This article was originally published on ProPublica. You can read it here.
Nursing home residents have been among those hardest hit by the new coronavirus. In some states, more than half of the recorded deaths have been long-term care residents. Some of the homes have been cited for putting residents at "immediate jeopardy" of harm or death, our analysis showed.
And many of the affected homes have been previously written up for violating federal standards. That's true in California, New Jersey and New York.
We're updating Nursing Home Inspect to include more information about nursing homes across the country, including past problems with infection control practices, and which ones have had cases of COVID-19 among residents or staff.
We introduced this resource in 2012 as a way to search through tens of thousands of nursing home inspection reports to find problems and trends.
You can easily compare the nursing homes in your state based on how many times they have been cited for violating infection control protocols in the past three inspection cycles (roughly three years). We've also added data from The Washington Post on homes with COVID-19 cases. Nursing Home Inspect also allows you to sort by the number of health deficiencies cited by regulators; the number of serious deficiencies per home (that is, deficiencies in which patients were put in immediate jeopardy of harm); the amount of fines imposed; and how often the government has suspended payments to the home for new patients, another type of penalty.
Our data is from the U.S. Centers for Medicare and Medicaid Services (CMS), which has its own website called Nursing Home Compare. We've taken the information and organized it into an easy-to-use resource for families and residents, as well as researchers and other journalists.
Our site includes:
• State pages: Every state has its own section that allows you to compare all of the homes in a state on a variety of indicators.
• Individual nursing home pages: Every home has a section listing all of the health deficiencies identified within the past three survey cycles (roughly three years). The full text of these deficiency reports, if available, can be accessed via links from this page to CMS. Each home's page also has ownership status — whether for-profit, government-run or nonprofit — and whether the home has been labeled by the government as a Special Focus Facility, meaning that it has many more problems than other homes. We've also labeled Special Focus Facility candidates, which meet the criteria to be a special focus facility but haven't yet been designated as one. (We only include health deficiencies, not fire and safety violations, in this database.)
• State-by-state maps: The main page of the app shows how states compare in terms of the percentage of homes with at least one serious deficiency, the average fine paid by homes in the state, and the percentage of homes in each state with at least one infection-related deficiency.
• Top 20 Lists: We've listed the homes that have paid the most in fines in the nation and those with the highest number of serious deficiencies.
If homes violate federal standards, CMS may impose fines or suspend Medicare/Medicaid payments to the nursing home for new residents until the facility corrects the deficiency.
If problems persist or are not fixed, CMS can end its agreement with the nursing home. Additional details about CMS' approach to enforcement can be found here.
Nursing Home Inspect continues to allow you to search through nearly 80,000 inspection reports by keywords, such as "choke" or "maggots," to look for issues you care about. These search results can be sorted by date, city, state or severity of the deficiency.
Nursing homes are inspected on both a regular schedule and when there is a complaint. Inspectors typically work for state agencies paid by Medicare. If they find problems, known as deficiencies, they rank them on a scale of A to L, the most severe. The vast majority are either labeled D or E.
What you won't find on these pages are self-reported quality measures for each home. Those can be found on Nursing Home Compare. We also don't list the state sanctions imposed against homes because those are not centrally collected. For information on penalties within a given state, you should consult the state agency that regulates nursing homes. The federal government has a list of contacts available here.
When reading through inspection reports, it is a good idea to keep in mind the caveats we've outlined previously.
How We Combined Data Sources
To compile our app, we used different datasets: a listing of all Medicare-certified nursing homes, inspection violations and penalties, and deficiency report narratives.
We merged spreadsheets containing findings from routine inspections and those identified during complaint visits and kept only health violations, not fire safety violations.
We used each home's unique identification code to match penalties imposed to the dates of their corresponding inspections so we could display that data together for each home. (We also noted some cases in which a penalty date did not have a corresponding inspection in the database.)
You can find the data we used on these sites:
• For a list of nursing homes: https://data.medicare.gov/Nursing-Home-Compare/Provider-Info/4pq5-n9py
• For penalties: https://data.medicare.gov/Nursing-Home-Compare/Penalties/g6vv-u9sr
• For health deficiency information: https://data.medicare.gov/Nursing-Home-Compare/Health-Deficiencies/r5ix-sfxw
• For deficiency report narratives (updated in April 2020): https://downloads.cms.gov/files/Full-Statement-of-Deficiencies-April-2020.zip
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Why do some folks use social media but don't engage?
Psychologist says people who never comment on social media share these 5 positive traits
For over 20 years, social media has developed into a staple in many people’s day-to-day lives. Whether it’s to keep in communication with friends and family, following the thoughts of celebrities, or watching cat videos while sipping your morning coffee, there seem to be two types of social media users: commenters and lurkers.
