1. Burston GR. Letter: Granny-battering. British Med J. 1975;3(5983):592.[PMC free article][PubMed]
2. Jogerst GJ, Brady MJ, Dyer CB, et al. Elder abuse and the law: new science, new tools. J of Law, Medicine & Ethics. 2004;32(4):62–3.[PubMed]
3. 111th US Congress, 1st Session. Elder Justice Act of 2009. S.795, 2010.
4. 111th US Congress, 2nd Session. Patient Protection and Affordable Care Act. HR.3590, 2010.
5. Krug EG, Dahlberg LL, Mercy JA, et al. World report on violence and health. Geneva, Switzerland: World Health Organization; 2002.
6. Social Development Department. The costs of violence. Washington, DC: The World Bank; 2009.
7. Quinn MJ, Tomita SK. Elder abuse and neglect: causes, diagnosis, and intervention strategies. 2nd ed. New York NY: Springer Publishing; 1997.
8. Laumann EO, Leitsch SA, Waite LJ. Elder mistreatment in the United States: Prevalence estimates from a nationally representative study. Journal of Gerontology: Social Sciences. 2008;63B(4):S248–254.[PMC free article][PubMed]
9. Biggs S, Manthorpe J, Tinker A, et al. Mistreatment of older people in the United Kingdom: Findings from the first national prevalence study. J of Elder Abuse & Neglect. 2009;21:1–14.[PubMed]
10. Aciemo R, Hernandez MA, Amstadter AB, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. Am J of Public Health. 2010;100(2):292–7.[PMC free article][PubMed]
11. National Center on Elder Abuse. Groundbreaking study of elder abuse prevalence in New York State released at elder abuse summit. NCEA e-News Newsletter. 2010 Dec;13(6):3.
12. Dobies K. High court upholds two murder rulings. The Marietta Daily Journal. Sep 21, 2010. Available at: http://www.mdjonline.com/pages/full_story/push?article-High+court+upholds+two+murder+rulings%20&id=9601132&instance=home_news_1st_right. Last accessed December 13, 2010.
13. Anonymous. Man sentenced over elder abuse. The Irish Times. Nov 18, 2010. Available at: http://www.irishtimes.com/newspaper/breaking/2010/1118/breaking67.html. Last accessed January 3, 2011.
14. Karch D, Nunn KC. Characteristics of Elderly and Other Vulnerable Adult Victims of Homicide by a Caregiver. Journal of Interpersonal Violence. 2010. Available at: http://jiv.sagepub.com/content/early/2010/04/21/0886260510362890.full.pdf+html. Last accessed December 13, 2010. [PubMed]
15. Wiglesworth A, Mosqueda L, Mulnard R, et al. Screening for abuse and neglect of people with dementia. J of the Am Geriatrics Society. 2010;58(3):493–500.[PubMed]
16. Conrad KJ, Iris M, Ridings JW. Conceptualizing and Measuring Financial Exploitation and Psychological Abuse of Elderly Individuals. National Criminal Justice Reference Service. Available at http://www.ncjrs.gov/pdffiles1/nij/grants/228632.pdf. Last accessed January 4, 2011.
In some ways financial abuse is very similar to other forms of elder abuse in that it can be devastating to the victim and is frequently traced to family members, trusted friends, and caregivers. But unlike physical abuse and neglect, financial abuse is more likely to occur with the tacit acknowledgment and consent of the elder person1 and can be more difficult to detect and establish. As a result, financial abuse requires a distinct analytical perspective and response. Unfortunately, these differences are often overlooked.
Little empirical research has been conducted that directly addresses financial abuse of the elderly, and in general it has received less attention than other forms of elder abuse (Nerenberg, 2000b). Although the amount of attention given to it has increased in recent years, most commentary rests on a relatively thin empirical base and draws heavily on anecdotal observations and relies (perhaps inappropriately) on research and analysis addressing other forms of elder abuse, child abuse, and spouse/partner abuse. Because financial abuse is frequently addressed in conjunction with other forms of elder abuse, a brief overview of elder abuse in general is provided before turning specifically to financial abuse of the elderly.
PREVALENCE OF ELDER ABUSE IN GENERAL
Elder abuse, at least to some degree, has probably always existed. Only in the past few decades, however, has it been recognized as a major societal problem. Attention to elder abuse followed the “discovery” of child abuse in the 1960s and spouse abuse in the 1970s. Today, elder abuse is widely characterized as both a pervasive problem and a growing concern (Dessin, 2000; Heisler, 2000; Moskowitz, 1998b).
The National Elder Abuse Incidence Study (NEAIS), which was described as the first national study of the incidence of elder abuse in the United States,2 estimated that nearly a half million persons aged 60 and over in domestic settings were abused or neglected during 1996 (National Center on Elder Abuse, 1998).3 Furthermore, this study determined that for every reported incident of elder abuse or neglect, approximately five incidents were unreported (National Center on Elder Abuse, 1998), supporting a wide consensus that elder abuse is greatly underreported (Choi and Mayer, 2000; Dessin, 2000; U.S. General Accounting Office, 1991; Kleinschmidt, 1997; Moskowitz, 1998b; National Center on Elder Abuse, 1996). The NEAIS confirmed a general view that state agencies established to receive such reports, such as Adult Protective Services (APS) agencies, receive reports of the most visible and obvious occurrences of elder abuse, but that there are many other incidents that are not reported. Nevertheless, the number of APS elder abuse reports substantially increased over the past 10 years, an increase that exceeded the growth in the elderly population during this period (National Center on Elder Abuse, 1998).
FORMS OF ELDER ABUSE
What constitutes elder abuse is defined by state law, and state definitions vary considerably (U.S. General Accounting Office, 1991; Kapp, 1995; National Center on Elder Abuse, 2001; Moskowitz, 1998b; Roby and Sullivan, 2000).4 Not surprisingly, researchers have also used many different definitions in studying the problem (Choi and Mayer, 2000; Kleinschmidt, 1997; Macolini, 1995; National Center on Elder Abuse, 2001; Pillemer and Finkelhor, 1988).5 The variation in definitions has been cited as a significant impediment to elder abuse recognition, management, research, and analysis (U.S. General Accounting Office, 1991; Kleinschmidt, 1997; Lachs and Pillemer, 1995; Moskowitz, 1998b; Nerenberg, 2000a; Roby and Sullivan, 2000; Rosenblatt et al., 1996).
Elder abuse in domestic settings (i.e., within the older person's own home or in the home of a caregiver) is often differentiated from elder abuse within institutional settings (i.e., within residential facilities for older persons such as nursing homes) (Brandl and Meuer, 2000; National Center on Elder Abuse, 1996, 2001). Domestic elder abuse has been asserted to be more prevalent than institutional elder abuse (Kosberg and Nahmiash, 1996; Marshall et al., 2000; Moskowitz, 1998b), in part because it has been estimated that 80 percent of the dependent elders in this country are cared for at home (National Center on Elder Abuse, 1996). However, research directly substantiating this assertion is lacking.6 Another dichotomy frequently used distinguishes between elder abuse by individuals who have a special relationship with the elder person (e.g., spouses, children, other relatives, friends, or caregivers providing services within the elder person's home) and individuals with whom such a preexisting special relationship does not exist (Kosberg and Nahmiash, 1996; Marshall et al., 2000; National Center on Elder Abuse, 1996, 2001).7 Within domestic settings, it has been reported that the perpetrators of elder abuse are much more likely to be family members (National Center on Elder Abuse, 1996).
