ProPublica released unredacted write-ups of problems found during nursing home inspections around the country.   For several months now, ProPublica has made redacted versions of this same information available in an easily searchable format in our Nursing Home Inspect tool. These versions, which reside on the U.S. Centers for Medicare and Medicaid Services website, Nursing Home Compare, sometimes blank out patients’ ages, medical conditions, dates and prescribed medications.

The agency has said the redactions are intended to balance patient privacy concerns with the need to inform consumers about the quality of care. ProPublica requested the unredacted reports because they are public records and because the added information can make them more useful.

For example, prescription information in the unredacted write-ups can help identify cases in which patients received medications such as antipsychotics that are dangerous for those with dementia.

Nursing Home Inspect allows patients and their families to quickly find nursing homes in their states and identify those with serious deficiencies and penalties in the last three years. The entire national collection of reports — listing more than 267,000 deficiencies — is searchable by keyword.

At this point, Nursing Home Inspect continues to link to only the redacted inspection reports. To search through the unredacted versions, you’ll have to download them and use a program like Microsoft Excel or a text editor that enables you to hunt for keywords or phrases.

The unredacted reports are grouped by CMS region and can be downloaded here. A list of states in each of the 10 regions is here.

The Leaf Chronicle reported the $740,000 fine issued to Spring Meadows Health Care Center in Clarksville, Tn.  The U.S. Centers for Medicare & Medicaid Services fined the nursing home for various violations of federal regulations. The inspection report by the Tennessee Department of Health lists a number of minor infractions and five serious ones. The most significant infraction was lack of supervision and other precautions that led to a resident repeatedly suffering serious injuries from falls.

The report said that one of the 20 residents surveyed fell eight times between February and July, suffering injuries that include a chipped tooth, a broken nose and lacerations that required sutures.  One section of the report alleges instances of verbal and physical abuse perpetrated by residents who weren’t properly handled by the staff.

It also describes an incident where a resident was transferred to a different room when she complained that the staff wouldn’t give her neighbor a bath or change the neighbor’s clothing. 

The Des Moines Register also had an article about The American Civil Liberties Union of Iowa  asking the state agency that inspects nursing homes to explain why they refuse to disclose statistical information related inspections and complaints. The information is collected and maintained by state employees paid for by taxpayers. The ACLU of Iowa is asking the department to turn over all correspondence, rules or directives from the federal government that the state is relying on to deny access to the information.

In July, The Des Moines Register asked the inspections department six questions regarding trends in the number of uninvestigated complaints of poor nursing home care, the number of violations cited by the state and the average amount of time now being spent on nursing home inspections.

The data requested by the Register could show whether the state’s enforcement efforts have relaxed under Gov. Terry Branstad


Critics and health care experts fear that Iowa Governor Terry Branstad’s relationship to the nursing home industry will cause premature deaths of vulnerable and disabled elderly.  Disability Rights Iowa, which is part of a national network of advocacy groups established by Congress in the 1970s, published a scathing, open letter to Branstad, questioning the governor’s lax supervision of Iowa’s nursing homes.

Sylvia Piper, executive director, Disability Rights Iowa, Des Moines recently wrote "Terry Branstad believes nursing home residents, many who have witnessed or experienced abuse or neglect, no longer need anyone to protect them. Rod Roberts, director of the Iowa Department of Inspections and Appeals, gets his marching orders directly from Branstad. They both agree that no inspectors are needed; the nursing homes should be left to police themselves."  Sylvia Piper told Branstad in the letter that because of his “political choices, people are suffering and dying on a regular basis in Iowa’s nursing homes.”  In March, Roberts who has no prior management experience, eliminated the positions of 10 nursing home inspectors and two abuse prosecutors, citing budget constraints. After lawmakers restored funding for the positions, the department opted to spend the money elsewhere, saying the inspectors were not needed.

"Branstad has a lucrative arrangement with the nursing home lobby. They give his campaign tens of thousands of dollars, he helps them run under the radar by removing those who would hold them accountable. Under this egregious arrangement, nursing home residents are left alone and helpless in an environment historically notorious for abuse and neglect."

The (Republican) state auditor, long-term care ombudsman, and Iowa citizen’s aid ombudsman cited him for failing to adequately regulate nursing homes. Clearly, he wants to protect his campaign contributors. There has been an increase in complaints regarding nursing homes and other types of care facilities in Iowa.

Piper said her organization has investigated specific cases in which residents have died or been injured as a result of negligent care that could have been prevented through more aggressive action by the inspections department. 


See articles at Des Moines Register, here and here.



The Palm Beach Post Opinion published a commentary from Brian Lee, executive director of Floridians for Better Care, who was removed by Gov. Scott in February after seven years as Florida long-term care ombudsman.  Lee references the inherent conflicts of interest and attacks against Florida’s Long-Term Care Ombudsman Program drastically weakening its ability to protect nursing home residents and their rights.

"At the apparent behest of an industry group, the Florida Assisted Living Association all but handpicked the new ombudsman, to have someone with a friendlier disposition toward their interests. The volunteer ombudsmen, led by Lynn Dos Santos, state council chairwoman, protested this as a violation of federal and state law. The Scott administration apparently tired of Ms. Dos Santos’ rants and had the Department of Elder Affairs secretary "de-designate" her for "alleged" Sunshine Law violations. The secretary failed to realize that he cannot "fire" her, but the administration and industry obtained their desired outcome. Ms. Dos Santos’ removal sent fear throughout the ombudsmen. Volunteers scattered, convinced that speaking up might result in their own dismissal. The issue at hand: the Legislature’s reduction in nursing home staffing hours."

