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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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 Assistance in obtaining Safety Net Benefits, SNAP (food stamps), HEAP and other utility benefits, Supplemental Security Income (SSI) or Social Security Disability Benefits;

 Applications for payment of rental and utility arrears;

 Identification of alternative living arrangements and/or emergency APS temporary housing placements;

 Providing homemaker and housekeeper/chore services in appropriate cases;

 Heavy duty cleaning services;

 Ongoing monitoring of safety and welfare;

 Informal financial management (assistance with bill payment, check writing)  Financial management of SSI or Social Security Benefits through appointment of APS by the Social Security Administration as representative payee;

 Petitioning court for appointment of guardian to manage personal and/or financial/property affairs; and  Providing advocacy and assistance in arranging for legal services to assure receipt of rights and entitlements due to adults at risk.

18 NYCRR 457.1(d)Progress Notes:

Regulations require that APS staff record progress notes of case related activities in the case record. Progress notes must be recorded as soon as possible but no later than 30 days after the date of the event which required use of progress notes. The progress notes are in the form of narrative rather than reportable data elements.

Adult’s Right to Self-Determination:

Adults are legally presumed to have the right to exercise free choice in making decisions affecting their lives. APS workers, when speaking with individuals being assessed for APS eligibility seek to determine whether such individuals can provide reasons for their choices, whether those choices have a basis in fact and reality, and whether the person can understand the consequences of his/her decision. A person with capacity can make their own decisions, even if someone else thinks such decisions are poor, or even harmful. Even where APS has a concern that a person faces danger

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If the client has the capacity to make decisions and understand the consequences of such decisions, the client is free to accept or decline services offered by APS. It is important to understand that most APS clients – even those with some form of cognitive impairment – have the capacity to make informed decisions and to refuse offered services.

Involuntary Interventions:

Regulations also provide, however, that when APS believes there is a serious threat to an adult’s well-being and that the adult is incapable of making decisions on his or her own behalf because of mental impairment, APS has the responsibility to pursue appropriate legal interventions to protect the adult, even if on an involuntary basis. APS must employ the least restrictive intervention necessary to effectively protect the adult.

18 NYCRR 457.6(a)

Among the involuntary interventions that can be sought by APS are:

 Order to gain access: (Discussed above) SSL Section 473-C  Short term involuntary protective services order: Authorizes APS to apply to court where an adult is imminent risk of death or serious physical harm, refuses services and is unable to understand the risk due to impairment. Permits involuntary emergency service such as removal to hospital; for a 72 hour period, subject to one renewal for an additional 72 hours.

 Application to police or mental health official for Involuntary Intervention under New York State Mental Hygiene Law (Mental Illness/Developmental Disability)  Representative Payee: Appointment of APS or local district by Social Security Administration to handle SSI/Social Security Benefits for a person deemed by SSA to be unable to responsibly handle such funds. APS must serve as representative payee where needed and no one else is willing and able to do so.

18 NYCRR 457.5(C) (3)  Guardianship: Appointment by a court to provide for personal needs and/or to manage the property and financial affairs of a person deemed incapacitated or in agreement with such appointment. APS must serve as the guardian of last resort for an APS-eligible client where guardianship is needed and no one else is willing and able to serve responsibly. 18 NYCRR 457.6 (c) (2)

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OCFS has issued an Adult Services Practice Model, setting forth the agency’s vision, mission, outcomes and values for adult services practice. This document states, with

regard to involuntary services planning:

 A decision to seek involuntary action is not to be taken lightly.

 Use the least restrictive intervention necessary to effectively protect the client.

 Use community-based services rather than institution-based services where possible.

 Document information needed to justify the use of involuntary intervention.

 Do no harm. Inadequate or inappropriate interventions may be worse than no intervention.

Contacting Police/Sheriff/District Attorney:

New York State law provides that whenever an APS worker has a reason to believe a criminal offense has been committed against an APS client, the worker must report this information to the appropriate police or sheriff’s department and to the district attorney when such office has requested such information be reported. SSL Section 473(5)

Client Contacts:

At a minimum, clients living in the community and in any of the situations set forth below

must be visited by APS at least once every calendar month:

 When abuse, neglect or exploitation by another person is suspected or documented.

 When environmental conditions exist in the home which are a threat to the health and safety of the client; or  When a client is homebound or when there is no other way to have face to face contact with the client without making a home visit.

In certain cases, these monthly visits can be delegated to the professional casework or social work staff of another agency.

For all other APS clients living in the community, APS staff must maintain at least face to face contact every calendar month and make a home visit at least once every three calendar months.18 NYCRR 457.5(B)

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In New York State, APS must determine and document, among other things:

 Whether a person referred for APS meets APS eligibility criteria;

 Whether such person has one or more specific types of risks and needs included in the comprehensive assessment;

 Whether the client is a victim of abuse, neglect or exploitation by another person;

 Whether there is one or more suspected perpetrators of abuse, neglect and/or financial exploitation; If so, such perpetrator(s) must be identified;

 The services plan components that best meet the identified risks and needs of the client.

New York State law does not require that APS determine whether or not a referral allegation is “indicated” or “unfounded,” nor is similar terminology used. However, as noted above, any findings of abuse, neglect of financial exploitation must be documented and any suspected perpetrators must be identified.