Although conceptualizations of what elder abuse encompasses vary considerably, the National Center on Elder Abuse (2001) identifies six major categories of elder abuse. They include physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial abuse. Among these categories, financial abuse has received limited attention and is often not assessed in studies of elder abuse (Choi et al., 1999; Kleinschmidt, 1997; Tueth, 2000). Nonetheless, financial abuse is increasingly viewed as both sufficiently important to necessitate its inclusion in studies of elder abuse in general and sufficiently distinct to justify addressing it separately (Choi and Mayer, 2000).
PARAMETERS OF FINANCIAL ABUSE OF THE ELDERLY
The remainder of this report focuses on financial abuse of the elderly within a domestic setting by individuals relatively well known to the elder person. This focus encompasses financial abuse by family members, friends, and caregivers of the elder person and excludes financial abuse within institutional settings or by strangers. Domestic settings are not only a frequent setting for this abuse,8 but their tendency to involve complex family dynamics and deep-seated conflicts tends to make them particularly challenging. Although financial abuse of the elderly within institutional settings (e.g., within nursing homes) and by strangers (e.g., in the course of consumer fraud) are serious concerns in their own right and in need of systematic study (of which little has been generated to date),9 they are not the foci of this report.
To address financial abuse of the elderly, its parameters should first be defined. Variously referred to as financial mistreatment; exploitation; or fiduciary, economic, or material abuse, this type of abuse encompasses a broad range of conduct (National Committee for the Prevention of Elder Abuse, 2001). There have been widespread complaints that financial abuse of the elderly is poorly defined, in part because it is hard to define, which makes it difficult to identify, investigate, and prosecute (Dessin, 2000; Langan and Means, 1996; Marshall et al., 2000; Roby and Sullivan, 2000; Sanchez, 1996; Wilber and Reynolds, 1996). The absence of a uniform definition perhaps explains why it is often not included or is poorly addressed in research on elder abuse in general (Langan and Means, 1996).
Because elder abuse, like other domestic ills, has generally been considered a state concern rather than a federal concern, the absence of federal law pertaining to elder abuse has placed on the states the responsibility to define this activity. Forty-eight states and the District of Columbia are reported to specifically mention financial abuse in their elder abuse statutes (Roby and Sullivan, 2000; Wilber and Reynolds, 1996).10 States' definitions, however, vary widely on what constitutes financial abuse and who can be held accountable for it (Roby and Sullivan, 2000; Sanchez, 1996).
One complicating factor is variations in the class of individuals targeted for protection from financial abuse. Three general approaches are employed. In some states all individuals who have reached a given age are specifically protected, in other states protection is provided to all vulnerable or incapacitated adults regardless of age, and a third group of states uses a hybrid approach that protects vulnerable or incapacitated adults of any age and all adults over a certain age (Dessin, 2000; Roby and Sullivan, 2000). The last two approaches can make it difficult for researchers to distinguish reports of elder abuse from reports of adults in general (Coker and Little, 1997). The first approach, however, has been criticized for perpetuating the unfounded stereotype that all elderly persons are vulnerable and in need of protection (Roby and Sullivan, 2000). Also, some states require diminished decision-making capacity by the elder person before financial abuse is considered to occur, while other states do not impose such a requirement (Tueth, 2000). States even vary on the age when someone becomes “elderly” (Coker and Little, 1997; Paveza, 2001).
Other variations in state definitions are associated with who can be held accountable for financial abuse. Some states require dishonest tactics by perpetrators, such as the use of force, duress, misrepresentation, undue influence, or other illegal means, to take advantage of the elder person. Other states do not require a showing of such tactics if the perpetrator knew or should have known that the elder person lacked the cognitive capacity to make financial decisions (Tueth, 2000). Similarly, some states limit financial abuse to an intentional improper use of the elder's resources, while other states encompass negligent, or at least reckless, advice or conduct, such as failing to use income effectively for the care of the older person (Dessin, 2000; Roby and Sullivan, 2000).
Generally the victim must experience some disadvantage as a result of the transaction, but some states also require that the perpetrator gain some advantage from the transaction (Dessin, 2000). The latter would not penalize actions that merely wasted the elder person's assets (Dessin, 2000). States also vary on whether abuse is limited to the abuse of the elder person's money and real property or also encompasses other resources such as the elder person's goods and services (Roby and Sullivan, 2000). Finally, some states limit financial abuse to those in a “position of trust” to an elder person (Roby and Sullivan, 2000).
It is widely recognized that it is difficult, even for experienced professionals, to distinguish an unwise but legitimate financial transaction from an exploitative transaction resulting from undue influence, duress, fraud, or a lack of informed consent (Tom, 2001).11 The seasoned professional can also be tested by the complex and varied nature of these transactions (Dessin, 2000). It may also be difficult to distinguish abusive conduct from well-intentioned but poor, confused, or misinformed advice and direction (Dessin, 2000; Langan and Means, 1996). Evaluating whether financial abuse has occurred has been characterized as a complex and often subjective determination (Bernatz et al., 2001).
Further complicating efforts to establish the parameters of financial abuse of the elderly are that both the elder person and the perpetrator may feel that the perpetrator has some entitlement to the elder person's assets (Dessin, 2000). Elder persons may feel a desire to benefit their heirs or to compensate those who provide them with care, affection, or attention (Dessin, 2000; Langan and Means, 1996). It can be difficult to discern a transfer of assets made with consent from an abusive transfer (Dessin, 2000; Wilber and Reynolds, 1996).
Also, conduct that began in the elder person's best interests may become abusive over time, as when perpetrators initially provide helpful advice regarding financial investments but take on greater control and ultimately misappropriate funds for themselves as the elder person's cognitive abilities decline (Dessin, 2000). Typically, financial abuse in a domestic setting reflects a pattern of behavior rather than a single event and occurs over a lengthy period of time (National Clearinghouse on Family Violence, 2001; Wilber and Reynolds, 1996). Determining when financial abuse began can be very difficult (Smith, 1999).
Finally, a number of commentators have asserted that whether financial abuse is considered to have occurred should reflect the elder person's perception of the purported abuse and the cultural context in which it takes place (Moon, 2000; Nerenberg, 2000a; Sanchez, 1996; Wolf, 2000; see generallyTatara, 1999). For example, attitudes about the legitimacy of a transfer may reflect expectations within a given culture that elderly persons will share their resources with family members in need, while other cultures reject this notion (Brown, 1999; Moon, 2000; Nerenberg, 2000a). Studies have shown considerable variation in what constitutes financial abuse across cultural, racial, and ethnic groups (Brown, 1999; Hudson and Carlson, 1999; Moon, 2000; Nerenberg, 2000a), and it has been argued that a failure to take into account these differences undercuts efforts to assess financial abuse of the elderly (Sanchez, 1996).12
TYPES OF FINANCIAL ABUSE OF THE ELDERLY
In efforts to address financial abuse of the elderly, advocates for the elderly often delineate typical examples of this abuse.13 Examples specifically relevant to a domestic setting and financial abuse by individuals relatively well known to the elder person include:
taking, misusing, or using without knowledge or permission money or property (Dessin, 2000; National Center on Elder Abuse, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001);
forging or forcing an elder person's signature (National Center on Elder Abuse, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001);
abusing joint signature authority on a bank account (Rush and Lank, 2000);
misusing ATMs or credit cards (New York State Department of Law, 2000);
cashing an elder person's checks without permission or authorization (National Center on Elder Abuse, 2001);
misappropriating funds from a pension (New York State Department of Law, 2000; Langan and Means, 1996);
getting an elder person to sign a deed, will, contract, or power of attorney through deception, coercion, or undue influence (National Center on Elder Abuse, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001);
providing true but misleading information that influences the elder person's use or assignment of assets (Dessin, 2000);
persuading an impaired elder person to change a will or insurance policy to alter who benefits from the will or policy (Central California Legal Services, 2001; Frolik, 2001; Smith, 1999);
using a power of attorney, including a durable power of attorney, for purposes beyond those for which it was originally executed (Hwang, 1996; National Clearinghouse on Family Violence, 2001; Thilges, 2000);
improperly using the authority provided by a conservatorship, trust, etc. (National Center on Elder Abuse, 2001);
negligently mishandling assets, including misuse by a fiduciary or caregiver (Dessin, 2000);
promising long-term or lifelong care in exchange for money or property and not following through on the promise (National Committee for the Prevention of Elder Abuse, 2001);
overcharging for or not delivering caregiving services (Central California Legal Services, 2001); and
denying elder persons access to their money or preventing them from controlling their assets (National Clearinghouse on Family Violence, 2001; Smith, 1999).
