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Staffing crisis plagues nursing homes in Texas

AUSTIN (NEXSTAR) – Amidst this holiday season, long-term care facilities are still dealing with a staffing crisis that is likely to last for months.

A Texas Health and Human Services report shows that at least 60 nursing facilities in the state — 2% — have been permanently closed since 2022. The impact of the pandemic, inflation, employee burnout, and low Medicaid reimbursement rates are among the reasons facilities have had to close their doors.

“I would simply say that the staffing and staffing crisis that we are dealing with is by far the biggest challenge I have seen. Since I’ve been in this profession,” said Kevin Warren, President and CEO of the Texas Healthcare Association.

The workforce crisis has impacted many communities across Texas, with rural communities being particularly hard hit. Two-thirds of the permanent closures since 2018 have been in rural areas.

Warren said the low staffing levels combined with facility closures can lead to dire situations. He cited the example when an elderly Texan is discharged from the hospital and needs 24-hour care, but the local facility they usually refer to doesn’t have staff to take in another resident.

At best, he said, families may have to wait longer for a bed or travel 20 to 30 miles to be cared for in another community. But for Texans in areas with no facilities, it can mean some are stuck without the care they need to get through their final years with dignity.

“People are living longer and staying at home longer. By the time they arrive at long-term care facilities, they are sicker. They require a higher level of maintenance,” Warren said. “So we have to make sure we have enough staff — with the training, with the skills — to take care of them.”

Bryan Bankhead is the Administrative Director of Focused Care at Stonebriar, a long-term care facility in Austin. Even in a metropolis, he has some important positions to fill that he finds difficult to fill. However, the understaffed facility is a problem that he says existed long before the COVID-19 pandemic.

“We’ve always had issues with the staff, even before the pandemic, now it’s harder to get the staff because they’re just not there,” he said. “We are able to staff it. But here, too, people work extra shifts.”

To prevent burnout, his facility offers flexible working hours to ensure caregivers have a better work-life balance.

Still, Warren says, an understaffed nursing home can lead to a multitude of problems when staff work overtime and double shifts just to keep the facility running.

“They want to make sure they don’t get tired and they don’t make mistakes just because they’re trying to do everything … it’s so important that we find ways and find solutions to get more staff into the facility,” Warren said.

Other short-term solutions that many facilities rely on include temporarily traveling nurses. But Warren said hiring traveling nurses can disrupt continuity of care for patients with diseases like Alzheimer’s, who often need consistency to stabilize; Not to mention cracks in permanent staff, as agencies pay travel nurses at least 50% more per hour than full-time staff.

The Texas Demographic Center projects that Texas’ aging population — those aged 65 and over — will reach nearly 6 million by 2030, a 115 percent change from the aging population in 2010. It’s just one reason advocates say these ongoing staff shortages must be addressed so Texans are able to receive the care they need as they age.

Warren and Bankhead said the big fixes start with funding long-term care facilities, specifically Medicaid’s reimbursement rates in Texas.

“What we really need is better compensation for our nurses and staff all around. It’s not just a nursing emergency. There is a shortage of staff among all doctors. We need better refunds to offset them and make the field more attractive,” Bankhead said. “It has to come from the state”

As for addressing long-term solutions, Warren said addressing labor shortages must start from the ground up. He wants legislation that creates more opportunities for nursing schools and practicing nurses to motivate them to work in long-term care facilities.

“We have been working with the legislature on this. They tried to help us with other advances. We need long-term, predictable and increased reimbursement rates to… address long-term labor shortages.”

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