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Federal law requires that Medicare and Medicaid certified skilled nursing facilities report abuse and neglect allegations and subsequent investigations/findings to the appropriate governmental authorities within a specified timeframe. The Office of Inspector General just issued its August 2014 report and concluded that nursing homes only correctly reported allegations of abuse or neglect, as federally required, 53% of the time.

Often times we find that the medical and long-term industry folks under appreciate the definitions of each type of allegation that requires a facility to report an incident. Attached is a table taken from the OIG report that includes the CMS definitions for the terms “abuse,” “injuries of unknown source,” “neglect” and “mistreatment.”

Table 1: Definition of Each Type of Allegation Definition
Abuse The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.

 

Injuries of Unknown Source  

An injury should be classified as an “injury of unknown source” when both of the following conditions are met: 1. The source of the injury was not observed by any person or the source of the injury could not be explained by the resident; and 2. The injury is suspicious because of the extent of the injury or the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma) or the number of injuries observed at one particular point in time or the incidence of injuries over time.

Neglect Failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.
Misappropriation of Resident Property The deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident’s belongings or money without the resident’s consent.
Mistreatment Not defined as of March 2014.

 

Bottom line: our governmental agencies need to do a better job of enforcing regulations that require that the facilities report instances of abuse, neglect or injuries of unknown origin, and mistreatment. Further, CMS needs to define the term “mistreatment” as there is currently no definition.

To read the OIG August 2014 report, please visit: http://oig.hhs.gov/oei/reports/oei-07-13-00010.pdf

Wendy York and the team at York Law Firm have been handling elder abuse cases for almost 20 years. If you believe your loved one has been the victim of elder abuse or neglect in a nursing home or assisted living facility, please contact our office so that we can investigate your case at 916-643-2200. We are dedicated to representing elders and dependent adults who have been injured, neglected or abused.

 

 

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