Imagine your elderly loved one suffered complications from bed sores in a nursing home. Bed sores are a classic sign of neglect, but when she is hospitalized, the doctors and nurses there seem not to make that connection. They simply treat the painful ulcers and send her back to the nursing home where she suffered the neglect.
That’s not supposed to happen. Nursing homes, along with healthcare professionals, nursing home inspectors and others are required by law to report suspected elder abuse and neglect to law enforcement or a state elder abuse agency. Yet two recent government studies add to the evidence that these mandatory reports aren’t being made as often as they should.
In April, we discussed a 15-year investigation by the Government Accountability Office (GAO) into whether the Centers for Medicare & Medicaid Services (CMS) was properly monitoring abuse and neglect in the nursing homes it pays for. The GAO recommended that CMS reevaluate its investigation of complaints, identify new ways to get the information it needs, and communicate to the public that there is a lack of data about Medicaid-funded nursing homes.
These more recent two studies were performed by the Office of Inspector General of the U.S. Department of Health and Human Services (OIG), the watchdog of all Health and Human Services programs, including CMS.
When evidence of abuse or neglect surfaces, who’s paying attention?
The OIG considered whether CMS audits emergency room claims for common symptoms of abuse and neglect. It also looked at whether nursing homes and state nursing home inspectors are referring cases to law enforcement as required by law.
According to the research, skilled nursing facilities failed to report about 20% of cases involving potential abuse and neglect.
That’s bad, but the investigating agencies performed even more poorly. The OIG considered evidence from five states with nursing home inspection programs. Even in cases where the state inspectors substantiated abuse, 97% of the cases were never reported.
According to the OIG’s deputy inspector general for audit services, the state inspectors in the study seemed confused about their legal responsibility to report these cases. One agency admitted contacting law enforcement only in “the most serious abuse cases.”
Healthcare providers, too, failed to make the required reports. In over 30,000 potential cases, doctors and hospitals failed to make reports in nearly a third.
The OIG recommends that CMS periodically audit the claims it receives from nursing home patients who are taken to the emergency room and look for signs of abuse or neglect. This could possibly identify actual cases to follow up on, but it could also provide the industry with important information about how common these claims are and where and when they are occurring.
CMS rejects those recommendations. It claims that Medicare billing is so untimely that periodic audits would reveal no useful information. The OIG argues that most Medicare claims are filed within a month. Moreover, openly tracking the data could put pressure on nursing homes to make the mandated reports more often.
It’s crucial to pay close attention to your loved one’s care
Abuse and neglect occur even in the most expensive nursing facilities. We can’t afford to check our loved ones into nursing homes and then check out.
If you suspect your loved one may be being abused or neglected, contact an attorney who understands how to uncover patterns of wrongdoing or inadequate care. Holding the nursing home accountable for abuse or neglect in one case can help countless others avoid the heartache of knowing a loved one was mistreated.