A publication of The Texas Tribune

Paid Placement

How to elevate quality of care for Texas seniors

By Kevin Warren, Texas Health Care Association, Feb. 9, 2015

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.

Kevin Warren, Texas Health Care Association

Kevin Warren is the president and CEO of the Texas Health Care Association in Austin, Texas

 

For Immediate Release
February 10, 2015

Contact: Rebecca Reid
410-212-3843

Texas Long Term Care Providers Announce
“Commitment to Care” Initiative to Achieve
Highest Standard of Care for State’s Elderly

Nursing Home Providers and Caregivers Launch Strategic Approach
To Effect Continuous Quality Care Improvements

 (Austin, TX) – The Texas Health Care Association (THCA) announced its statewide Commitment to Care initiative today, marking an effort by nursing home providers to chart a strategic course to improve care quality for seniors, promote transparency and collaboration among providers and stakeholders on the goal of establishing Texas as a leader in eldercare.

“Texas nursing home providers value the public trust, respect taxpayers’ demand for efficient and productive use of public funds, and share the goal that nursing home care in Texas meets the expectations of health consumers, elected officials, and all Texas citizens,” said Kevin Warren, President of THCA.  “Commitment to Care marks a unified effort to strengthen the delivery of long term care across Texas by reporting quality improvements made by nursing home providers, identifying issues that result in unmet care expectations, and partnering with senior care stakeholders to advance strategies that facilitate the provision of compassionate and effective long term care services.”

Warren noted that taking part in the Commitment to Care is designed to enhance care performance through adoption of four core principles:

• Improve workforce stability
• Improve clinical outcomes and care coordination
• Improve survey performance results
• Promote policies that enhance the quality care needs of the frail and elderly.

Initial efforts of the Commitment to Care include the completion of a quarterly survey by participating THCA members on current clinical priorities, successes and barriers to improvement, and access to available resources designed to assist long term care providers.

“Findings from survey responses will be used on an ongoing basis to direct efforts with respect to the development of improvement initiatives, dissemination of best practices, and sharing with participating stakeholders to measure progress and seek input for future efforts,” said Warren.

The Association is creating a new position of Director of Clinical and Quality Services who will manage the ongoing progress, identify areas where providers note challenges to improving specific quality measures, and share results with input from advocates and stakeholders.

”Commitment to Care is not a short-lived campaign but rather an ongoing, continuous effort to make consistent strides in the delivery of eldercare,” said Warren. “Public policy deeply and broadly impacts the long term care delivery system. We appreciate the opportunity to work with our legislators to minimize the challenges providers face in their mission to improve the care delivered to frail elderly Texans.”

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To learn more about Commitment to Care, please visit txhca.org/quality-care/commitment-to-care. For ongoing Twitter updates and information, follow @TXHCA and the #Commit2Care hashtag.

About THCA

Founded in 1950, the Texas Health Care Association (THCA) is the largest long-term care association in Texas. THCA’s membership is comprised skilled nursing facilities (SNFs), specialized rehabilitation facilities and assisted living facilities in Texas. These facilities provide comprehensive, around-the-clock nursing care for chronically ill or short-term residents of all ages, along with rehabilitative and specialized medical programs. THCA also represents more than 190 long-term care businesses that provide products and services to the state’s approximately 2,850 nursing homes and assisted living facilities.

Statement of Texas Health Care Association (THCA) President Kevin Warren
on the Sunset Commission Vote on Recommendations Impacting
DADS Regulatory Oversight of Texas Skilled Nursing Providers

“The Texas Health Care Association (THCA), on behalf of its members, urges lawmakers to consider with caution and prudence today’s Sunset Commission vote to support additional and unnecessary layers of regulation on our state’s skilled nursing facilities. Added enforcement actions and increased penalties proposed in the Sunset Commission report and subsequent amendments within the review of the Department of Aging and Disability Services (DADS) could severely hamper efforts to improve the quality of care delivered by nursing home providers by redirecting current resources away from patient-centered care.

Today’s vote should serve as a catalyst for a broader discussion of the challenges faced by facilities with repeated citations for the same or similar issues. Greater focus should be placed on the underlying issues and challenges that may inhibit sustained improvement efforts by nursing home providers and staff in caring for residents.

