3
Performance of Representative Payees

This chapter addresses the first of the four specific items in the committee’s charge: “assess the extent to which representative payees are not performing their duties in accordance with SSA standards for representative payee conduct.” The findings in this chapter come from the committee’s survey (see Appendix A) and 13 site visits to Social Security Administration (SSA) field and regional offices.

The findings in this chapter are presented in six substantive sections: (1) contact and communication between representative payees and beneficiaries, (2) the duties and responsibilities of payees, (3) communication with SSA, (4) handling beneficiaries’ funds, (5) payee and beneficiary perceptions of how beneficiaries’ needs are met, and (6) overall satisfaction and agreement between payees and beneficiaries. The final section presents the committee’s conclusions and recommendations on representative payee performance.

CONTACT AND COMMUNICATION BETWEEN REPRESENTATIVE PAYEES AND BENEFICIARIES

The frequency and quality of communication between payees and beneficiaries are important for ensuring that beneficiaries’ needs are being met: it is a key indicator of the degree to which payees are performing their duties.



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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse 3 Performance of Representative Payees This chapter addresses the first of the four specific items in the committee’s charge: “assess the extent to which representative payees are not performing their duties in accordance with SSA standards for representative payee conduct.” The findings in this chapter come from the committee’s survey (see Appendix A) and 13 site visits to Social Security Administration (SSA) field and regional offices. The findings in this chapter are presented in six substantive sections: (1) contact and communication between representative payees and beneficiaries, (2) the duties and responsibilities of payees, (3) communication with SSA, (4) handling beneficiaries’ funds, (5) payee and beneficiary perceptions of how beneficiaries’ needs are met, and (6) overall satisfaction and agreement between payees and beneficiaries. The final section presents the committee’s conclusions and recommendations on representative payee performance. CONTACT AND COMMUNICATION BETWEEN REPRESENTATIVE PAYEES AND BENEFICIARIES The frequency and quality of communication between payees and beneficiaries are important for ensuring that beneficiaries’ needs are being met: it is a key indicator of the degree to which payees are performing their duties.

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse Frequency of Communication During the committee’s site visits, SSA staff stressed that payees should be in frequent contact with their beneficiaries, and the survey results show such contact. The vast majority of payees, 86.1 percent (1.5),1 reported being in touch with their beneficiaries once a week or more. About one in nine, 11.6 percent (1.3), reported monthly contact with their beneficiary; 2 percent (0.4) indicated contact once every few months; and a very small number, 0.4 percent (0.1), reported never having contact with their beneficiaries. When payees who were not living with their beneficiaries had contact, 78.6 percent (2.6) met in person and 19.7 percent (2.6) talked by telephone. At the time of the interview, 70.2 percent (2.5) of payees reported their most recent contact with their beneficiary had been within the last week, and 16.8 percent (1.7) reported contact within the past month. Smaller proportions reported their most recent contact to have been 2-3 months ago, 5.1 percent (0.9), 4-6 months ago, 4.4 percent (0.7), 7-12 months ago, 2.5 percent (0.5), or more than 12 months ago, 1.0 percent (0.3). Most beneficiaries who were not living with their payees also reported having weekly, 84.0 percent (2.0), or monthly, 10.5 percent (1.8), contact. A small number of beneficiaries indicated less frequent contact, 3.5 percent (0.8), or no contact, 2.0 percent (0.7). Consistent with payees’ reports, beneficiaries also indicated their most common form of contact was in person, 77.8 percent (2.3), or by telephone, 21.6 percent (2.3). In addition, a majority reported their most recent contact with their payees had been within the past week, 79.6 percent (2.5), or the past month, 15.3 percent (2.5). For the rest, beneficiaries said that their most recent contact with their payees was 2-3 months ago, 2.9 percent (0.6), 4-6 months ago, 1.1 percent (0.3), 7-12 months ago, 0.8 percent (0.3), or more than 12 months ago, 0.4 percent (0.3). During the committee’s site visits, SSA staff also cited a few instances in which beneficiaries had little or no communication with their payees, and said that a small number of beneficiaries had no idea where their payees were located. Discussions of Beneficiary Needs Table 3-1 presents the survey findings on payee and beneficiary reports of discussions during the past year on beneficiary needs. Most payees 1 For all estimates in this chapter, the number in parentheses following the estimate is the standard error of the estimate. As a general rule, users can approximate a 95-percent confidence interval for the estimate by adding and subtracting two standard errors to the estimate. When two estimates have confidence intervals that overlap, the two estimates are not statistically different at the .05 level of significance.

