Judge Stops Scare Tactics

McKnight's reported the news that an Illinois judge ordered Illinois-based for-profit nursing home operators to stop using scare tactics on mentally ill residents including issuing misleading “information sheets” to mentally ill residents.  U.S. District Judge William Hart ordered the facilities to stop distributing the sheets immediately. Hart referred to some passages as inaccurate and incendiary, and ordered the operators to cease communication with the mentally ill patients without the consent of the ACLU or other patient representatives.

The American Civil Liberties Union filed the lawsuit against nursing home operators alleging that mentally ill residents were being misled about their options. A recent Illinois Nursing Home Task force recommended that they be allowed to seek community-based support services. “Information sheets” being distributed to the residents were purposefully lacking in details, and implied that those residents would be left homeless and without care if they left the nursing home, the ACLU charged.

 

Mentally ill in nursing homes

St. Louis' STLToday.com had an interesting article about the change in demographics at today's nursing homes including healthy mentally ill patients sharing homes with elderly vulnerable residents.   The conventional wisdom is that nursing home residents are frail and elderly. That's not the reality.   Increasingly, adults with serious mental illness are being housed and cared for in  nursing homes.  Nationally, the number of mentally ill nursing home patients has jumped by 41 percent since 2002, an analysis by the Associated Press showed. In Missouri, it climbed by 76 percent. 

The article discusses the recent forced closure of Whispering Oaks after a well that supplied water froze, causing toilets to overflow. The facility had a history of fire and safety violations. State nursing home regulators tried to suspend its license last June. Whispering Oaks housed a number of patients with serious mental illness.   Several were relocated to another nursing home in St. Louis — owned by a psychiatrist — that also has been cited for safety violations in the past two years.

In theory, no one is supposed to be admitted to a nursing home unless he has disabilities that require extra care or supervision. That requirement is contained in the 1980s-era federal Nursing Home Reform Act.   But state officials estimate that about 2,500 people are in Missouri nursing homes primarily because they are mentally ill. They could be treated in a less restrictive — and less expensive — setting.  Missouri consistently has failed to fulfill its responsibilities to people with mental illness. The share of state funding for treating the mentally ill has been shrinking for decades.

Missouri could get federal money to help provide housing and treatment to patients with serious mental illness — but only if it came up with matching state funds, which the Legislature has refused to do.  The result of this neglect isn't just tragedy for the mentally ill. In Illinois and other states, it's also a tragedy for elderly nursing home patients and their families.

When the state budget is tight and elderly people are increasingly opting for home care, it's tempting to see nursing homes as a short-term solution to the chronic lack of care for the mentally ill. It may be tempting, but it is wrong.

People with mental illness deserve housing and care in the communities where they live, not in facilities designed for the frail elderly.
 

Illinois Task Force Proposals

The Chicago Tribune had an article about the weak and disappointing proposals to improve safety and the quality of care in nursing homes.  A panel appointed by Gov. Pat Quinn proposed  an array of sweeping reforms designed to end the chronic violence and abuse that plague some nursing homes, while fostering better treatment for people with serious mental illness living in those facilities. The proposals range from tightened criminal background checks of new nursing home residents to stronger sanctions and enforcement of facilities with chronic safety breaches.

Quinn's Nursing Home Safety Task Force also recommended that state police begin searching nursing homes for residents with outstanding warrants, and urged the state to increase minimum staffing requirements of the facilities to bring them up to standards spelled out in federal government studies on nursing home care.  "Urge"?  Why don't they propose specific hours per patient day?

 

27 "preliminary recommendations" will be refined before a final report is delivered to the governor. Quinn's task force was formed in response to a series of Tribune reports on assaults, rapes and murders in the state's nursing homes. Illinois as most states, extensively mixes geriatric and mentally ill nursing home residents, and understaffed facilities have failed to treat and monitor their most violent patients, government records show.

Mark Heyrman, a University of Chicago Law School professor and chair of public policy for Mental Health America of Illinois, was more cautious, saying the recommendations "do not go far enough. ... We are concerned that, once the media attention dies down, the state will be under renewed pressure not to enforce either the old laws and rules or the new ones proposed by the task force."

The task force recommended that the state Department of Public Health hire additional nursing home inspectors and retrain its current inspectors to focus on safety and care issues involving the mentally ill. Although mentally ill people, if given proper treatment, are no more likely than others to be dangerous or to commit crimes, many facilities provided grossly substandard care, the Tribune found. Many of the psychiatric patients are clustered in a relatively small subset of nursing facilities whose impoverished residents have few other options, and the paper's analysis showed the homes with the most felons had the lowest nursing staff-to-patient ratios.

Among the reforms that might be put into place fairly rapidly are a tightening of criminal background checks and screenings of people entering nursing homes. The Tribune's review of confidential case files showed the state's criminal background checks on new residents were riddled with errors and omissions that grossly understated their criminal records and danger to others. Some of these poorly screened offenders went on to commit assaults and other serious crimes inside the homes where they lived.

