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«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 ...»

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Connolly, M., Brandl, B. & Breckman, R. (2014). The Elder Justice Roadmap: A Stakeholder Initiative to Respond to an Emerging Health, Justice, Financial and Social Crisis. Retrieved from http://www.ncea.aoa.gov/Library/Gov_Report/docs/EJRP_Roadmap_and_Appendices.p df Cooper, C., Selwood, A., Blanchard, M., Walker, Z., Blizard, R., & Livingston, G. (2009), Abuse of people with dementia by family caregiver: representative crosssectional survey. British Medical Journal, 33, 1-5 Eldercare Locator. Protect your Pocket: Tips to Avoid Financial Exploitation. Retrieved from http://www.n4a.org/pdf/n4a_Financial_Exploitation_Brochure_for_508.pdf Gunther, J. (2011). The 2010 Utah Cost of Financial Exploitation. Utah Division of Aging and Adult Services. Retrieved from http://www.nlrc.aoa.gov/NLRC/Docs/2010_Cost_of_FE_5_24_LE.pdf Gunther, J. (2012). The 2011 Utah Economic Cost of Elder Financial Exploitation. Utah Division of Aging and Adult Services. Retrieved from http://victimsofcrime.org/docs/default-source/financial-fraud/2011-economic-cost-offinancial-exploitation.pdf?sfvrsn=2 Hafemeister, T.L. (2003). Financial Abuse of the Elderly in Domestic Setting. In Bonnie R.J. & Wallace, R.B. (Eds.), Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America (pp.382-445). Washington, D.C., US: National Academies Press.

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Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, and New York City Department of Aging (2011). Under the Radar: New York State Elder Abuse Prevalence Study. Retrieved from http://ocfs.ny.gov/main/reports/Under%20the%20Radar%2005%2012%2011%20final% 20report.pdf Missouri’s Department of Health and Senior Services (2011). Abuse, Neglect and Financial Exploitation of Missouri’s Elderly and Adults with Disabilities. Retrieved from http://health.mo.gov/safety/abuse/pdf/FY11CryingEyeAR.pdf National Adult Protective Services Association (n.d.). What is Financial Exploitation?

Retrieved from http://www.napsa-now.org/get-informed/what-is-financial-exploitation/ National Center on Elder Abuse (1996). Elder Abuse: Questions and Answers.

Washington, D.C.: National Center on Elder Abuse

National Center on Elder Abuse (1998). The National Elder Abuse Incidence Study:

Final Report. Washington, DC: National Aging Information Center.

National Institute of Justice (2015). Financial Exploitation of the Elderly. Retrieved from http://www.nij.gov/topics/crime/elder-abuse/pages/financial-exploitation.aspx.

Navarro, A.E., Gassoumis, Z.D. & Wilber, K.H. (2013). Holding abuser accountable: An elder abuse forensic center increases criminal prosecution of financial exploitation. The Gerontologist, 53, 303-312.

New Mexico’s Aging and Long-Term Services Department (2014). Adult Abuse Awareness. Retrieved from http://www.nmaging.state.nm.us/Adult_Abuse_Awareness.aspx.

New York Codes, Rules, and Regulations (NYCRR), § 457.1(c).

New York Codes, Rules, and Regulations (NYCRR), § 457.6(a).

Pillemer, K, & Finkelhor, D. (1998). The prevalence of elder abuse: A random sample survey. The Gerontologist 28, 51-57.

Quinn, M.J. (2000). Undoing undue influence. Journal of Elder Abuse and Neglect, 12, 9–16

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The MetLife Mature Market Institute, the National Committee for the Prevention of Elder Abuse, and Center for Gerontology at Virginia Polytechnic Institute and State University (2009). Broken Trust: Elders, Families, and Finances—A Study on Elder Financial Abuse Prevention. Retrieved from https://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trustelders-family-finances.pdf The MetLife Mature Market Institute, the National Committee for the Prevention of Elder Abuse, and Center for Gerontology at Virginia Polytechnic Institute and State University (2011). The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders. Retrieved from https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financialabuse.pdf.

