Multi-Specialty Teams Help Seniors Manage Diabetes (Part 1 of 2)

A multi-disciplinary medical team of pharmacists, podiatrists, optometrists, ophthalmologists, dentists and dental hygienists best assist seniors in managing their diabetes by addressing medication, foot health, vision impairments, dental loss, and heart conditions, researchers at the U.S. Centers for the Disease Control (CDC) and Prevention and the U.S. National Institutes of Health (NIH) say.

While most of the aforementioned categories of physicians may not have time to take on these different aspects of diabetes outside of their specialties, they may be able to ask questions and provide their senior patients with advice during regular visits, check-ups and exams, the National Diabetes Education Program’s (NDEP) Pharmacy, Podiatry, Optometry and Dental Professionals Work Group of CDC and NIH say.

The joint-federal agency working group releases their annual reference guide titled Working Together To Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists and Dental Professionals to train medical professionals to converse with aging diabetics about treating their condition with insulin, drugs, proper diet, exercise and sleep.

The booklet’s recommendations on how to diagnose and manage pre-diabetes and diabetes are based on clinical work and research by the medical professional trade organization American Diabetes Association (ADA). It and other specialty-based literature and materials are available at

Affected professionals also include primary care, family practice or internal medicine physicians, physician assistants, endocrinologists, certified diabetes educators, nurses, nurse practitioners, registered dietitians, cardiovascular specialists, renologists, neurologists, psychologists, psychiatrists and social workers.

Certified diabetes educators are trained healthcare providers who can counsel and train diabetics about their condition by setting behavioral goals and discussing health issues. A diabetes educator is usually a nurse, dietitian or pharmacist certified to guide and instruct patients about diabetes and self-care.

Diabetes Prevalence and Impact

Deemed severe, common, expensive but able to be controlled, diabetes is considered the sixth leading cause of death in the country and impacts at least 21 million individuals with at least 6.2 million undiagnosed. It costs the nation nearly $200 billion in direct and indirect expenses.

Nationally, diabetes ranks first among all long-term, deadly diseases as the cause of lower limb amputation that is not connected to trauma, first as the cause of acquired blindness and first as the cause of kidney disease ending up in dialysis.

The condition also contributes significantly to heart disease, being its number one cause of death in the country. At least 65 percent of senior diabetics die from heart failure.

Meanwhile, the prevalence of diabetes increases. Federal research shows it has more than tripled in the last 25 years from 5.8 million to the current 21 million, and in some states, over 25 percent of adults are diabetic. Projections will continue to be high. By the year 2050, the number of diabetics is expected to reach 39 million.

With current trends, one out of every three individuals nationwide will contract diabetes in his or his adulthood and may find his or her life span reduced by 10 to 15 years.

There are three forms of diabetes, type 1, type 2 and gestational diabetes. Federal research shows that, as of 2005, about two-thirds of adults nationwide were obese with the body mass index (BMI) of over 25, contributing to the onset of diabetes in this segment of the population.

In fact, the incidence of obesity has jumped by 61 percent since 1991, leaving more than 60 percent of adults overweight. A high body mass index and obesity pose the greatest risks to individuals for developing diabetes.

Type 1 is defined an autoimmune disease that is characterized by the destruction of insulin-producing beta cells. This version of diabetes can take place at any age but most especially in childhood or young adulthood.

Type 1 diabetes patients can develop ketoacidosis, a diabetic complication in which the body releases excess blood acids also known as ketones. Diabetics must take insulin daily whether by injection, insulin pump or inhalation.

Additionally, type 1 diabetics must test their blood sugar several times every day, follow a customized meal plan and take part in physical exercise.

Type 2 diabetes is connected to insulin resistance. The pancreas produces insulin but it is not recognized or used by other body tissues. Patients of this form of diabetes are treated with insulin, drugs or both. Otherwise, the condition can be controlled with an individualized food plan and physical exercise.

The development of type 2 diabetes is multifactorial, with insulin resistance, sedentary lifestyle, advancing age and obesity contributing to this increase.

This version of diabetes hits nearly 10 percent of the country’s population of young adults and double of the senior segment with a high incidence among those who are obese and physically inactive.

Still, the number of type 2 diabetics among children and teens is increasing, a n important concern as the number and intensity of complications grow with age.

Type 2 diabetes affects African Americans, Hispanics, Native Americans, Alaska Natives, Hawaiians or other Pacific Islanders and they are all two times as likely to have the condition as whites of the same age group. Some sectors of the Native American population suffer the highest rates of diabetes in the world.

The third form, gestational diabetes, involves glucose intolerance in women at the time of pregnancy. Gestational diabetes is most likely to take place among African Americans, Hispanics and Native Americans. It also occurs in obese women with a family history of diabetes.

At the time of pregnancy, mothers are treated to have their blood glucose levels stabilized so as to not affect their infants. Afterward, five to 10 percent of gestational diabetics are discovered to have type 2 diabetes. Indeed, women with gestational diabetes harbor a 20 percent to 50 percent risk of contracting diabetes over the next five to 10 years.

Other forms diabetes stem from genetics such as “maturity-onset diabetes of youth,” surgery, drugs, malnourishment, infections and other illnesses. They make up 1 percent to 5 percent of such cases.

Prevention Tools

About 54 million individuals aged 40 to 74 years of age — an age group that makes up 40.1 percent of the country’s population — suffer from pre-diabetes, which endangers them into developing type 2 diabetes.

Without action, pre-diabetics can advance to type 2 by a rate of 10 percent higher every year. They also have a higher risk of heart disease and stroke.

Pre-diabetes, “a condition in which blood glucose levels are higher than” what is considered healthy “but not in the diabetes range,” is described as “impaired fasting glucose (IFG) of 100 to 125 mg/dL or impaired glucose tolerance (IGT) diagnosed by a post 75-gram glucose challenge of 140 to 200 mg/DL.”

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of NIH can assist patients and providers in determining whether they are at risk for pre-diabetes. Federal research identifies three types of prevention: primary prevention to keep diabetes from occurring and secondary prevention to prevent complications in those who are already stricken with diabetes (e.g., prevention of foot disease).

Still, a third version, called tertiary prevention, means avoiding worsening complications such as an amputation from injury to a diseased foot or death.

These three levels of prevention occur because of the high financial and non-financial costs of diabetes. Federal research shows that more than 4,100 individuals per day are diagnosed with diabetes. As a result, 55 lose their sight, 120 undergo renal failure and 230 lose a limb to amputation — daily.

To test for diabetes, medical professionals will perform finger sticks or forms of laboratory testing. To qualify to conduct laboratory testing, professionals must be registered with the Centers for Medicare and Medicaid Services (CMS) under the Clinical Laboratory Improvement Amendment (CLIA) of the law governing the policy and procedures of the federal agency.

The amendment sets quality standards for accuracy, reliability and timeliness of test results no matter what types of tests are performed. Three classes of tests and certification have been set and the categories depend on the level of difficulty and effort of the method used.

It has set up rules for each category of testing calling for quality control and documentation processes. Some states have added more requirements for different laboratory sites or medical professionals. For more information, professionals are asked to consult their state agency and the CMS website at

To help those who already have diabetes, the guide, Working Together To Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists and Dental Professionals, provides detail on the type of drugs that best manage blood sugar, including insulin, as well as blood pressure and cholesterol.

