Medicaid:

Addressing the Needs of Mentally Retarded Nursing Home Residents

HRD-87-77: Published: Apr 15, 1987. Publicly Released: Apr 15, 1987.

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GAO examined the services provided to mentally retarded nursing home residents through Medicaid in five states to determine if they were complying with Department of Health and Human Services (HHS) requirements for: (1) speech, occupational, and physical therapy; (2) training in personal care skills; and (3) training in community living skills.

GAO found that: (1) management controls were inadequate because Medicaid regulations to ensure active treatment and services for normal individuals admitted to a nursing home facility did not exist for retarded persons; (2) at some facilities, plans of care did not adequately address active treatment and developmental and behavioral needs for retarded residents; (3) in some instances, state inspections of nursing home facilities were inadequate, since they did not assess the adequacy of the services provided to retarded residents; and (4) since Medicaid agencies in three states failed to consult with their state retardation agencies, the retardation agencies were unaware of 1,477 of the 2,238 retarded nursing home residents that GAO identified.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Congress enacted legislation requiring HHS to assess the active treatment needs of mentally retarded nursing home residents.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator of the Health Care Financing Administration (HCFA) to require states that have not already done so to identify the mentally retarded currently in nursing homes, assess their active treatment needs, and develop programs to meet their needs.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: Legislation was enacted requiring an assessment of each mentally retarded and mentally ill individual before they can be admitted to a nursing home to help ensure appropriate placement and services for those who are admitted to nursing homes.

    Recommendation: The Secretary of Health and Human Services should revise Medicaid regulations to require: (1) nursing homes to specifically address active treatment in plans of care for their retarded residents; (2) inspection-of-care teams to assess the active treatment needs and services of mentally retarded nursing home residents; (3) states to include a staff member trained in mental retardation on inspection-of-care teams when a nursing home has retarded residents; (4) states to develop written procedures outlining the role of nursing homes in the state's program for the mentally retarded; and (5) states to have the state retardation agency assess the active treatment needs of the mentally retarded and the appropriateness of their nursing home placement.

    Agency Affected: Department of Health and Human Services

 

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