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'No better time for reform’ of Illinois’ nursing homes, among ‘lowest-ranked’ in nation, officials say


Thursday, October 14, 2021  |  Article  |  Associated Press

Medicaid, Managed Care , Nursing Homes (68)

Illinois lawmakers can improve the state’s long-term care facilities by tying Medicaid money to performance and using $444 million in incentives and subsidies to help the industry, according to a new report from the Illinois Department of Healthcare and Family Services.


The report, which was released Sept. 30, comes three weeks after department officials told members of four House committees the agency would recommend shifting the way Illinois’ long-term care facilities are funded by tying money to results in order to improve care. 


Related: Lawmakers, health officials push to tie nursing home funding to ‘results’


On Wednesday, officials from the Illinois Department of Healthcare and Family Services, as well as industry representatives and advocates, appeared once again before lawmakers to discuss the findings and recommendations contained in their review of the state’s nursing home payment system. 


Throughout Wednesday’s roughly two-hour hearing, lawmakers — like they did three weeks prior — pushed industry representatives for answers on a variety of topics for a wide-ranging discussion that at times featured pointed critiques.


By and large, lawmakers welcomed the 82-page report, which state officials said included recommendations on how to enhance the safety and quality of life in Illinois’ nursing homes. 


“This is not a report that can sit on a shelf and collect dust,” said Kelly Cunningham, the Medicaid director for the Illinois Department of Healthcare and Family Services. “The need to take action is now.”


The report contained myriad examples of how the state’s nursing home industry has long struggled, saying it ranks among the worst in the nation in several categories. 


For example, the report noted how Illinois “consistently” ranks last among states in staffing, according to a nationwide survey conducted by the Centers for Medicare & Medicaid Services. 

“Illinois doesn’t just come in last in nurse staffing levels — it dominates the list of states with the lowest-performing nursing homes,” the report said. 


Illinois accounts for 47 of the bottom 100 facilities in the country in terms of lowest-staffed nursing homes. The next-closest state was New York, with nine of country’s 100 lowest-staffed nursing homes.


Another nationwide survey of long-term care facilities found that 29 percent of Illinois’ long-term care residents had “depressive symptoms,” placing the state last in the nation. Rep. Deb Conroy (D-Villa Park) said such figures were “unacceptable.” 


“This is a crime and this must be fixed,” she said. 


At the same time, the report found nearly half of the state’s privately-run, for-profit skilled nursing facilities are under-staffed. Additionally, the report highlighted how the vast majority of the state’s roughly 700 skilled nursing facilities were under-staffed while having a high utilization of Medicaid. 


“Almost all (13 of 248) under-staffed for-profit facilities are above 50% Medicaid utilization,” the report found. “In plain language, high-Medicaid under-staffed homes drive earnings among Illinois [skilled nursing facilities].”


The report said the state’s for-profit facilities collectively earned $296 million in 2019. 


In addition, the report described how the state’s long-term care facilities were disproportionately impacted by the COVID-19 pandemic, with the brunt of the virus hurting minority residents. 


Cunningham pointed out that Black and Brown nursing home residents on Medicaid were “disproportionately impacted” by the COVID-19 pandemic because “they were more likely to reside in poorly staffed facilities and in ward-style rooms containing three or four beds.”


A department analysis found at least 40 percent more Black and Brown Medicaid customers in nursing facilities died during the pandemic than would be expected based on COVID-19 mortality rates among white residents. 


Further, the report found Black and Brown residents are nearly twice as likely to live in an under-staffed facility than their white counterparts. 


As such, Cunningham said continuation of the “status quo” is unacceptable and the state needs to hold long-term care providers throughout Illinois to a “higher standard.”


She noted that throughout the 18 months state officials have been working on the report, some in the nursing home industry have questioned why changes were needed now.


“Our report indicates that there is really no better time for reform,” Cunningham said.


Recommendations for reform


The report contained myriad recommendations on how to improve long-term care facilities.  


Among the most notable changes to the state’s long-term care facilities would be the way the state makes its Medicaid payments to long-term care providers. Every year, Illinois, through the Department of Healthcare and Family Services, spends billions of dollars on nursing home care for roughly 45,000 Medicaid customers. 


