Nursing Homes:

Complaint Investigation Processes in Maryland

T-HEHS-99-146: Published: Jun 15, 1999. Publicly Released: Jun 15, 1999.

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William J. Scanlon
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GAO discussed its recent findings on the effectiveness of federal and state nursing home complaint investigation processes, with a specific focus on its work in Maryland.

GAO noted that: (1) federal and states' practices for investigating complaints about care provided in nursing homes are often not effective; (2) among many of the 14 states GAO examined, GAO found numerous problems, including procedures or practices that: (a) may limit the filing of complaints; (b) understate the seriousness of complaints; and (c) fail to investigate serious complaints promptly; (3) in Maryland, GAO identified many of these and other concerns regarding the responsiveness and effectiveness of complaint investigations; (4) compared with other states GAO reviewed, Maryland: (a) dedicated fewer resources to investigating complaints; (b) recorded substantially fewer complaints than Michigan or Wisconsin; (c) generally classified similar complaints as needing less prompt investigation; (d) did not meet the assigned timeframes for investigating many complaints; and (e) had a large backlog of uninvestigated cases and poor tracking of the status of investigations; (5) as a consequence, serious complaints alleging that nursing home residents are being harmed can remain uninvestigated for weeks or months in Maryland; (6) such delays can prolong situations in which residents may be subject to abuse or neglect resulting in serious care problems like malnutrition and dehydration, preventable accidents, and medication errors; (7) despite problems such as those in Maryland, the Health Care Financing Administration (HCFA) has minimal standards and has exercised limited oversight related to states' complaint practices; (8) to address these issues, GAO recommended that HCFA strengthen its standards for and oversight of states' complaint practices as well as its management information systems to more completely include complaint investigation results; (9) in response to GAO's March report, both HCFA and the state of Maryland have initiated several important improvements intended to increase the responsiveness and effectiveness of complaint investigations; (10) for example, HCFA has instructed states to investigate any complaint alleging actual harm to a resident within ten workdays; and (11) in Maryland, the recent budget approved by the General Assembly includes funding for a significant increase in the number of nursing home surveyors.

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