PPA 419 – Aging Services Administration

1. PPA 419 – Aging Services Administration Lecture 9b – Mandatory Reporting of Elder Abuse

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

3. 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.

4. 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.

5. 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.

6. 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).

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. Alabama Adult Protective Services Act • The Alabama Protective Services Act of 1976 suffers many ofthe 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.

15. 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.

16. 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.

17. 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%.

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

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. Results

27. 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.

28. 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.

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