Report Says State Nursing Homes Are In Crisis Putting Seniors At Risk

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Illinois nursing home staffing shortages have reached critical proportions, and people of color are most at risk of the consequences, a new report says.

This is because these people are more likely to live in understaffed facilities or in “service” rooms with three or four beds per room, the report notes, a fact that became tragically evident during the pandemic. COVID-19 when black and brown Medicaid patients in nursing homes were 40% more likely to die from the disease than white patients.

The Illinois Department of Health and Family Services report calls for a radical overhaul of how the state’s Medicaid program reimburses nursing homes to reward those who improve their workforce and the quality of care.

“This is not a report that can sit on a shelf and pick up dust,” Kelly Cunningham, deputy director of long-term care for the Illinois Department of Health and Family Services, told a legislative panel. “We must act now. The issues we are dealing with are urgent. Maintaining the status quo is not acceptable. And we need to keep long-term care providers across Illinois at a higher standard. ”

The agency is proposing a $ 345 million increase in reimbursement rates for nursing homes, with increases related to a facility’s staffing and other quality and safety improvements. This money would come from a combination of streamlining billing procedures and an increase in a tax the state levies on every bed occupied by a nursing facility in the state, a pool of money that also attracts additional federal Medicaid reimbursements.

This would translate to an average increase in the payout rate of around 13%, although the amount for a given installation may vary. The funding increases would be based on a formula that also takes into account a facility’s profit margin so that profitable nursing homes that do not have sufficient staff in their facilities do not see their reimbursements increase on the same basis as those. who do.

The report notes that Illinois spends billions of dollars each year on nursing care for about 45,000 Medicaid patients, but the state consistently ranks last in the country for staff, as measured by the National Audit of Time and the intensity of staff resources, or STRIVE project. In fact, Illinois has 47 of the 100 most understaffed facilities in the country when comparing actual staffing levels to their target levels.

Andy Allison, deputy director of strategic planning and analysis for the Illinois Department of Health and Family Services, said these shortages had tragic consequences during the COVID-19 pandemic.

“Imagine a year or two before COVID, and if we had known it was going to happen, if we would have considered the safety of residents, overcrowding of rooms and staff as pressing issues,” he said. declared. “We have lost – it’s hard for me – thousands in our retirement homes. I don’t think there is anyone in the country who wouldn’t have said at that point, this is urgent. And I think the point is that nothing has changed except now we know how bad it can be. ”

Allison also said that increased funding alone will not solve the nursing home staff shortage. He said the industry itself also needs to make fundamental changes to meet its workforce challenges.

“We are in an urgent race to strengthen this job market – not to capture them, but to keep them in the service profession they have chosen,” he said. “And one of the ways to do that is to make it a profession, to give it a pay scale, to allow for a promotion, to provide a reward for staying with it, which is actually one of the main policy goals that HFS, the department, has had for years, which is consistency in the relationship between a staff and the residents they serve.

The recommendations came as welcome news for some in the nursing home industry.

Angela Schnepf, executive vice president of LeadingAge Illinois, an association of nonprofit aging service providers, said the policy changes recommended by the Illinois Department of Health and Family Services were long overdue. and should have been part of the plan when Illinois first adopted its nursing home assessment. in 2011.

“As many of you know, 10 years ago, the General Assembly narrowly adopted the tourist tax for an increase of 105 million dollars to support the staff ratios adopted in the spring of 2010”, a she declared. “The rate hike funded the status quo with the assumption that understaffed nursing homes would use the money to increase their number of employees. You would have thought that made sense. However, the data shows that this did not happen.

Schnepf went on to say that a survey of nursing homes just before the pandemic showed that the 120 facilities with the lowest staffing levels had in fact reduced their staff hours per resident day by 5.8%. since 2010, the year before the assessment went into effect, while the statewide average for all nursing homes in the state has increased 4.5 percent.

“As you may or may not know, LeadingAge Illinois opposed the bed tax in 2011 because we predicted the tax would transfer money from well-staffed nursing homes to the pockets of owners. of nursing homes understaffed due to the zero accountability requirement to apply the new funds to increase their staff, “she said.” As a result, over 40% of nursing homes of Illinois were losers or lost money, and over 60% of our LeadingAge Illinois members were losers. This means that the right providers bore the tax burden to fund the unsuccessful attempt to increase staff. in understaffed nursing homes, all to no avail. ”

But Matt Pickering, executive director of the Health Care Council of Illinois, which represents for-profit nursing homes, criticized the plan to strengthen what he called a “punitive relationship” and called for a general increase in nursing homes. rates, especially for those with high percentages of low-income residents.

“These facilities face the greatest challenges in providing care due to the state paying some of the lowest Medicaid reimbursement rates in the country,” he said. “We must prioritize quality health care for low-income residents and not compromise the stability of our system over the long term.”

This week’s hearing ahead of a joint meeting of four House healthcare-related committees was for informational purposes only, and no action was taken.

Representative Camille Lilly, D-Chicago, who chairs the Credit and Human Services Committee, called the recommendations “only the first step” towards improving the quality of care for the elderly in Illinois, and she said there would be more joint hearings in the future.

“This first step does not dictate that we are going to have quality services in these nursing homes,” she said. “It improves some of the staffing issues. But that does not mean that we are going to change the quality until we change the mindsets of those who work in these facilities and why they are there.


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