U.S. Government Accountability Office (2011). Stronger Federal Leadership Could Help Improve response to Elder Abuse. Retrieved from http://www.gao.gov/assets/130/125590.pdf U.S. Government Accountability Office (2012). Elder Justice National Strategy Needed to Effectively Combat Elder Financial Exploitation. Retrieved from http://www.gao.gov/assets/660/650074.pdf

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Overview:

In New York State, APS is a state-mandated service provided by local departments of social services, also known as local social services districts (districts). These are county districts, except in New York City. The New York City Human Resources Administration (HRA) serves, with regard to APS, as the local district for the five boroughs of the city.

APS staff receive and investigate referrals, interview clients and collaterals to determine eligibility for services, assess client risks, develop services plans to address identified risks and, as appropriate, provide or arrange for the provision of protective services in accordance with the services plan. Where APS determines that a vulnerable adult is in danger due to lack of capacity, APS must seek an involuntary intervention to address the danger.

Cases Reported to APS:





The number of cases reported to APS in New York State has increased significantly over the years. The 2014 APS referral number (44,367) is an increase of over six percent since 2013 (41,775), an increase of over 31 percent since 2008 (33,833) and an increase of over 77 percent since 1997 (25,000).

NYC HRA reported in 2014 that 62 percent of its APS referrals were persons age 60 or older. For the Rest of State APS referrals, 66 percent were persons age 60 and older.

According to data of the Adult Services Automation Project (ASAP), the APS electronic case recording and reporting system for all districts outside of NYC, of the types of referrals made to APS, about 28.3 percent of all risks reported were for perpetratorrelated risks. NYC HRA data shows this category comprising approximately 34 percent of all APS risks reported. Perpetrator–related risks are those that involve a perpetrator,

and include:

 Physical abuse  Sexual abuse  Emotional abuse  Financial exploitation  Neglect by others In 2014, ASAP data shows that category with the highest percentage of the perpetratorrelated risks was Financial Exploitation (36.8 percent for all ages, i.e., 18 and older;

39.2 percent for clients age 60 and older.

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ASAP data for 2014 shows that approximately 71.7 percent of all risks reported to APS are for so–called “self-neglect” cases, involving no perpetrator. NYC HRA data shows this category comprised approximately 66 percent of all APS risks reported. 'Selfneglect’ is defined as “an adult’s inability, due to physical and/or mental impairments, to perform tasks essential to caring for oneself, including but not limited to, providing essential food, clothing, shelter and medical care; obtaining goods and services necessary to maintain physical health, mental health, emotional well-being and general safety; or managing financial affairs." SSL section 473 (6) (f).

Financial exploitation cases reported to APS:

New York State experienced a 35 percent increase in financial exploitation cases from 2011 (4,198) to 2014 (5,680). In 2014, financial exploitation risks were the highest percent of all perpetrator–related risks for both NYC (37 percent) and the rest of the state (36.8 percent).

APS Eligibility Criteria:

APS is provided to assist adults age 18 or older who:

 Because of mental or physical impairments;

 Are unable to manage their own resources, carry out the activities of daily living, or protect themselves from physical abuse, sexual abuse, emotional abuse, active, passive or self-neglect, financial exploitation or other hazardous situations without help from others; and  Have no one available who is willing and able to assist them responsibly.

New York State Social Services Law (SSL) section 473, subdivision 1.

Referrals to APS:

Regulations define a “referral” as any written or verbal information provided to a district in which a specific person is identified as apparently in need of APS, or any verbal or written information provided to a district on behalf of an adult for whom the district determines that an APS investigation and assessment is necessary. 18 NYCRR 457.1(d).

In New York State, APS referrals are made directly to the local district. State guidance provides that an APS investigation must be initiated following a referral if the adult appears to be eligible or if eligibility cannot be ruled out based on the referral information.93 ADM 23.

