Social Workers’ Perceptions Regarding Legal Intervention for Older Adults without Significant Cognitive Decline Who Are Abused by Their Adult Child

ABSTRACT

Social workers aiding older adults facing abuse from their adult child confront an ethical dilemma: whether to honor autonomy or prevent harm. The study explores how social workers perceive legal intervention against the older adult’s will. Twenty-one aging-specialized social workers took part in semi-structured interviews using a vignette. The analysis was conducted inductively, guided by content analysis principles. Two main themes emerged, focusing on the disadvantages and benefits of legal intervention. The findings underscore that combining teleological and deontological considerations could form a foundation for developing decision-making tools to aid social workers in navigating this dilemma effectively.

KEYWORDS:

• Elder abuse
• social workers
• ethical dilemmas

The phenomenon of elder abuse is a prevalent issue affecting a substantial number of older adults worldwide, with approximately one in six individuals being affected (Yon et al., 2017). It is primarily perpetrated by a caregiver or other trusted individual (Hall et al., 2016). Social workers accompanying older adults who experience abuse from their adult child face a professional and ethical dilemma of whether or not to intervene in situations where the older adults have difficulty or refuse to contact the authorities to protect themselves from the offender(s). In these situations, the ethical dilemma is between respecting the older adults’ autonomy and taking a paternalistic action, without the cooperation of them and even against their will, to protect them from harm (Mackay, 2017; Stevens et al., 2020). Despite the theoretical and research discourse on the subject, it largely refers to this dilemma from a deontological perspective, which examines in which situations social workers would be legally and ethically entitled to contact the legal authorities, at their own initiative, to protect the older adults, even without their cooperation and consent (Norrie et al., 2016; Stevens et al., 2020). However, such interventions’ short- and long-term effects have proved to be limited (Preston-Shoot & Cornish, 2014; Stevens et al., 2020). Therefore, this study aims to fill this lacuna and provide a deeper understanding of how social workers perceive the effectiveness of legal intervention on their part in cases when the older adults, who have experience verbal, physical and/or emotional abuse at the hands of their adult child, refuses to collaborate with the law authorities and take legal action against them.

Barriers to cooperation between older adults and professionals

Older people who experience abuse find it more difficult to cooperate with professionals to end it when the perpetrators are family members than when they are strangers (Acierno et al., 2020). This barrier can be explained, at the intrapersonal level, by the older adults’ difficulty in recognizing the abuse as such or in accurately estimating its severity (Yan, 2015). In addition, the older adults’ prolonged experience of abuse might lead to depression (Bergeron, 2006), low self-confidence, and low self-esteem (Fraga Dominguez et al., 2021), which make it difficult for them to believe they can escape from the abusive relationship even with the help of a skilled professional (Bergeron, 2006).

At the interpersonal level, older adults’ dependency caused by a compromised functional or cognitive state, depression, or lack of social support, constitutes a risk factor for abuse (Storey, 2020). This dependency might make it difficult for them to seek assistance or end the abuse due to their fear of losing [the family member’s] support, being punished, experiencing increased abuse, or being transferred unwillingly to a nursing home (Chokkanathan et al., 2014).

Studies indicate that abusive adult children often suffer from some form of mental illness or addiction disorders (Storey, 2020). In these situations, the adult child’s financial and/or emotional dependency on the parent might be a factor in intensifying the older adults’ feelings of concern, commitment, and guilt toward their abuser(s), which may outweigh their concerns for their own safety and needs (Bergeron, 2006; Vrantsidis et al., 2016). Consequently, the parent avoids reporting them or acting against them (Bergeron, 2006). Furthermore, older adults may experience feelings of shame and self-blame, coupled with a sense of responsibility for the abuse they endure due to being a care burden to their family members or having poor parenting skills. These sentiments may hinder them from seeking professional intervention and support to terminate instances of abuse and neglect (Chokkanathan et al., 2014; Fraga Dominguez et al., 2021).