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse TABLE 3-1 Representative Payee and Beneficiary Reports of Discussions of Beneficiary Needs During the Past Year (in percentage) Beneficiary Needs Payees Saying Yes Beneficiaries Saying Yes Housing, including rent, mortgage, repairs, utilities, furnishing, and needing to move to another place 44.0 (2.0)a 47.9 (2.1)b Food and diet 68.0 (1.8)c 61.0 (2.1)b Clothing, including buying and taking care of clothes 81.7 (1.1)c 69.5 (2.3)b Medical care, including doctor, dentist, mental health, and vision services as well as medications 78.6 (1.3)c 73.4 (2.1)d NOTE: The numbers in parentheses are the standard errors of the estimate; see footnote 1. aAsked of nonparent payees of beneficiaries who are aged 18 and older and able to communicate. bAsked of beneficiaries aged 18 and older with nonparent payees. cAsked of payees of beneficiaries who are aged 7 and older and able to communicate. dAsked of all beneficiaries. SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006). serving beneficiaries aged 7 and older and who were able to communicate indicated that they had discussed medical, clothing, and food and dietary needs with them. However, among nonparent payees of beneficiaries aged 18 and older, less than a majority, 44.0 percent (2.0), reported having discussed housing needs with them during the past year. The responses for beneficiaries were similar to those for the representative payees. A majority reported having spoken with their payee about medical, clothing, and food and dietary needs. However, the percentage saying “yes” was slightly lower for them than for the representative payees. While less than a majority of beneficiaries reported having discussed housing needs, the percentage was slightly higher than that reported by representative payees. Most payees also reported consulting with other people about their beneficiaries’ needs at least once a week, 44.2 percent (2.1), or once a month, 22.6 percent (1.4). Most commonly, payees reported discussing beneficiary needs with the beneficiaries’ medical or mental health care provider, 68.9 percent (1.7), a relative, 74.2 percent (1.5), another service provider, 37.0 percent (2.1), a friend or neighbor of the beneficiary, 34.2 percent (1.6), or the SSA, 21.3 percent (1.4). A small number of payees reported that they never spoke with others about their beneficiary’s needs, 19.4 percent (1.7).

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse Discussions of Beneficiary Savings The SSA requires that a payee place any unspent benefit funds in a savings account for the beneficiary. Overall, payees reported that 34.7 percent (1.6) of all beneficiaries had general savings accounts. Of these, slightly less than half of the payees, 48.6 percent (2.3), reported having spoken with their beneficiaries during the past year about saving some of their Social Security benefit money. Beneficiaries were also asked whether or not they had discussed with their payee placing some of their Social Security benefit dollars into savings accounts. More than half, 57.3 percent (1.7) reported that they had not talked with their payees about savings during the past year. Most beneficiaries also reported not having any money saved for their future, 58.8 percent (2.1). Among those who did report some savings, the funds came largely from Social Security benefits, 70.6 percent (2.7), money given by family and friends, 45.0 percent (4.2), and from current or past employment, 27.3 percent (3.3). A majority of beneficiaries—57.4 percent (3.7)—identified their payees as the person who usually put aside some of their SSA benefit payments for savings, while almost one-third—30.6 percent (3.1)—reported that they and their payees together put aside some of the benefit payments for savings. Quality of Communications A large majority of representative payees reported that their beneficiaries are able to verbally express their needs very well, 59.9 percent (1.4), well, 13.9 percent (1.0), or “okay,” 15.1 percent (0.8). For the rest, payees reported that their beneficiaries were able to express their needs verbally “not well,” 7.1 percent (0.5), or “not at all,” 4.1 percent (0.5). Among beneficiaries deemed unable to express needs verbally at all or not well, payees also reported that their beneficiaries were able to express their needs nonverbally not well, 31.6 percent (3.9), or not at all, 24.1 percent (2.5). The most common explanation for beneficiaries’ inabilities to express their needs was a cognitive or intellectual condition, 87.4 percent (3.4). Physical and psychiatric barriers to communication were cited by payees as explanations by 59.7 percent (3.1) and 53.5 percent (5.3), respectively. Overwhelmingly, payees were either very satisfied, 83.0 percent (1.3), or somewhat satisfied, 14.1 percent (1.2), with their ability to understand their beneficiaries’ needs. Only 0.9 percent (0.2) and 0.2 percent (0.1) were dissatisfied or very dissatisfied, respectively. Of these, most, 93.5 percent (2.8) reported that the dissatisfaction was due to the beneficiary’s disability. Other reasons for payees’ dissatisfaction with understanding beneficiary

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse needs included a language barrier, 20.2 percent (11.1), and generational or other cultural differences, 17.3 percent (8.8). REPRESENTATIVE PAYEE DUTIES AND RESPONSIBILITIES It is essential that both payees and their beneficiaries have a clear understanding of the duties and responsibilities with which payees are charged. In this section we examine perceptions of these duties and responsibilities, as well as self-reports of payee performance. Perceptions of Duties and Performance Training and support of representative payees are crucial for smooth and effective operation of the payee program. When a payee is recruited, SSA provides a brochure about representative payee duties and responsibilities. This information is also found in the application (www.ssa.gov/online/ssa-11.pdf [June 2007]), along with a description of the selection process and available training and support for payees. SSA also maintains a website with support materials for representative payees (www.ssa.gov/payee/index.htm [June 2007]). The SSA specifies—in the brochure and elsewhere—nine responsibilities for representative payees: To ensure that a beneficiary has adequate clothing. To ensure that a beneficiary has adequate housing. To ensure that a beneficiary has adequate food. To ensure that a beneficiary has adequate medical care. To put into a savings account benefit funds not needed for current needs. To file an annual accounting form with SSA. To inform SSA of any changes or events that affect a beneficiary’s eligibility. To inform SSA of any changes or events that affect a payee’s ability to serve. To return to SSA any payments to which a beneficiary is not entitled. The vast majority of payees recalled that SSA had informed them of their responsibilities, 94.3 percent (0.6), and most payees have a reasonably complete understanding of their duties. Well over one-half could correctly identify all nine responsibilities, 62.7 percent (2.4); most other payees could correctly identify all but one, 29.5 percent (2.5), or two duties, 4.9 percent

