Tag Archives: nursing homes

Rise in nursing home infection rates lead to avoidable complications, deaths

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

Infections among nursing home residents are rising, according to a study presented Oct. 8, 2014, at IDWeek (an international gathering of experts in infectious disease and epidemiology).

Image by Ulrich Joho via flickr.

Image by Ulrich Joho via flickr.

Researchers from Columbia University School of Nursing and RAND Corporation analyzed infections in nursing homes over a five-year period from 2006-2010, using Minimum Data Set assessment data – the information submitted by the facilities to the Centers for Medicare and Medicaid. They found significantly increased infection rates for pneumonia, urinary tract infections (UTIs), viral hepatitis, septicemia, wound infections, and multiple drug-resistant organisms (MDROs), conditions that raise the risk of complications and death. Only tuberculosis rates did not show an increase.

Approximately 1.6 million to 3.8 million infections occur among U.S. nursing home residents each year. The new study found that UTIs remain, by far, the most frequently reported type of infection, but they also showed the smallest rise in prevalence – just 1 percent. Pneumonia was the second most common infection, and its prevalence rose 11 percent from 2006 to 2010. Infection rates increased 69.7 percent  for viral hepatitis, 25.2 percent for septicemia, 24.1 percent for pneumonia, 15.7 percent for MDRO and 4.6 percent for wound infections.

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AHCJ data include 16,806 nursing home deficiencies

Jeff Porter

About Jeff Porter

Jeff Porter is the special projects director for AHCJ and plays a lead role in planning conferences, workshops and other training events. He also leads the organization's data collection and data instruction efforts.

AHCJ’s latest update to nursing home inspection data gives members three years of the most severe deficiencies found during inspections and the current star ratings assigned by the U.S. Centers for Medicare and Medicaid Services.

The data could be a good starting point for reporters who want to pursue authoritative stories about their local nursing homes.

The data now contains 16,806 such deficiencies as recorded by CMS. Deficiencies are characterized by their severity, “A” being the least severe and “L” being the most severe. AHCJ pruned down the data to include just the most severe of the deficiencies, letters “G” through “L.” These range from an “isolated incident of actual harm” to “widespread immediate jeopardy to resident health or safety.”

Under its star rating system, CMS gives nursing homes between one and five stars. According to the CMS ratings web site “nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.” Each nursing home is given an overall rating, as well as three specific ratings: health inspections, staffing and quality measures.

The AHCJ version of nursing home data is derived from a large file that is split up for easier use by members.

Updated data available for covering nursing homes

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Every year, the Centers for Medicare & Medicaid issues a list of troubled nursing homes as part of its Special Focus Facility Initiative. CMS released an updated list on June 19 as a PDF and AHCJ has posted the list as a series of web pages and has made them available to download as Excel spreadsheets.

The initiative is intended to address nursing homes that cycle in and out of compliance. Homes in this program are visited by survey teams twice as frequently as other nursing homes. This list includes nursing homes added to the SFF initiative and updates the status of homes already in the program.

This year, 15 homes in 14 states were added to the list. Sixteen others were found to have “failed to show significant improvement,” 23 were deemed to have shown improvement, 33 have “graduated” from the program and four are no longer participating in Medicare/Medicaid.

Angelo Fichera of The Philadelphia Inquirer recently reported on one nursing home that will likely close after spending three years in the SFF Initiative, noting that CMS has not seen an improvement in care:

CMS expects that after two years on the watch list, nursing homes will either improve and “graduate” from the program; have funding terminated; or be granted an extension to improve because of “promising progress,” according to the agency.

To round out your reporting on nursing homes, AHCJ just updated its version of CMS’s Nursing Home Compare database, which includes details of the most severe deficiencies found during nursing home inspections for the past three years. AHCJ posted separate files covering the star ratings for nursing homes – from 1 to 5 – based on quality, inspection results, staffing and overall ratings.

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Past coverage

Explore how changing nursing home culture affects care

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

Nursing home rankingsAny journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.

