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Focus on the patients: Illinois leaders hope to reform nursing home payment model

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HFS NURSING HOMES

SPRINGFIELD, Ill. - Residents and staff at nursing homes across Illinois say it's well past time for reform.

The Illinois Department of Healthcare and Family Services spent roughly 18 months on a massive plan to change the system. State leaders note the COVID-19 pandemic showed them even more problems to address in the homes.

Black and brown residents of nursing homes are nearly twice as likely to live in an understaffed facility in Illinois. They're also more than twice as likely to have overcrowding in rooms. That led to disaster during this pandemic.

HFS Medicaid Administrator Kelly Cunningham says the agency has a clear message moving forward. Officials believe the nursing home market should be about people, not profit. The department hopes lawmakers can authorize a patient driven payment model by January.

"Owners are important. We're not trying to say they're not," Cunningham said. "But, we're really trying to change that focus and make it person-centered. Make it about the resident and put our customers at the center."

Addressing understaffed nursing homes

Illinois consistently ranks last among states in terms of nursing home staffing. In fact, Illinois accounts for 47 of the bottom 100 facilities in the country for staffing performance.

"This is even after the General Assembly infused new money into the nursing home system on at least two or three occasions in previous years," Cunningham said.

That money was supposed to go to staffing. But, while Cunningham says some of the funding supported staff, she stressed it didn't go to the extent leaders initially hoped.

Now, HFS is recommending lawmakers authorize funded quality and staffing improvements through the nursing home reimbursement methodology.

Increasing wages and improving care

The agency suggests Illinois should dedicate 2/3 of the funding to staffing increases and workforce transformation. Cunningham says that should include improved wages and benefits.

"We know that staff retention is a significant quality indicator," Cunningham said. "So anything that we can do to incentivize that is something that is important to the department."

HFS said the remaining third could reward providers for achieving higher levels of care. Cunningham noted it could also go towards plans to upgrade quality in homes.

The department also hopes Illinois can dedicate remaining funds from the American Rescue Plan to nursing homes.

Officials argue that money could help protect residents and staff from the next COVID variant or another virus. Cunningham said the department could specifically use ARPA funds to reduce room crowding and improve air quality in homes.

The department also wants to prohibit staffing agencies from having non-compete clauses that keep facilities from hiring agency staff assigned to them. Many advocates and lawmakers hope to see a requirement for additional transparency in nursing home ownership as well.

HFS officials will present the recommendations to a committee of House lawmakers Wednesday morning in Chicago. Cunningham hopes the recommendations will become legislative proposals during veto session or when lawmakers return in January.

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Mike Miletich

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