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse (0.6); and only a relatively small proportion of payees were unable to correctly identify three or more of their responsibilities, 2.9 percent (0.4). Table 3-2 presents the data on payees’ and beneficiaries’ knowledge of their responsibilities. As the table shows, knowledge of the complete list of duties is very high among payees with one exception: the requirement to place unspent funds for a beneficiary in a savings account. About one in four payees were unaware of this requirement, or 27.6 percent (2.3). Of course, there may be no funds available for saving, particularly for institutionalized beneficiaries. Only an estimated 35.0 percent (1.7) of beneficiaries have conserved funds for future needs; the amount of such savings was not covered by the committee’s survey. Beneficiaries have a level of understanding about payee’s responsibilities that is similar to that of the payees themselves. Slightly more than one-half of all beneficiaries, 53.8 percent (3.1), were able to correctly identify all eight of the payee’s responsibilities about which they were asked, while over one-third missed one item, 34.7 percent (2.7), and 7.6 percent (1.4) missed two items; only 3.9 percent (0.8) missed three or more of the items. During the committee’s TABLE 3-2 Payee and Beneficiary Knowledge of Payees Responsibilities (in percentage) Payee Responsibility Payees Saying Yes Beneficiaries Saying Yes Adequate clothing for beneficiary 98.8 (0.3) 97.1 (0.7) Adequate housing for beneficiary 98.9 (0.3) 99.3 (0.2) Adequate food for beneficiary 99.4 (0.1) 99.0 (0.3) Adequate medical care, including mental health care, for beneficiary 98.4 (0.4) 98.3 (0.5) Putting into a savings account any money left over after paying for current needs 72.5 (2.3) 72.8 (3.1) Filing an accounting form with SSA every year 92.9 (0.7) 94.1 (1.5) Telling SSA of any changes or events that affect beneficiary’s eligibility for benefits or amount of benefit payments 97.1 (0.4) 95.7 (0.9) Telling SSA of any changes or events that affect one’s ability to serve as a representative payee 97.6 (0.3) NA Returning to SSA any payments to which a beneficiary is not entitled 97.7 (0.4) 95.7 (0.7) NOTES: The nine responsibilities in this table are those listed in the SSA brochure. The numbers in parentheses are the standard errors of the estimate; see footnote 1. NA = not applicable. SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006).

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse site visits, SSA staff remarked that one hallmark of a good payee was his or her understanding of the responsibility to report changes in a beneficiary’s status to SSA in a timely manner. The SSA lists 11 reportable events: beneficiary moves; beneficiary marries; beneficiary starts working; beneficiary stops working; beneficiary dies; beneficiary’s disability condition significantly improves; beneficiary’s immigration or citizenship status changes; beneficiary is confined in a correctional institution; beneficiary no longer needs a representatives payee; change in the custodial status of a minor (including adoption); and death or divorce of the parents of a minor beneficiary. Indeed, most representative payees have a good understanding of when to report changes that affect their own eligibility to serve or their beneficiary’s eligibility to receive payments. More than 96 percent of payees knew that each of the 11 events is reportable to SSA. A large majority correctly identified all 11 events necessary to report to SSA, 86.0 percent (1.3), or correctly cited all but one, 3.4 percent (0.7), or two, 3.4 percent (0.7), conditions. Only a very small fraction of payees seems unaware of the full set of events that must be reported to SSA, 2.3 percent (0.5). Although the high rates of payee and beneficiary knowledge about payees’ responsibilities are impressive, it should be noted that they may in part reflect one or more systematic response biases that can influence respondent answers. Those biases include response acquiescence, which is the tendency to agree with survey questions regardless of their content, and social desirability bias, which is the tendency to represent oneself to others (including survey interviewers) in a positive manner. We believe, for example, that acquiescence is evident in the analyses of some questions about fictitious payee responsibilities, such as ensuring that beneficiaries have an interesting hobby and helping take care of a beneficiary’s pet. These items were included in the survey in order to assess the degree to which respondents were able to successfully differentiate between duties that are and are not specifically assigned to them by SSA. Clear majorities of both payees and beneficiaries incorrectly identified each of these as payee responsibilities when asked about them along with the actual required responsibilities: This pattern suggests some respondents simply agreed with each of these questions without carefully thinking about their answers. Consequently, the

