Several eye-opening stories about the plight of some Michigan nursing homes, written by Bridge Michigan reporter Robin Erb, highlighted horrendous conditions and attracted the attention of local and state leaders.
Erb’s stories and sidebars on conditions in long-term care facilities prompted state leaders to pledge improvements and begin drafting legislation increasing penalties and oversight of the most troubled institutions. Erb described her reporting process and what’s next in this “How I Did It.”
This conversation has been edited for brevity and clarity.
How did you get interested in reporting on this story?
Like most reporters, I heard stories from time to time about nursing homes, and I wondered if they’re true. And like most people, I’ve had experiences with loved ones in nursing homes — both good and bad. I did a similar project years ago at the Detroit Free Press, and we found cases of horrible neglect and abuse then. I wanted to know: Has anything changed?
With public inspection reports and data to guide our reporting, we had the makings of a solid, public interest reporting project.
We began with two questions: What’s happening inside Michigan’s nursing homes? How do we better protect residents?
How did you find the anecdotes?
Inspection reports are public record — [but] residents, staff and complainants are known only by numbers or letters such as “Resident 108” or “Nurse S. We cross-referenced the few details in these inspection reports with obituaries, death certificates, police reports, medical examiner’s records and, in a case or two, a news report. Often, it meant trying to convince very busy workers in vital records offices, in funeral homes and in police departments to take extra time to sift through records to match names to the few details from the inspection reports.
The next step was finding loved ones — lots of door knocks, disconnected phone numbers and dead ends. We also called personal injury attorneys to see if their cases might match. Every so often, we’d have a breakthrough. I had spent an entire day crisscrossing the west part of the state knocking on doors.I was frustrated and exhausted, but I figured I’d try one more “last-known address” for a woman whose mother had died in a nursing home. I dialed the number and —crazy enough — the woman answered my call in a car just a few yards away from mine!
You said it took old fashioned reporting to pursue this investigation? Can you describe the process, including FOIA requests?
The Nursing Home Compare website, operated by CMS, makes three years of inspection reports publicly available. My colleague, Simon Schuster, programmed a web scraper using Python to download PDF reports of every inspection — roughly 3,400 — then wrote more code to extract each citation in the PDFs into a massive spreadsheet so we could review the details more quickly. We wanted to use a Google-sponsored AI product aimed at journalists to assist our analysis, but it wasn’t able to handle the volume of data we threw at it.
While he was building the dataset, I was trying to connect names and details to these reports with no identifying information. Death certificates were great because they contain cause and manner of death as well as information about next of kin, whether an autopsy was performed and – at least sometimes – the decedent’s occupation.
Again, it required a lot of conversations with helpful staff in government offices, for example. Sometimes the staff was terrific; apparently happy to go on the hunt with me for those details. Other times, it took multiple emails under FOIA, including several paper requests that had to be “snail-mailed” through the postal service with the required money order and self-addressed, stamped envelope.
What went through your mind as you were reading some of this documentation?
That it’s hell to have no voice—that’s the simplest answer. These are people who in some cases are literally dying without care. They don’t know who to call as they live in filthy conditions, sitting in their own waste, missing meals and medications and forgotten by much of the world.
The below paragraph from your story really jumped out at me. How do those statistics compare to states of similar size and populations?
Bridge’s investigation documented at least 5,915 cases of abuse, neglect, exploitation or quality of life and care violations among the 15,471 total citations for violations ranging from incomplete paperwork to poor care. In all, homes have been fined $21.5 million over the past three years and been denied a total of 6,451 days of Medicaid reimbursements.
This was one of the most frustrating questions because we never found an answer. Nursing homes in each state work inside a federal regulatory framework, but experts repeatedly advised us there’s no fair way to compare care in one state against another.
Yet, it seems these violations are truly only a drop in the bucket, and only for the most egregious violations or deaths.
I think that’s what bothers me the most. These are the things documented when inspectors observe them or they respond to a complaint. What happens when they’re not there and a resident can’t complain?
Obviously, this has been going on for quite some time. What do you think is NOT being documented?
Inadequate staffing was a common citation. Residents repeatedly told inspectors that call lights weren’t being answered. These aren’t bells for afternoon tea. These are pleas for the most basic care, like help eating or going to the toilet. To me, that everyday misery is just as horrifying as the deaths. Imagine calling for help – in pain, in your own waste, unshowered, isolated, scared—and no one answers you?
What were some of the roadblocks you discovered in tackling the lack of accountability and transparency you describe?
There are great nursing homes and exceptional staff. We wanted to be fair to them, but nursing home leaders aren’t rushing to talk to reporters. Thankfully, we were able to visit two homes. The bright visuals and comments from staff and families there showed the brighter side of care—high-quality care with skilled, compassionate staff.
Why do you think the Governor’s office hasn’t responded to your queries? Is it pressure from industry? What does that say to the public?
The reporters I’ve spoken with, both at Bridge and at other news outlets, have had an increasingly tough time reaching leaders in this administration, despite its promise to be more transparent. I wish I knew why the governor’s office or the office that oversees inspectors in Michigan wouldn’t answer our repeated questions. It’s a lost opportunity and it’s certainly not a good look.
What suggestions do you have for reporters in other states who may want to take on a similar project?
After more than three decades in newsrooms, I still fell into the trap of moving through interviews without drawing back out periodically to take stock of what I had and didn’t have.
Writing quick bullet points or a summary of each interview would have saved countless hours later trying to make sense later of a mountain of notes. There are so many, many dots to connect in these inspection reports, it was critical to have an organizing plan in place from the get-go.
Robin Erb covers a range of health issues, including the industry of aging and the challenges facing older residents in Michigan, a state that is aging faster than most others. She joined Bridge in 2019, and has led investigations that tracked millions of dollars in opioid settlement money and explored severe worker shortages that threaten lives and the state’s economy.
