In addition to periodic surveys, state survey agencies investigate  complaints of inadequate care, including allegations of physical or sexual  abuse. Although one of their primary missions  is to investigate financial fraud and abuse in the Medicare and Medicaid  programs, MFCUs also have authority to investigate the physical and  sexual abuse of nursing home residents. Delays in Reporting Abuse Preclude Immediate Response by Law Enforcement or Survey Authorities

Most of the local police departments in the three states we visited told us  that they were seldom summoned to a nursing home following an alleged  instance of abuse. Abuse Allegations Not Immediately Reported to State Survey Agencies

Our review of 158 case files—mostly from 1999 and 2000—indicated state  survey agencies were often not promptly notified of abuse allegations.While individuals filing complaints are not compelled to report allegations  within a prescribed time frame, nursing homes in the states we visited are  required to notify the state survey agency of abuse allegations the day they  learn of the allegation or the following day. Only six  of these entities represented organizations—such as long-term care  ombudsmen—that are capable of pursuing abuse allegations. MFCU and local law enforcement  officials indicated that nursing home residents are often unwilling or  unable to provide testimony. CMS Employment Requirements and Background Checks Do Not Ensure Resident Protection

While CMS requires nursing homes to establish policies that prevent the  hiring of individuals who have been convicted of abusing nursing home  residents, this requirement does not include offenses committed against  individuals outside the nursing home setting, nor does it specify that states  conduct background checks on all prospective employees. By the time state survey agencies have determined that some aides are  abusive, these aides may have already found employment in other homes. In addition, law enforcement authorities need  to ensure that abusive individuals are prosecuted when appropriate, and  survey agencies should recommend to CMS that available administrative  sanctions be imposed against known abusers. We interviewed officials from the Centers for Medicare  and Medicaid Services (CMS ) regarding these requirements and also  discussed their oversight of the state survey agencies responsible for  surveying nursing homes and certifying their compliance with federal laws  and regulations. To evaluate whether sufficient safeguards exist to protect residents from  abusive individuals, we reviewed federal and state laws regarding criminal  background check requirements for nursing home employees and state  nurse aide registries.
Why GAO Did This Study

Often suffering from multiple physical and mental impairments, the 1.5 million elderly and disabled Americans living in nursing homes are a highly vulnerable population. These individuals typically require extensive help with daily living, such as such as dressing, feeding, and bathing. Many require skilled nursing or rehabilitative care. In recent years, reports of inadequate care, including malnutrition, dehydration, and other forms of neglect, have led to mounting scrutiny from state and federal authorities, which share responsibility for overseeing the nation's 17,000 nursing homes. Concerns have also been growing that some residents are abused--pushed, slapped, or beaten--by the very individuals to whom their care has been entrusted.

What GAO Found

GAO found that allegations of physical and sexual abuse of nursing home residents are not reported promptly. Local law enforcement officials said that they are seldom summoned to nursing homes to immediately investigate allegations of abuse and that few allegations are ever prosecuted. Some agencies use different policies when deciding whether to refer allegations of abuse to law enforcement. As a result, law enforcement agencies were never told of some incidents or were notified only after lengthy delays. GAO found that federal and state safeguards intended to protect nursing home residents from abuse are inadequate. No federal statute requires criminal background checks for nursing home employees. Background checks are also not required by the Centers for Medicare and Medicaid Services, which sets the standards that nursing homes must meet to participate in the Medicare and Medicaid programs. State agencies rarely recommend that sanctions be imposed on nursing homes. Although state agencies compile lists of aids who have previously abused residents, which can prevent an aide from being hired at another nursing home, GAO found that delays in making these identifications can limit the usefulness of these registries. GAO summarized this report in testimony before Congress; see GAO-02-448T .