Elder abuse is a growing problem in the United States – and one that potentially impacts all of us. One of the biggest obstacles to prosecuting perpetrators of elder abuse is the simple fact that the majority of victims do not report the abuse. Efforts have been made to encourage health care workers to be on the lookout for signs of elder abuse and report their suspicions to the appropriate authorities, similar to the reporting requirements for suspected child abuse cases. Unfortunately, however, recently published reports confirm that health workers are failing to report suspected elder abuse. The research, conducted and published by the Office of Inspector General of the U.S. Department of Health and Human Services, finds that in many cases of abuse or neglect severe enough to require medical attention, the incidents have not been reported to enforcement agencies despite the fact that the law requires it to be reported.
The Health and Human Services Report
One of the studies focuses solely on the possible abuse of nursing home residents who end up in emergency rooms. The report looks at claims sent to Medicare in 2016 for treatment of head injuries, body bruises, bed sores and other diagnoses that might indicate physical abuse, sexual abuse or severe neglect. Gloria Jarmon, Deputy Inspector General for audit services, says her team found that nursing homes failed to report nearly 1 in 5 of these potential cases to the state inspection agencies charged with investigating them. “Some of the cases we saw, a person is treated in an emergency room [and] they’re sent back to the same facility where they were potentially abused and neglected,” Jarmon says. But the failure to record and follow up on possible cases of elder abuse is not just the fault of the nursing homes. Jarmon says that in five states where nursing home inspectors did investigate and substantiate cases of abuse, “97 percent of those had not been reported to local law enforcement as required.” One problem appears to be that state inspectors of nursing homes who participated in the study appeared to be confused about when they were required to refer cases to law enforcement, Jarmon notes. One state agency said that it contacted the police only for what it called “the most serious abuse cases.”
The second study looked at Medicare claims for the treatment of potential abuse or neglect of older adults, regardless of where it took place. The data were collected on incidents occurring between January of 2015 and June of 2017. That study, published by the OIG, identified 34,664 Medicare claims that contained diagnosis codes indicating the treatment of injuries potentially caused by abuse or neglect of Medicare beneficiaries. They estimated that 30,754 of those Medicare claims were supported by medical records that contained evidence of potential abuse or neglect. They further estimated that, of the claims in the population associated with incidents of potential abuse or neglect, 2,574 were allegedly perpetrated by a healthcare worker, 3,330 were related to incidents that occurred in a medical facility, and 9,294 were related to incidents that were not reported to law enforcement.
“It’s very important that the first person who notices this potential abuse and neglect reports it, because then they can begin the investigative process to determine if abuse or neglect occurred,” says Jarmon. “And if it’s not reported, it can’t be tracked.” The HHS report says that Medicare could do a better job of analyzing the data it has on hand. It recommends that the Centers for Medicare & Medicaid Services, which oversees the health care program for older Americans, should periodically examine claims for treatment, looking for diagnoses that suggest possible abuse or neglect, as well as where and when those cases occur. “You have to be able to get the data to see how bad the problem is,” says Jarmon, “so that “everybody who can take action has it.”
Unfortunately, the Centers for Medicare & Medicaid Services, which pays for much of the health care for seniors and provides guidance on the reporting required of health care workers and health care facilities, has rejected most of the reports’ recommendations. In a written response, it argues that it can take up to a year for Medicare claims to be filed. So analyzing such claims, CMS says, would “not be [a] timely enough” way to identify and respond to cases of elder abuse and neglect. The Inspector General’s report counters that the vast majority of Medicare claims are filed within a month, not a year. And Gloria Jarmon says that just letting state agencies and health care providers know that they’re being tracked could reduce the problem of elder abuse.
Contact a Waukegan Elder Law Attorney
For more information, please join us for a FREE estate planning seminar. If you are concerned that an older loved one is the victim of elder abuse in Illinois, contact an experienced Waukegan elder law attorney at Hedeker Law, Ltd. by calling (847) 913-5415 to schedule an appointment.