Nursing Homes: Complaint Investigation Processes Often Inadequate to Protect Residents
HEHS-99-80
Published: Mar 22, 1999. Publicly Released: Mar 22, 1999.
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Highlights
Pursuant to a congressional request, GAO provided information on how states implement the federal requirement that establishes a process for nursing home complaint investigations, focusing on the: (1) effectiveness of state complaint investigation practices as a component of the system to ensure sustained compliance with federal nursing home quality-of-care standards; and (2) Health Care Financing Administration's (HCFA) role in establishing standards and conducting oversight of states' complaint investigation practices and in using information about the results of complaint investigations to ensure compliance with nursing home standards.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | To make complaint investigations a more effective tool for protecting nursing home residents' health and safety, the Administrator, HCFA, should revise federal guidance and ensure state agency compliance by developing additional standards for the prompt investigation of serious complaints alleging situations that may harm residents but are categorized as less than immediate jeopardy. These standards should include maximum allowable timeframes for investigating serious complaints and for complaints that may be deferred until the next scheduled annual survey. States may continue to set priority levels and timeframes that are more stringent than these federal standards. |
Closed – Implemented
In fiscal year 2004, CMS (formerly HCFA) completed two actions that improve guidance to states for conducting investigations of complaints. The first action, effective January 2004, in conjunction with the nationwide implementation of its new complaint tracking system, CMS provided detailed direction and guidance to the states for managing complaint investigations for numerous types of providers, including nursing homes. The second action, effective in June 2004, was the publication on the Internet of an updated chapter of CMS's State Operations Manual that consolidates complaint investigation procedures for numerous types of providers.
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| Health Care Financing Administration | To make complaint investigations a more effective tool for protecting nursing home residents' health and safety, the Administrator, HCFA, should revise federal guidance and ensure state agency compliance by strengthening federal oversight of state complaint investigations, including monitoring states' practices regarding priority-setting, on-site investigation, and timely reporting of serious health and safety complaints. |
Closed – Implemented
In response to this recommendation, HCFA (now CMS) developed and issued detailed guidance for the state survey agencies to follow to make complaint investigations more effective, and has also developed a new performance standard to guide CMS Regional Office staff in evaluating state survey agencies' handling of complaint investigations.
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| Health Care Financing Administration | To make complaint investigations a more effective tool for protecting nursing home residents' health and safety, the Administrator, HCFA, should revise federal guidance and ensure state agency compliance by requiring that the substantiated results of complaint investigations be included in federal data systems or be accessible by federal officials. |
Closed – Implemented
CMS implemented its new ASPEN Complaint Tracking System nationwide in January 2004. With its implementation, CMS is better able to track information about complaint investigations performed by all state agencies.
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Topics
Elder careElderly personsstate relationsMedicaidNegligenceNoncomplianceNursing homesPatient care servicesSafety standardsSanctionsState programsMedicare