The booklet concentrates on diabetes-related complications affecting foot health, vision, oral care and medication therapy issues. Using clinical graphics, including patient education posters to be hung in a medical office, and four specialty-based prevention brochures, it aims to encourage interdisciplinary medical team work to treat diabetes and make appropriate patient referrals.

Additionally, another booklet, the Working Together Medications Supplement, instructs on how to understand and properly use medications meant to control diabetes and can be used to organize team care. Package inserts or another guide titled the Physicians’ Desk Reference include prescribing information.

The Working Together Medications Supplement guide provides insights for professionals and senior patients on such issues as:

–The different types of insulin and the appropriate times to administer them so as to not conflict with a scheduled procedure;

–The most common symptoms of medication use to help a medical specialist to pinpoint a problem and make an appropriate referral to another specialist;

–Reduction of adverse interactions of drugs prescribed by different specialists;

–Avoidance of accidental overdosing or underdosing by generating awareness of medication names, strengths and dosages, and;

–Making the most of each visit, check-up or exam to teach patients about how to correctly use prescribed drugs and to receive drug use counseling from a primary care physician or pharmacist.

Physicians, specialists and other medical professionals can access the reference guides, which are all free, at the Centers for Disease Control and Prevention’s continuing education website, and fill out an evaluation form and post-test.

Taken together, the guides are meant to help professionals identify the different type of diabetes and to prevent complications; to practice key messages to senior patients about diabetes; to articulate the most pressing concerns about drug therapy, foot health, vision and oral care for diabetics, and; to interpret the outcomes of the Diabetes Prevention Program (DPP).

According to the American Diabetes Association Standards of Medical Care, Diabetes Care reference guide, professionals are required to train senior patients to pay attention to their hemoglobin A1C, a test that shows their average blood glucose over three months (the goal is an A1C of less than 7 or 150 mg/dL), a blood pressure reading at less than 130/80 mm Hg, and a cholesterol count of less than 100 mg/dL.

With such training, senior patients are expected to practice sound self-management habits. They can maintain a customized, healthy meal plan with the help of the dietitian, participate in physical exercise, avoid cigarette smoking with guidance from a certified diabetes educator, and take prescribed drugs properly with counseling from a pharmacist.

Social workers can help coordinate government services for patients, especially seniors, and mental health professionals can assist them with depression and other mental illness issues as they pertain to diabetes.

Resources geared at assisting them can be found at the NDEP’s Better Diabetes Care Web site at

Finding the Time

Pharmacists, podiatrists, optometrists, dentists and dental hygienists may not find time to look at a senior patient’s medications, feet, eyes or teeth, especially if each category of physician feels entrenched in his or her specialty, members of the joint CDC-NIH work group say.

However, specialists are capable of sending direct messages to their senior patients about health problems or issues they have noticed. Instead of opening a statement with wording such as, “You should see someone about that … ,“ a specialist could tell his or her patient that, “I recommend that you … “

For example, a pharmacist does not need to be a podiatrist, an optometrist or ophthalmologist or a dentist or dental hygienist or perform an exam to determine when a senior patient presents with a problem that warrants the attention of another category of specialist, the workgroup members say.

A minute is all that is needed, for example for a pharmacist, to view a senior patient’s foot, mouth or eye to ask some questions about medications, supplies or cigarette use, they say.

By merely mentioning the problem a pharmacist, for instance, may have identified, he or she reinforces the need for prevention once he or she examines the issue before referring the patient to another specialist-colleague, goes the argument of the workgroup.

A pharmacist, podiatrist, optometrist, ophthalmologist, dentist or dental hygienist can support comprehensive diabetic care by going beyond his or her specialty to point out potential issues and then make a referral with an “I recommend … “ statement.

CDC-NIH workgroup members say patients will be grateful to specialists for taking their health and well-being into consideration, setting up a referral system and adopting a comprehensive team-care approach with their professional peers.

Foot Health

Besides podiatrists and as part of a comprehensive diabetes care team, pharmacists, optometrists, ophthalmologists, dentists and dental hygienists and other specialists ought to watch their senior patients for the most common diabetes-related foot issues: neuropathy, vasculopathy, dermatological conditions and musculoskeletal problems.

To assess for peripheral sensory neuropathy or the loss of sensation in the feet, specialists should check for the senior patient’s experience of tingling, burning, numbness or sensation of bugs, crawling on the skin of the feet. Podiatrists seek to detect this foot condition by using an instrument known as the Semmes-Weinstein 5.07 (10 gram) monofilament.

Senior diabetics with neuropathy are nearly two times more likely to suffer from ulcers in the feet than their peers without this condition. For senior diabetics with both neuropathy and foot deformity, the danger of cultivating ulcers is 12 times greater. Still, furthermore, senior diabetics with a history of foot disease, including previous amputations or ulcers, face a worsening risk of up to at least 36 times greater.

The demographics most at risk for lower-extremity ulcers and amputations are members of the male gender, non-Hispanics, African Americans, seniors and diabetics of at least 10 years, having past cigarette use and having a history of poor blood sugar control or heart, eye and kidney complications.

A comprehensive foot exam for diabetics includes evaluating “pulses, sensation, foot biomechanics,” which is defined as foot structure and function, and nails. NDEP medical literature titled Feet Can Last A Lifetime describes how to use this monofilament to conduct a complete foot exam and can be accessed at

Vasculopathy represents the cramping of calf muscles when walking, also known as “charley horse”, which leads to several rest periods bet. The cramping stems from insufficient blood in the area below the knee, caused by the blocking of the arteries, which commonly happens in the lower extremities of senior diabetics.

Nighttime severe cramping and toe aches are known as rest pain and is treated by walking or allowing the feet to hang over the side of the bed. This particular symptom means there is an end-stage blood vessel disorder and tissue ischemia, all of which comes before the onset of diabetic gangrene.

Neuropathy is cited by clinical research as being most responsible for ulceration and related foot complications. However, an inadequate blood supply can also lead to bad ulcer healing and, thus, amputation. Both neuropathy and not enough blood should be factored into a complete diabetic foot exam and care.

Dermatological conditions are exemplified by feet corns and callouses, also hyperkeratotic lesions, which are the result of “elevated mechanical pressure and shearing of the skin.” These conditions come before the “breakdown of skin” and cause “blisters or ulcers.”

Additionally, “surface lacerations and heel fissures or maceration (softening by wetness)” can all result in infection. “Corns, callouses, toenail deformity and bleeding under the nail” may be symptoms of neuropathy. “Fungus infections of skin or nails” become secondary infections that must be treated immediately.

“Musculoskeletal symptoms” in diabetic feet may emerge with “muscle-tendon imbalances” because of motor neuropathy. Such deformities include the hammertoes, bunions, high-arched foot or flatfoot, which raises the possibility for irritation of the foot in the shoe.

A patient’s style of life and his or her family history can determine the status of foot health. Senior diabetics who smoke are four times more likely than smokers without diabetes to acquire lower-extremity vascular disease.

Consuming foods high in fat and sodium and remaining physically inactive can lead to insufficient long-term control of blood glucose and place the patient at risk for diseases of the peripheral nervous system and blood vessels.

Additionally, a family history of illnesses of the blood vessels in the brain and coronary artery disease may mean a greater risk of lower-extremity arterial complications. Foot types or shapes may make a patient more vulnerable to biomechanical deformities that could end in skin breakdown.

