Nursing Home Abuse Often Goes Unreported: CMS Report

According to the findings of a new governmental oversight report, cases of nursing home neglect and abuse often go unreported to law enforcement and regulators, indicating that as many as one in five emergency room visits involving elderly or disabled individuals may be the result of negligent care.

The Department of Health and Human Services’ Office of the Inspector General (OIG) released a new nursing home abuse report on June 12, indicating that many skilled nursing homes are failing to report injuries sustained by the residents in accordance with Federal requirements.

The OIG performed two studies. The first focused on determining the prevalence of potential abuse or neglect of Medicare beneficiaries in nursing homes that resulted in emergency room treatment in 2016, and whether those incidents were reported to law enforcement officials. The second focused on elderly abuse or neglect of older adults throughout the entire medical field.

Officials discovered 37,607 high-risk hospital and emergency room claims for Medicare beneficiaries were reported in 2016. These reports included events where a beneficiary was treated in a hospital for head injuries, body bruises, bed sores and other diagnoses that might indicate physical abuse, sexual abuse or severe neglect from the SNH.

Researchers were able to estimate one in five Medicare beneficiaries who were treated in emergency rooms in 2016 were a nursing home resident being treated for injuries arising from potential abuse or neglect occurring at their facility.

The study noted nursing home facilities are required to report alleged neglect and abuse claims to the State Survey Agency and the Centers for Medicare and Medicaid Services (CMS). However, researchers determined these incidents were often not reported, and even found many substantiated claims of abuse resulting in high-risk emergency room visits were not reported to local law enforcement to be further pursued.

The second study identified 34,664 Medicare inpatient and outpatient claims totaling $99.6 million for services provided from January 2015 through June 2017. The claims involved patients being treated for one or more codes related to potential abuse, including physical abuse, sexual abuse or rape, neglect or abandonment, or other maltreatment.

The data revealed 2,574 incidents allegedly perpetrated by a healthcare worker, 3,330 related to incidents occurring at a medical facility and 9,294 incidents not reported to local law enforcement.

The OIG report determined there is a breakdown in the reporting process the Center for Medicare and Medicaid Services (CMS) is currently following to properly identify and address Medicare and Medicaid beneficiary abuse and neglect claims.

The OIG report recommends CMS take action immediately to better identify and respond to neglect and abuse incidents arising at nursing home facilities. The agency recommends retraining State Survey Agencies on how to identify and report incidents and to provide a detailed guidance with examples of potential abuse or neglect common to nursing homes.