The Centers for Medicare & Medicaid Services is working to address numerous recommendations from federal agencies to improve reporting, investigation and law enforcement notification of elder abuse, the Government Accountability Office said in report released Wednesday. The report highlights the differences in requirements for assisted living communities versus nursing homes.

In comments provided to the GAO for the report, the Department of Health and Human Services “noted that although CMS’s oversight of assisted living facilities is more limited, CMS works in partnership with states — through providing guidance, technical support, training, and oversight of states’ quality reporting — to ensure the safety of Medicaid beneficiaries in assisted living facilities,” the GAO said.

The report noted that assisted living communities primarily are overseen at the state level but that “[w]hen assisted living facilities provide services to Medicaid beneficiaries, they are indirectly subject to CMS oversight through the agency’s oversight of state Medicaid agencies.” Approximately 16.5% of assisted living residents were Medicaid beneficiaries as of 2016, according to federal data, the authors said.

“In recent reports, we have found that improved federal oversight of the health and welfare of residents is needed in both nursing homes and assisted living facilities,” the GAO authors wrote, noting that an office report released in February 2018 “found that little is known about the incidence of abuse in assisted living facilities.”

In the 2018 report, the GAO found that for various reasons, 26 of the 48 state Medicaid agencies studied could not report the number of “critical incidents” — such as abuse, neglect or exploitation — that occurred in the assisted living communities located in their states.

“Among other things, we recommended that CMS establish standard reporting requirements for states to report key information on critical incidents,” the GAO noted in the new report. “CMS neither agreed nor disagreed with our recommendation and as of June 2019, has yet to take action.”

The GAO produced the new report at the request of Sen. Susan Collins (R-ME), chairman of the Senate Special Committee on Aging, and Sen. Amy Klobuchar (D-MN), ranking member of the Senate Committee on Rules and Administration. Klobuchar also is a candidate for the Democratic nomination for president of the United States in the 2020 election.

Collins also was one of the four senators who originally requested the report released in 2018 by the GAO.

“The GAO uncovered a number of troubling issues at some assisted living communities,” she said at the time of that report’s release, adding that she planned to “continue to work with my colleagues to support policies that improve the well-being of seniors who receive care at these facilities.”

A spokesperson for the American Health Care Association / National Center for Assisted Living told McKnight’s Senior Living that the organizations “take allegations of abuse very seriously and are focused on preventing these rare incidents.”

“Whether regulated at the federal or state levels, long-term care facilities — including nursing homes and assisted living communities — are committed to ensuring residents have a safe and enriching experience,” the spokesperson said.

Article updated Sept. 19 to include comments from AHCA / NCAL. 

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