Duration: 10/01/2017 to 09/30/2022

Administrative Advisor(s):

NIFA Reps:

Non-Technical Summary

Statement of Issues and Justification

The need as indicated by stakeholders

We have received letters of support for this research from the Wyoming Center on Aging, the Colorado Organization for Victim Assistance, the Wyoming Division of Aging, and the New River Valley Agency on Aging, Pulaski, Virginia (one team researcher is at Virginia Tech). All these letters were written in July 2016 for a grant proposal submitted in August 2016. Also, we have received grants Kappa Omicron Nu and Phi Upsilon Omicron (funded twice), both honor societies in Family and Consumer Sciences; and the University of Wyoming Social Justice Research Center that funded this research three times. Phi Upsilon Omicron funded it twice.  Most recently we received a letter of support from and Kelly Davis, Elder Attorney in Cheyenne, Wyoming and member of the National Association of Elder Law Attorneys (NAELA).

The importance of this research

Elder financial exploitation (EFE) “is the third most frequent form of abuse after neglect and emotional abuse” (Arizona Elder Abuse Commission, 2007, p.4).  Defined as the illegal or improper use of an adult's resources for another's profit or advantage, EFE has been growing since the 1980s.  This problem is 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).  In the U.S. the 60 and older age group is predicted to increase from just under 57 million in 2010 to over 92 million in 2030 and over 112 million in 2050 (Population Division, U.S. Census Bureau, 2008).  

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. Elders 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, OKeeffe, & 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, et al., 2006).

Characteristics of perpetrators: According to MetLife studies (2009, 2011), 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 men’s 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 elders’ money and possessions belonging to parents or other elderly family members. Their sense of entitlement also may result from negative attitudes toward older people or a particular older person. They may also assume consent to transfer assets that were not, in fact, given or they may take advantage of elders’ vulnerabilities such as those described above to exert physical or emotional pressure or undue influence (a deliberate effort to take control of elders’ decision-making) (Rabiner et al., 2006).

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 and therefore result in loss of their independence through guardianship or institutionalization may also create reluctance to report exploitation. All these conditions contribute to the perfect environment for financial exploitation (Dessin, 2003; Rabiner et al., 2006).

Consequences of elder financial exploitation:
The financial, cognitive, and physical status of elders can influence the size and scope of EFE. The financial resources for wealthy elders may be sufficient for them to withstand the financial shock resulting from EFE, whereas similar levels of abuse may leave others economically devastated. According to Rabiner, et al. (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. 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 elder’s life.

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 (American Society of Adult Abuse Professionals and Survivors [ASAAPS], 2005). After such an experience, other family members may be concerned about whom to trust when they need a financial representative.

Power of Attorney: Many financial planners, lawyers, and healthcare providers 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 another’s 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. The National Council on Aging (2017) reported that almost 90% of elder abuse and neglect incidents are perpetrated by a family member with two thirds being adult children or spouses (Lachs, Psaty, Psaty, & Berman, 2011). Why do trusted relatives betray that trust? What within families increases the likelihood that trusted family-member POA agents will become a perpetrators of EFE?

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, et al., 2004) 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 occur (American Society of Adult Abuse Professionals and Survivors [ASAAPS], 2005). 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).

Because research has documented some characteristics of perpetrators and victims, contextual factors, and opportunities for exploitation, there are expanding resources to help professionals, older adults, and family members recognize financial abuse and what to do if it is suspected, but this data is all based on reported cases with little known about experiences of unreported cases, estimated to be as many as 10-44 cases per reported case (Lachs et al., 2011). Because of this frequency of underreporting and the difficulties associated with prosecuting when reported, much more needs to be understood about the whole of the problem. 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 factors that increase the likelihood of POA abuse. Even when it is suspected, family loyalty, family and/or personal pride, embarrassment, and lack of understanding of the legal system also discourage reporting and encourage secrecy even within families.

Many government and non-profit organizations are trying to address this problem through adoption of the model Uniform Power of Attorney Act, and development of educational materials, workshops and webinars, and trainings for professionals, but what is missing is an understanding of risk and protective factors that provide a basis for careful analysis of family members and the family system that could better inform decisions about who should be designated POA agents and what arrangement in the planning documents and among family members that would increase the likelihood of success (lack of exploitation) during the waning years of elders’ lives. There is urgency in addressing this problem to forestall the escalation of this predicted familial and societal crisis.

