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TBG-Elder Justice Coordinating Council Meeting 

6/21/2022 9:00 AM 

CONFIDENTIAL ROUGHLY EDITED REALTIME FILE 

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This file was created in real time by a Certified Realtime Captioner for the purpose of 

communication access. It is not a certified legal transcript and may not be entirely verbatim. 

It is intended for use by the consumer only as notes of the proceedings. A consumer should 

check with the presenter for any clarification of the presentation. 

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>> Allison: Good morning and welcome to the members of the 

elder justice coordinating council. I'm also pleased to 

welcome members of the public who are joining us via live 

stream. It's a pleasure to open this first meeting of the 

Elder Justice Coordinating Council for 2022 which marks ten 

years since the first EJCC meeting was convened. My name is 

Allison and I am the administrator for community living, active 

administrator and assistant secretary for aging. I serve as 

the delegated chair of the EJCC, standing in for the U.S. 

council. Before I begin discussing today's meeting format, I 

want to highlight why the EJCC meeting is always held in June. 

This month contains a special day that is observed around 

the globe. On June 15th, we commemorated elder abuse day. 

They worked with us to plan our annual campaign for world elder 

abuse day. This year, we came to the nation purple, lifting up 

the almost 200 events from across the U.S. for example, 

Wisconsin hosted 21 events, Texas hosted 17 events and North 

Carolina hosted 17 events. Among the many creative events that 

were held, I want to highlight a few. The Alzheimer's 

foundation in Florida, posted a community expo and stroll down 
the memory lane. In Georgia, the cob county government had 

yarn storm project where they accepted donations of knitted or 

crocheted squares and displayed them to honor older adults and 

bring attention to the elder population. The Kickapoo, the 

human and health services in Wisconsin, ran a hygiene product 

drive and placed pin wheels around the community showing the 

number of APS referrals. The WWBL radio station in Indiana had 

a discussion with the Illinois department of aging director 

about financial exploitation and other common forms of abuse. 

And the Texas Department of family protective services housed 

its third annual elder abuse awareness day parade. This year 

was truly a nationwide and worldwide event and we shared with 

the public information about events in 12 other countries 

including Canada, Australia, the United Kingdom, New Zealand, 

Trinidad, India, guitar, Singapore, South Africa and South 

Korea. This is evidence of progress. Communities working 

together through Webinars and trainings to walks, resource 

fairs, proclamations, wearing purple pens in solidarity and via 

social media campaigning to end elder abuse by spreading the 

word about how do I identify risk and by taking part in 

prevention activities, showcasing interventions and 

disseminating resources. 

All of these actions left us with a hopeful feeling last 

week. This meeting and this month's commemoration reminds us 

all of our obligations to secure a just society in which older 

Americans live free from abuse, neglect and exploitation. We 

have a collective responsibility to ensure elder justice. To 

build greater awareness of the ways to prevent elder 

maltreatment and to identify and implement solutions to end 

abuse, neglect, and exploitation when it occurs and to recover 

from it when it does happen. By doing these things we are 

building a better society for all of us including older members 

of our communities. That is why we are here today to share 

some of the most pertinent updates from the field of elder 

justice. Today we'll be hearing from experts in government, 

academia, the non profit sector and from international 

partners.

They'll speak about two important subjects, nursing home 

reform enforcement and resident's rights and then what we know 

about effective messaging strategies to prevent scams and 

frauds that target older adults. Let me tell our members of 

the public a little bit about the elder justice coordinating 

council. 

The EJCC is composed of members spanning 17 federal 
 

departments, agencies and other entities with responsibilities 

for addressing elder abuse, neglect and exploitation. The 

EJCC's purpose is to ensure coordination across the federal 

government in elder justice and specifically to make 

recommendations to the health and human services secretary with 

the coordination of activities related to elder abuse, neglect, 

exploitation, and other crimes against older adults across the 

federal government. The council also provides Congress with a 

by annual report of opportunities, accomplishes and 

recommendations for further action. 

Housing and urban development, justice, labor, treasury and 

veteran's affairs and from America Corp, the consumer 

protection bureau, the FCC and FTC, the Social Security, U.S. 

postal inspection services and EJCC's most recent addition, the 

legal services corporation. We are honored to welcome the 

Legal Services Corporation today as our newest member. I want 

to personally welcome Ronald, LSC President who is the 

appointed president of the LSC effective February 20th of 2020. 

LSC has played an instrumental role in promoting elder justice 

and elder rights by administering grants that provide vital, 

civil legal aid in every state. With LSC as a member, I am 

confident that EJCC will even more meaningful address the 

justice gap experience by lower income older Americans. 

I also want to take a moment to thank the many members of 

our audience especially those who provide legal assistance and 

often provide life saving, legal support to America's older 

adults. At ACL, we know firsthand of the great work being done 

by legal assistants organizations funded through the older 

Americans act and the legal services corporation and I am sure 

that each member of this council can point to their experiences 

with a legal aid assistant organizations and communities across 

our nation. To each of you, thank you so much for your 

dedication and support. Many of you may notice that the format 

of today's meeting differs from the usual structure and the 

structure of our last meeting. We will not today be asking our 

council members to provide updates during our time together. 

Instead we are going to be hearing from renown experts who are 

invited to share presentations on elder justice priority 

issues. Member updates will be posted to our EJCC website soon 

after today's meeting. So let me turn to the heart of our 

presentation. We are gathered today to hear about key issues 

and priority areas of focus in the administration, and for all 

of us and we are so pleased to be sharing the space today with 

some of the nation's leading elder justice experts who will be 

addressing nursing home reform enforcement and residents rights 
and then effective strategies for messaging to combat elder 

fraud and scams. 

All member of the public are in listen only mode. If you 

have any questions, please send e- mails directly to EJ public 

comments, all one word, EJPUBLICCOMMENTS @ ACL.HHS.GOV. If you 

have any audio or visual problems today, we recommend exiting 

and reentering the live stream. Today, we're going to hear ten 

minutes of presentation of six experts grouped in these panels. 

Council members will have an opportunity to ask questions after 

each of the thirty minute panels. 

Council members, you will be cued for the 15 minute 

question and answer segment and your microphones will be 

unmuted at the start of the QA segment. Please keep your 

questions brief and we suggest that you write them down as you 

think of them so we can efficiently get to every question. 

Now, I would like to introduce our first panel, nursing home 

enforcement and resident's rights. It's critically important 

to ensure that older adults no matter where they live are safe, 

receive quality care, and have their rights protected. With 

more than a third of deaths from COVID in nursing homes, a 

spotlight was shown on the many problems that exist in nursing 

homes and that's the nursing home initiative we'll hear about 

from the panel today. 

At the same time, it's critical that we continue our work 

to help people in nursing homes who can and want to transition 

to homes in the community. We'll be hearing presentations by 

first, Will Harris, senior advisor from the centers of Medicare 

and medicaid services at the US department of health and human 

services. Next, we'll be hearing from Susan, senior trial 

council for elder justice in the civil fraud section at the 

United States department of justice. And then we'll be hearing 

from Will. He will provide remarks concerning CMS's work on 

the nursing home initiative and I'll just say, Will has been 

and continues to be a great ally, not only to ACL but to our 

entire community. Thank you so much, Will and I'll kick it to 

you. 

>> Will: Thank you so much, Allison and thank you for the kind 

introduction. I do not deserve but I am happy to help in any 

way I can. I'm a senior advisor here at the center for 

Medicare and medicaid services. If you're not familiar with 

us, we're an agency of about 6,000 full time employees that 

handles what we affectionally called three Ms, Medicare, 

medicaid, marketplace health insurance. Among all of those, we 
touch about 150 American live ins their healthcare. More 

importantly what I will talk to you about today is we set the 

safety and quality of care standards for our 17 different 

regulated provider types. One of which is skilled nursing 

facilities or nursing facilities. So that is the context in 

which I'm coming to you today. 

If you're interested in this topic, I may have already 

talked to you and had this conversation with you already and if 

I haven't, I'm sure I would like to because much of our 

approach has been in hearing from the community, experts and 

I --

So thank you if I have talked to you already and if not, 

we'll be very happy to hear from you and answer questions 

during the Q & A session. I'll start off by talking about what 

we're working on at CMS. As the President made clear, in his 

first state of the union address, we know that the time is now 

to address the crisis in America's nursing homes. At CMS we 

feel like we have really a moral responsibility to improve 

conditions for nursing home residents and their staff and we're 

acting on that. Nursing homes like my colleague Allison said 

before, were disproportionally affected by the COVID pandemic. 

We know that too many residents and staff lost their lives to 

COVID across the country. And as I'm sure you all know too 

well, throughout the pandemic residents experienced severe 

isolation and disruptions in care as the pandemic exposed and 

exacerbated long standing problems in the nation's nursing 

homes. I think the main point I would bring out here is that 

obviously, not every problem facing the nation's nursing homes 

today were caused by the pandemic. 

