Publicly Available Information About Nursing Homes
Did you know that key information about nursing homes is publicly available but often overlooked? Discover how you can use this information to make better decisions and protect residents. In this week’s episode, nursing home abuse attorney Rob Schenk welcomes guest Matthew Heimlich to talk about the crucial details you need to know.
Publicly Available Information About Nursing Homes
Schenk:
Publicly available information about your nursing home. Stick around
Hey out there. Welcome back to the nursing home abuse podcast. My name is Rob. I’ll be your host for this episode today. We’re going to be talking about all of the different types of information, types of data, types of documents that are. available online that are publicly facing that concern nursing homes.
So everything from how much the nursing home is paying for nurses to how many nurses are on staff to who owns the nursing home. All this information is publicly available and accessible to you in your investigations. If you’re wanting to put your loved one. into a skilled nursing facility.
We’re not doing that alone. We have trial attorney, Matthew Heimlich joining us today. Matthew Heimlich, an attorney at Mallman Law in Chicago, specializes in representing plaintiffs in nursing home negligence, personal injury, and wrongful death cases across Illinois. We’ll With extensive experience in long term care litigation, he strategically advocates for his clients.
He frequently contributes to local bar associations and co hosts the On Trial podcast, discussing pertinent topics in nursing home litigation. And we are so happy to have him on the show, Matt, welcome to the show. Oh, Rob, happy to be here. Thanks for having me on. No problem. I think that there, as a, as an industry, there’s a lot of things that we don’t know about the operations of nursing homes.
Everything from who owns them exactly to, the most recent survey. But that’s not to say that there’s not. some pertinent information that is easily available for us online with a simple search. And so that’s why I wanted to have you on today is to talk about some of the things that we can learn about nursing homes without having to be a private investigator of access to weird databases or go on the dark web or whatever it is.
What information is available on CMS nursing home compare?
Schenk:
So we’ll start with that. What is some key information that we would want to know about nursing homes, whether we’re a family of a loved one in a nursing home or an attorney that pursues nursing home cases. What is some of that information out there that we can get our, we can get our hands on?
Heimlich:
Yeah, that’s a very important question. And thankfully there are a bunch of different resources available for nursing homes. Families for residents for anyone who cares about someone in a nursing home. And particularly if you’re concerned about the operation of the nursing home, what kind of facility it is, or more specifically, if an injury occurred in a facility, what happened what were the circumstances of it?
So one of the first things that we do when someone calls about a potential injury at a nursing home is we say, did you call the Illinois department of public health? Okay. Because I practice in Illinois and the Department of Public Health is the entity that regulates all the nursing homes in the state.
And when you make a complaint to the Department of Public Health, they’re going to send somebody out, they’re going to do an investigation, they’re going to look through medical records, they’re going to interview staff. And if they find enough information to justify the complaint, they’re going to issue a citation and they’re going to do a write up about why the facility was not able to meet the minimum standards in the care and treatment of the patient.
And. One of the first things that we do after we learned that has been done, or if the incident is significant enough where they’re required to report it, is we’re going to send a freedom of information request to the Illinois Department of Public Health. And, sometimes it doesn’t turn up anything but other times it will give you a literal breakdown of.
For comprehensive ratings and detailed reports on nursing home facilities, explore the Nursing Home Compare tool.
What the failures in care were and sometimes what the staff said in response to being questioned about the care and treatment provided to a given resident. And in that case, you can have, basically an outline of your case ready to go before the defendant even knows that there is a case. So that is an incredibly powerful tool and we recommend.
Anybody who has a question or especially observe something to have occurred or is concerned about what’s going on with a loved one to contact public health and let them do their job because ultimately, as attorneys, we can take that information. And, have it at the ready before, while we’re evaluating the case and before the defendant even knows that there is a case.
Schenk:
And that’s not, and just for the listeners out there, that’s not just isolated to Illinois. Typically most states are going to have some type of state entity or an agency or department that oversees the nursing homes. And so in Georgia, it’s the Department of Community Health. And as, as Matt mentions, if the injury is typically a severe enough or is an assault related or some type of sexual assault related, there’s going to be typically some type of investigation done.
