Are Nursing Homes Inflating the Numbers?

Nursing home resident Edna Irvin became the source of controversy late last year. The 80-year-old Irvin, a guest of the Chenal Heights Health and Rehabilitation Center in Little Rock, Arkansas, was the featured anecdote in an eye opening-read from the Center for Public Integrity. The Center found widespread reporting discrepancies among nursing homes in the U.S., including the home where Irvin had been living.

Based on several accounts and an analysis of government resources, the CPI discovered a laundry list of inflated, self-reported staffing numbers, some of which had been recorded just weeks prior to federally mandated inspections. The article points out that Irvin was a victim of a flawed system.

Over the first few months since she began living at the residence, Irvin endured a series of mishaps and injuries, according to the article. She suffered a laceration to her head related to a fall and fought through a severe bowel obstruction. In a later medical report, a rehab nurse noted that Irvin had traces of bacteria in her intestine and did not receive appropriate care for the obstruction. A law firm, acting on behalf of Irvin, obtained the nurse’s documents for an impending lawsuit filed by Irvin’s daughter, Lisa Sanders.

Sanders eventually had her mother transferred to a new facility, only after learning disturbing details about the staff, the home’s hours of operation, and the method by which the home monitored its residents. She discovered some wildly inaccurate numbers, a shock that ultimately set the move and the lawsuit in motion.

Irvin’s story is not unusual. The Center for Public Integrity uncovered an all too common if not systemic problem that has plagued nursing homes for many years. The process of self-reported data has been widely criticized by government agencies and the public, not least for its lax standards and shoddy reporting. Almost 100 peer-reviewed, academic studies, according to the Center for Public Integrity, showed that the amount of care was most strongly connected to quality care; lower levels of care showed higher risk for injury and, in some cases, death. By skewing the numbers, homes are, inadvertently or not, perpetuating bad practice and misleading prospective residents about the care they should be receiving.

The Center for Public Integrity also pointed out that self-reported data has historically been a crucial metric for government agencies that rank homes based on staff numbers, a metric that often helps the public make consequential decisions on behalf of their loved ones. But relying on self-reported information comes with a price. Irvin paid the price, and now her case is in the hands of litigators.

Improvements have been made since 2010, resulting from a provision in the Affordable Care Act that requires many homes to change from a self-reporting method to a payroll-based method. The payroll-based system utilizes an electronic data collection system—practically standard in today’s digital world—that ensures more accurate tracking. But if anything, the report by the Center for Public Integrity reminds us that there’s much more to be done.