Conceptual Framework: Because there are multiple levels of opportunities and barriers that people experience in maintaining financial well-being in later life, we argue that Bronfenbrenner’s (1979; 1986) Ecological Systems Theory is an extremely useful framework for understanding individuals who have been victims of EFE and who are embedded within a system of hierarchical contexts. As an organizing framework for intervention and its sustainability, the model provides a focus on the elder victim and four influencing systems (See Attachment A):  (a) the microsystem is the elder victim within his or her environment, (b) the mesosystem represents the relationship between the victim and relatives and friends; (c) the exosystem represents environments external to the victim (e.g., community services) that may affect his or her well-being; and (d) the macrosystem includes broad ideological values, norms, and cultural and institutional patterns (e.g., state/federal programs and regulations /policies) (Parra-Cardona, Meyer, Schiamberg, & Post, 2007; Horsford, Parra-Cardona, Post, & Schiamberg, 2010).

In line with this perspective and rather than focusing on a single issue, our study will elucidate a broader understanding of the challenges faced by families who experience EFE by a family member POA agent. Because the etiology of EFE and the variables that influence a perpetrator’s decision to engage in exploitative behaviors are so complex, it is important to comprehensively examine EFE within the family structure. People are not isolated agents; they are embedded within and influenced by intricate social and environmental networks. Thus, a broad perspective increases an understanding of these complicated issues.

Within this ecological framework, Rabiner et al. (2004) developed their Conceptual Model of Elder Financial Exploitation. See Attachment B for a graphic representation. 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 financial 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 elder abuse and neglect and various public health problems.

This framework 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). 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.

This model also includes group factors which Rabiner et al. (2004) refer to as social networks which support victims and the perpetrators. 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. Long-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) identifying risk and protective factors within family systems that could assist elders and professionals working with them of what to consider when selecting a person with fiduciary responsibility to manage their affairs when they cannot. This is a proactive approach to preventing EFE rather than trying to stop it when it is recognized. The family system is foundational to the wellbeing of elders and 2) identifying consequences of  exploitation not only on the elders themselves, but also on the victims’ family system. This can  serve as a motivator to plan carefully with an understanding of the individuals, values, interaction patterns, conflicts and other strengths and challenges within their family system. Within a family system, the social networks of the victim and perpetrator overlap, thus this research should increase understanding of outcomes for the victims 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 the Conceptual Model of Financial Exploitation of Rabiner et al. (2004).

What the likely impacts will be from successfully completing the work.

This project complements or extends existing knowledge in the field in several ways. The field of elder mistreatment has grown exponentially, particularly the subtype area of financial exploitation.  Research has been conducted in the areas of elder financial capacity (Sherod, Griffith, Copeland, Belue, Krzywanski, Zamrini, Harrell, Clark, Brockington, Powers & Marson, 2009), scope of the problem (Acierno Hernandez, Amstader, Resnick, Steve, Muzzy, & Kilpatrick, 2010; Lachs et al., 2011), outcomes of the problem (Huang & Lawitz, 2016), and types of the problem (Jackson & Hafemeister, 2012).  Most studies reveal that family members are chiefly responsible for the perpetration of EFE; however, the dollar amounts of the exploitation may be higher from other forms of financial exploitation, such as medical fraud, telemarketing fraud, and other scams (Metlife Mature Market Institute, 2009; 2011).  While research has focused on identification of the problem, little work has been conducted on how and why the exploitation occurs, particularly within the family unit.  The closest conceptualization we have found is the Conceptual Model of Elder Financial Exploitation by Rabiner et al. (2004).  This research project will contribute more detail to their conceptualization.

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 EFE, and what goes on in unreported cases which is estimated to be a much larger group than reported cases of EFE. Without an identifiable sampling frame due to underreporting, random sampling is impossible, therefore generalizability of quantitative findings will be limited.

In addition, family systems are complex and varied in terms of concepts such as established patterns of interaction, relationships developed since childhood, values, financial management practices individually and within a family system, meanings and assumptions about money, gifting and exchange patterns, 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 EFE situations involve elders and relatives living in multiple states with varying laws and elders moving to be nearer relatives during their vulnerable years.

