This week’s guest contributor is Steve Kramer, Certified Senior Advisor and Principal of Blessings! For Seniors Companion Care (http://www.blessingsforseniors.com/)

I’ve known Steve and his wife/business partner Christie since 2009 and, like participating in our “Top 5,” they are always generous with their time and willing to share their expertise in the elder services field. I have worked with them to do a free memory screening on Alzheimer’s Awareness Day, which helped several people with early indicators of cognitive impairment obtain referrals to appropriate specialists for a proper diagnosis.

Memory issues are just one of many reasons why seniors are targets for scammers. Steve reminds us that it’s not just wealthy seniors who are targeted. Low-income older adults are also at risk of financial abuse.

Sadly, it’s not always strangers who perpetrate these crimes. The National Adult Protective Services Association reports that over 90% of all reported elder abuse is committed by an older person’s own family members (source: http://www.apsnetwork.org/Training/CitationsfromElderAbuseResearch.pdf), most often their adult children, followed by grandchildren, nieces and nephews, and others.

Steve has outlined some of the most common scams we are experiencing when working with vulnerable individuals. A qualified home care provider like Blessings! For Seniors is often the front line in spotting red flags that may indicate exploitation or fraud. A senior’s banker is also in a position to spot suspicious transactions. A licensed fiduciary can work with the vulnerable adult and/or his/her family to put a stop to exploitation and, in some instances, recover assets.

1. Health Care/Medicare/Health Insurance Fraud
This is becoming so prevalent that our clients’ providers now are using Web cams to photograph every new patient in their office to help combat fraud.

Since every U.S. citizen or permanent resident over age 65 qualifies for Medicare, there is rarely any need for a scam artist to research what private health insurance company older people have in order to obtain services through fraud.

In some Medicare scams, perpetrators pose as a government representative to get older people to give them their personal information.

Shady providers also use personal information collected from its “patients” (victims) to bill Medicare. ABC News recently reported on the largest Medicare fraud scheme in American history. (Link: Click here.)

2. Internet Fraud
It is a great development that seniors are using the internet at an increasing rate. However, they are particularly vulnerable to internet scams. A recent virus used pop-up browser windows simulating virus-scanning software to fool victims into downloading a fake anti-virus program (at a substantial cost). These types of Trojans and malware, which exploit security holes in browsing software such as Internet Explorer, can expose whatever information is on the user’s computer to scammers.

Family members can help by ensuring good virus protection, firewalls, and good instructions. Leave written instructions on index cards near the computer for reference on how to proceed if the anti-virus software detects a malicious file.

Email/Phishing Scams are very prevalent these days. You should not click on links from emails. If you receive an email from something that looks like your bank, don’t click through from the email. Instead use your browser shortcut to ensure you are going to your bank’s site and not being redirected to a hacker. Typically, these scam email messages appear to be from a legitimate company or institution, asking them to “update” or “verify” their personal information.

Another common scam email appears to be from the IRS and hooks people by luring them with a purported tax refund.

3. Funeral & Cemetery Scams
The Federal Bureau of Investigation warns of scams targeting seniors. You would be well served by taking time to read their entire public service announcement on this topic here: (Link: Click here.) They outline common ways that unscrupulous funeral planners can bilk money from unsuspecting targets. These include capitalizing on family members’ unfamiliarity with the considerable cost of funeral services by adding excessive charges to the bill. There are stories of funeral directors insisting that a casket (which cost from several hundred to several thousand dollars) is necessary when performing a direct cremation. In actuality, a cremation in Arizona only requires a rigid container, which is a heavy duty cardboard that costs about $150-$175 through a reputable funeral home.

More brazen scammers have been known to keep an eye on obituaries and attend the services of a complete stranger to take advantage of the grieving widow. They then try to extort money from relatives to settle fake debts. The Better Business Bureau has written about this type of scam and has loads of great advice here: (Click here.)
It’s important for anyone handling the estate of a loved one to know their rights with regard to debt collectors. The Federal Fair Debt Collection Practices Act applies to all debt collectors and, if violated, provides financial and other remedies to the personal representative and/or estate. A link to this Federal Law is here: (Click here.)

