Elder care homes ripe for probes

Journalists across the country use database reporting and open records requests to investigate poorly regulated assisted living centers and nursing homes, revealing widespread understaffing, patient neglect, and inadequate state oversight of the rapidly growing elderly care industry.

By Stephanie Kang, IRE and NICAR

As America's elderly population explodes, journalists use database reporting to explore the state of assisted living centers and nursing homes around the country.

At just more than 20 years old, the assisted living industry is still relatively new. Arising out of dissatisfaction with nursing homes, assisted living centers cater to the elderly with financial means and little need of intensive nursing care. Yet because they are regulated by states, not by the federal government as most nursing homes are, monitoring assisted living care can become difficult. Assisted living centers and nursing homes have come under fire for lax regulation, understaffing, and patient abuse and neglect.

Months of anecdotal stories from state inspectors prompted Milwaukee Journal Sentinel reporter Mary Zahn to investigate the conditions of Wisconsin assisted living centers. A six-month investigation resulted in "Overwhelmed and Broken Down: Caring for the Elderly and Disabled," published in August 2001. Zahn used Wisconsin's open records law to obtain a database of state inspections and citations against nursing homes and assisted living centers. The series found that hundreds of elderly and disabled people in assisted living facilities had been injured and put at risk. In addition, 10,000 of the state's disabled or elderly residents had been forced to wait for months or even years to move into an assisted living facility. (Story No. 18778 in the IRE Resource Center)

Reporters for The Oregonian built and used existing databases while investigating the assisted living industry, focusing on Keren Wilson and the company she created, Assisted Living Concepts. For a series that ran in June 2001, they built several databases to track investigations of centers run by the company, entering information from investigative reports. They also tailored a complaints database that they got from the Oregon Senior and Disabled Services Division. An analysis of the data showed that Assisted Living Concepts had a track record that was worse than the state average. (Story No. 18972)

In "Who Will Care For Them? Ohio's Elder Crisis" the Dayton Daily News examined how Ohio cares for its elderly. The Daily News analyzed more than a half dozen state regulatory databases with FoxPro and SPSS. Some of the databases had never been publicly available in Ohio and the reporters had to negotiate with health department officials to obtain them.

The Daily News discovered a system "dangerously under-scrutinized," where the elderly often are forced to choose between costly assisted living care centers and state-funded nursing homes. The Daily News also found that state inspection personnel reductions and a 70 percent decrease in citations for serious health and safety violations threatened to minimize the state's influence on a sub-par facility (Story No. 15917)

In the questionnaire that accompanies their stories in the IRE Resource Center, the reporters advise: "Data is virtually limitless. Don't get overwhelmed. Use it to answer your questions, not for fishing expeditions."

Finding data

For starters, federal law mandates that state regulators keep registries of aides working in every assisted living center and nursing home.

Nursing Home Compare data (www.medicare.gov/nhcompare/home.asp) allows you to check individual nursing homes in your area or download information to build your own database. The Online Survey Certification and Reporting file (OSCAR) at www.longtermcareinfo.com/crg/about_oscar.html is an administrative database of the Health Care Financing Administration. OSCAR provides survey and data. That means every institutional health-care provider in the United States that is certified to provide services under either Medicare or Medicaid (or both) is listed in OSCAR. Because different types of providers have to report different information during the survey and certification process, OSCAR results can vary.

Journalists also have access to complaint investigation forms. In Missouri, the Social Services Department Division on Aging regulates nursing homes and maintains a "Statement of Deficiencies and Plan of Correction" record. Most state health departments will maintain a complaints and enforcement database.

Look for datasets that lay out Medicaid and Medicare eligibility for nursing homes and assisted living centers, as well as a costs database, also from the Health Department.

These departments usually administer inspections and give licenses for adult care centers, adult residential care homes, intermediate care and skilled nursing centers. These datasets may include facility surveys, and provide operator information and resident demographics.

For details about the stories by the Milwaukee Journal Sentinel and The Oregonian, see the feature package about investigating assisted living centers in the November/December 2002 issue of The IRE Journal. Also included are tips and sources for covering assisted living and examples of other elder housing stories that used CAR. Order a copy through the IRE Resource Center by calling 573-882-3364 or e-mailing rescntr@nicar.org.

Contact Stephanie Kang by e-mail at Stephanie@nicar.org