As Nursing Home Complaints Rise, Some States Fall Short in Timely Investigations

In recent years, the number of nursing home residents has decreased, but the number of complaints about nursing homes has increased by 33%, a new report finds. While most are promptly investigated, some states are falling behind on completing follow-up investigations within required timeframes.

The report, issued by the HHS Office of Inspector General, compiles data submitted to CMS by each state’s nursing home survey agencies between 2011 and 2015. Residents, families, or nursing home staff may report concerns about health and safety in the facility, such as residents left sitting in their waste for hours, hospital admissions due to preventable infections, and even social media posts by employees that violate residents’ privacy.

According to the report, while the number of US nursing home residents fell by around 50,000 during this time, the number of complaints made rose 33% from 47,279 in 2011 to 62,790 in 2015. Both in 2015 and across the study period, there were wide variations in the rates of complaints reported in each state. For instance, across all 5 years, Hawaii had the lowest complaint rate at 3.3 complaints per 1000 residents, whereas Washington had the highest at 108.7 per 1000 residents.

The report explained that complaints are categorized into levels of severity that determine the required timeframes for onsite investigations of the facility. “Immediate Jeopardy” complaints describe serious injury, harm, or death to a resident, and necessitate an investigation within 2 working days. States receiving “High Priority” complaints, which involve allegations of harm that has negatively affected a resident’s mental, physical, or psychosocial status, must follow up within 10 working days. For other, less serious complaints, there is no required timeframe for an investigation.

Across the study period, the proportion of complaints categorized in the 2 more serious classifications requiring investigation increased from 55% to 59%. The number of immediate jeopardy complaints, the most severe type, nearly doubled from 2844 in 2011 to 5341 in 2015. However, the proportion of complaints categorized as immediate jeopardy and high priority varied across states. In 2015, 8 states did not classify any as immediate jeopardy, while 3 placed over 40% of all complaints into that category.

Tennessee and Georgia, which had some of the highest rates of immediate jeopardy classification, were less likely to conduct an investigation within the required 2 working days; together, they accounted for over half of all late investigations each year. In 2015, the 2 states received a total of 912 immediate jeopardy complaints; 654 of these were investigated late.

The report indicates that CMS has investigated the backlog of complaints in these 2 states and that the states intend to hire additional surveying staff to compensate for high turnover rates at their agencies.

In its conclusion, the report noted that the increase in complaints did not necessarily indicate worsening care quality in nursing homes; improved processes for filing complaints or better tracking of complaints may have also contributed to this increase. Still, the data on delayed responses to these complaints raise concerns that some allegations are not being promptly investigated and point to an opportunity for the lagging states to improve.

“Nursing home residents are a vulnerable population, and States serve as the front-line responders in addressing concerns raised by residents, their families, and nursing home staff,” the report concluded. “To ensure the health and safety of nursing home residents, CMS must remain vigilant and assist the States that are falling short in meeting timeframes for investigations of complaints.”