The task force recommended more detailed assessments to gauge people's potential for engaging in violent behavior, and said the criminal checks should be started before people are admitted to facilities. Also, the task force urged the state to sanction homes that do not promptly complete the screening reports.

The Health Department should get greater authority to revoke the licenses of nursing homes that repeatedly violate state safety regulations, the task force said. And government agencies should mete out more severe sanctions on nursing home administrators and top employees who engage in misconduct.

The Tribune reported that frail and elderly residents often were pumped with powerful anti-psychotic drugs without their consent and without a proper diagnosis. One of the nation's most prolific prescribers of psychiatric drugs provided assembly-line care for thousands of mentally ill patients housed in Chicago-area nursing homes -- while a large pharmaceutical company paid him to promote the drugs despite doubts about his credibility.

 

Making nursing homes places to house mentally ill felons

Chicago Tribune had a scary article about Federal, state and county officials finding dozens of resdients with outstanding arrest warrants and wanted on charges ranging from disorderly conduct to burglary to assault.  The raids involved about 20 federal marshals and Cook County sheriff's police.  Illinois Attorney General Lisa Madigan initiated the sweep in response to Tribune investigative reports about Illinois nursing facilities that house high numbers of felons and sex offenders.

Five people were arrested, including a sex offender wanted in another state for failing to register. In three cases, the residents were too sick to be taken into custody, and the other warrants were not immediately enforceable because they were issued in other jurisdictions.  The team found nine people with outstanding warrants when it swept Columbus Park Nursing & Rehabilitation Center on Chicago's West Side and another nine at Heather Health Center in Harvey.

Authorities also examined records for Somerset Place on the North Side and discovered three residents with outstanding warrants, but jurisdictional limits prevented immediate arrests.

The number of felons known to be living in Illinois nursing homes has grown as the state increasingly relied on the facilities to house younger psychiatric patients, thousands of whom have criminal records.  The Tribune reported that Illinois State Police once ran similar sweeps of nursing homes for felons with outstanding warrants and unregistered sex offenders. From January 2005 through June 2006, when 20 northern Illinois nursing homes were swept and roughly 80 fugitives and sex offenders removed, state police in that region recorded a nearly 67 percent decrease in nursing home abuse and neglect complaints, according to a department citation issued to the sweeps unit.   But the program was halted after five years in 2006 because federal regulators questioned whether the sweeps were an appropriate use of Medicaid anti-fraud funds. State police were not part of Tuesday's sweeps.

The Tribune has reported that the criminal background checks and risk assessments carried out for new residents of the state's nursing homes were riddled with errors and omissions.

 

Increase of mentally ill in nursing homes

Here is an interesting article from the Chicago Tribune stating that mentally ill patients now constitute more than 15% of Illinois' total nursing population (92,225) and the number of residents convicted of serious felonies has increased to 3,000, including 82 convicted murderers, 179 sex offenders and 185 armed robbers.  These are troubling statistics and may explain the increases in resident to resident assaults, rapes, and molestation.  Hopefully, the nursing home industry will decide to increase staffing to supervise residents with a history of violence or criminal behavior.
The article mentions several instances where the mentally ill and the nursing homes' lack of supervision caused injuries and death to residents.

More than any other state, Illinois relies heavily on nursing homes to house mentally ill patients, including those who have committed crimes. But the Tribune investigation found that the industry has failed to adequately manage the resulting influx of younger residents who shuttle into nursing facilities from jail cells, shelters and psychiatric wards.  The state's background checks on new residents are riddled with errors and omissions that understate their criminal records, and homes with the most felons are among those with the lowest nursing staff levels.  The facilities had a financial motive for accepting them, suggested Richard Dees, chief of the state public health department's Bureau of Long-term Care. When "the number of seniors going into nursing homes began to decline, there were facilities with empty beds," Dees said.

Meanwhile, state authorities don't track assaults and other crimes in nursing homes, making it difficult to uncover patterns and address the problems caused by unstable individuals.  Police reports show that since March 2008, police reported 511 cases of assault or battery, 27 cases of criminal sexual assault and 24 narcotics violations in city nursing homes.  The Tribune documented instances in which nursing homes failed to report attacks to the state health department as required by law. At the same time, state inspectors do not compile incident reports in a central location. And because the health department's computerized case-tracking software is antiquated and ineffective, department officials have difficulty assembling and analyzing the facility reports to uncover patterns of attacks at unsafe homes, the Tribune found.

Several national studies question whether they receive meaningful psychiatric care in nursing facilities. A pending class-action lawsuit, brought by the Bazelon Center for Mental Health Law and the American Civil Liberties Union, describes some Illinois homes as filthy, frightening holding pens where "groggy" residents watch TV in crowded, noisy common areas or are directed over loudspeakers to wait for medication and meals in long lines.

 

 

 

 

Poliakoff & Associates, P.A., is one of South Carolina’s most respected and distinguished law firms. The Poliakoff firm began nearly 60 years ago by three attorney brothers: Matthew, J. Manning, and Bernard. With a history of believing the justice system...More...