Two top journalists explain how to go deeper on nursing homes during the pandemic

Over the years, investigative journalism on nursing homes has been extensive, possibly leading some reporters to question whether there’s still more to say, said Charles Ornstein, deputy managing editor at ProPublica.

“As we’re learning through COVID-19, the answer is, most assuredly, yes,” he said in a Center for Health Journalism “Covering Coronavirus” webinar this week.

Ornstein 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. 

Revisiting a chronic problem 

Before reporting on nursing homes in the COVID-19 context, it’s important to understand some of the ongoing challenges they’ve faced even before the pandemic struck, Ornstein said. He pointed to a U.S. government report that showed 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.   

In reporting on nursing homes and the pandemic, it’s important to keep in mind what we still don’t know. For one, there still isn’t clarity on whether state policies on transferring COVID-19 patients from hospitals to nursing homes made a difference. And, there’s some debate as to whether a nursing home’s prior ratings and quality made a difference in how well they handled COVID-19.

Another big unknown: What has happened in assisted living facilities? Since they do not receive Medicare and Medicaid funds, they aren’t subject to the same regulations, something that “makes them a bit more invisible,” Ornstein said.

Find the available data and get started

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.

He suggested the AARP guide on what each state is sharing and how to find it, as well as the Kaiser Family Foundation’s deaths and cases at long-term facilities by state. The Washington Post offers this database of Medicare-certified nursing homes with at least one COVID-19 case.

Pro Publica’s Nursing Home Inspect offers a searchable database of 80,000 nursing home deficiency inspection reports nationwide. Try searching for inspection reports that include the word “outbreak” in your state. Understanding how a facility dealt with a previous outbreak might offer valuable insights into how they’re dealing with a COVID-19 outbreak, 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.

Behind-the-scenes of an investigation

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.

To bring those systemic staffing shortfalls to life for readers, he needed to understand what was happening on the ground. Kirkham turned to social media sites such as Facebook and LinkedIn, plugging in the nursing home name in the hopes it would appear on someone’s profile. If they didn’t respond to messages on that social media, he tried plugging their name into Nexus or other online directories to find a phone number.

One of his leads ended up referring him to a “perfect source,” a nursing home resident who was a former social worker. She had taken copious notes on the staffing shortages and became the lead anecdote in the resulting story.   

Through those interviews, he ended up finding compelling insider stories, such as a teenage nursing assistant trainee who had been left alone on a wing with 30 dementia patients. He also learned of staff who were so busy they couldn’t sit with dying residents — one worker offered her cell phone for a deathbed phone call.

Working with hesitant sources

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.  

Ornstein recommended ongoing callouts to engage willing sources and to always be listening — not just when you’re ready to report. Oftentimes, people who were fired for voicing concerns can be great sources because they may have a long document trail and emails they can share.

To connect with sources, Ornstein also recommended looking at online obituaries, searching for the facility name as a keyword. Finding and messaging a source found through Yelp is another strategy.

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.      

“Be patient and don’t worry about rejection,” Kirkham said. “It can be a long and torturous process sometime. I would just urge you to keep trying.”

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Watch the full presentation here: