1. -Patches Bryan, RN, BSN, CDONLTC, MHA, NHA Chief Executive Clinical Officer Greystone Healthcare Management Identity Theft in Long Term Care Facilities (NHs & ALFs)

2. Introduction One of the most predominant problems in LTC/ALF settings is lost, misplaced and or stolen items. We have interventions in place for such things. But what about “IDENTITY THEFT”? What do you have in place for this – if it should happen in your workplace setting? Do you even know what it is or how it can happen? Well I do, and it was an experience I will never forget! First, lets discuss the facts…

3. It’s Curtains for this Identity- Theft Scam Here’s how the story went … The husband of one of the residents received a call from Sears, regarding a purchase for a washer/dryer. Police were notified at the suggestion of the department store. It's not exactly the Hollywood ending for this mastermind of an identity-theft criminal exploit.

4. It’s Curtains for this Identity- Theft Scam Corporate office was notified and internal investigation began. Facility personnel were asked to identify an individual in a photograph taken from a surveillance camera Detective presented a list of names and asked if any were current or former residents

5. It’s Curtains for this Identity- Theft Scam Abuse Hotline called Adverse Incident Report completed

6. It’s Curtains for this Identity- Theft Scam Employee was suspended pending results of internal investigation. Support organizations sought for guidance.

7. It’s Curtains for this Identity- Theft Scam Letter to families was prepared

8. Sample letter to families: July 31, 2009 Dear Family, As Administrator of [Facility Name], I am writing you this letter to notify you that one of our residents have been identified as a victim of identity theft. This was brought to our attention by the resident. I want to assure you that I am working closely with the police department and the Credit Card Company to bring this matter to a definitive close. Our residents’ privacy is a matter I take very seriously and will do everything I personally can to assist local law enforcement as they bring the responsible party to justice. It is strongly suggested that everyone check their bank account and credit report for any unauthorized activity. This can be done at http://annualcreditreport.com which allowshttp://annualcreditreport.com you to receive at no cost an annual credit report from all three major credit reporting companies. If you have any further questions, please contact me at XXX-XXX-XXXX. Sincerely, Administrator

9. It’s Curtains for this Identity- Theft Scam Statement to the media was prepared

10. Sample Media Comment … “[Facility Name] had suspended the staff member once we were notified by the police of the allegations. Now that authorities have pressed charges, the employee will be terminated and reported to their respective professional agencies in keeping with our policy on these matters. We have been and will continue to be in full cooperation with authorities on this matter.”

11. It’s Curtains for this Identity- Theft Scam Town Hall meetings with the staff were held as well as educational training on identity theft.

12. It’s Curtains for this Identity- Theft Scam Victim’s husband was continuously informed throughout investigation.

13. It’s Curtains for this Identity- Theft Scam Police discovered the suspect was a part of a group targeting LTC facilities Theft amounted to > $100,000 between Sears, JC Penney ’ s, and Rooms to Go.

14. It’s Curtains for this Identity- Theft Scam Employee X was arrested, dashing her bid for Hollywood stardom

15. PRACTICAL SUGGESTIONS TO PREVENT LOSS AND THEFT IN LONG TERM CARE FACILITIES Before Admission Complete a full inventory of all personal items and file this inventory in the facility office. Keep a copy for your records. Mark clothing and personal items with resident’s name (not just initials) using permanent markers or tags. Engrave expensive items such as television sets with name and number. Dentists are also able to engrave dentures in this manner. Check Homeowner’s insurance to see if coverage can be extended to cover property during a nursing home stay. Certain valuable items, such as prosthesis, may be insured separately.

