Elder mistreatment reporting: differences in the threshold of reporting between hospice and palliative care professionals and adult protective service.

BACKGROUND Underreporting of elder mistreatment by health professionals is a significant problem. PURPOSE To investigate differences in elder mistreatment reporting threshold between hospice/palliative care (HPC) professionals and Adult Protective Services (APS); explore factors for not reporting elder mistreatment. DESIGN Cross-sectional questionnaire. SETTING/PARTICIPANTS Four HPC teams and 42 APS workers in one county. METHODS Five hypothetical elder mistreatment case vignettes along a spectrum of severity were scored on Likert scales for likelihood of reporting or accepting the cases. HPC professionals were surveyed about their knowledge and beliefs about reporting elder mistreatment. RESULTS All 42 APS workers and 74% of 73 (n = 54) HPC professionals completed the survey. In all but the most severe case of abuse, APS was more likely to accept reports of elder mistreatment than HPC professionals were in reporting (p < 0.002). HPC professionals had reported a mean of 2.5 (+/-2.8, standard deviation [SD]) cases in the last 5 years. Thirty percent of HPC professionals had suspected cases of elder mistreatment that was not reported in the last 5 years. The median difference between the total number of suspected and reported cases was 2 (+/-4.6, SD). Eleven percent had ethical concerns about reporting and 63% were concerned about practical consequences of reporting. Only 37% correctly identified the reporting agencies that have jurisdiction over abuse that occurs in long-term care. Correct identification of long-term care reporting agencies correlated with whether the HPC professional had training in elder mistreatment (r = 0.35, p = 0.009). Although 96% would report physical abuse that they witnessed, only 63% would report abuse verbalized by the patient. CONCLUSION There is evidence that significant differences exist in elder mistreatment reporting thresholds between APS and HPC professionals. This finding should encourage HPC professionals to discuss with APS the cases they are unsure about reporting. Future research is need on elder mistreatment in the HPC setting.