How USA TODAY Network reported on resident-on-resident harm in senior living facilities

In the summer of 2021, Arizona Republic investigative reporter Caitlin McGlade found out that Joann Thompson had been severely beaten by another resident at Bethesda Gardens Assisted Living facility in Phoenix.

Most reporters would have written Joann’s story right then, and it would have been compelling.

But McGlade had been covering the senior living industry since the early days of the pandemic, and she wondered whether the assault at Bethesda Gardens was a solitary event or if there was something more widespread going on.

She had just finished a series of stories about how Granite Creek Health and Rehabilitation Center in Prescott had hired a man with a felony conviction on his record to run the facility, how he forced employees to continue to work even though they were sick with COVID-19, and how 15 residents died.

McGlade knew that both of the organizations charged with regulating nursing homes and assisted living facilities, the Arizona Department of Health Services and the Arizona Board of Nursing Care Institution Administrators and Assisted Living Facility Managers, had been criticized in audits for not doing enough to protect seniors.

So she decided to dig into the subject of resident-on-resident harm to find out how often residents were hurting each other.

Her first calls were to plaintiff attorneys who confirmed that the issue was an important one and not well-known outside of families whose loved ones had been injured.

She then asked the Arizona Department of Health Services if facilities like Bethesda Gardens have to report assaults to the state. As it turns out, Arizona law does not require assisted living facilities to report all resident injuries to the health department.

The next step was to review stories written by newspapers across the country. There were a few notable articles, including a standout series in the Minneapolis Star Tribune.

It was through that research that McGlade came across Eilon Caspi, a researcher based at the University of Connecticut, who wrote a book about conditions that lead residents to hurt one another.

Caspi told McGlade that the problem was widespread, that it was generally caused by neglect in the facilities, that the industry viewed seniors hurting each other as inevitable and had taken to labeling them as “aggressive.”

'Fighting for Dignity': Watch Caspi's documentary on this topic

But how would she find out how many seniors were being hurt in Arizona?

The only solution was to turn to police reports.

McGlade first requested police call histories from every nursing home and assisted living facility in the state that serves more than 10 people. She then requested incident reports for calls stemming from assaults, domestic violence, fights, sex offenses and abuse, and variations of those keywords.

With help from other reporters at The Republic, McGlade spent nine months building a database that documented alleged or substantiated physical contact between residents, or between residents and facility employees. Team members listed information like times, dates, locations, medical diagnoses and other factors in order to determine where and how seniors were hurting each other across the state.

Though Centers for Medicaid and Medicare Services keeps organized data chronicling nursing home citations, there is no label for resident-on-resident harm-related deficiencies. So counting the total number of these cases — and where they happen around the country — is nearly impossible.

To find nursing home citations for resident-on-resident harm in Arizona, reporters filtered federal data for a variety of citation types that might include resident-on-resident harm, downloaded the 200-plus corresponding reports and searched them for keywords such as altercation, aggressive, hit, punch, kick and more. Some reports were not text-searchable, so reporters read those.

Reporters found fewer than 50 references to resident-on-resident harm out of about 1,500 citations, but there may be more in reports not included in their sample.

They also added to the database by reviewing hundreds of state citation reports on nursing homes, which have to report resident injuries to their licensing agency.

Once that was done, McGlade and fellow reporters interviewed families, attorneys, facility employees, facility directors and researchers over the course of seven months to deepen their understanding of what they were seeing in the data.

Resident-on-resident harm typically comes up in the news as short, breaking stories. The Republic’s series is different because it seeks to deepen the public’s understanding of a complex, systemic problem facing seniors, their families and the people who are paid to take care of them.

Joann is not alone. Read full article here.