The Tone of Nursing Home Portrayal in 51 Newspapers in the United States

• Date: 01 June 2018
• Author: Corina R. Ronneberg,Ian Livingstone,Edward Alan Miller
• Published date: 01 June 2018
• DOI: http://doi.org/10.1002/wmh3.268

The Tone of Nursing Home Portrayal in 51 Newspapers

in the United States

Edward Alan Miller , Corina R. Ronneberg, and Ian Livingstone

The purpose of this study is to systematically analyze and describe the tone of media coverage of the

nursing home sector and its relationship to other dimensions of the coverage reported. Through a

search of the LexisNexis database, 16,280 articles were identif‌ied from 51 U.S. newspapers from

1999 to 2008. Articles were analyzed for tone, themes, prominence, central actor, and issue

jurisdiction. Multinomial logit was used to examine the correlates of tone. Most articles were

negative (36.9 percent) or neutral (45.5 percent) in tone; very few were positive (12.6 percent) or

mixed (5.0 percent). Differences in tone were noted with regard to article placement and content.

Findings highlight the preponderance of negative coverage and suggest that its adverse inf‌luence on

public attitudes toward nursing homes may be enhanced by its prominence and focus on state/local

concerns and industry interests/behavior. Future research should examine the relationship between

media coverage and government agendas and outcomes related to nursing homes.

KEY WORDS: nursing home, media, tone, content analysis, agenda setting

Introduction

Nursing homes (NHs) provide health and personal care 24 hours a day,

7 days a week in a residential setting. Short-term care (<90 days) is provided to

individuals in need of post-acute care, rehabilitation, respite, or end-of-life care.

Long-term care (>90 days) is provided to individuals unable to perform basic

activities of daily living such as bathing, dressing, toileting, or eating due to

frailty, disability, functional def‌icits, or cognitive impairment. The nation’s 16,000

NHs serve approximately 1.4 million residents daily (Center for Medicare and

Medicaid Services, 2015). The likelihood of needing NH care at some point in

one’s life is high. It has been estimated that at age 50 individuals have a 53–59

percent chance of entering a NH for an average length of stay of 370 days before

they die (Hurd, Michaud, & Rohwedder, 2014). In 2017, the median annual costs

for this care ranged from $85,775 to $97,455 for a semi-private room and private

room, respectively (Genworth Financial Inc., 2017). Medicaid, the federal health

insurance program for low-income and disabled Americans, pays for most long-

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doi: 10.1002/wmh3.268

#2018 Policy Studies Organization

term NH care, typically after residents have spent down their own personal

resources to program income and asset eligibility levels. Medicare, the federal

health insurance program for older Americans, is the primary payer for short-

term visits. Eligibility for government payment requires NHs to undergo

approximately yearly inspections by state off‌icials contracted by the federal

government to assess quality using federally stipulated survey protocols.

Apprehension toward the way NH care is delivered, regulated, and f‌inanced

endures due to persistent challenges in ensuring access to the high-quality, cost-

effective care needed as a result of increased frailty and disability in old age

(Miller, Tyler, Rozanova, & Mor, 2012; Naylor, Kutzman, Miller, Nadash, &

Fitzgerald, 2015; Reinhard et al., 2014). Thus, despite progress improving the

quality of NH care over the last three decades, signif‌icant challenges persist given

ongoing federal and state efforts to spur quality improvement (Castle & Ferguson,

2010; Naylor et al., 2015; Wells & Harrington, 2013). A major concern is that NH

residents have become increasingly frail and medically complex and segregated

into higher and lower quality facilities on the basis of race, ethnicity, location, and

payment status (Feng, Grabowski, Intrator, & Mor, 2006; Feng, Fennell, Tyler,

Clark, & Mor, 2011). The NH industry’s poor reputation may inform efforts to

address these continuing challenges. Americans view NHs highly unfavorably

(Jones & Saad, 2016; Kaiser Family Foundation, 2007); so too do government

off‌icials and other opinion leaders (Miller, Mor & Clark, 2010). These attitudes

derive, in part, from personal experience and policy research (Kaiser Family

Foundation, 2005; Khatusky, Wiener, Green, & Thach, 2017). They may also

derive from the negative way in which NHs are represented in the mass media

(Kaiser Family Foundation, 2001, 2005), which itself may ref‌lect continuing

industry challenges.

The inf‌luence of negative media coverage on U.S. government policy toward

NHs has been discussed anecdotally for nearly 40 years (Smith, 1981; Vladeck,

1980; Wiener, Freiman, & Brown, 2007). Wiener et al. (2007), for example, argue

that the roots of NH quality reforms promulgated with the Omnibus Budget

Reconciliation Act of 1987 can be traced back to Reagan-era attempts to weaken

prevailing quality standards. The authors write that “leaks to the news media of

proposed changes, especially to The New York Times, led to negative publicity and

their disavowal by the Reagan White House” (p. 4). The result was an end to

efforts to weaken the standards of quality themselves but renewed interest in

implementing a more industry friendly survey, certif‌ication, and enforcement

process, something which both consumers and Congress opposed. Subsequent

negotiations between Congress and the administration led to agreement that the

Institute of Medicine (IOM) should take a look at the issue, culminating in the

IOM’s 1986 report and, ultimately, the 1987 reforms.

The inf‌luence of the mass media on government policy toward NHs has also

be discussed internationally (Elmelung-Praestekaer & Wien, 2008; Lloyd, Bane-

rjee, Harrington, Jacobsen, & Szebehely, 2014). This is ref‌lected in Elmelung-

Praestekaer and Wien (2008), which examined the relationship between f‌ive

“media hypes” and government policies impacting care for and spending on the

Miller/Ronneberg/Livingstone: Nursing Home Portrayal 147