Rethinking Elder Abuse Strategies: How Prophylactic Planning Can Safeguard Autonomy and Aging in Place

In a thought-provoking Forbes article published on September 18, 2025, legal scholar Nina Kohn explores the limitations of America's current approach to combating elder abuse, particularly the current overreliance on mandatory reporting laws.  As professionals and advocates for aging in place, we embrace a decentralized strategy that relies on family and home rather than institutional solutions, accepting the call to consider and reconsider approaches in both policy-making and individual planning. While policy reforms are essential, proactive legal planning nonetheless offers individuals and families powerful tools to prevent abuse before it occurs. Through comprehensive planning, establishing trusts, advance directives, General Durable Powers of Attorney (GDPOAs), and Health Care Powers of Attorney (HCPOAs), seniors can maintain control over and direct their affairs, reduce vulnerability to exploitation, and support their desire to age independently at home.  

The Current Landscape: Challenges in Elder Abuse Prevention
Elder abuse remains a pervasive issue, affecting more than 10% of Americans aged 60 and older each year, with financial exploitation alone costing victims over $28 billion annually. Kohn's keen analysis highlights how mandatory reporting laws, now in place across all states for certain professionals and extended to the general public in 16 states, have failed to deliver meaningful reductions in abuse. These laws funnel suspicions to underfunded Adult Protective Services (APS) agencies, which investigate only about 62% of reports, often leading to resource strain rather than effective interventions.  
Critically, such systems can inadvertently harm victims. For instance, reports of financial abuse may erode trust between seniors and their caregivers and/or professionals, or trigger overly intrusive measures like involuntary guardianships, conservatorships,  or forced nursing home placement. Kohn cites the case of Bessie Owens, a Detroit woman whose simple request for a home accessibility modification escalated into an unwanted guardianship petition, only resolved after media intervention. Similarly, a California assisted living facility owner faced felony charges for neglect due to understaffing, underscoring how systemic failures in care exacerbate risks.
Disputes within families regarding an aging parent's wishes can tear families apart, making seniors more vulnerable than they were before tensions escalated.  As family members act to protect an aging person's financial interests, whether or not entirely subordinating their own self-interest, the legal system typically responds by first looking outside the family for independence, and then to institutional care alternatives for ease and certainty (not to mention protection from liability for fiduciaries).  These real-world scripts play out too predictably and tragically in the blog posts of the National Association to Stop Guardianship Abuse.  The result too often is a senior removed from his or her home, community, and family, and more, not less vulnerable to abuse and exploitation.  
Kohn's keen analysis and observations illustrate broader challenges: chronic APS underfunding, caregiver shortages, and a focus on reactive reporting over preventive support. Kohn advocates for amendments to reporting laws, such as Wisconsin's model, allowing exceptions if reporting might harm the victim, alongside increased APS resources and innovative programs like the RISE Collaborative, which provides advocates to help victims achieve personal goals and repair relationships.
From a policy-making perspective, we would add that it would also be helpful if more states would enact banking and financial transaction "hold" laws.  An American Banking Association survey, earlier this year, revealed that most states still lack such basic protective measures. See, "2025 ABA Survey on State Elder Financial Exploitation Laws: Balancing Protection with Autonomy for Seniors Aging in Place."  Protecting the elderly from financial exploitation would remove such incidents as a precipitating cause for other forms of exploitation or abuse, especially those that are initially well-intentioned (e.g., hostile guardianships).   Emphasizing Prophylactic Planning: Legal Tools to Prevent Elder AbuseWhile systemic reforms are crucial, elder law emphasizes the power of prophylactic, i.e., preventive, planning to mitigate these risks at the individual level. By putting legal safeguards in place early, properly incentivizing and empowering a family or community, and protecting assets and property from loss, seniors can preserve their autonomy, finances, and health decisions. This approach reduces the likelihood of abuse and the need for reactive interventions. These tools are especially vital for aging in place, where maintaining independence at home requires clear directives to avoid disputes, loss of autonomy,  or exploitation.1. Advance Directives and Living WillsAdvance directives outline your wishes for medical and non-medical treatment if you become incapacitated, impaired, or require care, whether short-term or long-term.  There are several different types of advance directives you should consider:

• Aging in Place:  The most crucial advance directive is a stated preference for aging in place, rather than institutional care.  Stating that you want your care and treatment to be provided at home, or alternatively in the least institutional setting possible, regardless of cost, makes clear an intention to avoid institutional care. 

• Guardianship:  An advance directive regarding guardianship states explicitly that you have conferred authority via powers of attorney and a trust for the express purpose of avoiding guardianship, and that in no event should a court appoint a guardian of your estate.  These directives help prevent institutional guardianship and the loss of control, decision-making, and autonomy inherent in institutional alternatives.  

• Trust Control of Assets: Drafting a trust that actually prevents institutional guardianship control of assets further fortifies your life and estate from institutional control, a step rarely taken before the Uniform Trust Code, and changes to state trust law made such planning legally possible.  Modern trusts can fortify protection from guardianship by removing the authority of a court-appointed guardian to control the trust, either by directing assets or directing the trust. In most states, a court-appointed guardian can exercise your rights (or the rights of your spouse) to amend or revoke your revocable trust.  Advanced planning will include provisions protecting your estate from guardianship disputes by penalizing family members who directly or indirectly threaten your choices regarding non-institutional decision-making and care.  

