River Bluff nursing wounds after $20,000 fine

Last month, The Illinois Department of Public Health (IDPH) issued its list of violations from the month of January. The report reveals Winnebago County-run River Bluff Nursing Home, 4401 N. Main St., was fined $20,000 for allegedly failing to develop and implement a policy for monitoring resident-on-resident abuse.

The IDPH further alleged, “The facility also neglected to conduct a thorough investigation of a resident’s sexually inappropriate behavior toward four other residents.”

The fine stems from a Nov. 29 report from the Department of Health and Human Services, alleging River Bluff had not acted to put in place a policy to monitor abuse. The report indicates a 91-year-old male resident had been perpetrating inappropriate sexual behavior toward female residents. The Department of Health and Human Services determined the activity was not thoroughly investigated or adequately corrected.

River Bluff Nursing Home’s abuse policy is aimed at providing “an environment free of verbal, sexual, physical and mental abuse to the facility residents. … It is the policy of River Bluff Nursing Home to not tolerate abuse or neglect of its resident by any individual, including, but not limited to, facility staff, other residents, consultants, volunteers, staff from other agencies providing services to a resident, family members, legal agents and/or friends.”

The Illinois Department on Aging estimates 76,000 suffer elder abuse in Illinois alone. Financial exploitation is also considered a form of abuse.

River Bluff’s policy on reporting and investigating abuse stipulates: “Residents who allegedly mistreat another resident will be removed from contact with that resident during the course of the investigation. The accused resident’s condition shall be immediately evaluated to determine the most suitable therapy, care approaches and placement, considering his/her safety, as well as the safety of other residents and staff.”

The Health and Human Services report claims River Bluff did not follow its own policy, and that the male resident should have been removed to prevent continued sexually inappropriate behavior toward female residents.

The charges, Type A violations of the Nursing Home Care Act, are considered serious by the state. According to the IDPH, a Type A violation “pertains to a condition in which there is a substantial probability that death or serious mental or physical harm will result.”

At River Bluff’s request, a status hearing has been set for Aug. 27.

River Bluff Administrator Phyllis Schwebke told The Rock River Times the home is contesting the IDPH’s notice of violations.

“The Winnebago County State’s Attorney’s office is working with IDPH’s legal counsel to determine if this matter can be resolved without having to go through a contested hearing process,” Schwebke said.

Schwebke, who has been administrator since 1995, has seen her share of problems during her tenure.

In 1998, River Bluff was fined $9,555 for a mistake that led to the death of a resident.

Staffing shortages and a $1.5 million budget deficit in the late 1990s led to then-County Board Chairman Kris Cohn (R) assigning a task force for the facility. Staff morale also seemed at a low, with 92 percent quitting within one year. Although the task force’s executive summary identified problem areas, no mandate was issued by the county requiring the nursing home to make changes.

Other problems include allegations of Medicare fraud, strikes, lawsuits and a former bookkeeper who allegedly bilked River Bluff out of $172,000.

Residents and staff alike have alleged being met with intimidation when they’ve reported problems to administration. County Board Chairman Scott Christiansen (R) appointed an investigative panel in 2005 to serve as an intermediary for people to turn to with concerns.

Schwebke indicated the River Bluff Advisory Committee, whose chairman is Winnebago County Board member Angie Goral (D-7), has been essential to the development of River Bluff’s nurse retention and recruitment plans.

“They have also reviewed the processes by which resident, family, community concerns or complaints related to the nursing home may be raised and addressed,” Schwebke added.

County Board member Phil Johnson (D-8), Winnebago County Grants Coordinator Judy Barnard, health consultant Ray Empereur, Bill Megan and Lorraine Sachs also serve on the committee.

Chairman Christiansen says the fine may a bit harsh, considering River Bluff volunteered information about the problem.

“It just kind of amazes me,” Christiansen said of the fine. “That facility is self-policing, so they [River Bluff] turned it in.

“I’m always concerned about any department,” Christiansen asserted while acknowledging, “There’s always room for improvement.”

One change Christiansen would like to see at River Bluff is improved risk-management to minimize claim expenses.

In total, Medicare and the Department of Health and Human Services cited 10 health and seven fire safety deficiencies at the facility.

According to a Medicare report, substantiated violations indicate the facility failed to:

“Protect residents from mistreatment, neglect, and/or theft of personal property.”

“1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.”

“Provide social services for related medical problems to help each resident achieve the highest possible quality of life.”

“Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.”

“Make sure that nurse aides show they have the skills to be able to care for residents.”

The violations are considered serious because they evidence actual harm or immediate jeopardy.

Schwebke reported the IDPH accepted River Bluff’s plans to correct alleged deficiencies, and has since found the facility to be in compliance.

River Bluff is a 304-bed, county-owned home offering skilled and intermediate nursing. The average number of residents per nursing home in Illinois is 105.4. Nationally, the average is 95.7.

A 1977 court order, or Consent Decree, requiring homes like River Bluff to have a public aid preference is likely the biggest strain on River Bluff’s finances. A local tax levy sees to it building improvements are made, but River Bluff has also needed to turn to a foundation fund and memorial program to help make ends meet as Medicaid reimbursements have decreased.

Medicare and Medicaid certified, only a handful of River Bluff’s 234 residents are private pay. The Winnebago County Board recently approved a rate increase for private-pay residents, raising the cost of a semi-private room from $131 to $165. Private rooms increased from $151 to $202.

Asked whether the hike was a response to the $20,000 fine, Schwebke explained, “Our private pay rate was increased only to be in alignment with the private pay rates being charged by other facilities in our community.”

This past year, the facility implemented buffet and restaurant-style dining for residents.

“River Bluff has been a local leader in The Pioneer Movement,” Schwebke noted, “which is attempting to make changes in the operation of nursing homes away from a medical model towards a model of care which can be described as resident-centered or resident-directed.”

River Bluff was originally the site of the county poor farm in the late 19th Century. By the 1930s, the site was a county hospital. After passage of a 1970 referendum, ground was broken for the current building, which was completed in 1971 and initially housed 200 residents.

If you know of or suspect elder abuse occurring in a nursing home, call the IDPH’s Nursing Home Hotline at 1-800-252-4343.

from the Aug. 22-28, 2007, issue

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