On July 29, 2010, Gov. Pat Quinn (D-Illinois) signed the Illinois Nursing Home Safety Act (SB 326) (Public Act 96-1372) (the Act) into law. The Act, which immediately became effective, is aimed at reforming the state’s nursing home industry and represents the most significant set of reforms to the Illinois Nursing Home Care Act since it was enacted in 1979. The Act implements new restrictions on nursing homes that serve geriatric populations as well as residents who are mentally ill or who have certain criminal backgrounds. It also imposes new requirements on nursing homes, such as minimum staff-to-patient ratios, new certifications and additional fees, and generally increases the level of scrutiny nursing homes face from state survey teams. As a result, long-term care providers need to understand the Act’s new requirements and begin actively implementing revisions to policies and procedures.
The Act is the final result of initiatives recommended by the Nursing Home Safety Task Force (Task Force) created by Gov. Quinn in October 2009. The Task Force, which was led by a senior official from the governor’s office and included top officials from six state agencies, union leaders, nursing home representatives and patient advocacy groups, was formed in response to a series of stories in the Chicago Tribune highlighting various safety problems associated with mixing geriatric and mentally ill nursing home populations as well as problems with nursing home residents who have violent criminal histories.
The key provisions of the Act, which was subject to several months of negotiations by various stakeholders, include:
- Mandatory increases in nursing home staffing over the next four years. By Jan. 1, 2014, all facilities will need to provide 3.8 hours of direct care staffing for every skilled care resident and 2.5 hours of direct care staffing for intermediate residents. As of July 1, 2010, all facilities need to provide 2.5 hours of direct care staffing for every skilled care resident and 1.7 hours of direct care staffing for intermediate care residents.
- Mandatory certification of nursing homes serving persons with serious mental illness. By Jan. 1, 2011, the Illinois Department of Public Health (IDPH) must propose regulations to establish two new certifications: (i) certifying nursing homes serving residents with serious mental illness (SMI) and (ii) certifying separate behavior management units for high-risk residents.
- Increased survey personnel. IDPH presently employs one nursing home surveyor for every 600 nursing home beds. Beginning July 1, 2011, IDPH was required to employ one nursing home surveyor for every 500 beds. The Act mandates a further reduction to one surveyor for every 400 beds by 2012 and one surveyor for every 300 beds by 2013. The cost of increased staffing will be funded, at least partially, by increasing the cost of nursing home licensing fees.
- Higher licensing fees. Nursing home licensing fees will increase from the current $995 per year up to $1,990 per year.
- Increased sanctions and fines. The Act also gives IDPH authority to impose enhanced sanctions and fines. For example, the Act creates a new Type AA violation for any “condition or occurrence relating to the operation and maintenance of a facility that proximately caused a resident’s death,” which requires a mandatory conditional license for six months and a fine up to $25,000 per occurrence. Type A violations are also expanded in scope and related fines have been increased to $12,500 per violation. A new Type C violation is also created for facilities having 10 or more such violations in a single survey, with a fine of $250 per violation.
- Improved screening. Prior to admission, nursing homes are required to implement enhanced patient pre-screening procedures and background checks to identify potentially dangerous individuals and to discover any persons who have outstanding arrest warrants.
This client alert is intended to inform nursing home providers about the Act and certain key operational changes at the facility level and perhaps at the corporate level as well. Please contact one of the authors if you have questions regarding the information contained in this alert or if we may assist you in implementing policies and procedures necessary to comply with the Act.