I think everyone would agree that many were long standing 

problems that were just highlighted and exacerbated by the 

experience that everyone had in the last couple of years. So 

that's why we have unveiled an ambitious set of reforms to 

improve staffing, strengthen accountability and increase 

transparency in nursing homes. The foundation is an 

establishment of a minimum nursing home staffing requirement 

which will be informed by a rigorous new study and I'll talk 

more about that in just a minute. We're also going to enhance 

facility oversight and accountability which will be an over 

haul of the special focus facility program, updates on how to 

levy the financial penalties outside of the process and 

committing to work with Congress to make sure we can adequately 

fund our survey and certification efforts. We're also going to 

focus on improving the transparency of facility ownership and 
finances including more robust ownership data, making that 

information easier to find on our web portals and examining the 

role of investment owners and the healthcare sector. 

These reforms were developed through extensive consultation 

through experts, nursing home workers and most importantly 

conversations that we had with nursing home residents and their 

loved ones and the people who are working so hard to advocate 

for them. So as I'm sure you have seen in the White House fact 

sheet and if you haven't already, I encourage you to check it 

out. There's 21 initiative spread across five strategic goals. 

Those five strategic goals are ensuring that taxpayer dollars 

support homes for safe, adequate and dignified care, enhancing 

accountability and oversight, increasing transparency, creating 

pathways to good paying jobs with three and fair choice to join 

a union, especially for nursing and ensuring pandemic and 

emergency preparedness in nursing homes. 

I want to note that the way I just described these and the 

way they're structured are in five distinct strategic goals but 

the plan in the entirety is really a holistic approach to 

improving conditions in nursing homes for both resident and 

staffs. These are complex issues which is why the approach 

we're taking is trying to be comprehensive and thoughtful. So 

as we look across these 21 initiative, one of the core ways, 

the core pieces of work we have already begun in earnest is 

about staffing. What we know, all of us, is that adequate 

staffing levels are tied to safety and quality of care for 

residents. It's the number one metric that is directly tied to 

staffing to quality of care and safety. So that's why you're 

seeing this focus on that. So in our proposed payment rules 

that we put out earlier this year, we put out several request 

for information which I know many of you probably have already 

engaged with us on but that includes on a request of 

information on setting staffing measures and a staffing turn 

over measure for the value based payment program. 

The way that CMS is approaching this, I always say is that 

the RFI represents a really sincere R. It is very much a 

sincere request that we want to hear from others about and we 

are looking forward to being informed by the I that we received 

from you. And more than anything else, I want to highlight 

this. Our administrator Brooks make it one of our six 

strategic pillars of CMS's strategic plan to hear and 

incorporate feedback from stakeholders to make sure we're 

listening closely from people who have lived experience and 

integrate that into our policymaking. We value that input and 
it's why we do so much work on engagement and why I hope 

everyone will see those requests being very serious and sincere 

from CMS. So I'll talk about the core of our plan and 

developing a minimum staffing requirement in long term care 

facilities. 

Our goal with this initiative is to empower staff to 

provide better care by developing an evidence based and 

appropriate requirements that will be supported by a rigorous 

study that is going to permanently strengthen the quality of 

care to make sure there's enough well trained staff for the 

residents that rely on them. There's no doubt that we need to 

adopt a very carefully considered approach to implementing this 

initiative to make sure we find a meaningful balance among the 

many competing priorities that we have to consider and also to 

avoid any unintended consequences. That includes being 

cognizant of the needs of each facility's residents and that's 

why we want to make sure we hear from so many stakeholders 

during that work. 

So undeniably we have a lot of work to get done and we're 

actively planning the approach to implementing all of these 

important initiatives. Our focus right now is on identifying 

the ones where we can take swift action in the short term while 

doing strategic planning on efforts that will require a longer 

term approach. A couple other areas that we are focusing on in 

the short term are, as I mentioned earlier, over hauling the 

special focus facility program on addressing the inappropriate 

use of antipsychotics in nursing homes which is a big priority 

for us, and one we're focusing on carefully. Approving the use 

and data on nursing homes about compare and care. Continuing 

to address COVID- 19 in nursing homes and transparency on 

nursing homeowners which I'm sure you already saw we took 

action on earlier this year. That was publicly for the first 

time, we released data on mergers, acquisitions, consolidations 

and changes of ownership for nursing homes and hospitals from 

2016 to 2022 for those nursing homes and hospitals that are 

enrolled in Medicare. We think this is a powerful tool for 

researchers, state and federal enforcement agencies and be for 

the public to better understand the impacts of consolidation on 

healthcare prices and quality of care and again, I can save 

this is just a first step but it's an exciting one and it's one 

that we are going to keep updated on a quarterly basis going 

forward. 

I would also be remised not to mention something that my 

friend Allison spoke to at the top of the call here and that's 
I want to be sure this effort is running parallel to other work 

we have at CMS focused on making sure that people have the 

choice to get the care they need in their communities. We 

think all people should be able to access long term care in the 

appropriate setting of their choice. Including through home 

and community based services. The nursing home reforms I'm 

talking about today are really part of a both and approach. 

I'm talking about them because that's what we're here to talk 

about but I would hate for you to walk away thinking we don't 

have a lot of work happening on that part in parallel. We are 

working on improving the safety for residents who live there 

that rely on the care as well as the people who care for them. 

They're counting on us at CMS to raise that bar but in 

parallel, we're also wanting to work on efforts to strengthen 

and invest in home community based services to make sure that 

people with can disabilities and seniors and others who need 

that kind of care can have quality options when making these 

decisions about where to receive that care and ensuring they're 

not institutional biases that present hurdles for them. 

To sum it up, at CMS, we're considering a wide range of 

methods to get this work done. We're looking to use all of our 

existing authorities and leverage to the fullest because the 

people who are living and working at the nation's nursing homes 

are counting on us to do so and we know that. I'll wrap it up 

there and will be very happy to take questions here after the 

panel talks but I wanted to say how honored I am to be able to 

talk to you about this hard work we're doing and hope to be 

able to partner with as many of you in the future as we can. 

Thank you! 

>> Well, thank you so much for that great presentation and I'm 

really excited to be able to have folks ask you some questions. 

I just want to say how robust the stakeholder engagement has 

been. When we hear from Lori and others, but it's truly making 

sure this is not just hearing from industry but the people with 

who are the most impacted. The residents of the nursing homes 

and their families and other advocates so thank you, Will. 

Next up is Susan lynch who will be highlighting the department 

of justice's work to address abuse, neglect and fraud in our 

nation's nursing homes. So Susan, over to you. 

>> Susan: Good morning members of the Elder Justice 

Coordinating Council. I'm Susan, senior council for elder 

justice at the United States department of justice where for 

the past 23 years, I have prosecuted nursing home chains, 

individual facilities and owners who provide grossly care to 
their residents. I appreciate the opportunity to appear before 

you today to talk about the importance of nursing home 

enforcement and elder justice professional training at this 

critical time in our nation's history when many of the nursing 

home residents are not receiving the quality of care they 

desperately need and are not being treated with the basic human 

dignity we all deserve. 

As a result, some of our mothers, fathers, sisters and 

brothers in our nation's nursing homes are getting sicker, 

being abused, neglected and are even slipping into premature 

death. In my role leading the department's nation nursing home 

initiative, I approached some tragic stories and have seen some 

gut wrenching facts in some of the nursing home cases I have 

prosecuted. I want to be clear, we're not painting the nursing 

home industry with a broad brush and many nursing homes work 

very hard to provide quality services to those entrusted in 

their care. But I want to be clear with all of you members of 

the council and the public, some nursing home do not have 

adequate numbers of trained staff to care for their residents. 

That is to say, not enough staff to feed the residents, to take 

that extra time with them, to turn and reposition them as 

needed. Some nursing homes don't have enough staff to have the 

appropriate nursing home supplies there for residents. Some 

nursing homes don't follow required infection control protocols 

and some nursing homes don't keep their physical plant clean 

and safe and further, some nursing homes over use antipsychotic 

medications in an effort to keep their residents compliant. 

Some of these same nursing homes continue to admit 

residents to their full senseless capacity despite knowing they 

lack adequate staff and resources to care for these residents. 

With some of these some poor performing nursing homes, quite 

frankly, the nation watched in horror as the challenges of the 

COVID- 19 pandemic quickly exacerbated poor quality of care 

conditions with the devastating consequences for our nation's 

residents and later in this panel you will hear the voices of 

the residents themselves when they talk about problems with 

staffing, infection control, wait times during the COVID- 19 

pandemic. During COVID- 19, there were devastating 

consequences for some nursing staff that persist today as they 

worked tirelessly and heroically through the pandemic, all the 

way navigating impossible working conditions brought on by 

staffing shortages and senseless choices. Choices made owners 

and operators. 

Through the decades, we have brought civil and criminal 
cases against the nation's largest nursing home chains, small 

chains, single facilities and against nursing homes CEOs and 

executives who provide grossly substandard care to their 

residents and commit financial fraud. The national home 

initiative brought these entities to justice through the work 

and that of the decade long work of the elder justice 

initiative in particular. The department's nursing home 

initiative coordinate and enhance civil and criminal efforts to 

pursue nursing homes that provide grossly substandard care and 

enhance criminal efforts when it's appropriate in a financial 

fraud situation. The initiative reflects the department's 

larger strategy and commitment to protecting our nation's 

seniors to the work of multiple departmental compartments and 

that includes the elder justice initiative, national nursing 

home initiative, civil division, consumer protection branch, 

criminal division, civil rights division, all in conjunction 

with the U.S. attorney's office around the country. 

