Texas not-for-profits feel threat.

Results of a survey released in November 2000 by the Texas Association of Homes and Services for the Aging (TAHSA) showed that more than half of its mostly faith-based, not-for-profit nursing home members believe that they may have to close within five years unless the Texas legislature immediately addresses issues such as inadequate Medicaid reimbursement, escalating liability-insurance costs, and obtaining competitive wage rates for staff.

"What prompted us to do this survey was the knowledge that about 25 percent of the for-profit homes in this state are in bankruptcy," says TAHSA President David Latimer. "We felt that we needed to get a better look at how the not-for-profits would be faring. Many replied that they are very threatened by the current conditions."

TAHSA represents 182 not-for-profit providers of health care services, housing, and community-support programs. Latimer says that one member facility closed its doors this past September, and that another is "going bare"--operating without liability insurance--because of soaring premiums (see "Is liability insurance an endangered species?" on page 31 in this issue). Many not-for-profit homes in Texas see the state's 77th Legislature, which began Jan. 9, as their last hope.

Texas has one of the lowest Medicaid reimbursement rates in the nation, with an average of $83.50 per resident per day. More than 70 percent of Texas nursing home residents depend on Medicaid to pay for their care. TAHSA would like to see Texas reimbursement rates brought to at least the national average of $103. The association also advocates that more dollars be added for a staffing incentive payment.

"We're 45th in the nation in Medicaid reimbursement rates, and we're 46th and 47th in RNs and CNAs," says Latimer. "So there's clearly a link between the resources available to us and our staffing. We also want to do something in the litigation area to try and get a handle on these rising liability insurance costs."

To help offset what TAHSA terms "the litigation and insurance crisis" in nursing facilities, the association is urging the 77th Legislature to enact tort reform measures such as setting caps on punitive damages and limiting the use of survey reports in civil suits.