The Sacramento Bee searched databases containing millions of public records to determine which chains owned which nursing homes in California.
Some nursing-home owners were listed in a public file maintained by the U.S. Centers for Medicare and Medicaid Services. Those records show all owners with more than a 5 percent stake in the facility but do not say exactly what share of the home they own.
When the federal database was unclear about who owned a home, The Bee looked up the name of the partnership or corporation that held the license for each home using data from the California Department of Public Health compiled by the California HealthCare Foundation. Licensee records were matched with databases from the California Secretary of State showing details of every corporation and limited liability company in California. In some cases, The Bee traced owners through several layers of LLCs and other companies to identify chain ownership.
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The Bee examined ownership records as of early 2014. Some homes may have changed ownership since then.
Patterns of care
To determine patterns of care within nursing-home chains, The Bee used 46 measures that are among the categories routinely used by federal and private sources to rate individual nursing homes. The standards The Bee considered fell into four general categories: inspections and complaints; quality of care; staffing; and overall care ratings from the federal government and the nonprofit California HealthCare Foundation.
Specifically, The Bee looked at complaints reported to the state from 2009-13 related to abuse, administration, quality of care, environment, nutrition and resident rights; as well as deficiencies cited by the federal government over the last 31/2 years related to abuse, environment, life and safety, pharmacy services, quality of care, resident assessment and resident rights.
To compare chains to one another, The Bee calculated the rate of complaints and deficiencies per 100 beds at each chain.
The Bee also looked at benchmarks created by federal regulators to assess quality of care. It calculated the following measures for each chain last year: the percentage of long-stay residents whose need for help with daily activities had increased; long-stay residents who had a catheter inserted and left in their bladder; long-stay residents who were physically restrained; long-stay residents experiencing one or more falls with major injury; long-stay residents who reported moderate to severe pain; long-stay, high-risk residents with pressure ulcers; long-stay residents who received an antipsychotic medication; short-stay residents who had newly received antipsychotic medication; short-stay residents with pressure ulcers that were new or worsened; short-stay residents who reported moderate to severe pain; and long-stay residents with a urinary tract infection.
To assess staffing, The Bee used information self-reported by each nursing home regarding nursing turnover and the number of hours worked per resident day by nurse assistants, licensed vocational nurses, physical therapists and registered nurses. It also took into account spending on direct patient care. The Bee used an average across all homes to calculate chainwide performance on each of these measures.
The Bee’s analysis in some cases reflects performance over a multiyear period, but ownership information was available only for the current year. It’s possible that an owner only recently acquired a facility, but the home’s performance in recent years was attributed to the new ownership chain.