Archived: Reduce the long-term care facility complaint investigation backlog of non-immediate jeopardy complaints

Washington State is committed to providing oversight to assure safe, high quality facilities for seniors and adults with disabilities who need long-term care or specialized residential supports.

In addition to the many individuals who are served at home, Washington State has over 3,000 residential care facilities providing services to seniors and adults with disabilities. These include adult family homes, assisted living facilities, nursing homes, enhanced services facilities, and supported living and other certified services for people with developmental disabilities. The number of these facilities will continue to grow to meet the demands of an increasing population requiring care. All residential care facilities are licensed or certified and inspected by the state. Complaints about health, safety, and quality of care are investigated, with follow-up action required by the facilities, subject to enforcement by the state if needed.

Complaint volumes have increased both because the number of facility residents has grown, and because of improved reporting by the public and service providers. To best support safety, reduce harm and improve quality care, all complaints investigations should begin timely, according to the seriousness and immediacy of risk to residents. By conducting investigations in a timely way, we can 1) protect residents from abuse, neglect and exploitation; 2) make quality referrals to entities that help protect victims; 3) prevent the occurrence of abuse, neglect, and exploitation; and 4) improve care practices at facilities resulting in improved outcomes for residents.

Examples of what we investigate include: suspected abuse and neglect (partnered with Adult Protective Services), medication errors, failure of a facility to address an ongoing health issue (i.e. repeated falls, unexplained weight loss, developing bed sores), violations of resident rights, and inadequate record keeping and communication, including changes in a resident’s condition.

Due to the increase in the number of complaints, coupled with our limited investigative staff, it has been difficult to start investigations timely, except for our highest priority complaints where there is a risk of immediate jeopardy/harm to the resident. In September 2015, when this issue was first presented to Results Washington, there was a backlog of over 2,100 overdue complaints about residential care facilities. These were complaints where investigations had not yet been started and were overdue.

By April 2016, we had cut the backlog by more than half, and as of March 2017 our backlog is 80. We have revised our target from a maximum backlog of 500 to 100. Eventually we will effectively eliminate any backlog and keep up with the amount of complaints that are received. This will allow us to reduce the risk of harm and improve facility practices that enhance resident health, quality of life and safety.

We are actively using a number of strategies, including deploying more resources, using Lean tools,and taking a more modern, flexible approach to staffing and information technology. Specific action steps include:

• Recruiting and hiring per diem staff, and cross-training existing staff to accommodate high volume periods and when regular staff are on leave.
• Aggressively filling existing vacancies to keep staffing levels stable.
• Shifting staff from one region to another to help regions with higher complaint volumes avoid a backlog.
• Improving staff training in investigations and data keeping.
• Implementing remote access technology statewide to allow field staff to access investigation databases from any location with Wi-Fi access rather than returning to their offices.
• Improving data reporting so that we have timely,quality information to guide our actions.

If you know someone in a residential care facility such as a nursing home, adult family home, assisted living, supported living, or enhanced services facility, pay attention to their care and environment and take action about concerns. We are all partners in keeping our community safe. “If you see something, say something.” If you need to report health and safety concerns about a specific facility, contact the Complaint Resolution Unit at 1-800-562-6078.

If you suspect abuse or neglect please call 1-866-END-HARM (1-866-363-4276). (If the person is in immediate danger, call 911.) You do not need proof to report suspected abuse, and you do not need to give your name when you call.