A Family Guide to Safety in Illinois NURSING HOMES

Transcription

1 A Family Guide to Safety in Illinois NURSING HOMES

2 Preface WHY DID WE WRITE THIS GUIDE? Our law firm helps families every day to cope with problems caused by nursing home abuse and neglect. We prepared this guide to help families avoid facilities where their loved one could be at risk of mistreatment and to assist families in moving a loved one to a safer environment if harm has already occurred. WHO IS THIS GUIDE FOR? We wrote this guide for the thousands of families throughout Illinois who face the difficult decision of whether to move a father, mother or other elderly relative into a nursing home. This guide can help families to find a facility that will respect their loved one s rights and provide the care and attention he or she deserves. HOW TO USE THIS GUIDE? You can use this guide to identify the right nursing home for your family. You can also learn how to recognize and respond to abuse and neglect, including reporting it, taking legal action and, ultimately, finding a new home for your loved one.

3 TABLE OF CONTENTS 1. Introduction Abuse Neglect Rights Responsibilities Reporting Investigation Choosing a Home Getting Involved Do You Have a Case? Case Study

4 3 Introduction THE PURPOSE OF THIS GUIDE You have decided that the time has come to move your mother, father or other elderly relative into a nursing home. It is a tough choice one that thousands of people throughout Illinois must make every year as they juggle the needs of the family they are raising and those of an aging loved one. The situation is more challenging when you don t know which facility will provide the care and attention your loved one deserves. We hope our guide, Protecting Your Parents in an Illinois Nursing Home, leads you to the right solution. "As of 2013, 1.7 million residents of Illinois were ages 65 and older. By 2050, that number is expected to nearly double, the U.S. Census Bureau predicts." As Illinois Population Ages, Challenges for the Sandwich Generation Grow Many years ago, a writer coined the term sandwich generation to describe those who find themselves being sandwiched between raising a family and caring for an older parent. As Illinois population ages at a rapid rate, the challenges faced by those in the sandwich generation will only grow. As of 2013, 1.7 million residents of Illinois were ages 65 and older. By 2050, that number is expected to nearly double, the U.S. Census Bureau predicts.

5 4 Introduction THE PURPOSE OF THIS GUIDE CMAP, the northeastern Illinois regional planning organization, recently analyzed U.S. Census Bureau population data from 2000 and 2010 to paint a picture of just how fast the state s population is aging. CMAP found an 8.8 percent increase over the course of that decade in the number of people ages 65 and older who live in Cook, DuPage, Kane, Kendall, Lake, McHenry, and Will counties. Northeastern Illinois' Senior Population (2000 to 2010) Residents ages 65 and older in 2000 and 2010, with percentage of total population 2000 County Residents 2010 Pct. Residents Change Pct. Residents Pct. Cook 630, % 620, % -1.6% +0.2% DuPage 88, % 106, % +19.8% +1.8% Kane 33, % 49, % +46.2% +1.2% Kendall 4, % 8, % +80.8% -1.2% Lake 54, % 73, % +32.9% +1.9% McHenry 20, % 31, % +49.8% +2.1% Will 41, % 62, % +51.0% +1.0 Region 875, % 952, % +8.8% Source: CMAP Analysis of U.S. Census Bureau data, 2000 and %

6 5 Introduction THE PURPOSE OF THIS GUIDE Finding Quality Nursing Home Care in Illinois Can Be Difficult For many in the sandwich generation, the solution is to move an aging loved one into a nursing home facility. Unfortunately, in Illinois, it can be difficult to find a nursing home facility that can provide the quality of care and assurances of safety that a family is seeking. Problems in these facilities are widespread. According to Nursing Home Compare, a federal government-run website that provides quality-of-care information for the nation s Medicare- and Medicaid-certified nursing homes, more than 30,000 deficiencies were reported in Illinois facilities between February 2012 and May A deficiency is defined as a failure to meet federal standards. Deficiencies in Illinois Nursing Homes Between February 2012 and May 2015 Year Deficiencies Additionally, between 2010 and 2014, the , , , ,665 Total 30,270 Illinois Department of Public Health (IDPH) took more than 2,000 disciplinary actions against nursing homes mainly due to violations of the Nursing Home Care Act. Source: Nursing Home Compare, Data.Medicare.gov

7 6 Introduction THE PURPOSE OF THIS GUIDE Quarterly Reports of Nursing Home Violations in Illinois As reported to the IDPH between 2010 and 2014 Year Q1 Q Q3 Q4 Total Total ,396 Source: Illinois Department of Public Health, Quarterly Reports How to Use Our Guide The legal team of Salvi, Schostok & Pritchard P.C. helps families every day to cope with the problems created by the mistreatment of an elderly loved one in a nursing home. We wrote this guide to help families avoid facilities where their loved one could be exposed to mistreatment and to aid them in transitioning to a safer environment if harm has already occurred.

8 7 Introduction THE PURPOSE OF THIS GUIDE By using our guide, you can learn how to recognize and respond to mistreatment of your loved one in a nursing home, including identifying signs of: Physical abuse Emotional abuse Sexual abuse Neglect The intentional infliction of physical pain or injury through hitting, slapping and other forms of assault or through the use of restraints. The intentional infliction of emotional pain and anguish through intimidating, threatening or humiliating a nursing home resident. Making sexual contact of any kind, without consent, or forcing a resident to observe a sexual act or pornography. The failure of a nursing home to provide basic care to a resident, including providing food, shelter, medical care and safety. Our guide explains how to report suspected abuse and neglect and take legal action. Above all, our guide can be used to find a new home where your loved one s health and dignity will be protected, including using our checklist when you visit a nursing home facility. We hope this guide will help you and your family to make informed decisions that will ultimately lead to the best care for your elderly loved one in the years ahead. Next: 2. Abuse

9 8 Abuse RECOGNIZING ABUSE IN ILLINOIS NURSING HOMES Under the Illinois Abused and Neglected Long-Term Care Facility Residents Reporting Act, abuse is defined as any physical injury, sexual abuse or mental injury inflicted on a resident other than by accidental means. A report by the Illinois Department of Public Health (IDPH) shows that an alarming number of nursing home residents within our state may be subjected to this type of mistreatment. "As of 2013, 1.7 million residents of Illinois were ages 65 and older. By 2050, that number is expected to nearly double, the U.S. Census Bureau predicts." The agency reports that, between 2011 and 2013, it received more than 6,000 complaints about mistreatment of residents in our state s nursing homes, including allegations of: Allegation Total Physical abuse Sexual abuse Mental abuse Source: Long-Term Care Annual Report to the Illinois General Assembly, Illinois Department of Public Health

