Too often, daily newspapers are reluctant to pursue major investigative efforts after the so-called "big story" has been published and the problem exposed. But do we really go back and take a second look?
Sure, we all do follow-up stories: What is the reaction, if any, of the public or government officials to the findings of the investigation? Will anything likely change as a result of the investigation?
Those are important stories, but they may signal the premature end of an investigation. Often, there is much more work to be done. For various reasons — lack of resources, other investigative projects in the pipeline, fear of repetition — we fail to keep digging following an investigation.
We miss a lot of good stories when we do that.
When state government and health officials promised significant reforms following publication of a year-long investigation of nursing home care printed in June, it was tempting for The Indianapolis Star and The Indianapolis News to simply bundle up our documents, source lists and computer databases and move on to the next project.
Past and present
The newspapers had documented the pervasiveness of poor care in nursing homes and the shortcomings of numerous state and federal regulations that allowed the problems to linger. State and federal authorities reacted swiftly: State officials announced a series of reform initiatives, including tougher penalties against the worst providers.
We could have assigned a reporter to follow those reforms and considered our work done on the issue, but we knew there was more to the story. Stick with an investigation until you've exhausted all crucial subject areas.
The reporters had uncovered numerous leads and tips during the initial reporting effort. Others came flooding in after publication of the series, "The Tarnished Years." After several meetings, we decided to take the extraordinary step of undertaking another six-month investigation. Instead of reducing the staffers dedicated to the effort, the newspapers expanded the reporting team to three reporters, who, along with the CAR coordinator and a dedicated photographer, tackled an entirely new set of questions about the quality of care in nursing homes.
Among the key findings of the second investigation:
• As the need for reform was being debated by state health and government officials, problems in nursing homes rose dramatically from the previous year — there were 50 percent more health and safety violations, a computer analysis of state inspection records showed.
• In Indianapolis, residents in predominantly black nursing homes received far worse care than those in white facilities. Among the disparities: Homes serving low-income blacks had nearly five times as many harm-level violations as homes serving whites.
• Needless deaths and illnesses occur in nursing homes every year because of problems associated with the routine feeding and care of patients.
Separate and unequal
Aside from the significant increase in health and safety violations, the most striking element of the latest investigation were the racial disparities in quality of care. Tackling that issue was difficult.
Our first attempt to obtain data containing demographic information about nursing homes from was blocked by government officials, who denied our FOIA requests. Rather than continue that fight, however, we decided to pursue the matter at the state level, a strategy that had worked well while putting together our original series.
We knew the state of Indiana collected the same nursing home census information as the federal government, so we hoped it would be a simple matter of obtaining that database. It wasn't. State officials denied the existence of any such electronic records, claiming only hard copy forms tucked into thousands of files warehoused in their offices.
Even though we were running into roadblocks set up by officialdom, we had other successes that inspired us to keep going. Using Paradox and SPSS software to analyze several different databases we had already obtained, we determined other patterns in the data that let us know we were on the right track. For example, we documented the impact poverty has on quality of care by examining state inspection records, U.S. census data and Medicaid reimbursement rates from the government. Analysis showed that most poorly performing facilities were in low-