Using multimedia tools to untangle California's nursing home funding

In 2004 the state passed the Nursing Home Quality Care Act to help nursing homes increase worker wages and staffing levels. As Christina Jewett began to report we discovered that some nursing homes were not spending the money as the bill had intended. To fully explain the story we would need to review the bill, how homes were funded, how they are funded now and how homes were (or were not) spending the money. We decided to use several multimedia elements to help untangle complex concepts, highlight important pieces of the puzzle and to allow users to go beyond our reporting. 

OC Register Scott Brown

Graphics

Working with Orange County Register artist Scott Brown we created simple graphs to illustrate basic concepts. Actually seeing the slow rise of staffing levels against the much larger growth of income is much more effective than stating that direct care staffing only saw a five percent increase while net income had a 127 percent increase. The Register also created a flow chart to explain the six-part funding process.

Video

Jewett and I decided early on to highlight the story of one family and one nursing home. Although we talked to many families statewide, the Schreifels’ family allowed us to record them at home on several occasions. Harold Schreifels had died at the Homewood Care Center in San Jose. The state had cited the home, and the owner had used state funding from the law to reduce the citation. We were also able to speak with the Homewood Care Center’s owner, Jack Easterday, several days before he went to prison for payroll tax evasion.

Radio

While working on the video we also worked closely with California Watch/KQED radio reporter Michael Montgomery to pool video, audio and photo resources. Before the story ran in newspapers, KQED aired a California Report segment combining an interview with Jewett explaining the bill and quotes from key players.

Database

Jewett, our data analyst Agustin Armendariz and I decided that we wanted to provide both statewide context to the story and allow people to research individual homes in their area. We did not want to become another home ratings site. Instead we wanted to concentrate on whether homes were spending public funds in line with the goals of the 2004 law: to increase staffing and wages.

Over a period of three months we worked on designing the interface, deciding what were the indicators of success or failure and then actually coding out the database. To learn more about how we decided on our indicators and how we analyzed our data please read our methodology.

Armendariz used the python web framework Django to develop the database presented online. Leveraging the GIS features in Django, Armendariz mapped the homes, grouped them by county and prepped the data for presentation online. Meanwhile I worked on the interface design and with Jewett to decide what data we wanted to feature. With help from Chase Davis, our Money and Politics reporter and computer whiz, we created a way for readers to dig into the homes analyzed for the story using maps and charts to augment the numbers.

On the homepage, we wanted to focus on statewide numbers to give readers context for the story and for assessing individual homes. It was also a way to bring out our main metrics for assessing homes, staff levels and wages. We decided that users would probably tackle the data from two directions, finding homes in their area or finding those that fall on one end or another of the data. So on the homepage users can sort through color-coded homes, or through the sortable table. We then also included a sort by county feature so that people could go right to homes in their area.

All of our data comes from the state and is self-reported by the homes. We encourage users to contact us about anomalies and to contact a home directly if they have questions about specific reports. We hope that this database will give people another tool when determining the effectiveness of the 2004 law.

What we learned

From coding to distribution our team was constantly on the phone, e-mail and IM to communicate with each other, help each other with our pieces and provide general support. Because of our diverse backgrounds we were also able to get a little bit more creative about how to display the information. This project would have been impossible without everyone working together closely over a period of months.

Because Jewett and I worked closely together on the story from the beginning we were able to record the necessary interviews and gather the correct data for the multimedia pieces. We coordinated with KQED for audio interviews and photos, and later with the OC Register for graphics. Later, we both worked with all of our partners to answer questions about the story and multimedia, and to distribute all of our content.

Our database came out of work that Armendariz was already doing to help Jewett crunch the numbers. Without his and Davis’ help we never would have been able to piece, code and publish the database. This was my first large project with Django and many of us learned a lot more about Google’s chart and map APIs.

We all look forward to learning more and pushing the boundaries of investigative storytelling in the future.

Comments

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Walter Hekimian's picture
Kudos to Ms. Jewett for passionately investigating California’s nursing homes. The article selectively identified inappropriate, substandard care facilities and drew conclusions that pointed to guilt by association for all nursing homes. What does it mean that “they either cut staff paid lower wages or let caregiver levels slip below a state-mandated minimum”? Did any of the homes that cut staffing still find themselves above the state’s requirements? Were these issues a daily occurrence or isolated instances? Is it possible to add less costly staff and in so doing drive average pay rates down? Why is it that two sources quoted in the article stated that most of the state’s homes invested heavily in caregivers and yet their comments are denigrated as though there is no validity in them? The author’s approach by association creates the impression that substandard is the norm and accepted. The analysis begs the question of how do the percentages of poor performers compare with a similar review before AB1629 was implemented? The approach of guilt by association does a disservice to the positive efforts of the many facilities and their caring staff members who abided by the regulations. The nursing homes that did follow the guidelines are just as incensed as the author because reimbursement was diverted from their residents. Senator Alquist addresses “an implicit good faith agreement that things would get better”. The article then identifies that about two dozen homes had about one-third more deficiencies. Two dozen homes represent approximately 2% of 1100 facilities. One must therefore conclude that 98% were following the regulations and meeting the needs of the residents. The global question is what is the trend? Are things moving in a positive direction or are nursing homes in a status quo quagmire? Comment was made that state issued fines and citations have increased. Is it possible that newly trained surveyors made mistakes in issuing citations and that the only way for facilities to contest them is in a court of law? Are they not afforded their legal right to request a court hearing? Does this make them guilty before the facts are presented? Why would state regulators agree to take $5,000 in fines for a $100,000 citation if they were correct in their original citation decision? According to the authors, “reimbursement rates increased if they spent money on labor”. How could these homes receive an increase in rates if they did not spend money on labor? They seem to draw a conclusion that is at odds with their own statement. What were the additional bonuses meant to boost hiring and wages? Why was this statement made without any background or backup information? The point was made repeatedly that the low staff/low wage facilities had care issues that resulted in serious health issues and deaths. Every person cared for in a nursing home is precious and valued as an individual. By inference nursing homes that met all guidelines did not have any care issues. Do you really believe that to be the case?

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