“Medicaid pays for approximately 60% of all nursing facility days in Illinois and is the largest payor of days in both the state and in the nation,” the report said. “[The department] has a moral imperative to our customers to ensure that the services and care they receive in nursing facilities is safe, high quality and equitable.”


As a result, the department recommends the state replace the current Resource Utilization Group payment model for Medicaid customers with a new payment system known as the Patient Drive Payment Model. Under the patient driven model, which is used by Medicare, nursing home payments would be linked to facility performance and staffing levels. 


The report also recommends increasing the state’s licensed bed tax, which would generate $186 million for the state.  


To better attract and retain workers, the report calls for spending $224 million to create an incentive payment program for nursing staff improvement, $5 million to subsidize training for certified nursing assistants, $5 million for promotions for certified nursing assistants and $75 million dedicated to a tenure pay scale that incentivizes employee retention. 


In an effort to improve the quality of the state’s long-term care facilities, the report recommends spending another $100 million on incentives for providers to improve their performance. 

Other recommendations included in the report include additional transparency in ownership of nursing homes, as well as the revenue they generate, requiring the Department of Healthcare and Family Services to perform an equity study for residents and pay for workers and using any additional federal American Rescue Plan Act funds that are provided to facilities for “urgent one-time needs,” such as reducing room crowding and improving air quality. 


Lawmakers back reforms


As the four House committees discussed the report on Wednesday, several lawmakers offered their support for the department’s findings and recommendations. Conroy said she “strongly” believed in the report, which she said offered a “foundation” that lawmakers could build upon. Rep. Camille Lilly (D-Chicago) said the report further highlighted how “race is a real issue” in the state’s nursing home industry. 


Rep. Lakesia Collins (D-Chicago), who during the September hearing was critical of nursing home officials, expressed appreciation for the report while encouraging the department to continue to pay attention to issues that have been raised in recent months regarding the industry. 


When it came time for industry representatives to appear before the committee, lawmakers were less laudatory, in part due to the testimony of Matt Pickering, the executive director of the Health Care Council of Illinois, which represents more than 300 skilled nursing facilities in the state. 


Pickering said his organization agrees with the department on “a couple of things,” including the urgent need for helping the industry. He pointed to a recently-announced forthcoming closure of a nursing home in Springfield that will shutter in part because of short staffing as evidence of a need for the state to get “sincere” about the nursing home industry. 


Pickering criticized state officials after he said his organization recently submitted its own “bold plan” for addressing staffing and wages in the industry and heard nothing back from the department. 


Rep. Kathleen Willis (D-Addison) chastised Pickering for his comments, saying he “lost” credibility because he had not shared his plan with lawmakers and was offering no ideas on how to improve the industry. 


“I didn’t hear anything from you other than [to] say, ‘please don’t stop our money flow’,” she said. 


Pickering said although he didn’t mean to sound as if he was complaining about the department’s recommendations, providers represented by his organization were “disproportionately affected” by the various proposed changes. He did not share his organization’s recommendations but said he supported forthcoming regulations that will fine facilities for not meeting certain standards and was “open” to discussions about bed reductions. 


Unlike Pickering, other industry representatives and advocates who testified Wednesday, including officials from LeadingAge Illinois, the Illinois Health Care Association, AARP Illinois and the state chapter of SEIU Healthcare, largely expressed support for the department’s recommendations.


Steve Andersson, a lobbyist representing AARP Illinois, warned committee members that they would “hear phrases” from industry officials who said they were open to talking. “We’ll talk to the end of time, because some of the groups here, let’s be very honest, are interested in maintaining the status quo,” he said, adding that the state needs to “disrupt” the long-term care industry rather than simply “tweak it.”


As the committee hearing came to a close, Lilly, who chairs the House Appropriations-Human Services Committee, said she will host additional legislative meetings to continue the conversation around nursing homes in the future. She said the department’s recommendations were a “first step” with the broader goal of ensure that the improvement of the quality of life for all Illinoisans.