Forty percent more Black and Hispanic residents of Illinois nursing homes died from COVID-19 than would be expected, in part because they were more likely than whites to be living in three- and four-person rooms.
That statistic on preventable deaths related to overcrowding, as well as other numbers described as “tragic” and “a call to action” by advocates for nursing home residents, were presented to two Illinois House committees Wednesday by officials from the Illinois Department of Healthcare and Family Services.
The HFS analysis of COVID-19-related deaths between March 2020 and July 2020 — the first wave of the pandemic — provided the first in-depth look at racial and ethnic disparities surrounding the way nursing home residents are housed.
The report said Medicaid patients in nursing homes, and especially Black and Hispanic patients, were “far more likely” to live in a three- or four-person room, live in an understaffed facility and have contracted COVID-19.
“Inadequate staffing and overcrowding undermine basic infection-control procedures,” the report said.
Nursing home owners have complained for years that Illinois’ Medicaid rates, among the lowest in the country, lead to understaffing. But the HFS report said data show that many nursing home owners with a high percentage of residents on Medicaid “are profiting while relying on low staffing and room crowding.”
The numbers portray “a very sobering demonstration of inequities,” Andy Allison, HFS’ deputy director for strategic planning and analytics, told lawmakers.
HFS Director Theresa Eagleson said the COVID-19 pandemic has “laid bare” inequities in care that must be addressed.
She said the department, part of the administration of Gov. JB Pritzker, is working on a proposed change in the Medicaid rate structure that will need legislative approval and will more closely tie enhanced rates to higher staffing levels and good performance.
The proposal involves nursing homes paying an additional “bed tax” to the state that the state, in turn, would use to receive a higher federal match through the Medicaid program. The increase would bring in about $300 million more to improve care, according to HFS.
Healthcare and Family Services hopes to give incentives for nursing homes to move away from multi-person rooms, which can allow COVID-19 to spread through a nursing home more easily and which make it more difficult to provide good care overall, Eagleson said.
The HFS report said nursing homes in which low-income residents on Medicaid make up a greater share of all residents “earn owners the highest net income.” The report added that “lower-staffed facilities earn their owners more than better-staffed facilities.”
State Rep. Deb Conroy, D-Villa Park, said it’s embarrassing that it took a pandemic for lawmakers and the rest of state government to become more focused on fixing inequities.
“We have a lot of work to do,” she said.
State Rep. Anna Moeller, D-Elgin, said during the almost four-hour hearing that the nursing home industry is “ripe for reform.”
And Rep. Lakesia Collins, D-Chicago, a former certified nursing assistant in nursing homes, said the understaffing issues aren’t new but have been magnified by the pandemic.
Collins said any rate reform must have safeguards to prevent homes from falsifying records to justify higher rates.
“With this industry, in particular, it’s about profits over people,” she said.
Donna Ginther, a senior adviser to the Health Care Council of Illinois, a nursing home advocacy group, didn’t dispute the report’s findings, but she advocated for a simpler approach to boost Medicaid rates than what HFS officials proposed.
She said nursing homes are willing to increase what they pay in assessments to help the state secure more federal Medicaid matching dollars.
Ginther said Eagleson’s proposal, which would boost rates after nursing homes have demonstrated higher staffing levels, would be complicated by the difficulty for many nursing homes short on cash to hire more staff.
And Ginther said the state needs to help nursing homes afford to reduce the number of patients in rooms. “We have to make sure there is enough money there for the care of the resident in the bed,” she said.
Matt Hartman, executive director of the Illinois Health Care Association, another nursing home advocacy group, said information in the HFS report was “pretty compelling.” He said his association is willing to work with HFS on a payment structure that holds facilities more accountable.
“You can’t continue with the status quo,” he said.
Hartman said three- and four-person rooms are more common in the Chicago area but do exist in nursing homes in central Illinois and the rest of downstate.
There are about 45,000 Medicaid patients in the 1,000 nursing homes statewide, and the state spends billions of dollars every year on their care.
There have been almost 78,000 cases of COVID-19 and 10,460 COVID-19-related deaths among long-term care residents since the pandemic began in March 2020, according to the Illinois Department of Public Health.
At one point, more than half of all COVID-19 deaths involved long-term care residents, but that percentage has dropped significantly as residents have received the COVID-19 vaccine.
In the first five months of the pandemic, 60% of deaths of Medicaid patients in Illinois nursing homes occurred in facilities where at least 10% of residents were in rooms with three or more people, the HFS report said.
The analysis showed that the racial disparities in deaths were almost solely related to more Black and Hispanic patients living in three- and four-person rooms and their nursing homes sitting in ZIP codes with higher COVID-19 infection rates.
The report noted that the General Assembly boosted funding for nursing homes three times in recent years, and yet saw little to no improvement in staffing levels. That included $70 million appropriated in 2019 to help nursing homes meet minimum staffing requirements.
Lori Hendren, AARP Illinois’ associate state director of advocacy and outreach, said the report provided “heartbreaking” insight into inequities that need to be dealt with now and after the pandemic.
In particular, she said one of the report’s findings — that before the pandemic, 10,000 Medicaid patients in nursing homes were living with three or more other people in their room — was disturbing.
“Is this how we care for people as they age?” she asked.
House committee members also heard complaints from advocates of nursing home residents and residents themselves that many facilities continue with severe restrictions on visiting despite guidance from state and federal officials allowing for a relaxation of such policies.
“We can’t have any more deaths from isolation,” said Carrie Leljedal, spokeswoman for Illinois Caregivers for Compromise. “After the pandemic, we will find more deaths from abuse, neglect and isolation than COVID.”
Senate Bill 2137 is designed to reduce social isolation in nursing homes and require facilities, in certain circumstances, to provide technology to enhance communication with relatives. The bill is pending in the Senate.
Contact Dean Olsen: email@example.com; (217) 836-1068; twitter.com/DeanOlsenSJR.
via The State Journal-Register
April 28, 2021 at 07:26PM