Achieving better nursing home care

By Keith Perry

Guest columnist

For the last 10 years in every legislative session, nursing home reform has been a major topic. We are bombarded by politicians promising to clear up and reform Texas nursing homes. Why then are bad homes still in operation?

Nursing homes are allegedly the second-most-regulated industry, right behind nuclear power plants, yet the public fears us both. Why does reform not lead to results?

Nursing homes have more than 2,000 regulations that govern their daily operation. They are inspected by multiple state, city and federal agencies. They face fines of up to $10,000 for rule violations or lawsuits for negligent care, yet reform fails because our state and federal governments have failed to address the broader issues of caring for our elderly. Issues such as staff turnover, staff training, lack of physician involvement, misdirected business objectives and poor reimbursement.

Nurse aide turnover in Texas averages more than 200 percent per year. They are the very core of our business; without them our residents could not receive their basic needs, such as bathing, dressing, grooming, feeding assistance, ambulating or toileting. A nurse aide's job is difficult, demanding, stressful and unrelenting. Yet for all they must do, they receive an average hourly wage of approximately $5.25 statewide. The average nurse aide is a single parent trying to raise a family on such a wage. Most nursing homes are not able to offer benefits such as health insurance, child care or retirement benefits.

We must elevate nurse aides' self-esteem, training, wages and benefits to reduce turnover. If nurse aides can receive recognition for a job well done and take home a living wage, turnover in our nursing homes will drop dramatically.

The training required for our industry is woefully inadequate. Our employees need technical training to keep up with medical changes, technique changes or technology changes. Beyond job requirements, employees need life skill training. They could benefit from parenting classes, marriage communication classes, financial planning classes and assistance in how to access and obtain community services.

The second-largest problem is the lack of physician involvement. Physicians are not required to visit their patients in nursing homes, or know that staff is capable of carrying out their orders.

The primary reason why physicians do not go to nursing homes is that the government payment system penalizes them if they do. They are paid more to see a resident in their office than in the facility. Physicians seeing more than one resident in the same home at the same time find their reimbursement is further reduced for the second resident visited.

Physicians can lose significant reimbursement in making rounds in a facility. If physicians make regular visits, staff would learn much from the physician and physicians would have first-hand knowledge of the quality of care being delivered. They could assist the state in holding the facility accountable for the care. The result could be a higher level of care being delivered.

Perhaps the most significant obstacle to nursing home reform is reimbursement by the government. Costs have risen, while reimbursement has continued to lag behind. Seventy percent of the residents of Texas nursing homes are Medicaid (state-funded) recipients, yet Texas ranks 48th or 49th from year to year in its Medicaid payment system. Texas' reimbursement is approximately $62 per day, about $20-$25 per day below the national average.

There also are no requirements on how much a home must spend on patient care. As a result, an unscrupulous owner can make huge profits by not spending money on resident care. Profits can be so large that fines for poor care are viewed as a cost of doing business.

The government needs to mandate minimum spending for adequate care and incentives should be awarded for good care. When businesses can make more from providing good rather than bad care, practices will change. Also, we should have even large penalties for poor care practices and money for penalties cannot be taken out of the patient care budget.

Nursing homes can be reformed when government is more interested in care of the elderly than headlines. Reform is achievable, but it will cost more - quality is never cheap. It seems to me that in a modern society, our elderly have earned the right to be cared for with quality and dignity.

Keith Perry is president and CEO of Sears Methodist Retirement System, Inc., in Abilene.