Persons with mental illnesses in nursing homes

Background

  • There are approximately 12,000 persons with mental illnesses in nursing homes.
  • There are more than 4,500 persons with mental illnesses in so-called "IMD" nursing homes.  An IMD nursing home is one in which more than half of the residence have a primary diagnosis of mental illness.  Under federal law, these facilities are not eligible for federal Medicaid funding.
  • It costs more than $30,000 per year of state General Revenue Funds (GRF) to keep someone in an IMD.
  • Nursing homes in Illinois, including IMD nursing homes, rarely provide high quality mental health services.  Specifically, few IMDs provide residents with detailed treatment plans designed to promote recovery and frequently fail to take steps to place residents in less restrictive community alternatives.
  • Among the problems in Nursing Homes is the misuse of psychotropic medications.  In May, 2011, the Inspector General of the US Department of Health and Human Services issued a comprehensive report documenting this problem. 
  • Many persons in IMD nursing homes could survive safely in the community if they were provided with comprehensive community mental health services which would cost less than the cost of care in an IMD.  Additionally, many of these services would be eligible for reimbursement under Medicaid which would enable Illinois to obtain additional federal financial support.
  • One of the impediments to moving persons out of nursing homes is that Illinois fails to provide adequate funding for community mental health services.  A 2006 Report from the University of Illinois Institute of Government and Public Affairs found that the reimbursement rates for such services were grossly inadequate.  (This report is linked below)
  • Persons with mental illnesses in nursing homes face numerous obstacles when they wish to leave which include:
    • The use of physical force and verbal threats
    • Discouraging outside visitors
    • Their inability to save money needed to move due to the very low personal needs allowance of $30/month.
    • Difficulty/delay in obtaining access to their SSI funds upon discharge.
    • The failure of IMDs to comply with the Mental Health and Developmental Disabilities Code
  • Illinois is facing a class action in Williams v. Quinn  alleging that its placement of so many persons with mental illnesses in IMD nursing homes violates the Americans with Disabilities Act (ADA) as interpreted by the United States Supreme Court in Olmstead v. LC.  Plaintiffs are represented by Summit members Equip for Equality and Access Living  (as well as the ACLU of Illinois and other counsel) in this litigation.   In 2010, the Federal District Court approved a consent decree in which the state agree to begin a five year process of moving persons with mental illnesses out of IMDs.  On June 30, 2011, the Department of Human Services published its Implementation Plan.  A copy of that plan is linked below.  
  • In response to a serious of articles in the Chicago Tribune, the Governor appointed a Nursing Home Safety Task Force.  That group has conducted hearings in Springfield and Chicago.  Written materials presented at these hearings are now available.  On January 14, 2010, the Task Force released is Draft Recommendations.  These recommendations are linked below.
  • On February 18, 2010, the Task Force released its final recommendations.
  • In its waning days and after elaborate negotiations, a nursing home reform bill, Senate Bill 326, was passed by both the House and the Senate and was signed into law by the Governor on July 29, 2010 as Public Act 96-1372.   Unfortunately, this bill:
    • Applies only one small section (governing involuntary medication) of the Mental health and Developmental Disabilites Code to nursing homes which treat persons with mental illnesses.
    • Fails to require any increased spending on community alternatives to nursing homes
    • Provides for new units where persons with mental illnesses will be segregated with little or not care
    • Fails to provide for the implementation of the proposed settlement in Williams v. Quinn.
  • In May, 2011, the Illinois legislature passed Senate Bill 145 which has now been signed into law as Public Act 97-0038.  This 700-page bill was only made public a few days before it was voted on by the legislature, giving mental health and nursing home advocates little opportunity for review and comment.  The bill creates a new class of nursing home called a Specialized Mental Health Rehabilitation Facilities.  Only five nursing homes qualify for this designation.  The bill is designed to insure that the state's nursing home bed tax/rate increase plan passes scrutiny with the Federal government for the purposes of Medicaid reimbursement.  That plan was in jeopardy because it excludes these five facilities from the bed tax.  Now these facilities are no longer considered nursing homes even thought more than 95% of this new law is borrowed word-for-word from the Nursing Home Care Act and the regulations promulgated under this new law are the nursing home regulations.  The Summit opposed this bill because it will make permanent a class of nursing home which should be abolished.  A letter explaining this opposition is linked below.  The Summit will be working to amend or abolish this law.
  • On June 24, 2011, the Illinois Department of Public Health published proposed rules governing the administration of psychotropic medications in nursing homes.  The draft rules and comments on those proposed rules from Summit member Mental Health America of Illinois are linked below.  

Recommendations

  • Illinois must create and enforce standards ensuring that persons with mental illnesses who reside in nursing homes due primarily to a medical condition other than a mental illness are provided with appropriate mental health services.  Inspections and evaluations of all nursing homes should include review by personnel who are competent by virtue of their training and experience to determine whether appropriate mental health services are being provided to all residents who need them.
  • Illinois should enforce the decision of the Illinois Appellate Court in Muellner v. Blessing.(excerpts from this decision are linked below.)  Muellner affords residents of IMD nursing homes (and special mental health units within other nursing homes) the protections offered by the Mental Health and Developmental Disabilities Code.  While the Nursing Home Care Act does contain some protections for nursing home residents, this Act says almost nothing about mental health services and the rights of persons with mental illnesses. The passage of Senate Bill 1982 would greatly assist in this process. 
  • Depression is not a natural condition for the elderly.  Nursing homes should conduct periodic depression screening and ensure that appropriate treatment follows.
  • Increase the personal needs allowance for Medicaid recipients to at least $75/month to reflect inflation since the last increase 15 years ago.  

Links: