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What Agency Regulates the Nursing Homes to Ensure They are Providing a Safe Environment?

What Agency Regulates The Nursing HomesBoth state agencies and Federal agencies regulate nursing homes, rehabilitation centers, and assisted living facilities. The state Department of Health and the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) conduct inspections or "surveys" on nursing homes to ensure they are meeting all regulations.

Nursing homes in Illinois are regulated by the Illinois Department of Health (IDPH) and are governed by the Nursing Home Care Act (210 ILCS 45). The IDPH website can be accessed here. Complaints against Illinois nursing homes can be made via the hotline 800-252-4343.

Rosenfeld Injury Lawyers LLC represents victims of nursing home abuse and mistreatment and other types of professional negligence. Our law firm has successfully prosecuted cases for our clients who were injured by the reckless and negligent actions of others. Our attorneys are available to answer any legal questions on how to receive the monetary compensation you deserve if your injuries were a result of someone else's fault. Should you have additional questions, we invite you to contact our office for a free review of your legal rights.

The Government Regulating Quality of Care

There are over 16,000 residential nursing homes in the United States that provide care to more than 1.5 million men, women, and children. According to the National Institute of Health (NIH), the care provided to approximately one-third of all nursing home jeopardizes the safety, health, and well-being of its residents. Many of these facilities are owned and operated by profit-making companies and corporations while others are run by the government or nonprofits.

The NIH states that the “fundamental cause of poor care is the low number of nurses and other staff required by law.” The federal agency also states that the quality standards of enforcement and monitoring became lax once the responsibility was turned over the states. The government also states that the US “has failed to hold the nursing home industry accountable for how government funds are spent and to protect residents from poor care.”

The U.S. Congress enacted the Nursing Home Reform Act of 1987 as a part of that year's Omnibus Budget Reconciliation Act that provided nursing home regulations and care guidelines. Congress intended to set forth Nursing Home resident rights to minimize abuse, neglect, and mistreatment occurring in facilities across America. According to the AARP, these rights included a:

  • “Freedom from abuse, mistreatment, and neglect.”

  • “Freedom for physical restraints.”

  • “Privacy [and] the right to accommodation of medical, physical, psychological, and social needs.”

  • “The right to participate in resident and family groups;”

  • “The right to be treated with dignity;”

  • “The right to exercise self-determination [and…] communicate freely; the right to participate in a review of one's Care Plan, and to be fully informed in advance about any changes in care, treatment, or change of status in the facility.”

  • “The right to voice grievances without discrimination or reprisal.”

Medicare and Medicaid both provide financial payment for the care residents receive in nursing facilities both short-term and long-term. However, to receive federal dollars the facility must remain in compliance according to the Nursing Home Reform Act requirements.

Filing a Complaint

If your loved one is suffering from abuse, mistreatment, or neglect in the nursing home, assisted living center, rehabilitation unit, or skilled nursing facility (SNF), it is important to rectify the problem immediately. At first, you can ask for assistance from the Registered Nurse (RN), Licensed Practical Nurse (LPN), or Certified Nursing Assistant (CNA). The medical team and nursing staff might not be aware of the problem unless brought to their attention.

However, the nursing staff fails to take immediate action, you can speak with additional members of the nursing home staff including:

  • The nurse's supervisor
  • The staff social worker
  • The resident's doctor
  • The Director of Nursing
  • The facility's Medical Director

Ask any member of the nursing team or administration how to follow the grievance procedure for filing a formal complaint. Additionally, the skilled nursing facility or nursing home must also provide a posted name, address, and phone number of numerous state organizations and agencies that regulate nursing homes and handle grievances. These groups include:

  • State survey agency
  • State ombudsman program
  • State licensure office
  • Medicaid fraud control unit
  • Advocacy and protection networks

Additionally, you can file a formal complaint at Medicare.gov by clicking here. The federal agency receives complaints about unnecessary care, inappropriate surgeries, being discharged from the facility too soon, customer service complaints, drug plan complaints, and grievances involving home Health Care agencies.

Reporting a violation in a nursing facility to a State or federal agency requires describing the issues in detail. If necessary, call local law enforcement immediately if you suspect a crime has been committed. Common crimes that are associated in nursing facilities include abuse, mistreatment, neglect, sexual assault, financial exploitation, attempted poisonings, and others that violate nursing home law. A police officer can document your grievances and take immediate action if appropriate.

Once you have identified which agency in the state is in charge of nursing home inspections, file a formal complaint over the phone on their hotline, through an email, or online. Be sure to include all the information including the violation that occurred, the facility where it happened, and any participants in the event. You will likely be required to fill out a form to serve as an official document before an investigation can begin.