Members of the council, we at the department have done this 

important work with the help of and in partnership with many 

federal, state, local tribal and non governmental partners 

which include health and human services, CMS, some of the 

agencies at the council table today, the medicaid fraud control 

units, state and local prosecutor's offices, state protective 

services, state national consumer voice, law enforcement and 

emergency medical services nationwide to name a few. 

Through the department's initiative and across the United 

States with the help of 94 elder justice coordinators across 

the country, the department has daily dedicated prosecutors in 

every district who are focused on elder justice work. I will 

share with this council a few of the cases which highlight the 

important nursing home enforcement work we are doing across the 

nation. Just last week, the department's elder justice 

initiative announced that it filed a civil federal false claims 

act case against American health foundation known as AHF. Its 

affiliates and three nursing homes in Ohio and Pennsylvania. 

In the complaint, the United States alleged that three nursing 

homes provided grossly sub standard services that failed to 

meet the required standards of care, specifically by not 

maintaining adequate staffing, a theme we have heard a lot 

about today on this panel and we'll hear more. Failing to 

follow infection control protocols and be by providing 

residents with unnecessary medications including antibiotic, 

antipsychotic, anti anxiety and hypnotic drugs. 

The United States complaint provides specific allegations 
 

on how this grossly sub standard care harmed these nursing home 

residents. For example, the complaint alleged that one 

facility resident was admit WD a history of self harm and 

hospitalized after slashing his wrist while in the facility's 

care yet, when the resident returned to the facility, nursing 

home staff allegedly again ignored the warning signs and failed 

to provide this gentleman with desperately needed phychiatric 

services. Mere weeks after being readmitted to this AHF 

facility, this resident committed suicide by hanging himself 

from a bed sheet in one of the facility's shower rooms. 

Last May, the initiative announced it settled a civil 

claims with a Georgia based senior care and related entities 

for over 11.2 million dollars. Based on allegations that they 

billed the Medicare program for rehabilitation services that 

were not reasonable, not necessary, or even skilled. And to 

resolve allegations that they billed the Medicare and medicaid 

program for grossly sub standard nursing skill services. This 

settlement resolved allegations that for ten years between 2008 

and 2018, SAVA claimed falsely to grossly sub standard nursing 

services including that SAVS failed to have sufficient staffing 

in certain facilities, failed to follow appropriate protocols 

and failed to appropriately administer medication to some of 

its residents. 

Given the particularly egregious nature of some of these 

cases at issue in the potential resident harm, nursing home 

defendants frequently enter into what is known as quality, 

corporate integrity agreements with HHS office of inspector 

general. At the same time they settle a false claims act case 

with the department of justice. For example, as part of this 

SAVA civil settlement, they entered into a five year quality of 

care corporate integrity agreement with HHS OIG where they are 

required to have a comprehensive compliance with systems in 

place to address the quality of resident care and in 

particular, a provision regarding staffing. In the really most 

egregious cases the department has and will pursue criminal 

prosecutions of nursing homes and their owners and operators 

who commitment financial fraud and or provide grossly sub 

standard care to their residents. For example, in January of 

this year, the United States attorney's office with the 

district of New Jersey and the department's division charged 

Joseph -- 38 million dollars in payroll taxes owed to the IRS 

on behalf of his employees as required by law. 

He owned and operated the New Jersey based skyline 

management group LLC and several related skyline companies 
which in turn, owned and managed 95 healthcare and 

rehabilitation facilities operating in at least 11 states. If 

convicted, he faces a maximum penalty of five years in prison 

for each count of willful failure to collect and pay payment 

taxes, five years of prison for each tax evasion and if 

convicted, ten additional years for each count of failure to 

file a benefit report. 

In February of this year, Pennsylvania indicted Susan 

Gilbert, the former administrator of a mount Lebanon. In this 

case, according to the indictment, between 2018 and 2020, 

Gilbert and co conspirators deprived seniors of needed resident 

care by using inflated nursing hours and other schemes they 

concealed with two separate sets of books. According to the 

indictment, Gilbert and or co conspirators directed, 

administrated other employees to clock in for shifts but not 

actually work these shifts and paid bonuses to staff if they 

clocked in as instructed. 

This alleged conduct put facility residents at risk by only 

providing a dangerously low level of staffing, just before 

COVID came across the country. This resulted in paper 

compliance and left residents without sufficient staff to care 

for their basic needs. The department is committed in the work 

in nursing home enforcement and training elder justice 

professionals to prevent, identify, and report elder abuse in 

our nation's nursing homes. Through the department's 

programmatic efforts, we have trained federal and state 

prosecutors, law enforcement, emergency medical services, for 

issues of suspected abuse all around the country not only 

identifying abuse but where and how to report such abuse. In 

closing, the department is actively engaged in bringing to 

justice those who provide grossly sub standard services to the 

nation's vulnerable nursing home residents and remain committed 

to use pathways to investigate, prosecute and prevent the abuse 

of our nation's elderly in nursing homes. We remain committed 

to training elder justice professionals nationwide. 

As one government, we all have an obligation to ensure the 

nation's most vulnerable receive the quality of care and enjoy 

quality of life during the nursing home stays which for many 

residents is at the end of their lives when they are most 

dependent on others for their most basic care. Ensuring that 

nursing homes meet quality regulatory and physical plant 

requirements, falls within the mission of many of us at the 

council table today. At the department, we look forward to 

working with each of you on the council and your agency 
 

 

designation in service to combat the elder abuse when the time 

lessons of COVID- 19, the urging of the Biden administration 

and the work of the nation until academies are pointing to the 

fact that our collective action is urgently needed. Now we 

share with CMS this view is the time to work together. We have 

the opportunity and critically, we have the responsibility. 

Thank you! 

>> Allison: Thank you so much, Susan and thank you for that 

call to action and for sharing all of the work that those 

department of justice is doing to ensure accountability for 

nursing homes. Our final speaker on this panel is Lori who 

will share resident centered perspective on the recent nursing 

home reform announcement and the needs for ongoing enforcement. 

Lori, let me turn it to you. 

>> Lori: Thank you so much, chair woman. Thank you and good 

morning to members of the Justice coordinating council. As 

stated, I'm Lori, the executive director of the national 

consumer voice for quality long term care. We're a national 

non profit organization that works with and on behalf of 

individuals receiving long term care and services to achieve 

quality care, quality of life, and protection of rights. We 

are also proud to host and operate the national long term care 

ombudsmen resource center for community living where we provide 

training, technical assistance and to support to state and 

local long term care programs. Through their work, 

representatives provide critical advocacy, support, 

information, and resources to long term care facility residents 

and their families. Thank you for inviting me to speak today 

and for including this panel focused on nursing home issues. 

For more than 25 years I have worked in the field where I 

had the opportunity to talk with many residents, families, 

facility staff and others about the experiences of residents in 

long term care facilities. A reoccurring theme which research 

and data also clearly show and support is that the single most 

important element for ensuring that residents receive the care 

and services they need is having the necessary staff in a 

facility. Adequacy of staff includes numbers of staff, skills 

mix and training when there are not enough staff to provide 

care. Residents may not get out of bed for hours or even days. 

They have long wait times to be held to the bathroom. Often 

resulting in the person urinating or defecating and then 

waiting longer for someone to help clean and change them. 

Antipsychotic drugs are inappropriately used to residents to 

control behavior or for the convenience of staff. 
Teeth are not brushed and residents who need assistance 

moving and turning often develop pressure sores as they lie in 

the same position for countless hours. Residents tell us that 

showers are regularly skipped due to short staffing so instead 

of receiving two showers a week, for example, one person may 

receive one or sometimes none. At the end of her life, my 

grandmother who lived in a nursing home and needed health with 

eating would need specific assistance to finish her plate of 

feed. When I would visit and would help feed her, it would 

take twenty to thirty minutes or more for her to finish her 

plate. As a staff member caring for twenty residents, a common 

occurrence in today's nursing homes would be hard press to 

spend that amount of time helping one resident eat. We learned 

during the pandemic that many facilities are highly dependent 

on the informal care that families provide when they are on 

site. 

Short staffing also puts great stress on the staff 

themselves who are at increase risk of injury and often have to 

make the difficult choice of deciding which residents to assist 

and what kinds of assistance they can provide. Shortcuts get 

taken and mistakes are more frequently made. Staff also don't 

have the opportunity to connect on a personal level with 

residents because they're rushing to get to the next task. 

This is occurring in a longer systemic problem as you have 

heard from other speakers. Low wages and benefits, poor 

working conditions and inadequate training and support are some 

of the factors that lead to high turn over and difficulty 

attracting new workers into this field. We cannot allow this 

broken system to continue. Immediate changes need to be made 

that include minimum staffing, requirements and increased 

accountability and transparency for facilities both to meet 

quality standards and to account for the use of public dollars. 

That's why we commend the Biden administration for the bold set 

of reforms proposed in late February that would begin to 

address these issues and we support the implementation and we 

thank the administration for including residents and family 

members in the conversations about what is needed to make 

quality care better in long term care facilities. 

