REPORTING SUSPECTED ABUSE

All states have a mandatory reporting statute for elder abuse, although statutes vary as to the following areas:

  • Who is required to report abuse or suspected abuse (“mandated reporters”)
  • What activities constitute or require reporting
  • Whether or not the victim lacks capacity
  • Whether or not the victim resides at home or in an assisted living facility or nursing home

(For information on locating each state’s elder abuse statutes, see “Resources” at the end of this course.)

Dependent adult abuse and elder abuse laws provide for evaluations and assessments of alleged abused dependent adults and elders. These laws seek to provide services and make referrals to assist abused adults to acquire a safe living arrangement. Adult Protective Service agencies are available in most jurisdictions.

The primary purpose of the reporting process is to obtain available and pertinent information regarding the allegation of abuse. The ability of the reporter to gather this information is critical to the evaluation and assessment process and is often the first step taken to initiate safeguards for the dependent adult at risk. The intent of reporting laws is to accept and process valid reports while not infringing on an adult’s right to privacy.

A thorough intake will provide:

  • Protection for the dependent adult
  • Necessary information for the assigned Adult Protective Services worker
  • Information and referral

All allegations of abuse must be taken seriously whether they come from the patient, family, healthcare professional, neighbor, friend, or other service provider. Concerns must be reported to those responsible for assessment and followed up by inquiries about the nature and circumstances of the allegation.

Who Must Report?

MANDATED REPORTERS

All states have laws designating certain professionals as mandated reporters of dependent adult abuse (Meiner & Yeager, 2019; Phelan, 2018). By law, many organizations and individuals who are responsible for the care or custody of the elderly or dependent adults are required and mandated to report situations of abuse. Mandated reporters may include, but are not limited to, the following:

  • Healthcare professionals
  • Care custodians
  • Employees of Adult Protective Services agencies
  • Employees of financial institutions
  • Law enforcement officers
  • Clergy members

PERMISSIVE REPORTERS

Any person who believes a dependent adult has suffered some form of abuse may report the suspected abuse to the local Adult Protective Services (or equivalent governmental agency) or to law enforcement. This is referred to as permissive reporting. For example, a local shop owner may voluntarily report suspected financial exploitation of a dependent adult, or a neighbor may report suspected self-neglect of an older adult.

It is important to note that mandated reporters may also report suspected abuse outside the scope of their professional practice, as permissive reporters (Geiderman & Marco, 2020).

KEY CONCEPTS FOR NURSE MANDATED REPORTERS

The registered nurse is contextually involved in the dynamics of dependent adult abuse merely by the professional responsibility as a mandated reporter and an advocate for patients. Some of the key concepts involved within the profession of nursing include:

  • Nurses must maintain updated knowledge of signs and symptoms of suspected dependent adult abuse.
  • Nurses must maintain updated knowledge of laws pertaining to dependent adult abuse.
  • Nurses have a legal responsibility to report suspected abuse of dependent adults.
  • Nurses must be vigilant and sensitive to the potential for abuse in the frail and vulnerable adult.
  • Nurses must assess subtle signs of abuse.
  • Nurses must proceed with a full assessment, including determination of safety of the victim.
  • Nurses must participate in the prevention and early recognition of potential abuse.
    (Registered Nursing, 2020; Touhy & Jett, 2016)

These same concepts can be applied by all mandated reporters.

CASE
Reporting Abuse

Jean is a 25-year-old with muscular dystrophy and moderate intellectual disabilities. She is dependent on her parents for all her activities of daily living and attends a special work program to assist her. On a recent field trip with the program, Jean’s supervisor left her alone and unsupervised in the program’s van with two male members of the program for approximately ten minutes. While the supervisor was gone, one of the young males removed Jean’s shirt and took a picture of the two of them while he fondled her breasts. Upon arriving back at the program’s building, the two males showed the picture to other people in the work program.

Back at home, Jean, distraught from the incident, tearfully told her mother what had happened. Jean’s mother, Barbara, who happens to be a nurse, immediately called the police and then the work program administrator. Since she did not learn of the abuse while working in her capacity as a nurse, Barbara is not considered a mandated reporter in this instance according to her state’s laws. But as a healthcare professional, she is well aware of the harmful effects of the abusive actions on her daughter, and she understood that calling the police would be the correct intervention for her to take as a permissive reporter.