10 9 Abuse RECOGNIZING ABUSE IN ILLINOIS NURSING HOMES Unfortunately, many nursing home residents are too afraid, intimidated or embarrassed to report abuse to the facility s administrators, health officials, police officers or even to their own family members. In some cases, a nursing home resident may suffer from a physical or mental disability that prevents them from communicating to others that abuse is taking place. In fact, the National Center for Elder Abuse (NCEA) estimates that about 84 percent of abusive situations involving elderly adults are unreported or unrecognized. If you have moved your elderly loved one into a nursing home, the reality is that it will be up to you to pay close attention to the treatment they are receiving. You should understand the different types of abuse that can occur and know how to recognize whether your loved one is, in fact, being subjected to such abuse. Physical Abuse Physical abuse can involve slapping, punching, grabbing, shoving, kicking and other acts of violence. It may also involve the use of restraints such as gags or ties around the wrists or ankles or chemical restraints such as powerful antipsychotic medications. Withholding food or liquids from a resident as a means of punishment may also be a form of physical abuse. It may be inflicted on nursing home residents by staff members, including nurses, or even by fellow residents. Signs of physical abuse include: Bruises, welts, cuts or burns Marks around the arms, legs, back, stomach or face Frequent injuries that the staff describes as being the result of accidents Torn or bloody clothing Extreme drowsiness or lack of responsiveness Weight loss or malnutrition Nervousness or anxiety around certain staff members.

11 Abuse 10 RECOGNIZING ABUSE IN ILLINOIS NURSING HOMES Emotional / Psychological Abuse Emotional / psychological abuse can cause as much harm as physical abuse. It involves the infliction of emotional anguish or distress on a nursing home resident through verbal or non-verbal acts. Emotional abuse may include a wide range of actions, including harassing, threatening or intimidating a resident. It may also include shaming, demeaning or humiliating a resident or isolating him or her from other residents, activities or family members. It may be difficult to recognize the signs of emotional abuse. Instead of looking for scars or bruises, you need to be on the lookout for signs such as: Depression Withdrawal from interaction with family and friends Uncharacteristic or sudden behavioral changes Fatigue (which may be due to insomnia) Sudden weight loss Fear and apprehension around certain staff members. Sexual Abuse Sexual abuse may involve sexual contact without consent or forcing a resident to witness sexual acts or pornography. The victims may be male or female. A nursing home s failure to conduct proper criminal background checks of staff members could lead to patients being exposed to sexual predators.

12 Abuse 11 RECOGNIZING ABUSE IN ILLINOIS NURSING HOMES Potential signs of sexual abuse in a nursing home include: Unexplained sexually transmitted diseases Difficulty sitting or walking Bruising or fingerprints on the breasts, buttocks, genital areas and inner thighs Unexplained anal or vaginal bleeding Genital infections, including urinary tract infections Redness or irritation in the genital area Stained or bloody sheets Torn, bloody or stained underwear or clothing Rope burns or marks on the ankles and wrists Fear, stress or anxiety when approached by a particular staff member. If you have observed any of these red flags when visiting your elderly parent or other relative in a nursing home, please see our section on How to Report Nursing Home Abuse and Neglect in Illinois. Next: 3. Neglect

13 Neglect 12 RECOGNIZING NEGLECT IN ILLINOIS NURSING HOMES The Illinois Abused and Neglected Long-Term Care Facility Residents Reporting Act defines neglect as the failure in a long-term care facility to provide adequate medical or personal care or maintenance, which failure results in physical or mental injury to a resident or in the deterioration of a resident s physical or mental condition. Neglect is the most common form of mistreatment of Illinois nursing home residents, according to a report by the State s Department of Public Health (IDPH). During a recent three-year span (2011 to 2013), the IDPH s Central Registry received 3,833 complaints of alleged neglect in our state s nursing homes, or an average of nearly 1,300 complaints per year. In a study that examined 2,000 interviews of nursing home residents, 95 percent reported that they had been neglected or witnessed the neglect of another resident In a study that examined 2,000 interviews of nursing home residents, 95 percent reported that they had been neglected or witnessed the neglect of another resident, according to a National Center on Elder Abuse research brief. Due to fear or embarrassment, an elderly nursing home resident may be unwilling to report neglect to administrators, health and law enforcement officials or their family members. The resident may also suffer from a condition such as dementia that leaves him or her unable to report the neglect. As one with a parent or other elderly relative in a nursing home, you can play a crucial role in recognizing and responding to neglect.

14 Neglect 13 RECOGNIZING NEGLECT IN ILLINOIS NURSING HOMES When you visit your loved one, pay attention to these signs: Signs of Medical Neglect A nursing home may be failing to provide proper medical care for your loved one. For example, if your loved one is immobile, he or she should be routinely turned in bed or repositioned in a wheel chair. A nursing home s failure to do so can result in bed sores. Other signs of medical neglect include: Untreated cuts, wounds, sprains or fractures Infections that go unaddressed Medication-related health issues (due to the wrong medication type or dosage or the failure to administer medication according to schedule) Delayed emergency medical treatment or diagnosis of a condition. Signs of Hygiene Neglect A nursing home must provide at least basic personal care and maintenance of its residents. Serious health issues can be caused by a nursing home s failure to meet the basic hygiene needs of a nursing home resident or to provide a clean, sanitary environment. Signs of hygiene neglect include: Bed sores (caused by a resident lying or sitting still for long periods without being moved or repositioned) Staph infections Dirty skin, beard growth, unwashed or unbrushed hair or neglected nails Soiled sheets and mattresses

15 Neglect 14 RECOGNIZING NEGLECT IN ILLINOIS NURSING HOMES Unwashed clothing Unchanged bed pans or undergarments Dirty furniture, carpets or floors. Nutritional Neglect A nursing home must provide proper food, drink and nutrition, including meals that are suitable for a resident given his or her food allergies or special dietary needs. In some cases, assistance must be given to residents whose physical or mental disability prevents them from eating or drinking on their own. Nutritional neglect can lead to malnutrition and dehydration. Signs of nutritional neglect include: Sudden weight loss Lack of energy or fatigue Dizziness and confusion Headaches Muscle weakness (resulting in falls or fractures) Weakened immune system (resulting in infections). Emotional and Social Neglect A nursing home resident can suffer harm due to the facility s failure to allow personal contact, social interaction and companionship that a resident needs to maintain a healthy emotional well-being. Signs of emotional and social neglect include:

