Surveys fail to Protect Nursing Home
Residents from Abuse
Gary R. Ilminen, RN January 2001
Author of "Consumer Guide to Long-term Care" (University of Wisconsin Press)
(NOTE: Permission is granted by the author for non-commercial duplication, use and distribution of this article by consumers, families, advocates, professionals and anyone concerned about quality of care in nursing homes).
Despite a record 15,501 formal complaints alleging abuse, neglect or exploitation of nursing home residents filed with long-term care ombudsmen nationwide in 1998, (the most recent year for which complete data is available), state surveyors cited only 1.8 percent (about 277) of the nation's nursing homes for abuse violations that year.
That, according to figures reported in "Nursing Facilities, Staffing, Residents and Facility Deficiencies, 1993-1999," by Charlene Harrington, et. al., based on data from the Health Care Financing Administration and data from the Long-term Care Ombudsman program data base.
These data and several recent federal investigations indicate the current survey-based regulatory system does not protect nursing home residents from abuse, neglect or exploitation.
In its report, "Long term Care Ombudsman Program: Overall Capacity," the HHS Office of the Inspector General (OIG) found that state survey agencies and the long term care ombudsman programs often do not coordinate their efforts. OIG analysis of ombudsman and state survey agency data revealed that only 13 percent of abuse complaints received by the ombudsman program were ever relayed to the state survey agency. According to the report, a lack of staff in ombudsman agencies may be the reason.
In 1999, the General Accounting Office reported that, "neither complaint investigations nor enforcement practices are being used effectively to ensure adequate care for nursing home residents. As a result, allegations or incidents of serious problems, such as inadequate prevention of pressure sores, failure to prevent accidents, and failure to assess residents' needs and provide adequate care, often go uninvestigated and uncorrected."
Residents, families and advocates should be informed about how to identify various types of abuse (covered in chapter 22 of Consumer Guide to Long-term Care), and report incidents of abuse, neglect or exploitation to the facility administrator immediately. Steps to prevent further incidents should be taken, and medical attention provided if physical injury has occurred.
Most states have passed "vulnerable victims" laws making it a felony to harm nursing home residents. If the incident involves a physical or sexual assault, involve law enforcement and adult protective services. File reports immediately with the state survey agency and your state long-term care ombudsman, even if the facility promises to file such reports. If the facility is privately owned, whether for-profit or non-profit, get contact information for the main office and file a formal complaint there as well.
Follow-up with each agency you contact to assure action.
The Civil Rights of Institutionalized Persons Act (CRIPA) a federal law enacted in 1980, applies to publicly owned (state or county) facilities. According to the Department of Justice (DOJ), actions under CRIPA in 1997 alone involved 43 facilities in 20 states and "focused on protecting residents from abuse and neglect and undue restraint, providing adequate medical nursing care and rehabilitation." If abuse occurs in a publicly owned facility, contact the Civil Rights Division of the DOJ in addition to the agencies listed.
If there is uncertainty as to whether abuse has occurred, file reports about the incident or injury anyway--that should trigger an external investigation to determine whether abuse has occurred. It is true that injuries can occur accidentally even when the staff is careful and caring.
A facility must notify designated family members or decision-makers of accidents, injuries and changes of condition. When it doesn't, it has violated the federal nursing home standards and cast doubt on the actual origin of the injury.
The facility may conduct its own investigation, but that does not justify any delay in taking action to prevent further incidents and it does not require that consumers delay filing formal complaints. Retaliation of any kind by the facility against the resident or decision-maker who files a complaint is prohibited. If there is any doubt about the ability of the facility to assure the safety of the resident involved, it may be necessary to consider transfer to another care setting.
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