Saturday, February 20, 2010

In Illinois, timeline set to move psychiatric patients and convicted felons from nursing homes

From the Chicago Tribune:

The final report of Gov. Pat Quinn's Nursing Home Safety Task Force, issued early Friday morning, for the first time sets out an urgent timetable and concrete road map for a sweeping overhaul of the state's troubled long-term care system.

The proposals are aimed at reversing Illinois' decades-long practice of housing psychiatric patients and convicted felons in nursing homes — and ending a legacy of violence in which elderly and disabled people have been raped, assaulted and even murdered inside the facilities.

The 52-page report represents a significant advance from preliminary recommendations issued last month by the task force, which was prompted by an ongoing series of investigative reports in the Chicago Tribune.

The report outlines a plan to segregate the most dangerous residents in more secure settings, and to move thousands of mentally disabled people from nursing homes into an array of smaller residential programs that provide intensive therapy and supervision for those who require it, but greater independence for those who don't.

While the task force argues that most of its proposals are cost-neutral or save money, it presses for an increase in nursing home licensing fees to help cover the cost of increased safety enforcement. The short-staffed Public Health Department needs 79 new inspectors, the report said.

Task force chairman Michael Gelder set an April 30 deadline for implementing many of the key reforms, including more rigorous assessments and screening of all potential nursing home residents. Other recommendations would sharply raise the standards of care for nursing facilities, especially those serving people with mental illness; impose heftier fines and license revocations for unsafe homes; and beef up inspections for all of the state's 1,100 nursing facilities.

State departments have already begun drafting rule and policy changes as well as new legislation, Gelder said.

"I am planning to be very involved because this is a high priority for the governor," Gelder said. "Certainly by the end of this month we'll have a legislative package or a single bill."

While all the initial steps may not be completed by April 30, Gelder said, the "deadline was inserted there to make sure we knew how urgent this was."

More than any other state, Illinois mixes geriatric and mentally ill nursing home residents, and understaffed facilities have failed to treat and monitor their most violent patients, government records show.

There is no single solution for separating the two populations and ending the violence inside homes, the report acknowledges. Instead, it outlines 38 separate recommendations. Some can be quickly implemented by the governor and 10 state agencies, but others will require legislative action.

Among the final report's new proposals:

— New licensing requirements for nursing homes that house dangerous residents, placing them in separate facilities or wings where they will not have contact with vulnerable patients. Those homes will have to show they have the staff, training, physical plant and mental health programs to handle difficult patients.

— A working group to develop a policy that assures proper use of psychotropic drugs for nursing home residents with serious mental illness and dementia. In its reports, the Tribune found some frail and elderly residents were administered powerful anti-psychotic drugs without their consent and without a proper diagnosis.

— More than doubling the number of supportive housing units for people with mental illness who can function in a community setting. Currently Illinois funds about 5,000 such units, but the demand is more than twice that, the report said. The spectrum of settings would range from secure group homes with 24-hour staff and support services on site to individual apartments where people get outpatient therapy as they improve their living skills.

In a written statement, Quinn said he looked forward to "working with legislators, advocates and state agencies to make these reforms a reality."

"It's definitely a unique opportunity," said Janet Hasz, executive director of the Supportive Housing Providers Association. She has not seen the report but has testified before the task force. "I've never experienced in my lifetime this many forces coming together to solve the problem. I'm very hopeful."

Hasz said it would be possible to begin transferring at least 500 nursing home residents into supportive housing immediately, and roughly 900 a year after that. That transition could be made without draining state funds because Illinois currently pays at least $40,000 per person annually to nursing homes that specialize in the mentally ill — more than most supportive housing costs, Hasz said.

State lawmakers have already introduced more than a dozen preliminary nursing home safety bills that will be filled in and debated during the next three months. But some lawmakers said they are considering consolidating many of the legislative proposals into one so-called omnibus bill. Said state Sen. Heather Steans, D-Chicago: "We need a big bill that my colleagues have to say yea or nay to, and not a lot of little bills that people can play games with."

Steans and others said that if a comprehensive overhaul is not passed this year, when the governor and media are focused on the issue, the likelihood of enacting a bill next year diminishes significantly.

The report had not yet been shared with legislators, advocates and nursing home industry groups Thursday. While the leading industry trade association strongly supported the preliminary proposals issued last month, nursing home operators have traditionally fought increases in fees and fines.

In an interview, Gelder expressed confidence that industry groups and advocates are coming together to create meaningful reform.

The Illinois Hospital Association has signaled that it will fight a proposal that brings them into the criminal background check process. Currently, many nursing home residents are admitted from hospitals; to speed up the identification of dangerous patients, the proposed reforms require hospitals to initiate criminal background checks when the hospitals begin to discharge them.

Currently the nursing homes begin the checks when people are admitted, and the state pays them and pre-admission screening agencies to do background checks and screenings, said association Senior Vice President Howard Peters. "Why now drag hospitals into it?" Peters asked.

The Tribune found those screenings often took longer than a year, and omitted arrests and convictions of felons who went on to attack others in the homes.