Duration: 10/01/2012 to 09/30/2017

Administrative Advisor(s):

NIFA Reps:

Non-Technical Summary

Statement of Issues and Justification

There is an increasing number of victims who suffer each year from financial exploitation by a family member holding Power of Attorney (POA), a problem destined to increase as the elderly population (over 60 years of age) worldwide is predicted to reach two billion by 2050 (Global Action on Aging, 2011). Financial exploitation, the third most frequent form of elder abuse, is defined as the illegal or improper use of an adult's resources for another's profit or advantage.

Characteristics of vulnerable elders: Exploitation occurs in different income classes, genders, ethnicities, and among vulnerable elders of different ages. Risk factors for elder financial exploitation include being the oldest of the old, especially those who are over age 70 and especially over 80; and/or those who have recently gone through a major life transition such as a sudden illness or loss of a loved one. They are more vulnerable if they are lonely, suffering from one or more cognitive and/or sensory impairments which can affect decision-making capacity, judgment, and memory, and/or experiencing limitations in daily living activities, all of which can create dependency on others (Moschis, Mosteller, and Choong, 2001; Rabiner, OKeeffe, and Brown, 2004). Those with visible and substantial assets (Rabiner, OKeefe, & Brown, 2006), such as their own homes, are more likely to suffer exploitation. Women make up the majority of elder victims of financial exploitation, perhaps because they live longer and are therefore, a larger proportion of the oldest of the old. They may be perceived as weak and vulnerable, they may be less familiar with their own finances, the decisions that need to be made, and the methods for handling financial transactions (including electronic banking), and thus may be more vulnerable to abuse. In addition, to complicate matters they may be even unaware that they are being exploited? (Rabiner, OKeefe, & Brown, 2006).

Characteristics of perpetrators: According to a MetLife study (2009), more than any other type of abuse, substantiated cases of financial abuse involve an adult child (60% of cases), grandchild (9.2%), or other relative (9.7%). Professionals (18%) and caregivers (20.2%) are also common perpetrators. Men and women commit exploitation at about the same rates, but mens abuses are more likely to be covered in the news media. Perpetrators are commonly 40-49 years old and may feel a sense of entitlement to the elders money and possessions belonging to a parent or elderly family member. Their sense of entitlement also may result from negative attitudes toward the older person. They may also assume consent to transfer assets that were not, in fact, given or they may take advantage of an elders vulnerabilities such as those described above to exert physical or emotional pressure or undue influence (that is, a deliberate effort to take control of the elders decision-making Rabiner et al, 2006, p. 54).

Conditions that create an environment for exploitation: Physical and social isolation such as living alone creates a vulnerable environment for an elder. A close relationship between the elder and the exploitive family member and previous abuse may lead an elder to think financial exploitation is normal and not a crime. Elders ignorance of who can help, embarrassment or shame, fear of retaliation or fear that exploitation may be seen as evidence of their own incompetence that could result in loss of independence through guardianship or institutionalization may also create reluctance about reporting exploitation and contribute to the perfect environment for financial exploitation (Dessin, 2003, p. 9; Rabiner et al, 2006, p. 54).