Despite well established research showing that higher 

number of nursing care have higher overall rates better health 

ratings and fewer instances of abuse, we continue to have weak 

federal policies around nursing home staffing. Facilities are 

required to have sufficient staff, a standard, vague, 

subjective and difficult to measure. As daily average staffing 

decreases, so do the facility's overall rating and performance 
in health inspections and incidences of abuse rise. In the 

nursing home reforms proposed by the administration, a key 

element as you heard is the creation of a federal minimum 

staffing standard based on the findings of a new study that is 

being commissioned. Any staffing standard must include a 

baseline or a minimum below which a facility cannot go and have 

resident acuity to ensure higher staffing level when residents 

have higher care needs. Facilities must be held accountable 

for meeting minimum quality standards. Penalties for not 

complying must be meaningful and appropriate for deficiency 

cited and we cannot allow chronic bad actors to continue owning 

and operating facilities. There could and should be better 

agency, federal agency coordination around facility and 

corporate monitoring, data sharing and analysis and referrals 

of cases and complaints. Increase collaboration including the 

agencies on this council and the programs that over see would 

leverage the power and resources of the federal government to 

both systemically and individually address bad actors in the 

system and would improve conditions for residents. 

Additionally we must insist on greater transparency and 

accountability for the billions of dollar of public funds that 

nursing homes receive. The nursing home industry claims they 

do not receive enough money to hire the necessary staff and 

provide the high quality of care in which they are give B. 

The truth is shell games, strategies such as the use of 

related party transactions have been employed to divert 

attention from how money is really spent and make financial 

accountability difficult. Information that is available shows 

a profitability industry. It's essential then for the 

administration's proposed forms around transparency to be 

implemented. CMS should implement sections of the affordable 

care act, passed more than ten years ago and not fully 

implemented which require transparency in nursing homeownership 

and finances. Additionally, they should submit audited, 

consolidated cost reports reviewed by CMS and we encourage TD 

administration to require that a minimum percentage of revenue 

be spent on the direct care. 

One resident lived in a nursing home for more than a decade 

says she sees the changes that occur when her facility is 

bought and sold. Suddenly there's fewer staff on the floor. 

Fewer supplies available. Lower quality items especially in 

the food department. Billions of our tax dollars are given to 

nursing homes each year but little to no scrutiny is placed on 

how the dollars are spent. Essential to minimum staff 

standards, it needs to go to patient care. They view 
implementation of a minimum staffing standard as an unfunded 

mandate. The law is clear, however, that the secretary of 

health and human services has full authority to set standard 

that ensure nursing homes provide each resident with high 

quality care that Medicare and medicaid patients are spent on 

resident care which is a setting of a minimum staffing 

standard. 

Instead of the unfunded mandate, we have a long standing, 

unfulfilled mandate for residents, one that entitled each 

resident to maintain or retain his or her practical level of 

physical, mental, psychosocial well being. Nursing home 

operators voluntarily agree to meet the standard and return for 

federal funding while providers have received the funding, 

nursing home residents have largely not received the care and 

services to meet this promise. So I thank you for the 

opportunity to be here today and share the remarks and I 

commend the administration for prioritizing these issues and 

putting forth important reforms while implemented can make the 

critical difference for residents. Next, I think we'll see a 

short video where we would like you to hear directly from 

residents about their experiences when there's not enough staff 

available. These residents you will hear from, participated in 

a dialogue hosted by the consumer voice in late 2021. 

Thank you and I'll turn it to you Allison. 

>> Allison: Thank you so much, Lori for sharing your expertise 

and most importantly, sharing the voices of the people who are 

most impacted. Council members, we're going to segue into a 

fifteen minute question and answer segment. We'll keep track 

of time so we can stay on schedule and our technicians will now 

unmute you so you can raise your hands and ask questions for 

the panelist. This is an incredibly powerful panel covering a 

lot of really important strategies that we're using not only on 

the whole government approach but really in partnership with 

the whole range of stakeholders who are impacted by this and so 

let me see: Okay, great! 

Welcome, Ron and welcome to the council and I'm really 

excited for you to jump in. Let's turn it to you to start with 

the first question. 

>> Ron: Thank you, Allison and thank you to the council. It 

is an honor to join you all in this effort. I in that regard, 

ask the question, how can legal aid attorneys help in the work 

that you do? 
>> Lori: I can start there. Certainly residents of long term 

care facilities need access to support on a regular basis. 

They are threatened with discharge and need help to assert 

their rights related to directing people to be their agents 

under power of attorney. They often have issues with 

guardianship and unfortunately, they don't have good and 

regular access to legal council so legal services programs play 

a very critical part in supporting resident's rights 

protections and helping residents achieve quality care and 

quality of life coordinating with long term programs is a great 

way that legal services can assist. And certainly having 

programs prioritize issues related to that existent long term 

care facilities would be greatly beneficial. 

>> Will: I would just say really quickly for us. We really 

value hearing about what issues and trends that you see popping 

up. You're sometimes closer to the folks with lived experience 

and on the ground a little more than we are sometimes. We 

would like to get information from anywhere and everywhere we 

can about what trends you're seeing. If there's new issues 

coming up that CMS needs to be aware of and happy to get 

connected with you to make sure you have that information 

occurring. 

>> Ron: Is there mechanisms in place to facilitate those 

reports? 

>> Will: Yes, they are. We have a group that handles that 

thing but you can start with reaching out to me as well and 

make sure you get my contact info and we can get everywhere 

where they need to be. 

>> Susan: As I mentioned in my remarks, we have justice 

coordinators in 94 districts and units of multi- disciplinary 

teams that work to identify problems in nursing homes. As Will 

pointed out, boots on the ground. To the extend there's a 

problem, referral and information sharing with the elder 

justice coordinator in the district or you can obviously reach 

out to me. The department is very committed to following up 

anything that may be problematic and actionable from our 

standpoint so we look forward to the partnership. 

>> Allison: I will just add, from ACL, we fund legal services 

both on the disability and aging side as I mentioned. As Will 

talked about and I think, Lori touched on. Not only do people 

have a right and are we focused on making sure people are safe 

and getting quality care in nursing homes, but there are people 
 

who are in nursing homes who can and want to live in the 

community. It's something that our ombudsman work on, the 

protection and advocacy networks. They are not just younger 

adults but -- work with those populations and that's another 

place where we would love to really make sure in local 

communities that the legal services is connected with our 

disability on aging networks on the ground. So we can follow 

up on that. And welcome! Really really glad that you're a 

part of this. 

>> Will: Thank you so much. 

>> Allison: Great! It looks like I see another hand. Let me 

kick it to you for your question. 

>> Atalaya: Hi, thank you, Allison, to the committee and 

speakers. I'm very excited to hear about the work that you're 

doing. I represent AmeriCorps which is a national service. So 

as you were speaking, what came to mind for me is understanding 

how we continue to engage volunteers who do these supports for 

residents and how do we continue to help them know what they 

look for. How to raise flags and how they can also help people 

in their community family members understand this too. So is 

there any training that is provided for them? 

>> Lori: Thank you, I know historically, there's a number of 

AmeriCorps volunteers who have been placed and successfully 

worked with these programs around advocacy, education, and 

community outreach. Through the work of the ombudsman resource 

center and consumer voice, we have training and resources 

available that AmeriCorps volunteers can access. We have 

Webinars we offer and resources that can be downloaded on the 

website and we can share that information with you. And we 

would be happy to do that. And ombudsman program are very 

involved in working with communities around out reach and 

training including with residents and family members and other 

members of the community about rights and quality issues and 

long term care facilities. 

>> Susan: Atalaya, I would jump in and say, the department of 

elder justice.gov has training of the raising of the red flags 

of elder abuse exploitation and we have trained a number of 

other professionals and we would be happy to share that 

training with you and any of your team. Thank you for your 

engagement. 

>> Atalaya: Thank you, I look forward to connecting with you. 
 

>> Alison. Thank you! And we're taking notes and everything 

that we are saying, we can follow up and connect to. I promise 

you, we will do that. Let's see, I see Ben. Great to see you! 

>> Ben: Thank you, Alison and all of our presenters. 

Excellent presentation and some hard to hear but necessary. 

First I have a comment. I just wanted to make sure that I 

express the Social Security Administration interest in being 

involve, especially with the long term care ombudsman program 

in the state. We have a presence all over the country via our 

network of regional offices, area offices, so we would like to 

make sure we're making relationships with the long term care 

ombudsman around the country so any collaborations that we can 

be involved in, please do count us in. I did have a question. 

That was about financial exploitation of residents in nursing 

homes. 

I know we talked about abuse and things like the use of 

drugs, antipsychotic drugs but can anyone say a word or two or 

a couple of comments about the financial exploitation of our 

residents in facilities? 

>> Will: I will start and hand it to others who may say more. 

