For years, including the early months of the COVID-19 pandemic, Illinois officials failed to properly oversee nursing homes, including not enforcing staffing requirements and not imposing penalties sufficient to deter inferior operations, a consultant’s investigation concluded.
As a result, nursing home residents lodged an increasing number of complaints and faced ongoing dangers. Some facilities were cited repeatedly for the same violations, including abuse and neglect of residents, the report found.
Illinois had the second highest number of substantiated complaints per facility compared with similar states, with 1 out of 5 long-term facilities in the state having the lowest federal rating — one star. And ratings were disproportionately worse in Black areas with higher percentages of Medicaid patients.
A crucial contributing factor was that the state didn’t follow the law to maintain minimum staffing of its own inspectors, the investigation found.
To correct the situation, the state was advised to increase enforcement of staffing and other regulations, require public reporting of facility performance, use data to improve equity, and target consistently poor performing facilities for technical support, according to the review by Manatt Health Strategies, which was commissioned by the state.
The widespread shortcomings and sweeping recommendations were reported by Manatt in November 2020, but the Illinois Department of Public Health only recently revealed the findings after a Freedom of Information request by the Tribune.
In response to Tribune questions, the department did not address all the recommendations individually, but reported that it had taken numerous actions to improve its oversight of nursing homes. The agency “fully agreed with the report’s recommendations and took immediate actions to reorganize the office, increase staffing levels that had been decimated under prior administrations, and completely eliminate the backlog of complaints,” spokeswoman Melaney Arnold wrote to the Tribune.
The department has hired a new management team, a project manager to implement the recommendations and 40 new nurse surveyors since September 2020.
Perhaps most importantly, the state has also proposed revamping its funding formula to tie it to staffing and quality improvements. But that may take until next year for lawmakers to address.
Meanwhile, advocates for nursing home residents said that based on residents’ experiences not enough has been done. Nursing homes report that staffing shortages remain widespread, statistics show that many staff members remain unvaccinated and some residents worry they are still vulnerable to substandard care and death from COVID-19 and other health risks.
The consultant’s review follows years of complaints by senior care advocates about lackluster government oversight of a mostly for-profit industry that houses some of the state’s most vulnerable residents.
Besides being the main state agency that oversees efforts to fight a pandemic, one of IDPH’s steady jobs over the years has been to oversee nursing homes. And in March 2020, with the then-new virus particularly targeting the older and more frail, advocates warned IDPH that the agency needed to aggressively monitor facilities because of their poor track record on fighting infections.
Yet the agency’s initial response was broadly criticized as too timid and uncoordinated as the virus swept through facilities that were often understaffed and short on protective gear. A Tribune investigation later found that during COVID-19’s first wave — even as most COVID-19 deaths were tied to long-term care facilities — IDPH had largely stopped inspecting facilities. Even when inspectors went, they often went well after major outbreaks had occurred, with the agency at times struggling to have accurate counts of cases and deaths at facilities.
At the time, the agency said it was doing all it could in unprecedented times, and that it limited inspections to lessen the chance its inspectors could catch and spread the virus. But, with family visits disallowed too, that meant far fewer outsiders could keep tabs on what was going on inside facilities, worrying advocates and family members about poor care that could more easily be hidden.
Advocate Bruce Carmona noticed that the number of workers at the nursing facility where he lived in Elk Grove Village was steadily dwindling, but state officials didn’t seem to be enforcing staffing requirements.
As an advocate for nursing home residents statewide through Illinois Caregivers for Compromise, Carmona, 64, asked Illinois officials for more oversight, but hasn’t seen much of a response.
“During COVID, everybody laid in their beds, got bedsores, got sick and got lonely,” Carmona said. “From 2019 to 2020, there was a drastic change in staffing and the care you received. Staff was afraid of catching COVID, when they were actually bringing COVID into the nursing homes.”
The nursing home review by Manatt was launched in response to the state’s discovery that its Bureau of Long-Term Care was not properly investigating complaints of abuse and neglect from March 15 to June 2020 — even though complaints spiked in that time. Due to COVID-19, federal regulators had temporarily suspended deadlines to investigate certain complaints, but state requirements remained in place.
The health department reported that it subsequently investigated all of the 272 complaints from that time, and found 17 substantiated.
In the aftermath, the lack of state inspectors was of particular concern. At the time of the report, 90% of non-nurse surveyor positions were vacant.
The Bellwood region in the western suburbs had the largest gap, with almost two-thirdsof surveyor positions vacant, and one inspector per 588 beds, as of September 2020. The Bellwood region also had more facilities, more poorly performing facilities and far more complaints than other regions.
Statewide, Blacks made up 19% of nursing home residents, but 32% of those in one-star facilities. To counter that, the Manatt report recommended using data to assess and correct inequities.
AARP also called for reducing racial and ethnic disparities, in part by ending the practice of overcrowded nursing home rooms with three or four people per room, which disproportionately affects Black and Latino residents.
Commenting on the findings, Lori Hendren, AARP Illinois’ lead on nursing home issues, said, “What’s happened in Illinois nursing homes and other long-term-care facilities (LTCFs) through the pandemic is an unacceptable tragedy. Illinois must have stronger oversight of LTCF’s across the state.”
Specifically, AARP called for requiring nursing homes to put most of their taxpayer funding toward direct care for residents through adequate and vaccinated staff. The staffing shortage, made worse by overworked employees who fear getting sick, could be improved by requiring paid sick leave for workers.
The consultant’s report covered a wide range of time, going back to 2014 for some nursing home metrics, through late 2020. In that time, residents of long-term-care facilities were particularly hard hit by COVID-19 in Illinois, where they made up 51% of all pandemic-related deaths, compared with 40% nationwide.
The Health Care Council of Illinois, which represents more than 300 nursing homes in the state, welcomed the recommendation for the state to offer assistance to violators to ensure compliance, as opposed to repeated fines.
“We cannot ticket our way out of the long-standing structural issues that afflict the industry,” HCCI spokesman Kevin Heffernan said. “We have to look at the root cause, which is that for decades the state of Illinois has reimbursed care for low-income patients at among the lowest rates in the country.”
To help operators recover from the pandemic, Heffernan said, Illinois must increase Medicaid reimbursement, which would help to hire more staff and improve the quality of care.