16. PRACTICAL SUGGESTIONS After Admission Remember to include clothing worn on the day of admission on the inventory. Mark any new belongings brought to the home and enter them on the inventory sheet. If an item is discharged or sent home with someone for safekeeping, have it taken off the inventory. Communicate with family and friends to reduce misunderstandings about possessions brought to or removed from the home. Keep cash and small valuables which are not needed constantly and other valuables in a locked drawer or a safe. Report every loss to the designated staff member, in writing (via Grievance Report)

17. PRACTICAL SUGGESTIONS After Admission Provide a small container to hold dentures, eyeglasses, hearing aids, convenient to both residents and nurse’s aides. Have staff check this box each shift and sign their name. Use transparent trash liners and use personal mesh laundry bags for small items. Consider extending homeowner’s policy to cover residents’ personal possessions in the nursing facility, or to buy special insurance on therapeutic devices (hearing aids, dentures, eye glasses). Involve residents and families through the resident and family councils.

18. PRACTICAL SUGGESTIONS After the Fact Note: Item(s) are often misplaced: check the resident’s room with his/her help/permission; check with employees, and other residents and family. Check the facility’s Lost and Found. Have staff check other resident rooms or clothing for the missing item(s). Fill out a missing item report and give a copy to the staff/resident/family. Facilities may assign one staff person to handle all “missing items”.

19. PRACTICAL SUGGESTIONS After the Fact Call the police (this is what each of us would do in our own home. It acts as a good preventative for the future). If an employee is guilty of theft, facilities need to discharge and prosecute the employee immediately. If the facility is responsible for lost items, ask for reimbursement or replacement of the item. File insurance claim for lost or stolen item(s). If not satisfied, a claim can be filed in Small Claims Court.

21. Thank you !

22. -Peggy Rigsby Director of Government Services Florida Health Care Association Identity Theft in Long Term Care Facilities (NHs & ALFs)

23. History of Identity Theft and Federal Law  Identity Theft & Assumption Deterrence Act of 1998 Strengthened criminal laws regarding identity theft Recognized that the real victim is the person whose identity was stolen  Identity Theft Penalty Enhancement Act of 2004 Increases criminal penalties  Fair and Accurate Credit Transactions Act of 2003 Creditors and identity theft

24. False Identification Laws  False Identification Crime Control Act of 1982 Penalties for producing/possessing false documents  Internet False Identification Act of 2000 Closed loophole to include computer aided crimes

25.  Privacy Act of 1971 Controlling Government’s Access  Driver’s Protection Act of 1994 Limited DMV information  Health Insurance Portability and Accountability Act of 1996 Protection of health care records  Gramm-Leach-Bliley Act of 1999 Protected sale of consumer financial information  Social Security Confidentiality Act of 2000 Prohibited certain displays of SSN Privacy and Personal Data Laws

26. Federal Credit Laws  Fair Credit Reporting Act Collection and dissemination of consumer credit information  Truth in Lending Act $50 limit on fraud charges  Electronic Fund Transfer Act Framework for EFTs  Fair Credit Billing Act Resolution of billing errors

27. President Bush Task Force on Identity Theft  May 2006  Attorney General/Federal Trade Commission  Law Enforcement, Education, Government Safeguards  Strategic Plan

28. Who Governs What?  U. S. Department of Justice  Federal Trade Commission  Department of the Treasury  Department of Health and Human Services  Federal Reserve  Securities & Exchange Commission  Social Security Administration  Comptroller of the Currency  Secret Service  U.S. Postal Inspection  Federal Deposit Insurance Corporation

29. Identity Theft and State Law  Find your state statute  State Attorney General  Other relevant state agencies  www.idtheftcenter.org provides multi-state information www.idtheftcenter.org

30. Red Flag Rules  History  Components  Implementation Policy Effective date

33. Karen L. Goldsmith GOLDSMITH & GROUT, P.A. P.O. Box 2011 Winter Park, Florida 32790 (407) 740-0144 klgoldsmith@ggllawfirm.com Identity Theft in Long Term Care Facilities (NHs & ALFs)

34. IDEAS FOR PREVENTION OF IDENTITY THEFT  Mail control  One or two people should process mail  Will know what resident normally gets mail  Change in amount of mail may indicate diversion

35.  That person should be above suspicion – not the newest minimum wage employee  Do not drop mail off if resident not in room or not competent to understand maintaining mail safety  Consider a mailbox system for those residents alert and able to get around building

36. ENLIST THE RESIDENT  Education is key  Assist with shredding and explain importance  Give the alert resident a place to keep mail that is important – like a small lockbox

37.  Ask alert residents to let you know if other residents’ mail is left lying around  If resident wants to keep a checkbook on the premises ask them to allow you to keep it in the business office under lock and key but make it accessible 24 hours a day  What about lockers for this type of material?

