Last year, BuzzFeed News started trying to learn about a company called BrightSpring Health Services, which owns more than 600 group homes for people with intellectual and developmental disabilities. Specifically, we were interested in what the conditions were like in those homes in the three years since KKR — a legendary private equity firm — bought the company.
We had heard stories, but we wanted facts. We wanted data about the homes, what went on inside them, what kinds of inspections they’d had, and so on. It wasn’t going to be easy.
The federal government compiles a lot of data about nursing homes and puts it on a user-friendly website where families and researchers can examine it. But when it comes to the kinds of group homes that BrightSpring runs, there is scant information, and it’s not available in a single database.
So we decided to build our own.
The first challenge was figuring out what homes BrightSpring owned. Many of its facilities operate under different names, such as ResCare, EduCare, Normal Life, and VOCA. So reporters filed public records requests to state departments of health, then cross-checked the data gleaned from those requests against corporate filings in search of the relevant subsidiaries.
We examined BrightSpring’s intermediate care facilities (ICFs), the type of group home with the most comprehensive state inspection reports. These homes typically provide round-the-clock care for four to eight people. We focused on the states with the most for-profit ICFs, according to federal records: California, Indiana, Louisiana, North Carolina, Ohio, Texas, and West Virginia.
In the end, we compiled a dataset of the owners of nearly 4,000 ICFs across those seven states.
We paired the information about which homes BrightSpring owned with data from state inspections, which are conducted to assess the quality and safety of the facilities.
State inspectors typically visit ICFs at least once every 15 months (or more often, if there is a complaint) to check on everything from medication protocols to staffing levels to fire hazards.
The inspectors write detailed reports, describing conditions in the home and, in some cases, how any problems were resolved. Some states make it very hard for the public to obtain these reports. Louisiana, for example, asked for thousands of dollars to provide copies, and Texas sent them to us with heavy redactions.
But if a facility is not meeting federal standards, an inspector can issue a citation, and data about those citations make their way out of the states and into the Centers for Medicare & Medicaid Services, a federal agency, which makes them available online.
Our analysis looked at the most serious type of problems, known as “conditional” deficiencies.
BuzzFeed News’ analysis found that, from when KKR took over BrightSpring in March 2019 through the end of 2021, its homes were cited for dangerous conditions at a rate well above the average. In the seven states we analyzed, KKR owns only 16% of the homes but racked up 40% of the serious citations — more than 500 in total.
Before publication, BuzzFeed News provided BrightSpring and KKR with a nine-page methodology explaining the analysis.
KKR issued a statement saying, “We vehemently disagree with the grossly misleading narrative you presented.” BrightSpring sent a similar statement calling BuzzFeed News’ findings “inaccurate, misleading, and fundamentally flawed.” It said the data analysis was unsound because the underlying records were unreliable and were collected during a pandemic.
BuzzFeed News consulted with four leading social scientists about the analysis methodology. Three of the experts — Alison Morantz (Stanford University), George Garcia (Stanford University), and Charlene Harrington (University of California, San Francisco) — have experience analyzing ICFs specifically. A fourth, David Stevenson (Vanderbilt University), has done similar analyses for nursing homes. All of them said the federal data was a valid source to use for our analysis, that its limitations do not bias the results, and that our methodology was sound.
To review our full analysis, please see this GitHub repository.