Finally, older adults’ socio-cultural factors also play a crucial role in their reluctance to cooperate with professionals. For instance, their cultural or religious beliefs that one’s fate is unchangeable (Chokkanathan et al., 2014; Yan, 2015) and adherence to cultural or generational norms that discourage external intervention in private family matters can impede their willingness to cooperate (Donovan & Regehr, 2010). Furthermore, the lack of awareness and trust in social services, accessibility issues, an absence of clear solutions (Vrantsidis et al., 2016), social isolation and/or an inadequate support network (Yan, 2015) are additional hurdles that can hinder older adults from seeking and receiving assistance.

How social workers address the refusal of older adults to act to end abuse perpetrated by their adult child – deontological versus teleological perspectives

The refusal of older adults who experience abuse by their adult child to report to the authorities to protect themselves places social workers in a dilemma between acting to protect the older adults, even without their cooperation and consent, and respecting their autonomy and thus refraining from action, even at the risk of continued abuse (Mackay, 2017; Stevens et al., 2020).

The literature deliberating this dilemma can be examined through two significant bodies of ethical theory within the philosophy of morality: the deontological and teleological theories (Reamer,2018, 2021). The deontological theories posit that specific actions possess an inherent moral value regardless of the consequences. According to these theories, social workers are ethically obligated to adhere to all legal and regulatory frameworks, uphold truthfulness in their interactions with clients, and honor commitments made to them, regardless of the potential harm or benefit to the clients. In other words, the deontological approach holds that the morality of an action is not determined by its outcomes but rather by the inherent nature of the action itself. In contrast, teleological theories posit that the moral correctness of an action is established by its outcomes. From this perspective, social workers must assess the potential consequences of different courses of action and critically evaluate each option’s relative merits and drawbacks before making a decision. Ultimately, they should opt for the alternative most likely to generate the most favorable consequences for the client (Reamer, 2018, 2021).

Utilizing these two opposing ethical frameworks facilitates profound scrutiny of the theoretical and empirical literature regarding the dilemma of social workers responsible for the care of older adults who experience abuse from their adult child and refuse to contact the authorities to protect themselves. In many studies, the teleological and deontological theories were often intertwined, and separating them was difficult. However, unlike deontological considerations, which were often mentioned broadly and included conflicting laws, regulations, and ethical principles involved in the dilemma (Norrie et al., 2016; Stevens et al., 2020), few studies referred explicitly to teleological considerations (Preston-Shoot & Cornish, 2014; Stevens et al., 2020).

Examining this dilemma deontologically points to two conflicting ethical principles involved in this decision. On the one hand, the principle of autonomy claims that the autonomy and right to make decisions of older adults must be preserved, even if, as a result, these will endanger their safety (Norrie et al., 2016). On the other hand, the principles of promoting human well-being and protection from harm assert that the safety and well-being of older adults must be maintained, even at the cost of harming their autonomy and their right to make decisions. According to this principle, social workers are required to take a paternalistic stance and act to end abuse even without the consent of the older adult (Stevens et al., 2020). The research literature that examined this dilemma from a deontological perspective indicates that the social workers’ preference for promoting human well-being and protecting from harm over the principle of autonomy was mainly related to older adults’ significant cognitive or mental disabilities (Stevens et al., 2020). In addition, recent studies have indicated the importance of recognizing the environmental contexts in which older adults live when the relationships with the offending adult child may limit their autonomy. In these situations, a preference for well-being over autonomy should be considered, even when the older adult has no significant cognitive or mental decline (Stevens et al., 2020).

From a teleological perspective, studies which have examined this dilemma by focusing on the effectiveness of the social workers’ intervention and its long-term ramifications are quite limited. Teleological considerations, which emerged in these studies, emphasized the advantages of paternalistic interventions, particularly as a last resort when the older adult is at risk, and other solutions are unavailable (Donovan & Regehr, 2010; Stevens et al., 2020). Furthermore, teleological considerations emphasized the disadvantages of paternalistic intervention, including its limited influence in the long term because it does not affect the behavior patterns of either the offender or the victim (Lepping et al., 2016). In addition, paternalistic interventions might have a negative emotional impact on older adults (Preston-Shoot & Cornish, 2014) and might have a detrimental effect on the social workers’ relationship with the older adult (Norrie et al., 2016; Stevens et al., 2020). However, to the best of our knowledge, a systematic and complex examination of the pros and cons of paternalistic intervention on the part of social workers has yet to be examined.

