Page 5


The new law requires the Health Dept. to make annually at least one unannounced inspection of every nursing home in the state and to hold at least one public meeting yearly at each facility to allow patients and their relatives to register complaints about home management. The bill also included an amendment that established a grading system for nursing homes and allows superior institutions to cite their ratings in ads. But one whole section of the billa chapter providing broad protective services for all the state’s elderlywas completely scuttled. This provision would have required the DPW to look out for everyone over 65 who might suffer abuse, neglect or financial exploitation. House parliamentarian Bob Johnson said that consideration of protective services exceeded the governor’s call for regulatory legislation. When El Paso Rep. Jim Kaster cited Johnson’s demurral and threatened a point-of-order challenge to the bill, sponagreed to junk the protective services clause rather than see the bill sent back to .committee and delayed. Loss of protective services, protested Sen. _Carlos only 5 percent of the state’s elderly would be covered by the new legislation. ” That’s the percentage [some 60,000 out of 1.1 million elderly] of older people confined in nursing homes,” he said. Aside from a provision that the Health Department require nurses aides to get in-service training, nothing was done to improve the lot of the poorly paid workers who perform the tedious but sensitive jobs of washing, dressing and caring for patients. “The situation is that many of the staff who provide direct services are those who are the least well paid,” David Holton told the Observer. “We need to up `A booming industry’ By William Cabin New York The nursing home story in Texas is one of a booming industry with growing wealth and power. It is not necessarily a pretty tale. The concentration of nursing home ownership in the hands of a few corporate bigtimers, regulatory complacency, and a political establishment closely allied with the state’s nursing home industry are ingredients for generally lousy geriatric care. Texas, with 1.1 million elderly, ranks fifth among the states in the size of its over-65 population. That’s a big market, but what makes Texas really alluring to corporate chains who have moved in to operate long-term care facilities is the availability of state and federal money for care of the aged. Despite all the talk about holding down welfare costs, Texas places fourth in the country in the size of Medicaid payments made to its 1,000 nursing homes. Nationwide, nursing homes draw off an average of 37.7 percent of all Medicaid payments funneled into individual states; but in Texas the figure is 50 percent. The state welfare department reports that for fiscal 1978, $391.7 million has been budgeted for state and federal welfare payments to private nursing homes that care for 60,000 of the state’s elderly and mentally retarded. And the state has another $30 million in reserve should the minimum wage be boosted and nursing home costs rise accordingly. A reading of the 1977 Texas Directory 10 THE TEXAS OBSERVER of Nursing Homes shows that eleven corporations now control 254 of Texas’ care facilities. The four biggest chains have staked out more than a fifth of the entire state market. Consider ARA Services, the Philadelphia-based colossus with 1976 sales of $1.2 billion from subsidiary interests in the vending machine business, food concessionairing, transportation, and several other enterprises, including nursing home ownership. \(ARA was recently on the wrong side of a hefty judgment in a federal suit brought by S&S News Agency of Fort Smith, Ark. S&S had charged that ARA violated antitrust laws in magazine distribution operations in Oklahoma. On another front, ARA is currently under fire from the Federal Trade Commission, which is looking into possible pricefixing in the company’s vending-machine In the long-term care field, ARA is the parent concern of two enormous nursing home chains doing busines in Texas the Houston-based National Living Centers and Geriatrics, Inc., of Greeley, Colo., which recently took over the Retama Manor chain. ARA is the third biggest nursing home operator in the country, behind only Hillhaven, Inc., of and Beverly Enterprises, of Pasadena, Calif. In Texas, the two ARA chains operate 110 homesNLC has 88 and Geriatrics-Retama Manor 22and more than 11,700 beds. In the nursing home business, such bigness is hardly better. It can and does lead to less attention for residents, and administrators often have more to do than they can possibly handle. Nine of NLC’s administrators, for example, have two or more homes each to keep track of, and in some cases the homes are at opposite ends of the state. One NLC man has 34 institutions under his supervision, and two others have ten each. Texas Welfare Dept. officials acknowledge that nursing home care is generally better at family-owned or individually run establishmentsespecially in smaller communitiesthan it is at homes owned by the big chains. The single-home operator in a small town, DPW officials say, is more likely to worry about the censure of neighbors upset by conditions at a local nursing home. For the chains, however, the fear of community disapproval isn’t of consequence. The sanction most commonly applied to nursing home operators who fall short of DPW standards has been the suspension of Medicaid payments”vendor hold” it is called. Vendor hold may be effective against the smalltimer running a hand-to-mouth business, but against the likes of ARA and other giants for whom cash flow is no problem, the practice accomplishes little. In most instances, withheld payments are resumed with no loss to management when the cited deficiencies have been corrected. The hidden effect of vendor hold may actually be to run the small outfits out of business and increase the market share of the giants.