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse survey data may overestimate payee and beneficiary knowledge of payee responsibilities. A beneficiary’s eligibility requirements are more complicated if he or she also receives Supplemental Security Income (SSI) payments. To assess familiarity with the additional reporting requirements, payees who represent beneficiaries who receive SSI benefits were asked if, to their knowledge, SSA expected them to report when a beneficiary’s monthly resources exceed $2,000 (or $3,000 for a couple); when a married beneficiary separates from a spouse or reunites after a separation; when someone moves in or out of a beneficiary’s household; when the beneficiary moves to or from a hospital, nursing home, or other institution; and when a beneficiary plans to leave the United States for 30 or more consecutive days. At least 95 percent of all payees correctly answered each of these questions. COMMUNICATION WITH SSA Representative Payee and Beneficiary Queries SSA strongly encourages payees to contact them directly with questions or concerns regarding any aspect of their service or reporting requirements. During the past year, though, few payees, 6.7 percent (0.6), reported seeking help from SSA. Of those who did, most, 74.6 percent (3.4), indicated having done so only once or twice. The most common reported reasons for contacting SSA were to clarify the beneficiary’s benefit amount, 46.9 percent (5.8), to understand the payee’s responsibilities, 40.2 percent (4.1), and to request permission to allow the beneficiary to manage his or her own SSA benefit payments, 8.7 percent (2.7). Most payees reported being very satisfied, 43.9 percent (5.2), or somewhat satisfied, 27.6 percent (3.7), with the help they received from SSA. More than one in five, however, indicated being somewhat, 9.3 percent (2.6), or very, 14.5 percent (3.5), dissatisfied with the help they had received. Some payees, 8.6 percent (0.8) had reported events to SSA during the past year that might have affected the amount of benefit payments made to the beneficiary. Of those who had made a report, in most cases, 64.4 percent (4.7), SSA corrected the benefit amount. Among beneficiaries, the vast majority, 95.5 percent (0.9), had not sought help from SSA during the past year. When beneficiaries did seek help, it was for a variety of reasons: To determine what the payee was supposed to do, 30.8 percent (7.2). To understand how to manage benefit funds without a representative payee, 30.7 percent (9.2).

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse To learn why a payee was appointed, 25.6 percent (7.8). To find out what to do if the payee was misusing the beneficiary’s funds, 15.0 percent (6.8). To ascertain how their payee was chosen, 18.2 percent (7.5). To inquire as to why the payee did not give the beneficiary more money, 13.7 percent (5.0). Most beneficiaries were either very satisfied, 36.4 percent (6.5), or satisfied, 26.7 percent (7.5), with assistance that Social Security provided when contacted. However, a full 20 percent (7.5) of beneficiaries expressed dissatisfaction with the assistance provided. SSA Follow-Up During the committee’s site visits, some SSA staff reported having limited resources for following up on questions and problems identified by beneficiaries. Some SSA staff reported that, if a payee receives an SSA benefit check and then disappears, funds for the beneficiary are unavailable for that month. In some instances, SSA staff may be able to assist beneficiaries in taking legal action against payee misuse. However, SSA staff reported not having adequate resources to assess whether a new payee is truly more “suitable” than the old one and often not having resources to double-check the information that potential representative payees provide. Some staff said that if a suitable replacement payee cannot be located, it is better for a beneficiary to have no payee rather than an unsuitable one. Staff also suggested that lack of proper communication among SSA offices may enable a payee who may be unsuitable to “shop” offices in order to become or remain a payee even when one office may have information that disqualifies that person’s selection or continuation. SSA Internet Support for Representative Payees Although SSA maintains a website that provides information for payees (www.ssa.gov/payee/index.htm), it does not appear to be heavily used. Most payees report Internet access, but only 12.1 percent (1.1) of payees have accessed the SSA website for information on their duties. Low rates of website usage do not appear to be due to lack of access to the Internet, as nearly two-thirds of payees, 61.3 percent (1.4), have access. For finding information on the website, the majority of payees who used it found it very easy, 47.7 percent (4.6), or somewhat easy, 11.2 percent (2.4). For understanding information on the website, payees rated it as very easy, 51.8 percent (3.5), or somewhat easy, 31.1 percent (3.2). Still, 61,890 (15,738) found it somewhat difficult and 12,367 (4,647) found

