HERRIN - Nursing home reform legislation signed into law a few weeks earlier by Gov. Pat Quinn that will require more staff members to care for residents is being hailed by many health care providers as a step in the right direction to improve the quality of care.

But for many in the nursing home business, it's looking like a catch-22 because essential state money needed to help pay for the extra help isn't there because of the state budget crises that include Medicaid reimbursement delays.

"I have visited with staff administrators and they are wondering where the money is going to come to pay for all this. What we fear is the cost will ultimately go to the families of loved ones who are residents. You want to have the best care, but you may have to travel miles to a facility you can afford," said state Rep. Brandon Phelps, D-Harrisburg.

Senate Bill 326 is requiring many nursing homes to hire more staff members to care for residents. The state health department would also double the ranks of inspectors by 2013 to increase oversight.

The law calls also for more extensive criminal background checks and psychological screenings of incoming nursing home residents and require placement of dangerous patients into separate therapeutic wards.

"A major concern I've heard from those in the business is that nursing homes are more regulated than nuclear power plants. There are always so many advocacy groups coming in from both the federal and state levels," Phelps said.

What Phelps said he has seen in Southern Illinois in particular is smaller privately owned nursing homes are being bought out by large corporations that can afford to do the business.

Phelps said a delay in Medicaid finance from the state to nursing homes has caused problems such as nursing homes having to refinance or take out second mortgages to meet staff payroll, for example.

"It's tough to stay in the business," Phelps said.

The finance hurdle is not exclusive to the nursing home industry, but is something all agencies have to jump during the current state deficit, said John Smith, executive director of the Egyptian Area Agency on Aging, which provides services such as ombudsman visits to 70 licensed facilities in 13 Southern Illinois counties.

"All of us have had to cut back on nonessentials, borrow money and be creative. It's a problem for everyone that gets state support," Smith said, noting creativity can be found with using new programs such as the Illinois Pioneer Coalition to improve nursing home care at virtually no cost.

Programs such as the Illinois Pioneer Coalition teach nursing home staff members how to treat residents like family members and provide more dignity.

"We are rethinking the idea of what a nursing home should be," Smith said.

At Shawnee Christian Nursing Center, Administrator Sherry Neal said she and others in the office are busy assimilating information for federal forms that Illinois Medicaid pays from, which is tough because that information is locked in for at least a year regardless of changes in the caseloads and required care.

One of her bosses, Executive Vice President Steve Robison of Christian Homes Inc. said the not-for-profit provider with 15 centers in four states and more than 2,300 employees, is sound with its budget up through 2014-15.

Robison said the main challenge for Christian whenever any new changes need to be incorporated is finding trained staff.

Although increased regulations and new laws that will require more money are providing a host of challenges, Shawnee Christian Nursing Center is finding solutions and new avenues such as providing certified nursing assistant students from the nearby community colleges opportunities to do their clinical training at SCNC.

Attitude and help from the outside are elements also to meet the challenge, Neal said

"We've been successful and a huge part is because of our management. We've got a wonderful volunteer group and we receive generous donations. A huge part of our success is this (nursing home care) is a mission for us. We consider ourselves missionaries," Neal said.

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