{
  "brand": "Help Elders",
  "domain": "helpelders",
  "audience": "elder-care",
  "headline": "Put the care context behind the campaign.",
  "intro": "Connect the correct facility, dated care findings and reported staffing. Build a campaign brief around a specific care question, then test what happens through qualification and signing.",
  "figure": {
    "title": "A common pattern needs context",
    "scope": "California · 2026 Q2",
    "source": "pbj",
    "caption": "1,141 of 1,146 facilities show a weekend dip. Core includes defined RN/LPN/CNA categories and RN administrative/DON hours. This is not a facility-risk score."
  },
  "lensHeadline": "Separate the care themes. Ask better questions.",
  "lensIntro": "Pressure injuries, supervision and assisted-living protections need different evidence. A low rating or a staffing threshold cannot do all the qualification.",
  "examples": [
    {
      "id": "pressure",
      "title": "Pressure injuries",
      "subtitle": "Nursing-home care records",
      "observedTitle": "1,034 retained F0686 citations.",
      "observed": "The retained CMS cycles contain 1,034 pressure-ulcer-care citations, including 86 coded G–L. Those codes span actual harm and immediate jeopardy; jeopardy can involve threatened harm.",
      "scope": "Rolling retained survey cycles, not annual injury counts, unique residents or legal cases.",
      "sourceIds": [
        "citations"
      ],
      "testTitle": "Build a care-records information test.",
      "test": "Compare a pressure-injury records checklist with a general elder-care page under comparable eligible query traffic. Staffing is context, not an intake pass/fail rule.",
      "qualifiers": [
        "Resident protection status and care setting",
        "Exact facility license/CCN and stay dates",
        "Known risks, care plan, injury and relevant omissions"
      ],
      "measure": "Attorney acceptance, rejection reasons and signed matters after lag.",
      "boundary": "The historical Pine Creek quarter recovered for the selected pressure-injury case has no occupied day below eight reported RN hours. Exact claimant stay dates and causation remain unverified."
    },
    {
      "id": "falls",
      "title": "Falls and supervision",
      "subtitle": "Accident-prevention context",
      "observedTitle": "2,573 retained F0689 citations.",
      "observed": "The warehouse contains 2,573 accident-hazard/supervision citations, including 468 coded G–L. These are distinct from staffing, ownership and penalty records.",
      "scope": "Citation grain is facility, survey and deficiency identity. Counts are not a census of falls.",
      "sourceIds": [
        "citations"
      ],
      "testTitle": "Explain the supervision question.",
      "test": "Test fall-risk and care-plan information against broad neglect copy. Ask about preventive measures and the actual event before drawing a legal conclusion.",
      "qualifiers": [
        "Correct facility and resident stay dates",
        "Actual injury, known risks and care plan",
        "Supervision, response, causation and counsel’s culpability review"
      ],
      "measure": "Qualified and signed matters, with misrouting and response-time guardrails.",
      "boundary": "A fall does not by itself prove neglect. In a same-quarter descriptive join, 49 of 50 matched facilities with retained G–L citations had no zero-RN day."
    },
    {
      "id": "assisted",
      "title": "Assisted living",
      "subtitle": "A separate licensing path",
      "observedTitle": "A CMS match cannot fill a CDSS gap.",
      "observed": "Nursing homes and assisted living are different populations. Current licensing directories help identify a facility, but assisted-living complaint/narrative history remains incomplete in this research.",
      "scope": "Licenses and operators stay separate, including at a shared street address.",
      "sourceIds": [
        "cdss"
      ],
      "testTitle": "Route the care setting early.",
      "test": "Compare an intake that identifies the historical CDSS license/operator with a nursing-home-only path. Offer a dated research brief that keeps unresolved identity visible.",
      "qualifiers": [
        "Care setting and historical facility license",
        "Operator and dates of care",
        "Specific event, injury, records and relevant prior findings"
      ],
      "measure": "Setting/license routing accuracy and attorney acceptance.",
      "boundary": "Do not assign a former operator’s allegations to a current same-address operator, or substitute a co-located CMS license."
    }
  ],
  "evidenceHeadline": "A larger panel. A clearer identity.",
  "evidence": [
    {
      "label": "California staffing panel",
      "value": "207,066 facility-days",
      "grain": "Reported daily paid hours and MDS census across 2026 Q1/Q2. Q2 released October 28, 2026.",
      "source": "pbj",
      "limit": "Reported paid hours are not verified bedside attendance or an abuse finding."
    },
    {
      "label": "Q2 directory reconciliation",
      "value": "1,146 of 1,146",
      "grain": "Quarterly facilities matched to the current cleaned CMS directory by exact CCN.",
      "source": "providers",
      "limit": "A current directory match does not establish historical operator responsibility."
