Tag Archives: nursing homes

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.

Core Topics
Health Reform
Aging
Other Topics

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

Aging in LGBT community comes with anxiety, silence for some

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.

For a generation of lesbian, gay, bisexual and transgender adults now in their 60s, 70s and 80s, silence was, for a long time, a way of life.

Stu Maddux
Stu Maddux

Growing old and becoming ill and dependent can stir up painful feelings. Am I a worthwhile person? Will others stay by me or abandon me if I show them who I really am? Can I trust that I won’t be judged? Will I be treated well if I display my vulnerability, or do I have to put up my guard?

Filmmaker Stu Maddux, a former television journalist, anchor and producer, takes us inside this world in Gen Silent, a film that profiles six LGBT seniors and the issues they’re facing as they age. Maddux recently spoke at length with AHCJ topic leader Judith Graham about making this film and we share highlights of that conversation.

Housing, economic crises affect seniors’ health; briefing on long-term care

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.

Many of you may have focused on Alzheimer’s disease and AIDS in the past few weeks, with major international conferences on both subjects. If you’re like me, you probably missed other developments on the aging beat while trying to keep up. Here are a few recent reports that may have escaped your attention:

Core Topics
Health Reform
Aging
Other Topics

Nightmare on Main Street: Older Americans and the Mortgage Market Crisis, from AARP

This is the most comprehensive examination to date at how the housing crisis has affected older Americans. The key findings, as described on AARP’s website:

“As of December 2011, approximately 3.5 million loans of people age 50+ were underwater-meaning homeowners owe more than their home is worth, so they have no equity; 600,000 loans of people age 50+ were in foreclosure, and another 625,000 loans were 90 or more days delinquent. From 2007 to 2011, more than 1.5 million older Americans lost their homes as a result of the mortgage crisis.”

The New York Times was one of the few publications to write about the AARP report. An excerpt from that story highlights the economic insecurity that many older adults are experiencing:

“(O)lder Americans are losing their homes because of pension cuts, rising medical costs, shrinking stock portfolios and falling property values, according to Debra Whitman, AARP’s executive vice president for policy. They are also not saving enough money. Half of households whose head is between 65 and 74 have no money in retirement accounts, according to the Federal Reserve.”

What are the health care implications? Older adults without secure housing are less likely to seek ongoing care and more likely to develop preventable complications from existing conditions as they struggle to keep afloat.

Watch for a tip sheet on the economic status of older adults on the AHCJ website in the months to come.

Securing our Future: Advancing Economic Security for Diverse Elders, from the Diverse Elders Coalition

Another look at the economic crisis and older Americans, this documents the special challenges faced by seniors of African-American, Hispanic, Asian American and Pacific Islander (AAPI) and other heritages. As noted in the introduction, all these groups experience disproportionately high poverty rates: Continue reading

Investigation reveals N.Y. lax on home care oversight

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In the Albany (N.Y.) Times Union, Matt Drange’s investigation is titled “Home health care in crisis.” Having read the piece, I can say it’s safe to take that declaration at face value. At the very time that home care is booming in New York as a cheaper, more convenient alternative to nursing homes, the state has cut back on its number of health inspectors. Meanwhile, the complexity of home care cases is rising, as hospitals release patients earlier and the population as a whole ages. The results, Drange writes, have been predictable.

Lapses have gone undetected or, in many cases, unpunished by the Department of Health, the arm of state government tasked with overseeing home health agencies. Providers are not required to notify the department when patients experience sudden or unexpected changes in their condition, including death. And even when the state does learn about these incidents, it doesn’t always act on the information, records show.

For the investigation, Drange looked at public records regarding Medicaid billing, home care agency registration and plenty of state inspection reports. He focused his review on 40 of the worst offenders, and found more than enough examples to illustrate a system in crisis. Drange’s anecdotes recount numerous egregious lapses in care, and I strongly recommend digging into the meat of the piece, if only to see what incredible detail he found in public records. For now though, at the risk of mild spoilers, I’ll just reveal that they all end in the same way: The problem goes undetected, unenforced, or underpunished.

In the end, as reporters have found in other states as well, the root of the problem seems to be a weak and vaguely defined regulatory system. In his investigation, for example, Drange found a sharp contrast between the oversight of nursing homes and home care, two institutions which often perform similar functions.

(Researcher Sam Krinsky of the United Healthcare Workers East 1199 Union) said the culture of home care differs vastly from that of nursing homes, which have received more attention in New York and elsewhere.

Statements of deficiencies issued to home care agencies by the Department of Health are “not something that we take seriously,” Krinsky said.

“In nursing homes, the inspections are a big deal. There are a lot more regulations they have to comply with … It’s just a much more robust system,” he said. “In home care, it’s more of a review of paperwork. It [Department of Health] doesn’t have any teeth.”

Your thoughts on this story?

Drange, an AHCJ member and recent graduate of the Columbia Journalism School, did this investigation as his master’s project. He invites feedback from other health care reporters about the story and anything he could have done differently. Feel free to comment below or send your thoughts to him at mattdrange@gmail.com or on Twitter (@mattdrange).