Jason Karlawish, MD
Jason is a professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania Perelman School of Medicine. He is also co-director of the Penn Memory Center. His research focuses on neuroethics and policy. He has investigated issues in dementia drug development, informed consent, quality of life, research and treatment decision-making, and voting by persons with dementia. To learn more about his research and writing, visit www.jasonkarlawish.com.
Dr. Karlawish introduced the concept of Whealthcare in a 2015 Forbes column titled, "Why Bankers, Financial Analysts And Doctors Need To Start Working Together."
What is Whealthcare?
- a paradigm of merging the banking and financial sector, or wealth, with healthcare
- a strategy to help slow the growth of elder financial abuse
Whealthcare: Or how we can assure older adults' cognitive and financial well being
By Jason Karlawish, MD
Congressional Testimony on World Elder Abuse Awareness Day
Ten years ago, Renee Packel brought her husband Arthur for a new patient assessment at the Penn Memory Center. Not only had he missed paying three consecutive months of condominium fees, he’d either been defrauded or he himself had committed a series of bad financial transactions. Regardless of the cause, he’d lost much of their life savings.
Their life was transformed. She sold their house, they moved to an apartment, she took up the first job of her life, and shelved their retirement plans for travel and leisure; and I diagnosed him with Alzheimer’s disease dementia. They only visit he’d make to his beloved Paris would be after he died when Renee scattered his ashes over a grave in Pere Lachaise cemetery.
My message to you is that this did not have to happen.
The sufferings of Arthur and Renee Packel and millions of Americans like them can be prevented, prevented in the same way we can prevent heart attacks, strokes, and hip fractures. They can be prevented because among the first signs of cognitive changes caused by diseases such as Alzheimer’s disease, and cognitive aging as well, are changes in our capacity to manage our finances.
Financial transactions – bill payments, cash transfers, account withdrawals, investments – are all also data about our nation’s cognitive health. Errors in these transactions, or evidence that others are taking advantage of persons who make them, are data about cognitive function. These data are far more real-world, real-time and arguably cheaper than data from performing and interpreting esoteric cognitive testing or brain scans.
Doctors focus on health. Bankers and financial services professionals focus on wealth. Rarely in the practice of their professions do the two meet. Until now.
Errors in finances and cases of financial fraud and abuse are the strokes, heart attacks and hip fractures of the aging and diseased brain. Yes, they’re sometimes justice issues, sometimes criminal issues that need the full force of our justice system brought to bear to address them. But they’re typically matters of cognitive health -- even when criminal issues are not in question. And they could be prevented.
The banking and financial services industries are on the front lines of screening for cognitive impairment.
The intimate connections between health and wealth suggest the need for a new model to assure the financial security of aging Americans. We need to fuse health care and wealth care into “whealthcare.”
This new model of “whealthcare” fits nicely into the principles of public health:
- It requires education and empowerment of the public and financial professionals.
- It can use assessment to surveille and screen to detect the problem. Financial institutions have the real-time data showing problems with financial capacity – missed or double bills, odd cash transfers, unsuitable investments. They could deploy technologies to monitor transactions and develop algorithms to predict who may suffer problems.
- Interventions in the life space, outside medical settings, can promote both health and wealth. Interventions include changes in regulations and banking and financial services practices that make it routine to monitor, integrate reporting into a health care system, facilitate reporting suspected cases of abuse or fraud, and permit holds on suspicious or worrisome transactions.
- Assuring the financial well-being of aging Americans is a public health issue because the failure to address this problem leads to harms to others. Older adults who suffer losses in financial capacity that lead to losses in wealth cannot go back to work to make up the lost money. They lack the time and the capacity to do so. Someone else has to pay, their family or us, the public.
The public policy mandate is evident and it is in place. The CDC has issued the Healthy Brain Initiative: A national public health roadmap for maintaining cognitive health.” The Roadmap plainly explains why cognitive health is a public health priority. Whealthcare should be a part of that roadmap. The National Alzheimers Project Act is law and the U.S. now has a National Alzheimer’s plan. First among its five goals are that by 2025 we will discover effective interventions to treat or prevent cognitive impairment caused by diseases such as Alzheimer’s disease. You, congress, have been allocating millions to achieve this goal. Today’s hearing is a clear opportunity to include the nation’s banks and financial services industries in achieving this goal.
I urge you to review the President’s Council of Advisors on Science and Technology – PCAST – recent report “Independence, Technology and Connection in Older Age.” Chapter 3 — “Technologies to address changes in cognitive ability” — explains how technologies that allow passive monitoring of accounts and online view only accounts can monitor cognitive function and protect older adults’ economic security.
I’ll close with a summary of its recommendation:
We need to facilitate and promote the creation of industry standards for the collection and aggregation of data. These include requiring financial institutions to adopt commercially reasonable best practices for the use of technologies that detect potential fraud, abuse, or changes in financial capacity; and making rules that will prompt financial institutions that offer online banking to create a means for older adults to give monitoring power to a trusted party without enabling that party to initiate transactions, change the customer’s profile information, or otherwise engage in fraud or abuse.
