In the state of Illinois, nursing homes are “licensed, regulated, inspected and/or certified” largely by the Illinois Department of Public Health (IDPH) in enforcing the state’s Nursing Home Care Act. The U.S. Department of Health and Human Services (HHS) also has certain federal regulatory functions over nursing homes, specifically through the Centers for Medicare and Medicaid Services (CMS). Federal oversight kicks in where nursing homes accept money from Medicare and/or Medicaid, which are federally funded programs. By accepting federal funds, the nursing homes open themselves to federal jurisdiction under HHS. While federal and state jurisdiction and administration of laws and regulations differ, they do also overlap, and nursing homes can be subject to charges and sanctions by both governments. The IDPH also has a deal with the Centers for Medicare and Medicaid Services whereby the state agency also enforces federal rules and regulations for state nursing homes that accept Medicare or Medicaid dollars from the federal government.
Illinois Department of Public Health
The IDPH obviously enforces state laws and regulations regarding nursing homes. According to its website, IDPH makes about 1,300 license inspections each year, and deals with around 6,000 nursing home complaints on an annual basis. The Department conducts as many as 10,000 surveys of nursing homes statewide (including the aforementioned inspections). Inspection of a nursing home occurs at least once every 6-15 months, and typically occurs on average once per year (12 months), sometimes as a scheduled inspection and sometimes in response to a filed complaint. In either event, the nursing home is never aware of when the inspection is coming, which ideally keeps them honest so they don’t try to mask any problems for the one day that IDPH officials show up. Inspectors also mix up the schedule each year so nursing homes can’t easily predict when they can expect another visit. Also, nursing homes with more complaints or consistently poor surveys will naturally be subject to more frequent inspection visits.
Given that Illinois has around 1,200 long-term care facilities and at least 100,000 patient residents in those facilities, it is important to conduct regular inspections statewide and to take complaints seriously, which the department does. Regarding more immediate attention, IDPH employs a 24-hour hotline for complaints, receiving almost 19,000 calls each year.
Survey and inspection teams also mean serious business, as these teams typically include a registered nurse and nutritionist, as well as an environmental health official as well as sometimes experts on safety codes. These teams will look to ensure that residents gets proper rights, such as access to adequate medical care and proper nutrition, and to verify that no neglect or abuse goes on. They assess adequacy of the staff as well as cleanliness of the facility.
IDPH will often give nursing homes the chance to fix certain deficiencies or problems without penalty. Where deficiencies are more severe or serious, however, the Department will assert financial fines and penalties against an offending nursing home. It can also remove a nursing home’s manager or suspend or revoke a license to operate, among other actions. This can be done in response to violations of state regulations as well as federal ones where authorized by law. It can also refer a nursing home to CMS, if it receives federal dollars, for additional sanctions that could include suspension or revocation of a Medicare or Medicaid certification, as well as fines and penalties.
Recently IDPH released its Quarterly Report for January – March 2014. This report details how certain nursing homes were sanctioned for failing to follow regulations.
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