By Senate Finance Committee Chairman Chuck Grassley
The decision to entrust an aging loved one to a facility is a difficult one. It takes planning and research. Families rely on tools such as the Nursing Home Compare website and the Five-Star Quality Rating System, both operated by the Centers for Medicare and Medicaid Services to find a nursing home that best fits their needs. However, when these tools don’t work as they should, the health and safety of nursing home residents are put at risk.
Earlier this year as chairman of the Senate Finance Committee, I convened an oversight hearing. Members of the committee heard from the daughters of two elderly women who were living in nursing homes. One testified that her mother, an Iowan, died due to neglect in a facility that held a five-star rating – the highest possible rating – from the Five-Star Quality Rating System. The family discovered later that the nursing home was the subject of multiple complaint investigations. Yet after each complaint, government inspectors reported that the facility had come back “into substantial compliance with program requirements.” There were no public records of these complaints.
Approximately one in 10 Americans aged 60 and older will fall victim to elder abuse each year. According to the inspector general at the Department of Health and Human Services, one-third of nursing home residents may experience harm while under the care of these facilities. Worse, in more than half of these cases, the harm was preventable.
Congress has taken steps to address the problem of elder abuse. In 2017, I introduced the Elder Abuse Prevention and Prosecution Act, which became law. It enhances enforcement against perpetrators of crimes targeting older Americans. Specifically, it increases training for federal investigators and prosecutors and designates at least one prosecutor in each federal judicial district be tasked with handling cases of elder abuse. It also increases penalties for perpetrators of abuse and ensures that the Federal Trade Commission’s Bureau of Consumer Protection and the Department of Justice have an elder justice coordinator.
Additionally, I introduced the community-based Independence for Seniors Act, which promotes seniors’ independence by allowing them to receive individualized care in their homes rather than being sent to nursing homes. I’ve taken CMS to task over why it failed to ensure that nursing home abuse and neglect cases are reported to law enforcement as required and pressed the agency about its lack of urgency in responding to an early alert from the agency watchdog on the problem.
Though these are important and necessary measures, more must be done. The tools families rely on to make important decisions about their older loved ones’ care must be accurate and reliable.
Last week, the Government Accountability Office released a report that includes information about the Nursing Home Compare website. It found that CMS has not fully implemented recommendations from a 2016 GAO report to audit the reliability of data self-reported by nursing homes. Further, CMS has not yet established a process for monitoring modifications the agency has made in its nursing home oversight efforts. This means that the information publicly available on government-run websites may not be up to date or a true reflection of the quality of care a facility would provide.
The Senate Finance Committee held a hearing on elder abuse in America’s nursing homes last week. Witnesses who testified before the committee included representatives from the HHS Inspector General’s Office and the GAO. They offered their insight into these problems and how to find effective solutions moving forward. Later this year, I plan to introduce legislation that will, among other things, extend and update the Elder Justice Act to include critical reforms to the Five-Star Quality Rating System and the Nursing Home Compare website.
Families facing the decision to put a loved one in a care facility or nursing home deserve to have reliable tools to help make the best choice possible. They shouldn’t have to worry that their loved one will be abused at the hands of a caregiver. The additional measures being put forward will help ensure that government-provided information on nursing homes and care facilities are accurate and reliable, and that oversight efforts will continue to increase quality standards and keep them high.