Today has been designated as World Elder Abuse Awareness Day. Preventing elder abuse is now of global concern.
I recently was privileged to speak with Jim Reynolds, CEO of Caring Companions Home Care in Concord, Massachusetts. His insightful advice can help caregivers protect elders from becoming victims of abuse. What follows is a transcript of the interview.
World Elder Abuse Awareness Day
Friday, June 15, 2012
Phone interview with Jim Reynolds
CEO of Caring Companions Home Care – Concord, MA
PAT: I understand that Friday has been designated as World Elder Abuse Awareness Day. There are four aspects to this that I will appreciate your addressing.
One is what are the warning signs that an elder is not being treated well?
JIM: Let’s go through all four, and then I’ll come back to that one.
PAT: That’s fine.
The first one is Screening Processes used when hiring help for a loved one.
The second is Warning Signs.
The third is How to Prevent Financial Fraud.
The last is what to do if you suspect your elder is at risk for abuse.
I’m going to add one myself, which is, how can we raise awareness in hospitals who
treat loved ones who may be suffering from some form of dementia, helping them to be more sensitive to the needs of these people and be more caring and understanding.
JIM: Sure. Abuse can come from many different sources, including one’s own family. It’s not always thought of as abuse. But it sounds as though what you’re focused on right now is abuse by hired, caregiving staff; is that right?
PAT: There are really two parts to this. I think probably the most helpful is if you start with the family, especially when a loved one is just showing early signs of some dementia. Sometimes the family is not ready for this, or they don’t know what to say or think. And sometimes their words are very hurtful.
JIM: I will mention a few things. And please feel free to guide me in directions that help you or don’t, because you have mentioned such a broad topic. We could do ten articles on this and still not cover the waterfront!
JIM: I don’t want to spread it too thick, but let me try the following.
By the way, I’ll say when you just mentioned as people’s skills are starting to decline, I published an article maybe a month ago, “Before Dementia Strikes, Difficult Conversations.”
That was helping families have conversations that are difficult to raise, because people don’t want to think about their own demise. Yet it’s important to do it while someone is still able to have that conversation reasonably.
I have just submitted today an article that will be published next week on, “Difficult Conversations II, When Dementia Strikes.” That is, after someone’s skills have declined and they are not reliably able to make reasonable judgments, how do you keep the person safe and what actions do you need to take.
How do you sort through all the difficulties? Let’s start with one.
I know of a case – I am intimately familiar with a case — in which an elder was financially abused, exploited, his life savings embezzeled. I’m not talking about taking advantage; I’m talking about wiped out.
He had chosen his financial adviser and the family was uncomfortable with that adviser. But the adviser was a charlatan, and he was able to work his way in to the elder’s confidence and to be given sole signing authority over the checking accounts. And the money was taken away. It was embezzeled.
If you are talking about financial abuse, which is one you mentioned, my very first rule of thumb would be to be certain in all cases that at least two people have signing authority and complete visibility into the account.
This goes for corporations as well. As a corporation you would never give a single person the ability both to make the purchase and claim the decisions because it’s too easy for fraud to occur.
It’s the same thing here. Be sure that two people have complete visibility into the account and complete signing authority so that no one person can make off with the money and get away with it unseen for long periods of time.
That’s rule No. 1 and that certainly happens quite a bit.
As far as screening, the one thing I would give you is our state of Massachusetts – I just use this as an example because that’s where I am. Homecare Alliance has an accreditation process. One of the things that every accredited agency has to do — and, of course, not all agencies are accredited. Ours is. Approximately ten percent in Massachusetts are — I would certainly look for a homecare agency that has a published staff verification background checking process that the state association accredits.
For example, I will quickly read for you what the state of Massachusetts requires: 1) A criminal background check for past criminal activity that includes a check into the state that applicant has lived in the past five years; 2) Social security number verification and trace, 3) Nurse aide registry or professional licensing board, whatever is appropriate for the staff in every state where they have been known to have worked in the past five years; 4) Verification of professional references; 5) Verification of work history; 6) Driving record.
If an agency checks all of those things for caregivers, it’s more likely that someone who has a history of difficulty is going to show up. It’s not a guarantee, but it at least lets the family know that the agency they are going to is doing its due diligence and not just grabbing anybody off the street. You have to watch out for all of those things.
Another thing I would say – and we ask all of our families to do this – and, again, this is more on the homecare workers’ side than on the financial adviser side. Really it certainly makes sense in any case.
