Mandatory Reporting of Nursing Home Deaths: Markers for Mistreatment, Effect on Care Quality, and Generalizability

This project continues the efforts initiated under an FY2002 award entitled "The Role of Forensic Science in Identification of Mistreatment Deaths in Long Term Care Facilities." This project examined the implementation of a law in the State of Arkansas that requires that all deaths in long-term care facilities be immediately reported to and investigated by the appropriate coroner. The first phase of this project was a series of exploratory interviews with the Coroner of Pulaski County, AR and his staff of current and former investigators regarding the county=s implementation of this law. One-on-one interviews mapped the progress of the coroner's nursing home investigation procedures, gathered impressions about markers that are suspicious for mistreatment, and outlined barriers and facilitators. The second phase was a series of focus group interviews with medical examiners, coroners, geriatricians, and nurses aids from all over the country, designed to determine the current state of forensic investigation of institutional deaths in the United States and how to best distill out forensic markers for abuse and neglect. The third phase of this research was an in-depth record review of completed investigations for a one-year period in Pulaski County, comparing decedents referred for suspicion of mistreatment to those who were not. This will include the performance of full autopsies on a sample of decedents from two different counties in Arkansas. Based on the ongoing analysis of this project, the University of Missouri will continue this work with three specific aims in mind: the further elucidation of markers for elder mistreatment; the identification of the presence or absence of a sentinel effect of the reporting law; and the development of a replication guide for other coroners and medical examiners. ca/ncf