Tag Archives: nursing homes

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

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), 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 liz@healthjournalism.org.

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).

Tools, questions to see if nursing home oversight is really working in your area

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.

Any story that mentions maggots coming out of a patient’s ear is going to grab my attention.

After recovering from the “yuk” factor, I was appalled after reading Christina Jewett’s account last week of a new federal report on California’s nursing homes.

The report was issued by the Office of the Inspector General of the U.S. Department of Health and Human Services and it paints a sorry picture of nursing home oversight in the nation’s most populated state. It examined three homes that often send patients with severe infections or bed sores to nearby hospitals – an indicator of potentially poor quality care.

Among the study’s findings:

  • Nursing home regulators underestimate the severity of problems they spot in facilities. This happens with 13 percent of findings and may influence homes’ ratings on Nursing Home Compare.
  • Regulators routinely accept plans by nursing homes to correct problems even though these plans don’t meet federal standards. This happens 77 percent of the time.
  • Follow-up inspections are required in all cases in which homes are asked to draft a corrective action plan. But in practice, California inspectors only conduct such inspections when problems are deemed serious or involve a financial penalty.

Want to hear more about those maggots? Jewett notes that example comes from an earlier HHS Inspector General report that examined how California is handling nursing home complaints. She writes:

“That report highlighted the case of a woman who showed signs of neglect based on ‘multiple pressure sores and maggots coming from the resident’s ear.’ State inspectors determined that the nursing home’s ‘wound care nursing documented in the medical record that the resident’s right ear was treated on April 24, 2008, when no treatment was actually provided.’”

The report also found that when complaints were investigated, inspectors tracked violations of state nursing home standards but frequently failed to site federal deficiencies.

How unbearably sad that vulnerable older people have to endure these kinds of conditions in facilities that routinely fail to provide adequate care to residents.

What will you find?

If you’re interested in following up on similar issues, start by checking with the agency in your area responsible for nursing home oversight. How many staff members do they have and how many homes are they responsible for monitoring? Have budget cuts reduced the number of staff, putting pressure on their ability to conduct meaningful oversight?

What kind of process is used to monitor nursing homes in your state? How often do inspectors visit homes? Are inspections announced or unannounced? Are actual inspections conforming to this schedule?

How many complaints have been filed against nursing homes in your state? What happens when inspectors go in and state or federal violations are noted? If homes have to prepare a corrective action plan, are follow-up inspections made to certify that the changes listed were actually made? If not, what assurance is there that such plans make any difference?

Talk to your state’s long-term care ombudsman about the adequacy of its nursing home inspection process. Ask the ombudsmen which, if any, consumer groups are monitoring nursing home conditions.

Check out the ratings on Medicare’s Nursing Home Compare (or use AHCJ’s version in a more manageable format in Excel spreadsheets), and pay special attention to homes that have received one-star ratings (the lowest) several years in a row. USA Today looked at this issue in a recent story which you can read here. Finally, look at AHCJ’s extensive guide to covering the health of local nursing homes for more tips on information sources and what kinds of issues to look for.

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.

Dining decision brings discrimination issues in aging to forefront; lessons for reporters

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.

Paula Span of The New York Times clearly struck a nerve with her recent story about an upscale retirement community’s decision to exclude certain residents from its country-club style dining room.

The residents in question lived in assisted living apartments or a nursing home that are part of the Norfolk, Va., continuing care retirement community (CCRC).

For years, some had eaten in the main dining room, with its white-clothed tables, fancy food and nice views, without a fuss.

But last year, management at the complex decided that only people residing in independent living apartments could take their meals there.

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.

Residents of assisted living would have to eat in their own dining room, as would nursing home residents, management declared.

Yes, it’s a form of segregation, based on older peoples’ relative health.

And yes, it speaks to a little-discussed hierarchy often found among the old, with those who are “well” – active, mobile, without significant impairments – on top and those who are sick or disabled on the bottom.

We might not like to acknowledge this aspect of aging, but it’s a reality in all kinds of settings, including nursing homes where more “with it” residents often look down on those with significant cognitive or physical problems.

More than 150 people wrote in to comment on Span’s article, which appeared in the paper and on the Times‘ New Old Age blog. Many said they had experiences of the same sort.

MJ of New York City wrote, “A similar issue came up in my mother’s CCRC. Some residents wanted people who used wheelchairs to be barred from sitting in the spacious front lobby because they thought it was ‘depressing’ to see fellow residents in wheelchairs.”

An East Coast reader using the pseudonym DemocracyNow noted:

“When my father was in assisted living, I saw this kind of discrimination practiced not by the facility, but by the residents themselves. Healthier patients would form cliques, like the cool kids in high school, and would sit at their own tables. Those who were perfectly healthy enough to engage in lively conversation, but were saddled with walkers or a wheelchair or an oxygen tank, would be banished to the outer reaches of the dining room, sometimes left to eat alone. It was a sad sight.”

