The Department of Health in Illinois (IDPH) conducts annual inspections to ensure care facilities observe state-specific nursing home laws and regulations. On the other hand, CMS ensures that nursing homes that receive Medicare and Medicaid funding comply with federal regulations, like the Nursing Home Reform Act.
Nursing homes in Illinois are subject to regular inspections to ensure they meet federal and state standards. During these inspections, violations can be found. These violations are classified into Type AA, Type A, Type B, and Type C depending on their unique circumstances.
The Illinois Nursing Home Care Act (NHCA) protects the legal rights of all nursing home occupants in Illinois. It sets standards for their care and treatment in nursing homes and outlines the responsibilities of nursing homes and their staff.
How Are Nursing Homes Regulated in Illinois?
The IDPH inspects nursing homes in Illinois to ensure they adhere to state regulations. It conducts about 10,000 inspections annually, revolving around yearly inspections and investigating nursing homes’ adherence to set rules and regulations. The inspections assess the nursing home’s quality and capacity. They also assess the facility’s amenities, financial muscle, standard operating procedures, and employees.
A typical IDPH inspection constitutes examining medical documents, monitoring practices, and interviewing nursing home employees and residents. Surveyor teams comprise registered nurses, nurse assistants, and nutritional experts. Sanitarians may also be part of the surveyor team in some instances.
The IDPH publishes nursing home violations reports on its website every three to four months. These reports highlight the inadequacies of each nursing facility. They also allow facilities with inadequacies to dispute the alleged inadequacies. IDPH requires facilities with inadequacies to provide correction plans within 10 days. This requirement does not apply when the violation report has recommended corrective measures.
The IDPH gets called 20,000 times annually through its hotline. These calls can be about concerns, such as abuse, neglect, or poor standard of care. The IDPH then investigates the calls and takes appropriate action.
Nursing Home Certification
CMS (Centers for Medicare & Medicaid Services) is a federal agency under the U.S. Department of Health and Human Services (HHS). It oversees Medicare, a federal program that provides health insurance to people over 65 and people with disabilities and other eligible conditions. CMS also administers Medicaid, which offers health insurance to low-income individuals and families.
Illinois certifies nursing homes and skilled nursing facilities (SNFs) for complying with Illinois nursing home rules and regulations. CMS must officially approve the certification. A nursing home or SNF can obtain a compliance certificate if it satisfies the established federal conditions.
These conditions stem from state inspections conducted by the IDPH. The IDPH conducts annual inspections of all nursing homes and SNFs in Illinois. These inspections evaluate the facilities’ adherence to state regulations, including the quality of care provided to residents, the safety of the environment, the staffing levels, and the facility’s financial stability.
If a nursing home or SNF passes the annual inspection, it will be issued a compliance certificate. The facility can participate in the Medicare and Medicaid programs upon obtaining a compliance certificate.
The CMS is responsible for determining whether a nursing home qualifies for Medicare. It makes this decision based on the facility’s compliance certificate and adherence to compulsory state regulations. The CMS also offers a tool that allows people to check nursing homes’ ratings throughout all states based on facilities’ health assessments, number of employees, and quality control measures implemented.
When choosing a nursing home, check the facility’s compliance certificate status and read the inspection reports. Talk to current and former residents, visit the facility, and talk to the staff. You can also contact the long-term care ombudsman for help choosing the right nursing home.
Penalties for Facilities That Fail to Comply With State Regulations
Nursing homes that fail to comply with federal and state rules and regulations can be subject to penalties. These penalties can include:
- Government-imposed fines until the inadequacy is corrected, depending on the severity of the violation.
- Payment denial that prevents the facility from collecting Medicaid or Medicare funds for new patients until the deficiency gets rectified.
- License termination or getting issued with a special provisional license that can result in closure of the facility.
- Admission or readmission bans to keep a nursing home from enrolling residents until the deficiency is corrected.
- Compulsory training programs to curb recurrence.
Nursing Home Residents’ Rights
Nursing home residents in Illinois have rights that are intended to protect these vulnerable adults. Vulnerable adults cannot protect themselves from abuse, neglect, or exploitation.
The Illinois Nursing Home Care Act (NHCA) protects their rights by setting standards for care and treatment. These rights include the right to:
- Be treated with respect, dignity, kindness, and compassion without feeling humiliated or degraded.
- Receive the care that they need to maintain their health and well-being.
- Make their own decisions about their care and choose their doctor, treatments, and activities.
- Have their personal information kept confidential
- Be protected from abuse, neglect, and unfair treatment by nursing home staff or other residents.
- Participate in activities and social events
Nursing home residents have a right to exercise their religion freely and be allowed to practice it without interference from nursing home staff. They should also see their attorney, social worker, and other guests without interference from nursing home staff.