Senior patients with neuropathy are highly likely to acquire degenerative arthropathy, also known as Charcot foot, that targets the joints and results in a red, swollen and deformed foot that can be taken for cellulitis. A Charcot foot usually means little to no pain and may progress over weeks to months before a specialist discovers it in a patient.

Radiological imagery may reveal a collapse of joint structure and can be taken for osteomyelitis. Therapy for Charcot foot is a light cast, in the absence of any swelling, and special shoes to correct changed biomechanics. If Charcot foot is not treated, the senior patient’s feet can degenerate into greater deformity, ulcers and, in the end, amputation.

Podiatrists and specialists in general should watch for senior patients who complain that their shoes don’t fit or wear slippers or shoes with portions cut out to adapt to changes in foot shape or limping.

The American Diabetes Association (ADA) and the American Podiatric Medical Association (APMA) take into consideration two forms of risk for developing diabetic foot complications: high risk and low risk.

The symptoms of high risk for developing foot disease include a “loss of protective sensation, absent pedal pulses, foot deformity, a history of foot ulcers and prior amputation.” By sharp contrast, for low risk, none of these symptoms exist.

To prevent low-risk senior patients from advancing to high risk, both professional trade associations, the ADA and the APMA, ask specialists to urge them to control their A1C, or hemoglobin blood sugar levels, blood pressure readings and cholesterol count and to quit smoking for those using cigarettes.

To assist high-risk senior patients, both organizations ask specialists to help patients guard against developing ulcers through self-management training, foot care and using the proper footwear. Light trauma “such as stubbing a toe or stepping on a sharp object” is the event most likely to lead to acquiring ulcers.

As a result, specialists are asked to stress to senior patients and their families the need to take the initiative to clear out walking areas, especially near the bed and the route to the bathroom, and to use night lights to enable a senior patient to see in the dark.

Additionally, high-risk senior patients must know who and when to call about their foot health issues. Same-day emergency calls to a primary care physician or podiatrist will likely be about a puncture wound, ulcer, redness or new foot pain. For less urgent issues such as patients with callouses or thick or ingrown nails, a podiatrist should be phoned and visited within a matter of days.

Nearly 20 percent of senior diabetics who visit their primary care physicians or specialists for check-ups or exams will present a foot health issue. With each visit, their doctors must ask their senior patients to take off their socks and shoes and check both feet for problems.

The likelihood of developing foot ulcers among diabetics is 15 percent. Worse still, the probability of diabetics with kidney complications and undergoing dialysis at risk for foot complications is higher but is treatable.

A podiatrist or other specialists are asked to pose senior diabetics the following questions when probing for foot care problems:

Whether they know how diabetes affects their feet, that diabetes puts them at risk for ulcers, which can result in amputations, and that foot care can prevent this;

Whether they have had a comprehensive foot exam in the past year and, in particular, one by a podiatrist, and a foot inspection by a primary care doctor, and;

How do they care for their feet daily and if their care regimen includes looking and touching for cuts, bruises, puncture wounds, corns or callouses, redness or pus; cleaning the feet’s skin and nails daily; drying in between toes; checking the insides of shoes for materials before wearing them and avoiding walking barefoot at all times.

Specialists can also refer senior diabetic patients to foot care literature from NDEP in English and Spanish at

Panasonic’s HomeTeam Connects Grandparents, Grandkids With Books, Games

Though living far away, Grandma wants to connect with the little ones but they are not very engaged and communicative at their young ages.

And her grandchildren need a family member to help practicing their speaking skills, reading and writing and expanding their learning through games.

This is where Panasonic’s HomeTeam video chat software comes in, said Todd Rytting, chief technology officer of Panasonic who held a briefing and demonstration of the product and the connection between healthy aging and technology at an annual conference of the American Society of Aging.

ASA is a California-based 5,000-member, multi-disciplinary organization addressing different aspects of aging.

Panasonic HomeTeam software stores hundreds of games and books so grandparent and grandchild can play and read together.

“Grandparents [want to] connect with grandchildren,” said Andrea Schneider, public relations contact with Motorola Mobility Public Relations on behalf of Panasonic’s Health and Wellness Solutions department, which develops technology for the healthcare market. “[When you are only] 5 years old, it’s hard to get going.

“The service allows grandparents to browse through books. [Their children have their] favorite animals or characters.

“[The grandchildren and grandparents] flip through pages of books. [The] grandchildren [are] learning how to read. [They are] practicing reading books.”

Panasonic’s HomeTeam staff of executives, managers and software developers released and explained their product, an online service that uses an app for the tablet, laptop and computer to access interactive books and games with video calling.

The user can download the app from the Apple App Store or Google Play and can use Androids or OS ipads.

The program enables “tech-savvy” grandchildren to read and play and grandparents to coach or guide them from a long distance, empowering the children to learn and their grandparents to form lasting relationships with them.

“It’s about an experience,” Schneider said. “It started with Skype. [Grandparents ask their grandchildren], ‘What did you do? Something? Nothing?’ You create stories and jokes. [It] brings families in [the] spirit.”

The service is accessible for free for 30 days and then a premium subscription takes effect afterward either at $8.99 monthly or at $89.99 yearly.

“One only needs to subscribe,” she said. “You see who we try to call. [You] enter someone’s e-mail address. [You] read books and games. [There is] conference e-mailing. [You] see and hear each other talk.”

Panasonic has worked with publishers such as Houghton Mifflin Harcourt Publishing company and Disney and game developers to obtain and store 2,500-plus popular children’s books and games on the website, including Star Wars, Marvel and Pixar products.

“[In terms of books, I] recently read all favorites,” Schneider said. “[There are] animal adventures [for] different ages [such as]Curious George. You click on the book. It will bring it up. [It] brings up context.”

Books and games include math flash cards, Word Aventures for vocabulary, Curious George Gets a Medal, Curious George Goes to the Hospital, Martha Speaks: Leader of the Pack and Just Grace, Checkers, Tic-Tac-Toe, Go Fish to Word Play, Chess and Animal Math.

“Each game has a tutorial,” Schneider said. “[The tutorials] show [the child] how to play. [They have] a match. A child has to know [what games he or she wants to play such as] Tic Tac Toe.

“There is a video conference. [They] read a nighttime story. You get to experience it together. You heart the book.”

Jerry Kurtze, director of new business development and innovation of Panasonic. explained that the service helps grandparents and grandchildren find interesting subjects to discuss since children under aged 10 tend to answer questions with monosyllabic replies, cannot deepen the substance of their topics and don’t speak long enough to build ties with family members.

“[Our target market is for children aged] 3 to 10,” Kurtze said. “When they get above 10, [it is hard to connect them with their grandparents]. It’s hard to get the children at ages 11, 12, 13.”

Add to this geographical, cultural and generational differences and a child’s grasp of e-mail, Skype and text messaging within nuclear families and both parties have serious challenges to overcome, she added. HomeTeam is aimed at providing grandparents and grandchildren common ground, lasting conversations and enjoyment.

“[There is no more closeness with the] nuclear family,” Schneider said. “[There is] long distance.”

HomeTeam software presents a book selected by either the grandparent or grandchild and both start to read. When one person turns the page electronically on his or her computer screen, the page is also turned in the other’s system as well. The same applies for moves during a Chess or Checkers game.

