States Continue to Fall Short in Meeting Required Timeframes for Investigating Nursing Home Complaints: 2016-2018

Angie SzumlinskiAnnouncements, Case Study

The nursing home complaint process is a critical safeguard to protect 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 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 resident safety. A previous OIG report found that a few States fell short in the timely investigation of most serious nursing home complaints between 2011 and 2015. To follow up on this report, the OIG examined the extent to which States met required timeframes for investigating the most serious nursing home complaints from 2016 through 2018.

What the OIG found was that 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 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. The study also found that from 2016 through 2018, trends in late investigations of complaints in New Jersey, Illinois and Texas raise concerns.

The analysis raises questions about some States’ ability to address serious nursing home complaints and about the effectiveness of CMS’s oversight of States. It 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 and 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 the OIG recommendations.

What does this mean for you, the provider? Well, although it is kind of nice to read about a governmental agency being audited and coming up short, it can mean more trouble for us! No agency likes to come up short on an audit and you can bet that a lot of time and energy into this problem is going to be happening in States around the country. Unfortunately, that may also mean an increase in the number of on-site complaint investigations with resulting citations. What can we do? Be sure we are documenting all incidents and completing a thorough investigation including a root cause analysis and reviewing each one with the QAPI committee. New interventions, preventive actions, and goals/timeframes should also be initiated as appropriate. Remember, the best defense is a good offense; only you can prevent citations! Stay well, stay safe, and stay tuned!