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Investigating Nursing Homes

Published on July 10th, 2020

Kellie Schmitt wrote an interesting article for Center of Health Journalism about how two top journalists explained how to research and investigate nursing homes during the pandemic in a webinar called “Covering Coronavirus”.

Charles Ornstein, deputy managing editor at ProPublica, described the devastating and disproportionate toll taken by coronavirus on the country’s nursing homes, and how reporters can better understand, quantify and report on the crisis in their own communities. He was joined by fellow journalist Chris Kirkham, an enterprise reporter at Reuters, who offered a behind-the-scenes look at his own investigation into longstanding staffing shortages that left these facilities especially vulnerable to COVID-19.

Nursing homes had challenges even before the pandemic struck including 82% of nursing homes surveyed from 2013-2017 were cited for infection prevention and control deficiencies.

“This is a perennial problem and our coverage of the issue today needs to have that context of where we’ve been in the past,” he said.

When COVID-19 hit, nursing homes did not have the testing capabilities or the personal protective gear for staff they needed. Other challenges include low-paid staff who often need to work multiple jobs, and a history of deficiencies, particularly for infection control, he said.

The federal government’s searchable database on nursing homes and COVID-19 has been “deeply problematic,” and plagued with inaccuracies and inconsistencies, Ornstein said. As the pandemic has progressed, that information has improved, but it still doesn’t always line up with the information provided on state web sites.

“You need to be really careful about using this data without looking up as much as you possibly can and asking tough questions,” he said.

Ornstein also suggested telling the story of a nursing home in your community that kept COVID-19 at bay or one that got particularly slammed by the virus, and compiled this tip sheet for reporters covering the nursing home story.

Reuters reporter Chris Kirkham, who wrote a special report on nursing home staffing shortages with Benjamin Lesser, was initially interested in figuring out whether nursing homes with COVID-19 outbreaks had histories of deficiencies. But the reporters struggled with the spotty federal and state data.

They also wanted to report on something systemic, so they turned their focus to staffing. They heard from a lot of overworked workers who said staffing had always been a problem, but COVID-19 “has really just blown a hole into that entire system.” While management was publicly calling these workers “heroes,” many insiders did not feel they weren’t getting adequate support, he said.

To get a sense of the staffing situation at nursing homes coming into COVID-19, Kirkham and data journalist Lesser conducted their own analysis to grade staffing. They decided to use California’s minimum staffing requirements as a benchmark since its standards is among the highest and had been recently updated. They calculated that 37% of nursing homes throughout the country would not have met the minimum staffing requirement in California. And, at least 70% of the homes would not meet the higher bar that some experts recommend.

When two nurses who had gone on record about the “nursing home nightmare” faced retaliation,  Kirkham wrote a follow up story and quoted the Massachusetts attorney general.

Those fears of retaliation might scare sources into not talking on the record, a risk that means reporters should approach these situations carefully, he said. Even if someone doesn’t want to be interviewed on the record, listen to their story anyway and stay in touch, as their circumstances may change.

Kirkham emphasized the importance of determination and persistence when searching for on-the-ground voices. For his project, he created a spreadsheet with about 250 names and ended up connecting with 5% to 10% of them.

Joe Pioletti
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