Consequences of elder financial exploitation:
Financial, cognitive, and physical status of elders can influence the size and scope of POA exploitation problems. The financial resources for wealthy elders may be sufficient for them to withstand the financial shock resulting from POA financial exploitation, whereas similar levels of abuse may leave others economically devastated. According to Rabiner, OKeeffe, and Brown (2004), losing assets that have been accumulated over a lifetime through hard work and deprivation can be devastating, with significant practical and psychological consequences to the victim (p. 57). Financial exploitation can also have physical and emotional consequences including a loss of a sense of security and trust. In sum, it can affect the overall quality and length of an elders life. Financial, cognitive, and physical status can influence the size and scope of POA exploitation problems. Along with the financial damage to the individual and the family, financial exploitation also increases the incidences of elders needing Medicaid and other forms of public support, thus creating direct costs to society. Additionally, such family betrayal often results in psychological trauma for family members, leaving those involved feeling that their world, family, sense of safety, and faith in life itself are permanently damaged (ASAAPS, 2005, p. 1). Other family members may be concerned about whom to trust when they need a financial representative after such an experience.
POA: Whats the Problem? Many financial planners recommend establishing a power of attorney (POA) document to assist in legal and financial transactions should individuals become incapacitated. POA can help the elderly manage their finances and maintain some level of independence. However, since Power of Attorney documents often give another person complete control over anothers finances, it can create a perfect storm for exploitation when an elder unwittingly gives powers of attorney to an untrustworthy individual. In addition, weak protective measures and limited oversight allow abuses to occur.
Prevalence. It is difficult to estimate incidences (number of new cases in a particular period of time) or prevalence (total number of cases at a given point in time) (Rabiner, OKeeffe, and Brown, 2004, p. 55) because there is no federal agency or reporting system that collects incidences and prevalence of elder financial exploitation. Within states, there are no agencies that compile data across all the state agencies that handle different types of elder exploitation in all the settings in which they live (American Society of Adult Abuse Professionals and Survivors [ASAAPS], 2005, p. 4). There have been a few state-level studies that have tried to identify the extent of the problem. There is no system that gathers data directly from elders and their families. In relation to prevalence of elder financial exploitation, several recent national studies of elder maltreatment (Acierno, Hernandez, Amstadter, Resnick, Steve, & Muzzy, 2010; Laumann, Leitsch, & Waite, 2008; Lowenstein, Eisikovits, Band-Winterstien, & Enosh, 2009) have found that while elder neglect is the most common form of elder maltreatment (with rates of neglect from 5.9% to 18%), financial exploitation (FE) is the next most common form of maltreatment. Rates in two U.S. national samples were 3.5% and 5.2%, and a similar rate of financial exploitation (6.4%) was reported in a national sample of Israeli elders (Lowenstein, et al, 2009).

Conceptual Framework: It is also difficult to know just how many elders are exploited because non-reporting of elder abuse may be as high as forty-four cases for every one reported (Lachs et al, 2011), preventing accurate data collection. Anecdotal evidence seems to indicate that underreporting stems from shame, close relationships with the perpetrator, fear of isolation, lack of awareness of exploitation and unfamiliarity with resources and remedies concerning which factors increase the likelihood of POA abuse.

Challenges: There are many challenges for researchers and practitioners who want to address this problem in addition to the privacy and secrecy issues mentioned above. Other challenges include lack of agreement (both in research and state laws) about what defines elder exploitation, which hinders the ability to understand this problem.

In addition, family systems are complex and varied in terms of such things as established patterns; meanings and assumptions about money, gifting and exchange patterns, relationships developed since childhood, values, financial management practices individually and within a family system, and cultural influences. These all affect perceptions (that may vary considerably across family members within a single family) about whether a particular situation constitutes financial exploitation.

The problem can be further exacerbated by the fact that many elder exploitation situations involve elders and relatives living in multiple states and elders moving to be nearer relatives during their vulnerable years.

Benefits of this research: There is little or no research published on the impact of and on families from this intensely painful phenomenon. Data gathered from this study will be helpful to policymakers, medical professionals, social workers and other social service practitioners, lawyers and law enforcement officials, clergy, counselors/therapist, and family members. By gaining clarity about 1) contributing factors, interactions and exchange patterns in family systems foundational to later exploitation, 2) intrafamilial perceptions and interpretations of what happened and 3) impact of the exploitation on family members and the family system, we could improve recognition and prevention of financial exploitation and facilitate more timely intervention and remediation after financial exploitation has occurred.

Related, Current and Previous Work

There are also multiple perspectives within family systems about what has happened and what it means. Rabiner, OKeeffe, and Brown (2004), have proposed a conceptual framework for understanding elder financial exploitation. They admit that much still needs to be understood about the characteristics of families that are likely to experience this problem, its etiology, and consequences. Although their model focuses primarily on understanding the likelihood of a series of events leading to elder exploitation, it does not include an understanding of the consequences of elder abuse on family systems as well as individual members beyond the exploited elder. Built upon an earlier model reported in a 2003 National Research Council Report , Rabiner et al (2004) argue that use of their applied ecological perspective including a family systems model nested within and connected to other systems, has been successfully used to study model elder abuse and neglect and various public health problems (p. 55-56).

This framework (see attachment FRAMEWORK.JPG) draws attention to multiple processes occurring over time among the victim, perpetrator, and other interested parties (family and non-family) across and within environments as the older person changes physically, psychologically, and socially (Rabiner et al, 2004, p. 56). Their proposed model has two dimensions: microprocess and macroprocess levels. The microlevel includes factors associated with risk of financial exploitation such as characteristics of the elder and relevant attributes of the perpetrator, and interactions between them based on such factors as social and economic dependence (status inequality), the type of social relationships they have (quality of the relationships between the victim and perpetrator and whether it has improved or deteriorated over time), and then extent of power and exchange that occurs between them. The macrolevel includes the sociocultural and policy contextual factors such as cultural norms, views of older persons in general, public policies, programs, and statutes focusing on protecting elders, criminal and civil remedies, and prevention programs (pp. 56-57).

