Illinois' nursing homes would face significant penalties for short-staffing -- and loved ones could more easily learn about it -- under legislation passed by state lawmakers over the weekend.
The legislation mandates fines for nursing homes that don't meet minimum staffing requirements already set out in Illinois law. The push for fines was prompted in part by a 2018 investigation by Kaiser Health News and the Tribune on the proliferation of deadly sepsis infections.
Sepsis is a bloodstream infection that can develop in bedridden patients with pneumonia, urinary tract infections and other conditions, such as pressure sores. Regulators and patient advocates blame much of the problem on lack of sufficient staffing to monitor everything from falls to bedsores and infections that can develop into sepsis, putting a patient's life in danger.
Among those pushing for the legislation were AARP Illinois and the union that represents many nursing home workers, SEIU Healthcare Illinois.
In a statement, the union's president, Greg Kelley, called the step "nothing short of historic" for workers who should not be "constantly overburdened, exhausted, and stressed trying to care for sometimes up to 30 or 40 residents, if not more, at a single time."
The Illinois Health Care Association, which represents more than 500 nursing homes, did not oppose the legislation after helping negotiate its wording, said Matt Hartman, the group's executive director.
"We believe centers that understaff should absolutely be fined and cited for their failure to staff appropriately, and this bill moves to do that more aggressively," Hartman said in an email.
The measures were originally pushed in a stand-alone bill sponsored by state Sen. Jacqueline Collins, D-Chicago, but later tucked into the massive budget bill that lawmakers passed Sunday. The governor has said he intends to sign it.
Staffing levels for nurses and aides in Illinois nursing homes were among the lowest in the country, according to the joint KHN-Tribune investigation.
Illinois requires at least 2.5 hours of direct care daily for residents. Yet, the investigation found that at least a fourth of Chicago-area nursing home residents live in facilities that aren't consistently providing that much care.
The legislation will require state regulators to obtain detailed Medicaid payroll data submitted by each facility, along with each facility's own patient data, and then calculate each quarter whether the home met the care standard. It is similar to the way the KHN-Tribune investigation studied staffing.
Regulators must prepare the new rules by January and must begin issuing fines to violators by 2021. Those fines could climb to as high as double the amount saved by not staffing properly.
Under the legislation, violators have to advertise any state staffing violations on their websites, in their main lobbies, at their registration desks and at every public entryway to the facility.
The bill also would make it harder for homes to administer psychotropic medicine to residents without their consent or that of their families. Advocates have said they believe the issues are connected because understaffed homes can turn to these powerful drugs to sedate residents instead of properly caring for them.
"We know that happens a lot of times when there's not enough staffing," said AARP Illinois' associate state director, Lori Hendren.
The nursing home lobby has previously acknowledged low staffing is a problem but blamed the state's low Medicaid payment rates, which make up the bulk of homes' revenue.
To help homes reach the minimum staffing rates, the legislation passed over the weekend boosts Medicaid funding for homes by up to $240 million -- $70 million of which is set up specifically to help facilities address staffing needs.
Hartman said the extra money will be helpful, although he noted the industry "will still face the fact that there is a nursing shortage which needs to be addressed."
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