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Transcript for audio podcast: Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect

From the Office of Inspector General of Department of Health and Human Services

http://oig.hhs.gov

[Brian Whitley] I'm Brian Whitley, Regional Inspector General for the Office of Evaluation and Inspections, speaking with Rae Hutchison, a senior program analyst, about a report called "Nursing Facilities' Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect." Rae, this sounds like an important issue. Could you start by telling us what you focused on in this report?

[Rae Hutchison] Sure, Brian. We focused on finding out if facilities reported allegations of abuse or neglect to the appropriate people within the required timeframes. It's important to understand that reporting allegations is critical to fixing problems. We'd prefer to see more allegations reported versus a facility failing to report allegations of abuse or neglect.

[Brian Whitley] Thanks for emphasizing that point Rae. It's extremely important. Would you start by telling us exactly what an allegation of abuse or neglect is?

[Rae Hutchison] Sure. There are several types of harm, including abuse, injuries of unknown source, neglect, misappropriation of property, or mistreatment. The phrase "allegations of abuse or neglect" simply refers to all of these types of harm.

[Brian Whitley] Does an allegation of abuse or neglect mean that something actually happened to someone?

[Rae Hutchison] Not at all. An allegation is a claim that something happened. Not all allegations of abuse or neglect are proven.

[Brian Whitley] So what are nursing facilities supposed to do if someone claims that they are being abused or neglected?

[Rae Hutchison] Well, within 24 hours of learning about the claim, facility staff must report it to the facility administrator. Then the facility begins an investigation. Facility staff must also report the allegation of abuse or neglect within 24 hours to the State survey agency.

[Brian Whitley] What's a State survey agency?

[Rae Hutchison] A State survey agency is a government agency that makes sure that facilities comply with Federal regulations. This includes reporting abuse or neglect allegations, and reporting the investigation results, to the appropriate people within the required timeframes.

[Brian Whitley] So, what happens after the facility finishes its investigation of the allegation?

[Rae Hutchison] The facility staff must report the investigation results to the administrator, and the administrator must report those results to the State survey agency, all within 5 business days.

[Brian Whitley] So what did your study find?

[Rae Hutchison] We found that 85 percent of facilities reported to the Office of Inspector General at least one allegation of abuse or neglect in 2012.

[Brian Whitley] That seems like a high percentage. Were you surprised by that figure?

[Rae Hutchison] Not really. Remember, we're talking about allegations or claims of abuse or neglect - so we expect a high percentage. Allegations come from many sources like residents, family members of residents, or even facility staff.

[Brian Whitley] What was the most common type of allegation?

[Rae Hutchison] Abuse was the most common type of allegation and the allegations often involved suspected employee abuse of residents.

[Brian Whitley] So, did you find that facility employees were abusing or neglecting residents?

[Rae Hutchison] Not at all, because that was outside the scope of our study. We focused on if facilities reported practices, not if abuse or neglect actually occurred.

[Brian Whitley] So were the facilities reporting the allegations appropriately?

[Rae Hutchison] Not always. We found that for 37 percent of allegations, facilities were not in compliance with Federal reporting regulations.

[Brian Whitley] What about investigation results?

[Rae Hutchison] Facilities didn't always report the results of their investigations either. We found that for 37 percent of allegations, the facility administrator did not report results to the State survey agency within 5 business days.

[Brian Whitley] Interesting. So, what did OIG ultimately recommend based on these findings?

[Rae Hutchison] Well, we recommended that the Centers for Medicare & Medicaid Services, or CMS, ensure that facilities report allegations and investigation results in a timely manner and to the appropriate individuals.

[Brian Whitley] Did CMS agree with OIG's recommendations?

[Rae Hutchison] They did. Because State survey agencies are responsible for ensuring that facilities are in compliance with Federal regulations, CMS stated that it would discuss OIG's results with State survey agencies and reiterate Federal reporting regulations.

[Brian Whitley] Rae, thank you for sharing this important work.

[Rae Hutchison] Thank you, Brian.

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