As a private investigator and former newspaper reporter, I’ve spent years digging through spending reports, inspections, and other records involving nursing homes, hospitals, physicians, and other providers. The vast majority of the information I locate is easily accessible, and it’s not just for legal and healthcare professionals and journalists. It’s made public to help people make more informed healthcare decisions, though many don’t know this valuable data even exists let alone how easy it is to access.
Lately, I’ve used the same resources I relied on as an investigator after a family member on Medicare underwent several major hospitalizations and surgeries. With this experience in mind, here are three resources you might find helpful if you (or a loved one) end up in a similar situation:
Home Health Referrals
Hospital discharge planning can be a messy, harried process. One minute, you’re not sure if you’re getting out. The next, the nurse is telling you to pack up and your case manager may tell you that the surgeon recommends a home health provider.
If your physician or discharge planner is referring you to a specific home health provider, ask why. Before signing off on their recommendation ask for a complete list of available providers; they are required to provide you with one. Then grab your phone or tablet, open the browser, and go to the Medicare Home Health Compare website: medicare.gov/homehealthcompare/search.html.
Type in your city and state and click on the header option to sort by patient care and survey scores. The Medicare website yielded a total of 66 Washington state home care agencies in October 2018. Fewer than five providers in the entire state achieved the highest five-star rating in “quality of patient care.” More than half of the providers received only average or below average scores. Medicare might be footing the bill, but you’re empowered to make the best choice. We shop smart when buying cars or appliances or other big purchases, so look for five-star ratings when it comes to your health, too.
If you’re undergoing a major elective procedure such as a joint replacement, chances are your surgeon wants you at home as soon as possible. Prolonged hospital stays increase the risk of infection. But if you’re not making much progress, and if you live alone, you might find the physical therapist recommending what the hospital staff calls a “rehab facility.”
These facilities often provide important and necessary care to bridge the time between hospitalization and a return to independent living. In some cases, though, a rehab facility is housed inside of a nursing home. If you are heading to a rehab facility, it’s important to find out if it is located inside a nursing home and, if so, whether it is free of significant health and safety violations. For this information, go to the Medicare Nursing Compare website found here: medicare.gov/nursinghomecompare/search.html.
In the state of Washington, the research is encouraging. Of a total 215 nursing homes listed in the federal database, 78 had a five-star rating, while nine received the lowest possible one-star rating. To learn more about each nursing home, follow the links to view the actual Medicare inspection reports.
These documents can run many pages long, providing case-specific summaries of patients’ experiences, while redacting names or any other identification. A quick perusal of inspection reports for the lowest-performing nursing homes provides a truly disturbing portrait of places you’ll want to avoid.
While there is a lot of helpful information online, do not rely on just the Medicare websites. Pay an unannounced visit. Sometimes a site check and a quick conversation with a friendly resident sitting outside near the front door can tell you more than hours of research. Also, conduct a simple Google search. Not long ago, I researched a nursing home in Virginia. Despite good ratings it had a homicide a few years ago. Sure, staffing and health inspection data certainly are important indicators, but it doesn’t take a private investigator to tell you homicide tends to be something of a red flag.
The bottom line: No matter what healthcare choices you are facing, be your own investigator. Get documents. Ask questions. Take notes. And do your research. Because it’s your health. And you are the boss.
A former newspaper reporter, Jim McElhatton is a private investigator in the Washington, D.C., area. He has extensive experience investigating healthcare spending. For more information, he can be reached at firstname.lastname@example.org, or follow him on Twitter at @Jim_McElhatton.