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Nursing Home Dangers: Few state fines, facilities understaffed

Nursing homes in Texas rank low in quality of care.  They're understaffed, have trouble keeping trained employees, and carry a history of violations without penalties.

Most nursing home facilities in Texas would have a failing grade by most measures. Texas nursing homes have an average rating of 57.

“We're at the bottom of the barrel,” said Amanda Fredriksen, Associate State Director for Outreach and Advocacy for AARP Texas.

Neglect, mixed medications, and trouble stopping spreading infections are some violations rarely punished.

“It goes to this issue of tying regulators hands,” said Fredriksen in a Senate hearing Monday.

Texas AARP recently analyzed state data for their report “Intolerable Care.”

They found 17,466 citations for Texas nursing homes.

The state took 40 enforcement actions.

If regulators find a violation at nursing home, the state allows the facility time to correct the problem without any fines.

“We think that's a problem. It sends the wrong message,” said Fredriksen. “Sure, they need to correct the violation, but when you have violations that are causing actual harm to people, there needs to be more to it than just correct it.”

The facilities themselves have trouble keeping good workers, which can lead to more violations.

“Many of the staff is leaving for Walmart, dunking donuts,” said Robin Underhill, Cantex Continuing Care Network CEO.

She said better pay and less stress leaves some facilities with a 100% turnover rate. She’s pushing for Senate Bill 1130.

S.B. 1130 creates the Nursing Facility Reinvestment Allowance (NFRA).

It would allow the state to get additional Medicaid funding, specifically for nursing home care. It would not impact any state funds or general revenue.

According to the bill analysis, “An assessment of up to six percent per nursing facility bed would be paid by the provider monthly to the Health and Human Services Commission (HHSC). Those dollars will be used to access the federal dollars available, something 43 other states currently do. After the federal dollars are matched, HHSC will move those enhanced dollars to Managed Care Organizations so those calculations can factor into the Medicaid rate for Medicaid reimbursement to providers.”

Fredriksen says people are dying because of some of the problems highlighted.

She says Senate Bill 932 will help bring change.

Bill Analysis:
“S.B. 932 clarifies that the third party informal dispute resolution process established for nursing facilities in S.B. 304 (Schwertner, 84R) also applies to assisted living facilities. The bill also requires the executive commissioner of the Health and Human Services Commission (HHSC) to review and streamline the processes for how HHSC issues informational letters and policy updates to certain long-term care providers and requires HHSC to utilize a system to record and track the scope and severity of violations for certain providers. In addition, S.B. 932 prohibits certain long-term care providers from utilizing "right to correct" for a violation if it represents a pattern of violations that results in actual harm, is widespread in scope and results in actual harm, is widespread in scope and constitutes the potential for actual harm, or constitutes an immediate threat to the health and safety of a client. This legislation extends the licensure period of certain long-term care providers an additional year, and finally, S.B. 932 increases the penalty cap for assisted living facilities in instances that result in actual harm or constitutes an immediate threat to the health or safety or a resident and removes the penalty cap for intermediate care facilities (ICFs) for the total amount of a penalty assessed for a violation for both small and ICFs. As proposed, S.B. 932 amends current law relating to the licensing of, the executive commissioner of the Health and Human Services Commission's duties with respect to, and the administrative penalties for certain long-term care facilities”

You can look up a facility’s history at the state and federal level.

State (all providers in Texas):

Department of Aging and Disability Service

Federal (Medicare-accepted facilities):