Models for ethical decision-making in social work emphasize the need to conduct a complex observation that combines a deontological perspective (e.g., referring to laws, procedures, and ethical principles) and a teleological perspective (e.g., referring to evaluating the potential consequences, both favorable and adverse, of each available course of action) (Pasini, 2016; Taylor, 2021). Therefore, deepening the knowledge regarding the teleological considerations involved in ethical dilemmas faced by social workers when working with older adults who have experienced abuse at the hands of their adult child but refuse to collaborate with the law authorities can contribute to a broader and deeper understanding of the social workers’ decision-making process in these situations.

The current study

Israeli legislation permits infringement on the autonomy of older adults in certain situations to protect them from abuse, particularly if they suffer cognitive or mental impairment. The interpretation of the law also encompasses more intricate cases in which older adults have difficulty defending themselves. Paternalistic legal intervention may include appointment of guardians, institutionalization, issuing restraining orders against abusers, or mandatory reports of abuse (Schecter, 2017)

The law primarily addresses deontological considerations, emphasizing situations where social workers should act in a paternalistic manner. It does not explicitly incorporate teleological considerations, which concern the outcome of interventions. Hence, this study investigated the role of teleological considerations in the work of social workers with older adults who experience abuse from an adult child and refuse to involve the authorities. To do so, it examined social workers’ perceptions of the efficacy of paternalistic intervention in such situations.

Materials and methods

The study was conducted by means of the qualitative vignette method. The vignette technique entails the creation of realistic scenarios that are relevant to the research objectives. These vignettes are designed to contain distinguishable characteristics while still being sufficiently ambiguous to compel participants to establish their own definitions and interpretations of the situation based upon their unique perspectives. This approach is beneficial for conducting a thorough exploration of sensitive topics, as it provides a noninvasive and non-threatening way of eliciting the participants’ varied/diverse perceptions, opinions, beliefs, and attitudes in response to the story/situation depicted in the vignette (Azman & Mahadhir, 2017).

Participants

The present study examined 21 social workers from Israeli welfare facilities specializing in working with older adults. In order to establish a purposive sample, the participants were intentionally selected to maximize diversity (Marshall, 1996). Of the participants, 20 were female and one was male, with ages ranging from 35 to 60 years old (average 48). The majority of participants identified as Jewish (n = 19), with the remaining two identifying as Muslim. Regarding religiosity, nine participants identified as secular, one as traditional, and ten as religious. Five participants immigrated to Israel in the 1980s and 1990s (three from Russia, one from Ukraine, and one from Romania), while the remaining 16 were born in Israel. Participants’ professional social work experience ranged from 13 to 35 years (average 22.3), with six holding a bachelor’s degree in social work and 15 holding a master’s degree. The final sample size was determined by theoretical saturation, whereby the collection of data ceased to produce novel explanations, categories, and themes (Marshall, 1996).

Data collection

The ethics committee of the university of Authors 1 and 2 approved this study. To recruit interviewees for the study, Author 2 reached out to social workers with at least three years of experience in Ministry of Welfare departments for care of older adults. The author contacted local social services departments across Israel to ensure representation from diverse geographic regions and populations with different characteristics (Marshall, 1996). The three authors conducted the interviews, and all subjects provided voluntary consent to participate. Due to the third wave of the COVID-19 pandemic in Israel, the interviews were conducted remotely through the Zoom videoconferencing platform (https://zoom.us) during January and February of 2021. This platform supports real-time audio and full-motion video, and its free basic plan provides useful and user-friendly features (Lobe et al., 2020). To mitigate social desirability bias resulting from the focus of the study on a vignette presenting an ethical and professional dilemma, the interviewers emphasized the complexity of the scenario and explained that there were no correct or incorrect answers. They further clarified that the purpose of the study was not to assess participants’ ethical and professional conduct but rather to gain insights from their professional experience and knowledge concerning the various dimensions of the dilemma and suggested strategies for addressing it (Krumpal, 2013).

