 Hello, I'm Dr. Mary Meehan. As a Catholic university, Seton Hall University is committed to supporting educational achievement within our community. That's why we're proud to support the important educational programming produced by the Caucus Educational Corporation. Protecting our elders from abuse. Next on Caucus, New Jersey. Funding for this edition of Caucus, New Jersey has been provided by The Health Care Foundation of New Jersey, founded by the Jewish Community. Seton Hall University, where leaders learn. Horizon Blue Cross Blue Shield of New Jersey. The Robert Wood Johnson Foundation. The Northward Center. The Russell Berry Foundation. And by MD Advantage Insurance Company of New Jersey. Promotional support provided by nj.com, Small News, Big News, True Jersey. And AM 970, the answer. Welcome to Caucus. I'm Steve Adubato. You know, the National Institute on Aging says that each year, countless adults over the age of 60 are abused, neglected, or financially victimized. Joining me here in the studio to discuss the signs of elder abuse and ways to prevent it, we are joined by Carol Silver Elliott, president and CEO of Jewish Home Family. Amrit Walia, who is New Jersey Regional Managing Director, Wells Fargo Private Bank. Sharon Rivenson-Mark, Elder Law Attorney in Private Practice. And finally, Dr. Mark Pass, a geriatrician at Hackensack Meridian Health. I want to thank you all for joining us. It's a very important discussion. Dr. Pass, let me ask you the term elder abuse. Not a lot of people have heard of it. What does it mean? It usually means one of three things. Either someone has been neglected by someone who's caring for them. Someone's been physically abused by someone who's caring for them. Or someone's neglecting themself, not taking care of themself when they should. And I'm curious about this, Carol, how prevalent, we're going to have some of the financial issues in a minute, but how prevalent is what we're talking about? The estimates that we have read indicate that between three and a half and five million older adults are victims of abuse in this country alone every year. It is a huge problem. Who's doing the victimizing, the abusing? So there are lots of answers to that question. But we happen to run an elder abuse shelter and we are linked to the other shelters around the country. And what we see is most often it is a family member. Often it's an adult child or an adult grandchild who's moved back into the home and is abusing their loved one, if you will, physically, verbally, sexually and always financially. Now your type of, I shouldn't say your type of organization, but a shelter like yours, how many do we have in the nation? There are 16. In the entire country? In the entire country. Because? You know, I think part of it is because there's no real funding for elder abuse shelters. We provide an elder abuse shelter within the walls of our long term care facility because our commitment is to care for older adults. That's who we are. That's what we do. That's what we believe in. So we provide people with a stay of 90 to 120 days at no charge. We provide them with all the medical and nursing services at no charge. It's not easy to get people to understand that this is not a big deal for an organization that already cares for older adults. You know, we have a room. The core of shelter is a bed. I have a room. I have the staff. I have the food. We can care for these people. Our goal is to get people into shelter in what we call for crisis stabilization stay and then discharge them to the least restrictive and safest alternative. Let me ask you this. There are some family members who watch us on a regular basis who older family members who said to me, I can't believe it happened three or four times in our family that they think someone quote stole their identity but had to their credit card, their ATM, whatever it is. When we talk about financial abuse, what are we talking about? You know, this is this is a huge problem that we face, not only New Jersey but across the country from a perspective of population every day. 10,000 baby boomers turned 65, right? So when you think about the number of people that are moving into this space that we call our elder generation, it's a massive group or volume. I mean, when someone says there's there are charges on my credit card and I don't know again, it could happen to anyone. But I've noticed that I don't know if I don't know what the statistics are here and I don't want to be responsible because it's public broadcasting and we don't engage in fake facts. But here's the thing, my instincts tell me that it is sometimes older people that have these charges. They don't know where it came from. How does that happen? And does it happen more to older people? I think it does. You know, the reality is that our elder generation, they are prime targets for criminals that are looking to take advantage of them financially to take their identities and so on and so forth because they've reached an age where typically they've accumulated more wealth. They normally have some kind of a regular stream of income, whether it be social security or pension. They oftentimes have issues with health, right? Cognitive limitations, handicaps, other issues that perhaps limit their social interactions, oftentimes their ability to communicate or reason through some things. And so they become more vulnerable when their identities are accessed or their information is taken. Of course, that puts them at risk. That's something that any one of us could face, regardless of our age. But this generation of individuals is more susceptible. When you bring up topics of the fact that, you know, family members are oftentimes or people that are close to them are oftentimes abusers. That is indeed true. On the financial side as well. On the financial side as well, unfortunately. And then there's the embarrassment factor of reporting a family member or anyone, the shame of this having happened to you and they don't want to come forward or they're afraid to come forward because they're dependent on the person who's actually exploiting that. Wait a minute. So it's not just shame and embarrassment