become more reliable in recent years, even as their data suggest increasing incidence. As part of their responsibilities, the ombudsman program established a National Ombudsman Reporting System (NORS), using standardized definitions of complaint types and resolutions (Administration on Aging, 1998). The 1998 compilation of complaints received by the state Long-Term Care Ombudsman program and its parent agency, the Administration on Aging, using the NORS system, found that, nationwide, physical abuse was one of the five most frequent complaints to ombudsmen about nursing homes (Administration on Aging, 2000). Ten percent, or about 20,000, of the complaints received by ombudsmen during FY 1998 involved allegations of abuse, gross neglect, or exploitation, while another 5 percent related to financial abuse and misappropriation of property. In addition, ombudsmen reported more than 1,700 allegations of sexual abuse of nursing home residents during a two-year period (Burgess, personal communication,7November 2000; see also Burgess et al., 2000).

Deficiency Citations for Abuse

Ninety-six percent of all facilities nationwide participate in the Medicare or Medicaid programs or both (Strahan, 1997). These facilities are subject to annual surveys and to complaint investigations under federal law and regulation governing participation in these programs. These surveys also provide evidence of abuse and neglect in nursing homes.

Office of the DHHS Inspector General

The Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services reviewed data from the Health Care Financing Administration’s (HCFA) Online Survey Certification and Reporting System (OSCAR) for one full survey cycle (1997–1998) in 10 states. The OIG found 4,707 abuse complaints, involving nearly one-third of the facilities certified to participate in the Medicare or Medicaid programs.8

Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS, formerly HCFA) has reported even more current data on abuse in nursing homes. In


Personal communication and presentation at the Forensic Conference on Elder Abuse and briefing for Attorney General Reno, sponsored by the U.S. Department of Justice, Washington, DC, November 2000.


The vast majority of complaints (e.g., about two-thirds) were not substantiated, an issue discussed at greater length in the body of this report.

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