Summary: Federal and state practices for investigating complaints about nursing home care are often not as effective as they should be. GAO found many problems in the 14 states it reviewed, including procedures or practices that may limit the filing of complaints, understatement of the seriousness of complaints, and failure to investigate serious complaints promptly. Complaints alleging that nursing home residents were being harmed have gone uninvestigated for weeks or months. During that time, residents may have remained vulnerable to abuse, neglect (which can lead to serious problems like malnutrition and dehydration), preventable accidents, and medication errors. Although the federal government finances more than 70 percent of complaint investigations nationwide, the Health Care Financing Administration (HCFA) plays a minimal role in providing states with direction and oversight regarding these investigations. HCFA has left it largely to the states to decide which complaints put residents in immediate jeopardy and should be investigated immediately. More generally, HCFA's oversight of state agencies that certify federally qualified nursing homes has not focused on complaint investigations. GAO recommends (1) stronger federal requirements for states to promptly investigate serious complaints alleging situations that may harm residents but are not classified as posing an immediate threat, (2) more federal monitoring of states' efforts to respond to complaints, and (3) better tracking of the substantial findings of complaint investigations. GAO summarized this report and the preceding one in testimony before Congress; see: Nursing Homes: Stronger Complaint and Enforcement Practices Needed to Better Ensure Adequate Care, by William J. Scanlon, Director of Health Financing and Public Health Issues, before the Senate Special Committee on Aging. GAO/T-HEHS-99-89, Mar. 22 (10 pages).
