llinois residents need more protections against the practice of nursing homes discharging troublesome patients against their will and “dumping” them in hospitals, according to the Alzheimer’s Association and other advocates for residents of Illinois long-term care centers.
“The problem is alarming,” said Jamie Freschi, the Springfield-based statewide long-term care ombudsman.
Complaints about hospital dumping by nursing homes and assisted-living centers in Illinois is more common than in any of the nation’s most-populous states, she said.
“It is often because of unwillingness to take the time to manage difficult behavior,” Freschi said.
The appointee of Gov. Bruce Rauner recently joined with the Greater Illinois chapter of the Alzheimer’s Association and the Service Employees International Union at a news conference in support of legislation introduced this month in the Illinois House and Senate to address dumping of residents.
The legislation also would institute higher fines on nursing homes to better enforce minimum staffing ratios put in place in a landmark 2010 nursing home reform law.
“This is groundbreaking legislation,” Freschi said of Senate Bill 1624 and House Bill 3392.
State Rep. Emanuel “Chris” Welch, D-Hillside, the legislation’s House sponsor said: “We have to do the right thing. … A nation’s greatness is measured by how it treats its weakest members. This is just good public policy.”
HB 3392 is scheduled to be considered at 8 a.m. Wednesday by the House Human Services Committee. Both bills would institute new monetary penalties for improper discharges, make it harder for such discharges and understaffing to continue, and give long-term care ombudsmen more authority to advocate on behalf of individuals.
The legislation also would give the Illinois Department of Public Health the legal authority to order a resident readmitted to a facility if he or she prevails in a public hearing conducted by the department.
Surprisingly, such authority doesn’t exist in current law, Freschi said.
Representatives of nursing homes and assisted-living centers are opposing the legislation. They questioned data cited by the legislation’s advocates when it comes to the prevalence of unfair discharges and understaffing.
The industry representatives also questioned whether higher fines are the best motivator for good behavior. They added that higher fines take money away that could be used to improve care.
They said, however, that they hope debate about the legislation eventually ends in an updating of state law on involuntary discharges and staffing to ensure the best care for Illinois’ more than 100,000 residents in long-term care.
“We’re always willing to work with the advocates to come up with solutions where problems do exist,” said Matt Hartman, vice president of public policy for the Illinois Health Care Association.
The Department of Public Health hasn’t yet taken a stand on the legislation.
“IDPH works diligently to protect patients and their rights and will continue to enforce nursing home care and assisted-living facility laws with the ultimate goal of protecting the health and safety of all residents,” department spokeswoman Melaney Arnold said.
The department is reviewing the legislation “to ensure concordance with what laws already exist and to look at its impacts,” she said.
Complaints to regional ombudsmen about alleged improper discharges of Illinois nursing home residents — including abandonment of those residents after they have been transferred to hospitals — totaled about 1,000 in 2015, according to Andrew Kretschmar, the Alzheimer’s Association’s senior manager of advocacy.
There were half as many complaints in 2011, Freschi said.
Illinois’ dumping problem is in line with the national increase in complaints about the practice reported by The Associated Press in 2016, Kretschmar said. Those complaints center on involuntary discharge of residents whose care is more labor-intensive and less lucrative for nursing homes.
Illinois is paying at least $5 million more per year through the Medicaid program for more-expensive hospital care for discharged nursing-home patients — often Alzheimer’s patients — who have been needlessly dumped in hospitals, Kretschmar said.
On the issue of staffing, he said data reported by nursing homes to the state indicate 360 facilities in 2015 failed to comply with staffing ratios put in place by the 2010 law. Based on the state’s 727 nursing homes, the advocates’ data indicate half of all nursing homes aren’t complying.
And yet, only three nursing homes were fined a total of $3,300 in 2015 for staffing violations, Kretschmar said. By more aggressively enforcing existing law, Illinois could generate between $1.6 million and $4.8 million annually in fines connected with staffing, he said.
Hartman, a nursing home industry lobbyist, said he doesn’t see the issue of dumping as a widespread problem. Likewise, Pat Comstock, executive director of another industry group, the Health Care Council of Illinois, said, “Based on what we hear from our members, I don’t think it’s a major problem.”
But Hartman said, “If people are abusing this, we’re willing to address this.”
The legislation, by instituting new hurdles for facilities needing to discharge a resident, could put other residents in danger, said Donna Ginther, the Health Care Council’s deputy executive director.
Comstock said she hopes the legislation leads to rules that pave the way for additional nursing home units where residents with behavioral problems can receive specialized care and not have to mix with the general population of residents.
The way the bills would address staffing, Comstock said, “starts in the wrong spot” because the legislation continues to connect staffing levels to the 2010 law. A better way of measuring staffing in 2017 would be to tie staffing to the level of residents’ health-care needs, she said.
Nursing homes in 2014 began to have their Medicaid reimbursements tied to the acuity of those needs, she said. Acuity levels don’t come into play when state inspectors evaluate staffing levels, but they should, she said.
Comstock disputed claims that violations of staffing ratios by nursing homes are widespread.
“To say that they are arbitrarily ignoring regulations is ridiculous,” Comstock said.
Originally posted on The State Journal-Register