This story appears as part of a collaboration to strengthen investigative journalism in Maine between the BDN and The Maine Monitor. Read more about the partnership.
Transitioning an older loved one into a nursing home or assisted living facility is difficult enough. Figuring out whether a facility will be safe and meet their needs can also be a daunting process, and it can be hard to know where to look for information.
Through my years of reporting on these places, I've spent a lot of time digging through public databases that have a wealth of information, but they can be a bit confusing. I hope the guide below helps you find the information you need.
As you're searching these resources for information on different facilities, here are details to look out for:
Before getting into the databases, it's important to understand the difference between nursing homes and assisted living facilities because it changes where to find information about each.
Nursing homes are medical facilities and are regulated by a federal agency called the Centers for Medicare and Medicaid Services. Assisted living facilities are not considered medical facilities because they provide a lower level of care and they are state-regulated under the Maine Department of Health and Human Services.
The best place to look up information on nursing homes is on the Nursing Home Care Compare website, from the Centers for Medicare and Medicaid Services. Each nursing home has an overall rating, out of five stars, based on health inspections, staffing levels and quality measures.
Quality measures include rates of residents who received an antipsychotic medication, whose ability to move on their own worsened after entering the facility, who got a urinary tract infection, who lost too much weight or who went to the hospital, among many other metrics.
Under the health inspections tab on the website you can see the date of the most recent inspection and whether a facility received any citations related to the care of residents, how the staff and residents interact, and the nursing home environment.
In the example below, we can see that this facility was cited for more regulatory violations than the national and state average. The most recent regular inspection report is available, as well as investigations spurred by complaints.
The website also includes data on whether the facility was fined in the last three years, along with other information such as staffing turnover, the number of beds and the ownership type.
Also keep an eye out for whether a nursing home is flagged as a Special Focus Facility. This is a national list of facilities with "serious quality issues."
If you want to know more about a specific incident that resulted in a financial penalty, ProPublica's Nursing Home Inspect database is a great resource. It collects total fines, serious deficiencies and other data points. Under inspection reports, we can see which complaints resulted in a deficiency and how serious it was on a scale of A to L.
"Immediate jeopardy" is the most concerning classification for an incident. ProPublica has tied incident records from CMS with any fines the facility received in recent years, so you can read the incident report that corresponds to a fine. (The CMS website lists the fines but does not link to the corresponding incident report.)
Finally, the Maine state licensing website provides all inspection reports in recent years. In the example below, there are two types of documents available. SOD refers to a Statement of Deficiency document.
Each time the state inspects a facility, it produces this report, which lists any violations or notes if there were no deficiencies. Nursing homes that are found to have violations are required to submit a POC, or Plan of Correction, detailing how it will fix the problems.
This same state licensing website is where you can find information about assisted living facilities. From the homepage, select Assisted Housing. For the department, select Health and Human Services. For agency, select Division of Licensing and Regulation. From there, you can look up many different types of facilities, including residential care, assisted living, adult day services, hospice agencies and personal care services.
For residential care facilities, which resemble what are commonly known as assisted living facilities, you can look up the most recent inspections and see whether an investigator went to the facility. Investigators may visit the facility (an "on-site inspection") or conduct a "desk review," which means they conducted a review over the phone.
If the status says "No deficiencies," that means state inspectors did not find any violations. If the status states "Accepted plan of correction," that means the facility was cited for a violation and submitted a plan of correction back to the state about how it planned to address those problems.
The full results of these inspections and investigations are public record through a public records request to the state (any documents will be redacted to shield residents' personal information). The Maine Monitor and ProPublica used these documents to investigate Maine's residential care facilities, filing public records requests for three years' worth of reports for nearly 200 of these facilities, which we used to create a database categorizing each individual violation.
The result was an 18-month investigation that found these facilities were cited for dozens of resident rights violations including abuse and neglect incidents, more than a hundred cases where residents wandered away from their facilities and hundreds of medication and treatment violations.