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How to break down a big topic into a reader-friendly multipart series Date: 10/19/16

Anna Gorman

By Anna Gorman

The statistics were startling: About one-third of patients more than 70 years old, and more than half of patients over 85, leave the hospital more disabled than when they arrived.

I came across these numbers soon after I began researching a potential series of stories for Kaiser Health News about how elderly patients fare in hospitals. I was curious about the reasons for a high rate of disability. Was it because of infections and other problems we commonly hear about, or simply because the patients already were old and sick? Or was it something else entirely?

I read journal articles, news stories and government reports. I also requested and examined data on hospitalized seniors. I interviewed gerontologists, geriatricians and researchers. I also made an initial query to American Public Media’s Public Insight Network, which helps connect journalists to potential sources, to get an idea of the harm done to patients.

A common theme emerged. Hospitals seemed to be doing a decent job treating seniors for the acute illness or injury that landed them there, but they frequently failed to ensure that the patients left the hospital able to walk and talk the same way. Moreover, it was not simply because the patients were old or sick.

Across the board, hospitals were failing to properly feed elderly patients, control their pain and help them get enough physical activity and good sleep. They also were not doing enough to keep patients from becoming confused or taking too many medications. This put the older patients at greater risk of being readmitted, losing their independence, ending up in nursing homes and even dying.

I successfully applied for a Journalists in Aging Fellowship from New America Media and the Gerontological Society of America (GSA). After attending a GSA meeting and doing more reporting, I narrowed down my series to five stories, each focusing on one problem: loss of independence, mobility, polypharmacy, emergency care and discharges.

I picked hospitals where, first and foremost, I could have complete access. Second, I wanted to those institutions to at least be trying to change their culture for the better. That way, I could present the problems in intimate detail while at the same time showing possible solutions. Since I am based in California, I reported on three hospitals in Los Angeles, San Francisco and San Diego, but also traveled to some in Birmingham and New York City. In addition, I interviewed people at other hospitals around the country.

At my hospitals, I was able to meet and observe patients and family members, talk with staff and get a real sense of the issues. (A communications person at each hospital obtained the necessary patient consent forms.) I brought a photographer on each reporting trip. KHN’s talented photographer and videographer, Heidi de Marco, photographed four of the stories, and freelancer Hal Yeager covered the trip to Alabama. Their photos were haunting and helped draw in readers to the story.

Kaiser Health News is based on a partnership model, so each story needed to be able to stand on its own so it could run individually on a partner’s site if necessary. I also wanted to present the stories on our Kaiser Health News and California Healthline sites as a package. We titled the series Diagnosis: Unprepared and ran a segment weekly on a set page. The stories also ran in several other media outlets, including CNN, NPR, U.S. News & World Report, The Washington Post and USA Today. New America Media ran the entire series.

To get the word out, Lydia Zuraw and our Kaiser Health News web team created a weekly guide for each story that make it easier for staff to post stories, web addresses and photos on Twitter and Facebook pages. Suggested tweets included some of the more powerful quotes from my sources, such as “Just because they had four days in the hospital does not mean they are better,” and “The older you are, the worse the hospital is for you.”

Thinking back, what would have made the stories stronger is more data to quantify the problem, or if we had created a database of seniors who, over a given period, came out of the hospital worse off. There also were topics I did not explore, including surgery and outpatient care, and the impact of complications such as delirium.

The topic of caring for seniors is a crucial one for health care journalists, and can easily be explored at your local hospitals, clinics, urgent care facilities and emergency rooms. There are more stories to do as hospitals adapt to our nation’s growing population of seniors while facing pressure to reduce spending and still improve quality.

Anna Gorman (@annagorman) is an award-winning Los Angeles-based senior correspondent based for Kaiser Health News, a nonprofit news service covering health policy issues at the federal and state level. Gorman joined KHN from the Los Angeles Times, where she worked for nearly 15 years covering health care, immigration and the Mexican border. She was a 2011 Nieman Fellow at Harvard University and has taught journalism at Harvard and the USC Annenberg School for Communication and Journalism.