By Matt Canham
The Salt Lake Tribune
A nursing home staffer left an elderly woman who couldn’t walk out in the yard for hours. It was summer and it was hot. When found, the woman was rushed to the hospital with severe heat stroke and painful sunburns.
At another nursing home, a staffer washed out a woman’s mouth with soap because she used a naughty word.
And in a third home, a nurse’s aide left a resident alone in the hot tub for about four minutes. She returned to find the resident face down in the water. Dead.
These are but three of hundreds of “deficiencies” detailed in nursing home inspection reports I scoured for a series of articles about Utah’s long-term care facilities.
The inspection surveys are public record but how accessible they are depends on what state you live in. In Minnesota, and about a dozen other states, the reports are online. In Utah, it was a bit more challenging. It took me more than a year and a half to get all of the data, I sought, but in the end The Salt Lake Tribune published a two-day series with four stories and a rich online database that allows readers to look up the compliance history of every nursing home in Utah from 2000 to 2007.
For the most part, Utah’s nursing homes followed the federal rules. But the data identified a small group of problem homes. Most were “yo-yo”facilities, dipping in and out of compliance. The series also found that ownership is a top predictor of quality, though neither the state nor federal government has good information on who owns these facilities.
Nursing homes are regulated federally through the Centers for Medicare and Medicaid Services, but state teams actually conduct the recertification inspections. The standard data source is Medicare.gov’s Nursing Home Compare site. While loaded with information, Nursing Home Compare can be difficult to manage. It contains only three years worth of data and that data is broken down into general categories like “quality of life.”
I wanted to produce something more detailed. I wanted to know what the inspectors considered to be “abuse.” I wanted to know what a “dignity” or “quality of life” deficiency really meant. I wanted to read the actual reports.
But in Utah, the reports were only available in the lobby of each nursing home, and even then it was only the past year’s survey. I sent the state health department a record request for every survey from 2000 forward, but it wasn’t as easy as burning the files to a CD.
The public reports are mixed with private health records in a federally mandated system called ASPEN, which in some ways resembles microfiche. To get each survey, a state worker had to scroll through the documents, identify the starting and ending pages and pluck it out — a very labor intensive process. It would have also been prohibitively costly if I wanted every report from 2000. I had to narrow my scope to focus on the serious violations.
Inspectors give every violation a scope and severity rating that is in the form of a letter. A “B” is a very minor violation involving only one person, while an “L” means a large number of residents remain in harm’s way. A “G” or lower is considered an actual harm violation, where the actions of the staff or the management resulted in some form of injury to a resident. Generally, this means neglect.
I also examined other indicators of serious problems, including fines, generally less than $10,000 per incident.
The health department sent me an Excel spreadsheet that documented the fines and every violation, including its accompanying scope and severity code. This allowed me to add up the total deficiencies and the actual harm deficiencies for each facility. Then I renewed my request for electronic copies of the full reports, but this time only the ones where inspectors found actual harm.
This still ended up being hundreds of reports. Some were as short as a couple sheets of paper, others went on for more than 100 pages. In between other stories, I worked my way through the stacks of inspections, which originally came as TIFF documents, essentially a picture of the paper report. I coded each one with a red marker, focusing on violations a person without medical experience could spot, such as bedsores, sudden weight loss and unexplained bruising.
Once I added the information to my spreadsheet, the story just jumped out at me. Three homes had far more actual harm deficiencies than the rest in the state. And two ownership groups owned five of the 10 worst performers. They also were more likely to get an “immediate jeopardy” mark and were the leaders in fines, some topping $100,000 since 2000.
I ran the results by a number of people working in Utah’s nursing home industry. No one was surprised. They knew which homes had the bad reputations and they were all on my list. I took that as a sign that I was on the right track, pointing out the homes that truly deserve such public scrutiny. These results anchored the investigative piece, but the part that I’m most proud of is the database that gives a summary of the results but also allows people to read the reports for themselves.
Matt Canham is a Washington, D.C., correspondent for The Salt Lake Tribune.