16 Neglect 15 RECOGNIZING NEGLECT IN ILLINOIS NURSING HOMES Depression Anxiety Change in demeanor (moodiness) Emotional distress Self-destructive behavior. Security Neglect The failure of a nursing home to keep residents safe from harm inflicted by staff members, fellow residents or visitors to the facility is a serious issue. Due to a lack of property security, a nursing home resident such as one with Alzheimer s disease or another form of dementia may wander into a dangerous situation within the facility or elope from the campus. Signs of security neglect include: Lack of security guards, locks or monitoring equipment Injuries from physical or sexual assault Fractures or other injuries suffered in falls Hypothermia or other illness caused by exposure. If you have observed any of these signs of neglect when visiting your elderly parent or other relative in a nursing home, please see our section on How to Report Nursing Home Abuse and Neglect in Illinois. Next: 4. Rights

17 16 Rights UNDERSTANDING THE RIGHTS OF ILLINOIS NURSING HOME RESIDENTS Concerns about the quality of care being provided to elderly nursing home residents in Illinois led to the enactment of the Nursing Home Care Act in The Act promotes the health and safety of our state s nursing home residents and protects their right to be treated with respect and dignity. It applies to any long-term care facility, or a non-government owned or operated facility with three or more residents (who are unrelated to the owner). A nursing home cannot deprive any resident of any rights, benefits or privileges that are guaranteed by the state and federal constitutions or as otherwise provided by law. Illinois residents also enjoy rights under the federal Nursing Home Reform Act of The Act also is aimed at ensuring that nursing home residents rights are protected and that their living environment is one that allows them to achieve and maintain their highest practicable physical, mental and psychosocial well-being. It applies to facilities that participate in Medicare or Medicaid. If your elderly loved one is living in an Illinois nursing home, you should be aware of the rights that he or she is guaranteed through this combination of state and federal laws. You should pay close attention to whether the following 25 rights, in particular, are being respected by those who own and operate the facility.

18 17 Rights UNDERSTANDING THE RIGHTS OF ILLINOIS NURSING HOME RESIDENTS 1 The rights of a U.S. citizen. A nursing home cannot deprive any resident of any rights, benefits or privileges that are guaranteed by the state and federal constitutions or as otherwise provided by law. For example, a nursing home cannot deprive a resident of his or her right to free speech, religious freedom and voting. 2 The right to be free from abuse or neglect. This includes the right to be free from physical, mental or sexual abuse by a nursing home s staff or by fellow residents, and the right to receive proper care and treatment within the facility. 3 The right to be informed about the rules concerning spousal impoverishment. Under special Medicaid provisions, a certain percentage of a couple s combined resources may be protected for the spouse who is still living in the community. 4 The right to manage his or her own financial affairs. However, the resident and his or her guardian may give written authorization for the facility administrator to manage the resident s financial affairs. If this occurs, the resident (or guardian) has the right to receive quarterly financial statements. 5 The right to retain, use and wear his or her personal property. In some cases, a nursing home may deem it to be medically inappropriate for a resident to wear his or her own clothing. If so, the facility must provide properly fitting attire.

19 18 Rights UNDERSTANDING THE RIGHTS OF ILLINOIS NURSING HOME RESIDENTS 6 The right to have personal property adequately protected. The nursing home must provide an adequate storage area for personal property and take reasonable steps to prevent loss and theft. 7 The right to retain his or her own personal physician. The resident may use his or her own doctor as long as the resident pays for the medical care and treatment through personal assets, private health insurance or public assistance. 8 The right to obtain complete and current medical information. Regardless of whether the physician is a personal doctor or one provided by the nursing home, the resident has the right to be informed about his or her diagnosis, treatment and prognosis. The information must be conveyed in terms and language that a resident can reasonably be expected to understand. 9 The right to participate in the planning of his or her total care and medical treatment. A comprehensive plan should be developed that meets the resident s needs and allows him or her to attain or maintain the highest practicable level of independent functioning. The resident shall not be assessed any charges that were not authorized in writing at the time of admission. 10 The right to refuse medical treatment (unless it would harm others). This includes a resident s right to have his or her living will honored (such as a do not resuscitate provision).

20 19 Rights UNDERSTANDING THE RIGHTS OF ILLINOIS NURSING HOME RESIDENTS 11 The right to name one or more potential health surrogates. The surrogate can act on the resident s behalf if the resident loses decision-making capacity. 12 The right to respect and privacy in medical and personal care. In other words, the nursing home cannot release any confidential information about the resident without his or her consent. 13 The right to be free from unwarranted, unauthorized use of restraints or confinement. This includes the use of physical restraints and chemical restraints. A resident can never be restrained or confined for the sake of punishment or for the convenience of the facility s staff. A restraint can only be used when a doctor orders and documents the need for it. 14 The right to not be given unnecessary drugs. A resident cannot be given drugs in excessive doses or for an excessive duration. Any administration of drugs must be adequately monitored. A drug cannot be administered for an improper use or where it would dangerously interact with other medications. 15 The right to not be given a psychotropic medication without consent. A powerful, mood-altering drug cannot be given to a nursing home resident unless there is informed consent by the resident or his or her guardian.

21 20 Rights UNDERSTANDING THE RIGHTS OF ILLINOIS NURSING HOME RESIDENTS 16 The right to private, unimpeded and uncensored communication by mail, public phone or visitation. A nursing home must make it convenient for a resident to mail or receive letters and provide reasonable access to a phone. Additionally, a resident is entitled to private visits at any reasonable hour, or between 10 a.m. and 8 p.m. If a private visit is taking place, staff must knock before entering a room. This right can be restricted by a nursing home only if necessary to protect the resident or others from harm, harassment or intimidation. 17 If both spouses reside in the nursing home, they have the right to share a room. Only if there is no room available to accommodate both spouses, or if sharing a room is deemed to be medically inadvisable, can this right be restricted by a facility. 18 The right to be free from performing labor for the facility. As a condition of living at the nursing home, a resident cannot be required to perform cleaning, cooking, maintenance, landscaping or other services for the facility. 19 The right to speak and meet with a social worker, local ombudsman or attorney in private during the nursing home s business hours. This right extends to visits that are for the purpose of discussing a resident s legal rights or the availability of personal, social and legal services. The right does not extend to visits that are solely for commercial purposes.

