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Tipsheet: How to Use Nursing Home Inspect

Tips to help you get the best results from your searches.

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Update: We have updated Nursing Home Inspect with new data from the government, so the exact search result numbers cited here may no longer be accurate.

We’ve designed Nursing Home Inspect to make it fast and easy to search thousands of recent government inspection reports from around the country, most since the beginning of 2011. Following are some tips to help you get the best results.

First, a little background.

The reports come from the U.S. Centers for Medicare and Medicaid Services (CMS), which put them online in July. Unlike the CMS site, however, Nursing Home Inspect allows searches by keyword and city, as well as a home’s name. Also unlike CMS, our app allows you to search across all the reports at once.

As of today, the underlying database covers nearly 118,000 deficiencies at 14,565 homes. There are more than 15,000 nursing homes in the U.S., and as CMS releases newer inspection reports in the future, we plan to add them.

Our search engine looks through the narrative portion of the inspection reports — the part where inspectors describe conditions in the home and any deficiencies they discovered. This is where the details are.

It’s best to keep two things in mind while searching. First, the results are a snapshot and not necessarily comprehensive for homes nationwide. Second, because inspectors may write up their reports differently, it is wise to try several different search terms to be sure you’re getting the most complete results.

For example, take a common problem like bed sores, which can develop if a resident is confined to bed and staff do not turn the person often enough.

Searching for the phrase pressure sore returns 2,121 results. Searching for the phrase bed sore returns 1,946 results, some of them duplicates. But other words that also can return deficiencies related to bed sores include: decubitus, purulent and pus, as well as stage iii and stage iv (phrases that describe the most serious and dangerous sores, but can also describe cancer progression).

Another example: sexual assaults. Though uncommon in nursing homes, 88 reports include rape and 120 include sexual assault (there is some overlap). A broader search for the word sexual yields far more results, 787.

Some other searches that piqued our interest were: cigarette and burn (found patients who were burned when allowed to smoke without supervision); conviction (found nursing home staff with criminal records); ignore, mistreat and rude (found residents who believed they had been mistreated).

A search for the words terminate and suspend often produces results involving nursing home staff who were disciplined for alleged misconduct.

Here are more tips, cautions and limitations:

  • Nursing homes are inspected periodically as a matter of routine, and when the government receives a complaint about the home. Almost all nursing homes have been cited for some deficiencies, so they are not necessarily an indication that a home is subpar.
  • Nursing Home Inspect relies on narrative reports from a home’s most recent periodic review (known as standard surveys), as well as complaint investigations from the past 12 months. Although the majority of deficiencies in Nursing Home Inspect are from January 2011 and later, about 2,700 are from 2009 and 2010. Those are primarily from homes that haven’t had standard inspections since then. Earlier reports can be requested under the Freedom of Information Act (FOIA).
  • To count total deficiencies for a home, you can search by the home’s name in Nursing Home Inspect. Please note that this total may be different from the total listed on the “Inspections and Complaints” tab at Nursing Home Compare, the CMS web site. That is because the CMS site counts reports that go back 15 months, and because CMS sometimes finds new deficiencies during follow-up visits after a standard survey (those follow-ups are not included as yet in the narratives posted online).
  • Be careful when counting “deficiencies.” When searching for a keyword, our app only returns the number of deficiencies that contain the search term, not the overall number of deficiencies cited against the home on that visit or other visits.
  • ProPublica has not inspected the nursing homes and did not assign the severity scores for deficiencies, which range from A to L, with L being the most severe. Those scores are assigned by government inspectors.
  • If you want to search for all homes in a given state or all deficiencies by a given severity, leave the keyword box blank. That said, our app is optimized for keyword searches. If you look up a city or nursing home name, results for the same home may be spread over several pages. You can improve the way your results are returned by selecting a state and then sorting the data by city.
  • Inspection reports only focus on problems, not accomplishments or excellent care, so they should be used in conjunction with other information when assessing a home’s overall performance.
  • The government isn’t aware of all problems in nursing homes, so don’t assume if there is no report that a home doesn’t have problems. A complete list of nursing homes is available on Medicare’s website.
  • The reports contain a lot of jargon and sometimes don’t make clear who exactly is at fault for a problem. Don’t make assumptions. You should verify information with the nursing home’s administrator.
  • Some reports mention the words you’re searching in the text but they don’t describe a problem at the home. The word could be in a home’s policy statement or may describe past behavior. For example, a patient who has wandered off may be mentioned in a report that uses the word elope but does not refer to a deficiency. To be sure, read the report by clicking on the nursing home name.
  • Our search engine in most cases will only return results with the precise word you entered. In a few cases, we have designed our program to return related matches. For instance, if you search the term “elope,” you will also see results for “elopes,” “eloped” and “elopement.” (There still may be other variations or misspellings.) It is best to search by the singular and the plural, as well as past and present tense. (The search engine will sometimes return a related match without highlighting the word in the text blurb, so again make sure to click through to the report to see exactly how it appears.)
  • As noted above, nursing home inspectors in different parts of the country have different styles and techniques for writing up deficiencies. Use a variety of search terms if you are trying to determine the scope of a particular problem.
  • The government has redacted certain information, including medication names, diseases and certain dates. That means you can’t search for a drug like Seroquel or Zyprexa (common antipsychotic medications). But you can use the term antipsychotic to find mentions of the drug category. Similarly, searches for antidepressants and opioids (narcotic analgesics) yield reports mentioning those drug categories.
  • Although the government is reporting nursing home deficiencies online, it does not report how homes plan to fix the problems. These “Plans of Correction” can be viewed at the nursing home or by submitting a FOIA request to the government.

Although I no longer need a tool such as this I did use the CMS site reviews when I worked as a case manager and needed to place someone out of our service area and this tool will be a helpful addition to the difficult job of finding the right nursing home.  However, and I have not done a thorough search of your articles and site but my first impression is that there is a big focus on errors, mistakes and negatives in the health care system.  I am not suggesting that those topics should be ignored, but wouldn’t it also be helpful to provide clarifying information about what questions families and patients should ask, what kind of information they should be looking for and is there a way to track positive feedback on the health care system.  It is great to know what the inspectors have written up, but it would also be helpful to see the positive feed back.  It certainly would make the whole process of needing health care less destructive and helpful if some very basic information is provided along with what questions to ask especially if provided by a well informed objective observer.

@Connie: ProPublica doesn’t do “positive”. They do “helpful”, but only using an editorial lens that reports negative events exclusively.

@ProPublica: Speaking of helpful, this initiative seems that it could be, but not as presented in this post. If it is for academics or professionals, fine, but if for everyday people, it is far too complicated to use easily.

This article is part of an ongoing investigation:
Nursing Homes

Nursing Homes

Our Nursing Home Inspect tool allows anyone to easily search and analyze the details of recent nursing home inspections, as well as penalties imposed on each home over the past three years.

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