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.
In February 2011,
a nursing home resident in Michigan wandered away in a blizzard, unnoticed by
staff. He was wearing only pajama pants, a sweater, canvas shoes and a knit cap.
A technician driving to work found him half an hour later at a busy intersection,
wet and covered with snow, government
inspectors wrote.
Five months
later, a resident at a different Michigan nursing home climbed out of a secured
window in the home’s locked dementia ward, hitchhiked a ride and was picked up
by police hours later in a restaurant some 65 miles away. Nursing home staff
did not even realize he was missing, inspectors
found.
Were these
incidents, known as “elopement,”
isolated? Or do they suggest a pattern? Until recently, no one could really say
how often such incidents occur.
Now, ProPublica
has an app for that.
Drawing on
government reports posted online last month, today we are launching Nursing
Home Inspect — a tool that allows anyone to easily
search and analyze the details of recent nursing home inspections, most
completed since January 2011. As of today, that includes nearly 118,000
deficiencies cited against 14,565 homes, but we will add more each month as new
reports become available.
Users can search across
all the reports by any keyword, such
as elope — a feature the federal government’s
official nursing
home website doesn’t have. The results can then be sorted
by both the severity of the violation and by state.
Although more
elderly people are choosing to live at home or in assisted-living facilities, about
1.5 million people still live in nursing homes,
according to the 2010 Census. Of those, more
than 1.2 million were 65 and older.
For decades,
federal auditors have flagged dangerous and neglectful conditions in U.S.
nursing homes and faulted the government’s oversight. As the examples above
suggest, the problems haven’t gone away.
Arguing that awareness
is an answer, advocates for nursing home residents have long pressed oversight
agencies to make inspection reports readily available to the public. But until
last month, consumers, researchers and journalists had to file formal Freedom
of Information Act requests to view them — or visit in person, because
homes are required by law to make them available.
Having the
reports searchable online will help identify problematic trends and encourage
homes to make needed fixes faster, advocates say.
“It presents a
tremendous opportunity to examine the scope of serious nursing home problems
such as understaffing and misuse of antipsychotic drugs, and to see what, if
anything, is being done about them,” said Michael Connors, an advocate with California
Advocates for Nursing Home Reform.
Nursing home industry officials
agree that inspection reports are valuable for consumers, but they say the
reports leave out important information.
“One of our concerns is that it
doesn’t acknowledge the things that the facilities are doing well,” said Lyn
Bentley, senior director of regulatory services at the American Health Care Association, the industry trade group.
How Many Elopements?
Nursing homes are inspected on
both a regular schedule and when there is a complaint. Inspectors typically
work for state agencies paid by Medicare. If they find problems, known as
deficiencies, they rank them on a scale of A to L, the most severe. The vast
majority are either labeled D or E.
One regularly
cited deficiency involves unsafe wandering, a well-known problem that can result
from inadequate supervision. A report this year in the journal
Annals of Long Term Care, citing earlier research, said up to 31 percent of nursing home
residents with dementia wander at least once.
Nursing Home
Inspect turned up hundreds of such cases.
A search for elope
and variations returned 949 inspection reports that mention the term. Michigan
had the most of any state — 84. (Users
note: A hit on the word “elope” doesn’t always mean a resident wandered off,
only that the word is included in a report. See our tips for interpreting
search results.)
Hillcrest Nursing and
Rehabilitation Community in North Muskegon, Mich., where the resident wandered
away during a blizzard last year, was cited for deficiencies on three other
occasions from
May to October 2011.
Gary Vandenberg, a spokesman for
the home’s parent company, Atrium Centers, said inspectors found no problems at
Hillcrest during a follow-up review in November 2011. The chain provides
elopement training at all its facilities, he said.
Jon Look, administrator of the
Michigan home where the resident with dementia climbed out a window, said
alarms have been added to every window and every door. No resident has wandered
off since, said Look, who started in his role this June at the Iosco County Medical Care Facility in Tawas City, Mich.
