HOUSTON -- After analyzing thousands of records, the I-Team found Texas ranks second to last in the nation when it comes to nursing home staffing.
An advocate for the elderly says she has seen Texas nursing homes flat out lie about their workforce.
“It’s hogwash. It is hogwash,” said Gay Nell Harper, with Advocates for Nursing Home Residents (TANHR). "I've seen them count the cooks. I’ve seen them count the maids. I've seen them count the office staff.”
“But that's not direct care," she said.
Direct care staffers are the workers, such as nurses’ aides, who take on the daily duties of bathing, feeding and turning residents. They are duties that nursing home care experts say are critical to quality of care. But the I-Team found when it comes to having adequate numbers of direct care staff, Texas ranks near the bottom of the barrel.
Just ask Robert Lampkin who chose a nursing home for his sister but had trouble from the first day they arrived.
"They said 'just park her against the wall and we'll get to her when we get to her,’" Lampkin said.
Shirley Lampkin was a 42-year-old with cerebral palsy.
"This was a human being. You don't park someone until you get to them," Robert Lampkin said.
He said the signs of inadequate staffing grew worse, including soiled bedding that went unchanged and untreated bed sores on his sister that led to an infection.
"That led to her death, it led to her death," Lampkin said.
National researchers, such as Dr. Charlene Harrington with the University of California-San Francisco, say insufficient numbers of direct care staff directly affect quality of care.
“It is the number one most important thing, and probably most people in Texas don't realize the quality is so bad," said Harrington.
Just how bad?
The I-Team analyzed more than 60,000 federal records and found Texas ranks second worst in the nation for staffing. The Center for Medicare and Medicaid Services maintains a five-star comparative nursing home rating system.
With five stars being the best and one the worst, 26 percent -- or more than one out of four -- Texas nursing homes rate just one star.
So what's the problem? For starters, the problem is a weak Texas law.
"It says you have to have sufficient staff to meet the needs of residents," said Cecelia Fedorov with the Texas Department of Aging and Disability Services.
But what exactly does sufficient mean?
Fedorov: “There is not a set number.”
I-Team: “You can't tell me how many equals sufficient?”
Fedorov: “The requirement is that however many it takes for you to provide for the needs of your residents, that's what you need to do.”
I-Team: “Is that like telling people drive safe, but we're not going to give you a speed limit?”
Fedorov: “I wouldn't compare it to driving at all."
Fedorov said each nursing facility has different residents with different needs, and consequently, a different definition of sufficient staff to meet them.
"If we go into a facility and we find they do not have adequate staffing, then yes, that's a concern for us, that's something we're going to cite the facility for," Fedorov said.
But the I-Team found a problem there too. Of the more than 1,100 nursing homes in Texas, only five were cited for insufficient staffing this fiscal year.
I-Team: “That is an extremely small percentage.”
Fedorov: “That is a small number of citations for adequate staffing. That doesn't mean that we don't find it to be an issue."
But consider what happens in states that do have strict staffing laws—a dozen have less than two percent of nursing homes rated one star. Again, that is a fraction of the 26 percent in Texas.
Harper said the bottom line may be just that, the bottom line. The I-Team found of all the Texas nursing homes with that poor one-star rating for staffing, 93 percent are for-profit facilities.
"It's nothing but greed," Harper said.
"The bottom line is they make more money by not having the proper number of people to care for these residents," she said.
It's something Harper's known since her father died from neglect in a nursing home, and it's something you don't have to tell Robert Lampkin.
“'Park her, we'll get to her when we can,' and that was the level of her treatment,” Lampkin said. “They got to her when they could, not when she needed it, when they could."
Meanwhile, the Texas Healthcare Association, which represents nursing homes, said the system in Texas provides effective oversight for patient care. A spokesperson also said that recent funding cuts, including $57 million in Medicaid funding in Texas this year, pose a challenge to nursing providers to hire qualified and trained caregivers.
The Texas Healthcare Association encourages Texans faced with making a decision about skilled nursing car to visit several facilities, and talk with the residents and their families as well as the staff at nursing homes.
