Illinois officials discover that many in nursing homes have untreated mental illnesses

From The Chicago Tribune:

Top state officials who recently visited Illinois nursing homes said Wednesday they were stunned and disappointed by conditions at some facilities, describing grim institutions crowded with surprising numbers of mentally ill residents who wandered aimlessly without proper treatment.

"It was very eye-opening," Department of Human Services Assistant Secretary Grace Hou said of one unnamed nursing home. "The therapeutic environment was severely lacking. I couldn't get over the starkness, the whiteness and the institutional feel."

Hou and other state authorities shared their impressions at a meeting of Gov. Pat Quinn's Nursing Home Safety Task Force, a state panel formed in response to a Tribune investigation that found elderly and disabled residents have been assaulted, raped and even murdered by mentally ill felons living with them in the facilities.

In addition to examining conditions inside the facilities, some officials publicly questioned whether some of the mentally ill people had medical conditions that were serious enough to justify their placement in a nursing home.

At one facility, state Division of Mental Health Director Lorrie Rickman Jones said, close to 80 percent of the residents were mentally ill, but facility administrators "claimed the mental illness was a secondary diagnosis."

Those administrators told Jones the residents had been admitted for medical reasons, although some of the conditions they cited, such as hypertension and diabetes, "did not seem to be serious enough to warrant placement" in a nursing facility.

In an interview after the meeting, Jones said she did not review residents' medical files, but she did talk to administrators about them.

Many of the residents seemed to have a mental illness and "did not seem significantly or noticeably incapacitated by whatever medical [condition] it was," she said.

The issue of how these residents are classified has multimillion-dollar implications for the state because under Medicaid rules, the federal government stops reimbursing the state for care at nursing homes that fill more than half their beds with residents who are exclusively mentally ill.

Once homes reach that tipping point, they are classified as an Institution for Mental Diseases, or IMD, and the federal government stops matching payment for their care.

Those federal reimbursements total millions of dollars annually for many of the homes.

While the state currently lists 26 Illinois nursing homes as IMDs, state Department of Public Health data show an additional 29 homes where more than half the residents have a primary diagnosis of mental illness under health department classifications.

To take one example, all 68 residents at Tammerlane Health Care Centre in the western Illinois town of Sterling are primarily diagnosed with a mental illness, according to state public health records, yet Tammerlane is not an IMD.

"People are here because they have some underlying medical condition and the mental illness doesn't allow them to care for the medical condition within the community," Tammerlane administrator Shelly Reese explained in an interview after the hearing.

While the health department may list all of a facility's residents as having mental illness, it is up to a sister state agency, the Department of Healthcare and Family Services, or DHFS, to classify the residents' diagnosis for purposes of claiming Medicaid reimbursements.

DHFS uses different criterion, negotiated with federal Medicaid authorities, for counting the residents' diagnoses, said Theresa Eagleson, administrator of DHFS' Division of Medical Programs.

"HFS uses a more complex algorithm to make a classification based on all the diagnosis and clinical data available," Eagleson said. "We try to be very much upfront with the feds on how we claim the match because we're all accountable for it."

And DHFS authorities closely watch the facilities to ensure they don't pass the 50 percent tipping point.

Two weeks ago, Tammerlane received a sharply worded notice from DHFS saying the facility was "at risk of becoming" an IMD.

Tammerlane is one of seven nursing homes statewide on a DHFS "watch list" for becoming IMDs, officials said after Wednesday's hearing.

The letter said roughly 40.6 percent of Tammerlane residents qualified for nursing home care because they had a mental illness solely.

"Classification as an IMD is important to both the state and the facility because it affects the federal funds to the state of Illinois as well as the facility's reimbursement rate," the letter said.

"Staff from the Bureau of Long Term Care will be contacting you to discuss your facility's plan to address this significant issue," the letter added.