The book or game is the centerpiece of both parties’ attention but a video chat box appears on the side so they can see and speak with each other. E-mail and invitations functions are also featured to enable family members to contact and choose one another for discussion.

“[If grandparents and grandchildren want to] play games, [you go to the home screen and click] ‘go to all,’” Schneider said. “You see games available. [There are plenty of] games that [involve] younger children and young grandparents.

“There is a camera on the side. You can hear the decrease or increase [in volume]. You can hear yourself talking. All the tablets come with microphones and cameras. This is the home screen. I [can] see what’s online.

“There is a closed network. I [can choose to only have them if I] want my family members. My loved ones accept invites. “

Kurtze said that Panasonic’s HomeTeam was the result of two years of research, collaboration with company executives, managers and software developers and outreach to the healthcare market.

“We did not know what to do,” he said. “The number one [priority] is socializing with the family. We [were] led to this discussion [and] we tested sharing Web, technology and support. We found the big thing, [which was] games, books and reading.”

The more the development team learned about the public’s wants and needs, the more they were able to form partnerships with other companies and acquire text and game material, Kurtze said.

“We get a variety [of books] like Curious George,” he said. [These were for] simple reading. [These are] base-level books.”

Schneider said the team will continue research in order to offer more titles. “One of the developers [is involved in] testing,” she said. “We do criticize [the programs to improve them] and work [with] grandparents and children.”

Panasonic’s Health and Wellness Solutions department plans to add more instructional material overtime, Kurtze added.

“We will have informational books [in the future],” he said. “[These books will] teach about animals, science or [other subjects]. There’s a new medium.

“We will learn what people want. [We will] continue to add. [Then we will] adjust [our offerings accordingly].”

Care Angel Tracks Recovering Senior At Home For Families

After five weeks in the hospital for a heart operation, she is recovering at home alone in another town and state.

So how to keep track of mother?

Officially since the spring of 2015, Wolf Shlagman, founder/CEO of Care Angel in Miami and Fort Lauderdale, Fla., entrepreneur and, for 20 years, telemedicine expert, has been offering a solution.

Care Angel is a computerized system that can record and report an aging relative’s vital signs to alert families of any change in health status before they take action.

Billed the “Virtual Caregiver,” the Smart Care “artificially intelligent voice response technology” platform can be customized to record a soothing family member’s voice for the sick relative in question to hear, to provide the relative with care by landline or cell phone using Apple Play or Google Play and to provide health data about the relative for family members.

Shlagman explained that, through company research, he learned that other organizations such as the Diabetes Foundation, offered such health-oriented customized software service.

“Seniors don’t want to burden families,” he said during a demonstration/interview with this writer at an annual conference of the American Society on Aging, a 5,000-member, multi-disciplinary organization addressing different aspects of aging, in response to a question about the program’s different facets.

“[They] won’t check in. It helps seniors [become] more independent. [You] just answer the phone. It’s all audio. [You learn about mother’s vitals and you say, ‘Good’ or ‘Oh, not good.’]

“[You can then communicate by asking your mother,] ‘What’s your blood pressure? [Do you] need anything?’”

The Care Angel program answers questions by family members about their senior relative. The answers are converted into ready-to-use dashboard notification, alerts, care insights and reports on the Care Angel Caregiver app.

If the answers show that all isn’t well or the relative is in need, Care Angel will notify the selected family-and-friend network, also known in the product’s parlance as the Care Circle, to empower them to act quickly to prevent larger problems or tragedy.

“When I set my mother up [with the Care Angel system], it gives [up] information,” he said. “Who else do you want to receive alerts? [You can set up the program to send data to] friends, sisters, brothers and neighbors.”

He explained that senior long-term care and short-term care and chronic illness management in general make up two-thirds of the $3 trillion-plus spent yearly on health care.

Federal research, some of which appears on the Care Angel website, counts at least 50 million seniors in the country, which will increase to 120 million over the next 20 years and more than 1.5 billion around the world.

Research predicts that, in coming decades, adults will live at least 20 years longer, deal with several health conditions, take several prescription drugs, suffer from injuries and fight to stay alive, fully-functioning and independent.

“One of the realizations in healthcare [is that we are spending $4 trillion[-plus in] health care [costs],” Shlagman said. “Two-thirds [of that is in] senior care.”

Meanwhile, about 70 million caregivers are providing much of the senior care, he added. Shlagman pointed to federal research finding senior care fast-becoming the greatest expenditure to every layer of society.

“[The industry of senior care forms] 20 percent of our gross national product (GDP) and [it is] growing,” he said. “ … The task of caregiving [can] take a decade of a person’s life.”

Nearly 40 percent of adults in the nation serve as caregivers for more than 20 hours to their aging relatives who have serious medical issues, taking its emotional and financial toll on them and their families and triggering the $300 billion in costs to businesses, insurers and other facets of society.

As a result, he said, families, insurers and businesses are confronting these issues, finding new means of enabling seniors to age in place and addressing the high costs for senior care.

“It really is about [balancing work with family obligations],” Shlagman said. “It is relevant [to] those issues. You [can’t] be there for [aging] mothers and fathers [as you balance] family [and] work. You don’t connect. Days and weeks [can pass with] no connection [to your aging mother or father].”

In response, he said, Care Angel, also titled Care Angel VIP Care Service, is meant to alleviate such healthcare costs by using technology to inform families of medical problems in advance, decreasing the number of unneeded and pricey hospitalization visits and repeat visits, enhancing results and being detailed about the health status of patients.

“We are growing our company [and we’ve done the] research,” Shlagman said of the company and the previous firms he ran. “We got bought out. We got sold. I asked a colleague of mine [to join me in a new venture and we put together our] collective experiences and know-how.”

Prior to owning Care Angel, Shlagman served as CEO and founder of Consult-A-Doctor from 2007 to 2013, a former telehealth company connecting patients to physicians, and to MyCity Networks, an IT company.

He added that he and his business partner were inspired by their own roles as caregivers to their aging mothers.

“I realized how I took care my mother [and] my partner took care of his mother for 10 years,” he said. “[We both] had caregiving duties and tasks. … It [caregiving] impacts so many people. It has a ripple effect into life and work.

“Among [several] things in my head, [we thought about] what was going to be [our] approach. We really came together [to study this]. We had research and sleepless nights.

“[What we offer through Care Angel] is not out there. I looked at [several programs].”

Shlagman said that the flu, a fall or the wrong medication can worsen matters for chronically ill seniors and their families.

Vital details such as skipping prescriptions, neglecting to make refills, not drinking enough water or other fluids, not eating enough or at all and being inattentive to symptoms should not be overlooked — just because, for instance, an aging mother does not wish to phone family members and burden them with her troubles, he added.

“My mother takes medications,” he said. “She’s up and down. I don’t know how she feels. Care Angel [would serve as a] virtual caregiver, checking on mother [and her] blood pressure [and] alerting me and family members when something’s wrong. [Care Angel is meant to] prevent [mother’s health status from escalating [into something] worse.”

Shlagman said that Care Angel executives and product developers researched and thought about the absence of family caregivers from the care of seniors at home and the level of expense and training required to hire home health care nurses and other staff and to purchase medical devices for use in their homes.

“Home [health care] workers [and] devices in the home are costly [to hire and purchase],” he said. “[There’s] a lot to learn and train. [There’s] a lot involved.”

