Gender, Sexual Identity, and Families: The Personal Is Political

Power of Attorney and Elder Financial Exploitation

Costs associated with financial exploitation are high. A Metlife Mature Market Institute Study (2011, p. 6) found that the annual financial loss to victims of EFE referred to above increased 12% from 2008 to 2010. This figure fails to include estimates in excess of tens of billions of dollars “in health care, social services, investigative and legal costs, and lost income and assets” (MetLife Mature Market Institute, 2009, p. 6). Gunther (2011) reported that the costs of financial exploitation in the State of Utah alone are an estimated $1 million per week.

POA EFFE goes largely unreported and unabated (Acierno et al., 2010; Gunther, 2011; Rabiner, O’Keefe & Brown, 2004). Under-reporting occurs for multiple reasons: elder victims may not recognize behaviors as exploitive; they may remain silent because of shame, self-blame, fear of retaliation and/or further loss of independence; and they may fear loss of the support they receive from the abuser (Hafemeister, 2003; Rabiner, Brown, & O’Keeffe, 2006). Victims may also feel sympathetic and protective of the exploiter, especially when family loyalties, codependency, substance abuse, and mental illness are involved (Capezuti, Brush, & Lawson, 1997).

Extant data lack uniformity and exist only at the state level (Stiegel & Klem, 2008). Of the EFE cases reported, a national survey of state Adult Protective Services (APS) agencies found that only 14.7 percent were substantiated (Teaster, Dugar, Mendiondo, Abner, & Cecil, 2006). Because EFE often goes unreported, it remains a secret within many families. Estimates of the incidence of elder financial exploitation range from as low as 10 (Thomas, 2014) to as high as 44 (Lifespan of Greater Rochester, 2011) unreported cases for every one reported to authorities.

From data provided in reported cases, family members appointed as POA by elderly relatives are frequent perpetrators of EFE (MetLife Mature Market Institute, 2011). The MetLife Mature Market Institute studies (2009; 2011) are widely cited in connection with this concern; however, these studies relied solely upon secondary press accounts of EFE because firsthand accounts are extremely difficult to obtain. Rabiner, O’Keeffe, and Brown (2004) emphasized that it is important to learn about characteristics, causes, and consequences of EFE and that the family system represents a critical place to examine these factors. Understanding the characteristics of those who experience EFE, its antecedents, and consequences is crucial to prevention and intervention efforts. Being able to understand family systems where POA EFFE occurred adds to an understanding of risk and protective factors related to EFE.

Characteristics of EFFE Perpetrators and Victims

Data on reported cases of POA EFFE indicates that those who have responsibility for both caregiving and financial management are more likely to exploit (Stiegel & Klem, 2008) than those without both responsibilities. Stress caused by time, energy, and emotional demands of caring for someone with increasing needs and the demands of financial management responsibilities may be intensified by the lack of understanding of physical/mental changes that can occur with aging (James, 1994).

Prior researchers report that older (>75) White women who live alone are a high-risk group for financial abuse (Tueth, 2000). There are a number of explanations for this finding. For example, because women live longer than men, more women are available to be financially exploited. Furthermore, societal gender stereotypes that portray women as weak and vulnerable may also contribute to victimization. Cohort effects associated with gender role expectations can also play a role in financial exploitation; many widowed older women may not have experience handling household finances, opening the door for perpetrators to step in under the guise of helping. Few researchers have specifically examined gender differences and gender roles in elder abuse in general. Among those that have examined gender as a significant factor in elder abuse, the results have been mixed with some studies finding no gender differences in prevalence (Yon, et al., 2014; 2017). These mixed results underscore an empirical need for more focused attention on understanding gender within the context of elder abuse in general, and elder financial exploitation in particular.