that I quote. Someone could think I could have let this happen, but it could happen to anyone. But also that it's more than shame, isn't it? That the person who is who has done this to them is someone they're afraid of has control over the control over their existence, control over their care, control over their residence, control over their finances. So you're you don't know where to turn and how to turn on this person in effect because they're threatening you. And what are the legal aspects of this legal workforce? There are several things that can be done. Some of them are proactive. We always encourage people to do powers of attorney. What is power attorneys? By the way, this would be a whole wage of websites up there. Check it out to get more information as we do this program. What does power attorney give you? Well, you doesn't when you have the ability and capacity, you can designate someone to take care of your financial affairs either when you sign a document or what's called springing when when you become disabled and a backup person, a successor agent to someone who you trust. That's one way to deal with it. Separately, a medical directive and health care proxy to deal with medical decisions real quick before I come back to Dr. Past, what about if the person you've picked? To do these things is potentially the person who is victimizing. And that happens. We recommend a couple of things because you're right. You're right on point, you know, in addition to powers of attorney for both financial and health care, we also advise that, you know, people make sure that their wills are up to date, not something that you put together in your 30s and now you're in your 70s. And all of a sudden things aren't necessarily appropriate anymore. A living will is important. A living was important. Very, very much so. Irrevocable trusts. You want to make sure that you have a team and depending on the individual and their personal needs, that team may differ. But you usually want to have not only a trusted family member or friend, but also perhaps a financial professional, a legal professional and possibly a team to help you and to make sure that your wishes, not only your financial situation and your personal situation are protected, but that your wishes are carried out when you no longer can do it yourself. Let's try this. And by the way, Dr. Past and I know each other in a different part of our lives. I teach in a physician leadership academy that you've participated in. And so I know the kind of leader, physician leader you are. I'm curious about this. Mark, physical abuse. What are the physical signs that you and your colleagues in your field see in older folks who are being abused from a physical point of view? So physical signs to look for certainly are dehydration or boons. I think people who work with seniors know that it's very common to get skin tears. He's about 85 percent of them happen on your arms or your legs. But we see tears in other places, on the breasts, the abdomen, in the groin or the thighs. This is a telltale sign. Also, seniors tend to break bones. You probably heard of people who broke hips or bones in their spine, but not usually long bones and certainly not spiral fractures where someone has twisted an arm or twisted a leg. Well, one of these, it confused me there. What's that? The kind of fractures that we usually see when people break hips is a bone just breaking in half. But a spiral fracture means that the bone was twisted. Think about a rope burn. And that's a sign that someone physically was abusing that person. Someone didn't fall and that happened. Correct. Again, a break is this, a different kind of... A spiral fracture means someone was twisting it with two arms. But, Dr., what do you say to those who say, well, if I'm alone, if someone's older, someone's in a hospital situation or someone's in a facility, wherever they are. They're alone and a medical professional, someone there, a clinician, someone on the staff, whomever, is treating that person. How does he or she, the patient, protect him or herself? So anyone can make a phone call when they think someone is being abused or neglected. And in a facility, that would be to the ombudsman. And if someone doesn't live in a facility, that would be to adult protective services. But the person who makes that call could be the mail carrier. It could be the bank teller. The bank teller can pick up that someone has been coming in, always dressed nicely, and now all of a sudden, they're always accompanied by someone, a younger person, and they don't have their makeup on or they come in their house coat. A change in someone's appearance is a telltale sign. So it's not just healthcare practitioners that can pick up on this. It's anyone who has routine time spent face-to-face with these seniors. And those seniors are, honestly, they're women over the age of 80. Women over the age of 80, prime target. Yeah, if they've had a hip fracture, a stroke, senile, women over 80, if you have all five, those are the prime targets. Those are the people we have to look for. Kelly, let me jump back in here. Emotional abuse looks like what? I can tell you about cases that we've had in our shelter recently. We have had a woman whose daughter was constantly screaming at her and belittling her. And the woman was afraid of her to the point where she left the home. She didn't know where to go. She had nothing, but she left the home because she was so fearful. The woman being abused? The woman being abused. We have had, the stories are really quite awful. And in terms of what happens often with an older adult is they seek medical attention, not in a nutrition's office, but in an emergency room perhaps. And the abuser goes with them. And so before they can answer the question of what happened to them, the abuser says, she's so clumsy. Right. She's so clumsy. She's so clumsy in the bank as well. Yes. Well, because you see, you'll note that we train our team on an annual basis. It's a requirement to be able to understand what it looks like that is elder abuse. So if we see unusual financial transactions, significant amounts of money being written out in