    },
    {
      "label": "Weekend comparison",
      "value": "1,141 of 1,146",
      "grain": "Facilities with lower weekend than weekday core HPRD; median facility ratio 0.875.",
      "source": "pbj",
      "limit": "A common weekend dip has little discrimination alone and does not justify ad dayparting."
    },
    {
      "label": "Same-quarter counterexample",
      "value": "49 of 50",
      "grain": "Matched facilities with retained G–L citations in April–June 2026 that had no reported zero-RN day.",
      "source": "citations",
      "limit": "Ecological co-observation only. Not classifier performance, causation or a resident-level match."
    }
  ],
  "counterpoint": {
    "title": "Why reported staffing is not verified attendance or a neglect label",
    "text": "HHS OIG’s June 2026 audit found unsupported RN hours in its March 2024 sample and estimated about 5% unsupported hours within that sampling frame. Do not apply that percentage as a correction to all current California records. Keep reported staffing, care findings, resident-level proof and legal conclusions separate.",
    "sourceIds": [
      "oig",
      "pbj"
    ]
  },
  "coverage": "The panel covers CMS-certified nursing homes. RN includes director and administrative RN hours; core adds defined LPN and CNA categories. HPRD is summed hours divided by occupied resident-days. Assisted-living history, resident-level outcomes and campaign economics remain separate evidence gaps.",
  "legal": "Enhanced elder-abuse/neglect remedies require the protected-person and care relationship, actual omissions, harm, causation and the applicable culpability/proof standards. A citation alone does not establish civil liability. Professional negligence and financial abuse have different branches. Missing records alone do not satisfy the statutory judicial spoliation exception.",
  "ctaHeadline": "Bring a care question. Trace the evidence.",
  "steps": [
    {
      "title": "Define the evidence context",
      "text": "Pin the source, date window, record grain and exact entity. Preserve contradictory facts and missing information."
    },
    {
      "title": "Change one part of the campaign",
      "text": "Compare a specific information page or qualification flow with a concurrent control. Keep geography, intake coverage and the outcome definition comparable."
    },
    {
      "title": "Follow the matter through intake",
      "text": "Deduplicate inquiries, record attorney acceptance and allow time for signing. Reallocate only when mature economics, uncertainty and capacity support the decision."
    }
  ],
  "sources": [
    {
      "id": "pbj",
      "label": "CMS daily nurse staffing",
      "url": "https://data.cms.gov/quality-of-care/payroll-based-journal-daily-nurse-staffing",
      "note": "Verified CA-filtered 2026 Q1/Q2 pages, unique CCN/date grain and pinned raw hashes. Hours are paid/reporting measures, not observed bedside care."
    },
    {
      "id": "citations",
      "label": "CMS health citations",
      "url": "https://data.cms.gov/provider-data/dataset/r5ix-sfxw",
      "note": "October 2026 retained citation cycles, filtered to California facilities. G–L spans actual harm and immediate jeopardy."
    },
    {
      "id": "providers",
      "label": "CMS provider directory",
      "url": "https://data.cms.gov/provider-data/dataset/4pq5-n9py",
      "note": "Current roster supports exact-CCN reconciliation; it does not replace license/operator history."
    },
    {
      "id": "cdss",
      "label": "California facility search",
      "url": "https://www.ccld.dss.ca.gov/carefacilitysearch/",
      "note": "Assisted-living licenses form a separate population; absence of integrated findings does not mean no complaints."
    },
    {
      "id": "oig",
      "label": "HHS OIG staffing audit",
      "url": "https://oig.hhs.gov/reports/all/2026/cmss-processes-were-not-effective-in-ensuring-the-accuracy-of-staffing-information-reported-in-the-payroll-based-journal/",
      "note": "June 17, 2026 audit of March 2024 reported RN hours; its sampling-frame estimate is not a universal current correction."
    },
    {
      "id": "remedies",
      "label": "California WIC 15657",
      "url": "https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=15657.",
      "note": "Enhanced remedies have specific culpability, proof and employer requirements."
    },
    {
      "id": "spoliation",
      "label": "California WIC 15657.02",
      "url": "https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=15657.02.",
      "note": "The 2026 spoliation provision requires prescribed judicial findings and applicability; missing records alone are insufficient."