4. The Grandparent Scam
A Minnesota grandmother recently joined scores of other seniors who have been caught by “The Grandparent Scam.” She sent more than $5,000 to bail her grandson out of jail in Barbados following a purported car accident. However, her grandson wasn’t even out of the country: He was at home. (Link: Click here.)

This scam is particularly harmful to individuals suffering from dementia as they often cannot remember all of their grandchildrens’ names, and yet as protective and perhaps indulgent grandparents they are responsive to pleas to not tell Mom about this embarrassing incident.

5. Telemarketing and Lottery Scams
Fraudsters obtain lists of contributors to charitable organizations and use fake telemarketing calls to prey on older people by the mail and by telephone. Seniors are often comfortable with doing business by phone. One recent story of a woman who ran up $2,500 in bank fees by bouncing 70 checks is one example of how even small donations can be predatory when collected in large number. Luckily, this woman has a family willing to step up to the plate and prevent future wasting of her funds.(Link: Click here.)

With no face-to-face interaction, and no paper trail, these scams are difficult to trace. The scammer can then sell the senior’s information to other schemers looking for easy targets, so the fraud is perpetuated repeatedly.

We at Entrust received a referral once on an individual who had been scammed out of her entire life’s savings: over $350,000 was bilked out of her by Jamaican lottery scammers in an 18-month period. Had we received the referral the first or second time she had been scammed, we could have preserved her retirement funds for her own care. It was doubtful that she could even qualify for Medicaid because the money was viewed as “gifts” because the money was given “voluntarily.” However, it was clear that the individual’s executive functioning was severely impaired and she could not appreciate the consequences of giving away her entire estate.

Natural disasters are another means of exploiting funds from good-hearted seniors. The safest bet is to not give money to anyone who solicits it by telephone or mail.

If a senior wishes to make charitable gifts for tax purposes, they should work with their accountant, their church, or someone personally known to them to ensure the funds are going to a legitimate cause.

1. A Living Will is a “DNR” (Do Not Resuscitate).
Living Wills are also called “advance directives” or “directives to physicians.” They outline what kind of medical treatment you would want in certain circumstances. Your Living Will may state that you do not want to be resuscitated if you have a terminal illness. It might say the opposite, however: It may say you want every treatment possible including experimental treatments.

Just because your Living Will says you do not want CPR if you have a terminal illness, this still only applies if you actually have a terminal illness. If I get hit by a car tomorrow and my heart stops, you can bet that I want CPR if I flatline. If, however, grow to a frail old age, I have exhausted all of my medical options and treatment will only prolong the inevitable, obviously I don’t want anyone cracking my ribs while I breathe my last.

2. If I want to be a “DNR”, I won’t receive medical treatment.
This myth is often why people delay referrals to hospice, yet it is simply false. It is true that if you enter hospice with a cancer diagnosis, insurance will not pay for curative treatments. But even radiation treatments are sometimes covered by hospice if it is for a “palliative” (feel-good) reason, e.g. if a tumor might be shrunk to reduce pressure on nerves thereby relieving pain.

If you’re diabetic you are still eligible for all of your insulin, supplies and medication coverage, regardless of your DNR status (or admission to hospice). If you fall and break your hip at any time, this will be treated even if you don’t want CPR if your heart stops from an unrelated terminal disorder.


3. I have a Living Will so my wishes will automatically be followed.
Besides advance directives, in order to ensure you receive the kind of medical treatment you would choose if you were able to direct things yourself, it is best to name a health care surrogate, i.e. an agent under power of attorney.

Power of Attorney documents sometimes are included in the same document as a Living Will, but they are distinct legal instruments. One says what you want done. The other says who you want to appoint to make sure what you want done gets done. Living Wills are at best carefully worded guesses of what future medical catastrophes you may find yourself in; at worst they are vague forms that are barely applicable in most medical situations.

A medical surrogate should know your wishes, your values, your religious preferences, and should be someone you can trust to carry on your treatment as they believe you would want done. A medical power of attorney can avoid the need for the courts to appoint a guardian for you whereas a living will alone will not; most of my wards over the years have had advance directives.

