The U.S. Government Accountability Office (GAO) recently reviewed requirements for reporting abuse and neglect allegations to the Centers for Medicare & Medicaid Services (CMS). GAO concluded gaps existed in requirements for hospices as compared to requirements for extended care in nursing homes and hospitals providing extended care.
Currently, hospices are only required to report abuse and neglect allegations to state monitoring agencies if: “(1) the alleged perpetrator is affiliated with the hospice; and (2) after the hospice has verified it as abuse or neglect based on an internal investigation that could take up to 5 days.”[1] Conversely, nursing homes and hospitals providing extended care must report all abuse and neglect whether or not the alleged perpetrator is affiliated with the institution and before conducting an internal investigation. This means that reporting by hospice care providers to CMS may be less complete or timely than nursing homes and hospitals providing extended care. The gaps in reporting requirements could limit the ability of CMS and survey agencies to ensure that providers are protecting individuals receiving hospice care.
Over 1.6 million Medicare beneficiaries received hospice care services in 2019. About half (49%) of Medicare hospice care that year was provided in private homes. The remainder was provided through a combination of nursing homes (21%), assisted living facilities (11%), hospice facilities (11%), and hospitals (7%). Because hospices are not required to report allegations involving alleged perpetrators not affiliated with the hospice, abuses committed in the home by a person’s caregiver, for example, could go undetected. According to the Centers for Disease Control and Prevention, one in 10 adults 60 years and older who live at home experience abuse.[2] Many cases are not reported, however, because older adults might be afraid or unable to tell anyone about it.
The GAO recommends that CMS require hospices to immediately report all abuse and neglect observations involving all perpetrators – even those not affiliated with the hospice provider – to the hospice administrator, a state survey agency, and any other appropriate authorities.
January 12, 2023 – C. St. John
[1] GAO. GAO-23-105463, Abuse and Neglect: CMS Should Strengthen Reporting Requirements to Better Protect Individuals Receiving Hospice Care. U.S. Government Accountability Office. (Dec. 12, 2022). Available at: https://www.gao.gov/assets/gao-23-105463.pdf
[2] CDC. Fast Facts: Preventing Elder Abuse. Centers for Disease Control and Prevention. (June 2, 2021). Available at: https://www.cdc.gov/violenceprevention/elderabuse/fastfact.html