And then when there is an investigation, there’s paperwork. But I guess. And can you speak a little bit about to the idea of how difficult would it be for a family to get a hold of that? Or actually, let me back that up. What would be the process for a family of a loved one where something did happen?
How do they go through the process of Do they file a complaint online? Do they call somebody? How does that work?
Heimlich:
You can do both. You can go on to the, you just Google at least in Illinois, the Illinois Department of Public Health. They have a website. They have a complaint hotline. You can call 24 hours a day, seven days a week.
And you can make your complaint that way. There’s an online form you can fill out. And importantly for your residents who are, for loved ones who are in there, the complaints are anonymous. They’re not going to know. Who made the complaint on behalf of the resident? Obviously when the surveyors go in, they’re going to be looking through certain residents files.
They’re going to be looking based on the allegations made in the complaint, but it’s something that anybody can do online or on the phone. And, as far as, Once the public health department has your information, they are required to relay those results to you. So they’ll send you a confirmation letter.
Yes, we received your complaint. We’ll do an investigation. We’ll let you know what the investigation is. And then when the results come out, they’ll send that to that person as well. They are going to keep the person informed of how the investigation is going. And if for some reason that doesn’t happen you can submit.
a freedom of information request online. A family member can do that particularly like we were just talking about, if it’s something that’s required to be reported by the state and the family didn’t think to initiate it. They can still initiate a freedom of information act request and get that information that way.
So this is, these are all things that can be done by families outside of the court system on behalf of loved ones.
For broader healthcare resources and guidelines, check out the official Medicare website.
How can cost reports help us understand how a nursing home is run?
Schenk:
That sounds fantastic. Okay. So what’s the, so we have investigations by the overseeing entity. What’s what else could we, we get our hands on?
Heimlich:
Sure. From a consumer perspective, there’s a lot of good information out there Medicare’s website Care Compare.
Has a lot of good publicly available information about nursing homes. It starts on a high level and then you can dig a bit deeper depending on how far down the rabbit hole you want to go with the information. The most the kind of the all encompassing evaluation for nursing homes, the Medicare star rating system, five to one, five being the best one being the worst each facility has an overall rating.
And, you can guess. At least from a broad sense of what kind of care is generally being provided at a facility based on their Medicare star rating and I want to come back to it because we, like I said, you can go deeper down the information rabbit hole with them, but that is the big overall rating.
That’s a nice, easy thing to summarize what’s going on at a particular facility. On a state level, There are cost reports that nursing homes have to file with the state, and that has a really interesting assortment of information about how a facility is being run, what people are involved, what entities are involved, and from a business sense, where is the money that’s going into the facility actually going?
For example I, You can put and you can pull these up online. They’re just available. They can be downloaded. They’re, usually about a year or two behind. I don’t think we have the 2023 is up yet. That should be coming up in the next couple of months, but I’m looking at one right now where the total revenue generated by this facility during the year 2021 was 21.
9 million. That’s a lot of money. But their net income for the year. Was a loss of 280, 000. So how does that happen? How do we go from almost 22 million to more than a quarter million dollars in the whole. So you have to look through the information that’s in the cost report. And, did they allocate costs to the management company, which is, the group that owns, it’s a lot of related nursing homes are owned by a common management company.
Stay informed about infection prevention and control measures in long-term care facilities with resources from the CDC’s NHSN.
It’s like a brand that owns different franchises. And, did they allocate costs in the management company? And this year, yes, they did. Almost a quarter of a million or three quarter million dollars. Are there some very unusual expenditures for things that don’t fully make sense?
Yeah. In this case, they paid their dietary consultant over a million dollars for one year. That seems odd. That’s something to maybe look into. Did their, they pay dividends to their owners? In this case, yes, they paid two and three quarter million dollars dividends to their owners that year.
So once you take a look at this, you can see how, almost 22 million in revenue becomes, to a loss of 280, 000. When you look at the numbers and see where all the money’s going out of the facility too. So that’s been an interesting peek behind the curtain to see how these facilities are actually being operated.
