Texas nursing homes; a blessing or an abomination, YOU decide

The following was submitted by Pancho Valdez. His contact information appears at the bottom of his posting.

“Do not rebuke an older man but encourage him as you would a father, younger men as brothers, older women as mothers, younger women as sisters, in all purity.” – Timothy 5:1-2

By Pancho Valdez

NOTE: In May of 2009 I wrote an article entitled; “A Different View of National Nursing Home Week”. Now that my 88-year-old father is in a nursing facility, I felt compelled to write a follow up to the original article.

As a result of last year’s state budget “crisis,” Texas is now near the bottom in nursing home staffing and Medicaid reimbursement. Coincidence? Not really. Texas has a long history of being cheap when it comes to the needs of our most vulnerable citizens. Hardly a fact to be proud of, especially when a good solution would be to impose taxes on corporations doing business in the state.

My father a World War II veteran entered a nursing home in late February of this year due to his having advanced Alzheimer’s Disease. While I would prefer to care for him at home, Medicaid directs families to nursing homes where the cost is much higher than caring for an elderly person at one’s place of residence. (The nursing home lobby is far more powerful than the voices of ordinary citizens.)

When Medicaid reimbursement is reduced or frozen, nursing facility managements starts laying off staff or reducing hours from the bottom of the totem pole. The bottom includes certified nursing assistants (CNAs), housekeeping, laundry and dietary personnel. These are the least paid, the least appreciated, yet are in fact the back bone of any nursing home.

When staff is cut, worker morale declines. When worker morale declines, the quality of care delivered also declines. Cutting staff is NOT a good thing as it adversely affects the overall quality of care provided by nursing home personnel. When quality of care declines, elderly, frail residents are at risk for pressure ulcers, dehydration, and other health problems.

Why does reduced Medicaid reimbursement affect quality of care? We must all understand that the number one priority of most nursing home owners whether owned individually or by large corporations is to make profit. Making a profit takes priority over quality care as the vast majority of nursing home owners have absolutely no connection to the needs of elderly people in their nursing homes.

Since February of this year I have spoken to many family members of residents at Pecan Valley Rehab & Healthcare Center, a fairly new facility on the far Southeast side of San Antonio. Far too many of these family members repeat to me the same concerns; no one responds to the call light in a timely manner, CNAs do not assist in providing oral care for the resident awakening in the morning, residents are not being checked every two hours is as accepted practice to see if they need changing, and the list goes on.

While many nursing home owners, management and even employees down play the importance of the aforementioned concerns, those of us who have loved ones in a nursing facility take this very seriously. At Pecan Valley I have joined the Family Council as is our right under federal law. The Family Council at this particular facility while having enthusiasm, lacks much experience and tends to be not forceful enough with the management of the facility. However one must realize that the Family Council is even newer than the facility, so one must give some slack.

Under federal law nursing homes are required to meet and address concerns of the Family Council. Just how strict this law is enforced is up to the Family Council’s level of tolerance for being put off, snowballed and/or ignored.

This is where the Department of Aging & Disability Services (DADS) comes to play. Infractions of nursing home law, practice or quality of care is subject to enforcement by DADS. Unfortunately far too many inspectors tend to be hard-nosed over petty nick picking, yet serious issues are either swept under the rug or enforced with a light hand. I have seen one nursing facility closed due to DADS intervention, however that was inevitable as the owner could not secure credit for the food needed to feed the residents, an issue DADS had no choice but to intervene as it did.

The Texas Advocates for Nursing Home Residents is an organization founded to assist in reforming Texas nursing homes. Since the early 1980’s TANHR has been involved in educating nursing home resident family members, lobbying the state legislature and other advocacy on behalf of nursing home residents across the state. It is my goal to eventually have the Pecan Valley Family Council affiliate with TANHR in the near future. A bigger goal is to organize family councils at other facilities and have them come under the umbrella of TANHR.


1) Nursing homes are intentionally understaffed. I have seen one CNA be expected to care for between 15-35 residents by him/herself. Only a superman or superwoman could handle such a load with any semblance of tenderness or compassion!

2) As mentioned before; nursing homes exist primarily to make profit for the owner(s). Quality care is a very convenient slogan, but seldom delivered consistently.

3) Staff to resident ratios do not exist in the state of Texas according to a  DADS nurse/inspector. In light of this, How can quality care be delivered?

4) Nursing home staff are for the most part underpaid, overworked women of color. Their job while key to the overall quality of care in any nursing facility is seldom appreciated. In Texas 99 percent of nursing home staff are not organized into any union, thus they have NO voice, NO protection and are powerless to make any effective change!

5) Where there is no justice, there can be no peace! Abusive work loads, low pay, minimal opportunity for upward mobility only encourages resentment and poor morale. Again I must emphasize justice in nursing homes can be achieved, but it takes vigilance, sacrifice, unity with nursing home staff and above all well planed struggle!

Pancho Valdez worked some eight and a half years in local nursing homes. He is a 47 year veteran of civil rights, labor and peace activism. He can be reached at:

mestizowarrior59@yahoo.com or 210-422-8000


2 thoughts on “Texas nursing homes; a blessing or an abomination, YOU decide

  1. Non-profit nursing homes may be better as far as quality of care goes (and cheaper for full-pay residents) but they also have to respond to reduced Medicaid reimbursement rates.

    Remember that DADS is also seriously understaffed, as are just about all state agencies these days, and that effects their abilities as a regulatory agency, no matter how caring and concerned its inspectors and other workers are. Most of the legislature and top state officials want it that way–they’re against any regulation that affects the profits of their buddies (and often themselves).

    Child Protective Services is also understaffed, with mammmoth caseloads and crappy low pay. These workers are under extreme stress and turnover is great. So the public sees that the job is not getting done well and is encouraged by politicians to blame it on the workers or on “government” in general.

    Then there’s mental health services–a scandal of growing state cutbacks for DECADES.

    My mother was in an assisted living center last year. I researched and visited a lot before I chose one (and had to compromise with what she could afford–ALC’s are not covered by Medicare nor Medicaid). The caregivers, by and large (there are always a few exceptions) were terrific–I could not possibly do that job, and I have immense respect and admiration for those who do. When my mother said, “They’re doing their best to keep me comfortable–they know I’m dying,” I just cried.

    Later we had to move my mother to a nursing home; I was disturbed by the situation residents have to live in–I mean the standard setup in nursing homes, regardless of quality of care. If I’m in my right mind (as my mother was) I would not want to end my life in that environment. I think my mother gave up. Within a few days she had to go to the hospital, and from there to a hospice–where the care was wonderful. Again, the folks I’ve met who work in hospices are amazing people. Starkly, the doctor has to certify that you’re within 6 months of death in order for you to qualify for in-patient hospice. It is covered 100% by Medicare. I don’t know who lobbied for that, but they did a good job.

    I feel for your father–and for you, Pancho. And thank you for getting actively involved to improve conditions, and for writing this article.

  2. Generally I don’t learn article on blogs, but I would like to say that this write-up very compelled me to take a look at and do so!

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