Nursing Home Abuse Going Largely Unreported Due to Medicare Failing

According to a government audit, as many as 1 in 4 cases of nursing home abuse go unreported to police. The audit found fault with Medicare for the fallacy, stating that the agency did not enforce a federal law that requires immediate notification of physical or sexual abuse in a nursing home.

A sampling of 33 states revealed results that were alarming enough to warrant corrective action without hesitation.

An Ongoing Concern

Approximately 1.4 million Americans live in nursing homes. With numbers like that, it makes sense that quality control would be a consistent issue -- and in spite of regulations and protective measures, abusive incidents do still occur.

In a statement from Medicare, the agency claimed to keep nursing home safety as a high priority, but did not concede to respond to allegations that it had failed until a complete report was ready.

Out of the quarter of all nursing home abuse incidents that go unreported, about 80% of those involve allegations of rape or sexual abuse.

How Abuse Is Identified

When a case goes unreported, it can be hard to determine whether it happened at all. Fortunately, there is a way to compare nursing home records and emergency room records to find signs of abuse -- and the inspector general is urging Medicare to look over computerized billing records for things that may point to a problem.

From 2015 to 2016, 134 cases of abuse were identified with this method. The most incidents occurred in Illinois (17), followed by Michigan (13) and Texas (9).

While the law that requires immediate reporting of such incidents has existed for over five years, Medicare has not been enforcing its rule to report or risk fines up to $300,000. According to the law, nursing home staff must report any incident of suspected abuse within a two-hour time frame if serious injury is incurred, or within 24 hours otherwise.

Even among the cases that are reported, it can be difficult to determine if the “immediate” part of the rule was followed. Quick action is essential due to the risk of erasing or compromising evidence that may be needed for an investigation.

As more people live into their 80s and 90s, it’s expected that the number of nursing home residents will rise. Nursing homes must be vigilant in reporting suspected abuse, and Medicare must enforce its own rules -- or the results could be tragic.

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