22 21 Rights UNDERSTANDING THE RIGHTS OF ILLINOIS NURSING HOME RESIDENTS 20 The right to be discharged or transferred from the home. The resident or his or her guardian must given written notice to the facility. 21 The right to present grievances on behalf of the resident or others without threat of discharge or reprisal in any form whatsoever. The nursing home administrator must provide contact information for the proper government office where a complaint may be lodged such as the local Ombudsman or Illinois Department of Public Health. 22 The right to be free from discrimination. This includes discrimination based on a resident s Medicaid eligibility. Regardless of a resident s financial status, he or she should receive the same services as any other resident. 23 The right to organize a resident s advisory council. The council shall be allowed to hold meetings and serve its purpose of disseminating information to residents, identifying problems within the facility and proposing improvements within the facility. 24 The right to be free from an improper involuntary discharge or transfer. No resident can be removed from the home unless notified at least 21 days in advance of the discharge or transfer. The resident s right to appeal the discharge or transfer must also be honored.

23 22 Rights UNDERSTANDING THE RIGHTS OF ILLINOIS NURSING HOME RESIDENTS 25 The right to bring an action against the nursing home s owner or licensee. Illinois law specifically states that an owner or licensee is liable for any intentional or negligent act or omission that injures a resident. Bringing legal action can result in the recovery of damages as well as lead to an injunction. Any waiver of this legal right by a resident or guardian is treated as null and void, and without legal force or effect. If you believe that your elderly loved one s rights under these state and federal laws have been violated, and your loved one has suffered harm as a result, you should report it without delay and seek legal representation immediately. Please see our section on Reporting Nursing Home Abuse and Neglect in Illinois for more information. Next: 5. Responsibilities

24 23 Responsibilities UNDERSTANDING THE RESPONSIBILITIES OF ILLINOIS NURSING HOMES The Illinois Nursing Home Care Act and federal Nursing Home Reform Act place many responsibilities on nursing homes in Illinois. The goal of these laws is to ensure that residents are treated with dignity and that their rights to privacy and self-determination are respected. Above all, the laws serve the purpose of promoting the safety and health of those who reside in nursing homes. Between February 2012 and May 2015, more than 30,000 deficiencies were reported in Illinois nursing homes. As you assess the care that your loved one is receiving in a nursing home, you should pay attention to whether the facility s staff, administrators and owners are living up to their legally mandated duties under state and federal laws. In addition to ensuring that a resident s rights are respected please see our section on Understanding the Rights of Illinois Nursing Home Residents a nursing home must specifically: 1 Ensure that no resident is harmed by any intentional or negligent act or omission. If a resident is harmed, whether it is by a staff member or fellow resident, the nursing home can and should be held liable. 2 Establish a written plan to protect residents rights and carry out its responsibilities as required by law. The home must provide an explanation of the resident s rights in writing to the resident at the time of admission or within two days after admission.

25 24 Responsibilities UNDERSTANDING THE RESPONSIBILITIES OF ILLINOIS NURSING HOMES 3 Inform staff members of resident s rights and their responsibilities. The home has a legal duty to ensure that all of its staff members understand these rights and responsibilities. Again, if a nursing home resident suffers harm due to a violation of his or her rights, the facility owner and licensee can be held liable for damages. 4 Establish a complaint process. The nursing home s policies and procedures for investigating and resolving resident complaints must be clear and unambiguous and available for inspection by any person. 5 Develop and implement a comprehensive care plan for each resident. The plan must be developed with the participation of the resident and his or her guardian. It must include measureable objections and timetables to meet the resident s medical, nursing, mental and psychosocial needs and allow the resident to attain or maintain the highest practicable level of independent functioning. 6 Provide adequate staffing levels. In particular, under an Illinois law that was enacted in 2010, the facility must provide 3.8 hours of direct care staffing for every skilled care resident and 2.5 hours of direct care staffing for intermediate residents. The home can only admit that number of residents for which it is licensed.

26 25 Responsibilities UNDERSTANDING THE RESPONSIBILITIES OF ILLINOIS NURSING HOMES 7 Implement enhanced resident pre-screening procedures and background checks. The goal is to identify any potentially dangerous individuals. 8 Keep out or remove potentially dangerous persons. If administrators find that a person s presence in the facility would be injurious to the health and safety of a resident or would threaten the security of the property of a resident or the facility, the person may be refused access. Any employee who is found to be perpetrator of abuse must be immediately barred from the facility. If a fellow resident is found to be the perpetrator of abuse, the resident must be evaluated and moved. 9 Immediately notify the resident s next of kin, representative and doctor of the resident s death. Those parties should also receive immediate notice if the resident s death appears to be imminent. 10 Report violations as required by law. Under Illinois law, it is mandatory for certain professionals to report suspected abuse or neglect, including any doctors, registered nurses or staff members at a nursing home.

27 26 Responsibilities UNDERSTANDING THE RESPONSIBILITIES OF ILLINOIS NURSING HOMES Who Holds Nursing Homes to Their Responsibilities? The Illinois Department of Public Health (IDPH) is the state agency that is in charge of ensuring that the state s nursing homes comply with state laws. The agency conducts more than 1,300 on-site inspections, or surveys, and responds to more than 6,000 complaints each year. Many inspections and complaints result in disciplinary actions against a nursing home. According to the IDPH s quarterly violation reports, which are available online, the agency initiated more than 2,000 disciplinary actions between 2010 and 2014: Quarterly Reports of Nursing Home Violations in Illinois As reported to the IDPH between 2010 and 2014 Year Q1 Q Q3 Q4 Total Total ,396 Source: Illinois Department of Public Health

