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

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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.

Caregiving and Elder Abuse

This blog post was written by Briana Mansour, a second year law student at Suffolk University 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 ability to care for an aging loved one is a gift. Unfortunately, the selfless act is one that can also take a debilitating toll on caregivers, especially caregivers who are family members. In certain cases, that toll can lead to elder abuse and neglect. What factors may lead to caregiver abuse or neglect and what can be done to assist caregivers and prevent abuse?

For people of all ages, the role of caregiver can be challenging. A 2015 survey reported that 34 million Americans were caregivers to adults 50 years and older.[1]  The report indicated that one in five caregivers experience high levels of physical strain and 38% reported care giving to be emotionally stressful. In addition, most family caregivers have no formal training to undertake difficult physical as well as emotional tasks.  Caregivers who struggle to perform the necessary tasks because they have their own physical or mental impairments or who are overwhelmed may neglect the elder, or even mistreat the elder out of frustration.

Caregiver Neglect

In Massachusetts, caretaker neglect is considered a type of elder abuse.  Neglect is when a caregiver does not provide for an elder’s safety or for his or her physical or emotional needs.  This includes paid caregivers as well as family caregivers or family members who hold themselves out as caregivers. Caregiver neglect could be motivated by willful behavior by the caregiver who intentionally withholds care or necessities or the neglect could occur when the caregiver is unable to fulfill caregiving responsibilities due to his or her own issues such as mental illness, lack of resources, advanced age, disability, or stress. 

Indicators of neglect may include:

  • Allowing an elder to remain in unsafe living conditions (no heat or running water; fire hazards);
  • Allowing an elder with dementia to wander into dangerous situations;
  • Denying an elder food, medicine, clean and appropriate clothing, access to medical care or medical devices;
  • Unsanitary living conditions: dirt, bugs, soiled bedding and clothes, being left dirty or unbathed

Help For Caregivers = Elder Abuse Prevention

To avoid elder abuse and neglect, caregivers should seek additional assistance when needed to sufficiently care for their loved ones.  Signs for when it may be time to seek additional help for your loved one:

  • When your health is limiting the ability to keep your loved one and yourself safe
  • Increased frustration and forgetfulness
  • Inability to perform everyday functions for yourself
  • Diminished participation in activities that once were enjoyable
  • Neglecting the living space or personal hygiene  

If you require additional assistance to care for your loved one, know you are not defeated. It requires great strength to accept that your own health is decreasing, and if you were to continue being the sole caregiver you would be putting yourself and your loved one’s health at risk. By taking care of your well-being, your loved one will also be better taken care of.

[1] National Alliance for Caregiving and AARP, (2015).

The Heart and Soul of Elder Abuse Prevention – Our EJW AmeriCorps Law Students

Briana Mansour; Victor Absil; and Emily Bordenski

The Elder Abuse Prevention Project of Greater Boston Legal Services (EAPP) is extremely fortunate to be hosting three Equal Justice Works Elder Justice AmeriCorps law students who have done incredible work on behalf of our clients this Summer.  We have greatly enjoyed having Victor, Emily, and Briana as colleagues and are grateful for all of the people that they have been able to assist through legal advocacy and community outreach.

Victor Absil

Victor joined GBLS in the summer of 2017 as an Equal Justice Works, Elder Justice AmeriCorps JD intern with an Equal Justice America fellowship. He was born and raised in the Chicago area and received a BA in Philosophy from DePaul University. He is a rising second year, J.D./M.P.H. student at Boston University. Before starting law school he worked on an organic farm growing healthy vegetables for Chicago communities. During his first year at law school, Victor was a representative for the Health Law Association and beginning in the fall, he will be a member of the American Journal of Law and Medicine.

Throughout the summer Victor has enjoyed working as a legal advocate on a variety of issues facing the elderly population. Some of the major issues he encountered include Medicaid and SSI terminations, wrongful evictions, and working to help spread awareness of laws and various programs that can help the elderly to meet their basic needs and stabilize a healthy living environment. 

