WHY WE DID THIS REVIEW
The nursing home complaint process is a critical safeguard to protect the 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 (hereinafter, States) 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. A previous OIG report found that a few States fell short in the timely investigation of the most serious nursing home complaints between 2011 and 2015. To follow-up on this report, OIG examined the extent to which States met required timeframes for investigating the most serious nursing home complaints from 2016 through 2018.
HOW WE 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 from 2016 through 2018. 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 the most serious; and (3) the percentage of the most serious complaints that States investigated onsite within required timeframes. Furthermore, we conducted State and CMS interviews. Lastly, we reviewed a purposive sample of States’ corrective action plans for fiscal years 2016 through 2018.
WHAT WE FOUND
The rate of nursing home complaints per 1,000 nursing home residents increased from 45 in 2015 to 52 in 2018. Twenty-one States failed to meet CMS’s timeliness threshold for the second-most serious level of complaints in all 3 years from 2016 through 2018, and 10 of these States did not meet the threshold for 8 consecutive years, from 2011 through 2018. Of the five States that fell short in timely investigation of the most serious nursing home complaints from 2011 through 2015, Georgia had limited improvement, while Arizona, Maryland, New York, and Tennessee continued to fall short through 2018. Furthermore, we found that from 2016 through 2018, trends in late investigations of complaints in New Jersey, Illinois, and Texas raise concerns.
WHAT WE RECOMMEND
Our analysis raises questions about some States’ ability to address serious nursing home complaints and also about the effectiveness of CMS’s oversight of States. We found that many States are consistently failing to meet required timeframes for investigating the most serious nursing home complaints. States that we communicated with face challenges with receiving a high volume of complaints, triaging complaints, and having adequate human resources to investigate complaints. CMS has worked with States to address these challenges, yet few States have made progress. To ensure that States conduct timely investigations, CMS should ensure that all States receive training on the triage guidance it plans to update. Furthermore, CMS should also identify new approaches to address States that are consistently failing to meet required timeframes for investigating the most serious nursing home complaints. CMS concurred with both of our recommendations.