Following the signing of an informed consent form by each participant, the interviewer read out a vignette that portrayed a widower named David in his seventies. David is independent in his functioning and has not experienced any cognitive or mental decline. He lives with his daughter, Rachel, who is single and fifty years of age. Rachel does not allow family members or caregivers to enter the home, and she shouts, curses, and physically assaults David. Despite the distressing situation, David does not want to involve the police due to his love, concern, and sense of responsibility toward his daughter. Despite David’s efforts to persuade Rachel to receive treatment, she refuses to do so. After the vignette was read out to the participants, a detailed, semi-structured interview was conducted in Hebrew for around one hour. The interviewer asked participants to describe their reactions to the scenario presented in the vignette and to raise similar dilemmas they have faced in their work. The interviewers posed such questions as: “After listening to this vignette, what thoughts, feelings, and doubts arise in you?;” “If David’s case had been referred to you, what considerations and doubts would have arisen in you?;” “How would you make decisions in such a case? Why?;” and “Have you encountered similar cases? Can you briefly describe the case(s)? What were your considerations and doubts? How did you ultimately reach your decision? How did you feel afterward?” Each interview was audio-recorded and transcribed verbatim. Additionally, self-report questionnaires were used to obtain participants’ demographic data.

Analysis of the findings

This paper is part of broader research that examined the dilemmas, considerations, and decision-making processes of social workers who care for older adults who do not experience significant cognitive and mental decline and choose to remain in abusive relationships. The present analysis focused on the findings that relate to the teleological considerations of social workers who face this dilemma by examining their perceptions of the efficacy of paternalistic intervention in such situations.

The present study employed a qualitative research design, utilizing content analysis informed by the principles of inductive analysis (Creswell, 2013). The first analysis was conducted by all three researchers, who compared and discussed their interpretations of the first interview. The remaining interviews were then divided up among the researchers, and each researcher conducted an independent analysis. The line-by-line categorization method was used in the first stage of the analysis, adopting an open coding approach that allowed the data to guide the creation of the categories. In the second stage, axial coding was employed to identify commonalities and differences across interviews, which were then grouped into major content areas (themes and sub-themes) along with relevant quotes to describe the participants’ perceptions. Subcategories represented more specific content within the major categories. The third and final stage involved selective coding, which aimed to identify the core themes (Corbin & Strauss, 2014). Throughout the analysis, the researchers tested inter-rater reliability by comparing their individual analyzes, discussing any differences, and seeking agreement regarding theme content and the interpretation of meaning (Lincoln & Guba, 1985).

Results

The interviewees shared their doubts regarding the effectiveness of a legal intervention on the part of the social worker in cases when the older adult, who is experiencing abuse, refuses to cooperate with the law authorities and take legal action against the abusive adult child. The findings are reflected in two main themes that refer to the disadvantages and advantages of legal intervention for social workers.

The disadvantages of legal intervention

The interviewees proposed three different reasons for the ineffectiveness of legal intervention without the cooperation of the older adults: (1) Difficulty in achieving long-term stable results; (2) Damage to trust and the therapeutic relationship; and (3) Potential exacerbation of violence.

Difficulty in achieving long-term stable results

One of the main disadvantages of legal intervention on the part of social workers, lacking the cooperation of the older adults, is related to this intervention’s ineffectiveness in achieving stable and long-term results. The interviewees claimed that, from their experience, a unilateral intervention leads to the existence of a “revolving door” wherein older adults have difficulty enforcing the judicial restraining order, which ultimately results in continued abuse. This is because the older adults’ love, concern, and commitment to their adult child may outweigh their own need for protection and safety. The following quote demonstrates the powerlessness of one interviewee, who, despite repeated appeals to the police, has been unable to protect an older woman who experiences severe violence from her son, due to her lack of cooperation.

