Top 5 Ways Seniors Are Injured or Abused in Illinois Nursing Homes and What You Can Do About It

In 1987, the federal government implemented sweeping regulatory protections for American seniors living in nursing homes. The “1987 Nursing Home Reform Act” was passed into law that year as part of the Omnibus Budget Reconciliation Act of 1987, which created a wide range of new laws. Among the changes were rules that states now had to live by when providing long-term skilled nursing care for older Americans. These new rules came at a time when Americans had reached a real tipping point for elder abuse and neglect. In 1987, there were nationwide reports of deplorable nursing care in skilled nursing facilities all across the country. This legislation created a “Resident Bill of Rights” and, as explained by AARP, required that nursing homes provide for the “highest practicable” levels of “physical, mental, and psycho-social well-being.”  So, almost 35 years later, the poor quality of care being provided to many seniors should be absolutely infuriating to all who are paying attention.

After years of litigation and investigation into nursing homes nationwide, some trends can be identified. While there are plenty of ways that nursing homes can violate patients’ rights, Illinois nursing home abuse lawyers tend to see the same types of injuries and abuses over and over. In particular, these can essentially be distilled down to five specific ways that seniors are injured or abused in Illinois nursing homes. And while this is tragic and unacceptable, the good news is family members do have options for protecting their loved ones and enforcing their rights.

No. 1 – Poor Staffing

Almost all of the abuse and neglect that goes on in nursing homes happens due to a confluence of reasons, not the least of which is poor staffing. Under Illinois’ guidelines, there are strict rules for the ratio of residents to nursing staff. Much the way that a state regulates licensed day cares with staffing ratios designed to protect children, nursing home rules are there to make sure there are enough hands on deck, so to speak, to keep everyone safe. When staffing levels drop to dangerous levels, bad things tend to happen. Here are some key provisions taken directly from the Illinois Administrative Code, which relate to staffing levels:

AT LEAST 25% OF ALL NURSING AND PERSONAL CARE PROVIDED TO RESIDENTS SHOULD BE FROM PEOPLE TRAINED AS LICENSED PRACTICAL NURSES (LPN) OR HIGHER (I.E. REGISTERED NURSES – RN), AND NO LESS THAN 105 OF ALL CARE MUST BE DIRECTLY PROVIDED BY REGISTERED NURSES (RN).

WHY IT MATTERS?  This rule is designed to avoid facilities having just one RN and dozens of lower-level nurse’s aides or techs filling in. In many facilities, we find upwards of 100 residents being served by no more than 1 or 2 RNs per shift. Only RNs can administer narcotic medications for pain, offer fistula management, or monitor central lines, among many other advanced tasks.

 MINIMUM STAFFING RATIOS ARE CALCULATED BY ASSUMING THE FOLLOWING:

• Residents in need of “skilled nursing” care – 3.8 hours per day
• Residents needing only “intermediate” care – 2.5 hours per day

WHY IT MATTERS?  A facility with 100 residents, 50 of whom require skilled nursing care (higher level of care) and 50 with intermediate needs, would be required to demonstrate enough staff to provide (3.8 hours x 50 = 190 hours of skilled nursing care PLUS 2.5 x 50 = 125 hours of intermediate care). This means a total of 315 hours of direct care. Now multiply 315 hours x 10% = 31.5 hours of RN care, and 315 x 25% = 78.75 hours of LPN or higher care. More about this below.

THE FACILITY SHALL SCHEDULE NURSING PERSONNEL SO THAT THE NURSING NEEDS OF ALL RESIDENTS ARE MET.

WHY THIS MATTERS?  This is a general catch-all provision that essentially means even if ratios are met, if it isn’t enough to do the job and residents are in jeopardy of being injured, they have to add staff.

These three basic staffing rules may seem complicated to many people, but nursing homes know all too well how to get around them and play games with the numbers. Although there are many nursing home administrators who have excellent intentions and want to do the right thing, ownership and corporate management often make their jobs very difficult by leaving them with inadequate funding to staff the facility according to these ratios. Take for instance the example of 100 residents from above. In this scenario, each day that facility would have to have at a minimum, 2 nurses on duty, if each nurse worked a 12-hour day. A day is 24 hours, and they needed 31.5 hours of RN time. Likewise, because 78.75 hours of LPN or higher staffing is needed, this would mean a minimum of about 4 to 5 LPN’s or higher.

So, how do nursing homes play games with these numbers? Well, sometimes they will count an RN twice, listing her in the 10% and 25% ratios, which is obviously not correct. Regardless of training, one hour of that nurse’s time is still just one hour. Another clever trick is to remove resident names from the daily census if they are transferred to the hospital or out of the facility for a few hours. Even an hour trip to the hospital could result in a lower number of residents reported on the census for that day. There are plenty of tricks that nursing homes play in order to make their reporting look accurate, but ultimately, in some smaller rural areas, there is rarely more than a single RN on duty.

No. 2 – Inadequate Training

It should come as no surprise that a facility that chooses to under-staff a facility certainly would have no issues leaving their staff untrained. This becomes a real problem for things like bedsore management, fall precautions, and medication administration. Nursing homes are required to provide their nursing staff with adequate training and support to provide quality care to residents. Key types of training may include:

• Training on the use of proper patient lifting techniques, to prevent injuries to seniors.
• Proper identification and treatment of skin breakdown, such as bedsores and skin tears.
• Adequate treatment of pressure ulcers with the latest technology, ointments, and bandaging protocols.
• Training on national standards for medication administration to avoid giving residents the wrong medications or over-medication.
• Proper infection control measures, use of personal protective equipment (PPE), and disinfection procedures.
• Proper charting and documentation, as well as the correct use of new electronic medical records (EMR) systems.

