Long-Term Care - Illinois General Assembly

• Make doing home care, and working in equivalent programs -— day training, adult day care
— more attractive, by providing health insurance to the people who do this work. The most
obvious way to do this would be by incorporating them into the state system.
• Stop using nursing homes as housing of last resort, sticking people in them because there is
no place else to go. There are 12 thousand people with chronic mental illness in Illinois
nursing homes. Probably half do not "need" to be there. They are there because the
federally-mandated PAS (pre-admission screening) of chronically mentally ill persons is
routinely falsified by screeners, who understand that the alternative to entering a nursing
home is sleeping under a bridge. These people need hope. They need a life. They are in
nursing homes, because the facility owners have made political contributions as an
investment — thus far, a very successful investment — to make sure that their residents
stay put. Illinois no longer has the money to pay off those investments. Illinois is also
putting parolees into nursing homes, some of them with histories of committing violent
crimes. Most of them belong in half-way houses, not nursing homes. Nobody should have
to check the sex offender registry when picking a nursing home for their mother.
The difficulty with doing all these things is that we will decrease our nursing home population
even further. We are now at 80% occupancy for facilities open at least a year. Do all these
things, and we could be down to 60%. While this would be wonderful for the people who get to
stay home, it would be a disaster for those who remain. Illinois nursing homes are already
woefully understaffed, and the quality of care — actually, the quality of life — in far too many
homes reflects that understaffing. Fixed costs remain the same: staff, food, supplies: Keeping
open the same number of nursing homes, with fewer residents, residents who are sicker, have
less involved families, is a recipe for disaster. Every bit as important, as keeping people out of
nursing homes who neither want nor "need" to be there, is doing a much better job of caring for
the people who remain.
These are some of the things what need to be done:
• Illinois needs fewer nursing homes, and fewer nursing home beds. As a general rule, Illinois
should require a minimum occupancy rate to participate in the Medicaid program. There
have to be exceptions to this in rural areas, where closing a nursing home would mean that
families would have to travel unreasonable distances to visit their relatives. When
exceptions are made, the priority should be on funding the county homes, and the
not-for-profits, at least those not-for-profits that agree to admit residents on Medicaid. These
are facilities that are putting money into the home, not taking it out, are more likely to have
volunteers, and are more likely to have community involvement.
• Increase the number of Public Health nursing home surveyors. So many have taken early
retirement, the department has lost its ability to do thorough complaint investigations, or
initiate surveys of facilities that have repeated serious violations. The Department of
Children and Family Services was exempted from the hiring freeze because of the
importance we place on our children. Our grandparents should be treated with equal
concern.
• Expand the Illinois Department of Public Health (IDPH) legal staff, so that the department
does not feel pressured to settle cases because it does not have the staff to try them.
• Inform families and guardians of residents when a violation occurs in a nursing home that
affects them. IDPH has promised to do a rule change that accomplishes this; it has yet to
happen.
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