28 27 Responsibilities UNDERSTANDING THE RESPONSIBILITIES OF ILLINOIS NURSING HOMES These violations fall into the following categories (from most to least serious in terms of the conduct involved and resulting sanctions and fines imposed): Type AA When a condition or occurrence at a nursing home has caused the death of a resident due Type A When a condition or incident could lead or has led to physical harm and a substantial probability of death, mental or physical harm Type B When an incident that would likely cause mental or physical harm to a resident has occurred Type C When a less serious incident has occurred that would not cause immediate physical or mental harm but could lead to the probability of such harm occurring. In addition to ensuring that nursing homes comply with the Illinois regulations, the IDPH works with the U.S. Department of Health and Human Services for Medicare and Medicaid Services (CMS) to ensure that facilities that participate in Medicare or Medicaid meet their responsibilities under the Nursing Home Reform Act of Unfortunately, data from the Nursing Home Compare website indicates that numerous facilities throughout Illinois fail to meet their responsibilities. Between February 2012 and May 2015, more than 30,000 deficiencies were reported in Illinois nursing homes. Deficiencies in Illinois Nursing Homes Between February 2012 and May 2015 Year Deficiencies Additionally, between 2010 and 2014, the Illinois Department of Public Health (IDPH) took more ,466 than 2,000 disciplinary actions against nursing ,194 homes mainly due to violations of the Nursing ,945 Home Care Act ,665 Total 30,270 Source: Nursing Home Compare, Data.Medicare.gov

29 28 Reporting REPORTING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS If you believe that your mother, father or other elderly loved on is being abused or neglected in an Illinois nursing home, you should report the mistreatment as soon as possible. By reporting the mistreatment, you help to protect your loved one and, hopefully, prevent others from suffering similar harm in the future. The following is a step-by-step breakdown of the process you should follow. By reporting the mistreatment, you help to protect your loved one and, hopefully, prevent others from suffering similar harm in the future. 1 Do an initial evaluation of the situation. Before you go any further in the reporting process, you should assess why you want to report the suspected abuse or neglect. It may be a good idea to write a summary of what has happened. Ask yourself: Did I personally witness abuse or neglect of my loved one? Have I seen signs of abuse and neglect such as cuts, bruises or bed sores? Did my loved one complain about the treatment that he or she is receiving in the nursing home? Have fellow residents voiced similar complaints? Who has inflicted the harm my loved one has suffered? When did the harm occur?

30 29 Reporting REPORTING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS The stronger you understand the foundation for your concerns, the better you will be able to communicate those concerns to the proper authorities. You should also assess whether your loved one may be facing imminent harm. If so, you should take steps to immediately remove him or her from the facility. 2 File a complaint with your local Illinois Long-Term Care Ombudsman or the Senior Helpline. Once you have a firm grasp on the situation, you should go forward with filing a complaint with the Illinois Long-Term Care Ombudsman Program. This program is operated by the Illinois Department on Aging. It provides a variety of services, including investigating complaints of suspected abuse, neglect and other violations of state nursing home regulations and taking steps to resolve them. You can find the contact information for your local Ombudsman by going to the directory that is available on the Department on Aging website or by calling (866) (toll-free) or (888) (TTY). The Ombudsman may try to work directly with the nursing home to address the issues raised in your complaint. If that does not resolve the issue, the Ombudsman will assist you in filing a complaint with the Illinois Department of Public Health (IDPH). You can also report the suspected abuse or neglect by contacting the Senior HelpLine at (800) (toll-free) or (888) (TTY) or by at aging.ilsenior@illinois.gov. The Senior HelpLine is available Monday through Friday from 8:30 a.m. to 5 p.m.

31 30 Reporting REPORTING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS 3 File a complaint with IDPH. If you decide to go forward with filing a complaint with IDPH, you can do so by: Phone: (800) or (800) (TTY). The hotline is open from 8:30 a.m. to 4:30 p.m. Monday through Friday. Fax: (217) Mail: Illinois Department of Public Health Office of Health Care Regulation Central Complaint Registry 525 W. Jefferson Street, Ground Floor Springfield, IL Before you file the complaint, download the IDPH Complaint Form. You can complete the form and send it to IDPH by fax or mail, or you can use the form to guide you in reporting by phone. You should be prepared to answer questions such as: Who is the resident who has been abused or neglect? Be ready to give the name and age of your loved one. You may also want to provide the names of staff members or administrators that you believe are involved. What happened to the nursing home resident? Be prepared to describe the specific acts of abuse or neglect that you believe have occurred. For instance, was your loved one assaulted by a staff member? Is the nursing home failing to reposition your loved one, leading to bed sores? Are staff members administering medications without authorization?

32 31 Reporting REPORTING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS When did the abuse or neglect occur? You should be able to provide specific dates or, at the least, the time periods in which the suspected mistreatment occurred. Where is the facility located? You will need to provide the name of the nursing home and the city where it is located. You can find out or verify this information by going to the IDPH s nursing home directory. You should also give the room number or floor where the abuse or neglect occurred. How was the nursing home resident harmed or potentially harmed? You should be able to describe specific the actual harm your loved one has suffered or your concerns about the harm he or she could potentially suffer due to the abuse or neglect that is occurring at the facility. You can file a complaint anonymously. However, if you want to receive written confirmation that your complaint has been received and to be informed of the results of the IDPH investigation, you must give your name, address and phone number. IDPH will not reveal your identity as the one who filed a complaint unless: You give written permission Your identity is essential to the investigation A court case is filed by IDPH against the nursing home. It is important to know that the facility cannot retaliate against your loved one, including harassing, discharging or transferring him or her, simply because you have filed a complaint with IDPH. The IDPH has a legal duty to investigate your complaint. If you report suspected abuse or neglect, the IDPH investigation must complete the investigation within seven days. All other investigations must be completed within 30 days.

33 32 Reporting REPORTING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS 2 Contact a lawyer. In addition to filing a complaint with IDPH, you should contact a lawyer in order to ensure that your loved one s rights are fully protected. The lawyer can serve as a liaison between you, the nursing home and IDPH during the investigation or can conduct an independent investigation into the suspected abuse or neglect. A lawyer can also help you to assess your options for seeking relief through a lawsuit, including compensation for any physical, emotional or financial harm that your loved one has suffered. Next: 7. Investigation

34 33 Investigation INVESTIGATING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS If you observe signs that your loved one is being abused in an Illinois nursing home, your next step should be to report it to your local Long-Term Care Ombudsman or the Illinois Department of Public Health (IDPH). What can you expect to happen after you make your report? The following is a step-by-step description of how the IDPH will review your complaint, investigate it and if needed take corrective action against the nursing home. Any nursing home that is in violation of nursing home regulations is deemed under Illinois law to be a public nuisance. While the IDPH process is taking place, you should consider: Moving your loved one to a safer place as soon as possible Consulting with a lawyer to determine whether you should file a civil lawsuit. We conclude this chapter by discussing the approach a lawyer may take if you pursue a civil claim based on the suspected abuse or neglect. (In our next chapter, we discuss what you should consider when moving your loved one to a new home.)