PREVALENCE AND IMPACT OF FINANCIAL ABUSE
Prevalence of Financial Abuse of the Elderly
The prevalence of financial abuse of the elderly (like elder abuse in general) is difficult to estimate because there is no national reporting mechanism to record and analyze it, cases often are not reported, definitions vary, and it is difficult to detect (Coker and Little, 1997; Deem, 2000; National Clearinghouse on Family Violence, 2001). However, the consensus is that it is a significant problem (Dessin, 2000).
The National Center for Elder Abuse found that financial abuse accounted nationally for about 12 percent of all substantiated elder abuse reports in 1993 and 1994 (National Center on Elder Abuse, 2000; Zimka, 1997). A subsequent more comprehensive study conducted by the same entity found that 18.6 percent of the 115,110 substantiated elder abuse reports submitted to APS agencies nationwide in 1996—which included reports of self-neglect—and were reports of financial or material exploitation (National Center on Elder Abuse, 1998). Excluding reports of selfneglect, this exploitation appeared in 30.2 percent of the substantiated reports. This represented the third largest category of reports, less than neglect (48.7 percent) and emotional or psychological abuse (35.41 percent), but more than physical abuse (25.6 percent).14 A national survey in Canada found that financial abuse was the most common type of elder abuse in that country (Podnieks, 1992).15
Some parts of the country report an even greater prevalence of financial abuse.16 Financial exploitation has been reported to be the most frequent form of perpetrator-related elder abuse in Illinois (Neale et al., 1996) and Oregon (U.S. Congress, 2000). It has been asserted that half of all abuse cases in New York state include financial exploitation and that in New York City 63 percent of abuse cases involve finances (New York State Department of Law, 2000). A study of APS reports in upstate New York between 1992 and 1997 that led to state intervention found that financial exploitation was present in 38.4 percent of the cases (Choi and Mayer, 2000). A study in Massachusetts found that almost one-half of the cases of elder abuse serious enough to require reporting to a district attorney involved financial exploitation (Dessin, 2000). A review of California reports from 1987 found that fiduciary abuse was the most prevalent type of exploitation and appeared in 41.5 percent of the cases, with the next most prevalent type of exploitation being physical abuse, which appeared in 33.3 percent of the cases (County Welfare Directors Association, 1988). In their review of older studies, Wilber and Reynolds (1996) determined that between 33 percent and 53 percent of an estimated 1 million elder abuse victims experienced financial abuse.
Financial abuse has also been reported to be greater among various minority populations. For example, exploitation was found to be the most commonly reported abuse in samples of Korean immigrant and black elders (Hall, 1999; Moon, 1999). It has also been suggested that in general financial abuse is particularly likely to be underreported (Coker and Little, 1997; Hwang, 1996; Wilber and Reynolds, 1996).
It has been asserted that financial abuse often occurs in conjunction with other forms of elder abuse (Choi et al., 1999; National Clearinghouse on Family Violence, 2001; Paris et al., 1995), although research generally does not establish how frequently this overlap occurs.17 In a study of one county's investigated APS reports of financial exploitation Choi et al. (1999) found that caregiver neglect also occurred in 12.1 percent of the cases, selfneglect in 6.1 percent, physical abuse in 5.1 percent, and psychological abuse in 3.8 percent. In a later analysis, Choi and Mayer (2000) found that 33.7 percent of this county's investigated reports involved financial exploitation plus either neglect or abuse, while 37.6 percent involved only financial exploitation. However, in a Canadian national survey, only 19 percent of victims were victims of more than one form of maltreatment, although it was not reported how often financial abuse occurred in conjunction with other forms of elder abuse (Podnieks, 1992).
Financial exploitation has been described as the fastest growing form of elder abuse (New York State Department of Law, 2000), although empirical support for this assertion is scanty. Societal attention to elder abuse in general is a relatively recent phenomenon, and attention to financial abuse is even more nascent (Dessin, 2000). It has been suggested that an increase in reports reflects closer scrutiny by federal, state, and local officials rather than necessarily an increase in the prevalence of financial abuse (Lavrisha, 1997). Greater attention to this issue has been attributed to increases in the number of elderly people, an increased emphasis on care at home, and the substantial resources of the elderly (Langan and Means, 1996).
The Impact of Financial Abuse on the Elderly
One of the most frightening scenarios for an elder person is the possibility of financial ruin (Dessin, 2000). Although not systematically assessed, losing assets accumulated over a lifetime, often through hard work and deprivation, can be devastating, with significant practical and psychological consequences (Dessin, 2000; Nerenberg, 2000c; Smith, 1999). Financial abuse can have as significant an impact for an elder person as a violent crime (Deem, 2000) or physical abuse (Dessin, 2000).
Replacing lost assets is generally not a viable option for retired individuals or individuals with physical or mental disabilities (Coker and Little, 1997; Dessin, 2000; Moskowitz, 1998b; Nerenberg, 2000c). Also, because of their age, the elderly will have less time to recoup their losses and often are solely dependent on their savings to meet subsequent expenses and needs (Smith, 1999). A depletion of assets is likely to result in a loss of independence and security for the elder person (Choi et al., 1999; Nerenberg, 2000c), which can have significant symbolic and practical ramifications. Such abuse may necessitate that the elder person become dependent on family members, inducing or adding to their financial burden and stress (Coker and Little, 1997). Alternatively, financial abuse may result in elder persons becoming dependent on social welfare agencies, with a significant decline in their quality of life (Coker and Little, 1997).
From a psychological perspective, a loss of trust in others has been identified as the most common consequence of financial abuse (Deem, 2000). In addition, victims may become very fearful, both of crime and of their vulnerability to crime, which in turn may lead to dramatic changes in lifestyle and emotional well-being (Fielo, 1987). Victims may also experience a loss of confidence in their own financial abilities, stress, and isolation from family or friends (Deem, 2000). Financial abuse may lead to depression, hopelessness, or even suicide (Nerenberg, 2000c; Podnieks, 1992).
In addition, it has been noted that, unlike physical and psychological abuse, the effects of financial abuse may not end with the death of the victim. Family members whose inheritance was reduced or depleted as a result of the financial abuse will suffer loss and may themselves feel abused, particularly if they felt entitled to inherit the victim's assets (Dessin, 2000).
