How do I report nursing home abuse if I suspect abuse or neglect?
If you suspect a loved one is being abused in a nursing home facility it is extremely important that you report nursing home abuse. Medicare Pathways wants to make you aware of the signs of inappropriate care that may be an issue involving your loved one while in a nursing home. It is important to know the signs and when to report nursing home abuse. Filing a complaint is one way to report nursing home abuse.
Unfortunately it can becomes necessary for a Medicare beneficiary to be institutionalized in a nursing home for partial or complete care due to the fact they are unable to continue the activities of daily living on their own. Original Medicare covers 100 days of inpatient care per benefit period for a Medicare beneficiary that has been institutionalized in a nursing home. It is great that nursing home are available to provide the much needed care to the Medicare beneficiary; however, there are times when appropriate care is not provided which results in a form of abuse to the Medicare beneficiary.
Who is responsible for monitoring nursing homes to prevent abuse?
- The State
- Center for Medicare Service
- U.S. Department of Health and Human Service
Let’s take a look at how nursing homes are monitored by the State and what happens if someone does report nursing home abuse. If a nursing home wants to be eligible to provide care to Medicare and Medicaid beneficiaries there are certain performance standards that he nursing home must meet. Congress established minimum requirements for a nursing home to meet to provide care to Medicare and Medicaid beneficiaries. Regardless, the performance standards must be met. These requirements are set forth in the Social Security Act. Congress assigned the Department of Health and Human Services and the Center for Medicare and Medicaid Services with the responsibility of working out the details and determining how the law set forth in the Social Security Act would be implemented. This was done by writing regulations and manuals regarding performance standards. State governments oversee the licensing of nursing homes.
State governments have a contract with the Center for Medicare and Medicaid Services (also known as “CMS”) which is a branch of the United States Department of Health and Human Services, to monitor nursing and conduct on-site inspections to determine whether the nursing home meets quality and performance standards. On-site inspections of each nursing home that participates in Medicare and/or Medicaid occur on average about once a year. However, if a nursing home is found to be performing poorly, the State can conduct on-site inspections more frequently. The State also investigates complaints about nursing home care. Filing a complaint is one way to report nursing home abuse.
On-site inspections are conducted to ensure the nursing home is meeting performance standards and to eliminate the possibility of any form of abuse and, thus, eliminate any need to report nursing home abuse. The on-site inspections conducted by the State consists a team of trained inspectors, including at least one registered nurse. The regulations the team reviews cover a wide range of aspects of resident life, from specifying standards for the safe storage and preparation of food to protecting residents from physical or mental abuse or inadequate care practices. There are over 150 regulatory standards that nursing homes must meet at all times. Many are related. The team that conducts the evaluation of the nursing home evaluates whether the nursing home meets individual resident needs. This is accomplished by observing resident care processes, staff/resident interaction, and environment. Using an established protocol, the team interviews a sample of residents and family members about their life and care within the nursing home. The inspection team also interviews caregivers and administrative staff and reviews clinical records. In addition, fire safety specialists evaluate whether a nursing home meets standards for safe construction. When an inspection team finds that a home does not meet a specific regulation, it issues a deficiency citation. Depending on the nature of the problem, the Center for Medicare and Medicaid Services can take action against the nursing home. The law permits the Center for Medicare and Medicaid Services to take a variety of actions. For example, the Center for Medicare and Medicaid Services may fine the nursing home, deny payment to the nursing home, assign a temporary manager, or install a State monitor. CMS considers the extent of harm caused by the failure to meet requirements when it takes an enforcement action. If the nursing home does not correct its problems, CMS terminates its agreement with the nursing home. As a result, the nursing home is no longer certified to provide care to Medicare and Medicaid beneficiaries. Any beneficiaries residing in the home at the time of the termination are transferred to certified facilities.
Some things that can lead to more frequent on-site investigations are the number of individuals that report nursing home abuse or claims of nursing of abuse involving a certain facility. If you believe a loved one, or any other resident of a nursing home is, or has been, subject to any form of abuse, then it is your obligation to file a complaint and report nursing home abuse. The abuse that occurs in nursing homes occurs in many ways. Nursing home abuse can occur as a form of neglect which affects the mental or physical well-being of the resident. Federal nursing home regulations state that “the resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.” These regulations define nursing home abuse as “an intentional infliction of injury, unreasonable confinement, intimidation, care/service deprivation or punishment that results in physical harm, pain or mental anguish.” The federal nursing home regulations define neglect as “a failure, intentional or not, to provide a person with the care and services necessary to ensure freedom from harm or pain; a failure to react to a potentially dangerous situation resulting in resident harm or anxiety.”
What are the signs of nursing home abuse?
There are many signs and indications that are obvious indications of abuse and neglect and are just cause to report nursing home abuse. According to “Nursing Home Alert”, the following are common types of abuse and neglect found in a nursing home:
- Assault and battery (including kicking, slapping, pinching, pushing, shaking, beating, threats and verbal or emotional abuse)
- Lack of care for existing medical problems
- Prolonged or continual deprivation of food or water
- Rape or other forms of sexual assault or battery
- Unreasonable physical restraint or seclusion
- Use of a physical or chemical restraint or psychotropic medication for any purpose not consistent with that authorized by a physician
- Additionally, you should report nursing home abuse if you have reason to believe any of the following are a result of physical or verbal abuse and/or neglect:
- Bed injuries/asphyxiation
- Emotionally upset or agitated, extremely withdrawn and non-communicative
- Falls, fractures or head injuries
- Instances of wandering/elopement
- Pressure ulcers (bed sores)
- Rapid weight loss or weight gain; signs of malnutrition
- Reluctance to speak in staff members’ presence
- Unexplained or unexpected death of the resident
- Unexplained injuries such as wounds, cuts, bruises or welts in various stages of healing
- Unsanitary and unclean conditions
- Unusual or sudden changes in behavior (fear of being touched, sucking, biting, rocking)
- Wanting to be isolated from others
- You should also report nursing home abuse if you see, hear or suspect any of the following is a result of any form of abuse or neglect:
- Injuries requiring emergency treatment or hospitalization
- Any incident involving broken bones, especially a fractured hip
- Any injury or death occurring during or shortly after an episode of wandering (including outside the facility)
- Heavy medication or sedation
- One resident injures another resident
- Resident is frequently ill, and the illnesses are not promptly reported to the physician and family
How do I report nursing home abuse?
Every state in the United States has a toll free hot-line or helpline for an individual to call to report nursing home abuse. You can remain anonymous when you report nursing home abuse, or can provide your name and contact information. The more information provided by the individual when they report nursing home abuse the easier it is for the team that does on-site investigations (discussed above) to conduct the investigation regarding allegation of abuse. You can obtain the toll free number by contacting your State Department of Public Health or your State Department of Health and Human Services. Most states have an Adult Protective Services Division that is part of the state’s Department of Health and Human Services (sometimes referred to as “Department of Health and Human Resources”).
Medicare Pathways works very hard to ensure that seniors purchase the most appropriate and most affordable Medicare insurance plan, such as a Medicare Supplement or Medicare Advantage plan; however, it is up to everyone to work equally as hard to protect residents from abuse and neglect and report nursing home abuse to the appropriate authorities or state department.
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