Gov. Steve Beshear ordered state officials to immediately implement 20 improvements to the way reports of abuse and neglect at Kentucky nursing homes are investigated.
A better process of notifying local law enforcement about allegations; more required training; and more intensive, coordinated investigations are all part of the recommendations announced Friday.
Beshear called for a review after a series of Herald-Leader articles pointed out gaps in the way cases of alleged neglect and abuse at nursing homes are handled and overseen.
The Herald-Leader examined 107 Type A citations — those issued when a resident's life or safety has been endangered — issued over a three-year period by the Cabinet for Health and Family Services.
The investigation found cracks in the system, as only seven of the 107 cases of nursing home deaths or abuse cases were prosecuted as crimes.
The citations involved 18 deaths, 30 hospitalizations, five broken bones and two amputations that resulted from violations of state regulations. Thirteen residents were injured as a result of lapses by staff members, according to the citations.
The newspaper found that some cases languished and the attorney general's office misplaced or never received at least five citations issued by the cabinet from December 2006 through 2009.
After the newspaper series' initial articles ran, Beshear asked Janie Miller, secretary of the cabinet, and others to review the effectiveness of the coordination of efforts among state agencies and local prosecutors and law enforcement.
Several agencies, advocacy groups and industry representatives contributed to the report announced Friday.
Prosecutors told cabinet officials that coroners are hardly ever called in cases of suspected abuse and neglect. Coroners should be notified, and autopsies should be performed, they said.
They said law enforcement officers needed more training to investigate the allegations. Law enforcement officers asked to get reports of abuse and neglect more quickly and said they needed cameras and video equipment to preserve evidence.
The report noted that the system should be similar to the model Kentucky has already created for identifying and addressing neglect and abuse of children.
"Those same components are critical to bring together the elements of a system necessary to prevent, detect, investigate and prosecute adult neglect and abuse," said Miller, the cabinet secretary.
The report also calls for tracking which officials are notified of Type A citations.
Advocates on Friday said the recommendations appeared to be a step toward improving investigations.
Bernie Vonderheide, founder of Kentuckians for Nursing Home Reform, said he had not yet analyzed the report.
But Vonderheide said that based on a quick read, "It shows progress. It's a good start."
Marsha Hockensmith, director of Kentucky Protection and Advocacy, said it appeared that the cabinet had included some suggestions from her agency.
"Training and helping the front-line folks who are doing the investigation is a very good thing," said Hockensmith.
Making information about citations given to nursing homes easier for the public to understand is going to be helpful, Hockensmith said.
In Kentucky, the Cabinet for Health and Family Services sends all serious citations to Attorney General Jack Conway's office, and the office's Office of Medicaid Fraud and Abuse Control decides whether to prosecute. In the report, the attorney general's office recommended stiffer penalties for abuse and failure to report suspected abuse.
Nursing home industry leaders asked the cabinet to improve staffing and turnover of nursing home inspectors and to better train both inspectors and nursing home staff.
On Friday, one nursing home industry leader voiced support for the examination that resulted in the recommendations
"While instances of abuse and neglect in Kentucky's Long Term Care facilities are not the norm, even one instance of abuse is one too many," said Tim Veno, president of the Kentucky Association of Homes and Services for the Aging.
The recommendations released Friday included:
■ Improve the cabinet's notification to local agencies of suspected adult abuse and neglect.
■ Establish regional specialized Adult Protective Service teams in the Department for Community Based Services.
■ Allow better information sharing through electronics and by establishing joint investigative teams.
■ Involve coroners' offices more effectively during investigations.
■ Increase the training of long-term care investigators in the Office of Inspector General.
■ Explore the possibility of buying cameras and video recorders to document evidence
■ Revitalize an Elder Abuse Committee that is mandated by law.
■ Amend licensing regulations to require in-service training on abuse and neglect for all long-term care facility staff.
■ Provide training for law enforcement officials and prosecutors on elder abuse and neglect issues.
■ Publish statements of deficiencies issued by the Office of Inspector General in an easy-to-use format for the public.