Some States Fell Short in Timely Investigation of the Most Serious Nursing Home Complaints between 2011-2015

 

On September 29, 2017, the Office of Inspector General (OIG) released a report finding that some states fell short in timely investigation of the most serious nursing home complaints between 2011-2015. Under federal and state regulations, CMS relies on individual states’ respective state survey agencies to address various types of concerns raised by residents, family members, and nursing home staff. Such concerns include residents admitted to the hospital because of preventable infections, residents left sitting in their urine and feces for hours, and inappropriate social media posts by employees.

State agencies must conduct onsite investigations within a certain period of time for the most serious level of complaints. Previous reports by the OIG found that state agencies often did not conduct onsite investigations within the required time frame, which requires that immediate jeopardy cases be investigated within two working days and that non-immediate jeopardy-high priority cases be investigated within 10 working days.

OIG Results

The OIG found that during 2011-2015, while the number of nursing home residents decreased overall, the number of nursing home complaints state agencies received increased 33 percent (47,279 to 62,790). The report also found that, in 2015, both Tennessee and Georgia received a total of 912 immediate jeopardy complaints, which accounts for 17% of all immediate jeopardy complaints. Out of 912 complaints, 654 (71%) were investigated late. Additionally, across all five years, Arizona, Maryland, New York, and Tennessee accounted for almost half of the high priority complaints not investigated onsite within 10 workings days. Furthermore, almost one-quarter of states did not meet CMS’s annual performance threshold for timely investigations of high priority complaints in all four years and all states substantiated almost on third of the most serious nursing home complaints.

Overall, the OIG data report offers Centers for Medicare and Medicaid Services some insights into the states that have room for improvement in prioritizing and responding within the required time frame to nursing home complaints. The OIG will continue to monitor the oversight of nursing homes and will initiate additional reviews as necessary.

National Partnership to Improve Dementia Care Achieves Goals to Reduce Unnecessary Antipsychotic Medications in Nursing Homes

On October 2, the National Partnership to Improve Dementia Care announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent by the end of 2016. It also announced a new goal of a 15 percent reduction by the end of 2019 for long-stay residents in those homes with currently limited reduction rates. Nursing homes with low rates of antipsychotic medication use are encouraged to continue their efforts and maintain their success.

For More Information:

·         Fact Sheet

·         National Partnership to Improve Dementia Care in Nursing Homes webpage

CMS Updates Nursing Home Five-Star Quality Ratings

The Centers for Medicare & Medicaid Services (CMS) have updated their nursing home compare tool to include new quality measures.  The Nursing Home Compare web tool is a resource that provides quality of care and other facility characteristic information to consumers to allow them to compare nursing homes and make informed decisions when choosing a nursing home that meets their needs or the needs of a family member. 

CMS recently added six new quality measures to the website as a part of an initiative to increase the amount of nursing home information available to consumers.  Five of the six new quality measures are currently live.  They are: 

        1. Percentage of short-stay residents who were successfully discharged to the community (Medicare claims- and
            Minimum Data Set (MDS)-based)
        2. Percentage of short-stay residents who have had an outpatient emergency department visit (Medicare claims- 
            and MDS-based)
        3. Percentage of short-stay residents who were rehospitalized after a nursing home admission (Medicare claims- 
            and MDS-based)
        4. Percentage of short-stay residents who made improvements in function (MDS-based)
        5. Percentage of long-stay residents whose ability to move independently worsened (MDS-based)

The sixth new quality measure, the antianxiety/hypnotic medication measure, has not yet been incorporated into the system.  The five-star rating system used on the Nursing Home compare website combines ratings in each quality measure catetory to calculate an overall star rating out of five stars for each facility.  The system aims to "give patients and their families important information and helps people compare nursing homes, as well as think of questions to ask when visiting a nursing home. However, the Five-Star Quality Rating system should not be a substitute for visiting a nursing home."

For the time being, the new measures are being implemented gradually and will be fully implemented by January 2017.  Until then, the measures are only counted at half of their new value.  For more information visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-27.html