The Minnesota Health Department (MDH) made improvements in 2019 in acting on the most serious nursing home complaints but still failed to respond to 38% of complaints on time.
In a Thursday e-mail to legislators, state officials, industry officials and elder advocates obtained by the Star Tribune, the department said it made the improvement amid a more than twofold increase in complaints and reports that alleged maltreatment so serious that it could present an ongoing risk to patients.
The department sent the e-mail after the Star Tribune reported this week that in 2018 its complaints investigation unit missed federally mandated deadlines for launching investigations in six out of 10 cases.
Federal guidelines require a response in serious maltreatment cases within two days. Response times averaged 13 days in 2018 and went down to four days on average in the federal fiscal year that ended in September, the department said.
“We remain confident we are on the right path and we are seeing increasing signs of improvement,” Health Commissioner Jan Malcolm said in the e-mail.
At issue are what are known as “immediate jeopardy” complaints, which could include physical and sexual assaults, systemic care issues like a pattern of medication errors or even cases in which nursing home staff post pictures of residents on social media. Not all of these complaints are substantiated, but the two-day response threshold is intended to stop and prevent any future maltreatment.
“There is a reason why there are federal regulations,” said Eilon Caspi, a gerontologist and research associate at the University of Minnesota School of Nursing. “Each of those immediate jeopardy complaints could be an emotional or physical trauma or death.”
In 2019, MDH did initiate more immediate jeopardy investigations on time compared to all similar complaints lodged in 2018, an indication that its systems and workforce became more robust to handle significantly higher volumes. MDH has been working on improvements after an upswell of criticism from the Legislature, the public and a scathing 2018 audit by the Office of the Legislative Auditor.
Yet of the 429 immediate jeopardy complaints in 2019, 164 did not meet the two-day federal response standard.
“They are catching up, I get that,” said Caspi, who said he was supportive of the progress MDH has made so far.
A co-founder of Elder Voice Family Advocates, Caspi said more needs to be done.
“Residents are waiting too long for this change and we’ve got to continue the pressure on MDH to be very focused on improvement,” he said.
With 129 immediate jeopardy complaints in 2018, the 230% increase partly reflects federal regulatory changes designed to toughen up enforcement.
Patti Cullen, the head of the senior care industry’s largest trade group, Care Providers of Minnesota, said media attention on maltreatment could also be a factor, as well as problems within the industry.
“There are multiple issues why we are seeing it and it could be that in some communities the care, it’s not as good,” she said. “Just like everywhere else we have staffing shortages.”
MDH said in a written statement that the increase was also the result of better screening of incoming complaints.
The agency added that it has increased the number of unannounced nursing home inspections, which are a second track of enforcement that are often not tied to a specific complaint.
As a result of putting more resources in those areas, MDH said, “we’ve not been able to be as timely in addressing the dramatic increase” in what are known as “high priority” complaints, which is one step below the immediate jeopardy category and require a response within 10 days. In 2019, 75% of these cases did not meet the response standard, compared to 56% in 2018. The number of high priority cases jumped 250% in 2019.
Malcolm said the department was continuing to work on ways to better screen and track reports and was working with the federal government to meet federal timeline requirements. The department also received additional funding from the Legislature as part of an effort to improve state oversight of the elder care industry.
“We are using the new funding from the 2019 session to hire and train additional staff and continue the restructuring of our regulatory programs so we can respond more quickly and efficiently in all areas of the state,” Malcolm said.