Nursing home complaints handled by state authorities rose by one third between 2011 and 2015 — even as occupancy at skilled nursing facilities declined slightly.
In addition, a handful of states accounted for the majority of late investigations, according to a new data brief from the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG).
All Medicare and Medicaid-certified nursing homes must respond to complaints within defined timeframes laid out by the Centers for Medicare & Medicaid Services (CMS). States have just two days to investigate complaints classified as “immediate jeopardy,” which involve the injury or death of a resident, and 10 days to probe “high priority” cases — defined as any complaint regarding harm to a resident’s mental or physical health.
In 2015, the most common serious nursing home allegations involved the quality of care: For instance, CMS cited a case in which a resident with diabetes died after glucose testing strips were not made available on the floor. Resident neglect came in second place, followed by complaints related to resident rights.
While most states met the CMS timing requirements, Tennessee and Georgia routinely failed to investigate immediate jeopardy cases within the two-day timeframe, accounting for more than half of the delayed responses nationwide between 2011 and 2015. In 2015 alone, the two states combined to represent 86% of tardy immediate-jeopardy probes, according to the OIG.
For the less-urgent “high priority” cases, four states together accounted for nearly half of late investigations: Arizona, Maryland, New York, and Tennessee. Those jurisdictions were also responsible for the vast majority of high priority investigations conducted more than 26 days late, racking up two-thirds of the national total.
“This data brief raises questions about how some states respond to complaints, as these responses could have serious consequences for nursing home residents in those states,” the OIG wrote in its report. “Residents and their families rely on a functioning complaint system to take their complaints seriously and to investigate them appropriately.”
CMS levies formal sanctions against states when they do not meet the timing requirements for 95% of immediate jeopardy and high priority cases; between 2011 and 2015, 11 states received sanctions all five years, while four more — Colorado, Connecticut, Iowa, and Maine — missed the mark four out of five times.
Of the total amount of high-level complaints received, all states ended up substantiating about 31% of them.
Despite the impressive overall rise in complaint volume, the OIG cautioned that the results may not necessarily mean that the quality of care is declining nationwide.
“Other factors may contribute to an increase in complaints, such as more accessible and user-friendly options to file complaints, better tracking of complaints, or possibly an increased willingness among consumers to report on their nursing home experiences.,” the OIG observed.
Written by Alex Spanko