Federal Nursing Home Inspection Reports Indicate Increasing Number of Abuse-Related Citations Nationwide
A recent analysis of inspection reports filed with the Centers for Medicare & Medicaid Services (CMS) conducted by New Jersey Advance Media indicates that the number of citations issued nationwide to nursing homes related to the abuse and neglect of residents is increasing. These citations jumped from 3,083 in 2016 to 4,107 in 2018—a greater than 33 percent increase.
According to the Office of Inspector General for the U.S. Department of Health and Human Services’ June report, nursing homes are failing to report at least one out of five potential cases of abuse. Advocates for the elderly claim this is only the tip of the iceberg.
An underlying root cause that continues to surface in these unreported incidents involves overworked and overwhelmed staff who at times resort to physical force when dealing with residents with behavioral issues.
For example, one incident cited in a federal inspection report involved a “confused and disoriented” resident who needed “extensive assistance” with most daily activities and who was refusing to get off of the toilet. When the nurse’s aide sought help from another aide, that aide immediately employed physical force on the resident—pulling her hair and pinching sensitive areas on the resident’s body. The incident went unreported for five days because the first aide was afraid to report it.
In 2018, federal regulators investigated 30 abuse allegation complaints in New Jersey, and most of those involved a facility’s failure to make timely notifications to the state’s department of health.
Those 30 investigated complaints were a small portion of the 353 physical abuse complaints made through the New Jersey’s Long-Term Care (LTC) Ombudsman’s Hotline. An ombudsman said that most complaints received by her office can be traced back to inadequate staffing. She stated, “The better staffing ratios, the better the outcomes for residents. It feeds into everything else. If not enough aides are working, the more likely that people won’t get timely changes, or (the nursing home) won’t follow the care plan. Mistakes will be made.”
Compliance Perspective
Failing to report incidents involving the abuse of residents by staff members or others may be considered abuse, neglect, and the provision of sub-standard quality of care, in violation of federal and state regulations.
Discussion Points:
- Review policies and procedures regarding the level of staffing required in order to meet the needs of residents based on their acuity levels. Also review policies and procedures requiring training designed to ensure that staff are equipped to handle situations involving residents with behavior issues.
- Train staff on the protocols to use in addressing residents with behavioral issues, what constitutes abuse and neglect, and the importance of immediately reporting incidents of abuse and neglect to a supervisor or through the Hotline.
- Periodically audit the complaint log for allegations of abuse and neglect to ensure that they are promptly investigated, appropriately reported, and that necessary actions have been taken. Review staffing levels to determine if a sufficient number of staff are scheduled to ensure resident needs are met. Review training sign-in documents to determine that all staff have received required education on abuse prevention and reporting.
