Illinois hearing assesses volatile mix in nursing homes, with felons, mentally ill people and senior citizens together

From the Chicago Tribune:

More light was shed Nov. 19 on the volatile nature of Illinois nursing homes that house a mix of mix of felons, mentally ill people and seniors, as legal experts explained how laws governing both the facilities and the mentally ill are applied. "The issue is (that) the mental health code does apply but it is applied theoretically. It is not enforced." said Mark Epstein, an attorney practicing mental health law for nearly 40 years.

There are two separate sets of state laws regarding nursing homes and the mentally ill – and consequently have caused confusion about how to treat individuals. For example, under state law, voluntary nursing home residents may leave whenever they want, but if they are seriously mentally ill, the situation becomes more complicated. Records show elderly and disabled residents have been assaulted, raped and even murdered in the homes.

In the areas of restraint or medication in nursing homes when there's a conflict between mental health laws and those of nursing homes, the latter usually trumps, Patrick Knepler, an attorney with the Illinois Department of Human Services, told Gov. Pat Quinn's Nursing Home Task Force.

Illinois relies more heavily than any other state on nursing homes to house psychiatric patients, records show. Mentally ill people are no more likely than others to be dangerous or to commit crimes if given proper treatment, numerous studies have shown.

Epstein said Illinois needs "a single place where the issues are reviewed and information is accumulating, rather than having a structure where information is in different places and there's no unity." "We do have a broken mental health system in Illinois," he said.

Psychiatric patients are made aware of basic rights – like that of for an attorney – but nursing home residents not necessarily, Epstein said. There just aren't any signs posted or phone numbers to call, he said. "Everyone at a psychiatric facility in Illinois gets those rights to that authority and no one who is similarly situated in an Illinois nursing home gets those rights and gets those benefits," he said.

The Health Care Council of Illinois, a trade association of nursing homes, offered recommendations. Additionally, Terry Sullivan, regulatory director, said transferring patients from hospitals to a nursing home is more difficult when the individual suffers from mental illness.

"If it's Medicare, the hospital is very interested in having a speedy discharge but if it's a clear cut medical case with clear cut treatment that the nursing home can do, those discharges generally do happen in five, six hours," he said. "Whether it should be a more deliberate process with a person who has serious mental illness, there probably needs to be a better assessment."

Officials with the Illinois Hospital Association said that discharge process begins almost immediately upon admission to a hospital as doctors weigh factors such as financial resources and family support.

But Kathleen Pankau, an IHA lawyer, said it become complicated for hospitals because when sometimes they'll successfully find a home to accept a patient only to hear the home changed its mind because the individual had legal problems.

"If it's not something that is asked about or if it doesn't come up, they're not going to know," she said.

Daniel E. Bluthardt, director of the Illinois Division of Professional Regulation, told the panel he couldn't recall how many administrators are licensed in Illinois or how many have been disciplined. He said he assumed the amount disciplined likely reflects the norm in most professions of less than 1 percent.

It was the fourth hearing held by the panel, which was formed in response to a Tribune investigation that found government, law enforcement and the industry have failed to adequately manage a growing influx of younger adults who cycle into nursing facilities from jail cells, shelters and psychiatric wards. The panel will submit a report to Quinn by Jan. 31.

"We're on target," Gelder said at the start of Thursday's meeting. "We appreciate all your efforts, your communication, your conversations, your submissions – both publicly here and the written testimony that we've received."