A nearly seventy-year-old woman, who lives with her mentally ill adult son, is not willing to take any action; from time to time, he comes home, then is hospitalized, and when he comes home again, he tries to burn the house down. He hurts her very, very, very badly, [but] she is not willing to do anything [about the situation] and becomes extremely angry when we report to the police, and we do, indeed, report to the police. Still, she allows him to come home and is unwilling to do anything about it, and we [certainly] can’t do anything about it except look on in pain, keep abreast of what is going on there, and try to prevent a bigger disaster by reporting to the police, and that’s it. (Interviewee 4)

In the following quote, an additional participant described another case, in which an older woman initially cooperated with the legal authorities by applying to the court for a restraining order. However, even with this measure in place, there were significant difficulties with its long-term enforcement.

When we finally managed to persuade the mother to issue a restraining order and she complied with it… and he (the son) even went to rehab… If it had ended there that would have been great, but the problem is that once he went to rehab and started showing signs of taking better care of himself, she violated the protection order and brought him back in, and this actually caused a regression. (Interviewee 1)

According to the interviewees, there is a need for a long-term intervention with older adults, which eventually leads to a change in their attitudes and in the dynamics of their relationship, which in turn may achieve a stable change, as reflected in the following quotes:

Many things can occur gradually in a therapeutic procedure; a kind of process [but] it’s not instantaneous. It’s not that he will make a change tomorrow morning, but I believe it is possible…. (Interviewee 9)

There is a need to protect the older adult, but at the same time, it’s important to understand the difficulties he faces when trying to take action. This is a man who likely requires close monitoring and frequent, empowering conversations. With time, trust can be built, and cooperation can be achieved. He needs to know that he has a support system [behind him]. This man needs a lot of supportive interactions. (Interviewee 10)

Harm to trust and the therapeutic relationship

Another disadvantage of unilateral legal intervention is harm to the trust and the relationship with the patient. This is because paternalistic actions can be perceived as coercive in that they do not give room to the attitudes and perceptions of the older adults and thus do not allow them to exercise their right to self-determination. Furthermore, paternalistic steps are perceived as contradictory and damaging to the therapeutic relationship, which is largely characterized by trust and cooperation. As reflected in the following quote:

What would have stopped me was that I would have violated his trust, telling him: “I’ve decided this for you. I’m the one who decides here and … whatever you said is less important to me.” (Interviewee 2)

Exacerbation of violence

In addition, the interviewees stated that turning to the legal system may not only fail to protect the victim but actually increase the risk of harming him because the deterrence effect disappears when the offender discovers that legal intervention cannot harm him in the long term, as reflected in the following quote:

This [legal intervention] often escalates the situation, because then the element … of threat does not exist, because he [the offender] knows anyway that it will become a routine, and the parent will do nothing against him. (Interviewee 12)

The benefits of legal intervention

Along with emphasizing the disadvantages and risks of applying for legal intervention, without the cooperation and agreement of the older adult, the second theme emphasized the advantages of doing so. This theme was manifested in three sub-themes: 1. Protection of the victim; 2. The social workers’ relief from the burden of responsibility; and 3. The victim’s preference that the referral will come from the social worker.

Protection of the victim

The first advantage was simply expressed in the protection of the victim. The interviewees emphasized that when older adults are in danger, only immediate legal intervention can protect them, as reflected in the following quote:

I think that the very act of contacting [the police] and setting the boundaries in court …is a therapeutic tool in and of itself… The moment physical harm [toward the older adult] had taken place, we could no longer [just stand by]. We defined him as being [truly] helpless. Contacting the police caused the daughter to leave the house, and the life of the older adult changed significantly for the better. (Interviewee 14)

In the following quote, the interviewed social worker describes a paternalistic intervention of reporting to the police, over the parents’ opposition, due to a serious risk posed by their violent son. She claimed that sometimes an external shock is necessary to bring about change. At the same time, the interviewee emphasized the continuous, long-term therapeutic process with the family, which preceded the paternalistic intervention, as enabling the preservation of the change achieved.

