The State of Data

Recently we decided to augment the data that was have on skilled nursing homes by bringing in data provided by the individual states. This project began as an attempt to better understand the data that is published by The Centers for Medicare and Medicaid (“CMS”) and nearly all the data on the site is from this source. (We are still working on incorporating data that CMS provides.)

We have been looking at state level datasets for a few years and found some interesting data that the states provide. But trying to incorporate these datasets is a daunting task. There 50 states after all plus three territories. Not only is it a problem to have to pull in 50 different datasets, but we have to find where each state has squirreled away their data, and we have to standardize it so that records in Florida can be read like records from Texas. And then we also have to figure out how often to update the information. That’s why we have delayed looking for so long. (Pulling data on hospitals is a similarly daunting problem. They are required to publish cost data, but the requirement do not specify where this data is to be published, what specific data is to be published, nor what format.)

It’s Awful

Why am I writing about this? I am writing about this because after having spent several weeks diligently looking for additional data on nursing homes, we have concluded that the state of data in this country is awful!

What do I mean when I saw that the state of data is awful:

  1. Health Care Data is Hard to Find– States do not make it easy to find the data that you are looking for. Approached vary by state. And, of course, there is a lot of different types of data, so trying to report out data can be challenging.
  2. Health Care Data is Not Consistent– Fields and data points vary from state to state as does the delivery method. Some offer spreadsheet or CSV downloads, others provide a web page that you have to search to extract data.
  3. Health Care Data is Usually Out of Date- Much of the data that is available has not been updated in years. This can be a real problem.
  4. There is Insufficient Data– Often the data that is available is paltry. Name, address, phone number. Come on!

These problems not only plaque state repositories, it is also a problem for CMS. CMS updates its nursing home data 11 times a year, its doctor data very often, and some other data sets less often. We regularly get requests from groups asking us to update their information. When we mention that this is the latest data from CMS, it turns out that CMS does have the correct information in another area but has not bothered to update what they publish publicly. I know it can be difficult to synchronize different data sets, but come on, why do you have so many different storage systems that you have to maintain?

We need to do better

Everyone agrees that good data is important; it is important for people who are trying to decide on a nursing home, doctor, hospital, home health provider, hospice provider, or dialysis center. The data is there, the agencies are collecting it; CMS is conducting detailed inspections. They just are not doing a good job of sharing it.

The data landscape in this country needs to improve. We need better standards for collecting and managing data, and we need more transparency about the type of data being collected and how it is being used.

What Home Health Care is Covered by Medicare

If you have read any of my blog entries, you will see that I like home health care. I taking care of patients in their home is generally a better and less expensive way to deliver needed care. Patients are more relaxed at home and having care come to them is much easier. I remember having to take my mother to a doctors appointment once at Memorial Hermann Hospital in Houston. Having to park, then walk through a crazy maze of buildings, using two different elevators, and then having to wait more than an hour. It was too much.

Home health care is covered by Medicare. But like everything that Medicare does, what is covered and what is not covered is complicated. Some care is covered by one part of Medicare while other care is covered by other parts of Medicare. Then you have the Advantage Plans which offer some additional services. How did we get in such a mess?

What is Covered by Medicare

Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) combined cover eligible home health services like these:

  • Part-time or “intermittent” skilled nursing care. Part-time or intermittent nursing care is skilled nursing care you need or get less than 7 days each week or less than 8 hours each day over a period of 21 days (or less) with some exceptions in special circumstances.
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Part-time or intermittent home health aide care (only if you’re also getting other skilled services like nursing and/or therapy at the same time)
  • Injectable osteoporosis drugs for women
  • Durable medical equipment
  • Medical supplies for use at home

Some of these expenses may be subject to deductibles or co-pays depending upon the specific of your Medicare or Medicare Advantage plan. It is very important that you review this each year during the re-enrollment period.

What is Not Covered by Medicare

Some home health care companies provide additional services. Be aware that these services may not be covered by Medicare. For example, Medicare does not pay for:

  • 24-hour-a-day nursing
  • Meal delivery or meal prep
  • Housekeeping services including shopping, cleaning, and laundry
  • Daily needs like bathing, dressing, or bathroom visits if this is the only reason for home health care

Important Caveats to Be Aware Of

Home health care must be administered under the direction of a licensed physician. The agency must be licensed with Medicare to provide the required services. And, the care is typically offered for only a short period of time and must be renewed by the physician overseeing the care.