If someone lives alone and is not necessarily able to reliably look after his or her own interests all the time, be sure that anything that’s valuable and portable is removed from easy access to people who come in the door, not only homecare workers but also, say, the financial adviser, bill payers, and other people. It could be the cable guy; it could be the house cleaners; it could be the yard guy, whoever does whatever. If it’s easy for them to get into the house and take something that is valuable, it’s a lot more likely that something may get taken.
As an example at a homecare agency where we’re involved, I tell everybody; I say to our clients, look, I’m not concerned about our people. I trust them; and if we didn’t trust them, they wouldn’t be in your home. But I don’t want them under a cloud of suspicion.
If there’s something that’s not there, we’re not going to be the only ones there. There’s going to be the cable guy and there’s going to be the house cleaners and there’s going to be the financial adviser or the physical therapist. Suddenly, something is missing – and we were there; I don’t want them to look at our folks whom I trust.
It’s not a matter of whom you trust and don’t trust; the point is you want to remove the opportunity for there to have been a problem.
I would certainly say if you are a sandwich generation kind of person – and that’s typically the kind of person your writing is oriented to — somebody between 40 and 65, who has a parent who is between 65 and 100 – they are trying to take care of these folks, and they have their own jobs and own families, et cetera, that’s one of the due diligence things you can do, is to be sure valuables are removed from temptation.
To make it personal, my father-in-law had homecare for 15 years before he died. One time we went to his house on Cape Cod. We lived right outside of Boston, so he was about two hours away. My wife, her brother, and her sister, all three kids and their spouses came for Thanksgiving Dinner. We went to pull out the family silver. And there were two forks left! So it happens. Somebody found out where it was and took it.
I would say also if someone is – and again this would depend on what the local community and state is like — to the extent there is a local elder services organization or a local council on aging, be sure that they are aware of that person and that they look in from time to time. That’s part of what their job is in that community.
If you live in a place where that’s not easy to do, certainly use a faith community or whatever you can. The more people who are involved, the better off you will be.
Kind of combining two different things — one of them was what are the warning signs, and the other was what do you do if you suspect — I would kind of give the same answer.
In general the answer is the less isolated the elder is, the less likely that abuse will occur. People who take advantage of others do it when they can get away with it. Whether it’s a criminal that sets out to embezzle money from old people or whether it’s just someone who is unaware and unhealthy and believes people take things, either way the more people who are around who are likely to speak up, the less likely that someone is taken advantage of.
I would say keep family members involved to the degree you can. Get faith communities involved to the degree you can. Get the local Council on Aging or the local elder services or whatever. Depending on the community you are in, neighbors, it doesn’t have to be Grand Central Station with people coming and going all day long.
Most folks who are alone don’t want that much traffic. But just to the extent that people are all aware that there are people who care enough about this person that they are watching, the problem people will most likely not be back.
PAT: I think you were right on target there.
I did have a situation years ago with a friend who lived alone. Her son lived across town, and her dementia was rapidly growing worse. I was very concerned for her safety. I would call the son often. He was bringing sandwiches and leaving them for her to eat. But she was at a point where she could not even remember that she had a sandwich in the refrigerator. That’s another case that the more people who are checking in on her, the better off she would have been.
JIM: You’ve just brought up the classic – I don’t know if this might be what you want to have in this particular column, but we are exactly on the same page.
One thing that we do in my agency – and it boggles my mind that we are the only agency in the country that does this! After every one of our visits we put up an online visit report so that people can read it. It is for precisely that reason, because if we’re there and we see Mom eat — this doesn’t have to be medical.
It can simply be, “Served tomato soup and half a tuna sandwich for lunch and she ate it or didn’t eat it,” to say nothing of ‘Did physical therapy exercises or showered, or whatever.’ Then the remote family member – and remote may be living across town and just busy or even across the street and just busy.
When they can’t be there, back on the idea that if the fort is tended, the more people who know what’s going on, the better off it’s going to be. You can watch things like someone’s diet. You can be sure that their meds are taken on time. You can see that they’re doing their physical therapy or just that they are mobile, that they are able to get up and down the stairs on their own or not, or they get outside for a walk or not, or that they get a shower, or whether they get dressed, or whatever the indicators are for that person’s proper level of engagement with life – and of course there’s a wide variety, depending on the general health status.
But when there are changes, people who are not necessarily onsite can in fact monitor the situation and sometimes intervene, even if they can’t live in the house and visit every day. I am completely with you on the connection making an enormous difference.
PAT: I just wish this service had been available for me and my brother, caring for our mother. My mom was 400 miles away and my brother was about an hour and a half. Having an online report after each visit by a caregiver would have really made a difference in our lives during that time.
JIM: Sure. That’s why we created this system.
