Journalist Robert Garrett wrote a great article for the Dallas News about the failure of Texas to penalize nursing homes that neglect and abuse residents.  Current and former inspectors say that they’re being discouraged from reporting bad care and unsafe conditions. Experts fear that elderly and frail residents are at risk of abuse and neglect as some operators routinely cut corners and understaff facilities. 

The state has stopped imposing the most severe penalties, such as revoking a home’s license and government contracts, or seeking a court-appointed overseer.  Four employees who performed inspections for the state in recent months told The News that their superiors often resist letting them cite homes for possible life-threatening abuse and neglect.  Without that implicit threat, corporate owners will treat minimal fines as a cost of doing business instead of correcting the problem.

The Dallas News investigated and found:

State regulators whose job is to keep shoddy operators from owning or running homes have done cursory, and at times inaccurate, background checks that in at least one case failed to keep out a federally banned health-care provider.

State budget cuts have reduced staff by about one-fourth since 2001, even as the number of nursing homes in Texas is virtually unchanged, at about 1,200.

Legislative changes, especially limits on lawsuit damages passed in 2003, have virtually eliminated trial lawyers as de facto watchdogs of nursing homes. Other changes limited the state’s ability to fine nursing homes and have created an industry-friendly cadre of “quality monitors.”

After inspectors discovered practices endangering the lives of elderly and disabled residents, the state regulatory agency hasn’t gone after the homes’ licenses.

AARP said the state’s relatively infrequent use of harsh sanctions “raises serious concerns about the agency’s commitment to quality.”  AARP , a leading advocacy group for seniors, recently gave Texas poor marks for quality care. Using data from the federal government, it ranked Texas 34th among states in avoiding bedsores for high-risk nursing home residents and 42nd in preventing hospital readmissions.

In 2001 (the nursing home industry spent as much as $575,000 during the 2001 session),
Republican lawmakers removed about 45 of the 557 inspector positions and converted them to “quality monitors” who try to help operators solve persistent problems, such as bedsores. Today, the inspector force has dwindled to about 400.  And the quality of care has suffered.  Budget documents show that state nursing-home enforcement has remained on tight rations.  For the last several years, inspection teams have had fewer people and spent less time at a home during annual visits than in previous years.


TIMELINE: Milestones in Texas nursing home enforcement

1977: Lufkin News publishes stories detailing abuse and inadequate food at East Texas nursing homes, including the beating of a 76-year-old female resident in a Lufkin home by four aides with a belt and coat hangers. The revelations spark investigations by a congressional panel and state Attorney General John Hill.

1978: The death of a woman at Autumn Hills Convalescent Center in Texas City sets off a long-running inquiry, which eventually leads to the first murder trial of a corporation in state history. A task force named by Hill reports that the state “plays an endless ‘compliance game’ with substandard nursing homes.”

1981: Legislature passes a law allowing state regulators to seek court-appointed trustees to oversee troubled homes.

1984: Attorney General Jim Mattox’s office, after years of effort, obtains murder indictments against the Autumn Hills company and five current and former company officials. They are charged with murdering two female residents in 1978 through neglect and cutting corners to boost profits.

1986: A jury in San Antonio deadlocks, after a six-month trial of the Autumn Hills case. Jurors vote, 9-3, for convicting the corporation, though not the company officials. A mistrial is declared, ending the saga.

1987: Congress passes an extensive overhaul of nursing home health and safety standards.

1991: Gov. Ann Richards appoints Austin lawyer David Bragg as her “citizen trustee,” to resume work he did for Hill in pressing for stronger enforcement. Lawmakers, though, ignore most of Bragg’s and Richards’ recommendations.

1995: After federal officials finally adopt regulations for carrying out the 1987 law, the Legislature passes a law saying Texas’ standards can’t be more stringent.

1997: The national AARP makes repeal of the 1995 law its top priority. With help from Lt. Gov. Bob Bullock, advocates persuade lawmakers to repeal it and beef up penalties. Veteran state employee Jim Lehrman is chosen to head enforcement.

1998: The annual amount of fines imposed by the state doubles, to $7.6 million, and the state begins revoking licenses for nursing homes with a five-year history of repeated deficiencies. Also, changes in federal Medicare payments hurt homes’ balance sheets.

1999: The state asks courts to name trustees to run 13 nursing homes owned by Fort Worth-based Sensitive Care Inc., after its federal Medicare payments are cut off. Later the same year, Denton-based Texas Health Enterprises files for bankruptcy. The huge chain, owned by Peter “Woody” Kern of Pilot Point, has been a top target of regulators.

2001: Some Texas lawmakers sharply criticize state regulators as overzealous, and the Legislature cuts $5 million from Lehrman’s unit to create a new program of “quality monitors” who work with the industry on persistent problems such as use of physical restraints. He asks to be reassigned.

2003: The Legislature and voters approve limits on medical-malpractice lawsuit damages. The agency that inspects nursing homes is renamed the Department of Aging and Disability Services.

2009: Chris Traylor is named commissioner. Traylor organizes a “blitz,” using former inspectors and other department employees, to work off a backlog of unexamined complaints if there is high risk of harm to residents.

2010: Kern applies for licenses to resume operating some of his old homes, but withdraws his applications after the department advises him they’ll be denied.

2011: The department seeks and wins passage of bill letting it consider an owner or his partner’s lifetime records of compliance, not just the most recent five years.


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