«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 ...»
Page 28 of 94 Analytical Approach In addition to documenting the actual costs/losses reported in the case review component, several steps were taken to estimate the magnitude of fiscal impacts on a broader scale. As described in detail in the upcoming results chapters, case review records were used to extrapolate both district and statewide impacts. In the absence of comprehensive records detailing every APS referral and verified financial exploitation case served across the state, these exploratory analyses provide insight to how large the price tag surrounding financial exploitation in New York State may be.
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Chapter 3: The New York State Cost of Financial Exploitation Study:
Case Characteristics Study results are presented in two chapters. This chapter describes types of financial exploitation cases referred to APS offices, as well as the characteristics of verified cases. Fiscal impacts documented as part of the case study review and the statewide estimates generated from these findings are described in Chapter 4.
Sample Participating districts identified and coded a total of 928 APS referrals involving allegations of financial exploitation during the 12-month study. Prior case review studies, like those conducted in Utah, included a substantially smaller number of APS referrals. Thus, the current study marks a notable contribution to the financial exploitation literature and provides a more comprehensive base for exploring costs than available in the past. A table detailing the number of cases coded by each individual district can be found in Appendix C.
Referral Sources The most common sources for financial exploitation referrals were family members (23 percent) and banks or other fiduciaries (21 percent). In addition, 18 percent of referred cases came from health providers, including home care agencies, hospitals, mental health agencies, and others. Consistent with past research on elder abuse that found elders rarely report their own victimization (Hafemeister, 2003), only two percent of financial exploitation referrals were initiated by the client. While the majority of referrals were initiated by a single source, 42 cases (4.5 percent) were brought to the attention of APS by multiple sources.
Client Health and Functioning In 76 percent of referrals received, APS workers reported that the client had at least one serious health impairment. The most frequent health concern noted was a physical impairment (49 percent), followed by mental impairment (36 percent) and dementia (30 percent). A modest percentage of referrals (11 percent) involved clients with signs of both mental impairment and dementia, bringing the total percentage of referrals involving any type of cognitive concern to 54 percent.
At the time of APS intake, clients were also experiencing a range of co-occurring problems that supported the need for APS involvement. An inability to manage personal finances (32 percent) was most common, followed by neglect by others (14 percent) or self (11 percent).
Verified Cases Consistent with substantiation rates reported in other states that utilize a formal determination process (Teaster et al., 2007), workers verified the occurrence of the alleged exploitation in 479, or 52 percent, of received referrals. Verified cases differed
significantly from unverified cases on several client characteristics and risks, including:
Perpetrators Consistent with past research, victims often had a close relationship with their perpetrator. Family members were identified as perpetrators in 67 percent of verified cases, and perpetrators were reported to be living with their victim in 35 percent of cases. Approximately 18 percent of verified cases had perpetrators who fell in the “other” category, which included such roles as bank manager, handyman, phone/email
Perpetrators did not fit into any single demographic category, with age and gender varying across verified cases. Relatively few cases had perpetrators who were known to have a drug abuse problem (15 percent), alcohol abuse problem (10 percent), or mental illness (10 percent).
Financial Exploitation Method A wide variety of methods were used to exploit victims, and in 33 percent of verified cases multiple methods were used. Misappropriation of funds (use of funds or property for unauthorized purposes) was documented in 26 percent of verified cases, followed by larceny, coercion, power of attorney abuse, and false pretenses in 14 percent to 16 percent of cases.
Victim Impacts Many victims in verified cases were perceived by their caseworkers as being largely unaware of their mistreatment. Victims were rated as having no understanding in 21 percent of referrals and partial understanding in 29 percent. In addition, financial exploitation was associated with a wide range of negative outcomes for the victims, including emotional pain (29 percent), financial impoverishment (19 percent), guardianship (nine percent), and health concerns (six percent) and eviction (four percent). Only five percent of victims had stolen items or funds partially or fully returned to them.
Legal Outcomes Caseworkers also reported on whether clients were referred to law enforcement and if subsequent criminal or civil legal actions were taken. Twenty-six percent of all APS referrals were referred to law enforcement officials. In 24 percent of referrals, caseworkers were aware that criminal action was initiated, and in seven percent of referrals they indicated that civil action had been taken. Outcomes of these referrals were generally unknown but in three percent of referrals (n=23) workers indicated that the perpetrator had been prosecuted or convicted. In only one percent of referrals (n=7) were workers aware of a favorable finding as a result of civil action.
Status of Case Districts were asked to briefly describe the current status of the case at the time of submittal. This was a narrative response rather than a selection among predetermined responses. While this makes the reporting of the collective responses somewhat more challenging, the intention was to provide an opportunity for an open-ended response by the districts. The responses provide important information about the cases submitted under this study.
Some clear categories of responses were:
Financial exploitation verified, but victim refused to press charges;
Case remains open for investigation/services;
Financial exploitation not verified, no other abuse/neglect found; APS case closed;
Guardian appointed or in process;
Order of protection issued against perpetrator;
Representative payee appointed or in process;
Perpetrator arrested and/or convicted;
Restitution/reimbursement made to victim or in process;
Levels of Fiscal Analysis To provide a comprehensive picture of fiscal impacts associated with financial exploitation, information on the monetary value of service agency costs, public benefits and victim losses are presented at three levels. The methods used to determine costs occurring at each level are described below.
