Chicago Nursing Home Abuse Attorney Blog

It happens even at the best of Illinois' nursing homes: misuse of drugs used to treat mental illness. At least that's what reporters from the Chicago Tribune have found.

Looking back through regulatory records from the last eight years, Trib reporters found that half of homes rated four or five stars by the federal government have been cited for situations involving psychotropic drugs - medications that change the way people's brains work. And some of the violations involved injury and death.

This emphasizes how hard it is for potential nursing home residents and their families to evaluate their options; problems are everywhere.

Among the citations the Tribune reported was one in 2003 of Lake Forest Place, a five-star facility, for improperly using or monitoring psychotropic drugs given to six residents. One 95-year-old was given an antipsychotic drug though he had no psychotic symptoms. Three other residents reportedly received psychotropic drugs without justification or consent - and at least one man was given such a medication and sleeping pills in larger than recommended amounts. Inspectors wrote that his private caretaker after one such dosing tried to wake him and couldn't.

Hickory Nursing Pavilion, another five-star home, was cited because a resident had her dosage of a psychotropic doubled after she complained about people smoking on the bus taking her to an outside program. The Tribune said she told inspectors, "The doctor came to see me for one minute, then left. Next thing I know, he was increasing my medication."

Staffs ignorant of the dangers of these drugs were also reported. The paper said nurses at a four-star home near Peoria were unaware of a test that can check residents for tics and tremors, and staff at another four-star facility, a few miles away, knew of the test but not how to give it.

Deaths involving psychotropics included a woman who died at the four-star Wauconda HealthCare and Rehabilitation Centre after having trouble breathing for three hours after being given an anti-anxiety drug. While it was a regular medication for her, the staff failed to recognize the severity of her reaction that day.

Then there was a man on multiple psychotropics at the four-star P.A. Peterson Center for Health in Rockford. He became lethargic and then, when staff withheld the drugs for several days without informing the patient's doctor, he worsened and died. The report said the doctor, after learning the drugs were stopped, said they couldn't do that without throwing a patient into withdrawal. Cited, the facility unsuccessfully appealed and then agreed to train staff and change policies about contacting doctors.

The facilities, which retain top ratings, all explained that things happen.

However, the lesson is that when we choose a home, we need to consider a wide range of things. Though the star ratings of the moment may be accurate, it's worth looking further back and asking questions. If nothing else, it will tell the nursing home you're watching.

Michael Kosner, President
The Kosner Firm Chtd.

A public meeting earlier this week took a hard look at the practice of putting younger adults with mental illnesses in Illinois nursing homes. Members of Gov. Pat Quinn's Nursing Home Task Force spent four hours listening to social workers, nursing home residents and advocates demanding that the practice stop. These undesirable residents allegedly include felons who police say assaulted, raped and even killed elderly and disabled housemates.

"A nursing home is not the place to test the rehabilitation of violent offenders. It is not the place to see if the fox can live peacefully in the henhouse," said Jamie Jimenez, an advocate with the Community Counseling Centers of Chicago, quoted in an article in the Chicago Tribune.
As well they should be, the governor's representatives were also upset by the violence in the state's facilities. "We have a situation that is not acceptable to us," said task force chairman Michael Gelder, Quinn's senior health policy adviser. He described the hearing as "a call for action," that call coming in the form of questions about, and criticism of, Illinois' long-term pattern of putting criminals with mental illness with the elderly and disabled. The shuffling of younger residents into nursing homes from jails, shelters and psychiatric facilities has put a definite strain on that industry and fails both the psychaitric patients and other nursing home patients.

"We are in crisis now," said Phyllis Mitzen, co-director of the Center for Long-Term Care Reform. "We find ourselves ... with a need to change the entire long-term care system."

Mark Heyrman, a board member of Mental Health America of Illinois, noted that psychiatric patients often receive substandard treatment in nursing homes and could be more cheaply and effectively housed in community mental health centers and assisted living arrangements. "Our long-term plan has to be to stop institutionalizing people in nursing homes who are only there because of a mental illness," he said.

The Tribune says Illinois nursing homes currently house about 15,000 people whose primary diagnosis is a mental illness, and one speaker estimated two-thirds of them could be in less institutional settings within five years if the state budgets for community rather than institutional care. Anthony Zipple of Thresholds mental health centers said Illinois has two pilot programs, though small ones "relative to need," that seek to move hundreds of mentally ill people out of nursing homes.

State law requires criminal background checks (and assessments of risk to other residents if felonies are found) of all incoming nursing home residents. However, a Tribune investigation said those screenings were inaccurate and often took longer than a year.

Other speakers called the current process farcical, and noted that nursing homes don't always report crimes that take place to the police. Moreover, police reports are generally not shared with state inspectors. They called for closer cooperation between the state and local law enforcement and prompt removal of licenses from homes with continuing patient-safety issues.

The task force will hold its next meeting next week (Oct. 29) in Springfield. We can only hope the state moves quickly to correct the kinds of conditions that led another speaker at last week's meeting to report he had been stabbed by the same person in two different nursing homes. In the meantime, be ready to question a home's policies in this area (Who do you let in?). It can keep your loved ones safer.

And if you have comments or recommendations, check out the task force's web site.

Michael Kosner, President
The Kosner Firm Chtd.