An older couple…their son was extremely violent; he was in prison for attempting to murder his father… They were frightened, and we were concerned … and there arose a situation where he sent them threats again… I was razor-sharp. … there was intense opposition (from the parents) who said, “He just got out of prison; you’re ruining his life; what the hell are you doing?.‘ I said:’ I have to … I’m not going home without reporting him to the police.” … He [the abusive son] received a warning, was called in to the station, and the fact that they finished dealing with our case means that this son, at some point, internalized the fact that he cannot behave like this. The situation there is so much better compared to before…. So, sometimes, such an act also gets an apparently positive result, a change in life. The intervention of outside entities often causes a shock to such a family system, but also some good comes out of this shock. (Interviewee 4)

The social workers’ relief from the burden of responsibility

The interviewees also highlighted another advantage of reporting elder abuse to the police, namely, the social workers’ relief from responsibility. This responsibility transcends mere dictates of conscience and poses the possibility of being blamed by the older adult’s family members and even external societal entities, such as the legal system and the media, for their inability to protect the victim, as reflected in the following quote:

We really feel that we are going home with this story, and that it’s a very heavy burden. I mean, the woman tells us, “Don’t do anything,” but we walk around with it, and the heavy burden is on us, also because I think that maybe it could be helpful if a policeman came and reprimanded the daughter … and also because I too want to be “covered.” I live in a system where I need this cover. It’s impossible to ignore it. (Interviewee 2)

In the following quote, the interviewee shared her anxiety that if she doesn’t report [to the authorities], and as a result the older adult would be harmed, she might be perceived by the media as being responsible for it.

One of the things on my mind is that I mustn’t appear tomorrow in the media news and that he (the victim) mustn’t appear there either. (Interviewee 11)

The victim’s preference that the referral come from the social worker

Finally, the interviewees stated that although the older adults are frightened and therefore avoid submitting complaints for legal intervention themselves, they often do want the social workers to make the complaint on their behalf. In this way, they protect themselves from feelings of emotional burden and guilt, resulting from taking direct action against their adult child, as reflected in the following quote:

Not to place the parents in a position of having to act against their child because it goes against the parental instinct. Still, suppose someone else [from outside] comes and removes his daughter [from the home], without his having anything to do with it, and places her, even better, in a therapeutic facility. In that case, I’m sure that David (the older adult) would be both thankful and relieved. He will be able to live without violence and also know that his daughter is getting treatment. (Interviewee 16)

Moreover, the indirect complaint by the social worker prevents the escalation of violence against the older parent, as expressed in the following quote:

Because there was a decision to report on behalf of the older adult, to protect him from the accusations of his children that “you went to the police and reported us,” and then they would apply more pressure or undertake another form of violence against him… [He can reply to them]: “You see, I didn’t report you, the welfare agency did. I didn’t go to the police and I didn’t say anything.” He wants to show them that he is a good father. Who is the bad guy here? Welfare. (Interviewee 21)

Discussion

The current study’s findings present the different considerations of social workers who are experts in the field of aging regarding the effectiveness of legal intervention on their part in situations where older adults, who do not experience significant cognitive and mental decline, choose to remain in an abusive intergenerational relationship. The findings present a complex picture focusing on the advantages and disadvantages of this intervention.

One of the significant disadvantages of legal paternalistic intervention, which the interviewees revealed, related to the difficulty of creating a stable long-term change without the older adults’ cooperation. This finding is supported by the study of Lepping and colleagues, which emphasized the limited influence of paternalistic intervention on the behavior patterns of both the offender and the victim (Lepping et al., 2016).

