Regulators haven’t found a way to fully account for the ways Alzheimer’s disease and related dementias affect the nursing home complaint process, likely leaving some deficiencies unaddressed, a new study finds.

More training in facilities and more timely regulatory oversight is needed to accurately assess care quality and convey accurate information to consumers, study authors said.

Researchers focused on resident care complaints that did not result in formal deficiencies. These may have simply been unsubstantiated after an investigation, or they also may have been deemed as valid but without sufficient proof or an existing regulation to trigger a deficiency. 

Nursing homes with large numbers of residents with ADRD had “significantly higher” zero-deficiency complaints of all varieties, according to the study. Specifically, high-ADRD nursing homes averaged 0.19 more zero-deficiency complaints and 0.24 more zero-deficiency substantiated complaints per year than low-ADRD nursing homes.  

This suggests that cognitively impaired residents’ needs are not being adequately met by the complaint process, according to the researchers. 

“Our results point toward the possibility of residents with ADRD, or representatives of those residents, generating complaints that might not be adequately addressed by investigators because the follow-up regulatory process is not sufficiently sensitive to their cognitive limitations,” they wrote.

A resident’s cognitive limitations might make it more difficult to communicate the details of a complaint, for example, or to corroborate details with investigators later. This might be exacerbated by a backlog of surveys which leads to untimely investigations, according to the researchers.

Meeting residents’ needs

Lead author Kallol Kumar Bhattacharyya, PhD, of Utah State University acknowledged that staffing concerns make resolving this issue a challenge for nursing homes, but suggested that they should take more steps to ensure these high-need residents are receiving the best care.

“Adequate training for all levels of nursing home staff is a must,” Bhattacharyya told McKnight’s Long-Term Care News Thursday. “At the same time, proper monitoring of staff behavior is also necessary to ensure the residents’ quality of life.”

Regulators could also benefit from more training in how to approach complaints from cognitively impaired residents, Bhattacharyya said, especially how to gather information effectively from the residents involved and from their families.

The authors also highlighted the importance of revamping the survey process to make results more responsive to a highly vulnerable part of the skilled nursing population. 

“The failure to investigate complaints in a timely way may lead to serious quality deficits going undetected and unremedied,” they wrote. “The Inspector General for the U.S. Department of Health and Human Services has repeatedly highlighted the prevalence of late inspections in some states, raising questions about states’ abilities to address serious complaints. When a serious complaint is not quickly investigated, essential evidence can be lost.”

Surveys have been an area of increasing confusion and concern for both providers and regulators in recent years. The HHS Office of Inspector General recently announced plans to audit the Centers for Medicare & Medicaid Services’ use of contractors for state surveys.