4. My family knows what I want, so I don’t need a living will.
Two words: Terri Schiavo. She had no living will, and two factions of her immediate family warring over what she would have wanted for herself proceeded to, I presume, generously line the pockets of their respective attorneys. If my assumption is true, I’m sure the lawyers didn’t mind, but I’m equally certain the litigation did nothing to serve Terri’s or her family’s best interest.

5. Living Wills are for people of advanced age or people who have a terminal illness.

An Associated Press-LifeGoesStrong.com poll found that 64% of “boomers” (people born between 1946 and 1964) say they don’t have a health care proxy or living will. Those documents would guide medical decisions should a patient be unable to communicate with doctors.

“I’m very healthy for my age so, death and dying isn’t on my mind a lot.”

(Source Link)

I’ll repeat: Terri Schiavo. She was born in 1963. She was 27 years old when she was put on life support. I’m sure if she had a do-over, she would have been glad to avoid ripping her family apart on a public stage.

About the Author: Dawn R. Walters is an Arizona Licensed Fiduciary in Private Practice and a National Master Guardian. She has served as guardian for vulnerable adults for nearly a decade. She educates others on topics including guardianship, rights advocacy, elder abuse remedies and awareness, and life planning. She is a magna cum laude graduate of the University of Texas, holding dual degrees in Government and Latin American Studies. She was recently elected to the Board of Directors for the Arizona Fiduciaries Association.

We at Entrust are honored to have this edition of “Top 5″ authored by guest contributor Max Allen. Max is a Certified Geriatric Pharmacist who really knows his stuff. If you are impressed with the thoroughness of the article below, you should see what a full consultation for a client looks like. I have worked with other pharmacist consultants, but never received the level of consultation, detail, analysis, and documentation that Max provides.

If you or someone you know are on a high number of routine medications (all consultants I have worked with define “high” as 5 or more), whether they are over-the-counter or prescription, you may benefit from the services of a pharmacy consultant. You can learn more about Max and how he may be able to help you by visiting his site: MaxRx.net

If you have an elderly loved one taking any of these medications, please encourage them to discuss whether the medication is safe for them with their doctor.

TOP 5 (plus) OTC PROBLEM MEDICATIONS FOR SENIORS

by Max Allen, MaxRx Consulting Services

(Link to source): 2012 update Beers Criteria for Potentially Inappropriate Medication Use in Older Adults)

1. DIPHENHYDRAMINE (BENADRYL)
2. MINERAL OIL
3. ASPIRIN > 325 mg
4. FERROUS SULFATE > 325 mg per day
5. SLIDING SCALE INSULIN
6. H2 BLOCKERS (ZANTAC, PEPCID AC, ETC.)
7. PSEUDOEPHEDRINE

Diphenhydramine (Benadryl) is a 1st generation antihistamine and is classified as an anti-cholinergic agent. Among other antihistamines that can be included in this class is Chlorpheniramine (Chlor-Trimeton) and Climastine tablets. In the geriatric population, these drugs are very slow to clear the body and the risk is high for the following adverse reactions.

Editor’s note: Benadryl is often used in care settings as a chemical restraint due to its sleep inducing properties. Some folks are under the mistaken belief that it’s harmless, when in fact it often leads to broken hips. I am very cautious about consenting to Benadryl use for my clients and, unless someone is highly allergic to something like bees (see Max’s next comment below), I advocate for it to be discharged. –DRW

Diphenhydramine may be appropriately used in certain emergencies such as allergic reactions for short-term therapy.

Mineral Oil has the potential for aspiration and other similar “Adverse Drug Events”. Diarrhea and cramping is common in the elderly and especially if Light Mineral Oil is used, which can cause leakage and incontinence. There are many safer alternatives on the market.

Aspirin when give in higher doses (i.e. greater that 325 mg per day) can cause stomach upset. Other NSAIDS such as Ibuprofen (Motrin IB) and Naproxen (Aleve) produce an increased risk of GI bleeding, peptic ulcers, and stomach upsets especially in the higher risk groups such as 75 yrs and older. The risk increases with prolonged use.