    }
  ],
  "as_of": "2026-10-28",
  "status": "research_not_measured_ad_performance",
  "campaign_hypotheses": [
    {
      "hypothesis_id": "HE-PRESSURE-INJURY",
      "domain": "helpelders",
      "status": "research_hypothesis_not_launched",
      "query_theme": "Nursing-home pressure-injury protections",
      "supported_claim_ids": [
        "E01",
        "E05",
        "E06",
        "E07"
      ],
      "source_ids": [
        "warehouse_citations",
        "cms_pbj",
        "oig_staffing",
        "law_elder"
      ],
      "query_seeds": [
        "california nursing home pressure sore legal help",
        "pressure injury nursing home records attorney"
      ],
      "public_context": {
        "population": "CMS-certified nursing homes",
        "tag": "F0686",
        "retained_citations": 1034,
        "g_to_l_citations": 86,
        "not_an_injury_census": true
      },
      "restricted_intake_qualifiers": [
        "Resident protection status",
        "Exact CCN/license and stay dates",
        "Care plan and known risks",
        "Actual injury/records and alleged omissions",
        "Causation and culpability reviewed by counsel"
      ],
      "intent_review": [
        "Separate general clinical treatment or facility-shopping traffic",
        "No zero-RN requirement for a potentially relevant matter"
      ],
      "experiment_treatment": "Care-theme records checklist versus general elder-care legal page",
      "launch_gates": [
        "Dated planner/auction inputs and permitted measurement design",
        "Counsel-approved creative, landing page, procedure and advertiser disclosures",
        "Prespecified concurrent comparison, conversion lag and intake capacity",
        "No resident audience lists; no injury details in ad-platform measurement payloads"
      ],
      "primary_outcome": "Mature distinct signed-matter contribution, with attorney qualification and signed matters reported separately",
      "delivery": "Policy-eligible search/context/geography; no inferred injury/abuse audience list",
      "expected_cpc": null,
      "expected_monthly_search_volume": null,
      "observed_cpa": null,
      "observed_signed_case_lift": null,
      "budget_recommendation": null,
      "current_legal_eligibility": "Attorney determination required",
      "fiscal_value": "Partner-supplied expected discounted collected fees less variable case costs; public awards excluded"
    },
    {
      "hypothesis_id": "HE-FALL-SUPERVISION",
      "domain": "helpelders",
      "status": "research_hypothesis_not_launched",
      "query_theme": "Nursing-home falls and supervision",
      "supported_claim_ids": [
        "E04",
        "E05"
      ],
      "source_ids": [
        "warehouse_citations",
        "law_elder"
      ],
      "query_seeds": [
        "nursing home repeated falls legal help california",
        "nursing home fall supervision records lawyer"
      ],
      "public_context": {
        "population": "CMS-certified nursing homes",
        "tag": "F0689",
        "retained_citations": 2573,
        "g_to_l_citations": 468
      },
      "restricted_intake_qualifiers": [
        "Correct facility and care setting",
        "Fall dates/injury",
        "Known fall risk and supervision/care plan",
        "Preventive measures and response",
        "Causation and legal culpability"
      ],
      "intent_review": [
        "Do not infer a fall proves neglect",
        "Separate fall-prevention product/clinical advice intent"
      ],
      "experiment_treatment": "Supervision/records explanation versus general neglect copy",
      "launch_gates": [
        "Dated planner/auction inputs and permitted measurement design",
        "Counsel-approved creative, landing page, procedure and advertiser disclosures",
        "Prespecified concurrent comparison, conversion lag and intake capacity",
        "Citation and staffing remain context; no automated abuse score"
      ],
      "primary_outcome": "Mature distinct signed-matter contribution, with attorney qualification and signed matters reported separately",
      "delivery": "Policy-eligible search/context/geography; no inferred injury/abuse audience list",
      "expected_cpc": null,
      "expected_monthly_search_volume": null,
      "observed_cpa": null,
      "observed_signed_case_lift": null,
      "budget_recommendation": null,
      "current_legal_eligibility": "Attorney determination required",
      "fiscal_value": "Partner-supplied expected discounted collected fees less variable case costs; public awards excluded"
    },
    {
      "hypothesis_id": "HE-ASSISTED-LIVING",
      "domain": "helpelders",
      "status": "research_hypothesis_not_launched",
      "query_theme": "Assisted-living and memory-care protections",
      "supported_claim_ids": [
        "E02",
        "E06"
      ],
      "source_ids": [
        "warehouse_cdss_facilities",
        "law_elder"
      ],
      "query_seeds": [
        "california assisted living neglect legal information",
        "memory care elopement lawyer california"
      ],
      "public_context": {
        "population": "CDSS licensed residential care, separate from CMS nursing homes",
