AUSTIN (KXAN) – Amid the ongoing pandemic, Texas leads the nation with the most nursing homes reporting staffing shortages in each key metric tracked by the Centers for Medicare and Medicaid Services.

The federal data also indicates Texas is trending in the wrong direction, with the number of facilities reporting staff shortages steadily growing since May, according to CMS records released Thursday and analyzed by KXAN.

Experts say the troubling trends illuminate state and federal failures to fund nursing homes and enforce rigorous standards for critical needs, such as staffing.

Brian Lee, executive director of Families for Better Care, a nonprofit focused on improving nursing home care, said lawmakers failed to implement important nursing homes standards for years before the coronavirus pandemic began.

Legislators should create “tough staffing standards with rigorous enforcement,” and Texas families should “put the screws” on lawmakers that have failed nursing home residents, Lee said.

“The strong political rhetoric to help residents through this crisis has been nothing more than a lot of hot air,” Lee said. “The federal and state response has been an unmitigated disaster.”

Texas ranks first in the nation in the following staff shortage categories:

  • Nursing staff: Texas has 256 facilities reporting a shortage. Ohio is second with 191.
  • Clinical staff: Texas has 39 facilities reporting a shortage. Illinois is second with 26.
  • Aide staff: Texas has 303 facilities reporting a shortage. Ohio is second with 213.
  • “Other staff”: Texas has 156 facilities reporting a shortage. Ohio is second with 92.

Kevin Warren, president and CEO of Texas Health Care Association, which advocates and represents long-term health care providers, said Texas has a two-fold problem in regards to staffing. First, there is a supply issue. In Texas there are “simply not enough” licensed nurses and certified nursing assistants available. Second, Texas has one of the lowest Medicaid reimbursement rates in the country, and those reimbursements pay for almost two-thirds of all nursing home stays, Warren said.  

“These low rates have crippled our ability to attract and retain the necessary highly-skilled workforce and compete in competitive labor markets,” Warren said. “COVID has only exacerbated this crisis issue as the demand on the nursing workforce across all health care sectors has created a hyper competitive market that nursing facilities struggle to compete in due to a lack of funding.”

While additional money has been released to help long-term care providers, Warren said Texas lawmakers need a short and long-term funding solution.

“We have been sounding the alarm for years on the Medicaid funding crisis in long-term care to our state lawmakers. With so much attention now on long-term care facilities due to the pandemic, the consequences of this funding crisis have truly been laid bare for all to see,” he said.

Troubling Trends

The CMS data, which has been released weekly since early June, provides a snapshot of each nursing home’s coronavirus case counts, staffing and personal protective equipment supply. Long-term care facilities, like nursing homes, have been disproportionately affected by coronavirus. At least 2,391 nursing home residents have died in Texas, accounting for more than a quarter of all coronavirus deaths in the state, according to Texas Health and Human Services Commission data updated Wednesday.

In each key metric, the number of nursing homes reporting staff shortages is at, or near, an all-time high since CMS began publishing its data during the pandemic.

Federal response

Gov. Greg Abbott announced Friday that CMS had approved $1.1 billion for the state’s Quality Incentive Payment Program (QIPP), which provides performance incentive Medicaid payments to nursing homes.

“This funding will improve the quality of care and strengthen infection controls at Texas nursing facilities,” Abbott said in a prepared statement.

A spokesperson for Sen. John Cornyn, R-Texas, said he “supported $175 billion for a health care provider relief fund, from which some nursing homes were eligible to receive relief.

Cornyn’s office also said he supports the HEALS Act, including provisions they say would supplement the state’s nursing home strike force, support testing and infection control, improve reporting transparency and provide additional funds for those purposes.

U.S. Rep. Lloyd Doggett, a Texas Democrat, pointed to both state and federal government leaders for the state’s nursing home failures.

“This Administration needs to reinstate the regulations that it weakened, which required infection control specialists in facilities, updates to emergency preparedness plans, and strong penalties for safety violations. We also need reliable personal protective equipment instead of the appalling, shameful shipments FEMA sent to nursing homes, in some cases essentially trash bags to serve as medical gowns,” Doggett said. “Finally, as I advocated in the recent nursing home hearing I chaired, Congress must pass comprehensive legislation establishing firm staffing standards, assurances of a living wage and benefits for nursing home workers, and stronger oversight of facilities.”

KXAN has mapped the latest federal data for Texas, and you can view the interactive map below.

On June 4, 2020 – months after the coronavirus pandemic began in the United States and medical experts expressed concerns over people living in nursing homes – the Centers for Medicare & Medicaid Services (CMS) began publicly releasing data and results from targeted inspections of such facilities conducted by the agency since early March. While initial reporting appears incomplete and the agency acknowledges the likelihood of occasional human error, it also offers a more complete look at the virus’ spread within this vulnerable population. Stricter accountability in the reporting is expected in the future with the goal of further enhancing and updating the data regularly. KXAN will continue to update this map, as more details become available. Read more about this data.