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Audit: Nursing-home abuse in Illinois, across U.S. going unreported

SOURCE: AP / U.S. Department of Health and Human Services

More than one in four cases of possible sexual and physical abuse against nursing-home patients apparently went unreported to police, and Illinois had the most such incidents of any state.

That’s according to a new government audit that faults Medicare for failing to enforce a federal law requiring immediate notification.

The Health and Human Services inspector general’s office has issued an “early alert” on preliminary findings from a large sampling of cases in 33 states. The results were sufficiently alarming that investigators say corrective action is needed now.

“We hope that we can stop this from happening to anybody else,” said Curtis Roy, an audit manager with the inspector general’s office, which investigates fraud, waste and abuse in the health-care system.

The audit is part of a larger, ongoing investigation. Additional findings are expected.

With about 1.4 million people living in nursing homes nationwide, quality is an ongoing concern. Despite greater awareness, egregious incidents still occur.

In response to the inspector general’s finding, Medicare officials said nursing-home safety is a high priority but that they would wait until the report is completed before commenting further.

That didn’t impress Sen. Charles Grassley, R-Iowa, who said he will push for Medicare to take immediate action.

“A crime is a crime wherever it takes place,” Grassley said. “It’s unacceptable for more than one-fourth of potential crimes in nursing homes to apparently go unreported.”

Of the unreported cases, about four out of five involved possible rape or sexual abuse.

The inspector general urged Medicare to systematically scour computerized billing records for telltale signs of possible abuse of nursing- home residents. Investigators used that approach to find the cases, matching hospital emergency room and nursing-home records.

Its auditors identified 134 cases in which emergency room records indicated possible sexual or physical abuse or neglect. The incidents spanned a two-year period from 2015-2016.

Illinois had 17. Next on the list were Michigan (13), Texas (9), and California (8).

In 38 of the total cases (28 percent), investigators could find no evidence in hospital records that the incident had been reported to local law enforcement. That was despite a federal law that mandates prompt reporting by nursing homes, as well as similar state and local requirements.

The federal statute has existed for more than five years, but investigators found that Medicare hasn’t enforced its requirement to report incidents to police and other agencies, or face fines of up to $300,000.

Nursing-home personnel are required to immediately report incidents that involve a suspected crime, within a two-hour window if there’s serious bodily injury. Otherwise, authorities must be notified within 24 hours.

Medicare “has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in [nursing homes] are identified and reported,” the inspector general’s report said.

Medicare responded it has long required immediate reporting, but to state inspectors.

Even among the 96 cases that ultimately were reported to police departments, investigators for the inspector general’s office couldn’t determine whether the federal requirement for “immediate” notification was followed.

In one case classified as “reported to law enforcement,” an elderly woman with verbal and mobility limitations was taken to the emergency room after she was allegedly sexually assaulted by a male resident of the same nursing home. The report said two silver-dollar-sized bruises were noted on her right breast.

Workers at that nursing home had helped the woman bathe and change clothes after the incident. “These actions could have destroyed any evidence that may have been detected using the rape kit,” said the report.

The nursing home “should have reported the incident to law enforcement within two hours of witnessing the incident,” the report said.

Instead, the following day, the nursing home contacted the woman’s family, who called the police, triggering an investigation.

Citing a separate probe by state officials, the inspector general’s report said the nursing home “contacted local law enforcement in an attempt to keep law enforcement from investigating the incident.” No other details were provided in the federal report.

The number of nursing-home residents is expected to grow as more people live into their 80s and 90s. Medicaid is the main payer for long-term care, while Medicare covers doctors’ services and hospital care for elderly people and the disabled.

The American Health Care Association, the main nursing-home industry trade group, said its members know they must immediately report allegations of abuse and that it will work with the government to ensure safety.