He added that his team also also took into account every phase of senior care in designing the Smart Care platform.

“We saw [the] senior care continuum [and took it into consideration when developing Care Angel],” Shlagman said. “[It] shifts management [of] care [of] seniors [to this system]. [It helps the] family [keep track of mother].”

They also pondered ease and convenience in developing the platform.

“Our solution is aimed at being so simple since you need to answer the phone,” he said. “You can reach out and talk [to your aging relatives about] services.”

First, a family member using Care Angel registers with the platform and starts the app. He and she then clicks on a green circle with a “person+” icon on the page.

A Care Wizard will appear and instruct the family member to go through the sign-up process, which, Shlagman said, takes two minutes. During registration, he or she will be given the choice of recording a personalized greeting.

If the family member elects to, he or she can click on an “Care Recipient” icon and a “gear icon.” Finding a “Greetings” tab and a pencil icon, the family member can record and listen to his or her recording or hit “Re-Record” to start again.

“[A family member signs in to] Care Angel [and adds all of the information, following the instructions,” he said, demonstrating the platform at the conference. “You tell the system] who to watch [whether that is] mother [or] father and what conditions [they have]. I can record my voice.”

The calls to the aging relative from the Care Angel platform are referred to as “Care Angel VIP Care Calls,” which, Shlagman said, take less than two minutes.

The default setting allows the program to phone once on Monday, Wednesday and Friday but family members can edit the defaults to customize the system for their sick relative’s needs, he added.

Questions include “How did you sleep? How do you feel? Are you in pain? Did you take your medicine? How is your appetite? Did you drink enough water? Have you been exercising?” The system also inquires about blood pressure, blood sugar and oxygen level of the aging relative.

“[Care Angel will] call mother from the app,” Shlagman said. “ … [The] service will call [the family to let them know what is happening]. [The family] checks in on her. It [asks] her questions. [It learns if] she’s in pain [or if there is] blood.”

Family members can view data about the senior relative daily, weekly or monthly on the Care Angel VIP Care dashboard if they set it up and have access to Care Insights to learn about negative or positive health trends concerning the patient.

“[When we program the system,] we are asking [Care Angel] to take [our loved one’s] medical, blood pressure and glucose readings,” he said. “[The system] tells us what [mother’s vital signs] are. [The] reports [on mother’s vital signs] will be sent to families.”

In fact, the dashboard, which obtains its data from the Care Calls, includes information about the relative on sleep, feelings, needs, water, exercise and appetite. The Vitals section of the dashboard contains readings on blood pressure, sugar and oxygen levels if the family members set up Care Angel to retrieve it.

Through the calls and Care Alerts, the members can learn, for example, whether the relative is drinking enough water, taking his or her medicines or what their blood pressure readings were in a month.

“I [as a family member] will get alerted,” Shlagman said. “I will see the Care [Angel] insights, including blood pressure and glucose. [I learn if she is] sleeping or [how she is] feeling or, [for example, what is her] glucose [level].”

The Medications section of the dashboard exhibits whether medicines were taken, missed, skipped, ran out or were scheduled to be taken later. The Care Reports section maintains a summary of the relative’s health data in one site.

“Mother has high blood pressure,” he said. “[The Care Angel programs] are managing the blood pressure. [The Care Angel programs] are self-managed. [The program is designed to guarantee prescription drug use] adherence [and to deal with] unplanned [events].”

And the entire system can be accessed by families for free.

“Millions will use [it for] free,” Shlagman said, mentioning other software platforms Pandora and Spotify in terms of pricing and profit margins. “[There are] additional features. We want to provide as much value [as possible]. We [want to provide] additional value.”

He added that he worked with a number of senior-care organizations at the conference to forge partnerships to support and further develop Care Angel.

“[I am] working [with] partners at this conference,” he said.

“Everyone [is] in the care continuum. We may interface [with] organizations and may have contracts. [We are interested with partners who want to] help seniors and lower costs [for families]. A lot of [people] want to add value. [A] lot of customers look at what we are giving [them].”

Shlagman said that his team is dedicated to growing and enhancing Care Angel.

“Whenever you have any product, it’s a living, breathing thing,” he said. “You can get incredible [results]. [There is] constant [research and fine-tuning]. [It’s] never-ending. [It’s more] improvement. [We] take feedback.

“We want to help a million-plus families. [We are] helping families watch their loved ones. We [will] grow as quickly as it takes [to make it] grow.”

Age-Friendly Banking Instructs Seniors On Services, Guards Against Abuse, Experts Say (Part Five)

Chen said the Federal Reserve Bank there hosted two discussion events of their own. Participating seniors learned what services are being offered by their local area banks. Quarterly newsletters are released about these services and products. The center’s work is available at its website at

In like fashion, Aery said the coalition recruits ambassadors to teach seniors about financial abuse and exploitation issues and to go to Sacramento, the state’s capital, to lobby on their behalf. The ambassadors are recruited in Folsom in Sacramento County in California.

“[These seniors are visible] advocates for [all] elder adults in their community,” she said. “[They are] valuable partners [and model] citizens [in our initiative].”

One of the most critical pieces of legislation watched by the coalition is the California Homes and Jobs Act (SB 391), a popular bill designed to provide jobs, financial investment and safe and affordable apartments and single-family homes for state residents in need, including families, seniors, veterans, the disabled and the homeless.

As of February 2014, with 31 co-authors, 600-plus sponsoring organizations and 400-plus individual sponsors, the bill lacks three votes in the state legislature to achieve passage into law.

Rangel, Bank of the West’s senior executive, said her bank provides a financial services roundtable of BITS, a non-acronym of an organization also known as the Financial Services Roundtable’s Technology Task Force, which represents an association of the nation’s 100 top financial services with interests in technology.

Bank officers provide services in financial exploitation, at-risk adult training curriculum and education, fraud detection, identity theft and secure retirement and a working group on these issues.

“[We look at and address] challenges and impediments,” she said of her bank. “[We provide] group training for advocates and education for seniors. BITS [serves by providing the] at-risk adult training curriculum.”

Rangel said that the bank contacts other banks and tries to avoid embarrassment for its senior customers with respect to financial abuse and exploitation. She said bank officers check credit reports to protect older customers against identity theft.

“[We make sure our senior customers] stay active and engaged with others,” she said. “[We ensure that they] establish [a] budget and keep money management.

“Isolation is a great danger. [It is important that our senior customers] protect [their personal and financial] identity. [We caution them not to] give away [their] Social Security numbers. [We try to] take away [the] stigma [of their victimhood for abuse and exploitation].”

Rangel said that Bank of the West sponsors “Be Aware” workshops. The bank started the program in 2007 to comply with California laws requiring banks to create and host customer education workshops.

“[We] partnered with nonprofits,” she said. “[We] let the [bank] branches [customize their educational programs]. [We brought in community] resources, law enforcement agencies and [the] FBI [in to] talk about scams. [We had participants] share [their] experiences.”

Rangel added that the bank took part in a governmental program, especially with the different counties and other states to enable industrial shredders to dispose of documents containing sensitive data about senior customers.

As an example, she said, one of the bank branches in Omaha, Nebraska sponsored an event program titled “Be Aware” Seniors. The program was started and run by a legal aid society in Nebraska, she said. The Attorney General in Nebraska provided a free shredding service.

