Nursing Homes

In a March report, GAO cited nursing home problems in 14 states, including Maryland. These deficiencies ranged from procedures that may limit the filing of complaints to failures to investigate serious complaints promptly. Compared with other states, Maryland devoted fewer resources to investigating complaints, recorded substantially fewer complaints than Michigan or Washington, generally classified similar complaints as needing less prompt investigation, did not meet the assigned time periods for investigating many complaints, and had a large backlog of uninvestigated cases and poor tracking of the status of investigations. Consequently, serious complaints alleging that nursing home residents are being harmed can remain uninvestigated for weeks or months in Maryland. Such delays can prolong situations in which residents may be subject to abuse or neglect resulting in serious care problems like malnutrition and dehydration, preventable accidents, and medication errors. In response to GAO's findings, the Health Care Financing Administration has told states to investigate any complaint alleging actual harm to a resident within 10 workdays. The Maryland General Assembly recently approved funding to significantly increase the number of nursing home surveyors. However, the seriousness and systemic nature of the weaknesses GAO identified require sustained commitment and strengthened oversight to help ensure adequate care to nursing home residents.

GAO noted that: (1) federal and states' practices for investigating complaints about care provided in nursing homes are often not effective; (2) among many of the 14 states GAO examined, GAO found numerous problems, including procedures or practices that: (a) may limit the filing of complaints; (b) understate the seriousness of complaints; and (c) fail to investigate serious complaints promptly; (3) in Maryland, GAO identified many of these and other concerns regarding the responsiveness and effectiveness of complaint investigations; (4) compared with other states GAO reviewed, Maryland: (a) dedicated fewer resources to investigating complaints; (b) recorded substantially fewer complaints than Michigan or Wisconsin; (c) generally classified similar complaints as needing less prompt investigation; (d) did not meet the assigned timeframes for investigating many complaints; and (e) had a large backlog of uninvestigated cases and poor tracking of the status of investigations; (5) as a consequence, serious complaints alleging that nursing home residents are being harmed can remain uninvestigated for weeks or months in Maryland; (6) such delays can prolong situations in which residents may be subject to abuse or neglect resulting in serious care problems like malnutrition and dehydration, preventable accidents, and medication errors; (7) despite problems such as those in Maryland, the Health Care Financing Administration (HCFA) has minimal standards and has exercised limited oversight related to states' complaint practices; (8) to address these issues, GAO recommended that HCFA strengthen its standards for and oversight of states' complaint practices as well as its management information systems to more completely include complaint investigation results; (9) in response to GAO's March report, both HCFA and the state of Maryland have initiated several important improvements intended to increase the responsiveness and effectiveness of complaint investigations; (10) for example, HCFA has instructed states to investigate any complaint alleging actual harm to a resident within ten workdays; and (11) in Maryland, the recent budget approved by the General Assembly includes funding for a significant increase in the number of nursing home surveyors.