It’s funny; I was just at a conference and giving a talk on this. And someone came up to me afterward and said, you know, this is a lawsuit waiting to happen and here are all the reasons we shouldn’t do it.
My reply was, do you not trust your caregivers well enough to write down accurately what they did? Because if you don’t, what does that say to the family if you don’t trust these people well enough to write down what they did and how their mom’s doing?
Who are you sending into that house, thinking of who is doing the screening and all that kind of stuff? I was aghast. But that’s how people see this for whatever reason.
I kind of got off on a tangent there.
PAT: I think you answered another question I had, which is what if a friend notices some unusual things happening and they speak to the family member and things don’t really change? I guess the Agency on Aging or the Alzheimer’s Association perhaps are the places to consult.
JIM: I would probably think that the Alzheimer’s Association is not terribly likely to be able to help. That’s just not their role.
But I would say the local Council on Aging or Agency on Aging or a faith community or a civic organization. Faith communities are very good at this to the extent that someone is connected with one of those. The price tends to be right, and they see their role as looking out for people who are not able to take care of themselves. So if you can’t get any help from the local Council on Aging, that might be a good place to look. Or sometimes just neighbors.
PAT: I have a question about the Habilitation Therapy, which your caregivers use. I know you can’t tell us much in this brief space, but I’m very interested in what you’re doing.
JIM: Well, the Commonwealth of Massachusetts recently funded – we didn’t develop Habilitation Therapy. That was led by the Alzheimer’s Association.
What the Commonwealth has just done is develop a curriculum for Habilitation Therapy for people serving clients who are served by the state of Massachusetts aging services access points. That is, receiving homecare by people licensed by the State and also for people who do it in general so that we can train our own people and even train family members. It doesn’t always come naturally.
I was working with a client yesterday who was really having some trouble with this. Instead of trying to argue with the person who had the Alzheimer’s, I tried to help the caregiver understand that I understood how powerful this man had been in the past both emotionally and financially; but he’s not there right now and you can’t do that. It won’t work.
What we do is we train our own caregivers. We also offer community education. And, finally, we work with family members themselves in strategies around how one might handle various points.
In fact one of our caregivers just posted a blog. I’ll send you a link to it. It’s lovely.
In fact, now that I think about it, it was from her training with us. And it was the simplest thing, “How to Say Hello to Someone with Alzheimer’s.” It sounds really basic, and it is really basic.
Having this training changed the way she dealt with her clients. It was a wonderful blog. I’ll send that to you.
I will say I am proud of our Commonwealth, especially when it came at a time of a budget crunch, funding a program like this. It does show a sense of priority around it.
And I’m proud of our agency for devoting the interest, time, and effort to have become the first class of certified trainers. It’s certainly something we take seriously and spend a lot of time on.
PAT: This information is most helpful and timely, especially for caregivers. I want to share with my readers the ‘How to Say Hello to Someone with Alzheimer’s.’
JIM: I’ll relay your request.
Have I answered your questions, or is there anything else I can help you with that you need to cover in this call?
PAT: I do have one more question. Let’s say a loved one is in a nursing home and there is a question about some care that was observed that wasn’t the way it should be. Usually, in nursing homes there is an ombudsman.
How would a person get action on something like that?
JIM: What I would say is people in our generation and above believe you go to the doctor and you do what the doctor said. We’re used to in health care following orders. We’re used to assuming that our best interests are, of course, being looked out for.
And there is a bit of a tendency to simply accept things as they are because that must be the best that they can be. I think these days in the healthcare system, not simply in nursing homes – I mean this could be your child or spouse or anyone receiving care — it’s always best to have an advocate, who is healthy and energetic, not the person receiving care. Even if you went in healthy and energetic and just had an operation, you are not healthy and energetic immediately following.
It always helps to have someone who can act as your advocate. One hopes things go well; but in the event they don’t, that person needs to speak up.
When you have a nursing home, it’s typically one of the adult children. The first place to go would be the Care Coordinator and then to the ombudsman. Different nursing homes work different ways.
The answer is you simply need to escalate it until it gets the attention of whoever can step in to make things change. You’re paying! You are entitled to a certain level of care. You’re not entitled to everything you want, and they can’t make your mom healthy again. But if something is not happening that ought to happen, you are entitled to get aid and you need to do it.
The answer is you have to be willing to be the squeaky wheel.
PAT: May follow-up questions from our readers addressed through this blog be sent to your email?
JIM: Oh, please, sure.
PAT: Thank you for your insightful advice on preventing elder abuse.
h Jim Reynolds, CEO of Caring Companion Home Care located in the greater Boston area when he addressed protecting our elders from becoming victims of abuse. This is a transcript of our phone interview.