Rangel said the bank “[carried out much of the] heavy lifting” to inform seniors about financial abuse and exploitation on their website. The nonprofit Elder Financial Protection Network’s (EFPN) work can be viewed at and

She said the development of the website was “labor intensive [and took] a lot of time to manage in 2009”. The intent, Rangel said, was to reach more people about financial abuse and exploitation.

“[Our bank was responsible for] education and outreach [with a] broad dissemination [of content to our] target audience,” Rangel said. “[In our materials, we] defined financial elder abuse [with an] actionable message [from] trusted sources. [We formed] partnerships [with a variety of public and private sponsors].”

Event participants were advised not to let caregivers isolate seniors and urged them to make surprise visits of their homes.

The bank participated in and supported the San Francisco District Attorney’s campaign, she added. The campaign was a citywide multilingual business advertisement effort on elder financial abuse. She said the bank made sure that its officers generated “linguistically and culturally appropriate community outreach and press events [and materials].”

Rangel said the challenges of the bank’s age-friendly banking initiatives are “reporting out of their benefits, licensing of financial professionals serving elders, meeting the need for additional education and lobbying support for a national reporting statute.”

She explained that it is the duty of the executor of a will and the power of attorney to exercise the authority to authorize a protective hold on a customer’s finances and property and to grant permission based on age-based fraud monitoring.

“[We need to ask basic questions like:] are we violating other laws by monetary fraud?” Rangel said. “[We need to address the] hold harmless [clauses and instances of] suspected fraud.”

She explained that the bank approaches the financial institution’s trusted advisor on behalf of its customers. Bank officers take into consideration the turnaround time for reporting and exercising authority.

The bank performs internal training on SARS, also known as “suspicious activity reports” and trains families. Its officers check for fraud and the speed with which it is committed. During banking events, the officers field questions in the audience about the training and fraud monitoring programs. Many banks participate in the Elder Financial Protection Network, a “turnkey solution” meant to address the financial abuse and exploitation questions that has “received a great deal of support,” she said.

“[Seniors are at a] vulnerable stage [in their lives] and [have] given so much to society,” Rangel said. “[We believe it is worth the effort to] galvanize people to care about this.”

Read This Story From The Beginning:

Part One

Part Two

Part Three

Part Four

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Age-Friendly Banking Instructs Seniors On Services, Guards Against Abuse, Experts Say (Part Four)

“[This meant that there were] a lot of people [without affordable housing in California. There was] only one of me, my boss and support staff [performing this work]. We wanted to produce something of value.”

Firstly, Aery said, the coalition performed assessments of units and properties in rural communities. Coalition staff visited the member organizations in their offices. They examined the current services of their organizations, resident characteristics and site capacity.

Secondly, coalition personnel examined the implementation of the coalition’s recommendations and directives through resident surveys, educator workshops about financial empowerment and roundtable discussions, she said.

The surveys consisted of 11 questions, which were multiple choice, and were meant to be confidential. Aery said that the objective was to discover what seniors were dealing with in terms of banks and financial exploitation.

She explained that senior respondents were asked about checking accounts, banking and check cashing. Coalition staff found it interesting to tabulate the number and type of questions they skipped on the surveys.

“[We examined] implementation [at our] roundtable discussions,” Aery said. “We wanted to show real people are being affected. [We wanted to] do something other than surveys.

“[So we carried out] raffles for surveys. [We had] appetizers [and drinks for] two-hour long discussion events.” The events occurred at the Reserve Bank in Napa, California.

At the event, she said 15 to 25 older adults related the incidences of quality services, abuse, neglect and exploitation they experienced and the time of the events. There were three- to five-person discussion groups to allow them to share stories of banking experiences.

She added that coalition staff discussed implementation of the umbrella group’s recommendations of housing and financial services at the financial education workshops. Coalition personnel have used these discussions and data to implement solutions to the problems raised by seniors attending the event.

The seniors at the event, Aery said, “strengthened the well-being of their peers [through open dialogue].”

“[We talked about] examples,” Aery said. “[We presented scenarios of seniors who] won a fake lottery or [who participated in] a fake banking event. [Seniors explained] what they [would] like to [have] happened and [what actually] happened. Each group talked to everyone [after their own discussion sessions]. People were excited.”

Elaine A. Chen, training coordinator of the Center of Excellence on Elder Abuse and Neglect at the University of California at Irvine School of Medicine’s Division of Geriatric Medicine and Gerontology in Orange County, Calif., said the center is performing similar age-friendly banking activity. The center serves as the local clearinghouse for the federal National Center on Elder Abuse with funding from the federal Administration on Aging (AoA).

Continued: Part Five

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Age-Friendly Banking Instructs Seniors On Services, Guards Against Abuse, Experts Say (Part Three)

“[We make] recommendations [to enable banks to] create and customize financial products, [including] low-cost, low-fee accounts,” Zdenck said. “[This] requires financial institution staff to identify fraud and abuse. [It all supports] age-friendly banking.

“[Under the GO Direct program sponsored by the Federal Reserve Bank and the U.S Department of the Treasury,] all benefit payments [are scheduled] to go electronic. Direct deposit [is] better [for seniors] than debit cards with hidden fees. Yearly benefit check-ups [are offered] for older adults [to ensure that they are being served properly by government agencies]. [And we help banks work to] expand housing and financial options. [We examine and improve upon] CDFJs [County Department of Job and Family Services] and reverse mortgage.”

The next steps are to generate age-friendly banking papers, Zdenck said. NNS must provide introductory policies, campaigns and age-friendly banking standards to further assist banks in helping seniors, he said.

“[We need to look at the] recession in terms [of] elder abuse,” he said. “It’s so underreported. [There is] an uptake in outreach efforts. [For example, the] Hispanic community [is in great need of such initiatives to examine and prevent elder abuse].

“It may be [a series of life] circumstances [that are involved]. [The] climate [of the caregivers may not be conducive to ending elder abuse]. Elders [should] feel comfortable [enough to conduct financial activity without the fear of abuse]. They [should] know what steps to take and how to report crime. We are realistic partners [with banks] when it comes to assessing and acting on the life circumstances of seniors].”

Stacey Easterling, Program Officer of the Atlantic Philanthropies, the National Council on Aging (NCOA), a nonprofit senior services organization, and Better Directions, a program by the National Federation of Community Development Credit Unions to help low-to-moderate income seniors become economically secure, formed a team to develop and offer earned income credit to low-to-moderate income taxpayers around the country through the Internal Revenue Services (IRS). Benefits checkup for individuals, especially seniors, is only available in at least 20 states, he said.

“We don’t expect [a] doubling [of] banks, [especially the most age-friendly ones],” Zdenck said. “Banks are [expected to learn about], understand [and urge their aging customers to use] benefit screening. Elder individuals are not the only ones who don’t [know about this service].”

NCOA developed benefit calculators of government social assistance programs online at to enable individuals to determine which forms of aid they qualify for in their states of residence.

Rebecca Rangel, senior vice president of community affairs of Bank of the West in San Francisco, which has branches in 19 states in the Midwest, West Coast, North Central and Southwest regions of the country, said that benefits screening impacts the tax season because of seniors’ financial and government benefits habits.

“IRS has a form [known as the] 888 refund,” Rangel said of the IRS application sheet used to direct taxpayers’ refunds to their bank accounts or to purchase savings bonds.

