Texas Nursing Homes Are Missing Something: Nurses

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LUBBOCK — Robert Lozoya recently started a shift as the nurse manager for Carillon, Lubbock’s largest seniors’ residence, at 7 a.m.

For the next 12 hours, he sorted through his duties, taking over for nurses who didn’t show up for work. He made sure patients didn’t choke on their lunch, treated injuries, and fielded a myriad of calls to doctors, families, and pharmacies.

By the time Lozoya left, well after 7 p.m., he was exhausted. And he knew that tomorrow would be more or less the same. He and his team will adapt to the lack of personnel, as they have had to do so often in recent years.

“We will do it one way or another,” Lozoya said. “We’ve been working on it so far, so it’s okay, it just hasn’t been ideal.”

Texas does not have enough nurses for its aged care facilities. The shortage is fueled by a number of factors. There is growing apathy in the nursing industry, and the COVID-19 pandemic has only fanned the flames. Baby boomers are retiring from the nursing profession and need care themselves. Nursing homes have been particularly affected by this crisis due to financial constraints and medical students who want jobs in more prestigious fields.

In the context of the staffing crisis, another disturbing trend in Texas: nursing homes are closing. A Texas Health and Human Services report shows that between 2018-22, at least 60 nursing facilities in the state – 2% – lost the battle against inflation, low Medicaid reimbursement rates and other financial charges.

For Texas seniors and their families, the shortage of new healthcare professionals in aging populations is dire. At best, they wait longer to find beds and pay more when they do. At worst, they are left behind, forced to live out their final years without the kind of support an aging facility can provide.

“We’ve seen over time that individuals are sicker by the time they enter nursing homes and need a higher level of care, and providers don’t have the trained staff to accommodate this. type of patients,” said Kevin Warren, president. of the Texas Healthcare Association.

Finding a home where seniors can live out their lives safely and with dignity is more difficult for families living in the empty expanses of rural Texas. Nearly two-thirds of retirement homes closed since 2018 were in rural areas. And seven were in the High Plains, the region that stretches from Lubbock to the top of the Panhandle.

“In rural areas, it’s common for the next closest retirement home to be 30 miles or more away,” said Alyse Meyer of LeadingAge Texas, an advocacy organization that works with 200 senior service providers. across the state. “There are other factors that are important to families when faced with choosing a new retirement home for their loved one.”

A costly short-term solution

Carillon is Lubbock’s most ornate nursing home – a vital part of the town’s claim as a medical center, which draws patients from across the region. But despite all of Carillon’s accolades, it was unable to attract enough staff.

“This is the worst staffing I’ve seen,” said Pamela Roddy, Carillon’s CEO. “It’s amazing to me that we can stay afloat, but we have people taking extra shifts.”

Compared to 2019, there is an 18% decrease in the number of registered nurses employed in nursing facilities in Texas, according to data from the United States Bureau of Labor Statistics. The nursing shortage has forced some facilities to deny patients discharge, Warren said, which has a ripple effect.

“It puts pressure on hospitals and it adds stress to the family trying to figure out where to take their loved one,” said Warren, president of the healthcare association.

Facing shortages, facilities often hire temporary nurses through agencies, paying at least 50% more per hour than their full-time staff.

The use of traveling nurses can take a toll on staff morale. The pay gap has caused tension among Carillon staff. Some questioned why money could be spent on agency nurses who are paid $45 an hour or more, but not raises for regular employees.

“I promise them it’s because the agencies are a short-term deal, it’s not forever,” Lozoya explained. “But if we use them, we can open up more space. It’s like putting a band-aid on here, but you’re still bleeding there.

Meyer, vice president of advocacy at LeadingAge Texas, said the majority of its members have faced increased costs due to the shortage.

Often, agency nurses are drawn from long-term care, lured by promises of travel, higher pay and shorter weeks — an alluring lifestyle that most nursing homes can’t compete with.

“They cost nursing facilities more, sometimes two or three times what they would pay for a full-time nurse,” Meyer said. “On top of that, it impacts resident care because nurses come in and out, but that’s their house.”

Glamor and money keep nurses away

What worries Tara Strawn, director of the nursing program at South Plains College in Levelland, is that there are few new nurses who could ever relieve the pressure. She sees nurses building their careers from scratch, and she said they don’t go to nursing homes for one simple reason: they want what they see on TV.

While nursing homes might not be considered glamorous enough for a young college student’s “Grey’s Anatomy” fantasies, working in the emergency room or intensive care unit might live up to expectations. .

“These areas don’t have as big of a deficit because that’s where they all want to work,” Strawn said.

She would like to see the state develop a pathway for student loan forgiveness that encourages nursing students, which could help with the dire situation. Four other states — Kansas, Minnesota, Missouri and Oregon — offer state-funded pardons for medical students.

“We need to invest in our young people so they want to become nurses and because they have a heart for it,” Strawn said.

But part of what keeps students away from the profession is what now keeps nurses away from institutions: money. About 62% of residents of Texas nursing homes rely on Medicaid to pay for their services, but facilities don’t receive enough Medicaid to stay afloat for long.

“Texas is in a tough position because historically we’ve had very low Medicaid reimbursement rates,” said Meyer of LeadingAge Texas. “Financial constraints are compounded, so you can’t really have a conversation about solving staffing shortages without talking about reimbursement.”

Meyer said many nursing facilities in rural Texas can’t afford to compete with more metropolitan areas that pay more. Until they can get help balancing the books, the shortage will continue to be a problem.

“It’s going to be an uphill battle for us,” Meyer said. “It’s going to be difficult to attract nurses specifically because there are so many options, and those options, nine times out of 10, will pay more than nursing facilities.”

Disclosure: LeadingAge Texas and the Texas Health Care Association financially supported the Texas Tribune. Financial supporters play no role in the journalism of the Tribune.

The Texas Grandstand is a nonprofit, nonpartisan media organization that educates Texans about public policy, politics, government, and statewide issues.

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