Meals on Wheels = Elder Abuse Prevention

A recent article in the Boston Globe highlights the crucial role that the Meals on Wheels program plays in the lives of millions of older adults across the country who are food insecure and isolated.  Sadly, food insecurity and social isolation are widespread problems that can have devastating affects on older adults.  One of the crucial services available to older adults nationally is the Meals on Wheels program.  Meals on Wheels provides healthy food to people who experience hunger due to poverty, social isolation, immobility, or illness.  In addition to delivering food, Meals on Wheels volunteers also offer companionship and another set of trained eyes on a person’s home life.  For some people, the volunteer is the only person they see or talk to all day.  This “emotional nourishment” provided by volunteers such as Vito LaMura, the volunteer from Minuteman Senior Services featured in the Globe article, is why the Meals on Wheels program is such an invaluable asset in combating food insecurity, social isolation, and elder abuse.   

About Meals on Wheels America

 Meals on Wheels America is the leadership organization supporting the more than 5,000 community-based programs across the country that are dedicated to addressing senior isolation and hunger. This network serves virtually every community in America and, along with more than two million staff and volunteers, delivers the nutritious meals, friendly visits and safety checks that enable America’s seniors to live nourished lives with independence and dignity. By providing funding, leadership, education, research and advocacy support, Meals on Wheels America empowers its local member programs to strengthen their communities, one senior at a time. For more information,visit http://www.mealsonwheelsamerica.org 

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Elder Abuse and Older Veterans

The prevalence of elder abuse is alarmingly high for older veterans.  The types of abuse that older veterans experience include a higher risk of self neglect, caregiver dependence, and exposure to financial scams that specifically target veterans and their service.  In order to assist and protect veterans it is important to know how and why they are particularly vulnerable to elder abuse.

Heightened Risk Factors

Veterans are often at higher risk for elder abuse due to a greater prevalence of behavioral health issues; physical disabilities; substance misuse; and social isolation than the general population. Veterans who are physically disabled or emotionally traumatized may have an increased vulnerability to abuse, especially by people they trust such as family members or caregivers who take advantage of these limitations.  In addition, there is an increasing number of scams which are targeted specifically at veterans.

Self Neglect

Many older veterans are vulnerable to self neglect.  This occurs when behavioral health issues or physical disabilities or substance misuse makes it hard for a veteran to take care of their needs and can put their home, health, safety, or benefits at risk.  This often leads to housing insecurity or homelessness.  A recent study found that:

*  39 percent of homeless veterans are 51–61 years compared with 19 percent of homeless non-veterans

*  9 percent of homeless veterans are 62 years and older compared with 4 percent of homeless non-veterans

*  Veterans are fifty percent more likely to become homeless compared to all Americans and the risk is even greater among veterans living in poverty and poor veterans of color [1]

Financial Exploitation

Sadly, there are financial scams that specifically target older veterans. These scams threaten the health, safety, and financial freedom of thousands of older veterans across the country.  A 2017 AARP Fraud Watch Network study found that more than twice as many veterans as non-veterans lost money to scammers during the past five years. Some of the scams were aimed specifically at programs and charities geared to veterans.  Two such scams include:

* The “VA” Scam –  Scammers pose as officials of the Department of Veterans Affairs to collect personal or financial information, including credit card numbers. In one recent ruse that requested those numbers, potential victims were told that the VA was “changing its processes for dispensing prescription medications.”

* “Veteran’s Benefits” Scam – This scam targets older veterans and their families by promising to assist them with qualifying for veterans benefits such as Aid and Attendance through the sale of unsuitable financial products.  Veterans are promised that they can get additional VA benefits if they invest in certain products or are offered an insubstantial amount of cash if they turn over future benefits.   These scams jeopardize the financial wellbeing of older veterans every day.  The men and women who have served to protect and defend our country deserve much better.

 

 

 

 

 

 

[1] https://endhomelessness.org/resource/veteran-homelessness/

Domestic Violence Knows No Age Limit

“Elizabeth” is an 89- year old woman who currently resides in a nursing home. She was a victim of unreported domestic violence for several decades. Domestic violence in later life is often unreported. In fact, only 1 in 14 older adult victims report their abuse to authorities.[1] Elders may not report because they feel powerless or ashamed, distrust of authorities, or place a high value on their marriage vows due to cultural or religious reasons.

Elizabeth experienced multiple forms of abuse throughout the years including physical and emotional abuse, neglect, and financial exploitation. She was in deep fear of her husband, but she wanted to protect her children. Domestic violence for elders may appear in various forms other than acts of physical violence, and the abuse can be exacerbated by age, poor health, and other age-related needs. Abusers may limit access to medical care, give too much medicine, or take away assistive devices.[2] For example, Elizabeth described a moment where she required medical attention due to an accidental fall. Tragically, her husband left her on the floor for several hours, which aggravated her condition. He also failed to call 911 in a timely manner due to his cognitive issues and inability to understand the seriousness of the matter. Moreover, he created problems for Elizabeth at hospitals and other treatment facilities because he would discharge her from highly essential medical care. He was unwilling to pay for her treatment and wanted to bring her back home where he had control over her.

Elizabeth only found freedom to share her story and freedom to live when she entered the nursing home two years ago. She ultimately determined that she wanted to live the last days of her life, without abuse or neglect. With our assistance, Elizabeth was able to build a case and obtain an abuse prevention order. She was able to go to court and get it renewed each year. But her husband’s anger grew due to the separation and the story did not stop there.

Elizabeth recently contacted our office again to get the abuse prevention order renewed. Due to the circumstances and long history of violence, we feared that if Elizabeth’s husband was granted access to visit her at the nursing home, despite the fact that he is 90, he would try to harm her or bring her back home. Unfortunately, abusers that lose control over their victims can become enraged and there have been instances where the domestic violence has escalated. For example, the abuser would commit an act of murder- suicide seeking to possessively control his partner, and in most cases, to prevent her from leaving him. Feelings such as “rejection”, “rage” or having been “provoked” are sometimes the root cause of further violence, for victims still living with their partners or who have taken action against them.[3]

At a court hearing for a permanent abuse prevention order, her husband did show up and expressed anger about being kept away from his wife and about the cost of the nursing home care. However, we assisted Elizabeth in getting MassHealth to pay for her care so her husband did not bear the burden of paying her medical expenses. While he refused to admit that his actions were life- threatening to Elizabeth’s well-being, he admitted refusing to listen to the advice of several medical professionals and cooperate to provide her adequate care. We submitted an affidavit that gave a detailed description of Elizabeth’s continued fear of her husband and the immediate threat of harm he would cause if he tried to take her back home. In addition, her husband was unable to control his temper in the courtroom.

Ultimately, the Judge allowed the abuse prevention to be continued another year. Although we were denied the permanent abuse prevention order, we were able to allow Elizabeth to live safely and with peace of mind for the next year and are prepared to return to court next year to continue to ensure her safety and dignity.

[1] https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/

[2] http://www.pcadv.org/Learn-More/Domestic-Violence-Topics/Elder-Abuse/

[3] https://www.huffingtonpost.com/david-adams/domestic-murder-and-murder-suicide_b_6592950.html

My Room, My Home: Extended Stays in Hotels Are a Precarious Solution for Displaced Older Persons

This blog post was written by Andrew Bardetti a third year student at Northeastern University School of Law and a  Program on Human Rights and the Global Economy (PHRGE) Fellow with the Elder Abuse Prevention Project

 

Four years ago, Ms. Smith, now seventy-eight, came in from the cold and requested a room at the hotel.  Without signing any papers, the hotel offered her an extended stay at a discounted rate.  Now the hotel is threatening to remove her without notice because the original below market offer is costing them profits.  Meanwhile, Mr. Crane, age seventy-two, and his partner had a room at an extended stay hotel for the last seven months.  When his partner inexplicably left, he could not afford the daily rate.  Unlike Ms. Smith, the extended stay hotel sought to remove Mr. Crane by sending him a notice to quit.

In the past few months, the Elder Abuse Prevention Project has worked on a few cases similar to Ms. Smith and Mr. Crane.  Currently, for those displaced from their homes and looking for a replacement that same day, there are few options beyond shelters like the Pine Street Inn.  However, the transition from the home you were living in for the last few decades to a shelter which requires you to leave every day is far from conducive for persons vulnerable due to aging.  In the midst of this dire need for affordable housing, Ms. Smith and Mr. Crane turn to extended stay hotels which drain limited resources and do not provide a typical tenancy arrangement.  Yet would they ever qualify for the protections typically afforded tenants?

