Texas Nursing Home Leader Cautions Instability in Caregiver Workforce and Lack of Future Potential Workers Threatens Consistency in Care for Elderly

February 18, 2016



For Immediate Release                                                                                                              
February 18, 2016

Contact: Rebecca Reid


Texas Nursing Home Leader Cautions Instability in Caregiver Workforce and Lack of Future Potential Workers
Threatens Consistency in Care for Elderly

State’s Largest Nursing Home Provider Association Tells Legislative Committee
Survey/Regulatory Process Needs to Expressly Aim at
Assisting Providers in Improving Care Quality


(Austin, TX) – In a hearing before the Senate Health and Human Services Committee on the Interim Charge of Healthy Aging, the President and CEO of the Texas Health Care Association (THCA), underscored present and future warning signs that building and maintaining a stable, consistent direct-care workforce in nursing homes continues to be one of the greatest challenges providers face in a statewide effort to improve the quality of care for the elderly.

“The numbers don’t lie,” Kevin Warren, President and CEO of the THCA, told committee members. “As Texas’ aging population continues to rise, the number of people leaving the long term care profession and those choosing not to enter it is also rising and that is a perfect storm we need to vigorously work to prevent.”

Warren noted that according to the AARP Public Policy Institute, the proportion of potential caregivers for persons 80 and above was 7 to 1 in 2010. That number will fall to 4 to 1 by 2030 and 3 to 1 by 2050 when all baby boomers are 80 years or older. Today, the annual turnover rate in Texas nursing homes is one of the highest in the country and nearly 50 percent of Registered Nurses (RNs) identified as working in a nursing home or extended care facility in 2009, were no longer working in either environment as of 2014, according to the state’s Health and Human Services Commission Jan 2016 Nurse Data. Broken down by nursing certification, turnover rate in Texas nursing homes is as follows:

94% Registered Nurses (RN)

86% Licensed Vocational Nurses (LVN)

104% Certified Nursing Assistants (CNA)

Warren also asserted that the current facility survey program favors a punitive approach over a process that actually aides the provider in improving care strategies.

“When long time owners of nursing homes leave the business due to the strains of the survey process and underfunding, that in many ways is counterintuitive to actually facilitating improvement in care delivery performance, it is clear that something is not working,” said Warren.

THCA has stepped up engagement in several initiatives aimed at aiding providers in improving care for elderly residents. Most notably, the association launched the Commitment to Care (C to C) initiative a year ago marking 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. The objectives of the C to C is to:

  • 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

In addition, THCA partnered with other long term care stakeholders last fall to co-sponsor the One a Month campaign aimed to build on recent success by Texas long term care providers in lowering the use of off label antipsychotics in the treatment of some Texas nursing home residents. The effort involves partnering with nursing home providers statewide to commit to transitioning at least one resident a month off of these medications by using non- pharmacological interventions.

In conclusion, Warren emphasized the need to assess the adequacy of the long term care educational curriculums and training programs to ensure that nursing students are both well prepared and introduced to geriatrics and caring for long term care residents. Warren also voiced the association’s ongoing support for a value-based incentive reimbursement program that funds quality based add-on payments to nursing homes and recommended the council established by SB914 on long term care facility surveys and informal dispute resolution identify and examine best practices and protocols in other states and healthcare sectors for opportunities to improve consistency and promote effective quality improvement principles in the Texas’ regulatory system.

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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.