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covered individuals or a completed training/orientation attendance sheet specifying reporting obligations.” Related Reports In 2006, the Office of Inspector General (OIG) conducted an evaluation entitled Nursing Home Complaint Investigations (OEI-01-04-00340), which found that State agencies did not investigate some of the most serious nursing home complaints within required timeframes; States did not take full advantage of the available complaint reporting system; and, in a targeted review of five States, State agencies followed protocol for intake and triage but followup letters to complainants often lacked meaningful information.26 METHODOLOGY We conducted this study in two parts. The first part included a: (1) review of policies related to reporting allegations of abuse or neglect from a sample of 250 nursing facilities from two strata, as shown in Table 2, (2) review of the sampled nursing facilities’ policies and procedures related to reasonable suspicions of crimes, and (3) survey of administrators from the sampled nursing facilities. All estimates for part one are projected to the population of nursing facilities.27 24 CMS, Memorandum to State Survey Agency Directors, S&C: 11-30-NH, Reporting Reasonable Suspicion of a Crime in a Long-Term Care Facility (LTC): Section 1150B of the SSA, June 17, 2011. The memorandum was revised on January 20, 2012, to include an updated questions-and-answers section and appendix. 25 Ibid. 26 OIG, Nursing Home Complaint Investigations (OEI-01-04-00340), July 2006. 27 We received information from 245 of the 250 nursing facilities in our sample resulting in a 98 percent response rate. Therefore, the projected population for our sample is 15,550 instead of 15,854. Nursing Facilities’ Compliance With Requirements for Reporting Allegations of Abuse or Neglect (OEI-07-13-00010) 5 Table 2: Nursing Facility Population and Sample Size Stratum Definition Population Size Sample Size Nursing Facilities That Have a Total Certified Size Greater Than or Equal to 113 Beds (Large Facilities) 6,347 125 Nursing Facilities That Have a Total Certified Size Less Than 113 Beds (Small Facilities) 9,507 125 Total 15,854 250 Source: OIG analysis of the Certification and Survey Provider Enhanced Reporting database as of March 26, 2013. The second part of this study included an examination of a sample of 301 allegations of abuse or neglect (from the population of 2,502 allegations) identified by the nursing facilities in the first part of the study. The second part included a review of documentation related to sampled allegations of abuse or neglect (e.g., investigation records). All estimates for part two are projected to the population of allegations of abuse or neglect reported by sampled nursing facilities from part one. See Appendix A for a detailed description of our methodology. Standards This study was conducted in accordance with the Quality Standards for Inspection and Evaluation issued by the Council of the Inspectors General on Integrity and Efficiency. Nursing Facilities’ Compliance With Requirements for Reporting Allegations of Abuse or Neglect (OEI-07-13-00010) 6 FINDINGS Nursing facilities are required to report all allegations of abuse or neglect to ensure resident safety; 85 percent of nursing facilities reported at least one such allegation to OIG in 2012 It is both required and expected that nursing facilities will report any and all allegations of abuse or neglect to ensure resident safety. Eighty-five percent of nursing facilities reported at least one allegation of abuse or neglect to OIG in 2012. An allegation of abuse or neglect is required to be reported immediately; an investigation is subsequently conducted to determine and substantiate the allegation. Not all allegations of abuse or neglect are substantiated.28 Allegations of abuse or neglect include the following types: abuse, injuries of unknown source, misappropriation of resident property, neglect, or mistreatment. A total of 149,313 allegations of abuse or neglect were reported by facilities to OIG in 2012. Nursing facilities identified the type and nature of allegations that occurred. Abuse was the most common type of allegation, accounting for half of the allegations in 2012. See Table 3 for information regarding the types of allegations that nursing facilities reported to OIG in 2012. Nursing facilities described the individuals involved in the alleged incidents by identifying the nature of the allegations (e.g., resident to resident). Nursing facilities identified 40 percent of allegations as employee to resident. See Table 4 for information regarding the nature of allegations of abuse or neglect that nursing facilities reported to OIG in 2012. See Appendix B for all estimates and 95-percent confidence intervals for projections. 28 For the purposes of this study, we did not determine whether the allegations of abuse or neglect reported by the sampled nursing facilities were substantiated. Nursing Facilities’ Compliance With Requirements for Reporting Allegations of Abuse or Neglect (OEI-07-13-00010) 7 Table 3: Types of Allegations of Abuse or Neglect That Nursing Facilities Reported in 2012 Type of Allegation Number of Allegations in Sample (n=2,502) Projected Number of Allegations (N=149,313) Percentage of Allegations Abuse Injuries of unknown source Misappropriations of resident property Neglect Mistreatment Other 1,265 476 392
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