Theoretical Frameworks and Concepts

Because there are multiple levels of opportunities and barriers that people experience in maintaining financial well-being in later life and victims of EFE are embedded within a system of hierarchical contexts (e.g., individual, family, community, society), a socio-ecological approach is useful for understanding the problem. As an organizing framework for intervention and its sustainability, Bronfenbrenner’s (1979; 1986) Ecological Systems Theory provides a focus on the elder victim and four influencing systems (see Figure 1):

Figure 1. The Socio-Ecological Framework for Elder Financial Exploitation

(a) the microsystem is the elder victim within his or her environment, (b) the mesosystem represents the relationship between the victim and relatives and friends; (c) the exosystem represents environments external to the victim (e.g., community services) that may affect his or her well-being; and (d) the macrosystem includes broad ideological values, norms, and cultural and institutional patterns (e.g., state/federal programs and regulations/policies) (Horsford, Parra-Cardona, Post, & Schiamberg, 2010; Parra-Cardona, Meyer, Schiamberg, & Post, 2007).

It is important to examine EFE within the family system because the etiology of EFE and the variables that influence a perpetrator’s decision to engage in exploitative behaviors are highly complex. People experiencing EFE are not isolated agents but rather are embedded within and influenced by intricate social and environmental networks. A broad perspective increases our understanding of these complicated issues.

Participant Recruitment

Using a convenience sample, we recruited 14 participants from nine states by distributing flyers, contacting staff members at senior centers, word-of-mouth, email, and sharing information about the study at professional conferences. Participants were 18 years of age or older who believed that their loved one age 60 or older was a victim of POA EFFE. The study was approved by the University of Wyoming Institutional Review Board.

Study Instrument and Data Collection

The interview guide was developed by members of the research team and included semi-structured interview questions adapted from Siedman’s (1998) phenomenological approach involving three separate, in-depth interviews. Questions focused on family systems as the primary social systems in POA EFFE. The inquiry explored characteristics of older adults that made them vulnerable to perpetrators, relationship types, power and exchange dynamics, social networks of the victims and perpetrators, and the dynamics of the financial abuse itself. Questions for Interview I explored significant experiences that the interview participant perceived to be foundational to the EFE. Probing questions included exploring relationships between elders, perpetrators, and other family members. Questions for Interview II concerned details related to the exploitation, including who was involved and how was it handled by perpetrators, other family members, lawyers, Adult Protective Services, mediators, guardians and any others who were involved. Interview III focused on short- and long-term impacts on participants, elders, and family members.

Data Collection

Data were gathered through recorded interviews conducted by three co-investigators on the research team. Most participants were interviewed in-person (eight); however, four interviews were conducted by telephone due to issues of distance, and one interview was conducted both in person and via telephone, again due to distance. According to Novick (2008), telephone interviews are an adequate alternative to in-person interviews. Each of the three interviews was between 60 and 90 minutes in duration. Some interviews were separated by a couple of days, and others combined into one interview session depending on schedules and accessibility. During each interview, sketching a genogram, or a graphic representation of at least three generations in a family system (Chrazstowsi, 2011), for each family which helped the interviewer to remain clear about who family members were and their relationship to each other during the interview process. The genogram proved helpful in later analyses.

Data Analysis

Prior to analysis of the interview transcripts, pseudonyms were assigned to ensure confidentiality for the participants, victims, and other individuals. During the coding process using NVivo 11, investigators thoroughly read and analyzed each transcript to code salient excerpts. Discussions among researchers addressed differences in order to achieve consensus on incongruent coding of particular excerpts to aid the team’s interpretation of participants’ experiences. Subsequently, team members reviewed codes and grouped them into categories until consensus was achieved. They then used the same procedure to identify broader themes. The current analysis focused on the theme of risk factors within families for EFE as well as explored its gendered aspects.

Participants

Data were gathered between 2011 and 2013 concerning eight female and five male victims aged 60+. Fourteen study participants aged 18+ (11 females and 3 males) were recruited via snowball sampling and were assigned pseudonyms by the study team. Among the participants from the 10 families, there were 10 daughters or step-daughters, one granddaughter, two sons, and one son-in law (Table 1). Three couples were victims; the rest were either widows or widowers. Study participants described POA EFFE by nine female and four male perpetrators.

