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national health disparity month

April Is National Health Disparities Month

The National Institutes of Health (NIH) estimates nearly two-thirds of individuals who rely on federal and state funding to support their healthcare and long-term care services have multiple chronic conditions. Most of these conditions impact specific racial and ethnic minority communities who have disproportionately been supported with the appropriate diagnosis and treatment needed to thrive. As April marks an opportunity to call attention to these issues under National Health Disparities Month, it’s an important time to start discussion about the significant problems we have in the United States and right here in Illinois, in relation to at-risk populations who receive Medicare or Medical Assistance to treat chronic diseases. These groups are currently battling greater morbidity, mortality, and disability rates as a result of their long-term care coverage.

According to Centers for Medicare & Medicaid Services (CMS), Medicare and Medical Assistance (Illinois’ name for Medicaid) populations that experience disproportionately high burdens of disease are provided worse quality of care, and barriers to accessing long-term care than others. CMS officials say, “these populations include racial and ethnic minorities, sexual and gender minorities, persons with disabilities, as well as individuals living in rural areas.”

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Many executive level nursing home employees are seeing higher paychecks than in years past. According to the 40th annual Nursing Home Salary & Benefits Report, nursing home administrator salaries went up nearly 3% between 2016 to 2017. According to salary.com, the average nursing home administrator salary in Chicago is $116,515, more than the study’s reported national average of $97,401. Nursing home executive directors and directors of nursing are also faring well. Executive director average salaries went up 2.46%, from $127,262 in 2016 to $130,389 in 2017, while directors of nursing saw a 2.64% jump (from $89,092 to $91,444 in 2017).

Executives Thriving While CNAs Barely Getting By

The survey only serves to highlight the disparity in pay between executive level employees and those who actually engage in day-to-day care of elderly nursing home residents. A 2016 study reported that 1/3 of CNAs are receiving public assistance, with close to half of them living far below the poverty level. When the American Health Care Association was asked to respond, they blamed the high number of nursing home residents on Medicaid and the program’s notoriously low reimbursement rate. However, not being able to pay CNAs a living wage due to Medicaid reimbursement rates has obviously not affected facilities’ ability to pay top level executives.

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Our state has already had its hand slapped over delayed Medicaid payments and history has just repeated itself. Earlier this month, a judge ruled that Illinois was responsible for delinquent Medicaid application approvals and is allowing seniors who faced delays to sue the state. Seniors who applied for Medicaid after February 1, 2015, who were eligible for the program according to state requirements, and whose care was denied or hindered as a result of a delayed final eligibility determination can pursue action. According to the Centers for Medicare & Medicaid Services (CMS), states have 45 days to process and respond to a Medicaid application. Illinois has 90 days to process Medicaid applications that involve a disability. Many seniors have reported facing delays far greater than 45 days, even after submitting all necessary paperwork.

As a result of delayed approvals, nursing homes have had to discharge current residents and turn away potential residents. Seniors have also reported not being able to receive the care they need, missing out on crucial healthcare, drugs, and services.

Illinois: A Repeat Medicaid Offender

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Dementia is one of the most frequent diagnoses among nursing home residents. The Alzheimer’s Association reports that more than 50% of those in nursing homes or assisted living facilities have some form of the disease.

Despite its prevalence, dementia is a frequently misunderstood illness, even by those who care for elders on a daily basis. One of the most common misconceptions is that all behaviors associated with dementia or cognitive impairment are symptoms of the disease itself. Years of research has led experts to conclude that many vocal and physical expressions are not actually behaviors, but are cues that those suffering from dementia are unable to clearly express.


Distress Signals Mistakenly Believed to Be Dementia-Related Behaviors

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Understaffing

Nursing Homes with Serious Deficiencies Are Often Poorly Staffed

An analysis of data from Medicare’s Nursing Home Compare website concluded that nurses and support care staff such as nursing assistants and aides are grossly understaffed at some of the most troubled homes in Illinois. This proves something the nursing home abuse and neglect attorneys of Levin & Perconti know all too well. Understaffed care facilities put unnecessary pressures on employees that often lead to mistakes, injuries, and deaths of nursing home residents in their charge. And although we hear of changes in administrative staff, and fines aimed to tighten and clarify procedures as a solution to the issue, many of these poor performing homes continue to receive their funding, remain understaffed and contribute to more cases of nursing home abuse and neglect than facilities that are equipped to provide sufficient care and services.