The nursing home sector remains one of the most heavily regulated settings in healthcare by both state and federal agencies. DADS has authority in the current regulatory framework to identify infractions, impose financial penalties, and require facilities to correct violations within the agency’s state and federal oversight responsibilities. Regulation and evaluation of the care delivered in the skilled nursing setting must assist providers working to enhance quality, help define the standard of care for patients.

Expanding upon current improvement efforts and maintaining current successes in quality nursing home care in Texas is a common goal between long term care providers, state agencies and consumer stakeholders. We must work together to identify best practices and promote quality improvement principles.

It is critical that Texas’ regulatory environment for skilled nursing care encourage transparency, collaboration and candor and not hinder provider efforts to manage the care delivery of an aging population with increasingly complex conditions.

The discussion of how to ensure the highest quality of care in Texas is one that we welcome and appreciate. As we move towards the 84th Legislative Session in January, we look forward to working with state leaders, state agencies and all stakeholders to ensure every Texas senior receives the highest quality care in our state’s skilled nursing facilities.”

Former Deuell Aide Brings Healthcare Issues Expertise to Long Term Care Legislative Agenda

(Austin, TX) – The Texas Health Care Association (THCA) announced today longtime legislative director to Texas State Senator Bob Deuell, M.D., Scot Kibbe, will lead the state association’s government relations division. Kibbe brings more than twenty years of experience working in the state legislature with a strong background in healthcare issues in addition to having managed communications and advocacy initiatives for the American Heart Association Texas Affiliate.

“Texas long term care providers will be served well by Scot as he brings a deep and broad understanding of issues impacting the skilled nursing community,” said Kevin Warren, President and CEO of the THCA. “Scot’s leadership and expertise in healthcare policy, particularly Medicaid, will be a major asset as we prepare for the 84th legislative session in the coming months.”

Medicaid reimbursement for Texas skilled nursing facilities ranks 49th in the nation, a fact contributing to challenges in attracting and maintaining a stable workforce that is critical to improving and advancing quality care to Texas elderly.

“This is a challenging time in healthcare and providing quality care to Texas seniors must be a legislative priority in 2015,” said Kibbe. “I am looking forward to working on behalf of our vulnerable elderly and the long term care providers who care for them. I am happy to be a part of the THCA team and to once again collaborate with some familiar faces at the State Capitol.”

Kibbe served on State Senator Deuell’s staff for more than ten years, focusing on Senate Finance and Health and Human Services committee issues. From Medicaid to state insurance law and tort reform, Kibbe managed the Senator’s participation in passing legislation, holding bill hearings and conducting agency reviews. Prior to serving as Deuell’s legislative director, Kibbe held the same title in the office of Senator Drew Nixon. In between his legislative roles, Kibbe was the Public Advocacy Information Officer for the Texas affiliate of the American Heart Association.

Kibbe earned a Bachelor of Arts in Journalism from Texas A&M University in 1990.

Texas Nursing Home Leaders Caution “3 Strike Rule” Will Cause Unintended Consequences for Frail Elderly

Nursing Home Providers Assert Rule Removes Regulatory Discretion –

Could Jeopardize Access to Care for Texas Seniors

(Austin, TX) –Texas health care providers raised concerns today about legislation that creates a three-strike rule for nursing home closures in the state. Senate Bill 304, introduced by Senator Charles Schwertner (R-Georgetown), would close nursing homes that receive three specific state violations of care over a two year period.

“The 3 Strike rule legislation creates an opportunity to further discuss regulatory oversight and the assurance of quality in the care of our aging population, “said Kevin Warren, President of the Texas Healthcare Association (THCA). “When enforcing nursing home regulations however, the removal of the regulatory discretion with a three strike rule will create a harmful and additional regulatory burden.”

If passed, the bill would expand the authority of state agency personnel to determine whether a facility remains open. The results of those determinations could affect the quality of care for thousands of elderly in the state’s 1,200 nursing facilities. Both THCA and LeadingAge Texas, together, the state’s largest nursing home associations, agree that the bill could potentially close high performing facilities and jeopardize access to quality nursing home care.

“We appreciate Senator Schwertner’s commitment to the seniors of our state and pledge our commitment to standards that promote the quality of care for our most vulnerable Texans,” said George Linial, President of LeadingAge Texas. “The bill, as it is currently drafted, runs counter to contemporary approaches of improving patient safety across the spectrum of healthcare.”