Family Risk Factors for Exploitation

For this monograph, we report on the entire sample and themes that emerged from transcripts that revealed gender issues. Below, we discuss three major themes emanating from coding the interviews. One theme dealt directly with family dynamics, particularly when one or more family members became dominant or dominating as well as coercive of the parent and/or other family member. Another theme was family communication, or the lack thereof, influenced by: (a) family cultural communication patterns, (b) family members’ reactions to authority shifting to the POA agent(s) from parent(s), (c) geographic proximity, and/or (d) the time period and stages of the life course of relatives. A third theme was family members’ inability to recognize that POA EFFE was occurring, including factors, either individual, systemic, or in combination, that thwarted attempts to remedy the exploitive situation. We conclude with a discussion on the gendered aspects of EFE that emerged from the participants’ experiences.

Theme I: Family Dynamics (Micro and Mesosystem Levels)

Risks Inherent in Power Dynamics among Family Members. One risk factor that arose in our coding was that of a dominant family member. In some cases, there was a dominant parent, who, in addition to controlling a spouse and children, not surprisingly, controlled the family’s finances. This typology reflects an earlier time in the mid-twentieth century when control by a paternal head of the household was normative. However, as the controlling parent aged, the practice that involved not sharing the family financial decisions with a spouse or other members of the family became an opportunity for POA EFFE. Such was the case of Shawna’s father and mother.

Because Shawna’s mother knew little of the family finances, she was willing to respond to the requests of her other daughter, Hilary. One of two trusted daughters she and her husband had named as POA, Hilary lived nearby. The other agent, Shawna, lived 2,000 miles away, but visited her mother frequently. Because of the controlling relationship modeled by her parents, Hilary was submissive to her controlling father, and later, to her own spouse, Eddie. Again, Shawna explained that her mother would have signed anything Hilary asked her to sign because she trusted Hilary. This dependency opened the door for eventual exploitation by Hilary and her husband.

In another example of family domination, Rod remarked that his father-in-law, Noah, wanted his wife Holly to obtain money that her parents had put in a trust for her in order to support his failing business. He coerced Holly into giving him money from her trust, which was established to protect her from her husband’s poor financial management. This type of acquiescence is not uncommon among this generation of women, as mentioned in Shauna’s case above.

The experience of Bryce provides yet another example of power dynamics within the family. In this situation, Bryce believed his sister’s power and control over their mother enabled POA EFFE:

Risks of Coercion and Control Through Entitlement and Guilt. A typical scenario of POA EFFE is one in which children who cannot seem to survive on their own, due to personality traits and sometimes in concert with mental health issues, physical health issues, drugs, or alcohol, become highly dependent upon the older parent. According to Tueth (2000), some perpetrators are career criminals who lack a history of long-term and stable relationships. The infirmity of the elder becomes the occasion to provide “help,” but the offer of assistance is really an opportunity to move into the elder’s home and control him or her, especially the finances. Joyce described such a situation in which her Aunt Karla had experienced financial problems for a long time.

A second example is exemplified in Bryce’s family, where the sister became even more controlling after becoming a single parent of four children.

Bryce’s sister later exerted power and control to coerce their mother into signing legal documents and maintained little communication with Bryce about the well-being of their mother.

Risk of Control Through Deception and Threats. Some instances of POA EFFE are accomplished through deception, which was often facilitated by other family members. Below is an example of a deceptive situation. Again, Bryce explained.

Deception by family members and by collaterals enabling the deception isolates the elder. Family members who seek to gain access are thwarted by the deception, which draws the noose of isolation tighter, with the elder complicit with the deceptive acts because she is unaware of the actual situation.

In some instances, family members controlled each other through threats regarding persons or the disposal of the estate, as in the case of Marilyn, who was actually afraid of her brother, Morris.

Morris became POA for their mother, Holly, who, like his deceased father, also coerced his mother into giving him her trust funds.

In another example of a family member’s threatening behavior, Bryce recounted that his sister

Threats had the double effect of endangering the elder and family members. Consequently, as shown below, communication between and among family members diminished or stopped altogether.

Theme II: Family Communication (Micro and Mesosystem Levels)

Risks Inherent in Family Structure, Communication, and Culture. A second risk factor was that of family structure, particularly its unique culture and communication style. In the family of Bryce, early traumatic events significantly affected the family culture:

As a result of the tragedy that Bryce’s sister was born into, Bryce and his sister never felt close to their two older brothers, who dealt with lifelong, lingering trauma. Bryce’s sister may have suffered from inadequate attachment to her caregivers due to the attention her older siblings required during their recovery. The eldest brothers were distanced from their younger siblings and were uninvolved in the later care of their mother.