In additional the physician must certify that the patient is “homebound”. Homebound means: You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or leaving your home.

Where’s the Ownership Data?

On September 26, 2022, The Centers for Medicare & Medicaid issued a press release stating that they were making more Nursing Home Data publicly available: see here. According to the release: “This data will, for the first time, give… the public an enhanced ability to identify common owners of nursing homes across nursing home locations.”

The release suggested that this would happen immediately.

So, where’s the data? If you look at the two ownership tables that CMS has published since issuing the release, there is no change from what was shown before.

The press release specifically states:

The information posted today now includes detailed information on the ownership of approximately 15,000 nursing homes certified as a Medicare Skilled Nursing Facility (SNF) – regardless of any change in ownership, including providing more information about organizational owners of nursing homes. For example, the expanded data elements include information about each organizational owner, such as whether it’s a holding company or a consulting firm. CMS has also provided key identifiers that reflect groups of nursing homes with common ownership or managerial control.

https://www.cms.gov/newsroom/press-releases/biden-harris-administration-makes-more-medicare-nursing-home-ownership-data-publicly-available

Before this press release, CMS provided these categories related to ownership:

  • LEGAL BUSINESS ENTITY
  • 5% OR GREATER DIRECT OWNERSHIP INTEREST
  • 5% OR GREATER INDIRECT OWNERSHIP INTEREST
  • PARTNERSHIP INTEREST

After the press release, we have exactly the same categories.

This effectively allows anyone to know who directly owns a skilled nursing facility, any significant shareholders in that company (direct owners), and any significant shareholders of those shareholders (indirect owners or effectively holding companies). But often this is not enough to track all the way back to the final owner or ultimate holding company. For example, Genesis Healthcare, Inc. says that they are “one of the nation’s largest post-acute care providers” holding “nearly 250 skilled nursing centers and senior living communities”. But, if you look in the CMS ownership table, there is no record for “Genesis Healthcare, Inc.”. There are, however, 1,017 records with owner names beginning with “Genesis” in 25 different variations including “Genesis Holdings, LLC”, “Genesis Healthcare LLC”, and multiple versions similar to “Genesis Operations III LLC” .

CMS’ internal records clearly can identify each layer of holding company that ultimately own and control hundreds and hundreds of skilled nursing facilities nationwide. And, they themselves have admitted that knowing this information is important for consumers. But, nothing has change; there is nothing new here.

Again, where’s the data?

What Home Health Care Does

What Home Health Care Does

General Services

Home health care agencies provide services that help individuals maintain their health and well-being in their own homes. These services can be tailored to meet the specific needs of the individual and are often used to supplement the care provided by family members. Home health care agencies provide a variety of services that can help individuals maintain their independence, safety, and comfort. 

One of the most common services provided by home health care agencies is personal care. This includes assistance with activities of daily living such as bathing, dressing, grooming, and meal preparation. Home health care agencies can also provide assistance with ambulation, transfers, and range-of-motion exercises. Personal care services are designed to help individuals maintain independence and ensure their safety in the home. 

Home health care agencies also provide medical services such as wound care, medication management, and monitoring vital signs. These services can help individuals manage their chronic conditions and reduce the risk of complications. Home health care agencies can also provide medical equipment and supplies such as oxygen tanks, walkers, and wheelchairs. 

Beyond basic care, Home health care agencies also provide social support services such as companionship, transportation, and errand services. Staying connected to a community and maintaining their social connections is known to prolong healthy living. Home health care agencies can also provide educational services such as health and wellness classes and support groups. 

In Your Own Home

Providing care at home has proven to significantly reduce recovery time and keep patients mentally healthier for longer periods of time. This is due to the lower levels of stress that come with being able to remain in the comfort of one’s own home. Being in a familiar environment can help to keep the patient in a more relaxed state which is essential for better mental health. 