35 34 Investigation INVESTIGATING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS How IDPH Investigates Reported Cases of Abuse or Neglect Illinois law gives the IDPH the authority to license nursing homes in our state. As a result, IDPH can investigate complaints involving its licensed facilities and take action if its finds a violation of nursing home regulations. Here s how the process works: First, after getting a complaint, the IDPH must start an investigation within: 24 hours if the complaint indicates the resident faces imminent danger 7 days if the complaint alleges abuse or neglect 30 days for all other types of complaints. It s important to know: IDPH will not disclose your identity as the complainant. Also, neither you nor your loved one can be subjected to any transfer, discharge or other form of retaliation simply because you made a complaint. The more information you provide in your complaint, the easier it will be for IDPH to respond to it and conduct its investigation. You can expect this investigation to involve an on-site inspection that includes: Interviews with your loved one, other residents and staff members The inspectors observations of the facility and its residents Review of records at the facility. Within 10 days after the IDPH determines whether a violation has occurred, it will send a notice to the nursing home (and you should get a copy, too, if you gave your name and contact information to IDPH).

36 35 Investigation INVESTIGATING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS A nursing home violation can fall within four categories, depending on the nature of the condition or occurrence that gave rise to the violation: Type AA Proximately caused a resident s death Type A Creates a substantial probability that the risk of death or serious mental or physical harm will result or has resulted in actual physical or mental harm to a resident. Type B More likely than not to cause more than minimal physical or mental harm to a resident Type C Creates a substantial probability that less than minimal physical or mental harm to a resident will result therefrom. (Section of the Act) The IDPH can take administrative actions that include: Requiring the nursing home to follow a plan of correction Assessing a fine Putting the facility on conditional license status Suspending or revoking its license. Any nursing home that is in violation of nursing home regulations is deemed under Illinois law to be a public nuisance. The Attorney General has the power to seek an injunction. This could stop a nursing home from its abusive or negligent practices, or it could stop the facility from operating in any capacity. If you are dissatisfied with the IDPH s determination, you can request a hearing. You must submit your request in writing within 30 days after you get the IDPH s determination. The IDPH must hold the hearing within 30 days.

37 36 Investigation INVESTIGATING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS As part of this hearing, a hearing officer can compel a nursing home to produce records or other documents. It can also compel people to testify under oath. The record and transcript in this hearing may be useful later on in pursuing a lawsuit. If a nursing home licensee, owner or administrator or others fail to comply, it can be held in contempt of court. You may participate and be represented by a lawyer at this hearing. Within 30 days after the hearing, the hearing officer will make findings of fact and reach an administrative decision. If you wish to appeal the hearing officer s decision, you can file a complaint in Illinois Circuit Court. How Pursuing a Nursing Home Abuse or Neglect Claim Would Work Much of the information from the IDPH s investigation, finding of a violation and hearing can be used in a personal injury or wrongful death claim against a nursing home. An attorney may also conduct an independent investigation into the case. A lawsuit would need to be filed within two years after the injury was discovered and no later than four years from the date of the injury. If the lawsuit alleges wrongful death, it would need to be filed within two years from the date of death. After a lawsuit is filed, both your attorney and attorneys for those named in the lawsuit typically the nursing home licensee, owner, administrator and/or staff member involved will engage in a process called discovery. Discovery is a way to formally request information, including medical records, facility records and relevant communication among staff members. Sworn statements called depositions and affidavits may also be taken. At some point, your attorney will make a demand letter to the other parties. It may be a demand that requests certain actions be taken and/or compensation provided for the medical expenses, pain and suffering and other harm caused.

38 37 Investigation INVESTIGATING NURSING HOME ABUSE AND NEGLECT IN ILLINOIS The demand letter may begin a series of negotiations that result in a settlement. If no settlement can be reached, all sides can present their case to a jury at trial. The jury will then render a verdict on whether the nursing home is liable and the amount of damages that should be awarded. If either you or another party is dissatisfied with the trial outcome, the case can be appealed. You should know that, even during or shortly after a verdict, a settlement may still be reached. Once a settlement or verdict is final, the funds from the award must be distributed. In many cases, a private health insurer or government program such as Medicare or Medicaid must be reimbursed from the award funds before it will be distributed to you and/or your loved one. Next: 8. Choosing a Home

39 38 Choosing a Home MOVING YOUR LOVED ONE TO SAFER PLACE If your elderly loved one has been abused or neglected in a nursing home, one of your first steps should be to move him or her to a safer facility. After going through such a jarring experience, it is understandable if you doubt your ability to choose the right place or if you doubt whether any home could truly be safe enough. However, by visiting the homes you are considering, going through the 21 items on our checklist below and researching facilities through online sources such as those offered by the Illinois Department of Public Health (IDPH) or the Center for Medicare & Medicaid Services, you should be in a much better position to make the best choice. If your elderly loved one has been abused or neglected in a nursing home, one of your first steps should be to move him or her to a safer facility Choosing a Nursing Home Checklist The cost of a nursing home certainly will be a primary consideration for you. However, you should also ask yourself the following questions based on suggestions from the Centers for Medicare & Medicaid Services as you choose a new home for your mother, father or other elderly loved one: Physical Considerations 1. Is the nursing home located close enough for friends and family to visit? It is important to choose a conveniently located facility. After all, you will need to visit and make sure your loved one is receiving proper care and treatment. Go to the Illinois Council on Long-Term Care s online nursing home directory to find nursing homes near you.

40 39 Choosing a Home MOVING YOUR LOVED ONE TO SAFER PLACE 2. Are hallways and rooms well lit, comfortably heated, clean and maintained? If a nursing home is well-maintained, it is a good sign that the owner, administrator and staff members care about their residents as well. On the other hand, a neglected facility may be just the surface of deeper problems. 3. Can all areas of the home be accessed by wheelchair? Even though your loved one may not currently be in a wheelchair, one may be needed in the future. You should choose a facility that features common areas, rooms, bathrooms and doorways that accommodate wheelchairs. Security Considerations 4. Does the nursing home have a security system? A nursing home should feature locks on doors, alarms and surveillance equipment. A guard or staff members should be paying attention to who is going in and out of the building around the clock. This is especially important if your loved one suffers from Alzheimer s disease or another form of dementia and is prone to wandering. 5. Does the facility have smoke detectors, sprinklers and emergency exits? When you visit a home, look to see if it has smoke detectors, sprinklers and emergency exits. You should also ask about the home s fire evacuation plan. 6. Does the nursing home have a system for protecting residents possessions? Illinois law gives nursing home residents the right to have valuable possessions stored by the facility in a reasonably safe place. You should ask about steps the nursing home has taken to comply with this requirement. Treatment Considerations 7. Are residents clean, well-groomed and appropriately dressed? A nursing home may need to help residents to bathe, groom and dress themselves. The home may also need to frequently reposition residents in beds or wheelchairs. If you see that residents hygiene is being neglected, or if you learn that residents have bedsores, it very likely means that the facility neglects residents and cares little for their dignity.

