Four of 10 Texas nursing homes now are publicly owned under agreements between private companies and county hospital districts, according to a WFAA review.
The partnerships are spurred by higher Medicaid reimbursements for nursing home residents - up to several million dollars more each year for a participating nursing home.
And for county hospital districts, the partnerships may lead to taxpayer savings by giving county hospital patients access to more appropriate long-term care.
Dallas County has taken advantage of the program, with the Parkland Health & Hospital System now having ownership of 29 nursing homes – making it the state’s fifth largest nursing home chain.
The higher Medicaid reimbursements – about $43 more per day per Medicaid resident – were expected to translate into better overall care and increased staffing.
“The whole purpose of the program was to increase quality of care,” said J. T. Borah, a nursing home injuries attorney. “…It doesn’t appear as if the results they expected are actually happening.”
A WFAA review of publicly owned nursing homes in Dallas County, may support Borah’s concerns. The review failed to show overall improvement in the quality of care. At least, that’s according to the star rating system for the Centers for Medicare & Medicaid.
In fact, 20 of 29 Dallas county-owned nursing homes saw their overall star ratings either fall or remain the same after the county took over.
Maybe more troubling, the staffing star ratings for most of the Dallas County-owned facilities decreased. And most of them currently have a single star for staffing. That’s equivalent to an “F” rating.
“I don't know where the money's going,” said Margie Sullivan, a nursing home advocate. “Maybe they're buying new furniture with it so the front will look pretty when new residents come in. Maybe they're buying a bread machine to make the nursing home smell better when you walk in the front door. These are things I've seen.”
Judy Edwards and Monica Lewis both had their mothers inside one of the first Dallas County-owned nursing homes.
Both of them expected improvement in the quality of care after Parkland assumed ownership. But they failed to see any.
“When we heard the news, we were overly excited because we thought help is on the way,” recalled Edwards. “…We thought new staff, better staff, better equipment.”
“It just doesn’t make sense at all,” Lewis added. “Where is the money going?”
Several nursing home administrators declined to be interviewed about their decrease in staffing ratings.
Crestview Court, a Cedar Hill nursing home had a five-star rating for staffing. After it became county-owned, it now has a one-star rating.
In an email, their attorney said the facility is "recruiting additional Registered Nurses" and "aggressively working" to get their numbers back up.
Another facility, Duncanville Healthcare and Rehabilitation Center had its staffing rating fall after becoming county owned. The administrator declined an interview. When reached for comment, the Duncanville’s attorney said, “The funds are going to the operations of the nursing home.”
The attorney disputed the accuracy of the star rating system, and defended the quality of care provided by the nursing home.
The program to allow publicly owned nursing homes to receive higher Medicaid reimbursements began in 2015. The program, now known as the Quality Incentive Payment Program, recently instituted various quality benchmarks that participating nursing homes will face review prior to receiving higher payments.
None of the four benchmarks cover staffing numbers.
The Office of Inspector General for the U.S. Dept. of Health and Human Services has instituted an audit of the program in Texas.
The program allows Texas nursing homes access to a pool of more than $400 million in additional Medicaid reimbursements this year for nursing homes partnering with county hospital districts.
Texas has seen an 800 percent jump in publicly owned nursing homes, skyrocketing from 52 in 2014, to 479 government-owned nursing homes in 2018.
Nursing home association representatives said WFAA’s findings failed to take into account four metric benchmarks that Texas nursing homes now must show improvement in order to gain continued higher Medicaid reimbursements. The quality control is measured in reductions in four areas: pressure ulcers, anti-psychotic medications, falls with major injury, and physical restraints.
Kevin Warren, president and CEO of the Texas Health Care Association, said Texas nursing homes in the partnerships statewide have shown improvement in all four of the areas. He said 80 percent of nursing homes participating in the program realized improvements.
Dallas County Judge Clay Jenkins said he believes the program is good for Dallas County, with Parkland projected to receive $5.9 million. He said the partnership with nursing homes allows money to be re-invested into services for indigent patients.
He said government inspectors already have reviewed Parkland’s county ownership of nursing homes.
“They've already been to Parkland,” Jenkins told WFAA. “Based on the interactions there I'm not concerned that we will have a bad outcome. But the report hasn't been released so I shouldn't comment further.”
Jenkins said the ownership of nursing homes allowed Parkland to free up hospital beds by placing patients no longer needing emergency care, into more appropriate, longer-term nursing home facilities.
Others, like Borah, said the program should be judged not on cost savings, but primarily on the quality of care. He said otherwise the program is nothing more than a “paper swap,” with a county – on paper - assuming ownership of a nursing home, yet allowing the prior operator of the home to continue to manage and oversee the nursing home and its residents.
“It's just not acceptable,” Borah said. “They're being paid to provide a certain level of care, a certain number of nurses, a certain number of aides and they're refusing to do it. And they're pocketing the money.”