For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes.  Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.

Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Continue reading

Data on special dementia care units released

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

A new data brief from the National Center for Health Statistics compares residential care communities with and without special dementia care units in 2010. About four in 10 residents (42 percent) living in residential care communities had Alzheimer’s disease or another dementia. Some states have specific requirements for residential care for these patients such as locked doors and specially trained staff.

Among the major findings:

    • 17 percent of residential care communities in the U.S. Had special dementia care units in 2010
    • Beds in these special units accounted for 13 percent  of all residential care beds
    • Facilities with special dementia care units were more likely to be chain-affiliated and built specifically as a residential care community, and less likely to be certified or to participate in Medicaid.
    • At least seven out of 10 residential care communities with dementia special care units had features such as specially trained staff (88 percent), an enclosed courtyard (82 percent), doors with keypads or electronic keys (79 percent), and locked exit doors (76 percent).
    • More residential communities with dementia care units were located in the Northeast or a metropolitan statistical area and less likely to be situated in the western U.S.

There are some helpful charts to put the data in visual perspective. Reporters may want to see how local residential facilities compare to the national data, or use these figures in combination with a story like this one from KSWB-San Diego – on how a daughter decided her parents needed to move to a care facility.

Advocacy group issues nursing home report card

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

Alaska is the place to be if you need nursing home care, but steer clear of Texas. Families for Better Care, a Florida-based nursing home resident advocacy group, published a new state-by-state nursing home report card which aggregates data from several key measures.

The group scored, ranked and graded states on eight different federal quality measures ranging from the percentage of facilities with severe deficiencies to the number of hours frontline caregivers averaged per resident per day. The organization analyzed results of staffing data compiled by the Kaiser Health Foundation, performance measures from the Center for Medicare and Medicaid Services’ Nursing Home Compare database, and the Office of State Long-Term Care Ombudsman complaint data to come up with the final grades.

The best nursing home states are Alaska, Rhode Island and New Hampshire; Texas, Louisiana and Indiana were at the bottom.

Other results included:

  • More professional nursing staff are needed  Only seven states provided more than one hour of professional nursing care per resident per day.
  • An overwhelming lack of staffing  96 percent of states offered residents fewer than three hours of direct resident care per day.
  • Widespread abuse and neglect – One in five nursing homes abused, neglected or mistreated residents in almost half of all states.

This is another good opportunity to review the list of nursing homes in your state and compare results. There are numerous story angles that can work here – for example, which nursing home ranks best/worst in your state and why? Are administrators doing anything to correct deficiencies? Are state officials aware of these problems? What, if any, action is being taken? What do family members think?

The 2013 Nursing Home Report Card is available for download.

How to cover nursing homes with more depth and data #ahcj13

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology, Home Care Technology report and on HealthStyles Radio (WBAI-FM, NYC). She is a senior fellow at the Center for Health, Media & Policy at Hunter College, NYC, and a co-produces HealthStyles for WBAI-FM/Pacifica Radio.

It was worth the wait to attend one of the last sessions on the last day of Health Journalism 2013.

Data mining is one of those topics that can make the audience’s eyes glaze over, but the energy level in the room was high as the audience learned how two Boston Globe reporters used publicly accessible records to expose widespread overmedication of Massachusetts nursing home residents, resulting in a highly acclaimed front-page series.

Health reporter Kay Lazar led a panel which included her colleague, reporter Matt Carroll, and Patricia Fried, a consultant to lawyers investigating nursing home wrongdoing, subcontractor to the Centers for Medicare and Medicaid Services, and experienced nursing home director.

