Water damage and mold inside an adult daycare facility in Mississippi Credit: Office of Inspector General

After inspecting 20 Mississippi adult day care facilities, a federal oversight agency found that every facility it reviewed violated one or more state regulations, according to a report released Thursday.

The report, from the Office of the Inspector General at the U.S. Department of Health and Human Services, also found that Mississippi did not fully comply with federal and state requirements because the state’s own yearly inspections of adult day care facilities “(failed) to ensure a continuously safe and nonhazardous environment.”

The reason, according to the report, is that the state has chipped away at the funds it needs to regulate these facilities, which care for some of the state’s most vulnerable adults.

“According to Mississippi officials, budget reductions and low auditor staffing levels limited its oversight and monitoring of provider facilities, staffing, and training, and the lack of state licensing requirements contributed to provider noncompliance,” the report states.

In total the Office of Inspector General found 564 instances of provider noncompliance, including 194 regarding health and safety requirements.

Those safety violations included: toxic chemicals in accessible areas, exposed electrical wiring, and resident rooms that contained water damage, mold, and in one bathroom, a dead rodent. Food service areas and facility exteriors were also deemed unsanitary, and barbed wire was found just steps from outdoor seating area.

The remaining 370 violations were related to administrative requirements, according to the report, “some of which could significantly affect health and safety.”

“Vulnerable adults were at risk in numerous instances due to providers’ noncompliance of one or more health and safety requirements,” said Lori Pilcher, Regional Inspector General for the Office of Inspector General.  “We recommend that Mississippi implement a number of actions to protect these beneficiaries, starting with ensuring that providers correct the 564 instances of provider noncompliance identified in our report.”

The Mississippi Division of Medicaid, which conducts the state inspections, did not disagree with the OIG’s findings and offered ways to fix the violations. But in a letter addressed to the Office of Inspector General, included in the report, the agency also argued that blame for these violations should fall on the day care providers rather than the state agency itself.

The Office of Inspector General disagreed, arguing that while the day care providers were responsible for the violations, Mississippi still did not comply with oversight and monitoring.

In the letter included in the report’s appendix, the Division of Medicaid said it will complete a corrective action plan for each of the 564 violations and follow it with an audit to ensure the violations have been corrected.

Currently, adult day care facilities in the state of Mississippi are not required to obtain a license. The Division of Medicaid responded that it would work with the Legislature to change that to “ensure monitoring and oversight occur on a regular and consistent basis by an entity appropriately trained in health care facility standards.”

The Office of Inspector General conducted its audits between Sept. 11th and 22nd of last year and had a call with the Division of Medicaid in February to review the draft of the report.

Between April and July of this year, the Division of Medicaid completed 109 audits of adult day care facilities, and closed 13 as a result of the findings. The Division of Medicaid said in its letter that it “is committed to auditing all adult day facility providers which submitted claims for waiver services and are not under active investigation by the Attorney General Medicaid Fraud Control Unit.”

The Mississippi Elderly and Disabled Waiver program funds home and community-based services for people aged 65 and older and individuals with disabilities aged 21 to 64 who are eligible for medical assistance and require the level of care provided in a nursing home but have chosen to live in the community. The program pays for these services through a federal Medicaid waiver. Of the 133 programs in Mississippi that provide these services the Office of Inspector General chose the 20 it reviewed based on geography and size.

A link to the report can be found here.

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Larrison Campbell is a Greenville native who reports on politics with an emphasis on public health. She received a bachelor’s from Wesleyan University and a master’s from Columbia University's Graduate School of Journalism.Larrison is a 2018 National Press Foundation fellow in public health, a 2019 Blue Cross Blue Shield Foundation of Massachusetts fellow in health care reporting and a 2019 Center for Health Journalism National Fellow.