A bevy of state and federal laws govern and dictate the standards certified long-term care facilities must adhere to, and officials with U.S. Medicare publish a star-based ranking system for families researching nursing homes.
But despite the host of rules governing the facilities, industry observers argue many measures aren’t enforced, and lack of legislation in certain areas makes for a daunting task for families looking for the right place for their loved ones, particularly in Texas.
The Nursing Home Reform Act of 1987 set most of the standards for resident care and contains some good provisions, said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy organization for people receiving nursing care in long-term facilities.
The act gives residents a bill of rights and requires facilities to provide several services, such as periodic assessments, access to dietary and pharmaceutical services and a comprehensive health plan, among others.
It also stipulates a state must conduct unannounced visits to a facility to look for potential issues and dictates other guidelines for certification.
Texas state law, likewise, contains many provisions regarding the standard of care required at nursing homes and other long-term care facilities.
Some advocacy groups, however, argue there are holes in the state’s regulation of long-term care facilities.
“An inadequate state regulatory structure with insufficient powers for sanctioning violators of licensing requirements is allowing nursing home operators to escape accountability when they hurt residents or jeopardize their health,” officials with the American Association of Retired Persons found of Texas in a 2017 study.
The study found that about a third of the state’s 1,200 nursing homes accounted for 94 percent of serious violations, but that regulators were hamstrung in assessing meaningful sanctions because of a law allowing nursing homes to correct violations before receiving a penalty except those posing actual threats to residents.
After that report, Texas legislators passed House Bill 2025, giving regulators more power to discipline repeat offenders. That bill went into law Sept. 1, 2017.
Federal rules also have several shortcomings, such as not dictating specific staffing levels, Smetanka said.
The state of Texas, likewise, does not require a staff-to-resident ratio for nursing homes as it does for childcare, said Misty Sullivan, a staff ombudsman for the state of Texas.
That is a problem in a state where nursing staff turnover is at crisis levels, Sullivan said.
“Whether it’s Galveston County or all the other 253 counties in Texas, the big problem is shortage of staff, which results in lack of care type issues for residents that live in nursing homes,” Sullivan said.
Families looking for the best long-term care facility might not know where to look for staffing information, with limited data available on nursing homes’ ratio of caregivers to residents.
Nursing Home Compare, a Medicare star-based ranking system, does evaluate nursing homes based on three different measures, one of which is staffing.
The Meridian in Galveston, for instance, received a four-star rating out of a possible five-star rating, records show.
That staffing ranking is calculated based on the average number of residents per day and the total number of licensed nurse staff hours per resident per day, records show.
Even when states have passed laws regulating staffing levels, the rules usually don’t require the 4.1 hours per resident per day, which research has established as the minimum for quality care, Smetanka said.
Baywind Village in League City, which scored an average three-star rating for staffing, averaged 1 hour and 53 minutes per resident per day in total number of licensed nurse staff hours, records show.
The two main types of long-term care are assisted living facilities and nursing homes. Assisted living is often considered the step before a nursing home.
Assisted living typically has at least one nurse on staff, but not necessarily for 24 hours a day.
Assisted living offers residents help with dressing, bathing, feeding and other daily chores they can’t do for themselves any more. A nursing home offers around-the-clock nursing care for elderly residents with more serious medical needs.
“In Texas, we don’t really have enough standards for the operation of assisted living facilities,” said Patty Ducayet, the state long-term care ombudsman, in a previous interview with The Daily News. “It makes our job really challenging.”