The “Understaffed and Underserved” project tackled three areas of nursing home care that had received little to no previous journalistic attention. The first major piece exposed the systematic discrepancies between the self-reported staffing levels of nursing homes and the average daily level we calculated through an analysis of financial cost reports. These discrepancies were present for all ownership types and staffing positions, and they were greatest for registered nurses. In more than 80 percent of the nursing homes in the analysis, staffing levels listed on public website Nursing Home Compare were greater than those we calculated through the cost reports analysis. This continued use of self-reported staffing data violated a provision of the Affordable Care Act mandating that nursing homes transition from that method to a payroll-based approach by March 2012, which has not yet happened. In this story we also examined minimum state staffing standards for direct care for nursing home residents and the average daily level we calculated through the cost reports. We found that more than 700 nursing homes across the country had daily staffing levels lower than the state requirements. In an accompanying sidebar, we highlighted the close to 50 nursing homes that had a five-star rating for overall quality and had little difference between Nursing Home Compare staffing levels and the average daily levels calculated through the cost reports analysis. The second story revealed that 240 nursing homes across the country since 2009 have received low-cost, HUD-backed mortgages worth nearly $2 billion the month after receiving the lowest possible quality rating from the federal government. We dug deeper and found that nearly 30 percent of these facilities had received an earlier HUD-guaranteed mortgage; the values of these earlier loans was an additional $530 million. The third story highlighted the national disparities in the amount of registered nurse care received by residents of homes where the majority of residents are white compared with the amount received by residents of homes where most residents are black or Latino. These disparities existed in the Nursing Home Compare data, but were greater in the cost reports analysis, where average staffing levels for all groups were lower. We looked at a series of variables about the residents, the market concentration and whether the area was urban or rural to try to explain the differences. None fully did.
