case study: reporting

Ms. V, who has presented to the ED for cough and fever, admits to the social worker that she has been verbally abused by her son, who is also not refilling her medications. Her cough is diagnosed as likely a viral syndrome not requiring a medical admission.

Ms. V is adamant that she feels safe at home and that she wishes to return to the care of her son. Given concern for elder abuse and neglect, the ED social worker explains to Ms. V that he is required to report to Adult Protective Services. The social worker makes the report via telephone after Ms. V’s discharge.

In many states, elder abuse must be reported even if the victim does not want a report made.

ED providers should report potential cases of elder abuse or neglect to the appropriate authorities. A reasonable cause to suspect abuse is sufficient to make a report, and providers should feel confident reporting cases, even when uncertain if abuse or neglect has actually occurred.

Health care providers are mandatory reporters for elder abuse in most but not all US states. In many states, elder abuse must be reported even if the victim does not want a report made. Laws vary and all healthcare providers should be aware of requirements in their state. This information can be obtained from a state’s Department of Health website and a summary is available at:

For community-dwelling older adults, Adult Protective Services (APS) is the agency that leads the investigation of these complex cases. Information on how to contact state or local APS in different areas is available at: For confirmed or suspected elder abuse in nursing homes, board & care homes or assisted living facilities, ED providers should report to the Long-Term Care Ombudsman in their state.

Information on Long-Term Care Ombudsman programs may be found at:

Also, many state Departments of Health have protocols to receive reports of concerns about care provided in nursing homes.

When preparing to make a report, providers must be aware of the scope of APS’ role in investigation. In most states, the older adult must meet three criteria in order for a case to be opened:

  • the individual must have a physical or mental impairment
  • the person must be in need of protection from actual or threatened harm
  • the person must not have anyone in the community who is willing and able to assist.

Despite these restrictions, providers are encouraged to make referrals to APS, if concerns persist. Providers must also understand that APS operates much differently from Child Protective Services and will not respond to referrals in real time, as the hospital is considered a safe environment. Their investigation will commence only after discharge. Therefore, when concerned about a patient’s safety or that crime has been committed, ED providers should not hesitate to report to local law enforcement.