Nursing Homes Need Better Monitoring

By Thomas Korosec

AARP Texas and the state’s nursing home industry, with about approximately 1,200 facilities, are sometimes on opposite sides of issues in Austin. But they share one conclusion: Serious problems plague this vital part of the health care system.

“To strengthen nursing home quality in Texas, AARP is asking the Legislature to hold nursing home operators accountable when they provide poor care,” said Amanda Fredriksen, AARP Texas associate state director for advocacy.

A variety of sources and studies have highlighted the overall poor performance of Texas nursing homes. For instance:

• A May 2015 survey by the Henry J. Kaiser Family Foundation found that 51 percent of Texas nursing homes received ratings of one or two stars in the federal Centers for Medicare & Medicaid Services’ five-star quality rating system. That put Texas last in the nation. The 22 best performing states had less than 30 percent of their homes in the bottom two ranks.
• ProPublica, an investigative journalism organization, found that over the past three years Texas ranked third in the average number of “serious deficiencies” found at its nursing homes. Serious deficiencies are defined under federal guidelines as those where patients are at risk of or have experienced serious harm or death.
• The Texas Department of Aging and Disability Services provides a consumer rating of the state’s nursing homes. On a scale of 1 to 100, the average score recently was 58.

“That’s a solid F,” Fredriksen said. “There’s a robust amount of data that suggests there are real problems when it comes to providing quality care in Texas nursing homes.”

More state money sought
The Texas Health Care Association, the industry’s chief trade organization, has also been highlighting those problems as it advocates for more state money to support its members’ facilities.

In April, the group told a House Appropriations subcommittee that patient care is suffering because of chronic low pay and high turnover of nursing home staff, including 94 percent annual turnover of registered nurses.

In September, association officials told the Dallas Morning News that care is getting worse in Texas. Violations of health standards increased by 20 percent from 2010 to 2014, according to a study commissioned by the group. Nationwide, such violations decreased by 8 percent during the same period.

The nursing home owners blame Texas’ reimbursement rate for patients on Medicaid, which is among the lowest in the nation. Roughly 70 percent of Texas nursing home residents are covered by the federal-state health care program.

AARP Texas agrees that state funding should be increased, “but it’s a piece of the solution, not the whole solution,” Fredriksen said.

“Texas has been tolerating a system that’s providing poor quality care,” she said. “The state really needs to take more responsibility to make sure people in Texas nursing homes are safe.”

Toward that end, AARP Texas is advocating that the state establish a system of escalating sanctions against facilities that incur repeated violations. Under the current system, there were 17,647 violations reported in the year ending Aug. 30, 2015, but regulators took enforcement action on just 44. The average fine paid was $7,617.

State Sen. Charles Schwertner (R-Georgetown), chairman of the Senate Committee on Health and Human Services, said, “We clearly have a number of nursing homes in Texas that can afford to do a much better job of providing care to seniors.”

He added, “I’m always looking at ways to improve nursing home care and hold nursing home operators more accountable.”

AARP Texas also wants to see limits put on nursing homes’ right to correct problems without paying a penalty. Under current law, even violations causing harm to residents can be corrected without sanctions being imposed, Fredriksen said.

Allowing a facility to avoid a penalty for a burned-out light bulb in an exit sign—if it’s fixed—seems reasonable, she said, but it’s hardly reasonable if someone has been hurt.

Thomas Korosec is a writer living in Dallas.