Historically, a tenant is different from a guest (or lodger) because “only the tenant has an interest in the land.”[1]  A guest is more transient in nature, with “but a passing interest in the use of the premises and has relatively free access to other temporary quarters.”[2]  Generally, “hotel guests are traditionally considered licensees and not tenants.”[3]  The relevant landlord-tenant statutes reinforce this distinction as hotel guests are specifically excluded from statutory notice requirements, protections against invasion of quiet enjoyment, and defenses and counterclaims in summary process actions.[4] 

In jury instructions distinguishing a tenant relationship from a licensor-licensee relationship, retired Judge E. George Daher notes “the law provides that several different factors can be considered” when determining the existence of a tenancy.  These include “(1) whether consideration – ‘usually the payment of rent’ – was given for the tenancy; (2) the intent of the parties; (3) the language of any agreement; and (4) the extent of the parties’ control over the premises.”[5]  Consideration and the extent of the parties’ control, referred to as exclusive possession, are two pivotal factors in determining whether a hotel guest could become a tenant at will.

A tenancy at will “arises out of an agreement, express or implied, by which one uses and occupies the premises of another for a consideration – usually the payment of rent.”[6]  Further, “any consideration is sufficient to support a contract is all that is required to constitute an agreement from which a tenancy may result.”[7]  What constitutes sufficient consideration and possession?  In one case, an oral agreement with payment of residential taxes, homeowners’ insurance, and utility bills was sufficient consideration.[8]  However, two payments for utility bills and use of a “playroom area” were inadequate consideration.[9] Likewise, no payments were inadequate consideration and, because the defendant resided with his mother, no exclusive possession existed either.[10]  So long as a hotel guest pays for the room, consideration should be satisfied but typically a hotel guest does not have exclusive possession because “[t]he immediate control and the supervision of all parts of the premises are retained by the” hotel.[11]  The consequence of finding no tenancy at will is that a notice to quit is sufficient judicial process to remove a hotel guest from their room.[12] 

Even with a broad interpretation of the housing statutes, hotel guests are unlikely to be afforded additional judicial process absent consideration and exclusive possession.  In Serreze v. YWCA of Western Massachusetts, Inc., plaintiffs were in a transitional living program for battered women and their children.  Defendants attempted to remove them by issuing a thirty day notice and subsequently changing the locks.  Plaintiffs claimed they were unlawfully evicted without judicial process and, unlike Ms. Smith and Mr. Crane, had written agreements for an apartment which granted them exclusive right of possession and control.[13]  The Massachusetts Appeals Court held that a tenancy did exist yet recognized that the existence of one was not dispositive for the protections and remedies of § 14 to apply.[14]  The court based its reasoning on broad terms in the statute such as “any residential premises” and “occupant” to remark that a self-help eviction in these circumstances would constitute breach of quiet enjoyment.[15]  While these terms could encompass a hotel guest, the situation in Serreze is distinguishable from hotel guests like Ms. Smith and Mr. Crane because they are not granted exclusive possession of the room.  

Massachusetts simply does not have enough resources and protections in place to assist vulnerable persons when they are displaced from their homes.  Further, courts may be wary of finding extended stays in hotels are tenancies because it would obviate the difference between tenants and licensees.  Despite the lack of a tenancy, persons vulnerable due to aging are spending what limited resources they have on extended stay hotels because the shelter either cannot house them or it is a traumatic place for them to stay.  Extended stay hotels are merely a band aid for a larger systemic issue – a lack of affordable housing options.  Massachusetts must do more to transition vulnerable older persons to affordable housing options.

[1] Tenant, Lodger, and Guest: Questionable Categories for Modern Rental Occupants, 64 Yale L.J. 391, 396 (January, 1955).

[2] Id. at 402.

[3] Hon. David D. Kerman, Bench Memorandum for Residential Summary Process Cases I (15), (2016).

[4] M.G.L. c. 186, § 13, 14, and c. 239 § 8A.  But see Serreze v. YWCA of Western Massachusetts, Inc., 30 Mass. App. Ct. 639, 643 (1991) (those outside of a classic tenancy may avail themselves of § 14 protections). 

[5] 33 Mass. Prac., Landlord and Tenant Law § 1:6 (3d ed.) (September 2017).

[6] Williams v. Seder, 306 Mass. 134, 136 (1940).

[7] Story v. Lyon Realty Corp., 308 Mass. 66, 70 (1941).