WHY ELDER PERSONS ARE TARGETS FOR FINANCIAL ABUSE
Although empirical support is often not provided, many reasons have been identified for why the elderly are targeted for financial abuse. One set of reasons addresses the financial assets and acumen of the elderly. For example, one widely cited factor is that elder persons possess a large proportion of the nation's wealth (Central California Legal Services, 2001; National Committee for the Prevention of Elder Abuse, 2001), with 70 percent of all funds deposited in financial institutions controlled by persons age 65 and older (Dessin, 2000). Other explanations have been that older people may be more trusting than their younger counterparts (Central California Legal Services, 2001) or may be relatively unsophisticated about financial matters, particularly when they are unfamiliar with advances in technology that have made managing finances more complicated (National Committee for the Prevention of Elder Abuse, 2001). Also, they may not realize the value of their assets—particularly homes that have appreciated greatly in value (Central California Legal Services, 2001; National Committee for the Prevention of Elder Abuse, 2001). It has also been suggested that the difficulties of living on a fixed income may enhance their willingness to try a “get-rich-quick” scheme (Dessin, 2000).
Other reasons focus on characteristics of the elderly. One explanation is that elder persons may be easily identifiable and are presumed vulnerable (Central California Legal Services, 2001). In addition, elder persons may be more likely to have conditions or disabilities that make them easy targets for financial abuse, including forgetfulness or other cognitive impairments (Central California Legal Services, 2001; Choi and Mayer, 2000). Elder persons may also have a diminished capacity to rationally evaluate proposed courses of action (Dessin, 2000).
A third set of factors focuses on social isolation that the elderly may experience (Quinn, 2000). For example, elder persons may be more likely to have disabilities that make them dependent on others for help. These “helpers” may have ready access to elder persons' assets, documents, or financial information or be able to exercise significant influence over the elder person (National Committee for the Prevention of Elder Abuse, 2001; Nerenberg, 2000c; Quinn, 2000). In addition, seniors may be isolated due to their lack of mobility or because they live alone, which shields perpetrators from scrutiny and insulates victims from those who can help (Dessin, 2000; Nerenberg, 2000c). Also, the elderly may be lonely and desire companionship and thus be susceptible to persons seeking to take advantage of them (Hwang, 1996).
A fourth group of reasons suggests that perpetrators assume that financial abuse of the elderly is unlikely to result in apprehension or repercussions. Perpetrators may believe that elder persons are less likely to report abuse or take action against perpetrators, particularly if they have been victimized by family members or other trusted individuals (Central California Legal Services, 2001; Hwang, 1996; National Committee for the Prevention of Elder Abuse, 2001). The elder person may be afraid or embarrassed to ask for help or be intimidated by the abuser (Hwang, 1996). Perpetrators may also recognize that older people in very poor health may not survive long enough to follow through on lengthy legal interventions (Central California Legal Services, 2001; National Committee for the Prevention of Elder Abuse, 2001) or that they will not make convincing witnesses (National Committee for the Prevention of Elder Abuse, 2001).
RISK FACTORS AND CHARACTERISTICS OF VICTIMS
A number of conditions or factors have been identified as increasing the likelihood that an older person will be the victim of financial abuse in a domestic setting. However, there has also been limited systematic research on this issue.
Older women who are white and live alone are considered to be the most likely victims of this abuse, perhaps more so than for any other form of elder abuse. The national NEAIS report found that 63 percent of the APS reports from 1996 involved victims who were women, which was somewhat more than their percentage of the elder population at that time (57.6 percent) (National Center on Elder Abuse, 1998). However, when relying on the reports of their sentinels, which were asserted to be more comprehensive in scope and to include unreported incidents, the NEAIS report concluded that 91.8 percent of the victims of financial abuse of the elderly were women, the highest percentage for any form of elder abuse (the next highest proportion was 83.2 percent for physical abuse) (National Center on Elder Abuse, 1998). The NEAIS report also found that the targets of financial abuse tended to be the oldest old, with 48 percent of the substantiated APS reports and 25.3 percent of the sentinel reports involving victims 80 years of age or older, even though they only comprised 19 percent of the total elderly population (National Center on Elder Abuse, 1998). Finally, the NEAIS report found that 83 percent of the substantiated APS reports and 92.4 percent of the sentinel reports of financial abuse involved white victims (whites comprised 84 percent of the national population of elders in 1996) (National Center on Elder Abuse, 1998).
Another report concluded from the scant amount of research available and the authors' analysis of cases from Alabama that more than 60 percent of the victims of financial abuse of the elderly were likely to be elderly white females over the age of 70 (Coker and Little, 1997). A study of APS financial exploitation reports in an upstate New York county between 1989 and 1996 found that the elder victims were, on average, 78 years old, 68.7 percent of them were female, and 66.9 percent of them lived alone (Choi et al., 1999). A Canadian national survey found that 62 percent of elder victims of financial abuse were female, only 31 percent were married (the lowest percentage of any category of elder abuse—51 percent of elderly nonvictims were married), 54 percent were widowed, and 58 percent lived alone (the highest percentage of any category of elder abuse, with only 39 percent of elderly nonvictims living alone) (Podnieks, 1992). The widely cited profile of a target for financial abuse is generally a white woman over 75 who is living alone (Bernatz et al., 2001; Rush and Lank, 2000; Tueth, 2000).
A number of reasons are given for why most elder victims of financial abuse are women (Dessin, 2000). One is actuarial in nature; namely, women live longer than men and thus more women are available as targets for financial abuse of the elderly. Second, perpetrators may perceive women as weak and vulnerable in general. Third, many women have not handled their financial affairs because their husbands handled them. When their husbands die or lose the capacity to manage their finances, these women make particularly good targets for perpetrators who offer “help” but instead exploit available assets.
Regardless of gender, a lack of familiarity with financial matters in general or the means of conducting a particular financial transaction enhances the likelihood of financial abuse (Choi et al., 1999; Choi and Mayer, 2000; National Committee for the Prevention of Elder Abuse, 2001). Changes in and unfamiliarity with the means by which financial transactions are conducted, including electronic transactions, add to this vulnerability. The risk of financial abuse may also be increased when the elder person is uncomfortable speaking about financial issues (Rush and Lank, 2000). In general, elders who own a house, a substantial and visible asset, are more likely to be exploited (Choi et al., 1999; Choi and Mayer, 2000).
Other factors identified as increasing the likelihood of financial abuse focus on the social status of the elder person. Identified risk factors include an elder person's social isolation, loneliness, and recent loss of loved ones (Bernatz et al., 2001; Choi and Mayer, 2000; Hwang, 1996; National Committee for the Prevention of Elder Abuse, 2001; Podnieks, 1992; Quinn, 2000; Tueth, 2000; Wilber and Reynolds, 1996). Having family members who are unemployed or who have substance abuse problems have also been identified as placing an elder person at greater risk of financial abuse (National Committee for the Prevention of Elder Abuse, 2001). Similarly, when a relative is the elder person's only social support, the risk of financial exploitation may be increased (Choi et al., 1999). Conversely, having family members who are actively involved in good faith in assisting with or managing the financial affairs of the elderly has been determined to diminish the risk that the elderly will experience financial abuse (Rush and Lank, 2000). However, a combination of denial of a need for such assistance, busy lives, and a reluctance to confront difficult issues may keep many family members from such involvement (Rush and Lank, 2000). It has also been noted that little is known about the close bonds that develop naturally between the elderly and their caregivers, particularly when services are provided the elderly within their homes, and what leads to financial abuse (Quinn, 2000).