“Learning what it is like to work in a public interest organization and how to use practical skills to help those in need has been an incredibly rewarding experience that I will continue to learn from as I move forward in life. I’ve found that one of the best ways to prevent elder abuse is by assisting elders to become more independent and aware of the different forms of elder abuse and the organizations that are here to help.”

Emily Bordenski

Emily joined GBLS in the summer of 2017 as an Equal Justice Works Elder Justice AmeriCorps JD Intern. She grew up in Carroll County, Maryland. She received her B.A. in Health Administration and Public Policy from the University of Maryland, Baltimore County (UMBC) and is currently a rising third year at New England Law | Boston. She serves as the Technical Editor of Due Process, President of the American Health Law Association and a member of the International Law Society, the Public Interest Law Association, and the CORI Initiative. During the summer of 2016, Emily went abroad to London, England where she studied international comparative law topics such as criminal and business law. This experience gave her the opportunity to learn about the needs of communities all over the world. Now, she is concentrated on representing the needs of elderly community members here in Boston. 

“I think the best way to prevent elder abuse is through community outreach and spreading the word about this epidemic. Elder abuse is a complex problem that demands understanding and support by people of all ages. The Elder Abuse Prevention Project at GBLS provides free outreach to anyone who is willing to listen!  During these sessions, we provide information on all different types of elder abuse, examples of situations that some may not consider elder abuse, and resources for people who are victims or may know a victim of elder abuse. As a society, we need to be aware of the epidemic of elder abuse, proactive in preventing the problem, and persistent in making changes.”

Briana Mansour

Briana joined GBLS in the summer of 2017 as an Equal Justice Works Elder Justice AmeriCorps JD Intern. Briana was raised in Leominster, Massachusetts and currently lives in Boston, Massachusetts where she is attending Suffolk University Law School. She earned a B.A. in Psychology from The University of Tampa in Florida. Briana is a member of her school’s Immigration Law Association and she previously interned at the Worcester District Court.

Briana is thrilled to have the opportunity to advocate for elders and help preserve their rights. Since joining GBLS, Briana has advocated on behalf of multiple elders, preparing them for housing and small claims court and dealing with opposing counsel. She has also conducted extensive legal research, allowing her to offer clients legal advice and helping the GBLS staff attorneys answer complex legal questions. Briana is particularly skilled at forging connections with elders and making them feel comfortable opening up to her.

“Spreading awareness through education and being responsive to the signs of abuse will help combat the increasing prevalence of elder abuse.  Providing elders with a platform to project their voices will help prevent elder abuse.”

*  Thank you to Equal Justice Works Elder Justice AmeriCorps for choosing EAPP as a host site

Improv As Elder Abuse Prevention

Susan Pacheco speaking at the event

The Cambridge Elder Abuse Prevention Coalition (CEAPC) hosted an event entitled “Empowering Older Adults” for over 80 elders at the Cambridge Council on Aging to commemorate Elder Abuse Awareness Day.  The event included a performance by an Improv Troupe called “True Story Theater.”  True Story Theater performs an improvisational style called Playback Theatre in which audience members tell stories and watch them enacted on the spot.  The goal of the troupe’s events is to create a respectful atmosphere where every voice can be heard and any story told — even very painful stories about elder abuse. 

Members of CEAPC prepared several stories for the troupe based upon true stories of Cambridge elders experiencing abuse.  These were compelling situations that symbolize how complex and multi-faceted elder abuse often is.  The audience was very engaged with the performances – one woman said “we get information all the time in flyers and brochures, but seeing these situations acted out really brought the issue home to me.”  Many others in the audience echoed this sentiment.

Elder abuse can be an extremely difficult issue to think about or talk about.  Presenting real people’s stories of experiencing elder abuse is very powerful and can lead to a more open discussion about the issue.  This not only helps elders identify the different types of elder abuse and warning signs but, most importantly, it can help to proactively prevent potential abuse.  The event was a success on many levels – it was very well received by the audience, it started a lively discussion about the topic that is sure to continue, and it conveyed that the community as a whole values the dignity of each older adult in Cambridge.  Kudos to the City of Cambridge, Susan Pacheco, Executive Director of the Cambridge Council on Aging, and the members of CEAPC for their commitment to protecting the health, safety, and well being of the city’s older adults.

