Make nursing home care in Texas a placement of last resort

With one in five Texans soon to be over age 64, there’s no question that nursing homes are needed.

These vital care facilities — and the compassionate people who work in them — provide a variety of medical and personal services, including 24-hour supervision, prepared meals and assistance with mobility issues.

But most Texans wish to avoid placement in a nursing home for long-term care. Who can blame them?

Whether due to chronic understaffing or poor management, nursing home residents have suffered neglect and even abuse. Chronically, these facilities face problems controlling infectious diseases. And the COVID-19 pandemic has put a spotlight on many of the deficiencies with nursing homes.

Nearly every Texas nursing home has faced a COVID-19 outbreak of at least one case among residents and staff. More than 85% of Texas nursing home residents have been infected. And nearly 9,000 residents have died from COVID-19 since the outbreak of the pandemic.

But there’s more to consider. When it comes to nursing homes, one must keep in mind that as people age, they want to maintain their independence. They want to have control over their own decisions and receive assistance that’s both appropriate and allows them to remain in their own homes and communities. They simply want to avoid placement in a nursing home as long as possible.

Given the needs and preferences of older adults and individuals with disabilities, Texas’ long-term services and supports must adapt.

The good news is that the number of alternatives to nursing homes has never been greater. The even better news is that changes to the financial incentives in Medicaid would not only give people more options, it could make good financial sense to the state.

Texas lawmakers can make headway this session by reforming Star+Plus, Texas’ Medicaid managed care program. In essence, they can adjust the financial incentives so that more Texans get the care they need in the settings they prefer. This would rebalance the program so nursing homes will be a placement of last resort.

Today, the system favors nursing home institutionalization over home-based care. The state currently pays Star+Plus health plans about twice as much when the health plan places an individual in a nursing home than when it sets up someone at home or in another less-restrictive setting like assisted living. This perverse funding incentive isn’t the best outcome for Texans who need long-term care or for their families. It’s also a bad deal for taxpayers.

Bottom line, Texas needs to stop rewarding health plans for placing consumers in costly nursing facility care. A new focus belongs on cost-effective, less-restrictive long-term care options. The Texas Legislature can and must address this important and common-sense reform.