Both organizations stressed that serious violations of care in Texas facilities are never acceptable and nursing home providers must be committed to promoting quality care in their community. Both THCA and LeadingAge Texas support a process that identifies the root causes in facilities that incur repeated citations and assists providers with a corrective plan that addresses problem areas.

“Texas currently provides procedures for closing nursing homes that have one serious safety violation,” said Linial. “While safety and well-being is paramount, closing a facility has serious

consequences for the residents, families, health care workers, and the community supporting the facility.”

“Nursing homes are working to ensure the highest level of care for the over 90,000 elderly nursing home residents in Texas,” said Warren. “Their care and safety is of the utmost importance. Taking steps to address inconsistencies in the enforcement process and the interpretation of guidelines that define the severity of a violation is a positive step forward and possible within the current regulatory framework.”

Added Linial, “Long term care providers stand united in their commitment to provide the best care available to our elder Texans. We support consistent and effective regulatory policies designed to promote the highest level of patient safety and skilled nursing care.”

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About THCA

Founded in 1950, the Texas Health Care Association (THCA) is the largest long-term care association in Texas. THCA’s membership is comprised of several hundred licensed non-profit and for-profit skilled nursing facilities (SNFs), specialized rehabilitation facilities and assisted living facilities in Texas. These facilities provide comprehensive, around-the-clock nursing care for chronically ill or short-term residents of all ages, along with rehabilitative and specialized medical programs. THCA also represents more than 190 long-term care businesses that provide products and services to the state’s approximately 2,850 nursing homes and assisted living facilities. To learn more, visit http://txhca.org/ or connect with THCA on Facebook, Twitter and YouTube.

About LeadingAge

LeadingAge Texas is a trade association representing the full continuum of mission-driven, not-for-profit aging services providers in Texas by rendering up-to-date information, advocacy, education, representation, group services, and networking to aging services professionals to fulfill our promise: Inspire. Serve. Advocate.

As 2015 Texas Legislative Session Begins

(Austin, TX) – The Texas Health Care Association (THCA) today urged lawmakers to carefully consider the needs of the state’s most vulnerable elderly as the state comptroller announced a budget surplus and legislators convene for Texas’ 2015 state legislative session.

“Texas long term care providers are working diligently to improve quality measures in the delivery of care for our state’s elderly and for over a decade have faced the challenge of doing so with a nursing home Medicaid reimbursement rate that does not cover the actual cost of care,” said THCA President and CEO Kevin Warren.  “Two thirds of the patients in Texas nursing facilities today are Medicaid beneficiaries requiring a spectrum of services from short-stay rehabilitation to around the clock nursing care. Texas seniors’ medical needs continue to increase yet the Medicaid payment rate hovers near the bottom of the 50 states.”

State comptroller Glenn Hegar yesterday announced a budget of $113 billion in General Revenue available for the 2016-2017 state budget.  The general fund typically makes up nearly half of the state’s total budget. In addition, Hegar said the state will end the current biennium, which ends Aug. 31, with $7.5 billion in surplus funds.

“Texas nursing home providers understand that continuous quality improvements, staff retention and training and adequate resources are all correlated,” said Warren.  “There is no one solution to elevating the level of care in Texas nursing homes. Bringing Texas to the top of the nation in quality nursing home care requires a multi-faceted approach and implementing adequate Medicaid funding is a key part of that effort.”

Warren noted that the state Medicaid rate for nursing home care is 13.75 percent or $343 million in general revenue under what the state asserts will meet the cost of providing skilled nursing care for elderly Medicaid beneficiaries.

“Texas has a budget surplus and an unmet need in the ongoing challenge to deliver the best care possible to our state’s frail and elderly,” said Warren.  “Texas nursing home providers are committed to providing excellent care to our seniors.  We strongly urge legislators to join in that commitment by adequately funding the Medicaid rate for nursing home care.”

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Founded in 1950, the Texas Health Care Association (THCA) is the largest long term care association in Texas. THCA represents a broad spectrum of long term care providers and professionals offering long term, rehabilitative and specialized health care services. Member facilities, owned by both for-profit and non-profit entities, include nursing facilities, specialized rehabilitation facilities, and assisted living facilities.