The Factors Behind Understaffing

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A widow who is a resident of St. Anthony’s Nursing and Rehabilitation Center in Rock Island is suing the nursing home and two former employees for forcing her to sell her home and giving her only $2,000 from the sale. In addition to the civil suit, the Illinois Department of Public Health (IDPH) has fined the nursing home $2,000 for having a hand in financial abuse of an elder. The Rock Island County state’s attorney is also currently investigating the incident to determine if they will proceed with criminal charges.

Husband of St. Anthony’s Employee Bought Widow’s Home

The facts do not appear to be in the nursing home’s favor. Colleen Allen, a widow who was admitted to St. Anthony’s with congestive heart failure and bipolar disorder, says she was told she had to sell her home to keep her Medicaid benefits. She reluctantly consented and was given $2,000 from the sale in April 2016.

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People are always shocked to hear that nursing homes, responsible for the care and safety of 1.3 million Americans, are not always required to carry liability insurance. When a loved is injured as a result of negligence or abusive actions on the part of nursing home staff, a lack of insurance often deters them from pursuing a lawsuit, even when the injuries result in death.


Expensive Policies Deter Nursing Homes Focused on Financial Bottom Line

In Illinois, there is no law requiring a facility to carry nursing home liability insurance. Among other factors, insurance rates are based off of Centers for Medicare & Medicaid Services (CMS) inspection reports, specifically in areas relating to neglect.

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This week, a Cook County judge upheld a $4.1 million verdict that found Assisi at Clare Oaks in Bartlett liable for a stroke that ultimately contributed to the death of Dolores Trendel. Levin & Perconti served as attorneys for the family of Ms. Trendel, securing the record-setting verdict under the Nursing Home Care Act after a jury trial in July 2017.

Just this week, the nursing home attempted to overturn the verdict and was denied.  Instead, a Cook County circuit court judge ordered the nursing home to pay an additional $147,000 directly to the family, as well as $1.3 million in attorney’s fees. The combined amount added to the initial verdict makes the total awarded to the family $5.6 million.

Instead of Increased Dosage, Staff Stopped Medication 

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For-profit nursing homes are more frequently outsourcing business via sister companies operated by the same owner. But a recent Kaiser Health News (KHN) analysis of federal inspection and quality records reveals that, “Nursing homes that outsource to related organizations tend to have significant shortcomings: They have fewer nurses and aides per patient, they have higher rates of patient injuries and unsafe practices, and they are the subject of complaints almost twice as often as independent homes.” In addition, KHN found these like issues at other homes with similar corporate structures:

  • Homes that did business with sister companies employed, on average, 8 percent fewer nurses and aides.
  • As a group, these homes were 9 percent more likely to have hurt residents or put them in immediate jeopardy of harm, and amassed 53 validated complaints for every 1,000 beds, compared with the 32 per 1,000 that inspectors found credible at independent homes.
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It’s nice to hear medical malpractice claims have seen a 56 percent drop in the United States since 1992. That is what a March 27, 2018 report published by JAMA Internal Medicine has showed. Although, study authors also found that the most common medical malpractice claims still stem from diagnostic errors or missed diagnoses and that keeps the nursing home neglect attorneys at Levin & Perconti cautiously concerned. Our team hears of major medical errors happening all too frequently, especially to those who receive their care while in a nursing home or long-term care facility.

How To Identify Misdiagnosis or Failure to Diagnose

 
Since most nursing homes do not employ doctors, a large percentage of nursing home residents will still receive their care from family practice physicians, therapists, visiting doctors, and other medical specialists not affiliated with the nursing home. These clinicians, even medical specialists such as cardiologists and neurologists, may take visits to the nursing home at the request of nursing home patients and their family members. However, just like in a clinic or hospital setting, these medical professionals can fail to notice obvious signs of illness, or neglect to diagnose a condition. Nursing home staff can also contribute to the problem as some care workers have been directed by administrators to falsify reports of ongoing resident health issues and create medication errors..