Nursing home abuse or neglect often goes unreported, OIG finds

More than 1 in 4 cases of abuse or neglect at skilled-nursing facilities are not reported to law enforcement and the CMS fails to identify and report those incidents, according to HHS' Office of Inspector General.

In a preliminary report released Monday as an "early alert," the OIG identified 134 instances of potential abuse and neglect of Medicare beneficiaries at skilled-nursing facilities in 33 states. Approximately 28% of those incidents were not reported to local law enforcement, despite laws requiring hospital staff to do so.

The "early alert" was a signal for the CMS to take immediate action to amend procedures rather than wait for the entire report to be released next year.

According to the OIG, the CMS lacks procedures to quickly identify instances of abuse and neglect at SNFs. The HHS internal watchdog also has "significant concerns" that the number of incidents of abuse and neglect are underreported at SNFs. The CMS also hasn't enforced a 2011 section of the Affordable Care Act that requires long-term care facilities to report any suspicions of crimes committed against patients, according to the OIG.

In response to HHS OIG's concerns, the CMS said that it has not received authority to enforce the ACA provision from HHS' Office of the Secretary, but it is working with the office to ameliorate that.

HHS's OIG report is part of its larger, ongoing investigation by the OIG to detect elder abuse at skilled-nursing facilities and other long-term care providers after media reports and public concern has intensified regarding treatment of vulnerable patients at these facilities.

"It continues to shock me that the law was passed in 2011, and here we are in 2017 and the CMS is just now starting to incorporate it," said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care.

The OIG recommended that the CMS continue its work to enforce the ACA provision as well as impose penalties for violations. The OIG also said the CMS should implement procedures that compare Medicare claims for emergency room treatment with claims for SNF services to identify potential abuse and neglect issues better.

In a statement, the CMS said it will respond to the OIG's formal recommendations when they are complete. The CMS also said it requires skilled-nursing facilities to report abuse and neglect to state survey agencies. "Abuse and mistreatment of nursing home residents is never permitted and CMS takes allegations of these incidents very seriously," the agency said. "We appreciate the OIG's attention to this important issue."

It's not the first time OIG has raised concerns over the CMS' facility oversight. In 2014, the office released a report that found an estimated 22% of patients at skilled-nursing facilities experienced preventable injuries such as medication errors, falls and infections.

"There is a need for more training and increased resources around investigation of issues at long-term care facilities," Smetanka said.

The CMS, state agencies and long-term care providers can all do more to help report and identify incidents of neglect, she said. Staff at agencies should be better trained to quickly report suspicions of abuse to law enforcement so evidence isn't tampered with and state agencies should better report suspicions of abuse, she added.

The American Health Care Association, which represents long-term care providers, said in a statement that its 13,500 members know to report suspicions of abuse and neglect immediately. The association also said that it advises its members on practices to prevent abuse and neglect as well as reporting requirements if abuse is suspected.

"We welcome any opportunity to work together with CMS and other government agencies to ensure the safety and well-being of the individuals in our care," the American Health Care Association said.