PPA 419

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PPA 419 Aging Services Administration

• Lecture 9b Mandatory Reporting of Elder Abuse

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Source

• Daniels, R. S., Baumhover, L. A.,
  Clark-Daniels, C. L. (1989). Physicians
  mandatory reporting of elder abuse. The
  Gerontologist, 29, 321-327.

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Introduction

• The most common legislative response to elder
  abuse at the federal and state level has been the
  mandatory or voluntary reporting law.
• Reporting laws typically define a three-step
  process
• Reporting.
• Investigation.
• Service delivery.
• Most laws focus on reporting and investigation
  and underfund service delivery.

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Reporting

• An effective reporting component should include
  several elements
• First, the statute should make explicit the
  population that the law seeks to protect.
• Second, the statute ought to provide clear
  definitions of the behaviors prohibited to make
  determinations of incidence possible.
• Third, statutes should clearly define the
  reporting population covered under the provisions.

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Reporting

• An effective reporting component should include
  several elements (contd.)
• Fourth, the statute should provide justification
  for the selected population and the mandatory
  reporting requirement.
• Fifth, the statute should guarantee immunity from
  prosecution for the reporting individual and
• Sixth, the statute should provide that any
  information gathered is confidential and may not
  be accessed by unauthorized individuals and
  organizations.

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Reporting

• The requirements rarely may be met.
• The increased interest in elder abuse over the
  last decade has prompted a proliferation of
  definitions with respect to intentionality,
  outcome, physical versus nonphysical treatment,
  acts of omission versus acts of commission, and
  the range of acts considered abusive . . .
  (Pedrick-Cornell Gelles, 1982).

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Reporting

• In addition, many statutes mandate reporting by
  various classes of professionals likely to
  encounter cases of abuse. Such requirements may
  actually inhibit reporting by providing vague
  definitions of the reporting population or by
  mandating notification by a population with
  significant disincentives to report.

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Investigation

• To be effective and encourage repeat reporting,
  elder abuse reports must be investigated promptly
  and thoroughly.
• The investigating agency needs sufficient
  organizational slack to carry out its mandate.
• Legislation should designate the responsible
  investigatory agency and specify time and
  documentation demands for investigation.
• Unfortunately, most statutes provide for
  immediacy but not sufficient resources for
  investigation.

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Service Delivery

• To require mandatory reporting, states should
  provide sufficient resources to carry out
  extensive service delivery.
• In practice, most states established mandatory
  and voluntary reporting laws but required
  investigation and service delivery to be done
  within existing resources.
• Because many states fail to specify adequate
  linkages between reporting and services for
  elderly persons, the agencies are left with a
  draconian choice between no intervention and
  institutionalization.

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Summary

• Ideally, mandatory reporting laws seek to combine
  clear definitions, well-informed reporters,
  adequate services, and legal protection to
  achieve a balanced solution to the problem of
  abuse.
• In practice, many state abuse laws have weak
  definitions, vague identification of reporters,
  and inadequate justification of mandatory
  reporting, and are backed by inadequate
  commitment of resources for investigation and
  service delivery.
• The laws are, in fact, symbolic.

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Alabama Adult Protective Services Act

• The purpose of this study was to examine the
  operation of elder abuse laws in a single slate.
  The Alabama Adult Protective Services Program
  provides an excellent case study.
• Created by the Adult Protective Services of Act
  of 1976, the program provides protection to
  adults who are judged incapable of providing for
  themselves.

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Alabama Adult Protective Services Act

• Proscribed behaviors include abuse (physical
  injury, psychological abuse, willful deprivation
  of services), neglect (unintentional deprivation
  of services, self-neglect), and exploitation
  (misappropriation or misuse of resources).
• All "practitioners of the healing arts" are
  mandated to report if they is reasonable cause to
  believe abuse, neglect, or exploitation has
  occurred.
• Reports are made to the state or county
  Department of Human Resources or to the chief law
  enforcement officer in the jurisdiction.

