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Nursing Homes

Last Updated: 12-07-2023

Nursing homes are intended to be places of comfort and healing. According to Centers for Medicare & Medicaid Services (CMS) data, in July 2022, approximately 1.2 million people resided in more than 15,000 certified nursing homes.* Most nursing homes in the United States are certified to serve as both skilled nursing facilities, which provide a clinically managed recovery period after a person's illness or injury, and long-term care facilities that deliver health care and services a resident needs for mental or physical conditions not rising to the level of skilled nursing care.

Decades of OIG work on nursing homes has uncovered widespread challenges in providing safe, high-quality care. Our audits, evaluations, and investigations have raised concerns regarding staffing levels, background checks for employees, reporting of adverse events experienced by residents, and other issues.

Proper nursing home care requires a partnership involving Federal, State, and local entities, the provider community, residents, and their families. To protect residents, OIG continually assesses nursing home performance and oversight, monitors the impact of program changes, and uses our enforcement tools to address misconduct. Key goals in OIG nursing home oversight are below.

Protect Residents from Fraud, Abuse, and Neglect and Promote Quality of Care

Nursing homes should be environments that are free of harm. However, criminal and civil enforcement actions involving OIG have uncovered misconduct and grossly substandard care in nursing homes. Bad actors perpetrate criminal activity that targets nursing home residents. In other cases, substandard care can result in harm such as costly medical injury, unsafe conditions, and abuse and neglect of residents.

OIG investigates potential violations to hold accountable those who victimize residents of nursing homes. Patient neglect and inadequate care by nursing facilities is a recurring challenge that OIG works with the Department of Justice to address in False Claims Act cases.

Promote Emergency Preparedness and Response Efforts

Nursing home residents and their families rely on facility administrators to plan and execute appropriate procedures during emergency events such as emerging infectious disease outbreaks, natural disasters, and life safety threats. Noncompliance with preparedness requirements and plans can place residents at increased risk of injury or death during an emergency.

In 2020, OIG quickly pivoted to new work to help protect nursing home residents during the pandemic. These individuals are particularly vulnerable to infectious diseases, such as COVID-19, due to their age and underlying medical conditions.

Strengthen Frontline Oversight

State survey agencies are on the front lines for ensuring nursing home quality and safety. States conduct on-site surveys at nursing facilities to evaluate the care they provide and respond to allegations of noncompliance with Federal requirements from residents, their families, staff, and others.

OIG reports have identified shortcomings in State agencies' effectiveness and recommended improvements to strengthen this safety system for nursing home residents.

Support Federal Monitoring of Nursing Homes to Mitigate Risks to Residents

CMS has an essential, ongoing responsibility to oversee nursing homes and shares with State agencies the responsibility for ensuring that nursing homes meet Federal requirements for quality and safety. CMS oversees the State process for certifying nursing homes and provides guidance to States regarding the survey process.

OIG examines risks to residents' well-being and recommends ways for CMS to better monitor and mitigate these risks. This work often includes assessments of how CMS is—or could be—leveraging data more effectively for oversight and to make risks more transparent to consumers.

Resources

*Kaiser Family Foundation (KFF), KFF analysis of CMS Care Compare data, "Total Number of Residents in Certified Nursing Facilities," July 2022, accessed at Total Number of Residents in Certified Nursing Facilities on May 14, 2023.