This model also includes group factors which Rabiner et al (2004) refer to as social networks which support the victim and the perpetrator. These social networks can serve as monitors, informants, and social controllers. They also describe the model as including both short-term and long-term outcomes. Short-term outcomes could include whether the exploitation is episodic or recurrent, whether it occurs in isolation, and the amount of resources taken. Longer-term outcomes could include financial, physical, and emotional well-being of the victim and the perpetrator, the durability of the caregiving relationship, and the elders sense of security and trust. The interactions can be reciprocal in that a mistreated elder might become depressed and further isolated which creates greater vulnerability. This increased vulnerability may embolden a perpetrator to repeat the financial exploitation.

This multistate project will use this model, but will focus on 1) the family system as foundational to later elder exploitation by a family POA agent and 2) the impact of the exploitation on the victims family system, a particular aspect of the victims social network. Within a family system, the social networks of the victim and perpetrator overlap, thus this research should increase our understanding of outcomes for the perpetrator and the perpetrators social network (particularly his/her family system). Rabiner et al (2004) indicated the perpetrators social (and family) network has been studied very little. Thus, this proposed project will expand on Rabiner et als Conceptual Model of Financial Exploitation.

Interestingly, Acierno et al. (2010) examined which factors were associated with financial exploitation and found that elders who require assistance with daily activities were at the greatest risk for family perpetrated financial exploitation. This is exactly the type of elderly individual who may need a Power of Attorney in order to function somewhat independently. Use of the POA has become more widespread over the past 25 years, but with diminishing accountability (Box, 2001; Vu-Dinh, 2010). Anecdotally, professionals have questioned whether having POA allows family members to exploit the elder and mismanage or steal their money (Stiegel, 2008). Yet we know very little about how financial exploitation is connected to Power of Attorney, and we do not know how often attorneys-in-fact (the responsible party granted the Power of Attorney) abuse their power and financially exploit the elder. Finally, we know very little about the attitudes of family members who are named as attorney-in-fact. For example, we do not know about the burdens that are placed on attorneys-in-fact and the degree to which such burdens might heighten the risk of financial exploitation. Also, some attorneys-in-fact may not only take care of the elders bills, but might also be primarily responsible for taking the elder to the doctor, grocery shopping, and helping with household cleaning and repairs. These additional responsibilities may increase resentment and a sense of entitlement in the attorney-in-fact, and to what extent do resentment and/or sense of entitlement increase the risk of financial exploitation?

A preliminary search of the Current Research Information System (CRIS) database offers no directly related family financial elder abuse/exploitation research. Building on findings from several recent incident studies (Acierno et al., 2010, Laumann et al., 2008; MetLife Study, 2009) as well as a recent study Under the Radar: New State Elder Abuse Prevalence Study (Lachs, 2011), the current proposed multi-state, multi-disciplinary studies will use qualitative and quantitative methods. The qualitative study will focus on increasing understanding of the relationships between elder financial exploitation and family systems.

Objectives

1. 1. Understand the participants lived experiences (knowledge and feelings) related to elder financial exploitation.
   
2. 2. Identify factors in the victims/perpetrators family system that participants consider to be significant antecedents to the Power of Attorney elder financial exploitation in their family.
   
3. 3. Gain insights into the victims and perpetrators family experiences that could assist professionals in facilitating healing of emotional and relationship wounds within families.
   
4. 4. Identify the range and scope of family experiences related to foundational antecedents, exploitation situations, and impact and meaning of the elder financial exploitation that could contribute to prevention and effective redress.
   
5. 5. Refine and/or expand the Conceptual Model of Elder Financial Exploitation by Rabiner, OKeeffe, and Brown, 2004.
   
6. Objective 6. 6. Refine the current research design and identify future studies that could contribute to prevention and more effective redress of familial elder financial exploitation. Objective 7. Create a means of measuring the prevalence of elder financial abuse by family members who have had Powers of Attorney.
   