Physical or mental disabilities of elder persons have also been identified as risk factors, including medical problems that limit their ability to understand and comprehend financial issues and impairments that create dependency on others (Bernatz et al., 2001; Choi et al., 1999; Giordano et al., 1992; Hwang, 1996; National Committee for the Prevention of Elder Abuse, 2001; Podnieks, 1992; Tueth, 2000; Wilber and Reynolds, 1996). However, it has been argued that the extent to which older persons are vulnerable to financial abuse is more directly related to the circumstances in which they live than advanced age per se (Smith, 1999) and that age alone should not lead to a presumption of incapacity (Wilber and Reynolds, 1996).
SIGNALS OF FINANCIAL ABUSE
Relying primarily on anecdotal evidence, personal experience, or commonly shared beliefs, practitioners have compiled and circulated a number of indicators that suggest when financial abuse of an elder person may be occurring. These indicators have been distributed to bank employees, lawyers, and the public in general. It is recommended that no single indicator be taken as establishing the existence of financial abuse, as there may be other explanations for the occurrence of the indicator; instead reliance is placed on a pattern or cluster of indicators (National Committee for the Prevention of Elder Abuse, 2001). It has also been argued that it is almost impossible to detect financial abuse without considerable knowledge of the victim's financial affairs (Dessin, 2000). It has been suggested that bank tellers, personal bankers, officials responsible for registering deeds, family members, and neighbors are the most likely to observe the signs of financial abuse (Henningsen, 2001). The indicators can be grouped by the setting or circumstances in which they are most likely to be observed.18
For example, a number of indicators can be apparent during a visit to the home or residence of the elder person. A relatively obvious indicator is missing belongings or property (e.g., jewelry) (Hwang, 1996; National Center on Elder Abuse, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001; Zimka, 1997). Financial abuse may be suggested by an absence of documentation about financial arrangements or transactions (e.g., pensions, stock, government payments, credit card charges) (Central California Legal Services, 2001; National Committee for the Prevention of Elder Abuse, 2001). Implausible or evasive explanations by the elder person or the caregiver about the elder person's finances, the elder person's unawareness of or confusion about recently completed financial transactions, or the elder person appearing to be afraid or worried when talking about money may serve as indicators (Carroll, 2001; Central California Legal Services, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001). Alternatively, unpaid bills, eviction or foreclosure notices, or notices to discontinue utilities despite the availability of adequate financial resources may suggest financial abuse (Carroll, 2001; Central California Legal Services, 2001; National Center on Elder Abuse, 2001; National Committee for the Prevention of Elder Abuse, 2001; Zimka, 1997).
Financial abuse may also be indicated by a lack of care or substandard care, a decline in personal grooming, or an absence of clothing, food, or other basic necessities when the older person can afford them (National Center on Elder Abuse, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001; Zimka, 1997). Similarly, financial abuse may be suggested by complaints from the elder person about once having had money but not seeming to have much anymore (Carroll, 2001; Zimka, 1997) or a sudden inability to pay bills (Langan and Means, 1996). Additional signals may be provided by an unkempt residence when arrangements have been made for providing care or a failure to receive services for which payment has already been made (Central California Legal Services, 2001). Alternatively, the provision of services that are not necessary may also indicate financial abuse (National Center on Elder Abuse, 2001). Untreated medical or mental health problems may be an indication of financial abuse (Central California Legal Services, 2001; Hwang, 1996). In general, significant cognitive impairments suggest vulnerability to financial abuse (Choi et al., 1999; Choi and Mayer, 2000; Wilber and Reynolds, 1996).
Another widely cited indicator is social isolation of the elder person, including a discontinuation of prior relationships with family and friends (Central California Legal Services, 2001; Henningsen, 2001; National Clearinghouse on Family Violence, 2001; Wilber and Reynolds, 1996). Increased dependence on others, loneliness, loss of loved ones, and a reduced sense of self-worth can indicate vulnerability to financial abuse (Wilber and Reynolds, 1996). Relatedly, financial abuse may be suggested by new acquaintances or “best friends,” particularly those who take up residence with the older person, who the elder person relies on totally, or who express overenthusiastic affection for the elder person (Carroll, 2001; Coker and Little, 1997; Hwang, 1996; National Committee for the Prevention of Elder Abuse, 2001). Financial abuse may be suggested by a noticeable increase in the spending of people living with or caring for the older person (Dessin, 2000; Henningsen, 2001) or by sudden heavy traffic in and out of the home (Hwang, 1996). Another warning signal may be caregivers or family members who express excessive interest in the amount of money being spent on the older person, who ask only financial questions, or who do not allow the elder person to speak (Carroll, 2001; Langan and Means, 1996; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001; Tueth, 2000). Also a promise of lifelong care may be accompanied by an implicit or explicit expectation that the elder person's funds will be transferred to the caregiver (Hwang, 1996).
Family members who are addicted to alcohol or drugs or who indicate they feel entitled to the elder person's funds may suggest financial abuse (Hwang, 1996). Alternatively, a circle of mutual dependence or conflict that engulfs family members may engender financial abuse or leave family members blind to its possibility (Gold and Gwyther, 1989).
A second setting in which indicators of financial abuse may arise is associated with the conduct of banking transactions. For example, financial abuse may be suggested by withdrawals from or transfers between bank accounts that the older person cannot explain, unusual or unexplained sudden activity, including large withdrawals (particularly when the elder person is accompanied by another person), or frequent transfers or ATM withdrawals (Coker and Little, 1997; Commonwealth of Massachusetts, 2001; Henningsen, 2001; Hwang, 1996; National Center on Elder Abuse, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001). Other indicators include having bank statements and canceled checks sent to an address that is not the elder person's residence, suspicious signatures on checks or other documents, and the inclusion of additional names on an elder person's credit card or bank signature card (Coker and Little, 1997; National Center on Elder Abuse, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001; Zimka, 1997).
Related indicators focus on deviations from the elder person's usual banking behavior (Commonwealth of Massachusetts, 2001; National Center on Elder Abuse, 2001). They include suspicious activity on credit card accounts; bank activity that is erratic, unusual, or uncharacteristic; and bank activity inconsistent with the person's abilities (e.g., ATM withdrawals by someone who is homebound) (Central California Legal Services, 2001; Coker and Little, 1997; Dessin, 2000; Zimka, 1997). Another indication is provided when individuals have no awareness of the current state of their personal financial affairs (Rush and Lank, 2000). A signal may be provided when checks uncharacteristically begin to lack adequate funds to cover them, when the person is in debt and does not know why, when mostly smaller checks increase to larger checks for a variety of items, or an unusual number of checks are written to “cash” (Carroll, 2001; Dessin, 2000; Henningsen, 2001; National Clearinghouse on Family Violence, 2001).
A third cluster of indicators is associated with legal transactions involving the elder person and is directed largely at attorneys. They include the execution of legal documents or arrangements, such as powers of attorney, by an older person who is confused or who does not understand or remember the transaction (Carroll, 2001; Central California Legal Services, 2001; Hwang, 1996; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001). Other signs are suspicious or forged signatures on documents and changes in the older person's property, titles, will, or other documents, particularly if the changes are unexpected, sudden, or favor new acquaintances (National Center on Elder Abuse, 2001; National Clearinghouse on Family Violence, 2001; National Committee for the Prevention of Elder Abuse, 2001; Zimka, 1997). Another signal can be the sudden appearance of previously uninvolved relatives claiming rights to an elder person's affairs and possessions (National Center on Elder Abuse, 2001).
