Nursing Facilities' Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect

WHY WE DID THIS STUDY

To protect the well-being of residents, nursing facilities must comply with Federal regulations to develop and implement written policies related to reporting allegations of abuse, neglect, mistreatment, injuries of unknown source, and misappropriation of resident property (allegations of abuse or neglect). Further, allegations of abuse or neglect must be reported to the facility administrator or designee and the State survey agency within 24 hours. Results of investigations of these allegations must be reported to the same authorities within 5 working days. Nursing facilities must also notify owners, operators, employees, managers, agents, or contractors of nursing facilities (covered individuals) annually of their obligation to report reasonable suspicions of crimes.

HOW WE DID THIS STUDY

This study included a: (1) review of sampled nursing facilities' policies related to reporting allegations of abuse or neglect, (2) review of sampled nursing facilities' policies related to reasonable suspicions of crimes, and (3) survey of administrators from those sampled facilities. It also included an examination of a random sample of allegations of abuse or neglect identified from the sampled nursing facilities, and a review of documentation related to those sampled allegations of abuse or neglect.

WHAT WE FOUND

It is both required and expected that nursing facilities will report any and all allegations of abuse or neglect to ensure resident safety. We found that 85 percent of nursing facilities reported at least one allegation of abuse or neglect to OIG in 2012. Additionally, 76 percent of nursing facilities maintained policies that address Federal regulations for reporting both allegations of abuse or neglect and investigation results. Further, 61 percent of nursing facilities had documentation supporting the facilities' compliance with both Federal regulations under Section 1150B of the Social Security Act. Lastly, 53 percent of allegations of abuse or neglect and the subsequent investigation results were reported, as Federally required.

WHAT WE RECOMMEND

We recommend that CMS ensure that nursing facilities: (1) maintain policies related to reporting allegations of abuse or neglect; (2) notify covered individuals of their obligation to report reasonable suspicions of crimes; and (3) report allegations of abuse or neglect and investigation results in a timely manner and to the appropriate individuals, as required. CMS concurred with all three of our recommendations.