Methods

We will be using a qualitative approach for the study related to objectives 1-6 and a quantitative approach for the prevalence part of this project related to objectives 4, 5 and 7. Objectives 1-6: A qualitative approach will be used for this initial study. Demographic factors, such as, age, gender, education, occupation, marital status, race/ethnicity, and states involved in the exploitation experience, will be collected to provide a basic background for different family members involved in elder financial exploitation with a goal of finding patterns within and between families. Personally identifiable information will be omitted or de-identified to protect participants confidentiality. In the in-depth interviews, all persons mentioned by the participants as well as participants themselves will be assigned fictitious names. No identifying information will be included in the transcripts. All demographic information will be aggregated with other participants so as to protect the identity of individual participants. Participants: Participants will be English-speaking family members whose families have experienced an elder being financially exploited by another family member whom the elder had given Powers of Attorney. They must be 18 years old or older, either male or female. We would accept victims, family members, or alleged perpetrators, some of whom may be elders themselves (60 or older). Participant recruitment and selection: Recruitment has been a huge challenge. A voluntary, convenience sample was sought from public invitations primarily through senior centers, Area Offices on Aging, AARP, caregiver support groups, and faith-based organizations. We also tried recruiting by sharing information with bankers, financial planners, lawyers, accountants, hospice directors, and nursing home directors who would then pass along information about our study to relevant clients. Because of privacy regulations, potential participants cannot be referred to us by professionals. Rather, they would have to contact us directly. However, we have learned that word of mouth and our research presentations seem to be much more effective at encouraging people to volunteer to be interviewed. Because we want to understand the impact of family systems as well as the impact on family systems from this problem, often considered a family secret, we are going to try a snowball sampling approach. Often used in populations difficult for researchers to access, snowball sampling should result in multiple participants with multiple perspectives from the same family and possibly potential participants from additional families. We are not sure how well this will work and we also realize that there will be biases in the sample, but it could provide a family system understanding rather than providing the perspective of only one family member. These problems may be the very reasons why there is a dearth of research on this problem from within the family. Number of participants: For this study we chose approximately 12 U.S. families with one or more persons per family regardless of state of residence because we wanted each of two interviewers (in two different states) to conduct interviews with six families. Since we have been challenged in the recruitment process, we were not sure whether we could find more willing participants than six each. We now believe that we probably can, but we are dependent on initial family members referring other family members to us so that we can study the experience within the family system. Of course, the researchers will have to abide by the laws in all of the relevant states concerning reporting of abuse if it still exists at the time of the interview. However, since we want these interviews to provide a range of experiences that can help to refine the interview protocol and identify other studies that would address elder financial exploitation by familial POAs, we plan to continue conducting these interviews until they no longer add to the range and scope of family experiences. This will depend on funding and the number of researchers in other states who can assist with this particular research project. Criteria for selection: Participants must have experienced POA financial exploitation of an elder (60 years old or older) in their family when the POA agent is/was a family member. This age is appropriate since the Census Bureau and Adult Protective Services define elderly using this age. Capacity to provide consent will be tested by the University of Wyoming IRB-approved Decisional Capacity Evaluation for Participant Consent Form after the Consent Form has been read to a participant (see attachment, "Consent Capacity Evaluation"). The interviewer will verbally explain the nature of the study, and give the participant a consent form to sign before his/her interview. The Consent Form will be read to the participants while they follow along. They will then be asked about the nature of the study, risks, and about their right to withdraw without penalty. If any participant answers a question incorrectly, the relevant information from the Consent Form will be re-read. If the participant is not able to answer these questions correctly after 3 tries, they will be assumed unable to consent to this study and the interview will not proceed. Participants must be willing to have their interview audio recorded, and they must agree to the uses of the interview described in the Consent Form. Interview methodology: The interview process uses an adaptation of Seidmans (1998) protocol for phenomenological interviewing. It will employ a three-part interview structure intended to help participants understand and create meaning of their experiences. It will ask for macroprocess and microprocess descriptions (See attachment, "FRAMEWORK.jpg") related to foundational antecedents, exploitation situations, and impact and meaning of the elder financial exploitation on family members and the family system. (See attached Interview Protocol.) Seidmans protocol involves three one-to-two hour separate interviews several days apart. We realize that our adaption is not iterative, i.e., does not provide the participant the opportunity to begin each subsequent interview with revisions or additions to what was said in the previous interview. The 3-interview format would be ideal, but it is likely to require use of the telephone and/or voice-over-Internet-protocol for interviews. We would need to study the impact of these different interview methods. Because of the commitment of time this interview process requires, we plan to provide incentives of $30 in the form of a gift card for participants, especially those who provide three separate interviews. According to Clarke and Iphofen (2006), interviewing as a method in phenomenological research is used to elicit a life story or narrative from [participants]...The aim&is to discover knowledge related to specific phenomena (Sorrell and Redmond 1995)...[It] is concerned with interpreting concealed meanings in phenomena. The purpose of the interview, therefore, is to derive shared meanings by drawing from the...[participants] a vivid picture of...[their] lived experience, complete with the richness of detail and context that shape that experience. This approach blends listening and narratives. It is usual to use a low-structured format which is highly focused and allows the...