Story draws strong reader response
By Ziva Branstetter
Tulsa World
I had been writing about nursing homes for about five years before I turned my attention recently to assisted-living centers, which are sprouting up everywhere in Tulsa and across the country. What I found after eight months of investigation is the public is remarkably uninformed about major issues such as what services to expect in assisted living, when to choose a higher level of care and what a center’s inspection records reveal.
The reaction from our readers was strong. I had many calls from readers who had no idea that the homes where their relatives lived had bad records.
Because of a rapidly aging population, residents in assisted-living centers today are likely to be older and sicker than those in the past. These issues, combined with a lack of regulation, can lead to bad outcomes in some cases.
Even the term “assisted living” can mean different things to different people and in different states. Oklahoma defines assisted living as a facility for residents who need assistance with activities of daily living, including dressing, bathing, feeding and medication. Generally, residents in assisted living should not need 24-hour skilled nursing care.
Currently, there are no specific federal regulations governing assisted-living centers. Each state has its own standards and in Oklahoma, they boil down to a contractual relationship. If a center promises to provide certain care, the state checks to determine whether that care is provided.
Nursing homes, on the other hand, are regulated by the federal government if they accept patients on Medicare or Medicaid, which nearly all do. The exceptions are often the posh continuum-of-care facilities where privately paying retirees buy into a low level of care and move up through assisted living and nursing care if needed. Nursing home inspections are available online. You need to look at the paper files available in your state if you want details behind the deficiencies you see online. (See this tip sheet for more on covering nursing homes.)
Photo: Administration on Aging
Unfortunately, there is no such online database of assisted-living inspections nationally. The inspection reports in Oklahoma are kept in paper files at the state Health Department and I suspect many states handle reports the same way. Of course, most consumers are unlikely to review these documents. Though centers are required in our state to make the most recent inspection report available upon request, many consumers feel uncomfortable confronting an administrator in this way or simply don’t know the reports exist.
For our three-day series about assisted living, which ran July 8-10, I created a database from the paper reports. To do this, I asked the Health Department to send me a list of any homes inspected during 2006. Though the list only included 44 of the state’s 125 centers, it provided a large enough cross section of homes for my story. The list included small homes with only a few beds, large homes with more than 100 beds and homes in rural and urban areas.
I first reviewed the files of these 44 homes and flagged the inspection reports for copying. After all reports had been copied, I created a spreadsheet to enter the results. Each inspection report cites centers for violating certain “tags” or rules, which are coded numerically. So, for example, C401 means the facility was cited for violating a patient’s rights. In my spreadsheet, I entered the name of each center inspected, the inspection date and then listed each deficiency by number. Centers with multiple deficiencies had multiple entries so I could later track the worst offenders. Homes often had more than one inspection during the year because the inspectors return to be sure problems have been corrected.
In my database, I also included a notes column with the most shocking text from the reports. I later discovered that I needed to go back and add the centers that were cited for zero deficiencies, so I could give credit to the centers that have the best records.
Often, consumers are searching for a facility for a loved one about to be released from a hospital with only a few days to make a decision. Your readers, viewers and listeners will be grateful for this information.
Once I had this spreadsheet created, it was simple to analyze. Since there were only about 400 individual records, I could have done the analysis in Microsoft Excel but I feel more comfortable with Microsoft Access, so that is what I used. I queried the data to find out the most common deficiency cited: problems with the centers’ contracts and failure to describe what services would be provided.
I also asked inspectors what the most serious problems were. They told me they looked for violations of patient rights, accepting patients that exceed the level of care provided and medication errors. I ended up leading with the fact that half of the centers in Oklahoma had been cited last year for one or more of those serious issues.
Finally, I was able to add up the number of deficiencies throughout the year at each center and tell our readers about the worst offenders. One center had 27 deficiencies. The 13 centers operated by a large national chain, Brookdale Senior Living Inc., had 100 deficiencies combined. With our stories, we posted a spreadsheet allowing readers to see how many deficiencies each center had received.
In the reports, we found incidents where injured residents had been left unattended for hours, where untrained aides gave the wrong medications and even one center where residents were besieged by ants. At one center, a resident suffered a stroke but waited days for medical care. Later, employees told inspectors: “We don’t call the doctor at night.”
I called on plenty of experts, including the head of the state’s assisted-living association, to help me put the data in perspective. I talked to residents living in the centers who were quite satisfied with their care but also to family members whose relatives had died from alleged neglect.
Photo: Administration on Aging
In the end, my story depended more on the data and inspection reports but these interviews provided the color and face on the stories. I also went to one home that had an unusually high number of problems and came away with a totally different impression. The small center, based in a family’s home, was very well operated despite the many paperwork problems cited in its first inspection.
The reaction from our readers was strong. I had many calls from readers who had no idea that the homes where their relatives lived had bad records. The family of residents in one home organized a resident meeting so they could get answers from the home’s administrators. Many e-mailed or called to thank us for helping them navigate the system and get their hands on the records they wanted.
I would encourage other health-care reporters to take a close look at assisted-living centers. Often, consumers are searching for a facility for a loved one about to be released from a hospital with only a few days to make a decision. Your readers, viewers and listeners will be grateful for this information.
Ziva Branstetter is the projects editor of the Tulsa World, where she writes and edits investigative projects as part of a three-person investigative team. She has won awards for coverage of nursing homes, child abuse, the juvenile justice system, political corruption and work on open-records issues.