Aside from many of those activities being crimes, we do have 

conditions of participation through the Medicare program that 

prohibit and guarantee that residents have certain rights over 

their financial freedom and the use of their own financial 

resources and also prohibit certain practices that would 

violate their ability to do so. This is definitely a focus to 

us. It is something that any time it occurs, we take it 

incredibly seriously and as a very high severity issue, any 

time we locate it. I think a lot of this will be over in my 

colleague Susan's department at DOJ. I want to make sure you 

can talk about it. 

>> Susan: Yes, thank you, Will. Financial exploitation of 

elder adults occurs not only in the community but also 

retirement homes. Adults in nursing homes might be the victim 

of some type of financial exploitation scam you might hear 

about in the second hour. Anything from, you know, a text 

scam, et cetera. And we see in some of our grossly sub 

standard care is part of the financial component fraud which is 

part of the sub standard care is stealing from the residents. 

This is members from the care force, the caregivers but it can 

also be management and operators who are stealing from 

something like the resident trust fund. The resident trust 
fund is something that each resident can have a couple of 

thousand dollars to buy special things for themselves, you 

know, in the nursing home. Sometimes that is taken and 

funneled into the funds that the owners take. We see this both 

in terms of residents being victims like the broader community 

and we also see it targeted within the cases itself and we 

obviously do everything in our power to stop that. 

>> And I think this is an area of opportunity where different 

agencies and programs can work together to support residents. 

Certainly ombudsman become aware of financial exploitation, 

adult protected services in many states have a role in this 

area as well. Disability rights programs. I know they are 

engage indeed this area so there's a really good opportunity 

for sharing of information, referrals, back and forth between 

programs and including your representatives too as well, Ben, 

Social Security, and look at how they can work together to 

address these issues. 

>> Alison: Great, thank you, everyone. Thank you, Ben. I 

think we have time for one more question. Are there any more 

questions from council members? 

>> Suzanne: Good morning and thank you so much for this 

wonderful panel. On the subject of financial exploitation and 

nursing homes, I just wanted to add that there have been, we 

have talked that at a lot of nursing homes about keeping tabs 

on where your investment accounts are. If you're missing a 

statement or a statement goes missing or your password gets 

stolen or goes missing, those are very serious things to think 

about. Change and ask about because we have seen statements 

being stolen and accounts being, you know, taken. So I just 

wanted to bring that to the attention WHOIL it was brought up. 

Thank you. 

>> Alison: Thank you so much, Suzanne. I think we probably 

should start moving to the second panel. I really want to 

thank all of our panelist for this really important discussion 

as Will said, we're kind of in the beginning of this 

initiative. We have a lot of work to do together. And it 

sounds like there's a lot of interest across the panel and the 

council members on really connecting on some next steps whether 

it's legal advocacy, how do we share information, how do we 

leverage resources out there. How do we deal with quality of 

care, how do we deal with making sure that people who can and 

want to live in the community are transitioned and how do we 

tie in and make sure the work that we're doing to prevent fraud 
looks at people across the board. So thank you for this great 

conversation and thank you in advance. Lori, Will, and Susan 

for being a resource and for all of the follow up e- mails 

we'll send you later today. 

Okay, thank you, everyone! So with that, we are going to 

turn to the second panel which is called effective messaging to 

prevent senior scams and fraud. On this panel, we will be 

hearing from Dr. Marti who is a research assistant professor 

from the University of Minnesota Twin Cities and then the 

strategic policy from ARP bank safe and then finally from Sarah 

who is the manager of custom education strategy from the UK 

finance, take five campaign. So we will start off now with 

Dr. Marti and let me turn it over to you. 

>> Dr. Marti: Hi, everyone! Can you hear me and can you see 

my slides? Great! Well, thank you so much to members of the 

EJCC for inviting me to present on some of the work that I have 

done with the federal trade commission on government imposter 

scams. What I'm going to present today is a mixed methods 

analysis so we did a qualitative analysis of consumer 

complaints of the Social Security imposter scam and then a 

qualitative analysis comparing those who were reported and 

those who were targeted but did not pay money. 

So I want to first thank the U.S. Social Security 

Administration for funding this research as part of their 

retirement and disability research consortium. And also the 

conclusions are solely my own and do not represent the thoughts 

of any other government agency. So this is a little chart that 

I pulled from the federal trade commission's public tableau 

dashboard. It maps the prevalence of different consumer 

reports of different imposter scams in 2018. You can see with 

the orange line there, there's two prominent peaks and that is 

really driven by the prevalence of these times of the Social 

Security imposter scam. It did take a big hit around COVID- 19 

lock downs but then quickly rebounded and now it's some what 

over taken by business imposter scams but really what I want to 

talk about in this presentation is how these criminals 

convinced many people including older adults that they were in 

trouble with the federal government due to crimes they 

supposedly committed. 

So first was, I was interested in the persuasion tactics. 

What are the criminals saying or doing to appear they do really 

true are representative of the SSA or some other federal 

government agency? And the second question, what are the 

demographic and contextual correlates of victimization? So 
what different who are victims and those who are not. 

This comes from the consumer sentinel which is a tool that 

law enforcement can use to identify the individuals harmed by 

identity and fraud. The data is pulled together by the federal 

trade commission. Although there's contributors that include 

50 plus federal agencies and non profit organizations and 

states. So it's a really great data resource in addition to 

being a tool for law enforcement. 

For this study, we restricted only the complaints that went 

directly to the federal trade commission so this does not 

include all of the majority of complaints that went to the 

Social Security Administration itself. So when I was looking 

through and I was doing the qualitative analysis of the 

consumer complaint narratives where they wrote about what 

happened to them, describing it in their own words, I 

identified three of the six elements of persuasion, 

reciprocity, scarcity or urgency and authority. I also 

identified one more and that is secrecy. Secrecy is something 

that we see in many different types of scams in order to really 

control the victim. 

I'm just going to briefly talk about how the fraud 

criminals used each of these persuasion techniques based on 

what I learned from the case narrative. So authority is 

probably the most prevalent. The consumer used number spoofing 

so if they Google the number that called them, it's a local SSA 

office or the federal SSA office number would come up. They 

also referenced multiple federal agencies. Like they said the 

DEA was involved, FBI was involved in the case. Really to 

illicit fear. The criminals were clever and they gave fake 

names. They said to the target I'm going to give you a badge 

number and case ID number. These are important and so write it 

down even though they were fabricated and meaningless. They 

told the consumer they were under surveillance and in some rare 

cases, they did have the consumer's actual Social Security 

number which to me indicates they might, some of them might 

have been working off of lists but all of that adds 

authenticity to the story the criminals were telling the 

targets. 

So the reciprocity principle worked like this. The 

original agent on the phone would say to the person you're in 

big trouble. We have found drugs and cars in your name. You 

have committed crimes and of course the target says, no, that's 

not me. There's a mistake. And immediately the criminals 
 

switched their tune and said, I believe you. I'm on your side. 

I'm going to help you clear your name and avoid arrest. If I'm 

going to help you, you need to help me. So they kind of 

pretend they're on the target side and they're going to work 

together. Another one is urgency and we say this in many 

different scam types. You need to act right away. The 

government is going to freeze your assets and you know, you 

have to follow our directions and the criminals are about to 

catch wind of this and will come after you and your family. 

Again, using fear to provoke urgency and then secrecy. The 

participants or the targets of these scams were told to not 

tell anyone. They were told never put the call on speaker. 

Never put yourself on mute. They were coached, word by word 

what to say to bank tellers, to retailers on how to divert 

their attention or convince those people who are concerned that 

everything is okay. So in terms of the quantitative analysis, 

comparing the consumers who said they lost money to those who 

said they did not, we found that the majority, the vast 

majority of consumers were not victims so only 4.2 percent 

reported to be victims. 

We find that younger adults are more likely -- sorry, 

younger adults are more likely to report victimization but it's 

older adults that reported greater losses on average and that 

trend is pretty consistent with the Sentinol data overall. We 

used census bureau neighborhood characteristics and brought it 

into this data set and we found that consumers who resided more 

in Black, Hispanic, and Indian communities were more likely to 

report victimization versus no loss. However, they did report 

lower losses on average so lower dollar amounts. And that we 

also played a sentiment analysis to the narratives to 

understand how consumer's emotions relate to whether they were 

a victim or not. So emotions were associated with greater 

trust, anticipation and anger were all associated with 

victimization and a loss amount. 

What is interesting is all of these emotions were reported 

after the fraud occurred so we can't say those emotions were 

driving susceptibility or likelihood of pain but we do see they 

are related after the incident. 

If you were to ask me what really is driving loss amount. 

Like, what variable is most significant? And I would have to 

say it's how the consumer paid. In fact, you can see the 

majority around 70 percent paid with a gift card. However, 

these other methods of payment cash, crypto currency and wire 
transfer had the greatest median losses. So what does this 

mean for consumer education and intervention? So the first 

thing I want to point out was that number spoofing. So that 

really worked to immediately engender trust. The consumer saw 

a phone number on their phone, saw it was the SSA and were more 

likely to trust it. 

