Many states are unable to tally and describe safety problems at assisted living facilities, government inspectors said Monday, even as the popular alternative to nursing-home care soaks up an increasing amount of taxpayer dollars under Medicaid.
The Government Accountability Office said 26 states that pay for assisted living through Medicaid, a federal-state insurance program, were unable to report “critical incidents” such as physical and sexual abuse, suggesting a gap in oversight.
Meanwhile, 22 other states reported nearly 23,000 critical incidents at assisted living facilities in 2014 — the year that investigators used for their lengthy review.
“With more and more Americans living in assisted living facilities supported by billions in Medicaid dollars, the federal government must help ensure that our seniors and disabled residents receive quality care,” said Sen. Susan Collins, Maine Republican and one of four senators who requested the review. “Yet, the GAO uncovered a number of troubling issues at some assisted living facilities across the country, ranging from serious health and safety risks to fragmented data that make oversight difficult.”
Assisted living facilities offer a residential alternative to nursing homes for people who may need help with daily activities, like dressing and bathing, yet want to maintain their independence.
The aging U.S. population is poised to increase demand for these services. And while assisted living services are generally cheaper than nursing-home care — saving taxpayer dollars under Medicaid — watchdogs say they don’t know much about the care they provide.
“Although the federal government has comprehensive information on nursing homes providing Medicaid services, not much is known about Medicaid beneficiaries in assisted living facilities,” the GAO wrote to Senate Finance Committee Chairman Orrin Hatch, Ms. Collins and Democratic Sens. Claire McCaskill and Elizabeth Warren.
The GAO said Medicaid programs in 47 states, plus D.C., spent a combined $10 billion on assisted living services in 2014 for more than 330,000 beneficiaries.
Kentucky, Louisiana and West Virginia said they didn’t pay for assisted living services.
State Medicaid agencies are supposed to monitor cases of potential or actual harm among beneficiaries, though states that failed to report critical incidents lacked adequate systems to track them or had inconsistent definitions of what constituted a critical incident.
The GAO said the Centers for Medicare and Medicaid Services has cracked down on states and required better incident response and reporting systems, but has failed to provide clear guidance on what states should report up the chain to CMS.
“For years, states have been required to check a box attesting that they operate a critical incident management system, but have not always been required to report information on incidents of potential or actual harm to beneficiaries,” the GAO said. “Given the increasing prevalence of assisted living facilities as a provider of services to Medicaid beneficiaries, it is unclear why more than half of states responding to our survey could not provide us information on the number of critical incidents that occurred in these facilities in their states.”
CMS agreed that it should clarify some of its reporting requirements, though said it convened a working group to determine if additional reporting requirements are necessary.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
Please read our comment policy before commenting.