In 2009, while at The Chicago Reporter, I took a deep look at racial disparities in the quality of care in nursing homes in Chicago, Illinois and nationally. For a project that the Center for Public Integrity published in November 2014, I brought together Medicaid cost reports, self-reported staffing figures, testimonies from advocates and lawyers, and personal stories from nursing home residents and their families to address a simple question: how much care is a loved one actually receiving at a nursing home? The conclusion? Nursing homes serving minorities offer a lot less care than those predominately housing whites.
The three-part series began with a leftover.
Toward the end of my reporting on The Chicago Reporter story I brought together self-reported staffing levels on Nursing Home Compare, a government website the public uses to compare and evaluate nursing homes, with the average daily levels of care I calculated by looking at Medicaid cost reports.
I found that the self-reported data was higher than the daily figure from the cost reports in many more than half of the facilities.
Intrigued, I spoke to advocates and lawyers who said the finding suggested that nursing homes “staff up” for inspections.
Toward the end of 2013 I submitted FOIA requests for four additional years of Illinois cost reports. I repeated the analysis and found similar results that convinced me the first year was not an aberration.
David Donald, then the data editor at the Center for Public Integrity, encouraged me to locate cost reports for all 50 states in order to tell a national story.
Finding the data
But finding the data presented a real challenge as the first person with whom we interacted told us that the data we wanted was not kept in the cost reports. We looked through the nearly 100-page data dictionary before we found that was not true.
From there we needed to tackle the data.
At more than 14 million records, the file was the largest I had ever analyzed. It took me days before I could connect the data fields with their corresponding values in the dictionary.
I filtered the data with statistical software SPSS before getting a quantity of them I could analyze in Excel.
I located a 2007 peer-reviewed paper about over-reporting of staffing levels in Texas nursing homes. Guided by lead author Bita Kash and assisted by Charlene Harrington, a longtime national authority on nursing home staffing, I conducted the national analysis of more than 14,000 nursing homes.