37% of abuse, neglect claims not handled as required, OIG report finds

Thirty-seven percent of allegations involving abuse or neglect in nursing facilities in 2012 were not reported according to federal regulations, says a new report by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services.

“Within 24 hours of learning about the claim, facility staff must report it to the facility administrator. Then the facility must begin an investigation,” Rae Hutchison, a senior program analyst for the Office of Evaluation and Inspections, said in an OIG podcast related to the report. “Facility staff also must report the allegation of abuse or neglect within 24 hours to the state survey agency,” she added.

The facility staff must report the results of the investigation of the allegations to the administrator, and he or she must report them to the state survey agency, all within five working days, Hutchison said. And every year, nursing facilities must explain to owners, operators, employees, managers, agents or contractors that they have an obligation to report reasonable suspicions of crimes.

Eighty-five percent of nursing facilities reported at least one allegation of abuse or neglect to the OIG in 2012, according to the report, “Nursing Facilities' Compliance with Federal Regulations for Reporting Allegations of Abuse and Neglect” (PDF). Those incidents include several types of harm—abuse, injuries of unknown source, neglect, misappropriation of property or mistreatment.

Investigators also found that:

• 76 percent of nursing facilities had policies addressing federal regulations for reporting abuse or neglect allegations as well as reporting the results of related investigations;
• 61 percent of nursing facilities could document their adherence to federal regulations under the Social Security Act's Section 1150B; and
• 53 percent of allegations and the results of subsequent investigations were reported as required.

“We’d prefer to see more allegations reported versus a facility failing to report allegations of abuse or neglect,” Hutchison said.

Based on its findings, the OIG recommended that Centers for Medicare & Medicaid Services (CMS) should ensure that nursing facilities:

• maintain policies related to reporting allegations of abuse or neglect;
• notify responsible parties of their obligations to report reasonable suspicions of crimes; and
• report allegations and results of investigations in a timely manner and to the appropriate individuals as required.

CMS said it agrees with all of the recommendations.

To arrive at its conclusions, the OIG reviewed policies related to reporting allegations of abuse and neglect as well as reasonable suspicions of crimes and also surveyed administrators at select facilities. The OIG also examined a random sample of allegations from those facilities and reviewed documentation related to those allegations.