State health officials are slow at investigating reports of abuse and neglect at long-term care facilities, to the point where residents may be put at risk, according to a new audit.
The sometimes blistering report about the Arizona Department of Health Services found that 14 of 33 complaints they examined had been open at least 229 days without an investigation.
And state auditors cited one complaint, submitted by another state agency, which alleged that inadequate staffing levels had caused a resident who was unable to feed or use the restroom, to be soaked in urine and clothes stained with dried food. That complaint, the report said, was not investigated for 851 days.
The report by the Auditor General’s Office also faulted the health department for classifying a third of “self-reports,” those submitted by licensed long-term care facilities, as needing no action beyond reviewing a facility’s internal investigation of the incident. That, the auditors said makes no sense, as facilities are required to report only items that are potential regulatory violations – incidents which the department is required to determine if a violation actually occurred.
Auditors pointed to one self-report which was closed with a “no action necessary” conclusion on the same day it was reported, an incident that involved “allegations that a resident with ambulatory issues was being thrown around like a ‘rag doll’ by a staff member.”
The report does not provide names of any facilities or patients.
In a formal response, state Health Director Cara Christ disputed the findings, taking her own slap at the auditors for failing to “provide context” in terms of all of the roles of her agency.
“Long term care facilities represent less than 0.5 percent of total licensees under department regulation,” she said. And Christ said the auditors, who acknowledged they looked at only a sample of all reports, looked at only 0.4 percent of all complaints received by her agency during the two-year period under evaluation.
“Rather than articulating how the department performs across this wide range of activities to protect public health and safety and investigating and resolving complaints within its jurisdiction, the audit findings focus on this very narrow non-representative sample,” she said.
Christ also said her agency evaluates facilities for the federal Centers for Medicare and Medicaid Services and “is currently in compliance with those requirements.”
“The audit establishes expectations for the department beyond those that exist in its agreement with CMS or as currently established by the Legislature,” she wrote, including determining what are acceptable time frames – and without regard to available resources.
She did, however, agree to do more to allocate new staff or reallocate existing staff to prioritize, investigate and resolve complaints about long-term care facilities. And she said her agency is assigning two additional staffers to handle complaints.
But Christ suggested that resolving the problems may require more than just changing assignments.
“The department believes an additional 44 staff and an additional $3.3 million appropriation and general fund allocation will be needed to timely adjudicate the nearly 2,500 complaints received annually,” she said.
State auditors said that the primary responsibility for investigating allegations of abuse, neglect and exploitation of vulnerable adults in Arizona is with the Department of Economic Security. But it is the role of the health department to review the facility’s practices, policies and procedures to determine if there are “appropriate safeguards in place to mitigate the likelihood of abuse occurring.”
And the report warns that the health department not investigating complaints or taking too long to get them resolved “may put residents at risk.”
The auditors cited one case complaint by a nursing student who was on rotation at a long-term care facility who alleged residents were being subjected to abuse, neglect, unsanitary conditions and inappropriate quality of care and treatment. Yet that complaint had been open and uninvestigated for 299 days.
“By not initiating an investigation of this complaint, the department has yet to determine whether the allegations where substantiated (or) unsubstantiated,” the report reads. And if they were substantiated, the auditors said, the department should take action, ranging from requiring the facility to develop and implement a plan of correction to actually revoking the facility’s license.
“The longer a complaint or self-report remains uninvestigated, the more likely potential problems or violations will remain unaddressed,” the report says.