Nursing Home Abuse is Under-Reported, Government Agency Finds

By Hannah Smith - 18 Jul '19 09:30AM

Nursing home abuse often goes unreported in the United States, according to reports released by the Department of Health and Human Services' Office of the Inspector General.

An estimated 1 in 5 ER visits from a nursing home is the result of abuse, one report found. The agency reviewed 37,607 "high-risk hospital ER claims" made by nursing home residents to the Centers for Medicare and Medicaid Services (CMS) in 2016.

The agency also found that nursing homes often fail to report incidents of abuse to local law enforcement or CMS, which is required by federal regulators. Nursing home residents who suffer abuse or neglect have a 300% higher risk of death compared to older adults who receive the appropriate care.

The Office of the Inspector General recommends that CMS "take action to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported." 

The other report looked at 34,664 claims to Medicare with indications that injuries could be linked to abuse. Among those cases, inspectors found that 89% were associated with evidence of potential neglect or abuse. 

The recent reports come after preliminary research which was conducted in 2017. Those initial reports found that abuse was spread across 33 states, but Illinois had the highest number of cases (17). While 72% of the cases appeared to be reported to law enforcement within two hours, 28% were not. 

At the time, the Office of the Inspector General reported all 134 cases to the police. 

When the Office of the Inspector General released its alert in 2017, it recommended that CMS do more to track abuse cases. It suggested that the agency cross-reference Medicare claims from nursing home residents with their claims from the emergency room. This would allow investigators to determine whether the individual filed claims for both emergency room services and nursing home care. Investigators would then be able to see if the emergency room indicated that the patient was a victim of a crime.

Under federal law, suspected cases of nursing home abuse causing serious bodily harm must be reported to local law enforcement within two hours. If the suspected abuse does not involve serious bodily harm, the incident must be reported within 24 hours. Failure to report can result in fines of up to $300,000. 

According to the Inspector General's alert in 2017, CMS never received explicit authorization from the Secretary of Health and Human Services to enforce these penalties. They only began seeking that authority in 2017. 

An estimated 10 million seniors experience elder abuse every year. 

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