Financial Abuse of the Elderly: a Hidden Crime
By Judith Hancock

Many elderly patients are victims of financial abuse.

That point was driven home recently in a New York Times article: When Abuse of Older Patients Is Financial.

According to the Times, “doctors with older patients hear clues all the time. Elderly people mention, in passing, that they are missing money or that they signed forms they did not understand. Or maybe they can’t find a treasured possession like a watch or a wedding ring.

“But doctors traditionally have not been trained to recognize that confusion or forgetfulness can be signs that the patient is at financial risk, said Dr. Robert W. Parker, chief of community geriatrics in the family medicine department at the University of Texas Health Science Center in San Antonio….

“Three out of five older Americans fear death less than they fear running out of money before they die, according to a study last year by the AARP, the lobby for older Americans….”

 “After spotting elderly people at risk, doctors can refer them to state securities regulators and adult services providers for help.

 “Among the signs of potential financial abuse are overly protective caregivers, changes in ability to take medications, cognitive problems and being fearful, distressed or excessively suspicious.”

You can read the entire New York Times article here.

The Rev. George Handzo, HealthCare Chaplaincy’s vice president for chaplaincy care leadership & practice, says:

“I think the words to doctors also apply to chaplains.  They get told a lot of things that don’t get told to others. When a chaplain hears a story from an elderly patient similar to what the Times writes about, it shouldn’t be written off as confusion or forgetfulness. The chaplain should consider and evaluate the possibility that someone is stealing from the patient. What if they’re in the hospital because they haven’t been on their meds because someone in their home is stealing their meds and selling them on the street? If chaplains have any doubts, they should share them with their social worker who should take it from there. Then the chaplain should make sure the social worker does not dismiss the issue.

“This is kind of like chaplains being trained and expected to spot suicidal ideation. When is
‘I don’t think I can go on anymore’ just an expression of despair and when is it something more? We don’t do anything about it in terms of treating the patient, but we do share the information immediately with the team.”

From my experience both as a social worker and as a daughter, two words came to mind: home visits.

Years ago, it was standard practice for social workers to make home visits.  There was no better way to assess a client’s emotional, psychological and financial  situation.

With greater caseloads today, it’s tough to do that home visit. That’s unfortunate.

When my sister and I needed someone to oversee our father’s finances, we were referred to a man with a great deal of experience in the financial world. He set out one prerequisite before taking on this responsibility: he insisted on visiting our father.

Back then it never occurred to me that the home visit might have been his way of checking up on us and our father’s circumstances, and whether he was on board with our financial program for him.

Today, with the number of elderly patients growing dramatically, it’s more important than ever for caregivers, doctors and chaplains to be vigilant. The popular slogan “If you see something, say something,” applies just as well to financial abuse of the elderly. 

Prominent Physician and Professor Says
Spiritual Care Is an Important Component of
Patient-Centered Care

	Christina Puchalski, MD, MS

Medscape Medical News earlier this year interviewed Dr. Christina Puchalski, a friend of HealthCare Chaplaincy and our mission, on the importance of integrating spiritual care within medical care.

Dr. Puchalski is the founder and executive director of The George Washington Institute for Spirituality and Health in Washington, DC, and professor of medicine and health sciences at The George Washington University School of Medicine. Dr. Puchalski is an active clinician, board-certified in Internal Medicine and Palliative Care.

Here are some excerpts from the interview.

How do you define spirituality?

Dr. Puchalski: Spirituality [refers to the way] people understand meaning and purpose in their lives. It can be affected by illness or loss, and it can be experienced in many ways — not just religion, but nature, arts, humanities, and rational thinking. Some say it is God, some say it is family, and some find it in nature. It's a very personal thing for people.

It's also important for physicians. Spirituality is about relationships. We talk about providing compassionate care. If you go into any hospital, it says its mission is to provide compassionate care. Compassion means you're present with another human being, and unless a physician knows what gives his life meaning, the source of the call to serve others, it is very hard to be compassionate. Our profession is really a spiritual profession.

How does spirituality come into play in common medical practice?

Dr. Puchalski: It's about conversations, about recognizing that conversations are important in clinical care and not just end-of-life care. Every single visit I have with a patient includes a conversation about spirituality, about what's important to them. Every time we come to a crossroads that requires a decision, I want to know: 'Where are you today, what's important to you, what gives your life meaning and value, and how does this affect your decisions?'

Is spirituality often overlooked in health care?

Dr. Puchalski: In 1992, I started a course at The George Washington School of Medicine on spirituality and health. It was the first such course then, but today more than 75% of medical schools in the United States teach content in spirituality and health. Some Canadian schools are doing it as well, and there's a growing interest in Europe.

For the full Medscape Medical News interview with Dr. Puchalski click here.

Dartmouth College Fellows Convene
at HealthCare Chaplaincy

Left to right:  The Rev. Dr. Walter J. Smith, S.J. HealthCare Chaplaincy President & CEO; Jake Routhier,  Dartmouth class of '10; Jess Geevarghese, Chaplaincy Project Development Manager, Howard Sharfstein '67,  former HealthCare Chaplaincy trustee;  Mary Wertheim; David Friedman '10;  Chelsey Luger '10;  Alex Lloyd '10 (Chaplaincy’s Dartmouth Fellow); Karl Holtzschue '59; Nancy Woolf '86; Zoe Shtasel-Gottlieb '10.

The Dartmouth Partners in Community Service (DPCS) Post-Graduate Fellowship Program is a partnership of the William Jewett Tucker Foundation, Dartmouth Career Services and the alumni of DPCS.

Its purpose is to provide support and access to students seeking careers in organizations working for the common good.

Ten new graduates were selected to participate in year-long fellowship placements in 2010–11, eight in New York City and two in Washington, DC.

At the recommendation of Dartmouth alumni and former HealthCare Chaplaincy trustees Lawrence Toal (chairman emeritus) and Howard Sharfstein, HealthCare Chaplaincy decided to participate in the program for the first time. We selected Alexander Lloyd, who, as an undergraduate, combined a major in religious studies with pre-med and was a presidential scholar.

The New York fellows met regularly during the year to inform each other about the organizations and the focus of their particular work assignments.

In the spring, HealthCare Chaplaincy hosted this distinguished group of Dartmouth fellows who are engaged, among others, in fellowship engagements in the New York County District Attorney's Office, Montefiore Medical Center and Uncommon Schools, a nonprofit organization that starts and manages outstanding urban charter public schools.

HealthCare Chaplaincy president and CEO, the Rev. Dr. Walter J. Smith, SJ, briefed the group on HealthCare Chaplaincy’s history and vision as a leader in the research, education, and clinical practice of palliative care.

Alex Lloyd presented an overview of palliative care, an explanation of the importance of spirituality in health, the concept of spirit-centered care and the lack of options for long term care for the aging population.  He concluded by introducing his peers to the innovative plans for Chaplaincy’s proposed Palliative Care Campus.

HealthCare Chaplaincy project manager Jess Geevarghese described some of the architectural features of the Palliative Care Campus.

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