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Advocates Say Illinois Should Learn From COVID Crisis On Long-Term Care And Nursing Shortage

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Elder care advocates are urging state lawmakers to reduce the number of Illinoisans receiving long-term care at nursing homes after a study showing many of Illinois’ early COVID-19 deaths occurred at facilities that were both overcrowded and understaffed.

Read more: Minority Residents In Illinois Nursing Homes Died Of COVID-19 At Disproportionate Rates

According to 2017 data reported by the AARP, 10% of residents living in Illinois nursing homes have “low care needs”, which is higher than the 8.9% national average.

Nursing home critics say because a number of facilities struggled to control viral transmissions among residents during the pandemic, the state should prioritize at-home and community-based care services.

“For too long, our state has relied on institutional settings such as nursing homes to meet the needs of seniors and people with disabilities. This needs to change,” Services Employees International Union Executive Vice President Erica Bland-Durosinmi told lawmakers at a hearing last week. “We need to look at expanding home and community-based services so that the state is offering the wide array of services needed, where they are needed and for all who need them.”

Heidi Dalenberg of the American Civil Liberties Union of Illinois said for people with mental health conditions especially, nursing homes are not a conducive environment for progress due in part to a lack of programming options and difficulty in controlling certain triggers — like noise.

Although existing consent decrees related to the American Disabilities Act require the state to transition people with disabilities and mental illnesses out of nursing homes, those efforts have been slow.

“The contracts that were put in place before COVID hit anticipated moving about 900 people a year out of nursing facilities and back into the community,” Dalenberg said. “Right now we're seeing three people a month moving out of facilities.”

Dalenberg also stressed it’s important to limit institutionalization from the outset in order to reduce the number of people with less intensive needs being housed at and receiving care from a nursing home.

Federal guidelines require prospective nursing home residents to undergo a pre-admission screening known as PASRR. The second level of the screening phase determines not only whether a need for care is warranted, but if a person could adequately receive care from a community-based option.

The Illinois Department of Healthcare and Family Services has as recently as April reminded long-term care facilities to emphasize what is known as the Front Door Diversion Program and have indicated the department is in the process of evaluating potential improvements to the program in order to refer patients to alternative forms of care.

Dalenberg, who oversees a variety of consent decrees the state operates under for people with disabilities to children in foster care, says the PASRR program won’t just look at a person’s “level of need.”

“They're going to ask an additional question, and that additional question is, ‘Even if that need is present, could we still serve the person in the community with appropriate community based supports?’” Dalenberg said. “The second question is critical.”

Nursing Shortage

In 2020, as the pandemic strained the workforce capacity of understaffed nursing homes, Gov. JB Pritzker signed multiple executive orders in order to allow temporary nursing assistants to take on the duties of a certified nursing assistant.

Although these orders expired in January, some lawmakers are pushing to make those TNAs permanent in order to respond to nursing shortages in long-term care facilities.

Karen Messer, the President and CEO of the elder care provider association LeadingAge Illinois, said there are not many opportunities for advancement for TNAs that want to be able to engage in direct patient care without first pursuing additional school.

“There really has been no career ladder for anyone who might be interested in working in a senior living environment,” Messer said. “There's basically a CNA role or, with advanced education, [a licensed practical nurse] or [a registered nurse], also requiring advanced education.”

However, SEIU’s Andrew Kretschmar said the state should instead focus on raising workforce standards as opposed to letting TNAs permanently take on advanced roles in long-term care facilities.

“We don't believe that by creating a lower paid position that is not receiving as much training…on the front lines of what we've just witnessed is a recipe for success,” Kretschmar said. “We should be talking about, ‘How can we pay our frontline heroes more money?’”

State Rep. Lakesia Collins (D-Chicago), who previously worked for multiple years in a long-term care facility, also took issue with the concept.

“Temporary staff oftentimes come with inexperience,” Collins said. “It throws things off on the unit.”

In addition to temporary staff positions, some advocates also pushed lawmakers to authorize the creation of certified medication aides in long-term care facilities. If Illinois were to allow for the position, certain nurses like CNAs would be able to distribute certain types of medication directly to patients.

In order to be certified, a CNA would need to have over 100 plus hours of advanced education and training, and would still be prevented from distributing more complex medications to residents.

Although legislation has been filed this session to allow for permanent TNAs and the medication aide program ( HB 2423 and HB 1806 , respectively), both proposals have stalled and are unlikely to come up for a vote this spring.

However, one proposal that has managed to garner some movement in the state Senate is a call for Illinois to join what is known as the Nurse Licensure Compact.

The compact is an interstate cooperation which makes it easier for certain licensed nurses to move and practice in multiple states without having to apply for single-state licenses in member states. Already, 34 states operate within the compact, allowing RNs and LPNs to practice in multiple states.

“What we could have done in some of those peak moments of the pandemic, those peak times where cases were exploding, we could have had nurses from other states come in to alleviate some of the pressure,” Messer said “I think that that would have been an enormous help for professional nurses as they struggled to meet the needs.”

The proposal successfully passed out of committee and may be voted on the Senate floor later this month.

Derek Cantù is NPR Illinois' graduate student Public Affairs Reporting intern for the spring 2021 legislative session.
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