[participants] to tell their own experience in their own words with little or no prompting from the interviewer (para. 7). During the interview, the interviewer provides a general description of the three different foci of the interviews so a participant can organize her/his story. The interviewer then follows the predetermined research question protocol (See attachment, "Interview questions") so that if a participant does not cover the content needed, the interviewer will ask for it, trying to introduce a question where it seems most logical as a participants story unfolds. In order to help the interviewer follow the complexity of the family relationships in a participants story during the interview, the interviewer will use genogram notation. A genogram is a graphic representation of a family through three or more generations. In this study the interviewer can track family connections by noting relationships, occupations, and alignments. A fact sheet of contact information for Adult Protective Services, Area Offices on Aging (adapted for participants location) will be offered to all participants who want it. Training of Interviewers: Interviewers need to have an understanding of the principles of qualitative research and phenomenological interviewing. We will use mock interviews, active listener skills to prompt deeper reflection by the participants, share principles to obtain high quality recordings, transcriptions, genogram notation, and use of electronic interviewing using telephone and Skype (Voice-Over-Internet-Protocol, VOIP). This could require a two-day face-to-face training. Data collection and analysis: 1. Data to be collected: Family members stories of Power of Attorney elder financial exploitation will be collected through qualitative interviews of family members who have experienced POA exploitation in their family. Using a phenomenological interviewing protocol developed by Seidman (1998) explained earlier, A) the first interview asks participants to share focused foundational family and relationship experiences before the elder financial exploitation began, such as relationships in their families including ordinal position of siblings and intergenerational relations, values and norms, patterns related to money and possessions, power in relationships between family members, relevant schooling and work, and other significant experiences. Examples include: What is your family background and context that laid a foundation for this situation? What led up to this? What is your relationship to the exploited elder and the abuser? What has been your role? What is/was the relationship of the financial abuser (POA) to the elder? B) The second interview focuses on details of the alleged financial exploitation of an elder family member, who was involved and how, what happened, and what was done about it if anything. Examples include: What is your estimate of the financial damage? How was it handled? Why? Who was involved in addressing this problem? Family members? Authorities? Court system? Was redress achieved? Why? C) The last interview centers on reflections of the impact and meaning of this alleged elder financial exploitation experience on the participant and on the family system and its place in the whole of their lives individually and collectively. How satisfied are you? What has been the impact of this experience on your family? What would you have wanted to be different? How has it affected you? How has it affected your family? What have been the impacts resulting from the way it was handled? What do you expect will be the long-term impact on your family? What do you wish could happen? More specific clarification questions will emerge from the conversations themselves. (See attachment, "Interview questions"). Because we are experimenting with different methods of data collection, we will track whether face-to-face and electronic interviews are different, how balanced the perspectives are within individual families (whether multiple participants represent different roles and perspectives on the same family situation), differences in results from the one-interview-with-three-parts approach is from the three-separate-interviews approach. 2. Location: Interviews will be conducted in a location that is private, neutral, convenient and as comfortable as possible for participants, and without interruption. However, if it is not possible to do interviews in person, we plan to use the telephone or an electronic means such as Skype. According to Sweet (2002), the telephone can be used successfully with phenomenological interviewing. 3. Equipment: Digital audio-recording equipment with lapel microphones will be used. Recordings will be copied onto DVDs as backup, deposited in Drop Box, a secure, cloud storage and retrieval site accessible only to designated persons such as the research team, and research assistants, the technical person who transfers the recordings to DVDs and deposits them in Drop Box, and the transcriber. Objective 4, 5 & 7: The next component of our project is the development of a prevalence survey based on a review of national and international prevalence research, but adapted to focus more on elder financial exploitation within a family system. The intent is to complement the data available from other studies and to establish a benchmark for future studies. Because the development of the survey instrument depends in large part on findings from the qualitative phase of this project, the description of this quantitative phase presents a basic framework rather than a completed project plan. Survey instrument: Researchers have raised the alarm about the potential abuses associated with a Power of Attorney (e.g., Rabiner, et al., 2006). The survey will include measures to assess the extent to which having a POA with weak protective measures and limited oversight increases risk for financial exploitation and the extent to which it is associated with specific exploitive behaviors. The survey will also include an assessment of how financial exploitation affects family relations, including relations between the victim and perpetrator, as well as relationships among other family members. Sample questions from other surveys are included in an attachment. We expect to add other questions based on our findings from the pilot project qualitative interviews and other family relationship survey instruments. This survey will include many of the same questions that were included in other national prevalence studies. This will enable us to compare the prevalence of financial exploitation of our sample to other national samples. In addition, we propose a more refined study of exploitive behaviors. In the national studies (e.g., Acierno, et al., 2010; Laumann, et al., 2008; Lowenstein, et al.,2009) participants were questioned about a variety of exploitive experiences and the results were combined to form one measure of financial exploitation. In other words, questions such as Has any member of your family taken valuables belonging to you without your consent? were combined with Has there been an order of foreclosure issued against you because of a debt of a member of your family? We expect to separate these various measures to gain a more nuanced understanding of the forms of exploitation and how these impact family relationships. Field Test Respondents: We will conduct a field test of this quantitative survey with a sample of Wyoming voters age 60 and older. Once we confirm the survey provides valid and reliable measures, we will move to a national implementation. Sampling Frames: The final survey will be conducted with a nationally-representative sample of adults age 60 and older. Depending on our findings from the qualitative phase of this project, we may choose to oversample based on some characteristics (e.g., gender, race, urban-rural). There are several possible sampling strategies that we might employ, based on resources available. One possibility is to use a university survey research facility to conduct a mail or phone survey of eligible respondents. A second option would be to coordinate with other agencies, such as the Area Agencies on Aging, to obtain a sample. Another alternative would be to purchase a sample from a sampling contractor (for example, Survey Sampling International or Princeton Survey Research Associates) for either a mail or phone survey. We would expect to draw a large enough sample to assure that we have 1,500 to 2,000 respondents with completed interviews. Data analysis plan: In our study we plan to use factor analysis to discern patterns of financial exploitation among the different exploitive behaviors. We also will explore the extent to which victim variables such as gender, health, and age are associated with different factors. Further, we will also assess the extent to which Power of Attorney is associated with specific patterns of abuse. Finally, we will incorporate correlates of family relationships to distill the impacts of exploitation on these relationships.