[8] Ducker v. Ducker, 1997 Mass. App. Div. 147, 149 (1997) (oral agreement and payment of residential taxes, homeowners’ insurance, and utility bills sufficient consideration for creation of tenancy)

[9] Griffin v. Cogliano, 2002 Mass. App. Div. 55, *4-5 (2002) (two payments for utility bills and use of a “playroom area” was inadequate consideration)

[10] Lavelle v. Lavelle, 2012 Mass. App. Div. 150, *2 (2012) (no consideration because no payments and no exclusive possession because defendant resided with mother)

[11] Assessors of Everett v. Albert N. Parlin House, Inc., 331 Mass. 359, 362 (1954) (charitable corporation considered in possession of rooming house).

[12] See Lavelle at *2 citing West v. First Agr. Bank, 382 Mass. 534 (1981) (superseded by statute on different grounds).

[13] Serreze, 30 Mass. App. Ct at 644.

[14] Id. at 643.

[15] Id. 

One Step Forward, Two Steps Back: Scammers Prepare to Target Seniors as Government Readies New Medicare Cards

This blog post was written by John Harrington, a volunteer attorney with the Elder Abuse Prevention Project and our resident ScamBuster!  Medicare open enrollment begins on October 15th, so this is particularly important and timely information

It seemed like a good idea:  Congress passed legislation back in 2015 that required the Centers for Medicare & Medicaid Services (CMS) to stop using Social Security numbers on seniors’ Medicare cards and start using a new, randomly-generated 11-digit number to identify each Medicare participant.  The concept was to deter fraud by getting valuable Social Security numbers off Medicare cards and providing new cards and numbers to every single Medicare participant.[1]  All 58 million of them.

 

Unfortunately, ever-creative and flexible scammers inevitably found ways to exploit the switchover to new cards.  Scammers have an arsenal of weapons at their disposal but they’re most likely to employ one or more of the following:

  • Make telephone calls masquerading as a government official to “inform” seniors of the card switchover and “explain” that they just need to “update” their information in order for the senior to get the new Medicare card. Reality:  CMS will mail new Medicare cards to all Medicare participants automatically—participants need not do anything or pay anything in order to receive their new card
  • Make telephone calls pretending to be staff at your doctor’s office and asking for the new Medicare number “just to update our records” or “ensure correct billing.”
  • Set up desks at local health fairs and offer “freebies” like nutritional supplements in exchange for seniors’ new Medicare numbers and other personal information.[2]

To make things even more complex, the annual open enrollment season (the period during which you can switch your Medicare Advantage or Part D prescription plans) is coming up from October 15th through December 7th this year.  Scammers love to call seniors and tell them that open enrollment means they must switch plans or purchase a particular plan.  The reality is that there is no requirement to purchase such a plan or to switch plans if you already have one.  Note though that it is a good idea to review your plan annually and compare its costs for your prescription medications to those of other plans.

What’s the harm in providing your Medicare number or other personal information?  Simple:  scammers can exploit your Medicare number to fraudulently bill Medicare for expensive healthcare equipment they never provided (think power wheelchairs or complex braces and splints).[3]  Then if you someday need similar equipment, CMS may refuse to supply it on the grounds that you’ve already received it (!).

How to protect yourself against the scammers?  Remember a few fundamental rules:

Safeguard your Medicare number! Treat your Medicare card and number (both your current and the forthcoming new one) like you would a credit card.  Only give them directly to your healthcare providers!

Remember that CMS will contact you only through written, mailed letters. CMS won’t call you, much less ask for your Medicare number or other personal information over the phone!

Know that anyone requesting your Medicare number over the telephone is probably a scammer. So just hang up!

Remember that there’s no obligation to purchase a Medicare Advantage or Part D plan or to switch plans if you already have one. It’s a good idea to review your plan annually and compare its costs for your prescriptions to those of other plans.

