Good and Bad Nursing Homes Struggle with These 6 Issues

Certified skilled nursing facilities in Illinois are required to provide individualized care for residents. That is about 1,300 nursing homes responsible, both for-profit or not-for-profit, set to comply with about 1,500 state and federal standards. Yet violations related to abuse, safety and neglect as outlined by the Nursing Home Care Act occur each day, many undocumented or resolved. And unfortunately, trends in failing to comply can occur at both good and bad facilities.

The nursing home abuse and neglect attorneys at Levin & Perconti continue to identify these six common issues leading to nursing home abuse and neglect cited at facilities located throughout Illinois.

  1. Poor Care Rooted in Understaffed Departments

Nursing home residents and their families should never settle for the second-class treatment they are too often expected to deal with. Residents must be provided with assistance with daily activities such as dressing, eating, and using the toilet and grooming. They must be cared for to avoid sickness, injury or a further decline in health and well-being. Every resident must be treated as a human being and their choices promoted in all care plans. Their services and rehabilitation needs must be met, and medications and restraints should only be used to treat a resident’s medical conditions or symptoms.

Understaffing (or overworked staff) is often the root of many faults in neglected care. Even though the state requires 2.5 hours of direct care for residents each day, about a quarter of the residents in Chicago-area facilities are living in understaffed conditions putting them at risk for abuse and neglect. Many other nursing homes continue to use deceptive staffing tactics to fluff self-reporting data to federal agencies monitoring care worker hours.

Tip: Visit with loved ones often, and know what to expect.

  1. Eviction

Illinois has 1,200+ long-term-care facilities, most of which have been identified by AARP for having higher than average discharge and wrongful eviction rates. And today, Illinois ombudsmen are receiving more resident complaints about wrongful releases and transfers than any other grievance. Many of these cries for help arise when a facility pressures a resident to leave with “no due process rights, no notice” even though an advanced notice is required. Nursing home administrators often blame other reasons for eviction or release, but it remains known it is likely because Medicaid reimbursements have not been received.

Tip: Residents have the right to appeal a nursing home discharge decision.

  1. Medicaid

Medicaid already pays out less than other forms of insurance, even though it is the primary source of funding for 6 out of 10 nursing home residents. More than 3 million Illinois residents are enrolled in the state’s program amounting to 57 percent of nursing home residents who receive the assistance. The program remains the most significant single payer of nursing home care in the country and provides financial support to nearly 70 percent of all older adults with disabilities. Financial eligibility under Medicaid is based not on need, and a beneficiary must prove their limited resources and income. Some states allow a nursing home to certify only a portion of its beds for Medicaid payment, leading to issues with nonpayment and then eviction.

According to the Centers for Medicare & Medicaid Services (CMS), low-income populations on Medicaid will experience disproportionately high burdens of disease and face more barriers to accessing long-term care than others as well. CMS officials say, “these populations include racial and ethnic minorities, sexual and gender minorities, persons with disabilities, as well as individuals living in rural areas.”

Tip: To learn more about Medicaid benefits in Illinois, and the program’s requirements, be sure to visit the Illinois Department of Healthcare and Family Services website.

  1. Medicare Problems

Medicare only pays for nursing home care for a limited time, at most, 100 days per benefit period. Of those 100 days, only the first 20 days are paid in full. After that timeframe, the beneficiary must pay a daily co-payment. Medicare will only pay for nursing home care if the resident enters the nursing home within 30 days after a hospital stay of at least three nights, and the care must be related to the medical support received in the hospital.

Tip: These Chicago-area nursing homes stole Medicare benefits.

  1. Denials of Resident Rights

The 1987 Nursing Home Reform Law protects the rights of nursing home residents through precise language. Facilities must meet the federal residents’ rights requirements to allow their ongoing participation in Medicare or Medicaid programs. When they do not, the groups must be held accountable for their failures.

Tip: Residents (and their family members) must know of their legal protections and individual rights. 

  1. Admission Agreements and Billing Responsibility

Upon admission, a nursing home cannot require that a resident’s family member become financially responsible for nursing home expenses, even separate charges such as daily care supplies. If Medicare or Medicaid covers the resident’s care, the nursing home can charge the resident no more than the deductible or co-payment authorized by law, if any.

Also, upon admission, many families will be swayed into signing an arbitration agreement, which removes the court’s ability to settle disputes and will instead be handled by a private judge. Nursing home residents who receive inadequate care or are neglected or abused have few outlets for their complaints. Arbitration is not a good option for residents, and signing these agreements should be avoided – or at the least – reviewed by an attorney prior to admission.

Tip: Why you should never sign an arbitration agreement.

Illinois nursing homes must follow the many care regulations set forth by IDPH and CMS. All facilities should be equipped with a high degree of support by trained workers who are expected to follow professional standards. When facilities fail to do so, they deserve to be held responsible.

Nationally Recognized Leaders in Nursing Home Abuse and Neglect Law

With over half a billion dollars recovered for our clients, let our nursing home abuse and neglect attorneys based in Chicago put more than 150 years of combined experience in successfully fighting nursing homes to work for you.

If you suspect any injury resulting from neglect or abuse at your loved one’s Illinois nursing home, contact the attorneys of Levin & Perconti now at 1-877-374-1417 for a free consultation.

Also read: 71 Illinois Nursing Homes Named in Third Quarter Violation Report