How to Protect Seniors a Conversation with District Attorney Summer Stephan, Ep. 18

A Life & Death Conversation with Dr. Bob Uslander

District Attorney Summer Stephan shares what San Diego initiatives are in the works to protect seniors from abuse and fraud. She shares information about her programs and efforts to help keep our most vulnerable citizens safe. Note: A Life and Death Conversation is produced for the ear. The optimal experience will come from listening to it. We provide the transcript as a way to easily navigate to a particular section and for those who would like to follow along using the text. We strongly encourage you to listen to the audio which allows you to hear the full emotional impact of the show. A combination of speech recognition software and human transcribers generates transcripts which may contain errors. The corresponding audio should be checked before quoting in print. Contact San Diego District Attorney website Transcript Dr. Bob: In this episode, I speak with San Diego County District Attorney Summer Stephan, about her passion for protecting elders from abuse and fraud. Summer is leading the way to create a blueprint for a program that brings together many agencies and organizations throughout the county that typically work in silos, including the medical community, in an effort to create programs that protect our most vulnerable members of the population. I for one was inspired by her passion and her commitment, and I will be joining in this effort. I hope you enjoy the conversation. Summer, thank you so much for taking time out of your busy day. I'm sure that you have a pretty packed schedule most days, huh? DA Stephan: Oh, well, it is. As a district attorney for the second largest county in the state of California and the fifth largest in the country, we are hopping at all times, but protecting seniors is really a passion for me, so any chance I can get to talk about it and share information and things we've done, I love to do it. Dr. Bob: Fantastic. Well, I'm excited to hear some of ... I've read up and gotten familiar with some of the initiatives in your areas that you're really committed to and devoted to. I mean it spans of course from children to seniors, the whole gamut, but I understand needing to place emphasis on protecting seniors, because there's so many, and the numbers are growing, and I think that they're becoming more and more vulnerable over time. And you mentioned while we were talking a bit ago about really wanting to engage the medical community in partnership to help with these protections. Can you expand on that a little bit? What are your thoughts about how we as physicians who are working with the senior community, can be of support? DA Stephan: Well, I think that we're finding in a lot of our obstinate crimes or ones where the victims are especially vulnerable, that engaging the medical community is of really big value. And I've come at this through a 28-year journey of public safety and prosecution and working with vulnerable children, domestic violence, sexual abuse, and elder abuse. And we find that whenever you can get a well-educated and trained medical community to spot the warning signs, you can really do a lot better. It's something that I've done consistently in sexual trauma of having doctors really be able to detect that. In human trafficking, we are engaging the medical community on the warning signs of sex trafficking and human trafficking with our victims. And in domestic violence, we've done it for years to look for those telltale signs, document them, and engage police where necessary. But we've kinda left out the elder abuse area. And it is just as important if not more important. Seniors, generally they are so vulnerable to crime because their contacts with the community become less and less as they age. They're not showing up to work necessarily on a daily basis, they're not at school, so the regular places where people may spot those signs are not there. And so the ability ... But they often do still keep a medical appointment, or they have to be seen by a doctor for their eyes, or some issue with their health. And I feel, and my team of experts feel that that is a perfect opportunity to really touch base on the whole well-being of the senior, make sure that they are doing well. Really asking additional questions if there were signs of malnourishment or pain, it's incredible that amount of intersection that medical professionals can find. I mean we are ... Something as simple as even the pain killers or medications for some of our seniors that are suffering from cancer and different pain ailments is getting stolen by caretakers. And our seniors are left to stand for their pain. So that's just one thing. Sometimes they seem like their financial situation has really changed, and they're talking about moving from their home and poverty and things like that, that are also tell-tale signs. So we really believe that the medical engagement is gonna be critical. Dr. Bob: I can see that. I mean it makes so much sense. As you're talking about some of these things, that's actually ... I'm getting chills to think about how vulnerable some of these people are. And