Schenk:
And that’s the Medicare and Medicaid cost reports. And for our business friendly listeners, to the extent that we have any out there it’s obviously, it’s not a problem. If a company has common ownership, what Matt is talking about is it’s not just that they’re paying the million dollars to the management company.
It’s that the cost report is going to show that the management company is telling the federal government that it only costs us a hundred grand. to perform the management services, but yet we were paid a million dollars. And oh, yeah, we’re owned by the same group of owners that the facility as the facility licensee is.
So it’s not just nobody’s saying that you can’t own more than one company. What we’re saying is that when you’re one company Is overpaid by 900, 000. That’s the problem. And then ultimately, your facility showing a loss, something fishy going on. So I would say that and it’s a question is the cost report is probably more towards an attorney is going to look at this.
Lay people, if you could probably spend some time and learn, but That’s not going to be something that you could intuitively pick up a cost report and know where the money’s being skimmed. Whereas the Nursing Home Compare website, which you mentioned with the star rating, I think that is something that you could immediately go to and learn a lot about a nursing home.
Heimlich:
Yeah, you can, you, you really can. There’s a lot of good information on there. And then the comparative part of it is you can start with the Medicare star rating and work your way down, because you can sort the nursing homes and search for them geographically, because the vast majority of people are, they’re going to want to have their loved one in a nursing home close by.
So you’re only going to be looking at a certain geographic area. So your options are, can be fairly limited to, what’s around. You can take a look and see, okay, there’s a five star. nursing home, but it’s, it’s 30 minutes away, is that something we want to do?
There’s a three star nursing home right down the street, is that, what do you think, and you can weigh the pros and cons of what to do and then what you can do if you search further into the Care Compare website one of the things I always look for and, one of the things that’s the most important to make sure loved ones get good care, is first of all, it can’t, do they, can you go to the facility?
How often can you actually physically be in the building? That’s to me the biggest driver of making sure that, people are getting taken care of is is that everyone knows that their families, they’re there a lot, they’re there regularly, they’re asking questions, they’re sticking up, for their loved one, and that, that’s a big thing.
The other thing is, are they staffed enough to meet the needs of the people that they’re supposed to be taken care of? And they have a specific data and information on the website about just staffing, what kind of staff are in the building, does the staff, meet the needs of the residents.
And you can drill again, if this is more for the lawyers, but you can drill farther down on that. Based on some of the information that’s submitted to Medicare, where they do an analysis of, does this facility have the right amount and kind of staff to meet the needs of the patients?
So they really, there really is. And again, all of this is available publicly. You don’t need to rely on the facility. You can just, you can get on Medicare’s website and, get all this information.
For advocacy and empowerment of older adults, visit the National Council on Aging.
What is a PBJ data report and what does it tell us about nursing home staffing?
Schenk:
And just as a warning to, to the people out there that are doing what Matt is saying, which is trying to find a high star rated facility close to you or anywhere, just remember that the low stars.
We know that’s bad, but just because a nursing home has three, four, five stars, doesn’t mean it’s good. You still need to go because as Matt can probably attest to, there are ways in which the nursing home can game the system. So just because it is a high rating. doesn’t mean it’s good and a low rating means it probably almost certainly is bad.
So always kick the tires first. So we have we have specific complaint investigations by the state. We’ve got the information that’s on the nursing home compare in terms of the star rating. We’ve got cost reports, what’s another go to source of information that you look for.
Heimlich:
Yeah. Me as an attorney, when I’m looking at a potential defendant in the case there’s a bunch of reports and the information that you can run again, just that’s collected by the federal government.
And honestly, it’s organized well enough to be understandable. Once you get an understanding of what you’re looking for in most nursing home cases, like I was talking about earlier, staffing is always an underlying issue. And there’s this report called the PBJ staffing data, which is collected by Medicare, and it’s submitted to them by the nursing home.
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And they have to give them through these reports called MDS reports, what the census was, how many residents were in the building on a given day. And then they have to report how many registered nurse hours. How many registered nurses hours were service were performed in the building?