 

 

[1] New Medicare Cards Offer Greater Protection to More than 57.7 Million Americans, Centers for Medicare & Medicaid Services, at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-05-30.html

[2]How to Protect Yourself Against Common Medicare Scams, U.S. News & World Report, at https://health.usnews.com/health-news/medicare/articles/2015/10/15/how-to-protect-yourself-against-common-medicare-scams

[3] New Medicare Scams Spread Across U.S., AARP, at http://www.aarp.org/health/medicare-insurance/info-2015/medicare-scams-spread.html

Fighting Elder Hunger and Malnutrition Through Community Gardens

 

This blog post was written by Victor Absil, a second year law student at Boston University School of Law and an Equal Justice Works Elder Justice AmeriCorps law student who worked with the Elder Abuse Prevention Project of Greater Boston Legal Services this Summer

Malnutrition and food insecurity are widespread problems that can have far reaching effects on older adults.  Over ten million elders faced the threat of hunger in 2014, an increase of 65% from 2007 and the problem continues to grow.[1]  Unfortunately, only 42% of eligible older adults are enrolled and receiving Supplemental Nutrition Assistance Program (SNAP) benefits.  Even for those that receive SNAP benefits, many must still find alternative sources for food such as food banks just to get through the month. For older adults, hunger is caused by a number of factors, including poverty, but also other issues such as lack of transportation, social isolation, limited mobility, and health problems.  It can also be caused by elder abuse.

Different forms of elder abuse may lead to an older adult becoming food insecure or even malnourished.  The reasons this happens can vary – it may be the result of “passive” caretaker neglect such as when an elderly spouse caregiver can no longer grocery shop or prepare meals or it may be the result of willful neglect when a caretaker withholds food from a vulnerable elder.  It may also be a byproduct of financial exploitation whereby someone is taking an elder’s income or assets, and not leaving them enough money to buy food.  It can also result from self neglect – when an elder with dementia or mental health issues is no longer able to properly shop for or prepare food.  Different forms of elder abuse leading to food insecurity or malnutrition happens every day both in older adults’ homes as well as in institutional settings such as nursing homes where elders may be dependent on staff for access to proper amounts and types of food.

One very creative way to address the issue of food insecurity and malnutrition is by creating a community farm or garden in senior living environments including nursing homes. This would allow for access to good, healthy food and help combat social isolation, which is a risk factor for elder abuse, by creating more of a sense of community. It could also offer the opportunity for intergenerational projects with older adults and children gardening together.  Some nursing homes have already begun to realize the benefits of community farms. For example, Arroyo Grande Care Center has a community farm where residents grow vegetables.[2] Wheelchair accessible planters and modifications such as raised beds make it easier for elders who have trouble bending or performing other gardening tasks.

Malnutrition stemming from elder neglect is absolutely a growing problem, but it can be combated in part by community gardens, which can offer access to healthy, nutritious food, a sense of purpose, and help create a community of people working together.

 

 

[1] National Council on Aging, Senior Hunger Facts, 2014

[2] See Arroyo Grande Care Center, http://arroyograndecare.com/ (last visited July 17, 2017).

Combatting Social Isolation with Intergenerational Programs

This blog post was written by Emily Bordenski, a third year law student at  New England Law School and an Equal Justice Works Elder Justice AmeriCorps law student who worked with the Elder Abuse Prevention Project of Greater Boston Legal Services this Summer

The National Council on Aging lists social isolation along with diminished cognitive ability (such as dementia or Alzheimer’s disease) as prime risk factors for elder abuse.[1] Many older adults are isolated because of loss of physical or mental capacity, or through the loss of friends and family members. Intergenerational programs are just one way that communities may effectively fight social isolation in older adults by helping elders to form connections on a more intimate level.

What is an intergenerational program?

An intergenerational program is designed for younger and older generations to come together to interact and engage in mutually beneficial activities. There are many benefits to intergenerational programs, including socialization and learning opportunities for both children and older adults. Approximately, 288,085 older adults in Massachusetts live alone. Intergenerational programs provide important benefits to older adults such as increased connectedness and less isolation, which can lead to improved physical and mental health.  For communities and providers who work to prevent elder abuse, the need to fight social isolation is paramount. Every community can help by hosting intergenerational events or encouraging the establishment of intergenerational groups. Many successful examples already exist.

Intergenerational Programs = Elder Abuse Prevention

Another benefit of intergenerational programs is the ability to prevent future elder abuse by advocating and teaching the younger generation to be respectful of elders.  Intergenerational trust building is a largely untapped resource for understanding and preventing elder abuse. Mistreatment, loneliness, neglect, and bullying are terms that are heard and felt across every generation. Caring and meaningful relationships across the generations can help younger and older people feel cared for, needed, and part of a larger community.

 September is Intergenerational Month – so get started!

[1] NCOA. “Elder Abuse Statistics & Facts | Elder Justice.” NCOA.org. National Council on Aging, 25 August 2016. Web. 4 November 2016.