The importance of long-term processes in achieving sustainable change is anchored in the foundations of social work, a discipline which emphasizes that changes are generated through an interpersonal intervention process. This process includes evaluating the clients’ strengths, abilities, and support resources, as well as their problems, challenges, and obstacles that can hinder them from achieving their goals. The intervention’s goals are achieved through a continuous interpersonal process that allows the clients space and room for introspection and the development of new ways to perceive and cope with their problems (Bogo, 2018).

According to this perception, a paternalistic intervention that imposes a solution on the older adult without assessing their resources and difficulties and without enabling them to undergo a process of introspection, change, and active participation will have a limited ability to generate a sustainable change

The second disadvantage of legal intervention without the cooperation of the older adult, which emerged from the findings, is related to the social worker’s fear that a paternalistic intervention might endanger the client’s trust and the therapeutic relationship. This finding is supported by previous studies, which indicated that paternalistic intervention may negatively affect social workers’ relationships with their older adult clients (Norrie et al., 2016; Stevens et al., 2020). These teleological considerations of potential harm to trust and the therapeutic relationship can be associated with a similar ethical dilemma, which has received wide attention in the ethical literature of social work and deals with situations in which the social worker is required to decide between maintaining the clients’ confidentiality and protecting them or a third party from harm (Reamer, 2018).

Examining this dilemma from a teleological perspective might reveal a complex picture. It can be assumed that a teleological ethical consideration might attribute more importance to the risk of harm over the therapeutic relationship. In contrast, a deontological consideration would favor not violating the clients’ trust. However, due to the complexity and ambiguity of these situations and the absence of clear legal directives, the social worker can assume that damage to the therapeutic relationship would increase the risk to the client in the long term, and therefore the avoidance of reporting to the authorities may be perceived as a teleological ethical decision (Reamer, 2018).

The third disadvantage of paternalistic legal intervention raised by the interviewees, was the fear that this intervention would exacerbate violence. These findings are supported by a wide body of research knowledge, which indicates the fear of escalating violence as one of the barriers to disclosure of domestic violence and elder abuse by either older adults or social workers (Chokkanathan et al., 2014; Dow et al., 2020; Shaheen et al., 2020).

The second theme is related to the benefits of legal interventions. These advantages relate primarily to the protection of the victim. The interviewees attested to the importance of using paternalistic intervention without the client’s consent as a necessary step in situations where the older adult is in danger. Furthermore, the interviewees noted that this type of intervention can facilitate change, especially when coupled with a therapeutic process. These findings align with previous research that suggests that social workers resort to legal intervention without client consent as a final measure when a potential risk is involved (Donovan & Regehr, 2010; Stevens et al., 2020).

In addition, the interviewees emphasized that reporting to the legal authorities not only ensured the safety of the older adults but also eased their sense of personal responsibility for the client’s protection, as well as alleviating feelings of guilt, should the older adult be harmed in any way. Moreover, the interviewees emphasized the advantage of going to the police so as to defend against any potential blame from outside parties such as family members, the welfare and legal systems, the general public, and the media. The interviewees’ fear of being blamed by the media corresponds with recent studies that demonstrate the negative and critical representation of the social work profession in the media (Levin Keini et al., 2022).

Finally, the interviewees indicated that the social worker’s reporting to the authorities sometimes helps the victims by shielding them from direct confrontation with the perpetrator and other family members. The older adults’ difficulty in taking direct action against their adult child was explained by their desire to avoid feelings of emotional burden and guilt. An additional explanation for this avoidance was related to the older adults’ fear that reporting to the law authorities would cease support from the offending adult child and even lead to sanctions and worsening abuse. These two explanations are supported by previous studies (Chokkanathan et al., 2014; Fraga Dominguez et al., 2021).

The older adults’ preference that the referral come from the social worker can be enlightened by the “Thank-you theory.” This theory justifies the paternalistic intervention on the part of the social worker due to the probability of retrospective consent on the part of the client. According to this viewpoint, although the social worker acts contrary to the explicit wishes of the older adult, the probability that the client will acknowledge and thank the social worker for taking this step justifies the intervention (Carter, 1977; Kasachkoff, 1994; Stone, 1975).

