The Dallas Morning News had an article about the amount of money Texas provides to nursing home residents who are on Medicaid.  The article emphasizes that the amount of money is directly related to the quality of care and shows how Texas treats its most vulnerable citizens.

Texas’ Medicaid program only reimburses nursing homes an average of $112.79 per patient per day – less than 48 other states.  Texas remains 30 percent below the national average of $163.27 per day.  Patient advocates and industry experts say Texas’ 49th-place ranking means that nursing homes can’t pay employees competitive wages. That in turn leads to high staff turnover, which hurts residents’ care.  It is no surprise that 28 percent of Texas’ 1,100 nursing homes received the worst rating and only 10 percent scored the best when Medicare announced its new nursing home ratings late last year.

The reimbursements now don’t even cover nursing homes’ actual costs and would need to increase to at least $125 a day for facilities to break even.  Skilled nursing care costs tens of thousands of dollars a year, so many nursing home residents eventually exhaust their personal assets and qualify for Medicaid, the federal-state health care program for the poor.

Nursing homes have tried to hold the line on their labor costs, but that leads to high staff turnover. It’s difficult to compete with hospitals, which pay better, so nursing homes routinely lose registered nurses, licensed vocational nurses and nurses’ aides.  "The average annual turnover rate is 87 percent for certified nurses’ aides," said Pearl Merritt, who leads a center task force on long-term care. "It’s a challenge to maintain high-quality care in a revolving-door environment."

Nurses’ aides can work at a McDonald’s for more than what Texas nursing homes are willing to pay them.



The Edmond Sun had a recent article about a 131 page investigative report that supports complaints against a nursing home in Oklahoma.  One of the complaints includes a lack of an effective system for investigating and reporting abuse and failure to consult with a resident’s physician when there was an injury.  The investigation was triggered by a Sept. 16, 2008, incident at Grace Living Center. On that day, a resident, Lester Pendergraft, allegedly sexually assaulted a 67-year-old resident.   Pendergraft has been charged with one count of rape by instrumentation.

A meager $10,000 penalty resulting from the investigation has been proposed by the Centers for Medicare and Medicaid Services. 

Documentation showed the victim’s daughter was notified at 8:45 a.m., 1 hour and 35 minutes after the incident occurred at 7:10 a.m. Edmond Police arrived shortly after they were notified, at about 9 a.m. The victim’s doctor was called between 8:15-8:25 a.m., shortly after he arrived at his office.

On Sept. 25, the detective assigned to the case said, “The facility did a poor job of protecting the evidence.” He said facility staff threw away evidence and washed the victim’s bed linens and clothing and Pendergraft’s clothing.   Why would the facility do that unless they were trying to cover up what happened?

According to the report, the facility’s staff should immediately notify the director of nurses and the doctor, get the resident out of harm’s way and assess the resident whenthere is an allegation of abuse or neglect.  “The resident was not assessed timely after the incident,” the report stated.

The detective said someone in charge said to another officer that he felt  “The situation was being blown out of proportion.”

Citizen advocate Wes Bledsoe, founder of A Perfect Cause, an advocacy organization for disability and elder rights, said when he read the report he was “deeply disturbed."  Bledsoe said what was most shocking was that the incident happened in the first place, that evidence was destroyed with either intent or by incompetence and that a staff member voiced concern about police blowing the situation out of proportion.  Furthermore, there were warning signs before the incident that Pendergraft posed a threat to residents. Pendergraft was entering rooms of residents without reason or explanation who could not call out for help.

According to the report, a certified nurse aide reported before the Sept. 16 incident that she observed Pendergraft touch another resident who was dependent on staff for assistance. The same day, Pendergraft was seen pulling up the shirt of still another resident who was dependent on staff for assistance.