The U.S. Senate Finance Committee held a hearing last week on the latest report released by the Government Accountability Office (GAO), Improved Oversight Needed to Better Protect Residents from Abuse. The report states that abuse deficiencies cited in nursing homes have more than doubled between 2013 and 2017. GAO also found several oversight gaps that limit the agency’s ability to have strong oversight in place to protect residents from abuse, including:
- Information on abuse and perpetrator type is not readily available. CMS does not require state survey agencies to record the type of abuse and perpetrator, and when this information is recorded it cannot be easily analyzed. GAO found that, without this, CMS lacks key information to tailor investigation and prevention activities to address the most prevalent types of abuse or perpetrators.
- Self-reports lack key information. GAO found that CMS has not provided guidance to providers about what information should be included in self-reports. This can delay investigations and makes it difficult to prioritize investigations.
- Gaps in the CMS processes that delay referrals to law enforcement. CMS only requires surveyors to make referrals to law enforcement after a report is substantiated. As a result, GAO found that law enforcement investigations are frequently delayed.
The GAO made the following recommendations:
- Require that abuse and perpetrator type be submitted by state survey agencies in CMS’s federal databases for deficiency, complaint and facility-reported incident data, and that CMS systematically assess trends in these data.
- Develop and disseminate guidance — including a standardized form — to all state survey agencies on the information nursing homes and covered individuals should include on facility-reported incidents.
- Require state survey agencies to immediately refer complaints and surveys to law enforcement (and, when applicable, to Medicaid Fraud Control Units) if they have a reasonable suspicion that a crime against a resident has occurred when the complaint is received.
- Conduct oversight of state survey agencies to ensure referrals of complaints, surveys and substantiated incidents with reasonable suspicion of a crime are referred to law enforcement (and, when applicable, to Medicaid Fraud Control Units) in a timely fashion.
- Develop guidance for state survey agencies clarifying that allegations verified by evidence should be substantiated and reported to law enforcement and state registries in cases where citing a federal deficiency may not be appropriate.
- Provide guidance on what information should be contained in the referral of abuse allegations to law enforcement.
LeadingAge submitted this Statement for the Record to the Senate Finance Committee:
Abuse of nursing home residents must be effectively detected, punished, and prevented. LeadingAge will continue working with policymakers, consumers, researchers, and families to ensure that all nursing homes are safe places for people who need long-term care. We will build on our members’ initiatives that have made nursing homes a resource and safe haven for older people who have experienced abuse in the community. It is difficult to accept that most abuse of elders happens not at the hand of strangers or nursing home staff, but from the family members on whom an elder frequently must depend. But unless this reality is recognized and dealt with, elder abuse will continue unchecked.
