The Texas Department of Health and Human Services (HHSC) is responsible for licensing, certifying, and inspecting assisted living centers to ensure they comply with state and federal laws and regulations. On average, HHSC surveys each provider every three years and inspects each facility every two years. Marshall and colleagues have suggested that elder abuse is more common in homes than in institutional or residential settings, but they do not provide evidence to support this claim (Marshall et al.). To learn more about these providers and facilities, the Long-Term Care Provider (LTC) Search Tool can be used.
RCF consumers face a series of daunting challenges to protect their interests and ensure adequate health care. Home Health Compare is a federal website that contains information about the quality of care provided by Medicare-certified home health agencies around the country. Both studies revealed that most nurses (59% and 66%, respectively) were unaware of laws on elder abuse, and a surprising number of nurses (43%) who worked in the emergency room or at home health centers were unaware of the state's mandatory reporting requirements. In interviews with residents about whether they had ever submitted complaints about the care they received and how they had managed it, Barbara Bowers and I had great difficulty getting residents to talk about this difficult topic. For example, ombudsmen handled 121,686 cases in fiscal year 1998, but 82 percent of those cases were in nursing homes; only 17 percent were residents of residential care facilities. A study that surveyed agencies in 22 states reported 15,612 cases related to complaints of abuse from nursing home residents received by agencies such as Adult Protective Services, ombudsmen, and state Medicaid fraud units, which are responsible for prosecuting nursing home-related abuse cases (Tatara, 1990). The Department of Health and Human Services reviewed data from the Health Care Funding Administration (HCFA) Online Survey Reporting and Certification System (OSCAR) during a full cycle of surveys (1997-1999) in 10 states. There are relatively few studies on health professionals and problems related to the abuse of nursing home residents, and most of those that exist focus on the lack of complaints and the reasons for this phenomenon.
In residential care facilities, less up-to-date information is available to make sampling decisions about residents. Even more immediate data is available in the national database that CMS maintains on all nursing home residents in all nursing homes certified to participate in Medicare or Medicaid programs.