How many licensed practical nurse hours were performed in the building? How many hours were CNAs providing care in the building? And that is reported to them on a daily basis. And you can download that information for a facility. Facility for a given week, day, month, year, and it’s all there and in black and white, and it’s inherently reliable to an extent because it’s being reported by the facility.
I, they couldn’t, it would be hard to imagine saying, Oh, we actually just didn’t We weren’t telling Medicare the truth, that’s a big federal problem for them and they’re not going to go there. So you have inherently reliable information about what their staffing levels were and how many residents were in the building on a given day.
Learn about efforts to combat elder abuse by visiting the National Center on Elder Abuse.
Schenk:
So all of that is. just ready to be downloaded. PBJ sounds like a delicious sandwich, but it is in fact, payroll based journal information is what Matt’s talking about, where the facility literally has to submit an Excel spreadsheet basically to the federal government saying, these are the amount of hours of LPNs.
These are the amount of hours of RNs, the amount of hours of CNAs, even to the point where you’re bifurcating. nurses by whether or not they’re performing administrative duties versus direct care duties. And you can literally, and I’m actually going to have a podcast about this. I’m going to walk through this document because it’s a publicly available document.
You download the spreadsheet and you can literally see day to day, whether or not the facility that you’re concerned about is meeting at least the minimum required hourly requirements of nurses. And what’s interesting to me is that I do this in every one of my cases where if it’s, for example, if it’s a fall case, I can go immediately to the day of the fall and be like, Oh they, at least in Georgia, we, you have to have at least two hours.
Until the recent change, but you had to have at least two hours of nursing care and they’re at 1. 25. So you already know that, that’s an argument that you can make, but this is all data. Like cost report. Okay. If you’re a layperson, that’s going to be tough downloading this spreadsheet and looking to see how many nurses are on in a particular day.
That’s something that I think that you could do in an afternoon. And that’s, it’s really good information. Okay.
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Heimlich:
It’s also important to note the changes, the, those still surprise me, that they’ll have all kinds of staff on one day. Usually on a weekday and all of a sudden you get the weekends and staff drops off a cliff.
And, it’s unsurprising to anyone who’s been doing this for any length of time that, the vast majority of accidents happen on nights and weekends, because the facility isn’t staffed like it is during the day. And that bears itself out in the numbers that you can see in the staffing data that, we can all download for Medicare now.
Schenk:
Exactly. And I run it through a, an Excel spreadsheet that shows a graph and you can see like the peaks and valleys of you don’t even have to, you don’t even have to see the dates, the days of the week. You just know when it’s a weekend. Cause as you said, it’s there’s nobody there. What else can we learn by doing a a Google search, what else do we got?
Heimlich:
Medicare has got more for us. It really is. They’ve become a treasure trove of information about. These facilities and even about the management companies the facilities, there’s this another dataset called case mix data, and it is an absolutely enormous. Excel spreadsheet that I do my best to try to pare down to just the more relevant columns, but it really gives you a really just an unbelievable amount of information about a facility.
It has staffing data as well. And it has this case mix. Staffing data, which is basically comparing the amount of staff that’s needed to the amount of staff that was actually done. So the case mix is how acute are these residents? Are they a bunch of long term residents who are basically there for long term care?
They’re not, rehab patients that require a, a. higher level of care, higher level of need, you know for basic tasks, or is this a heavily rehab population? Is this a highly acute population that needs more hours per person? And you can get a sense of that and it compares here’s what should be provided based on the need, and then you can compare it to here’s what was provided, and that can be a really interesting analysis to do on a case.
There’s also, they give you facility reported You know, in injury incidents, how many substantiated complaints was the facility find during this period and for how much? And it really gives you all of this information again, one document publicly available available for anyone to download.
To understand more about nursing home staff perceptions and safety culture, refer to the AHRQ Nursing Home Survey on Patient Safety Culture.
Schenk:
Who’s looking hard enough, really? What, and what is that document called? Does it have a name?
