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Are Illinois Residential Care Facilities Adequately Regulated? Exploring Oversight Amid Abuse and Neglect Incidents

Female nursing home staff assisting a resident with her medication
Steven M Levin

Content Reviewed by:
Steven M Levin

Content Reviewed by: Steven M Levin

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Since 1976, Steve Levin has been dedicated to helping people injured by others’ negligence. He is one of the first attorneys in the U.S. to prosecute nursing homes for abuse and negligence. He’s also helped write new legislation that governs the operation of nursing homes, including the Illinois Nursing Home Care Act. Moreover, Levin & Perconti has obtained the top three jury verdicts in nursing home negligence cases in Illinois.

Nursing home regulations aim to guarantee that residential facilities provide safe, sanitary, home-like environments where residents receive quality care. Inadequate regulation in nursing homes has resulted in an epidemic of nursing home abuse and neglect. We are passionate advocates for reform who fight for change and hold nursing homes accountable when they harm residents by failing to provide the care and respect they deserve.

Nursing home abuse and neglect is an ongoing nationwide crisis that has persisted for decades amid lax nursing home regulations. Many nursing home providers are powerful corporations that use their wealth to influence public policy so they can continue to underfund nursing homes, which perpetuates the cycle of nursing home abuse.

As many as 15 percent of adults living in United States nursing homes report experiencing some form of abuse, including physical abuse, psychological abuse, sexual abuse, financial exploitation, and neglect. The actual numbers may be significantly higher, as the majority of cases are unreported.

Illinois nursing homes have long been among the nation’s worst offenders, as evidenced by the following:

  • In 2017, Illinois had the highest incidence of sexual abuse in nursing homes.
  • In 2018, Illinois was the worst state in the nation for overusing psychotropic drugs in nursing homes.
  • In 2019, Illinois ranked last in the nation for nursing home staffing, a driving factor in nursing home abuse.

State and federal regulators are not doing enough to protect our vulnerable elderly population in nursing homes, which are the very places where they should feel the safest. In recent years, we have handled cases against Illinois nursing homes for egregious conduct that authorities did not appropriately address, including the following:

  • Videotaped Bullying Incident: Two CNAs in a Chicago nursing home bullied a 91-year-old resident with dementia, videotaped it, and posted it on social media with laughing emojis. The nursing home failed to investigate or report it to the Illinois Department of Health until the family involved the police. The two CNAs were arrested on misdemeanor charges, and the nursing home terminated their employment. There is no record that the facility faced discipline for the incident.
  • Neglect and Retaliation: A 96-year-old World War II veteran developed pneumonia after the Westminster nursing home in Evanston failed to properly address a burst sewage pipe over his room. He was then left unattended, causing him to fall, break his pelvis, and eventually develop bedsores. After he filed his complaint, the facility filed an eviction action in apparent retaliation. Westminster was rated a five-star facility. The family is suing under the Illinois Nursing Home Care Act. There is no record that the facility was ever cited or fined over this incident.
  • Death Caused by Lack of Attendance: A Chicago nursing home’s staff allowed a man to bleed to death from his arm by failing to regularly check on him after a successful kidney transplant. He was a known bleeding risk. An employee with a criminal record also stole his phone around the time of his death. His death was not discovered until three hours after he died. The Illinois Department of Health only cited the facility for failing to properly report the death.

These are not isolated incidents. Scenarios like these play out daily in nursing homes nationwide with little or no consequences to the nursing home companies.

A scathing investigative report in Maine found that the state health department failed to take action in 91 percent of the 348 abuse and neglect reports regarding assisted living facilities throughout the state from 2020 to 2022.

Thirteen facilities in Maine had 10 or more neglect and abuse incidents. One facility received seven visits from public health officials during this period. Such incidents as the following are known to have occurred at this facility:

  • A resident with dementia was given a peanut butter sandwich despite a documented peanut allergy, resulting in death from anaphylactic shock.
  • An employee slapped a combative resident in the face.
  • A resident wandered outside into the snow without the facility noticing for two hours. The resident died of complications from hypothermia.

The facility was not fined for any of these incidents but was only required to develop a plan of correction. With no real consequences, there is no incentive for change.

