Leaders Declare Senior Care Staffing Crisis in Texas Amid 97% Turnover

Operators of nursing homes in Texas reported 97% turnover for certified nursing assistants, with 90% turnover for other key frontline caregiver positions — promoting leaders in the state to declare a “crisis.”

The Texas Health Care Association called for higher Medicaid reimbursement rates to help mitigate the trend in a recent report on its members’ financial and staffing challenges, pointing to data that shows a positive correlation between federal dollars and staffing quality.

“The nursing turnover rate and workforce availability in Texas nursing homes are at crisis levels, and low staffing levels are leading the industry to fall below national averages in survey, quality, and staffing measures,” the Austin-based group wrote in the report.


Per-day Medicaid reimbursements for nursing homes in the Lone Star State have lagged behind actual costs since 1994, according to the THCA, with more than 75% of operators saying they can’t make ends meet on Medicaid residents.

“Over time, the gap between Medicaid reimbursement versus nursing home expenses continues to increase, destabilizing the nursing home workforce and inhibiting operators from making much-needed investments in their facilities,” the group noted.

States with higher average Medicaid rates generally saw higher nursing staffing hours per patient day, while additional research suggests that better reimbursement figures can lead to reduced rehospitalizations — a key metric for the government and operators alike.


In 2015, Texas had the second-lowest Medicaid reimbursement rate in the country, at $143.48 per day, ahead of only South Dakota and its $133.74 payment rate. For comparison, Alaska led the way with $435.64, followed by Hawaii at $278.77 and Delaware at $256.69.

Operators in Texas certainly aren’t alone in their staffing woes, with near-full employment and wage competition from other jobs in retail and food service making life difficult for skilled nursing operators looking to fill out their ranks with steady, reliable employees.

But Texas is different from some other states in its demographic profile: While the population has surged in recent years, Lone Star State schools haven’t kept pace with nursing graduates, leading to a deficit in the number of available registered nurses, according to another recent report from advisory firm Mercer.

States like Illinois, meanwhile, have seen population declines as residents move away from the Chicago metropolitan area — but continue to boast robust nursing education programs that generate a surplus of available nurses, Mercer found.

But even in a state that’s already facing nursing shortfalls, Texas nursing homes have a particular struggle: While 46% of home health and hospice agencies in the state reported adequate staffing, just 8% of long-term care operators could say the same.

“National surveys consistently rank Texas as among the best states for business development and job creation,” the THCA noted. “Yet the nursing home workforce crisis stands in stark contrast to the overall robust Texas economy, where both employment and payrolls — outside of the nursing home expansion — are forecast to continue a strong expansion in 2018.”

Written by Alex Spanko

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