The term “lurker” sounds equally mysterious and insidious, with some social media users writing them off as non-participants at best or voyeurs at worst. However, mindfulness expert Lachlan Brown believes these non-commenters have some very psychologically positive and healthy traits. Let’s take a look at how each one of these traits could be beneficial and see how fruitful lurking might be even though it can drive content creators crazy.
1. Cautious about vulnerability
Consciously or not, making a post online or commenting on one puts you and your words out there. It’s a statement that everyone can see, even if it’s as simple as clicking “like.” Doing so opens yourself up to judgment, with all the good, bad, and potential misinterpretation that comes with it. Non-commenters would rather not open themselves up to that.
These silent users are connected to a concept of self-protection by simply not engaging. By just scrolling past posts or just reading/watching them without commentary, they’re preventing themselves from any downsides of sharing an opinion such as rejection, misunderstanding, or embarrassment. They also have more control on how much of themselves they’re willing to reveal to the general public, and tend to be more open face-to-face or during one-on-one/one-on-few private chats or DMs. This can be seen as a healthy boundary and prevents unnecessary exposure.
Considering many comment sections, especially involving political topics, are meant to stir negative emotional responses to increase engagement, being extra mindful about where, when, and what you comment might not be a bad idea. They might not even take the engagement bait at all. Or if they see a friend of theirs post something vulnerable, they feel more motivated to engage with them personally one-on-one rather than use social media to publicly check in on them.
2. Analytical and reflective mindset
How many times have you gone onto Reddit, YouTube, or any other site and just skimmed past comments that are just different versions of “yes, and,” “no, but,” or “yes, but”? Or the ever insightful, formerly popular comment “First!” in a thread? These silent browsers lean against adding to such noise unless they have some valid and thoughtful contribution (if they bother to comment period).
These non-posters are likely wired on reflective thinking rather than their initial intuition. Not to say that all those who comment aren’t thoughtful, but many tend to react quickly and comment based on their initial feelings rather than absorbing the information, thinking it over, researching or testing their belief, and then posting it. For "lurkers," it could by their very nature to just do all of that and not post it at all, or share their thoughts and findings privately with a friend. All in all, it’s a preference of substance over speed.
3. High sense of self-awareness
Carried over from the first two listed traits, these silent social media users incorporate their concern over their vulnerability and their reflective mindset into digital self-awareness. They know what triggers responses out of them and what causes them to engage in impulsive behavior. It could be that they have engaged with a troll in the past and felt foolish. Or that they just felt sad after a post or got into an unnecessary argument that impacted them offline. By knowing themselves and seeing what’s being discussed, they choose to weigh their words carefully or just not participate at all. It’s a form of self-preservation through restraint.
4. Prefer to observe rather than perform
Some folks treat social media as information, entertainment, or a mix of both, and commenting can feel like they’re yelling at the TV, clapping alone in a movie theater when the credits roll, or yelling “That’s not true!” to a news anchor that will never hear them. But contrary to that, social media is a place where those yells, claps, and accusations can be seen and get a response. By its design, social media is considered by experts and the media as performative, regardless of whether it is positive or negative. Taking all of the previously mentioned traits into account, one can see why they would prefer to “observe the play” rather than get up on the stage of Facebook or X.
On top of that, these non-commenters could be using social media differently than those who choose to fully engage with it. Using this type of navigation, there may be nothing for them to comment about. Some commenters are even vying for this for their mental health. There are articles about how to better curate your social media feeds and manipulate algorithms to create a better social media experience to avoid unnecessary conflict or mentally tiring debate.
If you go on a blocking spree on all of your accounts and just follow the posters that boost you, it could turn your social media into a nice part of your routine as you mainly engage with others face-to-face or privately. In terms of commenting, if your curated Instagram is just following cute dogs and all you have to offer for a comment is “cute dog,” you might just enjoy the picture and then move on with your day rather than join in the noise. These non-commenters aren’t in the show and they’re fine with it.
5. Less motivated by social validation
The last trait that Brown showcases is that social media users who browse without posting tend to be independent from external validation, at least online. Social media is built to grow through feedback loops such as awarding likes, shares, and reposts of your content along with notifications letting you know that a new person follows you or wants to connect. This can lead many people to connect their activity on social media with their sense of self worth, especially with adolescents who are still figuring out their place in the world and have still-developing brains.
Engaging in social media via likes, shares, comments, and posts rewards our brains by having them release dopamine, which makes us feel good and can easily become addictive. For whatever reason, non-commenters don’t rely on social media as a means to gauge their social capital or self worth. This doesn’t make them better than those who do. While some non-commenters could have healthier ways to boost their self worth or release dopamine into their systems, many get that validation from equally unhealthy sources offline. That said, many non-commenters’ silence could be a display of independence and self confidence.
Whether you frequently comment online or don’t, it’s good to understand why you do or don’t. Analyzing your habits can help you determine whether your online engagement is healthy, or needs to be tweaked. With that information, you can then create a healthy social media experience that works for you.