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse TABLE 3-3 Representative Payee and Beneficiary Reports of Joint Responsibility for Paying for Beneficiary Needs (in percentage)   Reported as Joint Responsibility Beneficiary Need Payees Beneficiaries Housing 11.5 (1.4) 16.1 (2.0) Food and dietary needs 18.2 (1.7) 20.6 (1.9) Clothing 41.8 (1.7) 35.2 (2.9) Medical needs 7.4 (0.8) 8.6 (2.2) NOTE: The numbers in parentheses are the standard errors of the estimate; see footnote 1. SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006). it very difficult to locate information on the website, and 27,702 (9,481) found it somewhat difficult and 8,045 (3,700) found it very difficult to understand the information provided.2 HANDLING BENEFICIARIES’ FUNDS Beneficiary Needs Many beneficiaries depend a great deal on their monthly Social Security income. When asked who took responsibility for paying for essential beneficiary needs, most payees indicated that they paid for their beneficiary’s housing, 80.6 percent (1.4), food, 69.5 percent (2.0), and medical bills, 73.0 percent (1.7). However, less than a majority, 44.2 percent (1.6), reported being responsible for paying for their beneficiary’s clothing, which is apparently viewed as a joint responsibility. Table 3-3 summarizes payee and beneficiary views on shared responsibility for four basic beneficiary needs. About 80 percent (1.4) of payees pay a beneficiary’s housing bills, 67.1 percent (2.0) pay for food, 44.1 percent (1.6) pay for clothing, and 60.2 percent (1.8) pay medical bills. When someone other than the payee took care of paying some of a beneficiary’s bills, the most common explanation, mentioned by 35.4 percent (2.5) of payees who did not directly make these payments, was that the beneficiary sometimes functioned well enough to manage his or her own benefit payments. Estimates based on our survey of beneficiaries 18 years of age and older suggest that the problem of incorrectly appointing a payee is a relatively minor one. The survey showed that beneficiaries and payees agreed that the beneficiary could solely manage his or her payments in only 4.4 percent 2 The raw numbers are weighted estimates.

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse (0.7) of cases (see Table 6-1 in Chapter 6). We note that it is a violation of SSA rules not to report that a beneficiary no longer needs a payee. In other cases, the beneficiaries lived in a facility that took care of meeting their needs. In these situations, payees signed over the Social Security benefit payments directly to the facility, an arrangement cited by 6.4 percent (0.9) of payees not directly paying bills on behalf of their beneficiaries. In another and slightly larger proportion of cases, in which the payee was not making these payments, 8.8 percent (1.2), someone other than the payee was able to meet the beneficiary’s needs. In those instances, payees signed over the Social Security benefit payments to the other person, which is in violation of SSA rules. Beneficiaries were also asked who they believed usually took care of paying for their needs. As did the payees, the majority of beneficiaries indicated that their payee was primarily responsible for housing, 68.5 percent (2.1), food and dietary needs, 55.2 percent (2.0), and medical needs, 59.6 percent (2.2). Also consistent with the payees’ reports, less than one-half of all beneficiaries said that the payee was responsible for purchasing their clothing, 35.2 percent (2.9). Overall, beneficiary reports are largely consistent with payee reports of joint responsibility (Table 3-3). Payees were also asked to estimate how much of their beneficiaries’ Social Security benefit payments were used each month to pay for various necessities; average amounts estimated are shown in Table 3-4. Not surprisingly, expenditures for food and shelter represented more than half of expenses reported. Savings represented the smallest category of expenditures reported. TABLE 3-4 Representative Payee Estimates of Social Security Benefit Expenditures (in dollars) Expenditure Item Mean Expenditure Food $132.07 (5.1) Shelter 173.98 (6.5) Food and shelter (when reported in combination) 324.02 (17.7) Clothing 82.35 (3.5) Education and training 38.65 (3.0) Medical, dental, and mental health expenses 35.71 (3.1) Recreation and personal items 58.41 (2.6) Clothing, education, medical and dental expenses, and recreation and personal items (when reported in combination) 236.98 (20.8) Savings 28.81 (3.6) NOTE: The numbers in parentheses are the standard errors of the estimate; see footnote 1. SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006).

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse Pocket Money Most payees give their beneficiaries pocket money from their SSA benefits to spend weekly, 45.7 percent (1.3), or monthly, 34.6 (1.6), while some beneficiaries never receive pocket money, 15.4 percent (1.4). Of those provided with pocket money, the average monthly amount received was $96.27 ($10.30). Consistent with what payees reported, close to one-half, 46.6 percent (1.8), of beneficiaries said their payees gave them pocket money from their Social Security funds once a week, while 36.2 percent (1.5) received pocket money once a month. Beneficiaries, however, reported a higher average monthly allocation of pocket money, $118.97 ($6.26). Commingling SSA and Other Funds Most payees, 81.4 percent (1.3), indicated that their beneficiaries did not have sources of income other than Social Security benefits. Most, 75.5 percent (1.3), also reported that none of their beneficiaries’ benefit payments from Social Security were saved for future use. When Social Security benefits are saved, typically the payee performs this task, 84.5 percent (1.9). Payees indicated that most of their beneficiaries, 65.4 percent (1.6), did not have a general savings account and that few, 27.8 percent (1.2), ever had their Social Security benefit payments combined with any other person’s funds in an account. Payees whose beneficiaries received SSI benefits were also asked what they did to make sure that savings and other resources did not reach the maximum SSI limit above which beneficiaries are no longer eligible for Social Security benefit payments. The most common strategy mentioned was checking beneficiary resources on a regular basis, reported by 66.1 percent (3.2) of payees. Keeping a budget for the beneficiary was also a common approach, 58.4 percent (2.3). More than one-third of all payees also reported asking their beneficiaries about their resources on a regular basis, 32.2 percent (1.8), and spending some of the money in the account used for savings on things the beneficiary needs in order to maintain the account within allowable limits, 38.2 percent (3.9). Representative Payee and Beneficiary Agreement on Funds Most payees, 86.9 percent (1.0), reported that they never had disagreements with their beneficiaries about how Social Security benefit payments were spent. One or two disagreements were reported by 8.1 percent (0.7) of payees, with smaller proportions reporting three to five disagreements, 2.3 percent (0.5), or more than five disagreements, 2.7 percent (0.4). Dis-

