ARKANSAS FOCUS: An investigation of discrepancies in reported figures on nursing home staffing uses an Arkansas case -- and the state's broader experience -- to illustrate the problem.

The Center for Public Integrity has published a report on widespread discrepancies in nursing home staffing when compared with what the facilities claim to provide. Arkansas is at the top of the list, in a bad way.

The anecdotal beginning of the story is about Edna Irvin, a patient in a West Little Rock nursing home, the Chenal Heights Health and Rehabilitation Center. Her daughter, Lisa Sanders, had placed her there after she was no longer able to live at home.


After just one week Irvin was hospitalized for a bowel obstruction.

Sanders said she arrived at the home to find her mother sitting in her own feces.

The nursing home, which has since been renamed as part of an ownership change, declined to comment.

On the public website where facilities post their daily staffing levels, Chenal Heights said it provided .19 hours, or about 11 minutes, of registered nurse care each day for its residents in 2012.

But harder-to-find federal financial documents examined by the Center for Public Integrity reported average daily staffing levels at the home that were lower.

Much lower.

Nursing homes across the country had similar reporting discrepancies between the two sources, the Center’s analysis reveals.

Data on the publicly available Nursing Home Compare website, which is promoted and operated by the government for comparison shopping, reflects staffing levels self-reported by nursing homes during a two-week period before annual federal inspections. Advocates say many homes work hard to prepare for those visits. As a result, critics say, those staffing levels may be artificially inflated.

The Centers for Medicare and Medicaid Services (CMS), the federal agency responsible for overseeing nursing homes, has talked repeatedly since 2001 about the inaccuracy of self-reported data. The self-reported staffing levels are also a crucial metric in the federal government’s broader quality rating of nursing homes on the Compare website, from one star to five stars.

Discrepancies were greatest in the South. Louisiana and Arkansas had  average self-reported levels at least twice those calculated through the cost reports analysis, CPI said.

The Affordable Care Act (Obamacare) mandated changes in Medicaid reporting, but they’ve not yet been put in place.


Edna Irvin’s situation didn’t improve. Her daughter, who’d sued Chenal, moved her to another nursing home, Sandalwood, which CPI said also shows a gap in reported staffing and staffing based on cost reports. It was sanctioned by the state for lack of staff, CPI said. Her daughter has now sued Sandalwood, too. The owner of Sandalwood, through an attorney, defends its record and staffing, saying it was short only on two occasions on account of bad weather. Irvin is now in a facility in Benton.

For the record: The attorney general’s office houses a Medicaid fraud division and a consumer protection division. The owner of a chain of Fort Smith nursing homes, Michael Morton, donated $92,000 to the campaign of Leslie Rutledge, who was elected the next attorney general. Home inspections are a function of the Department of Human Services, an executive agency under the governor’s control. Inspections of nursing homes have been dropping, the CPI analysis indicated.


Also for the record: At the link you’ll find a box in which you may type in the name of a nursing home and see how the figures on the Nursing Home Compare site matches up with figures based on nursing home financial documents CPI examined.

I plugged in the name Greenbrier Nursing and Rehabilitation Center in Greenbrier, Ark. The name stuck in my mind. It’s a Michael Morton-controlled nursing home. It’s the home where the family of a woman who died there after failing to receive ordered hospitalization won a $5.2 million unanimous jury verdict. It’s the home where then-Judge Mike Maggio reduced the verdict to $1 million. Coincidentally, Maggio was a recipient (along with a number of other Faulkner County judges including rising Supreme Court Justice Rhonda Wood) of Michael Morton campaign contributions. The CPI report:


Total care
4:55 hours of care per patient per day reported on Nursing Home Compare
4:31 hours of care per patient per day calculated from cost report

Registered nurse care
23 minutes of care per patient per day reported on Nursing Home Compare
11 minutes of care per patient per day calculated from cost report

Morton has defended the quality of his dozens of facilities and his attorneys also objected to the jury finding in the Greenbrier case.