The Lowdown on Nursing Home Deficiencies

By Charles Ornstein, ProPublicaThis piece originally appeared atProPublica.

Last week, we refreshed our Nursing Home Inspect app to include thousands more deficiencies found by government inspectors in nursing homes around the country.

Our tool, based on data from the U.S. Centers for Medicare and Medicaid Services (CMS), has already led to an impressive array of news stories.

The Shreveport Times reported that a resident with dementia at a Bossier City, La., nursing home went missing for more than 3½ hours last year before staff went looking for her. A worker found Hattie Mae Chambers “outside the facility lying in a fetal position near a fence, her white socks covered in grass,” the paper reported. “Blood was coming from her nose and mouth, and was pooled on the ground. The 57-year-old mother of three was dead. A police report later would reveal Chamber’s body temperature was 118 degrees.”

The Columbus Dispatch wrote about a nursing home in Yellow Springs, Ohio, at which a worker last year “opened the door of a resident’s room and saw another aide on top of the resident, having sex. The worker shut the door and went to get a supervisor, leaving the partially paralyzed woman alone with her abuser. The abusive aide continued working for more than an hour before being ordered to leave, and was later fired.”

The Daily News of Los Angeles found that 125 residents at a local nursing home had to remain in rooms last year that reached up to 90 degrees after the air-conditioning had failed for days.

And the Contra Costa Times reported on an Oakland, Calif., home at which the owner yanked family pictures off a resident’s wall, “took away a crackers-and-jelly bedtime snack, and said the resident could not keep other food items relatives had left. Eyes welling with tears, the resident told an investigator how much it meant to have photos of relatives in the room. ‘Why did they do that to me?’ the resident asked.”

ProPublica has not done its own nursing home reviews. Rather, Nursing Home Inspect relies on the government, which first began publishing the narrative portions of inspections last month.

The CMS data cover all deficiencies identified during each home’s most-recent periodic review, known as a standard survey. It also includes complaint investigations from at least the past 12 months.

Nursing Home Inspect allows users to search all inspection reports by keyword to look for problems that may appear across the country. Results can be sorted by state or severity level. Our tip sheet offers suggestions about how to get the best search results.

In addition to adding more reports to its site last month, CMS stopped redacting residents’ genders in inspection reports — though it continues to redact information about residents’ diagnoses and medications.

As of late August, the app included 134,602 deficiencies from nearly 15,000 nursing homes. They represent 26,990 separate visits by inspectors.

The inspectors rated the majority of the deficiencies, nearly 57 percent, with a severity score of D, on a scale of A (least severe) to L (most severe). A “D” score signals an isolated instance in which the violation created the potential for harm, but in which no actual harm occurred.

The most common deficiency, cited 8,281 times, was a home’s failure to ensure that it was free of accident hazards and that each resident received adequate supervision and assistance to prevent accidents. The second most-common related to infection control. A recent blog post said nursing home inspectors have increasingly cited homes for the failure of their staffs to wash their hands.

Nursing home industry officials have cautioned that while the reports can be of value when choosing a home, they are only a snapshot and don’t highlight good practices in the home. The American Health Care Association, a nursing home industry group, has launched a program that each year recognizes homes that it says are working to improve the quality of care.