*   The performance was generously funded through a Tufts Health Plan Foundation grant

 

Behavioral Health Services Are Key to Supporting At Risk Older Adults

  As a regular feature of this blog, we highlight our professional partners who have committed their knowledge, passion, skills, and time to protect older adults in their community.

Cassie Cramer, Somerville Cambridge Elder Services

photo credit:  Stephanie Becker

What do you do professionally and do you ever encounter elder abuse and self-neglect issues in your work?

I am a peer advocate, co-chair of the MA Aging and Mental Health Coalition and social worker in a mental health program at Somerville Cambridge Elder Services. Before I started this position, I worked in Elder Protective Services for 5 years. My background in elder abuse, neglect and self-neglect led me to the position I have today, providing longer-term support to people and advocating for the development of these supports statewide.

 How do behavioral health issues play a role in elder abuse and neglect?

In Protective Services I learned a lot; specifically I learned about when and why things go wrong. I found that by far, our biggest systematic failure was the lack of accessible (in-home) mental health services for older adults. Without on-going support in the community, people cycle through Protective Services- chronically “at-risk” and facing bleak outcomes.

            In Protective Services, I saw first-hand how behavioral health conditions can lead to poor self-care.  Poorly monitored diabetes or blood pressure can cause catastrophic health problems. Behavioral health conditions can cause isolation, cutting ties with would-be caregivers and social supports. Substance use among family members is often underlying abuse, exploitation or neglect.  Substance use and other behavioral health conditions among older adults can lead to problems with housing and risk of homelessness. I found that well-meaning providers are often quick to defer to institutionalization when older adults are facing crisis- people frequently called and expressed their view that an individual be “placed somewhere” because they “didn’t belong in the community.” 

            My observations are reflected in statistics: untreated behavioral health conditions among older adults are associated with higher health care use, development of preventable health problems, lower quality of life, caregiver stress, suicide and high rates of institutionalization.  Studies have shown that failure to provide mental health treatment in the community increases the likelihood of nursing facility admission by a factor of three, and that institutionalization is likely to occur at a much younger age.  Older adults with behavioral health conditions face many barriers to accessing traditional supports including lack of transportation, cost of co-pays, isolation, high levels of stigma around mental health, ageism among providers, and difficulty coordinating appointments due to co-occurring cognitive conditions, like dementia. For these reasons, older adults are least likely to receive mental health support.

What do you think is the best way to prevent elder abuse and self-neglect?

The MA Aging and Mental Health Coalition advocates for the development of a statewide network of in-home behavioral health supports, including case management, peer support, and therapy.  In the small pilot programs scattered across the state, we have already begun to see the effectiveness of these supports. In the program where I work, we are able to help people at risk of homelessness by taking referrals for people in the early stages of eviction, acting as a liaison with housing management and developing creative solutions to help stabilize tenancy. We help people in medically inappropriate housing, no longer able to climb the stairs of a walk-up apartment, move into accessible units.  We help people who are not receiving any medical care start seeing a primary care doctor or enroll in managed care programs, receiving in-home support from a nurse case manager. We also have an older adult peer specialist on staff who helps people who are isolated, often conducting visits in a local cafe or the library. Unfortunately these budding programs and success stories represent what is possible, rather than a reality for most people, who do not have access to in-home mental health support. A statewide network of in-home behavioral health supports is needed to ensure that all people- regardless of age or a mental health condition- have the opportunity to live full healthy lives in the community.

Is there anything else you would like to add about yourself or your work?

The Aging and Mental Health Coalition meets monthly in Boston and is open to anyone interested in joining our advocacy efforts. If you would like more information, you can contact me at ccramer@eldercare.org or 617-628-2601 x3089