A panel appointed by Gov. Pat Quinn proposed on Thursday an array of sweeping reforms designed to end the chronic violence and abuse that plague some nursing homes, while fostering better treatment for people with serious mental illness living in those facilities.
The proposals range from tightened criminal background checks of new nursing home residents to stronger sanctions and enforcement of facilities with chronic safety breaches.
Quinn's Nursing Home Safety Task Force also recommended that state police begin searching nursing homes for residents with outstanding warrants, and urged the state to increase minimum staffing requirements of the facilities to bring them up to standards spelled out in federal government studies on nursing home care.
Most ambitiously, the task force outlined a broad plan to expand housing and treatment options and divert mentally ill people from nursing homes into more appropriate treatment settings in their communities.
"We are in the homestretch of a very vigorous undertaking," task force chairman Michael Gelder said. "There has been unprecedented, Herculean efforts by all the state agencies."
In all, addressing a task force meeting in Springfield, Gelder outlined 27 "preliminary recommendations" that will be refined during the next three weeks before a final report is delivered to the governor. Some of the changes need action only by the governor and state agencies, but many would require new legislation.
Quinn's task force was formed in response to a series of Tribune reports on assaults, rapes and murders in the state's nursing homes. Illinois extensively mixes geriatric and mentally ill nursing home residents, and understaffed facilities have failed to treat and monitor their most violent patients, government records show.
While the state has a deficit of more than $12 billion, Gelder has said the proposed reforms can be achieved by redirecting current spending and increasing some fees paid by facilities.
Although eager to see the final, detailed report, advocates and industry representatives generally praised the proposals for being comprehensive and ambitious.
"It is a huge first step," said Wendy Meltzer, executive director of Illinois Citizens for Better Care, a resident advocacy group. The task force, she said, "has recognized the breadth of the problem they are facing."
Terry Sullivan, regulatory director of the Health Care Council of Illinois, the state's largest nursing-home trade association, also applauded the scope of the recommendations, saying he was confident that operational details could be ironed out in the coming weeks.
"Finally, the state is making some efforts to make the mental health system work better so that nursing homes are not the treatment of last resort," he said.
But Mark Heyrman, a University of Chicago Law School professor and chair of public policy for Mental Health America of Illinois, was more cautious, saying the recommendations "do not go far enough. ... We are concerned that, once the media attention dies down, the state will be under renewed pressure not to enforce either the old laws and rules or the new ones proposed by the task force."
The 27-point list of recommendations still leaves some critical issues to be resolved in the next few weeks.
Perhaps the most important is whether the state should establish specialized nursing home wards or even separate facilities for the most dangerous residents -- those with violent backgrounds who pose a threat to others. Sullivan's group and many advocates say Illinois must stop mixing dangerous and vulnerable residents.
The issue "still perplexes us and is something for which we need additional discussion," Gelder said. "This is one of the central issues in the concerns about keeping people safe,"
He added that the panel will hold another meeting Jan. 21 to hear additional testimony before proposing a concrete solution in its final report to the governor.
The most far-reaching proposals, which may take several years to fully implement, would curtail Illinois' decades-old practice of shuttling mentally ill people into nursing homes from psychiatric wards, jail cells and homeless shelters.
The vast majority of mentally ill people can work toward independence if given proper treatment and support, the panel said, and Illinois should expand home- and community-based housing programs.
Illinois also should create new compliance and training standards for facilities that serve people with severe psychiatric disorders, the panel said.
In the short term, the task force recommended that the state Department of Public Health hire additional nursing home inspectors and retrain its current inspectors to focus on safety and care issues involving the mentally ill.
Although mentally ill people, if given proper treatment, are no more likely than others to be dangerous or to commit crimes, some facilities provided grossly substandard care, the Tribune found. Many of the psychiatric patients are clustered in a relatively small subset of nursing facilities whose impoverished residents have few other options, and the paper's analysis showed the homes with the most felons had the lowest nursing staff-to-patient ratios.
Among the reforms that might be put into place fairly rapidly are a tightening of criminal background checks and screenings of people entering nursing homes.
The Tribune's review of confidential case files showed the state's criminal background checks on new residents were riddled with errors and omissions that grossly understated their criminal records and danger to others. Some of these poorly screened offenders went on to commit assaults and other serious crimes inside the homes where they lived.
The task force recommended more detailed assessments to gauge people's potential for engaging in violent behavior, and said the criminal checks should be started before people are admitted to facilities. Also, the task force urged the state to sanction homes that do not promptly complete the screening reports.
The Health Department should get greater authority to revoke the licenses of nursing homes that repeatedly violate state safety regulations, the task force said. And government agencies should mete out more severe sanctions on nursing home administrators and top employees who engage in misconduct.
Also under consideration, the task force reported, was a question: "How do we properly monitor use of psychotropic drugs for people with serious mental illness served in state-funded programs and settings?"
The Tribune reported that frail and elderly residents often were pumped with powerful anti-psychotic drugs without their consent and without a proper diagnosis. One of the nation's most prolific prescribers of psychiatric drugs provided assembly-line care for thousands of mentally ill patients housed in Chicago-area nursing homes -- while a large pharmaceutical company paid him to promote the drugs despite doubts about his credibility.
"We do not want to leave that issue unresolved," Gelder said, adding that the task force will seek the expertise of state medical experts before making a proposal to the governor "in the next few weeks."Copyright © 2014, Los Angeles Times