| Perspectives on Texas

Effective health care delivery requires a collaborative effort, regardless of the volume of patients or the complexity of conditions. The positive patient experience depends upon myriad encounters with medical personnel starting at the front door and continuing to the point of care. Every step of the way there is the potential for both success and error. 

The big question in health care becomes, “How do we minimize the obstacles that hinder high quality care and maximize the rate of positive outcomes?” It’s a simple question accompanied by a very complex answer. But it can be done.

Skilled nursing care for our state’s frail and aging populations provides both short-term rehabilitative care as well as around-the-clock skilled nursing care. Texas nursing homes, like most other health care settings, have high performing facilities and facilities that, for various reasons, are challenged with maintaining a consistent level of quality care, and underperform.  

To ensure the best possible care in a safe and effective environment, it is important to highlight the best practices of successful facilities and identify weaknesses in those that underperform.

Therefore, the Texas Health Care Association (THCA) has mapped a strategic course to improve care quality for seniors. Our Commitment to Care is a unified effort to escalate the delivery of long term care services through increased transparency and collaboration.

Commitment to Care is a solutions-oriented initiative aimed to strengthen the delivery of long term care across Texas by:

• Utilizing performance data to identify and report on quality improvements being made by nursing home providers;
• Seeking to identify the common causes of incidents that can or have resulted in unmet care expectations; and
• Partnering with senior advocates to identify and develop strategies that facilitate the provision of compassionate and effective long term care services.

Consider these statistics:

• The number of people in Texas ages 65 and older is projected to grow from 3.2 million in 2015 to 7.5 million in 2040. 
• Similarly, the percentage of people ages 85 and older is also projected to increase, doubling from 1 percent in 2015 to 2 percent in 2040.
• The annual Texas nursing home has turnover rates in the 90 percentile for registered nurses and 123 percent for Certified Nursing Assistants (CNAs), the latter of whom are the frontline caregivers in the nursing home setting.

THCA has long maintained a direct correlation between a stable workforce, consistent staffing and the delivery of quality senior care. A growing population of elderly requires a robust long term care workforce.

However, according to our Commitment to Care first quarter survey, more than 75% of provider respondents cite high staff turnover and nearly 56% cite lack of available clinically-trained health care professionals in the community among their greatest challenges.  It is critical we address how to grow the greatest asset in long term care – the caregiver.

Access to appropriate education resources is key to facilities striving to improve eldercare. Through our Commitment to Care survey, THCA will glean data so that we strategically direct education, training and quality improvement resources to facilities identifying areas of focus.

Transparency and collaboration are also central components to the Commitment to Care, which will create a forum for Texas nursing home providers and senior stakeholders to share information, ideas and report progress.

While internal reforms are a necessary first step to enhance the quality care delivery for our frail and elderly patients, Texas lawmakers also play a critical role. Patient outcomes and public policy decisions are intrinsically linked. Therefore, we urge lawmakers to support policies that facilitate providers’ ability to improve the care for nursing home patients throughout Texas. 

Fortunately, there are a number of legislative initiatives underway that our elected officials can put in motion immediately.

First, they can help ensure consistent, high-quality care through increased economic stability for long-term care providers. More than 70% percent of Texas nursing homes report the cost of care for Medicaid beneficiaries exceeds the Medicaid reimbursement.  With a stable economic base, providers are able to offer higher wages and better benefits, which will allow us to attract and maintain a highly trained, professional workforce. 

However, attaining adequate resources is not a singular fix. We must develop systems that utilize survey data to identify deficient practices and engage all facilities in an educational process that learns from process failure.

Commitment to Careis a nursing home initiative, but the goal of elevating Texas nursing home care should be shared by all Texans.  We all have mothers and fathers, grandparents and neighbors who will or already do require skilled nursing care. And that time is around the corner for many of us. 

Texas leads the nation on so many other fronts from a thriving economy to lower taxes. It’s time we work together to make Texas a leader in long term care.