A Few States Fell Short in Timely Investigation of the Most Serious Nursing Home Complaints: 2011-2015

WHY OIG DID THIS REVIEW

The nursing home complaint process is a critical safeguard to protect vulnerable residents of nursing homes. CMS relies on the States' respective survey agencies to serve as the front-line responders to address health and safety concerns raised by residents, their families, and nursing home staff. State survey agencies must conduct onsite investigations within certain timeframes for the two most serious levels of complaints-those that allege serious injury or harm to a nursing home resident and require a rapid response to address the complaint and ensure residents' safety. However, previous reports by OIG and the Government Accountability Office found that States did not conduct onsite investigations within the required timeframes for some of these complaints.

HOW OIG DID THIS REVIEW

OIG analyzed complaints regarding Medicare/Medicaid-certified nursing homes and associated investigation information entered into CMS's Automated Survey Processing Environment Complaints/Incidents Tracking System (ACTS) from 2011 through 2015. We analyzed these data to determine: (1) the number of nursing home complaints that States received; (2) the percentage of complaints that States prioritized as immediate jeopardy and high priority (the two most serious levels of complaints); (3) the percentage of immediate jeopardy and high priority complaints that States investigated onsite within required timeframes; and (4) the percentage of immediate jeopardy and high priority complaints that States substantiated.

WHAT OIG FOUND

Overall, States received one-third more nursing home complaints in 2015 than in 2011. Each year, half of all nursing home complaints were at the level of seriousness that requires a prompt onsite investigation, and the most common allegations among these related to quality of care or treatment. During the period we reviewed, States conducted nearly all the required onsite investigations. Although almost all States conducted most of their onsite investigations within required timeframes, a few States fell short. Furthermore, almost one-quarter of States did not meet CMS's annual performance threshold for timely investigations of high priority complaints in all 5 years. Lastly, States substantiated (i.e., verified with evidence) almost one third of the most serious nursing home complaints.

WHAT OIG CONCLUDES

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. It offers CMS some insights into the States that have room to improve in prioritizing and responding to nursing home complaints. To ensure the health and safety of nursing home residents, CMS must remain vigilant and assist the States that are falling short in meeting timeframes for investigations of complaints. OIG will continue to monitor the oversight of nursing homes and will initiate additional reviews as necessary.