41 40 Choosing a Home MOVING YOUR LOVED ONE TO SAFER PLACE 8. Do residents have access to personal phones or the Internet? A nursing home has a responsibility to give residents reasonable access to a phone, where they can hold conversations in private. The home should also make it convenient for a resident to use the Internet for research or entertainment purposes and, most importantly, to communicate with family and friends. 9. Are residents provided with exercise and recreational activities? Nursing homes must have ongoing activities that are designed to meet each resident s interests and enhance their physical and mental well-being. This is because regular exercise and activity plays a major role in an elderly person s physical and mental health. 10. How does staff monitor residents when they go outside? Ask the nursing home what it does to prevent residents especially those with dementia from wandering or eloping. Additionally, what is the condition of the outside of the facility? Are there nice places to sit, walk and enjoy exercise in the outdoors? 11. Does the nursing home provide for residents special dietary needs? A nursing home is required to meet each resident s nourishment needs. Ask the nursing home how it prepares meals: Are they staff-prepared or supplied by an outside vendor? Find out how the facility tailors meals to residents needs. Staffing Considerations 12. Does the home conduct criminal background checks before hiring staff? Checking the criminal background of potential staff members is not only common sense for a nursing home, it is also required under the Illinois Health Care Worker Background Check Act. The Act prohibits nursing homes from hiring any health care worker who has been convicted of committing or attempting to commit any one of several listed offenses. 13. Has there been any major or repeated turnover in administrators and staff? A lack of stability in a nursing home is not a good sign. It may indicate that staff members face poor working conditions or lack support from the home s owners and/or administrators. Disgruntled staff members may take out their frustration on residents.

42 41 Choosing a Home MOVING YOUR LOVED ONE TO SAFER PLACE 14. Are staff members warm, polite and respectful to residents? When you visit a facility, observe how staff members interact with residents. Are they warm, polite and friendly? Do residents seem anxious or fearful around any staff members (which is a sign of abuse)? Ask other residents about their experiences with the home s staff members. Medical Considerations 15. What is the nursing home s staff member-to-resident ratio? Under federal and state law, nursing homes must have enough staff to meet the needs of their residents. Since 2014, in Illinois, a nursing home has been required to have minimum staffing ratios of 3.8 hours of nursing and personal care each day per resident needing skilled care, and 2.5 hours of nursing and personal care each day per resident in need of intermediate care. 16. Are registered nurses (RNs) licensed practical nurses (LPNs) and/or certified nursing assistants (CNAs) available at the nursing home 24 hours per day? If a medical emergency arises with your loved one, will there be nurses and staff members available to quickly respond? At a minimum, the law requires a nursing home to have at least one RN on site for a minimum of eight consecutive hours a day, seven days a week. 17. Does the nursing home have a policy for administering medication? A medication error can cause serious, potentially fatal harm to a nursing home resident. Ask whether the home has strict controls in place for ordering, receiving and administering medications as they are prescribed. You should also know how powerful antipsychotic medications are controlled and administered at the home. 18. Are residents given routine preventative care and hearing and vision tests? Preventative medicine can be essential to keeping an elderly nursing home resident healthy and active. Ask about the nursing home s policy on flu shots, eye exams and hearing tests. 19. Does the nursing home help residents see their personal doctors? A nursing home should protect and facilitate a resident s right to see the doctor of his or her choice. Ask about transportation services or other arrangements that are available to help residents attend doctor appointments.

43 42 Choosing a Home MOVING YOUR LOVED ONE TO SAFER PLACE 20. Is there an arrangement with a nearby hospital for emergencies? If the home has ties with a nearby hospital or ambulance service provider, it should result in a faster, more-informed response to a medical emergency. 21. Does the nursing home have any reported deficiencies, and how were they corrected? Every nursing home in Illinois is required to keep the most recent five years worth of annual surveys, complaint investigations, follow-up surveys, notices of fines and plans of correction. The home should make these materials available to anyone who asks to see them. How to Use Ratings and Other Sources In addition to visiting a nursing home, there are several sources of information available online that can help you to make an informed decision. Nursing Home Compare The most widely cited and comprehensive ratings system comes from the federal government. At Nursing Home Compare, provided by the Centers for Medicare & Medicaid Services, you can find nursing homes rated on a five-star scale (one being far below average, and five being far above average). The ratings are based on three factors: Health inspections by state agencies Staffing levels Quality measures. You can search for nursing homes by city, zip code or by name. Pay close attention to whether the facility has a history of deficiencies, or violations of federal regulations. These deficiencies often are discovered during inspections that nursing homes must pass in order to receive federal funding. While it is actually common for a nursing home to have a few deficiencies on its record, a high number clearly are a red flag.

44 43 Choosing a Home MOVING YOUR LOVED ONE TO SAFER PLACE U.S. News & World Report This media outlet publishes an annual list of the top nursing homes in the country on a state-by-state basis. You can search for homes located near where you live in Illinois, including homes that accept Medicare. The publication also features a five-star ratings system, with five stars representing the highest level of care provided. Illinois Quarterly Violation Reports The Illinois Department of Public Health (IDPH) will take action against a facility if it is found to be in violation of the state s nursing home regulations. The IDPH also may recommend decertification to the Department of Health and Human Services for violations of federal standards relating to patient care. You can go to the IDPH website to see a list of all violations found by the IDPH since Hopefully, these tools will be useful to you and help you to choose a home that is comfortable and safe, meets your loved one s needs and satisfies any concerns you may have. Next: 9. Getting Involved

45 44 Getting Involved HOW TO GET INVOLVED IN NURSING HOME ABUSE AND NEGLECT ISSUES If you are concerned about the quality of care that nursing home residents receive in Illinois especially your mother, father or other elderly loved one you should get involved with efforts to improve the situation. As history shows, you and others like you can make a difference. Grassroots efforts by nursing home residents, their families and advocacy organizations such as Illinois Citizens for Better Care actually led to the landmark Nursing Home Care Reform Act of More recently, that same style of grassroots advocacy resulted in the Nursing Home Safety Act of 2010, which enacted several important reforms such as: Increasing nursing home staff-to-resident ratios Adding more statewide nursing home inspectors Changing penalties for nursing home violations, including adding a new violation level, AA, for violations that lead to the death of a resident Publishing a quarterly list of distressed facilities Improving criminal background checks of residents Giving protection to nursing home staff members who report suspected abuse, neglect or exploitation Requiring a new protocol for getting informed consent from a resident or guardian to administer powerful antipsychotic medications.

