It was statistics presented to Texas legislators last year that first hinted at a problem in the state’s nursing facilities, and it was those numbers that spurred the Texas Health Care Association to start taking a closer look at the industry.

A report recently released by the agency claims that there’s a workforce crisis troubling an industry that employs more than 5,000 people in Nacogdoches and Angelina counties, and the agency expects it could get worse.

The association’s study found that, in nursing homes in East Texas and around the state, there is a 97-percent average turnover rate among certified nurse aids, and a 90-percent turnover rate for both registered nurses and licensed vocational nurses.

A tough job

Around the state, nurses caring for the elderly are burning out and looking for higher-paying, lower stress jobs, leaving the nursing homes without the kind of employees who can deliver quality care over long periods.

The study cites Medicaid reimbursement rates that fall short of covering the cost of care, and high regulatory demands as contributing factors to the problem.

“About two thirds of care is paid for through Medicaid,” said Kevin Warren, the association’s CEO, explaining that the cost of daily care is often higher than what nursing homes received in repayment through Medicaid.

Essentially, revenue generated in nursing homes gets funneled into covering the cost of care, which makes it challenging for the homes to offer higher salaries to attract and keep employees.

“The Medicaid shortfall makes it very different for them to compete in the market place,” Warren said.

According to the study, Texas is among the bottom five states in the country for reimbursement.

“The states with the highest average Medicaid reimbursement rate also report a higher amount of time RNs and total nurse staffing hours, which includes RNs, LVNS, and CNAs, spent caring for residents,” according the study.

The study also refers to the high regulatory demands of the job, and Warren said that can contribute to why nurses are pushed to look for work elsewhere.

“Long-term care is one of the most heavily regulated industries in the country,” he said. “They spend an excessive amount of time doing paperwork and not at the bedside taking care of patients.”

Sammi Webb, the director of nursing at Westward Trails Nursing and Rehabilitation in Nacogdoches said the paperwork can be daunting.

“If a patient falls, you might have 15 forms to fill out,” said Webb, who has been a registered nurse at the facility for a year and a half.

While 97 and 90-percent turnover rates seem high, Webb said she feels like those statistics are accurate for all the reasons the report mentions.

“It is hard to stay staffed, it’s a very stressful job,” she said. “I feel like (nursing staff) gets burned out a lot.”

Mary, an LVN at a local nursing home who spoke on the condition that her last name and employer’s name not be published, agreed.

She said she’d spend seven years in the industry working in both Nacogdoches County and Angelina County.

“The turnover is ridiculous,” she said. “People go where the money and the benefits are. Some of them just get burned out.”

Mary said the physical demands of the job — lifting patients and helping move them, as well as helping with their basic needs — is taxing as well, a point Webb also mentioned.

“Sometimes, we’ll give 27 showers in a day,” she said.

Warren said the burnout caused by the demanding job can push staff to other facilities, or even to get out of the field entirely.

According to the study, East Texas faces a nursing shortage of all types of as many as 5,253 people by the year 2030 as the demand for employees grows. The state could be short as many as 48,000 nurses by that year as well.

The state’s changing demographics are going to drive that shortage, said Dr. J.B. Watson, Jr., associate professor or sociology and coordinator of the Gerontology program at Stephen F. Austin State University.

“With the graying of the population in Texas mirroring national trends, 11.49-percent of the population is currently over the age of 65,” he said. “With increasing numbers of the Baby Boomer generation reaching age 65, coupled with older adults generally living longer than in the past, the problems noted in this report will increasingly impact frail older adults and their caregivers.”

Fixing the problem

Watson said that while raising wages for nurses in long-term care facilities would be the easiest way to attract more people to the field, there are other steps companies could take to incentivize the work.

He said it could be beneficial for employers to offer additional training, or to pay for continuing education of employees, which would make staying at a job more appealing than salary alone.

They may look into programs that offer employees additional leave on top of vacation time to allow them more time to deal with the high-stress environments as well, which he saw as beneficial at a hospice facility he studied.

Increasing employee’s longevity seems to result in better care for patients as well, Watson said, echoing findings in the Texas Health Care Association report.

The association is looking into solutions and ways the burden could be eased on long-term care providers, like eliminating duplicate paperwork, and ultimately the study helped identify three areas that need to be focused on, Warren said.

The Medicaid shortfall needs to be addressed soon, he said, and communication between companies and health care educators and training programs could be improved, as well as making more career paths available in long-term care.

“With a more satisfied, well-trained and committed staff, nursing homes see increased retention rates, which contribute to better overall performance of the center,” the study concludes. “The more consistent and dedicated the staff are, the more they understand and are able to effectively respond to each individual’s needs — reinforcing the long term care profession’s commitment to delivering person-centered care.”

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