A fourth cluster of signals is associated with visits to physicians or other health care providers. One such signal is a patient's unmet physical needs notwithstanding the availability of financial resources (Lachs and Pillemer, 1995). Other identified behaviors are missed medical appointments, dropping out of treatment, uncharacteristic nonpayment for services, declining physical and psychological health, defensiveness or hostility by the caregiver during visits or on the phone, and an unwillingness by the caregiver to leave the elder person alone during appointments (Tueth, 2000).
MOTIVATIONS AND CHARACTERISTICS OF PERPETRATORS
As is true of most aspects of financial abuse of the elderly, little research has been conducted on the motivations and characteristics of its perpetrators. Nevertheless, there has been considerable speculation about them by professionals interested in reducing this abuse.
One set of motivations widely identified tends to be associated with all forms of elder abuse. Frequently cited motivations include the perpetrator's substance abuse, mental health, gambling, or financial problems (Dessin, 2000; National Committee for the Prevention of Elder Abuse, 2001; Tueth, 2000). The perpetrator's actions may be based on “learned violence” or be modeled after the prior behavior of the elder person (Dessin, 2000). Where the perpetrator is a primary caregiver, caregiver stress has been cited as a cause of this abuse (Dessin, 2000).
There are also a number of characteristics linked relatively uniquely to financial abuse. For example, the perpetrator may stand to inherit assets and feel justified in taking an advance or in exercising control over assets that are perceived to be almost or rightfully the perpetrator's own (Dessin, 2000; National Committee for the Prevention of Elder Abuse, 2001). When the perpetrator is an heir, he or she may conclude that preemptive steps are necessary to prevent the inheritance from being exhausted in paying for medical or other expenses (National Committee for the Prevention of Elder Abuse, 2001). Alternatively, negative attitudes toward persons identified as likely heirs may motivate the perpetrator to act to prevent them from acquiring the elder person's assets (National Committee for the Prevention of Elder Abuse, 2001). Because of a prior negative relationship with the elder person, the perpetrator may feel a sense of entitlement to these resources as payback for prior exploitation or abuse (Dessin, 2000; National Committee for the Prevention of Elder Abuse, 2001). The perpetrator may be motivated by a sense that he or she should be reimbursed for having carried a substantial care-giving burden for the elder person (Dessin, 2000). The perpetrator may conclude that the elder person has more assets than needed and the perpetrator has too few, and thus the perpetrator is entitled to a share of the elder person's assets (Quinn, 2000). Also, an intricate relationship may exist between elders and their caregivers. Older people, who may no longer place as great a value on their material possessions, may give gifts as a means of maintaining a power balance in their relationship with the caregiver. At the same time, the caregiver may indicate that such gifts are necessary if the elder person wishes to retain the caregiver's attention and assistance (Quinn, 2000).
When such motivations are present, a perpetrator may read into an elder person's words or behavior consent to a conveyance that a more objective perspective would not. The recipient of a gift may argue that the elder person provided implicit or explicit indications that the individual be given certain assets. When consent to a transfer of assets has been clearly provided and is not induced by fraud, duress, or undue influence, many assets can be transferred on a relatively informal basis.19 Because of the informal and private setting in which such transfers were purportedly made, the transfers may be the subject of good faith disputes but not represent financial abuse. However, individuals with the motivations described above may report consent to a transfer by an elder person that was not given or was not clearly provided, or attempt to induce this consent by fraud, duress, or undue influence.
Nonrelative perpetrators have been found to include career criminals in the business of defrauding others in general and elders in particular, while others were overcome by greed under the circumstances (Choi et al., 1999). It has been observed that many exconvicts become paid caregivers for vulnerable individuals, a practice that goes unchecked because most states do not require criminal background checks and do not prohibit persons convicted of certain crimes from working with the elderly (Nerenberg, 2000c).
As for the characteristics of the perpetrators, the NEAIS report concluded that the relative youth of perpetrators of financial abuse was particularly striking compared to other types of abuse (National Center on Elder Abuse, 1998). This study found 45.1 percent of the perpetrators were age 40 or younger (versus 27.4 percent for all forms of elder abuse) and another 39.5 percent were 41 to 59 years of age. It also found 59 percent of the perpetrators were male (versus 52.5 percent for all forms of elder abuse).
In addition, people who financially abuse the elderly are often family members, particularly adult children and grandchildren (National Center on Elder Abuse, 1996; Quinn, 2000; Rush and Lank, 2000; Sklar, 2000). The NEAIS report found that 60.4 percent of the substantiated 1996 APS financial abuse cases involved an adult child (versus 47.3 percent for all forms of elder abuse) and only 4.9 percent involved a spouse (versus 19.3 percent for all forms of elder abuse). In addition, it has been asserted that “crimes [by the elders' offspring] go undetected or are discovered long after the assets have been depleted” (Sklar, 2000:21).
A study of one county's APS reports of financial exploitation found that roughly 40 percent of the perpetrators were the victim's sons or daughters, 20 percent were other relatives (only 1.5 percent were spouses), and 4 percent were not relatives (Choi et al., 1999). A related study found that spouses were perpetrators of financial exploitation in only 1.5 percent of cases as opposed to 13.8 percent of all other elder abuse cases (Choi and Mayer, 2000). This study also found, however, that nonrelatives were the perpetrators in 38.8 percent of the financial exploitation cases in contrast to only 14.7 percent of all other elder abuse cases (Choi and Mayer, 2000). Another report concluded that perpetrators are often relatives, particularly children or grandchildren of the victim, many of whom depend on the elderly victim for housing or other assistance, have substance abuse problems, and are represented almost equally by both genders (Coker and Little, 1997).
Tueth (2000) constructed from the literature two types of perpetrators of elder exploitation. The first type consisted of dysfunctional individuals with low self-esteem who may be abusing substances, psychosocially stressed, or suffering from caregiver burden. Such individuals will not seek out victims but instead passively take advantage of opportunities that present themselves. The second, more aggressive type methodically identifies victims, establishes power and control over them, and obtains the elder's assets by using deceit, intimidation, and other forms of psychological abuse. Such individuals may have an antisocial personality disorder and have little regard for the rights of others. In a typical sequence, the victim is identified as impaired and vulnerable; the victim's trust is secured by being friendly, helpful, and providing assistance; the victim is made passive and comfortable and then isolated; and finally the perpetrator takes possession of assets by employing psychological abuse.
APPROPRIATENESS OF ADOPTING MODELS ADDRESSING CHILD AND SPOUSE ABUSE
Societal attention to child abuse and spouse abuse20 predated the attention given to elder abuse. The rising awareness of child abuse in the 1960s and that of spouse abuse in the 1970s have been cited as triggering societal awareness of the existence of elder abuse (Dessin, 2000).21
Preventive measures, reporting systems, and interventions designed to curtail child abuse frequently provided a model for efforts to address elder abuse (Capezuti et al., 1997; Gilbert, 1986; Kapp, 1995; Macolini, 1995; Nerenberg, 2000a; Wolf, 2000). As statutes were already in place that mandated child abuse reports and established service systems to redress such abuse when elder abuse was “discovered,” many states found it expedient to apply the same model to elder abuse as well (Anetzberger, 2000). One reason for using the same model is that child and elder abuse, whether physical or financial in nature, are difficult to detect because the victim may be reluctant or unable to report the abuse (Dessin, 2000), in part because the perpetrator is likely to be a family member (National Center on Elder Abuse, 1996). Also, the victims of both forms of abuse are frequently perceived as particularly vulnerable or sympathetic and in need of society's protection (Wolf, 2000; Anetzberger, 2000). Nevertheless, although a state may achieve a certain degree of efficiency when it builds on existing models and service delivery systems, as will be discussed, important distinctions caution against a whole-scale adoption of a child abuse model (AARP, 1993; Anetzberger, 2000; Brandl, 2000; Kapp, 1995; Kleinschmidt, 1997; Macolini, 1995; Vinton, 1991; Wolf, 2000), particularly when addressing the financial abuse of the elderly.
