«The New York State Cost of Financial Exploitation Study June 15, 2016 Page 1 of 94 The New York State Cost of Financial Exploitation Study Yufan ...»
In both studies, cases were identified using the U.S. Administration on Aging’s National Center on Elder Abuse newsfeed, which uses Google and Yahoo alerts to track daily media reports of elder abuse. Of the 357 unduplicated cases identified in the first study, 60 percent included information on the amount of monies and resources allegedly taken. When added together, these losses produced a combined total of approximately $400 million. In the 2010 sample, about two-thirds of the 389 unique cases included financial information, placing victim losses in the vicinity of $530 million. Operating under the assumption that observed cases were representative of financial exploitation cases across the year, the researchers multiplied observed totals by four to arrive at a total victim loss of $2.6 billion in 2008 and $2.9 billion in 2010.
In another set of groundbreaking studies, the state of Utah used APS reports to estimate both victim losses and system costs (Gunther, 2011; 2012). In these studies, Page 22 of 94 APS workers were asked to provide costs and other relevant information for all substantiated financial exploitation reports involving adults aged 60 or older. Based on the 80 cases reviewed in the 2011 study, the impact statewide was close to $7.7 million, with $6.8 million taken directly from the seniors and the remaining $900,000 accrued in the form of additional Medicaid costs. Estimates in the 2012 study were slightly lower at $4.8 million, but were based on only 52 case reviews.
Noting that many cases of financial exploitation go unreported, the research team multiplied case review costs by a range of magnitudes to generate lower and higher end estimates of potential losses, had all incidents been observable. Ranges were selected based on previously cited research that placed the ratio of reported to unreported financial exploitation cases somewhere in the one to 10 or one to 44 range. Based on this method, total losses attributed to financial exploitation within Utah were estimated to be between $77 million and $339 million in 2010, and between $48 million to $209 million in 2011.
The value of a multidisciplinary response to financial exploitation of vulnerable adults Not every case of abuse, neglect or even financial exploitation will require the involvement of a multidisciplinary team (MDT). However, an MDT can be of great benefit where there is a complex case that will require expertise and coordinated action from professionals in such fields as: adult protective services, aging, health, mental health, developmental disability, alcohol/substance abuse, social services, governmental benefits/services, emergency housing, police/sheriff, district attorney, civil attorneys, financial institutions, forensic accountants, etc. Many of the financial exploitation cases referred to APS and other providers involve the need for expertise and coordinated response from such professionals.
Need for further research Given the number of vulnerable adults estimated to be impacted by financial exploitation each year and the potential magnitude of the accompanying fiscal impacts, it is not surprising that advocacy groups have called for making efforts to quantify the costs and consequences of financial exploitation a national priority. The Elder Justice Roadmap (2014) has urged researchers to conduct additional cost studies and has cited the need for development of validated tools and methods capable of collecting cost-related data from key systems such as APS, criminal justice, financial services, Family Court, health care, law enforcement, ombudsman, and Social Security.
As described in the following chapter, the New York State Cost of Financial Exploitation Study is responsive to this call, and uses a specially developed case review instrument and promising estimation approaches to explore the fiscal impacts of financial exploitation in New York State.
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Chapter 2: The New York State Cost of Financial Exploitation Study:
Methodology To learn more about financial exploitation in New York State, the OCFS Bureau of Adult Services partnered with the OCFS Bureau of Research, Evaluation and Performance Analytics to conduct a comprehensive review of financial exploitation referrals received by local adult protective services offices across New York State.
Participating Districts4 Local APS offices were invited to participate in the study through a formal letter issued by the OCFS Commissioner. As shown in Figure 1, 31 of the 58 local social services districts agreed to work with the OCFS research team. Participating districts encompassed both urban and rural areas and included most of the state’s most populous cities. In addition, OCFS invited the participation of one non-profit agency, Lifespan of Greater Rochester, Inc. (Lifespan). Lifespan is a well-regarded and experienced provider of services to vulnerable elderly across the state, and is particularly active in the Finger Lakes Region.
In New York State, adult protective services (APS) are a mandated service provided in each county by the local department of social services (LDSS), with one exception. In New York City (NYC), the New York City Human Resources Administration (HRA) serves in the role of the LDSS and provides APS services for all five NYC boroughs. With this in mind, the term “district” is used to refer to the local entities responsible for service provision.
Page 24 of 94 Sampling Plan To maximize participation and reduce local burden, OCFS worked with local districts to develop an individualized sampling plan. Lifespan and 19 participating districts agreed to code all referrals involving allegations of financial exploitation received during the study window. For the remaining 12 districts, individualized, random sampling schemes were used to select a representative subset of eligible APS referrals. A complete listing of participating districts and their sampling plan can be found in Table 1.
Observation Period All districts identified and coded qualifying APS referrals received between January 1, 2013 and September 30, 2013. In addition, 28 districts expanded their data collection window and conducted historical case reviews on eligible referrals received in the last quarter of 2012.
Data Collection While New York State APS case recording and reporting systems document the number and types of APS referrals and contain valuable information on client assessment and service plans, these systems are not currently designed to collect in-depth, reportable elements specific to financial exploitation cases and associated costs. APS workers were therefore asked to complete a comprehensive case review instrument for all cases included in the study sample (see Appendix B). Created in partnership with the local districts, the instrument included 24 questions designed to elicit detailed information on financial exploitation incidents, case characteristics and outcomes, and fiscal impacts.
