Feature: Recent nursing home innovations mean better senior care for Texans

Texas nursing home residents Callie Lewis Watson and Peggy Hunter both rate quality of life at Tuscany Village for the elderly needing around-the-clock care the best possible outside of their own homes.

That's a starkly different view than the dissatisfaction Texas eldercare patients and inspectors expressed in a 2014 study by the national AARP (formerly American Association for Retired Persons). That study ranked the quality of government-assisted eldercare facilities 49th out of 50 states for quality of care, and 13th nationally for full-time patients in various types of nursing homes.

Those numbers reflect findings in a Texas Sunset Advisory Commission staff report that identified 18,735 nursing home violations but found action was taken in 11 cases.

Last year, when state-wide eldercare facility occupancy was 93,588 patients, Texas accounted for 15 percent of all state survey agency hours spent on investigations, 15 percent of immediate jeopardy situations and 19 percent of past legal noncompliance cases, according to the regulatory agency Texas Department of Aging and Disability Services (DADS).

Also in 2015, the agency also imposed 854 administrative penalties against facilities including 40 nursing homes, however, the majority of penalties, 741, were leveled against home and community support services agencies.

Top 2015 penalties in nursing homes were assessed for patient neglect or failure to provide services, treatment or care. Others included not adhering to resident rights, client protections and autonomy; failure to provide quality of care to maintain physical and mental conditions; failure to provide necessary care and services to maintain or prevent deterioration in a resident's abilities; infection control; and food storage, preparation and service.

Cecilia Cavuto, DADS spokesperson, said the state has been working to increase the quality of life in Texas nursing homes. In September, several of DADS eldercare services were transferred to Texas Department of Health and Human Services oversight. The remainder of the DADS programs are set to make the move in September 2017. programs and services transferred to HHS in September 2016; the remainder will do so in September 2017.

"Several initiatives were begun by (the agency's) Quality Monitoring Program," Cavuto said. "These programs will continue into the future and additional initiatives will be added."

On Cavuto's list of quality initiatives are revision of rapid response team processes to determine root cause analysis of quality of care concerns and-or poor outcomes and to assist facilities with a more detailed hands on approach to system changes. Also included are a mandatory three-day, intensive training course for nurses in eldercare facilities and state-wide initiatives in music, memory and reminisce activities.

Goals, Cavuto said, include staff training in abuse and negligence, scheduled to begin in May 2017; dementia and Alzheimer's Disease training and the Texas Oasis-Dementia Care Academy set to begin in November. Other initiatives currently under development include transitioning new nurses entering long-term care, to start next year; establishment of Centers of Excellence for Long Term Care with University of Texas-Austin School of Nursing; and outreach to other state agencies and multiple partnerships to assist with the plans.

"This year' s Geriatric Symposium for the first time was expanded to a two-day event, with day one focusing on advancing nursing in long-term care," Cavuto said. "Approximately 600 nurses attended. We received an overwhelming response from all over regarding this event on how wonderful, valuable it was."

One of the most exciting initiatives on Cavuto's list reaches out to Texas high school students interested in health care occupations through a new high school-level inter-generational relationship classes. The program also is developing a curriculum that allows students to volunteer in nursing homes to provide music or assist patients with memory loss.

"We brought the story to life with The Students Experience Music and Memory, an incredible video highlighting a Texas high school and their work with a Texas nursing home," Cavuto said. "The high school so want to provide them the link to the High School curriculum is titled, "A Snap Shot on Aging and Dementi1," sgsolo@savasc.com."

A recent U.S. News & World Report article cited 158 government-assisted nursing homes in the Houston, the nation's fourth largest city, and the surrounding metropolitan areas including Sugar Land, Baytown and Pearland. Of these, only 13 have received an overall rating of five stars -- the highest score possible -- from federal Centers for Medicare and Medicaid Services.

One of the five-star recipients is Tuscany Village, an 8-year-old private, family-owned, 70-bed capacity nursing home that offers round-the-clock skilled nursing and personal assistance. Administrator Cecil Barcelo, grandson of the multi-facility Texas company's founder, said the facility accepts both private and government funding and strives to accommodate them in a comfortable, home-like setting where they can enjoy a variety of physical, social, educational, recreational and restaurant-style dining activities.