Benefits of this research: There is a paucity of research published on the impact of and on families from this intensely painful and disruptive phenomenon. Data gathered from this study will be helpful to policymakers, health professionals, social workers and other social service practitioners, lawyers and law enforcement officials, clergy, counselors/therapists, financial planners and counselors, and family members. By gaining clarity about 1) risk and protective factors, 2) interactions and exchange patterns in family systems foundational to later exploitation, 3) intrafamilial perceptions and interpretations of family contexts and experiences related to this elder dependency period, and 4) impact of the exploitation on family members and the family system, more information can be provided for professionals and elders to  enable them to make better plans for the dependency period and to make more informed choices about the best person(s) to appoint as POA agent(s) (personal representatives). It can also provide more information to proactively address some of the risk factors that could contribute later to conflict and exploitation.  It could also provide a basis for earlier recognition and intervention and remediation after financial exploitation has occurred.

The technical feasibility of the research

To facilitate collaboration, the team is equipped with the software it needs and a server. We have also assembled the expertise we need: human development and family sciences, gerontology, ethics and public policy, consumer and family economics, psychology, prevention science, statistical and qualitative methods and analysis, Extension experience and networks, fraud investigation and real world insight about EFE cases that are reported to attorneys and the court system. Four members of the research team (Vincenti, Betz-Hamilton, Stum, and Teaster) have previous experience in conducting qualitative research utilizing in-depth interviews.  Four members (Betz-Hamilton, Bolkan, Steinman, and Teaster) of the research team have previous experience in conducting survey research.  Family EFE is an interdisciplinary problem that has benefitted from the specializations of each team member.

The advantages for doing the work as a multistate effort

It would be difficult to assemble in one state all the expertise needed from people who are dedicated to working on EFE prevention research. By coordinating work across multiple state projects, we should gain a more holistic understanding of family EFE than would occur if studies were done independently.  This approach might also shed light on how the variability of state laws with regard to POA documents and reporting of EFE might affect the family experiences and risk and protective factors within families.

A team member from Minnesota is working with a community-based advisory group on a qualitative study of 20 family members, other than the elder victim and the perpetrator(s), to understand the experience, costs, and impact of elder family financial exploitation from a family systems and resiliency perspective. Team members in Wyoming are working on a survey of two groups of participants in families to determine the validity of the currently identified potential risk and protective factors.  The team and other sub teams will need to decide what other studies they want to take responsibility for. For example, the team has decided to focus one study on exploring family perpetrators regardless of the means that are used to commit EFE. This study supports the objectives of “identify risk and protective factors in family systems that increase or decrease the likelihood of family elder financial exploitation” and “identify the range and scope of family experiences foundational to family elder financial exploitation, including the consequences of EFE on family systems”. The team will broaden this EFE research on family-member fiduciary roles beyond POA agent, e.g. trustee, guardian, caregiver, and healthcare proxy.

Related, Current and Previous Work

Interestingly, Acierno et al. (2010) examined factors associated with financial exploitation and found that elders who require assistance with daily living activities were at the greatest risk for family perpetrated financial exploitation. This is exactly the type of elderly individual who may need a POA 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 family systems and POA, and we do not know how often attorneys-in-fact (the responsible party granted the POA) abuse their power and financially exploit the elder. Finally, we know very little about the attitudes of family members who are named as attorneys-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 recent search of the Current Research Information System (CRIS) and the NIMSS databases offered no directly related family financial elder abuse/exploitation research. Building on findings from several incident studies (Acierno et al., 2010, Laumann et al., 2008; MetLife, 2009) as well as a recent study by Lachs (2011), the current proposed multi-state, multi-disciplinary studies will use qualitative and quantitative methods. Both the qualitative and qualitative aspects will focus on increasing understanding of the relationships between elder financial exploitation and family systems.

