Quick pivot produces a data-driven look at nursing homes during COVID-19

Earlier this year, we had clear ideas of how we were going to pursue separate projects on bullying and violence in California schools, and deaths in residential adult care facilities, for the Southern California News Group (SCNG).

And then the coronavirus pandemic hit.

Beau’s project was a successor to a year-long one he had done for SCNG that was finally published in the fall of 2019. That one looked at data from secondary students from across California, who self-reported whether they had considered killing themselves in the California School Climate, Health, and Learning Surveys, which are given to about 70% of California public school students. Working with data journalist Nikie Johnson, we identified which districts had the lowest number of students self-reporting suicidal thoughts and which districts had dramatically dropped the number of students reporting such thoughts over time. I then reached out to those districts to learn about the mental and emotional health supports offered by the school districts — even impoverished ones — that likely saved students’ lives.

The same survey asks about bullying and violence. He planned to repeat the process, from that earlier project, looking at what successful districts were doing with an eye toward helping other districts duplicate their successes.

The pandemic, of course, had other plans. Schools switched to at-home distance learning models, anti-bullying programs stopped cold and bullying became almost impossible to track when it moved online.

Brenda originally planned to look at unusual deaths in adult residential care facilities to see where the system had broken down and failed these residents. Her project was also complicated by the pandemic, as she had no idea when she would get the data she needed, given the deluge of requests triggered by the raging pandemic. (She ended up getting data for that request just a few weeks before her six-month California Fellowship ended.)

So, with the support of the Center for Health Journalism’s 2020 California Fellowship, we pivoted, teaming up on a project that combined Brenda’s desire to look at deaths at elder care homes and Beau’s desire to use data to guide reporting. We aimed to deepen the reporting Brenda had started as part of the “Eye of the Storm” nursing home series she had just launched as part of her fellowship project in light of the pandemic.

Specifically, we looked at the skilled nursing homes most severely affected by the coronavirus in Los Angeles, Orange, Riverside and San Bernardino counties, which the Southern California News Group covers. Initially, we discussed looking at facilities with the most deaths. But after realizing that the facilities varied wildly in size, we chose to pivot again to look at nursing homes with the most COVID-19 resident deaths per capita. 

We felt this was a more telling approach. Some of the nursing homes we had examined lost close to 30% of their average daily population from the virus.

We discovered no publicly available database had both the average number of daily residents in a facility and also the number of COVID-19-related resident deaths. So we had to make one, combining data from the California Department of Public Health’s COVID-19 database and Medicare’s Nursing Home Compare website in Google Sheets. We also used information from CDPH’s Cal Health Find and ProPublica’s Nursing Home Inspect, which along with Nursing Home Compare, have valuable data on nursing home deficiencies. 

This data gave us a different list than one that just focused on the raw numbers of deaths. Armed with this per capita list, we scoured hundreds of deficiency records for each of the hardest hit homes before and during the coronavirus pandemic looking for trends. We found that many of these homes had issues related to staffing, infection control and other health deficiencies, and room-size issues before the pandemic. 

We then reached out to family members of residents, advocates, experts, staff and institutional spokespeople to get a fuller picture of the issues.

Some nursing homes were transparent and willing to talk — or at least answer survey questions via email. Many others were not.

After significant effort, Brenda ultimately found some facilities in Los Angeles County that were willing to speak about the challenges they were facing and how they were trying to beat back the pandemic that had already claimed the lives of numerous residents.

Beau found a family online, bitterly responding to the sunny posts from a nursing home where their loved one had lived in before she died of COVID-19, something they believe the nursing home’s practices helped lead to. We also got a nursing home in Riverside County to comment for the piece at the very last minute.

While conducting our research, we soon realized this was not your run-of-the-mill deep-dive project. With an issue as gargantuan and complex — and as rapidly changing — as COVID-19 in nursing homes, the “Eye of the Storm” project required extra effort and care in terms of updating numbers, figuring out the most reliable sources of information and staying on top of new developments. It also required monitoring on some level the many evolving federal, state, and local health guidelines, orders and actions. The project consumed more time and effort than we thought it would.

Brenda wishes she would have accepted the Center’s offer for help from a data consultant from the beginning as she ended up doing some of the inputting manually, which took additional time. She also wishes she had tried to reach out to nursing home residents and staff sooner, as she realized that many of them were reluctant or afraid to talk. The more stories she did for the “Eye of the Storm” project, however, the more contacts she made and the more people started reaching out to her. 

In the end, we produced what we see as a human portrait of the battle against COVID-19 inside Southern California’s skilled nursing homes that was guided largely by death data and online deficiency records. It wasn’t the story we set out to report, but when the pandemic forced our hand, we landed on something that we think was still useful for families, advocates, the industry, and perhaps policymakers during a frightening and unpredictable time.