Tag Archives: inspections

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

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

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

AHCJ unveils searchable database of hospital inspections

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 AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

HospitalInspections.orgThe Association of Health Care Journalists today launched hospitalinspections.org, a free, searchable news application that compiles thousands of federal inspection reports for hospitals around the nation since January 2011.

The move follows years of advocacy by AHCJ urging the government to release the deficiency reports in an electronic format. Until now, reporters and the public had to file Freedom of Information Act (FOIA) requests to the Centers for Medicare and Medicaid Services (CMS) to obtain the documents, a process fraught with delays that can stymie timely public knowledge of problems at hospitals.

This site includes details about deficiencies cited during complaint inspections at acute-care and critical access hospitals throughout the United States since Jan. 1, 2011. It does not include results of routine inspections or those of psychiatric hospitals or long-term care hospitals. It also does not include hospital responses to deficiencies cited during inspections. Those can be obtained by filing a request with a hospital or the U.S. Centers for Medicare and Medicaid Services (CMS).

This effort follows years of advocacy by AHCJ to encourage federal officials to publish this information electronically. Until now, this information has only been available through Freedom of Information Act requests – and only in paper form. Funding for this project was provided by the provided by the Ethics & Excellence in Journalism Foundation.

Read more …

New tool allows searches of nursing home inspection reports

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), is a freelance journalist based in Denver and former topic leader on aging for AHCJ. She haswritten for the New York Times, Kaiser Health News, the Washington Post, the Journal of the American Medical Association, STAT News, the Chicago Tribune, and other publications.

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
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

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.

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), is a freelance journalist based in Denver and former topic leader on aging for AHCJ. She haswritten for the New York Times, Kaiser Health News, the Washington Post, the Journal of the American Medical Association, STAT News, the Chicago Tribune, and other publications.

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.

Hospital sues to block release of records

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 AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

Parkland Memorial Hospital in Dallas, the subject of recent reports that patients were at risk, has sued the Texas attorney general in an attempt to prevent the release of records requested by The Dallas Morning News.

Brooks Egerton reports:

Parkland filed the latest lawsuit — its fifth against the AG related to the newspaper — on Monday. This time the goal is to block release of Parkland police department records dealing with the psychiatric emergency room. The News is not seeking medical records.