38. ENLIST THE FAMILY  Work out a system with families of residents who are not aware to hold their mail in a safe place until the family is there or to permit a specified individual on staff to open what appears to be “junk” mail  A mailbox for these residents is helpful

39.  Lockbox in the room where mail can be slipped in is helpful  Alert families not to leave sensitive financial information in the resident’s room  Advise families not to discuss sensitive matters in a place where they may be overheard – will require you to provide a convenient place for such discussions

40. FAMILIES AND ALERT RESIDENTS (as well as those not so alert):  If the resident has a cellphone encourage them to check the bill monthly, even if they have unlimited minutes – unusual calls should be investigated  Resident should have a list of bills, bank statements, etc and when they are expected so that someone can verify that mail is not being diverted – keep the list in a safe place so it does not become a tool for an identity thief

41.  Suggest someone verify all charges and payments  Suggest someone regularly balance the checking account or other bank accounts  Suggest someone check accounts online from time to time – clever thieves will use card between cutoff times

42.  Extra checks and credit cards should be kept in a safe place  Have a secure place for outgoing mail, not the CNA’s pocket or receptionist desk  If a credit card expires or is no longer needed have a system in place to dispose of that card through a shredder in the presence of the resident or family

43. DUMPSTER DIVING is a thief’s dream activity!!!!! SHRED EVERYTHING WITH IDENTITY INFORMATION ON IT.

44. DEALING WITH YOUR STAFF  Let them know you are watching and theft will be handled harshly  Remind them of the concerns you share with residents and families

45.  Remind them of their roles  Enforce policies regarding privacy  They must be your eyes and ears – anonymous hotlines may be helpful

46. THE COMPUTER AGE  Baby Boomers are going to demand more computer time. Protecting their identity is critical, but difficult  Each resident should have a password and change them frequently – residents who may be confused or forgetful might need a staff person to get them online

47.  Protect the resident’s password from staff who are not cleared to assist residents – staff often is the identity thief  Have the computers residents use protected with a firewall or other method

48.  Tweeting and having a blog can give sensitive information to potential thieves – while your residents may want to participate in these activities, be sure they understand the dangers – if a resident who uses the computer regularly starts getting an inordinate amount of mail or visitors keep your eyes and ears open – give that resident a refresher course

49. OTHER IDEAS  Inventories are more important than ever  Discourage keeping valuables and important papers at facility or locked away  If a resident gives mail or other information to other than a family member, discuss with resident or family, if appropriate

50.  Keep the residents and family members advised of any problems – regularly report to family or resident’s council  Let staff know that if there is any suspicion of theft the police will be called  Have strict employee policies and enforce them – no room for interpretation

51.  Background screening may be necessary  Keep social security numbers off facesheets or other places with access by employees  Be mindful of what your volunteers are permitted to do

52. So you thwart all attempts to prevent identity theft – don’t forget the most simple – stealing wallets, passports, purses, etc.

53. IF YOUR IDENTITY IS STOLEN  Contact your credit card companies immediately and check for misuse and ask for a new account number - by phone and follow up with letter.

54. FILE A POLICE REPORT  Will go to the 3 credit reporting agencies  Will limit your liability to an extent  May stop collection efforts  File an identity theft claim with the FTC- get form online or call the hotline 1-877-ID-THEFT.