they're at a point in life when they become so trusting and dependent. And then if somebody is taking advantage, there is just reluctance to call them out on it, because then they're even more isolated or they're at that person's mercy. So there are so many factors at play that would keep people from getting out from under some sort of abuse of relationship. So, really, we need to look at any advantage that we can find and the physicians and the nurses and the people in those offices or whatever they're going, getting their blood drawn if they're going to get X-rays. I think it makes so much sense to create an army of people who have the same mindset, the same perspective of trying to protect our most vulnerable people who don't have enough protections in place. DA Stephan: I completely agree. I mean you've really hit it on the nose. It is creating that army of eyes and ears and touchpoints that are natural, where our vulnerable populations may have that kinda rare human touch of someone who actually cares and is there for them, and taking full advantage of that. So that was kind of part of the genesis for me bringing together in San Diego, a regionalized coordinated plan, blueprint, to combat elder abuse and to protect our seniors. And we had a blueprint, if you will, for domestic violence, child abuse. But while we were doing a lot of work on seniors and crimes against seniors, we were working in silos. So the prosecution, law enforcement lane, the aging and independence services, the medical community, all kinda working in separate venues. We weren't seeing the whole coordinated vision for how we can do better. And what drove me into prioritizing and recommitting to this, is that San Diego very very fortunate for this, and really a credit to our whole community that just has a beautiful spirit. We are one of the safest urban counties in America. We are at a 49 crime rate low. However, the one outlier is that crimes against seniors went up by 38% in the last five years. And for me, how our civilization treats our most vulnerable, our children, and our seniors, and our disabled, is really gonna be how we'll be judged, how we will be judged as a civilized society. So that just didn't sit well with me at all. And I am in a full combat mode to bring those numbers down. And we brought together small stakeholder groups to iron out where the gaps are, where the needs are. We then went to a larger stakeholder group. We drew out a blueprint of a coordinated plan so that we don't miss these touchpoints. What is really incredible is that we're seeing so much similarity between seniors not reporting and how under-reported the crimes are as we see in areas of sexual assault and human trafficking, strangely enough. It really is that element of shame. Seniors report to us, when we uncover their abuse, that they felt ashamed to tell someone, they felt it made them seem weaker, they felt stupid for falling for different fraudulent schemes and buying, for example in a case we did recently, fake gems that took out all of their retirement money as an investment. They felt silly for falling for those scams, and they didn't report them. So other seniors became victims as well. So it's really that kinda shame element. And then the element that you brought out so astutely, and that's that a lot of the abuse is really by caretakers who are sometimes family members, often in San Diego, and I know across the country, it's an older son, who is taking care of a widowed mother. That's our number one target for abuse. And that older son is ripping off the mom, they often have mental health issues and drug addictions, and the mom is ... This elder mom is just a victim continuously. Dr. Bob: And there's probably some really blurred borders there, right? The boundaries of that, where does helping your child and abuse begin. So that's probably a really difficult one to go after, but if the numbers show that this is one of the big areas, then obviously we need to figure that part out. DA Stephan: We do. And in San Diego, what we're trying to do is we're trying to offer the seniors an understanding that our goal isn't gonna be just to lock up their son. Our goal is to also provide mental health treatment, drug addiction treatment, offer treatment for the son, so that the mom is not alone. But we also are not gonna permit that abuse. It just can't happen. So really we have a very excellent elder abuse unit with trauma-informed people that care, victim advocates that talk to our seniors about look, if you don't come forward, if you don't go through this, this is only gonna get worse. But if you let us help, we will do everything possible to also help your son find treatment, find resources, so that you're not alone in this. So it's a very balanced approach to the issue. Dr. Bob: That's wonderful. Well, so we've been talking for about 13 minutes now, and I'm totally inspired to try to provide support and throw my hat in the ring in some way. So when we're done with this interview, I do wanna make sure we follow up. Because my practice, my whole model practice it was developed to protect people from the gaps that exist in the healthcare industry and the general care industry, because