Long-Term Care - Illinois General Assembly

The SEIU report, “Facing a Crisis in Care,” found that Illinois nursing homes were cited for 3,168
violations of federal resident care standards. Seventy-eight percent (78%) of nursing homes
inspected have been cited for violations that put residents at risk. Many of the violations were
due to insufficient staffing.
Low nursing staff levels correlate with a greater likelihood that residents will not be fed properly,
turned or re-positioned frequently enough, bathed and groomed adequately, or exercised to
ensure that they retain adequate range of motion. In such cases, residents lose weight,
become dehydrated, of suffer from deterioration. In 2002, 86.5% of Illinois nursing homes were
unable to reach the staffing levels recommended by the federal government. Last year, Illinois
ranked last in the nation in nurse aide hours and next-to-last in total nursing hours.
Low staffing results from low wages and inadequate training. The median pay for certified
nurse's aides in Illinois in 2002 was $9.51 an hour, or $19,781 annually, or an income that
qualifies a family of four for food stamps and public housing. The low pay and lack of benefits
contributes to high turnover for caregivers. In 2002, the annualized turnover rate for certified
nurse assistants (CNAs) in Illinois was a whopping 75.5%. The high turnover rate threatens to
compromise the continuity of care and makes an already challenging job harder for the
caregivers who stay.
Staff training is also inadequate. Certified nurse aides (CNAs), who provide 80-90% of the
direct care, are only required to get 120 hours of training.
The most recent research shows that Illinois ranks 49 th in the nation in Medicaid reimbursement,
behind only Louisiana. According to a 2002 study by BDO Seidman, Illinois pays less than the
cost of care for its Medicaid residents. The report concluded that it costs $8.12 per resident per
day more than the State provides, which leads to an annual shortfall of $156 million a year.
In 2002, the state cut nursing home rates by 5.9%, or approximately $116 million, while the cost
of care continued to increase.
Recently proposed changes to Illinois' Medicaid reimbursement system could worsen the quality
of care in Illinois in the nursing homes as well. Although the measure proposes setting
minimum staffing standards above current levels, it also proposes capping annual funding for
nursing homes. As a result of the cap, individual providers would face unpredictable rates that
would decline whenever overall statewide acuity increases. Limiting the money available for
additional staffing would force nursing homes to cut wages by approximately 20%, making it
even harder to attract and retain quality staff.
To provide the quality of staff in Illinois nursing homes, funding for care must be increased, not
decreased. More funding would mean higher wages and benefits for caregivers. It would also
go a long way toward reducing the turnover and improving staffing levels for residents.
SEIU recommends:
• Restoration of the 5.9% cut to the Medicaid reimbursement rate; and
• Restoration of the provider assessment to its previous level of 6%, but put the proceeds in a
quality care improvement fund to attract more medical matching funds for care. The
assessment would generate approximately $327 million. These funds should be used to
increase wages, benefits, and training for nursing home workers.
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