Measurement of Progress and Results

Outputs

• " We expect to have extensive interview data from the in-depth interviews of family members that can be examined in multiple ways, but which will help to define additional future studies.
• " We also expect to have useful survey data that can be analyzed in more specific ways to answer the question of prevalence of POA financial exploitation of elders by family members.
• " We will explore the possibility of a cooperative effort among various relevant state-level organizations and agencies that could develop a statewide data collection and integration system that could be used by other states.

Outcomes or Projected Impacts

• " This research can contribute to the understanding of family experiences as antecedents to exploitation, the experience of family members in addition to the elder victims, and the effects on the family, both short and long-term. Those who may benefit from the research include elders and their families, family/community educators, lawyers, counselors/therapists, policymakers and victim advocates.
• " The opportunity for participants to make their voice heard and to know that they are not alone is an important benefit of participation. They may experience a therapeutic benefit from telling their story to someone who listens intently; this has been reported as a benefit by participants currently being interviewed and by those in a previous study done by the P.I. Participation may also improve their understanding of their own family situation. They may be encouraged through this experience to address lingering consequences within their family. If so desired, participants will be provided with a copy of the aggregate research results from this study. If they want it, they will be given a list of resources and places to go for assistance.
• " Participants will also experience the indirect benefit of knowing that as a class, they are contributing to the body of knowledge and possibly helping to prevent such exploitation in the future. It is the intent of the researchers to develop educational materials that could be shared with the general public. Because of what participants and researchers learn through this interview process, they could encourage others to be more proactive.

