(August 21, 2014): Nursing facilities are required and expected to report any and all allegations of patient abuse or neglect to ensure patient safety. A recent study of their records by the Department of Health and Human Services’ Office of Inspector General (OIG) has found that a number of these facilities have not been fully compliant with this requirement. Many of these facilities likely lack adequate systems designed to safeguard against this problem. As discussed below, it is more important than ever that nursing homes develop and implement an effective compliance program that will facilitate the reporting of patient abuse and neglect allegations.
I. Policies and Procedures For Reporting Allegations of Patient Abuse or Neglect:
The elderly population in the United States is projected to more than double from 40.2 million in 2010 to 88.5 million in 2050. Many of these individuals will likely end up residing in a nursing facility. It is important that these facilities understand that resident welfare must be a primary concern.
To ensure resident safety, Federal regulations require that nursing facilities develop and implement written policies related to reporting allegations of abuse, neglect, mistreatment, injuries of unknown source, and misappropriation of resident property. Regulations also require that nursing facilities develop and implement written policies and procedures that prohibit abuse or neglect. 
Any and all allegations of abuse or neglect in a nursing facility must be reported to the facility administrator or designee, as well as to the State survey and certification agency, within 24 hours. If an allegation merits an investigation, the results of that investigation 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 committed against a resident of that facility.
II. What the OIG Study Found with Respect to Patient Abuse and Neglect Allegations:
OIG performed its study in two parts. The first part included:
- Review of sampled nursing facilities’ policies related to reporting allegations of abuse or neglect,
- Review of sampled nursing facilities’ policies related to reasonable suspicions of crimes, and
- Survey of administrators from those sampled facilities
The second part then 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.
Again, nursing facilities are both required and expected to report any and all allegations of abuse or neglect to ensure resident safety. The findings of the OIG report indicate that not all of them are following mandatory Federal regulations.
The OIG report found that 85% of nursing facilities reported at least one allegation of abuse or neglect to OIG in 2012. Patient abuse was the most common type of allegation made, making up just over 50% of all allegations. Shockingly, nursing facilities identified that 40% of all allegations of abuse or neglect involved employee to resident abuse.
The OIG report also determined that only 76% of nursing facilities maintained policies that address both Federal regulations for reporting both allegations of abuse or neglect and investigation results. As you recall, both of these policies are required by Federal regulations.
Additionally, 61% of nursing facilities had documentation supporting the facilities’ compliance with Federal regulations that require nursing facilities to both annually notify covered individuals (i.e., owners, operators, employees, managers, agents, or contractors of nursing facilities) of their obligation to report to the appropriate entities any reasonable suspicion of crime, as well as to clearly post a notice specifying employees’ rights to file a complaint.
Lastly, 53% of allegations of abuse or neglect and the subsequent investigation results were reported, as Federally required. 63% of these allegations of abuse or neglect were reported immediately to the nursing facility administrator or designee and the State survey agency, as required. Moreover, the subsequent investigation results for 63% of allegations of abuse or neglect were reported to the appropriate individuals within 5 working days, as required.
III. Patient Abuse and Neglect Reporting Recommendations:
With the elderly population in the US significantly increasing over the next several decades, elder abuse or neglect is likely to increase as well. Nursing facilities must ensure that the quality of care and safety for this age group is a priority.
Based on its findings, OIG made three recommendations to the Centers for Medicare & Medicaid Services (CMS). Specifically OIG recommended that nursing facilities:
Maintain policies related to reporting allegations of abuse or neglect;
Notify covered individuals of their obligation to report reasonable suspicions of crimes;
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.
Notably, CMS concurred with all three of the OIG recommendations.
IV. Final Remarks:
The results of this latest OIG study are slightly disheartening. As noted above, the elderly population in the United States is projected to double over the next several decades. A majority of these persons are likely to end up living in a nursing facility. However, the elderly are already vulnerable to instances of abuse or neglect. Therefore, it is imperative that nursing facilities make elder care and well-being a priority in their day-to-day operations.
However, the study finds that nursing facilities are not taking their Federal obligations as serious as they should. Again, it is Federally mandated that nursing facilities report ANY and ALL instances of patient abuse or neglect, whether that allegation ends up in a subsequent investigation or not. Moreover, these facilities MUST develop and implement written policies and procedures related to preventing and reporting allegations of abuse or neglect.
Unfortunately, not all nursing facilities are doing so. The report indicates that this problem is not limited to small facilities either. Several large nursing facilities are ignoring their obligations as well. To safeguard their interests – and more importantly, to protect their residents – nursing facilities must ensure that they develop and implement the necessary policies and procedures.
How can nursing facilities take this necessary and important step? With an effective compliance plan, of course. An effective compliance plan will not only assist your facility in implementing safeguards to protect your residents from abuse or neglect, it will also protect your facility from other harmful acts. There are numerous administrative, physical, and technical safeguards mandated by HIPAA and other Federal regulations which must be set in place. One of the most effective steps you can take to facilitate the reporting of patient abuse and neglect allegations is to set up a hotline for the reporting of these types of concerns. A low-cost compliance hotline option like the one offered at www.compliancehotline.com would greatly improve your nursing home's ability to stay abreast of these types of problems.
Does your facility currently have an updated compliance plan, one that includes all required policies and procedures? According to the OIG report, you may not. Let us assist you today in taking that first necessary step in developing and implementing an effective compliance plan.
Robert Saltaformaggio, Esq., serves as an Associate at Liles Parker, Attorneys & Counselors at Law. Liles Parker attorneys represent health care providers and suppliers around the country in connection with Medicare audits by ZPICs and other CMS-engaged specialty contractors. The firm also represents health care providers in the development and implementation of effective compliance programs, privacy breach matters, State Medical Board inquiries and regulatory reviews. For a free consultation, call Robert at: 1 (800) 475-1906.