Reporting At-Risk Adults and Elder Abuse

Pursuant to Wisconsin law, health care providers may be required to report at-risk individuals when the health care provider suspects that the at-risk individual is being abused or neglected (including self-neglect).  These FAQs are intended to help you determine if you should take the sometimes-difficult step of reporting a patient, you encounter in your practice.

If you have any questions regarding this or a current patient matter, please contact the Office of Legal Affairs at (608) 263-7400 and ask to speak with a health law attorney.

  • I have concerns about a patient that I’ve encountered in my practice.  How do I know if she or he qualifies as an adult at risk or elder adult at risk?

    • In order to be considered an “adult-at-risk,” a person must: (1) be an adult who has a physical or mental condition that substantially impairs his or her ability to care for his or her needs; and (2) have experienced, is currently experiencing, or is at risk of experiencing abuse, neglect, self-neglect, or financial exploitation. The term “elder adult-at-risk” is defined similarly, but with a key difference: rather than being a person with a physical or mental impairment, an elder adult at risk is any person 60 years old and older who meets the second criterion from the paragraph above.
  • What qualifies as “abuse”, “neglect”, “self-neglect”, or “financial exploitation”?

    • “Abuse” means physical abuse, emotional abuse, sexual abuse, treatment without consent, or unreasonable confinement or restraint as described here:
      • “Physical abuse” means the intentional or reckless infliction of bodily harm.
      • “Emotional abuse” means language or behavior that serves no legitimate purpose and is intended to be intimidating, humiliating, threatening, frightening, or otherwise harassing, and that does or reasonably could intimidate, humiliate, threaten, frighten, or otherwise harass the individual to whom the conduct or language is directed.
      • “Sexual abuse” is defined broadly to include first, second, third, and fourth degree sexual assault, which at a minimum means unwanted sexual contact with a person without the consent of that person.
      • “Treatment without consent” means the administration of medication without informed consent, or the performance of psychosurgery, electroconvulsive therapy, or experimental research on an individual who has not provided informed consent, with the knowledge that no lawful authority exists for the administration or performance.
      • “Unreasonable confinement or restraint” is intentionally controlling a person by physical means, such as locking her or him in a room, using physical restraints, or separating her or him from her or his living area. Additionally, it means the provision of unnecessary or excessive medication to an individual.
    • “Neglect” generally means the failure of a caregiver to fulfill her or his duties to the at-risk individual, creating a significant risk or danger to the individual’s physical or mental health. It does not include a decision not to seek medical care if the decision is consistent with a valid do-not-resuscitate order, a power of attorney, or as otherwise authorized by law.
    • “Self-neglect” means a significant danger to the individual’s physical or mental health because the individual is responsible for her or his own care but fails to obtain adequate care, including food, shelter, clothing, or medical or dental care.
    • “Financial exploitation” can mean outright theft, but also includes the taking of a person’s money or property by deceit, force, forgery, or unauthorized use of documents. It can also include the failure of a person empowered to oversee the individual’s finances to do so properly.
  • If the patient’s guardian or other surrogate is refusing care which I believe is medically necessary, does this qualify as neglect?

    • “Neglect” does not include a decision not to seek medical care if the decision is consistent with a valid do-not-resuscitate order, a power of attorney, or as otherwise authorized by law.  If you are unsure of a guardian’s or surrogate’s authority to refuse medical care on behalf of the patient, call the Office of Legal Affairs at (608) 263-7400 and ask to speak with a health law attorney.
  • I don’t know if what I’ve observed is abuse.  Who can I talk to about my concerns?

    • You may call the Office of Legal Affairs at (608) 263-7400 and ask to speak with a health law attorney.
  • Who is considered a “mandatory reporter”?

    • All health care providers, including nurses, physicians, physician assistants, physical therapists, psychologists, and occupational therapists are mandatory reporters. Other individuals may be mandatory reporters as well.  If in doubt, call the Office of Legal Affairs at (608) 263-7400 and ask to speak with a health law attorney.
  • Exactly when do I have to report an at-risk individual?

    • When any of three triggers are met, the law requires a health care provider to report an at-risk individual that she or he encounters in her or his practice.
      • The first trigger is when the at-risk individual requests that a report be made.
      • The second trigger is when the at-risk individual is at imminent risk of serious bodily harm, death, sexual assault, or significant property loss, and is unable to make an informed judgment about whether to report the risk.
      • The third trigger is when an at-risk individual other than the patient is at risk of serious bodily harm, death, sexual assault, or significant property loss inflicted by the same perpetrator. (This third trigger is likely intended to protect individuals in group homes or similar situations who may be abused by a caretaker or other individual.)
  • Do I always have to report abuse?  Are there any expectations?

    • You do not have to report at-risk individuals in every instance, but it is very important that you document why you believe that the abuse should not be reported. While the law generally requires health care providers to report cases of abuse that they encounter in their professional practice, there is a narrow exception for when the provider believes that it is not in the person’s best interest to report the abuse. In this case, the law requires that the provider record the reasons that she or he believes that it is not in the at-risk individual’s best interest to report.
  • How do I report an individual?

    • If you decide that you are required to file a report, you should contact the registered county adult-at-risk or elder adult-at-risk agency. In Dane County, the Dane County Department of Human Services fills these roles. Alternatively, you can contact the Madison Police Department, UW Police Department, or the state board on aging and long-term care.
  • Contact Information for Filing Reports

    • Dane County Department of Human Services: (608) 261-9933
    • Madison Police Department Non-Emergency: (608) 266-4316
    • UW Police Department: (608) 264-2677
    • State Board on Aging and Long-Term Care: 1-800-815-0015