Previous work accomplished during W2191 related to its goals

Project Goal 1. To better understand the participants' lived experiences related to EFE, a subcommittee of the research team has worked on coding and analyzing interviews from the first data collection and is poised to conduct the qualitative analysis on subsequent data collection. NVivo 11 Pro software has helped us conduct much deeper analysis than in previous years. It provides many more features than are described here. Relevant to this project NVivo allows the electronic storage of multiple transcripts and other data sources (e.g. audio files and datasets) that team members can access via an NVivo server hosted by the University of Wyoming. At any time, team members can access the server, code transcripts without seeing how other researchers coded the same transcript and have inter-coder reliability calculated and make notes linked to specific transcript or other parts of the project. It tracks what each researcher does and allows the researchers to view the data analysis conducted by other team members. It can run various kinds of queries and create many different types of graphic displays of data. It allows integration of many kinds of data sources (e.g. online survey data, spreadsheets, reference management files), into the project and merge separate projects into one project file which will be helpful with separate coordinated state studies within this multi-state project. It assists the team in organizing and reorganizing large amounts of qualitative data under a set of codes the team created. In addition to coding and analyzing transcripts for 10 families (13 participants), we found it necessary to reanalyze four transcripts that we had analyzed earlier without this software. As an extension of this goal as originally stated, we are obtaining data on unreported cases that have not been documented in other research. The only documentation on unreported cases available is in anecdotal accounts.

Project Goal 2. To identify significant antecedents to EFE by family members, our further analysis of the interviews identified and clarified potential risk factors in the victims'/perpetrators' family systems. With additional knowledge and expertise of the newest team members, the research team dramatically redesigned the survey. Steinman designed an online version of the survey using Qualtrics software. The team chose this survey software because of its compatibility with NVivo software and to improve our capacity to merge qualitative interview data with quantitative survey data. A major accomplishment that supports this goal was our investment in NVivo qualitative software. It took substantial time to research various software packages and to try it to determine the best software choice. We then had to negotiate price and pay for the licenses for multiple team members, some of whom did not have AES support. We also created a server set up with University of Wyoming IT and paid for server licenses for the transcript analysis subgroup members. The team spent considerable time setting up and learning to use this software.

Project Goal 3. Toward the goal of gaining insights into the family experiences of victims and perpetrators for the purpose of healing emotional and relationship wounds, several themes have emerged from the interviews. The focus of our research is on family members who believe that their loved ones was exploited by a POA perpetrator. The rationale for this is that victims are usually unable to participate due to cognitive and physical impairments or death, and perpetrators are often unwilling to participate. At this point we have had to study their experiences through the perceptions of other family members. If there are implications for healing of wounds within families, we have not yet identified them. This goal has refocused on prevention rather than understanding EFE within families and healing families afterwards. To that end, we have expanded and redirected this research from studying the impact on families to seeking to identify risk and protective factors in families to provide a foundation for more effective planning for dependency that prevents EFE and for earlier monitoring of behaviors that could precipitate EFE.

Project Goal 4. The range and scope of potential antecedents to EFE and the impact of EFE on families (which could be a deterrent) cannot be ascertained until further research is conducted with more participants. The upcoming survey with follow-up interviews will provide data that directly addresses this goal.

Project Goal 5. This goal of expanding the Conceptual Model of Elder Financial Exploitation by Rabiner, et al. (2004) cannot be addressed until more data is collected and analyzed. The upcoming survey with follow-up interviews will provide data that directly addresses this goal.

Project Goal 6. We have been continually working on the goal of refining the original research design and identifying future studies and have made progress. The procedure for further data collection has been reexamined and revised since gaining six new team members who have expertise in gerontology, statistics, ethics andpublic policy, psychology, prevention science, and research on family elder financial exploitation. Three of our team members have committed to making limited contributions as needed. Adopting the use of NVivo analysis software has been a powerful addition to our project, but it has also been a serious challenge to provide access and training to the team members who need it.

Project Goal 7. This goal measuring the prevalence of EFE by family-member POA agents was discarded early in the project as we learned more about the extent of underreporting and the lack of consistent data collection across states. In addition, there is no national database to aggregate state data that would have the limitation of including only reported cases of EFE.

Therefore, this is not a feasible goal.

During the four years W2191 project (now in the fifth year), some of the research team members changed several times with only four core researchers and an EFE fraud investigator remaining throughout duration of the project. In the fall of 2012 we gained a qualitative researcher and in late FY2014 the team gained five new members with expertise we needed in gerontology, ethics and public policy, psychology, prevention science, and statistics. The team now consists of seven active researchers, three members who provide ad hoc support as needed (one statistical expert, one emeritus Extension specialist and one professional EFE fraud investigator).

