Our audience is always curious and excited to know how we choose the subjects of our investigations and how we go about our work. Here are some frequently asked questions about “An Impossible Choice.”
What is this project about?
More than 4,000 people are on life support in California nursing homes. They live on special wards called subacute units, but among some doctors these places are known as “vent farms,” shorthand for the ventilators that keep so many of the residents breathing.
Medi-Cal, California’s program for the poor and disabled, pays for almost all of this care. Last year, payments to subacute units totaled more than $630 million. The cost has almost doubled in the past decade.
One week on life support can cost as much as an entire year of health care for the average person enrolled in Medi-Cal.
Reporter Joanne Faryon and video journalist Brad Racino gained access to one of these units to chronicle daily life for residents and their families.
How did you choose this subject and commit to it?
Faryon heard the term “vent farm” when she was investigating hospice care and the closure of San Diego Hospice in 2013. It was a term that haunted her and her editor, Lorie Hearn, for months. In 2014, Faryon finally had time to dig into this topic.
What she found was an entire world of people who are kept alive on machines. Most are unable to respond to their circumstances. One of the most stunning revelations was that so few people — even in the medical system — were aware these special units exist. It is urgent for the public to hear what their lives might be like in a medical catastrophe in the absence of a written document stating their wishes. This is how the system is set up.
The data, the exclusive access to one of these units and the stories of families hoping in the face of all odds — this was compelling material that needed time, financial investment and great care to tell locally, statewide and nationally. What can be more important than life and how we choose to live on the edge of death?
How did inewsource get access to the medical units seen throughout the series?
Faryon was told that Sharp HealthCare operated one of the largest subacute units in San Diego County on Coronado. She met with several doctors and other health-care workers before approaching Sharp with the idea that she document life on the unit.
The process took several meetings over months. inewsource’s responsible coverage on hospice care in 2013 helped convince Sharp the reporters would not sensationalize the story but rather would give it the balanced, in-depth coverage it required
What data were you able to get and why was it important to the story?
Early in her research, Faryon filed a request under the California Public Records Act for state data, which included the number of people in subacute care, average length of stay, and average age. The state said it would cost $11,250 to fulfill the data request.
After a series of negotiations, inewsource paid about $1,000 for significantly less data than originally requested. For example, the state’s Department of Health Care Services said it was unable to calculate average length of stay for subacute residents across all facilities. Sharp HealthCare provided inewsource with data on the 62 residents in its two subacute units, making it possible to calculate average length of stay for its population.
Joan Teno, a professor at Brown Medical School, also provided a snapshot of people living with tracheostomies or ventilators and feeding tubes in nursing homes across the country for national perspective.
Why was getting access to a unit essential to telling the story?
This project is called “An Impossible Choice” because throughout the reporting, what became clear is that patients and families all arrived at a critical crossroad: continue extraordinary medical treatment to live or withdraw treatment and die. It’s a choice many people will confront, but few know what choosing everything medically possible looks like.
Typical media images of life support don’t capture the reality of someone who relies on breathing and feeding tubes. Equally important is the profound impact on families who stand vigil by bedsides, sometimes for years. Bearing witness to these lives is critical to making an informed choice.
How did you stay objective and not let the access Sharp granted influence your reporting?
Sharp and inewsource established one major rule from the beginning: inewsource would respect privacy and only videotape residents and families who signed waivers. The angle and content of the stories were entirely up to inewsource.
Sharp is a large institution and aware of the risk it took by letting a team of investigative reporters into its facility. Both sides understood the relationship between reporter and institution wasn’t personal. That made it easier to maintain journalistic objectivity. It was a much more difficult balancing act when it came to reporting on the families of the subacute residents.
People who have no experience with the media, who are at times in emotional crisis, put their trust in a reporter and say things that perhaps they might regret. The team found it was a complicated struggle to tell an honest story and not cause these family members even more pain.
How did you find families to interview and why did they agree to speak with you?
Sharp informed a number of families of residents on the unit that a reporter was interested in speaking to them about their experiences. A few allowed Faryon to contact them. The initial conversations were on the phone, followed in some cases by in-person meetings. The families said they were willing to share their stories because they wanted to help other people who might find themselves in a similar situation.
How did you film the series?
Racino filmed the series with two Canon DSLR cameras and wireless audio equipment. Many times, cameras were left recording in rooms for extended periods to capture the daily routine and shared moments between loved ones.
Each shot was carefully framed to avoid identifying information about residents other than those whose families granted inewsource permission to film.
How did you determine the best way to “tell” this story?
inewsource routinely tells its stories in text, audio and video to reach the broadest audience possible. In this case, the material was rich with data, research, expert interviews and personal accounts, so it demanded an even more ambitious storytelling plan. The focus was the audience and how they would receive this material.
That includes traditional television viewers, radio listeners, social media followers, and those who read on the computer and on mobile devices. We wanted to reach people who only are interested in the highlights, as well as those who would spend time contemplating the material.
Long-term life support also is a taboo topic that would generate conversation, debate and a need for interactivity. The team’s conclusion is what is presented here: a mini-documentary, multiple short video vignettes, detailed narratives, an animated storybook and a number of ways to encourage a discussion about end-of-life issues.