Recent news reports has shown that IDPH stopped investigating allegations in abuse and neglect during the period between approximately March 15 and June 30.
By way of background, the Illinois Department of Public Health is the agency which inspects nursing homes and issues citations for violations of state and federal regulations. When a nursing home has a citation issued to it, they must submit a plan of correction to show what they will do to bring the nursing home back into compliance. This often includes retraining of the staff or repair and inspection of broken equipment. The citations are usually accompanied by a fine which usually tops out at $25,000 for the most serious violations that result in significant injury or death to the resident. Citations may also result in issues with the nursing home’s license or with their Medicare star ratings.
The date that IDPH stopped doing the abuse investigations of course correlates with the onset of the coronavirus pandemic. There can be no doubt that the pandemic has hit the nursing home industry particularly hard, especially in terms of resident and staff illnesses and deaths, and has made a hard task even harder. However, the extra demands brought on by the pandemic does not mean that other care needs of the residents could not/should not be met.
(Related resource: IDPH Long Term Care Facility Outbreaks COVID-19 – searchable database you can use to find out which facilities have COVID-19 case, how many, and how many deaths)
One of the recommendations that we make to families with a loved one in a nursing home is to be a frequent, but unpredictable visitor. In other words, visit often, but not on a set schedule so that the staff always has to be on top of their game with your family member. For example, if the staff know that you always come Tuesday evening, you can be sure that things will look good Tuesday evening … which may be a different story from Friday morning. We also recommend that you be pleasant but assertive regarding your family member’s care. None of this has been possible as of late with restrictions on visitors in nursing homes.
Over the last several months, we have heard from a number of families who have been very upset about their limited access to their family members, and justifiably so.
Investigations of abuse and neglect in nursing homes are often triggered by mandatory reporting by the nursing home to IDPH after an incident occurring in the nursing home or by a report submitted by a hospital or doctor who was concerned about the condition of a nursing home resident who was sent out for care. While IDPH has been inspecting nursing homes for compliance with infection control measures, the inability of family members to get into the nursing home left IDPH as one of the last lines of defense when it comes to stopping nursing home abuse and neglect.
The pandemic has doubtless made many of the basic functions that need to be carried out on a day-to-day basis much more difficult and this has opened the door to many of the types of preventable injuries much more likely to occur. Without even trying to address this in an exhaustive way, these are some of the ways:
The need to observe proper infection control measures makes going in an out of rooms something that takes longer, which means that the simple act of turning and repositioning bed-bound and chair bound residents is going to be harder to get done. Further, that also feeds in to it taking longer to change a resident after an episode of incontinence. This also makes it more difficult to make sure that residents get adequate amounts of food and liquid.
Why is this important? Because immobility, incontinence, and poor nutritional status are three of the main factors which place residents at risk for developing bed sores and addressing these issues are key steps for promoting healing after someone has already developed a bed sore.
One of the main stays for fall prevention is to keep residents in a common area where they can be easily monitored by staff. One of the ways of preventing the spread of the coronavirus is to keep residents in their rooms which neutralizes the effectiveness of this tactic.
Promptly responding to call lights and assisting residents to the bathroom when they need it are also key fall prevention measures. Just as with turning and repositioning, this is a more difficult task in the current environment.
One of our core beliefs is that constant or intermittent confusion is a strong risk factor for nursing home falls because the resident cannot be counted on to make good decisions for their own safety or ask for help. The combination of lots of social isolation and the staff being masked and gowned constantly is something that is likely to lead to further cognitive decline.
Past that, residents have a diminished ability to walk and exercise which leads to further decline in range of motion, strength, and balance.
Residents are no longer being served meals in dining halls. This means that they are generally eating alone in their rooms which means that residents who are experiencing declines in their ability to swallow are not being noticed and referred for swallow evaluations by speech therapy. Other residents who are already under care plans for choking risk are likely receiving lower levels of assistance and supervision with meals.
One of IDPH’s roles is to prevent nursing home residents from suffering unnecessary injuries, illnesses, and wrongful deaths, and with families unable to watch out for and advocate for their loved ones, carrying out that responsibility was more important than ever. Supposedly, IDPH has made a dent in the backlog of investigations that piled up while they stopped doing investigations, but the passage of time and the press of business makes it every more likely that those investigations will not be as thorough as they should be.
Unfortunately, failure was already baked into the system by which care was being provided in nursing homes in Illinois. For more information on why that is the case, order our FREE report, Built to Fail. If you have a loved one who you believe has suffered unnecessary injuries or been the victim of nursing home neglect or abuse during this time, please contact our experienced Chicago nursing home lawyers. The initial call and meeting are free, and there is no obligation to hire us if you do call. We serve nursing home residents and their families throughout the State of Illinois.