The OIG has released an executive summary on nursing facility compliance with Federal regulations on reporting allegations of abuse or neglect.  The study included a review of:

• Sampled nursing facility policies related to reporting allegations of abuse or neglect
• Sampled nursing facility policies related to reasonable suspicions of crimes
• Survey of administrators from those sampled facilities
• The study also included an examination of a random sample of allegations of abuse or neglect identified from the sampled nursing facilities and a review of documentation related to those sampled allegations.

The results of the study are a little disturbing as nursing facilities are required to report any and all allegations of abuse or neglect to ensure resident safety.  The results include:

• 85% of nursing facilities reported at least one allegation of abuse or neglect to the OIG in 2012
• 76% of nursing facilities maintained policies that address Federal regulations for reporting both allegations of abuse or neglect and investigation results
• 61% of nursing facilities had documentation supporting the facilities’ compliance with both Federal regulations under Section 1150B of the Social Security Act.
• 53% of allegations of abuse or neglect and the subsequent investigation results were reported as Federally required

So what does all this data mean and how to we as providers use it to improve quality and compliance in our homes?  It may be time for your organization to:

• Review the current policies and procedures on abuse and neglect to ensure they meet the requirements of the regulations.
• Re-educate the management team on reporting requirements for allegations of abuse or neglect.  53% of allegations of abuse or neglect and subsequent investigation results were reports as required.  Seriously?  53%?  We can and need to do better! 
• Review the facilities current documentation practices with regard to compliance with Federal regulations, specifically Section 1150B of the Social Security Act.

At the end of the day the OIG has determined that they recommend that the Centers for Medicare & Medicaid Services (CMS) ensure that nursing facilities:

• Maintain policies related to reporting allegations of abuse or neglect
• Notify covered individuals of their obligation to report reasonable suspicions of crimes
• Report allegations of abuse or neglect and investigation results in a timely manner and to the appropriate individuals as required

CMS concurred with all three recommendations indicating that this will be an area of high scrutiny during the survey process.  Are you comfortable that your policies, education and documentation will withstand a thorough review by CMS?  Don’t wait for citations, jump in with both feet and the entire team to review, update, replace, educate, audit and be prepared.  As always if you need additional assistance please don’t hesitate to contact your HealthCap Risk Manager.

Nursing Facilities' Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect (OEI-07-13-00010) http://go.usa.gov/Em99 or http://oig.hhs.gov/oei/reports/oei-07-13-00010.pdf