Heimlich:
It’s the case mix data. So if you Google Medicare case mix data, it’ll take you to a web page and you can, find what facility you’re looking for. You can find, I believe it’s on quarterly, you can find what quarter you’re looking for. And then you can just download that information for that facility. It’s a, it really is a, it’s a tremendous amount of information all in one place.
Schenk:
And this is like the nursing home abuse drinking game. But you mentioned that the resident population might need more or less care based on their, basically their acuity.
So a lot of times the nursing home will say we’ve met the minimum staffing requirements, but that doesn’t mean that they’re providing the care they need because the acuity of the resident population as a whole may mean they need a lot more than the minimum. Staffing. So it’s really an important distinction that we should make that staffing minimums don’t mean that care is being met because the acuity could be such that they don’t have enough.
Okay. So we’re CMS, Nursing Home Compare. We got all that info. Anything else we got?
Heimlich:
The last one, and this is a relatively new addition to what’s available on Medicare, is Affiliated Entity Performance. So this is more for management companies that own and operate, a number of facilities. And, what it will show is it’ll have a, they have their own kind of data set and it has some really interesting information, so you can take a look to see if this is something that this particular management company is known for, operating substandard nursing homes, or are they known for operating facilities that how many special focus facilities are they operating?
That’s when there’s been, a number of substantiated abuse and neglect complaints are in their facilities on the special focus, how many and then it says how many abuse icons is another column of data. So again, I’m looking at a a company right now. Right in front of me, their affiliated entity data says they operate 59 facilities and 13 of them have abuse icons.
So that’s a substantial amount. And this is, a major operator in Illinois. What is their average Medicare star rating for their facilities? On aggregate, over all 59 how many average nurse hours are they providing to their residents? Again, on aggregate, over all their all their facilities.
What’s the average staff turnover for all these facilities? How many fines have, did they have? How much work do they find and how many what percentage of patients have a fall with injury? And what percentage of patients, develop a pressure ulcer during their residency.
So all of that information is again, it’s all on Medicare ready to be viewed. And I would say from a consumer perspective, I would almost start there. And work their way, work your way down to the facility because if you figure out what entity owns and operates your facility, they’re, it’s they think of things globally, so you want to think of it too.
If you find an operator that you can find out a lot about what’s going on in a facility by finding out, what kind of operator they are, how many homes they have. Because if it hasn’t happened yet, if it’s maybe they just bought a facility from a different operator, so nothing’s really happened yet.
But if they’ve been around for a while, you can figure out what their track record is and, make your own, draw your own conclusions based on that.
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Schenk:
And that most recent document that you’re talking about is, does that have a name?
Heimlich:
It’s the affiliated entity performance report.
So when, if you go on Care Compare and you click on a facility, if you scroll all the way down, it’ll let is this part of basically a nursing home chain? Gotcha. And it’ll have the the name of the nursing home chain and you can click on that link. And it’ll take you to a different page where you can run this kind of a report and it’ll give you, all this information that in my mind is pretty useful for us as lawyers and it can also be useful for consumers to figure out, is this the kind of place is this the kind of company that I want, running the place where I’m keeping my loved one?
Schenk:
And I feel like the Care Compare, the Nursing Home Compare website, I feel like it went through an overhaul maybe a couple years ago. I can’t remember, but it’s getting easier and easier. I think the user interface is getting easier. So this is not necessarily something that should scare you away, but just go to the site and take a look around and you’ll see everything that Matt’s talking about.
Matt, thank you so much for coming on the show and sharing your knowledge. We really appreciate it. A lot of stuff like this is like one of the benefits of this podcast. I learned something new every single week. So I really appreciate it.
Heimlich:
Yeah, absolutely. Thanks for having me on.
And yeah, some of this stuff you see online can be confusing, reach out to an attorney, we look at this stuff all the time, we’re happy to answer questions, especially if you’re concerned about someone or something that happened at a facility, don’t hesitate to reach out because, a lot.
Like I said, it has gotten a lot, you said it has gotten a lot easier. The information, the data itself, it can be a little bit technical, reach out to someone, have them talk it through with them. But yeah, there’s a lot of good information out there if you’re looking for it.
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