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Report ranks Texas' long-term care system as middle-of-the-pack

Quality-of-care issues drag Texas' ranking down to No. 28 overall

A national report card released today on the states' performance on long-term care services and support for seniors, people with physical disabilities, and family caregivers places Texas roughly in the middle of the pack overall and singles out quality of care as the area where the state needs to make the most improvement.

"The good news is Texas ranks slightly above average when it comes to affordability and access, choice of care setting, and support for family caregivers," said Amanda Fredriksen, advocacy director for AARP Texas. "However, we have some fairly serious quality-of-care issues that speak to the issue of consumer safety and that need to be addressed immediately."

Texas' No. 42 ranking on quality of care reflects items such as: percent of high-risk nursing home residents with pressure sores; percent of long-stay nursing home residents who were physically restrained; nursing home staffing turnover; and percent of long-stay nursing home residents and home health consumers admitted to the hospital.

The study also suggests that Texas needs a "single point of entry" system for nursing home care—the state ranked a poor No. 38 on the percent of nursing home residents with low care needs. Since Texas has a fairly robust and accessible community care system, having a relatively high percentage of nursing home residents who have lighter care needs suggests that Texas is not doing as good of job as other states of screening and diverting appropriate individuals to much less costly community-based care.

The first-of-its-kind report, "Raising Expectations," was released jointly by AARP's Public Policy Institute, the Commonwealth Fund and the SCAN Foundation.

Texas' No. 28 overall ranking was broken down as follows:

• No. 19 in choice of setting and providers

• No. 19 in support for family caregivers

• No. 20 in affordability and access

• No. 42 in quality of life and quality of care

Top performers across all four categories were Minnesota, Washington, Oregon, Hawaii, Wisconsin, Iowa, Colorado and Maine. Many of the states in the bottom quartile have some of the lowest median incomes and the highest poverty and disability rates in the U.S. These include Alabama, Georgia, Florida, Kentucky, Mississippi, Tennessee, and West Virginia, which join Indiana, Oklahoma, Nevada and New York as the lowest-ranked states.

In Texas, as well as every other state, the cost of private-pay nursing home care exceeds the median income for the older population. Thus, the report says, "states need to take action to ensure that alternatives to nursing homes are available, an effective safety net helps people who are not able to pay for care, and family caregivers, who provide the largest share of help, receive the support they need."

During the 2011 state legislative session, AARP successfully fought to prevent catastrophic budget cuts to nursing homes and community-based long-term care programs—cuts that would have only worsened an already serious situation. AARP has also long advocated for better nursing home diversion efforts, including a single point of entry approach that would help identify and start services more quickly for individuals who need community-based care.

AARP also worked successfully to strengthen the quality of care and safety of residents in Texas nursing homes. A bill by Senator Jane Nelson (R-Flower Mound) and Representative Elliot Naishtat (D-Austin) increases the hours of initial training required for certified nurse aides (CNAs) who work in nursing homes from 90 hours to 100 hours. In addition, the new measure establishes a requirement for CNAs to take 24 hours of on-site continuing education every two years as a condition of remaining on the nurse aide registry.

During the special session, Senator Nelson passed Senate Bill 7 with AARP’s support. SB 7 includes several provisions designed to reward nursing facilities that consistently provide high quality care and those that avoid preventable complications.


Copies of the report are available at

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