25 Alarming Problems Illinois Nursing Homes Have

State-licensed elder care and rehabilitation centers in Illinois may include assisted living facilities, and residential or personal care homes. Unfortunately, hundreds of investigations into these facilities continue to reveal these 25 repetitive problems noted by the Justice in Aging. The organization’s newly published 2021 list points to issues related to relaxed oversight and understaffing workforces, preventable resident injuries, painful and unnecessary evictions, Medicaid complications, dangerous patient abuse and neglect, and irreversible tragedies for families.

Problem #1: Providing Less Care to Medicaid-eligible Residents

• What you hear: “Medicaid does not pay for one-on-one attention.”
• The facts: A Medicaid-eligible resident is entitled to the same level of service provided to any other resident.

Problem #2: Failing to Take Care Planning Seriously

• What you hear: “The nursing staff will determine the care that you receive.”
• The facts: The resident and resident’s family can participate in developing a care plan.

Problem #3: Disregarding Resident Preferences

• What you hear: “We don’t have enough staff to accommodate individual schedules. You must wake up at 6 a.m. every morning.” OR “Our group activity always is bingo.” OR “If you don’t like the dinner entrée, your only option is a peanut butter sandwich.”
• The facts: A nursing home must make reasonable adjustments to honor a resident’s needs and preferences.

Problem #4: Failing to Provide Necessary Services

• What you hear: “We don’t have enough staff. You should hire your own private-duty aide.”
• The facts: A nursing home must provide all necessary care, including the appropriate number of staff.

Problem #5: Improper Use of Physical Restraints

• What you hear: “Your father may fall if we don’t tie him into a chair or bed. There’s just no way we can always be watching him.”
• The facts: Physical restraints cannot be used for the nursing home’s convenience.

Problem #6: Improper Use of Behavior-Modifying Drugs

• What you hear: “Your mother needs drugs to make her more manageable.”
• The facts: Behavior-modifying drugs can be used only if the resident
  OR resident’s representative consents, and only if the drug’s use is not for the nursing home’s convenience.

Problem #7: Eviction Without Proper Notice

• What you hear: “You have to move out in three days.”
• The facts: A nursing home must give advance written notice of a proposed eviction, and the resident has the right to appeal.

Problem #8: Eviction for Being ‘Difficult’

• What you hear: “You must move out because you are too difficult.”
• The facts: A nursing home must provide necessary care whether a resident is “easy” or “difficult.”

Problem #9: Eviction for Complaining

• What you hear: “You complain about how poor the care is here, so you can be evicted under the reason that the nursing home cannot meet your needs.”
• The facts: A resident cannot be penalized for making a complaint, and a nursing home cannot justify eviction by providing substandard care.

Problem #10: Eviction for Refusing Medical Treatment

• What you hear: “You must move out because you are refusing medical treatment.”
• The facts: A resident has a right to refuse medical treatment. By itself, refusal of treatment is not an acceptable reason for eviction.

Problem #11: Eviction for Nonpayment While Medicaid Application is in Process

• What you hear: “You owe us for several weeks of care, and we can’t wait for Medicaid to be approved.”
• The facts: A nursing home cannot evict for nonpayment while a third-party payor is considering a claim.

Problem #12: Eviction Because Medicare Payment Has Ended

• What you hear: “We are a short-term rehabilitation facility, and you need long-term chronic care.”
• The facts: A nursing home cannot limit itself to short-term, Medicare-funded residents.

Problem #13: Eviction to an Unsafe Setting

• What you hear: “You will be transferred to your daughter’s house.”
• The facts: “A nursing home must transfer the resident to a safe, appropriate setting.”

Problem #14: Eviction While Resident is Hospitalized

• What you hear: “We won’t take you back from the hospital.”
• The facts: A Medicaid-eligible resident has the right to return to the next available Medicaid-certified bed. A nursing home must allow the resident to return while waiting for an eviction hearing.

Problem #15: Refusal to Accept Medicaid

• What you hear: “You may be Medicaid-eligible now, but we don’t have a Medicaid bed for you.’”
• The facts: “A nursing home can certify additional beds for Medicaid payment.”

Problem #16: Refusal to Bill Medicare

• What you hear: “We have determined that you aren’t entitled to Medicare
  coverage because of your limited health care needs.”
• The facts: A resident can insist that a nursing home bill Medicare.

Problem #17: Refusal to Pay by Medicare Advantage Plan

• What you hear: “Your Medicare Advantage plan won’t pay because you need only custodial care.”
• The facts: Residents can appeal Medicare Advantage denials.

Problem #18: Losing Therapy for Supposed Failure to Make Progress

• What you hear: “We must discontinue therapy because you aren’t making progress.”
• The facts: Therapy often is appropriate even if a resident is not making measurable progress.

Problem #19: Losing Therapy After Medicare Payment Has Ended

• What you hear: “We can’t give you therapy because Medicare coverage has expired, and Medicaid doesn’t pay for therapy.”
• The facts: Therapy must be provided whenever ordered by a doctor, regardless of the resident’s source of payment.

Problem #20: Forced Transfer From ‘Medicare Bed’

• What you hear: “Because Medicare payment has stopped, you must move from this ‘Medicare bed.’”
• The facts: A ‘Medicare bed’ is not limited to Medicare-funded residents.

Problem #21: Imposing Visiting Hours on Families and Friends

• What you hear: “Your children can visit only during visiting hours.”
• The facts: Residents can accept visitors at any time of the day or night.

Problem #22: Refusal to Support Resident and Family Councils

• What you hear: “We have no available space in which residents or family members could meet.”
• The facts: A nursing home must provide meeting space for a resident or family council.

Problem #23: Forcing Family Members and Friends to Take on Financial Liability

• What you hear: “We can’t admit your mother until you sign the admission agreement as ‘responsible party.’”
• The facts: A nursing home cannot require anyone but the resident to be financially responsible for nursing home expenses.

Problem #24: Forcing Residents to Arbitrate Disputes

• What you hear: “Please sign this arbitration agreement. It’s no big deal. Arbitration allows disputes to be resolved easily and quickly.”
• The facts: There is no good reason for a resident during admission to commit to arbitration and a resident should never have to sign an arbitration agreement to be admitted.

Problem #25: Excessive Charges

• What you hear: “You must pay separately for services listed on the nursing home bill.”
• The facts: A nursing home can bill only for charges authorized in the admission agreement.

To review the full Justice in Aging guide published January 21, 2021, visit justiceinaging.org.