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Commentary: Texas nursing homes at tipping point


Every day, caregivers in Texas nursing homes carry out the state’s duty to watch over the most vulnerable, frail and elderly of us. How well they accomplish that duty is largely up to decisions made in Austin.

Those caregivers are struggling. That’s not news for many who work in long-term care or who have family in a facility. The results of understaffing and high turnover are often obvious as staff pulls yet another double shift.

But a recent, in-depth look at nursing home inspections recently reported by the Dallas Morning News spells it out in detail: As nursing home care continues to improve across the nation, Texas is lagging behind. Our history of underfunding long-term care is catching up, and the strain on the system is beginning to show.

Texas posted a nearly 20-percent increase in the total number of health deficiencies cited during nursing home surveys and a 3-percent increase in severe deficiencies from 2010 to 2014.

I serve as president of the Texas Health Care Association, which commissioned this report. We represent the people and the businesses that most Texans depend on for long-term care.

Some have called the report’s publication a desperate attempt to convince the Texas Legislature to fully fund long-term care in Texas. If it is desperate to point out what years of inadequate funding has meant to the care of our vulnerable seniors, then I guess the label fits. However, I would note the desperation and urgency are more than appropriate because as an industry, we’re not allowed to fail. When we fail, it affects someone’s family member.

Since 1994, the difference between what it costs to care for Texans in nursing homes paid for under Medicaid and what Texas pays to care for these residents has grown. Nearly 70 percent of people in nursing homes rely on Medicaid because they have outlived the assets they have worked a lifetime to earn.

According to an analysis of the most recent available Medicaid cost report database, the average reportable cost per resident is $157 a day. The average reimbursement from the state for these same residents is just $138. Only one state in the union pays less than Texas on a daily basis to care for the frail and elderly. For a 100-bed facility with an average Medicaid census, this $20-a-day shortfall is an almost a $500,000 funding gap the facility has to overcome.

Nursing homes don’t have any cost-shifting options or other add-ons to boost the bottom line. Instead, the staff picks up the slack, always doing more with less — until they simply can’t any more. The turnover rate for nurses working in Texas nursing homes has reached a crisis level — over 90 percent a year.

This workforce crisis should concern all Texans because continuity of care and consistency in staffing are key elements to the quality of care expected. As the availability of caregivers continues to decline and competition for nursing and clinical staff increases across health care markets, the ability to attract competent staff while maintaining expected performance becomes increasingly problematic.

Everyone wants to see the quality of care in Texas nursing homes improve. Everyone should know there is a cost associated with that. Even under current funding levels, nursing home staff in communities across Texas are working to deliver the best care they can. However, we must be willing to support investment today before tomorrow is here. Ensuring the necessary resources and funding for those who built this great state should be a top priority — even when the budget is tight.

Warren is president and CEO of the Texas Health Care Association.



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