Federal Reports Find Incidents of Nursing Home Resident Abuse Are on the Rise but also Underreported

On July 23, 2019, the U.S. Government Accountability Office (GAO) published a report on nursing home resident abuse, Improved Oversight Needed to Better Protect Residents from Abuse. The GAO found that, in the span of five years, the number of cited abuse deficiencies more than doubled from 430 in 2013 to 875 in 2017. The GAO also found that 42.6% of abuse deficiencies in 2017 were cited at the highest levels of severity, compared to 31.9% of abuse deficiencies in 2013. The report also noted that a small proportion of nursing homes (8.4%) had multiple abuse deficiencies over the five-year period.

Additionally, the GAO discovered that the majority of the abuse deficiencies were identified through complaint and facility-reported incident investigations. Sadly, even when an abuse deficiency was cited, enforcement actions were often not implemented. Specifically, the GAO found that “one-third of abuse deficiencies had an enforcement action imposed but not implemented, and less than 8% of abuse deficiencies had enforcement actions that were implemented against the nursing home.”

According to the GAO’s analysis, resident abuse (perpetrated by staff 58% of the time) fell within three categories:

• Physical Abuse. 46% of abuse deficiencies were identified as physical abuse, such as “hitting, slapping, punching, biting, and kicking residents . . . .”
• Mental/Verbal Abuse. 44% of abuse deficiencies were identified as mental and/or verbal abuse.
• Sexual Abuse. 18% of abuse deficiencies were identified as sexual abuse.

The GAO also conducted stakeholder meetings in five states. Those invited included state survey agencies, Adult Protective Services, law enforcement, Medicaid Fraud Control Units, ombudsmen, and nursing home administrators and clinical staff. The stakeholders identified several risk factors for resident abuse, including (1) residents with infrequent visitors or cognitive impairments and (2) nursing homes with insufficient staffing, staff training, and staff screening. The stakeholders noted that “[s]taffing issues are not just risk factors for staff as perpetrators of abuse, but they can also limit a staff member’s ability to identify and report abuse.”

Similar to the GAO’s report, the Inspector General of the U.S. Department of Health and Human Services issued a report regarding nursing home resident abuse and neglect. The June 2019 report, Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated, found that one in five high-risk Medicare claims for nursing home residents who received hospital emergency room services in 2016 indicated potential abuse or neglect. The report noted that, based on sample results, 7,831 out the 37,607 high-risk hospital emergency room claims reviewed were the result of potential resident abuse or neglect. The report added that nursing homes failed to report 84% of the 7,831 potential abuse and neglect incidents to state survey agencies.

On July 23, 2019, the U.S. Senate Committee on Finance held a hearing on nursing home resident abuse entitled “Promoting Elder Justice: A Call for Reform.” Representatives from both the GAO and OIG provided testimony, detailing their recent reports. Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care, testified on behalf of her organization, LTCCC, and California Advocates for Nursing Home.

• To watch a recording of the hearing, please visit: https://www.finance.senate.gov/hearings/promoting-elder-justice-a-call-for-reform.
• Toby S. Edelman, Senior Policy Attorney at the Center submitted a Statement for the record. To read her Statement, please visit: https://www.medicareadvocacy.org/center-statement-on-nursing-home-reform-for-senate-finance-committee/.