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State ombudsman: All nursing home violations major

Daily Gazette (Sterling, IL) - 12/20/2014

Dec. 20--Residents in Sauk Valley nursing homes have died or been injured because of neglect or mistakes or lack of prudent policies.

There have been documented falls and unplanned weight losses, and infections have spread.

In a state that ranks among the worst in nursing home care, the Sauk Valley area has a higher rate of nursing homes with severe deficiencies than the rest of Illinois -- 65 percent here compared to 25 percent in the state overall.

But equally troubling to advocates for better care are the constant and repeated violations for building and fire codes -- and for the less-severe violations that are cited without penalties ever being imposed.

For instance, some violations relate to residents not being able to eat the food they want, or to do the activities they prefer.

They don't affect the residents' physical health in a negative way, or even rise to the level of a fine, but advocates for nursing home residents still see a problem.

"I wouldn't consider any of them being minor," said Sally Petrone, head of the state's long-term-care ombudsman program. "If it's cited, it's major to me, even if it's cited that the dietary plan did not meet the care plan requested."

Providing a nutritious meal is important, she said. "Food is a priority."

Nursing home residents should be considered community members who simply changed their address, said Cathy Weightman-Moore, who works for the Catholic Diocese of Rockford. She is one of 18 regional ombudsmen, her nine-county area covering Lee, Ogle, Whiteside, Carroll, Boone, DeKalb, JoDaviess, Stephenson and Winnebago counties.

The Illinois Long-Term Care Ombudsman Program, which was mandated by the Federal Older Americans Act and the Illinois Act on Aging, advocates for residents and those looking to move into a nursing home.

They work to give nursing home residents a voice and to ensure they get the level of care and the quality of life they want.

Under state and federal law, certified ombudsmen may enter any nursing home and "observe all areas, except the living area of any resident who declines," according to the program's standards.

After they've identified themselves to the facility, ombudsmen can speak with any resident, in private, even without a legal representative.

The state ombudsman program is just one example of nursing home advocates, locally and around the country, who push for new legislation, reforms, and added transparency in an effort to improve the quality of life and care in nursing homes.

Brian Lee is executive director of Families for Better Care, a long-term-care watchdog organization based in Florida. The industry hasn't done much to clean up and improve nursing homes in the past 4 decades, he said, so regional ombudsmen have a vital role.

"It's our parents and grandparents who live in these nursing homes," Lee said. "These are our loved ones. There's so much shop talk about the baby boomers going into nursing homes in the next 10, 20 years. But those aren't just numbers."

The top health-related violations in Illinois nursing homes, Petrone said, revolve around accident hazards, infection control, sanitary issues, abuse prevention, bedsore prevention, comprehensive care plans, and a consistent failure to ensure that residents aren't being fed unnecessary drugs.

All those violations have been identified in Sauk Valley nursing homes since early 2011.

Weightman-Moore's staff is made up of six paid employees and about 15 volunteers who are trained on what to look for in a nursing home, on residents' rights, and on how to resolve issues residents might have with their quality of care or life in a nursing home.

In addition to ensuring the residents' desires for care and lifestyle, providing them with the information they need to protect themselves is an important part of what the ombudsmen do, she said.

And while they'll work with the nursing home and the resident to resolve issues, Weightman-Moore made it clear that they aren't looking to find middle ground: Ombudsmen are there to represent the resident and the resident's desires.

Because some residents fear retaliation if they speak out about conditions, ombudsmen can file confidential complaints on behalf of a resident if they need to "force compliance."

That happens maybe 25 percent of the time, she said.

"Sometimes it's adversarial," she said of the relationship with nursing homes. "For the most part, people are really trying to make sure we're working together and on the same page."

In fact, among the most common complaints residents bring to Weightman-Moore and her staff is financial exploitation by family members or someone not associated with the nursing home.

In the past 5 years, Weightman-Moore said, the other common complaints have been a failure to respond to requests for assistance; not following requested plan of care; not treating residents with dignity; and inadequate discharge planning.

These types of violations, which are cited by surveyors or brought to the attention of the ombudsman or the state through a complaint, aren't necessarily indicators of a bad facility, though. Nearly every nursing home in the area had some instances of these types of violations.

Heritage Square in Dixon hasn't been issued a fine by the state or federal government since 2012. It's rated as a 5-star facility by the Nursing Home Compare website, which is run by the Centers for Medicare and Medicaid Services, for overall quality, staffing and quality measures.

But in July 2012, the nursing home was cited for a failure to have two meats to choose from in a meal.

When the survey team reviewed the nursing home's 4-week menu cycle, three instances were found. The violation was rated Level C for scope and severity. That means there was no actual harm and potential minimal harm to the residents, but the violation was widespread -- it could affect all residents.

