Sunlight Foundation Reporting Group

Medicare data reveals nursing home abuse and neglect

Resident #208 was found by inspectors at Capital Healthcare Center in Tallahassee, Fla., in a pool of urine. On July 16, 2009, inspectors found that the the resident -- who was incontinent -- hadn't been changed for five hours.

Other residents complained of ill treatment; one told inspectors he or she had fallen several times recently, and was then accused of faking those falls "to get staff in trouble." (The reports hide the identities of those making allegations.)

The reports go on. The facility was cited on multiple occasions for allowing pressure sores to develop on immobile patients, giving unnecessary catheters, allowing accidents and failing to meet residents' nutritional needs.

While Capital Healthcare Center appears to have cleared up some of these most egregious violations since last July, and fired the staff responsible for Resident #208's poor treatment last year, it remains on a short list of the nation's worst nursing homes, as identified annually by the Centers for Medicare and Medicaid Services (CMS). The home is designated as a Special Focus Facility by CMS, which means it requires closer monitoring due to substandard performance. Less than one percent of the nation's nursing homes fall into this category.

All of the above information was available online, and all but the actual inspection reports quoted above can currently be found at data.medicare.gov, the new portal for CMS' "Nursing Home Compare" datasets. While the information was available online previously, it is now much easier to view, sort, filter and download. Similar datasets are also posted for hospitals, home health agencies, dialysis facilities and medical equipment suppliers.

The information is broken up into slices. A general information file gives the name, address, and phone number of every nursing home in the country, along with the number of residents, an indication of whether the facility accepts Medicaid patients, whether the home is for-profit and whether it's part of a chain. Special Focus Facilities are also identified there.

Other datasets list any health and safety "deficiencies," as failures to meet federal standards are called. These files give the survey date, an explanation of the deficiency, how widespread the problem is, and how severe the harm, if any. A separate dataset measures staffing adequacy, based on how many hours each patient spends with a registered nurse, as well as with other staff, each day. The data can be sliced by state and zip code (though county isn't listed).

A quick look at Capital Healthcare Center's numbers will demonstrate how these datasets can be used. By importing the numbers into a database management program like Microsoft Access, we can see that the facility has been cited over 100 times in the past three-and-a-half years for failing to meet federal health and safety requirements. Ninety-nine percent of homes received fewer "deficiencies," as these failures are dubbed.

We can also see that Capital Healthcare tops the list of homes with the most citations for "actual harm" or "immediate jeopardy" to their residents in 2009 and 2010, the two highest levels of severity recorded by CMS. Capital Healthcare also racked up the most instances of "actual harm" that fell in three crucial categories: mistreatment of residents, quality of care, and residents' rights. Among other things, the home was cited for failure to "protect each resident from all abuse, physical punishment, and being separated from others," and for failing to keep or build "each resident's dignity and self respect." The facility fares better on staffing levels; it falls within merely the bottom 40 percent of homes on its ratio of registered nurses to patients.

So what's missing from data.medicare.gov? A mandate in the health care reform act will fill in two crucial gaps. First, residents' advocates stress caution when looking at the staffing numbers currently listed -- they're self-reported. By March 2012, these numbers will come straight from payroll data and cost reports. Second, the inspection reports quoted at the beginning of this story are currently only available piecemeal on some state sites. By March 2011, a link to each state's website, with the reports included, will be available through CMS.

In the meantime, reporters can find a guide to which information each state offers on nursing homes at the advocacy group NCCNHR (originally the National Citizen's Coalition for Nursing Home Reform) online here. It's a little out-of-date (it fails to mention that Florida and Ohio provide inspection reports, for example), but it's a good place to start.