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.



Reader Comments ...


Next Up in Opinion

Commentary: The danger behind North Korea’s jiu jitsu diplomacy
Commentary: The danger behind North Korea’s jiu jitsu diplomacy

After months of frantic brinkmanship with North Korea, President Donald Trump is now preparing for a summit meeting with North Korean leader Kim Jong Un. This would be comical if it wasn’t so dangerous. He has played right into North Korea’s hands. Trump no doubt thinks that his tough rhetoric has struck fear into the heart of the North...
Letters to the editor: April 25, 2018
Letters to the editor: April 25, 2018

Every time I endeavor to enter MoPac Boulevard at Enfield Road going south during the afternoon-evening rush “hour,” I feel screwed yet again. The backup of traffic from downtown at the southbound Winsted Lane entry ramp causes at least a 15- to 25-minute wait to enter the horribly backed-up freeway. In the meantime, those few drivers who...
Commentary: Asphalt is the last crop
Commentary: Asphalt is the last crop

Missed in the coverage of the recent release of the 2018 Farm Bill is an obscure program that will significantly impact the future of Texas. It is not a commodity program nor does it deal with nutrition assistance. It is smaller in scope and cost than those programs, yet is just as far-reaching. The Agricultural Conservation Easement Program (ACEP)...
President Bill Clinton coming to Bass Concert Hall on June 10
President Bill Clinton coming to Bass Concert Hall on June 10

Bass Concert Hall will host “A Conversation with President Bill Clinton” at 7:30 p.m. June 10. Clinton will discuss “The President is Missing,” his new novel co-authored with bestselling writer James Patterson. This is the first time a president has collaborated with a bestselling novelist on a work of fiction.  Tickets...
Commentary: Let us test then, you and I
Commentary: Let us test then, you and I

You are 15. You have been held against your will, writing, reading and bubbling answers for almost five hours. Naturally enough, you ask yourself, “Why is this being done to me?” Since you are taking a test, let’s put the possible answers into a familiar format: A) You are experiencing a modern version of the Spanish Inquisition....
More Stories