Most who work in hospice know that social workers are mandated to make reports to a protective agency when they perceive abuse, neglect and exploitation of children, the elderly and people with disabilities. But many hospice workers, in my experience, are unsure of how the process works and operate under several misconceptions. Because such misconceptions can lead to disagreements among team members and limit the effectiveness of reports, a good understanding of reporting policy can make your work experience more positive, as well as benefit patients who may need intervention.
Here are ten misconceptions accompanied by my attempt to provide clarity:
Misconception #1: “Reporting never helps anything…”
The truth: Reporting can lead to better living conditions for patients.
The belief that reporting never benefits anyone may have emerged from professionals making reports and not seeing anything change. This does happen. Some situations are not considered serious enough for the limited resources these agencies run on, and not all investigations lead to determinations that abuse is taking place. Reports don’t require certainty or evidence to be made: They require suspicion. If every reasonable suspicion is reported, as the laws in several states require, then only a portion of them will be actionable.
This does not mean you shouldn’t report. A nurse once called me because she found a patient home alone, in bed, soaked in urine. The family had claimed there would always be a family member at home caring for her, but this wasn’t the case that day.
A report was made. The family told us they were visited by APS. And we never again found the patient alone or in a state of neglect.
Misconception #2: “You need to be certain before making a report…”
The truth: You must make a report if you have a reasonable suspicion there is abuse, neglect or exploitation.
Different states have different laws about reporting. In Texas, a report must be made when there is a “reasonable suspicion.”
There’s a reason that the law doesn’t require proof or evidence or eye-witness accounts from healthcare professionals or private citizens: It’s not our job to investigate. Investigation is what the adult protective agencies do. All they want from us is to know where there is suspicion so that they know where to do their job.
Misconception #3: “Reporting requires team discussion…”
The truth: If you suspect an elder or disabled individual is being abused, neglected or exploited, your state most likely requires you to report, even if your team prefers not to.
Social workers tend to see things differently than the rest of the nursing-dominated team. What starts with an interest in psychology and/or social justice evolves as we consider ethics and self-determination countless times through school and then when working with clients. We see threats to self-determination in ways that many other professionals don’t see. If we didn’t, we wouldn’t be good social workers.
I have heard more than one hospice director state that suspicions need to be brought to the team so that other members who may have witnessed something can chime in. There can be value in this. It’s possible that what you think is a sign of abuse, like bruises, can have medical causes. And if there is abuse, other team members may have additional information that you can provide when you make your report.
But what do you do if your team doesn’t believe there’s abuse, but you do? You may want to get a second opinion from some fellow social workers, but at the end of the day, you will most likely need to report your suspicions.
Misconception #4: “Your supervisor decides what gets reported…”
The truth: You report based on your suspicion, even if your supervisor doesn’t want you to.
Your boss may fear that reports impact the revenue stream. They can. If you report suspicions about a family’s treatment of a patient, they may take the patient off your agency’s service. If you report suspicions that nursing home staff are mistreating or neglecting a patient, the facility might retaliate by refusing to let your agency in. It’s unethical and illegal for them to prevent patients from receiving care from external providers, but they do it anyway.
It’s important to remember that if you feel pressured to keep quiet about something, then probably others do to. If family members or facility staff are failing to adequately care for someone who can’t represent her own wishes, then state agencies are meant to get involved and advocate for the patient’s needs. They can’t do that if they don’t know what’s going on.
A question on this topic stuck with me from my LCSW prep. To paraphrase:
A social worker suspects a child is being abused. She discusses the situation with her supervisor, who doesn’t believe a report is necessary, but the social worker still believes abuse is taking place. What is the social worker’s best course of action?
The answer given: The social worker should inform the supervisor that she still needs to make the report.
An ethical obligation to defy your boss is an anxiety-provoking situation, but while you are promoting your patient’s wellbeing, you are also protecting your license and being true to ethical guidelines of your profession.
Misconception #5: “Social workers should always be the ones to report…”
The truth: The witness or the individual with the suspicion should submit the report.
I’ve received calls from nurses telling me they need me to report something they witnessed to APS. I’m happy to help, but a report from the nurse about what she saw will help a situation more than a 2nd-hand report from a 3rd person about what they heard the nurse say that she saw. I would respond to such requests by explaining as much and giving them the appropriate agency’s contact information.
The big misconception: Hospice follows different rules for reporting
The truth: the same laws apply to us as apply to anyone else.
It’s important to review your state’s laws on your own. It’s also good to enter discussion with fellow social workers about the challenging cases. I once brought a reporting dilemma to my clinical supervision group, and the response I got was unanimous: I needed to make a report, for the sake of the patient, my license, and for following a higher frame of reference than my agency’s bottom line.
Some issues are complex
In our next article, we’ll look at some nuanced situations in which it may not be obvious whether a report is appropriate. See you then!
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