During the four years of our W2191 project, the team members wrote

Grant proposals: 16 grant proposals (6 funded).

Disseminated information about EFE, this research project and findings through

Oral presentations: 14 refereed and 4 invited presentations to different groups of professionals, and 7 other presentations to various audiences including graduate students, professionals working with families concerning EFE issues, and conferences open to the public. 

Poster presentations: 4 refereed posters and 2 non-refereed professional audiences.

Publications: 2 refereed plus 1 revised and resubmitted, 1 non-refereed, 2 refereed abstracts

Webinars: 4 recorded for the U.S. Office of Personnel Management employees, Family and Consumer Sciences professionals, financial counselors and planning educators, and professional money managers

Policymakers: Invited to create a public policy brief on elder financial exploitation for the Wyoming legislature

Data collection and analysis: 14 in-depth participant interviews representing 10 families conducted and analyzed.  The in-depth interviews consisted of each participant engaging in three interviews per Seidman’s (1998) protocol.  Each participant’s interviews yielded from 50 to 130 pages of transcript, depending upon the complexity of the participant’s story. Not having published research on the specific research question, “What is the impact of family perpetrated EFE on family systems?” since that had not been studied, a qualitative approach was most appropriate. After coding the transcripts for this, the researchers decided to analyze the transcripts further for potential risk factors that could help prevent EFE since it is so difficult to prove and prosecute. Researchers coded transcripts (1246 pages) into 13 overarching themes, most of which have considerable categories and codes that support each theme.

After doing transcript analysis without the aid of qualitative analysis software, the team decided that it needed a better approach, given the time demands on the team members with qualitative research experience. De-identifying the transcripts, each involving numerous people, is not a simple task so that there would be no duplications across transcripts that would create problems when analyzing the coding. Although we got all the transcripts anonymized, one team member worked on a program to do this, but after several years, is still refining it.

The team’s earliest coding was fairly general and the number of pages of transcripts too great to keep organized and conduct the analysis by hand, and so we invested in NVivo qualitative software. Unknowingly we started using the software incorrectly during the trial period and entered transcripts as pdf documents into NVivo instead of entering Word documents. This required recoding after initially entering the sources (transcripts) back into the NVivo server. Although this has consumed significant time and was challenging, the transcript analysis is now much richer than it ever would have been without this software.

Because the research at that point was exploratory, we were unsure what themes would emerge. Consequently we coded too specifically which also led to inefficiencies. We have had to refine our codes again. This left us with less funding than was ideal to hire a Project Assistant who could have done much of the detailed work we did. From May through December we were able to pay for support for about 20 hours per month. We have obtained several small grants and tried unsuccessfully to obtain larger grants so that we could buy more support and more time to work on this complex, but promising project. I’ve been told that the sensitivity of our topic is probably concerning grant proposal reviewers.

A major accomplishment that supports this goal was our investment in NVivo qualitative analysis software. It took quite a while to research various software packages and to try them to determine whether this was the best choice. We then had to negotiate price and pay for the licenses for multiple team members, some of whom did not have AES support. We also created a server set up with University of Wyoming Information Technology and paid for server licenses for the transcript analysis subgroup members. The team spent considerable time learning to use this software.

A survey to capture key facts about cases was developed and then dramatically revised after the new members arrived, and a new study was designed. The survey will be piloted and deployed during the last year of W2191.

Because we have more data to collect and analyze, we have written fewer manuscripts than anticipated and have not shared findings with policymakers yet.

Objectives

1. Understand family members' experiences (thoughts and feelings) related toelder financial exploitation by a relative.
   
2. Identify risk and protective factors in family systems that increase or decrease the likelihood of family elder financial exploitation.
   
3. Identify the range and scope of family experiences foundational to family elder financial exploitation, including the consequences of EFE on family systems.
   
4. Disseminate findings and implications to gerontology, family studies, and family economics researchers and educators, law enforcement and attorneys, community-based practitioners, and family members.
   
5. Continue to design further studies that build on earlier findings and create a conceptual model or expand Rabiner et al. (2004) Conceptual Model of Elder Financial Exploitation.
   

