Morningside Ministries and LeadingAge Texas held a joint press conference focused on addressing the nursing home quality crisis in Texas. The conference was planned after Morningside Ministries’ recent announcement to close one of their nursing homes due to an unwillingness to jeopardize quality-care under the current Medicaid payment system.
“The level of quality in Texas nursing homes remains an ongoing and persistent problem. While many organizations like Morningside are unwilling to compromise quality, others have shown patterns of substandard care,” says Pat Crump, president of Morningside Ministries. “The disparity in quality is growing but the current payment system does nothing to distinguish our state’s top nursing homes.”
In San Antonio, over one-third of all nursing homes perform below average according to the Centers for Medicare & Medicaid Five-Star Rating System. The current payment system does not disginguish top nursing homes from under-staffed, low-quality, chronic poor performers. The result is high-performing nursing homes exiting the Medicaid program leaving senior Texans and their families with less quality options.
“Quality is compromised because below average nursing homes have little incentive to change their practices. We need a new payment system that puts quality first,” according to George Linial, president and CEO of LeadingAge Texas, an association representing not-for-profit nursing homes in Texas.
During the 85th Texas Legislature, LeadingAge Texas led the effort to improve quality by supporting legislation to reform the current payment system. HB 2454 and SB 1819 would have created a quality-based payment program tying Medicaid dollars to the achievement of quality outcomes for residents and adequate staff-to-resident ratios.
“Quality-care should be the first priority for every nursing home in Texas, and the Texas Legislature,” said Linial. “One story of abuse and neglect is one too many. We’ve increased regulations and penalties to deter chronic bad actors but it’s time we do something different.” A 2017 report by AARP focused on how Texas nursing homes nationally rank 46th in quality of care, and almost dead last in staff turnover. “All nursing homes would agree perpetual underfunding has only exacerbated the problem, but the current system lacks accountability and fails to encourage nursing homes from spending on direct resident care,” says Linial.
The problem exists beyond large cities like San Antonio. “Direct-care staff are the backbone of our nursing home. By offering competitive wages and benefits, and staffing at appropriate levels we not only attract great staff, but our investment has paid off in the level of quality we offer our residents. Unfortunately, the payment system does nothing to recognize that,” said Rodney Rueter, president & CEO of Lutheran Sunset Ministries, a Five-Star rural nursing home in Clifton, Texas.
The solution is to move away from a Medicaid payment system that largely pays all nursing homes the same, to a free-market approach that directs taxpayer resources toward quality resident care. In doing so, we can strengthen the workforce by promoting adequate staffing levels and competitive wages and benefits; all factors proven to impact quality care and reduce staff turnover.