Long-Term Care - Illinois General Assembly

Rick Dees
Illinois Department of Public Health
The Illinois Department of Public Health is the agency responsible for regulating long-term care
facilities in Illinois. Currently, the department licenses approximately 1,000 nursing homes
across the state, as well as 300 intermediate care facilities for the developmentally disabled.
The department regulates facilities in two ways. Under the Illinois Nursing Home Care Act, the
home must have a license to operate. It must meet licensure standards, which are very
comprehensive, addressing virtually every aspect of operation within a facility.
In addition to state licensure, any facility that participates in the Medicare and Medicaid program
must also meet federal regulations promulgated under the Social Security Act. The department
acts as the agent of the federal government in conducting the federal certification surveys, to
assure that facilities that are certified remain in compliance with the federal regulations.
Approximately 90% of all the long-term care facilities in Illinois participate in Medicare and/or
Medicaid, so the majority of the survey activities carry out two roles. The department conducts
State licensure and Federal certification at the same time. The department conducts routine
inspections of all licensed and certified facilities to ensure that they are remaining in compliance
with the applicable regulations. At a minimum, the department conducts a full survey annually.
If deficiencies are cited, the department conducts revisit surveys to assure that those
deficiencies have been corrected. In addition, the department conducts complaint investigations
when allegations of noncompliance are received by the department.
The survey process is highly prescriptive and complex. On average, it takes a survey team of
five individuals approximately four-to-five days to complete a full survey at a nursing home. The
survey teams for the department consist primarily of registered nurses, but also include licensed
environmental health practitioners, licensed dieticians and licensed architects.
In 2002, the department conducted 14,150 different survey activities in regulated long-term state
facilities. This included approximately 5,500 complaint investigations. In 2002, approximately
78% of all of the facilities surveyed had at least one substantial deficiency. On average during
2002, the department cited six deficiencies during each annual survey. The majority of the
facilities that the department surveys correct their deficiencies at the time of re-inspections.
There is a significant enforcement aspect of our program. There are fines and penalties that
can be applied to problem facilities under both state and federal regulations. A recent U.S.
General Accounting Office report on enforcement in nursing homes included state-by-state
statistics regarding the application of federal fines. That report indicated that between January
2000 and March 2002, the Department of Public Health's long-term care survey program
assessed $2.8 million in federal fines against long-term care facilities in Illinois.
The ultimate penalty within our licensure program is the revocation of a facility's license to
operate. That is a last resort. It is only pursued when the department finds a pattern of serious
problems that the facility is either unable or unwilling to correct. When the department pursues
revocation, it needs to keep in mind that the first individuals impacted by facility closure are the
residents of the facility. So when the department proceeds with revocation, a determination has
been made that the health and safety problems that have been identified outweigh the negative
impact of moving those residents out of that home.
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