Documented Costs/Losses: At the lowest level, service agency costs, public benefits, and victim losses were calculated using the information recorded in the case review. For ease of presentation, these figures are labeled “documented” costs/losses, as they represent actual, reported fiscal consequences.
Adjusted Costs/Losses: Eleven of the 31 participating districts lacked the resources to complete case review instruments on every financial exploitation referral received during the study period. Thus, documented costs capture only a portion of the expenditures triggered by financial exploitation referrals in these areas. To address this gap, an adjusted cost/loss estimate was calculated to reflect the full 31-county picture.
This was achieved by adjusting a district’s documented costs to capture the proportion of cases omitted during the sampling process. For example, Erie County coded one out of every 10 financial exploitation referrals received. Erie’s documented costs were therefore multiplied by 10 to estimate the total public expenditure bill. The adjusted estimates for the 12 districts employing sampling procedures were added to the documented costs in the remaining 20 participating districts to create an adjusted cost/loss estimate for the 31-district sample.
Statewide Estimates: Twenty-six of the 58 New York State districts did not participate in the OCFS study. Estimates of the potential costs incurred as a result of financial exploitation referrals in these districts were therefore generated using a matching process. Using Census Bureau data (U.S. Census Bureau: State and County QuickFacts 2013 estimate), each non-participating county was matched to a
participating county based on four factors:
For example, Allegany had 10 financial exploitation referrals during the study window, but provided no data. A review of the county-level profiles suggested that the demographics of Allegany County were similar to those of Cortland County. Cortland County did participate in the case review and had documented service agency costs of $3,059 spread across 21 APS referrals. Plugging these numbers into the formula above produced an estimate of $1,457 in service agency costs for Allegany County.
Service Agency Costs APS workers investigated each of the 928 referrals included in the study sample, and were able to provide monetary estimates of the service agency costs accrued by APS and other responding agencies in 844, or 91 percent, of all referrals. In addition to APS services, 33 percent (n=306) of referrals had involvement with other governmental agencies and community-based service programs. As shown in Table 10, referrals touched many types of agencies, with no one additional service type predominating.
After APS, involvement with law enforcement agencies was most common at 21 percent of referrals, followed by legal services (seven percent) and district attorney’s offices (six percent). Medical, mental health and financial service providers were involved in less than five percent of referrals.
As anticipated, service agency expenditures were high, with nearly $1.2 million devoted to investigation, assessment, and other related activities within the case review sample.
At $541,854, APS costs accounted for approximately 46 percent of all documented agency expenditures. The remaining $641,810 was divided across multiple agencies, with medical and health-related services accounting for a substantial proportion of service agency costs, despite the relatively modest percentage of referrals involved with these agencies. Adjusting for missing cases increased the total service agency cost within the 31 participating districts to an estimated $5,078,154. Finally, had data been collected on all referrals across the state for the 12-month observation period, our estimates suggest that over $6.2 million in new agency expenses would have been incurred as a result of financial exploitation referrals.
Public Benefit Costs In addition to agency services, 117, or 13 percent, of the 928 referrals included in the case review study received new or additional public benefits following their referral to APS. As shown in Table 11, food stamps or Supplemental Nutrition Assistance Program (SNAP) benefits and Medicaid/Medicare coverage were the most common types of benefits received, while health and housing-related benefits were some of the most costly. The overall cost of these additional benefits was comparable to documented service agency costs, with nearly $1.2 million accrued across the 928 referrals.
Page 40 of 94 Although not shown in Table 11, verified cases were associated with the greatest public burden, accounting for $1,067,391, or 89 percent, of all documented costs. When missing referrals were taken into account, the adjusted costs incurred within the 31 participating counties rose substantially to $7,549,976. Finally, extrapolating costs to the statewide level brought the cost of additional public benefits to an estimated $8,272,554.
Victim Losses Twenty-seven percent of verified cases involved repeated incidents of exploitation, and in 16 percent of cases multiple items were taken. As seen in Table 12, victim losses far outpaced service agency and public benefit costs. Across the 479 verified cases, over $24 million was reported in lost assets. The most common loss was monetary, with 42 percent of verified cases reporting cash losses of nearly $8 million. Misuse of personal checks, ATM transactions, and credit cards were also common and expensive, resulting in combined losses of over $6.5 million. Theft of real estate occurred in only seven percent of verified cases but represented a substantial fiscal loss at $5.6 million.
Adjusting these figures produced a loss of over $90 million dollars for participating districts and a statewide estimate of $109,048,214.
Adjusting Victim Losses to Account for Unreported Cases Research has repeatedly shown that incidents of financial exploitation frequently go unreported to APS and other authorities. While these incidents may not elicit a system response (and all service agency and public benefit costs associated with APS referrals), they can have very real, financially debilitating consequences for the vulnerable adults involved. To obtain an estimate of victim losses due to financial exploitation that are not reported to authorities, additional projections were made by applying the unreported rates to current research findings in participating study districts.