In the experience of Adrian, the family culture centered around values of rugged individualism, which resulted in distanced family relationships. In addition, birth order and age differences between siblings contributed to ambivalent adult sibling relationships. According to Adrian,

Adrian stressed that one of his siblings thought that their mother should just take care of herself, a mindset that led to POA EFFE later.

Alternately, Adrian was quick to point out that his mom was becoming quite frail and unable to care for herself.

The lack of communication reflected the lack of family closeness, which also created a risk factor for POA EFFE later. Family closeness was diminished by distance, age, and family culture. As another example of lack of family closeness, Bryce observed, “we just moved in different circles and, you know, if we’d been in an adjacent town, in an adjacent block it might have been different, but literally we were a family in name only.”

Theme III: Attempts to Intervene in the Exploitive Situation (Meso and Exosystem Levels)

At some point, family members realized that exploitation was occurring, and they tried to confront the problem themselves. Their early efforts were often greeted with roadblocks. For example, Opal remarked, “We’ve offered along the way to all pick up the slack and divide the responsibilities and um help however we could, but we get, you know, we get just a blank stare.”

Similarly, when family members tried to extract information from the elder, their efforts were unsuccessful, Adrian, Opal’s brother, tried to assist, but to no avail:

It was very unclear whether their sister, Erin, had POA. Adrian had many questions. He felt like he was unable to get information, stressing that he was shut out by his mother and sister and hindered from getting information from professionals by the Health Insurance Portability and Accountability Act (HIPAA). Also, apparent in the interviews was how stressful and difficult it is for family members to determine who actually has the POA designation and the powers extended to him or her. Not knowing whether his sister had POA authority, Adrian, questioned:

Gendered Aspects of EFE (Micro, Meso, Exo, and Macrosystem Levels)

We also observed how gender played a role in POA EFFE. For example, elements of power dynamics, control, and coercion that were exemplified in the themes described above can also be interpreted as representative of stereotypical masculine gender roles. In research on intimate partner violence, masculinity and gender roles have been used as a predictor for potential violent behavior; although more evidence is needed to understand the potential link between gender roles and abuse (Anderson, 2005), especially regarding elder financial exploitation.

Another example of how gender potentially plays a role in POA EFFE is when an elder’s choice of POA is based on gender biases, with the most obvious example illustrated by Susie’s story:

Due to gendered caregiver roles, choice of POA was selected, in many instances, because the caregiver was proximal to the elder and already providing him or her some help. Thus, the primary caregiver, regardless of competency to manage the elder’s funds, became the elder’s designee for POA. An example of this gendered choice is evident in the case of Bryce and his sister:

With a rise in gender fluidity and the changing landscape of gender identity, societal understanding of gender roles may evolve significantly for future cohorts. It will remain an important empirical question to explore how gender roles may play as a risk or protective factor for elder financial exploitation.

Limitations

This study and its findings are not without limitations. First, the findings are based on a small sample and are not intended to be representative of all cases of POA EFFE. Second, the POA EFFE upon which our analysis was conducted was typically not reported to or confirmed by authorities with power to act. Third, elders in our study who executed POAs were born in the 1920s and 1930s, persons who came of age in the years preceding and during World War II. Their children are likely Baby Boomers, persons born between the years of 1946 and 1964. As a result, it was societally normative for many women of the earlier age cohort to become homemakers. Thus, many women were unable to hold a mortgage or credit card in their own name. Unless a woman challenged these expectations, many were dissuaded from involvement in family finances, with the consequence that many rarely, if ever, were involved with financial matters. Moreover, many were left were ill equipped to address them when life circumstances (e.g., death or divorce of a spouse) changed, even more so when confronted with their own chronic illness and cognitive decline.

Our examination of POA exploitation by a family member contributes to an area of exploitation about which little is currently known. These data and their findings illuminate a body of knowledge on POA EFFE that was heretofore largely anecdotal in nature.