Methods

A mixed-methods approach will be utilized for this project.  A survey has been developed by the research team to collect data regarding participant demographics and other key facts regarding EFE experiences.  This survey is available via Qualtrics and will be administered to participants in a face-to-face setting by a member of the research team.  This will allow for more efficient and cost-effective data collection as compared to gathering such data via interviews, which was done in the pilot study in W2191. As was done in W2191, we will also utilize in-depth interviews with participants.  These interviews will be primarily utilized to gain a deeper understanding of the data provided in the surveys. Personally identifiable information will be de-identified to maintain participants’ confidentiality. In the in-depth interviews, all persons mentioned by the participants as well as participants themselves will be assigned pseudonyms. 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 aged 18 or older, English-speaking U.S. residents who have experienced an elder, aged 60 or older, being financially exploited by another family member whom the elder had given Powers of Attorney or have experienced a successful implementation of a family member POA agent with an elder relative.  The age of 60 was chosen because the U.S. Census Bureau and Adult Protective Services use age 60 in defining elders. We would accept victims, family members, or alleged perpetrators, some of whom may be elders themselves (60 or older); however, recruitment of victim and alleged perpetrators for the pilot study in W2191 was extremely challenging; therefore, we do not expect such participants in this study.

Participant recruitment and selection: Recruitment has been a substantial challenge for the W2191 project. 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 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 highly effective ways to encourage participation. 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 use 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, which would increase the validity of the research findings, and possibly potential participants from additional families.

Number of participants: We aim to collect data from 40 families with an average of three family members from each. Of these 40 families, it is our goal to have 20 families who have experienced EFE perpetrated by a family member and 20 families who have experienced the same period of elder dependency when a relative was given fiduciary responsibility to manage their affairs, but among participants there is no suspicion that EFE is or did occur. This is an acceptable sample size, based on previous qualitative studies of EFE that ranged from 13-81 participants (Setterlund, Tilse, Wilson, McCawley, & Rosenman, 2007, Vincenti, Browne, Betz-Hamilton, & Jasper, 2013/2014).  In subsequent studies we will be increasing the participant pool to gain additional depth into this phenomenon as well as increase the validity of findings.

Interview procedures: Participants will be asked to review and sign an IRB-approved informed consent document prior to participating in the interview. To help the interviewer follow the complexity of the family relationships in a participant’s 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 and Area Offices on Aging (adapted for participant’s location) will be offered to all participants who want it.

Training of Interviewers: The researchers who will conduct interviews for this project have extensive experience in conducting qualitative interviews for other empirical projects. There will be training of all who will conduct the interviews to be sure they have a common understanding of the questions and procedures for helping participants expand on responses to their survey questions without inhibiting them from sharing relevant detains unrelated to the survey.

Data collection and analysis:

1. Data to be collected: Quantitative data regarding participant demographics and technical details about the POA development and implementation will be collected via an electronic survey developed by the research team. This survey, which was developed using Qualtrics, will be administered to participants by a member of the research team in a face-to-face setting. It collects data on demographics related the participants, elders, and POA agents; facts related to the content of the POA documents, relationships and resource exchange patterns among the elders, agents, and participants, family communication and problem solving, and earlier significant events in families’ lives. As well, family members’ stories of successful Power of Attorney implementation and elder financial exploitation will be collected through qualitative interviews.  The focus of the interviews will be to elucidate deeper responses to survey questions in order to obtain a thorough understanding of the participants’ experiences.

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.

3. Equipment: Digital audio-recording equipment will be used. In the event Skype is used for an interview, MP3 Skype Recorder v4.29 will be used.

Field Test Respondents: We will conduct a field test of the survey with a sample of U.S. residents age 60 and older. Once we confirm the survey provides valid and reliable measures, we will move to a national implementation in areas covered by the research team members and others who respond to invitations in social media and national organizations, e.g. AARP, and professional societies.

Data analysis plan: The survey data will yield descriptive statistics that, when coupled with the qualitative findings, add a more complete description of EFE via POA within families.  Inferential statistics, such as t-tests and ANOVAs will be used to make comparisons between groups based on demographic data and between non-exploitive and exploitive cases. Interview transcripts will be uploaded into NVivo11, where members of the research team will be able to code meaningful interview data under 13 themes that were established in the pilot study.  The coding stripes feature within NVivo11 will be utilized to compare individual research team members’ coding. Differences in coding will be discussed by members of the research team in order to achieve consensus.

