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With the implementation of the Texas Unified Licensure Information Portal on September 4, 2018, all reporting of resident death information must now be completed in TULIP. The deadline for reporting deaths is within ten workdays after the last day of the month in which a resident death occurred (Texas Administrative Code §19.606). This would make September 17, 2018, as the deadline for reporting August deaths and October 12, 2018 for September deaths. However, in order to mitigate the potential delay in completing registrations within TULIP, the deadlines for August 2018, September 2018, and October 2018, death reports are now due by November 14, 2018. AARP’s analysis also found that staffing shortages in nursing homes, which one expert called a“staffing apocalypse,”show no signs of letting up. COVID-19 cases are expected to increase in the fall, which could coincide with a potentially nasty influenza season, based on the Southern Hemisphere’s rough winter.
Experts around the country have repeatedly found that corporate owners cut staff hours to increase profits, leaving residents at increased risk. Texas has, on average, the lowest staff-to-patient ratio in the country. In Texas, corporate-owned homes like Mountain View serve over 76,000 people—83 percent of the state’s nursing home residents. Since 2015, more than 1,800 dangerous incidents, categorized as “serious deficiencies,” have been reported to federal regulators from Texas—more than in any other state. In the past five years, at least 143 people have died due to neglect and poor quality of care in Texas nursing homes. Senate Bill 826 , which became effective on September 1, 2003, was designed to promote the timely reporting of certain deaths to the Office of the Attorney General .
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Many healthcare experts believe that long-term care facilities in Texas and other states around the country have not been doing a good enough job at preventing and controlling the spread of COVID-19. In the same report, they stated that more than a third of Texas’ 5,489 COVID deaths have been nursing home residents. Texas is home to roughly 1,215 nursing homes, and more than three-quarters of these facilities have reported at least one coronavirus case since the pandemic started. As reported at the end of July, there have 8,291 confirmed cases in Texas nursing homes, which was four times more than the number in all of June.
In 2019, more than half of Texas nursing homes reported no registered nurses on their payroll at any given point. But the standard is so low as to be essentially meaningless, requiring only 0.4 licensed care hours per day, or one licensed nurse for 20 residents. By this standard, all facilities in Texas were, on average, adequately staffed in 2019.
Tracking the Coronavirus
The authors contend that unnatural deaths of nursing home patients are significantly underreported. Attending physicians and death investigators should be urged to investigate more fully sudden deaths in nursing home patients. Data released at the end of July by Texas health officials finally provides a glimpse into infections, deaths, and recoveries at individual Texas nursing homes. The data also reveals that facilities run by Creative Solutions in Healthcare, a Fort Worth-based company with a poor record of infection control that owns and operates 64 nursing homes across the state, are COVID-19 hotspots.
This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news. The state health agency continues to propose cutting services for families while leaving fully intact a program that funds anti-abortion crisis pregnancy centers. The so-called Three Strikes Bill passed in Texas in 2016 required HHSC to revoke a facility’s license if the provider had committed three serious deficiencies in two years. But in 2018, the state reported that 15 facilities with one or more strikes simply changed ownership, so their strike count went back to zero. In addition to citing noncompliant facilities, HHSC can recommend federal fines, suspend new admissions to facilities, and revoke or suspend licenses based on inspectors’ findings.
Statistics on Nursing homes in the U.S.
In 2019, AGRC, a risk management company, released a report saying that Texas was among the states with the lowest “loss rate”—the annual amount of money, per bed, spent by long-term care providers to defend, settle, or litigate claims in a year. The state’s projected loss rate in 2020 is $670, far below the national projection of $2,300. That’s largely because in 2003, the nursing home industry lobbied zealously to keep malpractice awards at $250,000, the lowest malpractice cap in the country. Federal minimum staff-to-patient ratios do not exist, but CMS does require facilities to have a registered nurse on-site eight consecutive hours a day, seven days a week, with a few exceptions.
Can’t wait to hear the sounds of a nursing home bustling with visitors, socializing and joking and bickering in the common areas, rather than the relative quiet of the last few months. It was a critical reminder that in spite of the relaxing of state pandemic restrictions recently, her company had good reason to keep its protocols in place, she said. Only about a third of the staff agreed to get vaccinated, although those numbers went up “once more people started getting vaccinated and didn’t grow tails,” he said. Amistad was among the first facilities in the state to receive vaccines, and staff began receiving doses on Dec. 23. For Langford, it was the second milestone she’d missed because of the pandemic.
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At Focused Care at Summer Place in Beaumont, two residents tested positive for COVID-19 after one of them went home for Thanksgiving, McKenzie said. It was welcome news for some, but it brought fears of a holiday-fueled “third wave” of COVID-19 deaths. The facility started trying to boost morale through “virtual vacations” — themed weeks with food and music representing various vacation spots around the world.
As William Hanage at Harvard put it to me, both Massachusetts and Norway have seen about 60 percent of their coronavirus deaths occur in nursing homes. But for Massachusetts, that amounts to nearly 5,000 deaths, while in Norway, it is less than 200. Over a two-week period from late June to July 10, in 23 states that KFF characterized as “hot spots,” the number of cases in long-term care facilities increased by 18 percent. “With these corporate-owned facilities, where does the money go if we increase rates? The only way to improve care is to ensure the money doesn’t go into their pockets,” she said.
Managers at the center said COVID-19 raced through the nursing home despite its adherence to public health protocols. The Metropolitan Health District said it could not determine the source of the outbreak but suspected that the virus was brought in by a worker. Nationally, the death rate for the 23 states that report long-term care fatalities is 27 percent, according to the Kaiser Family Foundation.
Long-term care facilities have taken precautions — mandated testing, restrictions on visitors, isolating sick residents — but it still hasn’t been enough to suppress the virus’s spread. On April 13, nearly 30 percent of all coronavirus deaths were linked to nursing homes and assisted living centers. The COVID-19 death rate in U.S. nursing homes has increased for the fourth month in a row, anew AARP analysisof federal data shows. As deaths mounted, COVID-19 booster rates continued to lag, as they have for months, leaving many residents and staff without crucial protection. Each day, nursing homes report the number of residents who died due to COVID-19 to the Texas Health and Human Services Commission.
But she avoided catching the virus, even as the nation endured its highest-ever spike in deaths and hospitalizations. Throughout autumn, deaths across the state and the nation began to drop, and nursing homes in Texas saw the same decline. After a few days in an assisted-living facility, Langford moved into Amistad in August. Within a couple of months, the Corpus Christi area became a hot spot, grabbing national headlines when a 6-week-old infant died from the virus and again when nearly a quarter of all tests citywide came back positive for the virus. Within a month, the death toll in Texas nursing homes reached nearly 500.