checks or wired transfers, people that aren't normally making financial decisions, calling on behalf of one of our clients and asking for money to be transferred into different accounts, that kind of thing, they'll walk into a branch with the elderly client and maybe be pinching them from behind. Or kind of... You can cut out for your team, Mr. Armstrong, I'm sorry for interrupting you. They're trained to, yeah, they're trained to pick it up. They're trained to pick up those signs. And not only do we... And do what? Well, number one, you report it to the appropriate agency, but we're also working with regulators today to see if there are things that we can do from a banking industry perspective to take action immediately, right? To maybe not have that check or that wire transfer sent out. Because once the money's gone, it's very difficult to recover. Do me a favor, Shannon. Hold your part right there. Can I do this? I'm gonna take a quick break. We come back. I wanna pick up this conversation that we're having right now. This is elder abuse, folks, and you're not gonna find many places having this discussion, but I cannot think of a more important pressing issue for us to be talking about. Be right back right after this. To see more Caucus, New Jersey with Steve Adubato programs, visit us online at steveaudubato.org. If you would like to express an opinion, email us at infoatcacusnj.org. Bind us on Facebook at facebook.com slash steveaudubato.phd And follow us on Twitter at steveaudubato. We're talking elder abuse, critically important topic. Shannon, jump back in. You were gonna say? The problem that we have with these financial transactions particularly is not enough. Are they stopped before the funds are gone, even though you witnessed some of these behavioral issues? And when we're dealing with the seniors on the legal side, usually it's involving a long-term care placement at that point. And we run into a very severe problem of how is the long-term care going to be paid for because Medicaid is going to be the last resort. The money at that point is gone. It's been stolen. And Medicaid is very difficult in granting approval when you cannot account for how the funds have been dispersed. If it's a family member, the initial position may very well be that it was gifted or allowed to be taken with consent and Medicaid has a penalty that'll be imposed on the eligibility. So we really have to get into telling people you have to prosecute in order to document that this was not a consensual transaction. No, most do not. You know, it's interesting, one of our relatives, one of our relatives who has passed is an incredible woman in our family, a matriarch in our family. I remember several years ago, word was spreading around the family that $10,000 had been done. I was like, what do you mean $10,000? And someone, I believe as a story went, someone was calling, calling, calling, calling. And somehow told her that they were from not the IRS, but someone else, I want to screw this up, help me on this because it's not really about our relative. It could help her over. And she sent the money, don't ask me how. And no one else knew in the family. And then after the fact, it was like, you what? And I could see, she was embarrassed. It's like, you know, it could happen. That's exactly what I said before. It can happen any day, right? So you mentioned possibly the IRS. We had a couple coming. But it's not the IRS. It's not. Well, no, it's not. But they're fearful enough that they just write the check or give their financial information over the phone. I have your financial information, that's what happens. I'll tell you a couple come into our offices about a year back. They were in their mid-70s and they were very excited and wanted to finally talk to a financial advisor because they were expecting to come into money. They had received an email and then a follow-up phone call that there was an excavation being done in the Middle East that they were gonna uncover antiquities. And they needed funding for this excavation. And this couple went into the retirement monies and liquidated over $80,000 of funds and sent it. 80. 80. And then they expected to come into all of this money as these antiquities were unearthed. And of course, it was a tragic. They did. They lost it. The telltale sign for caregivers, doctors, nurses is when people were able to take care of themselves and afford their own care and now all of a sudden they can't. So they come to my office month after month and then all of a sudden they say they can't afford their medicine anymore. Or I noticed that they are not changing their clothes and they can't afford cleaning service anymore. They used to have an aid with them and now they can't afford an aid. What do you ask? Where did the money go? I asked them three questions. The same three questions that any of this can ask them. I asked them in private, not in front of the area. That's interesting. No one else in the room. No one else in the room. Three questions. This is what the AMA recommends, American Medical Association. Do you feel safe in your current home? It's an open-ended question and I listen for their response. I don't just ask and then move on. More the lack of response. I need to ask. Exactly. Who? Who helps you plan your meals? It's another open-ended question. Someone can really give you a lot of information when they tell you who helps them plan their meals. And the third one is who helps you with your checkbook? But what does that have to do with potential abuse? Because when they're alone, people admit to much more than when they're sitting next to their supposed trusted caregiver, power of attorney. Especially if they're the abuser and they're afraid. 90% of the people who are doing abuse are adult children of the abuser. 