“We’re charged with protecting our residents, and that is something we
take very seriously certainly at this nursing facility,” Look said. At the same
time, he said Michigan inspectors identify more problems at homes and levy
higher fines than in other states — a contention federal statistics support.
Queries for other terms also
returned hundreds of results.
A search for injuries produced 7,912 results. MRSA,
a drug-resistant staph infection, yielded 514 entries. The word ignore is found 275 times, and entrapment, which
can happen if a resident gets stuck in bed rails, brought 194 matches. (Again, not all the search results
indicate a problem. See our tip sheet.)
States
Aren’t All the Same
Nursing home industry officials
caution against drawing conclusions from what’s in inspection reports. Echoing
Look, they say that inspectors in different regions of the country have
different thresholds for issuing a citation, and that could unfairly make one state’s
homes appear worse than another’s.
“If an individual walks out the
front door and turns around and walks back in, some states will consider that
an elopement,” said Bentley, of the industry group. “In other states, it’s not
considered to be elopement unless somebody leaves the building, leaves the
grounds and there’s a negative outcome.”
To be sure, audits have found
variation in how inspectors handle nursing home complaints. A report last year by the Government
Accountability Office found that nationwide, of the nearly 50,000 complaints investigated
in 2009, 19 percent were substantiated and resulted in at least one citation.
In 19 states, though, more than 30
percent of complaints resulted in at least one deficiency. And in five states,
the proportion was less than 10 percent.
Advocates for residents say nursing
homes should focus on fixing their own problems instead of pointing fingers at others.
“It’s not a defense for facilities to say that other facilities have not been
cited for this,” said Toby Edelman, a senior policy attorney at the Center for
Medicare Advocacy in Washington, D.C.
If anything, Edelman said, auditors have found that inspectors cite too
few problems and rate their severity too low.
Nursing Home Inspect allows users to more
easily compare how one state’s K-rated deficiency, for example, stacks up
against another’s.
Worries
About Antipsychotics
For years, regulators, consumer advocates
and officials in the nursing home industry have tried to keep an eye on
problems by analyzing data about the number and types of violations found and
their severity.
Federal officials have used such scope
and severity data as part of campaigns to reduce the use of physical restraints
and to encourage homes to cut back on antipsychotic drugs, said Thomas
Hamilton, director of survey and certification at the Centers for Medicare and
Medicaid Services (CMS).
Of particular concern is the use
of antipsychotics to subdue residents with dementia, because the drugs can
increase the risk of death in such patients.
But this data is nowhere near as
detailed as the inspection report narratives, which were first released last
month by CMS. Until recently, even internally, Medicare officials haven’t been
able to search the text of all inspection reports to look for patterns,
Hamilton said.
Advocacy groups are eager to dig
into the reports.
Inspectors “don’t do a perfect job,”
said Richard Mollot, executive director of the Long
Term Care Community Coalition in New York. “They don’t do a consistent
job. [But] they’re the only independent authority coming into nursing homes
looking at this.”
Despite the value of these
reports, CMS has not posted narratives from historical inspections. Only the
most recent periodic survey report is online, along with complaint
investigations from the past 12 months. As time goes on, CMS plans to have
three years’ worth of reports for every home.
For privacy reasons, the reports
released by Medicare do not include residents’ names and have been redacted to hide
medications, diagnoses, room numbers and certain dates.
In many cases, CMS has also
obscured residents’ gender, referring to everyone as female — even in
cases in which gender may make a difference, such as sexual assault. Officials
said they intend to change this in the near future and list the correct gender
in the reports.
Advocates are pushing the
government to redact less information from the reports so they can look at
problems with specific medications.
“It’s really crucial for the
public, and it’s really crucial for us, the people who do policy work,” Mollot
said. “How are you going to know anything if the name of the drug is redacted?”
CMS’ Hamilton defended the current
approach but said the agency will continue to review the information and work
with advocates.
“As we make more information publicly
available in searchable databases,” he said in a statement, “we must be careful
to prevent various pieces of information from being combined in a way that
would violate the privacy or confidentiality of those residents.”