        "inspection_history_coverage": "incomplete; manual historical research required"
      },
      "restricted_intake_qualifiers": [
        "Historical CDSS license",
        "Operator and stay dates",
        "Protected-person/care relationship",
        "Specific event and injury",
        "Relevant records and prior findings"
      ],
      "intent_review": [
        "Do not substitute a co-located CMS license",
        "Do not assign a prior operator case to a current same-address operator",
        "Do not imply knowledge of a viewer's family"
      ],
      "experiment_treatment": "Early setting/license routing and transparent evidence gap versus nursing-home-only intake",
      "launch_gates": [
        "Dated planner/auction inputs and permitted measurement design",
        "Counsel-approved creative, landing page, procedure and advertiser disclosures",
        "Prespecified concurrent comparison, conversion lag and intake capacity",
        "Verify historical operator/license; narrative coverage remains incomplete"
      ],
      "primary_outcome": "Mature distinct signed-matter contribution, with attorney qualification and signed matters reported separately",
      "delivery": "Policy-eligible search/context/geography; no inferred injury/abuse audience list",
      "expected_cpc": null,
      "expected_monthly_search_volume": null,
      "observed_cpa": null,
      "observed_signed_case_lift": null,
      "budget_recommendation": null,
      "current_legal_eligibility": "Attorney determination required",
      "fiscal_value": "Partner-supplied expected discounted collected fees less variable case costs; public awards excluded"
    },
    {
      "hypothesis_id": "HE-FACILITY-BRIEF",
      "domain": "helpelders",
      "status": "research_hypothesis_not_launched",
      "query_theme": "Buyer-requested facility evidence brief",
      "supported_claim_ids": [
        "E01",
        "E02",
        "E03",
        "E04",
        "E08"
      ],
      "source_ids": [
        "cms_rating_guide",
        "cms_pbj_method"
      ],
      "query_seeds": [
        "B2B research brief request; no consumer keyword forecast assumed"
      ],
      "public_context": {
        "identity": "Exact CCN/license with operator/date context",
        "deliverable": "Dated evidence and unresolved issues, no danger rank"
      },
      "restricted_intake_qualifiers": [
        "Buyer service scope",
        "Facility license/site",
        "Requested research period",
        "Permitted matter context, held in governed systems"
      ],
      "intent_review": [
        "No automatic defamatory abuse-branded pages",
        "No geofencing based on patient/resident/family status"
      ],
      "experiment_treatment": "Measure analyst time and factual/identity error rate with versus without reconciled brief",
      "launch_gates": [
        "Define comparable research tasks and blinded quality review",
        "Protect matter details",
        "Do not claim measured time savings before a study"
      ],
      "primary_outcome": "Mature distinct signed-matter contribution, with attorney qualification and signed matters reported separately",
      "delivery": "Policy-eligible search/context/geography; no inferred injury/abuse audience list",
      "expected_cpc": null,
      "expected_monthly_search_volume": null,
      "observed_cpa": null,
      "observed_signed_case_lift": null,
      "budget_recommendation": null,
      "current_legal_eligibility": "Attorney determination required",
      "fiscal_value": "Partner-supplied expected discounted collected fees less variable case costs; public awards excluded"
    }
  ],
  "hypothesis_sources": [
    {
      "source_id": "cms_pbj",
      "url": "https://data.cms.gov/quality-of-care/payroll-based-journal-daily-nurse-staffing",
      "read_status": "retrieved_text"
    },
    {
      "source_id": "oig_staffing",
      "url": "https://oig.hhs.gov/reports/all/2026/cmss-processes-were-not-effective-in-ensuring-the-accuracy-of-staffing-information-reported-in-the-payroll-based-journal/",
      "read_status": "retrieved_text"
    },
    {
      "source_id": "cms_pbj_method",
      "url": "https://data.cms.gov/resources/payroll-based-journal-methodology-0",
      "read_status": "retrieved_text"
    },
    {
      "source_id": "cms_rating_guide",
      "url": "https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/downloads/usersguide.pdf",
      "read_status": "retrieved_text"
    },
    {
      "source_id": "law_elder",
      "url": "https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=15657.",
      "read_status": "full_text_read"
    },
    {
      "source_id": "warehouse_citations",
      "url": "https://data.cms.gov/provider-data/sites/default/files/resources/327fc64eff7ccc64fd7d23c853bb1ade_1792181729/NH_HealthCitations_Oct2026.csv",
      "read_status": "parsed_data"
    },
    {
      "source_id": "warehouse_cdss_facilities",
      "url": "https://services.arcgis.com/XLPEppdz2H9dOiqp/arcgis/rest/services/CDSS_CCL_Facilities/FeatureServer/0/query",
      "read_status": "parsed_data"
    }
  ]
}