[ And also why complaints jumped 8-fold at the end of 2013 ]
State inspections have always been a critical component of our analysis of senior care communities. We focus mostly independent living, assisted living, and memory care communities. Inspections are not comparable between states since each state inspects differently and on a different scale, but they are very useful for comparing within the same state.
States also differ in how much they share with the public and run the spectrum from no disclosure to full disclosure. The best states are gracious enough to publish the full inspections online (like Georgia, Texas, and Florida). Others, including New Jersey, only publish summaries online. Some states happily provide the inspections through Freedom of Information Requests (thank you Connecticut).
But some states spend the effort to complete inspections and simultaneously believe that the public shouldn’t be able to easily review them. California, the most notorious for this, will be the subject of an upcoming article on how we’re overcoming their roadblocks.
Since NJ only provides inspection summaries online we were forced to submit freedom of information requests, colloquially known as the Open Public Records Act in NJ. Several months and a few hundred dollars in fees later we received boxes and boxes of printed inspections. After laboriously scanning the thousands of pages we were able to perform a little computer magic and automatically analyze and score each inspection.
Here is what we learned.
Once you get your hands on the data, analyzing it is usually very telling. For example, the biggest surprise in the NJ data set is the huge jump in complaints at the end of 2013:
The average complaints over the last two years was just over 10 per month. In November 2013 it jumped to 8.5x to 85 complaints.
Perhaps related, the number of inspections plummeted in 2013. The state completed 6.5 inspections on average until March 2013. From March 2013 until November 2013 New Jersey completed just 2 per month, a 70% decrease.
Here’s another way to look at the huge shift from proactive inspections to reactive complaints:
We dug in a bit further to find out what is going on in the Garden State. Here are where the 195 different communities in New Jersey that are categorized as assisted living:
Left map: All communities
Right map: Communities per 10,000 residents aged 70+
The larger communities, as measured by the number of beds, are in the densest counties, as might be expected. Community size, however, is not correlated with how well they fare on inspections and complaints.
- Average beds per facility per county
Average violations per facility per county
While there isn’t a link between community size and violations, facilities in certain counties do much worse than the average. Here it is evident that communities in Camden, Salem, and Passaic counties receive considerably more violations per facility than the best counties.
Average violations per facility per county
The violations data also allows us to identify what the state believes to be the most pervasive issues. Topping the list are violations related to medication management (called pharmaceutical services) and sanitation.
Most common violations (click to enlarge)
After analyzing the distribution and nuances of inspections and violations in the state we can turn to individual facilities. There are many ways to slice the data but it is important to create a fair baseline. Simply adding violations is unfair because 39% of the facilities have not had a single inspection in over three years. Every facility in the state has either had an inspection or a complaint investigation, which is limited in scope but allows us to judge the outcome. We use several proprietary formulas to rank the communities but the simplest one is simply comparing the average violations per inspection and complaint investigation. Using this we see that 75% of all communities received violations from the state, and that the average number of violations was 1.3.
Most startling is that the communities with the biggest infractions have over five times the state average.
Highest average violations per community (click to enlarge)
We don’t yet know why New Jersey halted their inspection program at the same time that complaints skyrocketed, but we do now know a lot more about what communities are “good” and which need significant help.
Note: We analyze each state’s inspections and will regularly publish the results here.