The metro-east has some of Illinois' worst nursing homes, data says. Here's why.

In 2015, Ellen Paule, 79, of Belleville was admitted to St. Paul’s Nursing Home in Belleville. Within two months, a wound on her heel deteriorated to the point that live larvae and maggots were found crawling inside it.

Paule was hospitalized on June 28 with “a wound infection and maggot infestation,” according to reports from the federal Centers for Medicare and Medicaid. Another resident reported that the dressing on Paule’s leg ulcer would at times go two or three days without being changed.

CMS blamed the nursing home staff for the neglect of Paule and issued the home a severe violation.

Paule died two years later in April 2017. Efforts to reach her family for comment were unsuccessful.

At Belleville's Midwest Respiratory and Rehab, a diabetic resident fell into a “permanent vegetative state” in 2015 when staff failed to give her insulin for two weeks, according to reports from the Illinois Department of Public Health.

The facility, which is owned by Integrity Healthcare, was fined $25,000 and issued a severe violation by IDPH.

St. Paul’s executive director, Tammy von Yeast, said via email she could not comment on Paule's case because she is prohibited from providing information regarding residents' care and treatment.

An Integrity Healthcare representative also said she could not comment on specific cases due to privacy laws.

The citations issued to St. Paul and Midwest Respiratory and Rehab are just a few of hundreds issued to metro-east nursing homes in the past three years. It and many other local nursing homes have been issued violations at a rate that far exceeds state and federal levels.

Thirteen out of St. Clair County's 18 nursing homes score "below average" in overall care, according to CMS. Six of those had a rating of "much below average" Kaley Johnson kjohnson@bnd.com 

 

Nursing homes across the state, and especially in the metro-east, appear to be struggling to provide quality care. Critics say this is possibly due to inadequate government reimbursement or perhaps a failure to invest enough in staffing and patient care.

Local facilities have been issued numerous violations for neglect, bedsores, failure to investigate residents’ injuries and other issues.

Some blame nursing home owners for the lack of proper care in these homes, claiming corporations and owners are funneling money away from staffing and residents’ care and into their own pockets.

Others, however, blame Illinois’ privatized Medicare and Medicaid system, from which medical reimbursements arrive months late and are often too low to cover costs. Facility representatives say a backlog in reimbursements from Managed Care Organizations, health insurance corporations who control Illinois Medicare payments, are causing a crisis for facilities.

Whatever the cause, state and federal data shows metro-east nursing homes are facing a problem with violations issued on the state and federal level.

▪ ​Six residents died due to improper care in metro-east nursing homes from 2015-17, according to the Illinois Department of Public Health. Two more residents were sent into permanent comas because of nursing home errors, the department said.

▪ ​Thirteen out of St. Clair County’s 18 nursing homes score “below average” in overall care, including Midwest Rehab, according to the Centers for Medicare and Medicaid Services. Four of those have a rating of "much below average."

▪ ​In the past three inspection cycles, five of Belleville’s nursing homes have received a total of 260 federal violations, for an average of 17.3 health violations per home each inspection. This is more than double the state average of 6.2 per inspection and more than triple the national average of 5.8, according to the Centers for Medicare and Medicaid Services.

Columbia-based lawyer Steve Buser, who has worked in the metro-east for 40 years, said each year he works on 10 to 15 cases alleging nursing home neglect, abuse or improper deaths. However, he noted he receives requests for about 10 times that amount.

“I keep getting calls, usually several a month at least, and I probably only take one out of 20 cases,” Buser said. “My phone doesn't quit ringing.”

A pattern of neglect

Buser serves clients throughout Missouri and Illinois, but said most of his nursing home cases come from St. Clair and Madison counties. 

Nursing homes can receive violations on the state and federal level and are inspected at least once every six to 15 months.

Federal inspections, organized by CMS, issue 12 levels of violations. The level depends on the amount of harm caused and the number of people potentially or actually harmed.

The Centers for Medicare and Medicaid Services issue 12 levels of violations based on the severity and scope of the infraction.

Provided 

 

An “A” violation, for example, means there was the potential for minimal harm for a very small number of people. An “L” violation, the most severe a home can receive, means there was widespread, immediate jeopardy to residents’ health or safety.

The Illinois Department of Public Health also issues violations to homes based on CMS inspections and range in severity.

Since November 2014, only 28 L violations have been given by the state. Eight of those violations, 28.6 percent overall, were given to metro-east nursing homes. Seven were issued in St. Clair County alone, according to CMS.

When a violation is issued, an agency can fine the home up to $25,000 per offense depending on its severity. CMS can revoke a home’s Medicare and Medicaid reimbursement if they see fit. 

Some violations, such as four issued against Cahokia’s Autumn Meadows, were based around a specific incident. In July 2016, the home received multiple “L” violations when a fire broke out in the home. IDPH claims staff did not have an adequate emergency plan in place for patients. Autumn Meadows representatives disagree and say they are appealing the violations.

Other severe violations in the area indicate a pattern of neglect and endangerment of patients. 

For example, Integrity Healthcare in Wood River was issued a violation after a patient was sent to the hospital in a coma on Christmas with a 104.1 degree fever and sepsis. The man had been unresponsive for five days prior to his hospitalization, according to the report, and the facility had failed to “recognize, assess and treat” the man’s condition.

Data shows many homes are not issued a violation just once, but instead are repeatedly given citations for the same problems over and over again.

Since November 2014, 28 L level violations, the most severe CMS can give a facility, were issued in Illinois. Eight of them were in the metro-east. Seven were issued in St. Clair County alone.

Kaley Johnson kjohnson@bnd.com 

 

All deficiency data used in this story is based on 2015 to 2017 CMS reports available as of April 1, 2018.

At Cahokia’s Autumn Meadows, 9 of the 13 violations issued in 2017 were repeat violations, such as keeping residents free from physical restraints.

Jeff Davis, the director of operations of Southwest Healthcare Management, which owns Autumn Meadows, said repeat violations do not necessarily indicate the exact problem is recurring. In some cases, he said, a new violation may differ from a previous one but still fall under the same code because the categories are so broad.

“We may have corrected part of the problem but not all the aspects of it,” he said. “We have systems designed to prevent any violations that we have here, and sometimes those things need to be improved upon and they’re called out by state violations. We always take steps to re-mediate those.”

Integrity Healthcare in Belleville was issued four citations in two years for not providing care that ensured the highest well-being of each resident. Within an overlapping 15-month period, the facility was cited four times for not preventing avoidable accidents or protecting against accident hazards.

One of these violations in 2015 resulted in the hospitalization and severe injury of a resident whose tracheostomy tube was ripped out because he was moved improperly.

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The metro-east has some of Illinois' worst nursing homes, data says. Here's why.