55. PLACE A FRAUD ALERT ON YOUR CREDIT REPORTS  Equifax: 1-800-525-6285; www.equifax.com; P.O. Box 740241, Atlanta, GA 30374-0241www.equifax.com  Experian: 1-888-EXPERIAN; www.experian.com; P.O. Box 9532, Allen, TX 75013www.experian.com  Transunion: 1-800-680-7289; www.transunion.com; Fraud Victim Assistance Division, P.O. Box 6790, Fullerton, CA 92834-6790www.transunion.com

56.  Will permit you to get free credit report  May request only last four digits of your ss number are on report  Can be temporary (up to 90 days) or extended (7 years) – does not keep thieves from using existing accounts but may prevent them opening new accounts that require credit check

57. Check your credit report for unusual activity and follow up on it – do not put your entire social security number on your letter – credit companies do make errors!!!!

58. IDENTITY THEFT EDUCATIONAL CHECKLIST FOR RESIDENTS AND FAMILIES _____Familiarize residents and families with ways in which identity may be stolen _____Explain facility’s policies and procedures for handling mail _____Discuss privately with each resident and/or family member how they want to handle their incoming mail _____Explain procedures for outgoing mail _____Ask residents how they want you to handle their “junk” mail _____Discuss with residents who wish to use computers (either own or facility’s) importance of password and protecting it. Emphasize need to protect data if the computer is kept by the resident _____Instruct those residents on proper procedures in using computers and supply them with a reminder list of steps to take _____Assure residents that while you believe that staff is honest and trustworthy; you have designated certain individuals to handle mail and computer time and give them a list _____Stress the importance of leaving valuables at home and keeping an accurate inventory on file with the facility _____Explain shredding system and how best for residents to utilize it _____Remind residents of cell phone theft and to keep cell phones with them at all times _____Remind residents and families that they should watch out for one another _____Remind residents and families about using a private place to discuss financial matters _____If resident has left a home vacant remind family to check to be sure mail has been properly forwarded by the post office _____Alert resident and families for the need to check all bills and bank statements regularly (on computer if appropriate) _____Remind residents that volunteers may not be honest so be careful what is shared with them

59. Identity Theft IQ Test Are You at Risk for Identity Theft? Test Your "Identity Quotient" ___I receive several offers of pre-approved credit every week. (5 points) ___Add 5 points if you do not shred them (cross- cut shredder preferred) before putting them in the trash. ___I carry my Social Security card in my wallet. (10 points) ___I use a computer and do not have up-to-date anti-virus, anti-spyware, and firewall protection. (10 points) ___I do not believe someone would break into my house to steal my personal information. (10 points) ___I have not ordered a copy of my credit reports for at least 2 years. (20 points) ___I use an unlocked, open box at work or at my home to drop off my outgoing mail. (10 points) ___I do not have a P.O. Box or a locked, secured mailbox. (5 points) ___I carry my military ID in my wallet at all times. (It displays my SSN.) (10 points) ___I do not shred my banking and credit information, using a cross-cut “confetti” shredder, when I throw it in the trash. (10 points) ___I throw away old credit and debit cards without shredding or cutting them up. (5 points) ___I use an ATM machine and do not examine it for signs of tampering. (5 points) ___I provide my Social Security number (SSN) whenever asked, without asking why it is needed and how it will be safeguarded. (10 points) ___Add 5 points if you provide it orally without checking to see who might be listening nearby. ___I respond to unsolicited email messages that appear to be from my bank or credit card company. (10 points) ___I leave my purse or wallet in my car. (10 points) ___I have my driver's license number and/or SSN printed on my personal checks. (10 points) ___I carry my Medicare card in my wallet at all times. (It displays my SSN.) (10 points) ___I do not believe that people would root around in my trash looking for credit or financial information or for documents containing my SSN. (10 points) ___I do not verify that all financial (credit card, debit card, checking) statements are accurate monthly. (10 points) Each one of these questions represents a possible avenue for an identity thief. Understanding Your Score:100 + points - Recent surveys* indicate that 8-9 million people are victims of ID theft each year. You are at high risk. We recommend you purchase a cross-cut paper shredder, become more security-aware in document handling, and start to question why people need your personal data. 50-99 points - Your odds of being victimized are about average. 0-49 points – Congratulations. You have a high “IQ.” Keep up the good work and don’t let your guard down now.