Patients can receive medical attention while avoiding the risks of hospital stays, such as infections, depression, and limited access to friends and family. This is because patients can receive the same services that they would in a hospital but without the risk of being exposed to the high levels of germs and bacteria that are prevalent in healthcare facilities. 

Being at home may reduce feelings of loneliness and depression in people who are isolated in a hospital room, especially if the care is administered over a longer period of time. One study found that people who were admitted to the hospital and then moved to a home health care setting felt less lonely and had lower rates of depression than people who stayed in the hospital. This was likely due to the increased social interaction that people who were moved to a home health care setting experienced.

Finally, being at home patients feel a greater level of independence. This is because the patient is able to remain in the comfort of their own home, where they can make their own decisions. This autonomy can help the patient to feel more empowered and confident in their ability to manage their own health, which can lead to a more successful recovery process..

Helping the Caregivers

Caring for a family member who is elderly or has a disability can be an incredibly stressful experience, both emotionally and physically. Not only is it a challenge to ensure that all of their needs are met, but it can also be difficult to manage. Home health care can be a great way to provide support and assistance, while also giving caregivers a much-needed break. 

When caring for an elderly or disabled family member, it is important to recognize their needs and the amount of stress that can come with providing care. This can include helping with activities of daily living such as dressing, bathing, and eating, as well as more complex medical tasks. Caring for a loved one can take a toll on both the caregiver and the person receiving the care, so it is important to find ways to manage the stress and provide support. 

Home health care can be a great solution for caregivers who need a break from their duties. Home health care services can provide assistance with activities of daily living, medical care, and other tasks that may be too demanding for the caregiver. Home health care can also help to relieve the burden of caregiving, giving the caregiver some much-needed time off to rest and recharge. 

Home health care can also provide the necessary support and care that the elderly or disabled family member needs. Home health care providers are trained to provide personalized care and can help ensure that their needs are met in a safe and comfortable environment. Home health care can also provide companionship and emotional support, which can be especially helpful for those who may feel isolated due to their disability. 

Caring for a loved one who is elderly or has a disability can be a challenging and stressful experience. Home health care can be a great way to provide support and assistance, while also giving the caregiver a much-needed break. Home health care services can help to ensure that the needs of both the caregiver and the person receiving care are met in a safe and comfortable environment.

Finding Home Health Care Providers

There are usually multiple home health care agencies serving any given area in the United States.  The easiest way to find the home health care agencies in your area, is to use the NursingHomeDatabase.com search tool.  With this tool, you input the ZIP Code for your home and we will show which home health care agencies cover your area and also rank the list based on their overall 5-star rating.  You can also research each agency in depth by clicking through to detailed pages showing reviews rating and much more on each of nearly 11,500 home health care agencies.

Hospice Care is Different than Regular Health Care

Hospice is Not About Improving but About Feeling Comfortable 

Hospice care differs significantly from the type of care that we typically think of for health care.

First and foremost, hospice care is palliative care.  That means that the focus is on providing comfort and support, making the patient feel comfortable.  With hospice care the focus is not on treatments meant to cure an illness or help a patient recover from an injury. The difference may seem subtle but it has profound consequences.  Occupational and physical therapy is out.  Most treatments are curtailed.  A doctor trained in hospice care will review the patient’s medications and will stop or reduce many that are not specifically related to the patient’s immediate comfort.

NursingHomeDatabase provides an easy way to find the hospice providers in your area with detailed reports on each hospice provider which can help you to make an informed decision on which provider to choose.

Palliative care is about relieving the symptoms associated with a terminal illness. This typically means pain management.  Here also things are different.  Many medications like opioids that would not be prescribed to patients for fear of addiction are freely available to the hospice patient.

Hospice also address Psychological and Spiritual Issues

Along with the physical concerns, hospice will also attempt to help the patient deal with the psychological and spiritual issues that confront everyone who is dying. (How different is this from normal health care that gives very little attention to anything other than the physical issues confronting the patient.)  This help typically includes both secular assistance by counsels or social workers as well as religious professionals like priests, nuns, or other religious practitioners. 