Ferrous Sulfate (Iron) when give in doses higher than 325 mg per day will cause constipation and dosing must be monitored.

Sliding Scale Insulin is not recommended in the elderly because it causes increased risks of Hypoglycemia (low blood sugar) without any significant improvement of Hyperglycemia (high blood sugar) in any care setting whether physician ordered or not.

H2 Blockers (Zantac, Pepcid AC, Tagamet etc.) increase risks for the following:

Pseudoephedrine (Sudafed) will increase hart rates, raise blood pressure and if taken at night may cause insomnia. It is classified as a CNS stimulant.

1. Have they done their homework? If you’re like me, you always hated hearing, “Dawn Renee, have you done your homework?” Well, it’s time to turn the tables. “Mother. Father. Have you done your homework?” Do your parents have an estate plan? Have they drafted medical and financial powers of attorney in case they lose the ability to manage without assistance? Do they have a last will and testament? What are they waiting for? Do they think they’re getting younger? This isn’t to be approached cavalierly and it’s not about prying into whether you are going to have to fight with your sister over Great Maw-Maw’s Civil War diamonds. Incidentally, you aren’t entitled to anything that belongs to your parents. They might need to liquidate it to pay for their care: A potential future inheritance does not a retirement plan make. This is about knowing that their legal affairs are in order and their hard-earned assets are protected and available when needed to support them.

2. What do you know about their business? Whether either of you really likes it or not, you may be in charge of it one day. Do they have a list of their assets, bank account locations, important paperwork, valuable art, and collectibles somewhere that you could find it if you had to take over in an emergency? Your parents may be very private people. They might be secretive to the point of paranoia. You may not even know if your dad gets a pension from those rotten scoundrels who never appreciated his hard work all those years. Suggest that they make an inventory and quick reference guide for their household (you know, like how to not kill their orange trees if one of them is hospitalized) and make sure someone knows where to find it if it’s ever needed. You don’t have to pry; just encourage them to make the list on their own and check back with them (read: “keep pestering them”) until you know it’s been done.

3. What do you know about their health? It’s very common for parents to name their adult children as their healthcare agent in the event they become incapacitated. Most likely, you will have to take over suddenly if you ever have to make healthcare decisions for Mom or Dad. You should get to know their general diagnoses and know where to locate a list of their medications and medical doctors if called upon in a crisis. I know, you don’t need to hear any more about Mom’s hemorrhoids or Dad’s prostate than you already do. But do you know their surgical history? Their blood type? What did their parents die from? Did Dad have a heart attack back in ’97 or was that just bad gas? These things you never thought you’d need to know can suddenly be at the crux of an emergency room treatment plan. Next time Mom starts grumbling about the pain in her posterior, use it as a segue-way to this important talk.

4. How do they feel about death and dying? Do they want a burial or a cremation? Do they want religious services or memorial donations to be given to a certain charity? Funeral planning is, admittedly, a morbid topic that most families prefer to avoid. It’s best, however, to make funeral arrangements ahead of time so families aren’t overwhelmed at the time of need. Maybe there is a family plot back east that where they always assumed they would rest in eternal slumber. Even if they live in Arizona, that is easy enough to arrange ahead of time, but assumptions won’t get the job done. Buying funeral insurance locks in the pricing for most items at today’s dollars, too, so a funeral is always going to be less expensive to buy today than years from now.

5. How do they feel about not dying? Of course nobody wants to die, but it’s our one guarantee in life. Statistically very few people die suddenly and unexpectedly. For most of humankind, death is a process; sometimes a very prolonged process. What kind of end of life care do your parents want? Do they want aggressive treatment no matter what quality of life it produces? Do they want to avoid ever going to the hospital if at all possible? Carefully drafted advance directives, sometimes called a “Living Will”, will provide loved ones with guidance to a degree. But nothing replaces a true understanding of what Mom and Dad really want if they are no longer capable of giving direction. Hospice organizations can help with these conversations and usually have tons of literature on end of life topics that might facilitate these important conversations. “Conversations” is intentionally plural. People’s feelings on dying tend to change the closer they are to that irreversible event. Learning what a person wants for the end of their life involves an ongoing dialogue. Sometimes it’s just listening to what our parents say. If mom gets a cancer diagnosis and says she is going to fight for her life with everything inside of her, that’s a directive. If Mom has a recurrence of cancer after battling it for ten years and she says she’s just ready to go to heaven to be with Dad if the Good Lord sees fit that it’s her time, that’s also a directive.