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse agreements tended to be over what benefits were spent on, 59.2 percent (3.7), how much of the benefits were spent, 44.2 percent (3.7), who decided how benefits were to be spent, 48.8 percent (4.3), and about a beneficiary’s personal habits, such as smoking, 27.7 percent (3.4). Similarly, most beneficiaries, 87.6 percent (1.3), reported never having disagreements with their payees regarding how SSA benefits payments were spent. Disagreements once or twice were reported by 8.0 percent (1.2), three to five disagreements were reported by 2.0 percent (0.4), and more than five disagreements were reported by 2.4 percent (0.6). The most common reason for disagreements concerned expenditures for SSA benefits, 65.8 percent (5.0), followed by how much of the benefit should be spent, 54.3 percent (4.8), and who decides how the SSA benefits should be spent, 52.3 percent (4.0). Nearly one-quarter of all beneficiaries, 23.6 percent (4.9), reported having disagreements with payees regarding personal habits, such as smoking. When viewed together, payee and beneficiary responses are virtually the same (within 1 percent) on the number of disagreements about spending. Beneficiaries reported somewhat more disagreement with their payees than did the payees with their beneficiaries, with beneficiaries having slightly larger discrepancies concerning expenditures of benefits, how much of the benefit should be spent, and who decides. Representative Payee Record Keeping About two-thirds of all payees, 68.0 percent (2.1), reported keeping records of how beneficiaries’ Social Security funds were spent. Of those keeping records, paper records, such as notebooks or checkbooks, were the most common methods, 76.8 percent (1.6). Less than one in ten payees reported keeping records on a computer, 8.7 percent (0.8). More beneficiaries believed that their payees kept records of how their Social Security funds were spent, 79.0 percent (1.8), than the payees reported. When records were thought to be kept, beneficiaries also believed that payees were using a notebook, checkbook, or other paper record, 84.8 percent (2.9), or a computer, for 15.5 percent (1.6), which is more than their payees reported. MEETING BENEFICIARY NEEDS Ultimately, the purpose of the SSA Representative Payee Program is to ensure that beneficiaries’ needs for basic necessities are met. In this section we present the survey findings from payee and beneficiary reports on the degree to which beneficiaries experienced any unmet basic needs during the previous year.

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse We report, first, however, on payee and beneficiary responses to questions about overall satisfaction with payee performance. Satisfaction with payee performance, on the part of both the payees and beneficiaries, is important not only for the welfare of the beneficiaries, but also for payees’ continued willingness to serve. Overall, payees were either very satisfied, 82.1 percent (1.2), or somewhat satisfied, 14.4 percent (1.1), with their ability to help their beneficiaries. Similarly, the vast majority of beneficiaries were also either very satisfied, 86.5 percent (1.5), or somewhat satisfied, 9.0 percent (1.2), with their payees. Only small numbers of beneficiaries were somewhat dissatisfied, 1.1 percent (0.3), or very dissatisfied, 1.2 percent (0.6), with their payees. Perceptions of Unmet Beneficiary Needs Table 3-5 presents survey results of payee and beneficiary reports of unmet needs. Although less than 3 percent of payees reported a specific unmet need, 6.0 percent (0.6) of payees reported having a beneficiary with at least one unmet need. Similarly, less than 3 percent of beneficiaries reported any specific unmet need, but somewhat more of them reported having at least one unmet need during the previous year, 7.2 percent (1.0). Consistently, however, beneficiaries were more likely to report unmet needs than were their payees. In fact, although the number of these reports were small overall, beneficiaries were twice as likely to report having been without utilities TABLE 3-5 Representative Payee and Beneficiary Reports of Unmet Beneficiary Needs During the Past (in percentage) Unmet Need Payees Saying Yes Beneficiaries Saying Yes Beneficiary/Payee Ratio Place to live 0.7 (0.2) 1.0 (0.4) 1.4 Utilities, including heat, water, and electricity 1.0 (0.2) 2.2 (0.5) 2.2 Food (been hungry) 0.8 (0.2) 2.4 (0.6) 3.0 Clothes 0.5 (0.2) 2.0 (0.5) 4.0 Seeing a doctor, dentist, therapist, eye doctor, or other medical professional 2.8 (0.4) 2.8 (0.6) 1.0 Medication 1.8 (0.3) 2.8 (0.6) 1.6 Any need 6.0 (0.6) 7.2 (1.0) 1.2 NOTE: The numbers in parentheses are the standard errors of the estimate; see footnote 1. SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006).