The residents should manage their finances without getting forced to sign over their financial power of attorney to the nursing home. They should also use their personal property, such as clothes and belongings.
Residents should also see their medical records and get copies of any reports or test results, participate in their care plan, and file a grievance with the nursing home.
Who Regulates Nursing Homes in Illinois?
Nursing homes in Illinois are regulated by IDPH and the Centers for Medicare and Medicaid Services (CMS). The IDPH ensures that nursing homes comply with state regulations like the Illinois Nursing Home Care Act. On the other hand, CMS ensures that nursing homes that receive Medicare and Medicaid funding comply with federal regulations, like the Nursing Home Reform Act.
Though the IDPH and CMS have overlapping jurisdictions, each agency has its own mission. The IDPH ensures the health and safety of nursing home residents. In contrast, the CMS ensures that nursing homes provide quality care and are financially sound.
Nursing homes that receive Medicare and Medicaid funding should comply with federal regulations designed to improve the quality of care received by residents. These regulations cover staffing levels, quality of care, resident rights, infection control, fire safety, and financial management. Nursing homes that fail to meet these regulations may be subject to fines, penalties, or even license revocation.
What Is the Nursing Home Care Act?
The Illinois Nursing Home Care Act (NHCA) outlines the rights of nursing home residents in the state. It sets standards for the care and treatment of residents in nursing homes and outlines the responsibilities of nursing homes and their staff.
Under the NHCA, nursing home residents have the right to be treated with respect and dignity, participate in activities and social events, and get adequate and appropriate medical care. The act also allows residents to enjoy an environment free from elder abuse, neglect, and exploitation. It also allows them to maintain their autonomy, make decisions about their care, access their medical records, and know more about their care and medical treatment.
If you are a caregiver or loved one of a nursing home resident, you need to be familiar with the NHCA. The NHCA can help you protect the rights of your loved one and ensure that they receive the care and treatment they deserve.
Types of Nursing Home Violations
Nursing homes are subject to regular inspections to check if they meet federal and state standards. During these inspections, violations can be found. These violations are classified into Type AA, Type A, Type B, and Type C.
Type AA Violations
Type AA violations are the most serious and involve a condition or occurrence that can cause a resident’s death. For instance, a Type AA violation could occur if a nursing home attendant neglected a resident. The attendant’s negligence would manifest as failing to watch over and tend to the patient, leading to the resident falling and suffering a fatal injury.
Type A Violations
A type A violation is a condition or occurrence that creates a substantial probability that the risk of death or serious harm to a resident will occur. For instance, a Type A violation could occur if a nursing home fails to offer proper care to a resident with a wound. As a result, the wound can get infected, and the resident may develop sepsis.
Type B Violations
Type B violations substantially increase the likelihood of a resident suffering little physical or mental harm. They could occur if a nursing home fails to provide adequate supervision to a resident at risk of falling. The consequence is the resident falling and suffering a minor injury.
Type C Violations
A type C violation involves a condition or occurrence that creates a substantial probability that a resident will suffer less than minimal physical or mental harm. It could occur if a nursing home fails to provide a resident with a comfortable and safe environment.
How to Find Out If a Nursing Home Has Had Violations
To find out if a nursing home had previous violations, heck the quarterly reports the IDPH publishes online. These reports list all nursing homes in Illinois that have had violations and highlights the type of violation.
You can also take advantage of the Nursing Home Compare tool on Medicare.gov. With this tool, you can compare nursing homes in different cities and uncover their Medicare star rating. The rating is usually based on quality of care, staffing levels, and resident satisfaction.
Submitting Complaints Regarding Quality of Care
Since nursing home residents in Illinois have the right to submit complaints about their care, they can submit complaints on their own behalf or even on behalf of others. They can submit complaints to the administrator of their facility, the Long-Term Care Facility Board, or any other relevant agency with the help of their nursing home abuse lawyer. Either way, the nursing home has a legal obligation to avail contact details of the office where residents should file their complaints.
The nursing home must also implement an internal procedure for receiving residents’ complaints. These procedures must constitute of the following components:
- Steps a resident must follow when reporting a grievance.
- Length of time the nursing facility must react to a complaint or grievance.
- A detailed guide on resident’s right to get legal help when submitting a complaint or grievance.
The nursing home must notify a resident of its failure to address a complaint within 25 days of receiving that complaint. The nursing facility or home must also comply with requirements (federal and state) for reporting possible neglect, abuse, embezzlement of resident finances, or exploitation, as outlined in the complaint. It must retain a copy of all complaints, responses, and resolutions for three years.
When filing a complaint, residents must clearly and concisely describe the problem and offer examples to support the claims. They should also be respectful and professional in communicating with the nursing home staff. The resident should retain a copy of all correspondence related to their grievance, and if they are not satisfied with the outcome, they can submit a complaint to IDPH.