At-Risk Elder Financial Exploitation and the Client's Plea for Silence
Robert, 81, has been in therapy with Lena, LMFT, for six months after a stroke. On June 2 he reports that his son, with whom he lives, has withdrawn about $2,000 per month from Robert's pension account for five months without permission and says he will "put Robert in a home" if Robert tells anyone. Robert is alert, oriented, and not under guardianship. He begs Lena not to report because the son is his only family. Lena has documented the disclosure in the progress note. The son calls Lena and asks whether Robert has been "saying anything crazy." Lena also learns that Robert's daughter, who lives out of state, has power of attorney.
1. Does Lena have a mandatory report, and to whom?
Read the worked answer
Yes. Colorado requires certain professionals, including licensed mental health professionals, to report suspected abuse, including financial exploitation, of an at-risk elder. Robert's age, stroke history, and dependence on his son support at-risk status, and the unauthorized withdrawals and threat of institutionalization are red flags for exploitation. Lena must report to the county department of human services or law enforcement, not investigate herself. She should document the facts Robert gave her, the dates and amounts, and the son's statement. She should not confront the son or warn him that a report is being made. She should tell Robert that she must report, explain that the report is to protect him, and help him plan for safety. The report should not be delayed because Robert objects; mandatory reporting does not require the elder's consent.
2. Can Lena keep the disclosure confidential because Robert pleaded with her not to report?
Read the worked answer
No. The duty to report overrides Robert's request for silence and the usual confidentiality privilege for that limited purpose. Lena should not promise confidentiality before explaining the limits. She can preserve confidentiality otherwise: she should not tell the son, neighbors, or daughter more than necessary. The daughter's power of attorney does not authorize Lena to disclose therapy records; it may be relevant to the investigation, but Lena should let the investigating agency decide. Lena should document Robert's plea, her explanation of the duty, and the report. If Robert becomes angry, Lena should respond empathically and continue safety planning rather than argue. The key distinction is that reporting suspected elder abuse is a legal exception, not a general waiver of the therapy privilege.
3. How should Lena respond to the son's call, and what records issues arise?
Read the worked answer
Lena should not confirm or deny that Robert is a client or discuss his statements. She should say she cannot discuss any client and end the call politely. She should document the call, the time, and what the son said. If the son becomes threatening, she should consider a safety plan and law enforcement. On records, Lena should not release Robert's therapy record to the son or the daughter without a valid authorization or legal process. If Robert has capacity, he controls the release. If a guardian or agent later requests records, Lena should verify authority and apply the minimum-necessary standard. She should preserve the record and not alter it after the report. If DORA or the county requests records, she should respond as legally required and consult counsel about privilege objections.