With complaints of nursing home abuses doubling between 2013 and 2017, the federal agency with oversight of these facilities must improve significantly its efforts to protect millions of vulnerable seniors, the U.S. Government Accountability Office (GAO) has found.
That recommendation, from one of Uncle Sam’s top watchdogs, infuriated members of the U.S. Senate Finance Committee, which called on the Centers for Medicare and Medicaid Services (CMS) to act fast on six recommendations to address its failures in regulating nursing homes.
Sen. Thomas Carper, a Delaware Democrat, described these as including “CMS – the agency charged with ensuring that these facilities meet federal quality standards – often cannot access information about abusive incidents after they occur and, therefore, cannot take the necessary steps to remedy the situation.”
GAO investigators did not delve into individual cases nor did they provide details about incidents in their report, in which they noted that nursing home abuses likely are under reported. They relied on information provided by groups in states that CMS contracts with to assist in nursing home oversight.
The state groups reported 430 cases in 2013, doubling to 875 in 2017, with the most severe cases showing the greatest increases. The incidents involved physical, mental-verbal, and sexual abuse by nursing home staff, residents against each other, and others. Physical and mental-verbal abuse incidents made up the preponderance of the cases and nursing home staff were most often the culprits, the investigators found.
The findings also paint a painful picture of the vulnerability of residents most often involved in various types of abuse: The patients too often suffer cognitive and physical impairment and lack friends or loved ones who visit them regularly to check on them and their care. They also may be living in facilities that mix the ages and needs of residents in their care.
GAO said it has reported on nursing homes before and found problems with abuses, which it noted are rare among the 1.4 million Americans who need such facilities. But the nation is graying. And Medicaid is providing to nursing home residents, as the Congressional Budget Office has reported, “about 15% of the total $50 billion spent on the federal level to support state Medicaid programs.” So, CMS must step its oversight of the facilities, investigators wrote, concluding:
“We found weaknesses in both CMS’s understanding of abuse and in its oversight that need to be addressed. Specifically, because CMS cannot readily access information on abuse or perpetrator types in its data, it lacks key information critical to taking appropriate actions to address the most prevalent types of abuse and perpetrators. In addition, CMS has not provided guidance on what information should be included in facility-reported incidents, contributing to a lack of information for state survey agencies and, subsequently, delays in their investigations. This lack of guidance related to facility reported incidents is important in light of our findings that abuse deficiencies are identified most commonly through facility-reported incidents. We also found other gaps in CMS’s process related to ensuring timely referrals of abuse to law enforcement, tracking abuse referrals, defining abuse substantiation, and sharing information with law enforcement. These gaps affect CMS’s oversight of abuse in nursing homes—including the prevention, identification and timely investigation of abuse—and may limit CMS’s ability to ensure that nursing homes meet federal requirements for residents to be free from abuse.”
The Senate Finance Committee said it would welcome GAO follow-up on its six recommendations for Medicaid and Medical officials to fix deficiencies in nursing home oversight. The watchdogs called for CMS to require its state oversight agencies to submit data on abuse and perpetrator type and to compel them to immediately refer to law enforcement any suspicion of a crime. Medicare and Medicaid officials also must develop guidance on what abuse information nursing homes should self-report.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones due to nursing home neglect and abuse. Nursing home care is costly, averaging more than $92,000 annually for a resident in a single room. It isn’t easy to arrange for, especially because this requires research and preparation and too many patients find they need it only in the most dire and fast-developing circumstance. And it is unacceptable at that expense that operators appear to be scrimping on care and building their profits by keeping staffing levels low, leaving residents even more open to neglect and abuse.
With 10,000 baby boomers each day hitting age 65 — a trend likely to keep up until at least 2029 — lawmakers and regulators cannot ignore just how crucial will be quality nursing home, hospital, and hospice care and facilities. The watchdog warnings, alas, aren’t good, and we have lots of work ahead of us all.