Though nursing home operators and advocates for seniors have expressed support for an overhaul of Illinois' troubled long-term care system, sharp differences are emerging in Springfield over how much change is needed.
The nursing home industry is balking at three key proposals of Gov. Pat Quinn's Nursing Home Safety Task Force, whose February report served as a starting point for legislative action. Operators are objecting to raising minimum staffing levels across the board, increasing fines and penalties for unsafe and poorly run facilities, and raising fees to help pay for new safety enforcement.
Some senior advocates oppose the task force recommendation to license separate wings or facilities for violent patients so they will not endanger vulnerable nursing home residents. Such segregated units, they argue, would present little improvement over state-funded institutions that have offered the mentally ill inadequate therapy and support.
The legislative maneuvering follows months of stated support from industry and advocates for broad changes in Illinois' nursing homes. Quinn's panel was formed in response to Tribune reports documenting cases where elderly and disabled residents were assaulted, raped and even murdered by their housemates.
The tough and sometimes tense negotiations have been playing out in twice-weekly meetings co-chaired by task force chairman Michael Gelder and David Ellis, chief legal counsel for Illinois House Speaker Michael Madigan (D-Chicago).
State officials, elder advocates and industry representatives are now meeting in roughly two dozen smaller "working groups" in an effort to hammer out a consensus on the most difficult issues before proposed legislation moves forward in the next week or so. The General Assembly is scheduled to adjourn May 7.
It is unclear whether Madigan will use his considerable power to ensure that the bill emerging from Ellis and Gelder's committee reflects the recommendations of the task force report — and whether Madigan will then push that bill through the House. Ellis declined to comment.
"Dozens of interested stakeholders have been putting in scores of hours of effort to try and make this a legislative reality," Gelder said. "I am approaching the moment of decision where we have to decide what we will actually accomplish in this bill. No group is likely to get everything it wants."
Illinois relies more heavily than other states on nursing homes to house younger psychiatric patients — including thousands with felony records — and understaffed facilities have failed to treat and monitor violent residents who cycle in from jails, psychiatric wards and homeless shelters, government records show.
The task force's 52-page report attempts to address problems in the system through 38 specific recommendations along with an ambitious plan to move thousands of mentally disabled people from nursing homes into smaller residential programs that provide intensive therapy and supervision for those who require it, but greater independence for those who don't.
The report was widely praised by industry and advocates for the elderly and mentally ill, but in recent weeks the two sides have laid down markers of their own.
Wendy Meltzer, executive director of the nonprofit Illinois Citizens for Better Care, said the outcome of the negotiations is uncertain given that the nursing home industry is "minimizing the need for changes."
"We just don't know ultimately where this is going," said Meltzer. "We don't know what the bill will look like."
But Terry Sullivan, regulatory director of the Health Care Council of Illinois, the state's largest nursing home trade association, said the advocates are introducing "extraneous issues that have nothing to do with nursing home safety."
"An awful lot of legislative proposals in the past six weeks go far beyond the governor's nursing home task force and the main issues raised by the Tribune series," he said.
Sullivan argues that the industry's problems center on the subset of nursing homes that mix younger mentally ill patients with the elderly and disabled. He said legislative solutions should be focused on resolving that issue.
But David Vinker, AARP's associate state director, said many Illinois nursing homes fail to reach even minimum standards for quality of care and safety.
The two sides have introduced very different legislative proposals as part of the negotiating process, and Republican and Democratic lawmakers have entered the fray, sponsoring bills and occasionally participating in roundtable negotiations led by Gelder and Ellis.
State Rep. Lou Lang, D-Chicago, has emerged as the most prominent lawmaker pushing the industry-backed proposals. On the advocate side are Democratic legislators Heather Steans, Jacqueline Collins, Mary Flowers and Julie Hamos.
The nursing home industry has long been an influential voice in Springfield, in part because local nursing facilities are among the most important employers in many Downstate communities. The industry also has donated generously to the campaigns of prominent politicians and enlisted politically connected lobbyists, according to interviews and records.
"The nursing home lobby has traditionally been very strong," said Steans, a state senator whose Uptown/Edgewater district includes several troubled facilities. "But I remain cautiously optimistic."