When investigating a case, APS workers are trained to be alert for any type of possible abuse, neglect or exploitation, whether or not it was specifically included in the referral.

Verification of Financial Exploitation Used in the Current Study:

The tracking of the rate of verification of finding of financial exploitation done for purposes of the study is outside of normal practice for APS in New York State, as were the findings as to the cost of financial exploitation, some of the elements of study of victim and perpetrator characteristics and outcomes data. OCFS does not normally track verification of APS referrals.

Potential APS Actions when Financial Exploitation of a Vulnerable Adult Client:

This includes:

 Referral to police/sheriff/district attorney.

 Discussion with financial institution; request for documentation to assist investigation; request for potential actions such as; seeking a delay or freeze of transactions pending APS/law enforcement investigation: change accounts and/or ATM card; cancel ATM card; set up informal money management for client.

 Provision of more formal financial management services via representative payee for SSI/Social Security Funds or direct electronic payments.

 Seek information from agent under a power of attorney (POA) through a “15 Day Letter” demanding the POA document and all transactions the agent as entered into under the POA on behalf of the principal. If the agent fails to submit the documents to APS as requested, APS can commence a special proceeding in court to seek an order directing production of documents, as well as other relief

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APS Training:

Regulations require the following OCFS-sponsored trainings for APS staff:

 All workers who provide APS, including supervisors, must attend a Basic Training Program in APS. The New Worker Institute is an eight-day classroom training program covering the range of topics that new APS workers need. OCFS has also developed and put on its website an online APS New Worker Orientation Course that is recommended for new workers.

 All APS workers, including supervisors must attend trainings on the Legal Aspects of APS. These courses include such topics as Adult Guardianship;

Investigation of Financial Exploitation; APS Case Management and Legal Liability; as well as an Annual Legal Aspects of APS Updates Teleconference.

 All APS supervisors must attend Fundamentals of APS Supervision Training.

OCFS also offers special topic classroom trainings and surveys local APS units for topics of most interest of them. Some current special topic offerings include: Buried Alive: Working Effectively with Compulsive Hoarders; Mental Health Assessment; and Aging with Chronic Mental Illness.

Among several recent new training offerings are the following:

 What Constitutes Success in an APS Financial Exploitation Case (Webinar)  Domestic Violence Dynamics and Skills for APS Workers (Computer based training; developed in conjunction with New York State Office for Prevention of Domestic Violence)  APS and Law Enforcement (Computer based training; developed in conjunction with New York State Division for Criminal Justice Services)  Transitioning Youth: Successful collaboration Between Adult Services and Foster Care (Webinar) OCFS also sponsors an annual New York State Adult Abuse and Training Institute (AATI), a three-day conference that offers an extensive array of multidisciplinary workshops and plenary sessions addressing protection of and services to vulnerable adults. Financial Exploitation and Multidisciplinary Teams are among the many topics presented. The AATI of 2015 is the 22nd Annual Conference.

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The APS Delivery Network and Multidisciplinary Teams:

The provision of APS should be viewed as a community-based service responsibility rather than a single agency responsibility. It is often the case that APS clients need services and/or benefits from more than one agency. APS units are required to reach out to and seek the active participation of representatives of the many agencies that constitute the APS delivery network. This includes personnel or medical, psychiatric, nursing and legal resources, law enforcement, public and private agencies, advocacy and faith-based organizations, and more. APS units are also required to educate the general public, service providers, advocacy groups and other appropriate agencies about the scope of APS and how to obtain services. 18 NYCRR 457.7 OCFS has actively promoted the value of APS participation in a multidisciplinary team (MDT), including other partners in the APS delivery network, to address financial exploitation, abuse and neglect of vulnerable adults. This is a frequent theme of technical assistance, case reviews and trainings provided by the OCFS Bureau of Adult Services. The Bureau shares MDT Resources and Best Practices with local districts.

MDTs that serve vulnerable adults are regularly featured in conference sessions of the OCFS-sponsored New York State Adult Abuse Training Institute.

OCFS is a state partner with the Office for the Aging in the Elder Prevention Interventions Grant funded by the U.S. Administration for Community Living. Under this grant Enhanced Multidisciplinary Teams (E-MDTS) have been established in Manhattan and seven counties in the Finger Lake Region, focusing on prevention and intervention in cases of financial exploitation of vulnerable elderly adults, forensic accountants and geriatricians supplement the team. OCFS has coordinated the involvement of local APS, and has taken the lead in the component of the grant that provides trainings to financial professionals regarding recognition, prevention and reporting of financial exploitation.

There are several MDTS including APS staff across the state in operation or in the process of formation. It is expected that the number will rise in the future, particularly if sources of funding for coordination and operation of such teams can be secured.

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The following study is designed to identify the cost of financial exploitation of vulnerable elderly and dependent adults in New York. (See definition of Financial Exploitation at Appendix A) In recent years, the number of Protective Services for Adults (PSA) referrals alleging financial exploitation has steadily increased. However, the cost associated with financial exploitation has seldom been collected. This survey is intended to gather information on financially exploited individuals, the perpetrators, and the actual costs associated with the item(s) that have been taken from PSA clients. Understanding how financial exploitation affects the person, governmental agencies and the State will be used to inform decisions about how to best target preventive interventions.

Financial Exploitation Instructions

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