Health workers still not reporting suspected elder abuse, report finds

Elder abuse and neglect in nursing homes across the country are routinely not reported by health care workers, according to a watchdog report, even though it's a federal requirement for them to do so.

The report, conducted and published by the Office of Inspector General of the U.S. Department of Health and Human Services, found that nursing homes failed to report about one in five potential cases of abuse of elders on Medicare to the state inspection agencies.

Federal investigators determined that health workers at the Centers for Medicare and Medicaid Services, known as CMS, routinely don't report possible incidents of abuse or neglect to local law enforcement and other agencies to be tracked and recorded, in accordance with federal requirements.

However, a CMS spokesperson told FOX Business that the federal agency -- a part of the Department of Health and Human Services -- requires nursing homes to report allegations of abuse, neglect and mistreatment "promptly" to state survey agencies and other authorities.

The spokesperson added that the CMS independently made changes to its practices after an external assessment of its practices in 2016. Now, the CMS requires additional training for surveyors to identify and cite non-compliance.

"Going forward, CMS is clarifying when abuse must be reported to state agencies and law enforcement, and setting clear timelines for the review of abuse and neglect allegations," the spokesperson said. "CMS will continue to work with the OIG as we take swift action to implement its recommendations."

The elderly population is expected to reach 84 million by 2050; in 2008, 1 in 10 elderly people reported emotional, physical, sexual or potential neglect in the previous year. However, a number of cases go unreported, sometimes because the elderly are afraid (or unable) to tell the necessary person.

The study reviewed 37,607 high-risk hospital ER Medicare claims nation-wide for 34,820 Medicare beneficiaries living in nursing homes, totaling $163 million, and selected a sample of 256 claims from eight states. Of the 256 sampled claims, 51 were the result of incidents of potential abuse or neglect. Extrapolating that number, the study determined that 7,831 of 37,607 instances were the result of potential abuse or neglect.

“These incidents of potential abuse or neglect resulted in a variety of injuries, which we categorized as head injuries, bodily injuries, medical issues, and safety issues on the basis of the diagnosis codes,” the study said.

Joanne M. Chiedi, acting inspector general, inquired in the study why skilled nursing facilities did not report 43 suspicious incidents. The facilities that responded blamed unclear laws for the lack of reporting, particularly for injuries from an unknown source.

If the CMS Regional Office finds evidence of abuse, they must report those findings to local law enforcement. But the study determined that most nursing homes don’t follow through with reporting to local law enforcement, as required.

The report cited the example of a nursing home resident who was sitting in the dining room of a nursing home when a staff member walked by and pushed the person’s head, then continued walking out of the room. Although the staff member denied the accusation, investigators said, the incident was confirmed on surveillance video; despite that, the incident was never reported to law enforcement.


"Because the Survey Agency substantiated abuse by the staff member, the Survey Agency should have reported the incident to the local law enforcement and, if applicable, to the MFCU [Medicaid Fraud Control Units]," the report concluded.