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reasonable suspicions of crimes under Section 1150B of the Social Security Act (SSA). 2. To determine the extent to which allegations of abuse or neglect were reported by nursing facilities in compliance with Federal regulations. BACKGROUND It is estimated that approximately 5 million, or 10 percent, of elderly adults are abused, neglected, or exploited annually.1 Between now and 2050, the United States is projected to experience significant growth in its elderly population. In 2050, the number of Americans aged 65 and older is projected to be 88.5 million, more than double the population of 40.2 million in 2010.2 Nursing facilities are likely to experience increases in their resident population; therefore, it is important to ensure that residents are protected from abuse and neglect. Types of Allegations Pursuant to Federal regulations, all nursing facility residents must not be subjected to abuse by anyone, including, but not limited to, facility staff.3 Nursing facility residents also have “the right to be free from mistreatment, neglect, and misappropriation of property.”4 Further, all Medicare and/or Medicaid-certified nursing facilities must report “alleged violations involving mistreatment, neglect, or abuse, including injuries of 1 Administration for Community Living, Release of the FY 2014 Budget Request to Congress, February 13, 2013. of Residents. Nursing Facilities’ Compliance With Requirements for Reporting Allegations of Abuse or Neglect (OEI-07-13-00010) 1 Nursing Facilities’ Compliance With Requirements for Reporting Allegations of Abuse or Neglect (OEI-07-13-00010) 2 unknown source, and misappropriation of resident property….”5, 6 Table 1 includes CMS definitions of the terms abuse, injuries of unknown source, neglect, misappropriation of resident property, and mistreatment. For the purposes of this study, we will use the general phrase “allegations of abuse or neglect” to refer to all types of allegations. Table 1: Definition of Each Type of Allegation Allegation Definition Abuse The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.7 Injuries of Unknown Source An injury should be classified as an “injury of unknown source” when both of the following conditions are met: 1. The source of the injury was not observed by any person or the source of the injury could not be explained by the resident; and 2. The injury is suspicious because of the extent of the injury or the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma) or the number of injuries observed at one particular point in time or the incidence of injuries over time.8 Neglect Failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.9 Misappropriation of Resident Property The deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident’s belongings or money without the resident’s consent.10 Mistreatment Not defined as of March 2014. Source: CMS, Memorandum to State Survey Agency Directors, S&C-05-09, Clarification of Nursing Home Reporting Requirements for Alleged Violations of Mistreatment, Neglect, and Abuse, Including Injuries of Unknown Source, and Misappropriation of Resident Property, December 16, 2004. 5 42 CFR § 483.13(c)(2). Pursuant to 42 CFR § 483.5, a “facility” is defined as a “skilled nursing facility (SNF) that meets the requirements of sections 1819(a), (b), (c), and (d) of the Act, or a nursing facility (NF) that meets the requirements of sections 1919(a), (b), (c), and (d) of the SSA.” For the purposes of this report, we use the term “nursing facility” to refer to both Medicare skilled nursing facilities and Medicaid nursing facilities. 6 All nursing facilities participating in the Medicare and/or Medicaid programs must be certified as meeting Federal nursing facility quality and safety requirements, including requirements regarding allegations of abuse or neglect. For the purposes of this study, we did not review deficiency citations or actions taken for noncompliance by State survey agencies. 7 42 CFR § 488.301. 8 CMS, Memorandum to State Survey Agency Directors, S&C-05-09, Clarification of Nursing Home Reporting Requirements for Alleged Violations of Mistreatment, Neglect, and Abuse, Including Injuries of Unknown Source, and Misappropriation of Resident Property, December 16, 2004. 9 42 CFR § 488.301. 10 Ibid. Nursing Facilities’ Policies Related to Prohibiting Abuse or Neglect Pursuant to Federal regulations, nursing facilities must develop and implement written policies that prohibit abuse or neglect.11 Nursing facilities’ policies prohibiting abuse or neglect must address the following seven components: screening, training, prevention, identification, investigation, protection, and reporting/response.12 For the purposes of this study, we focused our review on written policies regarding reporting allegations of abuse or neglect. Reporting Allegations of Abuse or Neglect Nursing facilities must report all allegations of abuse or neglect13 immediately to the nursing facility administrator or designee, State survey and certification agency (State survey agency), and to other officials in accordance with State law.14, 15 An allegation of abuse or neglect is required to be reported immediately; an investigation is subsequently conducted to determine and
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