1. Provide the title of your story or series and the names of the journalists involved.
This was a series of stories about nursing home care published over the course of the year by our projects team — reporters Heather Gillers (me), Tim Evans and Mark Alesia and Computer-assisted Reporting Coordinator Mark Nichols. None of us are health reporters and we worked on these stories in between other projects. The titles of the individual stories were "CRISIS OF CARE," "$700M — no strings attached — didn't help nursing homes," "Cash flowed in, care lagged," "State often in dark about crime records of nurses" and "Nursing homes dodge scrutiny."
2. List date(s) this work was published or aired.
CRISIS OF CARE, Sunday, March 7, 2010 $700M — no strings attached — didn't help nursing homes, Sunday, March 28, 2010 Cash flowed in, care lagged, Sunday, May 9, 2010 State often in dark about crime records of nurses, Thursday, August 5, 2010, Nursing homes dodge scrutiny, Sunday, August 22, 2010
3. Provide a brief synopsis of the story or stories, including any significant findings.
Indiana nursing homes may be the worst in country. They have fewer aides per patient than nursing homes in any other state. Fifty-two of what the Government Accountability Office considers to be the country's worst 510 nursing homes are in Indiana. Our projects team at The Indianapolis Star looked into why that is. We found that Indiana had handed out more than $100 million of Medicaid money to nursing homes in a quality incentive program that officials later admitted to us was flawed. The program was pitched as a way to incentivize quality but all homes got the same amount of money no matter how poor their care. We found that our local county health department had bought up 39 nursing homes and then diverted more than $200 million in Medicaid funding from them in order to build a hospital — even as the quality of care at those homes dropped. We found that Indiana was failing to take such basic safety measures as doing background checks on the people to whom it issued nurses licenses. And we found that the attorney general had largely ignored his obligation to discipline administrators of dangerously bad nursing homes — even after the homes were flagged by the health department many years in a row.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
The inspection reports we used for just one of these stories weighed sixty pounds on a bathroom scale. We filed many FOI requests with the state health department, the state's Family and Social Services Administration and CMS federal agencies. We used Microsoft Excel and Access to analyze this data. We examined nationwide electronic data on nursing home inspections from Centers for Medicare and Medicaid in combination with staffing data from the state's Medicaid auditing firm and found that Indiana had fewer aides per resident than any other state. The state's professional licensing agency gave me an Excel file of all nursing and health facility administrator license holders which we analyzed in combination with an Access file of conviction records from Marion County, and found nurses with serious criminal convictions. We analyzed a data file of disciplinary actions by the attorney general in combination with a data file of nursing home inspection reports and found that the attorney general had largely ignored his responsibility to sanction poor nursing home administrators.
5. Explain types of human sources used.
We conducted hundreds of interviews with many many people including state health department officials, state Medicaid officials, federal Medicaid officials, nursing home residents and their families, nursing home administrators, nurses, certified nursing assistants, nursing home chain owners, independent nursing home owners, nursing home trade groups, local and national senior citizen advocacy groups, plaintiff's attorneys, lawmakers, the state attorney general and the governor.
6. Results (if any).
The state program that failed to incentivize quality with its more than $100 million-a-year payouts is being overhauled in a bill expected to pass the state legislature this year. When the Star investigated the program, all homes got the same "quality bonus," no matter how poor their care was. If the bill passes, the state will dedicate $194 million in bonuses to only high performing nursing homes. A separate bill expected to pass the legislature this year will institute regular background checks for nurses and all other health professionals who hold state licenses. The county health department has hired additional staff — including a top executive — to oversee its nursing homes and scores are up. The attorney general's office is studying rule changes that would make it easier to discipline nursing home administrators.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No we did not.
8. Advice to other journalists planning a similar story or project.
Many of the records that document the funding, operation, regulation and inspection of nursing homes are public. It is also good to know how to use Excel and Access, and, of course, to know as much about how the companies and agencies involved run as possible.