A comprehensive discussion of this theory is beyond the scope of this paper, and yet we will note that this theory’s underlying reasoning is that retroactive consent to a paternalistic action constitutes a moral justification for this intervention as it does not negate the autonomy of the individual. This claim is based on the notion that consent or gratitude expressed after the paternalistic action has a moral status equal to consent given in advance and, therefore, there is no violation of that person’s rights (Gross, 2005; Kasachkoff, 1994).

Research contribution and implications for research and practice

This study contributes to the developing body of research knowledge that deals with the decision-making processes and the professional and ethical considerations of social workers who care for older adults who experience abuse from their adult child and have to decide between protecting them from harm and respecting their autonomy. This is by making a clear distinction between deontological and teleological considerations, as well as giving space and recognizing the importance of these two types of considerations in social workers’ professional and ethical decision-making processes.

Based on these theoretical models, the present study’s findings have significant implications for the advancement of applied models aimed at guiding the decision-making processes and ethical deliberations of social workers who are faced with a dilemma in which they have to decide between autonomy and the protection of life in situations of older adults who experience abuse by their adult child. These models will initially help social workers distinguish between deontological and teleological considerations. After that, the social workers will be able to examine deontological considerations concerning the legal and ethical correctness of the action, alongside teleological considerations that deal with the consequences of this action (Reamer, 2018, 2021). A decision-making process that encompasses these two sets of considerations will enable reaching an ethical solution that can be both legally and morally correct and beneficial to the client.

Given the complexity of decision-making processes and their profound consequences, it is advisable to form multidisciplinary teams composed of experts in social work, law, and medicine. These teams can provide assistance in navigating ethical conflicts and dilemmas during decision-making.

Limitations and recommendations for further research

The findings of the present study provide a comprehensive picture of the teleological considerations of social workers who care for older adults who have suffered abuse from their adult child. However, a key limitation of the teleological theory is its subjective definition of “the most favorable consequences,” which allows for varied interpretations and perspectives. Consequently, different social workers may assess the best solution differently (Reamer, 2018, 2021). Moreover, older adults might perceive the optimal outcome differently than social workers do. For instance, in some cases, they may choose to remain with an abusive child if that child provides support (Lev et al., 2023). Further research that examines the perspectives of older adults would contribute to a more accurate understanding of this issue. Likewise, action research and participatory research that involves the evaluation of intervention models in such challenging situations could contribute to a deeper understanding of both the dilemma and effective coping strategies.

In light of the growing awareness with regard to research on decision-making processes and ethical considerations in social work (e.g., Mackay, 2017; Stevens et al., 2020), this study can serve as a basis for further studies that will deal with various ethical dilemmas and examine in depth the deontological and teleological considerations involved in the decision-making processes as well as the relationships between them. Moreover, the research findings suggest that beyond considering the benefit to the older adult, the social workers also factored in personal considerations such as relieving the burden of responsibility. Future research should explore how social workers integrate considerations of personal benefit into their professional and moral decision-making processes. Last, the representation of Arab Israeli social workers in the study was relatively limited. Given the unique characteristics of Arab society in Israel, future research could delve into how Arab Israeli social workers navigate and experience this particular ethical dilemma.

Conclusion

The present study analyzed the teleological considerations in the decision-making processes of social workers who take care of older adults who experience abuse from their adult child but refrain from involving authorities. This study adds another layer to the existing research on this ethical and professional dilemma, which has focused mainly on deontological considerations (Lev et al., 2023; Norrie et al., 2016; Stevens et al., 2020). Thus, the present findings offer a basis for models for decision-making processes in social work that take into account not only what is correct from a professional and legal point of view, but also what is most beneficial to the client.

Disclosure statement

The author(s) confirm that they have no relevant competing interests, whether financial or non-financial, to disclose.

Additional information

Funding

This work was supported by the Impact Center for the Study of Ageism and Old Age.