Meanwhile, the Orlando Sentinel had an article on the Florida Republican Legislature passing additional restrictions on the right of injured patients to sue the medical industry.  The legislation would arbitrarily exclude qualified medical professionals from explaining issues to the jury.

Although lawsuits, insurance premiums and the amount of damages paid have all gone down since jury awards were limited in medical-malpractice cases in 2003, GOP lawmakers say Florida needs to protect insurance companies in order to get more doctors to stay in the state.  Despite the fact that data shows that doctors are not leaving Florida.

A DOH survey of 23,297 active physicians last year found “low compensation” — not lawsuits — as the main reason doctors weren’t accepting new Medicaid patients. Of the 8,529 doctors not accepting new patients, 42 percent said low pay was the reason.

See this article from the Orlando Sentinel for more information about the problems in Florida’s nursing homes.

CBS reported an investigation into food inspections at Florida hospital and nursing homes.  No one is inspecting food preparations at Florida’s hospitals and nursing homes. The inspections were halted as a way to save money due to budget limitations. Food borne illnesses linked to these facilities have sickened hundreds of Florida consumers in at least 15 separate outbreaks since 1995. Experts say people at these facilities are the most vulnerable for foodborne illnesses.

The decision to end the inspections due to lack of funding came after the federal government gave more inspection authority to the states. The health department had inspected facilities four times a year before they stopped this year.


The NY Times had a recent article about the prevalence of violations in the vast majority of nursing homes. National for profit chains seem to get more violations than others.  The article cited that more than 90 percent of nursing homes were cited for violations of federal health and safety standards last year.   About 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.

Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.  Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.

About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.  The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.

“For-profit nursing homes had a higher average number of deficiencies than the other types of nursing homes,” Mr. Levinson said. “In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.”

On Monday, Mr. Levinson issued a compliance guide for nursing homes that says some homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.” Researchers have found that people receive better care at homes with a higher ratio of nursing staff members to patients.

The inspector general said he had found some cases in which nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all.”

More than 1.5 million people live in the nation’s 15,000 nursing homes. The homes are only inspected once a year and must meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.

Medicare pays a fixed daily amount for each nursing home resident, with higher payments for patients who are more severely ill. Mr. Levinson said some nursing homes had improperly classified patients or overstated the severity of their illnesses so the homes could claim larger Medicare payments.


Here is an excerpt from a recent article in the Conservative Wall St. Journal.

Last month, health inspectors in New York City shut down Serendipity, an upscale ice cream parlor. Though the closing made headlines, it is a common occurrence for less-famous eateries charged with violations like unclean cutting boards and floors, workers who fail to clean their hands, and improper food handling that could lead to bacterial contamination.

Restaurants in New York are inspected, without prior notice, once a year. In Los Angeles, inspections are done three times a year, and restaurants must display their grade near the front door. After L.A. instituted this inspection system in 1998, the number of people sickened by food-borne illnesses fell 13%, according to the Journal of Environmental Health. Other cities are now following L.A.’s lead.

Why aren’t hospitals {and nursing homes} held to the same rigorous standard? The consequences of inadequate hygiene are far deadlier in hospitals than in restaurants. The Centers for Disease Control and Prevention estimate that 2,500 people die each year after picking up a food-borne illness in a restaurant or prepared food store. Forty times that number — 100,000 people — die each year, according to the CDC, from infections contracted in health-care facilities.

Data recently published by the Journal of the American Medical Association show that infections from just one type of bacteria — methicillin-resistant Staphylococcus aureus (MRSA) — kill about twice as many people in the U.S. as previously thought. The finding is based on lab tests, not on what hospitals report. If the same methodology were used to quantify deaths from all hospital infections, the death toll would likely be much larger than 100,000.

These infections are caused largely by unclean hands, inadequately cleaned equipment and employee’s contaminated clothing that allow bacteria to spread from patient to patient. In a study released in April, Boston University researchers examining 49 operating rooms at four New England hospitals found that more than half the objects that should have been disinfected were overlooked by cleaners.

Testing surfaces is so simple and inexpensive that it’s used routinely in the food industry. Is it more important to test for bacteria in meat processing plants than in operating rooms?

Read More →

The Associate Press had this story today.   Fifty-six nursing homes are among the worst in their states and are being called out in an effort to goad them into providing proper patient care.

Lawmakers and advocacy groups complain that too many facilities get cited for serious deficiencies but don’t make adequate improvement, or do so only temporarily.

The homes in question are among more than 120 designated as a "special focus facility." CMS began using the designation to identify homes that need more oversight.   The homes on the list got not only the special focus designation, but also registered a lack of improvement in a subsequent survey. 

There are about 16,400 nursing homes nationwide. About 1.5 million elderly people live in nursing homes. Taxpayers spend about $72.5 billion a year to pay the cost of nursing home care.

The AARP also applauded the administration’s action.

"People in nursing homes have a right to know how well they’re performing," said David Certner, director of legislative policy for AARP, an advocacy group for people 50 and older. "Their families certainly have a right to know what kind of care their relatives are receiving and if that care is substandard."

Here is the link to the list.