During a recent Zoom conference call, four adult security services workers from California were trying to determine whether an 82-year-old woman was being interviewed for a decision-making ability, or using a tool called IDA. There’s something wrong with them that they know. Ms. K.
Adult protection agencies receive reports of potential neglect, self-neglect, abuse and exploitation of the elderly and other vulnerable adults in each state. But agency workers are constantly faced with a perplexing question: is the adult in question capable of making decisions about his or her medical care, living conditions or finances – even if it is not a decision that What should a family, doctor or financial advisor think?
IDA was developed by two pathologists to help address the issue of adult safety care workers. The program helps them learn to use a systematic interview method to gather information about the client’s decision-making ability. Two dozen California staff members taking the course had already completed the 10-hour individualized online instruction. He was now practicing his new interviewing skills in small groups, working with facilitators.
Ms. Kay was playing a legendary character, Base White, a special project administrator at Val Cornell Medicine. In the scenario, a bank manager reported some misgivings: Ms. K had $ 60,000 in her savings account but her withdrawals increased sharply, from $ 600 a month to $ 600 a week. A little man – his nephew, he said – had started going to the bank with him, where a teller thought the man seemed out of control and intimidating. An investigator who visited the lady’s home found that her only credit card had expired and she had very little cash.
But Ms. K denied financial exploitation. Her nephew lived with her, she said, and helped with chores and rode to doctor’s appointments. He used the money withdrawn from the bank to buy his grocery.
In practice, one of the APS trainees confirmed that she understands the basic concept of financial exploitation. Ms. Kay had heard about the scams from the news, she said. And yes, she knew in that look that a friend or relative could benefit.
So the interviewer continued: “What do you think would happen if someone took another person’s money without their permission?”
In Ms. K’s role, Ms. White responds: “I guess that person can take it and take it as long as there’s nothing left.” But when the interviewer inquired further to see if the lady understood that she might be facing the threat herself, she hesitated. He trusted his nephew, Ms. K said; She didn’t want to upset him.
The IDA was developed by Dr. Mark Leachs, co-head of bacteriological and paralysis medicine at Val Cornell Medicine, and his colleagues, and Dr. Jason Carlovis, a pathologist and co-director of the Pan Memory Center. “People have a right to make bad decisions,” Dr. Leachs said in an interview. But, he added, decision-makers need to be able to understand these risks and potential consequences.
“How can you go to a brokerage office at the age of 90 and say, ‘I’ve had treasury bills for 50 years but now I want to put in my last $ 200,000 bitcoin’ – and no one raises an eyebrow?” Dr. Lachs said. “We’ll look back and see, ‘What were we thinking?'”
In addition to applying for IDA in cases of financial negligence or abuse, California APS workers use it, including self-neglect, health and safety questions, denial of physical care or medical treatment, and physical or psychological or sexual abuse. There were a number of issues to review. .
“It’s not about changing a psychiatrist, but it does tell you when to contact a psychiatrist,” said Dr. Leachs. He added that clients whose IDA interviews show a failure to understand the risks or consequences should undergo a thorough professional review.
To date, approximately 500 APS workers – in two areas of New York City, Massachusetts and California – have taken the course and obtained certification. Kansas APS workers will undergo training this summer.
But Drs. Lachs and Karlawish think the IDA could have wider uses. Trust and state lawyers and financial firms are already asking about it.
Hospital discharge planners can use IDA to assess whether a patient has the ability to insist on going home instead of rehabilitation. A chain of supportive housing facilities approached Dr. Lachs, wondering if IDA could help ensure that new residents understand the complex agreements they are signing.
The IDA interview attempts to answer three basic questions about a particular issue or threat, Dr. Carlovis said: “Did you know that this happens? Do you think it could happen to you? Can you come up with a plan to deal with it, arguing and weighing the ups and downs?
Depending on the complexity of the problem, diagnosed cognitive impairment or even people with dementia are still smart enough to handle it.
Someone who demonstrates during an IDA interview that a three-part understanding may be able to make a decision – including a decision not to resolve the issue. Without this understanding one needs a more comprehensive assessment, which may include consulting family members or social service agencies. In extreme cases, this can lead to ultimate patronage or conservatism.
Dr. Daniel Marson, a neuropsychologist at the University of Alabama at Birmingham, says difficulties in managing finances often serve as an early warning of incompetence, having studied the subject for 25 years.
“Financial ability is probably the first level of functional ability affected by neurodegenerative disorders and normal aging,” he said. Using money skillfully requires complex thinking, “from basic things like using an ATM to more complex things like, ‘How do I handle this call from the telemarket?’ , Institutionalization – can be devastating.
Although the incidence of dementia is declining in the United States and Europe, aging of these populations means that more people will develop it.
Furthermore, in a six-year study, Dr. Marson and colleagues found that older adults diagnosed with mild cognitive impairment – often a precursor to dementia – also struggled faster. “Financial skills have declined over time,” he said.
Other agencies have tried to address the issue of lack of decision-making capacity. The American Bar Association last year updated its “Assessment of Older Persons with Decreased Skills: A Handbook for Lawyers.” The Bar Association and the American Psychological Association have also published books for judges and psychologists.
The Financial Industry Regulatory Authority, or FINRA, has posted online courses on the financial exploitation of older adults and other vulnerable investors. Its rules allow a member firm to temporarily suspend transactions and payments when it believes that exploitation is involved. It also allows member firms to ask “trusted contact persons” to consult with investors in the event of a suspected exploitation.
Dr. Carlovis said the IDA program is currently focusing on APS workers because “the general agency has less staff, less resources and is struggling.” According to state statistics, California APS agencies handle approximately 30,000 cases each month involving seniors, and are asked to make decisions about the capabilities that make it difficult for the chair of the psychiatric department. Maybe, “said Dr. Leachs.
During the Zoom training session, California staff were gently asking Ms. White – as Ms. K – how she could respond to the bank manager’s suspicions, finally concluding that she did not need any professional work. She seems to have understood her options.
Giving his nephew access to his savings account was probably not a wise move. But he had to make the decision.