Several regulatory nudges could incent the industry to make passive monitoring and reporting and online view-only accounts part of routine banking and financial management. These include:
The SEC should assure financial institutions that hold a transaction due to suspected elder abuse or fraud or impaired capacity does not violate regulations for efficient and timely execution of a transaction
The FDIC should require financial institutions to routinely offer safe-harbor forms to customers that authorize the institution to share information with a trusted people if an event of fraud or financial abuse is suspected or discovered.
The signatories to the 2013 Interagency Guidance on Privacy Laws and Reporting Financial Abuse of Older Adults should assure financial institutions that complying with State mandatory reporting requirements, and reporting suspected elder abuse and fraud in states that do not have mandatory reporting requirements, does not violate the customer’s privacy rights under Gramm-Leach-Bliley Act.
Congress and the Executive Office of the President should convene State governors to identify the challenges and share successful strategies that ensure that suspicious activity reports with information about suspected elder abuse or fraud are transferred to local adult protective services and law-enforcement authorities to protect seniors
If we do these things. If whealthcare becomes a routine part of life in America, Arthur Packel would still have suffered Alzheimer’s disease, but he would have live with the disease in his own home, in the company of Renne, and a journey to Paris as a person, not as ashes, would have been among his last memories.
The personal website of Dr. Karlawish offers a glimpse at his past and upcoming speaking engagements and provides more information about his first novel, Open Wound: The Tragic Obsession of Dr. William Beaumont.
Making Sense of Alzheimer’s is a creative space for people to understand the past, present and future of Alzheimer’s disease. It is an evolving forum, a gallery of ideas, a museum without walls.
“Typical Day” is a photography project that allows older adults living with mild cognitive impairmentto document their lives as they address their condition. The people featured in this project are living in a world that can be difficult to describe in words. Instead, they’d like to show you through images.
The Penn Memory Center, co-directed by Dr. Karlawish, is a single, unified Penn Medicine source for those age 65 and older seeking evaluation, diagnosis, treatment, information, and research opportunities related to symptoms of progressive memory loss, and accompanying changes in thinking, communication and personality.
Whealthcare in the media
Technological Innovations for Health and Wealth for an Ageing Global Population (World Economic Forum)
The World Economic Forum’s Global Agenda Council on Ageing, of which Dr. Jason Karlaiwish is a member, has examined the nexus of health and wealth among older adults. This executive briefing explores and evaluates technological and social innovations for healthy ageing with applicability to the financial services industry. It builds on the contributions of the Global Agenda Council on Ageing. It is intended for business executives engaged in innovation for older populations, policy-makers involved in designing protocols and policies for older adults, non-profit leaders advocating for the well-being of elder individuals, and academic researchers building the evidence for new technologies for healthy ageing and financial security.
Not Losing it: The Elderly, Cognitive Decline, and Banking (The Economist)
Studies suggest financial decision-making ability tends to reach its peak in a person’s mid-50s, after when deterioration sets in. “Age-friendly” banks are beginning to learn how to protect vulnerable older customers. Dr. Jason Karlawish discusses how his concept of "whealthcare" can help physicians and banks jointly help the aging population.
Whealthcare: Preventing financial fraud and promoting Cognitive Health and wealth (Forbes.com)
Dr. Jason Karlawish, co-director of the Penn Memory Center, introduces the concept of "whealthcare" by introducing Renee and Arthur Packel in his Forbes column. Arthur had lost nearly all of the couple's life savings, either through fraud or poor financial decisions. At the Penn Memory Center, he was diagnosed with mild-stage dementia caused by Alzheimer's disease.
In washington testimony, Karlawish calls for federal whealthcare action (Penn Memory Center)
Testifying before the Elder Justice Coordinating Council in April 2016, Dr. Jason Karlawish introduced whealthcare as “a new model to assure the financial security of aging Americans.”
“Among the first signs of cognitive changes caused by diseases such as Alzheimer’s disease, and cognitive aging as well, are changes in our capacity to manage our finances,” putting the banking and financial services industries on the front lines of screening for cognitive impairment, Karlawish said.
The hidden cost of dementia that can steal your life savings (www.nj.com)
Columnist Tony Dearing outlines actions that can be taken by children of older adults to help to protect their parents' wealth, including gaining read-only access to bank accounts or setting up automated bill-paying.
Aging and Cognition Symposium (Penn Memory Center)
The World Economic Forum’s Global Agenda Council on Ageing (WEF GAC) and the University of Pennsylvania’s Healthy Brain Research Center were pleased to host “Aging and Cognition: Maintaining Economic Security in Later Life” in May 2016.
At the fourth and final symposium in a series presented by the WEF GAC, thought-provoking debates and discussions led by world-renowned leaders in their fields informed and inspired the select audience of 60 attendees from academia, financial services, technology firms, and dementia research.
Building Communities to Fight Elder Financial Exploitation (Medium)
In a September 2016 presentation at the Diversity in Today’s Financial Marketplace conference hosted by the North American Securities Administrators Association, Philip Marshall included whealthcare as one of the cornerstones of a community coming together to combat elder financial exploitation.
Cognitive Aging, Health and money: Why we need whealthcare (Leonard Davis institute of health economics)
Ana Bonilla-Martinez, a summer intern with the Penn Memory Center, describes what she had learned about whealthcare by telling the story of Dr. Max Gomez, whose father unknowingly lost his business and all savings.
If you have questions about the concept of whealthcare or suggestions for www.whealthcare.org, use the form below.