Nursing homes are predominately occupied either by residents with private funds or those who rely on government subsidies to reimburse the facility costs, Barcelo said.

While Tuscany Village has patients on government-supplied Medicare, a large number of its residents are privately funded, he said, so it can afford upper-tier amenities at its Pearland location just outside of Houston.

"Care is based on the type of funding program. Texas is one of the lowest reimbursement states, providing the minimum from state funds, which does not translate to quality care because Texas does not like paying for subsidies," Barcelo said.

Facilities funded by reimbursements from state governments are frequently located in older buildings and have a high staff turnover that offer lower quality of care and quality of life than largely private-funding nursing homes tending to employ higher skilled staff and stewardship, Barcelo said.

Callie Watson, 80, is a former registered nurse and model, also founder of the 40-Plus Models Foundation, a nonprofit that raises money for youth education through fashion shows featuring dress and accessory designs for older women.

"I like it here because (the staff) cares and provides compassionate nursing assistance," Watson said. "I feel safe and secure here."

Watson's bedroom space at Tuscany Village is separated by a curtain from her roommate, and both share a single bathroom. Each has a bed, nightstand, dresser drawers, chair for visitors and a mirror and bulletin board on which to post their personal photos, letters and other individual touches.

It's different than her life four years ago, when a stroke confined her to a wheelchair and left her legally blind. Widowed by her fourth husband, a professional golfer, Watson is a mother of three, grandmother of five and great-grandmother of five.

But Watson is more vivacious than some half her age blessed with full mobility and sight. She enjoys the nursing home's bingo parlor and plays educational games, and has the home's physical therapists at her disposal. She frequently engages in wheelchair kickball in the home's large community room.

She also continues to model and raise money for her foundation. On a recent day that Xinhua visited Tuscany Village, Watson joined other foundation models, ages 40 and over, for a dress-and-hat ensemble fashion show.

"One of the wonderful things I like about living here is that if you want something special to eat or are dissatisfied with the food, you can pick up your phone and call the kitchen and tell them what you want," Watson said.

Barcelo said Tuscany Village has about 70 full-time live-in patients and 40 to 50 short-term who come for rehabilitation. The nursing home staff includes state-registered dieticians, beauty salon, massage and physical therapy rooms, and diagnostic and X-ray centers.

The home also hosts cocktail hours, musical concerts, holiday celebrations like the upcoming annual Halloween carnival, Christmas banquet and Easter egg hunt for its residents. Activities also include themed events such as cooking classes and casino nights. A big favorite is the Monarch butterfly habitat and garden, said Kathleen

Gallman, who oversees marketing, public relations and visiting applicants.

"I've worked in both large corporate-run nursing homes and skilled nursing centers around the country," Gallman said. "I prefer the family-run operation because residents can go straight to the staff and owners with any concerns. Here, the Barcelo family follows a national 13-point service plan, which is the gold standard in ensuring quality of care."

To accommodate the growth of the aging population in the Houston area, state and nation, Tuscany is building a new wing with 19 beds and an additional state-of-the-art kitchen and dining area. When those beds are filled, the home will have a total capacity of over 130 patients, she said.

Peggy Hunter has had a Tuscany Village room similar to Watson's for three years after experiencing other rehabilitation and nursing home facilities in New York and Texas. She said she vastly prefers her current home.

"There is no comparison. This building is new and the personnel are helpful friends. I count them as my friends," said Hunter, 73.". "I'd say 85 percent are here for the right reasons -- to make us as comfortable and acknowledge the fact that we are human."

Born into a large family of seven brothers and one sister, Hunter and her ex-husband have two children, three grandchildren and two great-grandchildren. Her several careers include proof-reading manager, a clerical worker in a top law firm and a store detective.

Hunter is wheelchair bound due to deteriorating spinal discs, but manages to roll herself to activities she enjoys and the physical therapy she needs.

"I like the live entertainment we have several times a month," said Hunter, who presides over the residents' counsel and hears complaints and from residents who just want to talk. "I also like to play bingo games and color in adult coloring books, which is a stress relaxer. I love the (Monarch) butterfly garden and planting herbs in boxes."

Hunter rates not only the staff, but the variety and quality of amenities at Tuscany Village as exceptionally good after her previous nursing home experiences.

"If you have to live somewhere other than your own home, this is as close to home as you could possibly want," she said. Endit