“[If seniors] don’t see [the] money, [then they] don’t spend. [The idea is to] increase bank networking. Younger people are decreasing bank networking. [They are banking more and more by] telephone [and on the] Internet. [These are critical issues in] branch banking. [We need to make our banks] more accessible.”

To learn more about senior’s banking practices and experiences, Sonia Aery, director of the Asset Building programs of the California Coalition for Rural Housing in Sacramento, Calif., said her organization performed their own research. The coalition’s work can be viewed at its website at

One of the discoveries made through research, Aery said, is that California has one of the oldest housing industries in the country as well as some of the most affordable homes, many of which are owned or occupied by seniors. The coalition has 15 grantees receiving funding and technical assistance to support community empowerment and eco-activity.

She added that there are three phases of coalition work: the invitation and engagement of member organizations under the umbrella group, assessment of the state of housing and socioeconomic status of communities and the work of the organizations and the implementation of their solutions to issues and problems.

To perform the assessment aspect of the coalition’s work, Aery said that research was conducted on its member organizations.

“[We] sent surveys to [community housing] developer members [of our coalition],” she said. “[We asked what was the] number of [housing] properties [in the state and] where [were they located. How many tenant organizations [were there]? [We learned by] RSVP [that there were] 3,400 [affordable senior housing] units [and] 64 properties statewide.”

Continued: Part Four

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Age-Friendly Banking Instructs Seniors On Services, Guards Against Abuse, Experts Say (Part Two)

With the struggling economy, bank savings among the nation’s population, including seniors, are decreasing and the use of defined benefits is rising. Additionally, Social Security accounts for 30 percent of the average older adult’s income and this figure is growing, he added.

Zdenck said federal research also found that 19 percent of seniors are unbanked; they didn’t have a bank account or participate in any banking services at all. The reason, he said, is that many seniors feared predatory lending, financial fraud, abuse and exploitation.

“[It] surprised me,” he said. The American Association of Patients and Providers (AAPP), a Seattle, Wash.-based organization aimed at promoting more efficient and cost-effective delivery of healthcare services, and the Center for Financial Services Innovation (CFSI), an organization targeting “unbanked” and “underbanked” consumers, such as seniors and low-to-moderate income families and communities, released the figures.

To carry out the research project, a survey of interviews of 14 of the largest banks in the country was conducted. The investigative effort consisted of financial practices research data and expert interviews and relied on the experience of banking practitioners.

“[Researchers learned that] financial institutions had no data on older adult customers,” Zdenck said. “No single bank [the researchers interviewed] developed an array of comprehensive products and services armed at seniors. Services [didn’t] meet the needs of older adults.”

As a consequence, he said government agencies such as the Consumer Financial Protection Bureau (CFPB), the Federal Trade Commission (FTC), the Federal Reserve System (FRS), the Office of the Comptroller of the Currency, Federal Deposit Insurance Corporation (FDIC)’s Consumer Response Center and state banking authorities, the National Credit Union Administration (NCUA), the Small Business Administration (SBA) and the U.S. Department of Commerce worked with the banking, housing, community development and geriatric medicine sectors to address this gaping need.

“[We need to] improve regulations, data collection and law enforcement at the state and federal boards,” Zdenck said. “[We] work with federal regulators to have [aging in place directives] as explicit [as the] CRA [Credit Reinvestment Act] investment and [bank] service test [to motivate banks to invest in low-to-moderate income and disadvantaged communities].

“Our principles [are to] protect older adults from fraud and abuse. [We are constantly] adapting and learning [how to achieve this better]. [We] train bank officials on detecting fraud and abuse. [We get them to] customize financial products and services for older adults. [We get them to] offer transparent, low-cost, low-fee accounts. [We ask them to] expand affordable financial management.”

Zdenck said NNS and other federal agencies must help banks to engage seniors in investigating the government benefits that may support them.

“[We help their customers to] access critical income supports and offer education to older adults,” he said, stating that NNS’ Housing Counseling Network and National Training Academy provides seniors with financial and housing consumer education.

“Financial institutions should have benefit screens. [For example, seniors are] not applying to food stamp programs or SNAP [the federal government’s Supplemental Nutrition Assistance Program] because they don’t know about them.”

Zdenck said that one of the issues raised by seniors about conducting business with banks is their physical accessibility. He said that LEED represents voluntary standards for building designs and the banking, architectural and civil engineering markets responded to the government’s age-friendly banking endeavors with implementing them to accommodate senior customers. As a result of government and business partnerships, most bank branches are now LEED-certified.

“[The development and opening of branch banks is] modeled after LEED building principles,” Zdenck said, explaining that LEED, also known as the Leadership in Energy and Environmental Design program by the U.S. Green Building Council (USGBC) to regulate environmentally correct building and construction.

“[We want to] improve access to bank locations and services [and build and open more] bank branches and online development. [To further physically accommodate seniors, we want to] facilitate aging in the community [with such services as] home repairs and modifications.”

He said that NNS assists banks in providing products and services, offering income supports and benefits and housing counseling to seniors. This has reduced the number of unbanked seniors.

Continued: Part Three

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Age-Friendly Banking Instructs Seniors On Services, Guards Against Abuse, Experts Say (Part One)

State and federal agencies and banks are partnering to enact age-friendly banking practices to teach seniors about the different services and products they offer and social benefits and to protect them against financial abuse and exploitation, four panelists at a conference on aging said.

Four government, banking, housing, community development and geriatric experts in their panel presentation on “Age-friendly Banking” at the Aging in America conference hosted by the American Society on Aging in downtown Chicago said that, with the new national policy, which is aimed at eliminating discriminatory practices toward seniors, older customers can learn about financial services relevant to them, government benefits, retirement plans, financial abuse and exploitation, fraud detection and identity theft.

Robert Zdenck, director of the National Neighbors Silver (NNS), the age-friendly banking division of the National Community Reinvestment Coalition (NCRC), a federal agency in Washington, D.C. charged with increasing capital and credit to underserved communities nationally and ending discriminatory banking practices, said his department has 15 grantees around the country.

“[We provide] community development counseling,” Zdenck said. “We are eclectic [in terms of the nonprofit housing and community programs we fund and provide technical assistance for]. [The aim to increase capital] flow and credit to communities.”

He explained that NNS has a multi-year funding and technical assistance campaign to fund 15 units around the country in the areas of advocacy, organizing and direct service.

It works closely with the banking industry, having cultivated 15 partners, including the California Coalition for Rural Housing, an umbrella group of fair, adequate and affordable housing advocacy organizations in the agricultural regions of California that carries out its policy objectives with the seniors it serves.

He said that NNS assists seniors with their finances in the case of bank foreclosures. NNS also helps seniors secure their estate plans, modifying them to their wishes as necessary, and locates funding and resources for their home improvement goals.

“Why not [provide seniors with] more advice about [their] investments?” Zdenck said. “[Why not tell them about] senior discounts [when they make purchases?] How does the recession limit [their purchases and other financial activity]? Why not [choose] credit unions? [They are a] better deal for seniors.”

One-third of the country’s population banks with credit unions, Zdenck said. The credit unions are the hub of socially beneficial banking, he said.