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse or having gone hungry at some point during the past year, and three times as likely to report having needed (and not received) clothing as their payee counterparts. Payees were also asked if they believed that their beneficiaries had all, most, some, or none of their needs met across the same domains during the past year. As shown in Table 3-6, more than 90 percent of payees reported that they believed all their beneficiaries’ needs were met in four of the six domains: housing, food, clothing, and medical needs. However, about one in five payees, 19.7 percent (1.1), reported that none of the education or training needs of their beneficiary were being met. As shown in Table 3-7, beneficiaries’ responses about unmet needs par- TABLE 3-6 Payee Perceptions of Beneficiary Needs Met During the Past Year (in percentage) Need All of the Time Most of the Time Some of the Time None of the Time Housing, including utilities 94.4 (1.0) 3.3 (0.6) 2.0 (0.4) 0.3 (0.1) Food 95.4 (1.1) 2.7 (0.7) 1.9 (0.4) 0.1 (0.1) Clothing 92.0 (1.1) 4.6 (0.7) 3.2 (0.5) 0.2 (0.1) Medical 93.1 (1.1) 3.0 (0.5) 3.0 (0.5) 0.8 (0.3) Recreation 81.9 (1.1) 7.1 (0.6) 8.6 (0.7) 2.4 (0.4) Education or training 74.6 (0.9) 3.2 (0.6) 4.2 (0.4) 18.0 (0.9) NOTE: The numbers in parentheses are the standard errors of the estimate; see footnote 1. SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006). TABLE 3-7 Beneficiary Perceptions of Their Needs Met During the Past Year (in percentage) Need All of the Time Most of the Time Some of the Time None of the Time Housing, including utilities 94.1 (1.2) 3.5 (0.8) 2.0 (0.6) 0.4 (0.2) Food 93.4 (1.2) 4.2 (0.9) 2.2 (0.5) 0.2 (0.2) Clothing 92.6 (1.1) 3.9 (0.7) 2.8 (0.5) 0.8 (0.3) Medical 93.5 (1.0) 3.9 (0.8) 1.9 (0.4) 0.7 (0.3) Recreation 83.2 (1.6) 5.9 (0.8) 7.1 (0.9) 3.8 (0.5) Education or training 74.9 (1.3) 3.9 (0.7) 2.8 (0.6) 18.3 (1.2) NOTE: The numbers in parentheses are the standard errors of the estimate; see footnote 1. SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006).

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse alleled those of payees. More than 90 percent of beneficiaries reported that all of their needs for housing, food, clothing, and medical care had been met. Like the payees, nearly one in five beneficiaries, 18.3 percent (1.2), reported that none of their education or training needs had been met. During the committee’s site visits, some SSA staff stressed that beneficiaries are reluctant to report issues of unmet need, either resulting from a payee’s failure to address known problems or a payee’s failure to exercise discretion regarding beneficiary funds. Some staff noted limited resources for the office to follow up on problems brought to their attention. Agreement Between Beneficiary and Representative Payee Reports The survey findings reported in this chapter show close agreement between payees and beneficiaries. However, these comparisons are at the aggregate level and do not necessarily indicate the level of agreement between pairs (dyads) of beneficiaries and payees. To assess the consistency of reporting between individual beneficiary and payee dyads, we examined the percent agreement3 between payee and beneficiary reports. Table 3-8 presents the agreement statistics; responses that are payee requirements by SSA are indicated by the symbol @. The data show that more than 95 percent of all payee-beneficiary dyads provided consistent responses on six questions about unmet needs. The percent agreement in responding to communication and financial practices questions was not as high, but still indicated that close to two-thirds or more of all payee-beneficiary dyads provided identical reports to those items. CONCLUSIONS AND RECOMMENDATIONS Communication Most payees indicated communicating with beneficiaries at least once a week, most often through face-to-face meetings, followed by telephone calls. The majority of payees consulted with others about their beneficiaries’ needs weekly, most often with medical or mental health professionals, and also with relatives. For beneficiaries with savings accounts, one-half of the payees had not spoken with their beneficiary about saving money. For those payees having discussed savings in the past year, slightly over one-half discussed it once every few months. Payees reported that nearly half of beneficiaries express their needs very well. One-third of payees thought that their beneficiaries were un- 3 The percent agreement measure is simply the proportion of cases in which both the payee and the beneficiary gave the same answer.