Hospice Care is Also for the Family

Hospice care is not just for the patient—it is also for the family and friends of the patient. Hospice care provides emotional and practical support for families who are dealing with a life-limiting illness. The hospice team can help families understand what to expect, manage symptoms, make decisions about treatment, and cope with their grief. 

Grief counseling and religious services are available to the family and friends of the patient during hospice care and for up to a year after the patient’s death. Grief counselors and religious practitioners can offer support and guidance as the family grieves. They can also help the family to process their feelings and emotions.  Counselors will often proactively reach out to family members to offer support and consolation.

Hospice – Special Facility or Home Environment, You Choose

Unlike regular medical care, hospice patients are not expected to go to see their medical professionals, the care comes to them.

There are many different types of hospice care, but the two main types are home hospice and facility-based hospice. Home hospice is when hospice care is delivered in the patient’s home, and facility-based hospice is when it’s delivered in a special facility like a nursing home or hospital.  This option also includes special group homes that are often normal single family homes but with the addition of nursing staff available 24 hours a day.  These group homes have the benefit that they are more comfortable for the patient and the family than a hospital or skilled nursing facility.

Both types of hospice have their own advantages and disadvantages, so it’s important to talk to your doctor or Hospice provider to see which one would be best for you or your loved one.

Hospice is Covered by Medicare

Medicare typically covers all the costs related to hospice care for a period of up to 90 days regardless of any patient deductibles.  It is important to understand that the coverage applies only to the medical professionals and the medications.  Medicare does not include costs for the hospice facility nor does it cover any costs after death.

After the initial 90 day period, patients on hospice are not out of luck.  Medicare allows for a second 90 coverage period. Patients still on hospice after 180 days can continue on hospice provided that a doctor meets with the patient in person and reauthorizes hospice treatment.  This reauthorization is for a 60 day period and can be renewed every 60 days. Some patients can remain on hospice care for years.

Hospice is Not Always the End- You Can Change Back

While someone may be told that they need hospice care, this does not always mean that they are going to die soon.  Some patients remain in hospice care for years.  Other patients improve and are moved off of hospice care.  

It is important to note that there is a clear line that distinguishes hospice care from regular health care.  If a hospice patient decides that they want to go to a doctor or to the hospital for some form of treatment, they will be taken off of hospice care.

Leaving hospice does not mean that you cannot return.  Patients can come and go from hospice as often as is needed.

More than Nursing Homes

There’s a lot of data out there and a lot of it is coming from the Centers for Medicare & Medicaid Services (CMS). We’re committed to making sure that you have access to all the data you need, and we’re constantly working to cover more ground. In this blog post, we’ll give you an overview of what CMS publishes, how you can access it, and what we’re doing to make sure that you can find everything you need.

What does CMS publish?

Here’s a list of the datasets that we making available:

Data for each of these health care areas is updated sporadically. We monitor CMS for updates and update our health care database as soon as new data is available.

We also aim to improve the quality of the data that CMS provides, including by finding new ways to assess the data (e.g. through lists of ratings upgrades and downgrades).

Here We Are Again

After more than a year’s effort and a considerable amount of money spent on SEO experts, we are now redirecting everything from seniorcaredata.com back to nursinghomedatabase.com.  The simple explanation for this is Google’s algorithm did not like the change.

I’ve covered the back story about why we decided to change domain names in a prior post.  

At the end of the day, the new site never could catch up to this site.  Even with many more pages, over 2 million compared to about 250,000 here, the new site was not performing as well.  Looking back, I think we should have redirected all our traffic to the new site, but at the time, we thought we could keep both sites running.

Apparently Google’s algorithm did not agree with our transition.  Activity was picking up gradually at the new site, but for some reason it just dropped to nearly zero a few weeks ago.  The general consensus is that Google thought SCD was scrapping NHD.  We had spent countless hours trying to make the two sites look different and to make sure that the similar pages covering nursing homes showed the data differently.  But I guess it was not enough.

I don’t have time to wait for Google to figure this out.  If it doesn’t like something, then I think the best thing is to change what we are doing.  (If you have ever tried to deal with Google you know that there isn’t anyone you can call or chat with that you can initiate to get an explanation for what happened.  It just happens and you have to react.)

