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.

Each state inspects its nursing homes to make sure they comply with state and local laws. In Illinois, each home is inspected, on average, once a year. But once the inspection is made, what happens to the results? One thing we know, they are not sent automatically to the residents or the families of residents at a home.

MemberoftheFamily.net puts it this way: "Federal Regulations do not require State inspectors or the nursing home to notify patients and their families that a particular patient's care has been the subject of a survey violation. Even a finding of substandard care or actual harm does not require notification."

Illinois law doesn't require such notification, either.

Here's part of what the Illinois Department of Public Health says about the inspection process: "The Illinois Department of Public Health is responsible for ensuring nursing homes comply fully with mandatory state regulations. (U)nder a cooperative agreement with U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS), (IDPH) is also responsible for ensuring that facilities accepting Medicare and Medicaid payment for services rendered to program beneficiaries meet federal regulations and certification rules. Each year, (IDPH) conducts approximately 1,300 full, on-site licensure inspections of nursing homes and responds to approximately 6,000 complaints."

By the way, if you want to file a complaint about an Illinois nursing home, you can call the IDPH toll-free hotline at 1-800-252-4343.

IDPH notes that licensure inspections evaluate the fitness and adequacy of a nursing home, its equipment, staff, policies, procedures and finances. Illinois has some 200 surveyors employed in teams that each consist of a registered nurse, a nutritionist and an environmental health practitioner. These experts may be joined by life safety code experts and other professionals.

Complaint surveys are conducted by experts in the areas involved in charges lodged.

IDPH notes, "Illinois' licensure surveys are generally conducted on-site over a three- to four-day period during which the ... teams evaluate all aspects of resident care and nursing home procedures and practices, assessing facility compliance with more than 1,500 specific state and federal standards. (Some areas of care reviewed include resident rights, access to care, activities, assessment and care plans, health care and dietary services, housekeeping, staffing, quality of care and quality assurance.)

"The Department's evaluation may include an inspection of medical records, observation of resident care, inspection of all areas of the nursing home and interviews of residents, family members, staff or other individuals. (IDPH) also may (analyze) statistical data reported by nursing homes or (review) reportable event information or other notices filed with IDPH. Reportable events include administrator or director of nursing personnel changes; interruptions of three or more hours of services essential to the health and safety of residents; alleged or suspected crimes investigated at the facility by police; and all fires, disasters, deaths or other risks to resident life or health resulting form accidents or incidents at the facility. ...

"Nursing homes are inspected at least once every six to 15 months. The state average is once every 12 months."

Facilities are not told in advance about inspections.

IDPH shares its findings with nursing home administrative staff in an exit interview at the end of each inspection. The findings are also included in a survey report sent to the facility. If IDPH finds the nursing home failed to comply with licensure standards, it is cited for deficiencies, which it has to correct.

So, information is available but, since the home where our loved one may be staying isn't required to let you or the patient know about inspection results, we have to act to keep up with what's going on. Find out the home's policy on releasing reports. Talk to your loved one's doctor and to the person in charge of the home. If you don't get a satisfactory answer, an attorney can help.

Information on reports and a home's status are important. You have to know what you're dealing with to make sure a nursing home is giving proper care. You should be able to get inspection reports and the nursing home's response from the home or IDPH. You can ask IDPH for an inspection file by writing the Illinois Department of Public Health Freedom of Information Officer at 535 W. Jefferson St. Springfield, IL 62761 (Attn: Division of Communications)

In addition, federal inspection surveys are at www.medicare.gov/NHCompare/home.asp.

Michael Kosner, President
The Kosner Firm Chtd.