Georgia nursing home patients who may be at imminent risk of serious injury or death have not been able to rely on the state to immediately investigate, according to a new report by a federal watchdog agency.
When a patient may be in immediate jeopardy, states are federally required to conduct onsite investigations within two days of receiving the complaint.
But with hundreds of complaints, Georgia took as many as 15 days or more to send an investigator, the report says. Only Tennessee did worse. Almost all the other states met the deadline, according to an analysis by the inspector general for the U.S. Department of Health and Human Services.
Georgia has blamed the slow response on high turnover, job vacancies and low pay at the state agency that oversees nursing homes, the Department of Community Health. Early this year, the department had a backlog of about 140 abuse and neglect reports.
In a written statement from a spokeswoman, the department said Friday the backlog has been eliminated thanks to a state allocation of $4.3 million.
“The health and safety of Georgia’s most vulnerable citizens remains a top priority,” the statement said. “As such, DCH requested and the governor and Georgia legislature approved the addition of funding in early 2017 to begin immediately addressing issues in the nursing home program.
“Since the funding was approved,” the statement said, “DCH has hired 18 new surveyors and has implemented a program to specifically target the complaint backlog.”
But in the interim, some of Georgia’s most vulnerable residents were left at risk, according to the report.
When a nursing home resident or family member reports possible elder abuse or a dangerous situation at a nursing home, a quick response is seen as a critical safeguard to protect vulnerable residents.
Injuries such as head trauma or fractures may indicate a resident is being abused. Bruises around a patient’s breast or genital area may signal sexual coercion or assault. Repeated infections may signal that infection control is shoddy, leading to a high number of hospitalizations. Extremely hot water may put residents at risk of burns.
The inspector general’s report says Georgia and Tennessee accounted for more than half of all the late responses across the nation. The two states received 912 immediate jeopardy complaints in 2015. Of those, they were late in investigating 654.
Sonya Hooks, who filed a complaint against her mother’s Atlanta nursing home early this year, said she wasn’t surprised by the finding. “It’s a mess. Even trying to get through to [the state] was a problem.”
Hooks said she made a lengthy complaint to Community Health with documentation suggesting a serious problem. While the state did eventually look into her allegations, she said it found no wrongdoing. “It’s a totally frustrating process.”
She attributes that to the political clout of the nursing home industry in Georgia, which makes large campaign donations to some of the state’s most powerful politicians.
“As long as the nursing home lobby pours money into the political campaigns of the politicians that oversee nursing homes, it’s going to stay like that,” she said.
The state’s late responses to complaints came as it recorded a huge increase in the number of complaints classified as the most severe. In 2011, Georgia received 908 complaints, 6 percent of which were prioritized as immediate jeopardy. In 2015, as the state received 1,081 complaints, 44 percent were in that category.
Until 2015, Georgia had accounted for only a few of the late investigations.
Nationwide, states received one-third more nursing home complaints in 2015 than in 2011, even as the number of nursing home residents decreased by 3 percent.
Georgia can face federal sanctions for repeated failures to meet the deadline. In a legislative hearing earlier this year, Community Health Commissioner Frank Berry said that a large backlog of complaints about nursing homes had helped lead to “a mess” with federal officials.
Berry also told Georgia Health News that he the state had spent $1 million outsourcing some of its lagging investigative work. He said pay scales were a problem, noting that a surveyor position paid just $50,000 per year.
To help battle the backlog, the state created a goal-based incentive program, which had employees working after-hours and on weekends, paid a flat fee for each inspection. Timely investigation of immediate jeopardy complaints has since increased from a rate of 11 percent to 100 percent, a DCH statement said.
Tony Marshall, president and CEO of the Georgia Health Care Association, the nursing home’s lobbying arm, said the state agency has the same challenges as nursing homes themselves: recruiting, retaining and paying competitive wages.
But even as the state endured a backlog and a slow response to complaints, he said, patient satisfaction surveys have showed more than 90 percent of nursing home residents and their families are happy with the services they get.
“Most complaints, when evaluated, triaged and reviewed, do not rise to a significant level,” Marshall said. “That isn’t to say that someone else’s opinion might be different, but complaints are not typically substantiated.”
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