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 more states should 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 or reactive institutionalization).   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. 

• Dementia Care: Standard advance directives are often not helpful for patients who develop dementia. Dementia is a unique disease that progresses slowly over many years and leaves people with a long time frame of diminishing cognitive function and loss of ability to guide their own care. Advance directives typically address scenarios such as an imminently terminal condition or a permanent coma, but they generally do not address the more common scenario of gradually progressive dementia.  For that reason, everyone should consider and adopt directives relating to dementia and cognitive decline.  All of our clients receive a standard Advanced Directive for Dementia that directs care, treatment, and support in the event of cognitive decline.  Aggressive estate plans (for those with profound and/or present concerns) have expanded these directives to include Supported Decision-making (SDM).  SDM is a voluntary process that promotes self-determination by enabling seniors and adults with disabilities to make decisions with the help of selected members of their supportive community. The individual identifies a person to assist them with determining the issue that needs to be decided, the choices or options available, and weighing the pros and cons of the possible outcomes when making such a decision.  Advance directives such as these often address:

• Memory Support: Preferences for cognitive therapies, reminiscence activities, or environmental adaptations (e.g., "I prefer non-pharmacological interventions like music therapy before drugs for memory issues").

• Isolation: Directives against restricting social interactions (e.g., "Ensure regular visits from family/friends unless safety dictates otherwise; avoid isolation to prevent emotional decline").

• Chemical Depressants/Mood-Altering Drugs: Limits on or encouragement of usage (e.g., "Use only as last resort for severe distress; prioritize behavioral interventions").

• Hallucinations/Psychological Issues: Guidance on compassionate responses (e.g., "Address hallucinations with reality orientation or distraction before medication; if compounded by emotional issues, involve mental health specialists").

There are other elements of SDM relevant to dementia or cognitive impairment care, such as ensuring that the suffering person remains central, even with impairments, by, for example, directing that certain decisions, such as the use of psychoactive drugs, be made only after consultation and with consent of the person's support network.  For more information, or to consider or adopt an Advance Directive for Dementia, consult with an elder law attorney.  

• 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 trust estate from guardianship disputes by penalizing family members who directly or indirectly threaten your choices regarding guardianship, 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 necessary protections.
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.

Unique Challenges for Latino Family Caregivers in Dementia Care: Key Insights from a Recent Study

As the population ages, family caregiving for individuals with dementia has become an increasingly critical aspect of elder care planning. For Latino families, this role often comes with unique cultural, linguistic, and systemic barriers that can exacerbate the already demanding responsibilities. A new study published in October 2025 in the Journal of the American Geriatrics Society sheds light on these issues, highlighting the experiences of Latino caregivers in New York City. This research is particularly relevant for those involved in aging in place planning and elder law, as it underscores the need for tailored support systems to help families navigate dementia care while maintaining independence at home.

Overview of the StudyThe study involved in-depth interviews with 19 Latino family caregivers supporting loved ones with moderate to advanced dementia. Conducted between June and November 2024, the research focused on caregivers in New York City, where a diverse Latino population resides. Key demographics included:

• Care Recipients: Average age of 88.5 years, with 94.7% born outside the United States.
• Caregivers: Average age of 64.7 years, predominantly female (78.9%), reflecting common gender dynamics in caregiving roles.

Interviews were conducted in Spanish (26%) or Spanglish, ensuring cultural and linguistic sensitivity. Researchers identified two primary themes driving the challenges faced by these caregivers:

• Caregiving and Understanding of Dementia Shaped by Individual, Family, and Social Factors (Theme 1):
  This theme explores how personal knowledge, family dynamics, and cultural perspectives influence caregiving. Subthemes include:

• Caregiver's Own Understanding of Dementia: Many caregivers reported limited prior knowledge, leading to feelings of unpreparedness.
• Lack of Support from Family Members: Unequal distribution of responsibilities was common, with one participant noting, “In our culture, we [the women] are the caretakers,” highlighting gender-based expectations.
• Latino Cultural Perspectives on Dementia: Stigma plays a significant role, as dementia is often equated with being “crazy” in Spanish-speaking communities, deterring families from seeking help and perpetuating isolation.
• Navigating Formal Services Amid Gaps in Cultural Alignment and Support (Theme 2):
  This theme addresses interactions with healthcare systems and external resources. Subthemes include:

• Trial and Error in Care Management: Caregivers often learned through mistakes due to inadequate guidance.
• Education and Resources Gap: Participants received little to no dementia-specific education from healthcare providers, leaving them feeling isolated.
• Cultural Tension with Healthcare: Miscommunications arose from language barriers, such as misinterpretations of Spanish idioms or the provision of complex, non-Spanish resources. However, positive experiences occurred when providers spoke Spanish or shared cultural backgrounds.

The study's authors concluded that Latino family caregivers of persons living with dementia (PLWD) often lack support from family, community, and healthcare teams. They emphasized the isolation and unpreparedness caregivers felt, calling for improved communication in appointments, culturally centered educational resources, and empowerment for caregivers to voice their needs. Implications for Aging in PlaceAging in place, the preference to remain in one's home and community as one grows older, is a cornerstone of many elder care plans, especially within Latino families, where multigenerational living and family-centered care are cultural norms. However, this study reveals how cultural stigmas and systemic gaps can hinder effective home-based dementia management. For instance, the stigma associating dementia with mental instability may delay diagnosis and intervention, increasing the risk of crises that could force institutionalization.
From an elder law perspective, these findings highlight opportunities for legal advocacy. Attorneys specializing in elder law can assist families in accessing resources like Medicaid waivers for home care services, advance directives that incorporate cultural preferences, or informal guardianship arrangements that respect family dynamics. Additionally, promoting awareness of programs like the Family Caregiver Support Program under the Older Americans Act could provide respite care, counseling, and training specifically tailored to Latino communities.
To support aging in place, recommendations based on the study include:

• Culturally Sensitive Education: Develop bilingual resources that address dementia stigma and use simple, idiom-aware language.
• Healthcare System Reforms: Train providers in cultural competency and ensure Spanish-speaking staff are available during appointments.
• Community Support Networks: Encourage family involvement through workshops that challenge gender imbalances and foster shared responsibilities.

Moving Forward: Empowering Latino CaregiversThis research serves as a call to action for policymakers, healthcare providers, and elder law professionals to bridge the gaps identified. By fostering culturally aligned support, we can help Latino families sustain aging in place while reducing caregiver burnout. For those planning for the future, consulting an elder law attorney early can ensure legal protections are in place, allowing families to focus on compassionate care rather than navigating barriers alone.
If you're a caregiver or planning for a loved one with dementia, consider reaching out to local resources like the Alzheimer's Association's Spanish-language helpline or community health centers for personalized guidance. Studies like this remind us that effective elder care is not just medical, it's deeply cultural and communal.