October 19, 2012 - CARP has been calling for a comprehensive approach to end elder abuse – not only to find and punish perpetrators of elder abuse but also to prevent the abuse from occurring in the first place. Our seven recommendations include a dedicated hotline to report suspected crimes, specialized investigative support, added caregiver support and victim support services. Among these is a call for a ‘duty to report’
Duty to report establishes guidelines and responsibilities for medical and other professionals to report suspected cases of elder abuse. CARP’s call for duty to report is not necessarily a call for legislation, but rather, it is a call for greater social responsibility, especially among professionals who work with older adults. Duty to report expects individuals to feel a personal responsibility to report or intervene when elder abuse is witnessed or suspected. Despite the potential of fostering greater awareness of elder abuse and responsibility for preventing and reporting crimes, duty to report is a contentious issue.
Debating duty to report
Most people want to see the end of elder abuse, but opinions vary on whether there should be the duty to report or not.[i] Those who are against the idea point out that the duty to report runs the risk of infantilizing of older adults. Mandatory reporting for child abuse exists because children may not be capable of making decisions about their own safety, cannot protect themselves from abuse, and are usually dependent on the person who is abusing them. Older adults, on the other hand, may have diminished capacity or be similarly dependent but must be supported in exercising their free choice rather than have that decision making right taken away from them, however well-meaning the intention.
It is also argued that a reporting system will be costly and ineffective and that prevention should be prioritized so that abuse is avoided from the start. In addition, some do not want the obligation to report due to various fears, such as the fear of being personally pulled into personal or family conflicts or of being embarrassed or responsible if they are mistaken as to whether there was abuse.
On the other hand, others in favour of the duty to report point out the power imbalance between a dependent older adult in need of care and those who are providing that care. Some older adults cannot seek help or recognize abuse due to certain circumstances including language barriers, or diminished mental or physical capacity, or reliance on caregivers. And as a result, these individuals are unable to advocate and exercise their own rights. Without the duty to report, there is a risk of leaving a large gap in pursuing a comprehensive approach against elder abuse.
Both sides have valid points and concerns, and it is important that a delicate balance is found.
Shifting societal values towards a greater social responsibility
Perhaps it is not about whether or not we make the duty to report mandatory, but rather it is about shifting our values and choices in response towards elder abuse. In the US, most states mandate frontline professionals to report suspected elder abuse, and furthermore, eight states require “any person” to report suspicion of mistreatment of older adults.[ii] We would need to further research to see what the US experience has been and whether there is a move to improve or delete those provisions. Nonetheless, due to reasons such as high costs of a reporting system and violation of autonomy and confidentiality, many have argued that reporting laws are not as effective as other strategies such as a high level of public and professional awareness.[iii] Therefore, legislating the duty to report might not be the best option. Instead, we need our societal values and constructs to change to ensure higher professional standards and protocols along with a greater sense of public duty to intervene when elder abuse is suspected.
The ultimate question: to act or not to act?
Ultimately, the duty to report poses the question: Is it better to report and be wrong about suspected abuse or is it better to not report and risk allowing elder abuse to continue? Social consequences may result if one’s suspicions are wrong, and those consequences may be addressed without serious impact on anyone’s well-being. However, if one’s suspicions are correct and abuse was not identified, then further abuse of a victim will most likely continue to take place.
As a result, CARP is calling for a greater social responsibility to report, but as the arguments for and against the duty to report demonstrate, more work and thought is needed to find the balance in establishing the parameters of such a duty to report. Certainly, more should be expected from front-line professionals than from ordinary neighbours, but we all have a role to play in ending elder abuse. At the very least, professionals who work with the health, money, and care of older adults should expected to have a higher obligation to report and be held to standards and protocols on how to appropriately intervene.
Ultimately, prevention tools and strategies are most important to ensure that the abuse does not occur in the first place. However, the realities of an imperfect world demand that we have additional mechanisms to address inevitable abuse that is taking and will take place, and the duty to report is one of many. Not all older adults are in vulnerable situations but for those who are and cannot speak for themselves, there is a greater responsibility to move beyond the status quo.
For more information, read CARP’s comprehensive approach against elder abuse.
[i] Canadian Network for the Prevention of Elder Abuse . http://www.cnpea.ca/mandatory_reporting.htm
[ii] American Bar Association. http://www.americanbar.org/groups/law_aging/resources/elder_abuse.html
[iii] Common Wealth of Virginia, Department of Social Services. leg2.state.va.us/dls/h&sdocs.nsf/…/$FILE/HD29.pdf