It was a violation because residents have a right to make choices.

They have the right to decide when they wake up, when they eat, and what activities they do, said Bonnie O'Connell, administrator at Heritage Square, who added that the facility works with residents to ensure their rights are respected.

For ombudsmen, who also work toward that goal, that means having a presence in the nursing homes.

"We're continually working on the issues," Weightman-Moore said. "We're not there one time. We're back, and keep going back, and make sure the issue is resolved."

Lee, with Families for Better Care, said a lot could be done to improve the system in Illinois and across the country, from higher staffing standards to higher fines to more transparency about nursing home conditions and their financial standing.

Even though Medicaid reimbursements are months behind, nursing homes know that money will come eventually, Lee said, so there is less incentive to provide a better product.

"The problem with the whole system is, it's socialized medicine on steroids," he said. "[Nursing homes] get paid no matter what, but there's no competition to force the marketplace."

Of the 20 area nursing homes reviewed by Sauk Valley Media, seven are owned by a company that owns at least one other nursing home in the area. And 12 of the 20 are owned by a company or ownership group that has a greater than 5 percent stake in at least one other nursing home in the state.

Anyone with a 5 percent or more ownership stake in a nursing home is listed on each nursing home's information page on the Illinois Department of Public Health's website. It's among the information that's required to be disclosed to the public and on the IDPH website.

Other than the seven area nursing homes owned by nonprofit groups, the nursing home owned by Morrison Community Hospital (and soon to close) and Coventry Living, which is owned by a limited liability company, 17 different individual owners are listed for the 11 other nursing homes.

Twelve have at least a 5 percent stake in five or more nursing homes in the state. Eight have an ownership stake in 10 or more nursing homes.

That represents a trend that Weightman-Moore has seen in the past few years: the shift from nursing homes being owned by small companies to larger ones, and more for-profit nursing homes.

"I think there are reasons why small businesses decide they want to sell," she said. "I can't give you the reason as to why. But I can guess. We all can."

'It's gotten more complex'

Nursing home administrators interviewed by Sauk Valley Media said their facilities provided quality care and were doing the best they could with the resources they had.

But they also say that, at times, the regulation, filings, paperwork and Nursing Home Compare website can make their jobs more difficult.

Since 2012, about 25 percent of Illinois nursing homes have been cited for a severe violation by state or federal regulators. In the Sauk Valley area, the rate is 65 percent -- 13 of 20 nursing homes were so cited.

What concerns Lee about that statistic is that rural areas, which have fewer options, usually have better care, in part because of the small-town environment.

"This record really runs against the grain," he said. "I'm at a loss as to why it's so bad. And to think that the regulators haven't worked to clean this up."

Illinois ranks near the bottom nationally in overall nursing home care, according to report cards done by Families for Better Care. It dropped from 42nd worst overall in 2013 to 44th in 2014.

"As far as the state level, it constantly needs to be improved," said Petrone, the state's long-term-care ombudsman. "There are some wonderful, wonderful facilities, and there are some crummy ones."

Speaking for herself, and not for the entire ombudsman program, Petrone said more staffing, more understanding, and more embracing of person-centered care could make a difference.

Weightman-Moore cautions against making blanket statements about Sauk Valley nursing homes, because what's good for one resident might not be good for another, she said.

The key is to empower residents with their rights and to give them tools they need to get the care they want, she said.

"I wish that we could work ourselves out of jobs, in terms of not needing an advocate," she said. "But there will always be a need for an advocate. I think there will always be a need for [long-term care]. We have to ensure that it's the best possible care and quality of life.

"I just don't see our job going away. Has it gotten easier? I think it's gotten more complex."

Common complaints

Ombudsmen are advocates for nursing home residents. They handle complaints ranging from not liking the food to financial exploitation.

According to information provided by regional ombudsman, the following are common

complaints or concerns that nursing home residents in Lee, Whiteside, Ogle and Carroll counties have taken to ombudsmen in the past 5 years.

--Financial exploitation of a resident by family or other not affiliated with the facility was the No. 1 or No. 2 complaint for 4 out of 5 years.

--Staff failure to respond to resident requests for assistance was in the top five complaints for 4 out of the 5 years.

--Staff failure to follow the plan of care or having an inadequate care plan was in the top 5 complaints for 3 out of 5 years; it was among top 10 complaints 5 out of 5 years.

--Failure to treat residents with dignity and respect was the No. 1 complaint in 2 out of 5 years and was in the top five 3 of 5 years.

--Failure to provide proper or adequate discharge planning moved into the top three complaints for the past 3 years.

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(c)2014 the Daily Gazette (Sterling, Ill.)

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