When nursing homes fail to keep their people up to date on the latest training and procedures, lots of things can go wrong. For instance, residents can contract dangerous or even deadly infections due to nursing staff cross-contaminating them by going from room to room. Residents can fall or be left to attempt to use the bathroom alone, despite being at a great risk of harm. Finally, residents are often left laying in their own urine or excrement for hours or even days, which typically leads to painful and even deadly pressure sores.

No. 3 – Improper Documentation

It should be relatively clear by now that all of these problems are interconnected. Failing to properly train staff and not having enough staff can lead to quality of care crises. One of these crises is improper charting. In the medical field, it is crucial to keep proper records.

For instance, if a nurse repositions a patient at 10:30 a.m. and the doctor has ordered the patient to be repositioned from side to side every 2 hours, as is commonly the practice for patients with a great risk of skin breakdown, imagine what could happen if a nurse failed to chart repositioning. For one, the next staff member to come in may be just 10-15 minutes later, not see notes about it, and reposition the patient right back to where they were, leaving them in the same spot for 4 hours or more – plenty enough time to develop a painful bedsore. Likewise, failing to document medications can result in over-medication, and failing to chart fall precautions can lead to a patient suffering a terrible or fatal injury.

No. 4 – Intentional Under-capitalization

This one is a bit more theoretical and less easily conceptualized for most people, but just think of it as deliberately choosing to run a company into the ground in order to protect yourself as the owner. Many nursing homes operate as part of a much larger corporate scheme, in which the wealthy owners may have no idea what goes on in the facility. Instead, they own a small limited liability company in one state, which in turn owns a management company that allegedly provides “services” to the facility. The actual facility is held in an LLC or Corporation that operates on a tiny profit margin, often even running in the red with negative earnings each year. Thus, if sued, the corporation can claim the business is bankrupt or defunct, and there is no money to pay the claim. In the best scenarios, insurance is the only thing the injured family can recover, but in the worst scenarios, there is no insurance and no funds to go after, and once enough people have sued the facility, the owners merely close that LLC and open it up under a new name.

So, how do nursing home investors and owners make money? By diverting profits through real estate holdings companies, management companies, self-owned pharmacies, medical device companies, and other amorphous companies, many of which operate as little more than shell operations to hide profits. In many cases, these shell companies are owned by family members or even by the very same owners.

No. 5 – Healthcare Fraud

Finally, perhaps the most egregious manner of abuse and neglect occurs when a nursing home commits healthcare fraud. As with most things in life, money can be a great motivator to do wrong. There have been cases of nursing home employees stealing life-saving drugs from patients but charting that they were given. This means the nursing home is charging Medicaid, Medicare, or private insurance for those drugs that were not really given. In other cases, nursing homes will document medical devices in order to protect against liability.

Consider the example of one case where an elderly gentleman developed massive stage 4 bedsores on his back and buttocks. He ultimately succumbed to the wounds and died. When the facility realized that they could be at fault and the State would soon be investigating the matter, they edited their chart to show that a low air loss mattress had been ordered and used for the patient. These mattresses can cost upwards of $8,000 to $10,000, depending on the markups. While this type of “cover up” is bad, what makes it worse is that there was no way to chart it without actually billing for it. After all, the records and bills must match. Therefore, the facility billed Medicaid for an expensive medical device that was never even used for the patient. There have even been cases where Medicaid or Medicare were billed for life-saving medications hours or even days after the resident had died and left the facility.

Getting Help After a Loved One is Hurt by an Illinois Nursing Home

Pursuing justice for your loved one requires a little effort and diligence. But injuries like bedsores, falls, hip fractures, infections, and other preventable issues should not be ignored. In fact, your family may be entitled to significant monetary compensation for such things.

However, keep in mind that not all nursing home abuse lawyers are the same. There are plenty of so-called ‘injury’ lawyers throughout southern Illinois who will claim to understand nursing homes and how they operate, but if you press them on regulations and which entities to sue, they often have no idea.

Over the last decade, attorney Jaye R. Lindsay has actively litigated hundreds of nursing home lawsuits from Chicago to the most rural parts of southern Illinois, obtaining millions in cash awards for his clients. In addition to being an experienced trial lawyer and skilled negotiator, Jaye is also a former paramedic who routinely went into nursing homes and saw firsthand the devastation that can be caused by poor care. As lead counsel on hundreds of medical negligence and nursing home cases throughout the state, Jaye also holds a master’s degree in Health Law & Policy, making him one of the few attorneys downstate who has a comprehensive academic and practical background in how healthcare corporations are actually run.

The skilled team at Crossroad Legal, LLC has close relationships with renowned emergency medicine providers, nurses, physicians, and geriatric specialists who advice and consult on cases to help identify exactly what when wrong. Quite frankly, when you work with an attorney, you want to know that you can relax knowing they will handle everything. The team at Crossroad Legal, LLC takes care of everything, and we only recover our fees and advanced litigation costs if we are successful in recovering money for you. Otherwise, you owe us nothing. But you have very little time to make a decision in Illinois. If you miss the statute of limitations, your case will be forever barred, and you will lose out on significant monetary compensation. While we know grieving can make it hard to talk about things like abuse and neglect, consultations are completely confidential and free of charge. So take a few minutes, and reach out to Crossroad Legal, LLC today to learn more about your rights.