The Need for Stronger Regulatory Measures

The Illinois Nursing Home Care Act establishes residents’ rights to be free of abuse, make decisions regarding their health care, and live in a home-like environment. Illinois nursing homes must also follow federal regulations imposed by the Centers for Medicare and Medicaid Services.

Every nursing home is subject to mandatory inspections, also known as licensure surveys, at least every 15 months. Additional surveys are performed when the state receives complaints. The Illinois Department of Public Health must perform surveys and report the results to CMS.

The survey results are publicly reported on Medicare’s website using a five-star rating system in the following categories:

  • Health
  • Staffing
  • Quality

Surveys typically take three or four days to complete and are conducted without prior notice to the nursing home.

In addition to receiving low ratings, nursing homes can also be fined for state and federal deficiencies discovered during surveys. Federal fines may be imposed one time, or they may be imposed daily at a rate of $50 to $10,000 per day until the deficiency is corrected.

The state can recommend fines for federal violations but does not have the authority to impose them. CMS can impose the fines recommended by the state but also has the discretion to waive them if the facility cooperates.

Facilities may be flagged for abuse if state inspectors find evidence that residents have a high risk of abuse. These violations are published on Medicare’s website. Facilities with repeat offenses may be placed on the Special Focus Facility list. These facilities must improve within specified time frames or lose their licensure.

While these measures seem protective, the continued prevalence of abuse and neglect in nursing homes demonstrates that they fall far short of providing the necessary incentives for nursing homes to reliably provide residents with the care and dignity they deserve.

Insufficient Penalties for Violations

In Chicago alone, there are 78 one-star facilities and 71 facilities that have been flagged for abuse. Most of the flagged facilities are one- and two-star facilities. Nursing homes receive low ratings for numerous deficiencies found during licensure and complaint surveys.

These facilities rarely make meaningful, lasting improvements, and many end up on the Special Focus Facility List. Despite being fined for these violations, they remain one-star facilities, and residents remain at risk. In many cases, they are not fined at all.

When fines are imposed, they are minimal in light of many nursing home companies’ considerable assets. The schedule of state-imposed fines for Illinois nursing homes is as follows:

  • $25,000 for conditions that cause a substantial risk of leading to a resident’s death, or Type “AA” violations
  • $12,500 for conditions that cause a substantial risk of death or serious mental or physical harm, or Type “A” violations
  • $1,100 for conditions that cause a substantial risk of “more than minimal” physical or mental harm, or Type “B” violations
  • $250 for conditions that cause a substantial risk of “less than minimal” physical or mental harm

These amounts are rarely sufficient to motivate nursing home companies to invest the resources needed to make the facilities safe and hospitable.

The fact that nursing homes fail to improve even after being fined shows that operators would rather pay fines than fix the problems. Understaffing in nursing homes is one of the primary causes of many deficiencies. Raising staffing levels would require nursing home companies to invest money.

It is currently less expensive for nursing home providers to pay fines than to bring nursing homes up to standards. If nursing home providers cared about patient welfare, perhaps the fines would be enough. Since they prioritize their profits, nursing home conditions will never improve until penalties are large enough to make it more cost-effective to hire sufficient staff.

Our law firm is at the forefront of the movement to penalize nursing home companies as much as it takes to incentivize change. Since fines are ineffective, we provide an additional layer of accountability through individual lawsuits, which typically result in settlements and verdicts much higher than federal and state fines.

Ability to Escape Liability by Transferring Ownership

Senior partner Steven Levin and partner Michael Bonamarte are representing two separate families whose loved ones died from negligent care in nursing homes that transferred ownership to other companies. The former owners claim they do not have the financial assets or insurance to pay the claims.

This is the latest tactic nursing home companies use to escape liability, and no state law currently prohibits it. In the last two years alone, 105 Illinois nursing homes have changed ownership.

We are actively advocating for reform of the Illinois Nursing Care Act to require nursing home owners to prove they have the financial viability to pay claims for harm that occurred on their watch before they are allowed to transfer ownership.

Nursing home abuse and neglect will never end as long as there are loopholes that allow nursing home owners to escape liability.

Lack of Enforcement

A 2023 final report by the U.S. Senate Committee on Aging found that as many as 28 percent of the nation’s nursing homes have not had an inspection for 16 months or more, violating the Nursing Home Reform Act. The lack of inspections has resulted from understaffed survey agencies.

