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GAO Reports

  • CMS Should Continue to Improve Data and Oversight (October 2015)

    • The General Accountability Office (GAO) in 2015 ran a study examining the factors that initiate a change in nursing home quality, evaluate the change in CMS oversight, and analyze changes in standard surveys, consumer complaints, staffing levels, and clinical quality measures in both national and state levels. This study found that during the time period of 2005-2014, despite consumer complaints per nursing home increasing by 21%, the average number of deficiencies per nursing home has significantly decreased by 41% indicating improvement. The data collected can be skewed by various issues which make it difficult to determine the accuracy of these trends, and whether they are attributed to changes in quality, data issues, or both. GAO recommends that CMS implements a clear plan to audit self-reported data, as well as, establishing a process for monitoring oversight modifications. This will ensure a better understanding of the effects on nursing home quality oversight and make quality of stay better for its’ residents. 

  • HHS Has Initiatives to Reduce Use among Older Adults in Nursing Homes, but Should Expand Efforts to Other Settings (January 2015)

    • The General Accountability Office (GAO) conducted an examination of psychotropic drug use in older adult nursing home residents. The report examined the extent at which antipsychotic drugs are prescribed for older adults with dementia, what is known about the factors contributing to such prescribing, and to what extent the Department of Health and Human Services (HHS) has taken action to reduce the use of these drugs. GAO found that about one-third of older adults with dementia who spent more than 100 days in a nursing home in 2012 were prescribed an antipsychotic, according to Medicare Part D. Further, GAO found that nursing homes that have low staff levels tend to have a higher antipsychotic drug use among their residents. It is recommended that HHS expands outreach to reduce antipsychotic drug use among older adults with dementia. 

  • Financial Characteristics of Approved Applicants and Methods Used to Reduce Assets to Qualify for Nursing Home Coverage (May 2014)

    • Medicaid has paid for almost one-third of the nation’s $158 billion in nursing home expenditures in 2012. Individuals who wish to be eligible for Medicaid cannot have assets above certain limits. Despite this, some individuals find loopholes by paying down their assets to be eligible for Medicaid.  GAO examined financial characteristic of individuals approved for Medicaid nursing home coverage, identified the loopholes, and identified information that is considered useful when assessing the individual’s financial eligibility. The report found that 75% of individuals approved owned some non-countable resources (burial costs, annuity, gifts, and spouse asses) which averaged $12, 530. GAO found that bank statements are the best source of information when assessing financial eligibility of the individual because they are able to show unreported assets such as life insurance policies. 

  • CMS’s Special Focus Facility Methodology Should Better Target the Most Poorly Performing Homes, Which Tended to Be Chain Affiliated and For-Profit (August 2009)

    • According to the General Accountability Office (GAO) almost 4 percent (580) of 16,000 nursing homes in the United States could be considered poorly performing. The GAO determined the number of most poorly performing homes nationwide, how their performance compared to homes identified using the SFF methodology, and characteristics of such homes. Through the Special Focus Facility methodology, GAO was able to assign points to deficiencies cited on standard surveys and complaint investigations, and then revisit them to make sure that the deficiencies have been corrected. GAO found that the most poorly performing nursing homes had clearly more deficiencies with the potential for more than minimal harm and revisits than other nursing homes. In addition, these poorly performing homes tended to be chain affiliated and for-profit, which tend to have more residents. GAO is recommending that CMS consider reevaluating SFF Methodology identifiers to provide a more efficient data that in turn provides a better experience for residents in the nursing home. 

  • Despite Increased Oversight, Challenges Remain in Ensuring High-Quality Care and Resident Safety (December 2005)

    • The General Accountability Office (GAO) conducted a study that ran from 1999-2005 assessing nursing home standards in partnership with the Centers for Medicare & Medicaid Services (CMS) survey. In this study, the GAO assessed the overall trend in nursing home quality, evaluated CMS's initiatives, and identified challenges to nursing home residents. The data from the study showed significant decrease in the quality of nursing home problems, but there is still more work to be done. CMS has improved nursing home quality by installing automatic sprinklers in case of a fire, retaining survey staff, and increased oversight.  In the coming years, CMS hopes to increase insight to further progress nursing home standards for its’ residents.