Measurement of Progress and Results

Outputs

• Survey data analyzed and manuscript submitted to a refereed journal
• Conduct additional interviews with family members who have experienced EFE and families who have not, code, and analyze transcripts
• At least 2 refereed presentations to academicians and practitioners Comments: Current Findings Unlike available data on EFE cases, 7 out of 10 family cases in this research to date were unreported to the appropriate authorities (Adult Protective Services, law enforcement, healthcare providers and other state mandated reporters.), an important contribution to understanding EFE more fully. In 90% of the family cases perpetrators were relatives who lived closest to the victims, selected without consideration of who was most qualified to manage elders’ financial affairs or understanding of individual values such as materialism, interpersonal skills, family dynamics such as lack of open, honest, and trusting relationships or misplaced trust; unresolved or repressed conflict; and use of power and control over others (e. g., dominance and acquiescence between victims and spouses and possible agents and their spouses), narcissistic behaviors, e.g., lack of empathy, self-serving patterns, and concern about one's personal and/or family's public image. Other potential risk factors include personal financial management difficulties, parental enabling of financial irresponsibility and dependency; minimal parental involvement during childhood, and favoritism. These findings could improve informed decision making by elders and their families. With more participant and family case data, comparison will also be possible of other group contextual characteristics such as rural and urban family experiences, and parenting and conflict resolution patterns. Design of subsequent studies will depend on the analysis of data that precedes them.
• At least 2 refereed journal articles submitted per year
• Disseminate findings to mid-life and older adults and families using various means, e.g. webinars, social media, website, and Extension publications
• Design additional studies to carefully validate the earlier findings.

Outcomes or Projected Impacts

• Contribution to Prevention of EFE Ideally, the ultimate impact of this research would be to measure a reduction in EFE by family members, but it is highly unlikely that we will be able to connect the findings directly to a reduction in number of EFE cases. Instead this research focuses on confirming risk and protective factors within families associated with whether or not EFE occurs. These results will assist professionals working with families to impact individual family members. They also provide a foundation for educational approaches to help elders and their families avoid EFE. This research can contribute understanding family experiences as risk and protective factors that influence the likelihood of EFE occurring from within the family system by a person given fiduciary responsibility. It will also provide understanding of the consequences of EFE within families not only to the victim, but also to the family system. Elders and their families will benefit by being able to proactively address family risk factors in some cases and/or to use this insight to make better decisions about who should be given fiduciary responsibility and what details should be written into planning documents to increase the likelihood that the family cooperation among family members during elders’ dependency period. Those who may benefit from the research include elders and their families, family/community educators, attorneys, law enforcement, Adult Protective Services professionals, counselors/therapists, policymakers and victim advocates.
• Benefits to Participants 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

(2017):Form an advisory committee (with representatives of stakeholders and experts from each of the multi-states involved to inform planning at least once per year. Continue writing articles in sub committees for refereed journals, practitioner publications, and consumer outlets to share the results of the quantitative and qualitative data on possible risk and protective factors in families. Each state subcommittee will design specific studies to further validate possible risk and protective factors. Continue to collect qualitative data until the data reaches saturation (when the data reveals no new insights). Because coding and analyzing interview transcripts are very time consuming, it is likely to continue for several years. Disseminate findings through various electronic, print, and presentations at community, state, national and international conferences. Continue grant writing within states and as a whole team. At the annual meeting state teams will report their work to the whole team so that it can plan and coordinate the next steps. For example, coordinate presentations with development of publications. If additional researchers are added to this multi-state project, development of new studies may be needed.

(2018):Continue coding and analyzing transcripts, writing articles, disseminating findings and educating various audiences such as elderly and their families, professionals working with elders and their families including lawyers, law enforcement personnel, Adult Protective Services (APS) professionals, accountants, financial planners, bankers, health, gerontology, and family and consumer sciences, family therapists, consumer specialists, educators, and policymakers based on findings and feedback from audiences. Explore differences between the experiences of rural and urban families. Continue grant writing. Obtain input from advisory committee to assist planning. Review team organization and governance and change as needed.