Nursing home surveys are foundational to identifying risk factors for abuse and neglect and enforcing standards. According to the report:

  • Inspection agencies have a high turnover rate.
  • There are notable surveyor vacancies in nearly every state.
  • Alabama has the highest surveyor vacancy rate at 80 percent.
  • The surveyor vacancy rate in Illinois is 22 percent.

The report cited letters from long-term care ombudsmen nationwide who expressed concerns about delayed complaint investigations. One ombudsman reported that a complaint alleging a worker struck a resident in the face was not investigated until months later. Another reported that a bedsore complaint was never investigated. Others related concerns about understaffing.

Even when regulatory agencies are aware of deficiencies, they don’t penalize the nursing homes to the extent the law allows. For example, more than 25 percent of sexual abuse cases in nursing homes are not reported to police. The fine for not reporting sexual abuse is $300,000, but CMS often fails to impose it.

Lack of Adequate Staffing Regulations

State and federal regulations specifying staff-to-patient ratios are lacking. CMS only requires nursing homes to hire an “appropriate” number of nursing staff members based on resident needs. Thus, nursing home providers with a vested interest in minimizing staff have too much room for interpretation.

Illinois has passed legislation specifying ratios, but the nursing home industry successfully fought to postpone the effective date until January 2025. Even when it does become effective, the staffing requirement will be 3.8 hours of care per resident per day, which is lower than the CMS recommendation of 4.1 hours. It also remains to be seen whether regulators will meaningfully enforce the measure.

CMS has proposed specifying a minimum requirement of three hours per resident per day, but it has yet to be approved, and the nursing home industry is likely to fight it. Even if it is approved, three hours of care per resident per day will likely be insufficient to prevent nursing home abuse and neglect.

Staffing regulations have favored nursing home providers for too long. Understaffing in nursing homes is at the root of most nursing home abuse and neglect. It is time for these requirements to promote the residents’ best interests.

The Long-Term Care Ombudsman Program

Every state must have an Ombudsman program to advocate for residents of long-term care facilities. The federal Older Americans Act and the Illinois Act on Aging established this requirement.

Long-term care ombudsmen provide free services to nursing home residents, including the following:

  • Providing information, education, and referrals
  • Visiting residents and listening to their concerns
  • Advocating for improvements in care quality in nursing homes
  • Investigating complaints and concerns
  • Reporting abuse to the state with consent from the resident
  • Protecting residents’ rights
  • Providing advocacy during involuntary transfers and discharges

An ombudsman often serves as a resident’s only contact with a friendly person. Ombudsmen have direct access to nursing home residents and can see what is happening inside nursing homes up close. They not only advocate for individual residents but also provide a collective voice for reform.

Ombudsmen are assigned to various regions throughout the state. To find your regional long-term care ombudsman, see the Illinois Department of Aging’s Public Contact List.

Effective January 1, 2024, all nursing homes in the state will be required to post the following information about the Long-Term Care Ombudsman Program on the home pages of their websites:

  • The statewide toll-free telephone number
  • A link to the Long-Term Care Ombudsman Program’s website

This measure aims to raise public awareness of the existence of the Long-Term Care Ombudsman Program and make it easier for residents and families to access an ombudsman. Nursing home residents need and deserve advocacy, and many more would likely access this program if they knew it existed.

An increased presence of ombudsmen inside nursing homes can help ensure more residents’ voices are heard when they receive substandard care or experience abuse. While this is not a replacement for increased penalties and enforcement, it is an important step in reform, and it may prevent some cases of nursing home abuse.

How to Select a Nursing Home in Illinois

Selecting a safe nursing home that offers quality care requires careful investigation. The only way to know for sure whether a nursing home is a place where you can feel comfortable placing your loved one is by visiting the facility multiple times at different times of the day.

With more than 200 nursing homes in Chicago alone, it will be necessary to narrow down your choices before getting started. You can use Medicare’s nursing home finder and local sources to help you find the best nursing home for your loved one.

Medicare’s Nursing Home Finder

Medicare’s website provides a nursing home compare tool that can help you narrow down your search. It provides the following information:

  • The star ratings of each nursing home
  • Whether a nursing home has been flagged for abuse
  • Complete inspection reports, including licensure inspections and complaint inspections

While this is a useful tool for eliminating some nursing homes from your search, it is important to note that a five-star rating or a good inspection report does not guarantee quality or safety. Inspections evaluate a small selection of residents and are only a snapshot of the nursing home’s operations at the time of the inspection.

