Life Safety and Emergency Preparedness Deficiencies Found at 18 of 20 Texas Nursing Homes

Why OIG Did This Audit

In 2016, the Centers for Medicare & Medicaid Services (CMS) updated its life safety and emergency preparedness regulations to improve protections for all Medicare and Medicaid beneficiaries, including those residing in long-term-care facilities (commonly referred to as nursing homes). Updates included requirements that nursing homes have expanded sprinkler systems and smoke detector coverage; an emergency preparedness plan that is reviewed, trained on, tested, and updated at least annually; and provisions for sheltering in place and evacuation.

Our objective was to determine whether selected nursing homes in Texas that received Medicare funds, Medicaid funds, or both, complied with Federal requirements for life safety and emergency preparedness.

How OIG Did This Audit

Of the 1,229 nursing homes in Texas that participated in Medicare or Medicaid, we selected a non-statistical sample of 20 of these nursing homes for our audit based on proximity to the Gulf of Mexico and the highest number of deficiencies previously identified by Texas.

We conducted unannounced site visits to check for life safety violations and review the nursing homes' emergency preparedness plans from February through May 2019.

What OIG Found

During our onsite inspections, we identified deficiencies in areas related to life safety or emergency preparedness at 18 of the 20 nursing homes that we audited. Specifically, we found 235 deficiencies with life safety requirements related to building exits and smoke partitions, fire detection and suppression systems, hazardous storage areas, fire drills and smoking policies, and electrical equipment and elevator inspection and testing. We found 55 deficiencies with emergency preparedness requirements related to written emergency plans, emergency supplies and power, emergency communications plans, and emergency plan training. As a result, residents at the 18 nursing homes were at increased risk of injury or death during a fire or other emergency.

The identified deficiencies occurred because management oversight at nursing homes was inadequate, and nursing homes had high maintenance and administrative staff turnover. In addition, maintenance personnel at some of the nursing homes indicated that building maintenance is challenging because of the advanced age of some buildings.

What OIG Recommends

We recommend that Texas follow up with the 18 nursing homes to verify that corrective actions have been taken regarding the life safety and emergency preparedness deficiencies identified in this report.

In written comments on our draft report, Texas agreed with our findings and provided details about actions it has taken or will take to address the recommendation.