The police began an investigation for dependent adult abuse in the form of personal degradation and sexual exploitation. They also directed the complaint to the county’s Adult Protective Services for further assessment. A social worker began to help Jean and her parents to find another work program and to seek psychological/mental health services. Appropriate actions were also taken toward the program and abusers.

What Is the Reporting Process?

IMMEDIATE PROTECTION CONTEXT

If urgent protection is believed necessary for a dependent adult, a reporter should immediately call 911 or law enforcement. The law enforcement personnel receiving this information will then report to the designated state agency (Registered Nursing, 2020).

COMMUNITY CONTEXT

Mandated reporters who suspect elder abuse or dependent adult abuse within the community generally must immediately make an oral report via an Adult Protective Services or elder abuse hotline or an online reporting system. Reporters who are a staff member or employee of a care facility must generally also notify the person in charge at the facility. A written report is usually required by the mandated reporter within a specified timeframe after the oral report (Samuels, 2020).

(See also “Resources” at the end of this course for a sample report form.)

HEALTHCARE FACILITY CONTEXT

If abuse occurs in a facility, the reporter must immediately notify the person in charge, who must then notify the state’s Long-Term Care Ombudsman Program within a designated timeframe (ACL, 2018). This program is established in all states under the Older Americans Act, which is administered by the Administration on Aging. Local ombudsmen work with and on behalf of residents in hundreds of communities throughout the country.

SELF-REPORTING ABUSE

Some victims of abuse may be able to self-report if they are provided with an opportunity to do so. Unfortunately, however, the rate of self-reporting abuse is low due to fear, futility, and/or embarrassment. Healthcare professionals can suggest the following actions to those who wish to self-report abuse:

  • Call 911 if you are in immediate danger.
  • Speak up; if unhappy with your care, tell someone you know and trust; ask that person to report the abuse, neglect, or substandard care to your state’s abuse hotline or Long-Term Care Ombudsman’s office; or make the call yourself. (See “Resources” at the end of this course for contact information.)
  • Report to the local Adult Protective Services agency.
    (Yon et al., 2019)

Report Contents

Reports of suspected dependent adult or elder abuse typically include:

  • Names and home addresses of the dependent adult or elder, relatives, caretakers, and other people believed to be responsible for the individual’s care
  • The dependent adult or elder’s present whereabouts, if not the same as the address given
  • The reason the adult is believed to be dependent or vulnerable
  • The dependent adult or elder’s age
  • The nature and extent of the abuse, including evidence of previous abuse
  • Information concerning the suspected adult abuse of any other dependent adults or elders in the same residence
  • Other information that may be helpful in establishing the cause of the abuse or the identity of the person(s) responsible for the abuse or helpful in assisting the dependent adult
  • Reporter’s name and address
    (IA DHS, 2020)

Legal Issues for Reporters

An individual participating in good faith by reporting, cooperating, or assisting in evaluating a case of dependent adult or vulnerable elder abuse or participating in a judicial proceeding generally has immunity from liability, civil or criminal, which may have occurred due to the act of making the report or offering assistance. State laws generally prohibit a person or employer from discharging, suspending, or disciplining an individual required to report or who voluntarily reports suspected abuse.

A mandated reporter who is required to report a suspected case of dependent adult abuse and who knowingly and willfully fails to do so is considered to have committed a crime and is subject to prosecution according to applicable state laws. Likewise, a mandated reporter who knowingly interferes with or fails to make a report can be held civilly liable in some states for damages proximately caused by such acts or failures to act (Akhbari, 2020).

BARRIERS TO REPORTING

Researchers estimate that only 1 of every 14 incidents of dependent adult abuse actually come to the attention of law enforcement or human service agencies. There are significant barriers to reporting the abuse of dependent elders. These include, but are not limited to:

  • Abused adult feels as if they somehow deserve the abuse
  • Abuser believes that dependent or older adult deserves the abuse
  • History of prior abuse
  • Fear of retaliation by the abuser
  • Fear of abandonment if the abuser goes to jail if abuse is reported
  • Cultural beliefs (e.g., “What happens at home is nobody else’s business.”)
  • Embarrassment
  • Shame
  • Vowed to secrecy by the abuser
  • Threats from abuser (e.g., that they will send the victim to a nursing home or withhold food and other necessities)
    (RAINN, 2020)