Nursing homes accounted for nearly half of Illinois’ COVID-19 deaths. But, as their owners said they were doing all they could about that suffering, they kept showering lawmakers with campaign contributions.
Now the main lobbying group for profit-driven facilities is asking those lawmakers for a big infusion of state dollars in the name of “recovery and stabilization” while fighting proposed accountability measures.
The group, the Health Care Council of Illinois, is pushing state lawmakers for $486 million without strings requiring the money to be spent on staffing and infection control. The council, meanwhile, is opposing legislation drafted by Gov. JB Pritzker’s administration that would focus a Medicaid boost on facilities that eliminate ward-style rooming and improve nurse-to-patient ratios.
“Now is not the time to introduce dramatic policy changes that would significantly disrupt the delivery of care while the pandemic is still active,” HCCI Executive Director Matt Pickering said in a written statement about the Medicaid bill.
A sample letter that industry lobbyists circulated last week in Springfield aimed to press House leaders to support increased funding, saying it “would go a long way to help facilities hire additional staff, purchase PPE and continue to protect residents from COVID.”
Illinois and the federal government already spend about $2.5 billion a year on Medicaid for 45,000 skilled-nursing residents in the state, according to the Illinois Department of Healthcare and Family Services, which manages those funds. Most of those residents live in facilities operated for profit.
A WBEZ investigation last year found that the for-profit facilities tended to have lower staffing coverage, which correlated with higher COVID-19 infection and death rates. The investigation also found that nursing home owners routinely hide their profits by paying themselves huge fees through vendors and real-estate firms they control. The complicated ownership structures allow them to cry poor while asking lawmakers to approve increases in state funding.
The most profitable facilities last year had staffing below federal guidelines, according to IDHFS.
Room crowding, understaffing
IDHFS officials say they crafted the Medicaid bill, introduced last week, to help Black and brown nursing-home residents who rely on that funding program. The department says those residents were 40% more likely than white Medicaid residents to die from the coronavirus and that the racial disparity stems partly from Black and brown people being more likely to end up in rooms with three or more residents.
The legislation would increase Medicaid funding to skilled-nursing facilities by 10%. To address the overcrowding, the bill would phase out the new funds over time for rooms with three or more residents. It would also increase funds to reward facilities as they bring on more nurses and aides and as they care for residents with more staff-intensive medical conditions such as dementia.
Theresa Eagleson, the IDHFS director, said the goal is “more accountability” for funds from Illinois taxpayers.
“We want to reward providers who are doing the right thing,” Eagleson said, “to try to drive better quality and results than what we saw during the pandemic.”
As of last Friday, according to Illinois public health data, 10,463 congregate care residents in Illinois had died from COVID-19. They amounted to 46.4% of the state’s coronavirus deaths.
Eagleson pointed to three Illinois funding boosts for nursing homes since 2014 that were intended to improve staffing coverage.
“When we go back and look at how staffing has changed over that time, while there are some homes that are doing the right thing, there are many homes that haven’t had an appreciable change in staffing,” Eagleson said.
Last year, Illinois nursing homes received hundreds of millions of dollars in state and federal funds for COVID-19-related costs and millions more from the federal Paycheck Protection Program.
Eagleson said any additional COVID-19-related funding for the industry should have strict conditions to ensure the money is spent on staffing and infection control.
But HCCI senior policy advisor Donna Ginther told an Illinois House committee last month that owners are already doing their best.
“We know our facilities don’t have the money to staff up and increase wages, to do recruitment campaigns and all of those things,” Ginther told lawmakers. “They don’t have the resources, necessarily, to be able to do it or they would have done it.”
HCCI has long complained about Illinois’ Medicaid rates, saying they are so low they drive some nursing homes out of business. The lobbying group says pandemic-related costs and occupancy drops have made it even harder for facilities to stay open.
The group’s voice is backed by prolific campaign donations. Since January of last year, HCCI’s political action committee has made more than $1.9 million in contributions.
The biggest beneficiary of the HCCI dollars has been Senate President Don Harmon, a Democrat of Oak Park. The five campaign committees he controls together have reaped more than $492,000 from the council’s fund during the past 17 months.
House Speaker Emanuel “Chris” Welch, D-Hillside, received a $50,000 contribution from the industry PAC nine days after he was sworn in as successor to ex-House Speaker Michael Madigan, D-Chicago, in January.
Before Madigan’s departure from House leadership, four funds he controlled while speaker received $450,000 from the HCCI fund.
State Rep. Anna Moeller, a Democrat from Elgin who is sponsoring the IDHFS bill in the House, said Madigan for years “protected” the industry from legislation aimed at tightening state regulation.
Moeller said Welch, the new House speaker, seems more open to requiring nursing-home accountability for state funding.
“Times have changed,” Moeller said. “There’s new leadership.”
But Welch’s office did not respond this week to questions about his position on the Medicaid bill.
A spokesman for Harmon referred questions about it to the legislation’s Senate sponsor, Ann Gillespie, D-Arlington Heights, who turned down an interview request about the matter and wrote that she remains “committed to passing legislation to increase accountability in nursing home staffing.”
Moeller and other supporters of the bill admitted that the chances of passing it before the legislature’s scheduled adjournment Monday are slim.
Illinois fines to enforce decade-old staffing minimums, meantime, were supposed to take effect this past January. But HCCI convinced lawmakers on an administrative rulemaking committee that it would be a bad idea to proceed when nursing homes were struggling to find workers during the pandemic. The committee agreed to delay the enforcement.