Senior care advocates promoted legislation Wednesday that is aimed at enforcing minimum staffing mandates, limiting the use of psychotropic drugs and heightening transparency for care violations at Illinois nursing homes.
At an Illinois State Capitol press conference, representatives of the senior advocacy group AARP said Illinois nursing homes have the worst rate in the nation for patient-to-staff care hours per day, and the second-worst rate in the nation for giving antipsychotic drugs without a psychiatric diagnosis, according to a study conducted by the group.
“Inadequate staffing at many Illinois nursing homes leave residents neglected, malnourished, suffering from bed sores or worse,” said Ryan Gruenenfelder, director of advocacy and outreach for AARP.
AARP also said 39 percent of nursing homes in Illinois received a low quality rating in 2015 from the Centers for Medicaid and Medicare Services, a federal agency within the United States Department of Health and Human Services.
State Sen. Jacqueline Collins, a Chicago Democrat, is the Senate’s lead sponsor of Senate Bill 1510, the Illinois Nursing Home Residents’ Quality Care Initiative.
Collins said the bill would implement a fine structure for nursing homes that fail to meet minimum staffing requirements, and would require the Department of Public Health to build a more easily searchable database for nursing home violations.
Illinois statute already requires 3.8 hours of care each day per resident needing skilled care and 2.5 hours each day per resident needing intermediate care. Collins said the fines are needed for nursing homes to “really become accountable.”
The bill also requires informed consent, meaning a signature from a resident or their legal representative, before psychotropic drugs can be administered. It would also mandate documentation if a psychotropic drug was administered under emergency conditions, such as if patients were considered a danger to themselves or others.
Shantonia Jackson, who has been a certified nursing assistant for 11 years, testified of staffing issues at facilities where she was once employed.
She said when she worked in an Alzheimer’s unit, she often had 15 residents under her care at one time.
“I’m not giving them the proper care that I need to give, which is like 3.5 hours of care,” she said. “But I can’t do that if I have 15 residents at one time.”
Jackson said to keep the residents sedated and more manageable, psychotropic drugs were often administered “to keep them still.”
Amanda Ginther, vice president of the nursing home lobbying group Health Care Council of Illinois, said after the press conference the organization was not taking a position on the bill, pending further analysis.
She said there’s more to the staffing issue than voluntary non-compliance from nursing homes, including state-wide labor shortages for health care professionals.
On top of that, Illinois nursing homes lose $41 per day – or about $15,000 per year – per Medicaid-reliant patient, according to a study commissioned by HCCI and conducted by Plante Moran, one of the nation’s largest certified public accounting and business advisory firms.
“Medicaid rates have failed to keep pace with the actual cost of care in Illinois,” Ginther said. “That’s another impediment to reaching staffing ratios.”
In 2016, Illinois nursing homes with more than 51 percent Medicaid utilization had operating losses of about $765,000 on average per facility for all payers, the study found.
According to data provided to HCCI by the Illinois Department of Public Health, 20 skilled care nursing facilities have closed since January 2016, with all but one of them listing their reason for closure as financial.
The HCCI is advocating for an additional $100 million in state funding for skilled care nursing homes in fiscal year 2020 to offset an estimated industry-wide shortfall of $649 million in FY 2020 alone.
At the press conference, Collins said she would like to see results before increasing funding for nursing homes.
“If you’re going to come to the table asking for increased reimbursement, we want to see what the end is,” she said. “What are you doing with your increase in the rate? We want to ensure that there is a direct link between the increased rate and increased care.”
Gruenenfelder said regardless of funding, the bills put forward Wednesday were necessary to hold nursing homes accountable in their care for the most vulnerable.
“The fact of the matter is that these facilities are in business to provide care for Illinois’ most vulnerable seniors,” he said. “There are functions that they must provide in order to meet that quality of care standard. So processes need to be put in place to hold them accountable.”
Ginther said HCCI would study whether the informed consent provision was duplicative of current state law, and the organization was not opposed to increased transparency on state websites.
AARP also promoted House Bill 2874, which would provide a tax credit of up to $1,500 for family members that provide care for their loved ones. The tax credit is applicable to family caregivers who pay for adult day services, transportation, equipment, home modifications and other expenses when caring for family. Its lead sponsor is state Rep. Anna Moeller, an Elgin Democrat.