GAO Report Reveals Little Accountability for Regular “Critical Incidents” in Assisted Living Facilities

GAO Report Reveals Little Accountability for Regular “Critical Incidents” in Assisted Living Facilities

The Government Accountability Office (GAO) recently released a report revealing that thousands of “Critical Incidents” in assisted living facilities occur regularly with little accountability. Because older people and people with disabilities receiving Medicaid assisted living services—over 330,000 in 2014—are vulnerable to abuse, neglect or exploitation, the Centers for Medicare & Medicaid Services is charged with overseeing how states monitor such incidents. Yet, as evident from this report’s findings, CMS guidance has not been strong or clear enough. This report highlights the necessity for new federal protections for assisted living residents and standards that ensure their safety and respect.

According to the GAO, “More than half of the 48 states providing these services couldn’t tell us the number or nature of critical incidents in assisted living facilities. In addition, states may not be monitoring things you might expect them to. For example, 3 states don’t monitor unexpected or unexplained deaths.”

Below are some of the GAO report’s key findings as summarized in the joint statement from the Center for Medicare Advocacy and Long Term Care Community Coalition:

  1. Americans spend more than $10 billion per year in federal and state Medicaid funding to provide access to assisted living for 330,000 people.
  2. Nationally, the average spending per beneficiary on assisted living services in the 48 states in 2014 was about $30,000.
  3. Though state Medicaid agencies retain “ultimate administrative authority and responsibility” over the quality, safety, and integrity of Medicaid assisted living services, GAO found that:
  • Fewer than half the states surveyed (22 of the 48) were able to provide any informationon abuse, neglect, exploitation, and death of residents (so-called “Critical Incidents”).
  • Those 22 states alone reported nearly 23,000 Critical Incidents in 2014.
  • Delegation of important responsibilities from the state agencies to other agencies is widespread. Despite fundamental responsibility to oversee quality and safety, GAO identified significant failures among state agencies to even review Critical Incident reports, exclusion lists, reports of abuse, and LTC Ombudsman findings, provided by those agencies.
  • The 48 state Medicaid agencies varied in: their ability to report the number of Critical Incidents in their states; how they defined what a Critical Incident is, and the extent to which they made information on Critical Incidents readily available to the public.

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(Source of graphic: GAO survey of state Medicaid agencies GAO-18-179)

The findings of this GAO report are unacceptable. California Health Advocates joins CMA and LTCCC in calling for immediate steps to:

  • Protect assisted living residents with strong and adequate standards to ensure safety and dignity;
  • Develop federal and state websites, similar to Nursing Home Compare, with validated information on staffing, inspection results, complaints, and “Critical Incidents.”

For more information, read the full GAO report: Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare Is Needed.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.