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Illinois nursing home settlement could have major impact

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A recent legal settlement regarding mentally ill nursing home residents in Illinois has the potential to transform the state's long-term system. It also likely will have a ripple effect on the field nationwide.

The agreement, which has been called a landmark decision, will give 4,500 mentally ill nursing home residents an opportunity to move out of institutions for mental diseases, also known as IMDs, and into smaller, community-based settings.

The agreement comes as the state is working to overhaul its long-term care system. It has created a task force that has offered 38 reform recommendations. Settling this lawsuit with the American Civil Liberties Union was seen as critical to revamping the system. 

Prompting the state to act was a series in the Chicago Tribune that reported on serious incidents of violence in eldercare in facilities housing younger mentally ill residents, including those who have committed felonies. (Some 10,000 other mentally ill residents reside in facilities not classified as IMD.)

While the settlement has garnered praise from advocates of the mentally ill, the reaction from the long-term care community that serves these residents in Illinois is more mixed (and understandably so).

The Alliance for Living represents residential care facilities dedicated to treating those with severe mental illness.

In a statement it said, “The main goal of the settlement is to provide housing choices for the mentally ill and in doing so, it is critical to be thoughtful of the timeline and processes put in place to achieve that goal.

“Illinois saw significant increases in homelessness, recidivism, and crime when it closed state mental health hospitals a number of years ago,” the alliance noted. “Real choice in residential housing for the seriously mentally ill means decisions are made jointly by the resident, their family and their doctors, not dictated by lawmakers.” 

Criticism of crackdown

Another long-term care association supports the settlement but has a problem with other recommendations the new Illinois task force has proposed. It believes that the state is coming down too hard on nursing homes in general.

Among other recommendations, the task force has suggested mandatory staffing levels and increasing fines for violations, as well as raising fees and the provider tax. Different provider groups are working with the state on the proposals.

“I think we're taking a broad brush stroke to a very specific problem,” said Kirk Riva, vice president of public policy for Life Services Network of Illinois, which represents nonprofit long-term care facilities that serve the geriatric population. (It does not represent nursing homes that serve the mentally ill.)

He believes the nursing home community in general is being punished for the problems of a few. Only two-dozen facilities in the state are considered IMD. That is only a fraction of the total long-term care community in the state.

The state should not levy increased fines and fees on nursing homes when the public health department already has the authority to regulate these facilities, he said. 

“I think we're overreaching here by creating all this, in my opinion, chaos, in all these other homes, when we know where these problems exist,” Riva said.

It sounds like a familiar tale—that story about a few bad apples tainting the rest of the barrel.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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