• Health Care: Medical powers of attorney, a living will, and an advance directive regarding dementia prevent unwanted or abusive medical decisions. For dementia patients or those with chronic conditions, these documents can specify preferences for life care, end-of-life care, pain management, and life-sustaining treatments. Without them, family conflicts or external interventions (like those triggered by APS reports) could lead to court-imposed decisions that disregard your values. In the context of elder abuse, advance directives empower trusted individuals to advocate on your behalf, minimizing risks of neglect or over-treatment in healthcare settings.

2. Health Care Powers of Attorney (HCPOAs)An HCPOA designates a trusted agent to make healthcare decisions when you cannot. This is distinct from a general power of attorney and focuses solely on medical matters. Properly drafted HCPOAs include HIPAA authorizations for agents to access medical records, ensuring seamless communication with providers. They counteract potential abuse by limiting decision-making to a vetted individual, rather than leaving it to opportunistic family members or strangers. For aging in place, HCPOAs facilitate home-based care arrangements, such as coordinating in-home nursing, without the fear of institutionalization imposed by external authorities. Be careful, though; state statutory forms usually do a great job of legally conferring authority, but other than end-of-life planning, do little in the way of providing advance directives.  For example, no state has statutory or legally sanctioned advance directives for dementia.   3. General Durable Powers of Attorney (GDPOAs)A GDPOA grants a chosen agent authority over financial and legal matters, remaining effective even if you lose capacity. This tool is a frontline defense against financial exploitation, a common form of elder abuse. By specifying powers—like managing bank accounts, paying bills, or handling real estate—you can prevent unauthorized access to assets. Springing GDPOAs, which activate only upon incapacity (certified by physicians), add an extra layer of protection. In light of Kohn's concerns about intrusive guardianships, a well-crafted GDPOA can often avoid the need for court-appointed guardians, preserving your dignity and control while aging at home.4. Trusts for Asset ProtectionRevocable living trusts or irrevocable trusts (e.g., Medicaid Asset Protection Trusts) allow you to transfer assets while retaining control, directly or indirectly, during your lifetime. Trusts protect against financial abuse by placing assets under structured management, often with successor trustees who step in seamlessly upon incapacity or incompetency. Trusts can confer necessary authority to implement late-in-life advanced planning mechanisms, like crisis Medicaid planning, or treatment modalities for advanced cognitive decline, that may be made unavailable by your incompetency or incapacity.   
Trusts can prevent living probate (guardianships and conservatorships) and probate at death, reducing family disputes.  Trusts can also protect assets from third-party control, i.e., guardians and conservators.  Trusts typically include spendthrift clauses to limit beneficiary access to assets when appropriate and protect against the loss of assets to third parties, such as creditors, divorced spouses, and others to whom a beneficiary may have intentionally or unintentionally pledged assets.
For seniors facing potential neglect in care facilities, trusts can earmark funds specifically for home modifications or in-home aides, supporting aging in place and deterring exploitation by ensuring assets are used as intended.
Integrating these tools creates a comprehensive estate plan that not only prevents abuse but also aligns with victim-centered approaches, Kohn recommends. For example, by designating agents who understand your cultural or personal preferences, you foster trust and autonomy, countering the erosion of relationships noted in mandatory reporting scenarios.
Practical Approaches to Preventing Fraud and Abuse
This Blog has numerous prior articles suggesting practical steps that may be used to prevent abuse or exploitation:  Consider the following:  

• Identity Theft: Credit Monitoring and Freezes (With Links to Credit Agencies);
• Navigating Family Disagreements in Caring for Others: Tips for Harmony and Legal Safeguards
• Protecting Your Legacy to Avoid Exploitation: Planning Lessons from Amy v. West-Cobb

But the best is yet to come; the article following this post will be a thorough, if not comprehensive, discussion of practical,  legal, and financial actions you can take to protect yourself or a loved one.  Stay Tuned!

Implications for Aging in Place and Elder LawAging in place thrives on autonomy, but without prophylactic planning, vulnerabilities to abuse can force relocations to nursing homes or assisted living, outcomes Kohn warns against. Legal tools like those described empower families to handle care at home, from hiring reliable aides to managing finances securely. Elder law attorneys play a key role here, customizing documents to state-specific laws and incorporating protections against undue influence.
Moreover, these plans complement policy shifts by reducing the burden on policy alternatives like APS and already burdened courts and care providers.  When individuals have clear directives, reports of suspected abuse are less likely to result in overreach, allowing agencies to focus on genuine crises.Conclusion: Act Now to Protect TomorrowThe Forbes article's call to rethink elder abuse strategies reminds us that prevention is more effective than reaction. Prophylactic planning through advance directives, HCPOAs, GDPOAs, and trusts offers a proactive path to safeguard against exploitation and maintain independence. If you're planning for yourself or a loved one, consult an elder law attorney today to draft these essential documents. Early action not only protects assets and health but also ensures your voice remains central in your care journey, embodying the victim-centered future Kohn envisions.