In its five-part “Failing the Frail” series, a PennLive investigation reveals the 18 most understaffed Pennsylvania nursing homes. The series includes an interactive map to search for staffing levels of individual nursing homes.

Based on PennLive’s analysis of 559 facilities, nursing homes in Pennsylvania provided residents with an average of only 3.6 hours of care per day, well below the minimum 4.1 hours recommended for safe care, although within Pennsylvania’s minimum staffing requirement of 2.7 hours of care per day. The analysis found 477 homes, or 85 percent, provided less than the recommended level. The analysis further found that 183 homes, or 33 percent, were dangerously understaffed because they provided less than 3.5 hours of care per day and, less than 32 minutes of care from registered nurses.

The publication of PennLive’s series followed the release of a year-long audit of the Department of Health’s regulation of nursing homes. Among other issues, that audit found multiple issues with the department’s regulation of the industry, including failure to ensure that Pennsylvania nursing homes met minimum staffing requirements.

After analyzing Medicaid/Medicare data and nursing home inspection reports relating to resident deaths due to care-related mistakes, PennLive’s investigation found problems beyond those identified in the audit. PennLive found the department appeared to be systematically understating the severity of cases where residents died from errors or negligence, that it rarely punished homes for those incidents, and that it may be failing to properly investigate serious cases of suspected negligence.

The federal Centers for Medicare and Medicaid Services recently completed a review of the Department of Health’s handling of serious incidents of nursing home negligence, and provided feedback and training on how to assess the severity of violations. The federal review noted an increase in citations of deficiencies at the ‘actual harm’ and ‘immediate jeopardy’ level. However, CMS chose not to issue any new penalties against the homes involved in the cases PennLive identified, determining that the facilities had largely corrected the violations. CMS reviewed the cases in question and provided recommendations. But any errors found went unpunished.