We need to continue to remind and educate consumers that we 

cannot trust caller ID. That numbers, official phone numbers 

can be spoofed. I'm really grateful to the FCC for their work 

in the regulatory actions against voice over internet protocol 

call providers who were allowed, you know, who allow these 

calls to reach American consumers. I think we actually do the 

most, we have the most benefit when we stop the message from 

reaching the consumer in the first place. So the earlier 

interventions, that will go the furthest in terms of consumer 

protection. And also, there's a lot of discussion on warning 

signs. Can we help educate the majority in this scam who are 

paying using gift cards? My graduate students and I went to 

multiple retailers in the Twin Cities area and photographed 

some of the warning signs that we observed and you can see they 

really range in quality and in visibility. Some are vague. 

Others were ripped and others, the PRIBT was so small you had 

to practically use a magnifying glass to read it. 

Other messaging was larger, was very clear, however, 

sometimes that messaging can even get lost in the sea of 

different gift cards on the gift cards kiosk. In case you're 

wondering where that sign is, it's right here, perpendicular to 

the consumer's eye gaze. 

Other signs are a little bit better. Surprisingly, we 

thought the ones low budget, like a print out by a manager 

actually caught your attention. And then another retailer has 

a warning that comes on the credit card reader and the consumer 

has to do an action, click continue in order to proceed with 

the gift card transaction. Enhancing it, making it more 

visible and putting stops like this on the credit card reader, 

all of that can go a long way in stopping the consumer on the 

act, assuming they are in the emotional state to take in that 

information. And again, you know, this retailer had so many 

warning signs but unfortunately, these warning signs were only 

on the money services counter. They weren't in the majority of 

consumers were driven by products which is self- check out. So 

again, how do we integrate fraud warning signs in the 

self- check out areas or are we going to restrict consumers 

that they can't buy gift cards in self- check out? 
So like I said, the bigger losses occurred from wiring 

funds to the criminals and in crypto currency ATMs. A lot of 

the consumers were told to go into the local gas station and 

put in the cash in a crypto currency ATM. From what I read, 

there's no warning signs related to the gift card fraud so 

that's an open playing field for consumer education. We also 

need to empower front line retailers to say something. They 

need to feel confident and have the authority to say no to 

consumers where they are suspicious this person is 

participating in a scan and that will require engagement from 

leadership, from these individuals or these companies. And 

then also, perhaps, another intervention is just lowering the 

limits so instead of being able to put whatever dollar amount 

you want on a particular card, limit the number of cards that 

can be purchased and how much can be loaded and that would 

just, even if someone is a victim, at least they lose your 

money. And then finally, I want to say, if we can encourage 

the gift card issuers, the payment processors who have insights 

into where the card is being loaded with value and then that 

value is being redeemed and if they can do more to identify and 

stop those fraudulent transactions, I think that will even go 

further than just signs in the retailers because it's really 

hard to reach everyone. 

So with that, I want to thank everyone and I am happy to 

answer questions after the other panelist. Thank you! 

>> Thank you so much for that great information! We really 

appreciate what you have just shared. Our next panelist is 

Jolene who will share ARP's work on combating gift card fraud, 

effective techniques to prevent and mitigate fraud. Turning it 

to you. 

>> Great, thank you so much! And I think someone is loading my 

slides. Perfect. Thank you so much! I'm a director at ARP 

writing the bank safe program and thank you for the kind 

invitation to speak here today. I come from three generations 

of community bankers, I'm a social worker, attorney, and spent 

my entire work dedicated to improving the lives of older 

adults. One in five are defrauded over the course of their 

lives with the average victim losing 120 thousand dollars. It 

is a stark reality encouraging those to do more. I want to 

talk about AARP's bank safe initiative and the recent report on 

the prevalence and impact of gift card fraud and how we're 

leveraging the industry retail partnerships to address the 

issues. Next slide. ARP's commitment is to fearly defend 
 

older adults and that's shown through the two prong approach. 

Our consumer efforts include fraud watch networks and the 

program where consumers can get report, guidance and resources 

and it also includes direct consumer materials like the fraud 

scam tracking map you can see here. 

On the industry collaboration front, we know the industry 

is the last line of defense. People are likely to see the 

exploitation and fraud that is family members but the industry 

also sees that and that means cashiers, tellers, investment 

advisors, store management and more. This empowers or industry 

partners to be the critical line of defense and we do it in 

three different ways. We gather and then we test promising 

practices of intervention from across the globe. We also 

create tools and resources with the industry that makes it 

easier for customer facing employees to protect all of their 

customers as Marti previously mentioned. And promote most 

prominently is the award bank safety training. Next slide. 

So bank safe is a powerful distribution channel: With 

that, it provides the business to business intervention. We 

partnered with more than 200 leaders in the industry to help us 

build data driven tools and then 2,000 individuals from 

regulators, financial institutions, front line employees, adult 

protective services and be more help us review this and these 

tools allow us to build the trusted relationships with industry 

players. Next slide. 

I mentioned our training. When we first launched in 2018, 

we had two courses. One for banks and then one for credit 

unions and in 2020, we added a third course for financial 

advisors and understanding the importance of trust and 

relationships within the financial sector, we partnered with a 

number of trade associations as our initial distribution 

partners. These organizations help recruit these banks, credit 

unions and broker dealers to use our AARP training. And that 

industry insider, stamp of approval combined with AARP's strong 

reputation around the need for older adults proves to be a 

powerful combination. 

So the industry impact we're achieving is notable. 

Industry leaders are changing their behavior as they push out 

the interventions that we know work. And this is because of 

how we position the interventions as a smart business practice 

or what they call an industry, a risk management strategy. And 

we also built a business case of why preventing fraud matters 

to their bottom line. What you see below is just a sampling of 
some of the larger financial institutions that have begun 

adopting AARP's recommended practices. Collectively, these 

organizations alone serve 200 million consumers and let me 

share one example. You will see data analytics on the left 

hand side. As part of our work as one of the large mega banks, 

they're investing significant resources into machine learning 

and other smart technology to help spot fraud. Next slide. 

So now what we have is thousands of front line employees 

who interact with consumers that are using our intervention 

tools that are proven by research to be effective. Next slide. 

And one of the tools they have embraced is taking our award 

winning training courses. And while our goal is really rooted 

in protecting the interest of older adults, I would be remised 

if I didn't mention and trouble with my team as well, that I 

didn't mention that our courses have been recognized with over 

a dozen awards, not only in industry categories but technology, 

training, adult education and even video production categories. 

Next slide. But most importantly bank safe works. We 

asked Virginia Tech to perform a rigorous assessment to 

quantify the impact on training on preventing financial 

exploitation among financial industry staff. So their research 

team assessed the difference between the front line employees 

in industry who took AARP's training and those who didn't and 

took a different type of training and they found that employees 

who completed the bank safe training saved sixteen times the 

amount of money than those who took a different type of 

training. 

People who also took our course were four times as more 

confident and successful in spotting it and reporting 

exploitation than their peers were. And additional insights 

from Virginia tech also discovered which of our interventions 

were most effective. Further improving our impact. And again, 

in our proven success with the financial industry, the FTC 

approached us about helping to fight gift card fraud and I have 

to tell you that Katie and Thomas Harris had been tremendous 

partners in our pursuit to help the retail sector stop gift 

card fraud which brings me back to the question, why am I here 

talking to you about gift card fraud? Next slide. 

It's a problem. Gift card sales have soared and they're 

projected to reach 221 billion by 2024 and as sales continue to 

climb, so does gift card fraud. I think you should be on the 

next slide, thanks. 
 

With that, and Marti talked about the FCC's consumer 

report. Gift cards now range in the top five frequently used 

payment methods in reported instances of scams. This is behind 

credit cards, debit cards, payment apps and wire transfers, 

many of which bank safe is actively combating through 

partnerships with financial institutions. And also with that 

is that older adults are more than half as likely to fall for 

gift card scam than their counter parts in their 20s. And when 

they do, they lose twice as much more money. So it's a 

problem. Next slide. 

I co authored a report that AARP published early this year 

with our vice president, of the most effective things that 

retailers can do to combat gift card fraud and not just 

retailers but the entire retail sector. The findings our paper 

based on is an interview with over 30 industry representatives 

and a comprehensive review of research and data from the FTC 

industry, associations, AARP and other non profits. Reflected 

on this slide are just some of the organizations that were 

generous enough to share some of their time as well as their 

insights with us. Next slide. So let touch on two big things 

that are included in our report. 

First is the fact there is no single silver bullet to this 

problem. It's our collective problem. Consumers play a role 

in being aware of potential scams. Retailers and gift card 

distributors play a role in helping to stop that suspicious 

transaction. Gift card associations and technology companies 

that create and develop retail systems also play a key role in 

advancing those tools as well as the education to stop that 

exploitation and then non profits like AARP play a role in 

arming retailers with the tools and resources to help them 

better work with consumers and really take the right steps to 

help them. And then ultimately industry regulators of law 

enforcement are the critical make and prosecuting those 

criminals and also studying the industry expectations and 

protection. Next slide. 

So our paper identifies three trends that are key to 

solving this issue together. And they are technology 

advancements and point of sales systems. Better educating and 

empowering consumers and arming employees with a better 

knowledge, skills and tools to effectively spot and stop the 

scam. So I want to talk a little bit about each of these. 