there are all these places where people, especially older adults, seniors, people with illness, where they're so vulnerable, and the system is not necessarily intentionally abusing them, like some of these other criminals, but the system is creating abuse just by nature of not meeting some of the basic needs of the people who are moving through the system. So there's a lot of alignment. I see our healthcare system just unable to really meet a lot of the complex needs, and so people are just sort of pushed along into what's most convenient, and what's most sort of accepted, and then they find themselves, I call it kinda like down the rabbit hole, looking up and thinking, "How did we get here, how did we find ourselves in this place that is so foreign and so unfriendly." So I think it's just a natural additional kind of commitment to try to help figure out how the medical community can partner better with you and your organizations to further protect these folks. DA Stephan: I agree. And these collaborations, they just really ... I call it the multiplier effect. I think the time for kind of silos and people thinking that they just care for their own lane, it doesn't really work when you're dealing with vulnerable populations. We need kind of to build those intersections in all of the world, to kind of work together. One really unique thing we're doing here in San Diego that I think is something to be copied, is we've developed a website called ChooseWellSanDiego.com or .org, Choose Well San Diego. And what it is, it's sort of like a Yelp for senior homes, to create a way where we track the complaints, complaints of falling, complaints of neglect, different things that may not result in criminal action, but they are sort of an incentive and a motivation for homes for seniors to do better, to provide... level of care. So we have about 100 now rated in our area and are creating ... We can't force them into the Yelp system, but we sort of make sure that we start to get them the majority in there, then if you don't see a particular home that you're trying to place your elder in on that list, then you have to wonder why aren't they participating, and what do they have to hide, so- Dr. Bob: Well, that's great. It's a great thing to promote for sure. DA Stephan: Yeah. So it's things like that. And then the other thing I'm really a believer in is everyone no matter how well-intentioned they are, doctors who care, and community members who care. I think having an easy, handy protocol like with questions to ask, signs to look for, that's what we've done in domestic violence, in sexual abuse, in human trafficking. Those sorts of easy, simple ways to detect harm, to look beyond what is right there in front of you, and look for vulnerabilities and signs of abuse, having something handy. And I'm sure with your experience; we would love to get your input on what would go on a card like this, what kinds of questions should medical professionals be asking. Dr. Bob: I would be happy to. I would love to participate. And then, of course, the next step in that is what do you do with the information, right? Where does it get reported or how does it get followed up on? I know that one of the challenges that physicians and other people who are in the healthcare continuum that they're struggling with, is just time, is not having enough time to deal with the basics of the encounters. And to then add another piece on this of trying to do this additional questionnaire screenings, or if you do identify something that seems concerning or suspicious, to take the time to file a report and do the followup. So all of those processes, of course, need to be streamlined and clear as to what the steps to take are. DA Stephan: Yeah. I mean for sure. I mean in California we have mandated reporting for elder abuse, but it needs to be simpler, more streamlined, more upline, so that people aren't spending more time on those sorts of things as opposed to actually doing the care. And it makes it easier to expand the reporting. So those are all issues that we are grinding away, but this blueprint, this regional blueprint gets us started in the right direction, and with a unified commitment from our community to move forward and make lives better for our seniors, healthier, and let them live in dignity in their later years is really really an important thing. Dr. Bob: Yeah. Well, I just wanted to tell that I'm proud to be a San Diegan, and I've been here for about seven, and I love it, and I don't think I'm ever leaving. I appreciate the work that you're doing; I know that you're ... I can tell how dedicated you are to improving the lot for everybody here. I do wanna make sure that we followup, 'cause I want to contribute to this really important initiative and programs. So thank you for taking the time. DA Stephan: Well, I'd love to meet you in person, and definitely we will be in touch with you. I mean you've been doing this important work and shedding light on these issues with the increase in dementia, and Alzheimer's, and all of the the different areas that make our seniors vulnerable. We all need to give them our voice and our attention. And I really appreciate you too.