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CONSENT FORM
Please return this copy to Researcher-University of Wyoming
Purpose: If you meet the following eligibility requirements:
• have an elder (60 or older) in your family or you are the older person
• who has appointed a relative as a power of attorney (POA) agent to manage his/her finances,
• you are an adult (18 years or older), and
• you are a U.S. English-speaking resident,
We are asking you to participate in a survey and an interview. We are interested in two groups of families:
those who have experienced elder financial exploitation (EFE) by a family-member POA agent and those
who have implemented a family-member POA without experiencing EFE. More specifically we are
studying family-member experiences to identify possible risk and protective factors for financial
exploitation. You will be asked to share your perspective on your family and situational factors that may
have contributed to this situation, what happened, how you and your family responded, as well as the
impact of this experience on you and your family.
Your Participation: We expect it to take you between 30-60 minutes to complete the survey and about
one hour for the interview. If necessary, you may pause the survey and return to it later; however, we ask
that you complete the survey within two weeks of receiving access. We will contact you to schedule the
follow-up interview.
It is important that you are aware that
your participation in this study is voluntary and you may terminate
your involvement at any time without penalty. In the event that you choose to withdraw during the study,
any responses that you make to survey items will be destroyed.
Risks of Participation: Although the personal risk of harm to you is small, potential risks may include
emotional discomfort caused by sharing your experience, possible breach of confidentiality, and possible
retaliation of a family member who has abused or is abusing an elder in your family. As researchers we
have a responsibility to protect those who cannot protect themselves and to uphold state laws; therefore,
we must report suspected ongoing elder abuse, neglect, or exploitation of your family member(s).
Benefits of Participation
: We will provide a $20 money order upon completion of the survey and a $30
money order for completing the interview to compensate you for your time. In addition, your participation
will provide an opportunity to tell your story and help educators, elders, family support staff, and relevant
professionals better understand how to prevent elder financial exploitation, and how to use power of
attorney documents appropriately to manage an elder’s finances. You may have a copy of the aggregate
results of this research if you request it.
Confidentiality: If you participate in this study, you will not be identified by name, appearance, or nature
of your personal data. To protect your confidentiality, a numeric code will be assigned to your data, and
linked to your contact information, which will be stored separately. Pseudonyms will be assigned to all
names and places within states in your transcripts. Research assistants are required to sign confidentiality
forms protecting the identity of those who are surveyed. While in the possession of the researchers, data
will be kept in password-protected computer files. However, confidentiality cannot be absolutely
guaranteed.
