Getting beyond the Obvious: Scrutiny at America's Nursing Homes
Hanger, Charlie, Investigative Reporters and Editors, Inc. The IRE Journal
Reporters all over the country recently have been exposing egregious cases of nursing home abuse. On its face, there's nothing too exciting about that.
"If you go to your editor and say, 'I want to do a story on nursing homes,' they're immediately going to say, `Well, they're bad aren't they?' says Michael Berens, a reporter for the Chicago Tribune. "Everybody knows that, so what's the story?"
It's crucial, Berens says, to find a compelling, fresh approach to the issue. Investigations in the past year have found new problems and identified new causes by going beyond the typical reports of patient abuse and neglect.
Finding system-wide problems at the local nursing home
Like many investigations on this subject, a series from the Tampa Tribune (IRE Resource Center #15072) titled "Money or Mercy," which ran in November 1998, started with a human source. When Adelaida Mongiovi was evicted from her nursing home, her son and daughter-in-law came to the newspaper. Elderly affairs reporter Lindsay Peterson started digging.
The home claimed it was evicting residents for a remodeling project, but Peterson soon discovered that all 54 residents evicted were low-income Medicaid patients. These patients were paying their bills; they just weren't paying enough.
Initially, says Doug Stanley of the Tribune, reporters approached the story as a "localized problem - one nursing home doing a bad thing," but on the first day the story ran a call came that changed the course of the investigation.
"We got a call from an employee of the corporation that owned the nursing home, Vencor Inc., saving that getting rid of Medicaid residents was a new corporate policy," says Stanley, the newspaper's computer-assisted reporting specialist.
This whistleblower supplied memos, and reporters began hearing that stockholders were putting pressure on the company to increase profits. It became clear that this example was symptomatic of a larger problem within the corporation and the industry. Profits seemed to be more important than patient care.
A computer analysis of OSCAR, the federal government's database of citations given during each inspection of every nursing home, found Vencor was not alone. The Tribune reported that residents of the six biggest nursing home corporations in Florida were about 20 percent more likely to be harmed or put at risk than residents of other Florida homes.
Similar trends have emerged in other states. "The Tarnished Years" (Resource Center #15138), an investigation by the Indianapolis Star and the Indianapolis News, found that 35 of 41 homes rated "poor" by the state were for-profit operations, and Vencor was evicting Medicaid patients in Indiana as well. Chris Adams and Michael Moss of the Wall Street Journal gave a detailed description of Vencor's policies in the Dec. 24, 1998, edition (Resource Center #15386). This article showed that media scrutiny of the eviction policy forced a "complete flipflop," as facilities began receiving memos that told them to accept patients regardless of where the money was coming from.
Seeking mental patients to fill beds
Berens of the Chicago Triune investigated a different area in his series "Warehousing the Mentally Ill" (Resource Center #15173), which ran in September 1998.
Berens found nursing homes that were actively seeking Medicaid patients rather than evicting them. Mental patients in Illinois psychiatric facilities, and in most other states, are the sole financial responsibility of the state. But Medicaid will pay half the bills for patients placed in nursing homes.
This resulted in a system where mental patients were dumped in nursing homes. According to Berens, a filled bed in a nursing home will bring between $125 and $250 per day from Medicaid. That means homes all over the country have an incentive for filling beds with whomever is available.
"A filled bed is paramount in the nursing home business," he says. …