46 45 Getting Involved HOW TO GET INVOLVED IN NURSING HOME ABUSE AND NEGLECT ISSUES Additionally, due to a push by patients and families and Attorney General Lisa Madigan another nursing home safety measure could be signed into law. On the last day of the most recent Illinois General Assembly session, both the House and Senate passed a law that would make Illinois the fourth state in the country to allow families to install audio and video monitoring devices in their loved one s nursing home room. The bill, H.B. 2462, is aimed at deterring and catching abuse and neglect. Hopefully, knowing they could be caught on camera, nursing home staff members will refrain from mistreatment of residents. If they do engage in wrongful activity, the cameras can provide clear evidence in criminal investigations, administrative actions and civil lawsuits. This bill provides a solid example of how your voice can be heard by lawmakers and lead to meaningful reforms that will ultimately benefit your loved one. State and National Advocacy Organizations If you would like to become more involved with nursing home reform efforts, the following is a list of national and Illinois-based advocacy organizations: Illinois Citizens for Better Care Since 1978, this non-profit organization has been a leading advocate for nursing home residents in Illinois, pushing the Illinois General Assembly, Congress and state and federal agencies to improve the quality of care that residents receive. Long Term Care Community Coalition This organization started in the late 1970s in New York in response to growing concerns about long-term care facilities in that state. Today, the group serves as a national watchdog.

47 46 Getting Involved HOW TO GET INVOLVED IN NURSING HOME ABUSE AND NEGLECT ISSUES Illinois Campaign for Better Healthcare This organization was founded in 1989 on the belief that accessible, affordable quality health care is a basic human right. Today, it consists of 300-plus local and statewide organizations, making it the state s largest health care coalition. Check out the Action Alert section to see if there is any pending legislation that could impact your loved one s life in an Illinois nursing home. National Consumer Voice for Quality Long-Term Care Formerly known as the National Citizen's Coalition for Nursing Home Reform, this organization was formed in The Consumer Voice strives to represent consumers in long-term care issues and to provide information to families, caregivers, advocates and ombudsmen. LeadingAge Formerly the American Association of Homes and Services for the Aging, this organization provides information and support to help people make the most of the aging experience. Its membership includes 6,000 non-profit organizations, 39 state partners and numerous foundations, consumer groups and research partners. Staying Updated on Nursing Home Legislation While issues such as placing cameras in nursing home residents rooms tend to garner a lot of media attention, there may be other important nursing home reform bills that are pending in the legislature that fly under the media radar.if you would like to learn more legislation impacting nursing home residents in Illinois, go to the Illinois Department of Aging website and check out its legislation updates. Another excellent source for information on a national level is the National Center on Elder Abuse (NCEA), which is actually a part of the Administration on Aging within the U.S. Department of Health and Human Services. Of course, you can keep track of the latest bills impacting the lives of nursing home residents and their families in Illinois by simply going to the Illinois General Assembly website, which allows you to search for bills by keyword. The ILGA website also features directories for House and Senate members. Look up your local representative and contact him or her if you want your voice to be heard on issues that concern you and your elderly loved one.

48 47 Do You Have a Case? If you suspect that your loved one is being abused or neglected in a nursing home, you should contact the Illinois Department of Public Health without delay. The IDPH can investigate the case and take appropriate steps to address the problem. Reach out to a lawyer who will make sure your family s rights are protected. However, in many cases, the harm has already been done, or the investigation by IDPH may lead to an unsatisfactory result. This is why you should also reach out to a lawyer who will make sure your family s rights are protected. When you call an attorney, you should be ready to provide important information about your case. The following are questions you may be asked: What was the age of the victim? How long ago did the incident occur? What type of compensation are you looking for? Did the incident occur at a state or privately facility? As a result of the incident, does the victim have long-term injuries? Is the victim still alive? Will the victim require long-term medical care to treat the injuries? What prior medical conditions did the victim have? Did the victim have dementia?

49 48 Do You Have a Case? Was the incident investigated by authorities? What was the result of the investigation? What information did the nursing home give you after the incident occurred? Were there prior instances of potential neglect or abuse? Did the nursing home or outside authorities look into these potential events? Was there a care plan in place for the victim? How long had the victim been at the facility prior to the incident? If the incident involved a fall, did the victim have a prior history of falls? Did the victim require supervision? Next: 10. Case Study

50 49 Case Study The victim was an 86-year-old woman who resided in a nursing home in Lindenhurst, Illinois. She had numerous medical conditions, including congestive heart failure, dementia, kidney disease, moderate malnutrition, anemia, esophageal reflux and osteoarthritis. As a result, she required a wheel chair and a clip and/or pressure alarm. No staff members were present in the room that had seen the victim fall from her wheel chair. Video footage that would have shown what occurred in the fall was missing. The incident occurred in The victim had been left unsupervised in her wheel chair, without a clip or pressure alarm attached. She fell out of the chair and suffered a broken hip. Three days later, the victim died from her injury. The Illinois Department of Public Health did not investigate the incident. The victim s family contacted Salvi, Schostok & Pritchard P.C. Our law firm proceeded to file a wrongful death and survival action in Lake County Circuit Court against the owner of the nursing home facility. In litigating the case, our law firm discovered that no staff members were present in the room that had seen the victim fall from her wheel chair. Video footage that would have shown what occurred in the fall was missing. However, there was footage available that showed events before and immediately after the fall. Additionally, our law firm learned that, despite being at a high risk of falls and an elopement risk, the nursing home did not constantly monitor the victim or provide her with a pressure alarm. At the time of her fall, a clip had not been attached to her shirt. As a result, no alarm sounded when she fell.