Among the senior population, the membership of NNS has noticed increased fraud and abuse. The Atlantic Philanthropies funded NCRC’s organizational and advice campaigns against elder financial abuse and exploitation.

“Why age-friendly banks?” Zdenck said. “[With the] increase in the number of older adults [in the country comes] growing economic vulnerability. Fraud and abuse [are] rampant. Financial institutions have a critical role to play [in] fostering [the movement by seniors to] age in place.”

What are banks doing about this upsurge in senior financial abuse and exploitation, he asked? Zdenck responded that, according to federal research, banks and lending institutions will have served 35 to 72 million individuals between the period of 2000 to 2030 on this issue. Twenty percent of these customers will be older adults.

With the decline of what economists call “the three-legged stool,” namely, savings, pensions and income supports, less than 30 percent of the country’s population have defined benefit pensions, the common category of pension plans in which employers promise to pay a specified monthly benefit on retirement determined by a formula based on employees’ earnings, length of time of service and age.

Continued: Part Two

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part Three)

Both researchers said that each of the 50 states they studied protects seniors from physical abuse, financial or material exploitation and neglect but definitions vary. Forty-four states carried emotional or psychological abuse provisions or laws. Forty states had laws or provisions on self-neglect. Thirty-seven states addressed sexual abuse. Thirteen states protected against abandonment. Ten states – Alaska, California, Hawaii, Louisiana, New York, Pennsylvania, Rhode Island, Utah, Washington, and Wyoming – defined all seven NCEA categories of abuse.

For example, Virginia identifies adult abuse as “the willful infliction of physical pain, injury or mental anguish or unreasonable confinement of an adult,” combining both physical and emotional or psychological abuse. Hawaii defines psychological abuse as “the infliction of mental or emotional distress by use of threats, insults, harassment, humiliation, provocation, intimidation, or other means that profoundly confuse or frighten a vulnerable adult.”

For independently-defined abuse, no state, Jirik and Sanders said, had independent definitions of all seven NCEA categories of abuse. This held for six states on physical abuse; 46 states on financial or material exploitation; 46 states on neglect; nine states on emotional or psychological abuse; 16 states on self-neglect; 17 states on sexual abuse, and eight states on abandonment.

For age definitions, sixteen states specified ages 60 and older; six states, ages 65 and older; Hawaii, ages 62 and older; 14 states specified two ages for persons under its elder abuse law, age 18 and older and ages 60, 62 or 65 and older. Four states – Maryland, Mississippi, North Dakota, and West Virginia – had no specified age for a defined population. The remaining states defined the age of requirement as 18 years and older.

Jirik and Sanders pointed to a lack of consistency among the 50 states on training requirements under their elder abuse and neglect laws with some provisions being detailed while others were vague. Thirty-two states did not define any training requirements for investigators of senior abuse or the categories of professionals to be involved, although training could be at an administrative or department level or regulated in a different law or code. The remaining 19 states specified training for investigators of elder/dependent adult abuse and the type of professionals required.

Read This Article From the Beginning: Part One

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part Two)

In recent years, both said, state laws on elder abuse and neglect have expanded. In particular, more states are requiring mandatory reporting of incidents. In 2000, researchers found that seven states did not demand reporting of elder abuse and neglect cases, a figure that has now dropped to three states.

States have greatly expanded the categories of abuse prosecuted. In 2001, researchers found abandonment to be addressed in 10 state laws, a number which has grown to 13 states. In that same time period, 42 state laws included emotional abuse in its categories and this has extended to 44 states.

Still, by comparison, Jirik’s and Sanders’ research paints a grimmer picture: abuse definitions vary from state to state; only eight states have specific elder abuse laws, namely, Connecticut, Illinois, Massachusetts, Ohio, Oregon, Pennsylvania, Rhode Island and Wisconsin.

Few states, they said, protect against all seven categories of elder abuse as defined by the National Council on Elder Abuse (NCEA) under the U.S. Administration on Aging, and have specific laws on mandatory reporting and penalties for failure to report, specifically, California, Pennsylvania, Rhode Island, Utah, Washington and Wyoming. Many types of abuse are not independently defined but described in general. While state laws share particular concepts, they all differ in the details and the methods in which they are carried out, making scientific comparison difficult, they said.

In fact, Jirik and Sanders reported, many of the professionals central to the study reported feeling unable to intervene on behalf of seniors in trouble, have had to grapple with the self-determination and mental competency levels of their victims, found difficulty understanding and applying the laws of their state, did not succeed in having the cases they report accepted for investigation and found it hard to partner with under-resourced and under-trained investigative agencies.

To embark on their study, both researchers examined elder laws in state university libraries or government websites, focusing on state laws germane to home-based community services (HBCS) instead of senior long-term care facilities. Jirik performed the coding for the laws and reviewed them with Sanders. Both discussed the outcomes with two other elder abuse researchers, sampled particular states and phoned their elder abuse program directors to confirm their findings.

Concentrating on 2011 and 2012 state laws, Jirik and Sanders made records of statute numbers and titles, the type of victims covered, elder abuse cases versus dependent adult abuse cases, definitions of elder abuse, comparisons to the categories defined by the NCEA, mandatory reporting requirements and penalties, investigative agencies, provisions of consent and professional training.

This mode of collection was based on two well-known attempts at elder abuse law analysis: the 2000 articles titled “Statute Definitions of Elder Abuse” by J. M. Daly and G. Jogerst and “Adult Protection Service Laws: A Comparison of State Statutes from Definition to Case Closure” by L. Roby and R. Sullivan.

NCEA defines the following seven terms of elder abuse and neglect as follows: physical abuse as “acts of violence, physical punishment, inappropriate use of drugs;” emotional or psychological abuse as “threats, humiliation, harassment and isolation;” financial of material exploitation as “misusing or stealing money or possessions;” sexual abuse as “unwanted touching, including all types of sexual assault or battery;” neglect as “failure or refusal to provide elder with necessities such as food or medicine;” self-neglect as “failure or refusal of an elder to provide himself or herself with necessities;” and abandonment as “desertion of an elder by person who has assumed responsibility for [an] elder.”

Aside from finding that only eight states had elder or dependent adult abuse laws, Jirik and Sanders found that 14 state laws protect both dependent adults and elders from abuse with California’s “Elder Abuse and Dependent Adult Civil Protection Act” being a prime example. Twenty-nine states have dependent adult abuse laws that include seniors under certain conditions such as New Jersey’s “Adult Protective Services Act” for victims aged 18 and older, mentally or physically disabled persons and victims of abuse, neglect or exploitation.

For mandatory reporting, both researchers found three states – Colorado, New York state and North Dakota – did not specify mandatory reporting. Six states – Delaware, Indiana, North Carolina, Rhode Island, Utah, and Wyoming – had a universal mandatory reporting requirement. Thirty-one states required a specific class of professionals to report incidents. The remaining 11 had a universal reporting requirement with a list of specific professionals.

For penalties for failure to report, Jirik and Sanders found that 42 states have penalties, which include classifying the negligence as a misdemeanor, applying a fine of a $500 maximum and imposing a six-month jail term. Six states – Delaware, Indiana, Maryland, New Jersey, North Carolina, and Ohio – did not specify a penalty for professionals who failed to report. Three states – Colorado, New York state and North Dakota – have neither a mandatory reporting law nor penalties.

Continued: Part Three

This article was originally published March 10, 2014 on the website of, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.