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Alabama Adult Protective Services Act

• The act requires the Alabama Department of Human
  Resources (DHR) to both investigate cases of
  abuse within 72 hours and provide services.
• The passage of the act has produced a dramatic
  increase in thee number of reported cases or
  abuse, neglect, and exploitation.
• In fiscal year 1978, the first full year of
  reporting, 477 cases were reported
• By fiscal year 1987, the number oi reported cases
  had risen to 5,220.

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Alabama Adult Protective Services Act

• The Alabama Protective Services Act of 1976
  suffers many of the weaknesses of the typical
  mandatory reporting law, with few offsetting
  strengths.
• Weaknesses in reporting requirements are
  compounded by the necessity of relying on
  existing sources of funding to cover
  investigation and service delivery.

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Alabama Adult Protective Services Act

• Despite these apparent limitations in
  investigation and service delivery, the Alabama
  law had been in effect for over 11 years at the
  time of the article, during which time precedents
  and consensus may have overcome lack of clarity
  in the statute.

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Alabama Adult Protective Services Act

• If the law had become an effective mechanism for
  case discovery, investigation, and service
  delivery, mandatory reporters should reveal
  relative clearly definitions of abuse, knowledge
  of the reporting population, understanding of the
  mechanisms of the law, and a willingness to
  report unencumbered by professional
  cross-pressures.

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Methods

• Random sample of general practitioners, internal
  medicine specialists, and family practice
  specialists in Alabama stratified by city size.
• We selected these specialties because they are
  the medical specialties most likely to treat
  elderly adults for general illnesses and
  injuries.
• Sample of 336 responses 156 response rate 46.

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Conclusions

• Many of early researchers suggested that the
  United States was faced with an epidemic of elder
  abuse.
• Mandatory reporting appeared to be a quick remedy.

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Conclusions

• Unfortunately, many of the researchers since that
  time have concluded that mandatory reporting
  without adequate service delivery places the
  social worker in the position of choosing between
  no intervention and institutionalization.

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Conclusions

• In summary, state mandatory reporting laws do
  appear in fact to be "an inappropriate,
  ineffective, and ageist response to the abuse of
  older adults (Faulkner, 1982). They promise an
  inexpensive solution to the problem of abuse and
  then impose unpalatable choices on the abused
  elderly person.

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Conclusions

• Under these circumstances, the best available
  alternatives would be better education of the
  mandatory reporters and a much closer and
  better-funded linkage between reporting,
  investigation, and service delivery, emphasizing
  the principle of least-restrictive intervention.

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Source

• Jogerst, G. J., Daly, J. M., Brinig, M. F.,
  Dawson, J. D., Schmuch, G. A., Ingram, J. G.
  (2003). Domestic elder abuse and the law.
  American Journal of Public Health, 93, 2131-2136.

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Introduction

• The best national estimate is that approximately
  555,000 persons aged 60 years or older
  experienced abuse or neglect, or both, in
  domestic settings in 1996.
• Lachs and Pillemer found increased mortality
  rates among physically abused or neglected elders.

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Methods

• Two sources of data.
• The number of domestic elder abuse reports,
  investigations, and substantiations for each
  state and the District of Columbia for 1999 or
  fiscal year 1999-2000.

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Results
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Discussion

• Public education increases reported rates of
  abuse.
• Mandatory reporting leads to higher investigation
  rates.
• Inclusion of a dependency requirement has no
  effect on investigation or substantiation.
• The higher the number of abuse definitions in the
  regulations, the higher the substantiation rates
  and ratios.

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Discussion

• Caseworkers who investigated both child and elder
  abuse had lower substantiation rates than
  caseworkers who investigated only elder abuse.
• States that track elder abuse reports have higher
  investigation and substantiation rates than
  states that do not.

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Conclusion

• Reporting, investigation, and substantiation
  rates vary by state.
• State variations appear to be partly due to
  variations in state protective services statutes.