Alternatively, some commentators argue that a spouse abuse model is better suited for crafting responses to elder abuse (Macolini, 1995; Pillemer and Finkelhor, 1988). However, as will also be noted, financial abuse of the elderly may represent a sufficiently distinct form of abuse that caution should likewise be exercised before applying a spouse abuse model to address it (Kleinschmidt, 1997).
Means of Detecting Abuse
Because of compulsory education, children of school age interact with people outside their home on a routine basis. Even younger children may regularly attend preschool or day care. These contacts result in individuals outside the home frequently being aware of a child's health and well-being and being in a position to detect and report abuse. For many elder persons, such outside contacts may be sporadic and infrequent, which in turn reduces the likelihood that elder abuse will be detected and reported. Indeed, an abuser of an older person may intentionally discourage or limit such contacts to diminish the likelihood of detection. Thus, unlike child abuse, a naturally occurring circle of individuals may not exist who can be encouraged or required to watch for and report elder abuse (Choi and Mayer, 2000; National Center on Elder Abuse, 1998).
Also, child abuse models focus heavily on physical abuse. Financial abuse is rarely an issue when a child is involved (Dessin, 2000).22 As noted, financial abuse is a frequent concern when the elderly are involved. Moreover, the manner in which financial abuse occurs and its manifestations are often very different from that of physical abuse. Rather than acting out of rage or a loss of self-control, the perpetrator of financial abuse often acts in a very calculated fashion specifically designed to avoid detection. Also, physical abuse is more self-evident and more readily subject to proof than financial abuse.
In addition, the nature of the relationship between perpetrators of financial abuse and their victims may create an expectation by third parties that at least some financial resources will flow from the victim to the perpetrator and this may obscure detection of abuse (Dessin, 2000). Indeed, the perpetrator may feel entitled to the elder person's assets and may point to the elder person's apparent tacit consent in attempting to establish the legality of a transfer. Such consent is unlikely to be forthcoming or is relatively easily dismissed as ineffectual when physical abuse is involved.
In general, third parties may be more likely to respond to and report instances of physical abuse than financial abuse. Within our society, victims of physical violence tend to receive greater attention, sympathy, and support than victims of financial exploitation. For example, the victims' rights movement, which in recent years has brought attention to the needs of victims of violent crime, has not similarly focused attention on the plight of victims of financial crimes (Nerenberg, 2000c). Also, children may elicit more sympathy and protection than the elderly and thus reports of their abuse may be more forthcoming.23 These factors suggest that models for detecting and preventing financial abuse of the elderly may need to be more proactive than models used to respond to child abuse.
Decision-Making Capacity of Children and the Elderly
Another reason for adopting a model for addressing financial abuse of the elderly that is relatively distinct from that used to respond to child abuse is that issues associated with the decision-making capacity of the elderly are quite different from those associated with children (Nerenberg, 2000a). Unlike children, elder persons at some point generally possessed the capacity to handle their financial affairs and exercised control over these affairs. All adults are presumed to possess this capacity unless shown otherwise in a legal proceeding. Until an elder person is determined to lack decisionmaking capacity, the elder person has the right to make what may seem to be poor or foolish financial decisions (Gilbert, 1986; Macolini, 1995; Wilber and Reynolds, 1996).24 In addition, to strip or limit the ability of elder persons to make such decisions can be psychologically devastating as it may represent for them the removal of the last vestige of independence and emphasize their physical and mental decline, which in turn may accelerate this decline (Dessin, 2000). As a result, many elder persons will actively resent and resist any steps to limit their financial independence (Macolini, 1995). For example, in Massachusetts approximately one-fifth of the elder persons for whom a report of abuse was filed refused a resulting offer of state services (Dessin, 2000).25 It should be noted that such reports are typically limited to relatively egregious incidents. Such data may suggest that intervention to address the financial abuse of the elderly should be limited to when there is fraud, duress, or undue influence or a clear lack of capacity to make an informed decision (Dessin, 2000).26 At a minimum, any model to prevent or remedy financial abuse of the elderly needs to take into account the fact that elderly victims are adults who in general previously had complete autonomy over their financial transactions (Dessin, 2000).27 In particular, any such model needs to address whether and how to proceed when the elder person denies a need for assistance or resents or resists intervention (Capezuti et al., 1997).
Second, determining when an elderly person lacks decision-making capacity can be a difficult matter. Even if an elderly person intermittently experiences diminished capacity, he or she may in general retain decisionmaking capacity. Decision-making capacity among children is quite clearly, even if somewhat arbitrarily, demarked by the age of majority.28 For elder adults, decision-making capacity tends not to be an all-or-nothing concept. An individual with a cognitive impairment may have the capacity to make some decisions but lack capacity to make others. Also, this capacity may vary over time, with individuals having good days and bad days (Dessin, 2000; Langan and Means, 1996).29 Also, the diminishment of decisionmaking capacity is often a gradual process. Determining when individuals no longer have the capacity to make financial decisions for themselves is often difficult (Nerenberg, 2000a).
The American legal system places great weight on the right of individuals to make decisions for themselves, whether they be good or bad decisions, and limits when someone who has experienced a diminishment of decision-making capacity can have these rights curtailed. Furthermore, the definitions and elements of decision-making capacity tend to vary considerably (Nerenberg, 2000c). A general consensus has developed that an evaluation of incapacity should be based on an appraisal of the functional limitations of the person. However, what comprises a functional limitation and what this appraisal should be based on is frequently poorly articulated and inconsistently applied.30
In addition, a wholesale adoption of a child abuse model can contribute to the infantalization of the elderly and the perpetuation of ageism as the elderly are mistakenly assumed to be like children and to lack decisionmaking capacity (Capezuti et al., 1997; Gordon, 1986; Kapp, 1995; Macolini, 1995; Nerenberg, 2000a; Tueth, 2000). Physical decline does not necessarily correspond to significant mental decline and there is no evidence that advanced years or physical disability alone render a person incapable of making decisions (Gilbert, 1986; Wilber and Reynolds, 1996). Many, if not most, elderly individuals retain their capacity to make financial decisions for themselves (Dessin, 2000). It has been noted that professionals, especially nonhealth ones, often jump to the wrong conclusion that elderly people have dementia or otherwise lack decision-making capacity (Langan and Means, 1996). Elder persons may justifiably resent the imposition of a paternalistic model that appears to presume their lack of capacity, imposes supervision of their decisions, and seeks to make financial decisions on their behalf or delegate their decision-making authority to others (Kapp, 1995).
Impact of Differences Between Child Abuse and Financial Abuse of the Elderly
As a result of the differences between child abuse and financial abuse of the elderly, models for redressing financial abuse of the elderly may need to adopt a different approach from that used in child abuse models. In light of the scarce amount of research on the topic, it is difficult to determine how a child abuse model might be usefully applied to the financial abuse of the elderly. If financial abuse of the elderly is more difficult to detect than child abuse, financial abuse of the elderly could necessitate a model that is more proactive in detecting and responding to instances of such abuse. Similarly, if research indicates that large numbers of egregious incidents of elder financial abuse go unreported or unaddressed under a child abuse model, more expansive measures than established under a child abuse model may be necessary to enhance the filing of financial abuse reports and their subsequent investigation.
