Frank Runyeon goes down the New York nursing home rabbit hole

There’s a good reason why many New York seniors jet down to Florida when they retire. When it comes to providing senior care, New York ranks as one of the worst in the country, a fact that reporter Frank Runyeon has uncovered in great detail over the course of several months of in-depth reporting.

City & State published the final part of Frank’s series on Tuesday, a snapshot of Hebrew Home, one of the state’s purportedly elite nursing home facilities, which has endured a flood of lawsuits since 2010 alleging medical malpractice or neglect that led to serious injuries or wrongful death.

In the first part of his series published March 27, Frank gave an overview of the spike in nursing home complaints throughout New York and the flawed oversight and poorly implemented policies in the state’s regulatory system. Frank followed that article with a report demonstrating New York City’s culpability in poor senior care – a system of cycling nursing home residents into its failing homeless shelter system.

Frank’s thorough reporting on a story that has seemingly fallen through the cracks caught my eye and led me to interview him on his process.

The following is an edited transcript.

Nick Powell: You’ve been reporting on the nursing home issue in New York City and state for a while now. What was it that first clued you into the deplorable conditions at for-profit nursing homes in particular and planted the seed for reporting it out as a series?

Frank Runyeon: I think it actually started with a line item in the mayor's preliminary budget. Back in February, I reported that de Blasio allocated $1.5 million to fight elder abuse. I started digging into that. From there, it didn't take long to stumble into the endless research on poor nursing home quality in the country generally, but also how the ownership landscape is evolving in New York, the for-profit phenomenon, abuse and neglect statistics, etc. Basically, once I started looking into this – talking to experts and people working in the industry – there was so much there to report. I went back to the editors and told them, "I think we need to do a series."

NP: In the first part of your series, you note that nearly 60 percent of the state’s nursing homes are run by for-profit agencies, and that the consistent trend with nursing home abuse is that it most often occurs in for-profit homes. Why does the Department of Health continue to contract with for-profit agencies if this is the case? Are there simply not enough adequate nonprofits?

FR: It's an interesting policy question for the health department. I suspect there could be logistical challenges there, but I didn't explore this in my reporting. What I can say is that regardless of the financial structure of a nursing home, experts told me it all seems to boil down to whether there are enough nurses aides and nurses to care for the elderly New Yorkers in nursing homes. It's a very labor-intensive job. Without enough staff, it's an impossible task. Ultimately, the experts told me, that's really what causes a lot of abuse and neglect in nursing homes. And behind that issue … every consumer advocate, academic expert, and elder abuse lawyer I spoke with said that the root problem is ineffective government oversight of skilled nursing facilities, for-profit or nonprofit. People differed somewhat on what was causing this – whether it was understaffing, underfunding, or a cultural problem at the state health department – but the common thread was that the department is not policing problems in the industry as aggressively as it should. Nursing home industry representatives completely disagreed. They told me nursing homes are over-regulated.

NP: Regarding the second part of your series – the city’s Human Resources Administration is notorious for being a boondoggle of bureaucracy and red tape. How much of this cycling of nursing home residents into homeless shelters was a result of simple lack of oversight at that agency?

FR: It’s incredibly complicated. The best understanding that I can get out of it in the time I reported it – basically there is the rollout of DSRIP (Delivery System Reform Incentive Payment) which basically amounts to – how are we going to overhaul the health care system, particularly for poor folks? They have these twin objectives – No. 1, save money; and No. 2, improve health care outcomes for everybody. It seemed like the most direct reason that this happened has to do with the poor rollout of DSRIP. There are these different sort of healthcare organizations, they are encouraged to push people along to the next step down in terms of health care. That’s what happened here, there were people who had been in nursing homes who had previously been homeless, and they didn’t have an obvious next place to go or next of kin to stay with, so they were just moved on down the line to the next step, so they get those people off of their plate, so they wouldn’t get in trouble with the Health Department, or they wouldn’t get docked for not getting people out of there who can be judged as not requiring a skilled nursing care environment. And generally, there’s a lack of communication, and then there’s your garden variety bureaucracy that just made all of this murky enough that people didn’t catch it.  

NP: As you reported this piece, did you have a chance to talk to any state or city legislators about the nursing home issue? Was it almost too under-the-radar for them to notice?

FR: It’s a good question. I’d love to explore it, I very well may. Basically, there is so much here that I had to draw a line on where I was going to be reporting. I would love to know what legislators are going to make of this, and the regulatory agencies, what their response might be to questions from legislators. I feel like that’s the next chapter here.  

NP: In the last part of your series on the flood of abuse and neglect cases at Hebrew Home in the Bronx, many nursing home providers are skeptical of the intentions of the lawyers litigating these types of lawsuits – saying that they are capitalizing on aggrieved New Yorkers in an overly-litigious part of the city. Based on your reporting, does this argument hold up?

FR: My gut reaction as a reporter is that that’s a very easy argument to make. There just really isn’t a lot of data out there to say whether that’s true or not. Even the claim that the Bronx is a litigious county, I talked to a lot of lawyers and they say that’s wisdom on the street, but they haven’t even seen that as a fact. The other thing that was pointed out to me that I found compelling, is once you get inside of the courtroom it’s the facts that matter. If people were bringing claims that didn’t have merit, these cases would be dismissed left and right, and that’s why we took the time to go through 26 lawsuits to see, alright well what were the outcomes here?  Were these all dismissed as being completely ridiculous? Were they just saying, “Oh well Hebrew Home has a lot of money, let’s go get some of it because we’re upset that grandma died,” which would be the cynical way of looking at it. But that’s just not what we found. A lot of these are still in process because they take forever to litigate, but we only found one where the judge said the evidence doesn’t hold up. Then amazingly, that lawsuit where they ruled against the plaintiff, that plantiff turned around and sued their own lawyer for basically being a bad lawyer. They said, this is ridiculous that we lost, I’m suing you for being a bad lawyer. I don’t know how to read that, exactly, but that was pretty striking to me.

NP: Now that you’ve wrapped up your series, what’s next? Are there other threads to this story that you intend to pursue?

FR: We’ll see if the editor still has an appetite for more stories on this topic, but there is so much here. I have two or three other leads I’m pursuing on this, and the rabbit hole is deep. There is a lot to explore here, this is an incredibly under-reported subject in an incredibly rich reporting environment, if there’s anyone else looking into this topic, it shouldn’t take you very long to find a story. As sad as it is, there’s a lot of untold stories here and they can be pretty grim.

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