As shown in Table 2, the extent of information gathered on each case varied by case status.
Full Referral Sample: For all referrals included in the case review component, workers identified referral source(s) and provided basic information on the alleged victim (referred to here as the client). This included demographic information, as well as the worker’s perceptions of the client’s overall health, vulnerabilities, and daily functioning.
To assess the fiscal impacts associated with serving each referral, workers answered a series of questions about the types of agencies, including APS and other communitybased providers, involved in the investigation, assessment, and management of the client’s needs. Workers also documented whether clients were connected to public Page 25 of 94 benefits. Costs were documented for all cases, regardless of verification status (see definition below), as service provision was based on need, not cause.
Verified Case Sample: While all cases in the case review component included allegations of financial exploitation at APS intake, evidence supporting the alleged exploitation may or may not have been found during the investigation process.
Consequently, workers were only asked to provide specific information regarding the nature of the alleged exploitation, the identity of the perpetrator, and the nature and value of the assets taken when sufficient evidence existed that the alleged exploitation had indeed occurred. Unlike other states, New York State does not make a formal determination of the allegations included in an adult protective investigation.
Thus, for the purposes of the current study, a financial exploitation case was labeled as “verified” when a worker concluded, based on his/her professional expertise that exploitation had occurred. For verified cases, workers also indicated whether or not the client appeared to understand what had happened to him/her and whether the exploitation had resulted in a set list of individual (e.g., bankruptcy, eviction) and system level (e.g., guardianship referral to law enforcement, civil suit, etc.) outcomes.
Measuring Costs and Victim Losses In keeping with the Elder Justice Roadmap’s call for better data collection tools specific to financial exploitation, case review items were specifically designed to capture detailed information on fiscal costs. Noting that prior research has tended to lump all types of fiscal impacts into a single cost figure, workers were asked to break out Page 26 of 94
costs/losses associated with financial exploitation in relation to three distinct categories:
service agency costs, public benefit costs, and victim losses.
Service Agency Costs: In New York State, APS staff are responsible for receiving and investigating referrals, interviewing clients and collaterals to determine eligibility for services, and assessing client risks. If necessary, APS must develop service plans to
address identified risks. Services may be provided directly by APS or other communitybased agencies and often include the following:
Referral for medical and/or mental health examination and the provision of ongoing care;
Assistance in obtaining benefits, such as Medicaid;
Assistance in obtaining safety net benefits, food stamps, Home Energy Assistance Program (HEAP) and other utility benefits, Supplemental Security Income (SSI) or Social Security Disability Benefits;
Assistance with applications for payment of rental and utility arrears;
Identification and provision of alternative living arrangements and/or emergency APS temporary housing placements;
Provision of homemaker, housekeeper/chore and/or heavy duty cleaning services;
Informal financial management (assistance with bill payment, check writing) or formal financial management of SSI or Social Security Benefits;
Filing of court petition for appointment of guardian to manage personal and/or financial/property affairs;
Advocacy and assistance in arranging for legal services to assure access to rights and entitlements; and Referral to police/sheriff/district attorney.
To document the costs incurred as a result of investigation, assessment and/or service plan activities, APS offices relied on both APS case records and documentation obtained from other involved agencies. Partnering agencies were asked to provide detailed accountings of staff hours and hourly wages. To promote sharing of cost information across agencies, the OCFS research team sent letters explaining the study to the Elder Abuse subcommittee of the District Attorneys Association of the State of New York, the New York State Police, the New York State Department of Health, the New York State Office for the Aging, and the New York State Office of Temporary and Disability Services. In 97 percent of referrals, partnering agencies were able to provide a detailed accounting of the costs incurred.
Table 3 provides an example of how service agency costs were determined in a sample case involving the misuse of power of attorney. As shown below, APS, law enforcement, the District Attorney’s Office, and Legal Aid Services were all involved in the investigation and assessment of the case. APS estimated that approximately 100 hours were devoted to the case at an agency cost of $26 per hour, for a total APS price
Public Benefit Costs: In addition to service agency costs, APS workers were asked to track how often clients were connected to new or additional public benefits (e.g., Medicaid, Medicare, public assistance, etc.). If new or additional benefits were received, workers were asked to record the benefit type and monthly value. Valuation of these costs was limited to the benefit received by the client, as staff time devoted to assisting clients with application paperwork was captured under service agency costs.
For example, a woman in her 80s who previously had sufficient funds to pay for roundthe-clock aides at home, became impoverished after her daughter took more than $160,000 from her accounts. Unable to continue to pay for her care, the woman was moved to a nursing home and enrolled in Medicaid. Her monthly Medicaid benefit was $3,200 a month and was recorded as a public benefit expense.
Victim Losses: The third and final category of fiscal information gathered focused on the items and assets taken from verified victims. Here the word ‘loss’, rather than ‘cost’, is deliberately used to emphasize that these figures refer to resources taken directly from the vulnerable adult. As noted above, workers only provided victim losses for verified cases. When the value of a given item was not readily known, workers were asked to provide a detailed description of the stolen item, such as the make and model of a vehicle or the address of the property signed over. The value of these items was then estimated, using reliable websites such as Kelly Blue Book, Property Assessment Directory and Zillow.