A highly critical report on Minnesota's Office of Health Facilities Complaints concludes that problems with the investigative structure and mistrust in management are to blame for an inadequate response to abuse allegations.
Legislative Auditor Jim Nobles released the lengthy report Tuesday after a nearly year-long review by his office. Auditors documented lapses in record keeping, overburdened investigators, high staff turnover and low morale at the office created to keep watch over licensed health care facilities that care for vulnerable and older adults.
"The problems at OHFC are deep and pervasive and they have been there a long time," Nobles told a Minnesota House committee reviewing the report. "They are rooted in poor management that was tolerated and ignored far too long."
Allegations received by the health facilities office have risen in recent years, topping 24,000 in the last full year reviewed by auditors. That was up from about 15,700 five years earlier. While the office's funding and staff complement have gone up, too, it hasn't been enough to keep up. Some investigators had more than 40 open cases assigned to them, far more than the goal of 15.
It has contributed to a high rate of staff turnover. Employees also told auditors in surveys that they lacked proper training.
"I was set up to fail, and I can never catch up," one told the auditors.
Auditors said another difficulty is a complex regulatory structure that straddles several state and county agencies, making it tough to determine which has jurisdiction to take on complaints and impose consequences for maltreatment.
The audit is part of an intense focus this year on elder care abuse and the state's response to it. Abuse can be physical assault, emotional intimidation, neglect or financial exploitation.
Judy Randall, the lead auditor, said her team shadowed investigators on site visits and other steps in the investigation and found those employees to be passionate and sincere in their work. But she said problems that took a long time to "get as bad as they are" will take a long time to repair.
"It took a long time for the problems to get as bad as they are," Randall said. "It's going to take a long time to get it back to where it needs to be."
The report recommends that legislators exercise more oversight and demand more regular progress reports. They also said the state should consider a new fine structure for facilities where complaints have been substantiated. And it says patients and potential patients should be able to access more information about complaints about facilities and what was done to address them.
Health Department Commissioner Jan Malcolm, who is only a month into the job, called the report "extraordinary" and "incredibly helpful."
"I agree with virtually every one of them, at least in terms of the spirit and substance of the recommendations," Malcolm told lawmakers.
She said the agency, along with the Department of Human Services, has already taken steps to reduce the backlog of outstanding complaints. She said all 2,300 complaint reports at the start of the year that hadn't been even looked at have now been reviewed, and many deeper investigations are moving along. The commissioner said a new document management system has been implemented to better handle the 400-plus complaints that come in each week.
"This work has begun but is not completed," Malcolm said, declaring her agency open to recommendations from lawmakers and others with a stake in the operations of care facilities.