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Multidisciplinary Support for Older People Who Experience Abuse, Neglect, and Financial Exploitation

World Elder Abuse Awareness Day (WEAAD) on June 15 is an annual event launched in 2006 by the International Network for the Prevention of Elder Abuse and World Health Organization within the United Nations, which recognized elder abuse, neglect, and exploitation as significant public health and human rights issues. WEAAD provides an opportunity for communities around the world to promote a better understanding of abuse and neglect of older people by raising awareness of the cultural, social, economic and demographic processes affecting elder abuse and neglect.

In Seattle and King County, we are working to address elder abuse, neglect, and financial exploitation by strengthening ties between the many agencies that respond to reports of elder abuse. At the start of 2019, with the generous support of the King County Council and funding through the Veterans, Seniors, and Human Services Levy, the Office of the King County Prosecuting Attorney, Aging and Disability Services (Seattle Human Services Department), and Adult Protective Services established the King County Elder and Vulnerable Adult Abuse Multidisciplinary Team (MDT).

The MDT brings together professionals from across disciplines to work collaboratively to improve the systemic response to cases of elder and vulnerable adult abuse, neglect, and financial exploitation in King County. It is comprised of: King County prosecutors, Aging and Disability Services supervisors and case managers, Adult Protective Services administrators and investigators, a King County Sheriff’s deputy, a state Developmental Disabilities Administration manager, medical professionals (including geriatricians), a full-time financial analyst, and a full-time program coordinator. The MDT invites other professionals to participate in specific cases, ranging from law enforcement officers to capacity evaluators, and financial managers to emergency services personnel.

The following story is one example of a case addressed by the King County Elder and Vulnerable Adult Abuse MDT (names changed to protect identities):

Mary is a 75-year-old woman who lives by herself in her own home. About three years ago, Mary’s husband, Martin, moved to a memory care unit in a skilled nursing facility. Martin had previously handled their family’s finances and bill paying. Mary had no real experience managing money.

Mary and Martin have two adult children who are estranged from each other but in regular contact with Mary. Both live out of state. Her daughter, Jessica, and Jessica’s husband, James, became concerned about the increasing difficulty they experienced trying to reach Mary. Sometimes it took more than a month to connect.

When James contacted the MDT, he related the following concerns:

• After Martin entered memory care, Mary displayed signs of hyper-religiosity and hoarding behavior.
• In the first year or two after Martin left the home, Mary and Tom began a platonic friendship. Later, she felt that Tom had abused her trust. Tom had stolen money.
• Harry, the son of a friend from church, helped Mary get rid of Tom, and he became her handyman. Then there were signs that Harry was taking advantage of Mary—she was said to have purchased a new truck, camper, and boat for Harry and was paying for several storage units for him in addition to paying him large amounts of cash for work that was not completed.
• While Mary had a healthy income, she also had some bills to pay. When she missed a payment for her husband’s memory care unit, Jessica and James became concerned about the safety of both parents.

When the MDT reached out to Adult Protective Services (APS), they discovered multiple previous APS investigations into possible financial exploitation of Mary by both Tom and Harry. The previous investigations were found inconclusive or unsubstantiated due to Mary’s lack of cooperation and no evidence that she had cognitive issues. The MDT reached out to a King County Sherriff’s deputy who confirmed he was aware of the situation and was concerned but felt there was not much that he could do as Mary clearly wanted Harry around and she didn’t appear to be a vulnerable adult.

The MDT worked with APS to launch a new referral and financial exploitation investigation. An Aging and Disability Services case manager who specializes in elder abuse engaged with Mary to build rapport and trust. The new investigation determined that Mary appeared to be at significant risk, especially after it was discovered that Tom and Harry knew each other and had both received money from Mary in an overlapping time period.

APS determined that more than $500,000 had gone to the perpetrators over a two-year period. The MDT was concerned because, while Mary was clearly bright and educated and thus compensated well in conversation, she likely had capacity issues based on her lack of financial management experience, hoarding behavior, and the way in which she spoke about the current perpetrator, Harry.

The MDT arranged for an in-home capacity evaluation. The capacity evaluator found that Mary lacked financial capacity, which allowed APS to obtain a Vulnerable Adult Protection Order against Harry and push for a financial guardianship.

Working to pursue the least restrictive option, APS initially allowed a church that had been named in Mary and Martin’s trust (established prior to Martin’s decline in cognition) to step into a supporting role, help manage Mary’s finances, and work to identify a long-term living solution that would keep her safe. Over time, this arrangement didn’t work as Mary was uncooperative with the church. James and Jessica ended up taking over as Powers of Attorney, re-referring Mary for self-neglect, and working with APS to establish guardianship.

Elder abuse, neglect, and financial exploitation cases can be incredibly complex and difficult to investigate. With issues ranging from the complicated relationships between family members, to financial or medical records that easily number in the hundreds, to wrestling with questions about cognitive decline and decisional capacity, cases of elder abuse are almost never straightforward and easy to determine. Additionally, both the MDT and the agencies that respond to cases of elder abuse have to determine the fine line between protecting the victim from current and future perpetrators and restoring the victim’s independence and dignity so that they can continue to live their life with as much self-determination as possible. This is why the MDT was formed—to provide a venue for professionals and organizations responding to these cases to maximize collaboration and efficiency when determining the best path forward.

As we approach World Elder Abuse Awareness Day, we would like to thank all of the incredibly hardworking case managers, investigators, law enforcement officers, family members, and others who are working every day to lessen, mitigate, and help raise awareness of elder abuse, neglect, and exploitation.

For more information about the King County Elder and Vulnerable Adult Abuse MDT, or to refer a case to the MDT, e-mail ElderAbuseMDT@KingCounty.gov or call 206-263-3022.

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Contributor Scott Rosenwood coordinates the Elder and Vulnerable Adult Abuse Multidisciplinary Team in the Office of the King County Prosecuting Attorney.

The theme of World Elder Abuse Awareness Day is “Lifting Up Voices.” For ideas of ways you or your organization can support older survivors to share their perspectives and experiences, see the Lifting Up Voices WEAAD Action Guide 2020.

This article originally appeared in the June 2020 issue of AgeWise King County.