Nursing Home Violations

Every state and the federal government maintain a nursing home inspection database that outlines all the information acquired during inspections, surveys, and investigations. The most common nursing home violations that occur in facilities nationwide include:

  • Maintaining a nursing home free of accident hazards
  • Establishing, implementing and enforcing infection control protocol
  • Providing all appropriate care for the highest practicable well-being
  • Developing and following Comprehensive Care Plans
  • Ensuring that the resident is free from unnecessary medication
  • Maintaining clinical records that meet professional standards of care
  • Providing services and cares that meet professional standards
  • Hiring employees who are guilty of abuse
  • Failure to provide the resident dignity and respect

Common Nursing Home Myths

Medicaid Has Financial Restrictions – Many believe that Medicaid does not pay for the services the resident wants. In fact, Medicaid provides residents with all the services they are entitled to receive. Some believe that the nursing staff is in charge of determining what type of care the resident will receive. In fact, both the resident and their family members have the legal right to participate with the doctor and the nursing staff to develop an effective Care Plan that will be regularly updated to meet the resident's immediate needs.

The Resident Must Live by the Facility's Schedule – It is a common mistake that the staff will not accommodate the resident's schedules, when in fact, the facility must make reasonable adjustments to ensure that the resident's preferences and needs are honored. The resident is never required to hire personal assistance because the nursing staff must provide every necessary service to accommodate the resident's needs.

The Staff Can Decide When to Use a Restraint – At some nursing homes, the staff makes claims that using restraint is necessary to prevent your loved one from wandering away from the facility. However, it is unlawful to use restraint as a form of discipline or convenience to the nursing staff. Restraints can only be used by the law with a physician's order that follows established protocols.

The Nursing Home Sets Family Visiting Hours – The nursing home is your loved one's legal residence and can choose when family members and friends can visit at any time during the night or day.

The Home Must Discontinue Therapy If the Resident Is Not Showing Improvement – in fact, the nursing home must provide all appropriate therapy even if the resident is not showing any signs of improvement. Medicare must pay for the services even if there is no current progression.

The Nursing Home Can Evict My Loved One for Refusing Medical Treatment – The nursing home cannot evict your loved one for their refusal to accept treatment or being difficult. The facility must follow established protocols including respecting the resident's rights of self-determination dignity and respect for individuality.

Illinois Long-Term Care Facilities

More than 100,000 disabled, elderly, and rehabilitating men, women, and children reside in about 1200 nursing homes, assisted living centers, and rehabilitation facilities in Illinois. The Illinois Department of Public Health (IDPH) licenses, regulates, and inspects each of these facilities at least one time every year to assist CMS (Centers for Medicare and Medicaid Services) to ensure the safety and well-being of every resident.

Approximately 10,000 surveys (on-site inspections) are conducted by the Department every year to follow up on annual licensure inspections, re-inspections, and complaints. The Department also offers a nursing home hotline (800-252-4343) that is available around-the-clock, 365 days a year. The Department responds to over 5000 formal complaints annually.

When Deficiencies are Identified

During an annual survey or complaint investigation, the Illinois Department of Public Health might identify a mild to severe deficiency that violates nursing home regulations. Some violations cause no actual harm to the resident, visitors, or others. However, a severe violation could place the resident or others in immediate jeopardy.

Inspectors will arrive at the facility unannounced when a deficiency has been alleged to provide the nursing home and opportunity to rebut the grievance. The facility must file a formal written plan of correction to the IDPH within ten days. The plan must detail how the deficiency will be corrected and when. If the violation poses a severe risk to the resident's safety and health, the Department usually demands that the facility make an immediate corrective action.

In Illinois, nursing home residents and family members can request a copy of a state conduct an inspection to the Illinois Department of Public Health. This information can be obtained at:

Freedom of Information Officer
535 W. Jefferson St.
Springfield, IL 62761
Attention: Division of Communications
(217) 782-5750 – Division of Communications
Toll-Free Hotline for Formal Complaints (800) 252-4343

Enforcing a Remedy

In dangerous circumstances, the IDPH may impose a monetary fine against the facility or stop their admissions, exchange their operating license with a provisional license, or revoke/suspend their license altogether. In the most egregious cases, the Department will close the facility or find another remedy based on maintaining compliance with federal and state regulations and agreements.

The Department might recommend imposing a monetary fine of $10,000 or more for each violation to the CMS. The civil monetary fines are usually issued to ensure that the deficiency is addressed with the nursing home's full cooperation.

Every nursing home in Illinois must meet the state standards to ensure that every resident receives the highest level of care. Any failure to meet the standards subject the facility to a monetary fine or another enforceable action.

Do You Have Additional Questions About the Care of a Loved One in an Illinois Nursing Home?

While the Illinois Department of Health can investigate an incident or an ongoing string of poor care, the agency cannot help families pursue a nursing home negligence case in civil court. Nor does reporting an incident to IDPH preserve the statute of limitations for a nursing home abuse or wrongful death lawsuit.

As attorneys who are committed to holding nursing homes accountable for poor care that results in a patient injury or death, Rosenfeld Injury Lawyers LLC represents families in civil lawsuits against nursing homes. Illinois law provides for families to recover compensation for injuries caused by the negligence of a nursing home.

We invite you to contact our office today for a free review of your situation and legal rights for a recovery. We accept all personal injury cases, wrongful death lawsuits, and nursing home abuse claims for compensation through contingency fee agreements. This arrangement will postpone payment of all your legal services until after we have resolved your case through a negotiated settlement or jury trial award. We give every client a “No Win/No-Fee” Guarantee, meaning you owe us nothing if your case is not resolved.

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