Learn more about how and why the BND investigated southwestern IL nursing home errors
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Southwest Illinois nursing homes with COVID infection errors had same issues for years
Search through details of pandemic inspection reports on southwestern IL nursing homes
Learn more about how and why the BND investigated southwestern IL nursing home errors
If you experience a problem with a southwestern IL nursing home, here’s what to do next
The Belleville News-Democrat began investigating nursing homes and their government oversight as it became clear from public health statistics that their vulnerable patients were disproportionately affected by the coronavirus pandemic.
The BND tracked coronavirus cases and deaths in nursing homes from their earliest release in April 2020. We also sought to answer the questions: How did nursing homes respond to the new virus? And what challenges did they face?
We started by reading nursing home inspection reports as they were posted publicly during the pandemic. Inspectors were among the few groups allowed inside nursing homes as the virus spread, and their reports offered a glimpse of what the response looked like.
They paid special attention to nursing homes’ compliance with “infection prevention and control” requirements, which include hygiene and safety rules workers are expected to follow to protect patients from disease.
As we worked to analyze regional trends, we published articles about the violations that inspectors considered the most serious, resulting in resident infections and, in one case, deaths from COVID-19.
Meanwhile, we were building a searchable database based on the pandemic inspection reports. We wanted to make inspectors’ detailed accounts of what they determined were errors easily accessible to readers.
Our initial findings from 52 pandemic inspection reports were that the most common violations across the region involved workers failing to clean their hands, put on personal protective equipment like gloves and face masks or change out of gear that could have been contaminated, according to inspectors.
We brought our findings to Chris Sutton, the region’s long-term care ombudsman, before his death in August 2021. He wasn’t surprised by the pandemic trends because he said metro-east nursing homes had these same citations before COVID-19.
To verify the past trends, the BND looked through the inspection history of the nursing homes that inspectors cited in the pandemic. We read reports from 2017, 2018, 2019 and the first few months of 2020 before efforts to fight the virus, like lockdowns, started in Illinois nursing homes.
We found 62 reports on 19 nursing homes involved the same errors — hand-washing and PPE use — multiple times in the years preceding the pandemic.
Using a questionnaire, the BND asked for comment from administrators at all the nursing homes that inspectors cited for breaking infection control rules during the pandemic. Two administrators filled out the questionnaire. Two more nursing homes responded through a corporate spokesperson and an attorney. The BND sent out the questionnaires from Aug. 24-26.
These are the questions we asked:
- How long have you been working at your current facility?
- Has your facility appealed any infection control or staffing deficiencies that the Illinois Department of Public Health cited between May 2020 and March 2021?
- Since March 2020, has your facility sought help from agencies such as the county health department or Illinois Department of Public Health to address any challenges your facility faced in responding to COVID-19?
- For which of the following challenges did you seek help: staff shortages, PPE shortages or other challenges?
- Did you receive the help you sought?
- Your facility has been cited since 2017 for the same infection control deficiency you had during the pandemic. Why do you think the problem persisted?
- Staff shortages and infection control deficiencies were common problems in nursing homes both before and during the pandemic. What do you think are some possible solutions to those problems?
- How would you grade your facility’s response to COVID-19?
After a citation, regulators including the Illinois Department of Public Health and the federal Centers for Medicare and Medicaid Services require nursing homes to address any problems that inspectors identified. Typically, regulators make nursing homes give their staff refresher training for violations of infection standards.
But these errors continued to show up in inspection reports.
The Illinois Department of Public Health official overseeing nursing home enforcement has publicly acknowledged that infection control deficiencies are common and predated the pandemic.
The BND gathered perspectives on why the errors persisted despite rules dictating how workers should act to prevent infections and state inspections that were supposed to hold them accountable for failure and what the solutions could be.
Our sources included area nursing home administrators, workers and families; local, state and national resident advocates; and state officials, lawmakers and trade group leaders.
We heard about workforce problems — frequent staff turnover from the top down and widespread worker shortages — as well as criticism of regulators’ enforcement and some nursing homes’ supervision of their employees. We also heard about the resources available to residents and families who experience a problem with a nursing home and published a short guide to seeking help.
State officials and lawmakers have been discussing some of these long-standing issues and proposed reforms with new urgency in the wake of COVID-19’s devastation in nursing homes.
The BND will continue to follow the reforms as the spring legislative session begins.