Illinois long-term care facilities can report fewer “serious incidents and accidents” under an amended state regulation that should become effective in 2009. Fewer reports to the Illinois Department of Public Health will result in fewer surveys of your facilities. All long-term care administrators, directors of nursing, and employees should become familiar with the amended regulation to help decrease the frequency of federal and state surveys.
The Illinois Department of Public Health (“IDPH”) has amended Section 300.690 of the Skilled and Intermediate Care Facilities Code, 77 Ill. Admin. Code §300.690, commonly known as the “Minimum Standards,” which governs when facilities must report “serious incidents and accidents” to IDPH.
Currently, Section 300.690 requires that facilities report to IDPH any incident or accident “which has, or is likely to have,” a significant effect on the health, safety, or welfare of a resident or residents. The amendment to Section 300.690, however, only requires that facilities report incidents or accidents “that had” a significant effect on resident health, safety, or welfare. Unless an incident or accident actually had a serious effect on resident health, safety, or welfare, facilities need not report such incidents or accidents to IDPH under the amended regulation.
For example, a resident falls, but has no serious complaints of pain or decreased range of motion, and no indications of fractures or other serious injuries exist. Under the current version of Section 300.690, IDPH could view such a fall as “likely to have” a significant effect on a resident’s health, therefore requiring a report to IDPH, and possibly triggering a survey. Under the amended regulation, however, this incident had no actual “significant effect” on the resident’s health, and the facility therefore need not report the incident to IDPH. Because IDPH received no report, it will not conduct a survey. The facility should still, of course, update the resident’s care plan to prevent recurrence, and consult with the resident’s doctor and family.
The second important change to Section 300.690 eliminates the need to report incidents or accidents to IDPH merely because the facility contacted a doctor or hospital on an emergency basis regarding a serious incident or accident. Currently, Section 300.690 requires a facility to report to IDPH every time even one resident requires, on an emergency basis, the services of a “physician, hospital, police, fire department, coroner, or other service provider.” The new version of Section 300.690, however, states that “Incidents and accidents that affect the health, safety, or welfare of a group of residents or all residents in the facility and that require a response by the fire department, police department or local emergency services agency shall be reported to the Department.”
Consider this scenario: a resident falls, and the facility calls the doctor, who orders the facility to send that resident to the emergency room via Medicar or private ambulance on a non-emergency basis, instead of ordering the facility to call 911 to have paramedics transport the resident on an emergency basis. If the ER finds no injury that had a serious effect on the resident’s health, safety, or welfare, then the facility need not report the incident to IDPH under amended Section 300.690, because no “emergency services agency” became involved. Calls to doctors and hospitals will no longer require a report to IDPH if the resident incurred no injury that had a significant effect on their health.
Another important change to Section 300.690 is the express statement that “A facility is not required to report an incident or accident that causes no harm to a resident.” This changes the current requirement that facilities report to IDPH incidents that are “likely to have” a serious effect on the resident’s health, safety, or welfare.
Lastly, the amendment to Section 300.690 requires that a facility record only “reportable” incidents or accidents in the progress notes or nurse’s notes for each resident affected, and that the facility maintain a file of all written reports of “serious incidents or accidents” effecting residents. Facilities must still report to IDPH such incidents or accidents by phone within 24 hours, with a follow-up narrative filed within seven days.
These amendments materially decrease the circumstances when a facility must report incidents and accidents, and thereby decrease the number of surveys conducted by the federal and state governments. Facilities should in-service all nursing staff about the new reporting requirements when the amendments become effective to decrease the frequency of surveys.
IDPH has not yet established the date on which the amendments to Section 300.690 become effective. It is anticipated that the rule-making process may take another six to nine months. Facilities should continue reporting incidents and accidents to IDPH under the existing regulation until the amended regulation becomes effective. IDPH will make identical amendments to the regulations governing shelter care facilities, facilities for the developmentally disabled, long-term care for residents under 22 years of age, and veterans homes.
Facilities should also remember that Illinois law separately requires facilities to report allegations of abuse or neglect only when, after an investigation, the facility “becomes aware” that a resident suffered abuse or neglect. Facilities need not report allegations of abuse or neglect unless its investigation elicits facts giving the facility “reasonable cause” to believe that the allegations are true.
* * * * *
*IDPH has also amended the Sheltered Care Facilities Code, 77 Ill. Adm. Code § 330.690, the Illinois Veterans Home Code, 77 Ill. Adm. Code § 340.690, the Intermediate Care for the Developmentally Disabled, 77 Ill. Adm. Code § 350.690, the Long Term Care for Under 22 Facilities, 77 Ill. Adm. Code § 390.690.