Nursing Homes

Federal and state practices for investigating complaints about nursing home care are often not as effective as they should be. GAO found many problems in the 14 states it reviewed, including procedures or practices that may limit the filing of complaints, understatement of the seriousness of complaints, and failure to investigate serious complaints promptly. Complaints alleging that nursing home residents were being harmed have gone uninvestigated for weeks or months. During that time, residents may have remained vulnerable to abuse, neglect (which can lead to serious problems like malnutrition and dehydration), preventable accidents, and medication errors. Although the federal government finances more than 70 percent of complaint investigations nationwide, the Health Care Financing Administration (HCFA) plays a minimal role in providing states with direction and oversight regarding these investigations. HCFA has left it largely to the states to decide which complaints put residents in immediate jeopardy and should be investigated immediately. More generally, HCFA's oversight of state agencies that certify federally qualified nursing homes has not focused on complaint investigations. GAO recommends (1) stronger federal requirements for states to promptly investigate serious complaints alleging situations that may harm residents but are not classified as posing an immediate threat, (2) more federal monitoring of states' efforts to respond to complaints, and (3) better tracking of the substantial findings of complaint investigations. This testimony summarizes the March 1999 GAO report, GAO/HEHS-99-80.

GAO noted that: (1) neither complaint investigations nor enforcement practices are being used effectively to ensure adequate care for nursing home residents; (2) as a result, allegations or incidents of serious problems often go uninvestigated and uncorrected; (3) GAO's work in selected states reveals that, for serious complaints alleging harm to residents, the combination of inadequate state practices and limited HCFA guidance and oversight have often resulted in: (a) policies or practices that may limit the number of complaints filed; (b) serious complaints alleging harmful situations not being investigated promptly; and (c) incomplete reporting on nursing homes' compliance history and states' complaint investigation performance; (4) further, regarding enforcement actions, HCFA has not yet realized its main goal--to help ensure that homes maintain compliance with federal health care standards; (5) GAO found that too often there is a yo-yo pattern where homes cycle in and out of compliance; (6) more than one-fourth of the more than 17,000 nursing homes nationwide had serious deficiencies--including inadequate prevention of pressure sores, failure to prevent accidents, and failure to assess residents' needs and provide appropriate care--that caused actual harm to residents or placed them at risk of death or serious injury; (7) although most homes corrected deficiencies identified in an initial survey, 40 percent of these homes with serious deficiencies were repeat violators; (8) in most cases, sanctions initiated by HCFA never took effect; (9) the threat of sanctions appeared to have little effect on deterring homes from falling out of compliance because homes could continue to avoid the sanctions' effect as long as they kept temporarily correcting their deficiencies; and (10) HCFA has taken a number of recent actions to improve nursing home oversight in an attempt to resolve problems pointed out in earlier studies.