February 9, 2024

By Alana Rocha

Rural nursing homes across the country have about two years to comply with new federal staffing requirements meant to improve the frequency and quality of one-to-one care that residents receive.

Care facilities already struggle to recruit and retain skilled workers. Most of those facilities are nowhere near able to comply with the new federal minimums — a reality revealed through a recent collaborative reporting project from INN’s Rural News Network and other partners.

The project, “Falling Short: Rebuilding elderly care in rural America,” combined on-the-ground reporting from seven rural newsrooms with data analysis support and visualizations from USA TODAY and Big Local News (BLN) at Stanford University. Support from the National Institute for Health Care Management (NIHCM) made the project possible.

INN collaborations are designed to lead to meaningful impact for the communities members serve and transformative value for the newsrooms themselves. All seven of the organizations that participated in “Falling Short” reported meeting their intended goals for this project. For most, that meant getting more comfortable with data reporting.

BLN and USA TODAY Investigative Data Reporter Jayme Fraser worked together to clean payroll data from the Centers for Medicare and Medicaid Services, which regulates nursing homes that accept public health insurance, to show nearly all nursing homes would have to add skilled care workers. They developed a story recipe the journalists followed to accurately interpret the numbers and get ideas for local sources to include.

“This project highlighted the power of combining topic expertise with local expertise,” Fraser said. “Recipes and other forms of knowledge sharing among journalists can make reporting accessible — and relevant — to more people. The RNN reporters explored new nuances and expanded what is generally known about the issue. Together, we advanced public understanding.”

The support reporters received on this project helped them clearly convey the local impact of a national issue and for many, incorporate data-driven storytelling for the first time. 

“The dataset was a great tool for contextualizing current staffing shortages and what the Biden administration’s proposal could mean practically for our state and nationally,” said Grace Vitaglione, a reporter for Carolina Public Press.“ I definitely could not have properly analyzed the data on my own.” 

Vitaglione’s report highlighted the competing opinions of the rule change —– how industry leaders say the proposed staffing requirements aren’t attainable, while advocates for residents argue they don’t go far enough.

In mid-January, she published a follow-up report examining the shortage of North Carolina state health surveyors tasked with enforcing state and federal nursing home guidelines. 

The Maine Monitor kicked off the series with a comprehensive report  that led key stakeholders to lobby lawmakers at the start of the legislative session three weeks later. “Nursing home providers and advocates [were] asking lawmakers to provide more funding to nursing homes to avoid additional closures,” Reporter Rose Lundy noted.

Long-term care industry leaders and news publications across the state praised the Monitor’s reporting. The Monitor is planning at least one additional article that will examine the causes and locations of recent nursing home closures — the majority of which, Lundy said, have been in rural areas. 

In Wisconsin, Emily Small of Door County Knock also illustrated a staff retention challenge for understaffed care facilities: burnout. She detailed how one mother became inspired to work as a certified nursing assistant after witnessing the wonderful care her adult daughter received before dying of a long-term illness. But after six years of often being assigned to tend to more than a dozen residents a day — care the CNA likened to the type a toddler needs — she burned out and left the industry.

Small found that all three of Door County’s nursing homes meet state-mandated minimum ratios for the number of hours of direct care each patient should receive from staff, but none of them would meet the higher minimums of the federal proposal.

“Our reporting has helped inform our community about the details of this issue, which previously has primarily been discussed in anecdotal or rumor-based terms,” said Andrew Phillips, editor-in-chief and executive director of Door County Knock.

For New Mexico In Depth, reporter Marjorie Childress’ analysis of the most recent available payroll data revealed only two of New Mexico’s 68 nursing homes would have met the minimum staffing standard for both registered nurses and CNAs throughout April, May and June of 2023.

New Mexico In Depth included a callout with the article to hear from readers like one rural New Mexican relayed her fears about accessing long-term care as she ages. The news outlet is planning to launch an extensive reporting project about nursing homes later this year.

For a national audience, Barn Raiser offered an overview and further context of how the proposed federal rule change would play out in rural America, incorporating threads from Carolina Public Press, Door County Knock, Mississippi Today and The Maine Monitor. Public Health Watch, a national nonprofit and nonpartisan investigative news organization, republished the story.

The Barn Raiser coverage also included an interactive map that shows how care facilities across the country would fare under the new requirements. 

Justin Perkins, deputy editor and publisher at Barn Raiser, said he anticipates follow-up reporting and investigations in local communities that “will hold nursing home operators more accountable while seeking more transparency in operating structure, financing and oversight.”

All of the RNN newsrooms encountered nursing home operators who didn’t respond to requests for comment. Still, they published in-depth articles that noted their outreach, included families’ experiences with staffing levels and incorporated telling data visualizations.

That was the case for the Journal of Olympia, Lacey and Tumwater, or JOLT, which noted in its reporting the repeated calls journalists made to all seven local care facilities to get information about staffing levels and the potential impact of the proposed change.

“This project took us outside of our pattern and covered an important issue,” JOLT Publisher Danny Stusser said. “And it required that we do what I always see as being important: Localize a national story.” 

“Raising awareness is a critical first step,” Sophia Paffenroth, community health reporter at Mississippi Today, noted in a post-series survey.

“These collaborations are win-wins for everyone involved. For us, they generate more reach, offer some extra funding, and connect us to valuable networking and resources,” Paffenroth said. “Sifting through Jayme Fraser’s highly detailed and well curated database of nursing home staffing, several story ideas came to light. It was a terrific crash course on a topic I didn’t have experience covering but think is crucial to cover within my health care beat.”

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