State Policies and Nursing Home Characteristics Associated With Rates of Resident Mistreatment

Background A federal complaint/incident system was implemented in 2004 with the stated purpose of promoting and protecting the health, safety, and the welfare of residents receiving health care services. This system provided the first national database of mistreatment in the nursing home setting. Methods The purpose of this research was to identify state and nursing home characteristics associated with the rates of nursing home resident mistreatment. Outcomes were incident reports filed by nursing home staff and complaints filed by persons other than service providers obtained from the federal complaints/incidents tracking system. Predictor variables used in the analysis of the reporting system included state legislation, census demographic data, and characteristics of the nursing home including aggregate characteristics of the residents. Results In 2004, based on complaint and incident reports, 1.6% of the nursing home population was reported to be mistreated. The average rates per 1000 residents were 16 reports, 14 investigations, and 4 substantiations. Incident report rates per 1000 ranged from 0.04 in Virginia to 46 in Alabama. Complaint report rates ranged from 0.42 in Hawaii to 52 in New Mexico. Incident outcomes were significantly lower in states that had nursing home statutes that require the facility, rather than the individual, to report mistreatment or in states that defined mistreatment in the nursing home differently from the definitions used by adult protective service statutes. Higher complaint outcomes were associated with lower levels of staffing. After controlling for resident characteristics, mistreatment measures remained associated with nursing home staffing levels but not with elements of statutes. Conclusions Documentation of nursing home mistreatment shows substantial differences in report rates across states. These differences cannot be explained by variations in the laws.