by Robert Holly and Claire Everett
Gerald Warmbier began a medical journey last year that took him to the nursing home Heartland of Champaign.
But instead of helping him recover after medical treatment at Carle Foundation Hospital, a lawsuit filed in the Circuit Court of Champaign County by his wife alleges the nursing home delivered such poor care that it led to his death.
Years earlier, Warmbier had survived and fully recovered from a kidney transplant. In his retirement, he remained active in helping his wife run their animal rescue farm.
In April 2013, however, he went into Carle Hospital with chest pains. From Carle, he went to Heartland in May for recovery.
"This is a man, a husband, who had big-ticket kidney-transplant surgery, and that was years ago," said Ryan Yagoda, the Chicago-based lawyer representing Warmbier's wife. "He made a great recovery, and you'd figure that would be the hard part of his life — not making sure his vitals were monitored and making sure he was getting medication."
Court records noted Warmbier weighed 199 pounds when he transferred into Heartland. Three months later, he weighed only 168 pounds, having suffered dehydration, a serious stomach illness and septic shock from a urinary tract infection.
His condition had so deteriorated that Heartland sent him back to Carle for emergency treatment. He died there at age 71.
Court records show the nursing home has denied the allegations, but the details of Warmbier's case point to the serious staffing and care problems found throughout many central Illinois facilities.
"Just, very frankly, I would not want to be in a nursing home," said Claudia Lennhoff, executive director of the advocacy group Champaign County Health Care Consumers. "And, I would do everything I could do to try to keep my parents out of a nursing home."
A review of court records shows at least eight other lawsuits have been filed against Champaign County nursing homes since 2009. Those suits allege the homes caused either injury or death to residents.
In addition, a CU-CitizenAccess.org examination of 81 nursing homes revealed the state has fined 51 facilities a total about $632,000 since the start of 2011. Those nursing homes range from areas as far north as Livingston County to as far south as Cumberland County.
A previous CU-CitizenAccess.org review of regional nursing homes found 93 homes had been fined more than $1 million from 2006 to 2010.
Inspectors often cite nursing homes for pressure sores, urinary tract infections and medication errors. In more extreme cases, they have found staff improperly using restraints, letting residents go missing, and physically and verbally abusing residents.
The problems have continued even after state reforms instituted in 2010.
"I've had some horrible cases," said Yagoda, whose firm — Kravolec, Jambois and Schwartz — has handled other central Illinois nursing home cases. "A diabetic patient who had zero wound care to the point where the patient developed maggots in his wounds."
However, those in the nursing home industry say the complaints, lawsuits, violations and fines are not entirely reflective of quality of care. Matt Hartman, vice president of public policy for the Illinois Health Care Association, said the inspections are part of a "gotcha system" designed to generate revenue from fines.
"We feel that facilities can be kind of behind the eight-ball in regards to that," said Hartman, whose association is comprised of 215 long-term geriatric care facilities.
County facilities score low on rating scale
Nursing home quality is rated using a five-star scale on Medicare.gov. It is a system many believe to be flawed, and one that critics say has historically let nursing homes boost their ratings by submitting self-reported and inaccurate information.
The ratings take into account staffing levels, inspection results and resident conditions.
Champaign County features seven Medicare-approved nursing homes. Three of those facilities — Heartland, Helia Healthcare, and Champaign Urbana Nursing and Rehab — are rated as one-star facilities. No officials from those homes offered comments.
"We've had a couple nursing homes over the last few years that have had some really serious problems," Lennhoff said.
Of the 81 central Illinois nursing homes, 16 are rated as one-star facilities, according to Medicare data released in August. Eighteen have received two-star ratings, meaning slightly more than 40 percent of nursing homes are rated below average.
Although ratings can suggest problems, they fail to fully describe dangerous and sometimes fatal deficiencies in care.
In a 2011 case against Champaign County Nursing Home in Urbana, court records show plaintiff John Slade was awarded $60,000 after his wife died while in the facility's care. The initial complaint states that "Wanda Slade was allowed to suffer a medication overdose, acute post hemorrhagic anemia, hypovolemia, shock, coagulopathy, hematoma, illness, and, eventual death."
A recent News-Gazette report found the county nursing home continues to be cited for problems. Inspection reports listed at least 11 nursing and dietary violations at the home. Champaign County Nursing Home has beds for 243 people that require skilled nursing care.
The facility did not respond to calls and emails requesting comment on the incident or the quality of care it provides.
At Helia in Champaign, inspection reports show officials fined the nursing home $25,000 in February for violations that included failing to follow physician orders for a resident's wound treatment, to do a comprehensive admission assessment, and to "assess and identify the presence of pressure ulcers" for four residents.
Helia, which has 118 skilled beds, declined to comment on the violation.
The state fined Heartland $2,200 in July for violations that included failing to immediately notify a resident's doctor after the resident fell from a wheelchair, and felt sharp leg and groin pain. An X-ray the next day revealed the resident suffered a "minimally" displaced and fractured hip.
Heartland — which has 102 beds — did not respond to multiple calls, emails and a certified letter requesting comment on the violation. It also did not respond to multiple requests for comment on the Warmbier lawsuit.
Fines stem from routine inspections and complaints
The state health department issues fines from violations its inspectors observe during surveys, which are either routinely scheduled inspections or conducted on a complaint-basis. Family members, residents and advocacy workers can file a complaint against a nursing home by calling 1-800-252-4343 or by filling out an online form. By law, nursing homes are also obligated to report any incidents.
If facilities receive Medicare or Medicaid funding and have a history of problems, they can be decertified and lose that funding. Medicare and Medicaid nursing homes are also overseen by the Centers for Medicare and Medicaid Services.
In July 2010, outgoing governor Pat Quinn signed off on a package of legislation meant to bring sweeping reform to Illinois nursing homes.
Among the changes the Illinois Nursing Home Safety Act brought were an increase in staff-to-patient ratios, an increase in health department inspectors, and an increase in sanctions and fines. Since the overhaul, Regional Ombudsman for the East Central Illinois Area Agency on Aging Tami Wacker said she has seen a rise in the number of "regulatory tags" that inspectors have written. She also said she has seen stronger oversight and more thorough inspections.
"I will say that I do see it has improved," said Wacker, whose organization works to monitor resident care. "I really do."
Yet, a recent Center for Public Integrity investigation found nursing homes across the country often reported much higher staffing levels compared to what they actually employ. In some cases, they falsely doubled staffing levels. The center, a non-profit news organization in Washington, D.C., used hard-to-find financial documents and data to uncover the discrepancies.
Hartman and others from his organization said staffing is one of the biggest challenges for nursing homes. Many facilities that are part of the Illinois Health Care Association advertise staff-vacancy openings for months at a time without getting any applicants.
Wacker said the inability to hire staff is not an excuse.
"When a long-term care facility — whether it's for profit or not-for-profit — when they achieve a license through the department of public health, they do make that promise," Wacker said. "They state that we are going to provide a certain level of service for every resident."
The Warmbier case also shows some nursing homes are not necessarily fined for serious violations.
Days before his death on Aug. 14, 2013, a physical exam noted Warmbier had "dry mucous membranes and cracked lips." A urine dip showed large amounts of blood, protein, leukocyte esterase, and red and white blood cells. In a health department report, inspectors observed that the facility failed to "provide each resident with sufficient fluid intake to maintain proper hydration," and that it failed to ensure "residents are free of any significant medication errors."
The state health department has not yet posted a fine connected to those findings. The report — dated Aug. 22, 2013 — also does not mention Warmbier died.
"Do we need to see more [progress]?" Wacker said. "Yes. We do, but I think that's going to be a slow process."