Discovering the truth about nursing home residents’ quality of life can be challenging, Lazar said. However, once you understand what to look for and how to analyze the data, it unearths a wealth of information, and many potential story ideas. Much of the analysis conducted by Lazar and Carroll came from statements of deficiency (SOD) forms submitted to CMS by nursing home surveyors, also known as inspectors. Continue reading

Seniors have special concerns in natural disasters like Sandy

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

It’s well known that older adults are more vulnerable in times of natural disaster. But there’s nothing like a storm the size of Sandy to drive this point home.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

In the past week, we’ve read about New York City hospitals and nursing homes that decided to wait out the storm rather than evacuating. Sheri Fink, who won a Pulitzer Prize for her report on decisions made at Memorial Medical Center in the wake of Hurricane Katrina, got out ahead of Sandy and talked to city and state health officials as well as facility executives. Her ProPublica story is must-reading for anyone who wants to understand the thinking of officials responsible for preparing for the storm.

A take-home point: Evacuations can be extremely difficult for frail seniors living in nursing homes. Balancing the potential impact of displacing residents against the potential impact of sheltering in place during a storm isn’t easy.

I hope that reporters writing these kinds of Sandy-related stories take this into account. For another look at decisions made by city and state decisions vis a vis nursing homes, see this piece by Ben Hallman in the Huffington Post. Kudos to this reporter for going out during the storm and going to a site where nursing home residents were being sheltered. Continue reading

Health care watchdog agency provides ideas for stories in coming year

Len Bruzzese

About Len Bruzzese

Len Bruzzese is the executive director of AHCJ and its Center for Excellence in Health Care Journalism. He also is an associate professor at the Missouri School of Journalism and serves on the executive committee of the Council of National Journalism Organizations.

The HHS Office of Inspector General (OIG) has unveiled its FY 2013 OIG Work Plan , a blueprint for the watchdog agency’s work in the upcoming year and beyond.OIG 2013 Outlook Webcast at oig.hhs.gov

For enterprising health care reporters, this publication is like a catalog of story ideas, featuring hundreds of summaries of OIG’s upcoming reports, descriptions of its investigative and legal work, plus an overview of guidance it provides to the health care provider community.  Topics of upcoming reports include same-day hospital readmissions, oversight of poorly performing nursing homes, and FDA’s process for investigational new drug applications.

Also, on Oct. 24, OIG will launch its OIG Outlook 2013 webcast.  The free online event will include OIG’s senior leadership discussing emerging trends in combating fraud, waste and abuse in federal health care programs, OIG’s top priorities for 2013, and upcoming projects outlined in the Work Plan.

OIG’s mission is to protect the integrity of HHS’s 300+ programs – including Medicare and Medicaid – and the well-being of beneficiaries by conducting audits, evaluations, and investigations; providing guidance to the health care industry; and imposing civil monetary penalties, assessments and administrative sanctions.

New tool allows searches of nursing home inspection reports

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

For the first time, reporters anywhere in the country can search nursing home inspection reports online and see how often common problems pop up.

Thank you, ProPublica, for creating Nursing Home Inspect. It’ll make our jobs much easier, and be a valuable source of story ideas for many months to come.

Included at the moment are more than 20,000 reports from government inspections of 14,565 nursing homes, most since January 2011. The database will be updated monthly, ProPublica says, and that will make it even more helpful as time goes on.

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Deficiencies are noted when nursing homes are unclean or unsafe, or when staff harm elderly or disabled patients, or give medication inappropriately, or violate other standards of care. (These are just a few examples; there are many, many more.) Grades are awarded depending on the seriousness of the problem observed, with “A” being the least severe and “L” the most severe.

The inspection reports were posted online by the government in July – a first-of-its-kind public disclosure – but not in a format that made it possible to search them by keywords, cities, or nursing homes’ names. That’s where ProPublica’s new app comes in. Charlie Ornstein of ProPublica has written up helpful tips on using the database.

Reporters might want to begin by seeing which nursing homes in their city or state have been cited for deficiencies deemed most egregious, those with a letter grade of “K” or “L.” These are the facilities you might want to focus on if you were doing an investigation. (You’d surely want to know, however, if the problems identified persisted over time, and that kind of information isn’t yet available via ProPublica. To get it, you’ll have to ask government regulators to let you look at previous inspection reports.) Continue reading