Next slide. So enhancing point of sale technologies. You can 

see this is a quote from our paper. Point of sale enhancements 

help protect consumers but they also have an added employee 
 

awareness benefit. You can see some of the examples of these 

enhancements of point of sale systems. The one I find more 

interesting is a retailer that shares with us, that if their 

point of sale flags a suspicious transaction, there's off site 

security that can focus on the in store security cameras on 

that register in question to address the situation. And they 

can instantly then alert store management to intervene but I 

also want at the same time, to flag an additional insight from 

a report and that is the concern that as major retailers 

enhance their point of sales system, criminals will then focus 

on downstream. The small and mid size retailers who are less 

likely to invest in such advance technology. Next slide. 

I'm looking at the time, if you can wrap it up that would 

be great. 

>> And of course, Marti talked about consumer education which 

is one of the ways that we have heavily invested in fraud watch 

network. We know it works. One of the two times, when a front 

line employee says something, it successfully stops the fraud. 

So employee training resources becomes critical. Key areas to 

focus on is what behavior signal is scanned and then how and 

what do we say is a scam versus, they're confident this is a 

scam. To do this, AARP did interviews with employees, AML and 

loss prevention officers and those who had boots on the ground. 

This brings us back to bank safe. So we created a 

collaborative approach that addresses the problem, seeing the 

impact that is achieved with banks, credit unions and financial 

advisors. They have a training -- in the retail sector. So 

today, our full suite of content includes the reuse and 

addition to two new trainings, one in wire transfers and gift 

card fraud and these all go live in May and are free to any 

retailers across the United States and with our partners at the 

FTC, are so wonderful in making introductions and opening doors 

to us, so ultimately Walgreens and best buy agree to be the 

retailers to train the new employees with these bank safe 

training. 

And ultimately our success is defined by our ability to 

empower our -- next slide, next slide, next slide, next slide, 

you want to go to the one with the graph. Yep, there you go. 

Ultimately our success is defined by our ability to empower our 

partners to protect older adults from fraud. The social impact 

we are seeing out of the bank safe initiative is absolutely 

astounding. But still we're really acutely aware of the 

adaptable and evolving nature of fraud and we're eager to 

continue this work in new industries as members and tactics of 
fraud continue to evolve. And with that, I'll turn it back to 

you, Alison. 

>> Alison: Great, thank you so much, for that great 

information. And for all of the great work that AARP does. 

For our final panelist today, I'm going to turn it over to 

Sarah who will share her remarks on the UK's financial 

innovative take five campaign and what we can learn from this 

model on effective messaging to stop scams and fraud. Sarah, 

turning it to you. 

>> Sarah: Thank you very much and inviting me to talk to you 

about what we have found here in the UK in terms of from a 

fraud scam perspective. My career in fraud and scams started 

over twenty years ago. It was really around the sort of 

unauthorized payments that people noticed on their bank 

statements when they came through with the post which makes me 

feel incredibly old to say that because nobody probably gets a 

statement in the post from our perspective. But moving through 

the years of us having to do this, all the way through sort of 

2015, 2016 where we really started to see a complete shift in 

that. Away from the unauthorized but into the authorized push 

payment sphere. And that's basically where a customer is 

convinced by a criminal to process safe transactions by bank 

transfer which obviously is for us here, means instant 

transaction by faster payment so it goes straight away. 

So take time to stop fraud is a national campaign that 

gives advise to help everyone to protect themselves from 

preventable financial fraud. From a consumer's perspective, 

but also we produced collateral for businesses as well. 

Really, the whole reason for launching this campaign and the 

reason it's called take five is because when we spoke to people 

who had fallen for scam and I say fallen because lots of people 

hate being called a victim. We know it from our research that 

they really don't like the idea they have been victimized. We 

had to give that sort of confidence and that confident 

challenge to people and where take five came from is that 

people said, you know, there's only a few minutes afterwards 

and I thought about it and then I thought, oh, no, something 

doesn't feel right. And that's really where take five is born. 

We have every major bank, law enforcement agency and many 

other organizations that support take five across the board. 

We have a take five charter that sets out how signatories can 

provide consistent and concerted use of the campaign messaging 

and the logo throughout their customer communications. So 
 

really, what that does is it starts to share a message because 

we can all talk about fraud a lot and fraud and scams a lot. 

We can talk about it from a lot of different agencies. Unless 

we get that messaging consistent and concerted, for consumers, 

it's incredibly confusing and that landscape is so very busy. 

We have an essential communications campaign that provides 

collateral and support for. We have a take five week every 

year. But also, PR and social media activities and a central 

take five messaging hub which sounds a posh way of saying a 

website. But literally that website is able to hone and give 

everybody the information that they need, not just from the 

advice perspective but also tools and collateral and things 

they can use. So co brandable, campaign material that you can 

get from a talk here. 

Can we go to the next slide. And the next one because I 

have done that one. In terms of the consumer attitudes, this 

is a hot topic. Consumers are more interested in the gory 

details of how -- than how they can protect themselves. Most 

have misplaced confidence and they ability their ability is 

higher than it is and they would never fall for these sorts of 

scams and be when we talk about these types of scams, we're 

talking identity theft, investment fraud, invoice scams, 

payment in advance, so up front fees for loans and impromptu 

scams where you any you're buying something that essentially 

doesn't exist but also things like romance scams. The long 

burn of one of those scams. It shows the emotional impact of 

this fraud and how the loss of money can affect them is a 

driver to action. Next slide. 

So one of the things that we need to do in order to get 

people to confront their misplaced confidence. We need to 

demonstrate it, make it personal, and provide a solution. 

That's really what take five is all about. It's about 

demonstrating how sophisticated their scanners are in their 

approach. The social engineering that has been discussed with 

the previous two speakers. How they get that information out 

of you. How they convince you to do things. They put the 

pressure on. They make you panic. But also making it 

personal, there's no shame in falling victim because you know, 

they really are advance these criminals and I call them 

criminals and I don't like to call them scammers or frauders, 

it makes them feel like cheeky types who are just trying to get 

away with it once or twice. These people are dedicated 

criminals. They're organized crime, that sits behind all of 

these scams. But also to show the emotional and financial 

consequences of you know, being a victim of fraud. For some 
 

people, it's utterly utterly devastating and specifically for 

that older population. Can really have a detrimental effect on 

their life, well being, and how they move forward afterwards. 

And that solution is really about, you know, stop challenge, 

protect, is our main mantra of our sort of take five to stop 

fraud campaign. Next slide. 

So while we know financial fraud is a problem, we're 

positive. We keep our tone of voice very informative, 

authoritative, clear and concise. You have twenty words or 

less to communicate a message to a consumer and probably even 

less if you're talking to businesses who are incredibly 

stretched for time. Therefore, by remaining personal and not 

patronizing, we're ensuring but not sensational about 

everything, we can actually talk people through and we can get 

them to understand the different nuances for all of these 

scams. Next slide. So as I mentioned, it's all about simple 

and consistent messaging. Be clear on the behaviors we want 

people to adopt. Remember consumers don't talk about fraud. 

They don't talking about fraud types so me says identity theft 

or invoice and mandate, invoice in advance means nothing to 

them. 

Talking in a way, as I mentioned, it's not criminal, it's 

fraud. It's about, what consumers want to know is not what 

they want them to do but what they -- they have actually gone 

back to us, why don't you tell us what we should be doing. You 

always say, don't, never, shouldn't, couldn't, it's very 

negative. What we would like to look at is when we can say, 

let's just go over the positive side. Next slide. 

As you will see, our primary messaging is incredibly short 

and to the point. You know, criminals or experts at 

impersonating people, organizations and they spend hours 

researching you for the scams and hoping you'll let your guard 

down and then there's the stop, challenge, protect. Stop and 

take a minute. Have a cup of tea. Go and talk to a friend. 

Talk to a family member. Just go somewhere else when you had 

either that call, that e- mail, that text message. That social 

media post that you see. Maybe the ad you see online that you 

are thinking about looking at and follow actions from. 

Challenging is really important. Can it be fake? Is that 

a part of your brain? Do you need to engage it and think? I 

hate to say everybody, this is suspicious of everybody, and 

everyone. But someone who has worked in fraud and scams for 

over twenty years, I can't think of another way to say that is 
just to show a really healthy skepticism of these things. 

Could it be fake? But building your confidence. It's okay to 

refuse, reject, or ignore requests. If someone is trying to 

sell you something over the phone or online and you didn't want 

it, then you would say no and you wouldn't have it. You 

wouldn't buy it. This is exactly the same when you come to 

things like people asking you of your personal or financial 

information, please say no. Only criminals will rush and panic 

you to do things genuine. Genuine organizations will not. 

And then last but not least, protect. If you have fallen 

for something, contact your bank immediately. They can 

generally help you. They can stop any further transactions. 

But also by reporting it through to law endorsement at action 

fraud, that helps to share that message for a wider so that 

obviously, the more people that see and know and the more 

people that hear can actually protect themselves. Next slide. 

