New Illinois bill would boost punishment for understaffed nursing homes to limit deadly sepsis infections and boost care

March 06-- Mar. 6--A state lawmaker and a major advocacy group are pushing stiffer penalties for short-staffed nursing homes as a way to limit deadly sepsis infections and boost overall care.

"You would think that anytime you put your loved one in a nursing home, the care would be there, because it's supposed to be regulated, but we find that's not the case," said state Sen. Jacqueline Collins, D-Chicago, who introduced reform legislation this week.

Collins and AARP Illinois are supporting the legislation partly in response to the findings of an investigation published in September by Kaiser Health News and the Chicago Tribune. The investigation found that about 6,000 Illinois nursing home patients a year who were hospitalized had sepsis, with roughly 1 in 5 dying.

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 low staffing to monitor everything from falls to bedsores and infections that can develop into sepsis, putting a patient's life in danger.

The investigation found staffing levels for nurses and aides in Illinois nursing homes were among the lowest in the country. In the six-county Chicago area, 78 percent of the facilities' staffing levels fell below the national average.

There is little agreement on how many caregivers should be employed by nursing homes, nor any federal regulations setting a rate per-resident. A recommendation from a 2001 federal study suggested 4.1 hours of total nursing time per resident.

Illinois, like most states, has a lower legal standard: requiring at least 2.5 hours of direct care daily for residents. Yet, the joint KHN Tribune investigation found that at least a fourth of Chicago-area nursing home residents live in facilities that aren't consistently providing that much care.

Collins' bill wouldn't change that standard. But it would require state regulators to obtain detailed Medicaid payroll data submitted by each facility, along with each facility's own data, and then calculate each quarter if the homes met that standard. It is similar to how the KHN Tribune investigation studied staffing.

Those homes that failed would be fined at least twice the money saved by not staffing properly. Plus those homes would have to post at all doorways a notice alerting the public that, in the previous quarter, the homes had failed to provide proper staffing.

The bill also would make it harder for homes to administer psychotropic medicine to residents without their consent or that of their families. Collins said she believes the issues are connected, with understaffed homes turning to these powerful drugs to sedate residents instead of properly caring for them.

AARP Illinois' associate state director, Lori Hendren, told the Tribune that her group has increasingly received complaints across the state of horror stories of people struggling with inadequate care in understaffed homes.

"People are living these stories, and we recognize that enforcement of the minimum standards of staffing is a step in the right direction," Hendren said.

Shantonia Jackson said she knows first-hand the struggles with staffing. As a certified nursing assistant, she said she's had shifts in nursing homes where she's been responsible for 15 Alzheimer's patients at a time.

"I'm not giving them proper care that I need to give. ... I can't do that if I have 15 residents at one time," she said at a Wednesday news conference to promote the legislation.

Jackson said understaffed homes too often push the use of drugs in place of proper attention.

The Illinois Health Care Association, which represents more than 500 nursing homes, did not immediately respond to a request for comment on the proposed legislation. It 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.

jmahr@chicagotribune.com

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