Certain categories of professionals are required to make reports to their state’s designated agency when they suspect abuse of a child or dependent adults. These people are known as mandated or mandatory reporters. Any person who believes that a child or dependent adult has suffered abuse may also make a report of the suspected abuse to their state agency. People who report suspected abuse even though they are not legally required to do so are called permissive reporters.
All fifty states, the District of Columbia, and U.S. Territories have laws mandating certain professionals and institutions to report suspected child abuse and neglect to a child protective services (CPS) agency (ACF, 2017).
In most states, a wide variety of healthcare professionals are mandatory reporters, including doctors, nurses, chiropractors, dentists, occupational and physical therapists, psychologists and counselors, most staff and employees of healthcare facilities, assisted living, and day services programs, and many others. Check with your state or your licensing board to determine if you are a mandatory reporter.
State statutes generally establish an agency to receive and process reports under a specific set of criteria and procedures, although some states have more than one place to report depending on the type abuse. Many also establish central abuse registries that perform a number of functions. Requirements and procedures vary for mandated and permissive reporters, and laws require training for mandated reporters, usually tied to professional licensing.
Most states’ laws address certain legal issues: immunity from liability, confidentiality, responsibilities and rights of reporters, and sanctions for failure to comply with the law or for filing false reports.
Dependent Adult Abuse
Many older adults are ashamed to report abuse or are afraid a report will get back to the caregiver and the abuse will get worse. If you think someone is being abused—physically, emotionally, or financially—talk to the person alone and offer to get help from adult protective services.
The National Center on Elder Abuse (NCEA) has detailed listings and links for every state for hotlines for abuse reporting, appropriate state agencies, and relevant state laws. Go to ncea.acl.gov for more information or call the Eldercare Locator weekdays at 800 677 1116.
Many local, state, and national social service agencies can help with emotional, legal, and financial problems. Most states require doctors, nurses, and other healthcare professionals to report mistreatment of older adults; (mandatory reporting). You do not have to verify that abuse is occurring, only alert others of your suspicions. Family and friends can also report suspected abuse:
- If an older adult is in urgent danger, call 911 or the local police.
- If the danger is not immediate, report the suspected abuse to the Adult Protective Services agency in the state where the person resides
If nursing home care abuse is suspected, call the Long-Term Care Ombudsman at 202 332 2275.
The Report Process
In most states, reports are made over the phone and followed up with a physical filing. Instruction is available to guide a potential reporter in collecting information and preparing to make the report. Once a report is made it will be evaluated by the agency and a determination is made as to whether there is sufficient grounds for further investigation. States use different terms at this stage. Some say a report is “registered” or “not registered,” while others simply say “accepted” or “rejected.” At this stage a rejected report may often happen because the victim is not a child, the alleged perpetrator is not a caregiver, or the alleged abuse does not fall within the state’s legal definition of abuse. Most agencies will still evaluate to determine if a child is in danger and law enforcement needs to be contacted.
If a report is accepted then an investigation is begun. Some states have only one process that is followed for all reports, while other states utilize what is called a differential response system where reports are evaluated against specific criteria and then assigned to one of two pathways. Generally, one pathway is for reports that are suggestive of a more serious child abuse problem while the other is for reports where some type of family assessment and assistance may be more appropriate.
After investigation, regardless of the system used, a determination is made as to whether or not child abuse or neglect has occurred. Again, states use varying terminology. Some may use “not confirmed/confirmed/founded” while others may use “unfounded/indicated.” Inquire with your state’s agency for specific terminology, procedures, and requirements.
Dependent Adult Abuse
States have been passing legislation and setting up programs to address dependent adult abuse and they observe a variety of processes for accepting and processing these reports. Over half of the states now maintain abuser registries, but they can differ significantly in the information they retain and not all feel that a registry is the best use of their resources (Quinn, 2019). For example, in California ”employees of financial institutions are mandated reporters for suspicious activity involving the senior population and dependent adults” (Miller, 2019).
The NCEA website maintains a state resources page with links to each state’s critical information. As an example, in Nevada (where new legislation just became effective on July 1, 2019) an investigation is begun within 3 working days of the report, there is an evaluation, and then arrangements and referrals are made for other services. The agency website notes that “Protective services are provided if the individual is willing to accept these services” and the agency’s mission is to provide or arrange for services “while safeguarding [the adult’s] civil liberties.” Because dependent adults are still adults they usually cannot be forced to accept services, so the resolution of cases may be complex (NVAPS, 2019, 2019a).
Many other factors may come in to play, including legal actions if a person appears to be unable to protect self. Other states, for example New York with an older program, have policies regarding pursuing both avenues—protecting an adult’s right to choose not to have services and what they do in cases of diminished capacity of the victim (NYSOCFS, 2019a).
Interventions and preventions that take advantage of a combination of personal and community resources may be the most effective at helping dependent adults (see section on Intervention and Prevention Strategies).
Attitudes Toward Reporting Abuse
Why Victims of Abuse Do Not Report
There are many reasons why victims do not report the abuse, including lack of confidence, a history of abuse, fear of retaliation by the abuser, cultural beliefs, embarrassment, and shame. For example, people who have never been self-confident are not likely to ask for help when they become dependent. Those who have been abused or neglected their entire lives expect maltreatment will continue, would never think someone would want to help, and often reject help when it is offered.
Abused dependent adults may have sought help from law enforcement or other agencies in the past, only to experience worse abuse, neglect, or exploitation when representatives of those agencies were not present.
Some cultures believe that whatever happens within a family is no one else’s business. The dependent adult may be ashamed or embarrassed to be neglected, abused, or financially exploited by a trusted family member. The victim may promise to keep the abuse secret so the abuser will not further abuse them or other loved ones, including pets. Abusers may threaten to withhold care or food or other necessities, or to send the dependent adult to a nursing home if the victim tells anyone about the abuse.
Why Mandatory Reporters Do Not Report
Those who are required by law to report suspected abuse of elders or dependent adults share some of the same fears as the abused individuals: that reporting will hurt the relationship with the victim or the abuser or will cause retaliation by the perpetrator. Other stated reasons for reluctance to report include:
- Fear of losing a job
- Court time—with loss of work time
- Nothing will change, and everyone involved will get upset
- Cannot get state agency to accept a report
- Do not want to get involved (“none of my business”)