Milestones

(2013): (Objective 1 & 4): Continue grant writing as needed. Add legal expertise to our team that can help to interpret legal aspects of participants experiences shared during the in-depth interviews. (Objectives 4 & 6): Write and submit for publication a manuscript on challenges faced in trying to study this family secret. (Objectives 1-5): Write and submit for publication a manuscript on the findings on the in-depth interviews. Share findings with academic and lay audiences. (Objectives 4, 5, & 7): Conduct the pilot prevalence survey. Seek additional funding. (Objective 6): If additional researchers are added to this multistate project, development of new studies may be needed.

(2014): (Objectives 1-5): Continue the in-depth interviews of family members of exploited elders. Write and submit for publication a manuscript on the findings. Share findings with academic and lay audiences. (Objectives 1-7): Use findings to design new studies to be done by sub-teams and/or to be done later by this team. Continue grant writing as needed. (Objectives 4, 5, 6, & 7): Write manuscripts on the prevalence pilot study and develop subsequent studies.

(2015): (Objectives 1-7): Continue the in-depth interviews of family members of exploited elders. Continue writing and submitting manuscripts to refereed journals on various aspects of the previous in-depth interviews and prevalence survey project. Design subsequent studies that address themes/variables identified from the interviews & survey. Share findings with academic and lay audiences, professionals, and/or policymakers. Use findings to design new studies to be done by sub-teams and/or to be done later by this team. Continue grant writing as needed.

(2016): (Objectives 1-7): Disseminate findings to academic and lay audiences, professionals, and policymakers, Continue working on studies developed in previous years and/or new studies. Continue grant writing as needed.

(2017): (Objectives 1-7): Disseminate findings to academic and lay audiences, professionals, and policymakers, Continue working on studies developed in previous years and/or new studies. Continue grant writing as needed.

Projected Participation

View Appendix E: Participation

Outreach Plan

When we get to the stage of disseminating findings, we will connect with various relevant organizations and agencies to determine the most appropriate means that will avoid duplication of efforts and have the greatest impact. Extensive dissemination is planned, through manuscript development for scholarly professional journals and presentations, electronic media, informational brochures to the elderly and their families, and others involved in their care, including lawyers, accountants, financial planners, bankers, physicians, nurses, and other professionals as well as policymakers. Many of these will be produced and distributed in association with the University of Wisconsin and University of Wyoming Cooperative Extension Office. Other outreach activities are planned, including informational fact sheets, publication of papers and public presentations. Other outreach activities are planned, including a webinar for the American Association of Family and Consumer Sciences. It is our intention to create not just academic publications to assist in the research of others interested in the topic, but also to create brochures and fact sheets that can be used by laypeople to create POAs that resist abuse.

Organization/Governance

Organization and governance will follow the standard format for multistate activities. An executive committee will be established in the future as needed.

Literature Cited

Acierno, R, Hernandez, M.A., Amstadter, A.B., Resnick, H.S., Steve, K. & Muzzy, W. (2010). Prevalence and correlates of emotional, physical, sexual and financial abuse and potential neglect in the United States: The National Elder Mistreatment Stud. American Journal of Public Health, 100, 292-297.

American Society of Adult Abuse Professionals and Survivors [ASAAPS]. (2005, August 12). New information and support programs for survivors, advocates, and professionals in elder and vulnerable adult abuse. Retrieved on February 28, 2011 from http://www.ncdsv.org/images/NewInformationSupportProgramsSurvivors.pdf

Clarke, K. A. and Iphofen, R. (2006). Issues in phenomenological nursing research: The combined use of pain diaries and interviewing. Nurse Researcher, 13(3): 62-74.

Dessin, C.L. (2003). Financial abuse of the elderly: Is the solution a problem? Retrieved from http://papers.ssrn.com/sol3/papers.cfm?abstract_id=461026 Global Action on Aging.

(2011, September 26). Elderly need protection as their population nears 2 billion, says UN. In Global Action on Aging. Retrieved from http://www.globalaging.org/elderrights/world/2011/elderly%20need%20protection.html.

Global Action on Aging. (2011). Elder rights: neglect/abuse. Retrieved from http://www.globalaging.org/elderrights/us/index.htm#neglect.

Justice for all: Ending elder abuse, neglect and financial exploitation: Hearing before the US Senate Special Subcommittee on Aging, U.S. Senate, 112th Congress. (2011).

Lachs, M., et al. (2011, May). Under the radar: New York state elder abuse prevalence study. Retrieved from http://www.lifespan-roch.org/documents/UndertheRadar051211.pdf.

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