Many readers called the practice of segregating CCRC residents at meals “appalling,” “disgusting,” “mean spirited” and noted that the practice appeared driven by fear.

Kate in Boston commented, “The residents in independent-living situations are looking at what can and very likely will happen to them over the next several years and it terrifies them.”

Curtis Selden Cone of Berkeley observed that the story spoke of “prejudice against the process of aging itself, which often involves physical frailty. The irony of the exclusion is that the individuals who are supporting this, may find themselves being excluded in the near future due to some disability.”

Others suggested that some kind of compromise was probably necessary.   When people are seriously disabled, unable to eat on their own, and require extra assistance, it’s probably appropriate for them to eat in a separate space, several said.  In this the case, dining rooms for more disabled residents should be similarly comfortable and inviting, they added.

Indeed, the CCRC that Span wrote about eventually let assisted living residents eat in the main dining room if they passed a functional assessment and if they had transitioned to assisted living from independent living. But nursing home residents remain excluded, as do people who move directly into assisted living when they enter the facility.

This story holds important lessons for reporters writing about aging and health:

  • Don’t assume that negative attitudes about being old and frail are held only by the young. Deeply ingrained cultural values favoring youth and vigor often remain with people through their own latter years.
  • Don’t think of the elderly as being a monolithic population. They’re not. The kinds of divisions that characterize people throughout their lives – differences of wealth, health, education, temperament and more – remain as people age and shape their preferences and experiences.
  • When you write about senior housing, be alert to the culture of senior housing facilities as well as health or safety concerns. Are these facilities inclusive? Or are healthier residents treated differently than more disabled residents? What do the people who live in these facilities say about their own situations?

Update: Elizabeth Simpson of The Virginian-Pilot published her own take on this CCRC’s controversial dining policies today.

Watch for a tip sheet with detailed information about senior housing on this site in the months to come.

‘Every day is an improvisation’ when caring for aging relatives

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.

How many of us have seen problems with older relatives that we’ve looked away from, not wanting to acknowledge their seriousness or fully face the consequences?

There’s a word for this: denial. And there’s a good example of how it can affect family decision making in the current issue of the Journal of the American Medical Association. [Note: AHCJ members have free access to JAMA.]

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.

It’s a personal story written by Carolyn Cannuscio, a social epidemiologist who studies aging, about her beloved 96-year-old grandmother, Nana.

After a nasty fall, Cannuscio and her mother move Nana from Florida to a Pennsylvania assisted-living facility that they had visited often and checked out with some degree of thoughtfulness.

“We grilled the staff about their services, the environment, and the nature, costs and limits of care my grandmother would receive there,” Cannuscio writes.  “We were assured by the credible marketing director on multiple occasions that this would be the last move Nana would ever have to make.”

What a reassuring promise.  If only it were true.

Cannuscio and her mom soon find that the facility is unprepared for Nana’s arrival, with “no clear plan for her daily care, no bedroom door, and – most importantly – no grab bars in the bathroom.”  What?  They didn’t make sure these plans were in place before Nana stepped on the airplane that took her away from Florida?

It gets worse – right from the start.

We quickly learned that the facility was so understaffed that Nana would be neglected on the standard care plan.  We saw residents stranded in wheelchairs in random spots in the hallway, hoping for a generous guest or a more able-bodied resident to guide them to dinner.  We then accompanied Nana to dinner ourselves and saw residents waiting unattended and unfed for long stretches, until they were addressed rudely by the harried wait staff.

Where were these alarming signs when Cannuscio and family members visited the facility in advance of her grandmother’s move?

As it turns out, they were hiding in plain sight.  Searching the Internet, Cannuscio had come across a report from the state health department that apparently showed problems with the facility’s sanitary practices.  And during a visit, she’d been taken to an apartment reeking of “cat excrement” that was home to a “disoriented, disheveled man who clearly needed more help than he was getting.”

Yet, hope prevailed:  hope that this squalid apartment was an aberration, that Nana would get the care she needed, that this difficult move would prove satisfactory in the end.

Hope such as this is entirely understandable.  But in this case, it led to denial:  a refusal to give adequate consideration to evidence that this assisted-living facility wasn’t what it was claiming to be.  After Cannuscio acknowledged that, she was distressed to discover that no federal standards govern assisted-living facilities.

In the end, however, she lays blame on “my fantasy that all of our elder care problems would be solved” with the move to assisted living.

Indeed. As older people become frail, like Nana, problems abound and there is no foolproof solution.  Not if the older person is cared for at home, not if they’re in assisted living, not if they’ve moved to a nursing home.   Daily challenges exist in all these settings and, as Cannuscio notes at the beginning of her piece, “every day is an improvisation.”

It’s our job as journalists to bring these challenges into the public realm, where they can be seen clearly and understood in context.  Our hope is that the material going up now and in the months ahead on AHCJ’s aging web resource – information about assisted living facilities and nursing homes, on long-term care and caregiving, on aging-in-place and home care – will help as you pursue these kinds of stories in your communities and make it harder to deny the very real problems that so many seniors face.