| Perspectives on Texas

America’s obsession with youth may be enduring but youth itself, as most of us discover at some point, is fleeting. Aging gracefully and with dignity warrants greater consideration as our population continues to live longer, yet not without the complications that almost inevitably accompany our elderly years. It is incumbent upon society and certainly government programs that aid low income seniors to make and honor a commitment to our older Americans’ well-being.

Medicaid, the state funded health care program for the poor, is supposed to serve as a safety net that pays for certain health care services. Three fourths of the elderly requiring skilled nursing care in Texas nursing homes are Medicaid beneficiaries. Yet for decades in Texas, a jagged tear in the safety net has been allowed to expand over time, and now, by the state’s own numbers, the Medicaid rate for nursing home care is underfunded by $343 million. That means what the state pays for Medicaid beneficiaries in nursing homes is roughly six dollars an hour. That $6/hour is supposed to cover skilled nursing care provided to patients struggling with complex conditions that threaten their mobility, threaten their health, and certainly their quality of life.

I’m certain I don’t need to point this out, but I will: Six dollars an hour does not cover the cost of providing skilled nursing care to Texas’ seniors.

The most recent population data indicates that 3.2 million Texans are currently over the age of 65 – a number that is expected to grow to 7.5 million by 2040. Similarly, the percentage of people ages 85 and older is expected to double over the same span.

Texas is not prepared on a number of levels to keep the promise to our aging Texans. We need to change that.

My geriatric practice oversees the care of elderly patients in fourteen skilled nursing facilities in the Austin area. I’ve been an Attending Physician and Medical Director for nine years now and have witnessed an evolution in skilled nursing care. My group of physicians, nurse practitioners and other clinicians is responsible for developing plans of care for nursing home residents and coordinating with on-site staff, off-site consultants, allied health professionals, the residents themselves, and their family members.

Geriatric care in long term care is both practical and sophisticated and efforts underway by nursing home providers to consistently make quality improvements that enhance health outcomes and quality of life for patients is truly impressive. Providing care to elderly patients is challenging and complex as aging bodies become more fragile and susceptible to disease and for many, the mind’s functions begin to diminish as well.

Long term care is all about personal care for the patient – it is, and must be individualized, and encompasses caring for the whole person --mind, body, and spirit. Personal care requires attention, consistency and compassion, all which cannot be delivered by state-of-the-art equipment or instruments, but rather by people. There is no MRI or specialized surgery or “Mercedes Benz” wheelchair that can or will ever take away the need to have good, caring, people working in long term care.

Long term care is a “people” profession. Nursing home providers must invest in their workforce and herein lies a tremendous challenge.

Everywhere I go in the greater Austin area, I see a growing city. There is an influx of new Austonians. We have a booming economy and thriving business sectors. Healthcare is one of the top five sectors driving the economic engine in the state capital. Opportunity is everywhere. Why then is it that nursing facilities in Austin struggle to find and retain nurse aides and nurses? In the fourteen facilities my group serves, there are over thirty Certified Nurse Aide (CNA) positions open and over ten unfilled nursing positions – that I know of. One of the main reasons is that nursing facilities cannot offer competitive wages, generous benefits and the promise of bonuses to reward excellent work performance at Medicaid’s reimbursement of $6/hour. It just doesn’t compute.

This is a problem now. Imagine what the future holds.

State budget conferees in both the House of Representatives and the Senate are meeting now to determine what programs are funded in the next budget. A fully funded Medicaid rate for skilled nursing care is necessary to elevate the quality of care for the elderly. Lawmakers must make eldercare a priority, and give those of us meeting the health care needs of our seniors the resources to ensure they and all of us can age gracefully and with dignity.