On the other hand, if research shows that victims of financial abuse find reports and subsequent interventions to be relatively invasive and repugnant, the reporting and investigation of financial abuse may need to be circumscribed more narrowly than is typical for child abuse. If research shows that most elderly persons resist or resent intrusion into their financial affairs, that most older persons have bona fide reasons for their resistance or resentment, or that most reports are not subsequently confirmed, arguably the criteria for reporting or undertaking an investigation of reported abuse should be narrowed from that applied to reports of child abuse. Under such circumstances, greater weight may need to be given to the wishes of purported victims and their right to enter into or remain in what appear to be abusive interactions (Dessin, 2000).
As current research, albeit relatively scanty, tends to show support for both of the above scenarios, a dichotomous model relatively unique to financial abuse of the elderly may be needed. A paternalistic model (similar to that used for child abuse) might be applied to elder persons for whom a determination can be made that there is a lack of financial decision-making capacity. However, a less paternalistic model would be used for those elderly persons for whom such a determination cannot be made. For the former, the parens patriae rationale associated with the child abuse model is arguably more fitting, justifying vigorous efforts to monitor their vulnerability to financial abuse and to enhance the reporting and investigation of potential abuse. For the latter, our legal system dictates that such individuals be presumed to know what is in their best interests. Even if a transfer of resources seems unjustified or inequitable to a third party, reporting and intervention would be limited to when there is an indication of fraud, duress, undue influence, or the like. Of course, determining when an individual lacks financial decision-making capacity can be a difficult matter (unlike for children, where age provides a blunt but clear dividing line) and additional research would be needed to establish how this can or should be done on a routine basis. Nevertheless, there are elderly persons for whom there is clearly a lack of financial decision-making capacity and for whom the dichotomy can clearly be applied.
Applicability of the Spouse Abuse Model to Financial Abuse of the Elderly
A number of commentators have argued that financial abuse of the elderly should be viewed as a form of domestic violence and that legislative models targeting spouse abuse better address its dynamics and serve its victims (AARP, 1993; Brandl, 2000; Brandl and Meuer, 2000; Heisler, 1991; Vinton, 1991, 1999; Vinton et al., 1997).31 For empirical support, an elder abuse survey conducted by Pillemer and Finkelhor (1988) is primarily and widely cited (seeAARP, 1993; Vinton, 1991, 1999; Vinton et al., 1997). Pillemer and Finkelhor (1988) asserted that their research on elder abuse indicates that spouse abuse provides a better model for understanding and addressing elder abuse than does child abuse.32 They argued that a child abuse model has been widely, but inappropriately, employed in responding to elder abuse because it was initially believed that elder abuse is intergenerational in nature. They contested this assumption based on their research findings that spouses were more likely to be perpetrators of elder abuse than adult children of the victim (58 percent versus 24 percent, respectively) and that there was no statistically significant difference in the seriousness of the abuse inflicted by these two groups of perpetrators.
However, Pillemer and Finkelhor did not include financial abuse in their definition of elder abuse. Thus, they did not examine its occurrence and did not determine whether spouses or adult children of the victims were more likely to be perpetrators of financial abuse. In contrast, as noted above, the NEAIS report found that 45 percent of the perpetrators of financial abuse were age 40 or younger and only 4.9 percent of the incidents involved a spouse (National Center on Elder Abuse, 1998). In addition, Choi and Mayer (2000) found that spouses were the perpetrators of financial exploitation in only 1.5 percent of all financial exploitation cases. It has been widely asserted that it is adult children and grandchildren of the elderly that are particularly likely to perpetrate financial abuse (Coker and Little, 1997; Quinn, 2000; Rush and Lank, 2000; Sklar, 2000).
In addition, the underlying dynamic provided by Pillemer and Finkelhor (1988) to explain the occurrence of the forms of elder abuse they studied (physical abuse, psychological abuse, and neglect) further suggests that a spouse abuse model may not be appropriate for addressing financial abuse of the elderly. They argued that an elder person is most likely to be abused by the individual with whom the elder person lives. They reasoned that the higher proportion of elder abuse committed by spouses reflected the fact that many more elders live with their spouses than with their children. However, as discussed, a frequently identified precursor of financial abuse of the elderly is their social isolation and, in particular, their living alone (Hwang, 1996; National Committee for the Prevention of Elder Abuse, 2001; Podnieks, 1992; Quinn, 2000; Rush and Lank, 2000). Victims of financial abuse are more likely to be widowed and to report they have no one to help them in the event of illness or disability, while victims of physical violence tend both to be married and to be living with their abuser (Choi et al., 1999; Podnieks, 1992). These findings further suggest that a spouse abuse model may be inappropriate when developing responses to financial abuse of the elderly.
Finally, spouse abuse models have focused heavily on curbing physical violence (Moskowitz, 1998b). Not surprisingly, these models center on the physical injuries such violence is likely to produce and the need to promote the safety of victims and means by which such injuries can be reduced (Brandl, 2000; Council, 1992; Klingbeil and Boyd, 1984; Vinton, 1991). The financial abuse of spouses has been a relatively minor concern. Although some commentators assert that financial abuse of the elderly almost always occurs in conjunction with physical abuse (Vinton, 1991), there is little research that has addressed this issue and what there is suggests the contrary (Podnieks, 1992). In general, the applicability of a spouse abuse model has not been tested with older women (Nerenberg, 2000a) and the “cycle of violence” that forms a foundation for the spouse abuse model may have limited applicability to the financial abuse of the elderly.
While a spouse abuse model may be appropriate when addressing the physical abuse of the elderly, as well as a subset of financial abuse cases when physical violence and financial abuse coexist, the spouse abuse model (like the child abuse model) does not appear to provide a comprehensive explanatory model for financial abuse of the elderly.33 A more eclectic approach that focuses on the relatively unique aspects of financial abuse of the elderly may be more appropriate. Among the specific factors that such an approach might encompass are the intergenerational nature of this abuse and tensions likely to occur across generations; the impact of financial dependence on these tensions; whether and when physical abuse and violence tend to accompany financial abuse and their impact; the nature and impact of more subtle forms of influence than violence; whether elder victims of financial abuse perceive the perpetrators of this abuse differently than perpetrators of physical abuse; and whether financial abuse is more likely to reflect mismanagment, financial need, or greed rather than a desire for power and control and the influence they exert on the manifestations of financial abuse. At the same time, such a model (and accompanying research) should also attend to the potential influence of factors typically associated with spouse abuse models such as the impact of power and control on financial abuse, victims' incorporation of internalized messages that they are to blame for this abuse, victims' fear of retaliation if they disclose their abuse, and social contexts that may lead an elder person to fear disruption of the status quo (Vinton, 1999).
Forty-four states and the District of Columbia have enacted statutes that mandate the reporting of elder abuse by certain individuals, with the other states providing for the voluntary reporting of such abuse (Stiegel, personal communication, October 2001).34 Although virtually all states specifically mention financial abuse in their reporting statutes (Moskowitz, 1998b; Roby and Sullivan, 2000), they often do not establish special procedures for the reporting and subsequent processing of reports of financial abuse.35 States with mandatory reporting generally impose penalties, such as fines, imprisonment, or license revocation, if reporting does not occur within a specified time period following discovery of the abuse (Capezuti et al., 1997; Kapp, 1995; Macolini, 1995; Marshall et al., 2000; Moskowitz, 1998b), although enforcement is generally lax (Heisler and Quinn, 1995; Roby and Sullivan, 2000). According to Roby and Sullivan (2000)