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse TABLE 3-8 Agreement Between Reports of Representative Payee and Beneficiary Dyads (in percentage) Domain Agreement Communication Between Payee and Beneficiary   Saving some Social Security benefit money 67.6 (3.5) @Housing needs 64.3 (2.2) @Food and diet needs 64.3 (2.2) @Clothing needs 67.7 (1.9) @Medical needs 74.7 (1.7) Financial Information and Practices   Beneficiary has other sources of income 86.4 (1.2) Beneficiary has a general savings account 70.2 (1.8) Payee keeps records of how SS benefits are spent 68.9 (2.0) Unmet Needs During the Past Year   Housing 98.6 (0.4) Utilities 97.3 (0.6) Hungry (been hungry) 97.3 (0.6) Clothes 98.0 (0.5) Seeing a doctor, dentist, therapist, eye doctor, or other medical professional 95.1 (0.6) Medication 96.5 (0.7) NOTES: The numbers in parentheses are the standard errors of the estimate; see footnote 1. @ = SSA requirement. SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006). able to express their needs nonverbally. The most common impediments to beneficiaries’ communication were cognitive or intellectual conditions. Most payees were very satisfied with their ability to understand beneficiary needs. For a small percentage, dissatisfaction was mainly attributed to the beneficiary’s disability. Most beneficiaries not living with the payee had weekly contact with them. Very few had no contact with the payee. Most beneficiaries said they were contacted in person, with the second most frequent mode being by telephone. For the few payees who had questions for SSA about their role, inquiries tended to concern the correct benefit amount for the beneficiary and further clarification of their responsibilities. One in five payees who contacted SSA reported being dissatisfied with the assistance provided. Also, one-fifth of the beneficiaries who contacted SSA were not satisfied with the assistance that SSA staff gave them. Although the number of payees and beneficiaries who seek help is small, the fact that more than one in five who

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse sought help are dissatisfied to some extent is of concern and bears further investigation by SSA. The website that SSA provides for assistance to payees does not appear to be used very much, in spite of a significant number of payees who report having access to the Internet. The lack of use may be due to a lack of knowledge of the site’s existence or to how information on the website is presented. In either case, the website’s usability (e.g., user friendliness, readability) should be periodically reviewed and updated by SSA staff, and its existence regularly communicated to representative payees. Meeting Beneficiary Needs and Saving Funds Over one-half of beneficiaries had not spoken with their payees about putting some Social Security benefit dollars in savings, and most had no money saved for their future, although one-quarter had saved some amount of benefit payments. However, many payees were unaware that they could or should place unused funds in a savings account. Because social security benefits are often the only source of income for most beneficiaries, it is important that payees use funds for the needs of beneficiaries and conserve them when at all possible. RECOMMENDATION 3.1 The Social Security Administration should strengthen its efforts to encourage representative payees to save money for beneficiaries and to enforce the requirement that the saved money is put in a specified savings account. One additional area for scrutiny regarding beneficiary needs is that of their education or training needs, an SSA-required payee responsibility that was reported not met by one-fifth of payees and beneficiaries. Payee’s attention to beneficiary education and training and to savings (when possible) should be a priority, one that SSA may want to strongly emphasize to representative payees. Information from the committee’s site visits is instructive regarding payees’ meeting beneficiaries needs. Some SSA staff said that beneficiaries were reticent to come forward to report problems due to a fear of potential retribution by the payee. Moreover, if the beneficiary is a person with a communication limitation, his or her ability to report to SSA is further compromised. Representative Payee Duties and Performance Most payees understood that they should provide beneficiaries with adequate housing, food, and clothing, but many did not appear to understand

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Improving the Social Security Representative Payee Program: Serving Beneficiaries and Minimizing Misuse that they were to deposit any leftover payments into a specified account (see above). Over one-third of payees said that they usually give the beneficiary pocket money, though a few never do. For beneficiaries receiving SSI payments, well over one-half of payees checked beneficiaries’ resources on a regular basis and maintained a budget for them. Most payees and beneficiaries reported having no arguments regarding how Social Security payments were spent. For the few beneficiaries with arguments, more than one-half were concerned about how the money would be spent. Again, one must be cautious in interpreting the level of agreement between payees and beneficiaries because, as stressed by SSA staff during our site visits, beneficiaries may be reticent to report disagreements with their payees. Most payees took responsibility for paying for essential beneficiary needs (e.g., housing, food, medical bills). For many payees and beneficiaries, this was a shared responsibility. In many of the instances in which the payee did not directly make payments, the beneficiaries did so or the facilities in which they lived did so. The committee concludes on the basis of its survey and site visits that payees are generally performing their duties in accordance with SSA standards. According to the more in-depth information from dyads of payees and their beneficiaries, they maintain reasonably frequent contact and discuss basic needs. The dyads are also in general agreement as to who pays for the beneficiary’s basic needs, whether or not the beneficiary receives pocket money, whether or not the payee maintains records of expenditures, and whether or not beneficiaries have experienced unmet needs in the past year. Payees and beneficiaries appear to have high levels of understanding of the basic duties and responsibilities of payees, with the exception of the requirement to put into specified savings accounts funds that are not required for current needs. Both payees and beneficiaries report high levels of satisfaction with payee performance.