(2019):Continue writing articles, dissemination, and educating various audiences such as elderly people and their families, professionals working with elders and their families including lawyers, law enforcement personnel, Adult Protective Services (APS) professionals, accountants, financial planners, bankers, health, gerontology, and family and consumer sciences, family therapists, consumer specialists, educators, as well as policymakers based on findings. Continue grant writing as needed. Obtain input from advisory committee to assist in planning. Share findings with policymakers increase to their understanding of the seriousness of this problem and the need to be more proactive to prevent it.

(2020):Continue writing articles, dissemination, and educating various audiences such as elderly and their families, professionals working with elders and their families including lawyers, law enforcement personnel, Adult Protective Services (APS) professionals, accountants, financial planners, bankers, health, gerontology, and family and consumer sciences, family therapists, consumer specialists, educators, as well as policymakers based on findings. Continue grant writing as needed. Obtain input from advisory committee to assist in planning. Share findings with national audiences and organizations and at international meetings, such as the International Federation of Home Economics conference. Review team organization and governance and change as needed.

(2021):Continue writing articles, dissemination, and educating various audiences such as elderly and their families, professionals working with elders and their families including lawyers, law enforcement personnel, Adult Protective Services (APS) professionals, accountants, financial planners, bankers, health, gerontology, and family and consumer sciences, family therapists, consumer specialists, educators, as well as policymakers based on findings. Continue grant writing as needed. Obtain input from advisory committee to assist in planning.

Projected Participation

View Appendix E: Participation

Outreach Plan

The team has been disseminating findings available to date through conference and webinar presentations and through refereed and non-refereed publications to various relevant professional and practitioner organizations and agencies. Future outreach plans include Extension electronic media and print publications to the elderly and their families, professionals working with elders and their families including lawyers, law enforcement personnel, Adult Protective Services (APS) professionals, accountants, financial planners, bankers, health, gerontology, and family and consumer sciences, family therapists, consumer specialists, educators, as well as policymakers. We also plan to forge relationships with the National Adult Protective Services Association (NAPSA); Administration for Community Living of the U.S. DHHS (ACL), particularly the ombudsman; and the National Association of Elder Law Attorneys (NAELA). Many of these will be produced and distributed widely in association with the University of Minnesota and University of Wyoming Extension Offices. Such materials will be available on the Internet. Other outreach activities planned include 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

Because we are a small committee, we have been functioning as a committee of the whole. Vincenti has been the P.I. and chair for the original five-year period.  We need to introduce a structure that will divide responsibility and accountability.  We will implement an elected executive committee structure with a Chair, Co-Chair, and Secretary for the whole team with two year terms. The Secretary would be responsible for whole-team minutes and arrangement of quarterly and annual meetings and other related activities as needed.

The team had only one researcher in Washington, Wisconsin, Minnesota, Illinois, Virginia and Wyoming for several years until September 2015 when a faculty gerontologist was hired in the Human Development and Family Sciences option, Department of Family & Consumer Sciences, University of Wyoming. Expanding the team to include Colorado and two researchers per state who could work together on subprojects would reduce the need for monthly full-team conference calls. The whole team could still meet quarterly via Zoom or Skype conference calls and in-person at two-day annual meetings.

Qualitative and quantitative methods and dissemination subcommittees could work across states.  Each state sub team would report its progress to its own AES office and that work would be compiled for reporting from the whole multistate team and the subgroups could work together on a project or compare data. The co-chairs would then pull all the subprojects together as contributions to this multi-state project and provide leadership to required NIMSS reports.  Additional members of the multistate team include a fraud investigator, academic statistician, and an emeritus Extension specialist, who would serve as ad hoc contributors as needed by any of the state sub-teams.

This structure could create an effective operational plan. All the active researchers will be at land-grant universities starting fall 2017, when the researcher at Eastern Illinois University moves to South Dakota State University.  This will facilitate the structural change proposed. The in-person annual meeting in FY2015, and was very productive so perhaps working locally with someone else will also improve productivity.

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Attachments

Land Grant Participating States/Institutions

IA, ME, MN, SD, VA, WA, WI, WY

Non Land Grant Participating States/Institutions

California Southern University, Nova Southeastern University, Robert Wood Johnson Foundation, Self Employed, University of Illinois at Urbana-Champaign, University of South Carolina, Wichita State University