Who Controls Nursing Homes in Illinois
Nursing homes are regulated by multiple public and private entities at the state and federal levels. The Illinois Department of Public Health (IDPH) and the US Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) regulate, inspect, and license nursing homes and other long-term care facilities.
These agencies have separate jurisdictions but overlap in some cases. The IDPH ensures that nursing facilities comply with state regulations, while the CMS ensures that nursing homes under Medicare and Medicaid funding meet federal laws and certification requirements.
What Are Nursing Home Requirements According to the Centers for Medicare and Medicaid Services?
Nursing homes that receive Medicare and Medicaid funding for delivering services to beneficiaries under the program must comply with federal regulations governing nursing home care. According to the 1987 Nursing Home Reform Act, every facility must:
Provide services and activities to achieve or maintain the highest possible physical, emotional, and psychosocial well-being of each resident consistent with a personal care plan
Have sufficient staffing
Prevent the decline of basic skills, such as bathing, grooming, ambulating, communicating, etc.
Provide adequate nutrition and hygiene care for residents unable to meet these needs independently
Prevent the development of pressure ulcers and provide pressure ulcer care
Provide appropriate medical treatment and medical devices to maintain hearing and vision
Ensure sufficient supervision to prevent accidents
Conduct comprehensive and accurate assessments of all residents
Prevent dehydration by ensuring adequate fluid intake
Maintain the respect and dignity of all residents
Additionally, nursing home residents have the following rights according to federal law:
The right to be free from abuse, neglect, and mistreatment
The right to be free from physical restraints
The right to privacy
The right to participate in and form social and family groups
The right to receive support for medical, physical, mental, and social needs
The right to be treated with dignity and respect
The right to exercise self-determination
The right to communicate freely
The right to participate in one’s care plan review and to be informed in advance of changes in care and facility status
The right to express complaints and grievances without reprisal or discrimination
What is the Nursing Home Care Act?
The Illinois Nursing Home Care Act (NHCA) was established to protect residents’ rights and prevent abuse and neglect. In addition to federal requirements, state nursing home regulations require facilities to:
Ensure that no resident is deprived of any privileges, benefits, or rights guaranteed by state or federal law
Inform new residents and spouses of their spousal impoverishment rights under the Illinois Public Aid Code and the Medicare Catastrophic Coverage Act upon admission
Allow residents to handle their own financial affairs
Provide residents with sufficient storage for personal belongings and a secure area for smaller valuables
Permit residents to wear personal property unless medically contraindicated
Allow residents to seek the services of personal doctors under their health insurance or personal expense
Refrain from conducting experimental research or treatment or permitting access to residents’ medical records for research unless the resident gives a prior written approval
Ensure that all medical services or treatments are under the orders and supervision of a doctor
Allow residents to refuse medical treatment
Refrain from using physical or medical restraints unless medically necessary
Respect all residents’ rights to privacy concerning medical or personal care
Refrain from administering unnecessary drugs
Refrain from abusing or neglecting a resident
Ensure the protection of residents’ personal property or funds
Respect each resident’s right to communication by text, call, or mail
How Does the Illinois Department of Public Health Regulate Nursing Homes?
Illinois has around 1,200 nursing homes, housing over 100,000 disabled and elderly individuals. The Illinois Department of Public Health inspects these facilities at least once a year (between six and fifteen months) to determine if they comply with mandatory state regulations.
Furthermore, the IDPH Bureau of Long-term Care ensures that nursing homes meet the provisions of the Illinois NHCA. Under a cooperative agreement with CMS, the Department also helps ensure that nursing homes receiving government funding meet facility compliance standards.
The state inspectors conduct approximately 10,000 surveys yearly, including annual inspections and complaint investigations. These surveys evaluate the quality and adequacy of the nursing facility and its amenities, equipment, staff, procedures, and finances. Usually, they involve the inspection of medical records, observation of practices, interviews with staff and residents, etc.
Surveyor teams include registered nurses, nutritionists, and environmental health practitioners—other professionals, such as sanitarians, join inspection teams when necessary.
The IDPH releases quarterly reports of nursing home violators on their website, detailing deficiencies of each non-compliant nursing home. Nursing homes with deficiencies can rebut alleged deficiencies; facilities with cited deficiencies must submit plans of correction within ten days unless the IDPH specifies corrective actions.
Additionally, the Department receives almost 20,000 calls yearly through its Nursing Home Hotline (800-252-4343).
How Does the CMS Certify Nursing Homes?
The State is responsible for certifying nursing home or skilled nursing facility’s compliance or non-compliance with nursing home regulations. However, the certification is subject to the Department of Health and Human Services CMS approval.
A facility with a Certificate of Compliance meets the federal requirements for participation in the CMS program based on state inspections by the Illinois Department of Public Health. The Illinois CMS regional office determines a nursing home’s eligibility to join the Medicare program, depending on its compliance certification and compliance with mandatory state regulations.
CMS provides a nursing home compare tool, allowing the public to view overall ratings of senior care facilities across all states. These ratings are based on facilities’ health inspections, staffing, and quality measures.
What Are the Penalties For Non-Compliant Facilities?
Agencies enforce penalties on nursing home administrators that do not meet state and federal regulations. When inspectors cite a facility for deficiency or violation, it could result in the following:
Fines: The government may impose fines on a facility once per citation or daily until it corrects the deficiency.
Payment Denial: When a facility is penalized with a payment denial, it will not receive Medicare or Medicaid funding for new residents until it corrects the deficiency.
Revocation of License or Placement of a Provisional License: A non-compliant facility may receive a provisional license (with special restrictions or conditions) or lose its right to operate.
Ban on Admissions or Readmissions: The government can prevent a facility from accepting new or returning residents until it corrects its citation.
Mandatory Training Programs: A facility may be forced to participate in training programs to prevent the deficiency from reoccurring.
Each facility receives written survey results following each inspection, containing the issues that need to be resolved, resulting charges, and (if applicable) the reasons for penalties and other enforcement actions.
How to Report Illinois Nursing Home Abuse
Nursing home abuse is any action that causes or creates a risk of harm to a resident. It includes but is not limited to the following:
Physical Abuse: Acts causing pain or injury to a resident, e.g., slapping, kicking, pushing, pinching, etc.
Sexual Abuse: Any non-consensual sexual act, e.g., sexual harassment, fondling, coerced nudity, indecent exposure, rape.
Psychological Abuse: Any verbal or non-verbal act intended to cause mental or emotional harm to a resident, e.g., humiliation, gaslighting, intimidation.
Financial Abuse: Any illegal or unauthorized manipulation of a resident’s resources, including money, credit cards, valuables.
Neglect: Intentional or unintentional acts depriving a resident of basic needs, including food, water, medical care, clothing.
You can report a negligent Illinois nursing home to local law enforcement, the IDPH, and Adult Protective Services. Consider seeking legal services from an attorney if you suspect your loved one is a victim of abuse or neglect at their facility.
Conclusion
Illinois nursing homes are responsible for providing quality health care to all residents in compliance with federal and state nursing home regulations. Failure to do so puts vulnerable residents at risk for injury, illness, or even death and counts as abuse subject to punishment.