Build a List From Multiple Local Sources

Gathering information about all nursing homes from one source can be difficult. You may be able to obtain information on the various nursing homes in your city through the following sources:

  • Your local yellow pages
  • Senior citizen organizations
  • Your local Social Security office
  • Members of the clergy
  • Health care professionals
  • People you know
  • The long-term care ombudsman in your area

Guidance from the Illinois Department of Health

You can narrow down your list by calling the nursing homes on your list and asking questions before visiting. It is also important to consider the nursing home’s location. Try to choose a location that is convenient for friends and family. More visitors can provide a layer of accountability for nursing home staff.

You are entitled to check the nursing home’s background. The law requires nursing homes to provide copies of all inspection reports and court orders from the last five years upon request. You are also entitled to a description of services and costs, a copy of the statement of ownership, and a list of nursing home staff.

When visiting nursing homes, look for the following:

  • Cleanliness
  • An absence of unpleasant odors
  • Adequate lighting
  • Sanitary food handling practices
  • Appetizing and well-prepared food
  • Sufficient food provided with snacks available
  • Attractive, clean, and well-lit dining areas
  • Clean, beautiful grounds
  • Staff who seem to genuinely care for the residents
  • A statement of residents’ rights
  • Positive feedback from residents, visitors, and volunteers
  • Residents who appear happy and well cared for
  • Handicap-accessible hallways, bathrooms, and rooms
  • A robust activities schedule with plenty of variety
  • Bedrooms that open into a hallway and have an outdoor window
  • Pleasant bedrooms with reading lights, closet space, and comfortable chairs
  • Privacy screens or curtains in the rooms
  • Private bathing and toileting facilities
  • Private visitation areas for family and friends
  • Access to secure outdoor areas

Be prepared to ask many questions based on your loved one’s needs. You will need to know whether the nursing home provides specific therapies your loved one needs and how well the facility can accommodate dietary requirements and other special needs. Ask how oral health care and outside medical visits are handled.

Staffing is an especially important consideration. Understaffing and undertraining are among the most important predictive factors for nursing home abuse and neglect. Ask the following questions about staff:

  • Is at least one RN or LPN on duty 24 hours a day, seven days a week?
  • Is an RN on duty seven days a week?
  • How many patients is each CNA responsible for?
  • Is the Director of Nursing an RN?
  • Can residents access call buttons in all bed, toilet, and bath areas?
  • Are social services available to residents and their families?
  • Is there an activities coordinator on staff?

We Can Help with Your Nursing Home Abuse Case

Nursing home abuse and neglect are violations of federal and state laws. State and federal regulators have let nursing home patients down by failing to enact and enforce meaningful regulations that would protect residents.

Our nationally recognized nursing home abuse lawyers are trusted advocates of abused and neglected nursing home residents who will give your loved one a voice, expose abusive nursing homes, and fight for justice. We are pioneers in nursing home litigation with over 30 years of experience.

We are nationally known for our work on behalf of injured nursing home abuse and neglect victims, and our work includes testifying to the state legislature and lecturing about nursing home abuse to lawyers, advocates, and community organizations.

As one of the first law firms in the nation to file lawsuits on behalf of nursing home abuse victims, we have developed the most aggressive and effective approach to nursing home litigation. Our knowledge of federal and state nursing home abuse laws is unmatched, and lawyers throughout the country refer their most challenging cases to us because of our consistent record of success.

We encourage you to join us in advocating for reform. Our most vulnerable citizens deserve better. If you or your loved one has been neglected or abused in a nursing home, we can help. Contact us today for a free case evaluation.

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Steven M Levin

Steven M. Levin

Founder and Senior Partner
Since 1976, Steve Levin has been dedicated to helping people injured by others’ negligence. He is one of the first attorneys in the U.S. to prosecute nursing homes for abuse and negligence. He's also helped write new legislation that governs the operation of nursing homes, including the Illinois Nursing Home Care Act. Moreover, Levin & Perconti has obtained the top three jury verdicts in nursing home negligence cases in Illinois.