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Patients matter most: Illinois could drastically change struggling nursing home system

Stakeholders want to move to a patient driven payment model for nursing homes, but many say...
Stakeholders want to move to a patient driven payment model for nursing homes, but many say staff must also be a top priority.(CNN)
Published: Nov. 22, 2021 at 5:54 PM CST
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SPRINGFIELD (WGEM) - The COVID-19 pandemic has put longstanding problems in Illinois nursing homes into the spotlight. State agencies continue to work alongside providers and lawmakers to create a plan to restructure the industry with a focus on patients.

Last month, the Gray TV Illinois Capitol Bureau spoke with the state’s top Medicaid administrator about the patient driven payment model. The Senate Health Committee had a chance to weigh in on the plan Monday morning.

The Illinois Department of Healthcare and Family Services wants a payment structure with new funding to incentivize quality of care and improved staffing. Administrator Kelly Cunningham also hopes to see significant changes in accountability and transparency from providers.

“HFS has a moral imperative to our customers to ensure that the services and care that they receive in nursing facilities is safe, high quality, and equitable,” Cunningham said.

She says all Medicaid customers deserve the highest quality of care. But many know that can’t happen if the state moves forward with the current payment model that allows facility owners to make a profit while CNAs and other staff struggle to make a living.

Some argue the constant turnover in staff leads to more health problems for patients in their care. Since the pandemic started, skilled nursing and residential care facilities have lost at least 14% of the workforce.

The Health Care Council of Illinois also claims the Department of Public Health has failed in its role as a collaborative partner to enhance care and ensure regulatory compliance. Council Executive Director Matt Pickering said IDPH continues to show a self-perpetuating cycle of violations and costly fines without assistance to improve protocols inside facilities.

“Violations have increased in recent months while the department continues to fail to respond to facilities seeking clarification on regularly changing rules and protocols. It’s a game of cat and mouse,” Pickering said.

He also said some of the major problems are IDPH understaffing in homes and a broken survey system. His organization met with IDPH officials to discuss these problems last week.

Pickering says residents and caregivers could benefit from a better partnership with the department. However, he stressed that keeping the status quo might lead to more nursing homes closing.

Overcrowded rooms are still a major program in many nursing homes serving low-income patients of color.

“There are over 5,000 beds in this ward-style three and four-bed rooms that should be eliminated so resident rooms have at most two beds,” said Greg Will.

The current room setup became dangerous during the pandemic with more close contact and easier spread of COVID-19.

Will serves as the research director for SEIU Healthcare IL-IN. His organization represents 90,000 healthcare workers in these facilities.

He also noted that the Federal Centers for Medicare and Medicaid Services banned the use of ward-style rooms years ago unless they were grandfathered in.

SEIU and AARP Illinois also believe the state should keep people out of nursing homes and focus more on community care.

“We have to ensure any assessment plan and savings are redirected to home and community-based services,” said Lori Hendren with AARP Illinois.

Hendren said there are too many people in nursing homes who don’t necessarily need to be there. Advocates also said Illinois cannot let more patients suffer from social isolation as too many have during this pandemic.

State representatives have also held hearings on this issue. Lawmakers hope to file language for an agreed bill when they return to Springfield to start session in January.

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