There are some pretty bad stories about people who were really messing up and losing a lot of money — in
some cases, their retirement nest egg — and the people around them, even their spouses, didn’t realize it.

— Naomi Karp ’76

At the same time that the elder justice system leaves a lot to be desired, we do have a certain amount of power to anticipate and plan for our own needs and those of the elders we care for. One way to do so is to think in terms of capacities: the capacity to manage finances; to make healthcare decisions; to food shop, cook and clean; to drive; to tend to our personal hygiene; and so on. Breaking out which capacities will diminish over time and which may be lost in an instant can help us anticipate what to plan for. Internet searches on topics like elder justice, caregiver training, aging in place and more can yield good resources to get started — with the caveat that all sources should be vetted for trustworthiness. And we can make sure that the lawyers we hire to draft powers of attorney and advance directives accurately express our personal wishes; help us thoroughly understand what we are signing, both the potential upsides and downsides; and discuss with us how to inform others of our plans.

Naomi Karp ’76, a policy analyst and researcher in the field of elder law whose clients have included the federal Consumer Financial Protection Bureau and AARP, focuses on the capacity to manage finances. “Studies have shown that financial capacity is one of the first, if not the very first, types of capacity to decline when someone is moving into mild cognitive impairment,” says Karp. Naming a “trusted contact” to call in case of suspicious activity and allowing banks, brokers and financial institutions to put temporary holds on accounts when they suspect fraud are critical and reduce the risk of personal bankruptcy. “There are some pretty bad stories about people who were really messing up and losing a lot of money — in some cases, their retirement nest egg — and the people around them, even their spouses, didn’t realize it,” she says.

Karp is the co-creator of the Thinking Ahead Roadmap, a practical guide for seniors that helps them designate a trusted financial advocate to help manage bill paying, government benefits, taxes, insurance and nest eggs. The idea is for older people to decide in advance who will be in charge of their money, rather than leave that decision to courts or others not of their choosing. “Financial advocates — who are typically agents under a power of attorney — can handle your money matters, like paying your bills, repaying money you owe, applying for government benefits, managing property, paying taxes, filing insurance claims and keeping an eye on your retirement savings,” says Karp, who notes that planning guides can be downloaded from the Thinking Ahead Roadmap website.

The financial advocate model has a corollary in a solution used by Page Ulrey ’93, senior deputy prosecuting attorney at the King County Prosecuting Attorney’s Office in Washington State. Under a grant from King County, her office deploys a multidisciplinary team of prosecutors, case managers, adult protective services investigators, police, geriatricians, capacity evaluators and other professionals to assist elder victims of crime and to coordinate investigations. The team frequently uses the services of a daily money manager, who, as part of the team, works with older adults who are victims of financial exploitation to assist them in recovering by managing their finances and protecting them from future victimization.

As a prosecutor, Ulrey has come to appreciate the importance of primary care providers and doctors as a first line of defense. “Doctors are often in a unique position to see signs and symptoms of abuse, neglect and even financial exploitation,” Ulrey says. A doctor may be the one person an isolated elder visits and trusts enough to disclose troubling circumstances to. In most states, doctors are legally obligated to report signs of abuse of elders or vulnerable adults to adult protective services, increasing the chances that the system will intervene — though that, too, can be complicated. Ulrey also recommends that doctors do better screening for dementia in order to catch it early, enabling patients and their families to plan further in advance. Recent research shows that people lose on average half of their net worth in the eight years leading up to a dementia diagnosis.

 

Doctors are often in a unique position to see signs and symptoms of abuse, neglect and even financial exploitation.

— Page Ulrey ’93

When a crisis hits, far too many aging adults and their caregivers are left to flounder. Some of them are clients of Deborah Filler ’84, a senior staff attorney at Greater Boston Legal Services. “We’ve had cases where the reason for a threatened eviction is housekeeping problems: the elder doesn’t have the capacity to keep their apartment in acceptable condition without needed services,” she says. “There are cases where people’s lack of personal hygiene creates either odor or incontinence problems that not only cause problems inside their own apartments but also affect neighbors, and that can lead to eviction notices. These issues also require necessary home-based services.”

Isolation, Connolly says, is the enemy. “We know that if you get isolated, you’re at a much higher risk for very bad things happening,” she says.

To answer the need for home-based services, there are programs such as MassHealth’s Personal Care Attendant Program, which helps qualifying individuals by providing funds to hire personal care attendants, and the Program of All-Inclusive Care for the Elderly (PACE), which combines Medicare and Medicaid benefits, providing comprehensive care and services to eligible seniors who need nursing home–level care but want to stay in their homes and communities. But with more than 17 million Americans over 65 living at or below 200 percent of the federal poverty level — that is, $31,300 per year for a single-person household in 2025 — according to the National Council on Aging, the strains on programs like these and others are tremendous and the resources inadequate.

Even for those with the ability and finances to seek care privately, the numbers don’t add up. Geriatric care is shown to improve health and extend independence, but although the US is expected to need 30,000 geriatricians by 2030, there were only 7,400 in 2022. According to Connolly, adequate staffing leads to better elder care and outcomes in facilities — but many facilities are understaffed, in part because of a severe shortage in the elder care workforce.

Connolly says the reactive model isn’t working. Instead, we must anticipate possibilities through upstream prevention, including using more evidence-based solutions and holistic, multidisciplinary approaches. She is part of the RISE Collaborative, which builds and tests new approaches to helping people take on the challenges of aging in more effective ways. Through the US Department of Justice and Department of Health and Human Services, she co-authored the Elder Justice Roadmap — a national strategic plan offering guidance for policymakers, researchers, nonprofits and practitioners to set priorities and take action in the areas of direct services, education, policy and research.

As we contemplate the needs of the aging, Connolly emphasizes that elders also deserve lives filled with joy, meaning, connection, fun, creativity and curiosity. Data shows that embracing the good can help us ward off some of aging’s perils, and doing so is in everyone’s reach. “There are no silver bullets, but a fuller contemplation of what it means to live long lives can help us move the needle — away from the negative and toward the positive aspects of aging. Paying more attention to where we want to end up, and helping others do the same, is the first step,” she says.

“Everywhere, everyone is aging,” says Connolly. “Everywhere, someone loves someone who is growing old. Everywhere, decent people do their best, with too little help, wonder how to do right, wonder if someone will do right by them, wonder how not to be broken by it all …. If we bring the same ingenuity, will and hope we’ve invested in lengthening life to improving it, much is possible: common consolations; a deeper, more lasting justice.”