So here is just a few examples of the collateral we actually 

produce to help us to amplify this particular campaign. So we 

have leaflets, posters, lots of stuff and activity that we do 

across the board which is made available to people from our 

website. But we do work in a lot of partnerships so there's a 

lot of talk about gift card fraud. This is something that we 

see here. So we are working with the supermarkets on their 

gift card signage. We're keeping it very short and sweet. Has 

someone asked you to buy these vouchers in order to pay a debt 

or a fee or a loan? Because again, as I say it needs to be 

sharp and it needs to be clear and it needs to be short because 

people just won't take any notice of it otherwise. Next slide. 

So we also have a number of things on our website in terms 

of we have the scam quiz that people can do. We have Facebook, 

Instagram, Twitter. We get all of our messaging out and across 

but it's not just about those. So as I have already mentioned, 

it's about working with supermarkets and partners, working with 

trade associations. Age groups in terms of age UK here that 

works with the older population. But also, we have ATM 

messaging across the board with our banking industry work, you 

can see the messaging on a more regular basis. One of the 

things we do, is a hell lot of research. One thing we know, 

the more people who say the take five campaign and the stop, 

challenge and protect messaging, the more likely they are to 

stop, challenge and protect which is the ultimate goal at the 

end of the day. Next slide. 

I have popped a couple of links here because one of the key 

things that we do is we share all of our collateral and all of 

our information with everybody for use. I appreciate obviously 
this is a UK driven campaign but we do have an international 

licensing agreement where we can actually license the use of 

take five for a wider internationally. So I mean, please do 

take a look and as I say, the information that we have is far 

and wide. It covers a multitude of different scams and the 

information we provide to protect people. As I always say, 

please take five, tell five, sharing is caring. 

The more people we tell, the more people we share the stuff 

with, the less people will fall for them. 

>> Sarah, thank you so much. I know we're running short on 

time so why don't we bring all of the panelist back. We 

probably have five minutes to open it up for questions. So 

let's open it up to council members. We heard some great 

strategies and some really great themes that cut across on the 

importance of education, the importance of messaging. And I 

know many folks who are part of the council play a role in 

enforcement and in education. Let's see. Elizabeth, do we 

have any? 

>> Lois: Thank you. Wonderful to be here with my fellow 

colleagues on this. Needless to say, I'm the FTC is huge fans 

of this type of research and I thank each of the panelist. 

This work segues perfectly with the new federal law, stop the 

CDER scams task that task them to convene an advisory group 

with a focus on retailer educating consumers and training 

employees. They want to touch on point of sale signage. We 

talked about how this can be a point of sale and you know, it 

can perpendicular and I'm not sure you have really focused as 

much on your training on point of sale because the focus has 

been on trainers and retailers actually taking practice in 

steps and you also spoke about signage, point of sale 

materials. I'm wondering, has it really been quantified by 

anyone how effective that type of point of sale indication to 

stop, indication of how the gift cards are for gifts? Any 

actually research on that? 

>> I know from our conversations retailers, one of the things 

they said, is internal research showing it's not effective and 

they want today have a point of sales sign to be collaborative. 

Whether it's, you know, whether that's really rigorous research 

or not, one of the things that we did hear and we focus on 

point of sale but it's really the technology that comes up and 

prompting the employees to say the right questions. Marti 

touched on this and we talked to operational officers as well. 

One of the issues they have with larger stores is getting the 
material to be consistent and not having the tears or those 

rips and then some of the retailers talked about placing it. 

Some of them had challenges of the point of sale because 

there's a lot of products there. So I think there's a lot of 

challenges we need to look at and thinking about how to over 

come this and how to we place the point of sales in an area 

that is most excited about Marti's research. 

>> Sarah: I can say with regards to the signage. It's very 

early days to be fair for us to tell at the moment whether or 

not the take five signage at super markets is going to have an 

impact. This is something we have done in the last year or so 

working with the supermarkets. It's by design, the reason why 

take five is yellow and black is not for any reason, they're my 

favorite color but because they're warning colors this stand 

out. Some of the things we're thinking about is to have the 

stuff that stands out and to keep it very very clear. I am 

hoping that we'll be able to tell when the next six months or 

so, whether or not that's had an impact but we'll know from the 

next batch of research, I guess. 

>> Great. I think we have time for one more question if 

there's any questions. Elizabeth, can you let me know if we 

have any others? 

>> I don't see any in the chat. It looks like Ben from SSA 

they have it. 

>> Ben: Thank you! I wasn't quick enough to raise my hand. 

One quick question for all of the panelist or any of the 

panelist. Are there any particular considerations for people 

who have cognitive decline that can out there, messages or at 

least things, or interventions that are put in place to support 

people with cognitive decline? 

>> Sarah: I can pick up on this. A lot of our efforts to be 

fair in the last couple of years have been concentrated on the 

online, social media, those types of scams. One of the things 

I want to concentrate on in the next year ahead is looking at 

how we can work with the digitally excluded. One of the things 

we are actually doing is looking to work with more care homes. 

There's a couple that are going across the communication 

channel but it's actually, for them, in terms of training their 

staff and what to look out for, but we do accessibility 

toolkits, et cetera. 

I think in terms of, there's more we can do to be able to 
communicate with a far wider audience. Although I have to say, 

all of our messaging is actually tested and fully goes through 

a process to say, look, would it work for different types of 

groups? So would it work for the young, you know, the middle 

aged, elderly or anyone with any learning disabilities or 

functionality problems and so far. 

>> Any last thoughts before we wrap up this topic? Thank you! 

Thank you everybody! Thank you to this panel. This really has 

been an incredible meaning and I'm sure the council members and 

public really learned a lot of important things. I want to say 

thank you to our panelist for providing such informative and 

impactful information about elder justice and the need for 

reforms and for sharing your effective messaging techniques. I 

want to end by just kind of highlighting a few themes that 

really I heard throughout the panels. There is a lot to follow 

up on from the first panel. I think one thing we heard 

consistently throughout is really the fall out from the issues 

of under staffing in nursing homes, the impact it is having on 

people being able to access everything from, you know, basic 

care that they need and that it's leading to the increase use 

and abuse of psychotropic medications. So I know that's 

something that seems like a cut across the board. While very 

interested in a number of folks who are continuing to work with 

you and is well committed to CMS, very engaged in working with 

a range of stakeholders as you're moving forward with this 

initiative, also highlighting how this compliments other 

efforts in transitioning nursing homes back to the community 

including money that follows the person. S informs from Susan 

and the department of justice aligned well and not only talked 

about the enforcement efforts but the important work to 

coordinate with federal state and local tribal partners with 

CMS and of course, with us at the administration for community 

living and long term care ombudsman program. That's one place 

where I think the legal service corporation can easily plug in 

and then finally, just wanted to say again, how powerful the 

resident video was. Really, bringing home the impact that the 

lack of adequate standard from the second panel. Really, 

hearing very much some strategies for getting information out. 

Not just consumer education, but involving retailers, financial 

institutions and how we need to talk about targeted messaging 

and I think across all three panelist really some important 

strategies that we all can put in place in the work that we are 

doing to prevent scams. So it's evident to me that the EJCC 

and all of the stakeholders who joined today are deeply 

committed to the many facets of elder rights and justice. All 

of us are committed to the rights of older people to live free 
 

from abuse, neglect, and exploitation. At ACL, our office of 

elder justice and adult protective services and our long term 

care ombudsman care program will continue to prioritize action 

in many of the areas that were highlighted for today's meeting. 

And while we have more work to do and I know my fellow council 

members feel the same way, I hope that everyone feels energized 

by today's presentations and will recommit to our partnerships. 

Something we heard today and know from other research is that 

it's important to identify both universal messages and specific 

interventions when appropriate for specific communities. So we 

need to make sure our approaches, our trauma informed and 

culturally appropriate. 

ACL and HHS across the board remain deeply committed to 

advancing equity and racial justice, promoting 

self- determination, and reforms to guardianship, upholding the 

rights of residents and supports older adults and be people 

with disabilities to live in their communities and enhance the 

response by adult protective services and preserve economic 

security and -- informing connections to legal assistance 

providers. We really appreciate the many ways our federal 

partners help our nation achieve these goals and the many many 

partners outside of federal government. 

It has been a privilege to host today's meeting and I want 

to thank you again to each and every one of our expert panelist 

and to each of my fellow EJCC members for your insightful 

questions. The work of EJCC is ever evolving as an all of 

government approach to elder justice. With our new member 

joining, our existing members, I hope we all can renew our 

commitment to identify areas of collaboration and explore ways 

we can amplify each other's work to move us to a society in 

which Americans truly experience life free from abuse, neglect, 

and exploitation. I want to give a huge thank you to the ACL 

staff, the office of elder justice and adult protective 

services staff who made today possible and I want to 

specifically call out Elizabeth, and many others who worked 

behind the scenes to make today's event possible. For more 

information about the EJCC, please visit our website at 

EJCC.ACL.gov. Finally, I really want to thank each of today's 

attendees for joining us. We always appreciate the issues you 

bring to our attention for action. Thank you for your 

commitment. We are all partners in this critical endeavor of 

striving towards elder justice. 

Today's EJCC meeting is now closed. Council members, we 

will convene again at the fall of 2022 meeting to continue our 
 

work together to address elder abuse, neglect, exploitation, 

and other kinds of maltreatment of older adults. Thank you, 

everyone! 

Good bye!