the patient and the possible responsible party

Interactions with Possible Responsible Party Use non-confrontational demeanor Ask about relationship to the patient Discuss patient s daily activities and routines Discuss any of patient s special

12 Interactions with Possible Responsible Party Use non-confrontational demeanor Ask about relationship to the patient Discuss patient s daily activities and routines Discuss any of patient s special needs Observe for following behaviors: demeaning comments about the patient defensive, suspicious attitude hostility about your inquiries threat to change doctors Tueth, M (Am J Geriatr Psychiatry 8:2, Spring 2000)

13 Referral Options Appropriate specialists such as a geriatrician, neurologist, psychiatrist, or psychologist may be warranted Reporting to Adult Protective Services is required by the laws of most states and grants immunity from civil or criminal liability for professionals who report suspected cases of abuse To find your state s APS contact information to make confidential reports, use this link:

14 Referral Sources Investor Protection: Irving Faught, Ok Dept of Securities TRIAD: coalition of law enforcement and seniors helping to prevent crime against elders and vulnerable adults. Oklahoma County TRIAD program: ; Tulsa TRIAD program: at , ext United Way 211 local hotline; National Assoc of Professional Geriatric Care Managers; Case Management Society of America; National Academy of Elder Law Attorneys (NAELA); Legal Hotline for Older Persons in your community Eg, Sr Law Resource Center - (405) Adult Protective Services (APS): (405) Attorney General s Office: Department of Insurance: (800) Local District Attorney s Office

15 EIFFE Prevention Program Materials Clinician s Pocket Guide Patient Education Brochure Invest Ed Program Lisa Angelotti, langelotti@ou.edu

Preventing Elder Investment Fraud: Assessing for Vulnerability to Financial Exploitation

Preventing Elder Investment Fraud: Assessing for Vulnerability to Financial Exploitation Dr. Bob Roush, Director Texas Consortium Geriatric Education Center Diane Childs Oregon Division of Finance and