So here we are again.  The domain name does not adequately express what data is available on the site, but hopefully that will not stop people from coming to take a look.

A new domain…

tl;dr: We have launched a new domain (seniorcaredata.com) which will allow us to delve into many other datasets that CMS and others publish.

When we first put together the pages for this site, we wanted to answer one simple question: what did all of this data from CMS mean? We had found that the Centers for Medicare & Medicaid were publishing large datasets monthly covering what appeared to be all of the skilled nursing homes in the United States. This was interesting information, but it is hard to understand what is going on simply by pouring through Excel spreadsheets containing tens to hundreds of thousands of records.

Our first insight was to put all of this data together on one page where you easily see all of the data for a specific facility that was currently spread across more than 10 datasets and hundreds of rows. Once we had that, we could start asking other questions and organize the data in many different ways, homes by state, by city, homes by ratings, and on and on. Then by collecting the records from other time periods we could also start to look at what was happening over time.

We have just begun to scratch the surface on the data; we’re finding new and interesting insights daily.

But, it turns out that CMS publishes data for more than just skilled nursing facilities. We’re finding new records regularly. Most recently we found data on doctors and doctors groups. This has proven to be a very interesting data set as it provides some insight into to costs.

After some anguish over what to do, we decided to continue digging into this data but to use a different domain name. Nursinghomedatabase.com seemed like a really good choice when we started but it looks strange for people who want to find out about hospitals, or dialysis centers, other whatever else.

A few months ago, we quietly launched the new domain, seniorcaredata.com.

For those who do not know, changing to a new domain can be a difficult process. Google and other search engines take a long time to index your site and start including your links in their search results. Almost all of our traffic comes not from going to are home page but from clicks related to specific homes or lists. Indexing can therefore become a real issue if your site has more than 200,000 pages! Even now several years have launching this site, Google does not include the majority of our pages in their search results.

Nursinghomedatabase.com has been growing very steadily for the past few years. In June we surpassed 140,000 monthly page views. We certainly do not want to lose this momentum. So, what we are going to do is maintain this site which will be true to its name and focus on the skilled nursing home data. SeniorCareData.com will provide this information too and will extend into all the other datasets that we finding.

Inspection Risk Continues for Nursing Homes

CMS just updated their data for nursing homes today and unfortunately the average lag time between nursing home inspections continues to rise.

As I noted last month, the average time between inspections has risen significantly during the Covid pandemic. For several months, CMS did not report an inspections. For the month of April, CMS shows 43 new inspections. This is insufficient to curtail the continued rise in lag time. For May 1st 2021 the average lag time is 540 days, up from 529 days last month.

We updated our chart showing the increase in average lag time to show the number of inspections reported monthly.

Covid-19 Not the Only Risk for Nursing Home Residents

I held off on publishing this article because I do not want to say something that is inappropriate in the middle of the Covid pandemic. But it seems like a significant concern.

Specifically I am writing about the fact that average time since being inspected by CMS continues to grow. As you can see from this chart that we posted last month, what is supposed to be an annual inspection has now risen to an average of 529 days (or nearly 18 months). By comparison before the pandemic this average hovered around 250 days (or 8.3 months). This is more than double the average time between inspections pre-pandemic!

What does this mean? Hopefully it does not impact patient care. Nursing homes are licensed by the states, so ideally this oversight continues.

At a minimum it means that the data is not as good as it has historically been and that CMS Five Star Quality Rating System (which we have discussed previously as very flawed) is even less reliable.

The latest data which has a date of March 1st, 2021 shows that inspections are beginning again. There were no inspections reported from May 1, 2020 through December 1, 2020. The data for January 1, 2021 shows inspections starting again and rising to 20 for March 1st and 33 for April 1st. Still this is significantly below the 80 to 90 that were inspected monthly prior to the pandemic.

As time goes by this inspection backlog will only get worse if CMS is not able to significantly ramp up its efforts. The latest provider information includes data on 15,328 nursing homes. At a rate of 33 inspections per month it will take 464 months to inspect every home.

At a time when nursing homes are suffering the lack of transparency makes it even more difficult.