About the Author: Dawn R. Walters is an Arizona Licensed Fiduciary in Private Practice and a National Master Guardian. She has served as guardian for vulnerable adults for nearly a decade. She educates others on topics including guardianship, rights advocacy, elder abuse remedies and awareness, and life planning. She is a magna cum laude graduate of the University of Texas, holding dual degrees in Government and Latin American Studies. She was recently elected to the Board of Directors for the Arizona Fiduciaries Association.

While we actively serve people who cannot manage on their own any longer under court-appointed guardianship arrangements, a person does not have to be incapacitated to benefit from our services.

You can take charge of your future by naming a licensed, educated, and skilled professional to work according to the plan you set out for yourself while you still can plan. Don’t leave your future up to the Probate Court!

Private, voluntary arrangements are much less costly to your estate than waiting for a disaster and leaving the courts in charge of disaster relief. Your private business does not have to become a matter of public record. Call us at (623) 386-3963 so we can talk about how you can exert control over your future — today!

~Late Angie Tenorio-Nerva
(Pueblo of Santo Domingo)

Welcome to the Entrust Guardianship Services, LLC Web site! We hope you’ll find helpful information about the services we offer. Whatever brought you here is probably an overwhelming situation. Contact us for a free, no obligation consultation to see if fiduciary services may be appropriate.

Great article in the Clinical Geriatrics journal on dementia and palliative care:

“Palliative care at the end of life is an interdisciplinary approach that applies a treatment philosophy of “coping,” rather than “curing,” for patients with an advanced or terminal illness. Despite shifting the focus away from finding a cure, the palliative approach does not exclude all disease-modifying therapies. In fact, the palliative continuum of care balances disease-modifying and palliative treatments based on an individualized treatment plan …

“When treating serious medical conditions in patients with dementia, physicians often find themselves in conflict with family surrogate decision makers regarding the ethics of providing versus withholding intensive treatments for their dependent relative. Providing education, access to counseling, and spiritual support for families is part of the palliative care approach, and ideally a palliative care team would handle these complex and often emotional discussions with families.”

Read the entire article here.

Your grown daughter doesn’t pay her bills on time. Your son lives way above his means. You love your kids, but you also worry their irresponsibility toward their own finances means they will be poor caretakers of your finances should you need help as you age. But have you given any thought to the possibility that your children might pilfer your money?

Experts estimate that between 60% and 90% of financial elder abuse is committed by family members. Read more …

Local Fiduciary Dawn Walters Attains Master Guardian Certification

Center for Guardianship Certification Grants Nation’s Highest Credential in the Fiduciary Practice

Dawn Walters, Licensed Fiduciary, Entrust Guardianship Services, LLC received notification on November 30, 2011 that the Center for Guardianship Studies has conferred National Master Guardian credentials. This prestigious designation, held by a select few Licensed Fiduciaries in the State, was achieved by passing an intensive examination on October 1, 2011 in Minneapolis, Minnesota following a rigorous application process in order to qualify to sit for the test.

Master Guardians must demonstrate a comprehensive knowledge of guardianship practices and the highest level of ethics across the full spectrum of the profession. Candidates must be recommended for certification by peers in the field, possess a minimum of five years in practice with an impeccable professional record, and demonstrate a commitment to leadership and advancement of the profession.

• Dawn Walters has 7 ½ years practice as founder of successful fiduciary firms and director of guardianship and care management services
• An engaging speaker and subject matter expert, she is highly sought after by community partners to present seminars and panel discussions on the fiduciary practice, ethics, rights advocacy, life planning, elder abuse, and related topics
• Services provided include court-appointed guardianship services, services as agent under Power of Attorney, care management, and consulting
• For a fee consultation or to book a speaking event, please call (623) 386-3963

Download this press release in PDF format here.