Skip to main content

Preventing and Addressing Abuse in Nursing Homes

Posted on August 21, 2019

Confirmed incidents of abuse in nursing homes more than doubled from 430 in 2013, to 875 in 2017. While the abuse of nursing home residents remains relatively infrequent, this increase is troubling, especially because the largest increase was in the most severe cases.

Today’s WatchBlog explores our recent report on nursing home abuse. You can also listen to our podcast with John Dicken, the director who led the report, to learn more.

Missing media item.

Federal oversight

There are over 15,500 nursing homes in the country that participate in the Medicare and Medicaid programs. Collectively, they provide care to about 1.4 million elderly or disabled residents. These residents often have physical and cognitive limitations that can make them particularly vulnerable to abuse.

These nursing homes are regulated by the Centers for Medicare & Medicaid Services (CMS), which enters into agreements with state survey agencies to oversee nursing home quality. These survey agencies investigate complaints regarding resident care and safety, among other types of oversight.

Reporting abuse

When a nursing home becomes aware of an incident, they are required to immediately report the allegation to the state survey agency. Reporting abuse allows survey agencies to respond to, investigate, and remedy the problem.

However, we found a number of issues with the abuse investigation and prevention process, including:

  • CMS doesn’t provide guidance on the type of information that nursing homes should provide when reporting potential abuse to survey agencies. This may contribute to incomplete information that makes it harder for these agencies to determine whether an investigation should occur and how soon.
  • Facilities are required to report potential crimes to law enforcement immediately. However, if a survey agency receives a complaint that may have criminal implications, it isn’t required to share that with law enforcement until the complaint has been substantiated. This could take weeks or months and potentially delay a law enforcement investigation.
  • CMS wasn’t able to readily access information on types of abuse and types of perpetrators in its data. Without this information, CMS may not be able to effectively tailor its prevention efforts.

Next steps

To improve CMS’s oversight of nursing homes, we recommended that it provide guidance for facilities on how to report incidents, require survey agencies to immediately report potential crimes to law enforcement, and improve the accessibility of data on abuse and perpetrator type.

To learn more, read our full report.

Related Products

About Watchblog

GAO's mission is to provide Congress with fact-based, nonpartisan information that can help improve federal government performance and ensure accountability for the benefit of the American people. GAO launched its WatchBlog in January, 2014, as part of its continuing effort to reach its audiences—Congress and the American people—where they are currently looking for information.

The blog format allows GAO to provide a little more context about its work than it can offer on its other social media platforms. Posts will tie GAO work to current events and the news; show how GAO’s work is affecting agencies or legislation; highlight reports, testimonies, and issue areas where GAO does work; and provide information about GAO itself, among other things.

Please send any feedback on GAO's WatchBlog to