90, 90. Is this right, Carol? And they isolate, that's absolutely true. They isolate the victim. Like in any other form of domestic violence, they isolate the victim. So that means that their life gets smaller and smaller and smaller. And they get more and more control and that's exactly what happens. They're controlling every aspect of the victim's life to a point where the victim really has nothing beyond that. And you talked about embarrassment before, think about it, this is my child. I taught them values. How do I go forward and say, I'm afraid of my child? Ask yourself the question. When you were 80 and above and you've broken a hip or had a stroke, who are you gonna trust the most? The kids? Yes. And that's the problem. Okay, but we trust our kids the most and they're the ones who take advantage of it. One in five people over the age of 65 are impacted by elder abuse. And one in five. And 2% of those cases actually get reported. That's right. Say it again, I stepped on that, say it again. One in five people over the age of 65 are impacted by elderly abuse and only 2% of those crimes are actually reported. Can we, there's something we haven't talked about that I'm curious about, neglect. Is neglect, A, what is it? And B, is it a form of elder abuse? There are two kinds. There's neglect by another party and there's also self-neglect when someone deteriorates and no longer has the capacity to take care of it. Well, how does that abuse it? No one's helping that person? Yeah, they're basically alone. Protective services, right. Adult protective services can respond to self-neglect cases as well. We're focusing on- In fact, that's the majority of what they respond to. The sad thing is that most of the cases that are reported to APS are self-neglected. APS is. Adult protective services. That's just responsible for community dwelling people. Oh, is that not on a county level? Every state. Every state, every county has a county. Is there uniformity in the way they are? What do you mean no? Whatever. Hold on, they don't run with the same standards. Every county is different. Some counties are more proactive than others. They're all underfunded, understaffed, overworked, but they don't operate the same. But the majority of cases that get presented to APS are self-neglect, meaning it is a bank teller. It is an extra neighbor who says, Sally hasn't been out of her house in a week, but I see her moving around inside. Someone picks it up. Something's different. The postal care force says the mail is humiliating. We worry about each other and self-neglect, and that's what we report. But the truth is, people are being physically abused. They're being mentally abused. They're being sexually abused. Those are not reported nearly as much because when you see a grandchild going into a pocketbook of woman in a nursing home and you work in that nursing home, you're afraid if you report it, you may lose your job. So even though the people who work in a nursing home may work there 40 or 50 hours a week, they're not the ones doing the reporting. But this can happen to people that live independently. This can happen to any wealth echelon. I can tell you a story about a client who is in what I would deem as the Ultra Hunt at Worth Wealth Contingent, right? She was a phenomenally successful and well-known financial professional. She's now in her late 80s. Out of nowhere, one of her former financial advisors, not part of Wells, who's about 30 years younger, decided to become her fiance. She is in the early stages of Alzheimer's. So all of a sudden, this tremendous amount of wealth is now being controlled and influenced by this new fiance. How does that happen legally? Well, her niece, who is the sole beneficiary and heir, reported it to the family attorney and said, I think my onset risk. Is this a legal case now? It is a legal case and we're doing everything we can to protect the client. So stay on this, by the way, we would not be able to be doing these programs if we're not for the Health Care Foundation in New Jersey. Who cares deeply about these issues? So I, you know, and the reason I say that is because it strikes me that this doesn't feel, Carol, like while it may be a bordering on an epidemic or an epidemic itself, it does not feel like a public crisis where there's tremendous discussion about it. Am I wrong? No, you're not wrong. And you know, we do a lot of speaking and education about elder abuse prevention. One of the things we say universally is that we need to raise the level of conversation about elder abuse to the level of conversation about child abuse. You take your child to the pediatrician and something looks funny. And they say, you know, mom, step out of the room for a minute. Let me ask, you know, little Johnny, what happened to them? But our older adults universally do not have that opportunity. And it happens over and over and over again. They don't have the ability to self-identify. They don't always look for help. They don't know where to go. They're embarrassed. They're controlled. They may have some dementia. They're in an incredibly difficult situation. And even when they're identified, we had a woman who was identified at the beauty parlor. The only place she went was to get her hair done on Friday afternoon. And the beautician noticed that she was wincing every time that she moved. She finally got out of this woman that someone had knocked her down and tossed her down the stairs. What did the beautician do? She called Adult Protective Services. They called us. How did she know how to do that? Because we train everybody we can think of to train. People, bank tellers, beauticians, physicians, police officers, first responders of all kinds, attorneys. We speak to attorneys all the time. Call the police. Call the police. Call mine on one. Absolutely. Okay, final words here. Yes. If you see something, say something. Amen. That's what we're trying to get out. Amen. It's quite simple. Hopefully we're gonna make some real progress here. Necessary. We can't. The whole idea of people being embarrassed is shamed. I get it. I understand it. But the more we talk about it, the more we put it out there, the more people like yourselves appear on a platform like this and help so many people, I am hopeful, prayerful that we will make a difference. So I want to thank all of you for doing great public service. Thank you for having us here. Thank you very much. We're very happy to be here. I'm Steve Adabato. We'll see you next time. 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