As of this writing, New York State is the only state that does not have a system of mandatory reporting for APS-eligible individuals.

Page 54 of 94 Upon receipt of a referral, APS must determine whether a life-threatening situation exists. If APS determines that a life-threatening situation exists, APS must commence an investigation as soon as possible but not later than 24 hours after receipt of the referral. If APS determines that a life-threatening situation does not exist, an investigation must commence within 72 hours and a visit must be made to the client within three working days. In New York State the law does not require that APS operate outside of normal working days and hours.

Intake documentation must be completed and a decision must be made, within three working days of the referral, whether the case should be assigned for further assessment. State policy provides that if there is any doubt about the adult’s physical or mental capacity, and if the adult’s needs or risk exceeds the ability of others who may be assisting, the referral should be accepted for assessment. PSA Intake, 93-ADM-23;

96- ADM-18.

After receipt of the APS referral, APS attempts to conduct a home visit to the adult believed to be in need of APS. If the person is not present, or if the person or someone else refuses to let APS into the house, APS must enlist the help of family members, friends, neighbors, law enforcement, and staff of other service providers as appropriate, for the purpose of persuading the person who may be in need of APS to permit AOS to complete the assessment of the person’s need for such services. APS must make prompt and continuous efforts to gain access to the person and their residence in order to conduct such assessment. If access continues to be refused, APS is authorized to go to court and seek an order to gain access where APS, having reasonable cause to believe that a person may be in need of APS, is refused access by that person or another individual. Such order, if granted by the court, only authorizes APS to make an assessment of the person’s needs for APS. It does not authorize any other involuntary action by APS.

APS Assessment:

APS has up to 60 days from the date of the referral to complete a comprehensive assessment of the client’s situation. When conducting the assessment, an APS caseworker will review: the client’s physical and mental health; living conditions;

household budget and sources of income; status of rent/mortgage and utility payments.

The caseworker will also evaluate whether there is evidence of: abuse, neglect (by others or self-neglect), financial exploitation, or other potential hazard. APS will also seek to determine whether there are others able and willing to assist the client. The worker will seek to interview the referral source, the client and others who may be able to provide important information (family, friends, neighbors, other service providers, among others).

Page 55 of 94

Regulations require that the APS assessment includes information regarding:

 Source of referral  Reason for referral  Household composition  Residence and living arrangements  Income and resources  Identification of significant other persons, such as family members and friends, and their willingness to assist the individual  Identification of other agencies involved with the individual  Assessment of problems and needs, and the names of agencies involved in the assessment  Client-specific objectives to be achieved  Services to be provided to obtain the objectives and names of the agencies providing the services  Expected duration of the services  Frequency of contact with the client  Concurrence and acceptance of services or a notation that the client is involuntary  In the case of a client who cannot or will not sign the application for services documentation as to why the worker is signing on behalf of the client  Frequency of review of the services plan  Progress evaluation at the time of review  Changes made in the client’s services plan as a result of the periodic reviews  Signatures of worker and supervisor  Such other information as the department shall require

18 NYCRR 457.2(B)

Additional information required by OCFS to be included in the assessment is as follows:

 Personal appearance indicators  Factors indicative of physical or mental impairment  Cognitive ability  Limitations on the adult’s ability to leave the home  Incapacitating illness or condition  Sources of medical and mental health information  Client characteristics; actual or threatened harm; level of endangerment; adult’s understanding of risk; willingness to accept assistance  Abuse, neglect or exploitation by other person (suspected perpetrator)  Ability and willingness of others to assist responsibly

–  –  –

Services Plan:

Upon completion of the assessment APS must determine whether the person is eligible for APS and if so develop a services plan to meet the needs of the client. The services

plan can include any of the following services to be provided or arranged by APS:

 Referral for medical and/or mental health examination and ongoing care;

 Assistance in obtaining benefits, such as Medicaid, home care;



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